In the video, I mention that the algorithm presented is "generally" consistent with ADA and AACE guidelines. In short, the video algorithm recommends that lifestyle modifications can be initially tried alone for motivated patients whose A1c
Thank you for your excellent input . I personally put most of my patients on metformin the moment they are diagnosed plus dietary and exercise advice, have done that many years before guidelines recommended so , I think now specially with covid 19 , it is necessary to act aggressively when it comes to the treatment of Diabetes type 2 .There are also indications that metformin due to its anti-inflammatory effects,. might also affect the course of Covid 19 suffering patients . Thanks again for an excellent summary and your time and dedication.
There have been several benefits of metformin found that are independent of BG benefits. It has been shown to improve cardiac risk factors (clotting tendency, LP profile, serum fibrin, BP) all independent of the BG lowering effects. With its ability to decrease oxidative stress, decrease blood vessel leakage (both renal and ocular) and decreased growth of fragmented new blood vessels (ocular only) it should be considered a fairly good first line regimen especially for those with increased cardiac risk factors. I can’t remember the dosing used for the studies off hand.
I agree with you. My general philosophy is to try to minimize medication use when possible. Especially when it seems like so many pharma companies are trying to push meds and changing the thresholds for when to start meds (e.g. in hypertension). I was trained and still believe that all meds have potentially serious side effects: the reality is every new patients started on a med is a n of 1 trial. It is easier from a logistical standpoint to put people on a med than actually have time/ make the effort to counsel them. I think many patients would choose to avoid meds if they knew of ways to solve their issues with less/ no exposure to side effects. In geriatric medicine, we've seen people do better when we carefully go through their med list and eliminate meds. BTW, thank you for your videos: they're great for Board reviews also.
Thank you very much Doctor Eric Strong, this is my third time, watching this video, and I seem to grasp thing I didn’t before. I did not watch medical video to take any particular examination, but I found ,that yours are the BEST in practical medicine, which I would never get if only I just read from textbook, or manual. I thank you for taking time to teach us , Doctors around the world. I would like to wish you and your family a very very Merry Christmas and a Happy New Year ! I have been listening your lectures for a little over the year , how time fly. :)
I came across some studies recommending SGLT2 inhibitors for isolated heart failure with reduced EF.. I want to ask about the risk of hypoglycaemia associated with this group of meds. Another question is about the physiology theoretically it doesn't make much sense to me that they lower blood glucose (maybe I'm not good enough in renal physiology ) : if Na and glucose were excreted in the proximal tubules wouldn't this osmotically lead to increased water excretion (acting like a diuretic ) and glucose wouldn't be much lowered in most cases or even increases (both glc and water are excreted) ? And what would be the effect on renin angiotensin aldosterone system since we are talking about heart failure ?
Thank you Dr. I take glimeride and I need a second med to lower my sugar I’m allergic to medformin. And I tried Jardiance but I fell the lack of oxygen so I guess I’m alérgic to that too what else do you recommend to take that are not the same as the meds mentioned. What would you give me so I can talk to my doctor
Great review! In the algorithm you mention GLP1 should be used as add on to metformin in CAD. I was under the impression that these medications have indications for CHF. Is there also CAD data?
Amazing, as always! Im always excited when I see a new lecture posted, since i've devoured most of your videos already! Hahaha, if only med teachers were as didatic and interesting as you!
Thank you Dr. Strong for another great video. Metformin still looks like the number one drug to prescribe. Do you have any recommendations on how to overcome the B12 absorption problem?
No specific recommendations other than to periodically check (at initiation of treatment and q1-2 years), and to provide B12 supplementation if it starts to trend towards the lower limit of normal. In my anecdotal experience, the association between metformin and B12 deficiency is underappreciated, and many doctors don't know they need to monitor for this.
Greetings Doctor I'm a 57yrsold longterm T2 diabetic. Was under Glimipiride 2 mg +Metformin 1gm+ INVOKANA 100 + LANTUS Glargine 16units. I stopped Glimipiride 2 mg after seeing some video. Hoping to get out of sulfunos. 15 days now. But my fasting and daytime readings are constantly raised to 180 ave. Even while fasting twice a week. And I feel drowsy.... Should I go back to Glimipiride 2mg? Thank you
Thank you Dr Strong. This is topic I like you to make , but I know that you are busy, therefore I am grateful that you took time to make. It is wonderful lecture . How severe the liver disease that Glucophage become contraindications?
