Ruchi Mathur, MD, FRCP(C) is an Attending Physician with the Division of Endocrinology, Diabetes and Metabolism and Associate Director of Clinical Research, Recruitment and Phenotyping with the Center for Androgen Related Disorders, Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center.
William C. Shiel Jr., MD, FACP, FACR received a Bachelor of Science degree with honors from the University of Notre Dame. There Dr. Shiel was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. Dr. graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
The U.S. Food and Drug Administration today approved Tradjenta (linagliptin)
tablets, used with diet and exercise, to improve blood glucose control in adults
with Type 2 diabetes.
People with Type 2 diabetes do not produce or respond normally to insulin, a
hormone that regulates the amount of glucose in the blood. Over time, high blood
glucose levels can increase the risk for serious complications, including
heart
disease, blindness, and nerve and kidney damage.
"This approval provides another treatment option for the millions of
Americans with Type 2 diabetes," said Mary Parks, M.D., director of the Division
of Metabolism and Endocrinology Products in the FDA's Center for Drug Evaluation
and Research. "It is effective when used alone or when added to existing
treatment regimens."
Type 2 diabetes is the most common form of the disease, affecting between 90
percent and 95 percent of the 24 million people in the United States with
diabetes. Tradjenta increases the level of hormones that stimulate the release
of insulin after a meal by blocking the enzyme dipeptidyl peptidase-4 or DPP-4,
which leads to better blood glucose control.
The major goal in treating diabetes is to minimize any elevation of blood
sugar (glucose) without causing abnormally low levels of blood sugar. Type 1
diabetes is treated with insulin, exercise, and a
diabetic diet. Type 2 diabetes
is treated first with weight reduction, a diabetic diet, and exercise. When
these measures fail to control the elevated blood sugars, oral medications are
used. If oral medications are still insufficient, treatment with insulin is
considered.
Adherence to a diabetic diet is an important aspect of controlling elevated
blood sugar in patients with diabetes. The American Diabetes Association (ADA)
has provided guidelines for a diabetic diet. The ADA diet is a balanced,
nutritious diet that is low in fat, cholesterol, and simple sugars. The total
daily calories are evenly divided into three meals. In the past two years, the
ADA has lifted the absolute ban on simple sugars. Small amounts of simple sugars
are allowed when consumed with a complex meal.
Weight reduction and exercise are important treatments for diabetes. Weight
reduction and exercise increase the body's sensitivity to insulin, thus helping
to control blood sugar elevations.
Medications for type 2 diabetes
WARNING: All the information below applies to patients who are not pregnant
or breastfeeding. At present the only recommended way of controlling diabetes in
women who are pregnant or breastfeeding is by diet, exercise and insulin
therapy. You should speak with your doctor if you are taking these medications
and are considering becoming pregnant or if you have become pregnant while
taking these medications.
Based on what is known, medications for type 2 diabetes are designed to:
increase the insulin output by the pancreas,
decrease the amount of glucose released from the liver,
increase the sensitivity (response) of cells to insulin,
decrease the absorption of carbohydrates from the intestine, and
slow emptying of the stomach to delay the presentation of carbohydrates
for digestion and absorption in the small intestine.
When selecting therapy for type 2 diabetes, consideration should be given to:
the magnitude of change in blood sugar control that each medication will
provide;
other coexisting medical conditions (high blood pressure, high
cholesterol, etc.);
adverse effects of the therapy;
contraindications to therapy;
issues that may affect compliance (timing of medication, frequency of
dosing); and
cost to the patient and the health care system.
It's important to remember that if a drug can provide more than one benefit
(lower blood sugar and have a beneficial effect on cholesterol, for example), it
should be preferred. It's also important to bear in mind that the cost of drug
therapy is relatively small compared to the cost of managing the long-term
complications associated with poorly controlled diabetes.
Varying combinations of medications also are used to correct abnormally
elevated levels of blood glucose in diabetes. As the list of medications
continues to expand, treatment options for type 2 diabetes can be better
tailored to meet an individuals needs. Not every patient with type 2 diabetes
will benefit from every drug, and not every drug is suitable for each patient.
