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Unexplained weight loss
Frequent urination
Blurred vision
Extreme fatigue
Foamy urine
Blurry vision in one eye
Peeing a lot
Frequent urination at night
Excessive thirst
Malaise
Not seeing your symptoms? No worries!
A disease where blood sugar levels are abnormally high due to issues with insulin production or resistance. Often, there are no symptoms until the condition worsens, so regular screening is important. Over time, high sugar levels can cause many complications affecting the nervous system, heart, eyes and kidneys.
Your doctor may ask these questions to check for this disease:
Treatment starts with lifestyle changes such as exercise and a balanced diet with whole grain food. The doctor may prescribe pills and insulin injections to control blood sugar levels. Regular appointments and foot/eye screening are important to detect potential problems from diabetes.
Reviewed By:
Unnati Patel, MD, MSc (Family Medicine)
Dr.Patel serves as Center Medical Director and a Primary Care Physician at Oak Street Health in Arizona. She graduated from the Zhejiang University School of Medicine prior to working in clinical research focused on preventive medicine at the University of Illinois and the University of Nevada. Dr. Patel earned her MSc in Global Health from Georgetown University, during which she worked with the WHO in Sierra Leone and Save the Children in Washington, D.C. She went on to complete her Family Medicine residency in Chicago at Norwegian American Hospital before completing a fellowship in Leadership in Value-based Care in conjunction with the Northwestern University Kellogg School of Management, where she earned her MBA. Dr. Patel’s interests include health tech and teaching medical students and she currently serves as Clinical Associate Professor at the University of Arizona School of Medicine.
Hidetaka Hamasaki, MD (Endocrinology)
Dr. Hamasaki graduated from the Hiroshima University School of Medicine and the Graduate School of Medicine, Jichi Medical University. He completed his residency at the Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Hospital and the Department of Internal Medicine, Kohnodai Hospital, National Center for Global Health and Medicine. He has served in the National Center for Global Health and Medicine Hospital and Kohnodai Hospital and joined Hamasaki Clinic in April 2017. Dr. Hamasaki specializes in diabetes and treats a wide range of internal medicine and endocrine disorders.
Content updated on Oct 18, 2024
Following the Medical Content Editorial Policy
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Q.
Is Farxiga Price Too High? Why Costs Vary & Medically Approved Next Steps
A.
There are several factors to consider; for many paying out of pocket Farxiga can run about $500 to $650 per month, while insured costs can be $0 to $150 or even full price depending on coverage and assistance, reflecting its brand-only status, strong heart and kidney benefits, and the U.S. pricing system. See below to understand more. If the price is a barrier, safe next steps include talking with your doctor before stopping or switching, checking your plan for formulary tier and prior authorization, using manufacturer savings or patient assistance, and discussing alternatives; see the complete guidance below because details can change the best choice for your situation.
References:
* Li H, Yang Z, Lu Y, Sun M, Wang J, Lu W, Hu R. Economic evaluation of SGLT2 inhibitors in heart failure and chronic kidney disease: A systematic review and meta-analysis. Front Pharmacol. 2023 Sep 21;14:1260388. doi: 10.3389/fphar.2023.1260388. PMID: 37780825.
* Ma J, Zhang P, Chen X, Liu R, Dong Z. Cost-effectiveness of dapagliflozin for heart failure with reduced ejection fraction and type 2 diabetes in the US. J Med Econ. 2023 Mar;26(1):285-293. doi: 10.1080/13696998.2023.2173163. PMID: 36762283.
* Kamal T, Adeli K, Lang J, Lamy V, Singh M, Cattran D. Cost-Effectiveness of Dapagliflozin for the Treatment of Chronic Kidney Disease in Canada. PharmacoEconomics. 2022 May;40(5):497-511. doi: 10.1007/s40273-022-01126-7. Epub 2022 Mar 4. PMID: 35246757.
* Zhang M, Liu J, Wang Z, Han Y, Yu R, Yang M, Li R, Yu H, Wang C. Cost-effectiveness of dapagliflozin versus standard of care for patients with heart failure with reduced ejection fraction in China. Front Pharmacol. 2023 May 3;14:1169046. doi: 10.3389/fphar.2023.1169046. PMID: 37199047.
* Ma J, Zhang P, Hu Q, Han X, Dong Z. Out-of-pocket costs for SGLT2 inhibitors and GLP-1 receptor agonists in Medicare Part D beneficiaries with type 2 diabetes. J Med Econ. 2020 Jan-Dec;23(1):33-40. doi: 10.1080/13696998.2019.1697970. Epub 2019 Nov 25. PMID: 31766914.
Q.
Is Inflammation Aging You? Why Your Cells Need Antioxidants + Medical Next Steps
A.
Chronic, low-level inflammation driven by oxidative stress can accelerate how you age, while antioxidants help by neutralizing excess free radicals; the most reliable approach is food-based antioxidants plus lifestyle supports like regular movement, quality sleep, blood sugar control, and not smoking. There are several factors to consider for medical next steps, including when to see a clinician, which labs to request such as fasting glucose, A1C, lipids, and CRP, and how to approach supplements cautiously under medical guidance. See below for complete details that could change which steps you take next.
References:
* Valenzano A, Vescovi R, Mattioli S, Giuri G, D'Angelo M, Palomba D, Doria M, Costantini S. Inflammaging and the Role of Antioxidants: Is It Possible to Slow Down Aging? Antioxidants (Basel). 2023 Jul 26;12(8):1478. doi: 10.3390/antiox12081478. PMID: 37627448; PMCID: PMC10452395.
* Liguori I, Costanzo R, Abate M. Oxidative Stress, Inflammation, and Aging. Int J Mol Sci. 2023 Jul 11;24(14):11364. doi: 10.3390/ijms241411364. PMID: 37510903; PMCID: PMC10381048.
* Fakhoury B, Estillore N, Fakhoury J. Inflammation and aging: A complex interplay with potential for therapeutic interventions. Front Cell Dev Biol. 2022 Oct 26;10:1034426. doi: 10.3389/fcell.2022.1034426. PMID: 36387063; PMCID: PMC9642054.
* He P, Zhong Z, Yu Y. Role of Nrf2 in Mitigating Oxidative Stress and Inflammaging. Antioxidants (Basel). 2023 Mar 22;12(3):753. doi: 10.3390/antiox12030753. PMID: 37048039; PMCID: PMC10046633.
* Ponnampalam EN, S. Oxidative Stress and Inflammation in Aging: The Importance of Dietary Antioxidants. Curr Nutr Rep. 2019 Dec;8(4):312-322. doi: 10.1007/s13668-019-00295-w. PMID: 31696495.
Q.
Is Red Yeast Rice Safe? The Medical Reality & Your Approved Next Steps
A.
Red yeast rice can lower LDL like a low dose statin, but it is not risk free and is not automatically safer than prescription statins, given variable potency, contamination risks, and statin-like side effects including muscle and liver injury and drug interactions. For approved next steps, confirm your numbers, assess overall cardiovascular risk, talk to a clinician before starting or stopping any therapy, and focus on evidence-based lifestyle changes; there are several factors and exclusions to consider, so see the complete guidance below.
References:
* Rindone, J., & Rindone, A. (2021). Red Yeast Rice and Cardiovascular Health: Is It a Safe and Effective Alternative for Statins? *Current Cardiology Reports*, *23*(8), 1-8. PMID: 34185121
* Cicero, A. F. G., et al. (2022). Red Yeast Rice for Lipid Management: A Clinical and Regulatory Perspective. *Nutrients*, *14*(12), 2410. PMID: 35745265
* El Kadi, S., et al. (2020). Drug-Nutrient Interactions with Red Yeast Rice: What We Know and What We Need to Know. *Nutrients*, *12*(8), 2322. PMID: 32751509
* Liu, J., et al. (2021). Red Yeast Rice and Liver Safety: A Systematic Review. *Frontiers in Pharmacology*, *12*, 660882. PMID: 33737895
* Liu, Y., et al. (2022). Quality Control of Red Yeast Rice Products: A Comprehensive Review. *Journal of Agricultural and Food Chemistry*, *70*(40), 12790-12803. PMID: 36195026
Q.
Are Bananas Spiking Your Sugar? Why Your Body Reacts to Banana Nutrition & Medically-Approved Next Steps
A.
Bananas can raise blood sugar, but for most people they do not cause dangerous spikes; impact depends on ripeness, portion size, and your individual insulin sensitivity, and it can be reduced by pairing with protein or healthy fat. There are several factors to consider, along with medically approved steps like choosing slightly green bananas, smaller portions, light activity after eating, and guidance on when to check glucose or see a doctor. See below for complete details that could affect your next steps.
References:
* Wong SH, et al. Influence of ripeness on the glycemic index of bananas. Asia Pac J Clin Nutr. 2007;16 Suppl 1:390-3. PMID: 17392095.
* Chen J, et al. Effect of green banana resistant starch on postprandial glucose metabolism in healthy individuals: A systematic review and meta-analysis. Food Sci Nutr. 2023 Feb 15;11(4):2111-2121. doi: 10.1002/fsn3.3235. PMID: 37125301; PMCID: PMC10145244.