I don't think anyone really knows how severe the liver disease needs to be. Personally, I would definitely discontinue/hold metformin (Glucophage) in anyone who developed symptomatic cirrhosis. Whether it should be discontinued/held in patients with less severe liver disease (e.g. chronic HCV with evidence of active inflammation on LFTs or biopsy)? ¯\_(ツ)_/¯
Thank you for an excellent summary , I wonder about HBA1c goal , is it 7.5 as in the shown image or 7%, 53 mmol/mmol, as in most international guidelines?
Thanks for the great question! This is one area in which there is some disagreement between recommendations from different societies and different experts, and why in the video I mentioned that my algorithm was "generally" consistent with ADA and AACE guidelines. In short, ADA/AACE guidelines recommend anyone diagnosed with type 2 diabetes, no matter how near-normal their A1c is, should be placed on metformin. In other words, the implication is that there should be no such thing as "diet controlled diabetes". Other recommendations may use A1c cutoffs of 7.0%. Given that motivated individuals with newly diagnosed type 2 diabetes can bring down their A1c 1.0-2.0% with diet and weight loss alone, and because I personally trend my practice towards keeping patient pill burden on the lower end, I don't generally recommend starting metformin at A1c levels < 7.5% *IF* the patient is motivated and otherwise able to enact major dietary changes. The argument against this (i.e. the argument to start every patient on metformin) is that it's cheap and very safe - but I'm not convinced there is any benefit for those patients whose A1c could otherwise be successfully brought to target A1c with diet/weight loss alone. EDIT: Have added a pinned comment above to address this.
Some of these medications should not be taken in the setting of kidney failure, although the specific cutoff when the medication should be stopped varies between medications. It's best to discuss your own situation with your own medical providers.
Sorry but Metformin should be taken off the market. I for one never had the drug preform at all for me. I also know many people who have suffered though the same results. As far as I am concerned it should never be used. Too many people have either gone through constant sickness or months of frustration because of the drug and eventually ended up having to switch to a different medication all together.
Good sleep is certainly helpful for promoting health, but it is not enough on its own to treat high blood pressure or diabetes. In some patients, a combination of diet, exercise, and weight loss are sufficient. Unfortunately, most patients will eventually require medication for optimal control.
In the video, I mention that the algorithm presented is "generally" consistent with ADA and AACE guidelines. In short, the video algorithm recommends that lifestyle modifications can be initially tried alone for motivated patients whose A1c
Thank you for your excellent input . I personally put most of my patients on metformin the moment they are diagnosed plus dietary and exercise advice, have done that many years before guidelines recommended so , I think now specially with covid 19 , it is necessary to act aggressively when it comes to the treatment of Diabetes type 2 .There are also indications that metformin due to its anti-inflammatory effects,. might also affect the course of Covid 19 suffering patients . Thanks again for an excellent summary and your time and dedication.
There have been several benefits of metformin found that are independent of BG benefits. It has been shown to improve cardiac risk factors (clotting tendency, LP profile, serum fibrin, BP) all independent of the BG lowering effects. With its ability to decrease oxidative stress, decrease blood vessel leakage (both renal and ocular) and decreased growth of fragmented new blood vessels (ocular only) it should be considered a fairly good first line regimen especially for those with increased cardiac risk factors. I can’t remember the dosing used for the studies off hand.
I forgot to thank you for the videos!
I agree with you. My general philosophy is to try to minimize medication use when possible. Especially when it seems like so many pharma companies are trying to push meds and changing the thresholds for when to start meds (e.g. in hypertension). I was trained and still believe that all meds have potentially serious side effects: the reality is every new patients started on a med is a n of 1 trial. It is easier from a logistical standpoint to put people on a med than actually have time/ make the effort to counsel them. I think many patients would choose to avoid meds if they knew of ways to solve their issues with less/ no exposure to side effects. In geriatric medicine, we've seen people do better when we carefully go through their med list and eliminate meds. BTW, thank you for your videos: they're great for Board reviews also.
thanks dr plz do some short and long cases , format of hx of presenting illness thanks dear dr
Thank you for the great videos Dr. Strong! I listened to your videos throughout med school. And now as I study for my board exams.
