Tag: diabetes

Insulin Resistance Diet, Symptoms, Treatment, Reversal & Tests

Facts you should know about insulin resistance

Exercise may help prevent insulin resistance.
Exercise may help prevent insulin resistance.

  • Insulin resistance is usually part of the metabolic syndrome, and it has been associated with higher risk of developing heart disease.
  • Insulin resistance precedes the development of type 2 diabetes (T2D).
  • Causes of insulin resistance include both genetic (inherited) and lifestyle factors.
  • Insulin resistance lacks specific signs and symptoms.
  • Insulin resistance is associated with other medical conditions, including
  • Individuals are more likely to have insulin resistance if they have any of several associated medical conditions. They also are more likely to be insulin resistant if obese or of Latino, African-American, Native American, or Asian-American
    ancestry.
  • While genetic risk factors exist, insulin resistance can be managed with diet, exercise, and proper medication.
  • Measurements of fasting blood glucose and insulin levels test for
    insulin resistance.
  • Insulin resistance is treated by lifestyle modifications and in some cases, medications.
  • In some cases, insulin resistance cannot be prevented, yet modifiable risk factors include maintaining a healthy weight and getting regular exercise.

Type 2 Diabetes Symptoms and Warning Signs

This type of diabetes develops gradually, over years, so the signs and symptoms can seem subtle, and you might think it is something you “just have to live with.” If you are overweight or obese, this is the major symptom, but not everyone will be overweight. In fact, weight loss can be a symptom.

Other symptoms and signs include the following:

  • Excess thirst
  • Frequent urination
  • Fatigue
  • Blurry or cloudy vision
  • Wounds that won’t heal
  • Tingling or numbness in the feet
  • Erectile dysfunction (ED)
  • Dark skin under the armpits and around the groin

Learn more about the symptoms and warning signs of type 2 diabetes »

What is insulin resistance?

Insulin is a hormone produced by the beta cells of the pancreas, an organ near the stomach. Beta cells are scattered throughout the pancreas in small clusters known as the islets of Langerhans. The insulin produced is released into the blood stream and travels throughout the body. Insulin is an essential hormone with many actions within the body. Most actions of insulin are directed at metabolism (control) of carbohydrates (sugars and starches), lipids (fats), and proteins. Insulin also regulates functions of the body’s other cells, including their growth. Insulin is critical for the body’s use of glucose as energy.

Insulin resistance (IR) is a condition in which the body’s cells become resistant to the effects of insulin. That is, the normal response to a given amount of insulin is reduced. As a result, the pancreas must generate higher levels of insulin for insulin to have its proper effects. This resistance occurs in response to the body’s own insulin (endogenous) or insulin administered by injection (exogenous).

With insulin resistance, the pancreas produces more and more insulin. When the pancreas can no longer produce sufficient insulin for the body’s demands, then blood sugar rises. Insulin resistance is a risk factor for development of type 2 diabetes and heart disease.




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What are insulin resistance signs and symptoms?

There are no specific symptoms of insulin resistance. Certain conditions make a person more likely to develop insulin resistance (see section below, “Who is likely to develop insulin resistance?”)

What causes insulin resistance?

Among several causes for insulin resistance, genetic factors (inherited causes) are usually significant. Some medications can contribute to insulin resistance. In addition, insulin resistance is often seen with the following conditions:

Other causes of
insulin resistance or factors that may worsen it can include:

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Is insulin resistance prediabetes?

Type 2 diabetes mellitus (T2D) can occur with obesity at any age. Insulin resistance precedes the development of T2D, sometimes by years. In individuals who will ultimately develop T2D, research showed blood glucose and insulin levels are normal for many years, until at some point in time, insulin resistance develops.

High insulin levels are often associated with central obesity, cholesterol abnormalities, and/or high blood pressure (hypertension). When these disease processes occur together, it is called the metabolic syndrome.

One action of insulin is to cause the body’s cells (particularly the muscle and fat cells) to remove and use glucose from the blood. This is one way how insulin controls the glucose level in blood. Insulin binds to insulin receptors on the surfaces of cells. You can think of it as insulin “knocking on the doors” of muscle and fat cells. The cells hear the knock, open up, and let glucose in to be used. With insulin resistance, the muscles don’t hear the knock (they are resistant). So the pancreas is notified it needs to make more insulin, which increases the level of insulin in the blood and causes a louder knock.

Insulin resistance of cells continues to increase over time. As long as the pancreas is able to produce enough insulin to overcome this resistance, blood glucose levels remain normal. When the pancreas can no longer produce enough insulin, blood glucose levels begin to rise. Initially, this happens after meals — when glucose levels are at their highest and more insulin is needed — but eventually while fasting too (for example, upon waking in the morning). When blood sugar rises abnormally above certain levels, T2D is present.

What are normal insulin levels?

Exact values for normal or high insulin levels vary according to the laboratory and the type of test performed. With insulin resistance, fasting insulin level is high with normal to high fasting blood glucose level. High or elevated insulin levels can be seen with other medical conditions too, including

  • insulin-producing tumors (insulinomas),
  • Cushing syndrome, and
  • fructose or galactose intolerance.

What conditions are associated with insulin resistance?

Metabolic syndrome links insulin resistance with abdominal obesity, elevated cholesterol, and high blood pressure.
Several other medical conditions are specifically associated with insulin resistance. Insulin resistance may contribute to the following conditions:

Type 2 diabetes: Overt diabetes may be the first sign insulin resistance is present. Insulin resistance can be noted long before T2D develops. Individuals reluctant or unable to see a health care professional often seek medical attention after they have developed T2D.

Fatty liver: Fatty liver is strongly associated with insulin resistance. Accumulation of fat in the liver is a manifestation of the disordered control of lipids
occurring with insulin resistance. Fatty liver associated with insulin resistance may be mild or severe. Newer evidence suggests fatty liver may even lead to cirrhosis of the liver and, possibly, liver cancer.

Arteriosclerosis: Arteriosclerosis (also known as atherosclerosis) is a process of progressive thickening and hardening of the walls of medium-sized and large arteries. Arteriosclerosis is responsible for:

Other risk factors for arteriosclerosis include:

Skin lesions: Skin lesions include increased skin tags and a condition called acanthosis nigricans (AN). Acanthosis nigricans is a darkening and thickening of the skin, especially in folds such as the neck, under the arms, and in the groin. This condition is directly related to the insulin resistance, though the exact mechanism is not clear.

  • Acanthosis nigricans is a cosmetic condition strongly associated with insulin resistance.
    Here skin darkens and thickens in areas of skin creases (for example, the neck, armpits, and groin).
  • Skin tags occur more frequently in patients with insulin resistance. A skin tag is a common, benign condition where a bit of skin projects from the surrounding skin. Skin tags vary significantly in appearance. A skin tag may appear smooth or irregular, flesh-colored or darker than surrounding skin. A tag may be either simply raised above surrounding skin or attached by a stalk (peduncle) so that it hangs from the skin.

Picture of skin tagsPicture of skin tags on an adult armpitPicture of skin tags on the eyelid

Polycystic ovary syndrome (PCOS): Polycystic ovary syndrome is a common hormonal problem which affects menstruating women. It is associated with irregular periods or no periods at all (amenorrhea), obesity, and increased body hair in a male pattern of distribution (called hirsutism; for example, moustache, sideburns, beard, mid-chest, and central belly hair).

