Diabetesmedicationsupplement3_2_edit-

Primary Action
Typical Dosage
Side Effects
Glyburide: 1.25–2.50 mg/day twice a day; Glipizide: 2.5–20.0 mg/day twice a day; Maximum, 40 mg/day; or XL* 2.5–10.0 mg/day Glimepiride: 1–8 mg/day; maximum, 8 mg/day before meals 2–4 times a day HbA1c >8: 1–2 mg, 15–30 min after each meal; increase weekly until results are obtained; maximum, 16 mg/day 4–6 wk; maximum, split dose before meals Combinations
Initial, 2.5 mg/250 mg once or twice a day with meals. Increase every 2 wk to maxi- mg per day. 2nd line, 2.5 mg/500 mg or 5 mg/500 mg twice a day with meals. Maximum, 20 mg/2000 mg per day Adapted from 2002 The Diabetes Center, Old Saybrook, CT, used by permission. ALT = alanine aminotransferase CHF = congestive heart failure GI = gastrointestinal HbA1c = glycated hemoglobin XL = extended release
TABLE 1. ORAL AGENTS TO TREAT TYPE 2 DIABETES*
Precautions
Critical Tests
Comments
60 hours. Use extreme caution with elderly Periodic evaluation of liver function tests. unless the patient has a well-established history patients or patients with hepatic or renal of taking them. Second-generation sulfonylureas provide more predictable results with fewer side effects and more convenient dosing. Glipizide is preferred with renal impairment. Periodic evaluation of liver function tests. Should not be used in patients with diabetic Patients should be instructed to take medication ketoacidosis and known hypersensitivity to Periodic evaluation of liver function tests. δ30 min before a meal. If meals are skipped or added, medication should be skipped or added Should not be used in patients with diabetic Patients should be instructed to take medication ketoacidosis and known hypersensitivity to Periodic evaluation of liver function tests. δ30 min before a meal. If meals are skipped or added, medication should be skipped or added as well. Nateglinide is approved only as mono- therapy or in combination with Metformin. Contraindicated if serum creatinine is: >1.5 Metformin is especially beneficial in obese patients alcohol frequently, liver, kidney disease or mg/dL in men or >1.4 mg/dL women, or use due to potential for weight loss, improved lipid pro- file, and lack of potential for hypoglycemia requiring Monitor hematological and renal function supplemental carbohydrate intake. Discontinue for 48 hr after procedure using contrast dye. Avoid initiation with patients with increased baseline liver Rosiglitazone is approved for use as enzyme levels (ALT >2.5 times upper limit of normal). enzymes monitored every 2 months for 12 months, then periodically. If ALT levels increase to >3 times the upper of normal, discontinue use and recheck liver enzyme Pioglitazone is approved for use as monotherapy or with metformin, sulfonylureas, or insulin. Avoid initiation with patients who have liver dis- ease or ALT levels >2.5 times the upper limit of normal. Patients with mildly elevated liver enzymes (ALT levels 1–2.5 times the upper limit of normal) should be evaluated. Discontinue if >3 times the Avoid if serum creatinine is >2.0 mg/dL. Monitor serum transaminase every 3 months >1.5 mg/dL in men or 1.4 mg/dL in women, doses at different times of day for best glucose control. Incidence of hypoglycemia is higher for combination than for single agent use. Monitor hematological and renal function Should not be used if frequent alcohol use, Contraindicated if serum creatinine is >1.5 liver or kidney disease, or CHF is suspected. doses at different times of day for best glucose mg/dL in men, or >1.4 mg/dL in women, or control. Incidence of hypoglycemia is higher for if creatinine clearance <60–75 mL/min. Should be avoided in patients with hepatic Agent is less expensive than its components Contraindicated if serum creatinine is >1.5 separately. Decrease in GI upset is reported with mg/dL in men or >1.4 mg/dL in women, or metformin compared with rosiglitazone alone. *Agents in a class of medicines share mechanisms of action, require similar precautions, and generally have similar side effects. For proper usage, please read label. Agents should not be used in patients with type 1 diabetes. TABLE 2. IMPORTANT INSULIN INFORMATION*
Effective
Comments
Duration
Duration
Must be taken just before or immediately after eating. Best if administered 30 min before meal. Frequently used instead of NPH in children. Must be taken before or immediately after eating. Administered at bedtime once a day. Cannot be mixed in same syringe and should not be given with use of same needle in same place Animal Source
Change over to human insulin recommended. Dose changes required; consult physician. Adapted from 2002, The Diabetes Center, Old Saybrook, CT, used by permission. *Site rotation for injections is necessary for all types of insulin. TABLE 3. RECOMMENDED INSULIN STORAGE

