September 12, 2008

Yet Another Problem with 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.

Update (January, 2009) : A much more important problem with Januvia--that it promotes cancer by inhibiting a tumor suppressor gene researchers have called "the trigger for prostate cancer"--is discussed in this more recent blog post:

More Research Shows Januvia and Glinides Inhibit Tumor Suppressor Gene DPP-4. Posted Dec 8, 2008.

Original Post:

If you have had or might get melanoma, ovarian cancer, lung cancer or prostate cancer, please read the above post before making your decision about whether Januvia is for you.

Here is the original post that was posted 9/12/08:

I have been hearing from people about a new, and, to me, very troubling problem with Januvia. The problem is this: now that doctors have decided that all people recently diagnosed with Type 2 Diabetes should be put on Januvia, prescriptions for the combination drug Janumet, which is made up of both Januvia and Metformin, are becoming much more frequent as a first prescription for diabetes.

Metformin is a very safe drug that has been used safely for decades. The most recent follow up to the UKPDS study, the 20 year follow-up, which was just presented at the annual EASD conference found that at 20 years after the start of the study, "Patients treated with metformin had a 21% reduction in risk of any diabetes endpoint (P=0.01), a 30% reduction in risk of diabetes-related death (P=0.01), a 33% reduction in risk of MI (P=0.005), and a 27% reduction in risk of all cause mortality (P=0.002)."

Metformin is a very good drug for people with Type 2 diabetes because it decreases insulin resistance both at the muscles and at the liver. If the liver becomes insensitive to insulin it becomes deaf to the message that rising insulin levels in the bloodstream should give it, which is: "Glucose coming in from food I just ate." Thus the insulin resistant liver continues to dump glucose into the blood stream when there already is glucose there from a meal. This causes even higher blood sugars after a meal than would be due to the meal alone.

Metformin is also the only oral drug which has been shown consistently in studies to lower body weight rather than cause weight gain.

And its only side effects are mild--digestive system effects that, while they may be unpleasant, are not in anyway life-threatening or even permanent.

But here's the problem: Metformin does irritate stomach and intestinal linings, particularly when a person has just started taking it. That is why the Extended Release (ER) form is a much better prescription than the regular form, as it minimizes unpleasant digestive reactions.

Januvia, however, has a side effect that makes Metformin even harder to tolerate: by boosting GLP-1 it causes the lower stomach valve to remain shut. Without metformin in your body, this merely leads to a feeling of fullness and upper abdominal bloat. But if you have metformin in your system, it leads to much worse stomach distress.

When I was taking metformin ER and added Januvia, I found that the only way I could tolerate the two together was to take the Metformin several hours before I took the Januvia. Otherwise, my stomach was a mess for hours.

But the Janumet combination pill combines fast-acting metformin--the version that already causes a lot more nausea and diarrhea than the ER form--with Januvia, so it greatly exacerbates the metformin gastric side effects.

So what I am hearing from people recently diagnosed with diabetes is that after being put on Janumet they develop horrible stomach symptoms and their doctors switch them NOT to plain metformin ER, but to plain Januvia!

Thus they lose any drug action against insulin resistance, and are left with a drug, Januvia, that, if it is effective at all--which it often is not --raises their insulin levels without lowering their insulin resistance.

They also come away believing they could never tolerate Metformin, when, in fact, most could were they given the gentler ER form without the stomach-valve-closing drug Januvia.

Given the extremely positive effect that was seen in patients taking Metformin in the UKPDS f0llowup study--patients who had almost half the risk of heart attack at 20 years as patients who had taken sulfonylurea drugs which, like Januvia, stimulate insulin secretion, this trend is disturbing.

Most prescriptions for diabetes drugs are written by overworked primary care doctors (family practitioners or doctors trained in "internal medicine") who have very little training in diabetes care beyond what they are told by drug company salespeople. Sadly, the Merck salesforce has done such a snowjob on these family doctors that they are now moving their newly diagnosed patients to Januvia, an expensive, dangerous drug that has no impact on insulin resistance, and away from metformin.

If you are on Janumet and are having serious stomach or intestinal side effects explain to your doctor that these side effects are being worsened by Januvia and that you want to take Metformin ER ALONE, without any Januvia.

Also, if you do stop Januvia or Janumet, remember that it takes about two weeks for the Januvia to completely leave your system, and even after that, it may take another few weeks for your stomach value to begin operating properly again.

It took me more than a month after I stopped Januvia to recover normal stomach emptying.

And if your doctor tells you that you should keep taking Januvia rather than Metformin because Januvia will "rejuvenate" your beta cells, point out to him that this is drug company hyperbole that is not substantiated by any study that has looked at the beta cells of human beings. Instead, it depends on misinterpretation of HOMA calculations, which merely reflect the amount of insulin secreted and which in addition, recent research has shown to be highly inaccurate.

Januvia does not regrow beta cells. It merely stimulates them to produce more insulin at meal times. And if you are insulin resistant, eating a high carb diet, and not taking metformin, that additional insulin will do one thing for you: pack on additional weight.

You've been warned!


The Old Man and His Dog said...

I'm officially off of Janumet. This is my first weekend on Byetta and I'm relieved. I had to argue with my endo to switch, but I was persistent and won the battle. Started on Byetta Fri night and haven't been over 109 all weekend. Prior to this on Janumet I was religiously at 180 after meals. Oh and the other good news is, NO NAUSEA! zero...none. Thanks for your excellent blog.

Jenny said...

Glad to hear that you are doing well with the Byetta. It is much more effective than januvia for people who respond to GLP-1 stimulation.

I have often heard from people who get the strongest response to it as far as blood sugar control goes that they don't experience the nausea.

It may also be because the nausea occurs when people eat a lot of food and the stomach emptying causes much discomfort. If one is already eating reasonable amounts, it maybe easier to tolerate. But that's just a surmise.

aurora said...

Hi Jenny...I am on Janumet 500x2a day for approx 12 mos...I became worried after reading all your comments on Januvia..I asked my endo to take me off..he did (very reluctantly) a1c is 5.3..I went strictly on metformin 1000 x2a b.s. control went crazy for the 2 weeks I was off Januvia..a.m. reading 120..after meals 140..I am low carb(Dr B) I was astonished..anyway called Dr...and cried uncle..he put me back on Janumet #'s are back .to "normal"..what is going on..I have never had any side effects with Janumet..but Metformin (only)tore my insides up..

