What is Glyburide?

Glyburide (otherwise known as glibenclamide) is a type of diabetes medicine that has insulin-releasing properties. It has been approved by FDA for the management of type II diabetes. This drug belongs to a class of oral hypoglycemic agents called sulfonylureas. Chemically, this drug is closely related to sulfonamide antibiotics. The drug functions as insulin secretagogues to promote insulin release from the pancreas (or more specifically, the beta cells of the islets of Langerhans). In general, the drug is only effective when beta cells have not been completely exhausted. This medication works best when diabetes is first diagnosed (when the body still produces insulin).

Managing weight gain

While generally well tolerated and safe, glyburide tablets may cause side effects such as hypoglycemia. Apart form that, the drug may also cause weight gain. Patients that are obese or overweight prior to treatment are especially affected.  If poorly managed, weight gain can potentially lead to other complications such as circulatory issues. Once started on glyburide, patients are advised to lose weight through lifestyle modification. As recommended by the American Diabetes Association, patients should exercise regularly and have a balanced, healthy diet. Apart from counteracting the side effect, weight loss may enhance the actions of glyburide, helping it to work more effectively. This may also reduce the dose of glyburide needed. Furthermore, weight loss is known to prevent the progression of type II diabetes. Studies by the Harvard Medical School has suggested that a 5% to 10% reduction of the body weight has a positive effect on diabetes control.

What to do if you gain weight

As with all other medications, glyburide should be used exactly as prescribed. Poor medication adherence may lead to hyperglycemia (high blood sugar). Subsequently, this may lead a range of symptoms such as drowsiness, fruity breath odor, dry mouth, hunger, increased urination and increased thirst. Additionally, patients may also experience weight gain. If weight gain occurs due to a recent dose change, patients should tell their doctor immediately. While highly effective in managing type II diabetes, glyburide (which inherently comes with a risk of weight gain) may eventually worsen the condition without the implementation of appropriate lifestyle modifications. Therefore, it is important to achieve weight loss though dietary change and exercise while using the drug. Weight loss in combination with drug use is the key to successful diabetes management.

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Patients with type I or II diabetes are more likely to develop cardiovascular diseases (CVD), such as coronary heart disease (CHD). Heart conditions are particularly prevalent in patients with poorly managed diabetes. In fact, coronary heart disease is the leading cause of death in diabetic patients, accounting for around 80% of total deaths.

Apart from cardiovascular diseases (e.g. heart attacks), diabetic patients are also at a higher risk of developing hypertension (high blood pressure), strokes, and vascular problems (such as poor circulation). Similar to diabetes, cardiovascular diseases can be asymptomatic. This is why they often go undetected. According to a 2017 report published by Diabetes UK, middle-aged men who have diabetes are five times more likely to develop cardiovascular diseases. Female diabetic patients, on the other hand, are eight times more likely to have a CVD. In addition, over half of the patients who have type II diabetes show signs of cardiovascular disease complications during diagnosis. Many people have the misconception that heart conditions only affect the elderly. In reality, even diabetes patients under 30 years old may get cardiovascular diseases. Both type I and II diabetes can increase the risk of developing heart conditions.

Risk factors

It is believed that hyperglycemia (which characterizes diabetes) along with other risk factors such as free fatty acids in the blood may alter the composition of blood vessels. This significantly increases the risk of CVD. At the same time, the thickness of blood vessel lining may increase, thereby impairing blood flow. In general, diabetics are more likely to experience heart problems and strokes.

Symptoms of cardiovascular disease

Cardiovascular disease is usually characterized by symptoms such as swelling of ankles, irregular heartbeat, short of breath and chest pain. To be diagnosed with a cardiovascular disease, patients are required to take an electrocardiogram (EKG). Angina (or chest pain) is one of the main symptoms of coronary heart disease. There are two major form forms of angina: stable and unstable angina. Stable angina may cause transient pain in the chest (e.g. heavy, dull or tight pain) that lasts for several minutes. The pain is often triggered by factors such as cold weather, stress or physical activity. Patients should see a doctor right away if they experience signs of stable angina.

If the symptom persists for more than five minutes (or occurs in the absence of triggers), the patient may have unstable angina. Seek medical help urgently in the case of a suspected unstable angina. In contrast, heart attacks are commonly a result of a clot that prevents blood supply to the heart. Some of the main symptoms of heart attacks are tightness of chest, coughing, shortage of breath or intense pain in the center of the chest. Occasionally, patients may also experience anxiety.

