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ANTIDIABETIC AGENTS, SULFONYLUREA (Systemic)
Some commonly used brand names are:
In the U.S.—
Amaryl 4
DiaBeta 6
Diabinese 2
Dymelor 1
Glucotrol 5
Glucotrol XL 5
Glynase PresTab 6
Micronase 6
Orinase 8
Tolinase 7
In Canada—
Albert Glyburide 6
Apo-Chlorpropamide 2
Apo-Glyburide 6
Apo-Tolbutamide 8
DiaBeta 6
Diabinese 2
Diamicron 3
Dimelor 1
Euglucon 6
Gen-Glybe 6
Med Glybe 6
Novo-Butamide 8
Novo-Glyburide 6
Novo-Propamide 2
Nu-Glyburide 6
Orinase ௮
Another commonly used name for glyburide is glibenclamide .
Note:
For quick reference, the following sulfonylurea antidiabetic agents are numbered to match the corresponding brand names.
This information applies to the following medicines:
1. Acetohexamide (a-set-oh-HEX-a-mide)‡
2. Chlorpropamide (klor-PROE-pa-mide)‡§
3. Gliclazide (GLIK-la-zide)*
4. Glimepiride (GLYE-me-pye-ride)†
5. Glipizide (GLIP-i-zide)†
6. Glyburide (GLYE-byoo-ride)‡
7. Tolazamide (tole-AZ-a-mide)†‡
8. Tolbutamide (tole-BYOO-ta-mide)‡§
* Not commercially available in the U.S.
† Not commercially available in Canada
‡ Generic name product may be available in the U.S.
§ Generic name product may be available in Canada
Category
Antidiabetic—Acetohexamide; Chlorpropamide; Gliclazide; Glimepiride; Glipizide; Glyburide; Tolazamide; Tolbutamide
Antidiuretic—Chlorpropamide
Description
Sulfonylurea antidiabetic agents (also known as sulfonylureas) are used to treat a certain type of diabetes mellitus (sugar diabetes) called type 2 diabetes. When you have type 2 diabetes, insulin is still being produced by your pancreas. Sometimes the amount of insulin you produce may not be enough or your body may not be using it properly and you may still need more.
Sulfonylureas work by causing your pancreas to release more insulin into the blood stream. All of the cells in your body need insulin to help turn the food you eat into energy. This is done by using sugar (or glucose) in the blood as quick energy. Or the sugar may be stored in the form of fats, sugars, and proteins for use later, such as for energy between meals.
Sometimes insulin that is being produced by the body is not able to help sugar get inside the body's cells. Sulfonylureas help insulin get into the cells where it can work properly to lower blood sugar. In this way, sulfonylureas will help lower blood sugar and help restore the way you use food to make energy.
Many people with type 2 diabetes can control their blood sugar level with diet or diet and exercise alone. Following a diabetes diet plan and exercising will always be important with any type of diabetes. To work properly, the amount of sulfonylurea you use must be balanced against the amount and type of food you eat and the amount of exercise you do. If you change your diet, your exercise, or both, you will want to test your blood sugar level so that it does not drop too low (hypoglycemia) or rise too high (hyperglycemia). Your health care professional will teach you what to do if this happens.
Sometimes patients with type 2 diabetes might need to change to treatment with insulin for a short period of time during pregnancy or for a serious medical condition, such as diabetic coma; ketoacidosis; severe injury, burn, or infection; or major surgery. In these conditions, insulin and blood sugar can change fast and blood sugar can be best controlled with insulin instead of a sulfonylurea.
At some point, a sulfonylurea may stop working as well and your blood sugar level will go up. You will need to know if this happens and what to do. Instead of taking more of this medicine, your doctor may change you to another sulfonylurea. Or your doctor may have you inject small doses of insulin or take another oral antidiabetic medicine called metformin along with your sulfonylurea to help the insulin you make work better. If that does not bring down the amount of sugar in your blood, your doctor may have you stop taking the oral antidiabetic agents and begin receiving only insulin injections.
Chlorpropamide may also be used for other conditions as determined by your doctor.
Oral antidiabetic medicines do not help diabetic patients who have type 1 diabetes because these patients cannot produce or release insulin from their pancreas gland. Their blood sugar is best controlled by insulin injections.
Sulfonylureas are available only with your doctor's prescription, in the following dosage forms:
Oral
Acetohexamide
Tablets (U.S. and Canada)
Chlorpropamide
Tablets (U.S. and Canada)
Gliclazide
Tablets (Canada)
Glimepiride
Tablets (U.S.)
Glipizide
Tablets (U.S.)
Extended-release Tablets (U.S.)
Glyburide
Tablets (U.S. and Canada)
Micronized Tablets (U.S.)
Tolazamide
Tablets (U.S.)
Tolbutamide
Tablets (U.S. and Canada)
Before Using This Medicine
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For sulfonylurea medicines, the following should be considered:
Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to sulfonylureas, or to sulfonamide-type (sulfa) medicines, including thiazide diuretics (a certain type of water pill). Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.
Pregnancy—Sulfonylureas are rarely used during pregnancy. The amount of insulin you need changes during and after pregnancy. For this reason, it is easier to control your blood sugar using injections of insulin, rather than with the use of sulfonylureas. Close control of your blood sugar can reduce your chance of having high blood sugar during the pregnancy and of your baby gaining too much weight, or having birth defects. Be sure to tell your doctor if you plan to become pregnant or if you think you are pregnant. If insulin is not available or cannot be used and sulfonylureas are used during pregnancy, they should be stopped at least 2 weeks before the delivery date (one month before for chlorpropamide and glipizide). Glimepiride should not be used at all during pregnancy. Lowering of blood sugar can occur as a rebound effect at delivery and for several days following birth and will be watched closely by your health care professionals.
Breast-feeding—Chlorpropamide and tolbutamide pass into human breast milk and glimepiride passes into the milk of rats. Chlorpropamide is not recommended in nursing mothers but, in some cases, tolbutamide has been used. Nursing mothers should not take glimepiride. It is not known if other sulfonylureas pass into breast milk. Check with your doctor if you are thinking about breast-feeding.
Children—There is little information about the use of sulfonylureas in children. Type 2 diabetes is unusual in this age group.
Older adults—Some elderly patients may be more sensitive than younger adults to the effects of sulfonylureas, especially when more than one antidiabetic medicine is being taken or if other medicines that affect blood sugar are also being taken. This may increase your chance of developing low blood sugar during treatment. Furthermore, the first signs of low or high blood sugar are not easily seen or do not occur at all in older patients. This may increase the chance of low blood sugar developing during treatment.
Also, elderly patients who take chlorpropamide are more likely to hold too much body water.
Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Do not take any other medicine, unless prescribed or approved by your doctor . When you are taking sulfonylurea antidiabetic drugs, it is especially important that your health care professional know if you are taking any of the following:
Alcohol—When low blood sugar occurs, it may last longer than usual if more than a small amount of alcohol is taken, especially on an empty stomach. Small amounts of alcohol at mealtime usually do not cause problems with your blood sugar but may cause a redness (called flushing) in the face, arms, and neck that can be uncomfortable. This can occur with most of the sulfonylureas but is most likely to occur with chlorpropamide and has occurred up to 12 hours after alcohol was taken during chlorpropamide உஸ்
Anticoagulants (blood thinners)—The effect of either the blood thinner or the antidiabetic medicine may be increased or decreased if the two medicines are used together
Aspirin or other salicylates or
Azole antifungals (miconazole [e.g., Monistat I.V.], fluconazole [e.g., Diflucan]) or
Chloramphenicol (e.g., Chloromycetin) or
Cimetidine (e.g., Tagamet) or
Fluoroquinolones (ciprofloxacin [e.g., Cipro], enoxacin [e.g., Penetrex], lomefloxacin [e.g., Maxaquin], norfloxacin [e.g., Noroxin], ofloxacin [e.g., Floxin]) or
Quinidine (e.g., Quinidex) or
Quinine or
Ranitidine (e.g., Zantac)—These medicines may increase the chances of low blood sugar
Asparaginase (e.g., Elspar) or
Corticosteroids (cortisone-like medicine) or
Lithium (e.g., Lithonate) or
Thiazide diuretics (e.g., Dyazide)—These medicines may increase the chances of high blood sugar
Asthma medicines or
Cough or cold medicines or
Hay fever or allergy medicines—Many medicines (including nonprescription [over-the-counter] products) can affect the control of your blood சுகர்
Beta-adrenergic blocking agents (acebutolol [e.g., Sectral], atenolol [e.g., Tenormin], betaxolol [e.g., Kerlone], bisoprolol [e.g., Zebeta], carteolol [e.g., Cartrol], labetalol [e.g., Normodyne], metoprolol [e.g., Lopressor], nadolol [e.g., Corgard], oxprenolol [e.g., Trasicor], penbutolol [e.g., Levatol], pindolol [e.g., Visken], propranolol [e.g., Inderal], sotalol [e.g., Betapace], timolol [e.g., Blocadren])—Beta-adrenergic blocking agents may increase the chance that high or low blood sugar can occur. Also, they can hide symptoms of low blood sugar (such as fast heartbeat). Because of this, a person with diabetes might not recognize that he or she has low blood sugar and might not take immediate steps to treat it. Beta-adrenergic blocking agents can also cause low blood sugar to last longer than usual
Cyclosporine [e.g., Sandimmune]—Sulfonylureas can increase the effects of cyclosporine
Guanethidine (e.g., Ismelin) or
Monoamine oxidase (MAO) inhibitor activity (isocarboxazid [e.g., Marplan], isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], selegiline [e.g., Eldepryl], or tranylcypromine [e.g., Parnate])—Taking a sulfonylurea while you are taking (or within 2 weeks of taking) these medicines may increase the chances of low blood sugar occurring
Octreotide (e.g., Sandostatin) or
Pentamidine (e.g., Pentam)—Use of these medicines with sulfonylureas may increase the chance of either high or low blood sugar occurring
Other medical problems—The presence of other medical problems may affect the use of the sulfonylurea antidiabetic medicines. Make sure you tell your doctor if you have any other medical problems, especially:
Acid in the blood (acidosis) or
Burns (severe) or
Diabetic coma or
Fever, high or
Injury, severe or
Ketones in the blood (diabetic ketoacidosis) or
Surgery, major or
Any other condition in which insulin needs change rapidly—Insulin may be needed temporarily to control diabetes in patients with these conditions because changes in blood sugar may occur rapidly and without much warning; also, your blood sugar may need to be tested more often
Diarrhea, continuing or
Female hormone changes for some women (e.g., during puberty, pregnancy, or menstruation) or
Infection, severe or
Mental stress, severe or
Overactive adrenal gland, not properly controlled or
Problems with intestines, severe or
Slow stomach emptying or
Vomiting, continuing or
Any other condition that causes severe blood sugar changes—Insulin may be needed temporarily to control diabetes mellitus in patients with these conditions because changes in blood sugar may occur rapidly and without much warning; also, your blood sugar may need to be tested more often
Heart disease—Chlorpropamide or tolbutamide causes some patients to retain (keep) more body water than usual. Heart disease may be worsened by this extra body water
Kidney disease or
Liver disease—Your blood sugar may be increased or decreased, partly because of slower removal of sulfonylurea from the body; this may change the amount of sulfonylurea you need
Overactive thyroid, not properly controlled or
Underactive thyroid, not properly controlled—Your blood sugar may be increased or decreased, partly because the medicine may be removed from the body too fast or too slow. Until your thyroid condition is controlled, the amount of sulfonylurea you need may change. Also, your blood sugar may need to be tested more often
Underactive adrenal gland, not properly controlled or
Underactive pituitary gland, not properly controlled or
Undernourished condition or
Weakened physical condition or
Any other condition that causes low blood sugar—Patients with these conditions may be more likely to develop low blood sugar while taking sulfonylureas
Proper Use of This Medicine
Use this medicine only as directed even if you feel well and do not notice any signs of high blood sugar. Do not take more of this medicine and do not take it more often than your doctor ordered . To do so may increase the chance of serious side effects. Remember that this medicine will not cure your diabetes but it does help control it. Therefore, you must continue to take it as directed if you expect to lower your blood sugar and keep it low. You may have to take an antidiabetic medicine for the rest of your life . If high blood sugar is not treated, it can cause serious problems, such as heart failure, blood vessel disease, eye disease, or kidney disease.
Your doctor will give you instructions about diet, exercise, how to test your blood sugar levels, and how to adjust your dose when you are sick.
Diet—The daily number of calories in the meal plan should be adjusted by your doctor or a registered dietitian to help you reach and maintain a healthy body weight. In addition, regular meals and snacks are arranged to meet the energy needs of your body at different times of the day. It is very important that you follow your meal plan carefully .
Exercise—Ask your doctor what kind of exercise to do, the best time to do it, and how much you should do each day.
Blood tests—This is the best way to tell whether your diabetes is being controlled properly. Blood sugar testing helps you and your health care team adjust the dose of your medicine, meal plan, or exercise schedule.
On sick days—When you become sick with a cold, fever, or the flu, you need to take your usual dose of sulfonylurea, even if you feel too ill to eat. This is especially true if you have nausea, vomiting, or diarrhea. Infection usually increases your need to produce more insulin. Sometimes you may need to be switched from your sulfonylurea to insulin for a short period of time while you are sick to properly control blood sugar. Call your doctor for specific instructions.
Continue taking your sulfonylurea and try to stay on your regular meal plan. If you have trouble eating solid food, drink fruit juices, nondiet soft drinks, or clear soups, or eat small amounts of bland foods. A dietitian or your health care professional can give you a list of foods and the amounts to use for sick days.
Test your blood sugar level at least every 4 hours while you are awake and check your urine for ketones. If ketones are present, call your doctor at once. If you have severe or prolonged vomiting, check with your doctor. Even when you start feeling better, let your doctor know how you are doing.
For patients taking glipizide extended-release tablets :
Swallow the tablet whole, without breaking, crushing, or chewing it.
You may sometimes notice what looks like a tablet in your stool. Do not worry. After you swallow the tablet, the medicine in the tablet is absorbed inside your body. Then the tablet passes into your stool without changing its shape. The medicine has entered your body and will work properly.
Dosing—The dose of these medicines will be different for different patients. Follow your doctor's orders or the directions on the label . The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.
The number of tablets that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the amount of sugar in your blood or urine .
For acetohexamide
For oral dosage form (tablets):
For treating type 2 diabetes:
Adults—At first, 250 milligrams (mg) once a day. Some elderly people may need a lower dose at first. Then, your doctor may change your dose a little at a time if needed. The dose is usually not more than 1.5 grams a day. If your dose is 1 gram or more, the dose is usually divided into two doses. These doses are taken before the morning and evening meals.
Children—The type of diabetes treated with this medicine is rare in children. However, if a child needs this medicine, the dose would have to be determined by the doctor.
For chlorpropamide
For oral dosage form (tablets):
For treating type 2 diabetes:
Adults—At first, 250 milligrams (mg) once a day. Some elderly people may need a lower dose of 100 to 125 mg a day at first. Then, your doctor may change your dose a little at a time if needed. The dose is usually not more than 750 mg a day.
Children—The type of diabetes treated with this medicine is rare in children. However, if a child needs this medicine, the dose would have to be determined by the doctor.
For gliclazide
For oral dosage form (tablets):
For treating type 2 diabetes:
Adults—80 milligrams (mg) a day with a meal as a single dose or 160 to 320 mg divided into two doses taken with the morning and evening meals.
Children—The type of diabetes treated with this medicine is rare in children. However, if a child needs this medicine, the dose would have to be determined by the doctor.
For glimepiride
For oral dosage form (tablets):
For treating type 2 diabetes:
Adults:
Glimepiride alone: At first, 1 to 2 milligrams (mg) once a day with breakfast or the first main meal. The dose then may be increased by your doctor based on your blood sugar level.
Glimepiride with metformin: The usual dose is 8 mg once a day with breakfast or the first main meal.
Glimepiride with insulin: The usual dose is 8 mg once a day with breakfast or the first main meal.
Children—The type of diabetes treated with this medicine is rare in children. However, if a child needs this medicine, the dose would have to be determined by the doctor.
For glipizide
For oral dosage form (tablets):
For treating type 2 diabetes:
Adults—At first, 5 milligrams (mg) once a day. Some elderly people may need a lower dose of 2.5 mg a day at first. Then, your doctor may change your dose a little at a time if needed. The dose is usually not more than 40 mg a day. If your dose is 15 mg or more, the dose is usually divided into two doses. These doses are taken thirty minutes before the morning and evening meals.
