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INVOKANA® can cause important side effects, including: Amputations. INVOKANA® may increase your risk of lower-limb amputations. Amputations mainly involve removal of the toe or part of the foot; however, amputations involving the leg, below and above the knee, have also occurred. Some people had more than one amputation, some on both sides of the body. You may be at a higher risk of lower-limb amputation if you: have a history of amputation, have heart disease or are at risk for heart disease, have had blocked or narrowed blood vessels (usually in leg), have damage to the nerves (neuropathy) in the leg, or have had diabetic foot ulcers or sores. Call your doctor right away if you have new pain or tenderness, any sores, ulcers, or infections in your leg or foot. Your doctor may decide to stop your INVOKANA® for a while if you have any of these signs or symptoms. Talk to your doctor about proper foot care Dehydration. INVOKANA® can cause some people to become dehydrated (the loss of too much body water), which may cause you to feel dizzy, faint, lightheaded, or weak, especially when you stand up (orthostatic hypotension). You may be at higher risk of dehydration if you have low blood pressure, take medicines to lower your blood pressure (including diuretics [water pills]), are on a low sodium (salt) diet, have kidney problems, or are 65 years of age or older Vaginal yeast infection. Women who take INVOKANA® may get vaginal yeast infections. Symptoms include: vaginal odor, white or yellowish vaginal discharge (discharge may be lumpy or look like cottage cheese), or vaginal itching Yeast infection of the penis (balanitis or balanoposthitis). Men who take INVOKANA® may get a yeast infection of the skin around the penis. Symptoms include: redness, itching, or swelling o Continue reading >>
How To Lower Your A1c Levels: More Steps You Can Take
You may be familiar with the “ABCs” of diabetes: A1C, blood pressure, and cholesterol. This acronym is part of a larger diabetes campaign called “Know Your Numbers,” and hopefully you’re aware of all of your numbers — what they are, what they should be, and how often to get them checked. Obviously, knowing your A1C and knowing what you can do if it’s not at goal is a big part of diabetes management. The focus last week and this week has been on all things A1C: what it is, what the general goal is, why it matters, and ways to get it to where it needs to be. What else does it take to lower your A1C? Figuring out how to lower your A1C to whatever your personal goal is can sometimes seem like solving a puzzle. You try something and it may or may not help, or it helps but not enough. Then you try something else. Yes, it can be frustrating, but eventually you’ll hit on a strategy that works for you. Last week, we looked at how a healthy eating plan (including keeping carbs consistent and sticking to an eating schedule) and a physical activity program can help. Research shows that an eating plan can lower A1C levels by 1–2%; physical activity can lower A1C by 0.6–1%, according to various studies. But what if these two strategies aren’t enough? Then what? Time for medication? Diabetes medicines generally lower A1C levels anywhere from 0.5% to as much as 3.5%. The A1C-lowering effect of medicines can vary from person to person, however, and the effect is often dependent upon how high the A1C is to begin with. Insulin. We know that people who have Type 1 diabetes must take insulin. Insulin can be delivered using a syringe or an insulin pen; it can also be administered using an insulin pump. How you decide to take your insulin is a decision best made with you Continue reading >>
Acp Guidance Statement On Hba | Annals Of Internal Medicine | American College Of Physicians
