Sitagliptin and RH

[Lamont D]

I have always wondered why my endocrinologist prescribed me the dpp4 inhibitor, and I know it's not a cure, but it does help and it is an insurance against mistakes and if I do fall off the low carb wagon.
So scrolling through a couple of medical drug description pages, I found a little explanation of how in conjunction with other diabetic meds it helps with lowering blood glucose levels in type two's.
What I have done is used the description to give you lot of RH ers an idea of why it helps with RH.

Sitagliptin works to inhibit the enzyme dpp4.
This enzyme breaks down the incretins GLP-1 and GIP, gastro intestinal hormones released in response to a meal
By preventing GLP-1 and GIP inactivation they are able to increase the secretion of insulin and suppress the release of glucagon by the alpha cells of the pancreas.

So, the drug changes the chemical make up of the glucose that goes into your blood. The first insulin response is now different, from there, because of the lower spike caused by the lack of glucagon.

It continues.
This drives blood glucose levels to near normal levels. As it happens, the amount of insulin released and glucagon suppressed diminishes, thus preventing an overshoot and subsequently prevent low blood sugar (Hypoglycaemia)

The second insulin response is not triggered enough, to cause the overshoot which governs the drop in blood glucose levels to a hypo!

So no hyper, no hypo!
It works better for RH ers without other diabetic meds!

In type two diabetics this drug works in conjunction with other meds such as Glicizide or with insulin dependent to try and drive blood glucose levels down.
The drug does not work well without other diabetic meds
Nor with only metformin.

 

[Kaz261]

I have always wondered why my endocrinologist prescribed me the dpp4 inhibitor, and I know it's not a cure, but it does help and it is an insurance against mistakes and if I do fall off the low carb wagon.
So scrolling through a couple of medical drug description pages, I found a little explanation of how in conjunction with other diabetic meds it helps with lowering blood glucose levels in type two's.
What I have done is used the description to give you lot of RH ers an idea of why it helps with RH.

Sitagliptin works to inhibit the enzyme dpp4.
This enzyme breaks down the incretins GLP-1 and GIP, gastro intestinal hormones released in response to a meal
By preventing GLP-1 and GIP inactivation they are able to increase the secretion of insulin and suppress the release of glucagon by the alpha cells of the pancreas.

So, the drug changes the chemical make up of the glucose that goes into your blood. The first insulin response is now different, from there, because of the lower spike caused by the lack of glucagon.

It continues.
This drives blood glucose levels to near normal levels. As it happens, the amount of insulin released and glucagon suppressed diminishes, thus preventing an overshoot and subsequently prevent low blood sugar (Hypoglycaemia)

The second insulin response is not triggered enough, to cause the overshoot which governs the drop in blood glucose levels to a hypo!

So no hyper, no hypo!
It works better for RH ers without other diabetic meds!

In type two diabetics this drug works in conjunction with other meds such as Glicizide or with insulin dependent to try and drive blood glucose levels down.
The drug does not work well without other diabetic meds
Nor with only metformin.

Very interesting Lamont. I mentioned Sitagliptin to my Endo and he could see why it would work for RH. He wouldn't prescribe it for me at the time as I was close to being underweight and still losing weekly (not something I have a problem with now). He said it suppressed appetite and therefore no good for someone who was desperately trying to gain weight.

I've often thought of asking my GP about it, but I don't like taking medication as I tend to get all the unwanted side effects . Do you know if it's relatively side effect free?

 

[Lamont D]

Very interesting Lamont. I mentioned Sitagliptin to my Endo and he could see why it would work for RH. He wouldn't prescribe it for me at the time as I was close to being underweight and still losing weekly (not something I have a problem with now). He said it suppressed appetite and therefore no good for someone who was desperately trying to gain weight.

I've often thought of asking my GP about it, but I don't like taking medication as I tend to get all the unwanted side effects . Do you know if it's relatively side effect free?

I have had no side effects at all!
And those that have reported them according to the research is very low percentage.
I think as you do eat a few carbs as this could be beneficial.

Nice to hear from you Kaz! You ok?

 

[Kaz261]

I have had no side effects at all!
And those that have reported them according to the research is very low percentage.
I think as you do eat a few carbs as this could be beneficial.

