Because many patients with diabetes have two or more comorbidities, they often require multiple medications. The prevalence of medication nonadherence is high among patients with chronic conditions, such as diabetes, and nonadherence is associated with public health issues and higher health care costs. One reason for nonadherence is the cost of medications. Being able to detect cost-related nonadherence is important for health care professionals, because this can lead to strategies to assist patients with problems paying for their medications. Some of these strategies are use of generic drugs or therapeutic alternatives, substituting a prescription drug with an over-the-counter medication, and pill-splitting. Interventions to improve adherence can achieve reductions in diabetes morbidity and mortality, as well as significant cost savings to the health care system. Smartphone apps have been found to improve self-management and health outcomes in people with diabetes through functions such as specific reminder alarms, while working with mental health professionals has also been found to help people with diabetes develop the skills to manage their medications and challenges of self-management effectively.
With diabetes, however, either the pancreas doesn’t produce the correct amount of insulin (Type 1) or the body’s cells are unable to process and utilize the insulin (Type 2). In both cases, this causes a buildup of glucose in the blood, which results in inadequate energy supply for the body and can cause dehydration, kidney and nerve damage, blindness, an increased risk for heart attack and stroke, and more.
When this happens for a period of time, the cells start to become resistant to the presence of insulin, causing a vicious cycle. The body then releases even more insulin, trying desperately to get the cells to uptake the toxic glucose. The presence of excess insulin in the bloodstream is also toxic and further damages the receptors on these cells. Eventually, the insulin allows the glucose access to your fat cells to get it out of the bloodstream. In other words- Fat isn’t stored as fat in the body- Sugar (from carbohydrates) is stored as fat!
Triglycerides are a common form of fat that we digest. Triglycerides are the main ingredient in animal fats and vegetable oils. Elevated levels of triglycerides are a risk factor for heart disease, heart attack, stroke, fatty liver disease, and pancreatitis. Elevated levels of triglycerides are also associated with diseases like diabetes, kidney disease, and medications (for example, diuretics, birth control pills, and beta blockers). Dietary changes, and medication if necessary can help lower triglyceride blood levels.
Diabetes can be very complicated, and the physician needs to have as much information as possible to help the patient establish an effective management plan. Physicians may often experience data overload resulting from hundreds of blood-glucose readings, insulin dosages and other health factors occurring between regular office visits which must be deciphered during a relatively brief visit with the patient to determine patterns and establish or modify a treatment plan.
In that analysis, the Khan study looks like an outlier. More studies have emerged since then: Crawford in 2009 found 1g of cinnamon per day reduced A1C levels compared to placebo. Suppapitiporn found no effect on any measure with 1.5g per day. Akilen, in 2010, found an effect with 2g per day. Another meta-analysis, published in 2012 and included 6 studies, concluded the opposite of Baker, and made positive conclusions:
Some medical professionals use an Oral Glucose Tolerance Test (OGTT) to test for diabetes. If you’ve ever been pregnant and had to drink the sickeningly sweet sugar cocktail and then have blood drawn, you are familiar with this one. Basically, a patient is given 50-75 grams of glucose in concentrated solution and his blood sugar response is measured. I’m not a fan of this test because no one should be ingesting that much concentrated glucose, and the test is not a completely accurate measure. (Just a side note: if you are a drinker of the “Big Gulp” drinks or large amounts of soda, you are putting your body through a similar test each day! Eventually, your body will respond, probably with something like “Fine, you want diabetes, I’ll show you diabetes!)
When the weight loss lessens the liver and pancreas fat, the insulin-producing beta cells in the pancreas come to life again. "Almost everyone will return to normal if they lose a substantial amount of weight," Taylor says. "This is a simple disease." What's yet to be figured out, he says, is why the weight loss doesn't lead to a reversal in everyone.
Pramlintide (Symlin) was the first in a class of injectable, anti-hyperglycemic medications for use in addition to insulin for type 1 diabetes or type 2 diabetes. Pramlintide is a synthetic analog of human amylin, a naturally occurring hormone made by the pancreas to help control glucose after meals. Similar to insulin, amylin is absent or deficient in person with diabetes.