Diabetic Neuropathy
Question: Can you give me all the latest information on how to combat Diabetic Neuropathy with various medications. I am asking for my father who has been suffering with type 2 diabetes for a couple of years. Also any neurological opinions you might have or if this field can help would be appreciated. He already goes once a month to have blood drawn due to a high iron count.

Answer: First the high iron count usually means hemochromatosis. Have you been checked, as well as all your siblings? An inherited condition, which causes diabetes in some. Second, the subject of diabetic neuropathy is too long for this column. There are many books available in medical libraries devoted to this subject. There are about 30-50 medicines, which we have tried with varying success in this disease. To date, nothing works well. There are new studies using nerve growth factor. Find a specialist in this area for a second opinion.

Diabetes - changing insulin
Question: I have had juvenile diabetes for the past 17 years. I have been on the old beef and pork insulin NPH & R. I am going to be switching to Humulin Insulin. What are the differences and will I be taking the same amount? Will I be having Insulin reactions?

Answer: Usually you need to reduce the dosage 5-10%, which is easily done and rarely causes a problem.

Diabetes
Question: My daughter was recently prescribed the medicine Guaifen for her allergies. Can this medicine effect her blood sugar level or cause the insulin to work faster or slower? I am asking this question because she had a very low blood sugar level at school today and required the school nurse to administer sugar to raise her level. She has been on this medicine for 4 days and her blood sugar levels have been on the low side and her insulin intake has been cut back due to these lower levels.

Answer: Wouldn’t be expected to.

Diabetes & Niacin
Question: Is it true that 6 grams of niancin a day for 10 years can bring on diabetes it effects the blood glucose and it will dissappear when niacin is discontinued? Please let me know.

Answer: No obvious cause of diabetes mellitus, but, can cause liver damage if unmonitored.

Diabetic Neuropathy
Question: I have been taking Vicodin ES, for the last 5 years,for Diabetic Neuropathy. I would like to know if there is a stronger med on the market or new surgical procedure that will stop, or help my pain it is a never ending cycle of pain that at times is total immobilizing.

Answer: All the narcotics work about the same. You will need to increase the dosage as you develop tolerance. If you haven’t seen a pain specialist I would.

Insulin Storage
Question: I am not diabetic, but my toy Poodle Duke is. He is 8 years old. We have him regulated very well with his insulin. He gets 3cc Novolin L Lente twice a day. We have done numerous glucose curves and also fructose test which all are good. My question is: I have been told I should not use a bottle of insulin for more than 6 weeks after opening. Is this good information? In 6 weeks time, I still have half vial remaining. Thanks for your help!

Answer: Doesn’t make sense. We usually recommend refrigeration to avoid any bacterial contamination;but, a rare problem.

When Should Blood Sugar Reduction Medications Begin [posted 11/13/98]
Question: If my blood sugar on a fasting diet is 210, do you feel I should start sugar reduction medication?

Answer: Have you given a strong push to diet and exercise? Most can be maintained initially(assuming you are an adult) with the proper diet and regular exercise. If you realistically won’t do the exercise, then start the medications while you work on the diet.

Diabetes Medications with an Ileostomy
Question: I have an ileostomy. (We will celebrate one year of successul operation and being cancer-free in just a couple of weeks.) I recently was diagnosed with Type II diabetes and am currently on Rezulin and Glucophage. Will the ileostomy interfere with the absorption of these meds.?

Answer: No.

Diabetes or Temporary high Glucose ?
Question: I have for several months have had a great increase in thirstiness and frequent urination. Also night sweats and tiredness. I went to the Dr. and it showed a blood glucose of 285. I was prescribed Glipizide and am being referred to a dietican. Does just one high level of glucose and those symptoms mean I am diabetic or could this just be a short term temporary showing of high glucose.

Answer: Yes. Technically any over 140(some say 120) fasting if diabetes mellitus. However, that doesn’t mean that diet and exercise won’t control it for years-regardless of the initial level.

Diabetes & Estrogen Replacement
Question: I have been on rezulin (600) since october 1997. the medicine works fine but i have gained about 25 pounds in that time period. is this a normal side effect? if so what can be done about it? the weight gain counteracts the rezulins glucose regulating.

Answer: Well, the weight gain per se is not related to the medicine. However, it may be related to the better control of your diabetes. That is, you are not urinating out several grams of glucose a day and these calories are being utilized.