Recommended Insulin Storage
Refrigerated (36°F–46°F)
Room Temperature (59°F–86°F)
Unopened
Unopened
PENS/CARTRIDGES
Not in use
Novolin R (prefilled and 1.5-mL cartridge) Novolin N (prefilled and 1.5-mL cartridge) Novolin 70/30 (prefilled and 1.5-mL cartridge) Adapted from 2002, The Diabetes Center, Old Saybrook, CT, used by permission. *Suggested, not clinically established TABLE 4. GLUCOSE LOWERING ACTIVITY—ORAL DIABETES AGENT
Medication
Blood Glucose Most Affected SMBG* Testing to Recommend
Greatest Risk for Hypoglycemia
Adapted from 2002, The Diabetes Center, Old Saybrook, CT, used by permission. SMBG = self-monitoring of blood glucose TABLE 5. MEASURES TO CONTROL GLYCEMIA

Biochemical Index
Action Suggested
Adapted from 2002, The Diabetes Center, Old Saybrook, CT, used by permission. Diagnosis: Diabetes
On what was supposed to be one of the happiest days of our lives, my husband, Tim Hanf, collapsed to the floor during our wedding reception. He had diabetes which was left undiagnosed until that night. Too much champagne and wedding cake caused his glucose levels to spike landing him in the emergency room. I don’t have to tell any of you how painfully scary this can be. What can be equally as intimidating is the plethora of information received from the doctors and nurses. Unfortunately, over-information and misinformation were a big part of the problem. One doctor recommended a certain type of drug… while other doctors recommended a different type… while still others spoke out against drugs all together. This prompted me to do some research myself. After talking with doctors, nurses, dieticians, and numerous patients who had beaten the disease, I discovered how my husband could be naturally cured of this disease without the use of medications. Side Effects
As you can see from the charts detailing today’s current treatments, there are numerous medications for assisting diabetics in keeping their glucose levels in check. You can also see the myriad of side-effects and precautions involved with each of them. • Hypoglycemia - Hypoglycemia, also called low blood sugar, occurs when your blood glucose (blood sugar) level drops too low to provide enough energy for your body's activities. In adults or children older than 10 years, hypoglycemia is uncommon except as a side effect of diabetes treatment. • Hyperinsulinemia - Hyperinsulinemia is a disorder characterized by a failure of our Blood Sugar Control System to work properly. This occurs when insulin progressively loses its effectiveness in removing the blood glucose from the blood stream into the cells that constitute our bodies. • Edema - Edema is the swelling caused by fluid in your body's tissues. It commonly occurs in the feet, ankles and legs, but it can involve your entire body. • Anemia - Anemia is a condition where there is a lower than normal number of red blood cells in the blood, measured by a decrease in the amount of hemoglobin. Hemoglobin is the oxygen-carrying part of red blood cells. • Nausea, diarrhea, fluid retention, gas, bloating, headaches, vomiting and weight can are also common side-effects to many diabetic medications.
Precautions & Procedures

Along with side-effects, each medication offers precautions and procedures for its use.
Having other health issues may limit your ability to take certain prescriptions. You and your
doctor must also consider other medications you are taking and how they interact. You have
to consider the time of day at which you take each medication, whether you’ve eaten, and the
proper storage of each one.
The Cure
Diabetes and the management of the disease could easily take over your life. This was not the
life my husband and I wanted for us. We didn’t want to spend every waking moment thinking
about or treating this disease. Through research, trial and tribulation, we were able to
eliminate his diabetes through natural methods.
Today Tim is diabetes free and takes no medications to regulate his glucose levels. Through
proper nutrition, exercise and dietary supplements, diabetes is no longer a part of our daily
lives. He is active, healthy and has more energy than ever before.
Talk to your doctor and discover if a natural treatment is right for you. Instead of living your
life dealing with diabetes, you can live a naturally healthy life.
Centers for Disease Control and Prevention. Working Together to Manage Diabetes: Diabetes Medications Supplement. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 2004. WORKING TOGETHER TO MANAGE DIABETES

Source: http://www.yourdiabetescure.com/DiabetesMedicationSupplementRevised.pdf