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When To Switch From Metformin To Insulin

Insulin And Weight Gain: Keep The Pounds Off

Insulin And Weight Gain: Keep The Pounds Off

Insulin and weight gain often go hand in hand, but weight control is possible. If you need insulin therapy, here's how to minimize — or avoid — weight gain. Weight gain is a common side effect for people who take insulin — a hormone that regulates the absorption of sugar (glucose) by cells. This can be frustrating because maintaining a healthy weight is an important part of your overall diabetes management plan. The good news is that it is possible to maintain your weight while taking insulin. The link between insulin and weight gain When you take insulin, glucose is able to enter your cells, and glucose levels in your blood drop. This is the desired treatment goal. But if you take in more calories than you need to maintain a healthy weight — given your level of activity — your cells will get more glucose than they need. Glucose that your cells don't use accumulates as fat. Avoid weight gain while taking insulin Eating healthy foods and being physically active most days of the week can help you prevent unwanted weight gain. The following tips can help you keep the pounds off: Count calories. Eating and drinking fewer calories helps you prevent weight gain. Stock the refrigerator and pantry with fruits, vegetables and whole grains. Plan for every meal to have the right mix of starches, fruits and vegetables, proteins, and fats. Generally, experts recommend that meals consist of half non starchy vegetable, one-quarter protein and one quarter a starch such as rice or a starchy vegetable such as corn or peas. Trim your portion sizes, skip second helpings and drink water instead of high-calorie drinks. Talk to your doctor, nurse or a dietitian about meal-planning strategies and resources. Don't skip meals. Don't try to cut calories by skipping meals. When you skip Continue reading >>

Prepare Your Patients For An Insulin Change For 2017

Prepare Your Patients For An Insulin Change For 2017

Mo st insurance plans will be dropping Lantus from formularies. Guest Post by David Kliff, Diabetic Investor Sometimes I’m amazed at how oblivious some people in this wacky world can be. Actually, I should say it really doesn’t amaze me given this is the wacky world of diabetes, which is full of clueless opinions. I mention this after some conversations on the nature of the insulin market. Yes, people are beginning to wake up to the fact (yes, those damn pesky facts again), that insulins have become a commodity. This is particularly true with long-acting insulins, of which there are now 5, one being a biosimilar. Lilly has the biosimilar, Basaglar, which is winning the war that counts: formulary position. Lantus, the current leader, isn’t just losing the war, it’s losing by a mile. Starting next year, when formulary changes go into full effect, Basaglar will become the long-acting insulin of choice. Not because it’s any better than Lantus — it isn’t. It’s the same as Lantus, only cheaper — which is exactly the point. Still, many seem to believe there will be pushback from physicians. Why would they switch any patient from Lantus to Basaglar, especially when Lantus works so well? First, as much as I hate to state the obvious, it really won’t be left up to the physician. It will be the payor and formulary position that wins, not the opinion of the physician. Think about the discussion a physician would have with a Lantus-using patient after these formulary changes take place. “Mr./Ms. Patient, you know I would like to keep you on Lantus. It’s been a great drug that has worked very well for you. Now I could keep you on Lantus, but there is a slight problem: your insurance company no longer covers Lantus. You can stay on Lantus, but I must warn you t Continue reading >>

Glucophage Sr 500mg, 750mg And 1000mg Prolonged Release Tablets

Glucophage Sr 500mg, 750mg And 1000mg Prolonged Release Tablets

500 mg: One prolonged release tablet contains 500mg metformin hydrochloride corresponding to 390 mg metformin base. 750 mg: One prolonged release tablet contains 750 mg metformin hydrochloride corresponding to 585 mg metformin base. 1000 mg: One prolonged release tablet contains 1000 mg metformin hydrochloride corresponding to 780 mg metformin base. For the full list of excipients, see section 6.1. Prolonged release tablet. 500 mg: White to off-white, round, biconvex tablet, debossed on one side with '500'. 750 mg: White capsule-shaped, biconvex tablet, debossed on one side with '750' and on the other side with 'Merck'. 1000 mg: White to off-white capsule-shaped, biconvex tablet, debossed on one side with '1000' and on the other side with 'MERCK'. • Reduction in the risk or delay of the onset of type 2 diabetes mellitus in adult, overweight patients with IGT* and/or IFG*, and/or increased HbA1C who are: - at high risk for developing overt type 2 diabetes mellitus (see section 5.1) and - still progressing towards type 2 diabetes mellitus despite implementation of intensive lifestyle change for 3 to 6 months Treatment with Glucophage SR must be based on a risk score incorporating appropriate measures of glycaemic control and including evidence of high cardiovascular risk (see section 5.1). Lifestyle modifications should be continued when metformin is initiated, unless the patient is unable to do so because of medical reasons. *IGT: Impaired Glucose Tolerance; IFG: Impaired Fasting Glucose • Treatment of type 2 diabetes mellitus in adults, particularly in overweight patients, when dietary management and exercise alone does not result in adequate glycaemic control. Glucophage SR may be used as monotherapy or in combination with other oral antidiabetic agents, or with in 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 >>

