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High Blood Sugar Despite Metformin

Type 2 Diabetes Faqs

Type 2 Diabetes Faqs

Common questions about type 2 diabetes: How do you treat type 2 diabetes? When you have type 2 diabetes, you first need to eat a healthy diet, stay physically active and lose any extra weight. If these lifestyle changes cannot control your blood sugar, you also may need to take pills and other injected medication, including insulin. Eating a healthy diet, being physically active, and losing any extra weight is the first line of therapy. “Diet and exercise“ is the foundation of all diabetes management because it makes your body’s cells respond better to insulin (in other words, it decreases insulin resistance) and lowers blood sugar levels. If you cannot normalize or control the blood sugars with diet, weight loss and exercise, the next treatment phase is taking medicine either orally or by injection. Diabetes pills work in different ways – some lower insulin resistance, others slow the digestion of food or increase insulin levels in the blood stream. The non-insulin injected medications for type 2 diabetes have a complicated action but basically lower blood glucose after eating. Insulin therapy simply increases insulin in the circulation. Don’t be surprised if you have to use multiple medications to control the blood sugar. Multiple medications, also known as combination therapy is common in the treatment of diabetes! If one medication is not enough, you medical provider may give you two or three or more different types of pills. Insulin or other injected medications also may be prescribed. Or, depending on your medical condition, you may be treated only with insulin or injected medication therapy. Many people with type 2 diabetes have elevated blood fats (high triglycerides and cholesterol) and blood pressure, so you may be given medications for these problem Continue reading >>

Metformin No Longer Working?

Metformin No Longer Working?

I've been on and off the diabetes roller-coaster for about five years now. Before I was diagnosed I had no idea my sugars were highbecause I wasn't heavily overweight (I'm 5/9, around 175 lbs) I didn't think *I* could have a problem, but I drank every single day since I was 18 and that became a problem. But I also loved pasta, rice, potatoes and sweets, so that really put the nails in my coffin. I was doing really well with diet and exercise there for a while, and was completely off metformin, but since the end of last year, my sugar habits having crept backalthough I still maintain a very low-carb, non-processed-food dietI restarted the metformin. I walk briskly for about five-eight hours a week and really try to keep my carb and sugar intake down, but it seems that these days the metformin are not helping keep my sugar levels down. Could I be building a tolerance to metformin? These days it seems that even up to 6-8 hours after I eat my main meal of a daywhich is regular-to-small portions of non processed foodsone of my favorite dinners is grilled chicken in a whole wheat pita with onions, peppers, garlic and lettuce/slaw mix (minus the mayonnaise)and I've completely laid off the pasta/rice/potatoes food train in the last few yearsmy sugars are high. By high I mean around 9-11Mmol (meaning up to 198 in US measurements). This seems to make my heart pound and wake me up in the middle of the night, which leads to my chronic insomnia. I know that's a lot of questions but what I mainly want to know is, could my metformin be losing its efficiency? I take 500mg daily and try to take it before I eat dinner, but it seems to make little difference whether I take it before or after dinnermy sugar levels soar and stay around 195 for hours. My doctor is a schmuck who knows very l Continue reading >>

Management Of Persistent Hyperglycemia In Type 2 Diabetes Mellitus

Management Of Persistent Hyperglycemia In Type 2 Diabetes Mellitus

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc. All topics are updated as new evidence becomes available and our peer review process is complete. INTRODUCTION — Initial treatment of patients with type 2 diabetes mellitus includes education, with emphasis on lifestyle changes including diet, exercise, and weight reduction when appropriate. Monotherapy with metformin is indicated for most patients, and insulin may be indicated for initial treatment for some [1]. Although several studies have noted remissions of type 2 diabetes mellitus that may last several years, most patients require continuous treatment in order to maintain normal or near-normal glycemia. Bariatric surgical procedures in obese patients that result in major weight loss have been shown to lead to remission in a substantial fraction of patients. Regardless of the initial response to therapy, the natural history of most patients with type 2 diabetes is for blood glucose concentrations to rise gradually with time. Treatment for hyperglycemia that fails to respond to initial monotherapy and long-term pharmacologic therapy in type 2 diabetes is reviewed here. Options for initial therapy and other therapeutic issues in diabetes management, such as the frequency of monitoring and evaluation for microvascular and macrovascular complications, are discussed separately. (See "Initial management of blood glucose in adults with type 2 diabetes mellitus" and "Overview of medical care in adults with diabetes mellitus". Continue reading >>