Reducing the risk

It is possible to reduce the risk of cardiovascular diseases through lifestyle modifications such as dietary change and exercise. At the same time, smoking cessation is known to lower the risk of developing CVD in diabetic individuals. Diabetes patients should also limit their alcohol intake in order to prevent heart conditions. Patients should devise the prevention plan based on medical advice. As a precaution, diabetics are advised to check their blood pressure and cholesterol level at least one time a year. Perhaps more importantly, patients should keep their blood glucose levels under control. This is essential in both diabetes treatment and prevention of CVD. Research has shown that a 1% reduction of HbA1c may decrease the risk of cardiovascular disease by as much as 16% in patients with type II diabetes.

Additionally, pharmacological interventions may help to reduce the risk of cardiovascular disease. This includes medications such as low-dose aspirin, statins, calcium channel blockers, and ACE (angiotensin-converting enzyme) inhibitors.

What are Actos and Metformin?

Both Actos and metformin are antidiabetic medicines that reduce elevated blood glucose levels in individuals with type II diabetes. However, there are substantial differences between the 2 drugs.

How do these medications work?

Containing different active ingredients, these prescription drugs exert their hypoglycemic actions through distinctly different mechanisms. In fact, metformin is not pharmacologically related to any other class of oral hypoglycemic agents. Metformin lowers blood glucose levels through the reduction of intestinal glucose absorption and hepatic glucose synthesis. At the same time, it increases glucose utilization and uptake peripherally, thereby enhancing insulin sensitivity. Formulated with pioglitazone (a thiazolidinedione), Actos has agonist activities on the peroxisome proliferator-activated receptors (PPAR) gamma. Through the reduction of insulin resistance (hepatically and peripherally), Actos inhibits the glucose output in the liver while promoting insulin-dependent glucose disposal.

Difference between Meformin vs. Actos

While both suitable for treating type II diabetes and polycystic ovarian syndrome, Actos and metformin are intended for different uses. Actos can be used to treat medical conditions such as prediabetes, atherosclerosis, and diabetic nephropathy. Metformin, on the other hand, is effective in preventing diabetes and treating obesity with high insulin and gestational diabetes.

In terms of glycemic control, metformin appears to perform better than Actos. On average, Actos is able to reduce the A1c level by about 1%, whereas metformin can achieve an A1c reduction of up to 2%. Notably, Actos is associated with a risk of increasing the body weight. In contrast, metformin is unlikely to cause weight gain. Actos is contraindicated in patients with a medical history of bladder cancer and heart conditions whilst metformin is contraindicated in individuals who have impaired kidney functions.

Actos is only available as tablets, while metformin is supplied in various dosage forms (including tablets, extended release tablets, and an oral solution). Apart from that, their side effect profiles are also different.

Actos is known to cause adverse effects such as:

• swelling,
• low blood sugar,
• cold and flu,
• chest pain,
• headache.

Metformin side effects

• nausea and vomiting,
• diarrhea,
• gas,
• weakness.

Insulin is a peptide hormone that controls the blood glucose levels. Found naturally in the body, it is synthesized by beta cells in the Islets of Langerhans. In order to support fetal growth, the body tends to produce additional insulin during pregnancy. Apart from that, pregnancy also increases insulin resistance. As a result, gestational diabetes (i.e. diabetes during pregnancy) may occur.

Hypoglycemia during pregnancy

While less common than hyperglycemia (high blood glucose), hypoglycemia may occur during pregnancy. Clinically, hypoglycemia (otherwise known as low blood sugar) is defined as a blood glucose of lower than 60mg/dL. To be diagnosed with hypoglycemia, the blood sugar readings need to be consistently low. A single low blood glucose reading does not necessarily imply the presence of hypoglycemia. Female patients with diabetes (including type I diabetes, type II diabetes, and gestational diabetes) are especially susceptible to hypoglycemia during pregnancy. Hypoglycemia is relatively rare in pregnant patients without diabetes. According to a study, approximately 23% of pregnant patients with type I diabetes had at least 1 hypoglycemic episode (many had multiple hypoglycemic attacks).

Causes of hypoglycemia during pregnancy

Hypoglycemia in pregnancy is often resulted from excessive exercise (which leads to a depletion of glucose), or the lack of blood glucose-stabilizing foods. In most cases, aggressive diabetes treatment (e.g. high dose of diabetes medications) is the cause of hypoglycemia during pregnancy.

Common hypoglycemic symptoms include:

• pale skin,
• tingling around the mouth,
• anxiety,
• sweating,
• heart palpitations,
• shaking,
• lightheadedness,
• nausea,
• vomiting.

The symptoms will usually resolve themselves when blood glucose is restored. In severe cases, you may lose consciousness due to a dangerously low blood glucose level. Some factors may increase your risk of developing hypoglycemia. This includes history of hypoglycemic episodes before pregnancy, malnourishment and sickness (and hence, lack of appetite). In addition, patients who are at the first trimester are more likely to develop hypoglycemia. Research has suggested that diabetes patients are 3 times more likely to develop severe hypoglycemia in the first trimester of pregnancy. A hypoglycemic episode is most likely to occur during the eighth to sixteenth week (it is least likely to happen in the second trimester).