A Timely Transition To Insulin: Identifying Type 2 Diabetes Patients Failing Oral Therapy

A Timely Transition To Insulin: Identifying Type 2 Diabetes Patients Failing Oral Therapy

Abstract Although oral antidiabetic medications initially may be effective for controlling hyperglycemia, these agents often fail to maintain adequate glycemic control as the disease progresses, and insulin eventually is required in most patients. This review explores strategies for identifying patients with type 2 diabetes who are failing to maintain glycemic control on oral agents and for transitioning these patients to insulin. Based on available data, patients are not reaching recommended glycemic goals due to delays in and reluctance towards intensification of therapy, resulting in an increased risk of complications. Patients who are failing therapy with≥1 oral agents and who require insulin can be identified by monitoring A1C, daily blood glucose, and duration of oral antidiabetic therapy. Patient concerns about insulin may be addressed through education and the implementation of easy-to-follow titration regimens such as those recently proposed for basal insulin. Such approaches may simplify treatment while improving glycemic control in patients with type 2 diabetes. (Formulary. 2005;40:114–130.) Type 2 diabetes is a progressive disease characterized by the dual defect of gradual declines in insulin secretion and insulin resistance.1 Both of these defects are present at the outset of disease in those destined to have type 2 diabetes. Insulin resistance is a disorder in which the body does not respond to or utilize insulin appropriately.2 While insulin resistance generally remains constant throughout the course of the disease, the β-cells of the pancreas gradually become unable to secrete enough insulin to overcome the degree of insulin resistance.2,3 As pancreatic β-cell function progressively deteriorates, some degree of absolute insulin deficiency develops Continue reading >>

Metformin Versus Insulin For The Treatment Of Gestational Diabetes

Metformin Versus Insulin For The Treatment Of Gestational Diabetes

Metformin is a logical treatment for women with gestational diabetes mellitus, but randomized trials to assess the efficacy and safety of its use for this condition are lacking. We randomly assigned 751 women with gestational diabetes mellitus at 20 to 33 weeks of gestation to open treatment with metformin (with supplemental insulin if required) or insulin. The primary outcome was a composite of neonatal hypoglycemia, respiratory distress, need for phototherapy, birth trauma, 5-minute Apgar score less than 7, or prematurity. The trial was designed to rule out a 33% increase (from 30% to 40%) in this composite outcome in infants of women treated with metformin as compared with those treated with insulin. Secondary outcomes included neonatal anthropometric measurements, maternal glycemic control, maternal hypertensive complications, postpartum glucose tolerance, and acceptability of treatment. Of the 363 women assigned to metformin, 92.6% continued to receive metformin until delivery and 46.3% received supplemental insulin. The rate of the primary composite outcome was 32.0% in the group assigned to metformin and 32.2% in the insulin group (relative risk, 1.00; 95% confidence interval, 0.90 to 1.10). More women in the metformin group than in the insulin group stated that they would choose to receive their assigned treatment again (76.6% vs. 27.2%, P<0.001). The rates of other secondary outcomes did not differ significantly between the groups. There were no serious adverse events associated with the use of metformin. In women with gestational diabetes mellitus, metformin (alone or with supplemental insulin) is not associated with increased perinatal complications as compared with insulin. The women preferred metformin to insulin treatment. (Australian New Zealand Clinical Continue reading >>

