Glucovance is cheap. If you do not have drug insurance, you can expect to pay about 50 cents per pill in the United States.
Many internet pharmacies sell Glucovance. This competition drives down the price of glucovance even lower. You can get a good price on glucovance if you comparison shop.
Pharmacies know that diabetics usually take many drugs. Sometimes they will give you a good price on glucovance, hoping to get the rest of your business.
Here are the top internet websites that sell gluconavce and other drugs. You can save money on gluconavce if you comparison shop.
Will glucovance get you high?
Q.-Do I need a prescription to order Glucovance?
A.-A prescription is NOT required to order Glucovance and other of our products.
Q.-What is the minimum and maximum amount I can order Glucovance at one time?
A.-We have no limits to how much you can order Glucovance.
Q.-How do I order Glucovance and can you explain your shopping cart process ?
A.-Ordering with Your-OnlinePharmacy.com is fast, easy and in real time. Simply press the BUY Glucovance button and order Glucovance online.
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Thursday, November 5, 2009
Friday, June 26, 2009
Strengths
Glucovance tablets are available in three strengths: Glucovance 1.25 mg/250 mg tablets -- containing 1.25 mg of glyburide and 250 mg of metformin Glucovance 2.5 mg/500 mg tablets -- containing 2.5 mg of glyburide and 500 mg of metformin Glucovance 5 mg/500 mg tablets -- containing 5 mg of glyburide and 500 mg of metformin. |
Fact - Glucova
| Very rarely, Glucovance has been known to cause a dangerous condition called lactic acidosis, a buildup of lactic acid in the blood. Lactic acidosis is a medical emergency that requires immediate treatment in the hospital. Notify your doctor without delay if you experience any of the following symptoms: A slow or irregular heartbeat; a cold, dizzy, or light-headed feeling; a weak, tired, or uncomfortable feeling; stomach discomfort; trouble breathing; unusual muscle pain |
Thursday, April 9, 2009
Side-Effects
Glucovance: Side Effects
Introduction to Glucovance
Licensed health care professionals may prescribe Glucovance for the treatment of type 2 diabetes. Glucovance is composed of two drugs known as glyburide and metformin. These drugs work together to attack high blood sugar levels.
Glyburide will stimulate insulin production in the pancreas. It will try to help the body use the insulin effectively. Metformin decreases sugar production and absorption. It also works to encourage the body’s effective use of insulin.
Diabetes
To understand Glucovance as a medical treatment, it is critical to understand that diabetes is an illness wherein the body is unable to control the level of sugar, (glucose) that is present in the body. Sugar is produced by the body, but may also be introduced to the human system through the consumption of starch based foods and foods that have been artificially sweetened.
Types of Diabetes
Diabetes will develop when a person’s body is unable to process sugar. This sugar will build up in the bloodstream. In most cases, patients will suffer from one of two major categories of diabetes. They are type 1 diabetes and type 2 diabetes.
Type 1 diabetes develops when the body is unable to produce insulin on its own. Patients may be treated with insulin injections, as well as modifications to diet and exercise regimes.
People who suffer from 2 diabetes usually develop the condition at 40 years of age or older. This type of diabetes occurs when the body is unable to create enough insulin to function, or is unable to process the insulin properly. This type of diabetes may also be treated with diet, exercise, and careful attention to maintenance of a healthy weight profile.
Complications of Diabetes
Medical professionals will attempt to reduce the likelihood of developing diabetes by encouraging their high risk patients to maintain a healthy weight, and adhere to diet and exercise routines. Doctors will advise patients that diabetes can negatively affect vision, and the functioning of major organs such as the heart and kidneys. Diabetic complications may also affect the feet, increase thirst, and create a feeling of extreme exhaustion.
Usage of Glucovance
Glucovance is an oral medication that may be taken up to twice per day with meals. Never take two doses at the same time, even if you have missed a dosage.
Side Effects of Glucovance
Glucovance is not a replacement for insulin treatment. This drug must be used in combination with regimes consisting of a healthy diet and adequate physical activity.
In general, usage of this drug may cause bouts of hunger, cold sweats, nausea, and dizziness. Others report generalized shakiness, development of anemia, stomach pain, vomiting, and upper respiratory infections.
Potential Complications of Glucovance
It is important to note that diabetic patients who utilize Glucovance must be aware that it can cause harmful reactions in the body. Some patients report episodes of hypoglycemia, or low blood sugar. Usage of this drug can also cause fatal complication in patients with kidney or liver deficiencies.
In some instances, Glucovance has induced lactic acidosis, which is a buildup of lactic acid in the blood. This medical emergency will require immediate professional care. Do seek attention from a physician if you notice stomach discomfort, unusual muscle pain or an irregular heartbeat.
Final Note
Glucovance may also negatively interact with medications that the patient already takes. For example, it may cause adverse reactions for patients who utilize birth control medications, cardiac prescriptions, thyroid medications, and antidepressants, among others. Given the high potential for health complications, patients must seek the advisement of a doctor prior to using, (or discontinuing the use of), Glucovance.
Introduction to Glucovance
Licensed health care professionals may prescribe Glucovance for the treatment of type 2 diabetes. Glucovance is composed of two drugs known as glyburide and metformin. These drugs work together to attack high blood sugar levels.
Glyburide will stimulate insulin production in the pancreas. It will try to help the body use the insulin effectively. Metformin decreases sugar production and absorption. It also works to encourage the body’s effective use of insulin.
Diabetes
To understand Glucovance as a medical treatment, it is critical to understand that diabetes is an illness wherein the body is unable to control the level of sugar, (glucose) that is present in the body. Sugar is produced by the body, but may also be introduced to the human system through the consumption of starch based foods and foods that have been artificially sweetened.
Types of Diabetes
Diabetes will develop when a person’s body is unable to process sugar. This sugar will build up in the bloodstream. In most cases, patients will suffer from one of two major categories of diabetes. They are type 1 diabetes and type 2 diabetes.
Type 1 diabetes develops when the body is unable to produce insulin on its own. Patients may be treated with insulin injections, as well as modifications to diet and exercise regimes.
People who suffer from 2 diabetes usually develop the condition at 40 years of age or older. This type of diabetes occurs when the body is unable to create enough insulin to function, or is unable to process the insulin properly. This type of diabetes may also be treated with diet, exercise, and careful attention to maintenance of a healthy weight profile.
Complications of Diabetes
Medical professionals will attempt to reduce the likelihood of developing diabetes by encouraging their high risk patients to maintain a healthy weight, and adhere to diet and exercise routines. Doctors will advise patients that diabetes can negatively affect vision, and the functioning of major organs such as the heart and kidneys. Diabetic complications may also affect the feet, increase thirst, and create a feeling of extreme exhaustion.
Usage of Glucovance
Glucovance is an oral medication that may be taken up to twice per day with meals. Never take two doses at the same time, even if you have missed a dosage.
Side Effects of Glucovance
Glucovance is not a replacement for insulin treatment. This drug must be used in combination with regimes consisting of a healthy diet and adequate physical activity.
In general, usage of this drug may cause bouts of hunger, cold sweats, nausea, and dizziness. Others report generalized shakiness, development of anemia, stomach pain, vomiting, and upper respiratory infections.
Potential Complications of Glucovance
It is important to note that diabetic patients who utilize Glucovance must be aware that it can cause harmful reactions in the body. Some patients report episodes of hypoglycemia, or low blood sugar. Usage of this drug can also cause fatal complication in patients with kidney or liver deficiencies.
In some instances, Glucovance has induced lactic acidosis, which is a buildup of lactic acid in the blood. This medical emergency will require immediate professional care. Do seek attention from a physician if you notice stomach discomfort, unusual muscle pain or an irregular heartbeat.
Final Note
Glucovance may also negatively interact with medications that the patient already takes. For example, it may cause adverse reactions for patients who utilize birth control medications, cardiac prescriptions, thyroid medications, and antidepressants, among others. Given the high potential for health complications, patients must seek the advisement of a doctor prior to using, (or discontinuing the use of), Glucovance.