5 Biggest Diabetes Management Mistakes

5 Biggest Diabetes Management Mistakes

Over seven years and millions of interactions on Diabetes Daily, we have seen many people make the same mistakes. Here are five of the most common ones along with potential solutions. What mistakes are missing from the list? Share your experience in the comments and help spare your peers some difficult days. Mistake #1: Thinking Only Food Impacts Blood Sugars Carbohydrates, and to a lesser extent fat and protein, impact blood sugars. But food is just one of many factors. Stress – whether it is caused by pain, a fight with a loved one, or intense exercise – increases blood sugars. Activity typically lowers blood sugars, but many forms of exercise can also raise your blood sugar, such as strength-training and sprinting. Exercise that is causing negative stress on your body can also raise your blood sugar. Little known fact: if a 20 minute, pain-free walk regularly increases blood sugars and you haven’t eaten recently, call your doctor and ask for a stress test. This can be an early sign of heart disease. Something is causing that stress. Sleep patterns can change your insulin sensitivity throughout the day. Not getting enough sleep can make you more insulin resistant and lead to higher blood sugars. Hormonal changes can cause your blood sugars to rise and fall. These hormones could be from things like increased stress, growth-hormones, menstruation, and menopause. As you learn about why your blood sugars change, it is critical to look at factors beyond food. Mistake #2: Guessing Your Blood Sugars People are horrible at guessing their own blood sugars. The key problem is that the symptoms of high and low blood sugars are not always consistent. Are you sweating and hungry because of a low blood sugar or because it’s 90 degrees out and you skipped breakfast? Are you Continue reading >>

Metformin, The Liver, And Diabetes

Metformin, The Liver, And Diabetes

Most people think diabetes comes from pancreas damage, due to autoimmune problems or insulin resistance. But for many people diagnosed “Type 2,” the big problems are in the liver. What are these problems, and what can we do about them? First, some basic physiology you may already know. The liver is one of the most complicated organs in the body, and possibly the least understood. It plays a huge role in handling sugars and starches, making sure our bodies have enough fuel to function. When there’s a lot of sugar in the system, it stores some of the excess in a storage form of carbohydrate called glycogen. When blood sugar levels get low, as in times of hunger or at night, it converts some of the glycogen to glucose and makes it available for the body to use. Easy to say, but how does the liver know what to do and when to do it? Scientists have found a “molecular switch” called CRTC2 that controls this process. When the CRTC2 switch is on, the liver pours sugar into the system. When there’s enough sugar circulating, CRTC2 should be turned off. The turnoff signal is thought to be insulin. This may be an oversimplification, though. According to Salk Institute researchers quoted on RxPG news, “In many patients with type II diabetes, CRTC2 no longer responds to rising insulin levels, and as a result, the liver acts like a sugar factory on overtime, churning out glucose [day and night], even when blood sugar levels are high.” Because of this, the “average” person with Type 2 diabetes has three times the normal rate of glucose production by the liver, according to a Diabetes Care article. Diabetes Self-Management reader Jim Snell brought the whole “leaky liver” phenomenon to my attention. He has frequently posted here about his own struggles with soarin Continue reading >>

