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Super Advisor
suesmith
Total Posts: 406
Registered on: ‎09-27-2011

Janumet vs. metformin?

I currently take 1000 mg/day Janumet, which is metformin + sitagliptin. My local phamacy offers metformin for just $4.00/30 days. The branded Janumet is very expensive ~$240/30 days, till I meet my deductible (I am self insured and my deductible is $1000) after that, it is still ~$40/mo. My question is-what does the sitagliptin add to the metformin? I am doing well with the med, but the cost is so high!

I appreciate any advice on this-of course I will talk with my doctor about it, too

Thanks!

Sue

Type 2
1000mg/day Janumet
DX: September 2011: A1C 13.6 FBG 389
July 2012: A1c 5.6 FBG 84
Super Advisor
carlking2
Total Posts: 2,724
Registered on: ‎04-08-2011

Re: Janumet vs. metformin?


suesmith wrote:

 My question is-what does the sitagliptin add to the metformin?



In general I AM NOT a fan of the combo drugs such as the one you are taking, but I won't go off topic and express my opinion here.  The Januvia (sitagliptin) part of the medication that your are taking works to control you BG rise during meals....Metformin alone does not do this.  Sitagliptin works by increasing the production of insulin and suppressing the pancreas in the production of glucagon.

 

It is possible you can manage with other less expensive options.  Talk with your PCP about it.  Many manage well with just Metformin, diet and exercise.

Thanks Rick

Diagnosed T2 4/4/2011
04/04/2011, A1c 11.2
06/27/2011, A1c 5.6
10/07/2011, A1c 5.7
1/14/2012, A1c 5.4
4/17/2012, A1c 5.4
7/27/2012, A1c 5.3
01/30/2013, A1c 5.2
08/26/2013, A1c 5.3
01/26/2014, A1c 5.5
07/25/2014, A1c 5.4

Lipids TC 203, LDL 110, VLDL 20, Triglycerides 100, HDL 73
Managed by diet and exercise along....former insulin and Metformin user
Advisor
ronaka
Total Posts: 950
Registered on: ‎12-24-2011

Re: Janumet vs. metformin?


suesmith wrote:

I currently take 1000 mg/day Janumet, which is metformin + sitagliptin. My local phamacy offers metformin for just $4.00/30 days. The branded Janumet is very expensive ~$240/30 days, till I meet my deductible (I am self insured and my deductible is $1000) after that, it is still ~$40/mo. My question is-what does the sitagliptin add to the metformin? I am doing well with the med, but the cost is so high!

I appreciate any advice on this-of course I will talk with my doctor about it, too


Janumet is two drugs; Januvia and metformin. Metformin mainly acts by reducing the release of glucose from the liver. It also slows digestion and increases sensitivity to insulin. Januvia works in two ways. One is similar to metformin it reduces release of glucose from the liver, and second it increases the stimulation of insulin. See this link on how Januvia works:

 

How Januvia Works

 

So really part of what Januvia does is the same as metformin -- reduce liver produced glucose. The part metformin does not do is increase insulin production. The drug you asked about in another thread, repaglinide, is probably one of the better ones to do that. It should be available as a generic, as it is in Canada (and it is cheap), but it is stalled by a lawsuit in the US. Cost aside I think your best bet would be to go to straight metformin and ask about increasing the dose to 2000 mg per day. Then add the repaglinide at each meal.

 

A lower cost alternative until repaglinide becomes generic may be to take a sulfonylurea type drug to stimulate insulin along with 2000 mg of metformin. Here is a link about the various sulfonylureas available. You should talk to your pharmacist about which ones work best and are available as a generic. The only downside of the sulfonylureas is that they stimulate insulin all day and night -- not just meal specific. You have to watch for lows in BG between meals and overnight.

 

Sulfonylureas

 

Lower cost still may be to try straight 2000 mg of metformin. Perhaps now that you have BG in control that much metformin will hold you there. It is a good drug for type 2, and is often recommended as the first line of treatment. Normal practice would be to maximize the use of it before adding a second drug.

 


 

Ron

Not a doctor, only another T2 diabetic with, unfortunately 11 year experience. Be cautious about accepting advice, including mine, on medical conditions from the internet. It can be a good place to get ideas, but validate them with your doctor and other medical professionals first.
Frequent Advisor
sunritef
Total Posts: 2,594
Registered on: ‎11-30-2009

Re: Janumet vs. metformin?

If I do some quick math, we are 3 months into the year you are paying $240/month for your Rx.  So you have spent at least $720 of your $1000 deductible.  So at this point, if you are going to hit the $1000, anyhow, which I assume you will, you are talking about considering this a $40/month cost.  Since it is working so well, I'd try and stay on it if I could.