Jenny said...

It is possible that there is a rebound effect that occurs when people stop Januvia. When I stopped it, my blood sugars were very hard to control on the same insulin doses I had been using before starting it. About a month later, they were back to what they had been.

If Januvia is effect, Byetta will be more effective and is a much safer incretin drug.

There were more excess cancers in the small group of pre-acceptance test subjects taking Januvia than there were cases of pancreatitis in the hundreds of thousands of people taking Byetta.

The connection between the symptoms is stronger for cancer and Januvia given that we understand the mechanism by which inhibiting DDP-4 shuts off the body's ability to fight cancerous cells. Pancreatitis occurs among people with diabetes at an unknown frequency that probably is that of pancreatitis among people taking Byetta.

Anonymous said...

Januvia has not worked for me at all. I have gained a lot of weight, my neuropathy feels like it is worse than ever. My blood sugar is really not any better. I still hit over 200 once in a while. My DR seems to swear by it, and is very reluctant to prescribe something else. Quite frankly, I think I would be better off on insulin.

Anonymous said...

Hi. I have a question. I was diagnosed about a year and a half ago. The only medication my doctor has me on is Janumet.

Ever since I started it my level has never been in the normal range. It's average is in the 140-150s.

For a while this summer I stopped taking my meds altogether for about 3 months becasue I couldn't stand taking all the drugs in my system. During this time my levels were in the high 200s and mid 300s.

I'm back on it again and am back in the 150-160s.

My question is, when you take diabetes meds such as Janumet, how long will it keep your levels low? Will my body just keep getting worse over time and the meds not be as effective at keeping the levels down? Thanks

Jenny said...


That isn't the kind of question to be asking in a blog comment section as it isn't a simple question to answer.

Why not stop by one of the diabetes support discussion groups (you'll find some listed on the side bar) and post a question in a locale where people stop by precisely to discuss this kind of question.

You can also learn a lot more about diabetes and the way it progresses and what you can do to slow that progression on my main web site Blood Sugar 101.

Anonymous said...

Hi..the doctor took me off byetta and put me on Januvia...he said was people dying of pancreatitis..I have also been on metformin for years..what do you think about this...thank you

Jenny said...

The number of people who got pancreatitis from taking Byetta is 6 out of tens of thousands. The excess cancer deaths in the group of people taking Januvia during the drug approval ranges was of a similar magnitude but far few people took the drug.

Byetta is a much more effective drug and probably as safe. I bet that the drug reps that sell Januvia "educated" your doctor about the "dangers of Byetta."

tinkysmom said...

Do you know if there is much weight gain with januvia? I am on 2500mg. metformin a day and my doctor just prescribed januvia because we can't get my sugar under control, especially the week leading up to my period.She has prescribed 100mg. of januvia a day. She was going to put me on byetta until those people died which is what I want to be on, she says I am not heavy enough and it will cause me to lose too much weight. I weigh 160 and am 5'7" tall I am not small my any means.I really can't tell much difference since the januvia except I don't feel as hungry as usual, I am worried I will gain back the 23 lbs I lost since I have been on the metformin. Please let me know.

Jenny said...


Januvia is "weight neutral" which means it neither causes gain or loss.

However, Byetta does not cause dramatic weight loss in people who are not overweight. For that matter, it doesn't cause dramatic weight loss in 2/3s of those who take hoping to lose weight.

Those 6 cases of pancreatitis (most of which were not fatal) were in millions taking the drug. There are tens of excess cancer deaths in about 2,000 taking Januvia. The risk of cancer is higher with Januvia than the risk of Pancreatitis with Byetta.

TomA said...

I am on Januvia and Glipizide. When I first went on Januvia in February, I passed out in a store because of low blood sugar. I was taking 25mg of Januvia and 5mg of Glipizide. I was taken off the Januvia and in October, I was put back on because my readings were high. In the past, I was on Avandia and my readings were at or below normal. But, back on Januvia, my readings started to creap up. Now, I'm on 50mg of Januvia and 2.5 of Glipizide. The problem I'm having is that my sugar level increases overnight. My readings show arond 120 before bedtime and in the morning they hit around 190. I am also taking Synthroid for my Thyroid. I noticed that after taking Synthroid, without eating, my readings increase by 30 to 40 points. Is Byetta something that works differently that Januvia and the combination with Glipizide? This cancer scare with Januvia is on par with that of Avandia!

Jenny said...

I have removed two anonymous posts that sounded suspiciously like they were posted by drug company reps. Since they were posted anonymously, there is no way to be sure.

In answer to a question from the anonymous poster, here is a link to where you can find a long list of citations to cancer research which has determined that inhibiting DPP-4 appears to be the trigger for prostate cancer and promotes metastasis for ovarian and lung cancer as well as for melanoma.


To find the citations to published cancer research, search for the section titled, "Research Connecting DPP-4 and Cancer."

Re whether Januvia is as strong as Byetta, the only study that looked at it found it to be true, but there is a lot of anecdotal evidence in the old Januvia blog at from people who were switched to Januvia from Byetta and saw their blood sugar deteriorate.

Anonymous said...

I have tried several different meds for my diabetes and always seem to have varying degrees of reactions to them. Most of which is muscle spasms, tiredness, nausea, etc. I am also taking Synthroid and have noticed the same rise in blood sugar after taking it. I mentioned this to my DR, but am told that med should not raise my blood sugar. Pam Currently I am taking Januvia and Byetta. I am having terrible stomach problems. I have been up half the night for 3 nights in a row with my stomach cramping. I've only been taking the Byetta for 2 weeks. And the Januvia for 3 months. My blood sugar has come down slightly but not much. I see my DR tomorrow. Wish me luck.

TomA said...

I read the commets concerning Metformin, especially having to take it early. I recently stopped Januvia and returned to Metformin because of problems I had when the dosage of Januvia was increased. When I first started taking Metformin, like all my medications, I asked the pharmacist for a printout on the medication. It stated that it should be taken at night. I asked my doctor about this and he said it didn't make any difference. I kept taking it in the morning and the results were not good. Hence, the Januvia was prescribed. Since I returned to the Metformin, I am taking it at night and it works much better for me. Those printouts on the medications help to understand whats going on so you can control your situation. The pharmacists should offer to give you one when you pick up your medications.