Metformin
Metformin hydrochloride is an oral antihyperglycemic drug used in the management of type 2 dia-betes. Metformin hydrochloride (N, N-dimethylimidodicarbonimidic diamide monohydrochloride) is not chemically or pharmacologically related to sulfonylureas, thiazolidinediones, or -glucosidase inhibitors. It is a white to off-white crystalline compound with a molecular formula of C 4 H 12 ClN 5 (monohydrochloride) and a molecular weight of 165.63. Metformin hydrochloride is freely soluble in water and is practically insoluble in acetone, ether, and chloroform. The pKa of metformin is 12.4. The pH of a 1% aqueous solution of metformin hydrochloride is 6.68.
GLUCOVANCE is available for oral administration in tablets containing 1.25 mg glyburide with 250 mg metformin hydrochloride, 2.5 mg glyburide with 500 mg metformin hydrochloride, and 5 mg glyburide with 500 mg metformin hydrochloride. In addition, each tablet contains the following inactive ingredients: microcrystalline cellulose, povidone, croscarmellose sodium, and magne-sium stearate. The tablets are film coated, which provides color differentiation.
GLUCOVANCE is available for oral administration in tablets containing 1.25 mg glyburide with 250 mg metformin hydrochloride, 2.5 mg glyburide with 500 mg metformin hydrochloride, and 5 mg glyburide with 500 mg metformin hydrochloride. In addition, each tablet contains the following inactive ingredients: microcrystalline cellulose, povidone, croscarmellose sodium, and magne-sium stearate. The tablets are film coated, which provides color differentiation.
FDA Accept Glucovance
Bristol-Myers Squibb Company announced that the U.S. Food and Drug Administration (FDA) has approved Glucovance™ (glyburide and metformin HCl tablets) for use, along with diet and exercise, as initial drug therapy for people with type 2 diabetes.
The drug was also approved as second-line therapy for patients with type 2 diabetes who are currently taking either or a sulfonylurea and a regimen of diet and exercise, but whose blood sugar levels are inadequately controlled.
Glucovance combines glyburide and glucophage -- the two most widely prescribed oral antidiabetic agents -- in a single pill. These agents work together to improve blood sugar in patients with type 2 diabetes.
"Glucovance represents a new approach to managing type 2 diabetes," said Richard J. Lane, president, Worldwide Medicines Group, Bristol-Myers Squibb. "It is our hope that the introduction of this novel agent could change the treatment paradigm for the more than 15 million patients in the U.S. with this condition."
Glucovance will be available in three dosing strengths, including 1.25 mg/250 mg (glyburide/metformin) tablets, 2.5 mg/500 mg tablets, and 5 mg/500 mg.
Glucovance has been proven safe and effective in clinical trials. In rare cases, Glucovance (or glucophage) may cause lactic acidosis, which can be fatal in up to half of the cases. Lactic acidosis occurs mainly in people whose kidneys are not functioning properly. Patients should not take these drugs if they have kidney problems, if they are 80 or older (unless they have their kidneys tested first), if they are taking medication for heart failure, if they have a history of liver disease or if they drink alcohol excessively. The most common side effects of Glucovance are normally minor ones such as diarrhea, nausea, and upset stomach. Less frequently, symptoms of hypoglycemia (low blood sugar) such as lightheadedness, dizziness, shakiness, or hunger may occur.
The drug was also approved as second-line therapy for patients with type 2 diabetes who are currently taking either or a sulfonylurea and a regimen of diet and exercise, but whose blood sugar levels are inadequately controlled.
Glucovance combines glyburide and glucophage -- the two most widely prescribed oral antidiabetic agents -- in a single pill. These agents work together to improve blood sugar in patients with type 2 diabetes.
"Glucovance represents a new approach to managing type 2 diabetes," said Richard J. Lane, president, Worldwide Medicines Group, Bristol-Myers Squibb. "It is our hope that the introduction of this novel agent could change the treatment paradigm for the more than 15 million patients in the U.S. with this condition."
Glucovance will be available in three dosing strengths, including 1.25 mg/250 mg (glyburide/metformin) tablets, 2.5 mg/500 mg tablets, and 5 mg/500 mg.
Glucovance has been proven safe and effective in clinical trials. In rare cases, Glucovance (or glucophage) may cause lactic acidosis, which can be fatal in up to half of the cases. Lactic acidosis occurs mainly in people whose kidneys are not functioning properly. Patients should not take these drugs if they have kidney problems, if they are 80 or older (unless they have their kidneys tested first), if they are taking medication for heart failure, if they have a history of liver disease or if they drink alcohol excessively. The most common side effects of Glucovance are normally minor ones such as diarrhea, nausea, and upset stomach. Less frequently, symptoms of hypoglycemia (low blood sugar) such as lightheadedness, dizziness, shakiness, or hunger may occur.
Uses
Glucovance Uses : This anti-diabetic medication is a combination of two drugs (a sulfonylurea and a biguanide). It is used along with a diet and exercise program to control high blood sugar in patients with type 2 diabetes (non-insulin-dependent diabetes). Glucovance works by stimulating the release of your body s natural insulin and by restoring your body s proper response to insulin. Controlling high blood sugar helps prevent heart disease, strokes, kidney disease, blindness and circulation problems, as well as sexual function problems (impotence).
How to Use Glucovance : Take Glucovance by mouth, usually twice daily with meals; or as directed by your doctor. Drink plenty of fluids while taking Glucovance. Use Glucovance regularly in order to get the most benefit from it. To help you remember, use it at the same times each day. Your dosage is based on your medical condition and response to therapy. Glucovance may come with a Patient Information Leaflet. Read it carefully and ask your doctor or pharmacist any questions you may have about your medication.
Glucovance Side Effects : Also see Warning section. Nausea, stomach upset, diarrhea, or weight gain may occur initially as your body adjusts to the medication. If stomach symptoms recur later (after you are on the same dose for several days or weeks), tell your doctor immediately. A late recurrence of stomach symptoms may be due to lactic acidosis. Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: persistent sore throat or fever, easy bleeding or bruising, severe stomach pain, yellowing eyes or skin, dark urine, unusual tiredness or weakness, unusual or sudden weight gain, mental/mood changes, swelling of the hands or feet, seizures. Glucovance can cause low blood sugar (hypoglycemia). This effect may occur if you do not consume enough calories (from food, juices, fruit, etc.). The symptoms include chills, cold sweat, blurred vision, dizziness, drowsiness, shaking, rapid heartbeat, weakness, headache, fainting, tingling of the hands or feet, or hunger. It is a good habit to carry glucose tablets or gel to treat low blood sugar. If you are in a situation where you don t have these reliable forms of glucose, eat a quick source of sugar such as table sugar, honey, or candy, or drink a glass of orange juice or non-diet soda to quickly raise your blood sugar level. Tell your doctor immediately about the reaction. To help prevent hypoglycemia, eat meals on a regular schedule and do not skip meals. Symptoms of high blood sugar (hyperglycemia) include thirst, increased urination, confusion, drowsiness, flushing, rapid breathing, or fruity breath odor. If these symptoms occur, tell your doctor immediately. Your medication dosage may need to be increased. An allergic reaction to Glucovance is unlikely, but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.
