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Opioids And Diabetes

The Relationship Between Opioid And Sugar Intake: Review Of Evidence And Clinical Applications

The Relationship Between Opioid And Sugar Intake: Review Of Evidence And Clinical Applications

Go to: THE RELATIONSHIP BEWEEN OPIOID ADMINISTRATION AND SUGAR CONSUMPTION Evidence from both preclinical and clinical studies demonstrates that chronic opioid exposure is associated with increased sugar intake. Preclinical research has attempted to refine the potential pathways and mechanisms of action through which opiates may regulate sugar intake, and how sugar consumption may affect the endogenous opiate system. Preclinical animal studies suggest that direct action of mu agonists at the nucleus accumbens shell, hypothalamus, and paraventricular nucleus is associated with development of sweet preference (2–7). This process possibly involves GABA-b activity in the ventral tegmental area (6). Consumption of palatable foods, especially on intermittent schedules, is associated with acute binding of the endogenous opiate B-endorphin in the hypothalamus, accumbens shell, cingulated, hippocampus, and locus ceruleus of rats (2, 8). Furthermore, in rats, intermittent access to sucrose leads to decreased enkephalin MRNA production (9). It is theorized that this down-regulation of enkephalin MRNA production may be associated with increased mu-opiate receptor agonism associated with the rats’ sugar intake (10). Methadone-maintained patients assessed at entry to treatment, 9 months and 4 years into treatment demonstrate increased consumption of sugary food, fewer complex carbohydrates, less fruits, vegetables and fats from fish or vegetables (11). It was noted that female methadone patients consumed fewer total calories, but maintained similar BMI to the national average (BMI 22.7) with sugar accounting for 31% of caloric intake. The authors speculated that weight was maintained with fewer calories because of the patients’ “sedate lifestyles” (12). Clinical literature Continue reading >>

Opioids And Diabetes Drugs Get Revised Warnings

Opioids And Diabetes Drugs Get Revised Warnings

Opioids and diabetes drugs get revised warnings Details on the latest recalls, warnings, and approvals. New warnings on the entire class of opioid pain medications. Safety risks include potentially harmful interactions with other medications (e.g., serotonergic medicines), adrenal insufficiency, and decreased sex hormone levels. The FDA is requiring changes to the labels of all opioids to include these risks. If serotonin syndrome is suspected, clinicians should discontinue opioid treatment and/or use of the other medicine. In cases of suspected adrenal insufficiency, clinicians should perform diagnostic testing before treating the patient with corticosteroids and weaning him or her off the opioid, if appropriate. In patients presenting with signs or symptoms of decreased sex hormone levels, clinicians should conduct laboratory evaluation. In addition, the FDA is requiring a new boxed warning for immediate-release opioids about the serious risks of misuse, abuse, addiction, overdose, and death. New drug label warnings on medications that contain saxagliptin and alogliptin, as these drugs may increase the risk of heart failure, particularly in patients with heart or kidney disease. These dipeptidyl peptidase-4 (DPP-4) inhibitors are found in Onglyza (saxagliptin), Kombiglyze XR (saxagliptin and metformin extended release), Nesina (alogliptin), Kazano (alogliptin and metformin), and Oseni (alogliptin and pioglitazone). Clinicians should consider discontinuing saxagliptin and alogliptin in patients who develop heart failure, making sure to monitor their diabetes control. The new warnings hinge on the findings of 2 large clinical trials conducted in patients with heart disease. One trial showed that 3.5% of patients receiving saxagliptin were hospitalized for heart failure Continue reading >>

Patient Education: Diabetic Neuropathy (beyond The Basics)

Patient Education: Diabetic Neuropathy (beyond The Basics)