Jenny said...


The topic of when to take metformin has been discussed many times in online discussion groups. The impact varies from person to person.

Some of us have found that taking it at night causes us to have to wake up multiple times to go to the bathroom which is a known way to raise insulin resistance. So if that is the case it is better to take it in the morning.

Others split the dose of the ER and take it both morning and night.

Before you take any drug you should always read the official prescribing information which is what the drug companies are legally required to supply. This is available online if you search for "[drug name] prescribing information."

There will be a version for physicians and one for patients. I read the one for physicians as it lists the actual side effects and warnings in detail. The one for patients is dumbed down.

Anonymous said...

I have been taking some form of Metformin for over 8 years. I tried Metformin with horrible gastro-intestinal results. I switched to XR with no change in the problem. I was then given Fortamet, which has been much better. I still have a bad day here and there, but nothing like before. I could never get my bs to respond to any form of Metformin on it's own. I tried Byetta, but was so sick all the time I couldn't take it. Even vomiting at times. I did lose weight, but who wouldn't if they were too sick to eat. I then went on Januvia and have not had any problems. My bs is back to normal and I feel great. Every person is different. What works well for one person will not work for another. Instead of deciding based on someone's opinion, please work with you doctor to find what works best for you. All of these drugs have side effects as we know and everyone has a different tolerance level. Listen to your body. It is your best guide in the end.

Jenny said...

Anonymous 7:09 says you should avoid anyone's (i.e. my) opinion and "listen to your doctor."

I'd suggest that if you are considering taking Januvia, you ask that doctor if he had read the research that has proven, conclusively, that DPP-4 is a cancer suppressor. If he only knows of DPP-4's relationship to GLP-1 and blood sugar, and not of its cancer suppression function, he is not equipped to tell you whether or not Januvia is safe.

Sadly, most doctors only know about drugs what drug company sales people tell them.

The data connecting DPP-4 with potential promotion of melanoma, ovarian cancer, lung cancer, and prostate cancer is mainstream, very compelling, and completely unknown to the average practicing doctor.

Anonymous said...

I just began Janumet 50/2000 mg four days ago. SO far I am doing great. My blood sugars are normal. I have had diabetes for several years. I started out using Metformin XR 500mg. I was taking 1000mg two times a day. After awhile it quite being effective. My dr. added Amaryl. I used it for awhile with the Metformin. WHen Byetta came out I started using it. I worked great in keeping my levels down. It made me have nausea in the beginning but it quit after a couple of weeks. After less than a year on it, I began to have severe stomach pain that would wake up in the middle of the night. I thought I had an ulcer. My stomach was scoped but there was nothing wrong that was visible. My dr. said to stop the Byetta immediately. I did so and the pain quit immediately. That left me without medicine to control my bs. I made an appointment with the diabetes specialists. She added Actos, Lantus (I started using a small amount to keep my bs normal overnight) and Amaryl. I began having too many highs and lows. So my dr. took me off the Amaryl and put me on the Janument. Immediately my bs has come down to normal. So far I am not having any side effects. What worries me now is the cancer issue associated with this drug and the stomach problems it causes. Does the stomach valve not work properly on everyone who uses Januvia?

Anonymous said...

This is an interesting bit of information on Januvia/Januamet.
While in hospital for surgery in January my B.S. was out of control and I had a phone consult with the diabetic department. They put me on Januvia and Prandin trial. Got immediate control... the best ever. And no, I do not work for a drug company.
When I got home I went to see a diabetic specialist who change me to Janumet and a slight Prandin increase.
I could only afford to buy the Janumet for a month (with Medicare Plan D. Also, I did not see any great improvement from the Janumet.
At the end of this month I have another appointment with the diabetic Dr. I was hoping she would put me on plan januvia with additional Metformin. I have been taking 2000 mg a day for several years and it does a moderate job of controlling.
I have called the number the januvia makers give to get financial help in taking januvia. For some reason the form never arrives in the mail.
Now I think that may be due to my good luck!! I have a reeding melanoma under the iris in my right eye. If Januvia does allow tumors to increase I would be working at cross purposes to save the eyeball!
Well, I'll discuss with the Dr. and ask about Byetta or something less costly.
But, Jenny, thanks again for this timely info and blog. It could save me from a return of the cancer.
I am sending this anonymously because the Google blog ID is such a bother.

Jenny said...


Januvia is definitely a bad idea for those of us who are melanoma survivors. I checked this out carefully with several of the researchers who have explored the relationship of DPP-4 inhibition and cancers, and their feedback was universally that the research has NOT been done to explore this connection and that it ought to be done. Until then, it is a good idea to avoid it.

Byetta should be safe in this regard as it has no impact on DPP-4 that I know of.

Kitty said...

Dear Jenny,
Thank you so very much. I have learned so much this morning. Last night I saw a lawsuit advertisement about Januvia & decided that I needed to do my homework NOW!(After taking Seroquel for 7 yrs [4@ 100 a night]& then learning about the side effects of THAT only after the fact, I had promised myself that I would be more vigilant on the meds prescribed me. I lapsed [sigh]).
I Moved & changed Dr's back in February of 2009. My new DR. prescribed Metformin & Januvia. A few months later he added Lantus.
The clinic that I go to has changed my DR. & sense he is new, he doesn't have the patient load that my other DR has, so I think I'll talk to him about a Metformin & Byetta treatment instead of the 3 that I'm now on, reason being is that I have been having horrible intermittent pain where my pancreas is located.
Maybe it's a good thing that I have a new Dr. I told that old Dr. about it & asked him if it was something to be worried about or all in my head, he chose the latter.
Kitty Koch

Sue said...


New to this site and blogging-but am finding it very interesting. I am a type 2 and the last month my A1C was 9.3-never over 7 for last 8 years. I had been on Metformin ER 500 x2 a dayfor a few year. No one told me that the stomach upset was not Irritable bowl but caused from the metformin. So they put me on Januvia and dropped my metformin to 500 mg That was over one year ago. Stomach problems pretty much gone. Except I was always bloating. Thought it was lactose so cut out milk products. But I noticed after eating or walking I would bloat too. It has gotten worse.