Patients with type 2 diabetes should work closely with their physicians to
achieve an approach that provides the greatest benefits while minimizing risks.
Patients with diabetes should never forget the importance of diet and
exercise. The control of diabetes starts with a healthy lifestyle regardless of
what medications are being used.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Hypoglycemia is a syndrome caused by low blood sugar. Symptoms of hypoglycemia include palpitations, trembling, intense hunger, sweating, nervousness, and weakness. Consuming lifesavers, table sugar, soda, and juice are good treatment options for hypoglycemia.
Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. Causes of insulin can include conditions such as stress, obesity, metabolic syndrome, and steroid use. Some of the risk factors for insulin resistance include fatty liver, heart disease, strokes, peripheral vascular disease, high cholesterol, and smoking. Treatment for insulin resistance are lifestyle changes and if necessary, medication.
Peripheral neuropathy is a problem with the functioning of the nerves outside of the spinal cord. Symptoms may include numbness, weakness, burning pain (especially at night), and loss of reflexes. Possible causes may include carpel tunnel syndrome, meralgia paresthetica, vitamin or nutritional deficiencies, and illnesses like diabetes, syphilis, AIDS, and kidney failure. Most causes of peripheral neuropathy can be successfully treated or prevented.
Hyperglycemia is a serious health problem for diabetics. There are two types of hyperglycemia, 1) fasting, and 2)postprandial or after meal hyperglycemia. Hyperglycemia can also lead to ketoacidosis or hyperglycemic hyperosmolar nonketotic syndrome (HHNS). There are a variety of causes of hyperglycemia in people with diabetes. Symptoms include increased thirst, headaches, blurred vision, frequent urination and more. Treatment can be achieved through lifestyle changes or medications changes. Carefully monitoring blood glucose levels is key to prevention.
The main features of metabolic syndrome include insulin resistance, hypertension (high blood pressure), cholesterol abnormalities, and an increased risk for clotting. Patients are most often overweight or obese. Lifestyle modification such as the Mediterranean diet, exercise, and quitting smoking are the preferred treatment of metabolic syndrome.
Peripheral vascular disease (PVD) refers to diseases of the blood vessels (arteries and veins) located outside the heart and brain. While there are many causes of peripheral vascular disease, doctors commonly use the term peripheral vascular disease to refer to peripheral artery disease (peripheral arterial disease, PAD), a condition that develops when the arteries that supply blood to the internal organs, arms, and legs become completely or partially blocked as a result of atherosclerosis. Peripheral artery disease symptoms include: intermittent claudication, rest pain, numbness in the extremities, and more. Treatment for peripheral artery disease include: lifestyle measures, medication, angioplasty, and surgery.
Diabetic Neuropathy is a complication of diabetes that causes damage to the nerves; this is related to the blood glucose of the body being too high for a long period of time. The four types of neuropathy include peripheral, autonomic, proximal and focal.
Radiculopathy, a condition in which a nerve or nerves along the spine are compressed causing pain, numbness, weakenss, and tingling along the nerve(s). Some causes of radiculopathy include bone spurs, disc hernation, osteoarthritis, tumors, infection, and neuropathy. Treatment depends on the are of nerve compression. Surgery is generally not required.
Orthostatic hypotension symptoms include lightheadedness, weakness, blurred vision, and syncope or passing out. Causes of orthostatic hypotension include dehydration, anemia, medication, blood loss, low blood pressure, heat related illnesses and more. Treatment of orthostatic hypotension depends on the underlying cause.
Fatigue can be described in various ways. Sometimes fatigue is described as feeling a lack of energy and motivation (both mental and physical). The causes of fatigue are generally related to a variety of conditions or diseases for example, anemia, mono, medications, sleep problems, cancer, anxiety, heart disease, drug abuse, and more. Treatment of fatigue is generally directed toward the condition or disease that is causing the fatigue.
Prader-Willi syndrome is a condition characterized by severe floppiness (hypotonia), poor growth, delayed development, and poor feeding problems in early infancy later followed in infancy by excessive eating that may lead to extreme obesity. The genitals in both females and males are underdeveloped and most are infertile. Prader-Willi syndrome is related to chromosome 15.
