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TABLETS

I’m on rosiglitazone and gliclazide and my doctor wants to put me on metformin as well. Is this OK?

This combination of tablets is known as triple oral therapy. It is known to be effective and is sanctioned by NICE, the official government watchdog. In July 2010, another government body warned doctors against prescribing rosiglitazone, so you should probably use the alternative pioglitazone, which is believed to be safer. It is available as a combination tablet with metformin called Competact.

Treatment diabetes with Tablets with Canadian Health Care Mall

Treatment diabetes with Tablets

The downside of using triple therapy is the increased risk of side effects. Gliclazide rarely causes problems, apart from the risk of hypoglycaemia. Glitazones may lead to weight increase and fluid retention. Metformin is notorious for causing gastric side effects, such as nausea, diarrhoea and wind. Provided you are not troubled by these unwanted effects, you have a 50% chance of delaying the need for insulin. We do not want to give the impression that insulin treatment is a last ditch option, since many people with Type 2 diabetes do very well when treated early with insulin. However, some people are determined to stay off insulin as long as possible, either for psychological reasons or because they risk losing their job.

My doctor says my diabetes is not as well controlled as it should be and he wants to try a new tablet, sitagliptin, which he says will not make me gain weight.

Sitagliptin (Januvia) is one of a class of new drugs called DPP4 inhibitors (or gliptins), which have been developed to prolong the action of a hormone called GLP-1. This hormone is produced by the intestines when food is taken into the stomach and one of its effects is to stimulate the pancreas to produce more insulin. GLP-1 is normally destroyed very rapidly by an enzyme known as DPP4 and if the action of DPP4 is blocked (by a DPP4 inhibitor) the effect of GLP-1 is prolonged for many hours. This enhances the blood glucose lowering effect of GLP-1. Unlike most tablets used to treat diabetes, the DPP4 inhibitors (gliptins) do not cause weight gain. Gliptins can be used in combination with any other blood glucose lowering tablet.

I have just started taking Clucobay tablets for my diabetes. Could you explain how Clucobay works?

Glucobay, the trade name for acarbose, acts by slowing down the digestion of starch and related foodstuffs. Acarbose slows the breakdown and absorption of many dietary carbohydrates, reducing the high peak of blood glucose which can occur after eating a meal containing carbohydrate. It was launched in the UK in 1993, having been used very extensively in other European countries. It is an addition to diet treatment and has been shown to be effective in many people with diabetes who do not require insulin treatment.

Type 2 diabetes prevention

As in most cases a little prudence and diligence will go a long way in preventing the advancement of diabetes mellitus, this is especially if you are in the pre-diabetes stage or have type 1 diabetes. It is a known fact that someone suffering from the symptoms of diabetes can actually prevent type 2 diabetes from developing.

This can be done according to information that have been around since ancient times, however, there is always a but in most equations. People need to stop living sedentary lifestyles and adopt healthier lifestyles in order to achieve success in the fight against diabetes.

Today with all the advancement in medicines and technology, many Doctors and experts recommend screening as a means of diabetes prevention, especially for those people at the high risk end of the scale.

This is where they would get accurate diagnosis and early effective treatment; the people at risk are those who have a history of diabetes in their family and also those who might be considered overweight.

Healthy lifestyle habits for Type 2 diabetes prevention

Adopting healthy lifestyle habits can prevent diabetes, but there are some things that cannot be changed, like your family’s history of diabetes, your age or your ethnic background. According to researcher, those mostly at risk of diabetes mellitus are people from Asian and African.

Many people have been wandering why this is the case? I really can’t answer that, but neither can the experts.

However, what I can tell you is that a healthy lifestyle, including a healthy diet and regular exercise could help in Type 2 diabetes prevention and stop the development of other related conditions, even if you are losing weight or not.

Your Doctor should be able to make the necessary recommendations and provide you with the appropriate health regime of exercise and diet to suit your particular circumstance.

Type 2 diabetes prevention studies

A study carried out by Harvard School of Public Health and published in The New England Journal of Medicine, highlighted that the single most important contributing factor in predicting if a person will develop type 2 diabetes is being overweight.