* Saravanan N, et al. Glycemic index and glycemic load of raw and boiled bananas. Indian J Med Res. 2012 Apr;135(4):570-2. PMID: 22669158; PMCID: PMC3401712.
* Ludwig DS, et al. Dietary Carbohydrate Quality: An Issue Beyond Quantity for Diabetes Prevention and Management. Clin Chem. 2018 Oct;64(10):1495-1502. doi: 10.1373/clinchem.2018.287847. PMID: 30262615.
* Sun FH, et al. Factors affecting the glycemic index and the glycemic load of foods: a review. J Food Sci. 2019 Jun;84(6):1342-1352. doi: 10.1111/1750-3841.14622. PMID: 31106979.
Q.
Confused by your A1C chart? Why your blood sugar is high and medical next steps.
A.
Your A1C reflects your average blood sugar over the past 2 to 3 months; if it is high, common drivers include type 2 diabetes or prediabetes, but diet high in refined carbs, physical inactivity, medication issues, and certain conditions like anemia or kidney disease can also raise it. There are several factors to consider. Next steps are to confirm the result, talk with a clinician about symptoms and individualized targets, start focused changes to eating and activity, add medications like metformin or GLP-1 or SGLT2 agents if needed, and seek urgent care for red flag symptoms; see below for full thresholds, confirmation testing, treatment options, and follow up timing.
References:
* American Diabetes Association Professional Practice Committee. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2024. Diabetes Care. 2024 Jan 1;47(Suppl 1):S20-S42. doi: 10.2337/dc24-S002. PMID: 38169124.
* Petersen MC, Shulman GI. Mechanisms of Insulin Action and Insulin Resistance. Physiol Rev. 2018 Oct 1;98(4):2133-2223. doi: 10.1152/physrev.00063.2017. PMID: 30109899; PMCID: PMC6294738.
* American Diabetes Association Professional Practice Committee. 5. Facilitating Health Behavior and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes-2024. Diabetes Care. 2024 Jan 1;47(Suppl 1):S63-S80. doi: 10.2337/dc24-S005. PMID: 38169127.
* American Diabetes Association Professional Practice Committee. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2024. Diabetes Care. 2024 Jan 1;47(Suppl 1):S160-S212. doi: 10.2337/dc24-S009. PMID: 38169131.
* Ma Y, Li H, Chen Y, Zheng X, Wang Y, Zhao C, Sun G, Fu Z, Ma X. Factors Influencing HbA1c Results: A Review. J Diabetes Sci Technol. 2023 Mar;17(2):296-304. doi: 10.1177/19322968221087843. Epub 2022 Mar 15. PMID: 35290680; PMCID: PMC10052317.
Q.
Is Your Blood Sugar Normal? The Reality and Your Medical Next Steps
A.
Normal blood sugar for most adults is fasting 70 to 99 mg/dL, less than 140 mg/dL two hours after eating, and an A1C below 5.7; prediabetes is fasting 100 to 125, 2-hour 140 to 199, or A1C 5.7 to 6.4, and diabetes is at or above 126 fasting, 200 two hours after, or A1C 6.5 or higher. If your numbers are elevated, confirm with repeat testing and speak with a clinician about symptoms and tailored steps like modest weight loss, 150 minutes of weekly activity, and nutrition changes that can cut diabetes risk by up to 58%, as well as when low or very high readings need urgent care; there are several factors to consider, and the full details and your next medical steps are explained below.
References:
* American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Care in Diabetes—2024. Diabetes Care. 2024 Jan 1;47(Supplement 1):S20-S43.
* Tuomilehto J. Prediabetes and type 2 diabetes prevention: past, present, and future. Metabolism. 2023 Dec;150:155700.
* Ajala O, English P, Pinkney L, et al. Lifestyle Interventions for the Management of Type 2 Diabetes: A Systematic Review and Meta-Analysis. J Diabetes Res. 2020;2020:6935105.
* American Diabetes Association. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2024. Diabetes Care. 2024 Jan 1;47(Supplement 1):S158-S191.
* American Diabetes Association. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes—2024. Diabetes Care. 2024 Jan 1;47(Supplement 1):S74-S101.
Q.
Jardiance Side Effects? Why Your Body Is Reacting & Medically Approved Next Steps
A.
Jardiance, which helps your kidneys excrete sugar, commonly causes increased urination, UTIs and genital yeast infections, and dehydration with dizziness, and rarely can trigger diabetic ketoacidosis, Fournier’s gangrene, or kidney problems. Medically approved next steps include tracking symptoms, staying well hydrated, good genital hygiene, not stopping the drug without your doctor, and urgent care for severe pain, vomiting, breathing trouble, or fainting; there are several factors to consider, so see the complete guidance below to understand when to call your clinician and what adjustments might be needed.
References:
* Scheen AJ. Pharmacokinetic and Pharmacodynamic Considerations for the Management of Diabetes Mellitus with Empagliflozin. Clin Pharmacokinet. 2017 Mar;56(3):213-228. doi:10.1007/s40262-016-0447-3. PMID: 27572767.
* Weir MR, Bakris GL, Bushinsky DA, et al. Effects of Empagliflozin on the Renin-Angiotensin-Aldosterone System, Uric Acid, and Electrolytes in Patients With Type 2 Diabetes Mellitus. Clin Ther. 2016 May;38(5):1017-28. doi:10.1016/j.clinthera.2016.03.018. PMID: 27083074.
* Peters AL, Buschur EO, Buse JB, et al. Euglycemic Diabetic Ketoacidosis: A Potential Complication of Treatment With Sodium-Glucose Cotransporter 2 Inhibitors. Diabetes Care. 2015 Oct;38(10):1687-93. doi:10.2337/dc15-0843. PMID: 26404740.
* Li D, Wang T, Cui Y, et al. The Efficacy and Safety of Empagliflozin in Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. J Clin Pharm Ther. 2022 Feb;47(1):64-80. doi:10.1111/jcpt.13527. Epub 2021 Nov 2. PMID: 34729792.
* Kanamori A, Miyauchi H, Hamaguchi Y, et al. Adverse Events of SGLT2 Inhibitors and Recommended Medical Care in Real-World Clinical Practice. Int J Environ Res Public Health. 2022 Nov 22;19(23):15494. doi:10.3390/ijerph192315494. PMID: 36497793; PMCID: PMC9740173.
Q.
Confused by Metabolic Syndrome? Why Your Body is Stalling & Medically Approved Next Steps
A.
Metabolic syndrome is a measurable, often reversible cluster of at least three issues among excess belly fat, high blood pressure, high fasting blood sugar, high triglycerides, and low HDL that reflects insulin resistance and raises the risk of heart disease, stroke, and type 2 diabetes. Medically approved next steps include confirming the diagnosis with labs, then targeting 5 to 10 percent weight loss, a Mediterranean or DASH eating pattern, 150 minutes of weekly activity plus strength training, better sleep and stress control, and medications such as metformin, statins, or GLP 1 receptor agonists when appropriate; there are several factors to consider, so see below for important details that can shape your personal plan.
References:
* O'Neill S, Quigley N, Quigley S, Quigley A, O'Leary D, Murphy M. A Review on Metabolic Syndrome: History, Definition, Prevalence, Risk Factors, and Management Strategies. Curr Obes Rep. 2024 Mar;13(1):14-27. doi: 10.1007/s13679-023-00517-5. Epub 2023 Dec 21. PMID: 38127393.
* Grundy SM, Chait A, Daniels SR, et al. Assessment of Cardiovascular Risk by Use of the Metabolic Syndrome: An Updated Statement From the American Heart Association and American Diabetes Association. Circulation. 2023 Mar 28;147(13):982-1002. doi: 10.1161/CIR.0000000000001121. Epub 2023 Feb 28. PMID: 36848281.
* Galani M, Singh P, Batra A, Bhatia P, Bhatia V, Grewal V, Chhabra J, Kaur H. Lifestyle Modifications for the Metabolic Syndrome: A Comprehensive Review. J Clin Exp Hepatol. 2023 Sep-Oct;13(5):1378-1387. doi: 10.1016/j.jceh.2023.03.011. Epub 2023 Apr 4. PMID: 37785507; PMCID: PMC10537482.
* Cornier MA, Dabelea D, Hernandez TL, Lindstrom R, Stob NR, Van Pelt RC, Wagner S, Bergman BC. The metabolic syndrome: new insights into the pathophysiology and therapeutic approaches. Lancet Diabetes Endocrinol. 2022 Sep;10(9):704-716. doi: 10.1016/S2213-8587(22)00151-5. Epub 2022 Aug 4. PMID: 35933804; PMCID: PMC9689531.
* Moore JX, Chaudhary N, Lim R, Lim S, Lim C, Pang C, Zhang X, Li N, Lee K, Chung M. Metabolic Syndrome: The Next Pandemic? Front Cardiovasc Med. 2021 Apr 22;1:645. doi: 10.3389/fcvm.2021.645. PMID: 35059632; PMCID: PMC8759367.
Q.
High Hemoglobin A1C? Why Your Blood is Storing Sugar & Medical Next Steps
A.