Children—The type of diabetes treated with this medicine is rare in children. However, if a child needs this medicine, the dose would have to be determined by the doctor.
For oral dosage form (extended-release tablets):
For treating type 2 diabetes:
Adults—At first, 5 mg once a day with breakfast. Then, your doctor may change your dose a little at a time if needed. The dose is usually not more than 20 mg a day.
Children—The type of diabetes treated with this medicine is rare in children. However, if a child needs this medicine, the dose would have to be determined by the doctor.
For glyburide
For oral dosage form (nonmicronized tablets):
For treating type 2 diabetes:
Adults—At first, 2.5 to 5 milligrams (mg) once a day. Some elderly people may need a lower dose of 1.25 to 2.5 mg a day at first. Then, your doctor may change your dose a little at a time if needed. The dose is usually not more than 20 mg a day. If your dose is 10 mg or more, the dose usually is divided into two doses. These doses are taken with the morning and evening meals.
Children—The type of diabetes treated with this medicine is rare in children. However, if a child needs this medicine, the dose would have to be determined by the doctor.
For oral dosage form (micronized tablets):
For treating type 2 diabetes:
Adults—At first, 1.5 to 3 mg a day. Some elderly people may need a low dose of 0.75 to 3 mg a day at first. Then, your doctor may change your dose a little at a time if needed. The dose is usually not more than 12 mg a day. If your dose is 6 mg or more, the dose is usually divided into two doses. These doses are taken with the morning and evening meals. A single dose is taken with breakfast or with the first meal.
Children—The type of diabetes treated with this medicine is rare in children. However, if a child needs this medicine, the dose would have to be determined by the doctor.
For tolazamide
For oral dosage form (tablets):
For treating type 2 diabetes:
Adults—At first, 100 to 250 milligrams (mg) once a day in the morning. Then, your doctor may change your dose a little at a time if needed. The dose is usually not more than 1 gram a day. If your dose is 500 mg or more, the dose is usually divided into two doses. These doses are taken with the morning and evening meals.
Children—The type of diabetes treated with this medicine is rare in children. However, if a child needs this medicine, the dose would have to be determined by the doctor.
For tolbutamide
For oral dosage form (tablets):
For treating type 2 diabetes:
Adults—At first, 1000 to 2000 milligrams (mg) a day. Some elderly people may need lower doses to start. The dose is usually divided into two doses. These doses are taken before the morning and evening meals. Your doctor may change your dose a little at a time if needed. The dose is usually not more than 3000 mg a day.
Children—The type of diabetes treated with this medicine is rare in children. However, if a child needs this medicine, the dose would have to be determined by the doctor.
Missed dose—If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Storage—To store this medicine:
Keep out of the reach of children.
Store away from heat and direct light.
Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.
Precautions While Using This Medicine
Your doctor will want to check your progress at regular visits , especially during the first few weeks that you take this medicine.
It is very important to follow carefully any instructions from your health care team about :
Alcohol—Drinking alcohol may cause severe low blood sugar. Discuss this with your health care team.
Tobacco—If you have been smoking for a long time and suddenly stop, your dosage of sulfonylurea may need to be reduced. If you decide to quit, tell your doctor first.
Other medicines—Do not take other medicines unless they have been discussed with your doctor. This especially includes nonprescription medicines, such as aspirin, and medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems.
Counseling—Other family members need to learn how to prevent side effects or help with side effects in the patient if they occur. Also, patients with diabetes, especially teenagers, may need special counseling about sulfonylurea or insulin dosing changes that might occur because of lifestyle changes, such as changes in exercise and diet. Furthermore, counseling on contraception and pregnancy may be needed because of the problems that can occur in women with diabetes who become pregnant.
Travel—Carry a recent prescription and your medical history. Be prepared for an emergency as you would normally. Make allowances for changing time zones, and keep your meal times as close as possible to your usual meal times.
Protecting skin from sunlight—Sulfonylureas can make you more sensitive to the sun. Use of sunblock products that have a skin protection factor (SPF) of at least 15 on your skin and lips can help to prevent sunburn. Do not use a sunlamp or tanning bed or booth.
In case of emergency —There may be a time when you need emergency help for a problem caused by your diabetes. You need to be prepared for these emergencies. It is a good idea to:
Wear a medical identification (I.D.) bracelet or neck chain at all times. Also, carry an I.D. card in your wallet or purse that says that you have diabetes and a list of all of your medicines.
Keep some kind of quick-acting sugar handy to treat low blood sugar.
Have a glucagon kit and a syringe and needle available in case severe low blood sugar occurs. Check and replace any expired kits regularly.
Too much of a sulfonylurea can cause low blood sugar (also called hypoglycemia). Symptoms of low blood sugar must be treated before they lead to unconsciousness (passing out) . Different people may feel different symptoms of low blood sugar. It is important that you learn which symptoms of low blood sugar you usually have so that you can treat it quickly .
Symptoms of low blood sugar can include: anxious feeling, behavior change similar to being drunk, blurred vision, cold sweats, confusion, cool pale skin, difficulty in concentrating, drowsiness, excessive hunger, fast heartbeat, headache, nausea, nervousness, nightmares, restless sleep, shakiness, slurred speech, and unusual tiredness or weakness.
The symptoms of low blood sugar may develop quickly and may result from:
delaying or missing a scheduled meal or snack.
exercising more than usual.
drinking a significant amount of alcohol.
taking certain medicines.
taking too high a dose of sulfonylurea.
if using insulin, using too much insulin.
sickness (especially with vomiting or diarrhea).
Know what to do if symptoms of low blood sugar occur. Eating some form of quick-acting sugar when symptoms of low blood sugar first appear will usually prevent them from getting worse.
Good sources of sugar include:
Glucose tablets or gel, fruit juice or nondiet soft drink (4 to 6 ounces [one-half cup]), corn syrup or honey (1 tablespoon), sugar cubes (6 one-half-inch sized), or table sugar (dissolved in water).
Do not use chocolate because its fat slows down the sugar entering the bloodstream.
If a snack is not scheduled for an hour or more you should also eat a light snack, such as crackers or a half sandwich, or drink an 8-ounce glass of milk.
Glucagon is used in emergency situations such as unconsciousness. Have a glucagon kit available, along with a syringe and needle, and know how to prepare and use it. Members of your household also should know how and when to use it.
High blood sugar (hyperglycemia) is another problem related to uncontrolled diabetes. If you have any symptoms of high blood sugar, contact your health care team right away . If high blood sugar is not treated, severe hyperglycemia can occur, leading to ketoacidosis (diabetic coma) and death.
Symptoms of high blood sugar appear more slowly than those of low blood sugar. Symptoms can include: blurred vision; drowsiness; dry mouth; flushed and dry skin; fruit-like breath odor; increased urination; loss of appetite; stomachache, nausea, or vomiting; tiredness; troubled breathing (rapid and deep); and unusual thirst.
Symptoms of severe high blood sugar (called ketoacidosis or diabetic coma) that need immediate hospitalization include: flushed dry skin, fruit-like breath odor, ketones in urine, passing out, troubled breathing (rapid and deep).
High blood sugar symptoms may occur if you:
have a fever, diarrhea, or an infection.
if using insulin, do not take enough insulin or skip a dose of insulin.
do not exercise as much as usual.
overeat or do not follow your meal plan.
Know what to do if high blood sugar occurs. Your doctor may recommend changes in your sulfonylurea dose or meal plan to avoid high blood sugar. Symptoms of high blood sugar must be corrected before they progress to more serious conditions. Check with your doctor often to make sure you are controlling your blood sugar, but do not change the dose of your medicine without checking with your doctor . Your doctor might discuss the following with you:
Decreasing your dose for a short time for special needs, such as when you cannot exercise as you normally do.
Increasing your dose when you plan to eat an unusually large dinner, such as on holidays. This type of increase is called an anticipatory dose.
Delaying a meal if your blood sugar is over 200 mg/dL to allow time for your blood sugar to go down. An extra dose or an injection of insulin may be needed if your blood sugar does not come down shortly.
Not exercising if your blood sugar is over 240 mg/dL and reporting this to your doctor immediately.
Being hospitalized if ketoacidosis or diabetic coma occurs with a possible change of treatment.