Nice to hear from you Kaz! You ok?

I'm good thanks. Hope you are too?

I'll give Sitagliptin some thought, thanks. It's great that you haven't experienced side effects. I'm finding lately that although I don't spike high, I don't seem to drop as quick so I can be higher than I'd like after two/three hours. I feel fine but I think it will affect my hba1c results that are due back some time this week. I eagerly await those and my cholesterol result. I fear both my have increased from last time

I'm not stressing about it anymore though. I know I can make further dietary changes if necessary to reduce my hba1c. Unfortunately, I think I'm pre-disposed to high cholesterol so not an awful lot I can do about that.

All the best

Kaz

 

[Lamont D]

I'm good thanks. Hope you are too?

I'll give Sitagliptin some thought, thanks. It's great that you haven't experienced side effects. I'm finding lately that although I don't spike high, I don't seem to drop as quick so I can be higher than I'd like after two/three hours. I feel fine but I think it will affect my hba1c results that are due back some time this week. I eagerly await those and my cholesterol result. I fear both my have increased from last time

I'm not stressing about it anymore though. I know I can make further dietary changes if necessary to reduce my hba1c. Unfortunately, I think I'm pre-disposed to high cholesterol so not an awful lot I can do about that.

All the best

Kaz

I'm really great Kaz.
Let us know your results and I won't be critical of how you are coping. (Ha!)
I have also got over worrying about what time I eat and planning everything in my diet. I just eat when I want, fast when I don't and not worry about it!
It really helps not stressing, don't it?

Cholesterol is a bit tricky, it should be getting better if you have your balance right.
But the way it is, I really wouldn't worry about it too much.

From where we have come from, no one can moan too much at our progress!

Don't forget to let us know!

Best wishes

 

[Kaz261]

I'm really great Kaz.
Let us know your results and I won't be critical of how you are coping. (Ha!)
I have also got over worrying about what time I eat and planning everything in my diet. I just eat when I want, fast when I don't and not worry about it!
It really helps not stressing, don't it?

Cholesterol is a bit tricky, it should be getting better if you have your balance right.
But the way it is, I really wouldn't worry about it too much.

From where we have come from, no one can moan too much at our progress!

Don't forget to let us know!

Best wishes

I'll be sure to let you know my results. I know you won't be critical of how I do things. After all we all have to find a way that works for us an our lifestyle. I've come so far and feel so much better, and that's the most important thing for me right now

Best wishes

 

[Lamont D]

I'll be sure to let you know my results. I know you won't be critical of how I do things. After all we all have to find a way that works for us an our lifestyle. I've come so far and feel so much better, and that's the most important thing for me right now

Best wishes

Too true @Kaz261

Best wishes.

 

[yukon4]

First post here, sorry to intrude in. On a similar note, has anybody had experience with voglibose for RH? If you search for "reactive hypoglycemia voglibose" on google, you'll get some studies. I was prescribed voglibose for my RH some years back but discontinued it because of gas/bloating and not so satisfactory results.

 

[Lamont D]

First post here, sorry to intrude in. On a similar note, has anybody had experience with voglibose for RH? If you search for "reactive hypoglycemia voglibose" on google, you'll get some studies. I was prescribed voglibose for my RH some years back but discontinued it because of gas/bloating and not so satisfactory results.

Well you learn something new everyday or so the saying goes!
Welcome to our forum @yukon4.
I take it from your username you are from that part of the states?
I can't read the website you linked but I would be very interested in nocturnal RH.
Does this differ from RH itself?, I would imagine because of the name, that the symptoms can or only can happen during the night or sleep.
I did have terrible symptoms and consequences before I was diagnosed, but had them also during the day, because I was told to eat the wrong diet for what was a misdiagnosis.
How do you control RH now?
Are you on a very low carb diet?
I have never heard of vogilbose, or what it is supposed to achieve, is it an American generic name for a diabetic drug?

Please read our forum or if you have any questions, please ask, one of us will answer.
If your not sure of something in a thread, ask. We will help.

Best wishes.

