Tuesday, November 6, 2012

Diabetes, Januvia and Cancer

I have attached a email exchange that you find interesting.  Dr. Calder

Nov. 1, 2012

Hello Dr. Calder,
  Recently I came across your very informative diabetes site, and after reading through many of your articles I decided to email you regarding a question I have about Janumet.  By the way, I am a 49 year old male with type 2 diabetes.  About a month ago my doctor decided that Metformin was not working as well as it used to in keeping my A1C down,  so he prescribed Janumet twice daily. Within a day or two of taking Janumet, I noticed a vast improvement in my blood sugar levels.  However, being the inquisitive person I am, I began researching Janumet and Januvia online, and quickly came across many articles warning that these medications can cause pancreatic cancer.  Do you have any updated information regarding this?  I certainly appreciate the fact that Janumet is working wonders for my blood sugar levels, but of course I do not desire to increase my odds of getting pancreatic cancer in the process.  Anything you might be able to share with me regarding this would be greatly appreciated.  Thank-you for your time.

NOV.4, 2012
Hello Jody
I apologize for not getting back to you sooner. I have an excuse , my wife and I are in the process of buying and remodeling a new home and selling the one we are in now. I had forgotten what a hassle this process is. 

Thank you for this very timely question. I will give you my initial reaction today and provide a more informed discussion later. 

Pancreatic cancer and its relationship to Type 2 Diabetes and diabetes medications is not clear.Even the  time of diagnosis of Type 2 diabetes and the diagnosis of pancreatic cancer is not clear . Did the cancer cause the elevated sugar and the diagnosis  of diabetes or did the diabetes cause the cancer?  Attaching a certain diabetes medication as a cause of pancreatic cancer is even more difficult .

In any case , pancreatic cancer is very rare in every one including people with type 2 diabetes. The complications  death and disability ( especially heart disease )from poor diabetes management is very common. 

My gut reaction is , the benefits of taking Janumet ( januvia combined with metformin ) are much greater than the risk of developing cancer.
Metformin has also been shown to reduce the risk of developing some cancers.

I will get more specific information for you and me.
Dr. Calder


Hello Dr. Calder,

  Please do not apologize for the delay in getting back to me, it is I who am honored that you took the time to respond.  After reading so many scare stories online about Januvia and Janumet, I temporarily stopped taking my twice daily Janumet.  After reading your reassuring and very logical response I resumed taking my medication today.  Although I think the internet is a Godsend, I am also aware that it is rather easy to misuse it when it comes to researching medications.  After reading the multitude of horror stories about patients having terrible side effects after taking a prescription drug, it is no wonder many patients become non-compliant.  You have the websites ranting about big bad pharma, and how the prescription drug makers are out simply to make a buck without regards to public safety.  There are even diabetes blogs where diabetics are warned about how dangerous taking their prescribed medication can be.  Many believe all diabetics can stop the disease in its tracks by diet and exercise alone.  Unfortunately that did not work for me.  Even with a low-carb diet my fasting blood sugars were well above normal.  

  Anyhow, I have rambled on enough.  Once again I thank-you for responding, and most likely saving me from an early death.  In all honesty, I had no intention of ever taking my Janumet again until I read your response.  You cut through all the crap I was reading and gave me an honest and very well thought out response.  I doubt I will ever be able to thank-you enough Dr. Calder.

  Good luck with your house.


 Thanks . Can I use your question and answers  as a post. I will remove your name and email address and have you approve it before it is published. I think we did a good job with a real problem that other people may be dealing with .  Dr. Calder


Please feel free to use my question, and using my name and email is fine.  I do not have to proof read it, I certainly have full trust in you Dr.  Thanks again. jody


I want to thank Jody for initiating this exchange about the risk of cancer associated with diabetes.

This is a complex issue with less than perfect answers. Type 2 diabetes and people with Pre-diabetes seem to have a slight increase cancer risk .  I don't think the increased risk applies to people with type 1 diabetes.