Diabetes & Estrogen Replacement
Question: I have frequent headaches “Migraines” and have sugar problems. They have me on Estradiol. The last one was Estrogens conjugated. I was taking the it until It started making me sick. I would take it in the morning by the afternoon I was sick in bed. My feet swell at night and i know my sugar level is will go up and down. I tired of being fat with this medicine.

Answer: You should focus on ensuring that one of your three problems is under control. I would focus on the estrogen replacement first. There are several types of replacement and it may take 6 months or so to find the right one. Keep with it.

Diabetes and Weight Loss
Question: I’ve heard that diabetes (I have Type 2) can become so out of control that it can cause weight loss instead of weight gain. True or False?

Answer: Very true.

Diabetes
Question: I wondering about the use of rezulin in a type I diabetic, who is not getting optimum use. Why would rezulin not work and what are the potential dangers?

Answer: I don’t think I understand your question. Is it not working in you? In general, Rezulin will increase the efficiency of insulin 10-30% depending on the patient-and thus allow the dosage of insulin to be decreased by increasing the efficiency of the insulin given. There are dangers of low blood sugar and the dosage of insulin needs to be decreased. There have been recent reports of liver toxicity, so this needs to be checked. One will usually get some GI effects from the medication - gas, etc.

Insulin Availability for Diabetics
Question: I am a diabetic on 75 to 100 units per day. I was laid off work and am without health insurance. The cost for insulin is over $100 per month. Without income, this cost is prohibitive. Is there anywhere I can get low cost or even free insulin. I am using Novolin 70/30 pen fills.

Answer: Some of the medicine companies have indigent patient assistance. Have your doctor write to their home office and request indigent assistance. I have several patients who receive assistance in this manner. However, not all companies participate and you may have to switch insulin types to find one that will.

Diabetes
Question: We are a Fifth grade class reading a story about a young man with diabetes. We would like to Know a little more about the disease. Where did the disease originate? What exactly is the disease? Is there a cure for it? Is it life threatening? How many times a week do they have to take their insulin shots? Or is it a certain time a day? How do they know when to take the insulin and how much do they have to take? Are you born with Diabetes or is it inherited?

Answer: There are two kinds of diabetes. Diabetes Mellitus (the kind that involves sugar) and Diabetes Insipidus (which involves the concentrating ability of the kidney). I’ll assume that you are interested in Diabetes Mellitus since that is the socially common disease. This has been around as long as there have been humans. Also seen in other animals as well. There are two basic types. Type I, which is insulinopenic(low to absent insulin) and Type II, which has normal to high insulin levels, but difficulty using the insulin efficiently. Usually, Type I is seen with onset in the early teens or occasionally childhood and Type II is seen in adult years. However, either can be seen at any age. The disease is caused by elevated blood sugar levels caused by either a lack of insulin or an inability to utilize one’s insulin efficiently. There is no cure for juvenile diabetes. But, Type IIs can often restore normal glucose levels with diet, weight loss and exercise. It does damage organs over time and leads to end organ disease of all the organs with the heart, kidneys, and eyes being the most damaged over time. Not all Diabetics need insulin-only the Type I diabetics. They usually take their shots a minimum of one a day and more commonly 2-4 times a day. The amount of insulin and time varies, but generally is morning and evening and the diabetic can test their own glucose using a home meter to determine the optimum dose or have the dosage preset by their physician. The Type I disease is not inherited, the Type II is inherited in terms of the tendency to develop the disease. Your local Diabetes Association can provide much more information. Lilly Pharmaceutical is also helpful at 800-545-5979.

Diabetes and Vasotec
Question: I am a Type II diabetic on 6 mg of glynase . I have a new physician who has prescribed 5 mg of Vasotec daily. My blood pressure is 110/70. He says this will help long-term with renal concerns. I like that idea but have never heard of this medicine (large family history of Type I and Type II). Can’t tell much from the pharmacological descriptions of Vasotec. Is this something which will help me? Are there any contraindications for long-term use?

Answer: Vasotec is in the class of medicines called Angiotension Converting Enzyme Inhibitors(ACE). Some people have shown dramatic improvement in renal decline in diabetics. Most physicians will proscribe these medications for any diabetic to achieve this long term benefit. There are no major side effects except cough in 10%(this is better with Cozaar, a cousin medicine). This class works by inhibiting conversion of rennin(made in the kidney) to angiotension(a potent vascular pressor). This is very helpful in hypertension, heart failure, diabetic renal disease and some other conditions. It is an excellent class of medicines.

