Sitagliptin

[steveelles]

Hi there. I was diagnosed Type 2 about 5 years ago but that was by a nurse and I have finally had a meeting with a consultant yesterday. I was not convinced by my type 2 diagnosis because I have had a range of issues since I was about 5 years old. The consultant agreed that I have had a glucose metabolising disorder since childhood and to think myself lucky no one diagnosed me with type 1 back in the 1970s. He says I have a variant of type 2 (as they would describe it currently) which I am satisfied with. I'm inclined to agree. To address what has been a lifetime of stomach problems he has put me on Sitagliptin 100mg p/d alongside my daily 2000mg Metformin. Anyone got experience of this? How did you get on?

 

[Daibell]

Hi. It's a bit strange that the consultant hasn't been able to fully diagnose you. Do you use a glucose meter and what was your last HBa1C blood test result? If you have stomach problems, are you on the Slow Release (SR) version of Metformin? I was on Sitagliptin for a few years. It can help reduce post meal spikes as it prevents the pancreas stopping insulin production too soon after meals. It has very few side effects apart from one or two bad but rare ones so read the leaflet. Apart for having a good low-carb diet, I would check that your HBa1C is below 7.0% in old money and perhaps nearer to 6.5% or less. If it's too high then you may need further meds. If your own insulin is suspected of being too low then Gliclazide or even insulin can be used. The c-peptide test is one way of finding out whether your own insulin level is too low. All of this assumes you haven't got one of the more unusual forms of diabetes but the consultant should keep on top of that.

 

[Lamont D]

Hi there. I was diagnosed Type 2 about 5 years ago but that was by a nurse and I have finally had a meeting with a consultant yesterday. I was not convinced by my type 2 diagnosis because I have had a range of issues since I was about 5 years old. The consultant agreed that I have had a glucose metabolising disorder since childhood and to think myself lucky no one diagnosed me with type 1 back in the 1970s. He says I have a variant of type 2 (as they would describe it currently) which I am satisfied with. I'm inclined to agree. To address what has been a lifetime of stomach problems he has put me on Sitagliptin 100mg p/d alongside my daily 2000mg Metformin. Anyone got experience of this? How did you get on?

Hi there, I too have a blood/glucose/insulin imbalance in my body.
I take sitagliptin (Januvia) to offset the problem, because it lowers the initial insulin/glucose hormone release.
It is a dpp4 inhibitor, which gives your initial insulin response more insulin and changes the glucagon/glycogen phase of digestion.
It can have side effects, but not any I have come across.
If you are taking separate sitagliptin and metformin, maybe you should ask your GP to give the both in one tablet, it goes under the name of Janumet.

Any more questions please ask.

Did your specialist give you a name for your condition?

 

[steveelles]

Wow that's great, thank you. I suspect they will put on combined following this initial trial of Januvia. It's weird but I feel different already. I didn't have that crushing wave of dark fatigue around 4pm today. I have also hardly hiccupped today and the nausea is almost none existent along with absolutely no spasming hunger pangs. Didn't give me a name for the condition as he advised that the NHS UK pragmatic approach was to simply call you diabetic due to the fast increasing number of variants. I was just delighted that someone finally acknowledged I've had this my entire life. For me that is a major milestone. With diabetes present in both sets of grandparents and parents my risk was extremely high.

 

[Lamont D]

Wow that's great, thank you. I suspect they will put on combined following this initial trial of Januvia. It's weird but I feel different already. I didn't have that crushing wave of dark fatigue around 4pm today. I have also hardly hiccupped today and the nausea is almost none existent along with absolutely no spasming hunger pangs. Didn't give me a name for the condition as he advised that the NHS UK pragmatic approach was to simply call you diabetic due to the fast increasing number of variants. I was just delighted that someone finally acknowledged I've had this my entire life. For me that is a major milestone. With diabetes present in both sets of grandparents and parents my risk was extremely high.

Hi again, it's more likely, your consultant couldn't put a name to the condition because of the number of tests needed to get a true diagnosis and the fact that a lot of them haven't got a clue!
At least you have got this far! But it's a battle ain't it?

What sort of treatment other than the meds have they offered you?
Have they mentioned diet?

I follow a really strict diet and this along with the safety valve of the meds have given me my life back. For my age, I am really healthy except my insulin imbalance, obviously.