Author, Article, and Disclosure Information This article was published at Annals.org on 6 March 2018. * This paper, authored by Amir Qaseem, MD, PhD, MHA; Timothy J. Wilt, MD, MPH; Devan Kansagara, MD, MCR; Carrie Horwitch, MD, MPH; Michael J. Barry, MD; and Mary Ann Forciea, MD, was developed for the Clinical Guidelines Committee of the American College of Physicians. Individuals who served on the Clinical Guidelines Committee from initiation of the project until its approval were Mary Ann Forciea, MD (Chair); Nick Fitterman, MD; Kate Balzer, MSW; Michael J. Barry, MD; Cynthia Boyd, MD, MPH; Carrie Horwitch, MD, MPH; Linda L. Humphrey, MD, MPH; Alfonso Iorio, MD, PhD; Devan Kansagara, MD, MCR; Jennifer Lin, MD, MCR; Scott Manaker, MD, PhD; Michael Maroto, JD, MBA; Robert McLean, MD; Reem Mustafa, MD, PhD, MPH; Janice Tufte; Sandeep Vijan, MD, MS; and Timothy J. Wilt, MD, MPH. Approved by the ACP Board of Regents on 26 March 2017. Author (participated in discussion and voting). Nonauthor contributor (participated in discussion but excluded from voting). American College of Physicians, Philadelphia, Pennsylvania (A.Q.) Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota (T.J.W.) Oregon Health & Science University and Veterans Affairs Medical Center, Portland, Oregon (D.K.) Virginia Mason Medical Center, Seattle, Washington (C.H.) Massachusetts General Hospital, Boston, Massachusetts (M.J.B.) University of Pennsylvania Health System, Philadelphia, Pennsylvania (M.A.F.) Note: Guidance statements are guides only and may not apply to all patients and all clinical situations. Thus, they are not intended to override clinicians' judgment. All ACP guidance statements are considered automatically withdrawn or invalid 5 years after publication, or once an update h Continue reading >>
Victoza® Lowers Blood Sugar Levels
Victoza® helps lower A1C In medical studies, many people taking Victoza® were able to reach the American Diabetes Association's A1C goal of less than 7.0%. (The A1C test measures your average blood sugar level over the previous 2 to 3 months.) Victoza® helps lower blood sugar in as soon as 2 weeks, and has been shown to keep it down in a 2-year medical study. Victoza® 1.8 mg taken alone or in combination with other diabetes medications lowered A1C by 1.0 to 1.5%, on average, in medical studies. That's good to know, because even a 1% drop in A1C can be important in the management of type 2 diabetes. One of these studies compared Victoza® with Januvia®. In this study, Victoza® was found to lower A1C better than Januvia®. Although not a weight-loss product, patients on Victoza® also had greater weight loss than those taking Januvia®. More patients taking Victoza® had short-term nausea as well as headache, diarrhea, and vomiting. Nausea was temporary, and fewer patients reported it over time. Another study compared Victoza® with Byetta®. In this study, Victoza® was found to lower A1C better than Byetta® and helped more patients get to goal. Side effects such as nausea and diarrhea were similar with both medications. See how Victoza® compares with the diabetes pill Januvia® or the injectable medication Byetta®. ► Victoza® works in 3 ways to lower blood sugar levels Victoza® works like the hormone GLP-1 (7-37)a to: Slow food leaving your stomach Help prevent your liver from making too much sugar Help the pancreas produce more insulin when your blood sugar levels are high aGLP-1 (7-37) represents <20% of the total circulating GLP-1 produced by your body. While not a weight-loss product, Victoza® may help you lose some weight In clinical studies ranging f Continue reading >>
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How Farxiga May Help
Being inspired to fight back against your type 2 diabetes is an important first step in your treatment plan. Sometimes, one of the next steps is taking a medication that may help control your blood sugar. FARXIGA (far-SEE-guh) is a once-daily pill taken in the morning with or without food. In studies, FARXIGA: Additionally, FARXIGA may help you: Do not take FARXIGA if you: have severe kidney problems or are on dialysis. Your healthcare provider should do blood tests to check how well your kidneys are working before and during your treatment with FARXIGA FARXIGA may cause serious side effects including: Dehydration (the loss of body water and salt), which may cause you to feel dizzy, faint, lightheaded, or weak, especially when you stand up (orthostatic hypotension). You may be at a higher risk of dehydration if you have low blood pressure; take medicines to lower your blood pressure, including water pills (diuretics); are 65 years of age or older; are on a low salt diet, or have kidney problems FARXIGA has been tested in 24 clinical studies that looked at its benefits and safety. The studies had more than 11,000 adults with type 2 diabetes, including more than 6,000 patients treated with FARXIGA. FARXIGA, combined with diet and exercise, was studied alone as well as in combination with other diabetes medicines you may be taking. The other medicines included metformin, glimepiride, pioglitazone, insulin, and sitagliptin. Real patients. Real stories. Patients who are fighting back, sharing their challenges—and their successes—managing their type 2 diabetes. See Patient Stories FARXIGA works with the body to flush sugar away in urine. Learn more about how FARXIGA works › Continue reading >>