DIABETIC NEUROPATHY OVERVIEW Neuropathy is the medical term for nerve damage. Neuropathy is a common complication of type 1 and type 2 diabetes; up to 26 percent of people with type 2 diabetes have evidence of nerve damage at the time that diabetes is diagnosed [1]. A generalized type of neuropathy, known as polyneuropathy, is the most common type of diabetic neuropathy. Other types of neuropathy can also affect people with diabetes, but will not be discussed here. Signs and symptoms of diabetic neuropathy include loss of sensation and/or burning pain in the feet. Early detection of diabetes and tight control of blood sugar levels may reduce the risk of developing diabetic neuropathy. Treatments for diabetic neuropathy are available, and include several elements: control of blood glucose levels, prevention of injury, and control of painful symptoms. DIABETIC NEUROPATHY RISK FACTORS In people with type 1 or type 2 diabetes, the biggest risk factor for developing diabetic neuropathy is having high blood sugar levels over time. Other factors can further increase the risk of developing diabetic neuropathy, including: Coronary artery disease Increased triglyceride levels Smoking High blood pressure DIABETIC NEUROPATHY SYMPTOMS The most common symptoms of diabetic neuropathy include pain, burning, tingling, or numbness in the toes or feet, and extreme sensitivity to light touch. The pain may be worst at rest and improve with activity, such as walking. Some people initially have intensely painful feet while others have few or no symptoms. Diabetic neuropathy usually affects both sides of the body. Symptoms are usually noticed first in the toes. If the disease progresses, symptoms may gradually move up the legs; if the mid-calves are affected, symptoms may develop in the hands. Continue reading >>

Omada Health's Duffy On Integrative Diabetes Coverage's Lessons For Integrative Pain Care

Omada Health's Duffy On Integrative Diabetes Coverage's Lessons For Integrative Pain Care

Tap here to turn on desktop notifications to get the news sent straight to you. Publisher-Editor, Integrator Blog News & Reports Omada Health's Duffy on Integrative Diabetes Coverage's Lessons for Integrative Pain Care I heard Omada Health president Sean Duffy on an April 13, 2017 NEJM Catalyst webinar reference the road by which non-pharmacological, integrative diabetes care gained coverage. Duffy, a high tech high touch Bay Area entrepreneur, displayed his literally out-of-the-box thinking elsewhere in the webinar when he urged the medical industry to build a pervasive culture in which in-person visits are a last resort. Might this interesting executives experience offer insights for those who realize that lack of coverage for non-pharmacologic, integrative pain treatment is a massive barrier to human health? I set up an interview. First, however, I looked into the Diabetes Prevention Program (DPP) that Duffy said provides the data foundation for Omadas now 50-state program. The 2002 DPP study compared a multi-modal integrative diabetes strategy - diet, physical activity and behavior modification - with the drug Metformin . The integrative arm performed with such success that research was halted early so public benefit could immediately commence. Unfortunately, the rest of the scientific and payer community didnt respond with such urgency. It wasnt until 12 years later in August 2014 that the US Preventive Service Task Force (USPSTF) issued a finding recommending that all plans cover lifestyle-based programs. Here is red flag #1 for those who think an integrative pain coverage solution may be right around the corner. It is good news that the AMA, anesthesiologists, American Pain Society and other major stakeholders that have publicly called for massive expansio n in Continue reading >>

Aan Summary Of Evidence-based Guideline For Patients And Their Families

Aan Summary Of Evidence-based Guideline For Patients And Their Families

THERAPIES FOR TREATING DIABETIC NERVE PAIN What is diabetic nerve pain? Diabetic nerve pain is a condition that can develop in people who have diabetes. Diabetes leads to high blood sugar levels. This can lead to nerve damage in about 50 percent of people with diabetes. The damage occurs in the nerve endings in the feet and legs and sometimes in the hands and arms. Blood vessels that carry oxygen to the nerves also can become damaged. This damage can slow down nerve signals to the muscles. It also can cause the nerves to send signals at the wrong times, which can result in pain. Sometimes the nerves stop communicating completely. This can lead to numbness in the feet and hands. People with diabetic nerve pain can develop many symptoms. Some people will have symptoms soon after starting treatment. However, symptoms tend to develop slowly over many years. They often are noticeable several years after diagnosis. These symptoms can disrupt sleep, which can lead to mood changes and lower quality of life. The main symptoms are painful tingling, burning, and numbness. As the condition worsens, weakness can occur in the legs. This may be experienced as feeling “unsteady.†Symptoms often start in the feet and, later, progress to the hands and arms. Other body parts also can be affected. These include the organs that control automatic body processes. Some people develop digestive problems such as nausea (upset stomach), vomiting, constipation, or diarrhea. Other problems include difficulty with bladder control or sexual function. Dizziness can happen when changing positions quickly. About 25 percent of people with diabetes will have pain and numbness from nerve damage. Controlling blood sugar levels can help prevent diabetic nerve pain. I have diabetic nerve pain. My do Continue reading >>