If you want more information, please ask.

 

[steveelles]

I think that the UK feels behind the USA when it comes to knowledge of diabetes at the GP level. I'm sure you are right about the requirement for further testing but the reality is the NHS won't even fund testing strips for Type 2s. In terms of current BGs, I have had a bad summer. One morning I recorded a 32.2 (and I live by myself). For two months it didn't go below 10-13. I seem to have recently stablised around 8 and 9. The consultant is putting me under a dietician as I admitted to sugar binging which I have done since childhood. About once a week I simply cannot hold the sugar cravings at bay and fall off the wagon. I describe it as a biological imperative rather than standard greed - I just have to have the sweet (does that make sense to anyone else?) Under a dietician I can at least have all my cards on the table and the consultant assures me that the new medication will massively help reduce those cravings.

 

[Lamont D]

I think that the UK feels behind the USA when it comes to knowledge of diabetes at the GP level. I'm sure you are right about the requirement for further testing but the reality is the NHS won't even fund testing strips for Type 2s. In terms of current BGs, I have had a bad summer. One morning I recorded a 32.2 (and I live by myself). For two months it didn't go below 10-13. I seem to have recently stablised around 8 and 9. The consultant is putting me under a dietician as I admitted to sugar binging which I have done since childhood. About once a week I simply cannot hold the sugar cravings at bay and fall off the wagon. I describe it as a biological imperative rather than standard greed - I just have to have the sweet (does that make sense to anyone else?) Under a dietician I can at least have all my cards on the table and the consultant assures me that the new medication will massively help reduce those cravings.

What you are describing is a carb binge driven by your body needing and desiring more carbs and sugars. It is a viscous circle, you eat what you believe is healthy and good for you, say porridge for breakfast.
Then you have a sandwich for lunch, then a dinner or a takeaway that is so filling, then you snack the night away!
Yes, I've been there!
Carbs are probably the root of your problems.
My blood glucose levels at my surgery were 31+ then 29, the second time!
I was misdiagnosed as T2!
It wasn't until I got referral to my endocrinologist that things began to make sense.
Restricting my carbs intake, lowered my blood glucose levels. My insulin resistance began to lower, in lost weight, I found myself in normal blood glucose range when fasting!
Before diagnosis, First thing before breakfast, my levels were normal, I would eat, then all hell would break loose. Because I had eaten carbs. If I didn't, my bloods stayed in normal range.
The fluctuating blood glucose levels up and down had me in a right state.
I now refer to it as my hypo hell!

You can control any 'type' of diabetes with a very low carb diet.
If you get it right, like I have, you will get your life back.
It's not easy, it's not what you would call normal but it will bring your health back.
And more importantly for you, the hunger pangs, the need to eat, the need to binge on sugar goes. It really does! It does work!
The success stories thread forum, will be worth a look as well as the low carb forum.
If you don't have a blood glucose monitor, get one, you need to find out what foods affect you. You have to find out why you spike so high to certain food groups like starchy vegetables, grains, pasta, wheat, fructose, sucrose, even glucose!
My body won't tolerate any of these. I have a major food intolerance. It makes my insulin overshoot! It could be very similar to your condition!

Have a read of our forum, reactive hypoglycaemia.
You will recognise so much.

 

[steveelles]

That's good to hear. I thought I was just weak. I used to sneak to the kitchen cupboard when I was little and dig a table spoon into the golden syrup. That's how long this has been going on for. I've managed to get on top of everything a few times but my muscles weren't recovering from my exercise and so after a few weeks I felt malnourished and had to stop. Funnily enough, I feel better if I don't eat three times a day. I feel better if I only have one meal a day but hopefully the sitagliptin will address that. You are the second forum responder to mention reactive hypoglycaemia to me. The truth is that I don't seem to have a problem with lows. I'm in almost a permanent state of hyper. I think it is because I have a transit issue and food is staying in my digestive system far too long. I suspect that is either a common diabetic symptom or perhaps some initial digestive tract neuropathy which started in my late teens and has progressed for the last 30 years as I unknowingly played the hokey cokey with my BGs prior to turning fully diabetic. I suspect this because my digestive issues have been investigated over this 30 period with no conclusions. I used to get cramps so bad I would almost pass out. Now I hardly get any pain at all even though all the other symptoms remain - toilet several times a day (definitely not celiac), sudden hot flushes and excessive sweating, nausea and a strange dark sensation across my shoulders and neck. I wonder if the pain nerves have started to die off? Anyway, we all know the dangers of self diagnosis and non-expert speculation.

