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8/12/2019 meds_508 http://slidepdf.com/reader/full/meds508 1/54 Diabetes Medicines What I need to know about National Diabetes Information Clearinghouse
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Diabetes Medicines
What I need to know about
National Diabetes Information
Clearinghouse
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What I need to know about
Diabetes Medicines
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Contents
What do diabetes medicines do 1
What targets are recommended forblood glucose levels 2
What happens to blood glucose levels inpeople with diabetes 4
Medicines for My Diabetes 6
Types of Diabetes Medicines 8What do I need to know aboutside effects of medicines 13
For More Information 14
Acknowledgments 15
Inserts in back pocket
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What do diabetes medicines do
Over time high levels of blood glucose also called bloodsugar can cause health problems These problemsinclude heart disease heart attacks strokes kidneydisease nerve damage digestive problems eye diseaseand tooth and gum problems You can help preventhealth problems by keeping your blood glucose levelson target
Everyone with diabetes needs to choose foods wiselyand be physically active If you canrsquot reach your targetblood glucose levels with wise food choices and physicalactivity you may need diabetes medicines The kindof medicine you take depends on your type of diabetes your schedule and your other health conditions
Diabetes medicines help keep yourblood glucose in your target range
The target range is suggested bydiabetes experts and yourdoctor or diabetes educatorSee page 2 for moreinformation about targetlevels for good health
1
You may need diabetes medicinesto reach your blood glucosetargets
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What targets are recommended for blood
glucose levelsThe National Diabetes Education Program uses bloodglucose targets set by the American Diabetes Association(ADA) for most people with diabetes To learn yourdaily blood glucose numbers yoursquoll check your bloodglucose levels on your own using a blood glucose meter
Target blood glucose levelsfor most people with diabetes
Before meals 70 to 130 mgdL
My targets
1 to 2 hours after Less than 180the start of a meal mgdL
Milligrams per deciliter
Also you should ask your doctor for a blood test calledthe A1C at least twice a year The A1C will give you youraverage blood glucose for the past 3 months
Target A1C result forpeople with diabetes
My target
Less than 7 percent
Your personal A1C goal might be higher or lower than7 percent Keeping your A1C as close to normal aspossiblemdashbelow 6 percent without having frequent low
2
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blood glucosemdashcan help prevent long-term diabetes
problems Doctors might recommend other goals for very young children older people people with other healthproblems or those who often have low blood glucose
Talk with your doctor or diabetes educator about whetherthe target blood glucose levels and A1C result listed in thecharts on page 2 are best for you Write your own targetlevels in the charts Both ways of checking your bloodglucose levels are important
If your blood glucose levels are not on target you mightneed a change in how you take care of your diabetesThe results of your A1C test and your daily blood glucosechecks can help you and your doctor make decisions about
l what you eat
l when you eat
l how much you eat
l what kind of exercise you do
l how much exercise you do
l the type of diabetes medicines you take
l the amount of diabetes medicines you take
3
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What happens to blood glucose levels in
people with diabetesBlood glucose levels go up and down throughout the dayand night in people with diabetes High blood glucoselevels over time can result in heart disease and otherhealth problems Low blood glucose levels can make youfeel shaky or pass out But you can learn how to makesure your blood glucose levels stay on targetmdashnot toohigh and not too low
What makes blood glucose levels go too high
Your blood glucose levels can go too high if
l you eat more than usual
l yoursquore not physically active
l yoursquore not taking enough diabetes medicine
l yoursquore sick or under stressl you exercise when your blood glucose level is
already high
4
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Medicines for My Diabetes
Ask your doctor what type of diabetes you have andcheck off the answer
I have
q type 1 diabetes
q type 2 diabetes
q gestational diabetes
q another type of diabetes ____________________
Medicines for Type 1 Diabetes
Type 1 diabetes once called juvenile diabetes orinsulin-dependent diabetes is usually first found inchildren teenagers or young adults If you have type 1diabetes you must take insulin because your body no
longer makes it You also might need to take other typesof diabetes medicines that work with insulin
6
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Medicines for Type 2 Diabetes
Type 2 diabetes once called adult-onset diabetes ornoninsulin-dependent diabetes is the most commonform of diabetes It can start when the body doesnrsquot useinsulin as it should a condition called insulin resistanceIf the body canrsquot keep up with the need for insulin you may need diabetes medicines Many choices areavailable Your doctor might prescribe two or moremedicines The ADA recommends that most people
start with metformin a kind of diabetes pill
Medicines for Gestational Diabetes
Gestational diabetes is diabetes that occurs for the firsttime during pregnancy The hormones of pregnancy or ashortage of insulin can cause gestational diabetes Most women with gestational diabetes control it with mealplanning and physical activity But some women need
insulin to reach their target blood glucose levels
Medicines for Other Types of Diabetes
If you have one of the rare forms of diabetes suchas diabetes caused by other medicines or monogenicdiabetes talk with your doctor about what kind ofdiabetes medicine would be best for you
7
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Types of Diabetes Medicines
Diabetes medicines come in several forms
Insulin
If your body no longer makes enough insulin yoursquoll needto take it Insulin is used for all types of diabetes Yourdoctor can help you decide which way of taking insulin isbest for you
l Taking injections Yoursquoll give yourself shots using aneedle and syringe The syringe is a hollow tube witha plunger You will put your dose of insulin into thetube Some people use an insulin pen which lookslike a pen but has a needle for its point
l Using an insulin pump An insulin pump is a smallmachine about the size of a cell phone worn outsideof your body on a belt or in a pocket or pouch The
pump connects to a small plastic tube and a verysmall needle The needle is inserted under the skinand stays in for several days Insulin is pumped fromthe machine through the tube into your body
8
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l Using an insulin jet injector The jet injector whichlooks like a large pen sends a fine spray of insulinthrough the skin with high-pressure air instead of aneedle
l Using an insulin infuser A small tube is inserted just beneath the skin and remains in place for severaldays Insulin is injected into the end of the tubeinstead of through the skin
If your body no longer makes enough insulin yoursquoll need to take it
9
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Types of Insulin
Each type of insulin works at a different speed Forexample rapid-acting insulin starts to work right after you take it Long-acting insulin works for many hoursMost people need two or more types of insulin to reachtheir blood glucose targets
Look at the list of types of insulin on Insert C in thepocket of this booklet Check off the names of thekinds of insulin you take Then write the names of your
insulins under My Insulins in the chart on Insert A
Diabetes Pills
Along with meal planning and physicalactivity diabetes pills help people withtype 2 diabetes or gestational diabeteskeep their blood glucose levels ontarget Several kinds of pills are
available Each works in a different way Many people take two orthree kinds of pills Somepeople take combination pillsCombination pills containtwo kinds of diabetes medicinein one tablet Some peopletake pills and insulin
Diabetes pills help people withtype 2 diabetes or gestationaldiabetes keep their blood glucoselevels on target
11
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Your doctor may ask you to try one kind of pill If it
doesnrsquot help you reach your blood glucose targets yourdoctor may ask you to
l take more of the same pill
l add another kind of pill
l change to another type of pill
l start taking insulin
l start taking another injected medicine
If your doctor suggests that you take insulin or anotherinjected medicine it doesnrsquot mean your diabetes isgetting worse Instead it means you need insulin oranother type of medicine to reach your blood glucosetargets Everyone is different What works best for youdepends on your usual daily routine eating habits andactivities and your other health conditions
For information about the different kinds of pills and what they do see the cards in the pocket of this bookletYoursquoll see the brand name and the generic namemdashthescientific namemdashfor each medicine Find your diabetespills and check off the names Then write the namesof your diabetes pills under My Pills and Injected
Medicines in the chart on Insert A
12
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Injections Other Than Insulin
In addition to insulin two other types of injectedmedicines are now available Both work with insulinmdasheither the bodyrsquos own or injectedmdashto help keep yourblood glucose from going too high after you eat Neitheris a substitute for insulin
See the cards in the pocket of this booklet for moreinformation about these injected medicines Checkoff the kinds you take Then write the names of
your injected medicines under My Pills and InjectedMedicines in the chart on Insert A
Talk with your doctor if you have questions about your diabetes medicines Do not stop taking yourdiabetes medicines without checking with your doctorfirst See Insert B for a list of questions to ask yourdoctor about your medicines
What do I need to know about side effectsof medicines
A side effect is an unwanted problem caused by amedicine For example some diabetes medicinescan cause nausea or an upset stomach when you first
start taking them Before you start a new medicine ask your doctor about possible side effects and how you canavoid them If the side effects of your medicine bother you tell your doctor
13
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For More Information
To find diabetes educatorsmdashnurses dietitians and otherhealth professionalsmdashnear you call the American Association of Diabetes Educators toll-free at1ndash800ndashTEAMUP4 (1ndash800ndash832ndash6874) Or go to wwwdiabeteseducatororg and see the ldquoFind a DiabetesEducatorrdquo section
For additional information about diabetes contact
American Diabetes AssociationNational Service Center1701 North Beauregard Street Alexandria VA 22311ndash1742Phone 1ndash800ndashDIABETES (1ndash800ndash342ndash2383)Fax 703ndash549ndash6995Email AskADAdiabetesorgInternet wwwdiabetesorg
Juvenile Diabetes Research Foundation International 26 Broadway 14th FloorNew York NY 10004Phone 1ndash800ndash533ndashCURE (1ndash800ndash533ndash2873)Fax 212ndash785ndash9595Email infojdrforgInternet wwwjdrforg
14
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15
National Diabetes Education Program
1 Diabetes WayBethesda MD 20814ndash9692Phone 1ndash888ndash693ndashNDEP (1ndash888ndash693ndash6337)TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndepmailnihgovInternet wwwndepnihgov
AcknowledgmentsPublications produced by the Clearinghouse arecarefully reviewed by both NIDDK scientists and outsideexperts This booklet was reviewed by Stuart T HainesPharmD University of Maryland School of PharmacyBaltimore
The US Government does not endorse or favor any specific commercialproduct or company Trade proprietary or company names appearing inthis document are used only because they are considered necessary in thecontext of the information provided If a product is not mentioned theomission does not mean or imply that the product is unsatisfactory
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National Diabetes Information Clearinghouse1 Information WayBethesda MD 20892ndash3560
Phone 1ndash800ndash860ndash8747TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndicinfoniddknihgovInternet wwwdiabetesniddknihgov
The National Diabetes Information Clearinghouse (NDIC) is a serviceof the National Institute of Diabetes and Digestive and Kidney Diseases(NIDDK) The NIDDK is part of the National Institutes of Health of theUS Department of Health and Human Services Established in 1978 the
Clearinghouse provides information about diabetes to people with diabetesand to their families health care professionals and the public The NDICanswers inquiries develops and distributes publications and works closely with professional and patient organizations and Government agencies tocoordinate resources about diabetes
This publication is not copyrighted The Clearinghouse encourages usersof this publication to duplicate and distribute as many copies as desired
This publication is available at wwwdiabetesniddknihgov
This publication may contain information about medications Whenprepared this publication included the most current information availableFor updates or for questions about any medications contact the US Foodand Drug Administration toll-free at 1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332)or visit wwwfdagov Consult your doctor for more information
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Inserts
My Diabetes Medicines Insert A
Questions to Ask about
Your Diabetes Medicines Insert BTypes of Insulin Insert C
Glyset and Precose (Alpha-Glucosidase Inhibitors) Insert D
Glucophage Glucophage XR and Riomet(Biguanides) Insert E
Starlix (D-Phenylalanine Derivative) Insert F
Januvia (DPP-4 Inhibitor) Insert G
Prandin (Meglitinide) Insert H
Amaryl DiaBeta Diabinese GlucotrolGlucotrol XL Glynase PresTab Micronasetolazamide and tolbutamide (Sulfonylureas) Insert I
Actos and Avandia (Thiazolidinediones) Insert J
Actoplus Met Actoplus Met XR Avandamet Avandaryl DuetactGlucovance Janumetand Metaglip (Combination Diabetes Pills) Insert K
Symlin (Amylin Mimetic) Insert L
Byetta (Incretin Mimetic) Insert M
About Low Blood Glucose Insert N
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert BWhat I need to know about Diabetes Medicines
Questions to Ask about Your Diabetes Medicines Ask your doctor these questions when you get a prescription fora medicine Make copies of this card and use one card for eachof your medicines
What are the names of my medicine
Brand name Generic name
What does my medicine do
When should I start this medicine
This medicine is prescribed by
How long will it take this medicine to workWhat is the strength (for example how many milligrams writtenas mg)
How much should I take for each dose
How many times a day should I take my medicine
At what times should I take my medicine
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert B
Should I take it before with or after a meal