After 16 years of following up patients, the results from the study suggest that 30 minutes a day of exercise for five days a week, along with a modified diet that is low in fat and high fibre rich foods, will dramatically reduce the chances of diabetes developing.

They concluded by suggesting that type 2 diabetes is preventable and also that it can be easily done by changing the way people live, if it is not an all-round healthy regime.

Another study carried out by the Finnish Diabetes Prevention Study Group of researchers focus on the effects of three factors in Type 2 prevention; they were weight loss, exercise and diet.

Their study included the monitoring of 500 overweight borderline diabetic patients and patients in the pre-diabetes stage, it used an impaired oral glucose tolerance test in the study.

The research has shown that medicines can play an important role in preventing type 2 diabetes, as well as the controlling of the disease if they are showing signs or symptoms already or if a person is impaired glucose tolerance.

Studies have shown that diabetes medications and a healthy lifestyle will reduce the risk of development of type 2 diabetes in those that are high risk.

Diabetics, both Type 1 and Type 2, like everyone else enjoy beverages while they eat. The problem comes in when they make the wrong choices and they find themselves consuming them outside of meals, as well.

There is a massive difference in having a beverage and sabotaging your eating plan. You first have to know what is acceptable to drink that won’t cause undue issues with blood sugar levels, and then you have to make the determination of when you can have it. Finally, you have to mentally stay on top of how much is okay and when it crosses the line into unhealthy.

Sodas are a common beverage for diabetics and, when consumed in moderation, the right beverage is fine… for a while. Of course, the better option would be to eliminate them altogether, but some people have a problem making that decision. Slowly weaning off of them will give a person the ability to one day put them down altogether.

Some may contend substituting diet sodas are the answer, but this is actually not the case. Giving your body an artificially sweetened drink may give it a sense of being tricked into thinking that it will gain a sugary treat, when in fact it is being fooled. The body will often respond by demanding it receive what was intended… sugar.

Another problem with diet drinks are that diabetics often use them as a way to justify overeating. While a diet drink does reduce calories, it is not a free pass to consume more calories. In the end, it is still overeating… no matter what you are drinking.

So what about fruit juice instead of soda? Since they are made from fruit they have to be healthier, right? Wrong! While fruit juices are often derived from fruit, they contain massive amounts of sugar… the problem is the fiber has been removed in the juicing process. Also one glass of juice contains at least three or four pieces of fruit; often sugar has also been added. Take a look at the label of your favorite fruit juice and you’ll see that downing one of these is like ringing the dinner bell for spiked blood sugar. Plus, it tends to crank up your sugar cravings, which leads to more sugar.

What to drink instead?

Any of the following is fine:

  • The best choice for a diabetic is to drink lots of water. While this might not be appealing during meals, there are ways around it. Squeezing a little lemon or lime juice into water gives it taste and doesn’t add any of the bad stuff. There may also be powders that can be added to water, on occasion, when you just have to have a little more than plain water.
  • Sparkling water (plain or calorie-free flavored)
  • Unsweetened ice tea
  • Coffee. Coffee can raise your blood sugar levels, so if you find this to be the case change to decaf.

Both Type 1 and Type 2 diabetics are forced to live with the constant barrage of having blood sugar levels drop suddenly and dramatically, sometimes at the most inopportune time. But sometimes this event, called hypoglycemia, occurs when an individual is working out. That’s why exercise induced hypoglycemia is something that has to be monitored.

Simply put, hypoglycemia is when there isn’t enough sugar in the blood. While this can be a rather annoying occurrence for some, for a diabetic it can be serious. It is important for diabetics who want to work out to know what they should be on the lookout for and how to respond so that it doesn’t become an even bigger, and more serious, issue.

There are telltale signs during exercise that signal a change is beginning to take place. The first apparent symptom is usually a feeling of shakiness. This could be mild or the individual may mistake it as overworking their muscles. Since working out tires the muscles and sometimes gives a temporary feeling of being shaky if overexerted, it might not immediately register with a diabetic.

The way to tell if it is your muscles that are responding to the workout or if it is actually hypoglycemia, is that in exercise, only the specific workout muscles will shake: hypoglycemia will normally affect the entire body.

Another symptom is extreme and unusually sudden fatigue. This is your blood sugar crashing and your body responding by going into emergency management of its vital energy. It could be almost instantaneous and typically takes the person by surprise.

