Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Janumet is a combination of two drugs, metformin
and sitagliptin, that are used for reducing blood glucose (sugar) levels in
individuals with type 2 diabetes. The FDA approved Janumet in March 2007.
Insulin is a hormone produced by the pancreas. It limits blood glucose levels
by reducing the amount of glucose released by the liver into the blood and by
increasing the removal of glucose from blood by muscle and fat tissues. Type 2
diabetes results when there is reduced sensitivity of muscle and fat to the
effects of insulin. When the diabetes progresses, the pancreas produces less
insulin. Both defects result in increased levels of glucose in the blood.
Metformin is an oral medication that lowers blood glucose by increasing the
sensitivity of liver, muscle, fat, and other tissues to the effects of insulin.
Increasing the sensitivity of tissues to insulin causes more glucose to be
removed from blood and thereby reduces the level of glucose in the blood. In
scientific studies, metformin reduced the complications of diabetes such as
heart disease, blindness and kidney disease.
Sitagliptin is an oral drug that reduces blood glucose levels in patients
with type 2 diabetes. Following a meal, incretin hormones such as glucagon-like
peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) are
released from the intestine, and their levels increase in the blood. GLP-1 and
GIP reduce blood glucose by increasing the production and release of insulin
from the pancreas. GLP-1 also reduces blood glucose by reducing the secretion by
the pancreas of glucagon, a hormone that increases the production of glucose by
the liver and raises the level of glucose in the blood. The net effect of
increased release of GLP-1 and GIP is to reduce blood glucose levels. In
addition, sitagliptin inhibits the enzyme, dipeptidyl peptidase-4 (DPP-4) that
destroys GLP-1 and GIP and thereby increases the levels and activity of both
hormones and thereby the release of insulin. As a result, blood glucose levels
fall.
GENERIC AVAILABLE: No
PRESCRIPTION: Yes
PREPARATIONS: Tablets: 50/500 and 50 mg/1000 mg
STORAGE: Tablets should be stored at room temperature, 15-30 C (59-86 F)
PRESCRIBED FOR: Janumet is combined with diet and exercise to improve blood
glucose levels in patients with type 2 diabetes. It is not be used for treating
type 1 diabetes.
DOSING: Janumet is taken twice daily with meals, and the starting dose is
based on the patient's current dose of sitagliptin and metformin. The maximum
dose of Janumet is 100/2000 mg daily.
DRUG INTERACTIONS:Cimetidine (Tagamet), by decreasing the elimination of
metformin from the body, can increase the level of metformin in the blood by
40%. This may increase the frequency of side effects from metformin and Janumet.
PREGNANCY: There are no adequate studies of Janumet or the individual
components in pregnant women. Most experts agree that insulin is the appropriate
treatment for diabetes during pregnancy.
NURSING MOTHERS: It is unknown whether sitagliptin is secreted in human
breast milk. However, metformin is excreted into breast milk and can therefore
be transferred to the nursing infant.
SIDE EFFECTS AND PRECAUTIONS: The most common side effects of Janumet are
abdominal pain, nauseadiarrhea, vomiting, and hypoglycemia. Lactic acidosis is
a serious side effect of metformin that occurs in one out of every 30,000
patients and is fatal in 50% of cases. The symptoms of lactic acidosis are
weakness, trouble breathing, abnormal heartbeats, unusual muscle pain, stomach
discomfort, light-headedness and feeling cold. Patients at risk for lactic
acidosis include those with reduced function of the kidneys or liver,
congestive heart failure, severe acute illnesses, and dehydration. Janumet should be
discontinued immediately if lactic acidosis is suspected.
Reference: FDA Prescribing Information for Janumet
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
The major goal in treating diabetes is controlling elevated blood sugar without causing abnormally low levels of blood sugar. Treatment for type 1 diabetes is with insulin, exercise, and a diabetic diet. Treatment for type 2 diabetes is first treated with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugar, oral medications are used. If oral medications are still insufficient, insulin medications are considered.
In the United States diabetes is the most common cause of kidney failure. High blood pressure and high levels of blood glucose increase the risk that a person with diabetes will eventually progress to kidney failure. Kidney disease in people with diabetes develops over the course of many years. albumin and eGFR are two key markers for kidney disease in people with diabetes. Controlling high blood pressure, blood pressure medications, a moderate protein diet, and compliant management of blood glucose can slow the progression of kidney disease. For those patients who's kidneys eventually fail, dialysis or kidney transplantation is the only option.
Managing your diabetes is important. The goal of diabetic therapy is to control blood glucose levels and prevent the complications of diabetes. Information about exercise, diet diet, and medication will help you manage your diabetes better. Blood glucose reagent strips, blood glucose meters, urine glucose tests, tests for urinary ketones, continuous glucose sensors, and Hemoglobin A1C testing information is also provided in this article.
Taking care of a disease such as diabetes is a life-long process. Learn how to care for yourself or loved one with diabetes in situations such as illness, work, school, travel, or a natural disaster.
Diabetes RSS
Healthy Living Tips
This site complies with the