Metformin For Diabetes

Metformin For Diabetes

Take metformin just after a meal or with a snack. The most common side-effects are feeling sick, diarrhoea and tummy (abdominal) pain. These symptoms usually pass after the first few days of treatment. Keep your regular appointments with your doctor and clinics. This is so your progress can be checked. About metformin Type of medicine A biguanide antidiabetic medicine Used for Type 2 diabetes mellitus Also called Bolamyn®; Diagemet®; Glucient®; Glucophage®; Metabet®; Sukkarto® Available as Tablets and modified-release tablets; oral liquid medicine; sachets of powder Insulin is a hormone which is made naturally in your body, in the pancreas. It helps to control the levels of sugar (glucose) in your blood. If your body does not make enough insulin, or if it does not use the insulin it makes effectively, this results in the condition called sugar diabetes (diabetes mellitus). People with diabetes need treatment to control the amount of sugar in their blood. This is because good control of blood sugar levels reduces the risk of complications later on. Some people can control the sugar in their blood by making changes to the food they eat but, for other people, medicines like metformin are given alongside the changes in diet. Metformin allows the body to make better use of the lower amount of insulin which occurs in the kind of diabetes known as type 2 diabetes. Metformin can be given on its own, or alongside insulin or another antidiabetic medicine. There are a number of tablets available which contain metformin in combination with one of these other antidiabetic medicines (brands include Jentadueto®, Competact®, Komboglyze®, Janumet®, and Eucreas®). Taking a combination tablet like these can help to reduce the total number of tablets that need to be taken each d Continue reading >>

Oral Diabetes Medications Fact Sheet

Oral Diabetes Medications Fact Sheet

Summa Health System developed this fact sheet for patients who need to take oral medicine to manage their diabetes. Care providers give it to patients during diabetes planned visits, and it is part of the Diabetes Planned Visit Notebook. Oral Diabetes Medications Family Medicine Center of Akron Copyright © 2006 American Diabetes Association Adapted from the ADA Patient Information The first treatment for type 2 diabetes is often meal planning for blood glucose (sugar) control, weight loss, and exercising. Sometimes these measures are not enough to bring blood glucose levels down near the normal range. The next step is taking a medicine that lowers blood glucose levels. How they work In people with diabetes, blood glucose levels are too high. These high levels occur because glucose remains in the blood rather than entering cells, where it belongs. But for glucose to pass into a cell, insulin must be present and the cell must be "hungry" for glucose. People with type 1 diabetes don't make insulin. For them, insulin shots are the only way to keep blood glucose levels down. People with type 2 diabetes tend to have two problems: they don't make quite enough insulin and the cells of their bodies don't seem to take in glucose as eagerly as they should. All diabetes pills sold today in the United States are members of five classes of drugs: sulfonylureas, meglitinides, biguanides, thiazolidinediones, and alpha-glucosidase inhibitors. These five classes of drugs work in different ways to lower blood glucose levels. Can diabetes pills help me? Only people with type 2 diabetes can use pills to manage their diabetes. These pills work best when used with meal planning and exercise. This way you have three therapies working together to lower your blood glucose levels. Diabetes pills Continue reading >>

Should I Use Diabetes Pills Or Insulin?

Should I Use Diabetes Pills Or Insulin?

Diabetes affects the way your body breaks down food. Treatment depends on which type of diabetes you have. In type 1 diabetes, your pancreas stops producing insulin. Insulin is a hormone that helps regulate glucose, or sugar, in your blood. Type 2 diabetes starts with insulin resistance. Your pancreas no longer produces enough insulin or doesn’t use it efficiently. Every cell in your body uses glucose for energy. If insulin isn’t doing its job, glucose builds up in your blood. This causes a condition called hyperglycemia. Low blood glucose is called hypoglycemia. Both can lead to serious complications. A variety of pills are available to treat diabetes, but they can’t help everyone. They only work if your pancreas still produces some insulin. They can’t treat type 1 diabetes. They aren’t effective in people with type 2 diabetes when the pancreas has stopped making insulin. Some people with type 2 diabetes can benefit from using both pills and insulin. Some pills to treat diabetes include: Biguanides Metformin (Glucophage, Fortamet, Riomet, Glumetza) is a biguanide. It lowers the amount of glucose in your liver and boosts insulin sensitivity. It may also improve cholesterol levels and might help you lose a little weight. People normally take it twice per day with meals. You can take the extended-release version once per day. Potential side effects include: upset stomach nausea bloating gas diarrhea a temporary loss of appetite It may also cause lactic acidosis in people with kidney failure, but this is rare. Sulfonylureas Sulfonylureas are fast-acting medications that help the pancreas release insulin after meals. They include: People usually take these medications once per day with a meal. Potential side effects include: irritability low blood glucose upset st 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 >>