Hyperandrogenism: With PCOS, the ovaries can produce high levels of the hormone testosterone. This high testosterone level can be seen with insulin resistance and may play a role in causing PCOS. Why this association occurs is unclear, but it appears the insulin resistance somehow causes abnormal ovarian hormone production.

Growth abnormalities: High levels of circulating insulin can affect growth. While insulin's effects on glucose metabolism may be impaired, its effects on other mechanisms may remain intact (or at least less impaired). Insulin is an anabolic hormone which promotes growth. Patients may actually grow larger with a noticeable coarsening of features. Children with open growth plates in their bones may actually grow faster than their peers. However, neither children nor adults with insulin resistance become taller than predicted by their familial growth pattern. Indeed, most adults simply appear larger with coarser features. The increased incidence of
acanthosis nigricans or skin tags mentioned earlier may also occur through this
mechanism.

Reproductive abnormalities in women

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Who is more likely to develop insulin resistance?

An individual is more likely to have or develop insulin resistance if he or she:

  • Is overweight with a body mass index (BMI)
    above 25 kg/m2. You can calculate your BMI by taking your weight (in kilograms) and dividing twice by your height (in meters).
  • Is a man with a waist more than 40 inches or a woman with a waist more than 35 inches
  • Is over 40 years of age
  • Has a blood pressure reading of 130/80 or higher
  • Is of Latino, African American, Native American, or Asian American ancestry
  • Has close family members who have type 2 diabetes, high blood pressure, or arteriosclerosis
  • Has had gestational diabetes
  • Has a history of high blood pressure, high blood triglycerides, low HDL cholesterol, arteriosclerosis (or other components of the metabolic syndrome)
  • Has polycystic ovarian syndrome (PCOS)
  • Displays acanthosis nigricans
  • Has a fasting glucose level over 100 mg/dL
  • Has a fasting triglyceride level over 150 mg/dL
  • Has an HDL cholesterol level under 40 mg/dL in men and 50 mg/dL in women

Which specialties of doctors treat insulin resistance?

Insulin resistance may be treated by primary care professionals, including
internists, family doctors, or pediatricians. Endocrinologists specialize in
hormonal disorders and treat patients with insulin resistance.

Is there a test to diagnose insulin resistance?

A health care professional can identify individuals likely to have insulin resistance by taking a detailed history, performing a physical examination, and simple laboratory testing based on individual risk factors.

In general practice, the fasting blood glucose and insulin levels are usually adequate to determine whether insulin resistance and/or diabetes is present. The exact insulin level for diagnosis varies by assay (by laboratory). However, a fasting insulin level above the upper quartile in a non-diabetic patient is considered abnormal.

Is it possible to reverse insulin resistance?

Management of insulin resistance is through lifestyle changes (such as diet, exercise, and disease prevention) and medications. Weight loss may help reverse insulin resistance along with and taking small steps, such as exercising and eating healthier foods. It also can prevent or delay type 2 diabetes in people with prediabetes.

Is there a special diet meal plan to treat insulin resistance?

The need for insulin can be reduced by altering the diet, particularly the carbohydrates in the diet. Carbohydrates are absorbed into the body as they are broken up into their component sugars.
High glycemic index refers to some carbohydrates that break down and absorb faster than others. These carbohydrates increase the blood glucose level more rapidly and require the secretion of more insulin to control the level of glucose in the blood.

Examples of carbohydrates with a high glycemic index that rapidly raise blood glucose levels include:

  • Unrefined sugars (such as fruit juice and table sugar)
  • White bread
  • Unrefined corn and potato products (such as bagels, mashed potatoes, doughnuts, corn chips, and French fries)

Examples of foods with a low glycemic index include:

  • Foods with higher fiber content (such as whole grain breads and brown rice)
  • Non-starchy vegetables (such as broccoli, green beans, asparagus, carrots, and greens). These are low in calories and in total carbohydrates, and contain vitamins and fiber.

Since foods are rarely eaten in isolation, one could argue that the glycemic index of each food is less important than the overall profile of the whole meal and associated drinks.

What foods help prevent type 2 diabetes?

Foods that are particularly helpful for people trying to prevent type 2 diabetes and maintain a healthy weight are similar to the low glycemic index foods described above:

  • Vegetables and fruits provide fiber and vitamins.
  • Fat-free or low-fat dairy products provide calcium and strengthen bones. Avoid full-fat dairy products, as high-fat foods can worsen insulin resistance.
  • Whole-grain products have a lower glycemic index than refined grains and are rich in fiber.
  • Nuts contain fiber, protein, and healthy fats.
  • Some fish can be a source of “good” (heart-healthy) fats, such as salmon, herring, mackerel, or sardines.
  • Lean meats or beans are an excellent source of protein.

Several studies have confirmed that weight loss — and even aerobic exercise without weight loss — increases the rate at which muscle cells take glucose from the blood as a result of improved sensitivity
to insulin.

Can exercise reduce the development of type 2 diabetes?

Multiple studies have shown that diet and exercise reduce the development of type 2 diabetes and can reduce insulin resistance.

What medications treat insulin resistance?

Metformin (Glucophage) is a medication used for treating type 2
diabetes. It exerts two actions to help control blood glucose levels. Metformin prevents the liver from releasing glucose into the blood, and it
also increases the sensitivity of muscle and fat cells to insulin, allowing them to remove more glucose from the blood. By these actions, metformin lowers blood insulin levels because lower blood sugar levels tell the pancreas to put out less insulin.

Metformin is a reasonably safe medication when used in the proper population.
Though occasionally associated with gastrointestinal side effects, metformin is usually well tolerated. While no FDA-approved drugs
exist to prevent type 2 diabetes or to treat pre-type 2 diabetes (insulin resistance), the American Diabetes Association has recommended that metformin be the only drug considered for the prevention of type 2 diabetes.

Is it possible to prevent insulin resistance?

It’s not always possible to prevent insulin resistance, but there are ways to modify risk factors, such as keeping a healthy weight and getting regular exercise.

What is the prognosis for insulin resistance?

Insulin resistance is associated with the development of type 2 diabetes. Effective measures can reverse insulin resistance. Weight loss, eating a healthy diet, not smoking, adequate sleep, and exercise can all help reverse insulin resistance.

What new research is being conducted on insulin resistance?

Insulin resistance has gained awareness and significance, in its own right, as a contributor to the metabolic syndrome. Timely intervention can delay the onset of overt type 2 diabetes. Future studies must assess longer intervals than
existing research to determine the duration for treatment to prevent the development of type 2 diabetes and related complications.

Lifestyle changes (in nutrition and physical activity) are clearly important to delay the development of type 2 diabetes in individuals with insulin resistance.
Lifestyle changes are the primary recommendation for prevention of diabetes in high-risk individuals. Metformin is the only drug recommended by guidelines for patients at highest risk. Education about these changes must be directed to all groups at risk for type 2 diabetes. Childhood obesity is epidemic and on the rise in developed countries. Changes must be made in homes and school cafeterias to ensure healthier nutrition.

What Is a High Insulin Level?

Insulin is a hormone (a chemical substance that acts as a messenger in the human body) that is secreted by an abdominal organ called the pancreas. High insulin levels are levels of the hormone that are higher than they should be after ingesting glucose.
Insulin is a hormone (a chemical substance that acts as a messenger in the human body) that is secreted by an abdominal organ called the pancreas. High insulin levels are levels of the hormone that are higher than they should be after ingesting glucose.