 

[Lamont D]

There are so many different 'types' and many of them are so individual, it is how your endocrine system works! We have so many with a metabolic condition (that is what some doctors call them) that I've not met two that are even similar, we all have a reaction to whatever intolerance our bodies don't like.
Potatoes are like a poison to me, they along with grains make me very ill!
So I don't eat them.

What puts us weirdos all together is that we can control these conditions with what we eat or don't eat!
We do without what makes us ill!
The normal, staple, so called healthy foods!
They are not healthy for us!
I have found out that most days despite my great endocrinologist advice is that not eating is better for my health than eating.
I feel better on fasting days.
I do know how you feel, it has become a necessary obsession, that I have to be so careful what goes down my throat!
It has taken a long time like yourself to get to where I am. No one is going to stop me doing what I have to do, if it means that I'm being this healthy!
I've adapted to my new lifestyle and so have others, finding that control is much better than having to deal with those awful symptoms.
This forum has helped me so much.
There is a lot of great advice on here!
I hope you take it on board and take a good look around and try it.
It does actually work, nothing else has!

Best wishes.

 

[steveelles]

Makes total sense. Everyone tells me to eat oats because they are slow release but that doesn't stop me from sky rocketing so I don't go anywhere near them. I also try to avoid potatoes, rice, pasta and bread although rice is my weak spot - I love it but accept that even brown rice isn't helping and I will have to say goodbye to it at some point. Being six foot four doesn't help because even the size of a plate of food looks insignificant next to the size of my hand. I'm really glad you've said that you feel better when you fast. A couple of years ago I started dropping in the odd fasting day but the metformin saw the end of that because the hunger pangs were so unpleasant. Thanks for all your supportive words. I will definitely stick with the forum because the alternative is everyone else's advice which is always "just be healthy". It ain't that simple. If I can do 75 minutes on a cross trainer on setting 25 with a raised heart rate of 165 I can't be that unhealthy and it wasn't even touching my weight unless I did it every single day and then the cycle of feeling malnourished would start again. I do feel that I am making some slow progress with the changes in my life and I hope that pace is quick enough for my body.

 

[Lamont D]

I think you will find that even slow release carbs are just carbs that rocket you a bit slower. They label these carbs as healthy, complex, full of fibre and so on. But in my case carbs are carbs, poison!
The lower the carb, the better I feel! That's how I've learned to control this weirdness!

Anyhow, how good it is that you can do that exercise! I can't even climb on one!
Kidding, I do a lot of walking and I have a great job which includes a lot of manual work, lifting, bending, carrying, etc. So I don't need to do gym work.
I would like you to consider something that you probably wouldn't believe.
The next time you exercise on the cross trainer, take a before reading, then a reading every fifteen minutes. Have you a monitor?
It may surprise you!
Why?
Well, I've learnt that some diabetics have a problem with strenuous exercise. As it higher blood glucose levels. It's to do with adrenaline, also because you use up glucose for the energy, the liver 'dumps' glucagon to keep giving you a boost for the exercise you haven't done yet!
Don't let me put you off as exercise is really important and it might not affect you!
There is a lot of evidence that you don't need carbs to do strenuous exercise.
A lot of athletes have a very low carb lifestyle and because the energy they get from muscle fat, the carb overloads are not necessary before or after.

There is so much you need to learn, as I did. Baby steps.
You might want to keep a food diary and along with your monitor record all your day to day readings and what you have eaten or drank.
You can experiment and experience, what certain foods do to you.
You can do portion size control.

What works for me is fresh food, home cooked, lots of protein, salad vegetables, I don't do dairy except full fat yoghurt, Greek style.Nowt wrong with dairy if you can tolerate. Nuts, avocado is brilliant! Bits of fruit, and so.
But I don't have any processed foods, take outs except for chicken without sauces etc.I don't do low fat because it's full of sugar!
I doing a fry up for my afternoon meal, gammon and eggs, with mushrooms onions, tomatoes. I will make a curry whilst that lot is cooking, fresh chicken with a low carb curry sauce or you can make your own.
There is always an alternative to carbs!
And if you get it right, you won't miss them (much!)