Glucovance Precautions : Glucovance should not be used if you have certain medical conditions. Before using Glucovance, consult your doctor or pharmacist if you have: kidney disease, liver disease, conditions that may cause a low oxygen blood level or poor circulation (e.g., severe congestive heart failure, recent heart attack, recent stroke), metabolic conditions (e.g., diabetic ketoacidosis), serious infection, lack of body fluids (dehydration). Before using Glucovance, tell your doctor or pharmacist your medical history, especially of: severe breathing problems (e.g., obstructive lung disease, severe asthma), thyroid disease, blood problems (e.g., anemia, vitamin B-12 deficiency), scheduled upcoming surgery, scheduled upcoming x-ray or scanning procedures, alcohol use, certain hormonal conditions (adrenal/pituitary insufficiency, SIADH-syndrome of inappropriate secretion of antidiuretic hormone), electrolyte imbalance (hyponatremia), high blood pressure, fertility problems (e.g., ovulation problems), any allergies. You may experience blurred vision, dizziness, or drowsiness due to extremely low or high blood sugar levels; use caution engaging in activities requiring alertness such as driving or using machinery. Limit alcohol while taking Glucovance because it can increase the risk of developing hypoglycemia. Rarely, alcohol can interact with glyburide and cause a serious reaction (disulfiram-like reaction) with symptoms such as facial flushing, nausea, vomiting, dizziness, or stomach pain. Consult your doctor or pharmacist about the safe use of alcohol. During times of stress, such as fever, infection, injury or surgery, it may be more difficult to control your blood sugar. Consult your doctor, as a change in your medication may be required. Glucovance may make you more sensitive to the sun. Avoid prolonged sun exposure, tanning booths or sunlamps. Use a sunscreen and wear protective clothing when outdoors. Caution is advised when using Glucovance in the elderly because they may be more sensitive to the effects of Glucovance. Glucovance can cause changes in the menstrual cycle (promote ovulation) in women with certain fertility problems, increasing the risk of becoming pregnant. Consult your doctor or pharmacist about the use of reliable birth control while using Glucovance. Glucovance should be used only when clearly needed during pregnancy. It is not recommended for use for at least 2 weeks before delivery due to the potential for fetal harm. Insulin may be preferred during pregnancy. Discuss the risks and benefits with your doctor. Based on information from related drugs, Glucovance may pass into breast milk. Breast-feeding is not recommended while using Glucovance.
Glucovance Interactions : Glucovance should not be used with the following medications because very serious interactions may occur: bosentan. If you are currently using any of these medications, tell your doctor or pharmacist before starting glyburide/metformin. Before using Glucovance, tell your doctor or pharmacist of all prescription and nonprescription products you may use, especially of: other diabetes drugs (e.g., insulin, rosiglitazone), aspirin or aspirin-like drugs (e.g., salicylates, NSAIDs such as ibuprofen, phenylbutazone), azole antifungals (e.g., fluconazole), cimetidine, birth control pills, blood thinners (e.g., warfarin), chloramphenicol, clofibrate, clomiphene, corticosteroids (e.g., prednisone), decongestants (e.g., pseudoephedrine), diazoxide, diet pills, epinephrine, estrogens, high blood pressure drugs (beta-blockers -- including glaucoma eye drops such as propranolol, timolol, metoprolol; calcium channel blockers such as nifedipine; ACE inhibitors such as captopril), isoniazid, MAO inhibitors (e.g., furazolidone, linezolid, moclobemide, phenelzine procarbazine, selegiline, isocarboxazid, tranylcypromine), niacin, phenothiazines (e.g., chlorpromazine), phenytoin, probenecid, quinolone antibiotics (e.g., ciprofloxacin), rifampin, sulfonamides (e.g., sulfa antibiotics), thyroid drugs, water pills (diuretics such as hydrochlorothiazide, furosemide), fenugreek, ginseng. If you are scheduled to undergo any x-ray or scanning procedure using injectable iodinated contrast material, be sure to inform your doctor that you are taking Glucovance. You will need to temporarily stop Glucovance around the time of your procedure. Consult your doctor for further instructions. Do not start or stop any medicine without doctor or pharmacist approval.
Overdose of Glucovance : If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include: rapid or trouble breathing, severe drowsiness, fast/slow/irregular heartbeat, shakiness, sweating, loss of consciousness.
Glucovance : If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.
Storing Glucovance : Store at room temperature (77 degrees F or 25 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medicines away from children and pets.
How to Use Glucovance : Take Glucovance by mouth, usually twice daily with meals; or as directed by your doctor. Drink plenty of fluids while taking Glucovance. Use Glucovance regularly in order to get the most benefit from it. To help you remember, use it at the same times each day. Your dosage is based on your medical condition and response to therapy. Glucovance may come with a Patient Information Leaflet. Read it carefully and ask your doctor or pharmacist any questions you may have about your medication.
Glucovance Side Effects : Also see Warning section. Nausea, stomach upset, diarrhea, or weight gain may occur initially as your body adjusts to the medication. If stomach symptoms recur later (after you are on the same dose for several days or weeks), tell your doctor immediately. A late recurrence of stomach symptoms may be due to lactic acidosis. Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: persistent sore throat or fever, easy bleeding or bruising, severe stomach pain, yellowing eyes or skin, dark urine, unusual tiredness or weakness, unusual or sudden weight gain, mental/mood changes, swelling of the hands or feet, seizures. Glucovance can cause low blood sugar (hypoglycemia). This effect may occur if you do not consume enough calories (from food, juices, fruit, etc.). The symptoms include chills, cold sweat, blurred vision, dizziness, drowsiness, shaking, rapid heartbeat, weakness, headache, fainting, tingling of the hands or feet, or hunger. It is a good habit to carry glucose tablets or gel to treat low blood sugar. If you are in a situation where you don t have these reliable forms of glucose, eat a quick source of sugar such as table sugar, honey, or candy, or drink a glass of orange juice or non-diet soda to quickly raise your blood sugar level. Tell your doctor immediately about the reaction. To help prevent hypoglycemia, eat meals on a regular schedule and do not skip meals. Symptoms of high blood sugar (hyperglycemia) include thirst, increased urination, confusion, drowsiness, flushing, rapid breathing, or fruity breath odor. If these symptoms occur, tell your doctor immediately. Your medication dosage may need to be increased. An allergic reaction to Glucovance is unlikely, but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.
Glucovance Precautions : Glucovance should not be used if you have certain medical conditions. Before using Glucovance, consult your doctor or pharmacist if you have: kidney disease, liver disease, conditions that may cause a low oxygen blood level or poor circulation (e.g., severe congestive heart failure, recent heart attack, recent stroke), metabolic conditions (e.g., diabetic ketoacidosis), serious infection, lack of body fluids (dehydration). Before using Glucovance, tell your doctor or pharmacist your medical history, especially of: severe breathing problems (e.g., obstructive lung disease, severe asthma), thyroid disease, blood problems (e.g., anemia, vitamin B-12 deficiency), scheduled upcoming surgery, scheduled upcoming x-ray or scanning procedures, alcohol use, certain hormonal conditions (adrenal/pituitary insufficiency, SIADH-syndrome of inappropriate secretion of antidiuretic hormone), electrolyte imbalance (hyponatremia), high blood pressure, fertility problems (e.g., ovulation problems), any allergies. You may experience blurred vision, dizziness, or drowsiness due to extremely low or high blood sugar levels; use caution engaging in activities requiring alertness such as driving or using machinery. Limit alcohol while taking Glucovance because it can increase the risk of developing hypoglycemia. Rarely, alcohol can interact with glyburide and cause a serious reaction (disulfiram-like reaction) with symptoms such as facial flushing, nausea, vomiting, dizziness, or stomach pain. Consult your doctor or pharmacist about the safe use of alcohol. During times of stress, such as fever, infection, injury or surgery, it may be more difficult to control your blood sugar. Consult your doctor, as a change in your medication may be required. Glucovance may make you more sensitive to the sun. Avoid prolonged sun exposure, tanning booths or sunlamps. Use a sunscreen and wear protective clothing when outdoors. Caution is advised when using Glucovance in the elderly because they may be more sensitive to the effects of Glucovance. Glucovance can cause changes in the menstrual cycle (promote ovulation) in women with certain fertility problems, increasing the risk of becoming pregnant. Consult your doctor or pharmacist about the use of reliable birth control while using Glucovance. Glucovance should be used only when clearly needed during pregnancy. It is not recommended for use for at least 2 weeks before delivery due to the potential for fetal harm. Insulin may be preferred during pregnancy. Discuss the risks and benefits with your doctor. Based on information from related drugs, Glucovance may pass into breast milk. Breast-feeding is not recommended while using Glucovance.
Glucovance Interactions : Glucovance should not be used with the following medications because very serious interactions may occur: bosentan. If you are currently using any of these medications, tell your doctor or pharmacist before starting glyburide/metformin. Before using Glucovance, tell your doctor or pharmacist of all prescription and nonprescription products you may use, especially of: other diabetes drugs (e.g., insulin, rosiglitazone), aspirin or aspirin-like drugs (e.g., salicylates, NSAIDs such as ibuprofen, phenylbutazone), azole antifungals (e.g., fluconazole), cimetidine, birth control pills, blood thinners (e.g., warfarin), chloramphenicol, clofibrate, clomiphene, corticosteroids (e.g., prednisone), decongestants (e.g., pseudoephedrine), diazoxide, diet pills, epinephrine, estrogens, high blood pressure drugs (beta-blockers -- including glaucoma eye drops such as propranolol, timolol, metoprolol; calcium channel blockers such as nifedipine; ACE inhibitors such as captopril), isoniazid, MAO inhibitors (e.g., furazolidone, linezolid, moclobemide, phenelzine procarbazine, selegiline, isocarboxazid, tranylcypromine), niacin, phenothiazines (e.g., chlorpromazine), phenytoin, probenecid, quinolone antibiotics (e.g., ciprofloxacin), rifampin, sulfonamides (e.g., sulfa antibiotics), thyroid drugs, water pills (diuretics such as hydrochlorothiazide, furosemide), fenugreek, ginseng. If you are scheduled to undergo any x-ray or scanning procedure using injectable iodinated contrast material, be sure to inform your doctor that you are taking Glucovance. You will need to temporarily stop Glucovance around the time of your procedure. Consult your doctor for further instructions. Do not start or stop any medicine without doctor or pharmacist approval.
Overdose of Glucovance : If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include: rapid or trouble breathing, severe drowsiness, fast/slow/irregular heartbeat, shakiness, sweating, loss of consciousness.
Glucovance : If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.
Storing Glucovance : Store at room temperature (77 degrees F or 25 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medicines away from children and pets.
Glucovance
Glucovance Side Effects
Also see Warning section. Nausea, stomach upset, diarrhea, or weight gain may occur initially as your body adjusts to the medication. If stomach symptoms recur later (after you are on the same dose for several days or weeks), tell your doctor immediately. A late recurrence of stomach symptoms may be due to lactic acidosis. Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: persistent sore throat or fever, easy bleeding or bruising, severe stomach pain, yellowing eyes or skin, dark urine, unusual tiredness or weakness, unusual or sudden weight gain, mental/mood changes, swelling of the hands or feet, seizures. Glucovance can cause low blood sugar (hypoglycemia). This effect may occur if you do not consume enough calories (from food, juices, fruit, etc.). The symptoms include chills, cold sweat, blurred vision, dizziness, drowsiness, shaking, rapid heartbeat, weakness, headache, fainting, tingling of the hands or feet, or hunger. It is a good habit to carry glucose tablets or gel to treat low blood sugar. If you are in a situation where you don t have these reliable forms of glucose, eat a quick source of sugar such as table sugar, honey, or candy, or drink a glass of orange juice or non-diet soda to quickly raise your blood sugar level. Tell your doctor immediately about the reaction. To help prevent hypoglycemia, eat meals on a regular schedule and do not skip meals. Symptoms of high blood sugar (hyperglycemia) include thirst, increased urination, confusion, drowsiness, flushing, rapid breathing, or fruity breath odor. If these symptoms occur, tell your doctor immediately. Your medication dosage may need to be increased. An allergic reaction to Glucovance is unlikely, but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.
Glucovance Precautions
Glucovance should not be used if you have certain medical conditions. Before using Glucovance, consult your doctor or pharmacist if you have: kidney disease, liver disease, conditions that may cause a low oxygen blood level or poor circulation (e.g., severe congestive heart failure, recent heart attack, recent stroke), metabolic conditions (e.g., diabetic ketoacidosis), serious infection, lack of body fluids (dehydration). Before using Glucovance, tell your doctor or pharmacist your medical history, especially of: severe breathing problems (e.g., obstructive lung disease, severe asthma), thyroid disease, blood problems (e.g., anemia, vitamin B-12 deficiency), scheduled upcoming surgery, scheduled upcoming x-ray or scanning procedures, alcohol use, certain hormonal conditions (adrenal/pituitary insufficiency, SIADH-syndrome of inappropriate secretion of antidiuretic hormone), electrolyte imbalance (hyponatremia), high blood pressure, fertility problems (e.g., ovulation problems), any allergies. You may experience blurred vision, dizziness, or drowsiness due to extremely low or high blood sugar levels; use caution engaging in activities requiring alertness such as driving or using machinery. Limit alcohol while taking Glucovance because it can increase the risk of developing hypoglycemia. Rarely, alcohol can interact with glyburide and cause a serious reaction (disulfiram-like reaction) with symptoms such as facial flushing, nausea, vomiting, dizziness, or stomach pain. Consult your doctor or pharmacist about the safe use of alcohol. During times of stress, such as fever, infection, injury or surgery, it may be more difficult to control your blood sugar. Consult your doctor, as a change in your medication may be required. Glucovance may make you more sensitive to the sun. Avoid prolonged sun exposure, tanning booths or sunlamps. Use a sunscreen and wear protective clothing when outdoors. Caution is advised when using Glucovance in the elderly because they may be more sensitive to the effects of Glucovance. Glucovance can cause changes in the menstrual cycle (promote ovulation) in women with certain fertility problems, increasing the risk of becoming pregnant. Consult your doctor or pharmacist about the use of reliable birth control while using Glucovance. Glucovance should be used only when clearly needed during pregnancy. It is not recommended for use for at least 2 weeks before delivery due to the potential for fetal harm. Insulin may be preferred during pregnancy. Discuss the risks and benefits with your doctor. Based on information from related drugs, Glucovance may pass into breast milk. Breast-feeding is not recommended while using Glucovance.
Also see Warning section. Nausea, stomach upset, diarrhea, or weight gain may occur initially as your body adjusts to the medication. If stomach symptoms recur later (after you are on the same dose for several days or weeks), tell your doctor immediately. A late recurrence of stomach symptoms may be due to lactic acidosis. Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: persistent sore throat or fever, easy bleeding or bruising, severe stomach pain, yellowing eyes or skin, dark urine, unusual tiredness or weakness, unusual or sudden weight gain, mental/mood changes, swelling of the hands or feet, seizures. Glucovance can cause low blood sugar (hypoglycemia). This effect may occur if you do not consume enough calories (from food, juices, fruit, etc.). The symptoms include chills, cold sweat, blurred vision, dizziness, drowsiness, shaking, rapid heartbeat, weakness, headache, fainting, tingling of the hands or feet, or hunger. It is a good habit to carry glucose tablets or gel to treat low blood sugar. If you are in a situation where you don t have these reliable forms of glucose, eat a quick source of sugar such as table sugar, honey, or candy, or drink a glass of orange juice or non-diet soda to quickly raise your blood sugar level. Tell your doctor immediately about the reaction. To help prevent hypoglycemia, eat meals on a regular schedule and do not skip meals. Symptoms of high blood sugar (hyperglycemia) include thirst, increased urination, confusion, drowsiness, flushing, rapid breathing, or fruity breath odor. If these symptoms occur, tell your doctor immediately. Your medication dosage may need to be increased. An allergic reaction to Glucovance is unlikely, but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.