Diabetes Neuropathy
Question: Are there any medications besides trental and carbamazepine?

Answer: For prevention or treatment? There are experimental medicines which are almost released to prevent neuropathy or minimize neuropathy. Currently, medicines to treat neuropathy are a real hodge podge. Many medicines will help the pain but in an unpredictable manner. That is, you need to try them for several weeks to see if they’ll help. They include Dilantin, Depakote, anti-depressants(especially Elavil and Doxepin), and a host of others. Your doctor should be able to do this.

Lupus and Type 1 Diabetes
Question: What interaction, if any, is there between these two conditions and/or the medications Humalog and Humulin NPH insulin and hydroxyquinone? I seem to be having greater difficulty in controlling my diabetes since the lupus was diagnosed and I was started on the hydroxyquinone. I have asked two doctors and a pharmacist, and they all indicated that there is no known interaction. However, in the past I have found that my own observations are often later confirmed by research results.

Answer: I am not aware of any problem. However, you were started on hydroxyquinone due to increased activity of your disease. I suspect it is the activity of the lupus which is effecting the diabetes mellitus, rather than the medications you are using to treat it. Either this or your activity level (or appetite) is changed due to the medications or basic disease process.

Diabetics and food
Question: What dietary information should diabetics know about their illness in order to minimize any further risk to their health when they travel a long distance?

Answer: Diabetes Mellitus can be a difficult condition to manage, both for the patient as well as for the health care provider. The disease becomes all the more difficult to control, and complications more difficult to avoid, during travel. However, a few basic dietary principles can help you manage your diabetes when your are away from home. Firstly, know that although diabetes is a problem of excessively high blood sugar, there is also the possibility, if you take either pills or insulin, that your sugars can go dangerously low if you do not eat enough. Therefore, regardless of how you control your diabetes, always carry non-perishable food with you on your person. Crackers or other dry snacks are a good idea. Having some hard candy with you is another good safeguard. In addition, know in advance when you will be taking your medication, be it pill or insulin, and plan out your trip in advance around your medication schedule. Meeting with your physician well in advance of an anticipated trip can aid greatly in this regard. Perhaps your medication regimen can be altered to make the trip more enjoyable and the medication administration less cumbersome. Always bring insulin administration (if needed) and sugar monitoring equipment with you, taking at least 7 extra days worth of equipment just in case. Finally, seeing a dietitian trained in dealing with Diabetes is a good idea, and your health care provider can refer you to one. Both your provider and dietitian can help you review the potential dietary pitfalls during your travels, as well as discuss with you the types of foods you will encounter and what changes, if any, you need to make in your medications while on your trip. Knowing the location or phone number to call in case of an emergency will also give you piece of mind on your trip and allow you to enjoy yourself and get the most out of your trip.

Insulin Dependent Diabetes Mellitus
Question: I’m a pharmacist looking for current information concerning the treatment of IDDM (Insulin Dependent Diabetes Mellitus) during stressful periods such as surgery, infection, ketoacidosis, etc., when the patient is NPO. Current recommendations are use of IV Insulin with Dextrose containing solutions. Can you recommend some references or a way to rephrase my search?

Answer: Some of the better studies have been done by Goldman and can be found in “Medical Evaluation of the Surgical Patient” by Lee Goldman.

Diabetes
Question: I have diabetes. The doctor has prescribed diabines 250 mg started with one half increased to one and a half. My numbers are around 185 in the AM before breakfast and around 240-300 at night 2 hours after dinner. When do I start to worry about damage from high numbers and are these numbers really high? I have been able to keep the numbers down with diet until about a month ago. I was on another type of med. about a year ago and my numbers dropped too low.

Answer: In general, we feel that damage to organs begins whenever the sugar level is above 140- 160. A better way of following your diabetes is to know the hemoglobin A1C. This is a measure of “control” averaged over 90 days and is a much better reflection of your control and the possibility of long term damage than daily glucose levels. I’d recommend keeping the HgAlC as low as possible. Levels of 240 will not accomplish this.

Synthroid and Diabetics
Question: My mother has been taking Synthroid for approximately 11 years now. 2.5 years ago she was diagnosed as being diabetic also. She takes a daily shot of Humulin along with her 200 mcg of synthroid. The problem is that in the last two months she has been in the hospital twice due to fast heart rate (140), lack of appetite, dehydration, and some other things. All of the symptoms that she has are accurate with those of having an extremely low thyroid condition yet she is taking her synthroid pill everyday. What I am wondering could there be a conflict between the synthroid and the humulin? Her doctor is beyond answers so we are waiting to take her to the Mayo Clinic if need be. She is going to a specialist in the next couple of days.

