Type II Diabetes and Sitagliptin
by Dr. Howard F. Loomis, D.C.
Type II Diabetes or non–insulin dependent diabetes is characterized by high blood glucose related to insulin deficiency, sometimes referred to as This condition is best managed by dietary modification and increasing exercise. Nevertheless, medications are being used more and more frequently. Sitagliptin (trade name Januvia) and Vildagliptin (trade name Galvus) are the most commonly prescribed oral anti-diabetic drugs. If your patient is taking one of these, he or she may also be taking other oral anti-hyperglycemic agents such as metformin or a thiazolidinedione.
In previous articles, I have mentioned that most prescription drugs are made to either block an enzyme system or to block selected receptor sites. Hence, they all have side effects and do not restore normal function. In that regard, oral anti-diabetic drugs are designed to inhibit the metabolic enzyme dipeptidyl peptidase-4 (DPP-4). This enzyme is produced in humans and is found on the surface of most cell types for the purpose of immune regulation, signal transduction and apoptosis.
Apoptosis refers to the process of programmed cell death that does not damage the organism and is the opposite of necrosis. Signal transduction refers to any process that involves ordered sequences of enzyme reactions that occur inside the cell.
DPP-4 has wide reaching applications in the body and reacts with at least sixty-two known substrates. For example:
• It suppresses the development of cancer and some tumors.
• It is useful as a marker for various cancers, with its levels either on the cell surface or in the serum being increased in some neoplasms and decreased in others.
Obviously, DPP-4 must also play a major role in glucose metabolism. Specifically, it is responsible for the degradation of incretins. Knowledge of this process will pay great dividends for you and your patients.
• Incretins are gastrointestinal hormones that cause an increase in the amount of insulin released from the beta cells of the Islets of Langerhans after eating, even before blood glucose levels become elevated. A good thing, if you have Type II diabetes.
• They also slow the rate of absorption of nutrients into the blood stream by reducing gastric emptying and may directly reduce food intake. A good thing, if you have Type II
diabetes.
• Incretins also inhibit glucagon release from the alpha cells of the Islets of Langerhans. A good thing, if you have Type II diabetes.
Stress and Type II Diabetes
It is important to point out here that, when a body is under stress, it suppresses insulin production and increases glucagon, forcing all cells (except the brain, eyes, and reproductive organs) to convert fat into energy instead of using glucose. This leaves the available glucose for use by the brain, eyes, and reproductive organs.
When the body is under prolonged stress, a very common condition in modern society, DPP-4 degrades incretins, thus reducing available insulin and increasing glucagon secretion in order to respond appropriately to stress and maintain its sympathetic and endocrine cascades.
Consequently, if we wish to increase insulin production and combat Type II diabetes without exercising and changing our diets then we must turn off our ability to cope with stress and inhibit the destruction of the metabolic enzyme DPP-4, which, as listed above, is found on the surface of most cell types for the purpose of immune regulation, and for normal disposal of debris during the cellular renewal process (apoptosis). And let’s not forget signal transduction for enzyme activity within the cells. That means how the body is shifting its energy production from glucose to fat as it receives signals from the sympathetic and endocrine systems in response to stressful stimuli.
All this can be accomplished by the pharmaceutical drugs Januvia and Galvus presently being prescribed to combat Type II diabetes.
Side Effects of Januvia
Januvia is considered to be an improvement over other DPP-4 inhibitors because it offers fewer occurrences of hypoglycemia and less weight gain. Nevertheless, you are instructed to get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Patients are instructed to call their doctors at once if they develop fever, sore throat or headache and if severe blistering, peeling, and red skin rash occurs, since these could be signs of a serious side effect.
It is more likely that less threatening side effects will occur, such as: runny or stuffy nose, sore throat; headache; or nausea, stomach pain, and diarrhea. Patients may also show signs of low blood sugar, such as hunger, headache, confusion, irritability, drowsiness, weakness, dizziness, tremors, sweating, fast heartbeat, seizure (convulsions), fainting, or coma.
It sounds like changing the diet, increasing exercise, and reducing stress may be worth the effort.
Howard F. Loomis, Jr., DC, President of Enzyme Formulations®, Inc., has an extensive background in enzymes and enzyme supplementation. As president for fifteen years of 21st Century Nutrition® (now the Loomis Institute® of Enzyme Nutrition), he has forged a remarkable career as an educator, having conducted over 400 seminars to date, in the United States and internationally, on the diagnosis and treatment of food enzyme deficiency syndromes.
Dr. Loomis welcomes your comments or questions through the Loomis InstituteTM at 6421 Enterprise Lane, Madison, WI 53719 or by phone at 1-800-662-2630.