Treatment

For symptomatic relieve, take 15g of carbohydrates during a hypoglycemic attack. Simple carbohydrates such as regular soda, fruit juice, honey or sugar, and glucose tablets tend to contain high levels of sugar. Always carry these foods if you have hypoglycemia in pregnancy. During a hypoglycemic attack, pull over if you are driving. Glucagon kit, while rarely prescribed, may be used as an emergency treatment. It helps to elevate blood glucose levels by stimulating the hepatic release of glucose. To prevent hypoglycemia during pregnancy, maintain a stable blood glucose level by having frequent, small meals. Moderate exercise may also help to reduce the risk of hypoglycemia during pregnancy. While infrequent episodes of hypoglycemia is unlikely to harm the fetus, frequent hypoglycemic attacks can be problematic. Some of the serious complications of hypoglycemia include coma, seizures and in extreme cases, death.

There is no simple answer to the question: can you get diabetes from eating too much sugar? Type II diabetes is characterized by an elevated blood sugar level. Therefore, it may seem logical to think that excessive sugar consumption can cause diabetes. In reality, there are many factors involved in the development of diabetes. Diabetes (especially type II diabetes) is a complex, multifactorial disease. For example, type I diabetes is resulted from an interplay of genetic and unknown factors, whereas type II diabetes usually arises from a combination of lifestyle and genetic factors. It is difficult to pinpoint the exact cause of diabetes.

Regardless, sugar consumption (including the consumption of sugar-sweetened drinks) can be a risk factor for diabetes (particularly type II diabetes). Examples of sugary drinks include sweet tea, sports drinks, energy drinks, fruit drinks, and soda. Providing hundreds of calories in a single serving, these sugary drinks dramatically increase blood sugar levels. For instance, sugary beverages like fruit punch generally contain more than 46g of sugar. A 12-ounce can of soda contains around 19g of sugar which is equivalent to the amount of 10 teaspoons of sugar. According to the American Diabetes Association, sugar-sweetened drinks should be avoided in order to prevent diabetes.

While studies have linked the consumption of sugary beverages to diabetes, there are many other risk factors that can contribute to the disease. This includes high calorie foods and obesity.

An understanding of all the risk factors (including sugar consumption) is essential to the prevention of diabetes. As recommended by the American Diabetes Association, it is important to exercise regularly, keep a healthy body weight, and have a balanced diet. The risk of developing diabetes cannot be eliminated by avoiding sugar (or any particular food group) entirely. However, eating food and drinks low in added sugar can contribute to weight loss and lower the risk for type II diabetes.

What is central (neurogenic) diabetes insipidus?

Central diabetes insipidus (CDI) is different from diabetes, and is significantly more complicated. It name is a deceptive misnomer, as it is completely unrelated to issues with insulin production and blood sugar regulation. While both diseases may cause similar symptoms, treatments and medications for the 2 illnesses are inherently different.

Central diabetes insipidus is also called neurogenic diabetes insipidus. This illness is caused when the body cannot create enough of the hormone vasopressin, which controls how much urine the kidneys produce. Vasopressin increases blood volume and decreases urine volume, which is why its absence causes excessive urination.

In the absence of vasopressin, the kidneys cannot work properly. Therefore, the body rapidly loses a great deal of water, resulting in diluted urine. This causes individuals to become dehydrated, forcing them to drink excess amounts of water.

Anyone may be affected by CDI. This being said, it is a rare condition, with only 1 in every 25,000 individuals suffering from it.

Central diabetes insipidus symptoms

Individuals with central diabetes insipidus typically have the following symptoms:

• Frequent urination (more than 3 liters of urine per day);
• Awakening frequently at night to urinate;
• Bed-wetting;
• Colorless, pale urine;
• Low estimated volume of urine;
• And extreme thirst, leading to the consumption of more than 1 gallon of liquid per day.

In extreme cases, central diabetes insipidus can lead to dehydration, confusion, and loss of consciousness. Symptoms of CDI in children include irritability, low energy, delayed growth, weight loss, fever, and vomiting.

Causes

Central diabetes insipidus can be caused by genetics. Other disorders that can lead to CDI include damage to the pituitary gland or hypothalamus, aneurysm, brain injury, tumors, sarcoidosis or tuberculosis, some forms of encephalitis or meningitis, and a rare disease called Langerhans cell histiocytosis.

Treatment

In mild central diabetes insipidus, the treatment is simply to drink more water. For more severe cases, physicians may prescribe desmopressin, which is a sort of vasopressin. Desmopressin regulates urine output, maintains proper fluid balance, and prevents dehydration. It is generally taken several times per day, and it is available as a nasal spray, tablet, or injection.