Answer: I know of no interaction with Humulin or any insulin. The symptoms you describe, if anything, would represent an over-active thyroid . What was her last TSH? If low, I’d try to lower her dosage somewhat and see if her symptoms improve.

Insulin Dependent Diabetes Mellitus
Question: I’m a pharmacist looking for current information concerning the treatment of IDDM (Insulin Dependent Diabetes Mellitus) during stressful periods such as surgery, infection, ketoacidosis, etc., when the patient is NPO. Current recommendations recommend use of IV Insulin with Dextrose containing solutions.

Answer: These are long, complex and completely different. That is, the treatment of DKA and pre/post op patients for example. A good source would be Harrisons Principles and Practices of Medicine. Also, the Merck Manual or Washington Manual both give practical advice on treatment in each of these situations. These are available in any medical bookstore or medical library.

Saccharine versus Aspertame
Question: There seems to be a high risk in using either Saccharine (Cancer prone) or Aspertame (brain damage) for a food sweetener. Which is more safe, or is there an alternative sweetener to either one of these?

Answer: For a diabetic it is much better to use fructose as a sweetener.

Diabetes medication
Question: My 28 year old boyfriend was diagnosed with type II diabetes two years ago. He takes three 10 mg tablets of Glucotrol XL a day, monitors his blood sugar and tries to watch his diet although he sometimes falters in this last area. Recently his blood sugar has become uncontrollable and his original symptoms of extreme lethargy, indifference, irritability and an increased need for sleep have returned. He has noticed the Glucotrol undigested in his stool several times, but he is reluctant to bring this to the attention of his doctor. I am very concerned for his health and I would appreciate any guidance you could provide us as to why this might be happening.

Answer: The pill casing for glucotrol XL does not dissolve and will always be expelled in the stool. Although it looks intact, the medication has been released in the body. It sounds like his diabetes is out of control and additional agents will be necessary if he is to regain his former health.

Diabetic Kidney Disease
Question: I am diabetic, and in a sick quest to lose weight I stopped taking my insulin and lost 50 pounds as a result. I also began using a lot of illegal medicines (heroin and cocaine) and was smoking about a pack of cigarettes a day. I found out the other day that I have the early signs of diabetic kidney disease, and that I was spilling lots of ketones in my urine. I need to know how to get my life back on track and the best way to do it.

Answer: Diabetes Mellitus is a common, but serious disorder that is due to either a lack of insulin production by the pancreas, and/or resistance to ones own insulin by the body’s tissues. When this occurs, the body’s usable form of sugar, or glucose, cannot enter the cells of the body where it is needed, and as a result glucose levels in the bloodstream build up to high levels. Diabetes, if left untreated, can lead to complications that include kidney disease, stroke, heart attack, as well as altered sensation in the hands and feet, balance problems, blood pressure problems, and increased susceptibility to infection. There is an abundance of information about this disease, which you can obtain either directly from your physician, or from sources to which he or she directs you.

Consistent use of medications, be they insulin, or pills, to treat your diabetes is the key to maintaining good blood glucose levels, at either preventing or slowing the rate of the many complications the disease can produce. Unfortunately, with our busy schedules, and day to day stressors, taking many medications over the course of each and every day is very time consuming and difficult. However, the cost of not doing so is a decline in health, and other illnesses than can be quite severe. Speak to your physician. He or she can discuss with you strategies to help you adhere to your medication regimen and schedule, and help you cope with a chronic illness that thousands of patients suffer from. There are, in addition, many support groups for individuals with diabetes, and your physician can provide the resources for you to get involved with one of these groups. Coping with a long term illness is not an easy task, but with help, and practice, you can gain control over the disease, rather than have it control over you.

Diabetic Kidney Disease
Question: I am diabetic, and in a sick quest to lose weight I stopped taking my insulin and lost 50 pounds as a result. I also began using a lot of illegal medicines (heroin and cocaine) and was smoking about a pack of cigarettes a day. I found out the other day that I have the early signs of diabetic kidney disease, and that I was spilling lots of ketones in my urine. I need to know how to get my life back on track and the best way to do it.