You go to school to learn, not for a report card.
You use your meter to learn, not for a report card

Type 1 (LADA).. Novolog/Levemir

Adult onset T1
Responder
ericas9780
Total Posts: 35
Registered on: ‎03-02-2012

Re: Janumet vs. metformin?

My dad has been on both so far. He began the Januvia almost 2 yrs ago and was on it until February when he was switched to the Metformin. However, we were not instructed to test while on the Januvia (it must have stopped working when he went into the hospital because he was off of it for 2 days when they finally found and diagnosed the T2D).

 

Since he awitched to the Metformin (500 mg 1x daily, not 2x like I thought), his BG has been between 80-130. Last night, however, after a stressful long day, he had his first BG low of 58 which we promptly treated with graham crackers and PB (should have been milk instead). Otherwise the Metformin seems to be the one that works best.

Responder
georm
Total Posts: 33
Registered on: ‎02-16-2012

Re: Janumet vs. metformin?

Su, I think you should consult your doctor for this particular question, as here, no one is certified medical professional, so its not appropriate to ask or offer any medicine related advise.

 

 

 

GM 

Super Advisor
jpg391
Total Posts: 5,927
Registered on: ‎05-22-2011

Re: Janumet vs. metformin?


georm wrote:

Su, I think you should consult your doctor for this particular question, as here, no one is certified medical professional, so its not appropriate to ask or offer any medicine related advise.

 

 

 

GM 



I think it is very appropriate to ask questions and talk about diabetes medicines here. All though we are not doctors, the people here are very knowledgeable about the medicines and what their effects due to the human body.

James G

I'm just a guy who has had type 2 diabetes for 30+ years.

"It is common sense to take a method and try it. If it fails, admit it frankly and try another. But above all, try something." – Franklin D. Roosevelt

"When you get to the end of your rope, tie a knot and hang on." – Franklin D. Roosevelt

"I always wondered why somebody doesn't do something about that. Then I realized I was somebody." – Lily Tomlin

"Happiness is a state of mind." - Walt Disney

On 9/5/14 had amputation of my right leg, below the knee.

Latest A1C 5.6 on 6/23/14

Lipids test on 8/22/13
Total Cholesterol 132
HDL Cholesterol 45
LDL Cholesterol 68
Triglycerides 94

Medications
2,000mgs X2 a day (2 weeks taking then 1 week not taking, then start over again) Capecirabine for Recital Cancer after surgery (not being taken at this time).
10mg Simvastain for Cholesterol.
500mg Metformin twice a day
10 units Levemir, a long lasting insulin
81mg Asprin once a day
40mg of Quinapril (also known as Accupril) twice a day for HBP (to be taken only if BP is over 120).
20mg of Lexapro once a day for depression
1mg of Doxazosin once a day at bed time for a Prostate problem
30mg of Buspirone twice a day for Anxiety
Advisor
ronaka
Total Posts: 950
Registered on: ‎12-24-2011

Re: Janumet vs. metformin?


georm wrote:

Su, I think you should consult your doctor for this particular question, as here, no one is certified medical professional, so its not appropriate to ask or offer any medicine related advise.


Forums are a good place to ask questions and get ideas. These are just ideas however, and should not be acted on without discussing with your doctor and other professionals.

Ron

Not a doctor, only another T2 diabetic with, unfortunately 11 year experience. Be cautious about accepting advice, including mine, on medical conditions from the internet. It can be a good place to get ideas, but validate them with your doctor and other medical professionals first.
Responder
georm
Total Posts: 33
Registered on: ‎02-16-2012

Re: Janumet vs. metformin?

the people here are very knowledgeable about the medicines and what their effects due to the human body.

 

PLEASE FORGIVEME I AM NOT SO KNOWLEDGEABLE, THATSWHY I AM HERE.

Super Advisor
suesmith
Total Posts: 406
Registered on: ‎09-27-2011

Re: Janumet vs. metformin?


ronaka wrote:

georm wrote:

Su, I think you should consult your doctor for this particular question, as here, no one is certified medical professional, so its not appropriate to ask or offer any medicine related advise.


Forums are a good place to ask questions and get ideas. These are just ideas however, and should not be acted on without discussing with your doctor and other professionals.


 

Of course, I will ask this question of my doctor-I couldn't get metformin alone on my own without a prescription anyway :smileywink: 

 

I respect everyone's opinions here, and know that everyone is on a different medication regimen-as a fairly new diagnosed person, I was curious as to what the sitagliptin adds to the metformin...with the price of the Janumet, I thought perhaps it was 14K gold? :smileywink:

 

Thanks all for your input.

Sue

Type 2
1000mg/day Janumet
DX: September 2011: A1C 13.6 FBG 389
July 2012: A1c 5.6 FBG 84