"Diabetes Update: Actoplus Met, Metformin, Januvia..." Topic

Just a quick update, in case any of my fellow diabetics might find this useful.

When I was first diagnosed with diabetes (type 2), I was put on Actoplus Met – which is a combination of Actose and Metformin. I had a rough first two days (the pill induces nausea for some first-timers), then had no further nausea/digestive trouble and my blood sugar levels came down.

In fact, I started to go slightly hypoglycemic, so I went on a reduced dosage.

However, I ran into another side effect: rapid weight gain. I put on about 30 pounds! The reduced dosage didn't make much difference.

Since my blood sugar levels were so good, my doctor agreed to let me go on just Metformin for a while (no Actose). The good news is that I started losing weight again. The bad news is that my blood sugars crept up.

So I switched to a new drug: Janumet, which is Januvia plus Metformin. Unfortunately, this didn't work for me – I came down with digestive upset and nausea, aggravated allergies, and general "yucky" feeling. At first, I thought I just had the flu…

(The odd thing is that digestive upset is usually linked to Metformin – but I've been tolerating Metformin for months, why react to it when taking it with Januvia???)

It felt great to get off Janumet.

Now I'm trying Januvia (without Metformin). No unpleasant side effects, too early to tell how the blood sugars will go…

Forgot to mention: My doctor said there's talk of taking Actose off the market, which is why I haven't gone back on it.

Oh, and Januvia = sitagliptin

Bill – just a side note. I found and I've seen it reported that weight gain is common with Actos. Also, if you ever experience joint pain, chest pain, or shooting pain in your extremeties, it can be caused by a reaction to being on Metformin (I had a heart procedure done unnecessarily because the Metformin caused a reaction similar to heart trouble).

Best of luck with all you are taking and trying to find a combination of meds that takes care of the blood sugar and makes you feel good. It is quite a trick.

All the best,

Erik

Bill – Actos is in the same family as "Avandia" which is linked to heart attacks or heart trouble. I was just taken off the Actos on Wednesday because of that finding.

Erik

Strange I am back on Actos again and am losing weight again. Lost 25 to 30 pounds when I was on it last year. I had the digestive problems with Glipizide which has some really side effects long term. There is a new injection for type 2 that is supposed to help with weight too. Can't remember what the name of the drug, but is but is very expensive.

Straight metformin seems to work well with me. Good control and no apparent side effects. A bit over the wieght the clinic would like (98kg @ 1.82m) so I'm trying to cut down on the calories to get me under 92kg.

Interesting to hear how others are treated.

x42

Bill: I was on Actos last year….it was awful. I gained weight, had awful paranoia, had digestive issues every day (…yes, polite way to say….diarrhea…). I am now on Avandia and all has settled down and am losing weight slowly. I am also on Metformin and Glyburide (I had a heart attack and quintuple by-pass in 2004)

Weight gain with Actos? never thought about that. It made me retain water around my heart so they cut me back from 40 to 20mg when I collapsed in the yard cutting grass.

Now I am own Byeta (lizard spit ) and have been losing weight since I was put on it 2 1/2 months ago. I do not like shots and this is twice a day. I was hesitant but the team doctor who specializes in diabetics for several football college programs came by the office and talked me into it.

Asked the Doctor about Januvia but she said that that was only supposed to maintain a weight level.

I left off the Actos one month when funds were tight.

(I had good numbers and didn't show any huge,life-
threatening difference with just the Metformin and
Glyburide.)

An ALC of 6 works just as well as 5.7 if it saves me $80 USD
plus a ton of fluid.

Ironically,I quit having allergies,gastric trouble,etc.
after I was diagnosed with diabetes.

The myalgia left when I cut back on statins.

I still outweigh our stacks of unpainted miniatures so
I might ask about the lizard spit.

I'm a firm believer in working with one's doctor to tweak
drug choice,dosage and schedules until the best treatment
is found.

Good luck!!!

P.S. Diet green tea (especially by Arizona) has been a
Godsend.

It really seems to help my overall health plus it tastes
great on a hot day.

I take a varying level of Metformin and 4 mg of Avandia every day. The Metformin varies depending on if I have anything with corn-syrup in it.

No side effects of any kind. They may have happened when I was in the hospital, but I have little memory of the hospital stay (thank God.)

DM

Hi Guys,

The reason that you may have gotten nausea from the comination of Januvia and Metformin isn't too hard to fathom, Bill. First of all, as you note Metformin frequently causes nausea and/or diarrhea at first, which often but not always resolves with time (days to weeks). Januvia works by inhibiting the metabolism of Amylin, a hormone co-secreted by the pancreas along with insulin (actually, it's packaged in the same granules of the islet cells, even). Amylin functions chiefly to delay the emptying of the stommache. So the increase in amylin levels caused by the drug delays gastric emptying, which may make you feel more full or even cause nausea. It helps blood sugar because the rise in blood sugar after eating (postprandial glucose to us) is blunted. Januvia is useful, but not likley to work well by itself, as average improvement in A1C is pretty modest, only about .5 percantage points.