Up to current date-I saw a commercial from a law firm warming those on Januvia who had experienced pancreatis or cancer to kidney failure to contact there firm. Was more concerned in what was wrong with the Januvia. Hence your site came up. Now I am scarred about putting that little orange pill in my mouth. I was diagnosed with uterine cancer 6 months ago and had to have a complete hysterectomy. Luckily it was stage 1 so no chemo or radiation. But could this have anything to do with Januvia. My doc upped my metforin after my last labs-DAH stomach problems doc-check the record-Now I am going to see an Diabetes specialist and I guess insulin will be in my future-cant afford to have the highs I have been having. Thanks for letting me blow off steam.

Jenny said...


Please print out the abstracts of the research papers liking DPP-4 inhibition with cancer. Doctors are not aware of this connection as they get their information only from drug reps and professional newsletters that are often supported by drug company advertising.

I do not believe it is safe for any cancer survivor to take Januvia until further research is done to look into the impact of inhibiting this tumor suppressor gene.

Meanwhile, try cutting back on carbs and using the strategy described in How to Lower Your Blood Sugar

If that doesn't help, ask your doctor to put you on Levemir basal insulin or a fast acting insulin at meals.

Anonymous said...

What a useful post! Thank you! My mother in law recently was put on Januvia and had a bad reaction to it. I'm sending her the link.

MNK said...

Hi Jenny, thanks for your blog. Along with hypothyroidism, I am also insulin resistant. I was taking Metformin ER 2000 xday and was doing great. I lost 10lbs of water weight and my fingers and feet were no longer swollen. I have been doing well for about 8 mos.

That being said, fatigue has been a symptom that won't go away. So few weeks back my Endo put me on Janumet 50/1000 in the morning and Metformin 1000 at night. He thinks my body is not converting my glucose into energy thus causing the fatigue. Long story short, I am so glad I did not pay for Janumet out of pocket. It doesn't work for me. I gained 5 lbs in two weeks and my hands and feet are swollen again. I am going back to Metformin ER 2000 a day tomorrow.

I wish big pharmas would focus their time & money on undiscovered drugs for cancer, HIV, and leave the old and tried drugs alone!

Thanks again! :)



Unknown said...

i take januvia and your article about metformin was quite interesting,only thing you did noy mention is that metformin is dangerous to your small fact since most of us seniors have weaker kidney function because of before you knock juniva to hell look at metformin its no better.juniva does not damage kidneys/from a intelligent reader who does not like bullshit

Jenny said...


There is no evidence that metformin damages kidneys. The only connection is that out of caution doctors do not prescribe metformin to people who already have seriously compromised kidney function. This is out of fear of lactic acidosis, though 20+ years of experience with metformin has shown that fear to be groundless.

We have no idea whether Januvia damages kidneys or not, since we have less than five years worth of experience with it and no large studies of its effects on populations have been run by anyone but the drug company who manufactures it. Eventually we will know what problems it causes, but only after the current generation of people taking it have been the lab rats whose results point to its dangers.

Metformin is by far the best understood and safest diabetes drug on the market.

Anonymous said...

I have not been able to control my levels and it's been very upsetting... so my doctor suggested that I get on insulin and I told her no freaking way... so she has put me on 500 mg of Metformin HCL, 100 mg of Januvia and 15 mg of Actos. I have not been able to get my levels under 388. I am watching what I eat and checking my levels before and after I eat and with me being on all 3 meds I'm higher then I've ever been. Do you have any suggestions? The side effects have been mild...If anyone has any suggestions it would be greatly appreciated...Help!!!

Jenny said...


Get over your fear of insulin. With numbers that high you are setting yourself up for ugly complications. Insulin is painless when injected properly and it works.

It is possible your beta cells aren't making insulin and if that's the case insulin is the only thing that will help.

Pam said...

Do you know anything about Victoza? My Dr. would like me to try it because I have kidney problems when I take metformin (500 mg 2x day). What kind of side affects are you aware of with Victoza? Does it do a good job controlling BS? I also take 10mg of glipizide XL 1x day. Thanks so much!

Jenny said...

Here's what I know about Victoza:

Victoza: A New Competitor for Byetta

Bascially, Byetta works better and has fewer dangerous side effects. That your doctor is pushing the new drug suggests he is overly influenced by drug sales reps and isn't very knowledgeable about diabetes treatments.

Pam said...

Thanks Jenny. Within 3-4 days on metformin and my kidneys are greatly affected and am going to the bathroom only 3 times a day. Metformin and glipizide do a great job of controlling my BS but the change in kidney function is scary. 6 months ago I stopped the metformin and only took the glipizide and my kidneys recovered but my BS started creeping up so I went back on the metformin a week ago and again am only going to the bathroom 3 time a day and have kidney pain. All my research shows most diabetes drugs are hard on the kidneys. My Dr. is trying to find a kidney friendly drug for me to control my BS.

Jenny said...


Insulin always works and won't harm your kidneys.

this study suggests strongly that glipizide is NOT healthy for anyone.

patipaw said...

Boy, great info, thanks!
Want to share that when I take a probiotic with my meds, the gastro intestinal fun is lessened greatly.

Also take the homeopathic remedy carbo veg. That helps immediately if things start to "rumble".

I'm confused. I was on Januvia and Metformin. I had to stop the Jan. because of insurance changes.

I got put on glipizide. Now, same time, I am recovering from a horrible chest cold, whatever, where I have been very ill for a month.

But, now, I can't go up a flight of stairs without running out of breath nd my chest pounding.

Just got a cardio ultrasound, no results yet. I'm told my chest is clear. But, most nights I can't lie down to sleep now. I feel panicky, can't breathe.

Scary to see that study on glipizide.

Now, last year, I got put on Actos. Long story, was traveling and didn't have time to research. Then the hotel had no wifi, so took it and had a horrible night.

I think I had congestive heart failure. I couldn't breathe, heart pounding. I'm alone with my sons, and just couldn't bring myself to dial 911. Prayer worked, or I doubt I'd be here.

Ever since then, never felt right.

Now this. Any thoughts appreciated.



patipaw said...

Oh, also, am retaining fluid like crazy and put on 20 plus pounds in just over a month. I'm not eating a lot, unless it's in my sleep. lol


Jenny said...


Glipizide's effect on the heart isn't instantaneous so it wouldn't be giving you heart symptoms shortly after you took it. It would take a few years to cause problems, if it did.