 

[Fenn]

Thankyou for posting that, I am taking alogliptin which I assume does the same thing as it ends with gliptin? You say it won’t work as well without other meds, I also take metformin and jardinace, would you say that this is a good combination for type 2

Opinion appreciated, Thankyou

 

[Lamont D]

Thankyou for posting that, I am taking alogliptin which I assume does the same thing as it ends with gliptin? You say it won’t work as well without other meds, I also take metformin and jardinace, would you say that this is a good combination for type 2

Opinion appreciated, Thankyou

I can't say that it does but I would assume there would be a slight difference in the chemistry of the drug and how it affects your first insulin response.
I'm not sure about Jardinace, maybe, someone else will help.
There will be a reason why your doctor has prescribed it, you could ask him!

Best wishes

 

[Fenn]

I can't say that it does but I would assume there would be a slight difference in the chemistry of the drug and how it affects your first insulin response.
I'm not sure about Jardinace, maybe, someone else will help.
There will be a reason why your doctor has prescribed it, you could ask him!

Best wishes

Thankyou very much

 

[yukon4]

Well you learn something new everyday or so the saying goes!
Welcome to our forum @yukon4.
I take it from your username you are from that part of the states?
I can't read the website you linked but I would be very interested in nocturnal RH.
Does this differ from RH itself?, I would imagine because of the name, that the symptoms can or only can happen during the night or sleep.
I did have terrible symptoms and consequences before I was diagnosed, but had them also during the day, because I was told to eat the wrong diet for what was a misdiagnosis.
How do you control RH now?
Are you on a very low carb diet?
I have never heard of vogilbose, or what it is supposed to achieve, is it an American generic name for a diabetic drug?

Please read our forum or if you have any questions, please ask, one of us will answer.
If your not sure of something in a thread, ask. We will help.

Best wishes.

Hi Lamont,
Been a lurker on DCUK for a few years. I'm from India. Was in the states many years back, hence the username
Since I'm a new member, can't put any links but voglibose was one of the earliest working treatments for RH. I don't know whether doctors still prescibe it. The newer molecule, acarbose is a bit more prescribed.

I didn't mention nocturnal RH in my post but addressing that, have had nocturnal RH a few times (I have had the Freestyle Libre pro installed a few times) but given that I'm asleep, I know if I've had an episode only when I wake up (dry mouth, a bit of sweating and a headache etc) or from the Freestyle data.

I've had RH for nearly a decade and a half now, it wasn't triggered naturally. Unfortunately, have had to live with it.

I've had a terrible decade with it + B12 deficiency, but will share my history in a standalone post; I can commiserate with you that this is a terrible thing to live with.

 

[lindisfel]

Hi Lamont,
hope you are ok?
Had some blood tests last week, some good some not so good.

After very significant measures there is now very little difference between my hba1c now from what it was when I was diagnosed, allthough I've stopped RH completely by low carb.
Conn's due to extremely high aldosterone damages the pancreas ability to produce insulin and glucogon. So I am wondering if I should be on a medication?
Perhaps Metformin should be sufficient since the diet stops hypos.
I also have problems with berries in an attempt to keep my potassium up.
Any fructose goes straight into the liver as fat.
So I am cutting out fruit and getting potassium elsewhere.
Although my Trigs and HDL are excellent I have now gone back over the threshold of 70 for ggt.

Thanks for your help.
atb
Derek

Hba1c up to 46 from 43
eGFR. 77
Total cholesterol 6.8
HDL 1.9
Trigs 0.8
LDL 4.5
ratio HDL to total 3.6
ratio Trigs div HDL less than 0.5

Gamma GT up to 73 from 45
Bilirubin 11
Alkaline phosphatase 59
ALT 17

serum total protein 70
sodium 133
potassium 4.5
urea 4.3
serum creatinine 83
AKI warning stage 0

Any thoughts, please?

 

[Lamont D]

Hi Lamont,
hope you are ok?
Had some blood tests last week, some good some not so good.

After very significant measures there is now very little difference between my hba1c now from what it was when I was diagnosed, allthough I've stopped RH completely by low carb.
Conn's due to extremely high aldosterone damages the pancreas ability to produce insulin and glucogon. So I am wondering if I should be on a medication?
Perhaps Metformin should be sufficient since the diet stops hypos.
I also have problems with berries in an attempt to keep my potassium up.
Any fructose goes straight into the liver as fat.
So I am cutting out fruit and getting potassium elsewhere.
Although my Trigs and HDL are excellent I have now gone back over the threshold of 70 for ggt.