Glucovance Precautions
Glucovance should not be used if you have certain medical conditions. Before using Glucovance, consult your doctor or pharmacist if you have: kidney disease, liver disease, conditions that may cause a low oxygen blood level or poor circulation (e.g., severe congestive heart failure, recent heart attack, recent stroke), metabolic conditions (e.g., diabetic ketoacidosis), serious infection, lack of body fluids (dehydration). Before using Glucovance, tell your doctor or pharmacist your medical history, especially of: severe breathing problems (e.g., obstructive lung disease, severe asthma), thyroid disease, blood problems (e.g., anemia, vitamin B-12 deficiency), scheduled upcoming surgery, scheduled upcoming x-ray or scanning procedures, alcohol use, certain hormonal conditions (adrenal/pituitary insufficiency, SIADH-syndrome of inappropriate secretion of antidiuretic hormone), electrolyte imbalance (hyponatremia), high blood pressure, fertility problems (e.g., ovulation problems), any allergies. You may experience blurred vision, dizziness, or drowsiness due to extremely low or high blood sugar levels; use caution engaging in activities requiring alertness such as driving or using machinery. Limit alcohol while taking Glucovance because it can increase the risk of developing hypoglycemia. Rarely, alcohol can interact with glyburide and cause a serious reaction (disulfiram-like reaction) with symptoms such as facial flushing, nausea, vomiting, dizziness, or stomach pain. Consult your doctor or pharmacist about the safe use of alcohol. During times of stress, such as fever, infection, injury or surgery, it may be more difficult to control your blood sugar. Consult your doctor, as a change in your medication may be required. Glucovance may make you more sensitive to the sun. Avoid prolonged sun exposure, tanning booths or sunlamps. Use a sunscreen and wear protective clothing when outdoors. Caution is advised when using Glucovance in the elderly because they may be more sensitive to the effects of Glucovance. Glucovance can cause changes in the menstrual cycle (promote ovulation) in women with certain fertility problems, increasing the risk of becoming pregnant. Consult your doctor or pharmacist about the use of reliable birth control while using Glucovance. Glucovance should be used only when clearly needed during pregnancy. It is not recommended for use for at least 2 weeks before delivery due to the potential for fetal harm. Insulin may be preferred during pregnancy. Discuss the risks and benefits with your doctor. Based on information from related drugs, Glucovance may pass into breast milk. Breast-feeding is not recommended while using Glucovance.
Thursday, February 19, 2009
The Symlin Pen
The FDA approved pre-filled Symlin pens in November of 2007 and Amylin made them available in January of 2008. Previously, it was only available in vials. There are currently two pens available: the SymlinPen 60 and 120. The SymlinPen 60 delivers 15, 30, 45, or 60 micrograms per dose. The SymlinPen 120 delivers 60 or 120 micrograms per dose. Both may be stored at room temperature, up to 86 degrees, after first use.
Symlin, An Injectable Form of Amylin
During the destruction of beta cells in Type 1 or Type 1.5 diabetes by friendly fire from antibodies, the body actually loses two hormones. And similar to insulin, Amylin production may fall in Type 2 diabetes over time. Amylin is normally co-secreted alongside insulin and, like insulin, is released by the beta cells around the clock with larger amounts released at mealtimes.
Insulin was the first of the two hormones to be discovered because it was so critical to survival. It was not until 1970 that amylin was discovered, and not until the early 1990s is that its role began to be understood. Not essential for life, amylin plays an important role in glucose regulation by slowing digestion and suppressing an excessive release of glucagon that is seen after meals in Type 1 diabetes. The excess glucagon rise seen in Type 1 diabetes causes additional glucose release by the liver at mealtimes. The release of amylin at mealtimes minimizes the glucose spikes that are often seen in Type 1 diabetes after meals.
Symlin is a modified longer-acting form of amylin that was released by the FDA in 2005. This prescription medication dramatically improves post meal glucose control and reduces glucose variability and glucose exposure in anyone whose insulin production is limited. Symlin decreases glucagon secretion, decreases appetite, and delays gastric emptying. When injected before meals, post meal blood sugars become easier to control. Users often comment that they feel better with more stable glucose readings.
One caution when starting on Symlin is that it can cause severe low blood sugars if meal insulin doses are not lowered on the day it is started and for at least the first few days of use. If meal insulin doses are not reduced, up to 30% of users experience severe hypoglycemia within about 3 hours of eating. To reduce the risk of hypoglycemia, Symlin is started at very small doses and then gradually increased every few days until the desired effect is seen. Meal insulin doses are typically reduced by 30% to 50% when starting and later adjusted based on pre and post meal glucose results once a final Symlin dose is reached. Long-acting insulin doses or basal rates may also need to be lowered, especially if these make up more then 50% of the starting TDD (total daily dose of insulin). As weight loss occurs in someone who is overweight, additional insulin reductions will be needed over time.
Dosing
Symlin is injected with a standard insulin syringe, so dosing is flexible. How much to use depends on what it is used for. For weight loss, maximum doses are usually best, while lower doses often work when the goal is to normalize post-meal glucose levels. The manufacturer recommends starting with 2.5 units and increasing to 5 units, then 7.5 units, and 10 units before each meal if no nausea is encountered for three days.
However, different people will require very different doses and we recommend that Symlin doses be individualized in the same way as insulin doses. If your goal is to reduce post meal spiking and glucose variability, raise the Symlin dose by one unit every three days until you reach a dose where most of your post meal blood sugar readings rise no more than 40 to 60 mg/dl (2.2 to 3.3 mmol) above where they started. The idea is to take enough to have good post meal control (less variability) without overly delaying the normal rise in glucose after a meal (less problem correcting a low reading). Keep raising the Symlin or increasing meal boluses until post meal readings are consistently less than 60 mg/dl (3.3 mmol) higher than the premeal readings. The correct doses of Symlin and insulin allow you to keep most post meal readings from rising much while causing few lows. In many Type 1s, only 2 to 6 units taken two or three times a day before meals are required to do this. Symlin is usually taken just before meals that contain at least 250 calories or 30 grams of carbohydrate. If a dose is missed, wait until the next meal to take the regular scheduled dose.
Your current TDD for insulin can guide your premeal Symlin dose. Approximately 10% of your insulin TDD is needed as Symlin before each meal. For instance, if you use 40 units of insulin a day you will need approximately 4 units of Symlin before each meal to control your post meal readings. For weight loss, of course, larger amounts will be needed. A safer way to increase Symlin is to start with 2 units before two or three meals a day, or 1 unit if your TDD is less than 30 units of insulin a day. Increase by 1 unit per meal every three days as long as nausea is not present.
Post meal Control
Glucose spiking after meals can be totally eliminated at higher doses, with flat glucose trend lines often seen on a continuous monitor. At higher Symlin doses, however, if a large carb meal is consumed, the rise in the blood sugar may not be seen until several hours later, such as a high reading at breakfast the next morning after a large carb intake at dinner. Matching injected insulin doses to Symlin can be difficult. Today's rapid insulins become too fast when larger doses of Symlin are used. If you inject your insulin, the use of a slower insulin like Regular may be preferred.
On a pump, a combo bolus (some now, the rest over time) or an extended bolus can be used to match the slower rise in glucose after meals. If a blood sugar is low before a meal, raise it before taking Symlin. Reduce the meal bolus and give it as an extended bolus. If Symlin doses are missed for more than two or three days, do not restart with full doses. Instead, restart at a lower dose and build up to lessen the risk of hypoglycemia.
Weight Loss
Less hunger allows some people who are overweight to lose significant amounts of weight, while normal weight individuals lose none. Symlin is currently undergoing studies for approval by the FDA as a weight loss drug.
For weight loss, the dose may occasionally need to go higher.
Stability
Symlin is less stable than insulin. If one bottle of Symlin appears to have no effect on your blood sugar try another bottle. Symlin activity is more vulnerable to time and temperature than insulin and can lose significant activity, especially if a sample bottle was handed out from a physician's office. If you seem to get little effect from a bottle, start a fresh bottle at a lower dose. Excess doses are easy to spot by a feeling of fullness or nausea after the dose is given. Vomiting and diarrhea may occur on an excessive dose. If side effects occur, simply lower the dose by one or 2 units. Increase the dose again after there is no fullness or nausea for at least three days.
Tips On Handling Lows
Symlin delays the digestion of all food, including the carbs you use to raise a low blood sugar. If a low occurs, use glucose tablets if available and chew them as long as possible to allow more glucose to be absorbed directly into the bloodstream. Be patient, as the rise in your glucose will be slowed because of Symlin. Likewise when lowering a high reading with insulin, it will take longer and may require larger than normal insulin doses because food is still being absorbed.
Insulin was the first of the two hormones to be discovered because it was so critical to survival. It was not until 1970 that amylin was discovered, and not until the early 1990s is that its role began to be understood. Not essential for life, amylin plays an important role in glucose regulation by slowing digestion and suppressing an excessive release of glucagon that is seen after meals in Type 1 diabetes. The excess glucagon rise seen in Type 1 diabetes causes additional glucose release by the liver at mealtimes. The release of amylin at mealtimes minimizes the glucose spikes that are often seen in Type 1 diabetes after meals.