It is possible that because it causes your body to secrete insulin whether or not you have eaten carbohydrates, that it is giving you either a hypo or a false hypo (a false hypo is a normal blood sugar that is much lower than what you are used to which can cause a stress hormone release that feels like a panic attack.) Both will cause pounding pulse.

You should check your blood sugars when you get these kinds of attacks. If they are much lower than what you are used to, that could explain the pounding heart beat. If they are in the normal range you will get used to it in another week or two. If they are low--70s or worse, then you need to talk to the doctor about adjusting your dose.

That said, your doctor should also check out your heart to reassure you that you don't have an actual cardiac condition like heart failure (which isn't something that comes and goes. If you have it, you will always have it.)

patipaw said...

Thank you so much, Jenny.

That all helped tremendously.


CryingHeart said...


I am hoping you can help answer a question for me. My grandmother is 85 years old. She is a diabetic type 2, and not very good at eating properly. I sincerely doubt it will get any better at this point either. My grandmother was on glyberide 2x a day and on metformin changing from 2 to 3 back to 2 times a day. Her regular family doctor was treating her. Her blood sugar rarely went up, but a couple times a week it went below 80. I decided to set her up with a diabetes dr. The doctor took her off the metformin stating it was too dangerous for patients over 80 years to take it and then put her on Januvia and continued with the glyberide. My grandmother has been stating for months that she does not like her doctor or the medicine that she put her on but never gave me a reason why. I talked to her a couple days ago and she said she took herself off the januvia and doubled her glyberide (2 in am 2 in pm) and she is feeling alot better. When she was on the Januvia her sugar was often in the 200's even high when she woke up in the morning. Now she said her readings are lower. I am worried about her increasing her gyberide as to the potential dangers to overworking her pancreas. Can she go back on the Metformin? Is it really dangerous for her to take it at her age? She does have high blood pressure and atrial fibulation. She is on meds for her blood pressure, blood thinner, cheolesteral and diabetes. Any suggestions you can offer would be greatly appreciated.

Jenny said...


Glyburide doesn't overwork the pancreas. That is a theory that has not been supported by any long term study data.

Metformin is not supposed to be given to people with low kidney function or some liver issues. The family doctor would have the labs and ideally know what he was doing. But one can never tell.

At 85 years old, I'd say, let your grandmother take the drug that makes her feel the best, and lets her eat enough to keep up her strength.

Januvia can make people anorexic, which is the last thing a person that age needs, as they tend to waste away no matter how healthy. If it wasn't controlling her sugars, there is NO reason she should be taking it. Especially with the expense. Januvia is a highly inappropriate drug for an older person, and your grandmother's instincts sound right. Can she find a doctor who will listen to her?

david said...

I took Januvia for tw0 years in which my PSA rose from 4 to 12
I went through 2 prostate biopsies which were negative
after stopping to take Januvia the PSA went down within 8 month to nearly 8
I also had a cancerous tumor (SCC) in my neck which was removed last month by operation and I am going currently through a chemothrapy and radiation treatment
I neve suffered from any cancerous tumor in the past.
David Erel

Judy said...

I have been taking Actos since March of 2000. I retired in July 2011. My new insurance won't pay for Actos because of the negative reports that have come out on it (can cause bladder cancer, heart failure). My doctor put me on Januvia three days ago. I haven't experienced any side effects with it but was wondering if I should try Metformin. Tell me what you think.

Jenny said...


You can read detailed discussions of all the various drugs prescribed for diabetes that explain the plusses and minuses here:

Metformin is the drug that doctors are supposed to prescribe first according to the American Diabetes Association's standard practice recommendations and those of the Amercian Association of Clinical Endocrinologists, but many family doctors are swayed by drug salespeople's hype.

Have you asked your doctor why he isn't following the usual prescribing recommendations?

patipaw said...

Hi Judy,
I've been on Metformin for a couple of years now.

I take it with a probiotic. I had trouble with GI issues without that.

Also used the homeopathic remedy Carbo Veg. That really helped in the beginning.

But, am well adjusted now, thank goodness!


Ukkudthapa said...

Dear Jenny, Greetings. I have been taking metformin 1gm twice aday for the last 1-2 years, but my FBS was showing above 150. My endo added Diamicron MR (gliclazide 30mg)but still no improvement. I started taking Januvia 100 for the last one month and surprisingly my BS came within the range. I stopped Diamicron and more recently started taking metformin only once. My BS is still within the limits and I intend to stop metformin completely soon and go with only Januvia. I solicit your valuable comments in this regard.

Ukkudthapa, India

Jenny said...

My comments are these: Januvia works, but it does so in a way that can promote cancer. The evidence continues to accumulate.

Just this past week evidence was published that links Januvia to a six times higher risk of pancreatitis (a painful inflammationt that can destroy the pancreas) and a higher risk of pancreatic cancer, too.

Unknown said...

My husband developed Congestive Heart Failure. He was taken off Actos and Januvia. For the past 7 years his mental state has diminished to the point of dementia. After being hospitalized for CHF the doctor took him off Actos and Januvia because he was going Hypoglycemic, which was causing the dementia. His HgA1c was 6.0-6.3 Everyone is amazed at the change. His memory and involvement in life has changed tremendously.
Has anyone experienced the dementia?

Jenny said...


I hadn't heard reports of dementia associated with either of these drugs, but it is associated with hypos. Hypos are more likely in older people who have something wrong with their autonomic nervous system, which can be a result of long time exposure to high blood sugars. If your doctor thinks the problem was related to the drugs he (or you, if he won't do it) should report the drug-related side effect to the FDA's Medwatch database. That is currently the ONLY way that the FDA has of learning of the tragic and life-ruining side effects of these new drugs. Very few doctors report so it takes years for them to become evident.

Here's the link: Medwatch Reporting Serious Problems.

Chatters said...

Help. I am so worried about all this. I live in an area where there are no diabetic specialists, I go to a young GP. I am type 2 and was using metformin 500 4x daily for four years. Six weeks ago, out of the blue I became sick as all get out, vomiting an hurting and thirsty and within a few hours my glucose was 395, I took the pills but figured I was just puking up the meds cuz of the flu. Not so. I spent two days in ICU with lactic acidosis at 6.9! I lived the thru it but now we can't risk using any drug with metformin properties in it. It worked for me before, kept sic at 7 or below. Now I'm on 50 januvia and 15 acts and I am running way hi fasting AM. My next dr appt isn't until dec ...has anyone else in the universe been thru lactic acidosis? Help!