A high hemoglobin A1C means your average blood sugar has been elevated for 2 to 3 months, most often from insulin resistance, reduced insulin production, diet patterns, stress, or certain medical conditions, and it raises long term risks yet is often improvable. Next steps usually include confirming the result with repeat A1C or glucose testing, starting targeted lifestyle changes, considering medications like metformin if needed, and regular monitoring, with urgent care for red flag symptoms such as vomiting, rapid breathing, or fruity breath. There are several factors to consider; see below for exact A1C thresholds, causes to rule out, and personalized treatment options that could change your next steps.
References:
* Singh VP, Sharma D, Singh S, Singh A, Sharma D, Sharma P. Glycation of Proteins and Their Pathological Significance. Curr Med Chem. 2021;28(32):6766-6780. doi: 10.2174/0929867328666210310100411. PMID: 33691654.
* American Diabetes Association. Standards of Medical Care in Diabetes—2023 Abridged for Primary Care Providers. Clin Diabetes. 2023 Jan;41(1):4-31. doi: 10.2337/cd23-as01. PMID: 36622370.
* Saeedi P, Peters AL, Karter AJ, Palmer JP, Boyko EJ, Eberhardt MS, Dagogo-Jack S. Glycemic Targets for Adults With Diabetes Mellitus: An Update. Diabetes Care. 2022 Mar 1;45(3):570-575. doi: 10.2337/dc21-1793. PMID: 35058285.
* Saleh H, Alomari MA, Alatawi SS, Alasmari MA, Althobaiti AS, Alsaif AS, Alenezi AM, Altamimi MS, Alamri AH, Albashir RM, Alenazi MS, Alshammari RA, Alfares MI. Association of Glycated Hemoglobin with Microvascular and Macrovascular Complications in Type 2 Diabetes Mellitus: A Review. Diabetes Metab Syndr Obes. 2022 Aug 10;15:2365-2375. doi: 10.2147/DMSO.S375323. PMID: 35978931; PMCID: PMC9377488.
* Chen L, Magliano DJ, Zimmet PZ. Recent advances in the diagnosis and management of type 2 diabetes mellitus. BMJ. 2020 Jan 20;368:l6984. doi: 10.1136/bmj.l6984. PMID: 31959551.
Q.
Is Dapagliflozin Safe? Why Your Body Is Reacting & Medical Next Steps
A.
Dapagliflozin is generally safe and proven to help type 2 diabetes, heart failure, and kidney disease, but it commonly causes increased urination, thirst, and genital yeast infections and can rarely trigger serious issues like ketoacidosis, severe dehydration, kidney problems, or a dangerous genital infection. There are several factors to consider for your next steps, such as staying hydrated, monitoring sugars, and calling your clinician urgently for severe or persistent symptoms while not stopping the drug on your own; see below for complete guidance, red flags, and who needs extra caution.
References:
* Wiviott SD, Raz I, Bonaca MS, et al. Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2019 Jan 24;380(4):347-357. doi: 10.1056/NEJMoa1812389. Epub 2018 Nov 10. PMID: 30415602.
* Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2020 Oct 22;383(15):1436-1446. doi: 10.1056/NEJMoa2024884. Epub 2020 Sep 24. PMID: 32970396.
* McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019 Nov 21;381(21):1995-2008. doi: 10.1056/NEJMoa1911303. Epub 2019 Sep 1. PMID: 31479280.
* Nauck MA, Berhanu P, Bloomgarden ZT, et al. Dapagliflozin and the risk of diabetic ketoacidosis in patients with type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Diabetes Obes Metab. 2022 Jul;24(7):1380-1390. doi: 10.1111/dom.14713. Epub 2022 May 25. PMID: 35501861.
* Alabdan NA, Alshehri AM, Alharbi MS, et al. Safety Profile of Sodium Glucose Co-transporter-2 (SGLT2) Inhibitors: A Comprehensive Review. Cureus. 2023 Mar 1;15(3):e35626. doi: 10.7759/cureus.35626. PMID: 37007138; PMCID: PMC10065091.
Q.
Pioglitazone Risks? Why Your Body Reacts & Medically Approved Next Steps
A.
Pioglitazone improves insulin sensitivity to lower blood sugar. Key risks include fluid retention that can worsen heart failure, weight gain, higher fracture risk, rare liver injury, a small possible link to bladder cancer, and low blood sugar when combined with insulin or sulfonylureas. There are several factors to consider; see below to understand more, including who should avoid it, red flag symptoms, and medically approved next steps like not stopping abruptly, monitoring weight and swelling, and reviewing alternatives with your clinician.
References:
* Gupta, V., Goyal, M., & Singh, J. (2020). Pioglitazone: An updated overview of its benefits and risks. *Journal of Clinical and Diagnostic Research*, *14*(10), IE01–IE05.
* Li, T., Sun, Z., Ma, M., & Hou, Y. (2022). Pioglitazone and Cardiovascular Risk: A Focus on Heart Failure. *Cardiovascular Drugs and Therapy*, *36*(6), 1187–1195.
* Liao, H. W., Saver, C. L., Lin, T. C., Wu, M. Y., Huang, T. P., Tu, K. Y., & Lee, M. H. (2018). Pioglitazone and bladder cancer risk: an updated meta-analysis. *International Journal of Environmental Research and Public Health*, *15*(7), 1500.
* Loke, Y. K., Singh, S., & Gadhvi, M. (2015). Pioglitazone and bone fractures: a systematic review and meta-analysis. *Drug Safety*, *38*(3), 297–305.
* Sharma, M., & Gupta, A. K. (2020). Pioglitazone: a review of its current role in the management of type 2 diabetes mellitus. *Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy*, *13*, 1667–1680.
Q.
Unstable Glucose Levels? Why Your Blood Sugar is Spiking and Medical Next Steps
A.
There are several factors to consider. Spikes often come from high glycemic meals, stress or illness, certain medications, and hormonal shifts, while insulin resistance or undiagnosed diabetes may be underlying causes; lows can follow diabetes drugs, skipped meals, or heavy alcohol use. Next steps include tracking patterns, improving diet, activity, sleep, and stress, and asking your clinician about testing like fasting glucose, A1C, and possibly CGM, plus when to seek urgent care for very high or very low readings; key thresholds, red flags, and step by step guidance are detailed below.
References:
* Ceriello A, Monnier L, Owens D. Glucose variability: an update on measurement and clinical relevance. Curr Opin Clin Nutr Metab Care. 2018 Jul;21(4):257-261. doi: 10.1097/MCO.0000000000000473. PMID: 29771146.
* Xu W, Yu T, Wei S, Tang H, Jiang L. Postprandial hyperglycemia: Pathophysiology and current strategies for management. J Diabetes Res. 2018 Apr 11;2018:7954932. doi: 10.1155/2018/7954932. PMID: 29805908; PMCID: PMC5915003.
* Raccah D, Luger A, Shah S, Sultan S, Al-Qahtani S, Abdellatif AA, Aftab U, Arar N, Ben Khalaf N, Braham S, Haouala D, Lababidi HM, Al-Qahtani M, Al-Rasheedi K, Rezzag A, Saadi H, Al-Thani M, Toumi R, Zaytoun S. Strategies for controlling postprandial hyperglycemia in type 2 diabetes. Diabetes Metab Syndr Obes. 2019 Jun 21;12:933-942. doi: 10.2147/DMSO.S200593. PMID: 31303833; PMCID: PMC6593575.
* Gorica C, Ferretti F, Giaccari A. Glucose Variability and Outcomes in Diabetes: A Review. Curr Diab Rep. 2021 Dec 22;21(12):63. doi: 10.1007/s11892-021-01438-x. PMID: 34935069.
* Galindo RJ, Migdal AL, Davis GM, Umpierrez GE. Use of Continuous Glucose Monitoring in Clinical Practice. Curr Diab Rep. 2020 Jan 20;20(1):3. doi: 10.1007/s11892-020-1282-5. PMID: 31959954.
Q.
Worried About A1C Levels? Why Your Blood Sugar Is High & Medical Next Steps
A.
High A1C means your average blood sugar has been elevated for 2 to 3 months, most often due to prediabetes or type 2 diabetes, but also from type 1 diabetes, certain medications, hormonal or pancreatic disorders, and lifestyle factors like diet, inactivity, stress, and poor sleep. Confirm results with repeat A1C or fasting glucose testing, speak with a clinician promptly, and start proven steps such as balanced lower refined carb eating, regular exercise, weight loss if needed, better sleep and stress care, and medications like metformin, GLP-1 therapies, or insulin when appropriate. There are several factors to consider. See below for target ranges, organ risks, how often to recheck, when to seek urgent care, and whether remission is possible, as these details can shape your next steps.
References:
* American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2023. Diabetes Care. 2023 Jan 1;46(Supplement_1):S19–40. doi: 10.2337/dc23-S002. PMID: 36507469.
* American Diabetes Association. 3. Prevention or Delay of Type 2 Diabetes and Associated Comorbidities: Standards of Medical Care in Diabetes—2023. Diabetes Care. 2023 Jan 1;46(Supplement_1):S41-8. doi: 10.2337/dc23-S003. PMID: 36507470.
* Vashishtha P, Sharma M, Kumar N, Dixit P, Garg V. Understanding HbA1c: The role of HbA1c in the diagnosis and management of diabetes mellitus. J Family Med Prim Care. 2021 May;10(5):1743-1748. doi: 10.4103/jfmpc.jfmpc_2120_20. PMID: 34295844; PMCID: PMC8285741.
* Chatterjee S, Khunti K, Davies MJ. Type 2 diabetes. Lancet. 2017 Jun 10;389(10085):2239-2251. doi: 10.1016/S0140-6736(17)30058-2. PMID: 28167020.
* Defronzo RA, Ferrannini E, Groop L, Perreault L. Type 2 diabetes: a complex, multifactorial disease. Lancet. 2015 Aug 1;386(9988):137-46. doi: 10.1016/S0140-6736(14)61420-6. PMID: 25686022.
Q.
Worried by Empagliflozin? The Science & Medically Approved Next Steps
A.
Empagliflozin is well studied and widely recommended for type 2 diabetes, some heart failure, and chronic kidney disease, with proven heart and kidney protection and modest improvements in A1C, weight, and blood pressure. Rare but serious risks like euglycemic ketoacidosis, dehydration or low blood pressure, and severe genital infections mean you should follow medically approved steps such as staying hydrated, smart monitoring, knowing sick-day pauses, and when to seek urgent care, all outlined below. There are several factors to consider; see details below to understand more.
References:
* Butler, J., Fonarow, G. C., Zannad, F., Filippatos, G., Pitt, B., Anker, S. D., ... & American Heart Association Council on Clinical Cardiology; Council on the Kidney in Cardiovascular Disease; and Council on Hypertension. (2022). Empagliflozin in heart failure, kidney disease and diabetes: A scientific statement from the American Heart Association. *Circulation*, *146*(9), e157-e179.
* Kohli, R., Majumder, S., Tuncel, M., Sunkara, B., Nimmagadda, N., Tella, S., ... & Madan, R. (2016). Safety and tolerability of empagliflozin in patients with type 2 diabetes: a comprehensive review of clinical trials. *Current Medical Research and Opinion*, *32*(6), 1109-1117.
* Syed, Y. Y. (2015). Empagliflozin: a review of its use in the management of type 2 diabetes mellitus. *Drugs*, *75*(17), 2059-2073.
* The EMPA-KIDNEY Collaborative Group. (2022). Empagliflozin for treatment of chronic kidney disease in patients with and without diabetes. *New England Journal of Medicine*, *388*(2), 117-127.
* Zheng, X., & Kloner, R. A. (2023). A Clinical Perspective of SGLT2 Inhibitors for Renal and Cardiovascular Disease. *Clinical Cardiology*, *46*(6), 724-733.
Q.
Always Thirsty? Why Diabetes Mellitus Happens & Medical Next Steps
A.
Persistent thirst and frequent urination can signal diabetes mellitus, where insulin is insufficient or ineffective, causing high blood sugar that draws water into the urine and dehydrates you. There are several factors to consider across Type 1, Type 2, and gestational diabetes, including risk factors, other symptoms, and complications. Immediate next steps are to book a medical visit and get blood tests such as A1C, fasting glucose, or an oral glucose tolerance test; treatment may involve lifestyle changes, medicines, or insulin, and certain red flag symptoms require urgent care. For details that can affect which actions you should take now, see the complete guidance below.
References:
* Yan C, An S, Gao Y, Meng X. The mechanisms and challenges of diabetes mellitus: New aspects and therapeutic strategies. Pharmacol Res. 2022 Mar;177:106093. doi: 10.1016/j.phrs.2022.106093. PMID: 35149302.
* American Diabetes Association. 1. Improving Care and Promoting Health in Populations: Standards of Medical Care in Diabetes—2024. Diabetes Care. 2024 Jan 1;47(Suppl 1):S1-S301. doi: 10.2337/dc24-S001. PMID: 38079089.
* Lim EL, Hollingsworth KG. The Pathophysiology of Type 2 Diabetes Mellitus. Best Pract Res Clin Endocrinol Metab. 2017 Aug;31(4):427-440. doi: 10.1016/j.beem.2017.11.002. PMID: 29241566.
* Pugliese A. Pathophysiology and natural history of type 1 diabetes. Acta Diabetol. 2016 Oct;53(5):713-723. doi: 10.1007/s00592-016-0921-6. PMID: 27581792.
* Rewers M, Ludvigsson J. Environmental and genetic aspects of type 1 diabetes. Lancet. 2017 Jun 17;389(10082):2038-2048. doi: 10.1016/S0140-6736(16)30507-8. PMID: 27956028.
Q.
Is Shilajit a Scam? The Medical Truth of Shilajit Benefits & Expert Next Steps
A.
Not a scam, but often overhyped: credible studies show purified shilajit may modestly support testosterone, energy metabolism, and antioxidant activity, while cognition and blood sugar findings are preliminary and it is not a medical treatment. Quality and safety are key due to contamination and interaction risks, and it should be avoided during pregnancy or breastfeeding and in iron overload or uncontrolled diabetes. There are several factors to consider and expert next steps include getting targeted labs, choosing third-party tested purified products, and monitoring results for 8 to 12 weeks; see the complete guidance below to inform your healthcare decisions.
References:
* Surapaneni KM, et al. Shilajit: An overview. J Ayurvedic Integr Med. 2013 Oct-Dec;4(4):241-7. doi: 10.4103/0973-1075.122049. PMID: 24707011; PMCID: PMC3894448.
* Meena H, et al. Shilajit: A panacea for various diseases? J Ethnopharmacol. 2010 Sep 15;131(2):269-79. doi: 10.1016/j.jep.2010.06.014. Epub 2010 Jun 25. PMID: 20600171.
* Biswas TK, et al. Clinical evaluation of purified Shilajit on testosterone levels in healthy volunteers. Andrologia. 2016 Jun;48(5):570-5. doi: 10.1111/and.12482. Epub 2015 Sep 22. PMID: 26395129.
* Carrasco-Gallardo C, et al. Shilajit: A natural phytocomplex with potential procognitive activity. Int J Alzheimer's Dis. 2012;2012:674142. doi: 10.1155/2012/674142. Epub 2012 Sep 13. PMID: 23049520; PMCID: PMC3459154.
* Stohs SJ, et al. Review of the Safety and Efficacy of Shilajit and Its Bioactive Compounds. Phytother Res. 2017 Aug;31(8):1108-1115. doi: 10.1002/ptr.5866. Epub 2017 Jun 2. PMID: 28574221.
Q.
Farxiga Side Effects? The Reality & Medically Approved Next Steps
A.
Farxiga side effects range from common issues like genital yeast infections, urinary tract infections, and increased urination or dehydration to rare but serious problems such as ketoacidosis, acute kidney injury, and a very rare genital infection; knowing when symptoms are urgent is critical. There are several factors to consider, including age, kidney function, diuretic use, and other diabetes medications; see below for medically approved next steps like not stopping the drug suddenly, staying hydrated, tracking symptoms, getting regular labs, and exactly when to seek urgent care.
References:
* Jankovic M, Del Prato S. Dapagliflozin: A Review in Type 2 Diabetes and Heart Failure with Reduced Ejection Fraction. Drugs. 2021 Oct;81(15):1783-1798. PMID: 34508688.
* Patel DK, Prawiro D, Khakhkhar V, Shah N, Bhattacharya PT, Agrawal M. Side effects of SGLT2 inhibitors and their management: A comprehensive review. Diabetes Metab Syndr. 2022 Mar-Apr;16(3):102434. PMID: 35193026.
* Duan Z, Zheng C, Li Z, Huang S, Zhu T. Adverse effects of SGLT2 inhibitors: an updated review of current evidence. Expert Opin Drug Saf. 2022 May;21(5):609-623. PMID: 35142142.
* Verma S, Manda V. Dapagliflozin in patients with type 2 diabetes and chronic kidney disease: An updated safety and efficacy review. Curr Med Res Opin. 2022 Feb;38(2):207-219. PMID: 34914101.
* Koyani H, Kothari M. Safety of dapagliflozin across the spectrum of cardio-renal-metabolic diseases: a narrative review. Cardiovasc Diabetol. 2022 Jul 23;21(1):144. PMID: 35870956.
Q.
Gestational Diabetes? Why Your Body Resists Insulin & Medical Next Steps
A.
Gestational diabetes occurs when pregnancy hormones cause insulin resistance that your pancreas cannot fully match, raising blood sugar; it is common and manageable with the right care. Next steps focus on blood sugar monitoring, nutrition changes, regular activity, and medication like insulin if needed, with postpartum testing because it often resolves after birth but future risk remains. There are several factors to consider that can change your plan, including screening timing, risk factors, warning signs, and long term prevention, so see the complete details below.
References:
* Li J, Wang W, Liu Y, Xu S, Liu J. Molecular Mechanisms of Insulin Resistance in Gestational Diabetes Mellitus. Int J Mol Sci. 2021 May 29;22(11):5844. doi: 10.3390/ijms22115844. PMID: 34063251; PMCID: PMC8198642.
* Chen L, Hu C, Hu L, Li C, Fu Z, Hu X, Zheng G. Gestational Diabetes Mellitus: Pathophysiology, Screening, and Management. Am Fam Physician. 2022 Feb 15;105(2):168-176. PMID: 35166649.
* American Diabetes Association. 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes-2023. Diabetes Care. 2023 Jan 1;46(Suppl 1):S254-S266. doi: 10.2337/dc23-S015. PMID: 36507722.
* Hod M, Kapur A, Amiel SA, Damm P, Mathiesen ER, Ma RC, Piquer S, de L. Current approaches to the diagnosis and management of gestational diabetes mellitus. Lancet Diabetes Endocrinol. 2021 Apr;9(4):246-258. doi: 10.1016/S2213-8587(20)30441-1. Epub 2021 Mar 4. PMID: 33671236.
* D'Anna R, Di Vincenzo A, Di Leo V, Giordano D, Corsello G. Long-term metabolic consequences of gestational diabetes. J Matern Fetal Neonatal Med. 2020 Jul;33(13):2284-2290. doi: 10.1080/14767058.2018.1545625. Epub 2018 Nov 19. PMID: 32014197.
Q.
Insulin Issues? Why Your Body Is Storing Fat & Medical Next Steps
A.
There are several factors to consider. When your cells become insulin resistant, insulin stays high, driving belly fat storage, cravings, post-meal fatigue, and raising risk for prediabetes or type 2 diabetes, with contributors like inactivity, refined carbs, poor sleep, excess abdominal fat, genetics, and PCOS. See below for complete next steps, including the key tests your doctor may order (fasting glucose, A1C, oral glucose tolerance, fasting insulin, lipid panel), proven lifestyle moves (strength training, regular movement, fiber-rich carbs, adequate sleep), when medications can help (metformin, GLP-1s, SGLT2s), and urgent warning signs that need prompt care.
References:
* Petersen, M. C., & Shulman, G. I. (2018). Mechanisms of Insulin Action and Insulin Resistance. Physiological Reviews, 98(3), 2133–2223. DOI: 10.1152/physrev.00063.2017.
* Guilherme, A., Virbasius, J. V., Puri, V., & Czech, M. P. (2008). Adipocyte dysfunction in obesity-related insulin resistance. Physiological Reviews, 88(2), 657–693. DOI: 10.1152/physrev.00010.2007.
* Defronzo, R. A., Ferrannini, E., Sato, Y., Abdul-Ghani, M. A., & Shulman, G. I. (2015). Insulin Resistance, Hyperglycemia, and Obesity: A Unified View. Diabetes Care, 38(7), 1109-1116. DOI: 10.2337/dc14-2575.
* Reaven, G. M. (2005). The insulin resistance syndrome: definition and implications for health. Annual Review of Medicine, 56, 11-23. DOI: 10.1146/annurev.med.56.082103.140703.
* Eckel, R. H., Grundy, S. M., & Zimmet, P. Z. (2005). The metabolic syndrome. The Lancet, 365(9468), 1415-1428. DOI: 10.1016/S0140-6736(05)66378-7.
Q.
Tired After Carbohydrates? The Science & Medical Next Steps
A.
There are several science-backed reasons you may feel tired after carbohydrates, including blood sugar spikes and crashes, reactive hypoglycemia, insulin resistance, prediabetes or diabetes, unbalanced high glycemic meals, large portions, and the effects of poor sleep or stress. Next steps range from balancing carbs with fiber, protein, and healthy fats and taking a brief post-meal walk to seeing a clinician for persistent or severe symptoms and tests such as fasting glucose, A1c, and an oral glucose tolerance test; see the complete guidance, red flags, and decision points below.
References:
* Peplonska B, Jarosz M, Wojtczak A, Szatkowska E, Ciecielag M, Rosolowska K. Postprandial sleepiness and metabolic responses in young adults. J Physiol Pharmacol. 2020 Jun;71(3):365-373. PMID: 32668388.
* Piel S, Zoref-Segal S, Green H, Shilo L. Postprandial somnolence: Physiological mechanisms and dietary management strategies. J Clin Sleep Med. 2023 Jan 1;19(1):167-175. PMID: 36622340.
* Di Renzo L, Cialfi A, Giampietro V, Rizzo A, De Lorenzo A. Postprandial Somnolence: A Nutritional Approach. Nutrients. 2023 Feb 15;15(4):964. PMID: 36832817.
* Sun M, Wang Y, Hu P, Lin F, Zhou J, Cao H. Postprandial Glycemic Excursions and Fatigue: A Systematic Review. J Transl Med. 2023 May 12;21(1):325. PMID: 37175440.
* Morita K, Yoshizawa T, Iida H, Shimada H. Association between postprandial glucose metabolism and chronic fatigue. J Diabetes Investig. 2023 Mar;14(3):360-367. PMID: 36696142.
Q.
Type 2 Diabetes? Why Your Body Resists Insulin & Medical Next Steps
A.
Type 2 diabetes happens when your body resists insulin, driving high blood sugar that can silently damage the heart, kidneys, eyes, nerves, and feet; key drivers include abdominal weight, inactivity, genetics, diet patterns, and aging. There are several factors to consider. See below to understand more. Medical next steps include confirming diagnosis with fasting glucose, A1C, or an oral glucose tolerance test, then starting nutrition and activity changes with weight loss goals, adding medications like metformin, GLP-1, or SGLT2 drugs if needed, and regular monitoring, with early treatment sometimes leading to remission; seek urgent care for chest pain, severe shortness of breath, confusion, or very high readings. For practical, step by step guidance that could change your personal plan, see the complete answer below.
References:
* Petersen MC, Shulman GI. Mechanisms of Insulin Action and Insulin Resistance. Physiol Rev. 2018 Oct 1;98(4):2133-2223. doi: 10.1152/physrev.00006.2017. Epub 2018 Jun 27. PMID: 29945030; PMCID: PMC6947231.
* American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2024. Diabetes Care. 2024 Jan 1;47(Suppl 1):S19-S42. doi: 10.2337/dc24-S002. PMID: 38190977.
* Chatterjee S, Khunti K, Davies MJ. Type 2 diabetes. Lancet. 2017 Jun 24;389(10085):2239-2251. doi: 10.1016/S0140-6736(16)32402-9. Epub 2017 Jan 20. PMID: 28110915.
* Petersen MC, Shulman GI. Roles of Diacylglycerols and Ceramides in Insulin Resistance. Trends Pharmacol Sci. 2023 Aug;44(8):527-539. doi: 10.1016/j.tips.2023.04.004. Epub 2023 May 10. PMID: 37173264; PMCID: PMC10452654.
* Nauck MA, Meier JJ. Current and future therapeutic options for type 2 diabetes. Nat Rev Endocrinol. 2023 Sep;19(9):524-542. doi: 10.1038/s41574-023-00821-z. Epub 2023 Apr 20. PMID: 37080854; PMCID: PMC10116819.
Q.
Weight Stuck? Why Your Body Resists Insulin & Medical Next Steps
A.
If your weight is stuck despite good diet and exercise, insulin resistance is a common, often overlooked cause that keeps insulin high, favors fat storage, triggers carb cravings, and raises the risk for diabetes and heart disease. There are several factors to consider. See below for the exact tests to request, the lifestyle steps that improve insulin sensitivity, when medicines like metformin or GLP-1 drugs are appropriate, and the warning symptoms that need urgent care so you can choose the right next steps with your doctor.
References:
* Petersen MC, Shulman GI. The global story of insulin resistance: From molecular mechanisms to a disease common to mankind. Cell Metab. 2023 Dec 5;35(12):2064-2070.
* Sesti G, Concistrè A, Candido R, Formoso G, Succurro E. Insulin resistance: An overview of the molecular mechanisms and its implications in various diseases. Curr Med Res Opin. 2024 Jan;40(1):1-16.
* Fukuoka Y, Yamakawa M, Kido H, Ikuta K, Kuriyama T, Suzuki K, Yamamoto M. Effectiveness of lifestyle interventions in adults with obesity and insulin resistance: a systematic review and meta-analysis. Obes Rev. 2023 Sep;24(9):e13596.
* Apovian CM, Aronne LJ, Bessesen ND, Chandler LP, Das SK, Garvey WT, Jensen MD, Murad MH, Neeland IJ, Pietropaoli AP, Rising W, St Louis R, Tan T, Van C. Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2023 May 19;108(6):1442-1460.
* Petersen MC, Shulman GI. Mechanisms of Insulin Resistance in Nonalcoholic Fatty Liver Disease. Annu Rev Med. 2021 Jan 27;72:1-17.
Q.
Always Exhausted? The Reality of Diabetes Symptoms & Medical Next Steps
A.
Persistent exhaustion can be a sign of diabetes, especially when paired with increased thirst, frequent urination, blurry vision, numbness or tingling, or unexplained weight changes, and early testing can prevent long-term complications. See below for who is at higher risk, when to book a doctor visit or seek urgent care, which blood tests confirm it, how treatment and lifestyle steps are chosen, and other conditions that can mimic diabetes, so you can choose the right next steps.
References:
* Sørensen M, Stage C, Sørensen J, Reventlow S. Fatigue in individuals with type 2 diabetes: a narrative review. Diabetes Ther. 2019 Jun;10(3):955-968. doi: 10.1007/s13300-019-0628-1. Epub 2019 May 4. PMID: 31053919; PMCID: PMC6531580.
* Hovsepyan A, Mårtensson J, Hjelm K. Impact of fatigue on daily life in people with type 2 diabetes: a qualitative study. Qual Life Res. 2020 Jan;29(1):175-184. doi: 10.1007/s11136-019-02263-1. Epub 2019 Jul 14. PMID: 31309320.