Thanks for your help.
atb
Derek

Hba1c up to 46 from 43
eGFR. 77
Total cholesterol 6.8
HDL 1.9
Trigs 0.8
LDL 4.5
ratio HDL to total 3.6
ratio Trigs div HDL less than 0.5

Gamma GT up to 73 from 45
Bilirubin 11
Alkaline phosphatase 59
ALT 17

serum total protein 70
sodium 133
potassium 4.5
urea 4.3
serum creatinine 83
AKI warning stage 0

Any thoughts, please?

Hi Derek, I am very good but really busy as pre season is always.
I agree with your plan of action, I believe that as far as the RH is now in complete control, it should not be your first treatment in your conns, and other problems.
If your initial insulin response is as weak as mine maybe some insulin response meds could be useful in boosting your insulin response. It would not be metformin for me, as my endocrinologist said that it would not be an effective drug to help with insulin production and not change anything much else but give you side effects in your digestion process, which is important not to upset, as metformin could possibly do.
From this thread, sitagliptin does change the initial insulin response for me, it may have different results for you, but there are a few different gliptins that can alter your initial insulin response. I don't have the knowledge about how different gliptins work.
Only my experience and reading about sitagliptin.
I would ask my endocrinologist, if it was me.
I also believe if you continue the way you are from your results, your Hba1c levels will be in diabetic range, you may eventually have to have diabetic blood glucose lowering drugs to help you anyway, with that which like a Gliptin would help with insulin.
There are some diabetic drugs that you should be aware of, Glicizide for example.
The types of drug that drop your blood glucose levels too quickly, even if insulin is suggested, I would be very wary of what meds, that could be prescribed.
I do fear that something similar will eventually happen to me, where other conditions interfere with either my health or my RH!
So far so good.
I have cut down on everything including fruit, I was warned about my love of fruit, just like a lot of eating habits, you eat a couple of strawberries and you want more, half a banana doesn't just do it! So I never plan for fruit, just some frozen berries, I remember reading that frozen berries are easier on your liver, but my memory is not that good, a handful at most, the same with nuts, why can't you just eat one or two, no! It's got to be about a dozen or you just don't enjoy them!
I would not worry about your cholesterol, if like me, my cholesterol levels corrected themselves through low carb, nowt else, just eat to your meter and keep your blood stabilised.
Hopefully your doctor may have an answer, but it depends on wether he understands RH, as usual!

Keep well mate,

All the best.

 

[lindisfel]

Thank you Lamont, that is exactly the kind of advice I was looking for.
I will have to discuss it with my endo as you say.
Problem is if the Conn's tumour is not removed it is a progressive disease but it's a bit late in the day to have it out.
ATB
Derek

Hi Derek, I am very good but really busy as pre season is always.
I agree with your plan of action, I believe that as far as the RH is now in complete control, it should not be your first treatment in your conns, and other problems.
If your initial insulin response is as weak as mine maybe some insulin response meds could be useful in boosting your insulin response. It would not be metformin for me, as my endocrinologist said that it would not be an effective drug to help with insulin production and not change anything much else but give you side effects in your digestion process, which is important not to upset, as metformin could possibly do.
From this thread, sitagliptin does change the initial insulin response for me, it may have different results for you, but there are a few different gliptins that can alter your initial insulin response. I don't have the knowledge about how different gliptins work.
Only my experience and reading about sitagliptin.
I would ask my endocrinologist, if it was me.
I also believe if you continue the way you are from your results, your Hba1c levels will be in diabetic range, you may eventually have to have diabetic blood glucose lowering drugs to help you anyway, with that which like a Gliptin would help with insulin.
There are some diabetic drugs that you should be aware of, Glicizide for example.
The types of drug that drop your blood glucose levels too quickly, even if insulin is suggested, I would be very wary of what meds, that could be prescribed.
I do fear that something similar will eventually happen to me, where other conditions interfere with either my health or my RH!
So far so good.
I have cut down on everything including fruit, I was warned about my love of fruit, just like a lot of eating habits, you eat a couple of strawberries and you want more, half a banana doesn't just do it! So I never plan for fruit, just some frozen berries, I remember reading that frozen berries are easier on your liver, but my memory is not that good, a handful at most, the same with nuts, why can't you just eat one or two, no! It's got to be about a dozen or you just don't enjoy them!
I would not worry about your cholesterol, if like me, my cholesterol levels corrected themselves through low carb, nowt else, just eat to your meter and keep your blood stabilised.
Hopefully your doctor may have an answer, but it depends on wether he understands RH, as usual!