Should I avoid any foods or medicines when I take it
Should I avoid alcoholic beverages when I take it
Are there any times when I should change the amount of medicineI take
What should I do if I forget to take it
If Irsquom sick and canrsquot keep food down should I still take my medicine
Can my diabetes medicine cause low blood glucose
What should I do if my blood glucose is too low
What side effects can this medicine cause
What should I do if I have side effects
How should I store this medicine
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Insert CWhat I need to know about Diabetes Medicines
Types of InsulinEach type of insulin has an onset a peak and a duration time
The onset is how soon the insulin starts to lower your blood glucoseafter you take it
The peak is the time the insulin is working the hardest to lower yourblood glucose
The duration is how long the insulin lastsmdashthe length of time it keepslowering your blood glucose
The times shown in the chart are estimates Your onset peak andduration times may be different Yoursquoll work with your health careteam to come up with an insulin plan that works best for you
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert C What I need to know about Diabetes Medicines In
Type of Insulin Brand Name Generic Name Onset Peak Duration
Rapid-acting qNovoLog q Insulin aspart 15 minutes 30 to 90 minutes 3 to 5 hours
q Apidra q Insulin glulisine 15 minutes 30 to 90 minutes 3 to 5 hours
qHumalog q Insulin lispro 15 minutes 30 to 90 minutes 3 to 5 hours
Short-acting q Humulin R
q Novolin R
q Regular (R) 30 to 60 minutes 2 to 4 hours 5 to 8 hours
Intermediate-acting q Humulin N
q Novolin N
q NPH (N) 1 to 3 hours 8 hours 12 to 16 hours
Long-acting q Levemir
q Lantus
q Insulin detemir
q Insulin glargine
1 hour Peakless 20 to 26 hours
Pre-mixed NPH(intermediate-acting)and regular (short-acting)
q Humulin 7030
q Novolin 7030
q 70 NPH and 30 regular 30 to 60 minutes Varies 10 to 16 hours
q Humulin 5050 q 50 NPH and 50 regular 30 to 60 minutes Varies 10 to 16 hours
Pre-mixed insulin lispro q Humalog Mix 7525 q 75 insulin lispro protamine 10 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 25 insulin lispro(intermediate-acting) andinsulin lispro (rapid-acting) q Humalog Mix 5050 q 50 insulin lispro protamine
and 50 insulin lispro10 to 15 minutes Varies 10 to 16 hours
Pre-mixed insulin aspart q NovoLog Mix 7030 q 70 insulin aspart protamine 5 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 30 insulin aspart(intermediate-acting) andinsulin aspart (rapid-acting)
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What I need to know about Diabetes Medicines Insert D
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Taking Glyset or Precose may cause stomach pain gas bloating
or diarrhea These symptoms usually go away after you have takenthese pills for a while
If you take Glyset or Precose What you need to know aboutlow blood glucose
If you take Glyset or Precose only glucose tablets or glucose gel
will bring your blood glucose level back to normal quickly Otherquick-fix foods and drinks wonrsquot raise your blood glucose as quicklybecause Glyset and Precose slow the digestion of other quick-fixfoods and drinks
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
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Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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What I need to know about
Diabetes Medicines
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Contents
What do diabetes medicines do 1
What targets are recommended forblood glucose levels 2
What happens to blood glucose levels inpeople with diabetes 4
Medicines for My Diabetes 6
Types of Diabetes Medicines 8What do I need to know aboutside effects of medicines 13
For More Information 14
Acknowledgments 15
Inserts in back pocket
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What do diabetes medicines do
Over time high levels of blood glucose also called bloodsugar can cause health problems These problemsinclude heart disease heart attacks strokes kidneydisease nerve damage digestive problems eye diseaseand tooth and gum problems You can help preventhealth problems by keeping your blood glucose levelson target
Everyone with diabetes needs to choose foods wiselyand be physically active If you canrsquot reach your targetblood glucose levels with wise food choices and physicalactivity you may need diabetes medicines The kindof medicine you take depends on your type of diabetes your schedule and your other health conditions
Diabetes medicines help keep yourblood glucose in your target range
The target range is suggested bydiabetes experts and yourdoctor or diabetes educatorSee page 2 for moreinformation about targetlevels for good health
1
You may need diabetes medicinesto reach your blood glucosetargets
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What targets are recommended for blood
glucose levelsThe National Diabetes Education Program uses bloodglucose targets set by the American Diabetes Association(ADA) for most people with diabetes To learn yourdaily blood glucose numbers yoursquoll check your bloodglucose levels on your own using a blood glucose meter
Target blood glucose levelsfor most people with diabetes
Before meals 70 to 130 mgdL
My targets
1 to 2 hours after Less than 180the start of a meal mgdL
Milligrams per deciliter
Also you should ask your doctor for a blood test calledthe A1C at least twice a year The A1C will give you youraverage blood glucose for the past 3 months
Target A1C result forpeople with diabetes
My target
Less than 7 percent
Your personal A1C goal might be higher or lower than7 percent Keeping your A1C as close to normal aspossiblemdashbelow 6 percent without having frequent low
2
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blood glucosemdashcan help prevent long-term diabetes
problems Doctors might recommend other goals for very young children older people people with other healthproblems or those who often have low blood glucose
Talk with your doctor or diabetes educator about whetherthe target blood glucose levels and A1C result listed in thecharts on page 2 are best for you Write your own targetlevels in the charts Both ways of checking your bloodglucose levels are important
If your blood glucose levels are not on target you mightneed a change in how you take care of your diabetesThe results of your A1C test and your daily blood glucosechecks can help you and your doctor make decisions about
l what you eat
l when you eat
l how much you eat
l what kind of exercise you do
l how much exercise you do
l the type of diabetes medicines you take
l the amount of diabetes medicines you take
3
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What happens to blood glucose levels in
people with diabetesBlood glucose levels go up and down throughout the dayand night in people with diabetes High blood glucoselevels over time can result in heart disease and otherhealth problems Low blood glucose levels can make youfeel shaky or pass out But you can learn how to makesure your blood glucose levels stay on targetmdashnot toohigh and not too low
What makes blood glucose levels go too high
Your blood glucose levels can go too high if
l you eat more than usual
l yoursquore not physically active
l yoursquore not taking enough diabetes medicine
l yoursquore sick or under stressl you exercise when your blood glucose level is
already high
4
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Medicines for My Diabetes
Ask your doctor what type of diabetes you have andcheck off the answer
I have
q type 1 diabetes
q type 2 diabetes
q gestational diabetes
q another type of diabetes ____________________
Medicines for Type 1 Diabetes
Type 1 diabetes once called juvenile diabetes orinsulin-dependent diabetes is usually first found inchildren teenagers or young adults If you have type 1diabetes you must take insulin because your body no
longer makes it You also might need to take other typesof diabetes medicines that work with insulin
6
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Medicines for Type 2 Diabetes
Type 2 diabetes once called adult-onset diabetes ornoninsulin-dependent diabetes is the most commonform of diabetes It can start when the body doesnrsquot useinsulin as it should a condition called insulin resistanceIf the body canrsquot keep up with the need for insulin you may need diabetes medicines Many choices areavailable Your doctor might prescribe two or moremedicines The ADA recommends that most people
start with metformin a kind of diabetes pill
Medicines for Gestational Diabetes
Gestational diabetes is diabetes that occurs for the firsttime during pregnancy The hormones of pregnancy or ashortage of insulin can cause gestational diabetes Most women with gestational diabetes control it with mealplanning and physical activity But some women need
insulin to reach their target blood glucose levels
Medicines for Other Types of Diabetes
If you have one of the rare forms of diabetes suchas diabetes caused by other medicines or monogenicdiabetes talk with your doctor about what kind ofdiabetes medicine would be best for you
7
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Types of Diabetes Medicines
Diabetes medicines come in several forms
Insulin
If your body no longer makes enough insulin yoursquoll needto take it Insulin is used for all types of diabetes Yourdoctor can help you decide which way of taking insulin isbest for you
l Taking injections Yoursquoll give yourself shots using aneedle and syringe The syringe is a hollow tube witha plunger You will put your dose of insulin into thetube Some people use an insulin pen which lookslike a pen but has a needle for its point
l Using an insulin pump An insulin pump is a smallmachine about the size of a cell phone worn outsideof your body on a belt or in a pocket or pouch The
pump connects to a small plastic tube and a verysmall needle The needle is inserted under the skinand stays in for several days Insulin is pumped fromthe machine through the tube into your body
8
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l Using an insulin jet injector The jet injector whichlooks like a large pen sends a fine spray of insulinthrough the skin with high-pressure air instead of aneedle
l Using an insulin infuser A small tube is inserted just beneath the skin and remains in place for severaldays Insulin is injected into the end of the tubeinstead of through the skin
If your body no longer makes enough insulin yoursquoll need to take it
9
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Types of Insulin
Each type of insulin works at a different speed Forexample rapid-acting insulin starts to work right after you take it Long-acting insulin works for many hoursMost people need two or more types of insulin to reachtheir blood glucose targets
Look at the list of types of insulin on Insert C in thepocket of this booklet Check off the names of thekinds of insulin you take Then write the names of your
insulins under My Insulins in the chart on Insert A
Diabetes Pills
Along with meal planning and physicalactivity diabetes pills help people withtype 2 diabetes or gestational diabeteskeep their blood glucose levels ontarget Several kinds of pills are
available Each works in a different way Many people take two orthree kinds of pills Somepeople take combination pillsCombination pills containtwo kinds of diabetes medicinein one tablet Some peopletake pills and insulin
Diabetes pills help people withtype 2 diabetes or gestationaldiabetes keep their blood glucoselevels on target
11
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Your doctor may ask you to try one kind of pill If it
doesnrsquot help you reach your blood glucose targets yourdoctor may ask you to
l take more of the same pill
l add another kind of pill
l change to another type of pill
l start taking insulin
l start taking another injected medicine
If your doctor suggests that you take insulin or anotherinjected medicine it doesnrsquot mean your diabetes isgetting worse Instead it means you need insulin oranother type of medicine to reach your blood glucosetargets Everyone is different What works best for youdepends on your usual daily routine eating habits andactivities and your other health conditions
For information about the different kinds of pills and what they do see the cards in the pocket of this bookletYoursquoll see the brand name and the generic namemdashthescientific namemdashfor each medicine Find your diabetespills and check off the names Then write the namesof your diabetes pills under My Pills and Injected
Medicines in the chart on Insert A
12
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Injections Other Than Insulin
In addition to insulin two other types of injectedmedicines are now available Both work with insulinmdasheither the bodyrsquos own or injectedmdashto help keep yourblood glucose from going too high after you eat Neitheris a substitute for insulin
See the cards in the pocket of this booklet for moreinformation about these injected medicines Checkoff the kinds you take Then write the names of
your injected medicines under My Pills and InjectedMedicines in the chart on Insert A
Talk with your doctor if you have questions about your diabetes medicines Do not stop taking yourdiabetes medicines without checking with your doctorfirst See Insert B for a list of questions to ask yourdoctor about your medicines
What do I need to know about side effectsof medicines
A side effect is an unwanted problem caused by amedicine For example some diabetes medicinescan cause nausea or an upset stomach when you first
start taking them Before you start a new medicine ask your doctor about possible side effects and how you canavoid them If the side effects of your medicine bother you tell your doctor
13
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For More Information
To find diabetes educatorsmdashnurses dietitians and otherhealth professionalsmdashnear you call the American Association of Diabetes Educators toll-free at1ndash800ndashTEAMUP4 (1ndash800ndash832ndash6874) Or go to wwwdiabeteseducatororg and see the ldquoFind a DiabetesEducatorrdquo section
For additional information about diabetes contact
American Diabetes AssociationNational Service Center1701 North Beauregard Street Alexandria VA 22311ndash1742Phone 1ndash800ndashDIABETES (1ndash800ndash342ndash2383)Fax 703ndash549ndash6995Email AskADAdiabetesorgInternet wwwdiabetesorg
Juvenile Diabetes Research Foundation International 26 Broadway 14th FloorNew York NY 10004Phone 1ndash800ndash533ndashCURE (1ndash800ndash533ndash2873)Fax 212ndash785ndash9595Email infojdrforgInternet wwwjdrforg
14
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15
National Diabetes Education Program
1 Diabetes WayBethesda MD 20814ndash9692Phone 1ndash888ndash693ndashNDEP (1ndash888ndash693ndash6337)TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndepmailnihgovInternet wwwndepnihgov
AcknowledgmentsPublications produced by the Clearinghouse arecarefully reviewed by both NIDDK scientists and outsideexperts This booklet was reviewed by Stuart T HainesPharmD University of Maryland School of PharmacyBaltimore
The US Government does not endorse or favor any specific commercialproduct or company Trade proprietary or company names appearing inthis document are used only because they are considered necessary in thecontext of the information provided If a product is not mentioned theomission does not mean or imply that the product is unsatisfactory
