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Janumet (sitagliptin, metformin) is a an orally administered Type II diabetes treatment. It is typically prescribed when a single medication is not effectively managing blood glucose.

The medication takes a dual approach in that it contains two medications:

• Sitagliptin, a phosphate salt, decreases gastrointestinal hormones secreted in response to food. This allows the pancreas to produce more of the hormone insulin and less of the competing hormone glucagon. Since insulin is the hormone responsible for limiting blood glucose, sitagliptin helps lower blood glucose levels and improves control of those levels.
• Metformin is one of the most widely prescribed Type II diabetes medications, especially for those who are overweight. Metformin slows down glucose production by the liver and also increases insulin sensitivity, meaning not only is there less glucose in the blood as a result but also the body responds more effectively to what insulin is produced.

In other words, the combination of sitagliptin and metformin in Janumet allows the pancreas to produce more insulin, increases the effectiveness of insulin, and slows glucose production by the liver---all in one simple tablet.

Other advantages of Janumet include:

• Does not cause weight gain---in fact many patients on metformin lose weight.
• Has a very low tendency to cause overly low blood glucose compared to most diabetic medications.
• Orally administered---no needles or injections to deal with.
• Convenient once-a-day administration.
• Tablets are easily portable and discreet.
• Can be used in conjunction with insulin and many other medications if needed.

As with any Type II diabetes medication, results are best with a healthy diet and exercise program. Over time, with regular exercise and dietary changes, many patients are able to wean off of medications entirely.

Treatment Overview

Janumet should be taken with a meal, typically once per day, and ideally at the same time each day to keep medication levels consistent in the body. Tablets should be swallowed whole and not split, crushed, dissolved, or otherwise damaged.

The majority of patients find 50 to 100 mg sitagliptin and 1000 mg metformin to be sufficient. Effects should be monitored for several days to several weeks, after which time dosage adjustments can be made if necessary.

Treatment may continue for as long as needed, often spanning years. If lifestyle changes are being made and/or other anti-diabetic treatments being taken, it is likely that at some point during long-term treatment one or more of the medications will require dosage adjustments, best done with the advice of a doctor.

Patients are also strongly advised to have kidney function tested prior to starting treatment and at regular intervals for the duration of treatment. Kidneys are already at risk from diabetes itself and may be further damaged by cleansing the body of medication residues. Untreated kidney damage can lead to costly, painful, and potentially fatal complications, and symptoms are rarely noticeable by patients until damage is already severe. Regular doctor visits may be an unwanted hassle and expense, but many unfortunate individuals on dialysis or waiting for for a donor kidney can attest that the benefits far outweigh the drawbacks.

Precautions & Side Effects

Because Janumet is removed from the body by the kidneys it should not be taken by those with poor kidney function. As it is processed by the liver it should not be taken by those experiencing liver impairment.

Consumption of alcohol, particularly to excess, while taking Janumet is not recommended.

The most common side effect reported is mild nausea, which, if severe enough to be disruptive, may be alleviated by taking a lower dose of the medication. Less common side effects include headaches and symptoms similar to a common cold.

Though rare, Janumet is associated with increased risk of lactic acidosis, a condition which can be fatal if not promptly addressed. Patients should be alert for symptoms and seek medical attention if they develop, even if symptoms are mild:

• Unexplained muscle pain or weakness
• Difficulty breathing
• Moderate to severe dizziness
• Persistent stomach pain, nausea and vomiting
• Cold or numbness in arms or legs
• Fatigue and weakness
• Slow or irregular heartbeat

Some of the above warning signs can be difficult to distinguish from less-concerning side effects or routine illness. Patients should use their best discretion and if in doubt seek medical attention.

As always, blood glucose levels should be carefully monitored and any significant variation brought to the attention of a doctor.