Insulin is a hormone (a chemical substance that acts as a messenger in the human body) that is secreted by an abdominal organ called the pancreas. It controls the breakdown of carbohydrates, fats and proteins in the body. It also guides the liver and muscles to store glucose and fat that can be used during periods of increased energy requirements and fasting. Insulin is a “key” that unlocks the cell gates so that glucose from the blood enters the cells. The cells of the muscle and fat tissue are dependent solely on insulin for glucose uptake and use.

The lack of insulin in the body or inefficient insulin action at cellular levels causes blood sugar levels to spike (hyperglycemia). Hyperglycemia is the hallmark of diabetes mellitus. Insulin is the only hormone in the body that can prevent hyperglycemia.

Hyperinsulinemia: Some individuals require higher than normal amounts of insulin to maintain their blood sugar levels. This condition is called hyperinsulinemia. It is often found to co-exist with insulin resistance.

Insulin resistance is a state in which a given insulin concentration does not cause an expected dip in blood sugar levels. Insulin resistance may be caused by

  • Antibodies to insulin or to the site in the cell where insulin binds (seen in autoimmune diseases such as systemic lupus erythematosus and Hashimoto’s thyroiditis).
  • Suboptimal quality insulin (less effective insulin) as seen in people with certain genetic diseases.
  • Genetic tendency to insulin resistance as seen in the people of Latino, African American, Native American or Asian-American heritage.

Certain conditions may cause temporary insulin resistance and resultant hyperinsulinemia, but as soon as the underlying cause is corrected, insulin resistance goes away. These conditions include long-term stress, infections, long-term sleep deprivation, obesity and pregnancy. These conditions release the stress hormones in the body. Stress hormones are a known cause of insulin resistance and high insulin levels.

The other causes of high insulin levels that may need medical intervention are as follows.

Compensatory hyperinsulinemia       
 

  • Prediabetic state
  • Type II diabetes mellitus

Metabolic syndrome

Metabolic syndrome is a cluster of multiple maladies including

  • High blood pressure
  • High blood sugar
  • Excess body fat around the waist
  • High insulin levels
  • Abnormal cholesterol levels

Drugs

  • Steroids
  • Over treatment of diabetes with insulin

Genetic

  • Congenital hyperinsulinism (mutation in the insulin-secreting gene)

Tumors of insulin-secreting cells

  • Insulinomas
  • Nesidioblastosis

Hormonal disorders

  • Polycystic ovarian disease
  • Acromegaly
  • Cushing’s syndrome
  • Hypothyroidism 

High insulin levels often have no clinical symptoms and may go undetected. Rarely, they may cause recurrent low blood sugar, which may be seen as palpitations, irritability, sweating and hunger pangs. Some individuals with long-standing insulin resistance may develop skin tags over the neck and armpits. Others may have dark underarms and groins (acanthosis nigricans).

What are normal insulin levels?

Insulin levels in the blood can be interpreted using a simple blood test that is performed after eight hours of fasting. This test must be performed in individuals with suspected insulin resistance or as a part of a hormonal panel in metabolic syndrome evaluation.

The normal values of insulin are as follows.

         Insulin level     
             Insulin level (SI units*)      
      Values in pmol/L            

Fasting
<25 mIU/L
<174 pmol/L

30 minutes after glucose administration
30-230 mIU/L
208-1,597 pmol/L

1 hour after glucose administration
18-276 mIU/L
125-1,917 pmol/L

2 hours after glucose administration
16-166 mIU/L
111-1,153 pmol/L

≥3 hours after glucose administration
<25 mIU/L
<174 pmol/L

What are the consequences of high insulin levels?

The following are the consequences of high insulin levels:

  • High insulin levels generally translate into an overworked pancreas. This may be followed by the exhaustion of the pancreatic cells, resulting in the development of diabetes mellitus.
  • Diabetes further brings on complications such as heart disease, nerve damage, eye damage and kidney damage.
  • High insulin levels have been linked to the development of certain cancers such as cancer of the gut, although it is not proven conclusively.
  • Non-alcoholic fatty liver disease (NAFLD) is a dysfunction of the liver due to increased fat deposition inside the organ. It is seen in individuals with insulin resistance.
  • High insulin levels hasten plaque buildup in the large blood vessels causing atherosclerosis (blockages).
  • High levels of insulin affect the estrogen-progesterone ratio in the ovaries and may result in polycystic ovarian syndrome (PCOS) that may cause irregular periods and infertility in young women.

10 High Blood Sugar Symptoms, Signs, Causes, and Treatment

Bottle of diabetes indicator strips for blood glucose testing.
Bottle of diabetes indicator strips for blood glucose testing. Hyperglycemia is a hallmark sign of diabetes (both type 1 diabetes and type 2 diabetes) and prediabetes, and diabetes is the most common cause of it.Source: Getty Images

High blood sugar (hyperglycemia) facts

  • Low high blood sugar (hyperglycemia) is abnormally high blood levels of insulin in the blood. Hyperglycemia is a hallmark sign of diabetes (both type 1 diabetes and type 2 diabetes) and prediabetes, and diabetes is the most common cause of it. Severely elevated glucose levels can result in a medical emergency like diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNS, also referred to as hyperglycemic hyperosmolar state).
  • The primary symptom of hyperglycemia is excessive amounts of sugar (glucose) in the urine. Other symptoms and signs of high blood sugar levels in the blood are blurred vision, hunger ("hangry"), and headaches.
  • Other conditions that can cause high blood sugar are pancreatitis, Cushing's syndrome, unusual hormone-secreting tumors, pancreatic cancer, certain medications, and severe illnesses.
  • Insulin is the treatment for people with type 1 diabetes, and life-threatening increases in glucose levels. People with type 2 diabetes may be managed with a combination of different oral and injectable medications. Hyperglycemia due to medical conditions other than diabetes is generally treated by treating the underlying condition responsible for the elevated glucose.

Diabetes Emergencies Need to Be Resolved Quickly

Diabetic Ketoacidosis Symptoms

People with diabetes don’t have the luxury of that auto-sensing. Not enough insulin and the glucose levels in the
blood stream start to rise; too much insulin, and they plummet.

The consequences of hypoglycemia are easy to understand. No energy source, no function – and the first organ to go
is the brain. It needs glucose to function and without it, the brain shuts down
quickly. Confusion, lethargy, and coma occur quickly. Blood sugar is one of the first things checked on scene of a comatose
patient, because it’s so easy to fix and very embarrassing for an EMT to miss.

Read more about diabetic ketoacidosis symptoms »

Glycemia collage consisting of a finger prick, blood drop in a reactive strip and a glucometer with a correct value.
Normal ranges for blood glucose measurements can vary slightly among different laboratories, but in general, a fasting (early a.m. before breakfast) glucose level is considered normal if it is between 70-100 mg/dL.Source: iStock

What is high blood sugar?

Hyperglycemia is the medical term describing an abnormally high blood glucose (blood sugar) level. Blood sugar is measured in a sample of blood taken from a vein or from a small finger stick sample of blood. It can be measured in a laboratory either alone or with other blood tests, or it can be measured using a handheld glucometer, a small device that allows frequent monitoring of blood glucose levels without the need for a doctor's office or laboratory.