Long-term Treatment With Metformin In Obese, Insulin-resistant Adolescents: Results Of A Randomized Double-blinded Placebo-controlled Trial

Long-term Treatment With Metformin In Obese, Insulin-resistant Adolescents: Results Of A Randomized Double-blinded Placebo-controlled Trial

As adolescents with obesity and insulin resistance may be refractory to lifestyle intervention therapy alone, additional off-label metformin therapy is often used. In this study, the long-term efficacy and safety of metformin versus placebo in adolescents with obesity and insulin resistance is studied. In a randomized placebo-controlled double-blinded trial, 62 adolescents with obesity aged 10–16 years old with insulin resistance received 2000 mg of metformin or placebo daily and physical training twice weekly over 18 months. Primary end points were change in body mass index (BMI) and insulin resistance measured by the Homeostasis Model Assessment for Insulin Resistance (HOMA-IR). Secondary end points were safety and tolerability of metformin. Other end points were body fat percentage and HbA1c. Forty-two participants completed the 18-month study (66% girls, median age 13 (12–15) years, BMI 30.0 (28.3 to 35.0) kg m−2 and HOMA-IR 4.08 (2.40 to 5.88)). Median ΔBMI was +0.2 (−2.9 to 1.3) kg m−2 (metformin) versus +1.2 (−0.3 to 2.4) kg m−2 (placebo) (P=0.015). No significant difference was observed for HOMA-IR. No serious adverse events were reported. Median change in fat percentage was −3.1 (−4.8 to 0.3) versus −0.8 (−3.2 to 1.6)% (P=0.150), in fat mass −0.2 (−5.2 to 2.1) versus +2.0 (1.2–6.4) kg (P=0.007), in fat-free mass +2.0 (−0.1 to 4.0) versus +4.5 (1.3 to 11.6) kg (P=0.047) and in ΔHbA1c +1.0 (−1.0 to 2.3) versus +3.0 (0.0 to 5.0) mmol mol−1 (P=0.020) (metformin versus placebo). Long-term treatment with metformin in adolescents with obesity and insulin resistance results in stabilization of BMI and improved body composition compared with placebo. Therefore, metformin may be useful as an additional therapy in combination with lifes Continue reading >>

Insulin And Type 2 Diabetes: What You Should Know

Insulin And Type 2 Diabetes: What You Should Know

Insulin and Type 2 Diabetes If your health care provider offered you a medication to help you feel better and get your blood sugar under control, would you try it? If so, you might be ready to start taking insulin. Does insulin immediately make you think of type 1 diabetes? Think again. Between 30 and 40 percent of people with type 2 diabetes take insulin. In fact, there are more people with type 2 diabetes who take insulin than type 1 because of the much larger number of people with type 2. Experts believe even more people with type 2 should be taking insulin to control blood sugar -- and the earlier, the better. With an increase in people developing type 2 at a younger age and living longer, more and more people with type 2 will likely be taking insulin. "If you live long enough with type 2 diabetes, odds are good you'll eventually need insulin," says William Polonsky, Ph.D., CDE, associate clinical professor of psychiatry at the University of California, San Diego; founder and president of the Behavioral Diabetes Institute; and author of Diabetes Burnout: What to Do When You Can't Take It Anymore (American Diabetes Association, 1999). Producing Less Insulin Naturally Over Time Research has shown that type 2 diabetes progresses as the ability of the body’s pancreatic beta cells to produce insulin dwindles over time. Your beta cells -- the cells in the pancreas that produce insulin -- slowly lose function. Experts believe that by the time you're diagnosed with type 2 diabetes, you've already lost 50-80 percent of your beta cell function and perhaps the number of beta cells you had. And the loss continues over the years. "About six years after being diagnosed, most people have about a quarter of their beta cell function left," says Anthony McCall, M.D., Ph.D., endocri Continue reading >>

What Is Metformin?

What Is Metformin?