7 Ways To Lower Your A1c Levels
If you have diabetes, you’re probably used to checking your own blood sugar with a glucose meter. These blood sugar measurements are important for controlling levels on a daily basis but are less useful for understanding your long-term blood sugar levels. Your doctor has a way to determine if your blood sugar has been in the recommended range by checking your hemoglobin A1C levels through a blood test. Your A1C shows how well you have been controlling your blood sugar levels over time and can help your health care team determine your average level over the past three months. What does my A1C mean An A1C level below 5.7% is normal whereas an A1C level between 5.7 and 6.4 signals prediabetes. For most, the goal is to lower A1C levels. Here’s what the A1C means in reference to average daily blood sugar. 6% A1C = 126 average blood sugar 7% A1C = 154 average blood sugar 8% A1C = 183 average blood sugar 9% A1C = 212 average blood sugar 10% A1C = 240 average blood sugar 11% A1C = 269 average blood sugar 12% A1C = 298 average blood sugar How often should I check my A1C? Your doctor or health care team will determine how often you should get your blood work, and A1C tested. Usually, you will be directed to get your A1C levels checked every three months. However, if your diabetes is well-controlled, your doctor may only require you to get your blood work done every six months. Is there a way to check my A1C besides going to the doctor? Yes. You can now purchase over-the-counter A1C test kids right from your local pharmacy. However, using an at-home testing kit for your A1C is not a substitute for regular blood glucose measurements or regular visits with your healthcare provider. What should my A1C goal be? Your doctor will help you determine what your personal A1C goal should Continue reading >>
Now Let’s Talk Lower A1c
JARDIANCE is a prescription medicine used along with diet and exercise to lower blood sugar in adults with type 2 diabetes, and also to reduce the risk of cardiovascular death in adults with type 2 diabetes who have known cardiovascular disease. JARDIANCE is not for people with type 1 diabetes or for people with diabetic ketoacidosis (increased ketones in the blood or urine). Dehydration. JARDIANCE can cause some people to have dehydration (the loss of body water and salt). Dehydration may cause you to feel dizzy, faint, light-headed, or weak, especially when you stand up. You may be at a higher risk of dehydration if you: have low blood pressure, take medicines to lower your blood pressure, including water pills (diuretics), are on a low salt diet, have kidney problems, are 65 years of age or older. Ketoacidosis (increased ketones in your blood or urine). Ketoacidosis is a serious condition and may need to be treated in the hospital. Ketoacidosis may lead to death. Ketoacidosis occurs in people with type 1 diabetes and can also occur in people with type 2 diabetes taking JARDIANCE, even if blood sugar is less than 250 mg/dL. Stop taking JARDIANCE and call your doctor right away if you get any of the following symptoms, and if possible, check for ketones in your urine: nausea, vomiting, stomach-area (abdominal) pain, tiredness, or trouble breathing. Serious urinary tract infections. Serious urinary tract infections can occur in people taking JARDIANCE and may lead to hospitalization. Tell your doctor if you have symptoms of a urinary tract infection such as a burning feeling when passing urine, a need to urinate often or right away, pain in the lower part of your stomach or pelvis, or blood in the urine. Sometimes people also may have a fever, back pain, nausea or vomit Continue reading >>
Your A1c Levels – What Goal To Shoot For?