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National Diabetes Information Clearinghouse1 Information WayBethesda MD 20892ndash3560
Phone 1ndash800ndash860ndash8747TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndicinfoniddknihgovInternet wwwdiabetesniddknihgov
The National Diabetes Information Clearinghouse (NDIC) is a serviceof the National Institute of Diabetes and Digestive and Kidney Diseases(NIDDK) The NIDDK is part of the National Institutes of Health of theUS Department of Health and Human Services Established in 1978 the
Clearinghouse provides information about diabetes to people with diabetesand to their families health care professionals and the public The NDICanswers inquiries develops and distributes publications and works closely with professional and patient organizations and Government agencies tocoordinate resources about diabetes
This publication is not copyrighted The Clearinghouse encourages usersof this publication to duplicate and distribute as many copies as desired
This publication is available at wwwdiabetesniddknihgov
This publication may contain information about medications Whenprepared this publication included the most current information availableFor updates or for questions about any medications contact the US Foodand Drug Administration toll-free at 1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332)or visit wwwfdagov Consult your doctor for more information
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Inserts
My Diabetes Medicines Insert A
Questions to Ask about
Your Diabetes Medicines Insert BTypes of Insulin Insert C
Glyset and Precose (Alpha-Glucosidase Inhibitors) Insert D
Glucophage Glucophage XR and Riomet(Biguanides) Insert E
Starlix (D-Phenylalanine Derivative) Insert F
Januvia (DPP-4 Inhibitor) Insert G
Prandin (Meglitinide) Insert H
Amaryl DiaBeta Diabinese GlucotrolGlucotrol XL Glynase PresTab Micronasetolazamide and tolbutamide (Sulfonylureas) Insert I
Actos and Avandia (Thiazolidinediones) Insert J
Actoplus Met Actoplus Met XR Avandamet Avandaryl DuetactGlucovance Janumetand Metaglip (Combination Diabetes Pills) Insert K
Symlin (Amylin Mimetic) Insert L
Byetta (Incretin Mimetic) Insert M
About Low Blood Glucose Insert N
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert BWhat I need to know about Diabetes Medicines
Questions to Ask about Your Diabetes Medicines Ask your doctor these questions when you get a prescription fora medicine Make copies of this card and use one card for eachof your medicines
What are the names of my medicine
Brand name Generic name
What does my medicine do
When should I start this medicine
This medicine is prescribed by
How long will it take this medicine to workWhat is the strength (for example how many milligrams writtenas mg)
How much should I take for each dose
How many times a day should I take my medicine
At what times should I take my medicine
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert B
Should I take it before with or after a meal
Should I avoid any foods or medicines when I take it
Should I avoid alcoholic beverages when I take it
Are there any times when I should change the amount of medicineI take
What should I do if I forget to take it
If Irsquom sick and canrsquot keep food down should I still take my medicine
Can my diabetes medicine cause low blood glucose
What should I do if my blood glucose is too low
What side effects can this medicine cause
What should I do if I have side effects
How should I store this medicine
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Insert CWhat I need to know about Diabetes Medicines
Types of InsulinEach type of insulin has an onset a peak and a duration time
The onset is how soon the insulin starts to lower your blood glucoseafter you take it
The peak is the time the insulin is working the hardest to lower yourblood glucose
The duration is how long the insulin lastsmdashthe length of time it keepslowering your blood glucose
The times shown in the chart are estimates Your onset peak andduration times may be different Yoursquoll work with your health careteam to come up with an insulin plan that works best for you
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert C What I need to know about Diabetes Medicines In
Type of Insulin Brand Name Generic Name Onset Peak Duration
Rapid-acting qNovoLog q Insulin aspart 15 minutes 30 to 90 minutes 3 to 5 hours
q Apidra q Insulin glulisine 15 minutes 30 to 90 minutes 3 to 5 hours
qHumalog q Insulin lispro 15 minutes 30 to 90 minutes 3 to 5 hours
Short-acting q Humulin R
q Novolin R
q Regular (R) 30 to 60 minutes 2 to 4 hours 5 to 8 hours
Intermediate-acting q Humulin N
q Novolin N
q NPH (N) 1 to 3 hours 8 hours 12 to 16 hours
Long-acting q Levemir
q Lantus
q Insulin detemir
q Insulin glargine
1 hour Peakless 20 to 26 hours
Pre-mixed NPH(intermediate-acting)and regular (short-acting)
q Humulin 7030
q Novolin 7030
q 70 NPH and 30 regular 30 to 60 minutes Varies 10 to 16 hours
q Humulin 5050 q 50 NPH and 50 regular 30 to 60 minutes Varies 10 to 16 hours
Pre-mixed insulin lispro q Humalog Mix 7525 q 75 insulin lispro protamine 10 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 25 insulin lispro(intermediate-acting) andinsulin lispro (rapid-acting) q Humalog Mix 5050 q 50 insulin lispro protamine
and 50 insulin lispro10 to 15 minutes Varies 10 to 16 hours
Pre-mixed insulin aspart q NovoLog Mix 7030 q 70 insulin aspart protamine 5 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 30 insulin aspart(intermediate-acting) andinsulin aspart (rapid-acting)
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What I need to know about Diabetes Medicines Insert D
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Taking Glyset or Precose may cause stomach pain gas bloating
or diarrhea These symptoms usually go away after you have takenthese pills for a while
If you take Glyset or Precose What you need to know aboutlow blood glucose
If you take Glyset or Precose only glucose tablets or glucose gel
will bring your blood glucose level back to normal quickly Otherquick-fix foods and drinks wonrsquot raise your blood glucose as quicklybecause Glyset and Precose slow the digestion of other quick-fixfoods and drinks
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
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Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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Contents
What do diabetes medicines do 1
What targets are recommended forblood glucose levels 2
What happens to blood glucose levels inpeople with diabetes 4
Medicines for My Diabetes 6
Types of Diabetes Medicines 8What do I need to know aboutside effects of medicines 13
For More Information 14
Acknowledgments 15
Inserts in back pocket
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What do diabetes medicines do
Over time high levels of blood glucose also called bloodsugar can cause health problems These problemsinclude heart disease heart attacks strokes kidneydisease nerve damage digestive problems eye diseaseand tooth and gum problems You can help preventhealth problems by keeping your blood glucose levelson target
Everyone with diabetes needs to choose foods wiselyand be physically active If you canrsquot reach your targetblood glucose levels with wise food choices and physicalactivity you may need diabetes medicines The kindof medicine you take depends on your type of diabetes your schedule and your other health conditions
Diabetes medicines help keep yourblood glucose in your target range
The target range is suggested bydiabetes experts and yourdoctor or diabetes educatorSee page 2 for moreinformation about targetlevels for good health
1
You may need diabetes medicinesto reach your blood glucosetargets
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What targets are recommended for blood
glucose levelsThe National Diabetes Education Program uses bloodglucose targets set by the American Diabetes Association(ADA) for most people with diabetes To learn yourdaily blood glucose numbers yoursquoll check your bloodglucose levels on your own using a blood glucose meter
Target blood glucose levelsfor most people with diabetes
Before meals 70 to 130 mgdL
My targets
1 to 2 hours after Less than 180the start of a meal mgdL
Milligrams per deciliter
Also you should ask your doctor for a blood test calledthe A1C at least twice a year The A1C will give you youraverage blood glucose for the past 3 months
Target A1C result forpeople with diabetes
My target
Less than 7 percent
Your personal A1C goal might be higher or lower than7 percent Keeping your A1C as close to normal aspossiblemdashbelow 6 percent without having frequent low
2
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blood glucosemdashcan help prevent long-term diabetes
problems Doctors might recommend other goals for very young children older people people with other healthproblems or those who often have low blood glucose
Talk with your doctor or diabetes educator about whetherthe target blood glucose levels and A1C result listed in thecharts on page 2 are best for you Write your own targetlevels in the charts Both ways of checking your bloodglucose levels are important
If your blood glucose levels are not on target you mightneed a change in how you take care of your diabetesThe results of your A1C test and your daily blood glucosechecks can help you and your doctor make decisions about
l what you eat
l when you eat
l how much you eat
l what kind of exercise you do
l how much exercise you do
l the type of diabetes medicines you take
l the amount of diabetes medicines you take
3
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What happens to blood glucose levels in
people with diabetesBlood glucose levels go up and down throughout the dayand night in people with diabetes High blood glucoselevels over time can result in heart disease and otherhealth problems Low blood glucose levels can make youfeel shaky or pass out But you can learn how to makesure your blood glucose levels stay on targetmdashnot toohigh and not too low
What makes blood glucose levels go too high
Your blood glucose levels can go too high if
l you eat more than usual
l yoursquore not physically active
l yoursquore not taking enough diabetes medicine
l yoursquore sick or under stressl you exercise when your blood glucose level is
already high
4
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Medicines for My Diabetes
Ask your doctor what type of diabetes you have andcheck off the answer
I have
q type 1 diabetes
q type 2 diabetes
q gestational diabetes
q another type of diabetes ____________________
Medicines for Type 1 Diabetes
Type 1 diabetes once called juvenile diabetes orinsulin-dependent diabetes is usually first found inchildren teenagers or young adults If you have type 1diabetes you must take insulin because your body no
longer makes it You also might need to take other typesof diabetes medicines that work with insulin
6
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Medicines for Type 2 Diabetes
Type 2 diabetes once called adult-onset diabetes ornoninsulin-dependent diabetes is the most commonform of diabetes It can start when the body doesnrsquot useinsulin as it should a condition called insulin resistanceIf the body canrsquot keep up with the need for insulin you may need diabetes medicines Many choices areavailable Your doctor might prescribe two or moremedicines The ADA recommends that most people
start with metformin a kind of diabetes pill
Medicines for Gestational Diabetes
Gestational diabetes is diabetes that occurs for the firsttime during pregnancy The hormones of pregnancy or ashortage of insulin can cause gestational diabetes Most women with gestational diabetes control it with mealplanning and physical activity But some women need
insulin to reach their target blood glucose levels
Medicines for Other Types of Diabetes
If you have one of the rare forms of diabetes suchas diabetes caused by other medicines or monogenicdiabetes talk with your doctor about what kind ofdiabetes medicine would be best for you
7
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Types of Diabetes Medicines
Diabetes medicines come in several forms
Insulin
If your body no longer makes enough insulin yoursquoll needto take it Insulin is used for all types of diabetes Yourdoctor can help you decide which way of taking insulin isbest for you
l Taking injections Yoursquoll give yourself shots using aneedle and syringe The syringe is a hollow tube witha plunger You will put your dose of insulin into thetube Some people use an insulin pen which lookslike a pen but has a needle for its point
l Using an insulin pump An insulin pump is a smallmachine about the size of a cell phone worn outsideof your body on a belt or in a pocket or pouch The
pump connects to a small plastic tube and a verysmall needle The needle is inserted under the skinand stays in for several days Insulin is pumped fromthe machine through the tube into your body
8
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l Using an insulin jet injector The jet injector whichlooks like a large pen sends a fine spray of insulinthrough the skin with high-pressure air instead of aneedle
l Using an insulin infuser A small tube is inserted just beneath the skin and remains in place for severaldays Insulin is injected into the end of the tubeinstead of through the skin
If your body no longer makes enough insulin yoursquoll need to take it
9
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Types of Insulin
Each type of insulin works at a different speed Forexample rapid-acting insulin starts to work right after you take it Long-acting insulin works for many hoursMost people need two or more types of insulin to reachtheir blood glucose targets
Look at the list of types of insulin on Insert C in thepocket of this booklet Check off the names of thekinds of insulin you take Then write the names of your
insulins under My Insulins in the chart on Insert A
Diabetes Pills
Along with meal planning and physicalactivity diabetes pills help people withtype 2 diabetes or gestational diabeteskeep their blood glucose levels ontarget Several kinds of pills are
available Each works in a different way Many people take two orthree kinds of pills Somepeople take combination pillsCombination pills containtwo kinds of diabetes medicinein one tablet Some peopletake pills and insulin
Diabetes pills help people withtype 2 diabetes or gestationaldiabetes keep their blood glucoselevels on target
11
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Your doctor may ask you to try one kind of pill If it
doesnrsquot help you reach your blood glucose targets yourdoctor may ask you to
l take more of the same pill
l add another kind of pill
l change to another type of pill
l start taking insulin
l start taking another injected medicine
If your doctor suggests that you take insulin or anotherinjected medicine it doesnrsquot mean your diabetes isgetting worse Instead it means you need insulin oranother type of medicine to reach your blood glucosetargets Everyone is different What works best for youdepends on your usual daily routine eating habits andactivities and your other health conditions
For information about the different kinds of pills and what they do see the cards in the pocket of this bookletYoursquoll see the brand name and the generic namemdashthescientific namemdashfor each medicine Find your diabetespills and check off the names Then write the namesof your diabetes pills under My Pills and Injected
