August 13, 2007

Some Disturbing News about Januvia

UPDATE (April 2, 2013): Before you take Byetta, Victoza, Onglyza, or Januvia please read about the new research that shows that they, and probably all incretin drugs, cause severely abnormal cell growth in the pancreas and precancerous tumors. You'll find that information HERE.

NEW Dec 19, 2008: If you want to better understand the health issues associated with Januvia, read the Dec 8, 2008 blog post citing the research that makes it clear that a "side effect" of how Januvia lowers blood sugar is that it turns off a tumor suppressor gene making it "a trigger for prostate cancer". This same mechanism has been linked with promoting melanoma, ovarian cancer and lung cancer. None of the approval testing for Januvia investigated this problem and there is evidence it is real and affecting people taking this drug.

You can read about this important issue here:

More Research Shows Januvia and Glinides Inhibit Tumor Suppressor Gene DPP-4

Here is the original post "Some Disturbing News About Januvia":

Diabetes in Control reports last week that "According to a survey, prescriptions for the diabetes drug Januvia have grown nearly threefold between the first week of 2007 and the week ending July 20. ... It was reported that patients were switched from metformin 21%, Avandia 17% and Actos 13%."

Once again we are being treated to the spectacle of doctors who do not understand a new drug's mode of action prescribing that new drug in a way that is guaranteed to damage the health of many of those patients.

Januvia does NOT affect Insulin Resistance

Januvia stimulates insulin production after meals and may inhibit the production of glucagon after meals. That's what it does folks, and that is ALL it does.

The problem here is that for at least 21% of the Type 2s in this study, doctors were taking them off drugs that countered insulin resistance and replacing them with this drug that stimulates insulin production.

Why is this dangerous? Because for many Type 2s insulin resistance, not lack of insulin production is the primary metabolic flaw causing their high blood sugars. Their cells do not respond normally to insulin, even very high levels of insulin, resulting in very high blood sugars. Drugs that reduce insulin resistance make it possible for less insulin to do a better job.

The term "insulin resistance" is bandied around a lot, but few people really understand its practical implications. The best way to get your head around what insulin resistance means is to compare the insulin doses required to achieve normal blood sugars by people who are not insulin resistant and those who are.

A 125 lb non-insulin resistant person with Type 1 diabetes who produces no homemade insulin at all might use a basal dose of Lantus of 12 units. If they ate a meal with a moderate number of carbohydrates--let's say, 30 grams, they would inject 2 to 3 more units of a fast acting insulin to mop up those carbs.

In contrast, a Type 2 who also weighs 125 (and yes, there are quite a few Type 2s who are normal weight) if taking no other drugs might use 50 units of Lantus and need 17 units of insulin to cover that same 30 grams of carbohydrate. If that insulin resistant Type 2 were to add metformin to their daily regimen, a drug which reduces their insulin resistance, their Lantus dose might drop to 30 units and their post-meal dose to 10 units.

In either case the insulin resistant person is using three to five times more insulin to get the same effect as the non-insulin resistant person.

But the study above reports that doctors are taking people OFF the drugs that reduce insulin resistance--21% of their patients were taken off Metformin and almost the same percentages were taken off Avandia and Actos, which also affect insulin resistance.

Then doctors are putting these insulin resistant patients a drug, Januvia, that does two things: Mainly it stimulates whatever beta cells are left to produce more insulin. Though since the doctor has just taken away the metformin, the patient is going to need to produce more than they were when they were taking metformin.

Januvia may also decrease glucagon secretion--glucagon is a hormone that pushes up blood sugar and there is some likelihood that it is overproduced in people with Type 2 diabetes. Decreasing glucagon production will lower blood sugar--but it is important to note it only lowers the blood sugar dumped by the liver into the blood stream in response to glucagon production. It does NOT lower the blood sugar rise caused by the digestion of the carbohydrates in your meal.

So switching someone to Januvia from Metformin means that you've now increased their insulin resistance while at the same time giving them a drug that only stimulates a very mild increase in insulin production from whatever living beta cells they have left.

Januvia DOES work very well in some people. But the thing that doctors don't seem to understand is that the people it works well for are those people who, like me, though diagnosed as "insulin resistant type 2s" are, as I am, insulin sensitive people whose beta cells due to some flaw have stopped secreting insulin in response to rising blood sugar.

People who are insulin sensitive but have a defect that stops living beta cells from secreting will also response strongly to sulfonylurea drugs like Amaryl or Glipizide.

And they will respond very strongly to Januvia, but unfortunately, the makers of this drug have carefully NOT measured the insulin sensitivity of their subjects before putting them on the drug. If they had done this, it would probably show that Januvia works mostly in people who are insulin sensitive, but doing that would rule out giving it to most Type 2s and destroy the lucrative market for this new drug.

Anecdotal Januvia Side Effect Report Updated

I have heard recently from someone who experienced serious constipation with Januvia. The Januvia Blog also has some new reports from people who have experienced rashes after taking it.


Copyright Janet Ruhl 2007. If you are NOT reading this on http://diabetesupdate.blogspot.com the content has been STOLEN.

11 comments:

elizabeth said...