Hyperglycemia or high blood sugar is a hallmark sign of diabetes (both type 1 diabetes and type 2 diabetes) and prediabetes. Normal ranges for blood glucose measurements can vary slightly among different laboratories, but in general a fasting (early a.m. before breakfast) glucose level is considered normal if it is between 70-100 mg/dL. Glucose levels may rise slightly above this range following a meal. Random blood glucose measurements are usually lower than 125 mg/dL.

MedicineNet
10 Symptoms and signs of high blood sugar are headaches, tiredness, blurred vision, hunger, trouble with thinking and concentrating, and frequent urination.Source: MedicineNet

10 Symptoms and signs of high blood sugar

The main symptoms of hyperglycemia are increased thirst and a frequent need to urinate. Other symptoms that can occur with high blood sugar are:

  1. Headaches.
  2. Tiredness.
  3. Blurred vision.
  4. Hunger.
  5. Trouble with thinking or concentrating.
  6. Frequent urination

Other symptoms and signs of high blood sugar include:

  1. Sunburns. Pain from a sunburn causes pain, which increases blood sugars.
  2. Coffee. Some people with diabetes have an extra sensitivity to caffeine.
  3. Gum disease. Gum disease is a complication of diabetes, and can make blood sugars rise.
  4. Loosing sleep. Going a night or two without sleeping can cause the body to use insulin less efficiently.

Nose spray. Some nasal sprays have chemicals that trigger the liver to make more blood sugar.

Severely elevated blood sugar levels can result in a medical emergency ("diabetic coma"). This can occur in both people with type 1 and those with type 2 diabetes. People with type 1 diabetes may develop diabetic ketoacidosis (DKA), and those with type 2 diabetes can develop hyperglycemic hyperosmolar nonketotic syndrome (HHNS, also referred to as hyperglycemisa hyperosmolar state). These so-called hyperglycemia crises are serious conditions that can be life threatening if not treated immediately. Hyperglycemic crises cause about 2,400 deaths each year in the U.S.

Over time, hyperglycemia can lead to damage to organs and tissues. Long-term hyperglycemia can impair the immune response, leading to poor healing of cuts and wounds. It can also cause nerve damage, vision problems, and damage to the blood vessels and kidneys (see below).

White hexagons in the blood represent glucose molecules which increase as a result of hyperglycemia.
Sometimes, high blood sugar is not the result of diabetes. Other medical conditions that can cause the condition include pancreatitis, pancreatic cancer, hyperthyroidism, dushing’s syndrome, unusual tumors, stress, and medications.Source: iStock

What causes high blood sugar?

A number of medical conditions can cause hyperglycemia, but the most common by far is diabetes mellitus. Diabetes affects over 8% of the total U.S. population. In diabetes, blood glucose levels rise either because there is an insufficient amount of insulin in the body or the body cannot use insulin well. Normally, the pancreas releases insulin after a meal so that the cells of the body can utilize glucose for fuel. This keeps blood glucose levels in the normal range.

Type 1 diabetes is responsible for about 5% of all cases of diabetes and results from damage to the insulin-secreting cells of the pancreas. Type 2 diabetes is far more common and is related to the body's inability to effectively use insulin. In addition to type 1 and type 2, gestational diabetes is a form of diabetes that develops in pregnant women. Studies show that between 2% to 10% of all pregnant women get gestational diabetes.

Sometimes, high blood sugar is not the result of diabetes. Other medical conditions that can cause the condition include:




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Diabetes is defined best as…
See Answer

A nurse collects finger blood specimens to test blood glucose levels.
A nurse collects finger blood specimens to test blood glucose levels.Source: iStock

How is high blood sugar diagnosed?

There are different kinds of blood tests that can diagnose hyperglycemia. These include:

Random blood glucose: this test reflects the blood sugar level at a given point in time. Normal values are generally between 70 and 125 mg/dL, as discussed earlier.

Fasting blood glucose: this is a measurement of blood sugar level taken in the early morning prior to eating or drinking anything since the night before. Normal fasting blood glucose levels are less than 100 mg/dL. Levels above 100 mg/dL up to 125 mg/dL suggest prediabetes, while levels of 126 mg/dL or above are diagnostic of diabetes.

Oral glucose tolerance test: this is a test that measures blood glucose levels at given time points after a dose of sugar is consumed. This test is most commonly used to diagnose gestational diabetes.

Glycohemoglobin A1c: is a measurement of glucose that is bound to red blood cells and provides an indication about blood sugar levels over the past 2 to 3 months.

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A healthcare professional discussing diet and showing a diabetic patient new technology for monitoring blood glucose levels on a smartphone or handheld device.
A healthcare professional discussing diet and showing a diabetic patient new technology for monitoring blood glucose levels on a smartphone or handheld device.Source: iStock

What is the treatment for high blood sugar?

Mild or transient hyperglycemia may not need medical treatment, depending upon the cause. People with mildly elevated glucose or prediabetes can often lower their glucose levels by incorporating diet and lifestyle changes. Discuss any dietary or lifestyle changes with your healthcare team to assure or use reliable resources such as the American Diabetes Association.

Insulin is the treatment of choice for people with type 1 diabetes and for life-threatening increases in glucose levels. People with type 2 diabetes may be managed with a combination of different oral and injectable medications. Some people with type 2 diabetes also take insulin.

High blood sugar due to medical conditions other than diabetes is generally treated by addressing the underlying condition responsible for the elevated glucose. In some cases, insulin may be needed to stabilize glucose levels during this treatment.

What are the dangers and complications of high blood sugar?

Long-term complications of prolonged hyperglycemia or high blood sugar can be severe. These occur in people with diabetes and are worse when the condition is poorly controlled. The long-term complications of diabetes tend to develop slowly over time. Some of the complications of hyperglycemia in poorly controlled diabetes are:

  • Heart and blood vessel disease, that can increase the risk of heart attack, stroke, and peripheral artery disease
  • Poor kidney function eventually leading to kidney failure
  • Nerve damage, that can lead to burning, tingling, pain, and changes in sensation
  • Eye diseases, including damage to the retina, glaucoma, and cataracts
  • Gum disease

How and Why Does Ethnicity Affect Diabetes?

Diabetes risk

Diabetes is a condition that causes elevated blood sugar levels. Acquired risk factors are associated with diabetes although ethnicity plays a role in increasing the incidence of the condition.
Diabetes is a condition that causes elevated blood sugar levels. Acquired risk factors are associated with diabetes although ethnicity plays a role in increasing the incidence of the condition.

Acquired risk factors are associated with diabetes although ethnicity plays a role in increasing the incidence of the condition.

The ethnic groups in the United States that are at risk for different types of diabetes are as follows.

 Types of       dabetes
Ethnic groups at risk   

Type 1 diabetes
African American and Hispanic/Latino American

Type 2 diabetes
African American, Hispanic/Latino American, American Indian or Alaska Native

Prediabetes
African American, Hispanic/Latino American, American Indian or Alaska Native (some Pacific Islanders and Asian Americans are also at high risk)

Gestational diabetes
African American, Hispanic/Latino American, American Indian, Alaska Native, Native Hawaiian or Pacific Islander

The prevalence of diagnosed diabetes mellitus in the United States by race/ethnicity in adults who are 20 years of age and older is as follows.