MORE Metformin is a prescription drug used primarily in the treatment of Type II diabetes. It can be used on its own or combined with other medications. In the United States, it is sold under the brand names Fortamet, Glucophage, Glumetza and Riomet. "Metformin is very often prescribed as the first step in a diabetic's regime," said Ken Sternfeld, a New York-based pharmacist. How it works "When you're diabetic you lose the ability to use the insulin you need to offset the food," Sternfeld explained. "If you eat a carb or sugar that can't be metabolized or offset by the insulin you produce, your sugar levels will be higher. Metformin and drugs in that category will help your body better metabolize that food so that insulin levels will be able to stay more in line." Metformin aims to decrease glucose production in the liver, consequently lowering the levels of glucose in the bloodstream. It also changes the way that your blood cells react to insulin. "It makes them more sensitive to insulin," said Dr. Stephen Neabore, a primary care doctor at the Barnard Medical Center in Washington, D.C. "It makes the same amount of insulin work better. It transports the insulin to the cells in a more effective way." Metformin may have a preventive health role, as well. New research presented at the American Diabetes Association 2017 Scientific Sessions showed that long-term use of metformin is particularly useful in preventing the onset of type II diabetes in women who have suffered from gestational diabetes. Because metformin changes the way the body uses insulin, it is not used to treat Type I diabetes, a condition in which the body does not produce insulin at all. Metformin & PCOS Metformin is sometimes prescribed to treat polycystic ovarian syndrome (PCOS), according to Neabore. "I Continue reading >>

Treatment

Treatment

If you have gestational diabetes, the chances of having problems with the pregnancy can be reduced by controlling your blood sugar (glucose) levels. You'll also need to be more closely monitored during pregnancy and labour to check if treatment is working and to check for any problems. Checking your blood sugar level You'll be given a testing kit that you can use to check your blood sugar level. This involves using a finger-pricking device and putting a drop of blood on a testing strip. You'll be advised: how to test your blood sugar level correctly when and how often to test your blood sugar – most women with gestational diabetes are advised to test before breakfast and one hour after each meal what level you should be aiming for – this will be a measurement given in millimoles of glucose per litre of blood (mmol/l) Diabetes UK has more information about monitoring your glucose levels. Diet Making changes to your diet can help control your blood sugar level. You should be offered a referral to a dietitian, who can give you advice about your diet, and you may be given a leaflet to help you plan your meals. You may be advised to: eat regularly – usually three meals a day – and avoid skipping meals eat starchy and low glycaemic index (GI) foods that release sugar slowly – such as wholewheat pasta, brown rice, granary bread, all-bran cereals, pulses, beans, lentils, muesli and porridge eat plenty of fruit and vegetables – aim for at least five portions a day avoid sugary foods – you don't need a completely sugar-free diet, but try to swap snacks such as cakes and biscuits for healthier alternatives such as fruit, nuts and seeds avoid sugary drinks – sugar-free or diet drinks are better than sugary versions; be aware that fruit juices and smoothies contain s Continue reading >>

Beyond Oral Antidiabetics: Insulin Therapy Options And Combinations

Beyond Oral Antidiabetics: Insulin Therapy Options And Combinations

Provider: American Pharmacists Association Activity type: Knowledge-based Target audience: Pharmacists Expiration date: June 1, 2020 Learning level: 2 ACPE number: 0202-0000-17-162-H01-P CPE credit: 2 hours (0.2 CEUs) Fee: There is no fee associated with this activity for members of the American Pharmacists Association. There is a $25 fee for nonmembers. The American Pharmacists Association (APhA) is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education (CPE). The ACPE Universal Activity Number assigned to this activity by the accredited provider is 0202-0000-17-162-H01-P. Advisory board: Stuart T. Haines, PharmD, BCPS, BCACP, BC-ADM, professor, University of Mississippi School of Pharmacy, University, MS. Disclosures: Stuart T. Haines, PharmD, BCPS, BCACP, BC-ADM declares that he has no conflicts of interest or financial interests in any product or service mentioned in this activity, including grants, employment, gifts, stock holdings, and honoraria. APhA’s editorial staff declare no conflicts of interest or financial interests in any product or service mentioned in this activity, including grants, employment, gifts, stock holdings, and honoraria. For complete staff disclosures, please see the APhA Accreditation Information section at www.pharmacist.com/education. Development: This home-study CPE activity was developed by APhA. Continue reading >>

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