- Messages
- 2,705
- Type of diabetes
- Type 2
- Treatment type
- Tablets (oral)
After being on just metformin since diagnosis ten years ago, I started on Janumet (combination metformin and sitaglyptin) earlier this month
I read the following information online about sitaglyptin.
"Sitagliptin works to competitively inhibit the enzymedipeptidyl peptidase 4 (DPP-4). This enzyme breaks down the incretins GLP-1 and GIP, gastrointestinal hormones released in response to a meal. By preventing breakdown of GLP-1 and GIP, they are able to increase the secretion of insulin and suppress the release of glucagon by the alpha cells of the pancreas. This drives blood glucose levels towards normal. As the blood glucose level approaches normal, the amounts of insulin released and glucagon suppressed diminishes, thus tending to prevent an "overshoot" and subsequent low blood sugar (hypoglycemia), which is seen with some other oral hypoglycemic agents.
Sitagliptin has been shown to lower HbA1c level by about 0.7% points versus placebo. It is slightly less effective than metformin when used as a monotherapy. It does not cause weight gain and has less hypoglycemia compared to sulfonylureas. Sitagliptin is recommended as a second-line drug (in combination with other drugs) after the combination of diet/exercise and metformin fails."
From this I understand that, for the first time, I am now on medication that induces my pancreas to produce insulin and not produce glucagon by suppressing the action of an enzyme that breaks down gastrointestinal hormones produced in response to a meal.
This is a worry in case I am causing further damage to my bets cells through squeezing more insulin out of them
But according to the above article as blood glucose lowers to normal levels "the amounts of insulin released and glucagon suppressed diminishes, thus tending to prevent an "overshoot" and subsequent low blood sugar (hypoglycemia),".
I low carb and my after meal glucose counts have been well behaved (with the aid admittedly of one 50/859 Janumet in the morning and the same in the evenings). As you can see from the graph over the last fourteen days my counts per meal were:
Before Breakfast: range from 95 to 128 with average 111 mg/dl (in mmol/l 5,3 to 7,1 with an average of 6,2)
After breakfast: range from 110 to 127 with average of 117 mg/dl (in mmol/l 6,1 to 7,0 with average 6,5 so average rise 0,3)
Before lunch: range from 86 to 127 with an average of 102 mg/dl (in mmol/l 4,8 to 7,1with 5,7 average)
After lunch: range from 84 to 130 with an average of 107mg/dl ( in mmol/l range from 4,7 to 7,2 with 5,9 average so average rise 0,2)
Before dinner: range from 86 to 122 with average of 101 mg/dl ( in mmol/l 4,8 to 6,8 with average 5,6)
After dinner: range from 93 to 117 with average of 109 mg /dl ( in mmol/l 5,3 to 6,5 with 6,1 average so average rise 0,5)
My overall average count over the same 14 day period is 110 mg/dl (6,1 mmol/l), which if I can maintain will lead to a predicted hba1c of about 5,5% ( 36 mmol/mol). A non diabetic score and a huge improvement on my last score of 9,6% (81 mmol).
Apologies for the avalanche of numbers and the length of the post but I had to give both the numbers that I use and those that would be understood by must of the users of the forum.
Whichever set of numbers we use, the easy conclusion is that I am happy with them.
But the nagging thought at the back of my mind is whether the sitagliptin is doing damage. Perhaps as I low carb anyway its action on the pancreas is limited and I should not worry unduly.
Should I let things be as they are since I am doing well on it ?
Or should I ask to return to my previous metformin only regime?
I am not sure about way forward.
Perhaps the sensible thing to do is let things be until my next actual hba1c review and discuss with my doctor then.
But my doctor belongs to the "diabetes will progressively worsen school" and thinks that more medication over time is almost inevitable. Having said that, when I suggested reducing the level of sitagliptin by half he was happy to leave it up to me based on my glucose counts.
I am not sure I am at that point yet though.
I read the following information online about sitaglyptin.
"Sitagliptin works to competitively inhibit the enzymedipeptidyl peptidase 4 (DPP-4). This enzyme breaks down the incretins GLP-1 and GIP, gastrointestinal hormones released in response to a meal. By preventing breakdown of GLP-1 and GIP, they are able to increase the secretion of insulin and suppress the release of glucagon by the alpha cells of the pancreas. This drives blood glucose levels towards normal. As the blood glucose level approaches normal, the amounts of insulin released and glucagon suppressed diminishes, thus tending to prevent an "overshoot" and subsequent low blood sugar (hypoglycemia), which is seen with some other oral hypoglycemic agents.
Sitagliptin has been shown to lower HbA1c level by about 0.7% points versus placebo. It is slightly less effective than metformin when used as a monotherapy. It does not cause weight gain and has less hypoglycemia compared to sulfonylureas. Sitagliptin is recommended as a second-line drug (in combination with other drugs) after the combination of diet/exercise and metformin fails."
From this I understand that, for the first time, I am now on medication that induces my pancreas to produce insulin and not produce glucagon by suppressing the action of an enzyme that breaks down gastrointestinal hormones produced in response to a meal.
This is a worry in case I am causing further damage to my bets cells through squeezing more insulin out of them
But according to the above article as blood glucose lowers to normal levels "the amounts of insulin released and glucagon suppressed diminishes, thus tending to prevent an "overshoot" and subsequent low blood sugar (hypoglycemia),".
I low carb and my after meal glucose counts have been well behaved (with the aid admittedly of one 50/859 Janumet in the morning and the same in the evenings). As you can see from the graph over the last fourteen days my counts per meal were:
Before Breakfast: range from 95 to 128 with average 111 mg/dl (in mmol/l 5,3 to 7,1 with an average of 6,2)
After breakfast: range from 110 to 127 with average of 117 mg/dl (in mmol/l 6,1 to 7,0 with average 6,5 so average rise 0,3)
Before lunch: range from 86 to 127 with an average of 102 mg/dl (in mmol/l 4,8 to 7,1with 5,7 average)
After lunch: range from 84 to 130 with an average of 107mg/dl ( in mmol/l range from 4,7 to 7,2 with 5,9 average so average rise 0,2)
Before dinner: range from 86 to 122 with average of 101 mg/dl ( in mmol/l 4,8 to 6,8 with average 5,6)
After dinner: range from 93 to 117 with average of 109 mg /dl ( in mmol/l 5,3 to 6,5 with 6,1 average so average rise 0,5)
My overall average count over the same 14 day period is 110 mg/dl (6,1 mmol/l), which if I can maintain will lead to a predicted hba1c of about 5,5% ( 36 mmol/mol). A non diabetic score and a huge improvement on my last score of 9,6% (81 mmol).
Apologies for the avalanche of numbers and the length of the post but I had to give both the numbers that I use and those that would be understood by must of the users of the forum.
Whichever set of numbers we use, the easy conclusion is that I am happy with them.
But the nagging thought at the back of my mind is whether the sitagliptin is doing damage. Perhaps as I low carb anyway its action on the pancreas is limited and I should not worry unduly.
Should I let things be as they are since I am doing well on it ?
Or should I ask to return to my previous metformin only regime?
I am not sure about way forward.
Perhaps the sensible thing to do is let things be until my next actual hba1c review and discuss with my doctor then.
But my doctor belongs to the "diabetes will progressively worsen school" and thinks that more medication over time is almost inevitable. Having said that, when I suggested reducing the level of sitagliptin by half he was happy to leave it up to me based on my glucose counts.
I am not sure I am at that point yet though.
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