Measuring Your A1C An A1C test gives you and your provider insight into all of your blood glucose ups and downs over the past two or three months. It’s like the 24/7 video of your blood sugar levels. Observing your A1C results and your blood glucose (also known as blood sugar) results together over time are two of the key tools you and your health care provider can use to monitor your progress and revise your therapy as needed over the years. Recent research is changing the way health professionals look at A1C levels. Instead of setting tight controls across the board, a healthy A1C level is now a moving target that depends on the patient. In the past, an A1C of 7 percent was considered a healthy goal for everyone. Yehuda Handelsman, M.D., medical director of the Metabolic Institute of America in Tarzana, California, says experts now recommend taking a patient-centered approach to managing A1C levels, which means evaluating goals based on individual diabetes management needs and personal and lifestyle preferences. Current ADA Goals The 2015 American Diabetes Association (ADA) Standards of Medical Care in Diabetes advise the following A1C levels: • 6.5 percent or less: This is a more stringent goal. Health care providers might suggest this for people who can achieve this goal without experiencing a lot of hypoglycemia episodes or other negative effects of having lower blood glucose levels. This may be people who have not had diabetes for many years (short duration); people with type 2 diabetes using lifestyle changes and/or a glucose-lowering medication that doesn’t cause hypoglycemia; younger adults with many years to live healthfully; and people with no significant heart and blood vessel disease. • 7 percent: This is a reasonable A1C goal for many adults with d Continue reading >>
The American College Of Physicians Recommends A1c Levels Between 7 And 8 Percent : Shots - Health News : Npr
A major medical association today suggested that doctors who treat people with Type 2 diabetes can set less aggressive blood sugar targets. But medical groups that specialize in diabetes sharply disagree. Half a dozen medical groups have looked carefully at the best treatment guidelines for the 29 million Americans who have Type 2 diabetes and have come up with somewhat differing guidelines. The American College of Physicians has reviewed those guidelines to provide its own recommendations , published in the Annals of Internal Medicine. It has decided that less stringent goals are appropriate for the key blood sugar test, called the A1C. "There are harms associated with overzealous treatment or inappropriate treatment focused on A1C targets," says Dr. Jack Ende , president of the ACP. "And for that reason, this is not the kind of situation where the college could just sit back and ignore things." The ACP, which represents internists, recommends that doctors aim for an A1C in the range of 7 to 8 percent, not the lower levels that other groups recommend. For people who have already achieved a lower level, "consider de-intensifying treatment," Ende says. "That is, reducing one of the medications, stopping a medication, just allow the A1C to be between 7 and 8." This Chef Lost 50 Pounds And Reversed Prediabetes With A Digital Program Some studies have shown that people who have aggressively pushed to lower their blood sugar are at somewhat higher risk of premature death. People also suffer from low blood sugar as a result of aggressive treatment. That was the case for Valerie Pennington, a special-needs teacher who lives in Odessa, Mo. She was diagnosed in her mid-40s and put on an aggressive treatment regime. "The nurse at school because I was going low so much made me ge Continue reading >>
Type 2 Diabetes: New Guidelines Lower Blood Sugar Control Levels
Type 2 diabetes: New guidelines lower blood sugar control levels The American College of Physicians have now published their new guidelines regarding the desired blood sugar control levels for people with type 2 diabetes. The recommendations aim to change current therapeutic practices, and doctors should aim for a moderate level of blood sugar when treating their patients. Blood sugar control levels should be moderate for people living with type 2 diabetes, according to new guidelines. According to the most recent estimates, almost 30 million people in the United States have type 2 diabetes , which amounts to over 9 percent of the entire U.S. population. Once diagnosed with type 2 diabetes, patients are often advised to take what is known as a glycated hemoglobin (HbA1c) test in order to keep blood sugar levels under control. The test averages a person's blood sugar levels over the past 