Suggest Treatment For Elevated A1C Levels Despite Being On Januvia

Posted on Thu, 24 Sep 2015

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Thu, 24 Sep 2015 Answered on

Fri, 16 Oct 2015 Last reviewed on

Question : Diagnosed in March with diabetes. Prescribed metformin but had to stop due to gastro problems (diarrhea). A1c had been 7.0
Started at 50mg Januvia A1c = 7.3 after 3 months.
Increased Januvia to 100mg, A1c increased to 7.7 after 3 months. (Exercise, weight, diet were same)

Today, GP added 50mg of Invokana. (Have not seen an endocrinologist.)
While insurance is paying the high price of each medication, is it unusual to be taking these two medications at the same time? I realize their mechanisms are 2 different approaches) but......

Answered by Dr. Binu Parameswaran Pillai (3 hours later)

Brief Answer:
Justified

Detailed Answer:
good day
Noted your question.
Since Januvia at the dose of 100 mg was not controlling the blood sugars adequately, adding a second drug is justified. Ideally In a Type 2 Diabetes patient, Metformin is indicated. But since you can't tolerate it, Invokana is justified. Otherwise adding a small dose Lantus (insulin ) would have been an alternate option.
Regards
Binu

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar