diabetestalk.net

Why Doctors Are Not Recommending Metformin

Rosiglitazone & Metformin

Rosiglitazone & Metformin

Combines 2 drugs to help lower blood sugar in type 2 diabetes. Works in part by increasing the body's response to insulin and decreasing the amount of sugar produced by the liver. Metformin/rosiglitazone is a prescription medication used to treat type 2 diabetes in adults. It is a single tablet containing two different prescription medications, metformin and rosiglitazone. Metformin belongs to a group of drugs called biguanides, which cause the liver to make less glucose. Rosiglitazone belongs to a group of drugs called thiazolidinediones, which increase the body's sensitivity to insulin to help control blood glucose levels. Metformin/rosiglitazone is available in 4 tablet strengths. It is taken by mouth, with meals, as directed by your doctor. Common side effects of metformin/rosiglitazone include diarrhea, nausea, upset stomach, cold-like symptoms. Do not drink alcohol while taking this medication. Metformin/rosiglitazone is a prescription medication used to treat type 2 diabetes (non-insulin dependent diabetes). Metformin/rosiglitazone may be used alone or with other diabetes medicines. This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information. Metformin/rosiglitazone may cause serious side effects. See "Drug Precautions". Some serious side effects include: new or worse heart failure heart attack swelling (edema) weight gain liver problems. Call your doctor right away if you have unexplained symptoms such as: nausea or vomiting stomach pain unusual or unexplained tiredness loss of appetite dark urine yellowing of your skin or the whites of your eyes. macular edema (a diabetic eye disease with swelling in the back of the eye) fractures (broken bones), usually in the hand, upper arm or foot low red blood cell count (anemia) lo Continue reading >>

Stop Prescribing Benzodiazepines For Anxiety

Stop Prescribing Benzodiazepines For Anxiety

As a physician in a rural health clinic, I frequently see patients who complain of anxiety. The majority of these patients are in their 20s to 40s. Some have never been evaluated by a mental health professional, and many of these patients take benzodiazepines on a chronic basis. After current review, I wonder if we as primary care physicians are good at treating anxiety, or are we contributing to drug dependency? Benzodiazepine dependency is a growing health concern. According to the Drug Abuse Warning Network (DAWN), visits to the emergency department involving benzodiazepines increased 141% between 2004 and 2010. Benzodiazepines were involved in 28.4% of emergency department visits involving pharmaceutical related suicide attempts during that time. The arrest reports in my local newspaper attest to the problem of the illicit sell of benzodiazepine in my area. Most current guidelines recommend SSRIs and SNRIs as first line treatment for generalized anxiety disorder. Buspar and Lyrica have been shown to be effective adjuncts if needed. A number of randomized clinical trials support the use of benzodiazepines, but for short term use only (up to 6 weeks). Importantly, benzodiazepines are ineffective in treating depression, which often exists as a comorbid condition. Cognitive behavioral therapy is also often helpful in treating anxiety. We all know the physical dependency that benzodiazepines cause. The abuse of this drug is also well known. Most of us are familiar with current guidelines concerning their use. Why then, is the problem of benzodiazepine abuse getting worse? One reason is that patients are often insistent on being prescribed benzodiazepines as first-line therapy for treatment. Patients already on taking them are reluctant to try a new medication due to the Continue reading >>

Metformin | Drugs And Side Effects | What Doctors Don't Tell You | Forums | Community | What Doctors Don't Tell You

Metformin | Drugs And Side Effects | What Doctors Don't Tell You | Forums | Community | What Doctors Don't Tell You

I would be very happy to answer any questions you have regarding diabetes and the raw food diet. In the meantime I'll try and give you a little more background to my circumstances. I was originally diagnosed as a type 2 diabetic 6 years ago. Due to my rapid progression onto insulin the Diabetic consultant I see said that it was very likely I have beta cell failure. I do not have any weight issues and have a BMI of 22/23 so I fit LADA diabetes more than type 2 although I've never been officially tested. As well as the raw food diet I also have to exercise regularly to keep BG under control (every day - walking/yoga and 3 times per week aerobic/weight training). I also use a lot of cinnamon in my raw food recipes - studies have shown that this lowers BG in some diabetics (articles in New Scientist). My raw food diet also ensures that I do not consume any hydrogenated or partially hydrogenated oils. I use cold pressed unfiltered oils like flax, hemp and olive. My husband is diabetic, insulin dependent, when I first met him he was injecting 106 u/s per day - he is now on 20u/s twice a day - we have tried many different approaches and if I was able to stay home with him all the time instead of working we could reduce this dose even further - there are many natural supplements that will help reduce a diabetic's need for medication, oral or s/c - among them are Bitter Gourd and other herbs - a wonderful source of information is available at [email protected] - by typing "diabetes" into the search engine of the message page you will find a host of different herbs to help - these are public pages so anyone can look - diet, supplements to support the pancreas and manage insulin resistance and exercise all help normalise blood glucose, for diabetics and for everyone Continue reading >>

Oral Treatments To Control Blood Sugar

Oral Treatments To Control Blood Sugar

When are oral medicines used? In type 1 diabetes (insulin-dependent diabetes), the cells in the pancreas that produce insulin are progressively destroyed by an immune reaction, stopping the production of insulin. Insulin replacement treatment is therefore needed for life, because we cannot make the beta cells in the pancreas work again to produce insulin. Insulin can't be taken in tablet form, because it is broken down in the digestive system. This destroys its effect. Insulin is given by injection. Type 2 diabetes Type 2 diabetes (non-insulin dependent diabetes) is different because the pancreas still produces insulin. Instead, problems are caused because: insulin is produced inefficiently in response to surges of blood sugar, eg following a meal the insulin produced gets less effective at controlling blood sugar, because the cells in the body become increasingly resistant to it. This is called 'insulin resistance'. Treatment for type 2 diabetes involves either improving insulin release in response to meals, or reducing the resistance of the body cells to the effect of insulin. Diet and exercise are the first treatments used to improve insulin resistance in type 2 diabetes. If blood sugar is not adequately controlled after at least three months of healthy eating and increasing exercise, oral medicines are used. What oral medicines are used in type 2 diabetes? There are various types of oral medicine that can be used to control blood sugar in type 2 diabetes. Glitazones (sometimes called thiazolidinediones): pioglitazone (Actos) is now the only one available, following the withdrawal of rosiglitazone (Avandia) in October 2010. Pioglitazone is also available combined with metformin (Competact). How do they work? Oral medicines work in five basic ways to lower blood gluco Continue reading >>

Safe Prescribing Of Metformin In Diabetes

Safe Prescribing Of Metformin In Diabetes

Metformin is the first-line pharmacological therapy for type 2 diabetes. It is the only glucose-lowering oral drug that has been shown to reduce mortality in patients with diabetes. The most common adverse effect is gastrointestinal upset. Starting at a low dose and increasing it slowly reduces this risk. Taking metformin with food also helps. Numerous contraindications to the use of metformin are listed in the product information, including reduced renal function. Strict adherence to these recommendations may deny a valuable drug to many patients. Introduction Metformin lowers both fasting and postprandial blood glucose. It reduces hepatic glucose output 1 and increases peripheral glucose uptake, and may delay intestinal glucose absorption. Its use is not associated with weight gain and hypoglycaemia is extremely rare when metformin is used on its own. It lowers triglyceride concentrations and has small but beneficial effects on total and high-density lipoprotein cholesterol. In the UK Prospective Diabetes Study metformin reduced diabetes-related and all-cause mortality, and reduced the risk of myocardial infarction in obese patients with type 2 diabetes when used as first-line therapy. It also reduced the risk of microvascular complications, but was no more effective than insulin or sulfonylureas. 2 A retrospective cohort study from the USA found a lower rate of hospitalisations for myocardial infarction and stroke and a reduced death rate when metformin was used first-line in type 2 diabetes in comparison with a sulfonylurea. 3 Metformin is effective when used with other glucose-lowering drugs. A standard-release (3000 mg/day maximum dose) and an extended-release preparation of metformin (2000 mg/day maximum dose) are available. The extended-release preparation can b Continue reading >>

Metformin

Metformin

Metformin, marketed under the trade name Glucophage among others, is the first-line medication for the treatment of type 2 diabetes,[4][5] particularly in people who are overweight.[6] It is also used in the treatment of polycystic ovary syndrome.[4] Limited evidence suggests metformin may prevent the cardiovascular disease and cancer complications of diabetes.[7][8] It is not associated with weight gain.[8] It is taken by mouth.[4] Metformin is generally well tolerated.[9] Common side effects include diarrhea, nausea and abdominal pain.[4] It has a low risk of causing low blood sugar.[4] High blood lactic acid level is a concern if the medication is prescribed inappropriately and in overly large doses.[10] It should not be used in those with significant liver disease or kidney problems.[4] While no clear harm comes from use during pregnancy, insulin is generally preferred for gestational diabetes.[4][11] Metformin is in the biguanide class.[4] It works by decreasing glucose production by the liver and increasing the insulin sensitivity of body tissues.[4] Metformin was discovered in 1922.[12] French physician Jean Sterne began study in humans in the 1950s.[12] It was introduced as a medication in France in 1957 and the United States in 1995.[4][13] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[14] Metformin is believed to be the most widely used medication for diabetes which is taken by mouth.[12] It is available as a generic medication.[4] The wholesale price in the developed world is between 0.21 and 5.55 USD per month as of 2014.[15] In the United States, it costs 5 to 25 USD per month.[4] Medical uses[edit] Metformin is primarily used for type 2 diabetes, but is increasingly be Continue reading >>

New Evidence Underlines Dangers Of Metformin For Type 2 Diabetes

New Evidence Underlines Dangers Of Metformin For Type 2 Diabetes

This diabetes drug is a dangerous dud Diabetic men, hide your hearts. That’s the urgent message from a recent study that tested metformin, the patent drug that millions of doctors turn to first when treating type 2 diabetes. Using PET scans, researchers determined that metformin caused men’s hearts to burn more fat and less sugar. And that’s exactly what a diabetic DOESN’T need. It puts a specific kind of stress on the heart muscle that can lead to heart failure. As one researcher put it, metformin worsened men’s heart metabolism, making the heart look “even more like a diabetic heart.” For women, results were the exact opposite. Metformin lowered fat metabolism and increased sugar uptake. Now, this appears to be good news for women. In fact, the press release from Washington University in St. Louis (where the study was conducted) practically GLOWS with reverence for metformin. It mentions again and again the “positive effects” of the drug. Unfortunately, all that gushing means that women will be more comfortable taking metformin. But they shouldn’t be. Not at all. In fact, they should do what men will do when they read about this study — they should put metformin behind them immediately. In the current issue of Nutrition & Healing (March 2014), Dr. Wright takes a long hard look at the history of metformin. And it gets pretty ugly. As you may know, the list of potential side effects is daunting. They include a variety of unpleasant digestive problems, hormone disruption (particularly the thyroid stimulating hormone), dizziness, and sinus infections. One of the most disturbing side effects is the depletion of two critical nutrients: vitamin B12 and folate. In one study, metformin users took B12 supplements and STILL couldn’t overcome the deficienc Continue reading >>

Diabetic Drugs: What You Need To Know

Diabetic Drugs: What You Need To Know

Have you ever heard of a diabetic getting healthier once he or she started taking metformin (Glucophage) or some other diabetic drug? Of course not! Gee, I wonder why .. Unfortunately, most diabetics are prescribed a diabetic drug such as metformin (Glucophage) by their doctors once they have been diagnosed with Type 2 diabetes. This drug (and other diabetes drugs) helps to lower your blood glucose back to the normal range. So it appears that the drug is working. Right? It depends on what you mean by "working". It addresses one of the primary symptoms of diabetes -- high blood glucose levels -- by lowering your blood glucose, hopefully back to the normal range. However, the drug doesn't do anything to actually stop the progression of the diabetes. But, because it lowers your blood glucose, it gives you the false sense of security that the drug is actually helping with your diabetes. Sure, in the short term, the drug does help a little bit, because it helps to lower your blood sugar. But, the doctor fails to tell you that the drug does absolutely nothing to stop the spread of the cell and tissue damage being caused by the diabetes! In fact, over a period of years, the drug may actually cause damage to the liver and kidneys! If you have an adverse reaction* to the drug (such as an upset stomach or diarrhea), your doctor will not tell you why this is happening -- instead, he/she will just put you on a different drug such as glimepiride (Amaryl) or glipizide (Glucotrol). *p.s. The reason why you have an adverse reaction is because your body is smart enough to know that something is wrong. Your body reacts negatively to most toxins by sending you a signal (upset stomach, diarrhea) letting you know that something is wrong. So, be careful, not to jump at taking this drug or an Continue reading >>

Influences On Prescribing Behavior In Diabetes

Influences On Prescribing Behavior In Diabetes

Influences on Prescribing Behavior in Diabetes A recent study,[ 1 ] conducted by three pharmacists and a nurse, explores why only 65% of patients with newly diagnosed type 2 diabetes (T2DM) and only 25% of people with ongoing T2DM are prescribed metformin. Although metformin is recommended as a first-line treatment for T2DM, it is still underused by clinicians who manage patients with T2DM. Using two focus groups with a total of 14 participants, including physicians, nurse practitioners, physician assistants, and pharmacists, the study explored situations in which clinicians were hesitant to prescribe or may have discontinued metformin use. These situations included renal insufficiency, heart failure, hepatic dysfunction, alcoholism, current or historical lactic acidosis, and manufacturer-listed contraindications. Despite a lack of scientific evidence supporting the precautions or contraindications to metformin use listed by the manufacturer, many clinicians were not comfortable prescribing metformin in the presence of a precautionary condition or contraindication. After a brief educational presentation about the evidence on the risks associated with metformin, the investigators reassessed the clinicians' level of comfort in prescribing metformin to patients with T2DM and such coexisting conditions as renal insufficiency, heart failure, and contraindications. They found that the participants were more likely to use metformin in these patients. The researchers concluded that the beliefs held by many clinicians about the risks associated with metformin use in T2DM are not consistent with the available evidence. They suggest that metformin use in patients with T2DM can be increased through clinician education to improve their level of comfort in using metformin in patient Continue reading >>

Why Isn’t Metformin Prescribed More?

Why Isn’t Metformin Prescribed More?

Since its debut in the United States in 1995, metformin has become the most popular oral drug for Type 2 diabetes in the country — and the rest of the world. Current guidelines by the American Diabetes Association state that unless there are special risks in a particular person, metformin should be the first drug prescribed to people with Type 2 diabetes. Yet perhaps due in part to its popularity, metformin isn’t free of controversy. As we’ve discussed previously here at Diabetes Flashpoints, there are concerns about prescribing metformin in people with kidney disease, and some doctors even question whether metformin deserves its status as the universally recommended first-line drug for Type 2 diabetes. In addition, there’s debate about whether metformin should be taken by more people with prediabetes. A recent study sought to explore the reasons why metformin isn’t prescribed as widely as clinical guidelines suggest it should be. Published last month in the journal Therapeutic Advances in Chronic Disease, the study notes that only roughly 65% of people with newly diagnosed Type 2 diabetes are prescribed metformin — and that over time, this number drops to just 25% of people with the condition. As noted in a Pharmacy Times article on the study, researchers from the University of Colorado put together focus groups of relevant people — doctors, pharmacists, and other medical personnel — to ask about their perceptions regarding metformin. Based on these focus groups, the researchers found that three main factors affected how doctors prescribed metformin: concerns about when to start the drug, concerns about the drug’s known risks, and whether procedures were in place to notice and deal with any adverse reactions caused by the drug. Based on the focus grou Continue reading >>

New Metformin Warning: Mandatory Supplementation With Vitamin B12

New Metformin Warning: Mandatory Supplementation With Vitamin B12

The most common medication used in women with PCOS is the insulin-sensitizer metformin. Research is strongly showing that long-term use of metformin and at high doses (1.5mg or higher daily) can deplete levels of vitamin B12. A deficiency of vitamin B12 can cause permanent neurological and nerve damage as well as mood changes and decreased energy. Here’s what you need to know to avoid a vitamin B12 deficiency if you take metformin. About Metformin Metformin is a medication that became available in the U.S. in 1995 for the treatment of type 2 diabetes. Metformin is the most widely used medication used to lower insulin levels in those with polycystic ovary syndrome. Other names for metformin include glucophage, glucophage XR, glumetza, and fortamet. Metformin lowers blood glucose levels in three ways: It suppresses the liver’s production of glucose. It increases the sensitivity of your liver, muscle, fat, and cells to the insulin your body makes. It slows the absorption of carbohydrates you consume Metformin use may affect the absorption of vitamin B12 possibly through alterations in intestinal mobility, increased bacterial overgrowth, or alterations of the vitamin B12-intrinsic factor complex. Metformin can cause a malabsorption in B12 due to digestive changes, which leads to the binding of B12-intrinsic factor complex (intrinsic factor is needed to absorb B12 in the gut) and a reduction of B12 absorption. Vitamin B12 Deficiency in Metformin Users The largest study thus far to examine the link between metformin and vitamin B12 is the Diabetes Prevention Program Outcomes Study (DDPOS). This study looked at B12 levels of individuals with prediabetes who took 850 mg Metformin 2x/day and compared them to those taking a placebo. At 5 years, 4.3% of the metformin users had 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 >>

Metformin Weight Loss – Does It Work?