5 Biggest Diabetes Management Mistakes

5 Biggest Diabetes Management Mistakes

Over seven years and millions of interactions on Diabetes Daily, we have seen many people make the same mistakes. Here are five of the most common ones along with potential solutions. What mistakes are missing from the list? Share your experience in the comments and help spare your peers some difficult days. Mistake #1: Thinking Only Food Impacts Blood Sugars Carbohydrates, and to a lesser extent fat and protein, impact blood sugars. But food is just one of many factors. Stress whether it is caused by pain, a fight with a loved one, or intense exercise increases blood sugars. Activity typically lowers blood sugars, but many forms of exercise can also raise your blood sugar, such as strength-training and sprinting. Exercise that is causing negative stress on your body can also raise your blood sugar. Little known fact: if a 20 minute, pain-free walk regularly increases blood sugars and you havent eaten recently, call your doctor and ask for a stress test. This can be an early sign of heart disease. Something is causing that stress. Sleep patterns can change your insulin sensitivity throughout the day. Not getting enough sleep can make you more insulin resistant and lead to higher blood sugars. Hormonal changescan cause your blood sugars to rise and fall. These hormones could be from things like increased stress, growth-hormones, menstruation, and menopause. As you learn about why your blood sugars change, it is critical to look at factors beyond food. People are horrible at guessing their own blood sugars. The key problem is that the symptoms of high and low blood sugars are not always consistent. Are you sweating and hungry because of a low blood sugar or because its 90 degrees out and you skipped breakfast? Are you irritable because of high blood sugars or a friend sa Continue reading >>

Control Of Type 2 Diabetes

Control Of Type 2 Diabetes

Embrace your diabetes Enlarge Haemoglobin, in your blood, joins up with glucose to form the chemical called HbA1c We are learning more about diabetes all the time, and it is becoming clear the harder you work to control your diabetes when it is diagnosed the more benefit you will get in the long term. Complications from diabetes will be prevented or delayed (NEJM 08) (UKPDS 08). Type 2 diabetes is a progressive condition. It is not a 'mild' form of diabetes. The exercise you take and the food you eat need to balance the remaining natural insulin your body makes. This page is designed to give readers an idea how decisions are made concerning their care, but remember every patient is different and advice can vary. Take control....learning how to control type 2 diabetes Your diabetes nurse can teach you the basics, and reading up is helpful. But there are structured diabetes education programs that your doctor must enable you to attend such a course. The programs teach you how to take control of type 2 diabetes, and patients who have attended the program have better diabetic control and fewer problems. Compliance Birmingham meeting 2012: Patients only take half their oral medication. Fixed dose combination tablets would help a little. 10% compliance with multiple drugs. What is happening in type 2 diabetes There are four particular problems. These factors work together to contribute to type 2 diabetes. The factors may be controlled by genes. So your children or brothers and sisters may be affected, and they should take precautions (exercise, healthy diet, not becoming overweight, and not smoking). First, there is a shortage of insulin You may have inherited this condition from your parents. Alternatively, a few people may have had pancreatitis or a bad attack of mumps that Continue reading >>

Metformin | Diabetesnet.com

Metformin | Diabetesnet.com

Thu, 11/18/2010 - 15:57 -- Richard Morris Two drugs from the biguanide class, metformin and phenformin, were developed in 1957. Unfortunately, phenformin reached the U.S. market first and resulted in several deaths from lactic acidosis. When this risk surfaced, phenformin was pulled from drugstore shelves worldwide. Metformin was eventually found to be 20 times less likely to cause lactic acidosis, but it was tainted by the history of its cousin. Metformin first became available in France in 1979 and has been widely used in Europe since then, but it was not cleared for use in Type 2 diabetes in the U.S. until 1994. Target Organ: Liver, secondary effects on muscle and fat. Action: Lower glucose production by liver, increase number of insulin receptors Side Effects: bloating, fullness, nausea, cramping, diarrhea, vit B12 deficiency, headache, metallic taste, agitation, lactic acidosis Contraindications: DKA, alcoholism, binge drinking, kidney or liver disease, congestive heart failure, pregnancy, use of contrast media, surgery, heart attack, age > 80 Metformin is a chemical kin to the French lilac plant, which was noted in the early 1900’s to lower the blood sugar. However, French lilac, like phenformin, turned out to be too toxic for use in humans. Metformin, with a much shorter action time than phenformin, has a much lower risk for severe side effects and is quite safe for use by anyone who is otherwise healthy. In fact, in the major UKPDS study, it was the only drug that reduced diabetes-related death rates, heart attacks, and strokes. It should not be used by those who use more than two ounces or two drinks of alcohol a day, who have congestive heart failure, or who have significant kidney, liver, or lung disease. Metformin lowers fasting blood glucose levels by an Continue reading >>