Morning Break: Type 3 Diabetes? Veterans And Opioids; Nra For Docs?

Morning Break: Type 3 Diabetes? Veterans And Opioids; Nra For Docs?

Note that some links may require subscriptions. Type 3 diabetes? Study uncovers new links between glucose metabolism and Alzheimer's. (Pittsburgh Post-Gazette) Just in time for Veterans' Day, Reuters looks at how the opioid crisis is disproportionately affecting former soldiers. Left to its own devices, the government will cook up policy based on the idea that "bad doctors" need to be controlled. There's a clear solution: Doctors need their own equivalent of the NRA. (KevinMD) Diets high in antioxidants were associated with less risk of type 2 diabetes, MedPage Today's Kristen Monaco reports. But more wasn't always better. The FDA approved the two-dose hepatitis B vaccine Heplisav-B to prevent infection in adults. Drugmaker Dynavax will conduct a post-marketing study at Kaiser Permanente focused on myocardial infarction and immune-mediated diseases, safety concerns raised at an FDA advisory committee meeting earlier this year. (MarketWired) The agency is also continuing its push to promote generic drugs. (Regulatory Focus) Quit trying to be a superhero. Team-based approaches to care can stave off burnout, MedPage Today's Joyce Frieden reports. Youth-targeted drug education programs are facing a tough challenge in the age of legal marijuana. In states with it, adolescents are more likely to say it's safe, and by and large they already view it as safer than alcohol. (NPR) Pollution is tied to more brittle bones, a study finds. (The Telegraph) More fallout from the Flint water crisis: fertility rates declined precipitously. (Mother Jones/Atlantic) Breast cancer can recur after lying dormant for 15 years or more, but extended treatment can help, the BBC reported. MedPage Today's Charles Bankhead has additional details. Morning Break is a daily guide to what's new and intere Continue reading >>

Effects Of Opioids On Diabetes

Effects Of Opioids On Diabetes

Watch This Report On The Relationship Between Opioids And Diabetes People with diabetes are often plagued by acute and chronic pain. According to an article in the Journal of General Internal Medicine, four out of ten adults with Type 2 diabetes suffer from pain. Whether because of diabetic neuropathy, osteoarthritis, or from the effects of obesity, patients often turn to opioids for pain relief. While opioid medications may provide some measure of relief, they’re also associated with significant health risks, including weight gain and glycemic dysregulation. When it comes to behavioral problems, the use of opioids can have an immediate effect on your ability to monitor and control your diabetes. The altered perceptions of pain that make opioid medications work can also affect the monitoring of your own diabetes conditions. In an altered state, it can become difficult to recognize hypoglycaemia, hyperglycaemia, or diabetic ketoacidosis. These altered perceptions themselves can also impact a normal health routine. When not in the right mind, it increases the risk of missing insulin injections that can then lead to hypoglycaemia, hyperglycaemia, or diabetic ketoacidosis. In addition, these altered perceptions from opioid use can influence your own healthy eating habits, making it more difficult to control your blood glucose levels and the ability to manage your diabetes. In a study published in the Journal of Opioid Management, researchers found that certain types of opioids may even induce a taste preference for sweet foods. This preference and acting upon it can, of course, lead to issues with diabetes control and management. It can also lead to weight gain and tooth decay. If you are on opioids for pain, discuss alternative forms of treatment with your doctor. While Continue reading >>