Medicines in the chart on Insert A
12
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Injections Other Than Insulin
In addition to insulin two other types of injectedmedicines are now available Both work with insulinmdasheither the bodyrsquos own or injectedmdashto help keep yourblood glucose from going too high after you eat Neitheris a substitute for insulin
See the cards in the pocket of this booklet for moreinformation about these injected medicines Checkoff the kinds you take Then write the names of
your injected medicines under My Pills and InjectedMedicines in the chart on Insert A
Talk with your doctor if you have questions about your diabetes medicines Do not stop taking yourdiabetes medicines without checking with your doctorfirst See Insert B for a list of questions to ask yourdoctor about your medicines
What do I need to know about side effectsof medicines
A side effect is an unwanted problem caused by amedicine For example some diabetes medicinescan cause nausea or an upset stomach when you first
start taking them Before you start a new medicine ask your doctor about possible side effects and how you canavoid them If the side effects of your medicine bother you tell your doctor
13
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For More Information
To find diabetes educatorsmdashnurses dietitians and otherhealth professionalsmdashnear you call the American Association of Diabetes Educators toll-free at1ndash800ndashTEAMUP4 (1ndash800ndash832ndash6874) Or go to wwwdiabeteseducatororg and see the ldquoFind a DiabetesEducatorrdquo section
For additional information about diabetes contact
American Diabetes AssociationNational Service Center1701 North Beauregard Street Alexandria VA 22311ndash1742Phone 1ndash800ndashDIABETES (1ndash800ndash342ndash2383)Fax 703ndash549ndash6995Email AskADAdiabetesorgInternet wwwdiabetesorg
Juvenile Diabetes Research Foundation International 26 Broadway 14th FloorNew York NY 10004Phone 1ndash800ndash533ndashCURE (1ndash800ndash533ndash2873)Fax 212ndash785ndash9595Email infojdrforgInternet wwwjdrforg
14
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15
National Diabetes Education Program
1 Diabetes WayBethesda MD 20814ndash9692Phone 1ndash888ndash693ndashNDEP (1ndash888ndash693ndash6337)TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndepmailnihgovInternet wwwndepnihgov
AcknowledgmentsPublications produced by the Clearinghouse arecarefully reviewed by both NIDDK scientists and outsideexperts This booklet was reviewed by Stuart T HainesPharmD University of Maryland School of PharmacyBaltimore
The US Government does not endorse or favor any specific commercialproduct or company Trade proprietary or company names appearing inthis document are used only because they are considered necessary in thecontext of the information provided If a product is not mentioned theomission does not mean or imply that the product is unsatisfactory
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National Diabetes Information Clearinghouse1 Information WayBethesda MD 20892ndash3560
Phone 1ndash800ndash860ndash8747TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndicinfoniddknihgovInternet wwwdiabetesniddknihgov
The National Diabetes Information Clearinghouse (NDIC) is a serviceof the National Institute of Diabetes and Digestive and Kidney Diseases(NIDDK) The NIDDK is part of the National Institutes of Health of theUS Department of Health and Human Services Established in 1978 the
Clearinghouse provides information about diabetes to people with diabetesand to their families health care professionals and the public The NDICanswers inquiries develops and distributes publications and works closely with professional and patient organizations and Government agencies tocoordinate resources about diabetes
This publication is not copyrighted The Clearinghouse encourages usersof this publication to duplicate and distribute as many copies as desired
This publication is available at wwwdiabetesniddknihgov
This publication may contain information about medications Whenprepared this publication included the most current information availableFor updates or for questions about any medications contact the US Foodand Drug Administration toll-free at 1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332)or visit wwwfdagov Consult your doctor for more information
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Inserts
My Diabetes Medicines Insert A
Questions to Ask about
Your Diabetes Medicines Insert BTypes of Insulin Insert C
Glyset and Precose (Alpha-Glucosidase Inhibitors) Insert D
Glucophage Glucophage XR and Riomet(Biguanides) Insert E
Starlix (D-Phenylalanine Derivative) Insert F
Januvia (DPP-4 Inhibitor) Insert G
Prandin (Meglitinide) Insert H
Amaryl DiaBeta Diabinese GlucotrolGlucotrol XL Glynase PresTab Micronasetolazamide and tolbutamide (Sulfonylureas) Insert I
Actos and Avandia (Thiazolidinediones) Insert J
Actoplus Met Actoplus Met XR Avandamet Avandaryl DuetactGlucovance Janumetand Metaglip (Combination Diabetes Pills) Insert K
Symlin (Amylin Mimetic) Insert L
Byetta (Incretin Mimetic) Insert M
About Low Blood Glucose Insert N
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert BWhat I need to know about Diabetes Medicines
Questions to Ask about Your Diabetes Medicines Ask your doctor these questions when you get a prescription fora medicine Make copies of this card and use one card for eachof your medicines
What are the names of my medicine
Brand name Generic name
What does my medicine do
When should I start this medicine
This medicine is prescribed by
How long will it take this medicine to workWhat is the strength (for example how many milligrams writtenas mg)
How much should I take for each dose
How many times a day should I take my medicine
At what times should I take my medicine
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert B
Should I take it before with or after a meal
Should I avoid any foods or medicines when I take it
Should I avoid alcoholic beverages when I take it
Are there any times when I should change the amount of medicineI take
What should I do if I forget to take it
If Irsquom sick and canrsquot keep food down should I still take my medicine
Can my diabetes medicine cause low blood glucose
What should I do if my blood glucose is too low
What side effects can this medicine cause
What should I do if I have side effects
How should I store this medicine
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Insert CWhat I need to know about Diabetes Medicines
Types of InsulinEach type of insulin has an onset a peak and a duration time
The onset is how soon the insulin starts to lower your blood glucoseafter you take it
The peak is the time the insulin is working the hardest to lower yourblood glucose
The duration is how long the insulin lastsmdashthe length of time it keepslowering your blood glucose
The times shown in the chart are estimates Your onset peak andduration times may be different Yoursquoll work with your health careteam to come up with an insulin plan that works best for you
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert C What I need to know about Diabetes Medicines In
Type of Insulin Brand Name Generic Name Onset Peak Duration
Rapid-acting qNovoLog q Insulin aspart 15 minutes 30 to 90 minutes 3 to 5 hours
q Apidra q Insulin glulisine 15 minutes 30 to 90 minutes 3 to 5 hours
qHumalog q Insulin lispro 15 minutes 30 to 90 minutes 3 to 5 hours
Short-acting q Humulin R
q Novolin R
q Regular (R) 30 to 60 minutes 2 to 4 hours 5 to 8 hours
Intermediate-acting q Humulin N
q Novolin N
q NPH (N) 1 to 3 hours 8 hours 12 to 16 hours
Long-acting q Levemir
q Lantus
q Insulin detemir
q Insulin glargine
1 hour Peakless 20 to 26 hours
Pre-mixed NPH(intermediate-acting)and regular (short-acting)
q Humulin 7030
q Novolin 7030
q 70 NPH and 30 regular 30 to 60 minutes Varies 10 to 16 hours
q Humulin 5050 q 50 NPH and 50 regular 30 to 60 minutes Varies 10 to 16 hours
Pre-mixed insulin lispro q Humalog Mix 7525 q 75 insulin lispro protamine 10 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 25 insulin lispro(intermediate-acting) andinsulin lispro (rapid-acting) q Humalog Mix 5050 q 50 insulin lispro protamine
and 50 insulin lispro10 to 15 minutes Varies 10 to 16 hours
Pre-mixed insulin aspart q NovoLog Mix 7030 q 70 insulin aspart protamine 5 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 30 insulin aspart(intermediate-acting) andinsulin aspart (rapid-acting)
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What I need to know about Diabetes Medicines Insert D
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Taking Glyset or Precose may cause stomach pain gas bloating
or diarrhea These symptoms usually go away after you have takenthese pills for a while
If you take Glyset or Precose What you need to know aboutlow blood glucose
If you take Glyset or Precose only glucose tablets or glucose gel
will bring your blood glucose level back to normal quickly Otherquick-fix foods and drinks wonrsquot raise your blood glucose as quicklybecause Glyset and Precose slow the digestion of other quick-fixfoods and drinks
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
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Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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What do diabetes medicines do
Over time high levels of blood glucose also called bloodsugar can cause health problems These problemsinclude heart disease heart attacks strokes kidneydisease nerve damage digestive problems eye diseaseand tooth and gum problems You can help preventhealth problems by keeping your blood glucose levelson target
Everyone with diabetes needs to choose foods wiselyand be physically active If you canrsquot reach your targetblood glucose levels with wise food choices and physicalactivity you may need diabetes medicines The kindof medicine you take depends on your type of diabetes your schedule and your other health conditions
Diabetes medicines help keep yourblood glucose in your target range
The target range is suggested bydiabetes experts and yourdoctor or diabetes educatorSee page 2 for moreinformation about targetlevels for good health
1
You may need diabetes medicinesto reach your blood glucosetargets
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What targets are recommended for blood
glucose levelsThe National Diabetes Education Program uses bloodglucose targets set by the American Diabetes Association(ADA) for most people with diabetes To learn yourdaily blood glucose numbers yoursquoll check your bloodglucose levels on your own using a blood glucose meter
Target blood glucose levelsfor most people with diabetes
Before meals 70 to 130 mgdL
My targets
1 to 2 hours after Less than 180the start of a meal mgdL
Milligrams per deciliter
Also you should ask your doctor for a blood test calledthe A1C at least twice a year The A1C will give you youraverage blood glucose for the past 3 months
Target A1C result forpeople with diabetes
My target
Less than 7 percent
Your personal A1C goal might be higher or lower than7 percent Keeping your A1C as close to normal aspossiblemdashbelow 6 percent without having frequent low
2
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blood glucosemdashcan help prevent long-term diabetes
problems Doctors might recommend other goals for very young children older people people with other healthproblems or those who often have low blood glucose
Talk with your doctor or diabetes educator about whetherthe target blood glucose levels and A1C result listed in thecharts on page 2 are best for you Write your own targetlevels in the charts Both ways of checking your bloodglucose levels are important
If your blood glucose levels are not on target you mightneed a change in how you take care of your diabetesThe results of your A1C test and your daily blood glucosechecks can help you and your doctor make decisions about
l what you eat
l when you eat
l how much you eat
l what kind of exercise you do
l how much exercise you do
l the type of diabetes medicines you take
l the amount of diabetes medicines you take
3
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What happens to blood glucose levels in
people with diabetesBlood glucose levels go up and down throughout the dayand night in people with diabetes High blood glucoselevels over time can result in heart disease and otherhealth problems Low blood glucose levels can make youfeel shaky or pass out But you can learn how to makesure your blood glucose levels stay on targetmdashnot toohigh and not too low
What makes blood glucose levels go too high
Your blood glucose levels can go too high if
l you eat more than usual
l yoursquore not physically active
l yoursquore not taking enough diabetes medicine
l yoursquore sick or under stressl you exercise when your blood glucose level is
already high
4
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Medicines for My Diabetes
Ask your doctor what type of diabetes you have andcheck off the answer
I have
q type 1 diabetes
q type 2 diabetes
q gestational diabetes
q another type of diabetes ____________________
Medicines for Type 1 Diabetes
Type 1 diabetes once called juvenile diabetes orinsulin-dependent diabetes is usually first found inchildren teenagers or young adults If you have type 1diabetes you must take insulin because your body no
longer makes it You also might need to take other typesof diabetes medicines that work with insulin
6
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Medicines for Type 2 Diabetes
Type 2 diabetes once called adult-onset diabetes ornoninsulin-dependent diabetes is the most commonform of diabetes It can start when the body doesnrsquot useinsulin as it should a condition called insulin resistanceIf the body canrsquot keep up with the need for insulin you may need diabetes medicines Many choices areavailable Your doctor might prescribe two or moremedicines The ADA recommends that most people
start with metformin a kind of diabetes pill
Medicines for Gestational Diabetes
Gestational diabetes is diabetes that occurs for the firsttime during pregnancy The hormones of pregnancy or ashortage of insulin can cause gestational diabetes Most women with gestational diabetes control it with mealplanning and physical activity But some women need
insulin to reach their target blood glucose levels
Medicines for Other Types of Diabetes
If you have one of the rare forms of diabetes suchas diabetes caused by other medicines or monogenicdiabetes talk with your doctor about what kind ofdiabetes medicine would be best for you
7
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Types of Diabetes Medicines
Diabetes medicines come in several forms
Insulin
If your body no longer makes enough insulin yoursquoll needto take it Insulin is used for all types of diabetes Yourdoctor can help you decide which way of taking insulin isbest for you
l Taking injections Yoursquoll give yourself shots using aneedle and syringe The syringe is a hollow tube witha plunger You will put your dose of insulin into thetube Some people use an insulin pen which lookslike a pen but has a needle for its point
l Using an insulin pump An insulin pump is a smallmachine about the size of a cell phone worn outsideof your body on a belt or in a pocket or pouch The
pump connects to a small plastic tube and a verysmall needle The needle is inserted under the skinand stays in for several days Insulin is pumped fromthe machine through the tube into your body
