Diabetes, a chronic, life-long condition that affects the way your body metabolizes glucose, is a major global health concern. While the disease is categorized into two types, type 2 diabetes is more prevalent – 90% to 95% of more than 30 million diabetic patients in the United States have type 2, according to Centers for Disease Control and Prevention.

Thought (the exact cause isn’t known yet) to be caused by a combination of health, genetic, and lifestyle factors, type 2 diabetes is mainly characterized by the development of insulin resistance, severely diminishing the body’s ability to utilize insulin. At first, the body tries to fight against the elevated blood sugar by signaling the pancreas to produce more insulin. But, over time, the pancreas fails to keep up causing glucose build up in the blood.

The reduced ability or the failure of the body to convert glucose into energy not only makes cells starve for energy, but also leads to many other health complications over time.

Signs and Symptoms – How to Know If You Are Suffering From Type 2 Diabetes?

Type 2 diabetes is often described by healthcare practitioners as silent and sneaky.  This is because it develops over time and does not cause always cause noticeable symptoms. Laurie Sandberg, a nurse, certified diabetes educator, and a member of the American Diabetes Association and American Association of Diabetes Educators, says:

“In type 2 diabetes, blood sugars increase slowly and gradually. You typically don’t wake up one day with a blood sugar level of 300.”

This means a person may be suffering from type 2 diabetes and not know about it for years. According to the American Diabetes Association, there are likely to be around 7 million undiagnosed cases of type 2 diabetes in the United States alone.[1]

Here are some signs that people often ignore as insignificant, but they may be hinting towards the developing condition, so make sure to get yourself tested for diabetes if you experience any of these:

  • Increased thirst
  • Increased hunger
  • Frequent urination
  • Fatigue
  • Weight loss for no apparent reason
  • Blurred vision
  • Frequent infections
  • Slow healing of wounds and sores
  • Dark skin patches, usually on neck and in the armpits

Treatment for Type 2 Diabetes

Diabetes is incurable, but it can be effectively managed with medications and lifestyle changes. While some patients only need to make lifestyle changes, such as getting physically active and eating healthy, others need medications to keep their blood glucose levels within a healthy range.

An important thing to note here is that type 2 diabetes generally gets worse with time. This means that even if you are not taking any medicine now, you may need it after some time. Also, the nature and type of medications that you use may also often change over time.

Janumet – Oral Medicine for Type 2 Diabetes

Janumet is the brand name for a combination medicine prescribed to adults with type 2 diabetes when metformin and sulfonylurea, the first and second line medications for type 2 diabetes, do not provide adequate glycemic control.

Containing metformin HCl and sitagliptin, the medicine is indicated along with exercise and a healthy diet to keep blood sugar levels under control.

How Does Janumet Help to Control Blood Sugar?

Both the active ingredients present in Janumet work in different ways to prevent blood sugar level from increasing.

Sitagliptin, a dipeptidyl-peptidase-4 inhibitor, helps to keep insulin levels in control after eating by blocking the breakdown of incretin hormones.

Incretin hormones are produced inside the body after we eat food to stimulate pancreas for insulin production. When these hormones are not broken down and are present in the blood in higher concentrations, the pancreas produces more insulin. In addition to this, sitagliptin also decreases the level of glucagon; a hormone that prevents blood glucose levels from dropping very low, as well as the amount of glucose produced by the liver. Sitagliptin doesn’t work when the blood glucose levels are low.

Metformin HCl, on the other hand, decreases the production of glucose in the liver as well as its absorption by intestines.

Limitation of Use

Janumet is only meant to be used for people with type 2 diabetes; it should not be used for the treatment of type 1 or diabetic ketoacidosis.

The medicine is only approved for adults; do not use Janumet if you are younger than 18 years.

Available Dosage Forms and Strengths

This diabetes medicine is available in the form of oral tablets in immediate-release and extended-release varieties, called Janumet and Janumet XR respectively, in the following strengths

  • 50 mg/ 500 mg – containing 50 mg sitagliptin and 500 mg metformin HCl
  • 50 mg/ 1000 mg – containing 50 mg sitagliptin and 1000 mg metformin HCl

In addition to the above two strengths, Janumet XR is also available in:

  • 100 mg/ 1000 mg – containing 100 mg sitagliptin and 1000 mg metformin HCl

Janumet Dosage

The dose of Janumet may vary from person to person because the right dosage for a patient is determined based on the severity of the disease, current medications, effectiveness, tolerability, and overall health of the patient. However, the maximum daily dosage should not exceed 100 mg sitagliptin and 2000 mg metformin HCl.

