Prevention of

Disease
 What is an A1c Test?

The hemoglobin A1c test tells you your average level of blood sugar over the past
2 to 3 months. It's also called HbA1c, glycated hemoglobin test, and
glycohemoglobin. It’s a lot like a baseball player's season batting average. A single
game doesn't tell you how a player is performing in their career. And 1 day's test
results don't give you the complete picture of how your treatment is
working.People who have diabetes need this test regularly to see if their levels are
staying within range. It can tell if you need to adjust your diabetes medicines. The
A1c test is also used to diagnose diabetes.
The goal of diabetes treatment remains the same for each
person—bringing blood glucose down to target levels and
preventing complications. But no one pill or injection works
for everyone. Some people can manage their conditions with
diet and exercise, while others must inject insulin or take oral
diabetes medications. With your help, your doctor will
develop a personalized treatment plan. The plan should
control your condition while fitting as easily as possible into
your daily life. Sharing information about your health, your
preferences, and your lifestyle can help you both make the
best decisions about therapy.
When choosing between treatments, your
doctor will consider:
01
Your Diabetes Type
If you have type 1 diabetes, your
pancreas no longer produces the insulin
your body needs to convert sugar to
energy. So, you will need insulin shots to
process the glucose from your meals.
In Type 2 Diabetes

● your body produces insulin but can’t use it properly. Sometimes, insulin
shots still help. But in many cases, diet, exercise, and oral medications
work better to control your blood glucose. In some cases, taking diabetes
pills at the same time helps the body use the insulin from shots better, or
you may take more than one type of medicine—this approach is called
combination therapy.
02
Your Blood Glucose
High blood glucose leads to the
complications of diabetes, such as eye,
nerve, kidney, and heart disease. If you have
extremely high levels, your doctor may
combine insulin shots and medications—
potentially more than one—in addition to
diet and exercise.
03
Your Diagnosis Timeline
If you have type 2 diabetes, your doctor
may first recommend making changes to
your eating habits and increasing the
amount of time you exercise. If that
doesn’t work to control your blood
glucose, the next step is usually trying
diabetes medicines. In most cases, these
pills work best for people who have had
diabetes for less than 10 years.
04
Your Pregnancy Plans
Tell your doctor if you plan to become
pregnant. In general, oral diabetes
medications aren’t safe for developing
babies, so you may have to manage your
condition with diet, exercise, and insulin
instead.
05
Your Exercise Habits
Physical activity helps control your blood
glucose levels—in fact, it’s an important part of
most diabetes treatment plans. However, your
blood glucose levels can temporarily dip too low
immediately after exercise, especially if you
have type 1 diabetes. Your doctor may change
the type and dose of insulin or other medications
you take based on your workout schedule. Share
the details of your routine.
06
Your Finances
Costs vary widely between types of
diabetes treatments. Talk with your
doctor if you have concerns about
paying for your medicines or
injections. Often, generic versions
of common medications cost less
and work just as well.
07 The Other Medicines
You Take
When you take pills or injections for
diabetes, they mix with all the other
drugs in your system. Sometimes this
causes changes you—or your doctor—
don’t want. For instance, your birth
control medications might not work as
well, or your blood glucose may drop
too low.
● Tell your doctor about all the medicines you take, including prescription
and over-the-counter drugs as well as herbal remedies and vitamins. You
may find it helpful to write them all down and keep a list with you, or use
an online service to track them (some also warn you of potentially
dangerous interactions).
08 Whether You Already Have
Diabetes Complications
All diabetes treatment aims to prevent
complications by lowering your blood
glucose, but some diabetes medications also
act directly on certain organs and systems to
improve your health. For instance, a medicine
called pioglitazone (Actos) appears to treat
and prevent damage to your kidneys as well as
controlling your blood glucose.
● In other cases, though, diabetes medicines can worsen complications or
require your doctor to monitor you more closely. People with existing
kidney disease risk a rare but life-threatening condition called lactic
acidosis when they take many diabetes drugs. Your doctor may educate you
on the symptoms of lactic acidosis (including severe diarrhea and
vomiting) so you can seek help quickly if necessary.
09 The Side Effects You
Develop
Your doctor prescribes diabetes medications
to reduce your blood glucose. But sometimes
these drugs have unintended consequences.
Depending on the drug and your personal
biology, you may experience stomach
problems, weight gain, or excessively low
blood glucose.
● Tell your doctor or pharmacist if any new symptoms develop after you start
a new medication. Switching medications may help control your condition
without the side effects.
10 Whether You Drink
Alcohol
Some diabetes medications, including
sulfonylureas, mix poorly with alcohol. You
may develop vomiting, flushing, or sickness if
you drink while taking them. Avoiding alcohol
is one good option—but you can also talk with
your doctor a
What is endogenous and exogenous?
Endogenous means originating within the body,
and exogenous means originating outside the
body. Health professionals who treat people with
diabetes often apply these terms to insulin:
Endogenous insulin refers to the insulin the
pancreas makes, and exogenous insulin refers to
the insulin people inject or infuse via an insulin
pump.
Metformin
is a commonly recommended initial medication for
patients with type 2 diabetes who have mild to
moderately uncontrolled blood glucose. In addition,
it is sometimes used to prevent diabetes in patients
who are at risk of developing the disease (though it
is not FDA approved for prediabetes). On average,
most patients find that their HbA1c levels drop by
as much as 1.5% on this medication. It can also be
taken with insulin.
 WHAT?
Oral Tablet
Metformin is manufactured under several different brand names.
The most common ones are: Metformin hydrochloride (marketed
as Glucophage, but also a common generic medication) Metformin
ER (extended release- marketed as Glucophage XR and Fortamet)

WHERE?
Metformin primarily reduces the liver’s ability to release glucose
from its stores.
 WHEN?
Metformin is usually taken with meals, either once or twice a day depending
on the brand. Available dosage of pills include 500 mg, 850 mg, and 1000
mg. The treatment plan will differ for each patient, but a common starting
regimen is listed below: To avoid stomach upset, patients usually start with a
very low dose (500 mg), taken with dinner. After a few weeks, the dose may
increase to 500 mg with breakfast and 500 mg with dinner. A few weeks
later, the dose may increase again to 500 mg with breakfast and 1 g with
dinner. If the patient has no side effects, the dose may increase to 1000 mg
with breakfast and 1000 mg with dinner. This is usually the maximum dose.
 WHY?
Metformin is the treatment of choice for type 2 diabetes
because it works well, is inexpensive, and it has been
around for decades. Patients may lose a few pounds of
weight on metformin. Metformin is very effective at
controlling blood glucose and lowers A1c levels by as
much as 1.5% at maximum doses. By itself, metformin
does not usually cause low blood glucose. Side effects
including diarrhea. However, a slow increase in doses
or extended release preparations can often prevent this.
In rare cases, metformin can have a serious adverse side
effect called lactic acidosis, where the body produces
potentially dangerous levels of lactic acid. This condition is
rare, and occurs more commonly in persons who are older or
have from heart failure, history of heavy alcohol use, or
advanced kidney disease. To prevent serious kidney damage,
patients generally should NOT take metformin for 24 hours
before—or 48 hours after—receiving IV contrast for a CT
scan. Patients with mild-to-moderate liver or kidney
problems may need to take reduced doses of metformin, and
in severe cases, be discontinued from this medication.