8
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l Using an insulin jet injector The jet injector whichlooks like a large pen sends a fine spray of insulinthrough the skin with high-pressure air instead of aneedle
l Using an insulin infuser A small tube is inserted just beneath the skin and remains in place for severaldays Insulin is injected into the end of the tubeinstead of through the skin
If your body no longer makes enough insulin yoursquoll need to take it
9
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Types of Insulin
Each type of insulin works at a different speed Forexample rapid-acting insulin starts to work right after you take it Long-acting insulin works for many hoursMost people need two or more types of insulin to reachtheir blood glucose targets
Look at the list of types of insulin on Insert C in thepocket of this booklet Check off the names of thekinds of insulin you take Then write the names of your
insulins under My Insulins in the chart on Insert A
Diabetes Pills
Along with meal planning and physicalactivity diabetes pills help people withtype 2 diabetes or gestational diabeteskeep their blood glucose levels ontarget Several kinds of pills are
available Each works in a different way Many people take two orthree kinds of pills Somepeople take combination pillsCombination pills containtwo kinds of diabetes medicinein one tablet Some peopletake pills and insulin
Diabetes pills help people withtype 2 diabetes or gestationaldiabetes keep their blood glucoselevels on target
11
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Your doctor may ask you to try one kind of pill If it
doesnrsquot help you reach your blood glucose targets yourdoctor may ask you to
l take more of the same pill
l add another kind of pill
l change to another type of pill
l start taking insulin
l start taking another injected medicine
If your doctor suggests that you take insulin or anotherinjected medicine it doesnrsquot mean your diabetes isgetting worse Instead it means you need insulin oranother type of medicine to reach your blood glucosetargets Everyone is different What works best for youdepends on your usual daily routine eating habits andactivities and your other health conditions
For information about the different kinds of pills and what they do see the cards in the pocket of this bookletYoursquoll see the brand name and the generic namemdashthescientific namemdashfor each medicine Find your diabetespills and check off the names Then write the namesof your diabetes pills under My Pills and Injected
Medicines in the chart on Insert A
12
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Injections Other Than Insulin
In addition to insulin two other types of injectedmedicines are now available Both work with insulinmdasheither the bodyrsquos own or injectedmdashto help keep yourblood glucose from going too high after you eat Neitheris a substitute for insulin
See the cards in the pocket of this booklet for moreinformation about these injected medicines Checkoff the kinds you take Then write the names of
your injected medicines under My Pills and InjectedMedicines in the chart on Insert A
Talk with your doctor if you have questions about your diabetes medicines Do not stop taking yourdiabetes medicines without checking with your doctorfirst See Insert B for a list of questions to ask yourdoctor about your medicines
What do I need to know about side effectsof medicines
A side effect is an unwanted problem caused by amedicine For example some diabetes medicinescan cause nausea or an upset stomach when you first
start taking them Before you start a new medicine ask your doctor about possible side effects and how you canavoid them If the side effects of your medicine bother you tell your doctor
13
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For More Information
To find diabetes educatorsmdashnurses dietitians and otherhealth professionalsmdashnear you call the American Association of Diabetes Educators toll-free at1ndash800ndashTEAMUP4 (1ndash800ndash832ndash6874) Or go to wwwdiabeteseducatororg and see the ldquoFind a DiabetesEducatorrdquo section
For additional information about diabetes contact
American Diabetes AssociationNational Service Center1701 North Beauregard Street Alexandria VA 22311ndash1742Phone 1ndash800ndashDIABETES (1ndash800ndash342ndash2383)Fax 703ndash549ndash6995Email AskADAdiabetesorgInternet wwwdiabetesorg
Juvenile Diabetes Research Foundation International 26 Broadway 14th FloorNew York NY 10004Phone 1ndash800ndash533ndashCURE (1ndash800ndash533ndash2873)Fax 212ndash785ndash9595Email infojdrforgInternet wwwjdrforg
14
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15
National Diabetes Education Program
1 Diabetes WayBethesda MD 20814ndash9692Phone 1ndash888ndash693ndashNDEP (1ndash888ndash693ndash6337)TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndepmailnihgovInternet wwwndepnihgov
AcknowledgmentsPublications produced by the Clearinghouse arecarefully reviewed by both NIDDK scientists and outsideexperts This booklet was reviewed by Stuart T HainesPharmD University of Maryland School of PharmacyBaltimore
The US Government does not endorse or favor any specific commercialproduct or company Trade proprietary or company names appearing inthis document are used only because they are considered necessary in thecontext of the information provided If a product is not mentioned theomission does not mean or imply that the product is unsatisfactory
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National Diabetes Information Clearinghouse1 Information WayBethesda MD 20892ndash3560
Phone 1ndash800ndash860ndash8747TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndicinfoniddknihgovInternet wwwdiabetesniddknihgov
The National Diabetes Information Clearinghouse (NDIC) is a serviceof the National Institute of Diabetes and Digestive and Kidney Diseases(NIDDK) The NIDDK is part of the National Institutes of Health of theUS Department of Health and Human Services Established in 1978 the
Clearinghouse provides information about diabetes to people with diabetesand to their families health care professionals and the public The NDICanswers inquiries develops and distributes publications and works closely with professional and patient organizations and Government agencies tocoordinate resources about diabetes
This publication is not copyrighted The Clearinghouse encourages usersof this publication to duplicate and distribute as many copies as desired
This publication is available at wwwdiabetesniddknihgov
This publication may contain information about medications Whenprepared this publication included the most current information availableFor updates or for questions about any medications contact the US Foodand Drug Administration toll-free at 1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332)or visit wwwfdagov Consult your doctor for more information
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Inserts
My Diabetes Medicines Insert A
Questions to Ask about
Your Diabetes Medicines Insert BTypes of Insulin Insert C
Glyset and Precose (Alpha-Glucosidase Inhibitors) Insert D
Glucophage Glucophage XR and Riomet(Biguanides) Insert E
Starlix (D-Phenylalanine Derivative) Insert F
Januvia (DPP-4 Inhibitor) Insert G
Prandin (Meglitinide) Insert H
Amaryl DiaBeta Diabinese GlucotrolGlucotrol XL Glynase PresTab Micronasetolazamide and tolbutamide (Sulfonylureas) Insert I
Actos and Avandia (Thiazolidinediones) Insert J
Actoplus Met Actoplus Met XR Avandamet Avandaryl DuetactGlucovance Janumetand Metaglip (Combination Diabetes Pills) Insert K
Symlin (Amylin Mimetic) Insert L
Byetta (Incretin Mimetic) Insert M
About Low Blood Glucose Insert N
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert BWhat I need to know about Diabetes Medicines
Questions to Ask about Your Diabetes Medicines Ask your doctor these questions when you get a prescription fora medicine Make copies of this card and use one card for eachof your medicines
What are the names of my medicine
Brand name Generic name
What does my medicine do
When should I start this medicine
This medicine is prescribed by
How long will it take this medicine to workWhat is the strength (for example how many milligrams writtenas mg)
How much should I take for each dose
How many times a day should I take my medicine
At what times should I take my medicine
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert B
Should I take it before with or after a meal
Should I avoid any foods or medicines when I take it
Should I avoid alcoholic beverages when I take it
Are there any times when I should change the amount of medicineI take
What should I do if I forget to take it
If Irsquom sick and canrsquot keep food down should I still take my medicine
Can my diabetes medicine cause low blood glucose
What should I do if my blood glucose is too low
What side effects can this medicine cause
What should I do if I have side effects
How should I store this medicine
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Insert CWhat I need to know about Diabetes Medicines
Types of InsulinEach type of insulin has an onset a peak and a duration time
The onset is how soon the insulin starts to lower your blood glucoseafter you take it
The peak is the time the insulin is working the hardest to lower yourblood glucose
The duration is how long the insulin lastsmdashthe length of time it keepslowering your blood glucose
The times shown in the chart are estimates Your onset peak andduration times may be different Yoursquoll work with your health careteam to come up with an insulin plan that works best for you
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert C What I need to know about Diabetes Medicines In
Type of Insulin Brand Name Generic Name Onset Peak Duration
Rapid-acting qNovoLog q Insulin aspart 15 minutes 30 to 90 minutes 3 to 5 hours
q Apidra q Insulin glulisine 15 minutes 30 to 90 minutes 3 to 5 hours
qHumalog q Insulin lispro 15 minutes 30 to 90 minutes 3 to 5 hours
Short-acting q Humulin R
q Novolin R
q Regular (R) 30 to 60 minutes 2 to 4 hours 5 to 8 hours
Intermediate-acting q Humulin N
q Novolin N
q NPH (N) 1 to 3 hours 8 hours 12 to 16 hours
Long-acting q Levemir
q Lantus
q Insulin detemir
q Insulin glargine
1 hour Peakless 20 to 26 hours
Pre-mixed NPH(intermediate-acting)and regular (short-acting)
q Humulin 7030
q Novolin 7030
q 70 NPH and 30 regular 30 to 60 minutes Varies 10 to 16 hours
q Humulin 5050 q 50 NPH and 50 regular 30 to 60 minutes Varies 10 to 16 hours
Pre-mixed insulin lispro q Humalog Mix 7525 q 75 insulin lispro protamine 10 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 25 insulin lispro(intermediate-acting) andinsulin lispro (rapid-acting) q Humalog Mix 5050 q 50 insulin lispro protamine
and 50 insulin lispro10 to 15 minutes Varies 10 to 16 hours
Pre-mixed insulin aspart q NovoLog Mix 7030 q 70 insulin aspart protamine 5 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 30 insulin aspart(intermediate-acting) andinsulin aspart (rapid-acting)
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What I need to know about Diabetes Medicines Insert D
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Taking Glyset or Precose may cause stomach pain gas bloating
or diarrhea These symptoms usually go away after you have takenthese pills for a while
If you take Glyset or Precose What you need to know aboutlow blood glucose
If you take Glyset or Precose only glucose tablets or glucose gel
will bring your blood glucose level back to normal quickly Otherquick-fix foods and drinks wonrsquot raise your blood glucose as quicklybecause Glyset and Precose slow the digestion of other quick-fixfoods and drinks
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
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Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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What targets are recommended for blood
glucose levelsThe National Diabetes Education Program uses bloodglucose targets set by the American Diabetes Association(ADA) for most people with diabetes To learn yourdaily blood glucose numbers yoursquoll check your bloodglucose levels on your own using a blood glucose meter
Target blood glucose levelsfor most people with diabetes
Before meals 70 to 130 mgdL
My targets
1 to 2 hours after Less than 180the start of a meal mgdL
Milligrams per deciliter
Also you should ask your doctor for a blood test calledthe A1C at least twice a year The A1C will give you youraverage blood glucose for the past 3 months
Target A1C result forpeople with diabetes
My target
Less than 7 percent
Your personal A1C goal might be higher or lower than7 percent Keeping your A1C as close to normal aspossiblemdashbelow 6 percent without having frequent low
2
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blood glucosemdashcan help prevent long-term diabetes
problems Doctors might recommend other goals for very young children older people people with other healthproblems or those who often have low blood glucose
Talk with your doctor or diabetes educator about whetherthe target blood glucose levels and A1C result listed in thecharts on page 2 are best for you Write your own targetlevels in the charts Both ways of checking your bloodglucose levels are important
If your blood glucose levels are not on target you mightneed a change in how you take care of your diabetesThe results of your A1C test and your daily blood glucosechecks can help you and your doctor make decisions about
l what you eat
l when you eat
l how much you eat
l what kind of exercise you do
l how much exercise you do
l the type of diabetes medicines you take
l the amount of diabetes medicines you take
3
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What happens to blood glucose levels in
people with diabetesBlood glucose levels go up and down throughout the dayand night in people with diabetes High blood glucoselevels over time can result in heart disease and otherhealth problems Low blood glucose levels can make youfeel shaky or pass out But you can learn how to makesure your blood glucose levels stay on targetmdashnot toohigh and not too low
What makes blood glucose levels go too high
Your blood glucose levels can go too high if
l you eat more than usual
l yoursquore not physically active
l yoursquore not taking enough diabetes medicine
l yoursquore sick or under stressl you exercise when your blood glucose level is
already high
4
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Medicines for My Diabetes
Ask your doctor what type of diabetes you have andcheck off the answer
I have
q type 1 diabetes
q type 2 diabetes
q gestational diabetes
q another type of diabetes ____________________
Medicines for Type 1 Diabetes
Type 1 diabetes once called juvenile diabetes orinsulin-dependent diabetes is usually first found inchildren teenagers or young adults If you have type 1diabetes you must take insulin because your body no
longer makes it You also might need to take other typesof diabetes medicines that work with insulin
6
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Medicines for Type 2 Diabetes
Type 2 diabetes once called adult-onset diabetes ornoninsulin-dependent diabetes is the most commonform of diabetes It can start when the body doesnrsquot useinsulin as it should a condition called insulin resistanceIf the body canrsquot keep up with the need for insulin you may need diabetes medicines Many choices areavailable Your doctor might prescribe two or moremedicines The ADA recommends that most people