Blood Sugar: What Causes High Blood Sugar Levels In The Morning

Blood Sugar: What Causes High Blood Sugar Levels In The Morning

There are two reasons why your blood sugar levels may be high in the morning – the dawn phenomenon and the Somogyi effect. The dawn phenomenon is the end result of a combination of natural body changes that occur during the sleep cycle and can be explained as follows: Your body has little need for insulin between about midnight and about 3:00 a.m. (a time when your body is sleeping most soundly). Any insulin taken in the evening causes blood sugar levels to drop sharply during this time. Then, between 3:00 a.m. and 8:00 a.m., your body starts churning out stored glucose (sugar) to prepare for the upcoming day as well as releases hormones that reduce the body's sensitivity to insulin. All of these events happen as your bedtime insulin dose is also wearing off. These events, taken together, cause your body's blood sugar levels to rise in the morning (at "dawn"). A second cause of high blood sugar levels in the morning might be due to the Somogyi effect (named after the doctor who first wrote about it). This condition is also called "rebound hyperglycemia." Although the cascade of events and end result – high blood sugar levels in the morning – is the same as in the dawn phenomenon, the cause is more "man-made" (a result of poor diabetes management) in the Somogyi effect. There are two potential causes. In one scenario, your blood sugar may drop too low in the middle of the night and then your body releases hormones to raise the sugar levels. This could happen if you took too much insulin earlier or if you did not have enough of a bedtime snack. The other scenario is when your dose of long-acting insulin at bedtime is not enough and you wake up with a high morning blood sugar. How is it determined if the dawn phenomenon or Somogyi effect is causing the high blood sug Continue reading >>

Managing Morning Blood Sugar Highs: How To Treat The Top 3 Causes

Managing Morning Blood Sugar Highs: How To Treat The Top 3 Causes

A high blood sugar reading first thing in the morning can throw off your whole day — and signal a chronic problem. Despite their best efforts to control their blood sugar levels, some people simply wake up with elevated blood sugar. Starting your day this way isn't just alarming: If it becomes a pattern, high morning readings can make it difficult to achieve your long-term diabetes management goals. Whether you have type 1 or type 2 diabetes, a morning blood sugar high can be due to several causes. But with a little detective work and the help of your diabetes care team, you can isolate the cause and take steps to correct it. Here are three common scenarios: 1. The Dawn Phenomenon This occurs during the night while you're asleep and the body releases stress hormones. This phenomenon usually occurs between 3 a.m. and 8 a.m. and involves growth hormone, cortisol, and adrenaline, which trigger the production and release of glucose from your liver. The end result of this chemical cascade is an increase in blood sugar. “These hormones are designed to get us up and moving in the morning,” says endocrinologist Renee Amori, MD, assistant professor of medicine in the division of endocrinology at the Drexel University College of Medicine in Philadelphia. While everybody experiences these natural changes in hormone levels, in people with diabetes the body may not adjust appropriately. This can lead to higher-than-normal blood sugar at the start of the day. Testing for these elevated first morning blood sugars is one way to diagnose people with type 2 diabetes. 2. The Somogyi Effect High morning readings can also be caused by the Somogyi effect, a rebound response that occurs when the body overcompensates for a low blood sugar reaction at night. If you take blood sugar–lowe Continue reading >>