Jenny said...

I have not heard other reports of lactic acidosis with metformin, but my understanding is that if something else compromises kidney function (like x-ray dyes) it can occur.

Insulin would be the obvious drug to use, as it will work very well for most people when oral drugs don't. Family doctors often don't understand how to prescribe it, but you can read the book, Dr. Bernstein's Diabetes Solution and/or Using Insulin, and with the explanations in those books you can work with your doctor to find the dose that gives you good control.

You'll find a reassuring article about using Insulin here.

Chatters said...

Thank you Jenny, for your reply. I am so scared taking the januvia and the actos. It's been seven weeks and I don't feel in control. The only side effects have been mucus in my throat and a somewhat stuffy nose. But it could be allergies as I tend to get them this time of year. Also, my neck has been stiff and sore off and on, like I have slept on it wrong and have to move carefully or it hurts like electric shocks. This too could maybe not be related to my new drugs. I am terrified of taking this stuff and I completely understand I Need to be on something to control my glucose. I am ok during the day, staying in a a range of 70-160, but if I don't keep eating something every few hours it goes higher. Fastin am has been as hi as 236, in fact n my log tracking, am has only been lower than 140 17 days out of 45. If I eat something very sweet, like a square of brownie or a cup of ice cream at 11 pm it seems help. But I have to gag it down yuk! I am 58 hrs old female, 5'4" and weigh 145. Is insulin more expensive than januvia and actos?

Jenny said...


A person of your weight getting those kinds of numbers almost certainly has a problem producing insulin rather than being a classic type 2 with insulin resistance.

Insulin may be much less expensive than the oral drugs you are taking. Walmart sells R insulin (a fast acting version for meal time) for less than $30 per vial. The more recent versions were in the $60 a vial range last I checked. You may only need one vial a month, plus needles which aren't all that expensive.

The needles are painless nowadays (tell your doctor to prescribe the short thin ones since you aren't heavy. Many doctors give all patients the long needles needed for people who are obese.)

And do read the books I mentioned as you need to know more than anyone can tell you in a few messages.

Chatters said...

thank you again Jenny. I have made an appt with a diabetic nurse/ counsellor for tomorrow. I think I need some insulin to help me. I don't like how high my numbers are all the time. For what little carbs I consume I should be in the normal range at all times. I walk my yorkie every evening for half hour and I jog on a mini tramp for 20-30 min after that. I pretty much know what carbs work and what is bad. I lost about 20 lbs four years ago and have kept it off. Today AM was 117 and I was thrilled. I have to gag down a full carton of Greek yogurt (14gr protien) at 11 pm to make it be even that low. Otherwise I am 160 or even more. What insulin regime would you recommend?

Jenny said...


What insulin regimen would work depends on your individual circumstances and diagnoses. I'd suggest you read the book, Using Insulin, by John Walsh to get a general idea of how insulin is used or Dr. Bernstein's Diabetes Solution to learn how to use it with a low carb diet, however Bernstein is not familiar with how the newer insulins work (he admitted this in a teleconference). In my experience Novolog or Apidra work much faster than Humalog (or R) and are often a much better choice for controlling meals than what he suggests.

Chatters said...

I am mostly thinking I need something at night. If I don't have any carbs at all during the day I am fine. I will typically have two eggs with cheese or avocado at 7 am then snack all day on peanuts or almonds and an apple or small bunches of carrots and veggies. Dinnertime is a hunk of some sort of meat, my fave is fried chicken! Oops! Then yogurt before bed. Weekends I splurge a little but the numbers tell on me in a big hurry. So yes, I think I might need something fast acting so I could not be so strict with it. I could still lose a few more pounds altho I really do feel pretty good most of the time. Yeh. The invisible killer.

Empath K said...

I went to my doctor today, who, by th way, never listens to me, because my sugar has been well overr 200, sometimes over 300. I have serious gastro issues with metformin and my a1c is slowly creeping up from being 6 to now 6.8. TodayI tested while in her office and my sugar was 244. She took me off metformin and sent me home with samples of Januvia. After reading this, I am not taking it. I am tired, I dont feel well and I have put on 20 pounds since August. I am already a fat girl and cannot lose any weight no matter how hard I try. I am going to try the probiotic with metformin and see how that works. I made an appointment with a new doctor on Tuesday.

Jenny said...


I hope you can find a doctor who does listen.

Meanwhile, if you haven't already tried this strategy, please do. How to Lower Your Blood Sugar. It often causes dramatic improvements.

If it doesn't, when you see your next doctor first thing you should be talking with her about is using some insulin to bring those blood sugars down. When sugars are that high, they make us more insulin resistant than usual which makes for even higher sugars and a vicious cycle. Insulin can help a lot, and then when your sugars are better, you can try other techniques to improve them.

maxwell said...


Thankyou for your interesting article(s).

I have found that my biological age feels like it has been wound back by a decade to (60yrs) since I was properly diagnosed with diabeties type 2 and treated with diabex XR and Janumet. Your comments on the januvia are disturbing to say the least...

I realize that metabolic disorder and endocrinology and all metabolic functions are a riddle to compare with the fourth dimension in Einstein's world! I personally spent several years not understanding (but passing) those subjects at Uni in the early 1970's

Would you mind giving your qualifications?


Jenny said...

Maxwell, My "qualifications" for commenting on these issues are 13 years of reading diabetes research and studying metabolism, on top of a graduate degree in another field which taught me how to do journal research and years of experience as a software developer at IBM and elsewhere which taught me how to debug complex, poorly documented systems.

But if you read my writings here and on the main Blood Sugar 101 web page, you will see that I don't ask anyone to believe anything because I say so. I provide a wealth of cites to relevant research which you can read and evaluate on your own.

I never questioned that januvia works--it normalized my blood sugars, though it also, over time produced anorexia and troubling gastroenterological side effects. But as a melanoma survivor I found the information as to its impact on a cancer suppression gene troubling.