start with metformin a kind of diabetes pill
Medicines for Gestational Diabetes
Gestational diabetes is diabetes that occurs for the firsttime during pregnancy The hormones of pregnancy or ashortage of insulin can cause gestational diabetes Most women with gestational diabetes control it with mealplanning and physical activity But some women need
insulin to reach their target blood glucose levels
Medicines for Other Types of Diabetes
If you have one of the rare forms of diabetes suchas diabetes caused by other medicines or monogenicdiabetes talk with your doctor about what kind ofdiabetes medicine would be best for you
7
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Types of Diabetes Medicines
Diabetes medicines come in several forms
Insulin
If your body no longer makes enough insulin yoursquoll needto take it Insulin is used for all types of diabetes Yourdoctor can help you decide which way of taking insulin isbest for you
l Taking injections Yoursquoll give yourself shots using aneedle and syringe The syringe is a hollow tube witha plunger You will put your dose of insulin into thetube Some people use an insulin pen which lookslike a pen but has a needle for its point
l Using an insulin pump An insulin pump is a smallmachine about the size of a cell phone worn outsideof your body on a belt or in a pocket or pouch The
pump connects to a small plastic tube and a verysmall needle The needle is inserted under the skinand stays in for several days Insulin is pumped fromthe machine through the tube into your body
8
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l Using an insulin jet injector The jet injector whichlooks like a large pen sends a fine spray of insulinthrough the skin with high-pressure air instead of aneedle
l Using an insulin infuser A small tube is inserted just beneath the skin and remains in place for severaldays Insulin is injected into the end of the tubeinstead of through the skin
If your body no longer makes enough insulin yoursquoll need to take it
9
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Types of Insulin
Each type of insulin works at a different speed Forexample rapid-acting insulin starts to work right after you take it Long-acting insulin works for many hoursMost people need two or more types of insulin to reachtheir blood glucose targets
Look at the list of types of insulin on Insert C in thepocket of this booklet Check off the names of thekinds of insulin you take Then write the names of your
insulins under My Insulins in the chart on Insert A
Diabetes Pills
Along with meal planning and physicalactivity diabetes pills help people withtype 2 diabetes or gestational diabeteskeep their blood glucose levels ontarget Several kinds of pills are
available Each works in a different way Many people take two orthree kinds of pills Somepeople take combination pillsCombination pills containtwo kinds of diabetes medicinein one tablet Some peopletake pills and insulin
Diabetes pills help people withtype 2 diabetes or gestationaldiabetes keep their blood glucoselevels on target
11
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Your doctor may ask you to try one kind of pill If it
doesnrsquot help you reach your blood glucose targets yourdoctor may ask you to
l take more of the same pill
l add another kind of pill
l change to another type of pill
l start taking insulin
l start taking another injected medicine
If your doctor suggests that you take insulin or anotherinjected medicine it doesnrsquot mean your diabetes isgetting worse Instead it means you need insulin oranother type of medicine to reach your blood glucosetargets Everyone is different What works best for youdepends on your usual daily routine eating habits andactivities and your other health conditions
For information about the different kinds of pills and what they do see the cards in the pocket of this bookletYoursquoll see the brand name and the generic namemdashthescientific namemdashfor each medicine Find your diabetespills and check off the names Then write the namesof your diabetes pills under My Pills and Injected
Medicines in the chart on Insert A
12
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Injections Other Than Insulin
In addition to insulin two other types of injectedmedicines are now available Both work with insulinmdasheither the bodyrsquos own or injectedmdashto help keep yourblood glucose from going too high after you eat Neitheris a substitute for insulin
See the cards in the pocket of this booklet for moreinformation about these injected medicines Checkoff the kinds you take Then write the names of
your injected medicines under My Pills and InjectedMedicines in the chart on Insert A
Talk with your doctor if you have questions about your diabetes medicines Do not stop taking yourdiabetes medicines without checking with your doctorfirst See Insert B for a list of questions to ask yourdoctor about your medicines
What do I need to know about side effectsof medicines
A side effect is an unwanted problem caused by amedicine For example some diabetes medicinescan cause nausea or an upset stomach when you first
start taking them Before you start a new medicine ask your doctor about possible side effects and how you canavoid them If the side effects of your medicine bother you tell your doctor
13
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For More Information
To find diabetes educatorsmdashnurses dietitians and otherhealth professionalsmdashnear you call the American Association of Diabetes Educators toll-free at1ndash800ndashTEAMUP4 (1ndash800ndash832ndash6874) Or go to wwwdiabeteseducatororg and see the ldquoFind a DiabetesEducatorrdquo section
For additional information about diabetes contact
American Diabetes AssociationNational Service Center1701 North Beauregard Street Alexandria VA 22311ndash1742Phone 1ndash800ndashDIABETES (1ndash800ndash342ndash2383)Fax 703ndash549ndash6995Email AskADAdiabetesorgInternet wwwdiabetesorg
Juvenile Diabetes Research Foundation International 26 Broadway 14th FloorNew York NY 10004Phone 1ndash800ndash533ndashCURE (1ndash800ndash533ndash2873)Fax 212ndash785ndash9595Email infojdrforgInternet wwwjdrforg
14
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15
National Diabetes Education Program
1 Diabetes WayBethesda MD 20814ndash9692Phone 1ndash888ndash693ndashNDEP (1ndash888ndash693ndash6337)TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndepmailnihgovInternet wwwndepnihgov
AcknowledgmentsPublications produced by the Clearinghouse arecarefully reviewed by both NIDDK scientists and outsideexperts This booklet was reviewed by Stuart T HainesPharmD University of Maryland School of PharmacyBaltimore
The US Government does not endorse or favor any specific commercialproduct or company Trade proprietary or company names appearing inthis document are used only because they are considered necessary in thecontext of the information provided If a product is not mentioned theomission does not mean or imply that the product is unsatisfactory
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National Diabetes Information Clearinghouse1 Information WayBethesda MD 20892ndash3560
Phone 1ndash800ndash860ndash8747TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndicinfoniddknihgovInternet wwwdiabetesniddknihgov
The National Diabetes Information Clearinghouse (NDIC) is a serviceof the National Institute of Diabetes and Digestive and Kidney Diseases(NIDDK) The NIDDK is part of the National Institutes of Health of theUS Department of Health and Human Services Established in 1978 the
Clearinghouse provides information about diabetes to people with diabetesand to their families health care professionals and the public The NDICanswers inquiries develops and distributes publications and works closely with professional and patient organizations and Government agencies tocoordinate resources about diabetes
This publication is not copyrighted The Clearinghouse encourages usersof this publication to duplicate and distribute as many copies as desired
This publication is available at wwwdiabetesniddknihgov
This publication may contain information about medications Whenprepared this publication included the most current information availableFor updates or for questions about any medications contact the US Foodand Drug Administration toll-free at 1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332)or visit wwwfdagov Consult your doctor for more information
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Inserts
My Diabetes Medicines Insert A
Questions to Ask about
Your Diabetes Medicines Insert BTypes of Insulin Insert C
Glyset and Precose (Alpha-Glucosidase Inhibitors) Insert D
Glucophage Glucophage XR and Riomet(Biguanides) Insert E
Starlix (D-Phenylalanine Derivative) Insert F
Januvia (DPP-4 Inhibitor) Insert G
Prandin (Meglitinide) Insert H
Amaryl DiaBeta Diabinese GlucotrolGlucotrol XL Glynase PresTab Micronasetolazamide and tolbutamide (Sulfonylureas) Insert I
Actos and Avandia (Thiazolidinediones) Insert J
Actoplus Met Actoplus Met XR Avandamet Avandaryl DuetactGlucovance Janumetand Metaglip (Combination Diabetes Pills) Insert K
Symlin (Amylin Mimetic) Insert L
Byetta (Incretin Mimetic) Insert M
About Low Blood Glucose Insert N
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert BWhat I need to know about Diabetes Medicines
Questions to Ask about Your Diabetes Medicines Ask your doctor these questions when you get a prescription fora medicine Make copies of this card and use one card for eachof your medicines
What are the names of my medicine
Brand name Generic name
What does my medicine do
When should I start this medicine
This medicine is prescribed by
How long will it take this medicine to workWhat is the strength (for example how many milligrams writtenas mg)
How much should I take for each dose
How many times a day should I take my medicine
At what times should I take my medicine
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert B
Should I take it before with or after a meal
Should I avoid any foods or medicines when I take it
Should I avoid alcoholic beverages when I take it
Are there any times when I should change the amount of medicineI take
What should I do if I forget to take it
If Irsquom sick and canrsquot keep food down should I still take my medicine
Can my diabetes medicine cause low blood glucose
What should I do if my blood glucose is too low
What side effects can this medicine cause
What should I do if I have side effects
How should I store this medicine
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Insert CWhat I need to know about Diabetes Medicines
Types of InsulinEach type of insulin has an onset a peak and a duration time
The onset is how soon the insulin starts to lower your blood glucoseafter you take it
The peak is the time the insulin is working the hardest to lower yourblood glucose
The duration is how long the insulin lastsmdashthe length of time it keepslowering your blood glucose
The times shown in the chart are estimates Your onset peak andduration times may be different Yoursquoll work with your health careteam to come up with an insulin plan that works best for you
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert C What I need to know about Diabetes Medicines In
Type of Insulin Brand Name Generic Name Onset Peak Duration
Rapid-acting qNovoLog q Insulin aspart 15 minutes 30 to 90 minutes 3 to 5 hours
q Apidra q Insulin glulisine 15 minutes 30 to 90 minutes 3 to 5 hours
qHumalog q Insulin lispro 15 minutes 30 to 90 minutes 3 to 5 hours
Short-acting q Humulin R
q Novolin R
q Regular (R) 30 to 60 minutes 2 to 4 hours 5 to 8 hours
Intermediate-acting q Humulin N
q Novolin N
q NPH (N) 1 to 3 hours 8 hours 12 to 16 hours
Long-acting q Levemir
q Lantus
q Insulin detemir
q Insulin glargine
1 hour Peakless 20 to 26 hours
Pre-mixed NPH(intermediate-acting)and regular (short-acting)
q Humulin 7030
q Novolin 7030
q 70 NPH and 30 regular 30 to 60 minutes Varies 10 to 16 hours
q Humulin 5050 q 50 NPH and 50 regular 30 to 60 minutes Varies 10 to 16 hours
Pre-mixed insulin lispro q Humalog Mix 7525 q 75 insulin lispro protamine 10 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 25 insulin lispro(intermediate-acting) andinsulin lispro (rapid-acting) q Humalog Mix 5050 q 50 insulin lispro protamine
and 50 insulin lispro10 to 15 minutes Varies 10 to 16 hours
Pre-mixed insulin aspart q NovoLog Mix 7030 q 70 insulin aspart protamine 5 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 30 insulin aspart(intermediate-acting) andinsulin aspart (rapid-acting)
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What I need to know about Diabetes Medicines Insert D
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Taking Glyset or Precose may cause stomach pain gas bloating
or diarrhea These symptoms usually go away after you have takenthese pills for a while
If you take Glyset or Precose What you need to know aboutlow blood glucose
If you take Glyset or Precose only glucose tablets or glucose gel
will bring your blood glucose level back to normal quickly Otherquick-fix foods and drinks wonrsquot raise your blood glucose as quicklybecause Glyset and Precose slow the digestion of other quick-fixfoods and drinks
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
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Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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blood glucosemdashcan help prevent long-term diabetes
problems Doctors might recommend other goals for very young children older people people with other healthproblems or those who often have low blood glucose
Talk with your doctor or diabetes educator about whetherthe target blood glucose levels and A1C result listed in thecharts on page 2 are best for you Write your own targetlevels in the charts Both ways of checking your bloodglucose levels are important
If your blood glucose levels are not on target you mightneed a change in how you take care of your diabetesThe results of your A1C test and your daily blood glucosechecks can help you and your doctor make decisions about
l what you eat
l when you eat
l how much you eat
l what kind of exercise you do
l how much exercise you do
l the type of diabetes medicines you take
l the amount of diabetes medicines you take
3
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What happens to blood glucose levels in
people with diabetesBlood glucose levels go up and down throughout the dayand night in people with diabetes High blood glucoselevels over time can result in heart disease and otherhealth problems Low blood glucose levels can make youfeel shaky or pass out But you can learn how to makesure your blood glucose levels stay on targetmdashnot toohigh and not too low
What makes blood glucose levels go too high
Your blood glucose levels can go too high if
l you eat more than usual
l yoursquore not physically active
l yoursquore not taking enough diabetes medicine
l yoursquore sick or under stressl you exercise when your blood glucose level is
already high
4
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Medicines for My Diabetes
Ask your doctor what type of diabetes you have andcheck off the answer
I have
q type 1 diabetes
q type 2 diabetes
q gestational diabetes
q another type of diabetes ____________________
Medicines for Type 1 Diabetes
Type 1 diabetes once called juvenile diabetes orinsulin-dependent diabetes is usually first found inchildren teenagers or young adults If you have type 1diabetes you must take insulin because your body no
