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-   -   Why don't docs prescribe lantus instead of januvia etc.? (https://www.diabetesforum.com/diabetes-treatment/77074-why-dont-docs-prescribe-lantus-instead-januvia-etc.html)

batman 01-24-2016 15:29

Why don't docs prescribe lantus instead of januvia etc.?
 
I've been on Metformin ER 1000x2 for the last 7 years with A1C between 6.1 and 6.9, with moderately healthy diet and exercise (no carb counting etc.). Last year my A1C shot up to 8 so I got serious and this led me to BloodSugar101 and this forum.

So far the consistent message I here on this forum is that one should drive carb consumption down to as low as necessary as a first line of diabetes management. Now that I'm counting carbs, I find I can maintain a 100g per day diet or maybe 75g , but 50g or 25g seems extremely difficult.

Seems to me that all medications have side effects - EXCEPT insulin. I know that insulin improperly dosed can cause hypo, but for a T2, a basal insulin like lantus should be the safest option of all.. When I tried to ask my doc about it, all she would say is we only try lantus after exhausting all other oral medications.

She put me on 100mg Jauvia - It doesn't seem to do anything to me - no side effects, no good effects either - no change in FBG (130-150).

I find that I have a morning spike in BS for no reason at all... rising 20-30 points from 4:30 AM to 6:00AM and back down by 8:00AM

The rest of the day, 2 hr pp is between 145-160 and pre-meal between 100-115.

Seems to me if I could just take a lantus shot first thing in the morning, it should get my A1c down by a fair bit. My question is why is this not the first option after Metformin, and why is it not preferable to driving carb consumption down to levels low enough to be very difficult to maintain? What am I missing?

David Burke 01-24-2016 15:33

Money and politics.

Most docs are horribly undereducated on how to properly manage diabetes. They rely on the latest meds and actually do very little research on safer and healthier techniques.

John.in.France 01-24-2016 15:43

This is entirely a personal view, based solely on the fact that historically, insulin for a type 2 was considered a last resort treatment. Needle phobia still rules to a great extent. BloodSugar101 discusses this Insulin for Type 2 Diabetes

Before the advent of meters, control using insulin was pretty hit and miss and "a pill" much easier to swallow and just as sloppy.

Now with big Pharma in charge, they make a lot more money selling their expensive pills that keep the patient on the roller coaster to complications than they would offering insulin dosed using the guidance of someone trained to follow the protocols of someone like Dr. Richard Bernstein (see Diabetes Solution) that might actually arrest the progress.

Again, an entirely personal view - if, and I do say if, I ever have to use more than my Way of Eating to manage my blood sugar, I'll be at the head of the insulin queue - nothing else.

batman 01-24-2016 15:45

Thanks David... so would it be correct to state that a basal insulin like Lantus should always be a better choice compared to Januvia and all the other new medications being developed?

John.in.France 01-24-2016 15:54

The two drugs are targeted at different things. Lantus is a basal insulin, aimed at long term levels. Januvia is an insulin stimulating medication that helps to manage meal time spikes.

So the comparison should be with a fast acting insulin like Humalog and there I would agree with you 100%

div2live 01-24-2016 15:59

Welcome batman....

I have been diagnosed as a Type 2 for over 9 years. I initially was put on metformin and then after a couple of years my doctor put me on Januvia. I too initially had no effects, either bad or good! Then after a few months on it I started getting upper chest infections. At first I did not connect the dots, as these things would start out as a bit of congestion, but then within 24 hours they would turn into a full fledged upper respiratory infection that would only respond to heavy antibiotics. During the first two year of taking Januvia I had 4-5 of these episodes and prior to Januvia it was unusual for me to be sick like this. I did more research on side effects of Januvia, and then for the first time I found out that it was known to cause upper respiratory problems among many other problems....I stopped taking it that day, and never went back. I have not had any respiratory infections since that day! Problem solved....

The problem with all new drugs is that they have not been in use for years with proven track records amongst the general population. Many of the problems and side effects will not show up right away. Some side effects can become permanent problems....so when you find out about them it is to late!

Therefore I take my metformin and Lantus injections and will not take anything else period! Since I started following Low Carb High Fat I have been able to reduce my Lantus from 126u daily to 25u! My A1c is now at 5.8% LCHF has solved my medication problems.....I hope to be completely off of Lantus by the end of this year....