The exerciser will also normally experience a sudden and profound headache. This is your brain telling you the same thing that your muscles are saying: “I need sugar”. Depending on how depleted your blood sugar is will determine the severity of your headache, as it could be dull to almost migraine intensity.

Anytime hypoglycemia occurs, it needs to be addressed quickly. The best way to handle this is to administer something sweet such as a fruit juice or normal soda. In a pinch, candy will work, too. Whatever you have on hand to immediately bring the blood sugar levels back up as fast as possible to stave off a worsening of the symptoms, will do.

In severe cases, exercise induced hypoglycemia can cause a diabetic to lapse into a seizure. In this instance, blood sugar has crashed dramatically to the point that the brain temporarily shuts down consciousness. At this stage it would be necessary for someone to contact emergency personnel so that the diabetic can be monitored by healthcare professionals. This is the time to mention the benefit of wearing a medical identification bracelet, sportsband or necklace identifying you as being a Type 2 diabetic – they can be a godsend in an emergency such as a severe hypoglycemic episode.

If you have Type 2 diabetes, chances are you have heard about the complications associated with long-term high blood sugar levels and how they wreak havoc on your body? In fact, for those people with diabetes who do little or nothing to reduce the risk of these complications, diabetes-related problems are a near certainty, not just a possibility.

The good news is you can take steps today to ensure a future without diabetic complications. You are not alone in your quest to avoid these complications. Roughly 8 percent of the American population has diabetes, according to the National Diabetes Fact Sheet 2011 released by the Centers for Disease Control and Prevention. And just like you, they are also trying their best to lead a productive life despite their health problem.

So, how can you prevent the complications of diabetes?

1. Control your blood sugar level. Controlling your blood sugar is considered to be the most important step in preventing diabetic complications. According to the Centers for Disease Control and Prevention, every 1 percent drop in your HbA1c value reduces your risk for microvascular complications, such as eye problems and nerve damage, by an amazing 40%! In people with Type 1 diabetes, strict control of their blood sugar levels can reduce their risk for cardiovascular complications.

2. Normalize your blood pressure. One of the most important reasons to control your blood pressure is to lower drastically your risk for the development of cardiovascular diseases such as heart problems and stroke. In fact, good control of your blood pressure can decrease your risk for cardiovascular disease by 33 to 50%, and your chances of developing microvascular complications by 33%.

3. Control your blood cholesterol levels. Type 2 diabetes coupled with increased cholesterol levels is considered to be one of the most dangerous predisposing factors to the development of chronic complications. And by normalizing your cholesterol levels, your risk for cardiovascular complications may decrease by 20 to 50%.

4. Other preventive care practices:

1. have your eyes tested 12 monthly. Visiting your ophthalmologist regularly may be a preventive measure to avoid eye complications associated with diabetes. By doing so, eye complications may be diagnosed, managed, and corrected at the earliest possible time.

2. always care for your feet. Decreased sensation, particularly in both of your lower extremities, may cause unwanted infections. Left untreated, an infection can spread to the bone and result in the need for amputation of the affected toes, foot, or lower leg. Always wear protective shoes and make sure you check your feet for scrapes, cuts, swelling, bleeding, and signs of infections every day.

3. have your kidney function checked regularly. Your kidneys are especially sensitive to high blood sugar levels.

Whilst there is no cure for Type 2 diabetes, it can certainly be controlled and the complications can be avoided.

Diabetic neuropathy, or the pathology of diabetic neuropathy, can appear mysterious and complicated to understand, for anyone who’s first introduced to these terms. They are particularly difficult to understand for someone with a small amount of previous knowledge of the nervous system. You may be presenting to your doctor with a symptom like a certain pain, or loss of feeling in your feet, and instantly, your health care provider knows these as diabetic neuropathy symptoms. Most likely, you’ll be confronted with some medical terms that you have never heard of previously. It seems that no matter how old we are, men and alike need to understand why we have a certain symptom, and the best way to treat it.

