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Sitagliptin and LADA. Anyone else?

Sorry to hear that. Have you had any luck getting your appointment with a diabetes specialist brought forward, as suggested here?
http://www.diabetes.co.uk/forum/threads/doctors-say-different-things.81357/

Here is some info about the benefits of insulin for T2s, which I think also applies to LADA:
http://www.phlaunt.com/diabetes/15478720.php

If you like, you could start a new thread in the low carb diet subforum and we can help you with the specifics of low carbing.
 
Just started on sitagliptin today (Januvia), and I have seen a massive effect on my BG. My control had been pretty good, but I'd been keen to reduce spikes at dinner time (which would rise to 8-ish, but for all other meals I will peak at 7) - my consultant was loathe to prescribe me fast-acting insulin, and recommended this stuff instead. The price looks fairly similar, so I'm kicking myself for not asking why he was so dead against Humalog or Novorapid instead.

Anyway, just to try it out I ate a ridiculous amount of random carbs this afternoon, including: a pint of regular milk, a punnet each of cherries and strawberries, a protein bar and 4 crackers. I should point out that I rarely stray near any of these things, none of which I'm able to eat in any sort of moderation. But here's the kicker: my BG an hour later reacted as if I'd eaten a light snack. It also fell far faster than it normally would.

It's tempting to stay on this, but I have a bad 'no such thing as a free lunch' feeling, particularly given everything I've read about the pancreatic cancer risk. I realise they've only retrospectively found tumours in corpses, but that does nothing to allay my fears.
 
As a LADA you are type 1 so low carb won't be enough. Insulin is probably better as it will protect remaining beta cells. S'glip will tire them out quicker.
 

It sounds like you're still producing a fair amount of insulin yourself, possibly the Lantus and your diet are leveled out just enough to make the oral meds effective for you right now, which means there's no real reason to put you on rapid acting insulin in the doctor's eyes. The same thing happened to me, but once I figured out my oral meds weren't cutting it anymore I went into a 6 month battle with my healthcare team to get Novorapid prescribed. Some doctors can be very persistent and stuck in what they think is right even when a patient has done extensive research.

Do what feels right to you. Eventually the oral meds will stop working, how long this takes is an individual thing, but monitor your values closely so you can alert your doctor immediately and get put on rapid acting insulin quickly when needed. This is your health, you have the final say on your treatment!
 
Diakat said:
As a LADA you are type 1 so low carb won't be enough. Insulin is probably better as it will protect remaining beta cells. S'glip will tire them out quicker.
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My consultant (who's quite a well-known LADA specialist) said that he'd found that it was gliclazide that burned out beta cell function in his patients, and that sitagliptin wouldn't affect them - are you speaking from your own experience? I don't want to roll the dice on all the other myriad possible side effects though. Ultimately this drug is only around 10 years old, so the long-term effects remain fairly mysterious.


I'm going to be persistent! You know where you are with insulin. It's perverse, but I've managed to eat like a normal person today with total impunity, but rather than feeling liberated by it, I'm just freaked out that I don't know where I stand. I had an incremental rise when I ate around 50g carbs between meals, but an hour ago I had an obscenely carby cookie that had no business being in my house - it barely registered. I'm about to go to bed with BG of 5.5, which is lower than I'd normally like.
 
It makes total sense that you're freaked out by that! I think I would be too.

What are your values like without the sitagliptin? Would it be doable to go without them for now? If you end up eating to cover your body's stimulated insulin production you'll end up in trouble.

It sounds like your stress doesn't just come from not knowing where you stand either; worry about side effects won't do you any good and rob you of your peace of mind. I'd either accept things as they are and go with the flow, which includes not worrying, or just go off the meds and go back to my doctor to get the alternative that will keep me sane and healthy.
 
 
DaftThoughts said:
What are your values like without the sitagliptin? Would it be doable to go without them for now? If you end up eating to cover your body's stimulated insulin production you'll end up in trouble.
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My numbers are fine really, wake up with 5mmol/L and average 6.8 overall each day, it's just most of the time after my evening meal I'm hovering at around 8 a little longer than I'd like - I either go for a walk at times like that, or have a drink, both of which have the desired BG-lowering effect. Unfortunately I've been doing the latter a bit more frequently than I ought to. Bolusing for the evening meal, however slightly, would give me back some semblance of control.
 
thanks, an interesting feed, in some respects it mirors my experiences. Diagnosed Feb 2017 with a BG in exceess of 33 - had a health screen at work, spoke to the GP about the numbers who flapped a little then said to go to A&E - went there the next day and was taken straight to the clinic where i received 2 shots.

they treated in the first instance as T2 - although i did not display the comment traits, and after some pushing got GAD tested and now T1 LADA - i have the 100mg of Sitagliptin ona morning and 4x Metformin a day. seems standard and the diabetic specialist GP is not willing to make changes or suggestions.

am thinking of dropping the meds in favour of diet and more exercise - i know this is good with t2 but how would it be with LADA? from an exercise perspective can routinely cycle 60miles without too many issues, go to the gym etc, the usual fare (although i can't run too much due to warn out knees)

should I opt for change or remain with the status quo and the likelihood that, either way, I will require insulin sometime in the coming years ?

my last HbAiC was 38.(Oct 17) my daily average since 01-02-17 for morning BG tests is 6.9mmol

cheers
 
I was on sitagliptin & metformin
Had a problems,
dn was about to put me on insulin.
I decided to find a different way of eating found this forum & lchf 70 to 80 g a day
Metformin lowered my b12 levels a lot
Sitagliptin made some joints heavy, couldn’t lift left arm
Off all diabetic meds now joints & b12 levels fine
 
knowlestr said:
am thinking of dropping the meds in favour of diet and more exercise
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I can never understand why so many people here regard diet & exercise and meds as alternatives rather than complimentary. I fought to be prescribed Metformin, am currently taking the maximum dose, eat very low carb and do my best to exercise. I would like perfectly normal bg levels, and I have no intention of giving up any part of this strategy unless / until I get them. Apart from people who suffer from bad reactions to Metformin, why would anyone abandon a treatment that promises lower bg, lower heart attack and stroke risk, lower risk of some cancers, improved life expectancy etc etc?
 
knowlestr said:
should I opt for change or remain with the status quo and the likelihood that, either way, I will require insulin sometime in the coming years ?
Click to expand...
I have no idea about Sitagliptin, but in your place I would keep the Metformin until my bgs were a lot lower, unless it was causing me a lot of digestive problems, and even then I would try going back to the lowest possible dose and building up gradually again. My latest A1c was also 38, but I'd much prefer to see it at 34 or even lower. My fasting bg is usually at present in the low 5s, and again I'd prefer it to be nearer the supposed "normal" reading of 4.7.
PS if Sitagliptin puts you at risk of hypos, maybe you can't aim to get your bgs too low while you are taking it? Metformin alone doesn't carry that risk.
 
I'm LADA too not type 2 as my profile says (not yet worked out how to change it on my phone) I'm on gliclazide which has worked exceptionally well and I only need to take the lowest dose. My consultant talked about insulin but I think I will take it when and if I have to and hopefully delay it as long as poss. I'm taking my example from my dad who was diagnosed type 2 at around 38 years old and lasted 50 years on just low dose gliclazide so I'm hopeful i won't ever get to the needing insulin stage. I think I would rather wait for my beta cells to die off completely before taking insulin as I think it might make it difficult to control hypos if I'm producing random bursts of my own insulin in addition to injected (No science that's just the way I see it) not been offered a gliptin yet but I am really well controlled how I am so would like to keep the apple cart upright! Hope you get on ok.
 
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