J is for Januvia

Jennifer,

 

I was just waiting for somebody to ask me this question! Thank you.

 

While Public Citizen hasn't said explicitly that Byetta falls into the "rare breakthrough" category that it exempts from its so-called "Seven Year Rule," it does implicitly indicate that.

 

For example, in its "Worst Pills, Best Pills" book, it warns against two first-generation sulfonylureas and says the other sulfonylureas are OK for “limited use”) Generic metformin and brand-name Glucophage are also OK “for limited use.” Do not use, the book says, Actos, Avandia, Starlix, or Prandin.

 

It doesn't seem to have a problem with insulin. The book doesn’t mention two seldom used drugs, Precose and Glycet. And specifically, Public Citizen has never faulted either Byetta or Symlin, which in my mind and in the minds of many people who use it are truly breakthrough drugs.

The fact of the matter is that people with diabetes have an increased risk of many other diseases, including heart failure. It is a progressive disease and those that have it tend to live a unhealthy lifestyle. The best medicine for diabetes is a healthy diet and regular exercise but many refuse to change their lifestyle. If medicine is the answer then know that no matter what medicine you take there will always be side effects to go along with the benefits. The point of taking them is to prevent the fact that diabetes itself can kill you. You must weigh the benefits with the side effects and pay attention to your body, see your doctor regulary and take care of yourself. Unfortunatly when someone does die of "complications of diabetes" that can mean so much more than hypoglycemia- think kidney disease, retinopathy, neruopathy, and heart failure. Diabetes is deadly and I know that if I ever end up with it I want the best, most up to date medicine. I don't know how my body will react to any medicine I take, but what I do know is that I want the chance to try even the newest medicines knowing that there may be some rare side effect I have to them, but the alternative (not doing something, or using an inferior drug because it has been around for seven years) is so much worse.

Dear Linda,

When did you have your liver enzymes tested before then? If those level did just rise, stopping Januvia is certainly a good idea. I haven't heard other reports about such a connection, but everybody is different. Long term, if you are overweight, as almost everybody with type 2 diabetes is, losing weight slowly is what you absolutely have to do in order to avoid serious liver problems (slowly is key, because very rapid weight loss can be counterproductive). And, of course, Januvia has never been demonstrated to lead to weight loss; but Byetta has!

On the weight loss aspect of Byetta, check out the prescribing information under adverse events. Does anyone else make the connection between 44% of patients reporting nausea and weight loss?

Dear Janice,

Not yet at this time.  At 77 recovery from congestive heart failure is not an easy road... In fact once you have congestive heart failure there has ususally been permanent damage to you heart.  They have left her on the Januvia at this time due to her very critical situation with her heart.  They are not sure whe would make it thru the transition to insulin at this point.  She is have heart surgery next week, but at this point she is home bound and on oxygen 24/7 due to the reduced heart function.  Insulin may have been a more difficult choice for a lifestyle change but I think if she had it to do again she would choose the insulin route over the risks of this new medicine Januvia.... and I would bet money that in a few years we will see the same warnings on this drug as we see on Avandia and Actos...    Janice

I am sorry about your mother and would just like to let you know that her condition could have been the Actos she was on. TZDs have a long "wash out" period, meaning that it can take a long time to get the medicine out of the body. From what I know, it can take up to 10 weeks to completely clear TZDs from the body once the medicine is stopped.

The other question is, what other medicines was your mother on? Many other medicines can cause this side effect, especially as someone ages.

Januvia is weight-neutral. It will not help you to lose weight. And that is what you most need to do. I know of only two ways to do this: the drug Byetta, which I have written a lot about here, and a very low-carbohydrate diet, of which I have also written a lot here.

 

The low-carb diet will also improve your triglycerides very quickly. And while your A1C is within standard limits, as you write, those limits are too slack. Unless you get your A1C below 5 you are at risk for any and all of the serious complications of diabetes.

 

Either Byetta or a low-carb diet -- and preferably both -- will help you to lose weight, control your lipids (cholesterol and triglycerides) and your blood glucose levels.

 

The itching bothers me a lot. Maybe I am overreacting from my personal experience. My wife complained about her terrible itched for a long time before she found out that her liver had failed. It can be a complication of liver failure -- although many other conditions can cause it. But my wife died of liver failure, so I thought that I should mention it to you to encourage you to get in control of your diabetes before it's too late.

 

If you would like additional help, just call me at (303) 499-5544.

 

David

  Thank you for your speedy reply. My liver test recently came back fine.was tested 2 months ago. Just started itching since taking Januvia. I just assumed it is a side effect that will go away after getting used to it. This new drug makes me NOT want to eat go figure. I used to be hungry alot now I do NOT desire food. Strange?

 

  I am so sorry about the loss of your wife.

Thank you for your condolences.

 

I am very relieved that it is Januvia and not liver failure that is causing your itching.

 

David

dear david - help - started janumet in feb, in april dr doubled dose. weight was 121, i am female 5'2" and had sugars around 215 fasting or not. sugars came down to fasting 150-200 and non-fasting 120-170.  dr added glipizide 10 mgm and i now weigh 128.  almost impossible to believe as diet is primarily protein, veggies and fruit - very few carbs.  AND diarrhea 2-3 days a week which is severe.  how am i gaining weight.  does not appear to be water retention and scales are extremely accurate.  i don't feel this weight is excessive for me but continued weight gain is frightening.  any ideas?

 

Dear GC,

 

Strange. But weight is TOTALLY related with the number of calories that you consume. If I were in your shoes (and in fact when I was in your shoes!) I would and did keep a detailed record of the number of calories that I consumed each day.