In the right patient, I rather like the Byetta that Rudy is taking. It's expensive, and a shot that has to be taken twice a day. AS Rudy alludes, it is synthetic Gila Monster Amylin. As Gila Monsters only eat twice a YEAR, they need *really slow* gasttric emptying, and thus the duration of action is many hours for it (as opposed to minutes for Human Amylin). Main side effect is nausea. In motivated, overweight patients, weight loss of 20 lbs or so occurs in about 30-40%, and THAT plus the delayed rise in blood sugar can work wonders for Type II diabetes.

Metformin is usually weight neutral, as is Januvia. Almost all other diabetes medications tend to cause weight gain, uinfortunately. Both Actos and Avandia are well known to cause fluid retention, and thus are relatively strongly contraindicated in Heart failure.

At the same time, the recent meta-analysis of Avandia is hardly conclusive regarding the heart attack and stroke risk issue (not an actual study, but a complex statistical analysis of data combined form multiple inherrently dis-similar trials, and thus inherently subject to all kinds of errors and assumptions). The authors were extremely heavy handed and inflammatory with regard to their conclusions, far more so than the actual evidence warranted. Indeed, there is contradictory evidence from direct trials with regard to Avandia (no increased risk) and Actos (decreased risk). This is not new for this team, who did the awful Calcium Channel blocker retropective study about 10 years ago and also issued repetitive iflammatory condemnations of the use of these drugs for treatment of hypertension, again due to increased heart attack risk, that were in no way justified by there study, which had very obvious issues with a likely selection bias (ie, the patient's docs had likley actually prescribed the drugs for known or suspected heart disease!) Proper prospective studies done to follow up on this indeed showed not only NO increased risk but actually better reductions of heart disease compared with some other classes of BP meds.

I personally think that using either drug (Actos/Metformin) as first choice therapy is probably seldom appropriate, if only beacuse of their great cost (about six dollars a pill, compared with as little as 20 cents for Metformin.) Of course, proper diet, excercise, and especially weight loss (for Type II, of course) is still the MOST effective and cheapest treatment out there. Quatamcat, you had it right – an individualized approach, working with your doctor, is the best way to go!

Good luck to all of you struggling with this challenging disease!

Peter Anderson, MD

Gonsalvo,

My doctor said just what you did about the dubious studies.

The maligned drugs were thoroughly vetted years ago and had
excellent reports.

(I remember the scuttlebut at Emory and Anaheim when the
cardiologists were first singing the praises of these then
new proposed diabetic treatments.)

I'd be careful of anything but avoid getting too alarmed
if the qualms seem unwarranted.

But,I'm prejudiced.

They withdrew Baycol-the only cholesterol treatment that
never offered to eat up my cartilage or make me feel as if
I'd been pummeled with a baseball bat.

Oh,and it helped my lipids,too.

"Of course, proper diet, excercise, and especially weight loss (for Type II, of course) is still the MOST effective and cheapest treatment out there."

Indeed. I gained 100 pounds while on actos with a little help from terrible eating habits-but then what caused my eating habits to change so drastically???Actos maybe. I
never want that crap in my body again.

Well I developed nine awful symptoms not to mention severe sleep apnea. I took myself off actos. My doctor didnt like it but I did it anyway. Yes you can disagree with your doctor. I was right, too. I've lost 30 some pounds, all my symptoms have gone away without taking any diabetes medicine. I also bought a bipap and the sleep apnea is in its place too.

I have a long way to go still but its been a good start. Read everything you can and do the basic stuff, the bottom line is weight control, its even more important than exercise no matter what they say. I havent been able to stick to an exercise program and I've still lost 30 pounds. That said I am trying to stick to a program as it will speed up your program and really kick the big D's @$$!
You do need to do some exercise but you dont need 1 1/2 hours of vigorous exercise everyday like the government morons tell you.

BTW word of advice, dont buy food substitutes on a diet. Find good healthy things you can tolerate and have the real big mac or whatever else one or twice a week not the low carb french fries or ostrich burger, it'll only disgust you worse, bringing your diet closer to ending before its time.

They have me on Metformin/1000 mg's 2x per day,as well as 1 mg of Glimepiride once a day and inject 16 units of Lantus before bedtime. Doc says I'm managing it reasonably well.

Type 2 runs in my family,and next week I turn 45,and am diagnosed as morbidly obese. I decided a month ago that I dont want to develop any symptoms,so I took the bull by the horns and am practicing good dietary habits- I dont consider it as a diet,but rather a lifestyle change. I have lost 40 lbs so far,and am slowly adding exercise to the regimen. I cannot belive how much better I feel. There is nothing hard and fast to what I am doing,except that I eat 3 modest meals a day,no white flour and definately no "High Fructose Corn Syrup",while increasing my uptake of raw veggies,and some fruits when I want something on the sweet side.

Forgot to mention: They tried me on glipizide as an additional medicine. It worked at bringing my blood sugar down, but the level would sometimes bottom out – down into the 70s, even down to 50 once in the middle of the night. (But then you just swallow some hard candy, and you're back up again…)

They took me off glipizide after 6 months. Funny thing is, I'd been complaining to the doctor about feeling generally unwell, lack of energy… never associated it with the glipizide, but I felt immediately better after stopping taking it.