Ethnic group        
Prevalence of diagnosed diabetes (%)      

Non-Hispanic whites
7.5

Asian Americans
9.2

Hispanic Americans overall
12.5

Non-Hispanic blacks
11.7

Native Alaskans
14.7

Native Americans
33

The prevalence of diagnosed diabetes in Asian Americans is

  Asian subgroup       
  Prevalence of diagnosed diabetes (%)      

Chinese
5.6

Filipinos
10.4

Asian Indians
12.6

Asian Americans
9.9

Japanese
4.9

Vietnamese
6.1

Korean
4.0

The prevalence of diagnosed diabetes in Hispanics/Latinos includes

 Hispanic/Latino subgroup    
 Prevalence of diagnosed diabetes (%)    

Central and South Americans
8.3

Cubans
6.5

Mexican Americans
14.4

Puerto Ricans
12.4

Japanese
4.9

Vietnamese
6.1

Korean
4.0

Ethnicity and diabetes

There are medical and non-medical issues that make particular ethnic groups vulnerable to diabetes. Some of the medical reasons include

  • Genetic factors that cause insulin resistance: Genes can affect the ability of the pancreas to produce sufficient insulin. It may also affect the body’s ability to respond to insulin. Genetic tendency to accumulate fat in the abdomen (abdominal obesity) can contribute to insulin resistance and hence make a person more likely to develop diabetes.
  • Lifestyle factors: Factors that can hasten beta-cell damage include

Non-medical issues include

  • Disparities in income
  • Education
  • Health
  • Literacy
  • Access to healthcare
  • Cultural factors

For example, Hispanics/Latinos are more liekly to develop type 2 diabetes because of the following reasons.

  • They have genes that make them more susceptible to type 2 diabetes.
  • Their traditional diet is rich in fat and calories. Moreover, family celebrations may involve social pressure to overeat.
  • They tend to be less active physically compared to non-Hispanic whites. Culturally, being overweight is identified as healthy instead of being a health problem.

Please note that these risk factors are general and do not apply to any individual or specific Hispanic/Latino groups.

Another example is Asian Americans. Although they do not appear overweight, they are at a high risk of type 2 diabetes. This may be due to higher visceral fat (extra body fat) and lower muscle mass.

Visceral fat isn’t visible and can increase the risk of heart disease, stroke and other health conditions.

The body mass index (BMI) does not apply to Asian Americans in the normal weight range (18.5 to 24.9). Researchers suggest that people of Asian ancestry should be tested if their BMI is 23 or above.

Diabetes can be prevented or delayed, but only if people know they’re at risk and take action. This includes increasing physical activity, getting regular screening for blood sugar levels and eating a diet that contains more fiber and proteins.

What Is Diabetic Neuropathy? Symptoms, Causes, Treatment

Diabetic neuropathy is damage to the nerves that is caused by prolonged elevated levels of blood glucose in a person with diabetes.Diabetic neuropathy is damage to the nerves that is caused by prolonged elevated levels of blood glucose in a person with diabetes.

Neuropathy is damage to nerves, and diabetic neuropathy is damage to nerves that occurs as a result of diabetes. Diabetes is thought to damage nerves as a result of prolonged elevated levels of blood glucose. Diabetic neuropathy can affect different parts of the body, and symptoms can range from mild to severe. Diabetic neuropathy is the most common complication of diabetes.

  • Different types of diabetic neuropathy include:
  • Peripheral neuropathy most commonly causes:
    • pain,
    • burning,
    • tingling, and
    • numbness of the feet and lower legs.
  • Autonomic neuropathy causes symptoms related to dysfunction of an organ system, such as:
  • Diagnosis of diabetic neuropathy is usually done by a clinical exam.
  • There is no cure for diabetic neuropathy, but treatments are available to manage the symptoms.
  • Diabetic nerve pain may be controlled by medications such as tricyclic antidepressants, duloxetine (Cymbalta), or certain antiseizure medications.
  • Lidocaine and capsaicin are two topical agents that can help relieve nerve pain in many people.
  • Keeping tight control of blood sugar levels is the best way to prevent diabetic neuropathy and other complications of diabetes.

What are the types of diabetic neuropathy?

There are different types of diabetic neuropathy. The distinction depends upon which types and location of nerves are affected.

  • Diabetic peripheral neuropathy refers to damage to peripheral nerves, most commonly the nerves of the feet and legs.
  • Diabetic proximal neuropathy affects nerves in the thighs, hips, or buttocks.
  • Diabetic autonomic neuropathy affects the autonomic nervous system, the nerves that control body functions. For example, it can affect nerves of the gastrointestinal, urinary, genital, or vascular systems.
  • Diabetic focal neuropathy affects a specific nerve or area at any site in the body.

Neuropathy Symptoms

Loss of Pain and/or Temperature Sensation

Damage to the nerve pathways responsible for receiving, transmitting, or processing of external stimuli can result in the loss of pain and/or temperature sensation in that extremity (for example, arms, hands, fingers, legs, feet, and toes).

Read more about loss o pain or temperature sensations in the arms, hands, legs, and feet »

What are diabetic neuropathy symptoms and signs?

The symptoms and signs of diabetic neuropathy depend upon the type of neuropathy that is present. Signs and symptoms can also vary in severity among affected people.

Signs and symptoms of diabetic peripheral neuropathy include:

  • Numbness or tingling of the feet and lower legs
  • Pain or burning sensations
  • Loss of sensation in the feet or lower legs
  • Sometimes, but less commonly, these symptoms can occur in the hands or arms

Signs and symptoms of diabetic proximal neuropathy include:

  • Pain, usually on one side, in the hips, buttocks, or thighs
  • Weakness of the legs

Signs and symptoms of diabetic autonomic neuropathy depend upon the organ system that is involved and can include:

Signs and symptoms of diabetic focal neuropathy also depend upon the location of the affected nerve.

The symptoms can appear suddenly. It usually does not cause a long term problem, and symptoms often improve over weeks to months. Symptoms can include:

What causes diabetic neuropathy?

The cause of nerve damage in diabetes is not well understood. Long-term exposure to high levels of blood glucose is able to damage nerve tissue, although the reason for this damage is unclear.

Can diabetic neuropathy be reversed?

Nerve damage typically cannot be reversed once it has occurred. However, there are medications and self-care measures that can help control the symptoms of diabetic neuropathy.

How is diabetic neuropathy diagnosed?

  • Diabetic neuropathy is usually presumptively diagnosed clinically by the patient's symptoms, medical history, and physical exam. However, there are other tests that can definitively diagnose the condition by actually measuring the loss of nerve function.
  • Nerve conduction studies measure the speed of nerve signals in the arms and legs, while electromyography measures the electrical discharges produced in muscles. Other tests of nervous system function may be done on some patients.
  • About 45% to 50% of all patients with diabetes are eventually diagnosed with some form of neuropathy.

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What are diabetic neuropathy treatments?

  • While diabetic neuropathy cannot be cured, there are treatments available to help manage some of the symptoms.
  • Another treatment goal is keeping blood glucose levels under good control through a combination of diet and medication so that the neuropathy does not worsen.
  • Keeping blood glucose levels under control has been shown to improve symptoms and prevent worsening of the pain.

What natural home remedies help relieve pain?

There are a number of self- and home care measures that you can take to relieve the symptoms of diabetic neuropathy. Examples are:

  • Using a device known as a bed cradle to keep bedcovers off of sensitive feet and lower legs
  • Using heat or cold patches, but since diabetic neuropathy can damage sensory nerves, care should be taken to avoid burns or freezing
  • Eating small, frequent meals and avoiding fatty foods may help those with digestive symptoms
  • Standing up slowly or wearing elastic compression stockings can improve orthostatic hypotension
  • Exercises, stretching, or massage may help relieve pain




QUESTION

What is diabetic peripheral neuropathy?
See Answer

What are the best medications for diabetic neuropathy?