My personal experience as diabetes specialist in an endocrine group supports my thoughts about how rare cancer is in patients with diabetes. I can recall the the few people that I saw with cancer and type 2 diabetes. I am also sure that a cancer specialist has probable had a different experience.

My experience with diabetes associated complications , especially heart disease , was a frequent daily experience. Our endocrine group managed the in hospital diabetes care for the cardiovascular surgeons. We followed 5 to 10 people with primarily type 2 diabetes and undiagnosed diabetes daily admitted  for coronary bypass surgery.
This story reminds me of the child hood story of  blind men examining and describing an elephant.

Have Fun, Be Smart and remember your personal doctor is still your best source of medical advise.
David Calder, MD

I have attached links to some of my previous post discussing cancer and diabetes


  1. Hello Dr. Calder,

    Once again I am in need of your expert advice please. As I have stated previously, I am on Janumet twice daily. I have had some side effects such as sinus headache and particularly muscle and jaw pain in my right arm and jaw only. Anyhow, during the course of my web-search, I happened to find an interesting article which you can find here: http://www.phlaunt.com/diabetes/18538604.php

    This particular blog is operated by a self-proclaimed diabetes expert named Jenny Ruhl. She lists many negative potential side effects from Januvia which include pancreatitis and pancreatic cancer, as well as a slew of other issues. For me, the Janumet has helped my blood sugars considerably, and I do not want to cease taking it because of scare stories I discover online. However, I also want to be reassured that I am not putting my health in risk down the road by taking Janumet. I am not sure what to make of Jenny Ruhl, she seems to be against most diabetic medications with the exception of Metformin, which she claims is superior than Januvia or Byetta. I am considering asking my Doctor about another DDP-4 inhibitor called Linagliptin combined with Metformin, as it may have less risks than Janumet. My questions to you would be, have you ever heard of Jenny Ruhl, and is her advice sound? Should I worry about taking Janumet long-term? Any insight you might offer would be greatly appreciated. Thank-you for your time Dr. Calder.

    Jody Rivers

    1. Thanks for your followup note . I understand your concern about medications and risk. I think it is wise to be cautious with all medications including vitamins and over the counter pills that we all use. I still believe balancing the know benefits vs the possible risk may be a way to become more comfortable with your decision.
      The reality is that glucophage is a very good first medication for treating type 2 diabete but it fails as the disease progresses and insulin deficiency worsens. We know what the risk of doing nothing and living with uncontrolled diabetes does to a persons heart , eyes , kidneys and nervous system is. We now have these wonderful second line medications , including Januvia that will allow a person the opportunity to preserve their good health. This known benefit has to be balanced against the rare possible increased risk of getting cancer. All of the second line medications , including insulin , come with added risk. I favor dealing with and correcting the the known risk of diabetes and living a healthy active life. These new medications do not have the benefit of long years of observation. I think it is a good idea to talk with your doctor and while you are their how many diabetic patients he has seen with any cancer compared to the number of diabetics he has seen with heart disease , kidney failure , vision loss and nerve damage.. David Calder,MD

    2. Well here I am...the one that got the cancer while on Januvia. Was it chance? I don't know. First came shingles and then came the cancer. I had good blood sugar results on the Januvia. Mine was breast cancer. They caught it early not that means anything in the end. But ........ which is your lesser evil. I don't know.
      I guess I would take Januvia again, and I might. because now the cancer is gone, the diabetes is high and we all know the risks that can entail and I have been over 225 for almost a year. No side effects yet. but no balance. I am on metformin and glipizide. Because they were cheap. Januvia is over 800 now for 90 days. That is so expensive.

      What is our life worth?