Metformin For Gestational Diabetes - What It Is And How It Works

Metformin For Gestational Diabetes - What It Is And How It Works

In the UK it is common to use Metformin for gestational diabetes where dietary and lifestyle changes are not enough to lower and stabilise blood sugar levels. It is widely used to help lower fasting blood sugar levels as well as post meal levels. Metformin is an oral medication in tablet form. It is used in diabetics to help the body use insulin better by increasing how well the insulin works. In pregnancy it can be used in women who have diabetes before becoming pregnant (Type 2 diabetes) and in women who develop diabetes during pregnancy (gestational diabetes). Metformin is also used for other conditions too, commonly used in those that have PCOS (polycystic ovarian syndrome). Metformin is a slow release medication. Here are the most commonly asked Q&A on Metformin for gestational diabetes from our Facebook support group Why do I need to take Metformin? For many ladies with gestational or type 2 diabetes, if lower blood sugar levels cannot be reached through diet and exercise then medication will be required to assist. If blood sugar levels remain high, then the diabetes is not controlled and can cause major complications with the pregnancy and baby. Some consultants will prescribe Metformin on diagnosis of gestational diabetes on the basis of your GTT results. Others will let you try diet control first and when blood glucose levels rise out of target range, or close to the target range, they may prescribe Metformin as a way to help lower and control your levels. NICE guidelines regarding the timing and use of Metformin for gestational diabetes 1.2.19 Offer a trial of changes in diet and exercise to women with gestational diabetes who have a fasting plasma glucose level below 7 mmol/litre at diagnosis. [new 2015] 1.2.20 Offer metformin[4] to women with gestational dia Continue reading >>

Metformin And Insulin Resistance

Metformin And Insulin Resistance

About a year ago, my endocrinologist determined that I was exhibiting signs of insulin resistance. In short, my body requires more than the average amount of insulin to cover carbohydrate. She suggested that I start taking metformin, noting that it would do two things for me: It would decrease the amount of insulin I need to take and it would help curb my appetite, thus resulting in weight loss. When I first got on it, I thought it was great. My blood sugar levels improved, my appetite was in fact curbed, and all seemed wonderful — until I stopped taking my metformin. As a high school senior, I had atrocious sleeping habits! That, coupled with the fact that taking metformin was really killing my appetite, was causing me to become exhausted and get some pretty severe headaches. Looking back on it now, it’s very clear that the metformin wasn’t the problem, it was me. However, as a stubborn senior in high school, I was determined to maintain my sleeping habits, as I deemed them completely normal and in accordance with the typical behavior exhibited by my peers (boy, how I’ve changed…). So, I stopped the metformin. The last three weeks or so, I’ve been back on metformin regularly. I decided to start it up again after my last appointment with my CDE. Thus far, it’s really been working wonders and my blood sugars have decreased substantially! Where my 30-day average was hovering around 190 just a few weeks ago, it has now dropped to 137! I was seriously shocked when I saw how much my average fell. For the most part, my blood sugar levels are in range, but I have had my fair share of lows as well. Managing metformin really is a science that can change on a daily basis depending on my activity level. For example, the first two weeks that I was back on metformin, I Continue reading >>

Metformin: Are You Taking This Common Type 2 Medication? Here’s What You Need To Know

Metformin: Are You Taking This Common Type 2 Medication? Here’s What You Need To Know

For the treatment of Type 2 diabetes, most of the time, the first course of treatment is to try and control it with diet and exercise. However, if your blood sugar levels are still high despite these lifestyle changes, your doctor may recommend starting you on Metformin. Here is what you should know. What Is Metformin? Metformin is prescribed to patients with Type 2 diabetes, mainly to those patients who are insulin resistant and overweight. Metformin is an oral medication that is manufactured by Bristol-Myers Squibb Company. It was approved in 1994, by the Food and Drug Administration (FDA). Metformin is under the class of diabetes drugs known as biguanide and is sold under the brand names Fortamet, Glucophage, Glucophage XR, Glumetza and Riomet. Glucophage is dispensed as an immediate-release tablet, while Fortamet, Glucophage XR and Glumetza are released as extended-release tablets and Riomet is dispensed as an oral solution. Metformin is prescribed in doses of 500 milligrams, 850 milligrams and 1,000 milligrams, with 500 milligrams being the most common dosage. Metformin may be used in conjunction with diet and exercise or it may be used with other diabetes medications, like Competact or Janumet. What Else is Metformin Used For? Besides Type 2 diabetes, Metformin is also to treat other conditions as well, including Polycystic Ovary Syndrome (PCOS), obesity, Insulin Resistance Syndrome and female infertility. How Does Metformin Work? Metformin works in three ways. First, it stops glucose from forming in your liver. Second, it reduces the amount of sugar that your intestines absorb. Third, it improves your body’s insulin sensitivity. I advise reading the following articles: What is Metformin FDA Black Box Warning? The Food and Drug Administration (FDA) has placed a Continue reading >>