Opioid Use And Diabetes: An Overview

Opioid Use And Diabetes: An Overview

1 Department of Psychiatry, National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi, India 2 Department of Psychiatry, National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi, India; International program in Addiction Studies, King's College London, London, UK; International program in Addiction Studies, University of Adelaide, Adelaide, Australia; International program in Addiction Studies, Virginia Commonwealth University, Richmond, Virginia, USA Continue reading >>

Diabetes May Be A Major, Overlooked Reason Americans Are Now Dying Earlier

Diabetes May Be A Major, Overlooked Reason Americans Are Now Dying Earlier

ballyscanlon/getty In 2015, a blockbuster study came to a shocking conclusion: Middle-age white Americans are dying at younger ages for the first time in decades, despite our advances in medical technology and the positive trends in other wealthy countries. The research, by Princeton’s Anne Case and Angus Deaton, highlighted the links between economic struggles, suicides, and alcohol and drug overdoses. Since then, researchers have been scrambling to fully explain the trend, which now seems to be affecting the entire population. The efforts have suggested it’s not just “deaths of despair”— from opioids, alcohol, and suicides — that account for the dip in life expectancy, but that violence and cardiovascular disease seem to be major contributors, too. Now, a new study provides another clue about what’s behind the backward sliding of American mortality: the hidden toll of diabetes. Diabetes’ prevalence has exploded in the US over the past 20 years. Nearly 30 million Americans live with the disease today — more than three times the number in the early 1990s. And researchers have long known that diabetes is an underreported cause of death on death certificates, the primary data source for determining life expectancy trends. That’s because people with diabetes often have multiple health conditions, or “comorbidities,” such as cardiovascular disease, high blood pressure, high cholesterol, obesity, and even cancer. When both diabetes and heart disease are listed on a death certificate, the decision to list diabetes as the primary cause of death is “highly variable,” said Andrew Stokes, assistant professor of global health at Boston University’s School of Public Health. “Often times, the [death certificate] certifier will code the death as being Continue reading >>

How Pain Relievers Can Affect Blood Sugar Levels

How Pain Relievers Can Affect Blood Sugar Levels

Many of us don’t even think about our blood sugar levels when we’re scrabbling through the medicine cabinet, looking for a pain reliever. We just want to make the pain disappear—stat. But people with diabetes do need to take that matter into consideration when they’re taking any medication. If you have type 2 diabetes, your doctor or diabetes educator has probably warned you to be vigilant about the effects that that your diet, your activity level, and any other medication you take on a regular basis can have on your blood sugar levels. You also need to be careful about any pain relieving medication that you take, even if it’s just on an occasional basis, because certain types of pain killers can lower or raise your blood sugar levels. NSAIDs There are times when you can easily treat pain with an over-the counter pain reliever. You may take a low dose of aspirin or a nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen or naproxen to relieve the occasional headache or muscle pain. A regular dose is unlikely to affect your blood sugar levels, but a higher-than-usual dose may lower your blood sugar level. Talk to your doctor about what’s an appropriate dose for your occasional aches and pains so you don’t accidentally cause an episode of hypoglycemia. Another word of caution. You might have settled on an effective dose of a particular pain reliever that won’t drastically alter your blood sugar levels. But your diabetes puts you at elevated risk for certain other health conditions. So you may have other medical conditions you need to manage—and you will need to watch out for the effect any pain killers you take can have on those. For example, NSAIDS like ibuprofen and naproxen can increase your blood pressure. And they can affect your kidneys, too, Continue reading >>

