It all started with Actos (pioglitazone). When the very popular diabetes drug Avandia (rosiglitazone) was found to produce serious cardiovascular risks (increased likelihood of heart attacks and strokes), a competing drug called Actos took over. Full page ads in newspapers touted the benefits of Actos for controlling type 2 diabetes. Sales soared.
Then reports linking Actos to bladder cancer began to surface. In 2010 the FDA announced that it had begun a safety review of Actos after reviewing some worrisome results of a long-term study suggesting a possible link to bladder cancer.
In June of 2011 the FDA went a bit further: ”
Actos: Potential Increased Risk of Bladder Cancer
The use of the diabetes medication Actos (pioglitazone) for more than one year may be associated with an increased risk of bladder cancer.”
The FDA offered the following recommendations:
Recommendations
• Do not take pioglitazone if you are being treated for bladder cancer.
• Tell your doctor right away if you have any of the following symptoms of bladder cancer:
• blood or red color in urine
• urgent need to urinate or pain while urinating pain in back or lower abdomen

As of this writing the FDA has done nothing more than issue a warning. But on August 9, 2012 the Journal of the National Cancer Institute released a report suggesting that there was indeed a worrisome link to bladder cancer. Investigators reviewed records from more than 60,000 people with type 2 diabetes in the United Kingdom. Those who took Actos were two to three times more likely to be diagnosed with bladder cancer compared to those taking other antidiabetes drugs. Although Actos remains available in the U.S., France and Germany banned the drug in 2011.
New Concerns: Byetta, Bydureon, Januvia, etc.
A report from Johns Hopkins University on February 25, 2013 in the journal JAMA Internal Medicine noted that GLP-1 drugs were linked to inflammation of the pancreas (pancreatitis). Symptoms include digestive distress, abdominal pain, nausea and vomiting.
A few weeks later on March 14th, the FDA issued a “Drug Safety Communication” about this entire class of medications:
“The U.S. Food and Drug Administration (FDA) is evaluating unpublished new findings by a group of academic researchers that suggest an increased risk of pancreatitis, or inflammation of the pancreas, and pre-cancerous cellular changes called pancreatic duct metaplasia in patients with type 2 diabetes treated with a class of drugs called incretin mimetics.”
“FDA has not reached any new conclusions about safety risks with incretin mimetic drugs. This early communication is intended only to inform the public and health care professionals that the Agency intends to obtain and evaluate this new information. FDA will communicate its final conclusions and recommendations when its review is complete or when the Agency has additional information to report. ”
“At this time, patients should continue to take their medicine as directed until they talk to their health care professional, and health care professionals should continue to follow the prescribing recommendations in the drug labels.”

According to the FDA, Drugs in this class include:
• Bydureon
• Byetta
• Janumet
• Janumet XR
• Januvia
• Jentadueto
• Juvisync
• Kazano
• Kombiglyze XR
• Nesina
• Onglyza
• Oseni
• Tradjenta
• Victoza

What is a patient to make of all this? The FDA generally moves quite slowly when it comes to cancer cautions. In this case, however, FDA staffers moved with surprising speed to alert the public and health care professionals to their concerns about possible precancerous changes within pancreatic cells. Nevertheless, the FDA has made it clear that patients should not stop taking their medicine.
This leaves millions of people in a double bind. It also puts doctors in a difficult position while the FDA investigates these new findings. It could take months, if not years, to sort through the data and determine whether there really is an increased risk of pancreatic cancer.
In the meantime, we encourage people to become as informed as possible about ALL options involving blood sugar control. In our new Guide to Managing Diabetes we discuss many non-drug options. You will learn about the Low-Cal vs. Low-Carb controversy and get practical recommendations on the best vegetables to keep blood sugar under control. Find out about the role of cinnamon, vinegar and supplements such as vitamin D, selenium and chromium as well as herbs like bitter melon, fenugreek and nopal cactus.
You will also learn about the pros and cons of metformin. Not only does this drug help control blood sugar without the usual weight gain associated with many other medications, it has been linked to a lower risk of cancer!
In June, 2012 a study published in the Journal of Clinical Oncology has some very good news about metformin:
“In a large population of postmenopausal women, use of oral metformin was associated with lower incidence of invasive breast cancer…Our results inform future studies evaluating use of metformin in the management and prevention of breast cancer.”
This isn’t the first time metformin has been linked to a lower risk of cancer. A comprehensive review of the medical literature published in Cancer Prevention Research (Nov. 2010) revealed that metformin was associated with a 31% reduced risk of cancer in general compared to other diabetes treatments. In particular, the reduction in rates of pancreatic and liver cancer were statistically significant.
To learn more about metformin’s benefits and risk as well as other practical ways to manage diabetes and prediabetes, we hope you will find our new Guide to Managing Diabetes worthwhile. Even if you have not been diagnosed with elevated blood sugar, we think the dietary suggestions in this guide will make sense for you and those your love.
Please let us know how you mange your blood sugar by commenting below.

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  1. Kris
    Reply

    Insulin may do the job, but you have to deal with injections, on the positive you can dose it, however insulin is not likely to affect those with insulin resistance or hepatic glucose production, so while helpful, it helps to try to “put out the fire at the source” rather than add more water to it.