For example, maybe you have scheduled a physician visit due to pain, and your doctor instantly recognizes this as neuropathic pain, and starts to explain neuropathy affects which are related to diabetes. Additionally, in place of hearing about your levels of blood sugars, this talk has grown to talking about levels of sorbitol. It may be overwhelming for a patient to hear a barrage of new terms all at 1 time, or going from 1 subject to the other, such as flitting from discussing blood, to talking about a nerve. When doctors bring in new words to patients, such as nitric oxide and, it’s not unheard of for a patient to leave the office with more questions than they went in with.

Diabetic neuropathy is actually divided into four groups: Peripheral neuropathy which affects the arms, hands, legs, feet, & toes; autonomic neuropathy affects the blood vessels & heart, the digestive system, urinary tract, sex organs, eyes, sweat glands & lungs; proximal neuropathy affects the hips, buttocks legs and thighs; & focal neuropathy which affects the lower back & pelvis, abdomen, chest, thighs, legs, feet, eyes, ears & facial muscles.

As you can see, diabetic neuropathy can affect the nerves throughout the body. Because of this, there can be several different kinds of symptoms. Because pain, numbness, sensitivity to temperatures, sweating, etc. are very noticeable symptoms of neuropathy from diabetes, there are several other more hard to determine signs that you can miss. This is why it’s very important to inform your doctor of any physical changes you may notice.

Neuropathy may manifest in such a variety of ways that symptoms like high blood pressure, constipation, sexual dysfunction, blurry eyesight, heavy perspiration and so on, need to be assessed by a professional before they evidence themselves as, or are attributed to, diabetic neuropathy. In order to properly diagnose you, your physician can order specialized tests i.e. nerve conduction studies to see how well your nerves are transmitting and how the muscles surrounding them respond, use ultrasound to look at various organs, and they may check for a variance in your heart beat.

Stress-Diabetes Connection- Is there any and what is the mechanism?

While there are several factors that contribute to the development of diabetes, stress is an important one.

This is how:

Type 2 Diabetes:

About 95% of diabetics suffer from Type 2 diabetes, which occurs due to a process in the body called insulin resistance. Stress is a major cause for insulin resistance. Obesity is another important culprit for insulin resistance. Stress Eating is the main underlying cause for obesity. In this way, stress significantly contributes to a person’s obesity and risk for developing diabetes.

Insulin resistance is a process in the body which causes insulin, a chemical in your body, to be less effective in keeping your blood sugar normal. Consequently, your body produces more insulin in order to keep your blood sugar normal. This compensatory increase in the amount of insulin may control your blood sugar for a while, but it’s harmful for the rest of the body. Large amounts of insulin can raise your blood pressure and increase your risk for cancer. Insulin resistance also increases your risk for heart attacks and strokes.

After many years of escalating insulin resistance, eventually your insulin producing cells in the pancreas get exhausted and cannot churn out the huge amounts of insulin. At this point, your blood sugar starts to rise and you end up being diagnosed with Type 2 diabetes.

Type 1 Diabetes:

Type I diabetes is the other type of diabetes. It is much less common, accounting for about 5% of diabetics. Type 1 diabetes is an autoimmune disease in which your dysfunctional immune system starts to attack and kill your own insulin producing cells. Eventually your pancreas is unable to produce any insulin and you become diabetic.

Stress negatively influences immune system and plays a major role in the pathogenesis of autoimmune diseases.

Stress Worsens Diabetes.

Many diabetics know that their blood glucose gets elevated when they are under stress, even though their eating habits didn’t change at all. They also know that with the release of stress, their elevated blood glucose comes down.

Over the years, I have seen many such examples. I vividly remember one particular case.

The gentleman was a highly successful businessman who was struggling to keep his blood glucose levels down. Then he went on a vacation to his native homeland in a rural setting. When he came back from vacation, he came to see me. “Doc, you’ve been telling me about the effects of stress on diabetes. You are absolutely right. During my vacation, my blood glucose readings were perfect for the first time. Now that I’m back at work, my blood glucose levels are going up again.” He was genuinely excited to see for himself the strong relationship between stress and high blood glucose levels.

Even subtle stress can elevate your blood glucose levels. For example, some diabetics get so preoccupied by their blood glucose readings that they stress themselves out. As a result, their blood glucose reading starts to escalate. Then they get more stressed out and a vicious cycle sets in.