Janumet immediate-release is usually taken twice a day whereas the extended-release tablet is taken once daily.

The usual starting dose is kept low to determine the patient’s response and tolerability to the active ingredients and then gradually increased, if needed.

How to Take Janumet?

Janumet should be taken with food to reduce or prevent the gastrointestinal side effects metformin may cause. Janumet XR should preferably be taken in the evening.

Swallow the tablets whole; do not crush, split or chew the tablets.

Possible Side Effects of Janumet

The most common side effects of Janumet include:

  • Nausea
  • Sore throat
  • Runny or stuffy nose
  • Indigestion
  • Upset stomach or gas
  • Diarrhea
  • Headache
  • Upper respiratory infection
  • Weakness

Although less common, Janumet may also cause:

  • Abdominal pain
  • Vomiting
  • Acute renal failure
  • Hypersensitivity reaction
  • Ski disorder that causes the scalp skin to exfoliate
  • Angioedema
  • Stevens-Johnson syndrome
  • Rhabdomyolysis

Sometimes, the tablets may not dissolve completely in the blood and pass out in the stool. While there is nothing to worry if parts of the tablet pass out from the body occasionally, consult your doctor if you see undissolved tablets in feces, repeatedly.

Janumet may rarely cause lactic acidosis. But, it is a serious health condition that requires immediate treatment, so be careful and get emergency medical aid even if you experience mild symptoms of it. Some common symptoms of lactic acidosis are:

  • Cold or numb arms or legs
  • Dizziness
  • Nausea with vomiting
  • Feeling tired or very weak
  • Trouble breathing
  • Stomach pain
  • Slow and/or uneven heart rate

While Janumet does not cause hypoglycemia on its own, we cannot completely rule out its possibility as well because every diabetic patient is at the risk of low blood sugar. Since hypoglycemia needs to be treated immediately, it is recommended that you remain careful while taking any diabetic medicine. If you experience any signs of low blood sugar, quickly consume some fast-absorbing sugar food, such as fruit juice, regular soda, raisins, crackers, or hard candy.

Symptoms of hypoglycemia include:

  • Feeling shaky
  • Sweating
  • Drowsiness
  • Fast heart beat
  • Nausea
  • Dizziness
  • Hunger
  • Headache
  • Irritability

Contact your doctor right away or get emergency medical help if you experience any of the following symptoms for no other apparent reason:

  • Unusual tiredness
  • Unusual and quick weight gain
  • Fluid retention and/or swelling, particularly in legs, ankles, and feet
  • Increasing trouble in breathing or shortness of breath, especially when lying down.


Needless to say that you shouldn’t take Janumet if you are allergic to any of the ingredients present in the medicine.

Things to Consider Before Taking Janumet

Before beginning treatment with any new medicine, it is highly important that you tell your doctor about every health condition, no matter how little or insignificant it may seem to you, you are suffering from and the medications you are taking.

In particular, inform your healthcare provider if you are or have ever suffered from:

  • Liver or kidney issues
  • A health condition that may negatively affects your kidneys
  • Any disease that reduces the supply of oxygen to lungs and different body tissues
  • Heart disease or have recently suffered a heart attack
  • Precoma or ketoacidosis
  • Gallstones
  • Pancreatitis i.e. inflammation of the pancreas.

The safety of Janumet may also need to be determined if you are an alcoholic or consume it excessively or have had a surgery.

The dosage of Janumet needs to be adjusted for pregnant and nursing mothers, so make sure to tell your doctor f you are pregnant, planning to get pregnant, or breastfeed.

Janumet Prescription Assistance

Merck’s Patient Assistance Program, also known as Merck Helps, provides Janumet free of cost primarily to patients who are uninsured and cannot afford to buy this prescription medicine without any assistance. However, exceptions can be made for patients who do not meet the insurance criteria, but have demonstrated medical or financial hardships and do not earn enough to buy the medicines on their own.

With a single application, qualifying patients will get up to a year of Janumet’s supply for free with the option to reapply as many times as they would need.

Visit Merck Helps website to find out more details about the eligibility criteria, to check if you qualify for it, and to know the process of application. Alternatively, you can also call 1-800-727-5400 between 8 am to 8 pm EST from Monday to Friday.

If you know that you qualify for the Merck Helps program, click here to fill out the application form.

[1] https://www.meritushealth.com/media-center/news/2019/january/diabetes-the-silent-killer/