Symlin is a modified longer-acting form of amylin that was released by the FDA in 2005. This prescription medication dramatically improves post meal glucose control and reduces glucose variability and glucose exposure in anyone whose insulin production is limited. Symlin decreases glucagon secretion, decreases appetite, and delays gastric emptying. When injected before meals, post meal blood sugars become easier to control. Users often comment that they feel better with more stable glucose readings.
One caution when starting on Symlin is that it can cause severe low blood sugars if meal insulin doses are not lowered on the day it is started and for at least the first few days of use. If meal insulin doses are not reduced, up to 30% of users experience severe hypoglycemia within about 3 hours of eating. To reduce the risk of hypoglycemia, Symlin is started at very small doses and then gradually increased every few days until the desired effect is seen. Meal insulin doses are typically reduced by 30% to 50% when starting and later adjusted based on pre and post meal glucose results once a final Symlin dose is reached. Long-acting insulin doses or basal rates may also need to be lowered, especially if these make up more then 50% of the starting TDD (total daily dose of insulin). As weight loss occurs in someone who is overweight, additional insulin reductions will be needed over time.
Dosing
Symlin is injected with a standard insulin syringe, so dosing is flexible. How much to use depends on what it is used for. For weight loss, maximum doses are usually best, while lower doses often work when the goal is to normalize post-meal glucose levels. The manufacturer recommends starting with 2.5 units and increasing to 5 units, then 7.5 units, and 10 units before each meal if no nausea is encountered for three days.
However, different people will require very different doses and we recommend that Symlin doses be individualized in the same way as insulin doses. If your goal is to reduce post meal spiking and glucose variability, raise the Symlin dose by one unit every three days until you reach a dose where most of your post meal blood sugar readings rise no more than 40 to 60 mg/dl (2.2 to 3.3 mmol) above where they started. The idea is to take enough to have good post meal control (less variability) without overly delaying the normal rise in glucose after a meal (less problem correcting a low reading). Keep raising the Symlin or increasing meal boluses until post meal readings are consistently less than 60 mg/dl (3.3 mmol) higher than the premeal readings. The correct doses of Symlin and insulin allow you to keep most post meal readings from rising much while causing few lows. In many Type 1s, only 2 to 6 units taken two or three times a day before meals are required to do this. Symlin is usually taken just before meals that contain at least 250 calories or 30 grams of carbohydrate. If a dose is missed, wait until the next meal to take the regular scheduled dose.
Your current TDD for insulin can guide your premeal Symlin dose. Approximately 10% of your insulin TDD is needed as Symlin before each meal. For instance, if you use 40 units of insulin a day you will need approximately 4 units of Symlin before each meal to control your post meal readings. For weight loss, of course, larger amounts will be needed. A safer way to increase Symlin is to start with 2 units before two or three meals a day, or 1 unit if your TDD is less than 30 units of insulin a day. Increase by 1 unit per meal every three days as long as nausea is not present.
Post meal Control
Glucose spiking after meals can be totally eliminated at higher doses, with flat glucose trend lines often seen on a continuous monitor. At higher Symlin doses, however, if a large carb meal is consumed, the rise in the blood sugar may not be seen until several hours later, such as a high reading at breakfast the next morning after a large carb intake at dinner. Matching injected insulin doses to Symlin can be difficult. Today's rapid insulins become too fast when larger doses of Symlin are used. If you inject your insulin, the use of a slower insulin like Regular may be preferred.
On a pump, a combo bolus (some now, the rest over time) or an extended bolus can be used to match the slower rise in glucose after meals. If a blood sugar is low before a meal, raise it before taking Symlin. Reduce the meal bolus and give it as an extended bolus. If Symlin doses are missed for more than two or three days, do not restart with full doses. Instead, restart at a lower dose and build up to lessen the risk of hypoglycemia.
Weight Loss
Less hunger allows some people who are overweight to lose significant amounts of weight, while normal weight individuals lose none. Symlin is currently undergoing studies for approval by the FDA as a weight loss drug.
For weight loss, the dose may occasionally need to go higher.
Stability
Symlin is less stable than insulin. If one bottle of Symlin appears to have no effect on your blood sugar try another bottle. Symlin activity is more vulnerable to time and temperature than insulin and can lose significant activity, especially if a sample bottle was handed out from a physician's office. If you seem to get little effect from a bottle, start a fresh bottle at a lower dose. Excess doses are easy to spot by a feeling of fullness or nausea after the dose is given. Vomiting and diarrhea may occur on an excessive dose. If side effects occur, simply lower the dose by one or 2 units. Increase the dose again after there is no fullness or nausea for at least three days.
Tips On Handling Lows
Symlin delays the digestion of all food, including the carbs you use to raise a low blood sugar. If a low occurs, use glucose tablets if available and chew them as long as possible to allow more glucose to be absorbed directly into the bloodstream. Be patient, as the rise in your glucose will be slowed because of Symlin. Likewise when lowering a high reading with insulin, it will take longer and may require larger than normal insulin doses because food is still being absorbed.
Lantus
Lantus® (insulin glargine [rDNA origin] injection) is a new true once a day background insulin from Aventis Pharmaceuticals. It represents a remarkable breakthrough in that it is the first insulin to offer truly flat insulin levels through the entire day for most users. It can be used by people with Type 1 or Type 2 diabetes who are six years old or older. Considered an alternative to an insulin pump, it is the first long-term insulin that has a predictable and consistent insulin activity.
Tips For Starting
Morning or night? Aventis recommends taking Lantus at bedtime. Lantus' actual duration of action is 18 to 26 hours. Although the timing varies from indiviual to individual, it appears to be consistent in the same indiviual. The advantage to bedtime dosing is that for most people any gap in Lantus' activity would happen after dinner and this gap could be covered with a little extra Humalog or Novolog in the dinner injection.
Whether you take it at bedtime or breakfast, it helps to be consistent about timing, so pick a time when you will remember to take the injection at the same time each day.
A good way to eliminate any gaps in insulin delivery, whether caused by a duration of action less than 24 hours or by erratic timing of injections is to split the Lantus dose equally into 2 injections a day given at breakfast and at dinner or bedtime. This smoothes out the sometimes erratic insulin levels that may occur with once a day dosing.
Lantus is a clear insulin which is unlike other long-acting insulins (Lente, NPH, Ultralente) that are all cloudy. Although the bottles have a different shape, some users have already injected a bedtime dose of Humalog rather than Lantus! Be very careful not to confuse Lantus with Humalog and other clear insulins.
DO NOT MIX Lantus with any other insulin. Do not even reuse a syringe in Lantus that has come in contact with another insulin.
Lantus becomes inactivated if it comes in contact with even small amounts of other insulins. This makes it appear hazy. Never use any Lantus that is not crystal clear.
Lantus cannot replace the need for Humalog or another fast insulin to cover carbs in meals. However, occasionally in people with Type 2 diabetes, when the before breakfast blood sugar is normalized with Lantus, a premeal medication like Starlix, Prandin, or even Precose may be able to control the post meal blood sugars.
How Do I Know When I'm On The Right Dose?
One really nice feature of Lantus is that it makes finding the correct dose easy. Because of its very stable 24 hour action, the dose is gradually increased until the fasting or before breakfast blood sugar has been normalized. If low blood sugars occur during the night and they are not being caused by a dose of fast acting insulin taken during the evening hours, the dose of Lantus would be gradually reduced until the lows stop.
Similar to the basal rate of an insulin pump, the Lantus dose can be checked by skipping a meal during the day, but the real test for whether the dose is accurate comes from stable, flat overnight blood sugars.
Once the Lantus dose has been determined, the doses of premeal Humalog, Novalog, Starlix, etc. would then be adjusted to keep postmeal blood sugars normal. With a stable background insulin, carb counting becomes especially helpful as a way to decide on the insulin dose before each meal.
How Lantus Works
This insulin analog was designed to have low solubility in water at a neutral pH, such as that found in body fluids and other insulins. Lantus becomes completely soluble only at an acid pH of 4. Once this is injected under the skin, the acidic solution is neutralized leading to the formation of microprecipitates. The microprecipitates allow small amounts of insulin to be released slowly, resulting in a relatively constant concentration/time profile over 22 hours +/- 4 hours with no pronounced peak in activity.