longer makes it You also might need to take other typesof diabetes medicines that work with insulin
6
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Medicines for Type 2 Diabetes
Type 2 diabetes once called adult-onset diabetes ornoninsulin-dependent diabetes is the most commonform of diabetes It can start when the body doesnrsquot useinsulin as it should a condition called insulin resistanceIf the body canrsquot keep up with the need for insulin you may need diabetes medicines Many choices areavailable Your doctor might prescribe two or moremedicines The ADA recommends that most people
start with metformin a kind of diabetes pill
Medicines for Gestational Diabetes
Gestational diabetes is diabetes that occurs for the firsttime during pregnancy The hormones of pregnancy or ashortage of insulin can cause gestational diabetes Most women with gestational diabetes control it with mealplanning and physical activity But some women need
insulin to reach their target blood glucose levels
Medicines for Other Types of Diabetes
If you have one of the rare forms of diabetes suchas diabetes caused by other medicines or monogenicdiabetes talk with your doctor about what kind ofdiabetes medicine would be best for you
7
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Types of Diabetes Medicines
Diabetes medicines come in several forms
Insulin
If your body no longer makes enough insulin yoursquoll needto take it Insulin is used for all types of diabetes Yourdoctor can help you decide which way of taking insulin isbest for you
l Taking injections Yoursquoll give yourself shots using aneedle and syringe The syringe is a hollow tube witha plunger You will put your dose of insulin into thetube Some people use an insulin pen which lookslike a pen but has a needle for its point
l Using an insulin pump An insulin pump is a smallmachine about the size of a cell phone worn outsideof your body on a belt or in a pocket or pouch The
pump connects to a small plastic tube and a verysmall needle The needle is inserted under the skinand stays in for several days Insulin is pumped fromthe machine through the tube into your body
8
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l Using an insulin jet injector The jet injector whichlooks like a large pen sends a fine spray of insulinthrough the skin with high-pressure air instead of aneedle
l Using an insulin infuser A small tube is inserted just beneath the skin and remains in place for severaldays Insulin is injected into the end of the tubeinstead of through the skin
If your body no longer makes enough insulin yoursquoll need to take it
9
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Types of Insulin
Each type of insulin works at a different speed Forexample rapid-acting insulin starts to work right after you take it Long-acting insulin works for many hoursMost people need two or more types of insulin to reachtheir blood glucose targets
Look at the list of types of insulin on Insert C in thepocket of this booklet Check off the names of thekinds of insulin you take Then write the names of your
insulins under My Insulins in the chart on Insert A
Diabetes Pills
Along with meal planning and physicalactivity diabetes pills help people withtype 2 diabetes or gestational diabeteskeep their blood glucose levels ontarget Several kinds of pills are
available Each works in a different way Many people take two orthree kinds of pills Somepeople take combination pillsCombination pills containtwo kinds of diabetes medicinein one tablet Some peopletake pills and insulin
Diabetes pills help people withtype 2 diabetes or gestationaldiabetes keep their blood glucoselevels on target
11
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Your doctor may ask you to try one kind of pill If it
doesnrsquot help you reach your blood glucose targets yourdoctor may ask you to
l take more of the same pill
l add another kind of pill
l change to another type of pill
l start taking insulin
l start taking another injected medicine
If your doctor suggests that you take insulin or anotherinjected medicine it doesnrsquot mean your diabetes isgetting worse Instead it means you need insulin oranother type of medicine to reach your blood glucosetargets Everyone is different What works best for youdepends on your usual daily routine eating habits andactivities and your other health conditions
For information about the different kinds of pills and what they do see the cards in the pocket of this bookletYoursquoll see the brand name and the generic namemdashthescientific namemdashfor each medicine Find your diabetespills and check off the names Then write the namesof your diabetes pills under My Pills and Injected
Medicines in the chart on Insert A
12
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Injections Other Than Insulin
In addition to insulin two other types of injectedmedicines are now available Both work with insulinmdasheither the bodyrsquos own or injectedmdashto help keep yourblood glucose from going too high after you eat Neitheris a substitute for insulin
See the cards in the pocket of this booklet for moreinformation about these injected medicines Checkoff the kinds you take Then write the names of
your injected medicines under My Pills and InjectedMedicines in the chart on Insert A
Talk with your doctor if you have questions about your diabetes medicines Do not stop taking yourdiabetes medicines without checking with your doctorfirst See Insert B for a list of questions to ask yourdoctor about your medicines
What do I need to know about side effectsof medicines
A side effect is an unwanted problem caused by amedicine For example some diabetes medicinescan cause nausea or an upset stomach when you first
start taking them Before you start a new medicine ask your doctor about possible side effects and how you canavoid them If the side effects of your medicine bother you tell your doctor
13
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For More Information
To find diabetes educatorsmdashnurses dietitians and otherhealth professionalsmdashnear you call the American Association of Diabetes Educators toll-free at1ndash800ndashTEAMUP4 (1ndash800ndash832ndash6874) Or go to wwwdiabeteseducatororg and see the ldquoFind a DiabetesEducatorrdquo section
For additional information about diabetes contact
American Diabetes AssociationNational Service Center1701 North Beauregard Street Alexandria VA 22311ndash1742Phone 1ndash800ndashDIABETES (1ndash800ndash342ndash2383)Fax 703ndash549ndash6995Email AskADAdiabetesorgInternet wwwdiabetesorg
Juvenile Diabetes Research Foundation International 26 Broadway 14th FloorNew York NY 10004Phone 1ndash800ndash533ndashCURE (1ndash800ndash533ndash2873)Fax 212ndash785ndash9595Email infojdrforgInternet wwwjdrforg
14
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15
National Diabetes Education Program
1 Diabetes WayBethesda MD 20814ndash9692Phone 1ndash888ndash693ndashNDEP (1ndash888ndash693ndash6337)TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndepmailnihgovInternet wwwndepnihgov
AcknowledgmentsPublications produced by the Clearinghouse arecarefully reviewed by both NIDDK scientists and outsideexperts This booklet was reviewed by Stuart T HainesPharmD University of Maryland School of PharmacyBaltimore
The US Government does not endorse or favor any specific commercialproduct or company Trade proprietary or company names appearing inthis document are used only because they are considered necessary in thecontext of the information provided If a product is not mentioned theomission does not mean or imply that the product is unsatisfactory
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National Diabetes Information Clearinghouse1 Information WayBethesda MD 20892ndash3560
Phone 1ndash800ndash860ndash8747TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndicinfoniddknihgovInternet wwwdiabetesniddknihgov
The National Diabetes Information Clearinghouse (NDIC) is a serviceof the National Institute of Diabetes and Digestive and Kidney Diseases(NIDDK) The NIDDK is part of the National Institutes of Health of theUS Department of Health and Human Services Established in 1978 the
Clearinghouse provides information about diabetes to people with diabetesand to their families health care professionals and the public The NDICanswers inquiries develops and distributes publications and works closely with professional and patient organizations and Government agencies tocoordinate resources about diabetes
This publication is not copyrighted The Clearinghouse encourages usersof this publication to duplicate and distribute as many copies as desired
This publication is available at wwwdiabetesniddknihgov
This publication may contain information about medications Whenprepared this publication included the most current information availableFor updates or for questions about any medications contact the US Foodand Drug Administration toll-free at 1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332)or visit wwwfdagov Consult your doctor for more information
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Inserts
My Diabetes Medicines Insert A
Questions to Ask about
Your Diabetes Medicines Insert BTypes of Insulin Insert C
Glyset and Precose (Alpha-Glucosidase Inhibitors) Insert D
Glucophage Glucophage XR and Riomet(Biguanides) Insert E
Starlix (D-Phenylalanine Derivative) Insert F
Januvia (DPP-4 Inhibitor) Insert G
Prandin (Meglitinide) Insert H
Amaryl DiaBeta Diabinese GlucotrolGlucotrol XL Glynase PresTab Micronasetolazamide and tolbutamide (Sulfonylureas) Insert I
Actos and Avandia (Thiazolidinediones) Insert J
Actoplus Met Actoplus Met XR Avandamet Avandaryl DuetactGlucovance Janumetand Metaglip (Combination Diabetes Pills) Insert K
Symlin (Amylin Mimetic) Insert L
Byetta (Incretin Mimetic) Insert M
About Low Blood Glucose Insert N
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert BWhat I need to know about Diabetes Medicines
Questions to Ask about Your Diabetes Medicines Ask your doctor these questions when you get a prescription fora medicine Make copies of this card and use one card for eachof your medicines
What are the names of my medicine
Brand name Generic name
What does my medicine do
When should I start this medicine
This medicine is prescribed by
How long will it take this medicine to workWhat is the strength (for example how many milligrams writtenas mg)
How much should I take for each dose
How many times a day should I take my medicine
At what times should I take my medicine
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert B
Should I take it before with or after a meal
Should I avoid any foods or medicines when I take it
Should I avoid alcoholic beverages when I take it
Are there any times when I should change the amount of medicineI take
What should I do if I forget to take it
If Irsquom sick and canrsquot keep food down should I still take my medicine
Can my diabetes medicine cause low blood glucose
What should I do if my blood glucose is too low
What side effects can this medicine cause
What should I do if I have side effects
How should I store this medicine
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Insert CWhat I need to know about Diabetes Medicines
Types of InsulinEach type of insulin has an onset a peak and a duration time
The onset is how soon the insulin starts to lower your blood glucoseafter you take it
The peak is the time the insulin is working the hardest to lower yourblood glucose
The duration is how long the insulin lastsmdashthe length of time it keepslowering your blood glucose
The times shown in the chart are estimates Your onset peak andduration times may be different Yoursquoll work with your health careteam to come up with an insulin plan that works best for you
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert C What I need to know about Diabetes Medicines In
Type of Insulin Brand Name Generic Name Onset Peak Duration
Rapid-acting qNovoLog q Insulin aspart 15 minutes 30 to 90 minutes 3 to 5 hours
q Apidra q Insulin glulisine 15 minutes 30 to 90 minutes 3 to 5 hours
qHumalog q Insulin lispro 15 minutes 30 to 90 minutes 3 to 5 hours
Short-acting q Humulin R
q Novolin R
q Regular (R) 30 to 60 minutes 2 to 4 hours 5 to 8 hours
Intermediate-acting q Humulin N
q Novolin N
q NPH (N) 1 to 3 hours 8 hours 12 to 16 hours
Long-acting q Levemir
q Lantus
q Insulin detemir
q Insulin glargine
1 hour Peakless 20 to 26 hours
Pre-mixed NPH(intermediate-acting)and regular (short-acting)
q Humulin 7030
q Novolin 7030
q 70 NPH and 30 regular 30 to 60 minutes Varies 10 to 16 hours
q Humulin 5050 q 50 NPH and 50 regular 30 to 60 minutes Varies 10 to 16 hours
Pre-mixed insulin lispro q Humalog Mix 7525 q 75 insulin lispro protamine 10 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 25 insulin lispro(intermediate-acting) andinsulin lispro (rapid-acting) q Humalog Mix 5050 q 50 insulin lispro protamine
and 50 insulin lispro10 to 15 minutes Varies 10 to 16 hours
Pre-mixed insulin aspart q NovoLog Mix 7030 q 70 insulin aspart protamine 5 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 30 insulin aspart(intermediate-acting) andinsulin aspart (rapid-acting)
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What I need to know about Diabetes Medicines Insert D
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Taking Glyset or Precose may cause stomach pain gas bloating
or diarrhea These symptoms usually go away after you have takenthese pills for a while
If you take Glyset or Precose What you need to know aboutlow blood glucose
If you take Glyset or Precose only glucose tablets or glucose gel
will bring your blood glucose level back to normal quickly Otherquick-fix foods and drinks wonrsquot raise your blood glucose as quicklybecause Glyset and Precose slow the digestion of other quick-fixfoods and drinks
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
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Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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What happens to blood glucose levels in
people with diabetesBlood glucose levels go up and down throughout the dayand night in people with diabetes High blood glucoselevels over time can result in heart disease and otherhealth problems Low blood glucose levels can make youfeel shaky or pass out But you can learn how to makesure your blood glucose levels stay on targetmdashnot toohigh and not too low
What makes blood glucose levels go too high
Your blood glucose levels can go too high if
l you eat more than usual
l yoursquore not physically active
l yoursquore not taking enough diabetes medicine
l yoursquore sick or under stressl you exercise when your blood glucose level is
already high
4
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Medicines for My Diabetes
Ask your doctor what type of diabetes you have andcheck off the answer
I have
q type 1 diabetes
q type 2 diabetes
q gestational diabetes
q another type of diabetes ____________________
Medicines for Type 1 Diabetes
Type 1 diabetes once called juvenile diabetes orinsulin-dependent diabetes is usually first found inchildren teenagers or young adults If you have type 1diabetes you must take insulin because your body no
longer makes it You also might need to take other typesof diabetes medicines that work with insulin
6
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Medicines for Type 2 Diabetes