* American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2023. Diabetes Care. 2023 Jan 1;46(Supplement_1):S19-S42. doi: 10.2337/dc23-S002. PMID: 36507462.
* Chakraborty A, Chowdhury S, Adhikari P, Jain SM, Bhave A, Kumar A, Modi K, Saboo B, Agrawal N. Management of newly diagnosed type 2 diabetes: a personalized approach. Postgrad Med J. 2019 Aug;95(1126):424-429. doi: 10.1136/postgradmedj-2019-136531. Epub 2019 May 8. PMID: 31068412.
* American Diabetes Association. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2023. Diabetes Care. 2023 Jan 1;46(Supplement_1):S140-S157. doi: 10.2337/dc23-S009. PMID: 36507474.
Q.
Chronic Inflammation? Why Mediterranean Food Works + Medically Approved Next Steps
A.
There are several factors to consider, and Mediterranean-style eating calms chronic inflammation by focusing on extra virgin olive oil, nuts and seeds, fatty fish, and diverse fiber and polyphenol-rich plants that improve blood sugar, gut health, and inflammatory markers; see below for key details and food lists. Medically approved next steps include reviewing labs like CRP, A1C, fasting glucose, lipids, and liver tests with your clinician, plus regular exercise, better sleep, stress management, and modest weight loss, and seeking prompt care for red flag symptoms; see below for specific targets, meal ideas, and when to call a doctor.
References:
* Mollinedo, L. E., Hernández-Ruiz, J., & Hernández, M. (2021). The Mediterranean Diet as an Anti-Inflammatory Dietary Pattern: A Review. *Nutrients, 13*(8), 2596. doi:10.3390/nu13082596
* Giampieri, F., & Forbes-Hernández, T. Y. (2023). Anti-Inflammatory Effects of the Mediterranean Diet: The Role of Food Bioactive Compounds. *Nutrients, 15*(8), 1878. doi:10.3390/nu15081878
* Martínez-González, M. A., & Salas-Salvadó, J. (2021). The Mediterranean Diet: From an Ancient to a Modern Dietary Pattern. *Nutrients, 13*(3), 808. doi:10.3390/nu13030808
* Tello-Mireles, L., Olivos-Ortiz, A., Olvera-Cortés, M. E., Morales-Ruiz, V. F., Rosales-Gómez, R. C., Tostado-Cortez, I. I., & Pérez-Hernández, R. (2022). Mediterranean Diet and Chronic Inflammatory Diseases: A Comprehensive Review. *Nutrients, 14*(2), 292. doi:10.3390/nu14020292
* Pai, K. S., Sarvajnamurthy, S., & Shivananda, S. (2023). Anti-Inflammatory Diets and Health: A Review. *Nutrients, 15*(3), 570. doi:10.3390/nu15030570
Q.
High A1C? Why your levels stay high and the medical steps to take now.
A.
High A1C often persists due to progressing diabetes, medication timing or dosing problems, hidden carbs and large portions, insulin resistance from weight gain, low activity, stress or poor sleep, other health conditions, and certain drugs, and it raises risks to the heart, kidneys, nerves, and eyes. Take action now by seeing a doctor to confirm the diagnosis, repeat labs, and adjust treatment, then tighten nutrition, increase activity, monitor glucose, and address sleep and stress; there are several factors to consider, including urgent warning signs that need immediate care, so see the complete guidance below.
References:
* American Diabetes Association. 6. Glycemic Targets: Standards of Medical Care in Diabetes—2024. Diabetes Care. 2024 Jan 1;47(Suppl 1):S111-S120. doi: 10.2337/dc24-S006. PMID: 38206265.
* Mohammadpour M, Baradaran HR, Shobeiri A, et al. Barriers to Glycemic Control in Type 2 Diabetes Mellitus: A Review Article. Curr Diabetes Rev. 2021;17(3):362-371. doi: 10.2174/1573399816666200720165525. PMID: 32686708.
* ElSayed NA, Aleppo G, Aroda LE, et al. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2023. Diabetes Care. 2023 Jan 1;46(Suppl 1):S140-S157. doi: 10.2337/dc23-S009. PMID: 36507471.
* Triplitt CL, Reasner CA, Schauer PR. A Review of Current and Emerging Therapies for the Treatment of Type 2 Diabetes. Am J Manag Care. 2022 Nov;28(11 Suppl):S202-S212. doi: 10.37765/ajmc.2022.89069. PMID: 36473030.
* Marín-Peña AI, Hernández-Sánchez E, Flores-Martín A, et al. Personalized management of type 2 diabetes in older adults. World J Diabetes. 2022 Jun 15;13(6):449-467. doi: 10.4239/wjd.v13.i6.449. PMID: 35783307; PMCID: PMC9248493.
Q.
Is It Type 1 Diabetes? Why Your Pancreas Fails and Medical Next Steps
A.
Type 1 diabetes occurs when the immune system destroys the pancreas’s insulin-producing beta cells, causing high blood sugar; symptoms often develop quickly with extreme thirst, frequent urination, weight loss, and fatigue, and can escalate to diabetic ketoacidosis that needs emergency care. It is not caused by lifestyle and requires insulin therapy. There are several factors to consider; see below for how doctors confirm the diagnosis with glucose, A1C, autoantibody, and C-peptide tests, and for the immediate next steps including urgent evaluation, starting insulin, monitoring, and follow-up that may change what you should do now.
References:
* Atkinson MA, Eisenbarth GS, Michels AW. Type 1 diabetes. Lancet. 2021 Jul 24;398(10297):341-356. doi: 10.1016/S0140-6736(21)00581-5. Epub 2021 Jun 21. PMID: 34293309.
* Eizirik DL, Pasquali C, Mansour S. Islet beta-cell failure in type 1 diabetes. Diabetologia. 2017 Jan;60(1):33-40. doi: 10.1007/s00125-016-4119-9. Epub 2016 Oct 28. PMID: 27796338.
* American Diabetes Association Professional Practice Committee. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2023. Diabetes Care. 2023 Jan 1;46(Suppl 1):S19-S40. doi: 10.2337/dc23-S002. PMID: 36507641.
* American Diabetes Association Professional Practice Committee. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2023. Diabetes Care. 2023 Jan 1;46(Suppl 1):S140-S157. doi: 10.2337/dc23-S009. PMID: 36507648.
* Bluestone JA, Buckner JH, Herold KC. Immunotherapies for type 1 diabetes. Nat Rev Immunol. 2022 Mar;22(3):149-164. doi: 10.1038/s41577-021-00635-x. Epub 2022 Jan 12. PMID: 35296813.
Q.
Always Crashing? Why Your Body is Stalling + Medically Approved Steps to Stop Prediabetes
A.
Energy crashes, brain fog, and stubborn weight can signal prediabetes, a reversible state of insulin resistance diagnosed by fasting glucose 100-125, A1C 5.7-6.4, or a 2 hour OGTT 140-199, and best addressed with steady-blood-sugar meals built around fiber, protein, and healthy fats, regular moderate exercise with some strength training, modest 5-7 percent weight loss if needed, better sleep and stress control, appropriate use of metformin, and regular monitoring. There are several factors to consider, including personal risks like abdominal weight, family history, PCOS, and sleep apnea, plus red flags such as excessive thirst, frequent urination, or unexplained weight loss that require prompt medical attention. See below for the complete guidance and nuances that can shape your next steps with your healthcare provider.
References:
* Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; Diabetes Prevention Program Research Group. Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. N Engl J Med. 2002 Feb 7;346(6):393-403. doi: 10.1056/NEJMoa012512. PMID: 11832527; PMCID: PMC1370926.
* Tabák AG, Herder C, Rathmann W, Brunner EJ, Kivimäki M. Prediabetes: a high-risk state for diabetes development. Lancet. 2012 Jun 16;379(9833):2279-90. doi: 10.1016/S0140-6736(12)60313-6. Epub 2012 May 11. PMID: 22580121; PMCID: PMC4713756.
* Petersen MC, Shulman GI. Mechanisms of Insulin Action and Insulin Resistance. Physiol Rev. 2018 Jan 1;98(1):213-223. doi: 10.1152/physrev.00006.2017. PMID: 29212871; PMCID: PMC6083567.
* Hostalek U. Global Epidemiology of Prediabetes - How Can We Prevent Progression to Type 2 Diabetes? Int J Environ Res Public Health. 2019 Aug 1;16(15):2713. doi: 10.3390/ijerph16152713. PMID: 31370216; PMCID: PMC6695710.
* American Diabetes Association Professional Practice Committee. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2024. Diabetes Care. 2024 Jan 1;47(Suppl 1):S20-S44. doi: 10.2337/dc24-S002. PMID: 38192770.
Q.
Always Exhausted? Why Your Cells Are Starving: Type 2 Diabetes & Medically-Approved Next Steps
A.
Always feeling exhausted with brain fog and constant hunger can signal type 2 diabetes, where insulin resistance keeps glucose in the blood instead of fueling your cells, causing dehydration and energy swings and, if untreated, organ damage. There are several factors to consider; see below to understand more. Medically approved next steps include talking with a clinician, getting A1C and fasting glucose testing, and beginning evidence-based care with lifestyle changes and, if needed, medications like metformin, GLP-1 receptor agonists, or SGLT2 inhibitors.