Outstanding valued information about medicines to keep diabetes under control. Thank you very much!
Diabetes medications and insulin therapy
:
Metformin (Glucophage, Glumetza, others). Generally, metformin is the first medication prescribed for type 2 diabetes.
Sulfonylureas.
Meglitinides.
Thiazolidinediones.
DPP-4 inhibitors.
GLP-1 receptor agonists.
SGLT2 inhibitors.
Insulin.
Very precise and informative specially when to use which drug and the combination of drugs explained clearly. Thank you so much
Essential information for anyone taking care of DMT2 patients. Thank you.
The best review I´ve ever watched. Thanks a lot Doctor!
Dr Stronng ; Thaaaanks for you from Saui Arabia 🤚🏻 I am following your channel with great intrest ... I cnseder you my best teacher 👌🌺🌹
Thank you very much Doctor Eric Strong, this is my third time, watching this video, and I seem to grasp thing I didn’t before. I did not watch medical video to take any particular examination, but I found ,that yours are the BEST in practical medicine, which I would never get if only I just read from textbook, or manual. I thank you for taking time to teach us , Doctors around the world. I would like to wish you and your family a very very Merry Christmas and a Happy New Year ! I have been listening your lectures for a little over the year , how time fly. :)
Very informative! I learn alot for my exam tomorrow. Thank you Dr.
Can a pt having hypothyroidism take metformin?
I came across some studies recommending SGLT2 inhibitors for isolated heart failure with reduced EF.. I want to ask about the risk of hypoglycaemia associated with this group of meds. Another question is about the physiology theoretically it doesn't make much sense to me that they lower blood glucose (maybe I'm not good enough in renal physiology ) : if Na and glucose were excreted in the proximal tubules wouldn't this osmotically lead to increased water excretion (acting like a diuretic ) and glucose wouldn't be much lowered in most cases or even increases (both glc and water are excreted) ? And what would be the effect on renin angiotensin aldosterone system since we are talking about heart failure ?
It should be noted that SGLT2 are not allowed for pilots going for a new Medical license. Example Invokana is one.
Thank you Dr. I take glimeride and I need a second med to lower my sugar I’m allergic to medformin. And I tried Jardiance but I fell the lack of oxygen so I guess I’m alérgic to that too what else do you recommend to take that are not the same as the meds mentioned. What would you give me so I can talk to my doctor
Hi I need help I don't know what type of my sugar diabetes
I'm sorry, but I recommend you speak with your doctor about your personal health questions.
Great review! In the algorithm you mention GLP1 should be used as add on to metformin in CAD. I was under the impression that these medications have indications for CHF. Is there also CAD data?
Amazing, as always! Im always excited when I see a new lecture posted, since i've devoured most of your videos already! Hahaha, if only med teachers were as didatic and interesting as you!
thanks a lot PROF, greetings from Italy
Thank you Dr. Strong for another great video. Metformin still looks like the number one drug to prescribe. Do you have any recommendations on how to overcome the B12 absorption problem?
No specific recommendations other than to periodically check (at initiation of treatment and q1-2 years), and to provide B12 supplementation if it starts to trend towards the lower limit of normal. In my anecdotal experience, the association between metformin and B12 deficiency is underappreciated, and many doctors don't know they need to monitor for this.
Hello dr strong. Is there any prediction of when will the insulin video be released? Thanks in advance and sorry for my bad english.
great. thanks once more. I am learning with all your videos for a board certification test :-)
Amazing video, amazing content ❤️
Thanks as usual for the great stuff. Looking forward to the video on insulin. Regards.
Thank you!! Sharing with a family member:)
Greetings Doctor
I'm a 57yrsold longterm T2 diabetic.
Was under Glimipiride 2 mg +Metformin 1gm+ INVOKANA 100 + LANTUS Glargine 16units.
I stopped Glimipiride 2 mg after seeing some video. Hoping to get out of sulfunos.
15 days now.
But my fasting and daytime readings are constantly raised to 180 ave. Even while fasting twice a week.
And I feel drowsy....
Should I go back to Glimipiride 2mg?
Thank you
I'm very sorry, but I can't provide specific, individualized medical advice here.