2 or 3 months, with an HbA1c score of 6.5 percent indicating diabetes . But some studies have pointed out that the HbA1c test may currently be overused in the U.S., and they have suggested that such over-testing may lead to over-treating patients with hypoglycemic drugs. These drugs often have a range of side effects, such as gastrointestinal problems, excessively low blood sugar, weight gain, and even congestive heart failure . Additionally, as some researchers have pointed out, "Excessive testing contributes to the growing problem of waste in healthcare and increased patient burden in diabetes management." In this context, the American College of Physicians (ACP) set out to examine the existing guidelines from several organizations and the evidence available in an effort to help physicians make better, more informed decisions about treating people with type 2 diabetes. Their guideline Continue reading >>
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Controversial New A1c Recommendations For Diabetes: What To Know | Everyday Health
RELATED: How Brooklyn Politician Eric Adams Lowered His A1C and Reversed Diabetes Through Diet Changes A Closer Look at the Doctors Proposed A1C Guidelines To make the new recommendations, study authors analyzed past studies and guidelines issued by other organizations from around the world. Beyond making the general recommendation for a new A1C target, the group proposed the following three guidelines: Ease up on diabetes treatment for any patient with an A1C of 6.5 or lower, to avoid his or her blood sugar levels from dipping further. Individualize management goals based on factors like life expectancy, cost of care, and medication risk. Do not set a target A1C level in people who have a life expectancy of less than 10 years due to advanced age (80 years old or older), have certain chronic conditions, or are living in a nursing home. Six coauthors of the report assessed each guideline using a tool that evaluates research materials based on six criteria, including clarity of presentation and a study's scope and purpose. While the ACP did not return repeated requests for comment before publication of this story, Jack Ende, MD, president of the ACP who is based in Philadelphia, said in a news release that avoiding treatment in people with an A1C below 6.5 will reduce unnecessary medication harms, burdens, and costs without negatively impacting the risk of death, heart attacks, strokes, kidney failure, amputations, visual impairment, or painful neuropathy, referencing macrovascular complications. Type 2 diabetes is a widespread problem and is linked to the complications Dr. Ende mentions in the release. There are more than 30 million people in the United States who have diabetes, with 90 to 95 percent of them having type 2 diabetes, according to the Centers for Disease C Continue reading >>
- A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes
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Type 2 Diabetes
Print Diagnosis To diagnose type 2 diabetes, you'll be given a: Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates you have diabetes. A result between 5.7 and 6.4 percent is considered prediabetes, which indicates a high risk of developing diabetes. Normal levels are below 5.7 percent. If the A1C test isn't available, or if you have certain conditions — such as if you're pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — that can make the A1C test inaccurate, your doctor may use the following tests to diagnose diabetes: Random blood sugar test. A blood sample will be taken at a random time. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst. Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes. Oral glucose tolerance test. For this test, you fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood s Continue reading >>
Diabetes Medicines You Don’t Inject
When you think about diabetes drugs, you may think of insulin or other medications that you get from a shot or a pump. But there are others that you take as a pill or that you inhale. Your doctor will consider exactly what you need, which may include more than one type of diabetes medicine. The goal is to get your best blood sugar control, and the oral drugs do that in several ways. How it works: Blocks enzymes that help digest starches, slowing the rise in blood sugar. It belongs to a group of drugs called “alpha-glucosidase inhibitors.” Side effects for these kinds of drugs include stomach upset (gas, diarrhea, nausea, cramps). Alogliptin (Nesina) How it works: Boosts insulin levels when blood sugars are too high, and tells the liver to cut back on making sugars. Your doctor may call this type of drug