Answer: Diabetes Mellitus is a common, but serious disorder that is due to either a lack of insulin production by the pancreas, and/or resistance to ones own insulin by the body’s tissues. When this occurs, the body’s usable form of sugar, or glucose, cannot enter the cells of the body where it is needed, and as a result glucose levels in the bloodstream build up to high levels. Diabetes, if left untreated, can lead to complications that include kidney disease, stroke, heart attack, as well as altered sensation in the hands and feet, balance problems, blood pressure problems, and increased susceptibility to infection. There is an abundance of information about this disease, which you can obtain either directly from your physician, or from sources to which he or she directs you.

Consistent use of medications, be they insulin, or pills, to treat your diabetes is the key to maintaining good blood glucose levels, at either preventing or slowing the rate of the many complications the disease can produce. Unfortunately, with our busy schedules, and day to day stressors, taking many medications over the course of each and every day is very time consuming and difficult. However, the cost of not doing so is a decline in health, and other illnesses than can be quite severe. Speak to your physician. He or she can discuss with you strategies to help you adhere to your medication regimen and schedule, and help you cope with a chronic illness that thousands of patients suffer from. There are, in addition, many support groups for individuals with diabetes, and your physician can provide the resources for you to get involved with one of these groups. Coping with a long term illness is not an easy task, but with help, and practice, you can gain control over the disease, rather than have it control over you.

Diabetes- Exercise
Question: What are the immediate effects of exercise on a diabetic who is exhibiting acute hyperglycemia? (levels of 200 or above?)

Answer: Exercise has several effects on improving both glucose levels and general diabetic control. Given two identical diabetic patients-one who exercises and one who does not exercise-the exerciser will always have better control and lower glucose levels. Curiously, this is not just the effect of burning calories with exercise which lowers glucose levels. Exercise appears to improve the efficiency of insulin at the cellular level so that the same amount of insulin has a far larger effect with exercise than without. This may be due to changing so called “counteregulatory hormones”;that is, other hormone levels in your body that also control glucose control like growth hormone, cortisol and others. Another possibility is that it improves the intracellular efficiency of insulin.
The three main controls of glucose levels are exercise levels, insulin levels, and calorie intake. Like most other aspects of diabetes, it is best to keep one’s exercise about the same each day. However, depending on how high one’s sugar is, additional exercise will lower glucose levels within two or three hours. The effect of exercise also lasts for about 12-24 hours in improving diabetic control.
One additional note, if a diabetic takes insulin and then runs, the absorption of insulin will be increased over normal, so the site of injection may effect the type of exercise one does.

Weight Problem
Question: I am a 16 year old diabetic. I am very diligent in my diabetes care, and maintain normal blood sugar levels. However I am about 51-20 pounds overweight(about 152lbs and I am 5’6”). I am on a very strict diet and do lots of exercise. For several years I swam regularly. Now I walk long distances and bike. Why am I not losing any weight? I can’t understand it. I am taking approximately 20 units of humulin insulin a day…a small dose indeed and my blood sugar levels are well within normal ranges. By the way my doctor took a blood test to check my thyroid, everything was normal.

Answer: Sounds like you’re pretty healthy-why do you need to lose weight? Your weight has a lot to do with the build of your parents at each decade of life-check their pictures, I’ll bet there is a high correlation.

Menstruation Problems
Question: . I am a 16 year old diabetic who has not yet menstruated yet without the aid of “chlomid.” My doctor put me on the chlomid for three consecutive months in which I did menstruate. However now I am entering the first month in which I am not taking any medication and thus far(almost seven weeks) nothing has happened. Please note I was sent for a sonogram and it was determined that all was in order, “eggs” and all. Please be further advised that I am very diligent about my diet and my diabetes. I also exercise regularly.

Answer: What is your weight? Most women will stop menstruating below a certain weight-usually about 10% below ideal weight. Has your thyroid and pituitary been checked? Do you have normal levels of FSH and LH. Do your body core temperatures cycle? Try some of these.

Propulsid & Erythromyacine
Question:. Hi, I’m a diabetic and have had nerve damage in my stomach my doctor started me on propulsid and erythromyacine. It has healed my stomach problems but now I am tired all the time and don’t feel like doing anything. My hair has also started coming out by the comb full. I am also taking zoloft, accupril and a multi vitamin. I have quit taking the propulsid and the erythromyacine. I was just wondering if these could cause hair loss.