Side Effects of This Medicine
The use of sulfonylurea antidiabetic agents has been reported, but not proven in all studies, to increase the risk of death from heart and blood vessel disease. Patients with diabetes are already more likely to have these problems if they do not control their blood sugar. Some sulfonylureas, such as glyburide and gliclazide, can have a positive effect on heart and blood vessel disease. It is important to know that problems can occur, but it is also not known if other sulfonylureas, particularly tolbutamide, help to cause these problems. It is known that if blood sugar is not controlled, such problems can occur.
Along with their needed effects, sulfonylureas may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Less common
Convulsions (seizures); unconsciousness
Also, check with your doctor as soon as possible if any of the following side effects occur:
More common
Low blood sugar, including anxious feeling, behavior change similar to being drunk, blurred vision, cold sweats, confusion, cool pale skin, difficulty in concentrating, drowsiness, excessive hunger, fast heartbeat, headache, nausea, nervousness, nightmares, restless sleep, shakiness, slurred speech, unusual tiredness or weakness; unusual weight gain
Less common
Peeling of skin; skin redness, itching, or rash
Rare
Chest pain; chills; coughing up blood; dark urine; fever; fluid-filled skin blisters; general feeling of illness; increased amounts of sputum (phlegm); increased sweating; light-colored stools; pale skin; sensitivity to the sun; shortness of breath; sore throat; thinning of the skin; unusual bleeding or bruising; unusual tiredness or weakness; yellow eyes or skin
Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:
More common
Changes in sense of taste; constipation; diarrhea; dizziness; increased amount of urine or more frequent urination; heartburn; increased or decreased appetite; passing of gas; stomach pain, fullness, or discomfort; vomiting
Less common or rare
Difficulty in focusing the eyes; increased sensitivity of skin to sun
For patients taking chlorpropamide or tolbutamide:
Rarely, some patients who take chlorpropamide may retain (keep) more body water than usual. This happens even less often with tolbutamide. Check with your doctor as soon as possible if any of the following signs occur:
Depression; swelling or puffiness of face, ankles, or hands
Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.
Additional Information
Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although this use is not included in product labeling, chlorpropamide is used in certain patients with the following medical condition:
Diabetes insipidus (water diabetes)
If you are taking this medicine for water diabetes, the advice listed above that relates to diet for patients with sugar diabetes does not apply to you . However, the advice about hypoglycemia (low blood sugar) does apply to you. Call your doctor right away if you feel any of the symptoms described.
Other than the above information, there is no additional information relating to its proper use, precautions, or side effects for this use.
Revised: 10/14/2004
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Monday, March 9, 2009
Sunday, March 8, 2009
how Metformin Hydrochloride acts
Here is how Metformin Hydrochloride acts. This is called glucopage in USA and Diabex in Australia
http://www.drugs.com/pdr/metformin-hydrochloride.html
Metformin hydrochloride
Generic name: Metformin hydrochloride
Brand names: Glucophage
Why is Metformin hydrochloride prescribed?
Glucophage is an oral antidiabetic medication used to treat type 2 (non-insulin-dependent) diabetes. Diabetes develops when the body proves unable to burn sugar and the unused sugar builds up in the bloodstream. Glucophage lowers the amount of sugar in your blood by decreasing sugar production and absorption and helping your body respond better to its own insulin, which promotes the burning of sugar. It does not, however, increase the body's production of insulin.
Glucophage is sometimes prescribed along with insulin or certain other oral antidiabetic drugs such as Micronase or Glucotrol. It is also used alone.
Standard Glucophage tablets are taken two or three times daily. An extended-release form (Glucophage XR) is available for once-daily dosing.
Always remember that Glucophage is an aid to, not a substitute for, good diet and exercise. Failure to follow a sound diet and exercise plan can lead to serious complications such as dangerously high or low blood sugar levels. Remember, too, that Glucophage is not an oral form of insulin and cannot be used in place of insulin.
Most important fact about Metformin hydrochloride
Glucophage could cause a very rare--but potentially fatal--side effect known as lactic acidosis. It is caused by a buildup of lactic acid in the blood. The problem is most likely to occur in people whose liver or kidneys are not working well, and in those who have multiple medical problems, take several medications, or have congestive heart failure. The risk also is higher if you are an older adult or drink alcohol. Lactic acidosis is a medical emergency that must be treated in a hospital. Notify your doctor immediately if you experience any of the following:
Symptoms of lactic acidosis may include:
Dizziness, extreme weakness or tiredness, light-headedness, low body temperature, rapid breathing or trouble breathing, sleepiness, slow or irregular heartbeat, unexpected or unusual stomach discomfort, unusual muscle pain
How should you take Metformin hydrochloride?
Do not take more or less of Metformin hydrochloride than directed by your doctor. The drug should be taken with food to reduce the possibility of nausea or diarrhea, especially during the first few weeks of therapy.
If taking Glucophage XR, be sure to swallow the tablet whole; do not crush it or chew it. The inactive ingredients in the tablet may occasionally appear in the stool. This is not a cause for concern.
--If you miss a dose...
Take it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Never take 2 doses at the same time.
--Storage instructions...
Store it at room temperature.
What side effects may occur?
Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Glucophage.
If side effects from Glucophage occur, they usually happen during the first few weeks of therapy. Most side effects are minor and will go away after you've taken Glucophage for a while.
More common side effects may include:
Abdominal discomfort, diarrhea, gas, headache, indigestion, nausea, vomiting, weakness
Why should Metformin hydrochloride not be prescribed?
Glucophage is processed primarily by the kidneys, and can build up to excessive levels in the body if the kidneys aren't working properly. It should be avoided if you have kidney disease or your kidney function has been impaired by a condition such as shock, blood poisoning, or a heart attack.
You should not use Glucophage if you need to take medicine for congestive heart failure.
Do not take Glucophage if you have ever had an allergic reaction to metformin.
Do not take Glucophage if you have metabolic or diabetic ketoacidosis (a life-threatening medical emergency caused by insufficient insulin and marked by excessive thirst, nausea, fatigue, pain below the breastbone, and fruity breath). Diabetic ketoacidosis should be treated with insulin.
Special warnings about Metformin hydrochloride
Before you start therapy with Glucophage, and at least once a year thereafter, your doctor will do a complete assessment of your kidney function. If you develop kidney problems while on Glucophage, your doctor will discontinue Metformin hydrochloride. If you are an older person, you will need to have your kidney function monitored more frequently, and your doctor may want to start you at a lower dosage.
You should not take Glucophage for 2 days before and after having an X-ray procedure (such as an angiogram) that uses an injectable dye. Also, if you are going to have surgery, except minor surgery, you should stop taking Glucophage. Once you have resumed normal food and fluid intake, your doctor will tell you when you can start drug therapy again.
Avoid drinking too much alcohol while taking Glucophage. Heavy drinking increases the danger of lactic acidosis and can also trigger an attack of low blood sugar.
Because poor liver function could increase the risk of lactic acidosis, your doctor may decide to check your liver function before prescribing Glucophage and periodically thereafter. If you develop liver problems, your doctor may stop treatment with Glucophage.
If you are taking Glucophage, you should check your blood or urine periodically for abnormal sugar (glucose) levels. Your doctor will do annual blood checks to see if Glucophage is causing a vitamin B12 deficiency or any other blood problem.
Glucophage does not usually cause hypoglycemia (low blood sugar). However, it remains a possibility, especially in older, weak, and undernourished people and those with kidney, liver, adrenal, or pituitary gland problems. The risk of low blood sugar increases when Glucophage is combined with other diabetes medications. The risk is also boosted by missed meals, alcohol, and excessive exercise. To avoid low blood sugar, you should closely follow the diet and exercise plan suggested by your doctor.
If your blood sugar becomes unstable due to the stress of a fever, injury, infection, or surgery, your doctor may temporarily take you off Glucophage and ask you to take insulin instead.
You should stop taking Glucophage if you become seriously dehydrated, since this increases the likelihood of developing lactic acidosis. Tell your doctor if you lose a significant amount of fluid due to vomiting, diarrhea, fever, or some other condition.
The effectiveness of any oral antidiabetic, including Glucophage, may decrease with time. This may occur because of either a diminished responsiveness to the medication or a worsening of the diabetes.