T2DM Never do fasting just be consistent
Thank you Dr Strong. This is topic I like you to make , but I know that you are busy, therefore I am grateful that you took time to make. It is wonderful lecture . How severe the liver disease that Glucophage become contraindications?
I don't think anyone really knows how severe the liver disease needs to be. Personally, I would definitely discontinue/hold metformin (Glucophage) in anyone who developed symptomatic cirrhosis. Whether it should be discontinued/held in patients with less severe liver disease (e.g. chronic HCV with evidence of active inflammation on LFTs or biopsy)? ¯\_(ツ)_/¯
Thanks for putting efforts in making these videos.
What about Januvia ?
Januvia is a DPP-4 inhibitor, discussed @11:40. I know it's a popular medication here in the US, but I'd considered it 3rd or even 4th line (at best).
Brilliant summary. Any chance these slides could be released in pdf form? They would be great as a quick study reference.
No problem. I just uploaded them to my shared Google drive: drive.google.com/drive/folders/0B9SDUwepGWeUTmtscnJSSjR5OE0
@@StrongMed the link doesn’t work ,can you get it fixed please and thank you for the lecture
@@GodCall Sorry, I took all my slides down - too many people were plagiarizing them, and I kept getting emails asking how Google drive worked.
waiting eagerly for Insulins (specially U500 and other new ) Eric
Thank you, Dr Strong!
I am from Australia and enjoying your great videos!
Keep going.
Thank you for an excellent summary , I wonder about HBA1c goal , is it 7.5 as in the shown image or 7%, 53 mmol/mmol, as in most international guidelines?
Thanks for the great question! This is one area in which there is some disagreement between recommendations from different societies and different experts, and why in the video I mentioned that my algorithm was "generally" consistent with ADA and AACE guidelines. In short, ADA/AACE guidelines recommend anyone diagnosed with type 2 diabetes, no matter how near-normal their A1c is, should be placed on metformin. In other words, the implication is that there should be no such thing as "diet controlled diabetes". Other recommendations may use A1c cutoffs of 7.0%. Given that motivated individuals with newly diagnosed type 2 diabetes can bring down their A1c 1.0-2.0% with diet and weight loss alone, and because I personally trend my practice towards keeping patient pill burden on the lower end, I don't generally recommend starting metformin at A1c levels < 7.5% *IF* the patient is motivated and otherwise able to enact major dietary changes. The argument against this (i.e. the argument to start every patient on metformin) is that it's cheap and very safe - but I'm not convinced there is any benefit for those patients whose A1c could otherwise be successfully brought to target A1c with diet/weight loss alone.
EDIT: Have added a pinned comment above to address this.
@@StrongMed makes sense.
Wow! Your videos are amazing. Thank you!
Thank you very much for these great videos, really appreciated!
Absolutely wonderful! Thank you
Thank youn once again dr. Eric
Thanks for the video, nice explanation.
Absolutely great video!
How can I contact you?
One should take these medicines until kidney fails?
Some of these medications should not be taken in the setting of kidney failure, although the specific cutoff when the medication should be stopped varies between medications. It's best to discuss your own situation with your own medical providers.
I take Metformin for my Diabetes and I also prick my fingers
Loved it sir!!
Thank you so much ❤️
Thanks!
I'm glad you found it helpful!
My high blood ano ang gmot .
Sorry but Metformin should be taken off the market. I for one never had the drug preform at all for me. I also know many people who have suffered though the same results. As far as I am concerned it should never be used. Too many people have either gone through constant sickness or months of frustration because of the drug and eventually ended up having to switch to a different medication all together.
4years na ako take ng metformin
May bad effect daw po metformin?
Acca dayabetic metro pro name Kono osud ace ki
Dear sir, Only good sleep can stop sugar and pressure.
Good sleep is certainly helpful for promoting health, but it is not enough on its own to treat high blood pressure or diabetes. In some patients, a combination of diet, exercise, and weight loss are sufficient. Unfortunately, most patients will eventually require medication for optimal control.
Forxiga spelled wrong. Farxiga
It's spelled Farxiga in the US, and Forxiga in most other countries.
@@StrongMed good to know Doc ! 😂 US always likes to be different than the rest of the world
Tq
Nice # diabetes
Midecina
moah moah loveyou
diabextan