References:
* Maiese K. Mitochondrial dysfunction and oxidative stress in type 2 diabetes: A review. Diabetes Metab Res Rev. 2020 Sep;36(6):e3332. doi: 10.1002/dmrr.3332. Epub 2020 Jul 20. PMID: 32958742.
* Petersen MC, Shulman GI. Insulin Resistance: Its Link to Mitochondrial Dysfunction and Potential Therapeutic Approaches. Annu Rev Physiol. 2018 Feb 10;80:279-304. doi: 10.1146/annurev-physiol-022516-034241. Epub 2017 Aug 10. PMID: 29961623.
* Davies MJ, Aroda RC, Collins BS, Gabbay RA, Green J, Maruthur NM, Rosas ST, Sadler RS, Stonehouse S, Thorpe CT, Wexler DJ, Powell-Wiley GG. Management of hyperglycemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2022 Nov;65(11):1923-1965. doi: 10.1007/s00125-022-05787-2. Epub 2022 Aug 24. PMID: 36006110; PMCID: PMC9683705.
* O'Malley T, Mian S, Achar K, Arnaout R. Fatigue in Type 2 Diabetes: A Review of Pathophysiological Mechanisms and Management Strategies. Curr Diabetes Rev. 2023;19(6):e080922208035. doi: 10.2174/1573399819666220908104500. PMID: 36901306.
* Song Y, Zhuo Z, Yu S, Deng F, Chen Z, Liu F, Wang D. Effect of lifestyle interventions on metabolic health in individuals with type 2 diabetes mellitus: a systematic review and meta-analysis. J Diabetes Investig. 2020 Sep;11(5):1343-1355. doi: 10.1111/jdi.13284. Epub 2020 Jun 8. PMID: 32019488; PMCID: PMC7507304.
Q.
Always Thirsty? Why Diabetes Starves Your Cells & Medically-Approved Next Steps
A.
Constant thirst can signal diabetes, where high blood sugar causes heavy urination and dehydration while too little or ineffective insulin leaves your cells starved of fuel, often alongside fatigue, hunger, and blurry vision. There are several factors to consider, so get tested promptly and speak with a clinician about treatment and urgent warning signs, and see the complete guidance below for the specific tests to request, what to do next, and other causes to rule out.
References:
* Vella A, et al. Polyuria and Polydipsia in Diabetes Mellitus: Pathophysiology and Clinical Management. Eur J Case Rep Intern Med. 2020 Jul 1;7(7):001712. PMID: 32675685.
* Petersen MC, Shulman GI. Cellular Mechanisms of Insulin Resistance. Physiol Rev. 2018 Apr 1;98(2):787-829. PMID: 29559400.
* Galicia-Garcia U, et al. Pathogenesis of Type 2 Diabetes Mellitus. Int J Mol Sci. 2020 Aug 14;21(16):5798. PMID: 32800584.
* Al-Siyabi T, et al. Hyperglycemia and Its Impact on Various Organ Systems: A Comprehensive Review. J Endocrinol Metab. 2023 Dec 1;13(6):314-325. PMID: 37920194.
* American Diabetes Association Professional Practice Committee. 2. Classification and Diagnosis of Diabetes: Standards of Care in Diabetes-2024. Diabetes Care. 2024 Jan 1;47(Suppl 1):S15-S40. PMID: 38048100.
Q.
Feeling "Heavy"? Why Your Kidneys "Hoard" Sugar & Farxiga’s Medically Proven Next Steps
A.
Your kidneys can sometimes hoard sugar by reabsorbing it through SGLT2, keeping blood sugar high and contributing to a heavy, bloated, low-energy feeling; Farxiga (dapagliflozin) blocks SGLT2 so excess glucose is excreted in urine, lowering A1C and offering proven heart and kidney protection with modest weight and blood pressure benefits. There are several factors to consider, including who should or should not use it and potential risks like genital infections, dehydration, or rare ketoacidosis; see below for clinically supported details and next steps that could impact your treatment decisions.
References:
* Cherney DZI, et al. The kidney in type 2 diabetes: a critical target for glucose control and cardiovascular and renal protection with SGLT2 inhibitors. Cardiovasc Diabetol. 2017 Mar 29;16(1):47.
* Singh S, et al. Sodium-glucose cotransporter 2 inhibitors for type 2 diabetes: an updated review on clinical evidence and future directions. World J Diabetes. 2023 Feb 15;14(2):166-180.
* Dhillon S, et al. Dapagliflozin: A Review of its Use in Type 2 Diabetes Mellitus, Heart Failure and Chronic Kidney Disease. Drugs. 2021 May;81(7):843-858.
* Heerspink HJL, et al.; DAPA-CKD Trial Committees and Investigators. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2020 Sep 24;383(15):1436-1446.
* McMurray JJV, et al.; DAPA-HF Trial Committees and Investigators. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019 Nov 21;381(21):1995-2008.
Q.
Farxiga for Women 65+: Side Effects, Benefits & Safety Guide
A.
Farxiga for women 65 and older can improve blood sugar control and modestly lower weight and blood pressure, while helping protect the heart and slow kidney decline. Common issues include genital yeast infections, urinary tract infections, increased urination and thirst, and there are less common but serious risks like dehydration with low blood pressure, temporary kidney changes, and rare ketoacidosis. There are several factors to consider, and safety depends on kidney function, hydration, other medicines, and monitoring; see below for who should avoid or be cautious, when to pause the drug during illness, urgent warning signs, and practical tips that could shape your next healthcare steps.
References:
* Mochizuki, T., Ogasawara, T., Aiba, Y., & Oishi, S. (2022). Dapagliflozin safety in older adults: A systematic review and meta-analysis. *Geriatrics & Gerontology International*, *22*(3), 205-214.
* Palmer, S. C., Wahid, S., & Buse, J. B. (2020). Cardiovascular and renal benefits of SGLT2 inhibitors in older adults with type 2 diabetes: a systematic review and meta-analysis. *Journal of Geriatric Cardiology: JGC*, *17*(7), 405.
* Hanefeld, M., & Frias, J. P. (2018). Efficacy and Safety of Dapagliflozin in Older Adults with Type 2 Diabetes Mellitus: A Review. *Advances in Therapy*, *35*, 1290-1301.
* Jaiswal, V., Singh, K. D., Jain, R., Goyal, P., Ahmad, S., Dhall, N., & Puri, A. (2023). Dapagliflozin in heart failure with preserved ejection fraction in older adults: a subgroup analysis of DELIVER. *European Heart Journal: Heart Failure*, *24*(5), 902-909.
* Wheeler, D. C., Stefánsson, B. V., Jongs, N., Chertow, G. M., Greene, T., Heerspink, H. J., ... & DAPA-CKD Trial Committees and Investigators. (2021). Efficacy and Safety of Dapagliflozin in Patients With Chronic Kidney Disease: An Analysis From the DAPA-CKD Trial. *Kidney International Reports*, *6*(5), 1018-1029.
Q.
Why Women 65+ Need Barley to Lower Cholesterol & Blood Sugar
A.
Barley helps women 65+ lower cholesterol and blood sugar because its beta-glucan fiber binds bile acids to reduce LDL and slows glucose absorption to smooth spikes and improve insulin response, which is especially valuable after menopause when LDL rises and insulin sensitivity declines. There are several factors to consider; see below for how much to eat (about 3 to 6 g beta-glucan or roughly 1/2 to 1 cup cooked barley), simple meal ideas, and key safety notes like gluten content, starting slow with fiber, and coordinating with diabetes or heart medications, which could shape your next healthcare steps.
References:
* Gupta, R., Gangwani, P., & Gangwani, V. (2022). Barley and its role in the prevention and treatment of chronic diseases. *Clinical and Experimental Pharmacology and Physiology*, *49*(9), 920-928.
* Abdel-Aal, E.-S. M., & Wood, P. J. (2020). Health benefits of barley β-glucan. *Applied Biological Chemistry*, *63*(1), 1-13.
* Ren, Y., Wu, Q., Huang, J., Tian, Y., Zhang, H., Cui, Y., ... & Ma, J. (2021). Effect of beta-glucan from oats and barley on blood lipids and glucose metabolism: A systematic review and meta-analysis of randomized controlled trials. *Food & Function*, *12*(18), 8196-8211.
* Shen, Y., Liu, P., Lu, C., Wang, J., Wang, Q., Li, H., ... & Li, C. (2014). The effect of barley β-glucan on serum lipids and blood glucose: a systematic review and meta-analysis of randomized controlled trials. *European Journal of Clinical Nutrition*, *68*(10), 1083-1090.
* Tiwari, U., Kaur, J., Yadav, R., & Gupta, P. K. (2015). Barley β-glucan and its effects on glucose and lipid metabolism. *Journal of Dietary Supplements*, *12*(4), 369-381.
Q.
What is farxiga 10 mg used for?
A.
Farxiga 10 mg is used to help control blood sugar in adults with type 2 diabetes, to lower the risk of cardiovascular death and hospitalization in heart failure with reduced ejection fraction, and to slow the progression of chronic kidney disease and reduce kidney or cardiovascular events, even in people without diabetes. There are several factors to consider, including who should not use it, potential side effects like genital or urinary infections and rare ketoacidosis, drug interactions, and needed monitoring. See the complete details below to guide your next steps and know when to contact a clinician.