 

[steveelles]

Wow, you're definitely all over things. I have a great BG meter that I imported from Germany because the software links with my Samsung Health App and all I have to do is touch the devices together (NFC enabled). I will definitely check every 15 mins next time I'm on it. Funnily enough, a couple of years back, I recorded a 3.1 straight after exercise. I've had a lifetime of being totally wrecked after exercise so I was used to shaking like a leaf for an hour afterwards. I used to faint in my karate lessons during my early 20s. I've recently discovered zero carb electrolite hydration tablets which have been nothing short of miraculous. I also have a sauna afterwards depending on how dehydrated I feel - things have improved drastically following my new hydration regime and the cramps/spasms have stopped. Your diet sounds great actually. Right up my street except for the no sauce thing (I'm a northerner and I shall have wet). Carbs make me feel shocking too. The second they hit my stomach I just know. I have been on Lansoprazole for 15 years because otherwise I'll blow up like a balloon and have crippling heartburn. It's quite interesting when you hear some people refer to diabetes as a Carbohydrate Intolerance. Caveman diet it is - now, where's my spear?

 

[steveelles]

Hi. It's a bit strange that the consultant hasn't been able to fully diagnose you. Do you use a glucose meter and what was your last HBa1C blood test result? If you have stomach problems, are you on the Slow Release (SR) version of Metformin? I was on Sitagliptin for a few years. It can help reduce post meal spikes as it prevents the pancreas stopping insulin production too soon after meals. It has very few side effects apart from one or two bad but rare ones so read the leaflet. Apart for having a good low-carb diet, I would check that your HBa1C is below 7.0% in old money and perhaps nearer to 6.5% or less. If it's too high then you may need further meds. If your own insulin is suspected of being too low then Gliclazide or even insulin can be used. The c-peptide test is one way of finding out whether your own insulin level is too low. All of this assumes you haven't got one of the more unusual forms of diabetes but the consultant should keep on top of that.

Hi. I think he's waiting to see how I respond to the new medication. My last HBa1C was in the 50s (can't remember what that was in the other metric 4-7 but I have been as low as 3.1 and as high as 32.2). I've always had stomach problems so, rather oddly, I am able to tolerate the full 2000mg per day without any real issues. I had the first taste of Sitagliptin side effect last night in the form of an expected sense of fullness. Wow, yes, I felt really full. Will definitely make me eat less. This morning I was 8.8 for my fasting measurement but I didn't wake up on suddenly at between 4 and 5am like I always do. Thanks for the heads up about the c-peptide test. I suspect I do have a less ordinary form of Type 2 because 1 paternal grandparent was type 1, one maternal grandparent was type 2, my Dad is pre-diabetes and my Mum is under investigation and has recorded a fasting of 9.2

 

[Lamont D]

Wow, you're definitely all over things. I have a great BG meter that I imported from Germany because the software links with my Samsung Health App and all I have to do is touch the devices together (NFC enabled). I will definitely check every 15 mins next time I'm on it. Funnily enough, a couple of years back, I recorded a 3.1 straight after exercise. I've had a lifetime of being totally wrecked after exercise so I was used to shaking like a leaf for an hour afterwards. I used to faint in my karate lessons during my early 20s. I've recently discovered zero carb electrolite hydration tablets which have been nothing short of miraculous. I also have a sauna afterwards depending on how dehydrated I feel - things have improved drastically following my new hydration regime and the cramps/spasms have stopped. Your diet sounds great actually. Right up my street except for the no sauce thing (I'm a northerner and I shall have wet). Carbs make me feel shocking too. The second they hit my stomach I just know. I have been on Lansoprazole for 15 years because otherwise I'll blow up like a balloon and have crippling heartburn. It's quite interesting when you hear some people refer to diabetes as a Carbohydrate Intolerance. Caveman diet it is - now, where's my spear?

Northerner myself!
Swimming in gravy!
Interesting that you have had lows tho! The shaking etc!
We don't use spears around here, we have harpoons!

 

[Daibell]

Just a note to be aware that many NHS dieticians haven't got a clue about diet. It is getting better but avoid anyone who says to have carbs with every meal and to have low-fat everything.