Possible food and drug interactions when taking Metformin hydrochloride
If Glucophage is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Glucophage with the following:
Amiloride (Moduretic)
Calcium channel blockers (heart medications) such as Calan, Isoptin, and Procardia
Cimetidine (Tagamet)
Decongestant, airway-opening drugs such as Sudafed and Ventolin
Digoxin (Lanoxin)
Estrogens such as Premarin
Furosemide (Lasix)
Glyburide (Micronase)
Isoniazid (Rifamate), a drug used for tuberculosis
Major tranquilizers such as Thorazine
Morphine
Niacin (Niaspan)
Nifedipine (Adalat, Procardia)
Oral contraceptives
Phenytoin (Dilantin)
Procainamide (Procanbid, Pronestyl)
Quinidine (Quinidex)
Quinine
Ranitidine (Zantac)
Steroids such as prednisone (Deltasone)
Thyroid hormones such as Synthroid
Triamterene (Dyazide, Dyrenium)
Trimethoprim (Bactrim, Septra)
Vancomycin (Vancocin)
Water pills (diuretics) such as HydroDIURIL, Dyazide, and Moduretic
Do not drink too much alcohol, since excessive alcohol consumption can cause low blood sugar and alcohol enhances some effects of Metformin hydrochloride.
Special information if you are pregnant or breastfeeding
If you are pregnant or plan to become pregnant, tell your doctor immediately. Glucophage should not be taken during pregnancy. Since studies suggest the importance of maintaining normal blood sugar (glucose) levels during pregnancy, your doctor may prescribe insulin injections instead.
It is not known whether Glucophage appears in human breast milk. Therefore, women should discuss with their doctors whether to discontinue the medication or to stop breastfeeding. If the medication is discontinued and if diet alone does not control glucose levels, then your doctor may consider insulin injections.
Recommended dosage
Your doctor will tailor your dosage to your individual needs.
ADULTS
Glucophage
The usual starting dose is one 500-milligram tablet twice a day, taken with morning and evening meals. Your doctor may increase your daily dose by 500 milligrams at weekly intervals, based on your response up to a total of 2,000 milligrams.
An alternative starting dose is one 850-milligram tablet a day, taken with the morning meal. Your doctor may increase this by 850 milligrams at 14-day intervals, to a maximum of 2,550 milligrams a day.
The usual maintenance dose ranges from 1,500 to 2,550 milligrams daily. If you take more than 2,000 milligrams a day, your doctor may recommend that the medication be divided into three doses, taken with each meal.
Glucophage XR
The usual starting dose is one 500-milligram tablet once daily with the evening meal. Your doctor may increase your dose by 500 milligrams at weekly intervals, up to a maximum dosage of 2,000 milligrams a day. If a single 2,000-milligram dose fails to control your blood sugar, you may be asked to take 1,000-milligram doses twice a day. If you need more than 2,000 milligrams a day, the doctor will switch you to regular Glucophage.
CHILDREN
Glucophage
For children 10 to 16 years old, the usual starting dose is one 500-milligram tablet twice a day with meals. The dosage may be increased by 500 milligrams at weekly intervals up to a maximum of 2,000 milligrams daily. Glucophage has not been tested in children younger than 10.
Glucophage XR
This form of the drug has not been tested in children younger than 17.
OLDER ADULTS
Older people and those who are malnourished or in a weakened state are generally given lower doses of Glucophage because their kidneys may be weaker, making side effects more likely.
Overdosage
An overdose of Glucophage can cause lactic acidosis (see "Most important fact about Metformin hydrochloride"). If you suspect a Glucophage overdose, seek emergency treatment immediately.
http://www.drugs.com/pdr/metformin-hydrochloride.html
Metformin hydrochloride
Generic name: Metformin hydrochloride
Brand names: Glucophage
Why is Metformin hydrochloride prescribed?
Glucophage is an oral antidiabetic medication used to treat type 2 (non-insulin-dependent) diabetes. Diabetes develops when the body proves unable to burn sugar and the unused sugar builds up in the bloodstream. Glucophage lowers the amount of sugar in your blood by decreasing sugar production and absorption and helping your body respond better to its own insulin, which promotes the burning of sugar. It does not, however, increase the body's production of insulin.
Glucophage is sometimes prescribed along with insulin or certain other oral antidiabetic drugs such as Micronase or Glucotrol. It is also used alone.
Standard Glucophage tablets are taken two or three times daily. An extended-release form (Glucophage XR) is available for once-daily dosing.
Always remember that Glucophage is an aid to, not a substitute for, good diet and exercise. Failure to follow a sound diet and exercise plan can lead to serious complications such as dangerously high or low blood sugar levels. Remember, too, that Glucophage is not an oral form of insulin and cannot be used in place of insulin.
Most important fact about Metformin hydrochloride
Glucophage could cause a very rare--but potentially fatal--side effect known as lactic acidosis. It is caused by a buildup of lactic acid in the blood. The problem is most likely to occur in people whose liver or kidneys are not working well, and in those who have multiple medical problems, take several medications, or have congestive heart failure. The risk also is higher if you are an older adult or drink alcohol. Lactic acidosis is a medical emergency that must be treated in a hospital. Notify your doctor immediately if you experience any of the following:
Symptoms of lactic acidosis may include:
Dizziness, extreme weakness or tiredness, light-headedness, low body temperature, rapid breathing or trouble breathing, sleepiness, slow or irregular heartbeat, unexpected or unusual stomach discomfort, unusual muscle pain
How should you take Metformin hydrochloride?
Do not take more or less of Metformin hydrochloride than directed by your doctor. The drug should be taken with food to reduce the possibility of nausea or diarrhea, especially during the first few weeks of therapy.
If taking Glucophage XR, be sure to swallow the tablet whole; do not crush it or chew it. The inactive ingredients in the tablet may occasionally appear in the stool. This is not a cause for concern.
--If you miss a dose...
Take it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Never take 2 doses at the same time.
--Storage instructions...
Store it at room temperature.
What side effects may occur?
Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Glucophage.
If side effects from Glucophage occur, they usually happen during the first few weeks of therapy. Most side effects are minor and will go away after you've taken Glucophage for a while.
More common side effects may include:
Abdominal discomfort, diarrhea, gas, headache, indigestion, nausea, vomiting, weakness
Why should Metformin hydrochloride not be prescribed?
Glucophage is processed primarily by the kidneys, and can build up to excessive levels in the body if the kidneys aren't working properly. It should be avoided if you have kidney disease or your kidney function has been impaired by a condition such as shock, blood poisoning, or a heart attack.
You should not use Glucophage if you need to take medicine for congestive heart failure.
Do not take Glucophage if you have ever had an allergic reaction to metformin.
Do not take Glucophage if you have metabolic or diabetic ketoacidosis (a life-threatening medical emergency caused by insufficient insulin and marked by excessive thirst, nausea, fatigue, pain below the breastbone, and fruity breath). Diabetic ketoacidosis should be treated with insulin.
Special warnings about Metformin hydrochloride
Before you start therapy with Glucophage, and at least once a year thereafter, your doctor will do a complete assessment of your kidney function. If you develop kidney problems while on Glucophage, your doctor will discontinue Metformin hydrochloride. If you are an older person, you will need to have your kidney function monitored more frequently, and your doctor may want to start you at a lower dosage.
You should not take Glucophage for 2 days before and after having an X-ray procedure (such as an angiogram) that uses an injectable dye. Also, if you are going to have surgery, except minor surgery, you should stop taking Glucophage. Once you have resumed normal food and fluid intake, your doctor will tell you when you can start drug therapy again.
Avoid drinking too much alcohol while taking Glucophage. Heavy drinking increases the danger of lactic acidosis and can also trigger an attack of low blood sugar.
Because poor liver function could increase the risk of lactic acidosis, your doctor may decide to check your liver function before prescribing Glucophage and periodically thereafter. If you develop liver problems, your doctor may stop treatment with Glucophage.
If you are taking Glucophage, you should check your blood or urine periodically for abnormal sugar (glucose) levels. Your doctor will do annual blood checks to see if Glucophage is causing a vitamin B12 deficiency or any other blood problem.
Glucophage does not usually cause hypoglycemia (low blood sugar). However, it remains a possibility, especially in older, weak, and undernourished people and those with kidney, liver, adrenal, or pituitary gland problems. The risk of low blood sugar increases when Glucophage is combined with other diabetes medications. The risk is also boosted by missed meals, alcohol, and excessive exercise. To avoid low blood sugar, you should closely follow the diet and exercise plan suggested by your doctor.