Diabetic Neuropathy

Diabetic Neuropathy

Diabetic neuropathies are nerve damaging disorders associated with diabetes mellitus. These conditions are thought to result from a diabetic microvascular injury involving small blood vessels that supply nerves (vasa nervorum) in addition to macrovascular conditions that can accumulate in diabetic neuropathy. Relatively common conditions which may be associated with diabetic neuropathy include third, fourth, or sixth cranial nerve palsy[1]; mononeuropathy; mononeuropathy multiplex; diabetic amyotrophy; a painful polyneuropathy; autonomic neuropathy; and thoracoabdominal neuropathy. Signs and symptoms[edit] Illustration depicting areas affected by diabetic neuropathy Diabetic neuropathy affects all peripheral nerves including sensory neurons, motor neurons, but rarely affects the autonomic nervous system. Therefore, diabetic neuropathy can affect all organs and systems, as all are innervated. There are several distinct syndromes based on the organ systems and members affected, but these are by no means exclusive. A patient can have sensorimotor and autonomic neuropathy or any other combination. Signs and symptoms vary depending on the nerve(s) affected and may include symptoms other than those listed. Symptoms usually develop gradually over years. Symptoms may include the following: Trouble with balance Numbness and tingling of extremities Dysesthesia (abnormal sensation to a body part) Diarrhea Erectile dysfunction Urinary incontinence (loss of bladder control) Facial, mouth and eyelid drooping Vision changes Dizziness Muscle weakness Difficulty swallowing Speech impairment Fasciculation (muscle contractions) Anorgasmia Retrograde ejaculation (in males) Burning or electric pain Pathogenesis[edit] The following factors are thought to be involved in the development of dia Continue reading >>

Can Pain Med Tramadol Cause Low Blood Sugar?

Can Pain Med Tramadol Cause Low Blood Sugar?

Tramadol (Ultram) is prescribed for pain more than ever, with new recommendations to limit the use of opioid analgesics. Tramadol is a non-opioid that works on the opiate receptors. Unlike other opioids (like hydrocodone and codeine), tramadol doesn’t affect your breathing or heart. It’s a good option for trying to avoid opioids if NSAIDs (nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen) aren’t recommended for you. Why use tramadol instead of an opioid like hydrocodone? Tramadol works well for pain and is safe—because respiratory depression, cardiovascular side effects, drug abuse and dependence are minor, unlike with opioids. However, with increasing use of tramadol have come reports of low blood sugar (hypoglycemia) as a side effect. It can be a problem even in people who don’t have diabetes and aren’t taking other medications to control blood sugar. So does tramadol cause low blood sugar? Yes. A recent large study found that tramadol use is associated with an increased risk of hospitalization for hypoglycemia. That risk is highest around the time you first start taking it—mostly within 10 days of starting. In fact, people taking tramadol had more than three times an increased risk of hospitalization for hypoglycemia. This was true for folks with and without diabetes, and taking tramadol at the recommended doses. Although it’s rare, occurring in only 7 out of 10,000 people, tramadol-induced hypoglycemia is a potentially fatal adverse event. Why can tramadol cause low blood sugar? One of the ways tramadol works is by inhibiting serotonin and norepinephrine reuptake. Serotonin pathways are known to have effects on blood sugar regulation. The activation of µ opioid receptors by tramadol (remember, it isn’t an opioid, but works on the s Continue reading >>

Drugs That Can Raise Bg

Drugs That Can Raise Bg

By the dLife Editors Some medicines that are used for treating other medical conditions can cause elevated blood sugar in people with diabetes. You may need to monitor your blood glucose more closely if you take one of the medicines listed below. It’s important to note that just because a medicine has the possibility of raising blood sugar, it does not mean the medicine is unsafe for a person with diabetes. For instance, many people with type 2 diabetes need to take a diuretic and a statin to lower blood pressure and cholesterol. In these and many other cases, the pros will almost always outweigh the cons. Don’t ever take matters of medication into your own hands. Discuss any concerns you have with your healthcare provider. Certain Antibiotics Of all the different antibiotics, the ones known as quinolones are the only ones that may affect blood glucose. They are prescribed for certain types of infection. Levofloxacin (Levaquin) Ofloxacin (Floxin) Moxifloxacin (Avelox) Ciprofloxacin (Cipro, Cipro XR, Proquin XR) Gemifloxacin (Factive) Second Generation Antipsychotics These medicines are used for a variety of mental health conditions. There is a strong association between these medicines and elevated blood sugar, and frequent monitoring is recommended. Clozapine (Clozaril) Olanzapine (Zyprexa) Paliperidone (Invega) Quietiapine (Seroquel, Seroquel XR) Risperidone (Risperdal) Aripiprazole (Abilify) Ziprasidone (Geodon) Iloperidone (Fanapt) Lurasidone (Latuda) Pemavanserin (Nuplazid) Asenapine (Saphris) Beta Blockers Beta blockers are used to treat high blood pressure and certain heart conditions. Not all available beta blockers have been shown to cause high blood sugar. Atenolol Metoprolol Propranolol Corticosteroids Corticosteroids are used to treat conditions where th Continue reading >>