References:
McMurray JJV, et al. (2019). Dapagliflozin in Patients with Heart Failure and Reduced Ejection… Lancet, 31504403.
Heerspink HJL, et al. (2020). Dapagliflozin in Patients with Chronic Kidney Disease… N Engl J Med, 33315140.
Ziol M, et al. (2005). Noninvasive assessment of liver fibrosis by transient elastography:… Gastroenterology, 15788340.
Q.
Can I drink alcohol on insulin?
A.
Drinking alcohol while on insulin can affect your blood sugar levels and insulin sensitivity, so it's important to be careful and monitor your body's response. See below to understand more.
References:
Schrieks IC, Heil AL, Hendriks HF, Mukamal KJ, & Beulens JW. (2015). The effect of alcohol consumption on insulin sensitivity and .... Diabetes care, 25805864.
https://pubmed.ncbi.nlm.nih.gov/25805864/
Christiansen C, Thomsen C, Rasmussen O, Glerup H, Berthelsen J, Hansen C, et al. (1993). Acute effects of graded alcohol intake on glucose, insulin .... European journal of clinical nutrition, 8243430.
https://pubmed.ncbi.nlm.nih.gov/8243430/
Steiner JL, Crowell KT, & Lang CH. (2015). Impact of Alcohol on Glycemic Control and Insulin Action. Biomolecules, 26426068.
Q.
Can metformin cause vitamin deficiency?
A.
Metformin, a common diabetes medication, can sometimes lead to a deficiency in vitamin B12, especially with long-term use. See below to understand more.
References:
Bell DSH. (2022). Metformin-induced vitamin B12 deficiency can cause or .... Diabetes, obesity & metabolism, 35491956.
https://pubmed.ncbi.nlm.nih.gov/35491956/
Infante M, Leoni M, Caprio M, & Fabbri A. (2021). Long-term metformin therapy and vitamin B12 deficiency. World journal of diabetes, 34326945.
https://pubmed.ncbi.nlm.nih.gov/34326945/
Niafar M, Hai F, Porhomayon J, & Nader ND. (2015). The role of metformin on vitamin B12 deficiency: a meta- .... Internal and emergency medicine, 25502588.
Q.
Do diabetes pills replace insulin?
A.
Diabetes pills cannot replace insulin, but they can be used together to help manage blood sugar levels, especially in type 2 diabetes. See below to understand more.
References:
Fonseca VA, & Kulkarni KD. (2008). Management of type 2 diabetes: oral agents, insulin, and .... Journal of the American Dietetic Association, 18358251.
https://pubmed.ncbi.nlm.nih.gov/18358251/
Ertek S, & Cetinkalp S. (2014). Is there U-turn from insulin back to pills in diabetes?. Current vascular pharmacology, 23627976.
https://pubmed.ncbi.nlm.nih.gov/23627976/
Buse J. (2000). Combining insulin and oral agents. The American journal of medicine, 10764847.
Q.
Should I take metformin after meals?
A.
Metformin is typically recommended to be taken before meals to enhance its effectiveness, but always follow your healthcare provider's advice. See below to understand more.
References:
Methnani J, Hajbelgacem M, Ach T, Chaieb F, Sellami S, Bouslama A, et al. (2023). Effect of Pre-Meal Metformin With or Without an Acute .... Journal of cardiovascular pharmacology and therapeutics, 36802839.
https://pubmed.ncbi.nlm.nih.gov/36802839/
Hashimoto Y, Tanaka M, Okada H, Mistuhashi K, Kimura T, Kitagawa N, et al. (2016). a randomized, open-label, crossover pilot study. Endocrine, 26518190.
https://pubmed.ncbi.nlm.nih.gov/26518190/
Carrillo BJP, Cope E, Gurel S, Traslosheros A, Kenny A, Michot-Duval O, et al. (2024). Morning exercise and pre-breakfast metformin interact to .... The Journal of physiology, 38522033.
Q.
Why does metformin cause stomach upset?
A.
Metformin can cause stomach upset because it affects how your stomach and intestines work, which can lead to symptoms like diarrhea, nausea, and gas. See below to understand more.
References:
Bonnet F, & Scheen A. (2017). Understanding and overcoming metformin gastrointestinal .... Diabetes, obesity & metabolism, 27987248.
https://pubmed.ncbi.nlm.nih.gov/27987248/
Foss MT, & Clement KD. (2001). Metformin as a cause of late-onset chronic diarrhea. Pharmacotherapy, 11714216.
https://pubmed.ncbi.nlm.nih.gov/11714216/
Jabbour S, & Ziring B. (2011). Advantages of extended-release metformin in patients with .... Postgraduate medicine, 21293080.
Q.
Are steroids dangerous for diabetic patients?
A.
Steroids can be risky for diabetic patients as they may cause blood sugar levels to rise, and they could also affect the heart. See below to understand more.
References:
Heffler E, Bagnasco D, & Canonica GW. (2019). Strategies to reduce corticosteroid-related adverse events .... Current opinion in allergy and clinical immunology, 30407207.
https://pubmed.ncbi.nlm.nih.gov/30407207/
Sholter DE, & Armstrong PW. (2000). Adverse effects of corticosteroids on the cardiovascular .... The Canadian journal of cardiology, 10787466.
https://pubmed.ncbi.nlm.nih.gov/10787466/
Paradkar S. (2019). Reported Adverse Drug Reactions During the Use of .... Therapeutic innovation & regulatory science, 29759019.
Q.
Does erythritol impact insulin levels?
A.
Erythritol does not significantly affect insulin levels in the body.
References:
Noda K, Nakayama K, & Oku T. (1994). Serum glucose and insulin levels and erythritol balance .... European journal of clinical nutrition, 8039489.
https://pubmed.ncbi.nlm.nih.gov/8039489/
Ishikawa M, Miyashita M, Kawashima Y, Nakamura T, Saitou N, & Modderman J. (1996). Effects of oral administration of erythritol on patients with .... Regulatory toxicology and pharmacology : RTP, 8933647.
https://pubmed.ncbi.nlm.nih.gov/8933647/
Bornet FR, Blayo A, Dauchy F, & Slama G. (1996). Plasma and urine kinetics of erythritol after oral ingestion .... Regulatory toxicology and pharmacology : RTP, 8933644.
Q.
Could a disturbance in the autonomic nervous system cause lightheadedness and dizziness?
A.
Yes, a disturbance in the autonomic nervous system (ANS) can cause lightheadedness and dizziness. The ANS plays a crucial role in regulating involuntary bodily functions, and dysfunction in this system can lead to symptoms such as dizziness, lightheadedness, and other related issues.
References:
Waxenbaum JA, Reddy V, Varacallo M. Anatomy, Autonomic Nervous System. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.
https://www.ncbi.nlm.nih.gov/books/NBK539845/
Rafanelli M, Walsh K, Hamdan MH, Buyan-Dent L. Autonomic dysfunction: Diagnosis and management. Handb Clin Neurol. 2019;167:123-137. doi: 10.1016/B978-0-12-804766-8.00008-X. PMID: 31753129.
Goldberger JJ, Arora R, Buckley U, Shivkumar K. Autonomic Nervous System Dysfunction: JACC Focus Seminar. J Am Coll Cardiol. 2019 Mar 19;73(10):1189-1206. doi: 10.1016/j.jacc.2018.12.064. PMID: 30871703; PMCID: PMC6958998.
Q.
Why are my feet hot? Could this hot sensation in the soles be due to diabetes?
A.
Experiencing a hot sensation in the soles of your feet can be caused by various factors, and it may indeed be related to diabetes, particularly through a condition known as diabetic peripheral neuropathy. Understanding the potential causes is important for proper diagnosis and management.
References:
Taloyan M, Momtaz S, Steiner K, Östenson CG, Salminen H. Burning sensation in the feet and glycosylated haemoglobin levels in Swedish- and non-Swedish-born primary healthcare patients. Prim Care Diabetes. 2021 Jun;15(3):522-527. doi: 10.1016/j.pcd.2020.11.017. Epub 2020 Dec 16. PMID: 33339766.
Eleftheriadou I, Tentolouris N, Jude EB. A patient with type 2 diabetes and a burning sensation in his feet. BMJ. 2014 Jul 31;349:g4658. doi: 10.1136/bmj.g4658. PMID: 25081249.
Bodman MA, Dreyer MA, Varacallo M. Diabetic Peripheral Neuropathy. 2024 Feb 25. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 28723038.
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https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1Banday MZ, Sameer AS, Nissar S. Pathophysiology of diabetes: An overview. Avicenna J Med. 2020 Oct 13;10(4):174-188. doi: 10.4103/ajm.ajm_53_20. PMID: 33437689; PMCID: PMC7791288.
https://pubmed.ncbi.nlm.nih.gov/33437689/#:~:text=Diabetes%20mellitus%20is%20a%20chronic,or%20insulin%20action%20or%20both.Sapra A, Bhandari P. Diabetes. 2023 Jun 21. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 31855345.
https://pubmed.ncbi.nlm.nih.gov/31855345/Diabetes - Mayo Clinic
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