If your blood sugar becomes unstable due to the stress of a fever, injury, infection, or surgery, your doctor may temporarily take you off Glucophage and ask you to take insulin instead.
You should stop taking Glucophage if you become seriously dehydrated, since this increases the likelihood of developing lactic acidosis. Tell your doctor if you lose a significant amount of fluid due to vomiting, diarrhea, fever, or some other condition.
The effectiveness of any oral antidiabetic, including Glucophage, may decrease with time. This may occur because of either a diminished responsiveness to the medication or a worsening of the diabetes.
Possible food and drug interactions when taking Metformin hydrochloride
If Glucophage is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Glucophage with the following:
Amiloride (Moduretic)
Calcium channel blockers (heart medications) such as Calan, Isoptin, and Procardia
Cimetidine (Tagamet)
Decongestant, airway-opening drugs such as Sudafed and Ventolin
Digoxin (Lanoxin)
Estrogens such as Premarin
Furosemide (Lasix)
Glyburide (Micronase)
Isoniazid (Rifamate), a drug used for tuberculosis
Major tranquilizers such as Thorazine
Morphine
Niacin (Niaspan)
Nifedipine (Adalat, Procardia)
Oral contraceptives
Phenytoin (Dilantin)
Procainamide (Procanbid, Pronestyl)
Quinidine (Quinidex)
Quinine
Ranitidine (Zantac)
Steroids such as prednisone (Deltasone)
Thyroid hormones such as Synthroid
Triamterene (Dyazide, Dyrenium)
Trimethoprim (Bactrim, Septra)
Vancomycin (Vancocin)
Water pills (diuretics) such as HydroDIURIL, Dyazide, and Moduretic
Do not drink too much alcohol, since excessive alcohol consumption can cause low blood sugar and alcohol enhances some effects of Metformin hydrochloride.
Special information if you are pregnant or breastfeeding
If you are pregnant or plan to become pregnant, tell your doctor immediately. Glucophage should not be taken during pregnancy. Since studies suggest the importance of maintaining normal blood sugar (glucose) levels during pregnancy, your doctor may prescribe insulin injections instead.
It is not known whether Glucophage appears in human breast milk. Therefore, women should discuss with their doctors whether to discontinue the medication or to stop breastfeeding. If the medication is discontinued and if diet alone does not control glucose levels, then your doctor may consider insulin injections.
Recommended dosage
Your doctor will tailor your dosage to your individual needs.
ADULTS
Glucophage
The usual starting dose is one 500-milligram tablet twice a day, taken with morning and evening meals. Your doctor may increase your daily dose by 500 milligrams at weekly intervals, based on your response up to a total of 2,000 milligrams.
An alternative starting dose is one 850-milligram tablet a day, taken with the morning meal. Your doctor may increase this by 850 milligrams at 14-day intervals, to a maximum of 2,550 milligrams a day.
The usual maintenance dose ranges from 1,500 to 2,550 milligrams daily. If you take more than 2,000 milligrams a day, your doctor may recommend that the medication be divided into three doses, taken with each meal.
Glucophage XR
The usual starting dose is one 500-milligram tablet once daily with the evening meal. Your doctor may increase your dose by 500 milligrams at weekly intervals, up to a maximum dosage of 2,000 milligrams a day. If a single 2,000-milligram dose fails to control your blood sugar, you may be asked to take 1,000-milligram doses twice a day. If you need more than 2,000 milligrams a day, the doctor will switch you to regular Glucophage.
CHILDREN
Glucophage
For children 10 to 16 years old, the usual starting dose is one 500-milligram tablet twice a day with meals. The dosage may be increased by 500 milligrams at weekly intervals up to a maximum of 2,000 milligrams daily. Glucophage has not been tested in children younger than 10.
Glucophage XR
This form of the drug has not been tested in children younger than 17.
OLDER ADULTS
Older people and those who are malnourished or in a weakened state are generally given lower doses of Glucophage because their kidneys may be weaker, making side effects more likely.
Overdosage
An overdose of Glucophage can cause lactic acidosis (see "Most important fact about Metformin hydrochloride"). If you suspect a Glucophage overdose, seek emergency treatment immediately.
Dr. Shirish Kumar
http://www.doctorndtv.com/FAQ/detailfaq.asp?id=7978
Q. I am 37 years old. I am 6 feet 1 inch tall and weigh 100 kg. On a recent health check up, my blood sugar readings showed a fasting number of 139 mg/Deca Lt and a postprandial of 219. I also had a severe cold with a heavy head and profusely running nose that day. My blood pressure was 130-90, with normal ECG and TMT (with excellent tolerance for exercise); good cholesterol was 36, bad cholesterol was 161 and total cholesterol was 173. Doctor said that I am absolutely normal except that I have Type II diabetes and suggested Metaformin Hydrochloride (Glydimet) tablets 500 mg to be taken twice a day with a diabetic diet of 1400 calories. I walk briskly for 45 minutes everyday early in the morning and also walk for 10 minutes after every meal. Is it possible to revert to normal sugar levels with moderate exercise and strict diet regimen? Can I stop having tablets once my sugar levels are normal consistently for 3-4 weeks and continue only with my exercise and diet regimen? I have a fairly physically active life despite my high weight and used to exercise regularly in the past. I do not take soft drinks, junk food and I do not eat non-vegetarian food.
A. Diabetes is a chronic disorder caused by the inability of the body to either produce or properly utilise insulin, the hormone responsible for sugar metabolism. As a consequence, the blood sugar levels rise and persistent elevation affects blood vessels, eyes, kidneys, heart, nerves etc. Type 1 diabetes is an auto immune disease in which the body's immune system produces antibodies, which destroy the cells producing insulin in the pancreas. It has an acute onset and is usually seen in children. Due to absence of insulin, patients need lifelong insulin injections. Type 2 diabetes, in contrast, begins as a resistance of the body to the action of insulin. This necessitates increased insulin production but finally this decreases and diabetes develops. Type 2 diabetes is usually seen in adults and people who are overweight. But with increasing obesity, this is occurring more often in young people.
Criteria for diagnosis of diabetes:
Random blood glucose > 200 mg/dl* with symptoms (increased thirst, increased urination and unexplained weight loss)
Fasting blood glucose > 126 mg/dl*
2 h blood glucose > 200 mg/dl* following an oral challenge with 75 g glucose
* This should be repeated on another day to confirm
Treatment aims to maintain:
Hb A1C < 7 %
Fasting blood glucose 90 - 130 mg/dl
Peak post-prandial blood glucose < 180 mg/dl (usually 1-2 h following a meal)
Blood pressure < 130 / < 80 mmHg
LDL Cholesterol < 100 mg/dl
HDL Cholesterol Men > 40 mg/dl Women > 50 mg/dl
Triglycerides < 150 mg/dl
Healthy diet, increased physical activity and weight loss can prevent or delay diabetes and its complications. Lifestyle changes need to be individualised by tailoring the goals and targets to the patients preferences and progress. You need to discuss all this with your doctor before starting medication.
09 December 2005
Answered by
Dr. Shirish Kumar
DoctorNDTV.com
Q. I am 37 years old. I am 6 feet 1 inch tall and weigh 100 kg. On a recent health check up, my blood sugar readings showed a fasting number of 139 mg/Deca Lt and a postprandial of 219. I also had a severe cold with a heavy head and profusely running nose that day. My blood pressure was 130-90, with normal ECG and TMT (with excellent tolerance for exercise); good cholesterol was 36, bad cholesterol was 161 and total cholesterol was 173. Doctor said that I am absolutely normal except that I have Type II diabetes and suggested Metaformin Hydrochloride (Glydimet) tablets 500 mg to be taken twice a day with a diabetic diet of 1400 calories. I walk briskly for 45 minutes everyday early in the morning and also walk for 10 minutes after every meal. Is it possible to revert to normal sugar levels with moderate exercise and strict diet regimen? Can I stop having tablets once my sugar levels are normal consistently for 3-4 weeks and continue only with my exercise and diet regimen? I have a fairly physically active life despite my high weight and used to exercise regularly in the past. I do not take soft drinks, junk food and I do not eat non-vegetarian food.
