Januvia and type 1

Lamont D said:

Hi, I'm not type 1 but I was on januvia (sitagliptin) for over eight years because I have a very weak first phase insulin response. It increases the insulin when eating.
This is how over time, because it reduces the spike, lowers hba1c levels.
How this works for you, I have no idea!

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Antje77 said:

Hi @Jantype1 , is your specialist an endocrinologist?
Do you know why you've been prescribed metformin and trulicity, and now januvia if you have a type 1 diagnosis?
Those are usually T2 medications, although they can sometimesbe prescribed in T1 to help with insulin resistance.

However, the main treatment of T1 is insulin, because T1 means having an insulin deficiency.
Is there any reason why you're not being treated with insulin only?

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Antje77 said:

In T1, those spikes are usually dealt with with quick acting insulin taken before meals.

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EllieM said:

Hi @Jantype1 and welcome to the forums.

Here's the NHS link on it and I agree it says it isn't for T1s.

Who can and cannot take sitagliptin

NHS medicines information on who can take sitagliptin and who may not be able to take it.

www.nhs.uk

My understanding is that it both increases insulin production and decreases production of sugar by the liver (like metformin) so it's possible that they are just using it because you can't tolerate metformin??? (Wild guess, I am not a doctor).

If you are still in the honeymoon period then the insulin stimulating effect might still be having some use, I suppose? Maybe (another wild guess not based on experience or medical knowledge) it will keep you off short acting insulin for a bit longer?

But honestly, I think your question would be a really good one for your specialist.

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Finnlee said:

I was prescribed Januvia (sitagliptin) from my T1 diagnosis, along with basal and bolus insulins.

I never knew if the Januvia made a difference until one day I accidentally took two Januvia (instead of one Januvia and one Vitamin D tablet) and spent the whole morning low.

I had another C-Peptid test recently (two years after diagnosis) and it came back much lower than on diagnosis, so I've been told to stop taking Januvia. The C-Peptid reference range is 1.1-4.4 ng/ml. In August 2021 (on diagnosis) I was 0.4 ng/ml and in October 2023 I was 0.16 ng/ml.

I don't notice a big difference in my insulin requirements since stopping it, so I think as my self-made insulin was in a slow decline, I was getting less and less benefit from the Januvia.

I didn't have any adverse affects to Januvia or the generic sitagliptin meds that became available in the time since I was diagnosed, so I didn't try any other meds (beside basal and bolus insulins from the start). I'm in Germany so the prescription standards for newly diagnosed adult T1Ds might be different than in the UK.

Also, I agree with @Antje77 that having all the tools to manage your diabetes is key. For T1Ds, that means both a basal and a bolus insulin. Your endo asking you to manage with only a basal insulin isn't fair to you, in my opinion. Yes, it takes a while to get used to injecting before every meal and there is a steep learning curve, but using both a basal and a bolus insulin gives you a better chance at managing your blood sugar.

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In Response said:

There is absolutely nothing to.dread when it comes to getting the right treatment for your condition.
Fast acting insulin gives you flexibility to eat what you want when you want it.
It has kept me alive, driving, working, travelling, eating, exercising, partying, ... for 20 years.

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Finnlee said:

I'm not sure how it could do this unless there were little robots in the tablets actively making decisions on what to do based on your blood sugar. If that existed, everyone would be taking it!

I suspect that Januvia is more effective more if your body produces more insulin naturally. When I took two tablets on accident early on, it caused me to go low all morning. I was producing more insulin then. Now, two years later, I don't produce much insulin and I didn't notice a difference when I stopped taking it.

If you're newly diagnosed, you've probably got more self-made insulin, so Januvia is having more of an effect.

If you're going low when you do sports, you could try reducing your basal further or having a snack before you start the activity to get your blood sugar up a bit. I like granola bars for this.

When you move on to basal and bolus insulin (perhaps still with sitagliptin), you also have the option of reducing your bolus dose for the meal before the activity. When I go for a walk after lunch, I'll do something like 60% of my mealtime bolus to avoid going low on the walk. It's just one of the benefits of having more tools at your disposal - more flexibility.

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Finnlee said:

I'm not sure how it could do this unless there were little robots in the tablets actively making decisions on what to do based on your blood sugar. If that existed, everyone would be taking it!

I suspect that Januvia is more effective more if your body produces more insulin naturally. When I took two tablets on accident early on, it caused me to go low all morning. I was producing more insulin then. Now, two years later, I don't produce much insulin and I didn't notice a difference when I stopped taking it.

If you're newly diagnosed, you've probably got more self-made insulin, so Januvia is having more of an effect.

If you're going low when you do sports, you could try reducing your basal further or having a snack before you start the activity to get your blood sugar up a bit. I like granola bars for this.

When you move on to basal and bolus insulin (perhaps still with sitagliptin), you also have the option of reducing your bolus dose for the meal before the activity. When I go for a walk after lunch, I'll do something like 60% of my mealtime bolus to avoid going low on the walk. It's just one of the benefits of having more tools at your disposal - more flexibility.

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Finnlee said:

I was diagnosed in the early hours of Friday the 13th (of August, 2021).


Do you have a CGM (FreeStyle Libre 2 or 3, or Dexcom G6 or G7) yet? Those are really helpful for spotting downward trends, especially when exercising.

When I go for walks, I try to treat low blood sugars before they're hypos. I'll usually start having something when I hit 100mg/dL (5.5 mmol/L) be safe, unless I'm walking to a bakery, then I might let it go a little lower since I know there's a tasty low treatment waiting for me in the cafe.

Treating early means I can have tastier (but slower) hypo treatments, like granola or fruit rather than glucose tabs. Juice is also a good fast-acting low treatment for me. I often keep a small 330mL bottle in my bag (it's about 33g of sugar, so multiple hypo treatments in one bottle).

It does take some time to figure out what an appropriate low treatment dose is for different situations. I can be fine with one glucose tab (2.2g sugar) overnight, but need 10g of sugar or more when walking. And it depends on how much insulin I have on board (this will be more important to consider when you start on a bolus insulin). Eventually you'll figure out what your body needs.

Also, glucose tablets are generally tastier than plain sugar lumps if that's what you're using now. Dextro Energy is the most popular glucose tab brand in Germany and it's available in the UK, so probably also in France. It's usually in the candy aisle and/or at the checkout tills of supermarkets and drugstores here. They also usually have some at the pharmacies. Be aware some brands and flavours taste better than others, so find what you like.

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