  2. Betsy
    Reply

    My husband was diagnosed with diabetes last June — his A1C was 11.7. Pretty much immediately, he began following the Blood Sugar 101 http://www.bloodsugar101.com protocol: a very low carb, high protein diet. By September he had lost at least 30 lbs and was in the 5% club (his A1C was down around 5.5).
    Initially his doctor had him on Metformin, but that wasn’t bringing the blood sugar down enough so he switched him to Janumet. But at the Sept. checkup, his doctor agreed to put him back on Metformin, which is so much cheaper than the Janumet and doesn’t have the bad side-effects. And he continues to do well. Periodically he’ll eat a high carb food like bread, pasta or a white potato, after which he tests his blood sugar 1 hr and then 2 hrs after eating. If it spikes and hasn’t dropped below 125 at the 2 hr interval, he knows he needs to continue avoiding that food.
    Oddly enough, beer doesn’t spike his blood sugar, which is great because he would feel really deprived if he couldn’t drink beer. He has tried going off the Metformin at times, but his blood sugar then starts to edge up. It seems like he may be on Metformin for the rest of his life.

  3. MW
    Reply

    My kidney specialist took me off metformin — said it was affecting my kidneys. I’m type 2 and now control through diet and exercise — no foods with high fructose corn syrup (including ketchup, mustard, etc.) and basically gluten free.

  4. JB
    Reply

    Even though I have been diagnosed, many years ago, as being diabetic, my A1C has never been over 6.7 and this month (3/13) it was 6.3. I am very careful about the foods I eat and never drink sodas or tea sweetened with sugar. My cold cereal has no more than 3 g sugar in it (cheerios has 1 g, and I put slice almonds and slice apple or fresh berries in it) and I have educated myself on what foods have a high sugar content (such as baked beans) and I avoid them. A good snack for diabetics is pecans or a few walnuts. I eat LOTS of fresh veggies and not not much red meat. I feel every diabetic owes it to themselves to be informed as to what will cause their sugar to rise or fall….there is life without diabetic drugs for some of us.

  5. k2
    Reply

    The one factor that makes the biggest difference is sleep. If I get less than 8 hours of sleep, my blood sugar will be elevated. My doc prescribed Glucophage and I don’t take the generic (because I have Celiac and you never know what binder is used in generics). It helps but it still comes back to sleep.
    I’ve also found Dr. Bernstein’s book “The Diabetes Solution” very helpful. I have to eat gluten-free and most gluten-free products are much higher in carbs than the regular gluten versions. Reducing the carbs in my diet increased my success in maintaining normal blood sugar levels. I don’t restrict my carbs as much as Dr. Bernstein does but if I keep the total carb intake for the day to under 100 grams, my blood sugar stays in the healthy zone.
    I tried regular walking for exercise but of work, sleep and exercise, I can usually only manage 2 out of 3. A sleep specialist told me if you have to choose between sleep and exercise, take sleep. It’s been working for me.

  6. cpmt
    Reply

    I sent an email to the FDA in 2010 about it. I find out on TV and newspaper report on it. Their website STILL doesn’t show any problems with these medicines. (LAST TIME I checked was Jan. this year). they rate it as # 2 of 5 in dangerous. People look at their website to make a decision and they still didn’t update the information.

  7. Helen M
    Reply

    I began metformin around 1995. In 2001 I was diagnosed with thyroid cancer, lost my thyroid and the use of my parathyroids. In 2007 with breast cancer, which was contained within a duct and for which I had a lumpectomy. In 2008, scant weeks after I finished radiation therapy I was diagnosed with cancer in both kidneys. One cancer had not spread, it was two different cancers. I lost one kidney and had the other ablated, cryo. I was taken off metformin when I was diagnosed with the kidney cancers and went to insulin only.
    My insulin usage with the met was app 40 units a day, without about 60. In 2010 I discontinued lipitor and my insulin usage dropped back to 40 units a day. Since then I have lost about 30 pounds and my insulin usage dropped to about 35 units a day.
    I loved metformin. When I began it, I lost about 15 pounds without any change in diet or exercise. A life long problem with constipation disappeared. And my first A1c with it dropped from 7 to 5.5. Always ran under 6. Controlling with insulin alone has been more difficult and my A1c reflects this; the last one was 6, others since usually around 6.2. I would go back on it in a NY minute; however, cannot with only one kidney. Additionally, the met helped control my appetite and low carbing with it was a lot easier than now.

  8. LP
    Reply

    While living in UK, I was diagnosed as borderline diabetic. At the time, I was taking several drugs for HBP and A-fib. I was told to start taking L-carnitine and ALA. The practitioner said it would take up to six (6) months to see the changes.
    After three (3) months, my BP is normal without the HBP meds, and my glucose levels were lowered from day one. Total cholesterol levels have dropped from 260 to 170. My energy level is so much higher. This combo has been amazing. My brain fog is gone. I am now off all prescriptions except Xarelto.
    Why is this miracle combo a secret? I’ve even lost a few pounds.

  9. Mouse
    Reply

    Can you please advise on Gliclazide (Diamicron) with regard to adverse effect. My husband is on Metformin as well as Gliclazide. We will purchase your book Guide to Managing Diabetes as it has a great concern to me in particular, that Dr’s will just prescribe what the Drug companies recommend, sometimes because of the kick-back effect and we’ve challenged Dr’s as to why they just believe every word that comes out of the Drug Companies mouth. They absolutely hate it when you do your own research!

  10. RobLL
    Reply

    Most of these oral drugs drop diabetics A1Cs only about by 0.5% (i.e., from 8.0 to 7.5), not really enough to be significant. They have potentially severe side effects – heart effects, fractured bones, and rarer more some cancer risks. Most of them are also very expensive.
    Insulin properly dosed will always do the job. And with reduced carb intake less insulin is needed. For some none linear results can make dosing difficult, but generally easier than properly dosing orals.

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