A. Diabetes is a chronic disorder caused by the inability of the body to either produce or properly utilise insulin, the hormone responsible for sugar metabolism. As a consequence, the blood sugar levels rise and persistent elevation affects blood vessels, eyes, kidneys, heart, nerves etc. Type 1 diabetes is an auto immune disease in which the body's immune system produces antibodies, which destroy the cells producing insulin in the pancreas. It has an acute onset and is usually seen in children. Due to absence of insulin, patients need lifelong insulin injections. Type 2 diabetes, in contrast, begins as a resistance of the body to the action of insulin. This necessitates increased insulin production but finally this decreases and diabetes develops. Type 2 diabetes is usually seen in adults and people who are overweight. But with increasing obesity, this is occurring more often in young people.
Criteria for diagnosis of diabetes:
Random blood glucose > 200 mg/dl* with symptoms (increased thirst, increased urination and unexplained weight loss)
Fasting blood glucose > 126 mg/dl*
2 h blood glucose > 200 mg/dl* following an oral challenge with 75 g glucose
* This should be repeated on another day to confirm
Treatment aims to maintain:
Hb A1C < 7 %
Fasting blood glucose 90 - 130 mg/dl
Peak post-prandial blood glucose < 180 mg/dl (usually 1-2 h following a meal)
Blood pressure < 130 / < 80 mmHg
LDL Cholesterol < 100 mg/dl
HDL Cholesterol Men > 40 mg/dl Women > 50 mg/dl
Triglycerides < 150 mg/dl
Healthy diet, increased physical activity and weight loss can prevent or delay diabetes and its complications. Lifestyle changes need to be individualised by tailoring the goals and targets to the patients preferences and progress. You need to discuss all this with your doctor before starting medication.
09 December 2005
Answered by
Dr. Shirish Kumar
DoctorNDTV.com
Dr. Bernsteins books
Here is the link to Dr. Bernsteins books. The amazing story is that he was born in 1936 and has had diabetes since age 12.
He is an engineer who at age 43 decided to do medicine and then specialised in endocrinology. His conclusions are mostly based on personal experiences as an endocrinologist as well as a type 1 diabetic and very logical considering he is an engineer.
http://diabetes-normalsugars.com/readit.shtml
I have been meaning to order his books but have not got around to it yet.
He is an engineer who at age 43 decided to do medicine and then specialised in endocrinology. His conclusions are mostly based on personal experiences as an endocrinologist as well as a type 1 diabetic and very logical considering he is an engineer.
http://diabetes-normalsugars.com/readit.shtml
I have been meaning to order his books but have not got around to it yet.
Controlling Type 2 Diabetes Through Diet and Exercise
http://www.foxnews.com/story/0,2933,300120,00.html
Controlling Type 2 Diabetes Through Diet and Exercise
Monday, October 08, 2007
Heart Disease is still the No. 1 cause of death in the United States, but diabetes or dangerously high blood sugar levels, the No. 6 killer, is becoming more of a national concern.
The American Diabetes Association (ADA) reported that 21 million people, about 7 percent of the population, have diabetes. More than 90 percent have type 2, a combination of relative insulin deficiency and insulin resistance, a condition where the body fails to properly use insulin, according to the ADA.
Insulin, a hormone produced in the pancreas, is essential for converting sugar, starches, and other food into energy that the body draws upon for daily life.
The medical community has yet to pinpoint exactly why an individual develops diabetes, but holistic nutritionist, Luanne Pennesi said that pre-diabetes occurs when a person's blood glucose or sugar levels are higher than normal, which over time taxes the body, particularly the pancreas, and if not treated through diet and exercise can lead to multiple chronic diseases.
Overweight conditions, she said, can also contribute to the onset of diabetes, but can often be controlled with a low-fat, low carbohydrate diet and daily exercise.
"In time," said Pennesi, "high glucose or sugar levels can literally cut your life short and is the primary cause of new cases of blindness, renal disease, increased risk in heart disease, painful peripheral nerve damage and amputations."
Change of Life
According to Pennesi, there are many ways that individuals can control diabetes and continue to live a normal, long and fulfilling life.
"I have worked with many people who have changed their lifestyles for the better," she said. "One gentleman who was morbidly obese lost over 100 pounds in one year, and his blood sugar stabilized, his blood pressure is now normal, and he has a whole new lease on life. Now he teaches physical fitness to the blind in the five boroughs of New York City, something he never thought he would be doing."
Here are Pennesi's dietary tips for controlling diabetes:
— Eat lots of fresh organic veggies and fresh fruit that are either raw, sprouted, steamed, baked or stir-fried with little to no oil
— Drink water with a slice of lemon or lime, over sodas, sugary juices and sports drinks
— Munch on non-starchy veggies like spinach, broccoli and green beans
— Adopt a low carbohydrate diet by weaning out refined breads, pizza, pastas, cakes, cookies and candies
— Cut out all fried and fast foods
— Drink lots of fresh green vegetable juices to curb sugar cravings
— Eat healthy proteins like nuts, seeds, beans, lentils, veggie burgers, low mercury, wild caught fish and good quality protein powders for shakes
— Enjoy low glycemic foods like berries, lemons, limes, miso soup and squashes, which can be combined with any green vegetables and flavorful spices
— Choose whole grain foods over processed ones. For example, select brown rice instead of white rice with stir-fry or spelt, quinoa or brown rice spaghetti over the normal white flour and semolina-based variety
— Down-size your food portions
— Eliminate all high-calorie snacks.
When it comes to sweeteners, not all are created equal nor have the same effects on your blood sugar.
Pennesi warned that many people gravitate towards sweet things when feeling emotionally unstable, are looking for love or even when they are just plain bored. This often leads to over indulging in sweets, which can spike blood sugar levels.
However, substituting white sugar and high fructose corn syrup with natural and lower glycemic level sweeteners, allows people with diabetes, or pre-diabetes, to enjoy the sweeter things in life in moderation without compromising their health.
Pennesi's list of healthy alternative sweeteners:
— Stevia, a naturally sweet herb that is commonly found in health food stores in powder or liquid forms
— Agave, cactus nectar that resembles maple syrup, also found in most health food stores
— Xylitol, a naturally occurring sweetener found in the fibers of many fruits and vegetables that looks like typical white sugar
— Organic raw honey, which is readily found in most stores.
However, the most effective way to control diabetes is combining proper nutrition with daily exercise.
“Exercise is also very important, so be sure to integrate it into your daily routine, but make sure you have variety and be sure you are doing an exercise you enjoy," said Pennesi.
Controlling Type 2 Diabetes Through Diet and Exercise
Monday, October 08, 2007
Heart Disease is still the No. 1 cause of death in the United States, but diabetes or dangerously high blood sugar levels, the No. 6 killer, is becoming more of a national concern.
The American Diabetes Association (ADA) reported that 21 million people, about 7 percent of the population, have diabetes. More than 90 percent have type 2, a combination of relative insulin deficiency and insulin resistance, a condition where the body fails to properly use insulin, according to the ADA.
Insulin, a hormone produced in the pancreas, is essential for converting sugar, starches, and other food into energy that the body draws upon for daily life.
The medical community has yet to pinpoint exactly why an individual develops diabetes, but holistic nutritionist, Luanne Pennesi said that pre-diabetes occurs when a person's blood glucose or sugar levels are higher than normal, which over time taxes the body, particularly the pancreas, and if not treated through diet and exercise can lead to multiple chronic diseases.
Overweight conditions, she said, can also contribute to the onset of diabetes, but can often be controlled with a low-fat, low carbohydrate diet and daily exercise.
"In time," said Pennesi, "high glucose or sugar levels can literally cut your life short and is the primary cause of new cases of blindness, renal disease, increased risk in heart disease, painful peripheral nerve damage and amputations."
Change of Life
According to Pennesi, there are many ways that individuals can control diabetes and continue to live a normal, long and fulfilling life.
"I have worked with many people who have changed their lifestyles for the better," she said. "One gentleman who was morbidly obese lost over 100 pounds in one year, and his blood sugar stabilized, his blood pressure is now normal, and he has a whole new lease on life. Now he teaches physical fitness to the blind in the five boroughs of New York City, something he never thought he would be doing."
