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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.
Managing Gestational Diabetes: A Doctor-Approved Meal Action Plan
A.
There are several factors to consider for a doctor-approved meal action plan for gestational diabetes. Emphasize steady, balanced eating with 3 small to moderate meals plus 2 to 3 snacks, prioritize high fiber carbohydrates, pair carbs with protein and healthy fats, and aim for consistent glucose control to lower risks to you and your baby. Key specifics that could change your next steps are detailed below, including starter carb ranges per meal and snack, a sample daily menu, breakfast strategies, the plate method, simple post meal activity, glucose targets and when to use medication, postpartum testing, and urgent symptoms that require calling your doctor.
References:
* pubmed.ncbi.nlm.nih.gov/33928178/
* pubmed.ncbi.nlm.nih.gov/34316744/
* pubmed.ncbi.nlm.nih.gov/33715104/
* pubmed.ncbi.nlm.nih.gov/35068222/
* pubmed.ncbi.nlm.nih.gov/30671409/
Q.
Need an Endocrinologist? Why Your Hormones Are Failing and Medically Approved Next Steps
A.
Hormone problems often develop gradually due to autoimmune disease, insulin resistance, aging, tumors, chronic stress, or genetics, and can look like thyroid changes, blood sugar issues, fatigue, weight shifts, and reproductive symptoms. There are several factors to consider. For clear, medically approved next steps, see below for when to start with primary care and targeted labs, when to see a board certified endocrinologist, which treatments and lifestyle changes are evidence based, the emergency warning signs that need urgent care, and what to avoid like unproven tests and supplements.
References:
* Gelfand, R. A., & Lipton, E. (2021). Endocrine disorders in primary care: A practical overview. *Current Opinion in Endocrine and Metabolic Research*, *18*, 223-228.
* Weir, L. E., & Dhatt, J. S. (2021). When to Refer to an Endocrinologist: Common Clinical Scenarios and Pitfalls. *Clinical Medicine (London, England)*, *21*(3), e272-e277.
* Khan, M. I., & Hashmi, F. J. (2021). Update on endocrine disorders in primary care. *Postgraduate Medical Journal*, *97*(1147), 304-311.
* Vella, A. (2021). Diagnostic tests in endocrinology: an overview. *Best Practice & Research. Clinical Endocrinology & Metabolism*, *35*(3), 101538.
* Chokshi, P. A., & Bacha, M. N. (2020). Advances in the management of common endocrine disorders. *Medical Clinics of North America*, *104*(6), 949-960.
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.
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.
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.
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.
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.
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.
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 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.
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.
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
https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444