Since you are not a doctor, you don't know everything. Since starting Januvia, my insulin has been cut in HALF! Nothing else has worked for my insulin resistance, even close to the way Januvia has. And I have lost 20 lbs, which I could not do before, so before you make a blanket statement, do your homeowrk. It does work for many people who are insulin resistant, but no drug works for everyone, and it is foolish to believe that it should. Elizabeth.

Jenny said...

I have done plenty of homework.

I have NEVER denied that Januvia may control blood sugar in some people. It gave me normal blood sugars without insulin.

But I am NOT willing to pay the price of cancer for those normal blood sugars when there are other ways of controlling blood sugar that do not present that risk.

There is solid evidence that Januvia shuts off an important mechanism that the immune system uses body to kill cells that have become metatastic (i.e. cancerous).

As part of your "homework" I suggest you read Dr. Mark R. Goldstein's letter to annals of Internal Medicine which you can find HERE.

Dr. Goldstein is a doctor and he documents in the letter why he believes Januvia is even MORE dangerous than I thought it might be.

uncontrolled said...

I was just started on Januvia, i have out of control blood sugars, very high then when insulin is taken, bottoming out. Talked with my doctor and ask him to put me on this, he was reluctent, i am a 48 yr old female, and have had type II diabetes since i was 24. i hope this works for me but if it can cause cancer, of course i do not want to take it. i feel hopeless. i want to control my sugars, my mom is type II and have watched her have all the bad side effects from this disease.

Jenny said...

Uncontrolled,

If you are not getting good control with insulin it is probably because you haven't been given either the right kind or the right dose of insulin.

Are you using a combination of slow acting insulin for fasting control and fast acting for meal control?

Is the fast acting insulin dosed to match the carbs in your meal?

Have you tried the different fast acting insulins, for example, Novolog or Apidra?

Are you using NPH which is notorious for giving the highs and lows you describe.

If your doctor is not a young, well-trained expert in diabetes you need to find a new doctor who is.

There is some version of insulin in some dose that will give you good control, especially if you are willing to cut back on your carbohydrate intake and get rid of those starches and sugars.

You might want to read Dr. Bernstein's book, "Dr. Bernstein's Diabetes Solution", too.

Katherine said...

jenny - thank you so much for your mini lecture on insulin resistance and januvia - i printing it out to study! katherine, nurse practitioner student!!

ps - hopefully, if i can wrap my brain around this, you will have helped many patients through me!

Israr Ahmad said...

Januvia is a wonder drug,however it shoould be prescribed with appropriate drugs to control resitance to insulin.there is something called titration of dose of antidiabetic drugs.while starting Januvia, the dose of other drugs should be titrated.

As regards cancer, the risk of dying from uncontolled diabtes is very high compared to dying from cancer due to Januvia.

a word of caution though, every new drug is a wonder drug when it is discovered.

Dr.I.A.Khan, MD,FRCS,FRCS
A patient of type2,since 30 years.

Robert Forrey said...

I have been taking Januvia for several months with no apparent change in my blood sugar levels. I have however become very constipated, which the official side effect warnings do not mention.

My dentist (!) strongly recommends GlucoReg. Any comments?

Roberto

Jenny said...

I do not recommend the GlucoReg which is a bitter melon supplement. There are currently no supplements which have been shown to reliably lower blood sugar and quite a few that appear to do so, when taken to the lab turn out to contain cheap generation 1 Sulfonylurea drugs which are known to trigger heart attacks.

Metformin, Byetta, and Insulin are the drugs that really lower blood sugar, though Metformin and Byetta don't work for everyone.

Januvia causes constipation because GLP-1 causes slowed digestion. I found the digestive side effects of Januvia grew through the time I took it and it took more than a month after I stopped it for my system to start being normal again.

Alethea said...

Hi Jenny,

I think I have MODY. 7 out of 7 people in my primary family have some kind of diabetes either diagnosed type 1 or 2. I got urticaria from Metformin and Glibizide. I do better with a combo, because I am susceptible to insulin resistance. Januvia has worked well with precose. Don't know what else to do because of my sudden and deadly allergic reactions to many medications. Actos caused me symptoms of heart failure. Any ideas? Doctor has no more. blood sugars are under control now. -Alethea

Jenny said...

Alethea,

I'm not fond of Januvia for reasons stated in this post and others, but if you respond well to it there are a couple other drugs to ask your doctor about, hough with your history, your doctor may have already eliminated all but Insulin.

1. Byetta.
2. Prandin or Starlix at meal times.
3. Fast acting Insulin at meal times.

If you did not have a dramatically intense hypo reaction to glipizide the most common forms of MODY are less likely. But with your family history you doubtless have SOMETHING heritable. And I have heard from someone with the very rare form of MODY that does have IR, though it also brings deafness.

Jassnaround said...

I found your website because I was looking to find out if the reaction to the reduction of Januvia dosage that I have started is typical. Because of the high cost of Januvia and because I currently am not working and do not have health insurance, I discussed stopping Januvia with my doctor. He discouraged me from stopping it and I still have about 30 x 100 mg pills left. So I thought I would try taking 1/2 pill each day to see if it would still continue to help me at all. What I have seen so far after doing this for 5 days is that my fasting blood sugar (morning)has dropped significantly. I had been taking 80 units of Lantus every night when I took 100 mg of Januvia. Now I can take 60 units of Lantus and still have my morning blood sugar levels under 120. Have any idea what is happening with this situation?

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