The pain of diabetic neuropathy can sometimes be managed with certain medications. Certain prescription antidepressants and antiseizure medications have been shown to be effective in relieving pain that originates in the nerves.

For example:

In severe cases, opioid analgesic medications may be needed.

Other kinds of treatment for nerve pain include patches containing the topical anesthetic agent lidocaine. Capsaicin cream is an over-the-counter topical agent that has been shown to relieve nerve pain.

Medications can also help manage the troublesome symptoms of autonomic neuropathy. For example, antispasmodic or anticholinergic drugs can help prevent urinary incontinence. Drugs to treat erectile dysfunction like sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) may help some men with ED due to diabetic neuropathy. For women, vaginal estrogen creams and lubricants may provide relief of vaginal dryness and irritation.

Botulinum toxin (Botox) injections have been used to treat abnormal sweating.

Can diabetic neuropathy be prevented?

  • Keeping diabetes under control is the best way to prevent or stop the progression of diabetic neuropathy. Your doctor can advise you about the best target range for your blood glucose levels, and keeping tight control of blood sugar within this range can help prevent neuropathy and other complications of diabetes.
  • Avoiding smoking, getting exercise, and eating a healthy diet are other measures that can help people with diabetes have the best long-term outcomes.

Which Glucose Meter Is the Best? Monitoring Diabetes

Blood glucose meter tester for diabetes
Here are the best available glucose meters to monitor your blood glucose levels and keep your diabetes under control.

If you are looking for a glucose meter based on accuracy, Contour Next is your best option. This device has shown 100 percent compliance in accuracy testing.

Other devices that have passed the accuracy-test include:

  • Accu-Check Aviva Plus from Roche (99 percent compliance)
  • ReliOn Confirm from ARKRAY (97 percent compliance)
  • FreeStyle Lite from Abbott Diabetes Care (96 percent compliance)
  • Accu-Check SmartView from Roche (92 percent compliance)

Home glucose meters must show accurate results since they are meant to monitor your glucose between your doctor’s visits.

If you are looking for blood-free readings, FreeStyle Libre is your best option. It is a continuous glucose monitor (CGM) that uses interstitial fluid to measure blood sugar levels and works by wearing a sensor on your upper arm. It utilizes a flash system, which means you can scan the sensor with the device to get your glucose reading, and you can repeat the process as often as you like. If you wish to explore CGMs, Dexcom G6 provides more accurate results and gives glucose monitoring readings similar to those by glucometers.

People looking for a more user-friendly option should consider the Care Touch blood glucose monitoring system as it’s easy to use and affordable. Some highlights of this glucose meter include:

  • Readings available in less than five seconds
  • Provides a 14-day reading average
  • Stores up to 300 readings at a time

If you are looking for an affordable option, you may try the TrueMetrix meter. It has additional features such as four sets of reminders and can store 500 test results.

Moreover, the Prodigy glucose monitoring kit can help visually challenged people. It is small, inexpensive and portable and fits easily into a pocket or purse. Results are read aloud through a built-in speaker with adjustable volume levels.

Before zeroing down on your option, always consult your physician for an optimal device.

Why should you monitor with a blood glucose meter?

Monitoring with a blood glucose meter at home has the following advantages:

  • Helps identify dangerously high or low levels of glucose
  • Understands how diet and exercise can influence your glucose levels
  • Determines if any adjustments are beneficial in your treatment

Additionally, better glucose control using home monitors leads to fewer disease complications.

How do you choose a glucose meter?

There are many types of meters available for purchase. However, you should choose a glucose meter depending on the following factors:

  • Accuracy
  • Amount of blood needed for each test
  • Ease of use
  • Pain associated with using the product
  • Testing speed
  • Overall size
  • Ability to store test results in memory
  • Likelihood of interferences
  • Ability to transmit data to a computer
  • Cost of the meter
  • Cost of the test strips used
  • Physician’s recommendation
  • Technical support provided by the manufacturer
  • Special features such as automatic timing, error codes, huge display screen or spoken instructions or results

What are the latest trends in blood glucose meters?

Some people may not prefer traditional blood glucose monitoring due to the fear of pricking their fingers. For them, some of the latest trends in blood glucose monitoring are as follows:

  • Alternative site monitor: It allows blood to be taken from areas less likely to be painful such as the arm, palm or thigh.
  • Continuous glucose monitoring: It uses a sensor placed under the skin to measure blood sugar levels and transmits each reading to a small recording device.

Which is Worse – Type 1 or Type 2 Diabetes?

What is diabetes?

Diabetes is a condition in which your body doesn't make enough insulin or your cells lose sensitivity to insulin. There are some differences between type 1 and type diabetes and it is not clear which one is worse. Diabetes is a condition in which your body doesn't make enough insulin or your cells lose sensitivity to insulin. There are some differences between type 1 and type diabetes and it is not clear which one is worse.

Diabetes refers to the medical condition that keeps your body from producing enough insulin or that prevents your cells from using the insulin that your body produces. 

Your body requires a form of sugar called glucose to function. Insulin is a hormone that is produced by your pancreas. Insulin allows the glucose to move from your bloodstream into your cells, where it can be created into energy.

The most common types of diabetes are type 1 and type 2. They share some similarities. Both involve the body’s ability to produce and use insulin. Both can be managed with a doctor’s support.

The two types of diabetes have some important differences, but there is no clear answer regarding which one is worse.

Signs and symptoms of diabetes

Type 1 diabetes

Type 1 diabetes is an autoimmune disorder. This means that your body attacks itself if you have it. 

The body’s immune system does not recognize the beta cells in your pancreas and attacks them. These cells are responsible for producing insulin. When your body attacks them, it leaves you unable to process glucose correctly. 

Without the insulin to convert glucose into energy for your cells, the sugar you eat remains in your bloodstream. 

Type 1 diabetes is typically diagnosed in children and young adults. It has no relation to your body weight. 

Unlike those of type 2, the symptoms of type 1 diabetes can appear suddenly and include:

Type 2 diabetes

Type 2 diabetes is usually diagnosed in adults. In the U.S. 90 to 95% of diabetes cases are type 2.

The main difference between type 2 and type 1 is that with type 2 your pancreas produces plenty of insulin. Your cells that should use the insulin to transform glucose into energy don’t respond to it. This is dangerous, because it leaves changing amounts of the sugar you eat in your blood.

You may be at more at risk for developing type 2 diabetes if you:

  • Have prediabetes
  • Are overweight
  • Are over the age of 45
  • Have a parent or sibling with diabetes
  • Are physically active fewer than 3 times per week
  • Have ever had gestational diabetes
  • Are of African American, Hispanic, or Native American descent

The symptoms of type 2 diabetes are very similar to those of type 1. In addition to the symptoms associated with type 1, type 2 diabetes might lead to:

  • Frequent infections
  • Tingling, numbness, or pain in hands, feet, or legs

Diagnosis for diabetes

Your doctor can determine whether you have diabetes, and which type it is, with one of these tests:

  • The A1C test measures your average blood sugar level over the previous 2 to 3 months
  • The Fasting Blood Sugar test measures your blood sugar level after an overnight fast
  • The Glucose Tolerance test measures how your body reacts after you drink a liquid that has a high level of sugar in it

These blood tests are reliable and easy to conduct. Your doctor will be able to determine whether you are prediabetic, or have type 1 or type 2 diabetes with these tests.