Patients should always carry their medications with them and avoid situations where they have no access to water. Additionally, it is advisable for patients to wear “medic alert” jewelry or to keep a note with them to inform medical professionals about their condition in the event of an emergency.

Obesity has been found to play a massive role in the development of type 2 diabetes (T2D). In fact, recent research has suggested that obese individuals are up to 80 times more likely to develop this ailment than those at a normal weight. Because of this, obese individuals must be informed on the proper management of diabetes, should they develop it.

Obesity

Obesity is a medical condition in which the excess accumulation of fat has a negative impact on a person’s health. Specifically, it causes changes in the body’s metabolism and increases the risk for developing other diseases, such as type 2 diabetes and heart disease.

Type 2 diabetes

Type 2 diabetes is a chronic medical condition that affects the way the human body metabolizes glucose. In T2D, the body either cannot properly use the insulin it makes or does not produce enough insulin at all.

Lack of physical activity, poor diet, and being obese are some factors that contribute to developing T2D. As a person’s BMI increases, so does their risk of developing this disorder.

Insulin Resistance

The body contains specialized receptors that let glucose pass from the bloodstream into the cells. Insulin, a hormone, unlocks these receptors. If these receptors become resistant to insulin, glucose cannot enter the cell and stays in the bloodstream, causing a rise in blood sugar levels.

Fat—especially in the abdominal area—is a leading cause of insulin resistance. Fat clogs up the insulin receptors, preventing insulin from entering the cells. With this, sugar is not removed effectively from the blood, leading to the development of diabetes.

Conclusion

Medical treatment is required to lower blood sugar levels. However, drugs alone cannot reverse the harmful effects of type 2 diabetes: research shows that physical activity can improve insulin sensitivity—and aid in the fight against obesity. As such, following a healthy, active lifestyle is an excellent way to treat and avoid these conditions

What is fasting hyperglycemia?

Monitoring blood glucose levels is important in the diagnosis and treatment of diabetes. Fasting hyperglycemia is a symptom to look for in the onset of diabetes. Hyperglycemia is a state of having elevated blood glucose levels. In a fasted state—after not consuming meals for 8 or more hours—blood glucose typically resides between 70–130mg/dL. Levels above 130mg/dL in a fasting state would indicate that someone is experiencing fasting hyperglycemia and most likely decreased insulin sensitivity.

Fasting blood glucose levels are important to measure, if you consider the effects of metabolism during and after sleep. High glucose levels can remain elevated overnight, which can propagate complications with diabetes. It is important to note that in some cases this can actually be caused by consuming food prior to sleeping in order ward off the potential for hypoglycemia overnight. This may not be the best strategy for managing fasting blood glucose levels.

Signs and symptoms

How would you know that you are experiencing fasting hyperglycemia? If it has been several hours since your previous meal, you may experience symptoms such as headaches, blurred vision, fatigue, increased thirst or hunger, or frequent urination. These are just a few symptoms to watch for, and they may not occur all at once. These symptoms may also appear with the onset of hypoglycemia (low blood sugar), so if you’re in a fasted state it is important to check your blood glucose levels in order to know which steps to take when bringing it back to normal levels.

An Energetic Start to the Day

Many Canadians like to start their day with a hot cup of coffee. If you have diabetes or are at risk of developing diabetes, you may be aware that extra care needs to be taken in your food choices. So, what does that mean for the consumption of coffee and other sources of caffeine?

What does the research say ?

Recent research has shown that consuming coffee can help with reducing the risk of developing type 2 diabetes. Unfortunately, the implications of caffeine consumption are not so easily spread across the board. Even though research has also shown that caffeine can help with prevention, the degree of protection varies depending on it’s source. Green tea, coffee, and pure caffeine were found to have the most effect on diabetes prevention. For otherwise healthy individuals, a study was conducted that showed that consuming coffee with a low or high glycemic index food may alter insulin sensitivity.

For people diagnosed with diabetes, there are a few benefits that are being explored but still need to be further studied. A study found that caffeine has showed an ability to reduce nocturnal hypoglycemia in people with long standing type 1 diabetes. Another series of studies conducted found that caffeine may induce hypoglycemia and reduced insulin sensitivity in people with gestational and type 2 diabetes. Scientists have also noted that symptoms of hypoglycemia can be highly intensified if you decide to consume caffeine and are diabetic.

Final verdict

Caffeine can safely be consumed, keeping the preceding information in mind. It is important to consider that you must also account for other nutrients being added to the coffee (cream, sugar, etc). These are extra sources of calories that may require the use of insulin to regulate, so it is important to be sure to monitor your blood glucose levels in the same way that would be done for any food you consume.