I remember one lady who was always preoccupied with her blood glucose readings. During one visit, I told her to stop checking her blood glucose. Two months later, her diabetes was under better control, as evidenced by her blood test report from the laboratory. She was completely amazed.

These examples clearly demonstrate the negative impact of stress on diabetes.

Diabetes is a condition that impedes the body’s natural process of breaking down foods and converting them into energy. But how is that done? Well, our body naturally extracts glucose (energy) from food via mechanical digestion (chewing) and chemical digestion (saliva and stomach acids), but with diabetes, on the cellular level, the body’s inability to absorb glucose as a power source can result in a myriad of health complications. And while diabetes is genetically passed on, its on-set can be attributed to a person’s dietary practices, as well.

Malegra 100 mg

One of the symptoms of diabetes is kidney failure. In a diabetic, blood vessels within the kidneys malfunction, compromising its ability to filter bodily excretions. Oftentimes, kidneys stricken with diabetes will just shut down – requiring the need of dialysis to function properly. Cardiovascular disease, loss of sight, dulled sensation in lower extremities (resulting from micro circulatory disease) and slower recovering ability (due to decreased circulation) – are other diabetes related symptoms that can lead to a host of long-term complications.

  • Type 1 diabetes is usually an autoimmune disorder. An autoimmune disorder occurs when the body’s ability to combat infection is compromised, and the immune system turns against the entire body. With diabetic issues, the immunity processes attack and eliminate the insulin-producing cells within the pancreas. As a result, the pancreas then generates little (if any) blood insulin. An individual who has type 1 diabetes will need to take insulin shots everyday to live. Type 1 diabetes- oftentimes regarded as juvenile diabetes or insulin-dependent diabetes- may occur at any age throughout childhood. Grownups are occasionally stricken with this, as well.
  • Type 2 diabetes are usually identified after age 45; however, it is becoming more and more prevalent with younger folks. With type two diabetes, blood insulin is made in insufficient quantities, thus can’t be utilized by the body to manage blood glucose levels. Individuals with type 2 diabetic issues manage blood glucose levels by eating sensibly, participating in regular exercise, getting their medications (via injections or orally), and keeping track of their glucose levels. Oftentimes, many medications and insulin-shots are required to regulate sugar levels.

Prevention and management of all forms of diabetes demands a comprehensive strategy. Meaning, that as one progresses in coping with the burden of diabetes, all issues and difficulties have to be dealt with in its entirety; taking into account the medical complexities and social impact on those who suffer from this ailment. Armed with proper training, treatment, dieting and exercise to manage blood sugar levels – those afflicted (and those at risk) can design a lifestyle best-suited to either manage or prevent diabetes.

According to the National Diabetes Educational Program about 21 million adult Americans have diabetes. Type 2 diabetes is a serious condition and is actually a bit more complicated than Type 1. In Type 2, both a deficiency in insulin and the body’s poor response to insulin, known as insulin resistance, are at work. It causes an increase in the blood sugar level resulting in the development of possible acute and chronic complications.

A few years ago, adults who were over the age of 45 were the only ones at risk for Type 2. But now, many children and young adults are also being diagnosed with this metabolic problem because of the ever-increasing prevalence of overweight and obesity.

To know your risk factors for Type 2 diabetes, scan over this list and check off any risks factors you may have for the development of this condition:

  • are you age 45 years or older?
  • are you overweight or obese. If you are an Asian, the cut-off BMI value for you is 23. For Pacific islanders, the BMI cut-off is 26 and for others, the cut-off is 25
  • do you have a first or second degree relative with Type 2 diabetes?
  • did you have gestational diabetes or diabetes during pregnancy? Giving birth to a nine pound baby or a baby that weighed even more, often indicates Type 2 diabetes in the future, especially if care is not taken to prevent its recurrence if it has gone away following delivery of your baby
  • do you have hypertension or episodes of increased blood pressure readings?
  • if you have high “bad” cholesterol readings… recommendations for desirable levels of LDL have been lowered by the American Diabetes Association to <100mg/dL (2.6 mmol/L). Do you have a low reading of “good” cholesterol or HDL? Desirable levels of HDL, are >40 mg/dl (1.1mmol/L). A decreased level of HDL, may also put you at risk for Type 2 diabetes
  • do you have an inactive lifestyle? The most obvious benefit of exercise is its ability to accelerate weight loss. When you become more physically active, your burn more calories or kilojoules, and use your body’s insulin more efficiently
  • have you been diagnosed with polycystic ovarian syndrome or PCOS
  • do you have dark patches of skin around your neck or armpits? This is called acanthosis nigricans. If your armpit and neck appears to be dark and dirty-looking no matter how much you clean and scrub that area, chances are you have acanthosis nigricans, a risk factor for Type 2 diabetes
  • how about blood vessel problems such as atherosclerosis and coronary artery disease