a “DPP-IV inhibitor.” These drugs do not cause weight gain. You may take them alone or with another drug, like metformin. Bromocriptine mesylate (Cycloset, Parlodel) How it works: This tablet raises the level of dopamine, a brain chemical. It’s approved help improve blood sugar control in adults with type 2 diabetes, along with diet and exercise. It’s not used to treat type 1 diabetes. Canagliflozin (Invokana) How it works: Boosts how much glucose leaves your body in urine, and blocks your kidney from reabsorbing glucose. Your doctor may call this type of drug a “SGLT2 inhibitor.” Side effects can include: Urinary tract infections Dizziness, fainting Ketoacidosis or ketosis Increased risk of bone fracture Decreased bone mineral density Chlorpropamide (Diabinese) How it works: Lowers blood sugar by prompting the pancreas to release more insulin. Your doctor may call this type of drug “sulfonylureas.” This drug is not used as often as newer sulfonylurea Continue reading >>
Ultimate Guide To The A1c Test: Everything You Need To Know
The A1C is a blood test that gives us an estimated average of what your blood sugar has been over the past 2-3 months. The A1c goes by several different names, such aswa Hemoglobin A1C, HbA1C, Hb1C, A1C, glycated hemoglobin, glycohemoglobin and estimated glucose average. What is Hemoglobin? Hemoglobin is a protein in your blood cells that carries oxygen. When sugar is in the blood, and it hangs around for a while, it starts to attach to the red blood cells. The A1C test is a measurement of how many red blood cells have sugar attached. So, if your A1C result is 7%, that means that 7% of your red blood cells have sugar attached to them. What are the Symptoms of a High A1C Test Level? Sometimes there are NO symptoms! That is probably one of the scariest things about diabetes, your sugar can be high for a while and you may not even know it. When your blood sugar goes high and stays high for longer periods of time you may notice the following: tired, low energy, particularly after meals feel very thirsty you may be peeing more than normal, waking a lot in the middle of the night to go dry, itchy skin unexplained weight loss crave sugar, hungrier than normal blurred vision, may feel like you need new glasses tingling in feet or hands cuts or sores take a long time to heal or don’t heal well at all frequent infections (urinary tract, yeast infections, etc.) When your blood sugar is high, this means the energy that you are giving your body isn’t getting into the cells. Think about a car that has a gas leak. You put gas in, but if the gas can’t get to the engine, the car will not go. When you eat, some of the food is broken down into sugar and goes into your bloodstream. If your body can’t get the sugar to the cells, then your body can’t “go.” Some of the sugar tha Continue reading >>
A Complete List Of Diabetes Medications
Diabetes is a condition that leads to high levels of blood glucose (or sugar) in the body. This happens when your body can’t make or use insulin like it’s supposed to. Insulin is a substance that helps your body use the sugar from the food you eat. There are two different types of diabetes: type 1 diabetes and type 2 diabetes. People with both types of diabetes need medications to help keep their blood sugar levels normal. The types of drugs that can treat you depend on the type of diabetes you have. This article gives you information about drugs that treat both types of diabetes to help give you an idea of the treatment options available to you. Insulin Insulin is the most common type of medication used in type 1 diabetes treatment. It’s also used in type 2 diabetes treatment. It’s given by injection and comes in different types. The type of insulin you need depends on how severe your insulin depletion is. Options include: Short-acting insulin regular insulin (Humulin and Novolin) Rapid-acting insulins Intermediate-acting insulin Long-acting insulins Combination insulins NovoLog Mix 70/30 (insulin aspart protamine-insulin aspart) Humalog Mix 75/25 (insulin lispro protamine-insulin lispro) Humalog Mix 50/50 (insulin lispro protamine-insulin lispro) Humulin 70/30 (human insulin NPH-human insulin regular) Novolin 70/30 (human insulin NPH-human insulin regular) Ryzodeg (insulin degludec-insulin aspart) Amylinomimetic drug Pramlintide (SymlinPen 120, SymlinPen 60) is an amylinomimetic drug. It’s an injectable drug used before meals. It works by delaying the time your stomach takes to empty itself. It reduces glucagon secretion after meals. This lowers your blood sugar. It also reduces appetite through a central mechanism. Most medications for type 2 diabetes are o Continue reading >>