Treatments for diabetes

If you have either type of diabetes, your treatment will involve maintaining your blood sugar level at a safe level. How you go about that will depend on the type you have.

Treating type 1 diabetes

Type 1 diabetes is a lifelong condition and is managed with a combination of insulin medication and lifestyle choices. 

People with type 1 diabetes supplement their insulin levels with injections or an insulin pump. Additionally, it is recommended that people with this condition maintain a healthy body weight, eat a balanced diet, exercise often, and check their blood sugar levels as prescribed. 

Treating type 2 diabetes

Type 2 diabetes is also managed through a combination of medication and lifestyle choices. 

If you have type 2 diabetes, you’ll need to check your blood sugar levels to ensure that they are in a safe zone. Your doctor might prescribe medication to help keep your levels where they should be. 

Experts also recommend eating a healthy, balanced diet and getting plenty of exercise.

Possible complications and side effects

Type 1 and type 2 diabetes can have very serious side effects if they are not diagnosed or managed well. 

One is not better or worse than the other. Both conditions require careful and mindful management. If your cells do not get the sugar they need to function, they will begin to die. 

Blood sugar that is too high or too low is dangerous, especially to your brain. It is essential to manage your insulin and sugar levels to avoid loss of consciousness, organ damage, and other serious complications. 

Canagliflozin (Invokana): Diabetes Drug Side Effects & Dosage

What is canagliflozin? What is canagliflozin used for?

Canagliflozin is an oral drug that reduces blood sugar (glucose) levels in patients with type 2 diabetes. It is a new type of diabetes medication in a class of medications called sodium-glucose co-transporter 2 (SGLT2) inhibitors.

Under normal conditions, glucose is filtered out of the blood and into the kidney tubules as blood passes through the kidneys. The glucose then as absorbed from the tubules back into the blood so that glucose is not lost in the urine. SGLT2 is an enzyme in the kidney tubule that causes glucose to be reabsorbed from urine. Canagliflozin blocks the action of SGLT2. Therefore, canagliflozin reduces the reabsorption of glucose from renal tubules, leading to more excretion of glucose in urine. Canagliflozin was approved by the FDA in March 2013.

What brand names are available for canagliflozin?

Invokana

Is canagliflozin available as a generic drug?

No

Do I need a prescription for canagliflozin?

Yes

What are the side effects of canagliflozin?

The most common side effects of canagliflozin are:

Other side effects of canagliflozin include:

What is the dosage for canagliflozin?

Canagliflozin should be taken before the first meal of the day. The recommended starting dose is 100 mg once daily and the maximum dose is 300 mg once daily. Renal function should be assessed prior to starting
canagliflozin and periodically during treatment, and the dose of canagliflozin should be modified based on renal function.




QUESTION

______________ is another term for type 2 diabetes.
See Answer

Which drugs or supplements interact with canagliflozin?

Canagliflozin may slightly increase the concentration of digoxin (Lanoxin) in the body when both drugs are being taken. Digoxin concentrations should be monitored appropriately.

Rifampin, phenytoin (Dilantin, Dilantin-125, phenobarbital, and ritonavir (Norvir) may reduce the effect of canagliflozin by increasing its elimination and reducing its concentration in the body. The dose of canagliflozin should be increased to 300 mg daily when combined with rifampin, phenytoin, phenobarbital, or ritonavir.

Monitoring glucose control with urine glucose tests is not recommended in patients taking canagliflozin and similar drugs. These drugs increase urinary glucose excretion and will lead to positive urine glucose tests. Use alternative methods to monitor glucose control.

Is canagliflozin safe to take if I’m pregnant or breastfeeding?

It is unknown whether canagliflozin is secreted in human
breast milk.

What else should I know about canagliflozin?

What preparations of canagliflozin are available?

Tablets: 100 and 300 mg

How should I keep canagliflozin stored?

Tablets should be stored at room temperature, 15 C to 30 C (59 F to 86 F)

24 tolazamide Side Effects, Uses & Dosage

What is tolazamide? How does it work (mechanism of action)?

Tolazamide is used with diet and exercise to reduce blood glucose levels in adult patients with type 2 diabetes mellitus. Other diabetes drugs are sometimes used in combination with tolazamide if needed. Tolazamides initial effect is to increase beta-cell insulin secretion. Tolazamide causes the pancreas to produce insulin and increases the body's response to it. Tolazamide also may decrease rate of hepatic glucose production, increases insulin receptor sensitivity, and increases number of insulin receptors.

  • There are no brand names for tolazamide.
  • Tolazamide is available in generic form.
  • You need a prescription to obtain tolazamide.

What is tolazamide used for?

Tolazamide is used with diet and exercise to reduce blood glucose levels in adult patients with type 2 diabetes mellitus.

What are the side effects of tolazamide?

Side effects associated with tolazamide therapy include:

  1. Dizziness
  2. Fatigue
  3. Headache
  4. Malaise
  5. Vertigo
  6. Increase sensitivity to the sunlight (photophobia),
  7. Itching
  8. Rash
  9. Hives
  10. Anorexia
  11. Constipation
  12. Diarrhea
  13. Sensations of stomach fullness
  14. Heartburn
  15. Nausea
  16. Vomiting
  17. Muscle weakness
  18. Water loss from the body (diuresis)

Possible serious side effects of tolazamide include:

  1. Disulfiram (Antabuse)-like reactions (for example, severe flushing accompanied by low blood pressure (hypotension) and tachycardia
  2. Low blood glucose
  3. Low blood sodium
  4. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
  5. Blood disorders
  6. Liver dysfunction




QUESTION

______________ is another term for type 2 diabetes.
See Answer

What is the dosage for tolazamide?

Adults

  • Generally, patients are started on 100 to 250 mg of tolazamide once daily with breakfast or first meal of the day.
  • Start with 100 mg/day for fasting blood sugar <200 mg/dL or 250 mg for fasting blood sugar >200 mg/dL.
  • Use 100 mg/day for patients who are malnourished, underweight, elderly, or those not eating properly.
  • Dosage may be increased by 100-250 mg at weekly intervals.
  • The maximum daily dose is 500 mg orally twice daily (1000 mg/day).

The safety and efficacy of tolazamide has not been established in pediatric patients. No specific dose adjustments are recommended in patients with kidney or liver disease.

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Which drugs or supplements interact with tolazamide?

  • Coadministration of tolazamide with quinolone antibiotics may cause abnormal changes in blood glucose. Therefore, blood glucose must be closely monitored if these agents must be used together.
  • Tolazamide may increase blood levels of methotrexate (Rheumatrex, Trexall) by interfering with the binding of methotrexate to blood proteins.
  • Anti-retroviral protease inhibitors, a type of anti-HIV medication, may decrease the effectiveness of tolazamide and consequently worsen blood glucose control.

Is tolazamide safe to take during pregnancy or while breastfeeding?

  • There are no adequate studies of the effects of tolazamide for pregnant women.
  • It is not known if tolazamide is secreted in breast milk.

What else should you know about tolazamide?

What preparations of tolazamide are available?

Oral tablets: 100, 250, and 500 mg

How should I keep tolazamide stored?

Tablets should be stored at room temperature, between 15 C and 30 C (59 F to 86 F).