Morphine, Opioid Peptides, And Pancreatic Islet Function

Morphine, Opioid Peptides, And Pancreatic Islet Function

Since the isolation of enkephalins 7 yr ago, there has been an explosive increase in knowledge and an enormous interest in the action of both exogenous and endogenous opiates. This review deals with the interaction of opiates with the endocrine pancreas. The results of animal studies performed in vitro do not allow any conclusion to be drawn, because the effects of opioid peptides on pancreatic hormone release seem dependent on many variables, including the agent investigated, dose administered, concentration of glucose in the medium, and experimental procedure used. The results of in vivo animal studies suggest that central administration of opiates and opioid peptides acts indirectly via the sympathetic nervous system to cause hyperglycemia and impaired insulin secretion, while peripheral administration tends to stimulate insulin and glucagon secretion. This last statement seems also to be true for studies performed in human beings. The narcotic addict offers a model to evaluate the hormonal and metabolic effects of a chronically administered agent that binds and activates endogenous receptors. In these subjects, it is possible to find increased concentrations of glycosylated hemoglobin A1 and a marked reduction of the acute insulin response to intravenous glucose, but not to arginine, which suggests a state of defective glucose recognition by pancreatic β-cells during narcotic addiction. Thus, the heroin addict, like patients with non-insulin-dependent diabetes, does not respond appropriately to glucose signals. Moreover, naloxone, an opiate-receptor blocking agent, can cause a partial restoration of the acute insulin response to i.v. glucose in some subjects with non-insulin-dependent diabetes. An increased sensitivity to endogenous opiates—enkephalins—might be Continue reading >>

Opioids And Related Disorders | Definition And Patient Education

Opioids And Related Disorders | Definition And Patient Education

Many opioids are used to treat pain. Some opioids, such as oxycodone, codeine, and morphine, are prescription pain medications. Using these medications for recreation or in a way not prescribed by a doctor can be considered abuse. Other opioids, like heroin, are illegal. Opioids are highly addictive. Abuse can lead to addiction. Both abuse and addiction can cause serious health problems and can lead to death. Opioids can be used in a variety of ways. They can be: Prescription forms are sometimes used as suppositories. Effects may depend on the method of consumption. The type of opioid also determines its effect. Opioids impact the brain, leading to a temporary feeling of intense pleasure. Addiction to opioids can develop very quickly, even with minimal use. The addiction can be physical, in that a habitual users body craves the drug. It can also be mental, in that a user consciously desires the drugs effects. A person who is addicted to opioids will do whatever it takes to get more of the drug, regardless of the risks or consequences. Long-term opioid use has serious health consequences, impacting multiple organs. Opioid abuse can impair the brains production of natural painkillers and dopamine, the brains feel-good chemical. Whatare the effects of opioid abuse and addiction? Opioids temporarily reduce pain and anxiety. They create a sense of numbness in the body and mind. High doses can create a short-lived feeling of euphoria and drowsiness. These effects can make it difficult to stop. Habitual users begin to crave this feeling, but the high is short-lived. Opioid abuse and addiction can have negative mental and physical effects, such as: increased risk of HIV or infectious disease, common in intravenous use increased risk of hepatitis, also common in intravenous use Continue reading >>

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