Lantus was modified to allow this precise action. Normal insulin has two protein chains called A and B that have two zinc crosslinks between them. Lantus differs from other insulins in that one asparagine at position A21 of the A chain is replaced by glycine, and two arginines have been added added to one end of the B-chain.
Cautions
Occasionally, the acidic nature of this insulin may cause mild discomfort at the injection site in some individuals. This does not appear serious enough to cause users to discontinue the insulin.
Like Humalog, Lantus is structurally different from human insulin, but it appears to rarely cause an immune or allergic response. Like any insulin allergy, the response can range from a mild local itching to a severe allergic reaction with swelling of the tongue, inability to breath and shock or death if rapid treatment is not found.
Lantus should be used with great caution and only under the supervision of a physician during pregnancy or prior to pregnancy.
How Often Does Lantus Fail To Work?
How many people fail to respond to Lantus is unknown. The vast majority of users get a consistent action from this insulin every day. However, Aventis' clinical studies did pick up some individuals who had marked differences in the action time for Lantus from one day to the next. In rare individuals, it's action time was as short as 11 hours, but it is unknown why this difference occurs.
Lantus may not work for everyone, but for the vast majority who are willing to take an extra injection or two a day in order to get terrific control, this insulin is definitely worth a try.
Tips For Starting
Morning or night? Aventis recommends taking Lantus at bedtime. Lantus' actual duration of action is 18 to 26 hours. Although the timing varies from indiviual to individual, it appears to be consistent in the same indiviual. The advantage to bedtime dosing is that for most people any gap in Lantus' activity would happen after dinner and this gap could be covered with a little extra Humalog or Novolog in the dinner injection.
Whether you take it at bedtime or breakfast, it helps to be consistent about timing, so pick a time when you will remember to take the injection at the same time each day.
A good way to eliminate any gaps in insulin delivery, whether caused by a duration of action less than 24 hours or by erratic timing of injections is to split the Lantus dose equally into 2 injections a day given at breakfast and at dinner or bedtime. This smoothes out the sometimes erratic insulin levels that may occur with once a day dosing.
Lantus is a clear insulin which is unlike other long-acting insulins (Lente, NPH, Ultralente) that are all cloudy. Although the bottles have a different shape, some users have already injected a bedtime dose of Humalog rather than Lantus! Be very careful not to confuse Lantus with Humalog and other clear insulins.
DO NOT MIX Lantus with any other insulin. Do not even reuse a syringe in Lantus that has come in contact with another insulin.
Lantus becomes inactivated if it comes in contact with even small amounts of other insulins. This makes it appear hazy. Never use any Lantus that is not crystal clear.
Lantus cannot replace the need for Humalog or another fast insulin to cover carbs in meals. However, occasionally in people with Type 2 diabetes, when the before breakfast blood sugar is normalized with Lantus, a premeal medication like Starlix, Prandin, or even Precose may be able to control the post meal blood sugars.
How Do I Know When I'm On The Right Dose?
One really nice feature of Lantus is that it makes finding the correct dose easy. Because of its very stable 24 hour action, the dose is gradually increased until the fasting or before breakfast blood sugar has been normalized. If low blood sugars occur during the night and they are not being caused by a dose of fast acting insulin taken during the evening hours, the dose of Lantus would be gradually reduced until the lows stop.
Similar to the basal rate of an insulin pump, the Lantus dose can be checked by skipping a meal during the day, but the real test for whether the dose is accurate comes from stable, flat overnight blood sugars.
Once the Lantus dose has been determined, the doses of premeal Humalog, Novalog, Starlix, etc. would then be adjusted to keep postmeal blood sugars normal. With a stable background insulin, carb counting becomes especially helpful as a way to decide on the insulin dose before each meal.
How Lantus Works
This insulin analog was designed to have low solubility in water at a neutral pH, such as that found in body fluids and other insulins. Lantus becomes completely soluble only at an acid pH of 4. Once this is injected under the skin, the acidic solution is neutralized leading to the formation of microprecipitates. The microprecipitates allow small amounts of insulin to be released slowly, resulting in a relatively constant concentration/time profile over 22 hours +/- 4 hours with no pronounced peak in activity.
Lantus was modified to allow this precise action. Normal insulin has two protein chains called A and B that have two zinc crosslinks between them. Lantus differs from other insulins in that one asparagine at position A21 of the A chain is replaced by glycine, and two arginines have been added added to one end of the B-chain.
Cautions
Occasionally, the acidic nature of this insulin may cause mild discomfort at the injection site in some individuals. This does not appear serious enough to cause users to discontinue the insulin.
Like Humalog, Lantus is structurally different from human insulin, but it appears to rarely cause an immune or allergic response. Like any insulin allergy, the response can range from a mild local itching to a severe allergic reaction with swelling of the tongue, inability to breath and shock or death if rapid treatment is not found.
Lantus should be used with great caution and only under the supervision of a physician during pregnancy or prior to pregnancy.
How Often Does Lantus Fail To Work?
How many people fail to respond to Lantus is unknown. The vast majority of users get a consistent action from this insulin every day. However, Aventis' clinical studies did pick up some individuals who had marked differences in the action time for Lantus from one day to the next. In rare individuals, it's action time was as short as 11 hours, but it is unknown why this difference occurs.
Lantus may not work for everyone, but for the vast majority who are willing to take an extra injection or two a day in order to get terrific control, this insulin is definitely worth a try.
Lilac plant
Metformin is a chemical kin to the French lilac plant, which was noted in the early 1900’s to lower the blood sugar. However, French lilac, like phenformin, turned out to be too toxic for use in humans. Metformin, with a much shorter action time than phenformin, has a much lower risk for severe side effects and is quite safe for use by anyone who is otherwise healthy. In fact, in the major UKPDS study, it was the only drug that reduced diabetes-related death rates, heart attacks, and strokes. It should not be used by those who use more than two ounces or two drinks of alcohol a day, who have congestive heart failure, or who have significant kidney, liver, or lung disease.
Metformin lowers fasting blood glucose levels by an average of 25% (17 to 37%), postprandial blood glucose up to 44.5%, and the A1c by an average of 1.5% (0.8 to 3.1%). Metformin reduces raised plasma insulin levels in cases of metabolic syndrome by as much as 30% and reduces the need for injected insulin in Type 2s by 15 to 32%.
Metformin is available under the trade name Glucophage, or as an extended-release tablet called Glucophage XR. It works well when combined with sulfonylureas. A combination of glyburide and metformin is available as Glucovance. Combined therapy leads to a greater reduction in blood sugar than can be attained by either class alone. Generic metformin is available at a reduced cost.
Metformin possesses some distinct advantages in treating diabetes. Excess glucose produced by the liver is the major source of high blood sugars in Type 2 diabetes and is typically the reason for high blood sugars on waking in the morning. Metformin reduces this overproduction of glucose. It helps in lowering the blood sugar, especially after eating, with no risk of hypoglycemia when used alone. Modest improvement in cholesterol levels are also seen. The 10 year UKPDS Study of over 3,000 people with Type 2 diabetes found that those who were placed on metformin had a 36% decrease in overall mortality and a 39% decrease in heart attacks.
Because metformin shuts off the liver’s excess production of glucose, it reduces the amount of injected insulin needed to control the blood sugar in both Type 1 and Type 2 diabetes. People with Type 2 diabetes who are on insulin usually are advised to lower their insulin doses prior to starting metformin. The full improvement in glycemic control and cholesterol levels may not be seen until 4 to 6 weeks of use have passed.
Side effects from metformin include a change in taste, loss of appetite, nausea or vomiting, abdominal bloating or gas, diarrhea, or skin rash. These may occur during the first few weeks of taking the medication but are seldom long-lasting. Taking the medication with food and starting out with a low dose help reduce side effects. The dosage can be gradually increased as side effects diminish.