 

Best regards,

 

David

Dear Susan,

 

Januvia is the first of a new class of drugs, which doesn't have any generic version yet.

 

However, one of the best and most powerful drugs to help us control our blood glucose levels is generic. It costs VERY little.

 

That drug is metformin.

 

In terms of weight, both Januvia and metformin are weight neutral for most folks. However, some people ARE able to lose some weight on metformin.

 

Your husband needs to press his doctor into considering metformin. According to the clinical trials of these drugs, it can reduce blood glucose even better than Januvia. Metformin is also one of the safest drugs: it's been on the market here since 1995 and more people use it than any other diabetes drug.

 

Best regards,

 

David

Thank you.  I had been reading about that.  I don't like to push the Dr., however, the financial burden of the drugs would be so overwhelming.  I will push for that.  I'm not sure what is levels are at this point.  I just now ordered a meter.  I don't even think he was in a really high range.  Thanks for your information.

 

Susan Hall

Dear Sonja,

 

Wow! It's a good thing that you stopped taking Januvia right away. You may have an allergic reaction to Januvia or something in the pill. Since our bodies have amazing recuperative powers, I think the effects you suffered from taking it will pass soon.

 

Best regards,

 

David

Thank You David

 

I am hoping they all go away but so far its been a few weeks and the pounding heart, shortness of breath, and The chest cold .....being stuffed up as well as the join pain numbness in the hands come and go they just won't stay gone grrrrrrrrrrrrrr.

If I had not stopped taking Januvia when I did I am not sure what would have happen. I am going to give it time and hope and pray things return to normal.

 

Sonya

Sonya,

 

Sorry to hear that you are having such difficulty.  I also have gone through some of the symptoms you mentioned in your post.  I am now on Januvia, but these symptoms started eight years before. 

 

After many tests, even went through Mayo in Jacksonville, Florida, it appears that I have diabetic neuropathy.  Most diabetics have to deal with neuropathy at some point in time, and many already have neuropathy when first diagnosed with diabetes.  I noticed numbness in tingling in my right hand at night.  I awakened shaking the hand to get feeling back in the hand, particularily the little and ring fingers.  This is caused by cubital tunnel syndrom, usually associated with diabetes.  My feet burn badly, and my legs feel like worms are working in the area below the knees.  Additionally, I have tremendous ringing in my ears and burning in my neck, ears and chest area.

 

Many times I thought my problems were medication related, and in somes cases this was true.  Insulin, Lantus, really stings me all over.  Also my heart is beating very fast, and I wonder if Januvia is the cause.  That is what got me to this website tonight.

 

Hang in there.  Talk to your doctor about your problems.  Maybe changing to metformin is in order.  I think this is what I am going to do. It is so very difficult to get the right medications in place once one has diabetes and diabetic neuropathy.  But I am still encouraged that it is possible.

 

Best wishes,

 

Keith

Amaryl is a sulfonylurea and all sulfonylureas push the pancreas. You are absolutely right that the sulfonylureas are suspected of causing beta cell burnout and there is no proof. Some of the top experts whom I have talked with absolutely deny it. Personally, I don't want to get in the middle of those groups!

 

But all drugs have side effects. And everyone reacts differently to different drugs.

 

I was able to use Byetta most successfully to control my blood glucose and weight. Many people have done the same thing -- but not everyone. Some experience side effects, some of which can be serious.

 

That's why, even though Byetta worked so well for me, I wanted to get off all drugs. When I went on a very-low carb diet, my A1C improved (it's currently 4.8 percent) and my weight continued to go down (my BMI is currently 19.3). Low-carbing for me and many others works without side effects once we get over the break-in period of the body adjusting to not getting glucose from carbs.

 

Best regards,

 

David

Hi,

 

What is Byetta?

 

Secondly, I have often thought of abandoning carbs or at least cut them about 80 percent but since I don't eat eggs and don't want to just scarf down meat or tofu for breakfast what can a hard core pancakes, waffels, muffin and bacon person eat?

 

Breakfast is the big villian because I just can't find a viable and satisfactory substitute for carbohydrate based items. I would welcome any ideas.

 

Thanks.

Hello. Awhile back my endo had me try Byetta. I was horribly ill. I spent the majority of the next two hours throwing up, dealing with scary low blood sugar levels, headaches, etc. I had to plan my whole day around the fact that I would be sick for a couple hours after each meal. ANd I didn't lose a single pound in the two weeks I tried it. That was surprising because I was throwing up everything I ate! I am one of those lucky small number of people whose reaction to Byetta is so severe that I can't take it. A shame since my doc says Byetta is really the only thing that will help me.

 

My endo now wants me to try Januvia. I hear it is a much lower dose of the same stuff in Byetta. Will it cause me to be just as sick? I also read that it does not cause weight loss. I am unable to lose weight at all! Very frustrating. But mostly I want to make sure I will not be sick like I was with teh Byetta.

I was put on Januvia a year ago by my endocrinologist/diabetic specialist.  I did not suffer any of the problems these other people have mentioned.  It is very expensive, however.  I have the medicare prescription plan and hit the "donut hole" in August last yaer, due to the cost of the Januvia (my co-pay $55 per month) and my Xalatan for glaucoma (also co-pay of $55.)  That meant i had to pay full price, about $68 f0r the Januvia and $88 for a 2.5 ml. boyyle of Xalatan.  I don't know what the price is now, brcause I went on line to Northwest Pharmacy in Canada and now get these same meds for about 1/4 t0 1/3 the cost.