Answer: Propulsid is a brand name of a medication known as cisapride, and is used to increase the “pumping” function of the intestines, including the stomach. You are probably taking this medication because your physician feels that you have stomach problems from your diabetes. The diabetes has the effect of deceasing the function of your stomach, so that it does not digest and push the food into the small intestines as well as it should. Erythromycin, although useful for certain infections in the stomach, also has the effect of increasing stomach pumping, thereby increasing its ability to push the food you eat into your small intestines. Although the Physician’s Desk Reference does mention rash as a possible side effect of both of these medications, it does not mention hair loss. However, the other symptom you mentioned, namely fatigue, may be a sign of another condition, or perhaps indicate a problem with your diabetes. Do you have any other conditions that can cause fatigue or hair loss? You report taking Zoloft, a commonly prescribed anti-depressant medication. Your fatigue may reflect that your depression is acting up. A visit to your health care provider would be beneficial. He or she can take a thorough history, perform a physical exam, and determine what further testing, if any, is needed to determine the cause of your hair loss, and fatigue.

Pancreatitis
Question:. My 33-year-old brother has recently been diagnosed with diabetes. Since his mid-20s he has been hospitalized for pancreatitis and has had recurrent problems with gout in his toes and recently arm. While he was a heavy drinker in his early 20s, this still seems quite unusually young for these problems, especially in a family with no history of any of this. When my mother was pregnant with him she was on some prescription medicines to prevent bleeding and miscarriage — could this have damaged my brother’s pancreas?

Answer: Most likely it relates to his alcoholism and recurrent pancreatitis. Pancreatitis has the ability to permanently damage the pancreas so that it will not perform its normal job of releasing insulin and digestive enzymes(into the small intestine). Many patients with pancreatitis(regardless of the cause) will develop diabetes mellitus. I would focus on his alcohol and pancreatitis-not medicines taken while in utero.

Glucotrol
Question:. My dad was diagnosed with diabetes at the age of 45. He began taking oral glucotrol. After seeing an endocrinologist, he is now taking insulin injections 2x/ day. What causes this change and what can be done to avoid having to take the injections? He was told he may only need them for 3-4 months to get regulated. Do you have any tips that he can follow to keep him off insulin?

Answer: Lose weight, exercise and limit daily calories. Many adult diabetics can successfully avoid all medications if they follow these steps.

Nicotinamid Acid
Question: Can nicotinamid acid prevent patients with pre-diabetes of becoming diabetics for a few years, and if so, how does it work ?

Answer: Not that I am aware of.

As a physician, this situation, while humorous, proves to be quite a problem. The methods of action, dosages, side effect profile, and the rationale for prescribing these medications all vary. An assumption about what the medication could be may lead to wrong prescription refills, inadequate blood sugar control, improper follow-up, and serious consequences. So, how can patients avoid confusion?

If possible, you should bring all of your medications with you to your doctor appointments. If this is not practical, you should keep an updated list of all your medications and doses in your wallet or purse. This is a good idea regardless of doctor visits, since information of this sort is extremely useful in the event of an emergency or accident. If you are seeing a physician and are not absolutely certain about the name or dose of your medication, don’t try and guess. In this case, no information is much better than wrong information. Simply tell your doctor that you can’t remember and that you will phone his/her office with the information.

It is also important for patients to empower themselves with knowledge. All of the drug names listed above start with “G” are “trade names” that were originated by the pharmaceutical companies that manufacture the drugs. These names are NOT the names of the actual drug.

It is important for patients to realize that trade names may change from country to country, and this may cause confusion when traveling. Likewise, physicians who have trained in other countries may not be readily familiar with the trade names of this country. It is my opinion that patients should be aware of the generic names of all of their medications. This can help avoid uncertainty and minimize the risk of errors occurring because of confusion. “G”ee - it’s worth the effort!