The history of many drugs for diabetes and other conditions is that acceptance testing does not uncover the other impacts of the drugs, many quite troubling. The drug companies' history of hiding disturbing test results and exerting goon-like pressure on doctors who attempt to reveal them makes me all the more inclined to err on the side of caution.

I blew the whistle on Avandia's connection with heart failure and macular edema more than a year before it hit the mainstream medical news. The studies were already published, they just had not received any press, possibly because the drug companies are such big advertisers for so many publications.

Bottom line: follow the cites, review the evidence and make your own decisions. All I am doing is giving people pointers to issues they need to be aware of.

dw49 said...

I was put on Januvia in October 2011. On 5 December I was admitted to the hospital with severe acute pancreatitis. For those that may not know about pancreatitis it's very serious and very painful. I'm still recovering and I'm still not close to my old self. BEWARE !!!


Chatters said...

My question is that I can watch my bs sail upward every evening while fasting and often my morning readings are too high. What is the best thing to do? Eat something? What should it be? Carb or protein or fat or all of the above? It's really hard for me to choke down food after 8 pm. Any suggestions? I refuse to take Lantus EVER again. What else could I try? I've never taken the humulin without food, that would be scary to me...I sure wish I had a doctor that knows what to do to help me with this!

Jenny said...


Levemir is another long acting insulin that doesn't last as long as Lantus and doesn't have some of its side effects. Have you tried that. In smaller doses it lasts 12 hours rather than the 22-3 Lantus lasts.

You're right that it's a bad idea to take Humulin without food.

Are you taking a maxed out dose of metformin? It can help with the fasting blood sugar too.

Chatters said...

Metformin caused me to have a severe case of lactic acidosis and I Was in ICU for 48 hrs last Sept. I am not taking any oral meds, only small amounts of humulin. My dr keeps trying to put me back on the metformin. Do you feel that it would cause the lactic acidosis again or was that just a rare fluke? I am very nervous about having another episode but the dr says if it happens again I'd be a guinea pig at the mayo clinic within a day and he highly doubts it would happen again. Sounds scary to me. Any thoughts?

Jenny said...


Your doctor knows your situation, so you have to ask him what the reasons are that he doesn't think the metformin was at fault. Lactic acidosis can be caused by kidney problems. But unless he can make a very good case, you're right to be wary.

Ask about levemir. A shot at might might be helpful and not cause hypos during the day.

Chatters said...

My kidneys were tested and they found nothing unusual and no problem. The ICU docs told me to never take metformin again. First thing my reg doc said was that I could continue using it. I nearly fell out of my chair! He put me on acts and januvia and I refuse to take it now cuz of side effect studies. I tried lantus and gained 12-15 lbs in less than a month and it did NOTHING to improve my morning numbers at all. So I stopped using it and tried the china study method...that was a disaster...I cannot have so many carbs whether from veggies or not! So now I am using over the counter humulin cuz the dr won't give me insulin script. I take 5 units only if I am going to have carbs and so far, this is really working.

Jenny said...


If the ER doc said never to take it, don't take it. If you're getting good control from 5 units of Humulin, you may not be insulin resistant. That's a pretty low dose closer to Type 1 than Type 2.

Levemir is supposed to not pack weight on people unlike Lantus. And if you are responding to very low doses, you wouldn't need a large dose, in which case it will only last 12 hours, so it might work for you. Worth a try if your insurance would cover it.

jermy said...

Hi I am 32 years 165 lb. 5.8in high, I was diagnosed with diabetes 30 months ago. For the first 20 months I controlled my BS by diet(40g of carbs). But after about 20 months it started to rise my fasting was about 180 so my dr. put me on Glimepiride 2mg a day after 4 weeks without any changes he increased to 4mg and then to 6mg after 2 months without any results my dr. told me since I have no family history, the meds are not responding, I am not over weight, (was never) young and the diet stopped working (I was very strict)so he came to conclusion that I have a lack or very little of insulin so he put on Lantus SoloStar 12 units at bed time and 500mg Metoformin hcl once a day and my fasting dropped to 115. But my wife wasn’t so happy with me being on insulin at this age so we decided to go for second opinion the second dr. said insulin is not for a type 2 (I am not so sure if I am a typical type 2 because my C-Peptide Serum was 1.3 ng/ml when my Glucose Serum was at the same time 140 mg/dl so why was the C-Peptide almost on the lower end when the Glucose wasn’t at the lower end. This test was done by the second dr.) so he put on 500mg Metoformin hcl 2x day after 2 months he increased to 3x day but didn’t work (my fasting was 160) so he put on Janumet 50mg/1000mg.I had for the first 3weeks gas and diehria and stomach cramps but it did subside after 3 weeks and now it happens from time to time. But my numbers are about 150 fasting (when I called him after 4 weeks he said let’s wait another 3 months) and I am still on the strict diet (40g of carbs). So my question is wouldn’t it be better to go back to my first dr. with the Lantus SoloStar and metoformin 500mg 1x day after seeing all those info about Janumet ? Is there any problem by being on insulin? The second dr. said insulin should be the last thing after trying all the meds is this true in my case, if the first dr. was right that I have a lack of insulin? The second dr. said if he was to put me on insulin it would be fast acting 4x a day and not what I was before is there anything wrong with being on long acting rather than fast acting? Please help me decide what path to go? Thanks a Million

Jenny said...

Jermy, If you are young and not making insulin, insulin is the most appropriate prescription for you. Insulin is far more effective and safer than Janumet. But you need to read up about insulin and not rely on doctors who don't sound like they understand much about the kinds of diabetes that affect young, normal weight people. It is very possible that you have a form of slow-onset Type 1. Avoiding insulin could end up landing you in the hospital.

If possible, see an endocrinologist. You should have tests to see if you are making insulin and if you have Type 1 antibodies. This isn't a matter of guessing, it can be determined by tests.

Don't panic. Type 1 can be managed very well nowadays and insulin is safe and effective.

I'd suggest reading Dr. Bernstein's book, Dr. Bernstein's Diabetes Solution, to get a rough idea of what is involved. However, many people can handle more carbs than he describes, especially with novolog and apidra insulins.

MARGGGY said...