Time to stop and take a breath. If you happen to have any of the abovementioned risk factors, it would be wise to see your doctor and undergo some laboratory testing to eliminate or confirm Type 2 diabetes.

There is clear evidence from scientific literature that Type 2 diabetes is reversible, especially if it is caught in the early stages and treated with a healthy approach to lifestyle and nutritional support, and occasionally with medications.

Glycemic Index List?
The Glycemic index list is one that gives a number to each of the foods that are on the list. Stay with the low index list of foods as much as possible. Then, print out the Glycemic index list, or write down a list of good foods – those with a low Glycemic number – and take it to the store.

Foods
Foods having an increased GI tend to be soaked up rapidly into the bloodstream and spark a fast increase in blood sugar levels. Foods with a GI over 70 are flooders and are red. These foods tend to cause rapid increases in blood sugar. Foods with few to no carbohydrates, like meats, cheeses and fats, will likely result in the index close to zero.

How the Index Works
If you go for foods with a high Glycemic index, you are choosing foods that will break down into sugar very quickly, which your body will clear out quickly with insulin. At a very basic level, this is how it works: When you eat something that has a lot of sugar in it, your body breaks it down easily, because it’s already practically sugar. Controlling your blood sugar can be relatively easy for most people if you pay attention to the types of carbohydrates that you consume. Ice cream is incredibly high in table sugar but only has a rating of about 50 (depending on the exact kind) on the index. A diet or lifestyle high in refined sugars, highly processed foods, caffeine, emotional stress or a combination of these factors can cause reactive hypoglycemia.

Blood Sugar
This is about blood sugar levels and how too high levels can ruin your weight loss and how you’ll benefit from the index diet (and what is this index really? Whenever the blood sugar levels are steady most of us have ample easily obtainable energy to the brain and muscle tissue. Having less volatility within blood glucose levels avoids the lethargy associated with sugar crashes.

Diet
In a normal, mixed diet you won’t have any benefits at all from GI cause research have resulted in no benefits at all in a mixed diet. Introducing gradual changes into your diet isn’t always the easiest way to go, but for some, they consider it the only way. Following and using the low Glycemic diet describes this difference by ranking carbohydrates according to their effect on our blood glucose levels.

Low Glycemic
Low Glycemic eating is the most efficient and natural way to lose fat. According to the Glycemic Research Institute, which does a great deal of research on the index, high Glycemic carbohydrates store in the fat cells? Low Glycemic index carbohydrates include non starchy vegetables like broccoli, cucumber, green beans, salad greens, peppers and cauliflower. Critics of the index and the diet state that the foods that are objected to in a low Glycemic index diet are good for people who are not watching their sugars and should not be avoided. It is also important to note that there is no distinction in the Glycemic index for how the foods are cooked, which can make a huge difference in the diet.

Carbohydrates
Carbohydrates are good for you as long as they are low in the Glycemic index list. Carbohydrates that score high on the Glycemic Index have been to shown to cause significant fluctuations in blood sugar, while carbohydrates that score low on the Glycemic Index result in much smaller fluctuations. But not all carbohydrates act the same. Some carbohydrates cause an immediate spike in blood sugar levels.

While “good” carbohydrates are essential for a healthy body, “bad” carbs not only creates havoc on blood sugar levels, they also cause all sorts of other major health problems. Low Glycemic foods are a great healthy and tasty part of low Glycemic index recipes.

Conclusion
To understand what the Glycemic index list is, you need to get a grasp of the Glycemic index, how it works, and how it can affect your life. More information is available in the Resource Box.