    3. Hello Dr. Calder,

      Once again I have come across a link published by Jenny Ruhl regarding the dangers of DDP-4 Inhibitors which I wish you could review when you have the time. It can be found here: http://www.phlaunt.com/diabetes/18538604.php As I currently take the Linagliptin and Metformin combo, (Jentadueto) I am very concerned about what her article implies regarding a possible link between cancer and DDP-4 Inhibitors. Personally I dislike Jenny Ruhl as I think she uses scare tactics to frighten diabetics from taking their medication. She makes it clear that she is not a Doctor, but she does offer some compelling evidence with links to back her up. However, as you are a Doctor, perhaps you could shed some much needed light on her article. I am continuing to take my Jentadueto as prescribed until clear evidence surfaces to indicate otherwise. Your response to this would be greatly appreciated. Thank-you Dr. Calder.

      Jody Rivers

  2. Dr. Calder,

    Thanks for putting my mind at ease somewhat after all the sleazy advertising I have seen recently regarding Janumet. I grew concerned because my levels have been rising recently and I thought that damage to my pancreas may be the cause. Even after a day of fasting before a medical test, my glucose level was well over 200! Perhaps it's just that, after several years, the Janumet is no longer effective? I'll be seeing my doctor soon and discuss it with him.


    1. Thanks for your comment. As you know cancer in any form is a complex problem without perfect answers. The association with diabetes and diabetes medications is even more complex. I have a lot of faith in medical research and less faith in TV adds by lawyers and comments on the internet. While we are waiting for good answers , we all have to deal with the realities of uncontrolled diabetes and use the available tools to slow down and prevent the real damage caused by diabetes. Talk to your doctor and review your options and proceed in your comfort zone. Dr. Calder

  3. Hello Calder,
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    sugar substitutes for diabetics

  4. I had testicular cancer 3 years after starting Januvia, no one else in my family has had testicular cancer and I had it at age 55 , the urologist said it was unusual for someone my age to have this kind of cancer, it usually happens to men before age 35. so Januvia probably is the culprit. spent two hospital stays of 9 days each ,cardiac arrest , myocardial infarction times 2 while there. from loss of blood etc. nurse took 39 minutes to bring me a nitrostat, troponin surged from 0.256 to over 0.410 on that day and then I got nitro paste and then imdur. and after chemo 1 stent, and 3 failed attempts place another, went back to a cardiologist I saw in 2003 and got the other 2 stents.
    Now I'm trying to find a replacement drug for januvia that is safer , maybe will go on insulin ,,I'd rather stick myself then have them taking blood from me so often they had to use the veins in the back of my hands, they ran out of places and had to give me 2 tranfusions to replace all the blood they took for cultures and tests. what other drug is there for type 2 ? that is safer and without dangerous side effects. thanks in advance.

  5. Dr. Calder,

    I have been a type 2 diabetic for almost 16 years now (diagnosed about the time my daughter was born). I am in excellent shape. I am an avid and semi-accomplished triathlete, cyclist, and runner. I have generally maintained a good weight and body fat % (170lbs, <20%). I eat very healthy and Cholesterol levels are always 130 to 145 mg/dL. Trigylcerides are always very goood (never higher than 90mg/dL). Early on I started of on glipizide, then glocuphage , then metformin. My A1C pretty much always hovered around 7-8. About 11 years ago my doctor started me on Januvia and I saw an improvement. Soon after that my doctor changed it to Janumet. I have been on Janumet since....my A1C dropped to around 5.9 fairly consistantly. About a year and a half ago it started rising again...as high as 7.2 and as low a 6.2. Same lab, same doctor performoiing the tests. My most recent level was 6.2, but I changed my diet even more to accomodate try and lower it. My most recent reading was 6.2 about two weeks ago. I am happy about that. However...my liipase level was 700 U/L, my WBC was 3.2K/CMM, RBC was 4.66M/CMM. My doctor immediately ran some more tests and also had a CT scan ordered for me. On the follow up labs by Lipase level was back down to about 350 U/L (same lab, one week later). However this time my CEA level noted as very high 6.8 ng/mL. My doctor asked for me to see a specialist as soon as possible and I am doing that next week. I probably do not have to worry but I want to be informed as much as possible. My question to you is what questions should I be asking the specialist? Can I expect more tests?

    Thank you

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Your comments and questions are appreciated. David Calder,MD