Enjoying a satisfying sex life as we age is important to both physical and mental health. As we age, diseases and conditions may pose challenges in our sexual health, and sexual experiences. Learn how to manage your conditions and still have a gratifying sex life as you age.
A diabetic diet, or diabetes diet helps keep blood glucose levels in the target range for patients. Exercise and medication may also help stabilize blood glucose levels. Keeping track of when you take your diabetic medicine, keeping track of food choices, eating the proper amount of fruits, vegetables, carbohydrates, and fats will also help maintain proper blood glucose levels.
The risks for developing type 2 diabetes include family history, ethnicity, birth weight, metabolic syndrome, and obesity. Warning signs pointing to an increased risk for developing type 2 diabetes include irregular menstruation, impaired fasting glucose, inflammatory markers, and other risks. Gestational diabetes is also a risk factor for developing type 2 diabetes later in life. Prevention of type 2 diabetes can be achieved through a healthy diet (Mediterranean diet), exercise, weight control, not smoking, and medication.
Diabetes-related foot problems can affect your health with two problems: diabetic neuropathy, where diabetes affects the nerves, and peripheral vascular disease, where diabetes affects the flow of blood. Common foot problems for people with diabetes include athlete's foot, fungal infection of nails, calluses, corns, blisters, bunions, dry skin, foot ulcers, hammertoes, ingrown toenails, and plantar warts.
In the United States diabetes is the most common cause of kidney failure. High blood pressure and high levels of blood glucose increase the risk that a person with diabetes will eventually progress to kidney failure. Kidney disease in people with diabetes develops over the course of many years. albumin and eGFR are two key markers for kidney disease in people with diabetes. Controlling high blood pressure, blood pressure medications, a moderate protein diet, and compliant management of blood glucose can slow the progression of kidney disease. For those patients who's kidneys eventually fail, dialysis or kidney transplantation is the only option.
Diabetes and eye problems are generally caused by high blood sugar levels over an extended period of time. Types of eye problems in a person with diabetes include glaucoma, cataracts, and retinopathy. Examples of symptoms include blurred vision, headaches, eye aches, pain, halos around lights, loss of vision, watering eyes. Treatment for eye problems in people with diabetes depend on the type of eye problem. Prevention of eye problems include reducing blood pressure, cholesterol levels, quitting smoking, and maintaining proper blood glucose levels.
Managing your diabetes is important. The goal of diabetic therapy is to control blood glucose levels and prevent the complications of diabetes. Information about exercise, diet diet, and medication will help you manage your diabetes better. Blood glucose reagent strips, blood glucose meters, urine glucose tests, tests for urinary ketones, continuous glucose sensors, and Hemoglobin A1C testing information is also provided in this article.
Having diabetes can mean early onset and increased severity of bladder symptoms (urinary incontinence and urinary tract infections) and changes in sexual function. Men may have erectile dysfunction; and women may have problems with sexual response and vaginal lubrication. Keep your diabetes under control, and you can lower your risk of sexual and urologic problems.
Taking care of a disease such as diabetes is a life-long process. Learn how to care for yourself or loved one with diabetes in situations such as illness, work, school, travel, or a natural disaster.
Diabetic neuropathy, a common complication of diabetes, is damage to the nerves that allow you to feel sensations such as pain. There are a number of ways that diabetes damages the nerves, but they all seem related to blood sugar being too high for a long period of time.
Diabetes-related nerve damage can be painful, but it isn't severe pain in most cases.
There are four types of diabetic neuropathy: peripheral, autonomic, proximal, and focal.
Diabetic Peripheral Neuropathy
The areas of the body most commonly affected by
diabetic peripheral neuropathy are the feet and legs.
Nerve damage in the feet can result in a loss of foot sensation, increasing your risk of foot problems. Injuries and sores on the feet may go unrecognized due to lack of sensation. Therefore, you should practice proper skin and foot care. Rarely, other areas of the body such as the arms, abdomen, and back may be affecte...