Many experts see diabetes as a marker for aging, as diabetics have been known to develop higher cholesterol and typically die of heart disease at a younger age than non-diabetics. It is hypothesized that elevated glucose generates a large number of free radicals, which damage cells. When practitioners hear about problems with glucose and insulin, they normally think of diabetes. In 1988 Stanford endocrinologist Gerald Reaven, MD, coined the term Syndrome X. Syndrome X refers to conditions brought about by excessive refined carbohydrate diets. This includes two or more of the following: insulin resistance, elevated cholesterol or triglycerides, abdominal obesity, and high blood pressure. Having Syndrome X increases one’s odds of getting diabetes or heart disease. The easiest way to diagnose insulin resistance is with a glucose tolerance test.(purchase Glucotrol)

In abdominal obesity (”beer gut,” “pot belly”) glucose is stored as fat, genetically this has helped our species during times of famine. As the number of fat cells increase, the relative percentage of muscle cells decreases, reducing the number of sites for insulin to function. Obesity increases the risk of diabetes, heart disease, and some cancers; obese women are more likely than thin women to develop breast cancer. Cholesterol and triglycerides are associated with an increased risk of heart disease and stroke. In Syndrome X, there may be a high total cholesterol, low good HDL cholesterol, high LDL to HDL cholesterol ratio, or high triglyceride levels. There may also be oxidized LDL cholesterol. Sugar Overload

The body strives to maintain a balance of glucose (blood sugar). After meals, the body responds to the rise in blood glucose by secreting insulin, a hormone produced by the beta cells of the pancreas. Insulin lowers blood glucose by increasing the rate at which cells throughout the body absorb glucose. A decline in blood glucose causes the release of glucagon, a hormone produced by alpha cells of the pancreas. Glucagon stimulates the release of glucose stored as glycogen in body tissues, especially the liver. If the blood glucose falls rapidly or if a person is angry or fearful, the result causes a release of epinephrine (adrenaline) and corticosteroids by the adrenal glands. These chemicals have the power to breakdown stored glucose to provide extra energy to cope with a crisis. Insulin can increase blood pressure in a number of ways. It can increase the retention of sodium, increase the secretion of cortisol, a stress hormone, as well as triggering the sympathetic nervous system to speed up heart rate and blood pressure. Increased blood flow in the arteries can be due to obesity, as the heart has to pump harder through a larger body, and/or arteriosclerosis (hardening of the arteries) which makes the vessels less elastic. (Given equal water pressure, water moves through a narrow hose faster and with greater pressure than it does through a wider hose,purchase Glucotrol.)

Hypertension can lead to heart disease, stroke and kidney disease, and is also associated with memory loss and Alzheimer’s disease. Causes of diabetes and Syndrome X include stress, excessive amount of processed foods and lack of exercise. Physical and psychological stress increase cortisol levels, which reduces the ability of glucose to get into the cells, as well as being a risk factor for heart disease and Alzheimer’s disease. Fatigue, mental exhaustion, and anger are associated with excess levels of cortisol.

Sweeteners including sugar, fructose, sucrose, maltose, lactose, corn syrup, and grape concentrate are consumed at alarming rates. The average US consumption of sugar is over 150 pounds per year, as compared with residents in the 1800’s who consumed 12 pounds per year. If we go back further, sugar was rarely consumed at all, the main source of sweets being honey and whole fruits. In addition to being damaging on their own, sugars provide empty calories, which replace nutrient dense foods. Sugar increases LDL cholesterol and triglycerides. It makes platelet cells aggregate, which tends to contribute to heart disease and stroke, and also reduces levels of calcium and phosphorus, which are needed to maintain healthy bones.

This medicine can cause low blood sugar (hypoglycemia,buy Glucotrol). This effect may occur if you do not consume enough calories (from food, juices, fruit, etc,world wide shipping). The symptoms include chills, cold sweat, blurred vision, dizziness, drowsiness, shaking, rapid heart rate, 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 do not 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 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 medicine dosage may need to be increased. An allergic reaction to this medicine is unlikely, but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include rash, itching, swelling, dizziness, or trouble breathing. If you notice other effects not listed above, contact your doctor, nurse, or pharmacist.

If you take too much

If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include shakiness, rapid heartbeat, sweating, and loss of consciousness.

Additional information

Carry an identification card at all times that says you are taking this medicine. Proper diet, regular exercise, and regular testing of blood sugar are important for best results when using this medicine. This medicine is not a substitute for them. Be sure to follow the diet plan provided by your doctor. It is recommended that you attend a diabetes education program to better understand diabetes, prevention of complications, and all the important aspects of its treatment. These include meals/diet, exercise, weight loss, personal hygiene, medicines and blood glucose monitoring, and the need for regular eye, foot, and medical exams. Follow your doctor’s instructions carefully.

Do not share this medicine with others for whom it was not prescribed. Do not use this medicine for other health conditions. Keep this medicine out of the reach of children and pets. If using this medicine for an extended period of time, obtain refills before your supply runs out.

