tell me about Januvia

November 14, 2022 4:20 PM

After a lengthy battle with my insurance company in which they kicked back two prescriptions my doctor prescribed me they have finally agreed to fill a prescription of Januvia. Has anyone out there taken it? What should I expect?

I've been on Metformin since I was 16 for PCOS that presents with insulin resistance. It sucks. My system never adjusted to the GI side effects that Metformin is known for. I'm officially considered Metformin Intolerant now. I'm also now officially diabetic (just about, A1C of 6.7) so Metformin did fuck-all for me for 21 years except make me run for the bathroom.

My endocrinologist tried to prescribe me Jardiance, insurance kicked it back asking for a pre-auth. I think she's going to go to bat for me with the pre-auth process even though she typically doesn't do pre-auths. After that, she tried to prescribe me Farxiga, which again got kicked back. Today they called me to say that my insurance company said they would cover a medication called Januvia.

I've been on Metformin for a long time, as you can see, and I don't know much about other types of medications for Type 2 diabetes. I've been reading about Januvia this evening (it looks like the only major side effects are a stuffy/runny nose, which I'll happily take over my GI misery), but I thought I would query the hive mind to see if there's anyone out there who takes or has taken Januvia and what your experience was like with it, specifically in terms of:

1) Controlling A1C
2) Weight loss
3) Appetite
4) Side effects

I know Januvia is often prescribed WITH Metformin from my Dr Google research, but I will only be taking it by itself because my body literally cannot handle Metformin.

I eat a mostly pescaterian diet and try to avoid starchy carbs. I don't excersize as much as I should but I'm meeting with a personal trainer tomorrow as working with trainers in the past have helped me with weight loss and keeping me accountable, especially during the winter when getting outside for a walk or job will be miserable.

I'm mostly just excited to not be taking the bloody Metformin anymore.

A secondary question I have is whether I should start taking probiotics after stopping the Metformin as I'm pretty sure my gut bacteria is fucked beyond belief after 21 years of GI misery. If I should, does anyone have any recommendations?

posted by nayantara to Health & Fitness (5 answers total)

Best answer: (this is not medical advice). Sitagliptin (Januvia) is a DPP-4 inhibitor, which means it works differently than the Jardiance or Farxiga. It's a slightly older medication although not as old as metformin. Generally well tolerated and reasonably effective, less expensive than either of the others. We used to use it a lot before the SGLT-2 inhibitors and GLP-1 agonists came along. It lacks the side benefits of those medications on heart and kidney disease, although if you don't have complications of diabetes like protein in the urine it's probably not a big deal. It's weight neutral--typically doesn't cause weight gain or loss. Won't cause nausea. It is often prescribed with metformin because each of those medications usually cause a drop of about 1% in hemoglobin A1c, which means that many people need more than one medication. If you were well controlled on just metformin, you will probably also be OK on sitagliptin alone unless your eating patterns change a lot now that you're less nauseated.

If the sitagliptin doesn't work out for you for whatever reason (like a stuffy nose) or it looks like you're starting to develop some of the complications that the other medications treat effectively, your insurance company would probably accept that as a reason to switch to the other medications.
posted by The Elusive Architeuthis at 4:48 PM on November 14, 2022

I take Janumet, which is s 50 mg Januvia and 500 mg Metformin. I've been on it for 11 years, since about 10 weeks after I was diagnosed with a 15.8 A1C. (Yes, 15.8. 8 weeks of Lantus + Metformin brought it to 7.8, and then it was just two Janumet per day plus another 50 mg Metformin without any insulin).

Outside of my body's reaction to Metformin, in general, Januvia hasn't caused any side effects. My A1C has stayed around 6.3 for over a decade. I didn't lose any weight, but I wasn't hoping to. (I'd lost 20 pounds in a month prior to diagnosis; in the next two months I went back to my normal weight.) It hasn't had an impact on my appetite at all.

I've got no complaints about it. YMMV.
posted by The Wrong Kind of Cheese at 5:02 PM on November 14, 2022

I would avoid it after reading through this page on Blood Sugar 101, which links to studies supporting its analysis. I trust that site and author a lot—her book was life-changing for me after my diagnosis. Ignore the terrible site design. The content is great. Here’s a page with an overview of different diabetes meds.

As a general principle, I would personally try to avoid treating type 2 diabetes (a disease stemming from insulin resistance) by just raising the amount of insulin circulating in the body, which is what this drug does. Treating the root cause (the insulin resistance) makes way more sense. Metformin is the best drug for this, as it actually helps reduce insulin resistance and your liver dumping glucose, so it’s too bad you haven’t had luck with it (I’m assuming you already tried the extended release stuff that is gentler on your GI tract).

Intermittent fasting, exercise (especially strength training) and low-carb diets are other good ways to treat it that get at the root cause.

Given the potential long-term side effects of something you would be putting in your body daily, plus the issue that you would be lowering glucose by brute forcing more insulin in your body and not treating the actual insulin resistance, I would be really wary of this drug.
posted by music for skeletons at 6:34 AM on November 15, 2022

Response by poster: Switching to Metformin ER alas did not do anything to dissipate the bad GI side effects. My endocrinologist has basically said that I am in the very very small minority of her patients that she considers Metformin-intolerant. (I'm apparently only the third patient she has that falls into this category and she felt bad I hadn't spoken up about my misery years ago.)
posted by nayantara at 4:37 PM on November 15, 2022

Look, just to be clear, I’m not anti-medicine as a blanket attitude (not is the author I linked, but her website as I mentioned has some presentation issues) and I see a LOT of naturalistic fallacy, anti-medicine stuff floating around in diabetes circles that alarms me too. I would just advise reading through the page and looking at the cited papers before starting a drug you’ll be on the rest of your life. Or think about revisiting the decision to take it in a year.

My physician told me I didn’t need to measure my blood sugars at all because “you’re well controlled” —well, yeah, and I’d like to keep it that way. So I don’t think most doctors are necessarily infallible when it comes to diabetes care—the attitude I’ve encountered so far is generally “stop eating too much candy, do whatever you want lifestyle-wise and when your A1c gets too high we’ll prescribe you medicine, when that stops working we’ll prescribe you insulin.”
posted by music for skeletons at 7:40 AM on November 16, 2022