Here are Pennesi's dietary tips for controlling diabetes:
— Eat lots of fresh organic veggies and fresh fruit that are either raw, sprouted, steamed, baked or stir-fried with little to no oil
— Drink water with a slice of lemon or lime, over sodas, sugary juices and sports drinks
— Munch on non-starchy veggies like spinach, broccoli and green beans
— Adopt a low carbohydrate diet by weaning out refined breads, pizza, pastas, cakes, cookies and candies
— Cut out all fried and fast foods
— Drink lots of fresh green vegetable juices to curb sugar cravings
— Eat healthy proteins like nuts, seeds, beans, lentils, veggie burgers, low mercury, wild caught fish and good quality protein powders for shakes
— Enjoy low glycemic foods like berries, lemons, limes, miso soup and squashes, which can be combined with any green vegetables and flavorful spices
— Choose whole grain foods over processed ones. For example, select brown rice instead of white rice with stir-fry or spelt, quinoa or brown rice spaghetti over the normal white flour and semolina-based variety
— Down-size your food portions
— Eliminate all high-calorie snacks.
When it comes to sweeteners, not all are created equal nor have the same effects on your blood sugar.
Pennesi warned that many people gravitate towards sweet things when feeling emotionally unstable, are looking for love or even when they are just plain bored. This often leads to over indulging in sweets, which can spike blood sugar levels.
However, substituting white sugar and high fructose corn syrup with natural and lower glycemic level sweeteners, allows people with diabetes, or pre-diabetes, to enjoy the sweeter things in life in moderation without compromising their health.
Pennesi's list of healthy alternative sweeteners:
— Stevia, a naturally sweet herb that is commonly found in health food stores in powder or liquid forms
— Agave, cactus nectar that resembles maple syrup, also found in most health food stores
— Xylitol, a naturally occurring sweetener found in the fibers of many fruits and vegetables that looks like typical white sugar
— Organic raw honey, which is readily found in most stores.
However, the most effective way to control diabetes is combining proper nutrition with daily exercise.
“Exercise is also very important, so be sure to integrate it into your daily routine, but make sure you have variety and be sure you are doing an exercise you enjoy," said Pennesi.
Depression linked to neglect of diabetes
Depression linked to neglect of diabetes
By Michelle Rizzo
NEW YORK (Reuters Health) - In patients with type 2 diabetes, the adult on-set variety, depressive symptoms -- even if they do not meet criteria for major depressive disorder -- is associated with poor adherence to self-care, according to results of a study published in Diabetes Care.
Dr. Jeffrey S. Gonzalez, of Massachusetts General Hospital, Boston, and colleagues compared the effects of depression on 879 diabetic patients from two primary care clinics. The participants were surveyed using the Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS), the Summary of Diabetes Self-Care Activities, and self-reported medication adherence.
Overall, 19.3 percent of the patients met HANDS criteria for probable major depression (HANDS score at least 9) and 66.5 percent reported at least some depressive symptoms without meeting the criteria for probable major depression.
Only 14.2 percent of the subjects reported no depressive symptoms.
Of those with probable major depression, 59.4 percent had depression listed in their medical records, and 48.8 percent had been prescribed an antidepressant agent.
A significant association was observed between major depression and poorer adherence to diet, exercise, and glucose self-monitoring regimens after controlling for other health risk factors. Patients with major depression had a had 2.3-fold increased odds of missing medication doses in the previous week compared with the other subjects.
Among the 709 subjects who did not meet the criteria for major depression, "increasing HANDS scores were incrementally associated with poorer adherence to self-care behaviors," the investigators found.
"The presence of symptoms of depression in type 2 diabetes may hinder a patient's ability to adhere to their self-care routine," Gonzalez said in an interview with Reuters Health. "Depressive symptoms such as diminished interest, fatigue, concentration difficulties, and feelings of hopelessness could each interfere with the hard work that's involved in diabetes self-management."
"These patients might benefit from extra support or from a referral to psychological services, especially when their symptoms are impacting functioning or causing distress," Gonzalez added. "Since we know that depression in diabetes is associated with higher risks of complications, poorer diabetes control, and even increased mortality, it's really crucial to evaluate patients and offer appropriate treatment when necessary."
More generally, Gonzalez concluded, "Our findings suggest that decreased ability to adhere to one's medical regimen may be an important explanatory pathway through which depression affects health outcomes. Treating depression in the context of chronic illness may be an increasingly important role for mental health providers as rates of chronic illness continue to increase and evidence mounts for the harmful effects of depression in patients with chronic illness."
SOURCE: Diabetes Care, September 2007.
http://news.yahoo.com/s/nm/20071008/hl_nm/depression_diabetes_dc_1;_ylt=ApFI.k_b17poJUj50QmdeC1kMfQI
By Michelle Rizzo
NEW YORK (Reuters Health) - In patients with type 2 diabetes, the adult on-set variety, depressive symptoms -- even if they do not meet criteria for major depressive disorder -- is associated with poor adherence to self-care, according to results of a study published in Diabetes Care.
Dr. Jeffrey S. Gonzalez, of Massachusetts General Hospital, Boston, and colleagues compared the effects of depression on 879 diabetic patients from two primary care clinics. The participants were surveyed using the Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS), the Summary of Diabetes Self-Care Activities, and self-reported medication adherence.
Overall, 19.3 percent of the patients met HANDS criteria for probable major depression (HANDS score at least 9) and 66.5 percent reported at least some depressive symptoms without meeting the criteria for probable major depression.
Only 14.2 percent of the subjects reported no depressive symptoms.
Of those with probable major depression, 59.4 percent had depression listed in their medical records, and 48.8 percent had been prescribed an antidepressant agent.
A significant association was observed between major depression and poorer adherence to diet, exercise, and glucose self-monitoring regimens after controlling for other health risk factors. Patients with major depression had a had 2.3-fold increased odds of missing medication doses in the previous week compared with the other subjects.
Among the 709 subjects who did not meet the criteria for major depression, "increasing HANDS scores were incrementally associated with poorer adherence to self-care behaviors," the investigators found.
"The presence of symptoms of depression in type 2 diabetes may hinder a patient's ability to adhere to their self-care routine," Gonzalez said in an interview with Reuters Health. "Depressive symptoms such as diminished interest, fatigue, concentration difficulties, and feelings of hopelessness could each interfere with the hard work that's involved in diabetes self-management."
"These patients might benefit from extra support or from a referral to psychological services, especially when their symptoms are impacting functioning or causing distress," Gonzalez added. "Since we know that depression in diabetes is associated with higher risks of complications, poorer diabetes control, and even increased mortality, it's really crucial to evaluate patients and offer appropriate treatment when necessary."
More generally, Gonzalez concluded, "Our findings suggest that decreased ability to adhere to one's medical regimen may be an important explanatory pathway through which depression affects health outcomes. Treating depression in the context of chronic illness may be an increasingly important role for mental health providers as rates of chronic illness continue to increase and evidence mounts for the harmful effects of depression in patients with chronic illness."
SOURCE: Diabetes Care, September 2007.
http://news.yahoo.com/s/nm/20071008/hl_nm/depression_diabetes_dc_1;_ylt=ApFI.k_b17poJUj50QmdeC1kMfQI
Control diabetes with exercise
Control diabetes with exercise
Posted: Oct 2nd 2007 12:14PM by Lauren Greschner
Filed under: Fitness, General Health, Healthy Habits
Dealing with the symptoms of diabetes, along with treating the disease itself, can be an exhausting challenge. Those of you out there currently dealing with diabetes might be interested in this piece, which says that as little as 20 minutes a day of exercise can help raise energy levels, as well as deal with a number of the side-effects that come with the condition.
According to the information in the piece, daily physical activity can also increase whole-body insulin levels, lower A1C (blood glucose test) levels, and decrease the risk of developing cardiovascular disease and hypertension. Not bad for a short, brisk walk arond the block! And of course, any kind of regular activity is good for your body and mind as a whole, so if you're dealing with diabetes, finding time for a bit of exercise has numerous benefits.
Posted: Oct 2nd 2007 12:14PM by Lauren Greschner
Filed under: Fitness, General Health, Healthy Habits
Dealing with the symptoms of diabetes, along with treating the disease itself, can be an exhausting challenge. Those of you out there currently dealing with diabetes might be interested in this piece, which says that as little as 20 minutes a day of exercise can help raise energy levels, as well as deal with a number of the side-effects that come with the condition.
According to the information in the piece, daily physical activity can also increase whole-body insulin levels, lower A1C (blood glucose test) levels, and decrease the risk of developing cardiovascular disease and hypertension. Not bad for a short, brisk walk arond the block! And of course, any kind of regular activity is good for your body and mind as a whole, so if you're dealing with diabetes, finding time for a bit of exercise has numerous benefits.
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