Metformin Weight Loss – Does It Work?

Metformin weight loss claims are something that are often talked about by health professionals to be one of the benefits of commencing metformin therapy, but are they true? At myheart.net we’ve helped millions of people through our articles and answers. Now our authors are keeping readers up to date with cutting edge heart disease information through twitter. Follow Dr Ahmed on Twitter @MustafaAhmedMD Metformin is possibly one of the most important treatments in Type II Diabetes, so the question of metformin weight loss is of the utmost importance, as if true it could provide a means to lose weight as well as control high sugar levels found in diabetes. What is Metformin? Metformin is an oral hypoglycemic medication – meaning it reduces levels of sugar, or more specifically glucose in the blood. It is so effective that the American Diabetes Association says that unless there is a strong reason not to, metformin should be commenced at the onset of Type II Diabetes. Metformin comes in tablet form and the dose is gradually increased until the maximum dose required is achieved. How Does Metformin Work & Why Would it Cause Weight Loss? Metformin works by three major mechanisms – each of which could explain the “metformin weight loss” claims. These are: Decrease sugar production by the liver – the liver can actually make sugars from other substances, but metformin inhibits an enzyme in the pathway resulting in less sugar being released into the blood. Increase in the amount of sugar utilization in the muscles and the liver – Given that the muscles are a major “sink” for excess sugar, by driving sugar into them metformin is able to reduce the amount of sugar in the blood. Preventing the breakdown of fats (lipolysis) – this in turn reduces the amount of fatt Continue reading >>

Ratio-metformin

Ratio-metformin

Search or browse for information on Prescription Drugs How does this medication work? What will it do for me? Metformin belongs to the class of medications called oral hypoglycemics, which are medications that lower blood sugar. It is used to control blood glucose (blood sugar) for people with type 2 diabetes. It is used when diet, exercise, and weight reduction have not been found to lower blood glucose well enough on their own. Metformin works by reducing the amount of glucose made by the liver and by making it easier for glucose to enter into the tissues of the body. Metformin has been found to be especially useful in delaying problems associated with diabetes for overweight people with diabetes. This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here. Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor. Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it. The recommended adult dose of metformin ranges from 500mg 3 or 4 times a day to 850mg 2 or 3 times a day or 1000 mg 2 times a day. The maximum daily dose should not exceed 2,550mg daily. Tablets should be taken with food whenever possible to reduce the risk of nause Continue reading >>

Metformin Best For Type 2 Diabetes First Treatment

Metformin Best For Type 2 Diabetes First Treatment

HealthDay Reporter TUESDAY, Oct. 28, 2014 (HealthDay News) -- People newly diagnosed with type 2 diabetes who are initially given the drug metformin are less likely to eventually need other drugs to control their blood sugar, a new study suggests. The study found that, of those started on metformin, only about one-quarter needed another drug to control their blood sugar. However, people who were started on type 2 diabetes drugs other than metformin often needed a second drug or insulin to control their blood sugar levels, the researchers said. "This study supports the predominant practice, which is that most people are started on metformin," said lead researcher Dr. Niteesh Choudhry, an associate professor of medicine at Harvard Medical School in Boston. "Metformin might be more effective than others in controlling blood sugar," he noted. "Metformin, which is one of the oldest drugs we have and which the guidelines recommend as being the first drug to use, is associated with a lower risk of needing to add a second drug or insulin compared to any of three other commonly used classes of drugs," Choudhry said. The report was published in the Oct. 27 online edition of JAMA Internal Medicine. A hallmark of type 2 diabetes is insulin resistance, according to the American Diabetes Association (ADA). That means the body doesn't effectively use the hormone insulin. Insulin is produced by the pancreas and helps usher sugar from foods into the body's cells to be used as energy. When people have insulin resistance, too much sugar is left in the blood instead of being used. Over the long-term, high blood sugar levels can lead to serious complications, such as heart and kidney disease, according to the ADA. There are eight classes of oral type 2 diabetes medications, according to the Continue reading >>

More in ketosis