Keep well mate,

All the best.

 

[Lamont D]

Thank you Lamont, that is exactly the kind of advice I was looking for.
I will have to discuss it with my endo as you say.
Problem is if the Conn's tumour is not removed it is a progressive disease but it's a bit late in the day to have it out.
ATB
Derek

That's ok,
Have you definitely been told its inoperable?
Isn't there meds to control the tumour?
I'm not too knowledgeable about Conns, I'm sorry!
Don't give up mate, or we wouldn't have fought so much to get the RH diagnosis.
Speak to your endocrinologist, he knows what options are open to you, with RH in the mix, anything is possible.

My best wishes, let us know how you get on.

 

[Lamont D]

Just as an aside Derek, as part of my medicine that I've taken for nearly twenty years, the one drug that I've often asked to drop is Irbesartan, this is a hypertension med.
Maybe through lack of diagnosis earlier than if RH was a better known condition, hypertension, is a major factor, the longer the necessary dietary treatment is not used. Hypertension could be asymptomatic in all of us with RH.
Other than aspirin and Irbesartan, the Gliptin, I have been told to be very careful with drugs, and only use paracetamol for pain, colds, flu and so on.
That is probably why, I do have concerns for my future health. And stronger to insist on being very strict with myself.
Have you tried an Ace inhibitor?
I wish I could help more.

Best wishes mate.

 

[lindisfel]

That's ok,
Have you definitely been told its inoperable?
Isn't there meds to control the tumour?
I'm not too knowledgeable about Conns, I'm sorry!
Don't give up mate, or we wouldn't have fought so much to get the RH diagnosis.
Speak to your endocrinologist, he knows what options are open to you, with RH in the mix, anything is possible.

My best wishes, let us know how you get on.

Hi Lamont,
No, but its not advised at 79 with my health profile according to my daughter(GP). I am taking 150mgs of Eplerenone and 25mg Losartan to control the 20x normal aldosterone, plus low sodium diet! I am going to have the tumour imaged again to see if it's grown. The endo showed me the scans from four years ago and it didn't look like a simple bump to me, it was irregular had taken over the right adrenal and surrounding tissue almost completely and was 30cms across, they don't know if their malignant at that size until they get them out. So if it's grown I shall think about having it out.
She wouldn't recommend sitagliptin for me with afib, left ventricular thickening and a pacemaker.
She said I could try slow release Metformin 500mg but it might still affect my stomach.
Anyway, I didn't tell her, but I am going to go ultra low carb and cut out fruit to get into ketosis and get my ggt right and recheck my hba1c in three months.
Thanks again, Lamont
Derek

 

[Lamont D]

Hi Lamont,
No, but its not advised at 79 with my health profile according to my daughter(GP). I am taking 150mgs of Eplerenone and 25mg Losartan to control the 20x normal aldosterone, plus low sodium diet! I am going to have the tumour imaged again to see if it's grown. The endo showed me the scans from four years ago and it didn't look like a simple bump to me, it was irregular had taken over the right adrenal and surrounding tissue almost completely and was 30cms across, they don't know if their malignant at that size until they get them out. So if it's grown I shall think about having it out.
She wouldn't recommend sitagliptin for me with afib, left ventricular thickening and a pacemaker.
She said I could try slow release Metformin 500mg but it might still affect my stomach.
Anyway, I didn't tell her, but I am going to go ultra low carb and cut out fruit to get into ketosis and get my ggt right and recheck my hba1c in three months.
Thanks again, Lamont
Derek

No worries mate, I still believe that metformin will upset your digestive process even if it is either slow release or enteric.
Best wishes.