Hi Jenny, I came across your blog quite by accident. Trying to figure out how I can get rid of some of my weight. I think what your doing is AWESOME. You are so knowledgeable, and really give people fabulous guidance. I too am a Janumet user, but after being informed of the cancer risks I am stopping it. My diabetes is from the old weight gain, after a car accident the weight just piled on, and now I am a whopping 290 LBS. I'm curious on your thoughts. I take lantus 20 units in the pm. Janumet twice a day. I don't eat a lot, and try to eat healthy, with the odd sweet 2x a week. I'm not as active as I'd like to be (I suffer from many health problems from accident chronuc pain, fibromyalgia, chronic muscle spasm. I get out for a 15 min walk maybe 3x a week) I take Humalog 6 units maybe once a day. My AIC dropped from 11 to 8.1 at my last test (happy about that). My sugars are fairly stable I never see them go over 10. Any ideas as to what diabetes meds or insulin I could change to to help lose anything? At this point an pound loss is beneficial to me. Before my accident I was 170 LBS so I've gained 110LBS in the last 6 years. I didn't realize lantus caused weight gain. Keep up the awesome work!! Drug companies love to hide information from the public eye, only to find out in later years that people were indeed lab rats. Thank You so so much. Regards, Margggy

Jenny said...


I've just written a book about dieting, Diet 101: The Truth About Low Carb Diets. Pretty much what it explains is that if you can flatten your blood sugars, that will eliminate the hunger that makes it so tough to lose weight. To do that you usually have to cut back on carbs, though how much varies from person to person.

After you flatten your blood sugars, you still have to cut back on calories to lose weight, but it's easier if you aren't always ravenous, as people are when blood sugars are going up and down all day.

Since you have a prescription for insulin, you can learn how to match your insulin very closely to carbs (Dr. Bernstein's book, Dr. Bernstein's Diabetes Solution, explains that well though many people find they can eat more carb than he suggests and meet reasonable blood sugar targets, which I believe are under 140 mg/dl after meals, which isn't as stringent as what he insists on.

Figure out how to match insulin to carbs, get a food scale and be certain your portions contain the amount of carb you think they do. Then you can eat only the number of grams of carbs that you can match to your insulin without risking hypos. That should keep your blood sugar from going up and down steeply enough to make you hungry.

Insulin makes many people gain weight because it isn't dosed to match carb intake, and that causes "rollercoaster blood sugars".

I have a nutritional calculator that you can use to figure out what nutrient mix would work for you as far as producing weight loss which you can find HERE.

Unknown said...

I was on Metformin 250 2 times a day and 2 gylbride 2 times a day since Oct. A1C went for 7 to 9 and i was just out on Jannuvia and the metformin still but i didn't see any change in my bs it seems ed higher so i tried 1 of the gylbride at night before bed and so far my bs has been great it was a little low the first day was 77 but in the after noon and at night it has been great. This morning it was 112 which is the best it's been in several months. Now i found your site and I'm afraid to take the Januvia. what else can I ask my Dr. about?

Jenny said...


A safer drug for someone in your situation might be insulin. A new study presented at the ADA Scientific Sessions convention verified that insulin is safe and that contrary to some doctors' fears it did not worsen heart disease. Byetta would also be worth a try as it works on the same hormone as Januvia does but in another manner.

Unknown said...

I have had to get off of Januvia due to skin rash and lesion issues. Dr. told me I came very close to getting Steven-Johnson syndrome from the Januvia. What I saw on-line about Steven Johnson is scary. I have been off of it for six days now and am having withdrawal side effects (I was only on medication for 2 months). Joint pain, nausea and fatigue are the symptoms I am experiencing. Hope it goes away in a few more days.

Jenny said...


So sorry to hear you had to experience such a disturbing side effect from this dangerous drug. I hope your doctor reported your experience to the FDA. Many don't, and when they don't no one learns just how dangerous Januvia and related drugs like Onglyza are.

Technically you aren't experiencing withdrawal, just more of the disruption caused to your immune system by the way Januvia alters immune function. It takes a while for the drug to wash out, and it takes longer for your immune system to calm down, but eventually it will.

Bigga Christian said...

Thank you for your blog. I've run out of januvia as I was prescribed 100 mg daily and 500 mg metformin 2x daily. I've changed jobs and I will have no insurance until November. I can't afford cobra insurance. I'm nervous but anxious to see how this will affect me. Thank you.

Jenny said...


If the metformin alone isn't enough to lower your blood sugar, ask your doctor to raise your metformin dose as what you are on is lower than many people need to take for it to be effective. 1500 to 2500 for the regular and 1500 to 2250 are the effecitve ranges for the regular and ER versions of Metformin.

Cut back on your starches and sugars, too, using the strategy you'll find HERE.

Laura E. said...

I just started taking Januvia today. I hope the things I've read from others don't happen to me. I'm also on Metformin 850mg twice a day. Sometimes I think my dr is nothing more than a drug pusher since he's been after me to get on Januvia for the last three visits. Finally today I agreed. Hopefully it does what it's supposed to do.

darling said...

Hi Jenny, just want to say thankyou for the great Blog, I have learned so much in reading it! Such a great site for us that suffer with diabetes. I have been a type 2 diabetic for 10 years now and am currently on metformin and (about 1 year ago replaced the Actos) with januvia and just started on humilin (needle). in the last year my quailty of life has been on the decline. I have been diagnosed with IBS, I am pretty consistently in pain with a naging pain in my upper right side which goes around to the back, am not really sleeping well as I am having to get up 6 to 7 times a night to go pee, my joints are always sore, get sinus headaches almost everyday, kidney infections, bladder infections and my latest problem has been pink eye... I am so frustrated with my health as I feel so crappy ALL the time. PLEASE if you could offer any input or any advice I would be soo appreciative.

Jenny said...


Januvia and Trajenta work in a similar fashion, but they are not the same drug. There are chemical differences between them. Report your side effect to your doctor and have a chat with the pharmacist who gave you the drug, too. Sometimes pharmacists are more aware of problems with drugs than doctors.

Anonymous said...

so is Trajenta a safer drug than Januvia??thank you.

Jenny said...

You can read about the problems with Trajenta and ALL the drugs that work in a similar manner HERE. There is a significant chance that over long periods of time they cause the growth of highly abnormal cells in the pancreas and of precancerous tumors.

The drug companies are trying to brush off the research that discovered this, but their "proofs" rely on very brief studies. You can "prove" that cigarettes don't cause cancer if you only run studies that last only 5 years.