GLP-1 And Other medications plus Specialist Doc

Agreed with having an Endo but let the Endo tell you what to taper off.

I still take metformin. Once your A1C drops, then Endo might suggest to stop Jardiance. The weightloss meds don’t always work. I tried Ozempic but switched to Mounjaro. Jardiance does 2 things, it manages sugar and protects your heart.

All of those medications have different biological pathways to manage glucose so the 3 have additive effects. Discuss with your doctor if still required or a lower dose is better. Most medications produce lower added benefit and higher side effects as the dose is increased so taking several drugs at a lower dose that attack the disease in different ways is beneficial. Sulfonylureas or Insulin can produce hypoglycemia when GLP-1s are added and DPP-4s (like Januvia) 100% overlaps with the GLP-1. Therefore, questioning the complete mix of drugs is always worthwhile. If cost is a concern, Dapagliflozin (generic Farxiga) acts on the same biological pathway and is about 10% of Jardiance's cost. The SGLT2s are also protective of kidney and heart function in addition to lowering glucose.

In answer to your the GP or Endo question I agree as a general rule. However, choice of the individual practitioner is more important. I have a GP that is versed in T2 Diabetes and provides good monitoring. I find it harder to get appointments and monitoring from endocrinologists, so I depend on a good GP and my own knowledge and research.

There are so many types of meds available now for help with diabetes, blood sugar control, weight management….. What you need depends on your health history, your goals, your eating & exercise habits plus so many other things. Keep in mind that meds and treatments interact with these other factors. I think it is best to find a provider who is willing to get to know you and work with you to customize a plan that will work best for you. I have found that I need several specialists and it helps me to have them all in the same healthcare system. It makes collaboration easier.

My case history started with extreme readings so I started with an endocrinologist on the job, though of course my PCP was involved too. My case was unusual, they thought I had LADA (Latent Autoimmune Diabetes in Adults), but it turns out I didn't. So I was on insulin for about 30 days then stopped and used Jardiance for 30 days and then stopped and have been just on metformin (and diet and exercise!!!) ever since. After about a year my insurance company wasn't even letting the endo run an A1C test in his office, and it was just metformin, and my A1C was below 5.7, so I decided it was time to just go with the PCP.

Many people with fairly serious type2 seem to get by with just the PCP. Now, I'm not sure if they're really getting great support and treatment there, but there it is.

So whether you should taper off this or that drug depends on your blood glucose and A1C numbers more than anything else. Of course discuss with your doctor, but it's really not rocket science!

I have Type 2 Diabetes and just switched from Ozempic to Mounjaro. I have been finding I have been finding my oral medications are either no longer effective or are less effective. The Mounjaro is very effective at managing my diabetes; my A1C is 6.0. I don't want to stop taking the shot, but am getting frustrated with my other oral prescriptions not working. The two I am having the most issue with are Trazodone (taken for sleep--getting to sleep quickly and staying asleep) and Tizanidine (I have MS and take it at night to relax muscles and cramping in my legs). I am currently on an oral antibiotic which also seems to be having a hard time kicking in to treat a UTI. Would appreciate insights/thoughts from anyone who has experienced this or who has knowledge!

@sistevens Both Ozempic and Mounjaro slow digestion. This increases the time an oral medication takes to enter the bloodstream while also decreasing the amount. Most medications are not affected enough to be noticeable. Contact your prescriber to see if adjustments should be made in the timing (time of day; with/without food) or dose to compensate for any medication you believe is no longer effective.

@jim18

I met with my doctor today. The two prescriptions I am having problems with are impacted by Mounjaro. My doctor doubled the amount I am taking for both drugs, starting tonight. Guess i will see--hopefully this will work! He is also having me take them earlier than I have been. I appreciate your feedback!