By the way you mention dropping your carb intake, but if you do, you must increase your fat intake or the LCHF model will not work and actually could be dangerous....hope you read Blood Sugar 101 website....knowledge is the key here!

Good Luck

batman 01-24-2016 17:49

Quote:

Originally Posted by John.in.France (Post 1064770)
The two drugs are targeted at different things. Lantus is a basal insulin, aimed at long term levels. Januvia is an insulin stimulating medication that helps to manage meal time spikes.

So the comparison should be with a fast acting insulin like Humalog and there I would agree with you 100%

Hi John.. perhaps I should rephrase my question. If there are no permanent side effects to using a basal insulin like Lantus, why should I even try the fancy stuff like Januvia and others, given that they have possibly dangerous side effects? What is the benefit of trying the other drugs over basal insulins like Lantus and Levemir? The pens are pretty painless.

batman 01-24-2016 17:55

Quote:

Originally Posted by div2live (Post 1064778)
Welcome batman....

I have been diagnosed as a Type 2 for over 9 years. I initially was put on metformin and then after a couple of years my doctor put me on Januvia. I too initially had no effects, either bad or good! Then after a few months on it I started getting upper chest infections. At first I did not connect the dots, as these things would start out as a bit of congestion, but then within 24 hours they would turn into a full fledged upper respiratory infection that would only respond to heavy antibiotics. During the first two year of taking Januvia I had 4-5 of these episodes and prior to Januvia it was unusual for me to be sick like this. I did more research on side effects of Januvia, and then for the first time I found out that it was known to cause upper respiratory problems among many other problems....I stopped taking it that day, and never went back. I have not had any respiratory infections since that day! Problem solved....

The problem with all new drugs is that they have not been in use for years with proven track records amongst the general population. Many of the problems and side effects will not show up right away. Some side effects can become permanent problems....so when you find out about them it is to late!

Therefore I take my metformin and Lantus injections and will not take anything else period! Since I started following Low Carb High Fat I have been able to reduce my Lantus from 126u daily to 25u! My A1c is now at 5.8% LCHF has solved my medication problems.....I hope to be completely off of Lantus by the end of this year....

By the way you mention dropping your carb intake, but if you do, you must increase your fat intake or the LCHF model will not work and actually could be dangerous....hope you read Blood Sugar 101 website....knowledge is the key here!

Good Luck

Thanks!.. I read Blood Sugar 101 (bought the kindle version). Which is why I'm not happy that my Doc is insisting on Januvia. She mentioned something else as a next step if Januvia doesn't work... so I'm thinking I don't want to take anything other than Metformin, Low Carb, exercise and basal insulin if necessary.

I'm trying to look at it scientifically...
Option 1... go real low on carbs and get my numbers down.
Option 2... keep carbs reasonable.. say around 100g per day and use Lantus/Levemir.

In the end, it seems to be a tradeoff between using a pen and quality of life... or is there some downside to basal insulin which makes it preferable to go extreme low carb as a first option?

John.in.France 01-24-2016 18:22

First off, I'm not persuaded that a carb content in the 50 gram range destroys the quality of life :)

However, more important is that high insulin doses bring their own issues.

If nothing else, it's almost impossible to match the big dose to the big surge in blood sugar that a higher carb meal delivers. So you go high, then you go low (or the other way up). Have a look at The Laws of Small Numbers - Diabetes Solution - Dr. Bernstein's Diabetes Solution. A Complete Guide to Achieving Normal Blood Sugars. Official Web Site , an extract from Dr Richard Bernstein's book where he discusses his "Law of Small Numbers".

skb 01-24-2016 21:50

Quote:

Originally Posted by batman (Post 1064834)
I'm trying to look at it scientifically...
Option 1... go real low on carbs and get my numbers down.
Option 2... keep carbs reasonable.. say around 100g per day and use Lantus/Levemir.

Scientifically, there is no option 2. If you go deeper in your research into glycolysis you will come across AGEs (Advanced Glycation Endproducts). That should convince anyone on the benefits of low carbing, which 100gm/day isn't. Option 1 is natural, it's better for all round health, it's my only option.


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