Drug interactions

Drug interactions can result in unwanted side effects or prevent a medicine from doing its job. Some medicines or medical conditions may interact with this medicine. Inform your doctor or pharmacist of all prescription and over-the-counter medicine that you are taking.

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This is an anti-diabetic medicine (sulfonylurea-type,order Glucotrol) used along with a proper diet and exercise program to control high blood sugar. It is used in patients with type 2 diabetes (non-insulin-dependent diabetes). It works by stimulating the release of your body’s natural insulin. Effectively controlling blood sugar helps prevent heart disease, strokes, kidney disease, blindness, and circulation problems, as well as sexual function problems (impotence).

Before using

Additional monitoring of your dose or condition may be needed if you are taking other diabetes medicines (e.g., insulin, metformin), aspirin or aspirin-like medicines (e.g., salicylates, nsaids such as ibuprofen, phenylbutazone), azole antifungals (e.g., fluconazole,low cost Glucotrol), beta-blockers including glaucoma eye drops (e.g., propranolol,buy cheap Glucotrol  timolol, metoprolol), birth control pills, “blood thinners” (e.g., warfarin), calcium channel blockers (e.g., diltiazem), chloramphenicol, cimetidine, clofibrate, corticosteroids (e.g., prednisone), decongestants (e.g., pseudoephedrine), diazoxide, diet pills, epinephrine, estrogens, isoniazid, mao inhibitors (e.g., furazolidone, linezolid, moclobemide, phenelzine, procarbazine, selegiline, isocarboxazid, tranylcypromine), niacin, phenothiazines (e.g., promethazine), phenytoin, probenecid, quinolone antibiotics (e.g., ciprofloxacin,buy cheap Glucotrol ), rifampin, sulfonamides (e.g., sulfa antibiotics,order Glucotrol), thyroid medicines, “water pills” (diuretics such as hydrochlorothiazide,discount Glucotro, furosemide), fenugreek, or ginseng.

Do not start or stop any medicine without doctor or pharmacist approval. Inform your doctor of any other medical conditions including liver, kidney, or thyroid disease; certain hormonal conditions (adrenal/pituitary insufficiency, siadh-syndrome of inappropriate secretion of antidiuretic hormone), electrolyte imbalance (hyponatremia), high blood pressure, allergies, pregnancy, or breast-feeding. Use of this medicine is not recommended if you have metabolic conditions (e.g., diabetic ketoacidosis,buy Glucotrol). Contact your doctor or pharmacist if you have any questions or concerns about taking this medicine.

Directions

Follow the directions for using this medicine provided by your doctor. Take this medicine by mouth 30 minutes before a meal. The dosage is based on your medical condition and response to therapy. Take this medicine regularly to receive the most benefit from it. Taking the medicine at the same time each day will help you to remember. Monitor blood glucose levels on a regular basis. Store this medicine in a tightly-closed container at room temperature below 86 degrees f (30 degrees c,low cost Glucotrol), away from heat, moisture, and light. If you miss a dose of this medicine, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Cautions

It is important that you keep all doctor and laboratory appointments while you are using this medicine. Laboratory and/or medical tests (buy Glucotrol ,e.g., liver and kidney function tests, fasting blood glucose, glycosylated hemoglobin, complete blood counts) should be performed periodically to monitor your progress or check for side effects. Regularly check your blood or urine for sugar as directed by your doctor or pharmacist.

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 operating machinery. Limit alcoholic beverages while using this medicine because they can increase the risk of developing hypoglycemia. Rarely, alcohol can interact with glipizide and cause a serious reaction (disulfiram-like reaction,online drugs) 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 medicine may be required.

This medicine may cause increased sensitivity to the sun. Avoid exposure to the sun or sunlamps until you know how you react to this medicine. Use a sunscreen or protective clothing if you must be outside for a prolonged period. Before you begin taking any new medicine, either prescription or over-the-counter, check with your doctor or pharmacist. Caution is advised when using this medicine in the elderly since they may be more sensitive to the effects of this medicine, especially hypoglycemia.

For women: if you plan on becoming pregnant, discuss with your doctor the benefits and risks of using this medicine during pregnancy. Glipizide is not recommended for use for at least 1 month before delivery due to the potential for fetal harm. Insulin may be preferred during pregnancy. Discuss all options with your doctor. It is unknown if this medicine is excreted in breast milk. Do not breast-feed while taking this medicine.

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