Synjardy (empagliflozin/metformin): Diabetes Drug Side Effects


Generic drug: empagliflozin and metformin

Brand name: Synjardy

What is Synjardy (empagliflozin and metformin), and how does it work?

Synjardy (empagliflozin and metformin) is a prescription medicine used to treat the symptoms of Type 2 Diabetes Mellitus. Synjardy may be used alone or with other medications.

Synjardy belongs to a class of drugs called Antidiabetics, Biguanides; Antidiabetics, SGLT2 Inhibitors.

It is not known if Synjardy is safe and effective in children younger than 18 years of age.

What are the side effects of Synjardy?

WARNING

LACTIC ACIDOSIS

Postmarketing cases of metformin-associated lactic acidosis have resulted in
death, hypothermia, hypotension, and resistant bradyarrhythmias. The onset of
metformin-associated lactic acidosis is often subtle, accompanied only by
nonspecific symptoms such as malaise, myalgias, respiratory distress,
somnolence, and abdominal pain. Metformin-associated lactic acidosis was
characterized by elevated blood lactate levels (>5 mmol/Liter), anion gap
acidosis (without evidence of ketonuria or ketonemia), an increased
lactate/pyruvate ratio; and metformin plasma levels generally >5 mcg/mL.

Risk factors for metformin-associated lactic acidosis include renal impairment, concomitant use of certain drugs (e.g., carbonic anhydrase inhibitors such as topiramate), age 65 years old or greater, having a radiological study with contrast, surgery and other procedures, hypoxic states (e.g., acute congestive heart failure), excessive alcohol intake, and hepatic impairment.

Steps to reduce the risk of and manage metformin-associated lactic acidosis
in these high risk groups are provided in the full prescribing information.

If metformin-associated lactic acidosis is suspected, immediately discontinue
Synjardy and institute general supportive measures in a hospital setting. Prompt hemodialysis
is recommended.

Synjardy may cause serious side effects including:

Get medical help right away, if you have any of the symptoms listed above.

The most common side effects of Synjardy include:

Tell the doctor if you have any side effect that bothers you or that does not go away.

These are not all the possible side effects of Synjardy. For more information, ask your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What is the dosage for Synjardy?

Prior To Initiation Of Synjardy

  • Assess renal function before initiating Synjardy and as clinically
    indicated.
  • In patients with volume depletion, correct this condition before
    initiating Synjardy.

Recommended Dosage And Administration

  • Individualize the starting dose of Synjardy based on the patient’s current regimen:
    • In patients on metformin HCl, switch to Synjardy containing empagliflozin 5 mg with a similar total daily dose of metformin HCl;
    • In patients on empagliflozin, switch to Synjardy containing metformin HCl 500 mg with a similar total daily dose of empagliflozin;
    • In patients already treated with empagliflozin and metformin HCl, switch to
      Synjardy containing the same total daily doses of each component.
  • Monitor effectiveness and tolerability, and adjust dosing as appropriate, not to exceed the maximum recommended daily dose of empagliflozin 25 mg and metformin HCl 2000 mg.
  • Take Synjardy twice daily with meals; with gradual dose escalation to reduce the gastrointestinal side effects due to metformin.

Dosage Recommendations In Patients With Renal Impairment

  • Initiation of Synjardy is not recommended in patients with an eGFR less than 45 mL/min/1.73 m2, due to the metformin component.
  • Synjardy is contraindicated in patients with an eGFR less than 30 mL/min/1.73 m2
    or in patients on dialysis.

Discontinuation For Iodinated Contrast Imaging Procedures

Discontinue Synjardy at the time of, or prior to, an iodinated contrast imaging procedure in patients with an eGFR less than 60 mL/min/1.73 m2;
in patients with a history of liver disease, alcoholism or heart failure; or in
patients who will be administered intra-arterial iodinated contrast. Re-evaluate
eGFR 48 hours after the imaging procedure; restart Synjardy if renal function is
stable.





QUESTION

______________ is another term for type 2 diabetes.
See Answer

What drugs interact with Synjardy?

Table 4 Clinically Relevant Interactions with Synjardy

Carbonic Anhydrase Inhibitors

Clinical Impact
Topiramate or other carbonic anhydrase inhibitors (e.g., zonisamide, acetazolamide or dichlorphenamide) frequently causes a decrease in serum bicarbonate and induce non-anion gap, hyperchloremic metabolic acidosis.

Intervention
Concomitant use of these drugs with Synjardy may increase the risk of lactic acidosis. Consider more frequent monitoring of these patients.

Drugs that Reduce Metformin Clearance

Clinical Impact
Concomitant use of drugs that interfere with common renal
tubular transport systems involved in the renal elimination of
metformin (e.g., organic cationic transporter-2 [OCT2] / multidrug
and toxin extrusion [MATE] inhibitors such as ranolazine,
vandetanib, dolutegravir, and cimetidine) could increase systemic
exposure to metformin and may increase the risk for lactic acidosis.

Intervention
Consider the benefits and risks of concomitant use.

Alcohol

Clinical Impact
Alcohol is known to potentiate the effect of metformin on lactate metabolism.

Intervention
Warn patients against excessive alcohol intake while receiving
Synjardy.

Diuretics

Clinical Impact
Coadministration of empagliflozin with diuretics resulted in increased urine volume and frequency of voids, which might enhance the potential for volume depletion.

Intervention
Before initiating Synjardy, assess volume status and renal function. In patients with volume depletion, correct this condition before initiating
Synjardy. Monitor for signs and symptoms of volume depletion, and renal function after initiating therapy.

Insulin or Insulin Secretagogues

Clinical Impact
The risk of hypoglycemia is increased when empagliflozin is used in combination with insulin secretagogues (e.g., sulfonylurea) or insulin. Metformin may increase the risk of hypoglycemia when combined with insulin and/or an insulin secretagogue.

Intervention
Coadministration of Synjardy with an insulin secretagogue (e.g., sulfonylurea) or insulin may require lower doses of the insulin secretagogue or insulin to reduce the risk of hypoglycemia.

Drugs Affecting Glycemic Control

Clinical Impact
Certain drugs tend to produce hyperglycemia and may lead to loss of glycemic control. These drugs include the thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blocking drugs, and isoniazid.

Intervention
When such drugs are administered to a patient receiving Synjardy, the patient should be closely observed to maintain adequate glycemic control. When such drugs are withdrawn from a patient receiving
Synjardy, the patient should be observed closely for hypoglycemia.

Positive Urine Glucose Test

Clinical Impact
SGLT2 inhibitors increase urinary glucose excretion and will lead to positive urine glucose tests.

Intervention
Monitoring glycemic control with urine glucose tests is not recommended in patients taking SGLT2 inhibitors. Use alternative methods to monitor glycemic control.

Interference with 1,5-anhydroglucitol (1,5-AG) Assay

Clinical Impact
Measurements of 1,5-AG are unreliable in assessing glycemic control in patients taking SGLT2 inhibitors.

Intervention
Monitoring glycemic control with 1,5-AG assay is not recommended. Use alternative methods to monitor glycemic control.

Is Synjardy safe to use while pregnant or breastfeeding?

  • Advise pregnant patients, and patients of reproductive potential, of the
    potential risk to a fetus with treatment with Synjardy.
  • Instruct patients to report pregnancies to their physicians as soon as
    possible. Advise patients that breastfeeding is not recommended during
    treatment with Synjardy.