Lactic acidosis, the serious but rare side effect originally seen with phenformin, results when a buildup of lactic acid occurs due to an inability to clear metformin from the system. Lactic acidosis occurs very rarely, only once in every 30,000 person-years of use. It almost always occurs in older people who have another major health problem, especially one that may impair breathing or circulation. Warning signs of lactic acidosis include fast and shallow breathing, diarrhea, severe muscle aches, cramping, unusual weakness or tiredness, or feeling cold. Because lactic acidosis has a mortality rate of about 40%, anyone who has significant lung disease, congestive heart failure, or kidney disease should never take this drug.
Because drinking alcohol while taking metformin may also trigger lactic acidosis when other health risks are present, be sure to ask your doctor about alcohol consumption if you are taking this drug. Be aware that Tagamet, a gastrointestinal medication, may enhance the effects of metformin. Therefore, the dose of metformin may need to be lower if you already take Tagamet.
Although not yet FDA approved, metformin is now in clinical trials for treatment of teens who have developed Type 2 diabetes. Some pediatricians also prescribe it, on occasion, to help control a strong Dawn Phenomenon seen in a growing teen with Type 1 diabetes. This use is also not approved. It also helps lower insulin resistance in women with polycystic ovary disease. One side-effect for these women, sometimes a desired outcome, is a greater likelihood of pregnancy.
Metformin lowers fasting blood glucose levels by an average of 25% (17 to 37%), postprandial blood glucose up to 44.5%, and the A1c by an average of 1.5% (0.8 to 3.1%). Metformin reduces raised plasma insulin levels in cases of metabolic syndrome by as much as 30% and reduces the need for injected insulin in Type 2s by 15 to 32%.
Metformin is available under the trade name Glucophage, or as an extended-release tablet called Glucophage XR. It works well when combined with sulfonylureas. A combination of glyburide and metformin is available as Glucovance. Combined therapy leads to a greater reduction in blood sugar than can be attained by either class alone. Generic metformin is available at a reduced cost.
Metformin possesses some distinct advantages in treating diabetes. Excess glucose produced by the liver is the major source of high blood sugars in Type 2 diabetes and is typically the reason for high blood sugars on waking in the morning. Metformin reduces this overproduction of glucose. It helps in lowering the blood sugar, especially after eating, with no risk of hypoglycemia when used alone. Modest improvement in cholesterol levels are also seen. The 10 year UKPDS Study of over 3,000 people with Type 2 diabetes found that those who were placed on metformin had a 36% decrease in overall mortality and a 39% decrease in heart attacks.
Because metformin shuts off the liver’s excess production of glucose, it reduces the amount of injected insulin needed to control the blood sugar in both Type 1 and Type 2 diabetes. People with Type 2 diabetes who are on insulin usually are advised to lower their insulin doses prior to starting metformin. The full improvement in glycemic control and cholesterol levels may not be seen until 4 to 6 weeks of use have passed.
Side effects from metformin include a change in taste, loss of appetite, nausea or vomiting, abdominal bloating or gas, diarrhea, or skin rash. These may occur during the first few weeks of taking the medication but are seldom long-lasting. Taking the medication with food and starting out with a low dose help reduce side effects. The dosage can be gradually increased as side effects diminish.
Lactic acidosis, the serious but rare side effect originally seen with phenformin, results when a buildup of lactic acid occurs due to an inability to clear metformin from the system. Lactic acidosis occurs very rarely, only once in every 30,000 person-years of use. It almost always occurs in older people who have another major health problem, especially one that may impair breathing or circulation. Warning signs of lactic acidosis include fast and shallow breathing, diarrhea, severe muscle aches, cramping, unusual weakness or tiredness, or feeling cold. Because lactic acidosis has a mortality rate of about 40%, anyone who has significant lung disease, congestive heart failure, or kidney disease should never take this drug.
Because drinking alcohol while taking metformin may also trigger lactic acidosis when other health risks are present, be sure to ask your doctor about alcohol consumption if you are taking this drug. Be aware that Tagamet, a gastrointestinal medication, may enhance the effects of metformin. Therefore, the dose of metformin may need to be lower if you already take Tagamet.
Although not yet FDA approved, metformin is now in clinical trials for treatment of teens who have developed Type 2 diabetes. Some pediatricians also prescribe it, on occasion, to help control a strong Dawn Phenomenon seen in a growing teen with Type 1 diabetes. This use is also not approved. It also helps lower insulin resistance in women with polycystic ovary disease. One side-effect for these women, sometimes a desired outcome, is a greater likelihood of pregnancy.
Thursday, January 22, 2009
Nutrition Plan
Nutrition Plan does not count calories. Instead, it gradually directs your body to a healthy diet. In essence, it provides the solution to one of the primary causes of Insulin Resistance and excess weight and obesity - too many carbohydrates. The Nutrition Plan also addresses the addictive quality of certain foods and advocates a high-protein, low-carbohydrate diet, with lots of green vegetables and fruits. We don't have an "induction phase" where you're deprived of all carbs and are just eating protein and fat. We ask that you lower your carbohydrate intake from where you are now and slowly persevere in reducing it each week, so it doesn't feel like such a shock to your system.
Monday, January 12, 2009
Glucovance
In August, Bristol-Myers Squibb released an improved version of their popular diabetes pill, Glucophage. The new medication called Glucovance combines Glucophage with another well known glucose lowering medication, glyburide. Glyburide is also marketed under the brand name Micronase. Glyburide is a member of the class of drugs known as sulfonylureas which also includes, Glucotrol (glipizide), and Amaryl (glimepiride) while Glucophage is the only available drug in the class of biguinides. Glucovance offers a one-two punch on high blood sugar by joining the unique effects of its two components drugs into a single, even more powerful combination. Studies show that two thirds (66%) of diabetics will achieve excellent control of their blood sugars as defined by the American Diabetes Association (a glycohemoglobin A1c level of 7% or less), when using Glucovance. Since lower doses of Glucophage and glyburide are used in the combination pill then when used individually, there have been less side-effects, as well. It should be noted that although hypoglycemia (low blood sugar) is generally not seen when taking Glucophage alone, due to the additive effect of glyburide, hypoglycemia is possible when using Glucovance.
How does this new drug achieve such impressive results? Type 2 diabetes, which comprises about 90% of all diabetes in the U.S., is caused by a lack of the glucose regulating hormone, insulin, as well as a resistance by the body to the effects of whatever insulin is in the blood. Glyburide increases the production of insulin by the pancreas and Glucophage restores the body’s normal sensitivity to the insulin, thereby simultaneously reversing both of the major metabolic abnormalities that cause diabetes.
Cynical health care consumers will snicker, “Sure it’s a great drug. If you can afford it!!” Believe it or not, Glucovance is actually cheaper than purchasing the two component drugs separately, and is about the same price as Glucophage alone. You therefore get the second medication, glyburide, for free. For that reason cost conscious managed care organizations and HMO’s are lining up to put Glucovance on their formularies.
Glucovance is now approved to be used by itself as “first line” diabetes treatment, for those not controlled with either Glucophage or sulfonylurea alone, or can replace both medications if the patient is already using them in combination.
Only you and your doctor can decide which of the available diabetes drugs will be best for you. Be sure to visit your health care provider to learn more about this exciting new addition to diabetes treatment.
How does this new drug achieve such impressive results? Type 2 diabetes, which comprises about 90% of all diabetes in the U.S., is caused by a lack of the glucose regulating hormone, insulin, as well as a resistance by the body to the effects of whatever insulin is in the blood. Glyburide increases the production of insulin by the pancreas and Glucophage restores the body’s normal sensitivity to the insulin, thereby simultaneously reversing both of the major metabolic abnormalities that cause diabetes.
Cynical health care consumers will snicker, “Sure it’s a great drug. If you can afford it!!” Believe it or not, Glucovance is actually cheaper than purchasing the two component drugs separately, and is about the same price as Glucophage alone. You therefore get the second medication, glyburide, for free. For that reason cost conscious managed care organizations and HMO’s are lining up to put Glucovance on their formularies.
Glucovance is now approved to be used by itself as “first line” diabetes treatment, for those not controlled with either Glucophage or sulfonylurea alone, or can replace both medications if the patient is already using them in combination.
Only you and your doctor can decide which of the available diabetes drugs will be best for you. Be sure to visit your health care provider to learn more about this exciting new addition to diabetes treatment.
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