Why Am I Taking Metformin?

Why Am I Taking Metformin?

I was controlling my blood sugar with regular insulin injections, so why did my doctor add metformin during my last visit? Conditions Expert Chief Medical Officer, American Cancer Society Type 2 diabetes mellitus is a disease that can initially show no symptoms. Eventually very high blood sugars cause symptoms of blurred vision, increased urination, and increased thirst. The long-term effects of diabetes, especially uncontrolled diabetes, can include cardiovascular disease, heart attack and stroke, peripheral vascular disease, and kidney disease. In type 2 diabetes, the cells of the muscles and organs of the body have difficulty bringing blood sugar, which is also called blood glucose, inside to use as fuel for metabolism. Insulin's normal function is to help bring sugar into the cell, and the problem is these cells have what is called insulin resistance. The body's response to insulin resistance is to increase the amount of insulin secreted by the pancreas. Over time, higher and higher amounts of insulin are secreted to overcome insulin resistance. Eventually the blood sugar levels rise higher than normal despite the high levels of circulating insulin. Type 1 diabetes differs from type 2 diabetes in that type 1 is a disease in which the pancreas stops producing insulin. The initial treatment of mild type 2 diabetes mellitus is lifestyle intervention. This usually consists of diet modification, exercise and weight loss. If this does not control blood sugars, metformin is usually the first drug prescribed. Metformin is an oral medication that is taken once or twice a day. It decreases sugar production in the liver and decreases blood sugar levels by increasing muscle and organ sensitivity to insulin. The dose of metformin can be increased over a period of weeks to months Continue reading >>

Metformin 101: Blood Sugar Levels, Weight, Side Effects

Metformin 101: Blood Sugar Levels, Weight, Side Effects

As a type 2 diabetic, you've probably heard of Metformin, or you might even be taking it yourself. Metformin (brand name “Glucophage” aka “glucose-eater”) is the most commonly prescribed medication for type 2 diabetes worldwide…and for good reason. It is one of the safest, most effective, least costly medication available with minimal, if any, side effects. There are always lots of questions around Metformin – how does metformin lower blood sugar, does metformin promote weight loss or weight gain, will it give me side effects – and lots more. Today we'll hopefully answer some of those questions. How Metformin Works Metformin belongs to a class of medications known as “Biguanides,” which lower blood glucose by decreasing the amount of sugar put out by the liver. The liver normally produces glucose throughout the day in conjunction with the pancreas’ production of insulin to maintain stable blood sugar. In many people with diabetes, both mechanisms are altered in that the pancreas puts out less insulin while the liver is unable to shut down production of excess glucose. This means your body is putting out as much as 3 times as much sugar than that of nondiabetic individuals, resulting in high levels of glucose in the bloodstream. Metformin effectively shuts down this excess production resulting in less insulin required. As a result, less sugar is available for absorption by the muscles and conversion to fat. Additionally, a lower need for insulin slows the progression of insulin resistance and keeps cells sensitive to endogenous insulin (that made by the body). Since metformin doesn’t cause the body to generate more insulin, it does not cause hypoglycemia unless combined with a sulfonylurea or insulin injection. Metformin is one of the few oral diabe Continue reading >>

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