Type 2 diabetes once called adult-onset diabetes ornoninsulin-dependent diabetes is the most commonform of diabetes It can start when the body doesnrsquot useinsulin as it should a condition called insulin resistanceIf the body canrsquot keep up with the need for insulin you may need diabetes medicines Many choices areavailable Your doctor might prescribe two or moremedicines The ADA recommends that most people
start with metformin a kind of diabetes pill
Medicines for Gestational Diabetes
Gestational diabetes is diabetes that occurs for the firsttime during pregnancy The hormones of pregnancy or ashortage of insulin can cause gestational diabetes Most women with gestational diabetes control it with mealplanning and physical activity But some women need
insulin to reach their target blood glucose levels
Medicines for Other Types of Diabetes
If you have one of the rare forms of diabetes suchas diabetes caused by other medicines or monogenicdiabetes talk with your doctor about what kind ofdiabetes medicine would be best for you
7
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Types of Diabetes Medicines
Diabetes medicines come in several forms
Insulin
If your body no longer makes enough insulin yoursquoll needto take it Insulin is used for all types of diabetes Yourdoctor can help you decide which way of taking insulin isbest for you
l Taking injections Yoursquoll give yourself shots using aneedle and syringe The syringe is a hollow tube witha plunger You will put your dose of insulin into thetube Some people use an insulin pen which lookslike a pen but has a needle for its point
l Using an insulin pump An insulin pump is a smallmachine about the size of a cell phone worn outsideof your body on a belt or in a pocket or pouch The
pump connects to a small plastic tube and a verysmall needle The needle is inserted under the skinand stays in for several days Insulin is pumped fromthe machine through the tube into your body
8
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l Using an insulin jet injector The jet injector whichlooks like a large pen sends a fine spray of insulinthrough the skin with high-pressure air instead of aneedle
l Using an insulin infuser A small tube is inserted just beneath the skin and remains in place for severaldays Insulin is injected into the end of the tubeinstead of through the skin
If your body no longer makes enough insulin yoursquoll need to take it
9
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Types of Insulin
Each type of insulin works at a different speed Forexample rapid-acting insulin starts to work right after you take it Long-acting insulin works for many hoursMost people need two or more types of insulin to reachtheir blood glucose targets
Look at the list of types of insulin on Insert C in thepocket of this booklet Check off the names of thekinds of insulin you take Then write the names of your
insulins under My Insulins in the chart on Insert A
Diabetes Pills
Along with meal planning and physicalactivity diabetes pills help people withtype 2 diabetes or gestational diabeteskeep their blood glucose levels ontarget Several kinds of pills are
available Each works in a different way Many people take two orthree kinds of pills Somepeople take combination pillsCombination pills containtwo kinds of diabetes medicinein one tablet Some peopletake pills and insulin
Diabetes pills help people withtype 2 diabetes or gestationaldiabetes keep their blood glucoselevels on target
11
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Your doctor may ask you to try one kind of pill If it
doesnrsquot help you reach your blood glucose targets yourdoctor may ask you to
l take more of the same pill
l add another kind of pill
l change to another type of pill
l start taking insulin
l start taking another injected medicine
If your doctor suggests that you take insulin or anotherinjected medicine it doesnrsquot mean your diabetes isgetting worse Instead it means you need insulin oranother type of medicine to reach your blood glucosetargets Everyone is different What works best for youdepends on your usual daily routine eating habits andactivities and your other health conditions
For information about the different kinds of pills and what they do see the cards in the pocket of this bookletYoursquoll see the brand name and the generic namemdashthescientific namemdashfor each medicine Find your diabetespills and check off the names Then write the namesof your diabetes pills under My Pills and Injected
Medicines in the chart on Insert A
12
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Injections Other Than Insulin
In addition to insulin two other types of injectedmedicines are now available Both work with insulinmdasheither the bodyrsquos own or injectedmdashto help keep yourblood glucose from going too high after you eat Neitheris a substitute for insulin
See the cards in the pocket of this booklet for moreinformation about these injected medicines Checkoff the kinds you take Then write the names of
your injected medicines under My Pills and InjectedMedicines in the chart on Insert A
Talk with your doctor if you have questions about your diabetes medicines Do not stop taking yourdiabetes medicines without checking with your doctorfirst See Insert B for a list of questions to ask yourdoctor about your medicines
What do I need to know about side effectsof medicines
A side effect is an unwanted problem caused by amedicine For example some diabetes medicinescan cause nausea or an upset stomach when you first
start taking them Before you start a new medicine ask your doctor about possible side effects and how you canavoid them If the side effects of your medicine bother you tell your doctor
13
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For More Information
To find diabetes educatorsmdashnurses dietitians and otherhealth professionalsmdashnear you call the American Association of Diabetes Educators toll-free at1ndash800ndashTEAMUP4 (1ndash800ndash832ndash6874) Or go to wwwdiabeteseducatororg and see the ldquoFind a DiabetesEducatorrdquo section
For additional information about diabetes contact
American Diabetes AssociationNational Service Center1701 North Beauregard Street Alexandria VA 22311ndash1742Phone 1ndash800ndashDIABETES (1ndash800ndash342ndash2383)Fax 703ndash549ndash6995Email AskADAdiabetesorgInternet wwwdiabetesorg
Juvenile Diabetes Research Foundation International 26 Broadway 14th FloorNew York NY 10004Phone 1ndash800ndash533ndashCURE (1ndash800ndash533ndash2873)Fax 212ndash785ndash9595Email infojdrforgInternet wwwjdrforg
14
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15
National Diabetes Education Program
1 Diabetes WayBethesda MD 20814ndash9692Phone 1ndash888ndash693ndashNDEP (1ndash888ndash693ndash6337)TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndepmailnihgovInternet wwwndepnihgov
AcknowledgmentsPublications produced by the Clearinghouse arecarefully reviewed by both NIDDK scientists and outsideexperts This booklet was reviewed by Stuart T HainesPharmD University of Maryland School of PharmacyBaltimore
The US Government does not endorse or favor any specific commercialproduct or company Trade proprietary or company names appearing inthis document are used only because they are considered necessary in thecontext of the information provided If a product is not mentioned theomission does not mean or imply that the product is unsatisfactory
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National Diabetes Information Clearinghouse1 Information WayBethesda MD 20892ndash3560
Phone 1ndash800ndash860ndash8747TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndicinfoniddknihgovInternet wwwdiabetesniddknihgov
The National Diabetes Information Clearinghouse (NDIC) is a serviceof the National Institute of Diabetes and Digestive and Kidney Diseases(NIDDK) The NIDDK is part of the National Institutes of Health of theUS Department of Health and Human Services Established in 1978 the
Clearinghouse provides information about diabetes to people with diabetesand to their families health care professionals and the public The NDICanswers inquiries develops and distributes publications and works closely with professional and patient organizations and Government agencies tocoordinate resources about diabetes
This publication is not copyrighted The Clearinghouse encourages usersof this publication to duplicate and distribute as many copies as desired
This publication is available at wwwdiabetesniddknihgov
This publication may contain information about medications Whenprepared this publication included the most current information availableFor updates or for questions about any medications contact the US Foodand Drug Administration toll-free at 1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332)or visit wwwfdagov Consult your doctor for more information
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Inserts
My Diabetes Medicines Insert A
Questions to Ask about
Your Diabetes Medicines Insert BTypes of Insulin Insert C
Glyset and Precose (Alpha-Glucosidase Inhibitors) Insert D
Glucophage Glucophage XR and Riomet(Biguanides) Insert E
Starlix (D-Phenylalanine Derivative) Insert F
Januvia (DPP-4 Inhibitor) Insert G
Prandin (Meglitinide) Insert H
Amaryl DiaBeta Diabinese GlucotrolGlucotrol XL Glynase PresTab Micronasetolazamide and tolbutamide (Sulfonylureas) Insert I
Actos and Avandia (Thiazolidinediones) Insert J
Actoplus Met Actoplus Met XR Avandamet Avandaryl DuetactGlucovance Janumetand Metaglip (Combination Diabetes Pills) Insert K
Symlin (Amylin Mimetic) Insert L
Byetta (Incretin Mimetic) Insert M
About Low Blood Glucose Insert N
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert BWhat I need to know about Diabetes Medicines
Questions to Ask about Your Diabetes Medicines Ask your doctor these questions when you get a prescription fora medicine Make copies of this card and use one card for eachof your medicines
What are the names of my medicine
Brand name Generic name
What does my medicine do
When should I start this medicine
This medicine is prescribed by
How long will it take this medicine to workWhat is the strength (for example how many milligrams writtenas mg)
How much should I take for each dose
How many times a day should I take my medicine
At what times should I take my medicine
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert B
Should I take it before with or after a meal
Should I avoid any foods or medicines when I take it
Should I avoid alcoholic beverages when I take it
Are there any times when I should change the amount of medicineI take
What should I do if I forget to take it
If Irsquom sick and canrsquot keep food down should I still take my medicine
Can my diabetes medicine cause low blood glucose
What should I do if my blood glucose is too low
What side effects can this medicine cause
What should I do if I have side effects
How should I store this medicine
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Insert CWhat I need to know about Diabetes Medicines
Types of InsulinEach type of insulin has an onset a peak and a duration time
The onset is how soon the insulin starts to lower your blood glucoseafter you take it
The peak is the time the insulin is working the hardest to lower yourblood glucose
The duration is how long the insulin lastsmdashthe length of time it keepslowering your blood glucose
The times shown in the chart are estimates Your onset peak andduration times may be different Yoursquoll work with your health careteam to come up with an insulin plan that works best for you
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert C What I need to know about Diabetes Medicines In
Type of Insulin Brand Name Generic Name Onset Peak Duration
Rapid-acting qNovoLog q Insulin aspart 15 minutes 30 to 90 minutes 3 to 5 hours
q Apidra q Insulin glulisine 15 minutes 30 to 90 minutes 3 to 5 hours
qHumalog q Insulin lispro 15 minutes 30 to 90 minutes 3 to 5 hours
Short-acting q Humulin R
q Novolin R
q Regular (R) 30 to 60 minutes 2 to 4 hours 5 to 8 hours
Intermediate-acting q Humulin N
q Novolin N
q NPH (N) 1 to 3 hours 8 hours 12 to 16 hours
Long-acting q Levemir
q Lantus
q Insulin detemir
q Insulin glargine
1 hour Peakless 20 to 26 hours
Pre-mixed NPH(intermediate-acting)and regular (short-acting)
q Humulin 7030
q Novolin 7030
q 70 NPH and 30 regular 30 to 60 minutes Varies 10 to 16 hours
q Humulin 5050 q 50 NPH and 50 regular 30 to 60 minutes Varies 10 to 16 hours
Pre-mixed insulin lispro q Humalog Mix 7525 q 75 insulin lispro protamine 10 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 25 insulin lispro(intermediate-acting) andinsulin lispro (rapid-acting) q Humalog Mix 5050 q 50 insulin lispro protamine
and 50 insulin lispro10 to 15 minutes Varies 10 to 16 hours
Pre-mixed insulin aspart q NovoLog Mix 7030 q 70 insulin aspart protamine 5 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 30 insulin aspart(intermediate-acting) andinsulin aspart (rapid-acting)
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What I need to know about Diabetes Medicines Insert D
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Taking Glyset or Precose may cause stomach pain gas bloating
or diarrhea These symptoms usually go away after you have takenthese pills for a while
If you take Glyset or Precose What you need to know aboutlow blood glucose
If you take Glyset or Precose only glucose tablets or glucose gel
will bring your blood glucose level back to normal quickly Otherquick-fix foods and drinks wonrsquot raise your blood glucose as quicklybecause Glyset and Precose slow the digestion of other quick-fixfoods and drinks
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
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Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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Medicines for My Diabetes
Ask your doctor what type of diabetes you have andcheck off the answer
I have
q type 1 diabetes
q type 2 diabetes
q gestational diabetes
q another type of diabetes ____________________
Medicines for Type 1 Diabetes
Type 1 diabetes once called juvenile diabetes orinsulin-dependent diabetes is usually first found inchildren teenagers or young adults If you have type 1diabetes you must take insulin because your body no
longer makes it You also might need to take other typesof diabetes medicines that work with insulin
6
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Medicines for Type 2 Diabetes
Type 2 diabetes once called adult-onset diabetes ornoninsulin-dependent diabetes is the most commonform of diabetes It can start when the body doesnrsquot useinsulin as it should a condition called insulin resistanceIf the body canrsquot keep up with the need for insulin you may need diabetes medicines Many choices areavailable Your doctor might prescribe two or moremedicines The ADA recommends that most people
start with metformin a kind of diabetes pill
Medicines for Gestational Diabetes
Gestational diabetes is diabetes that occurs for the firsttime during pregnancy The hormones of pregnancy or ashortage of insulin can cause gestational diabetes Most women with gestational diabetes control it with mealplanning and physical activity But some women need
insulin to reach their target blood glucose levels
Medicines for Other Types of Diabetes
If you have one of the rare forms of diabetes suchas diabetes caused by other medicines or monogenicdiabetes talk with your doctor about what kind ofdiabetes medicine would be best for you
7
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Types of Diabetes Medicines
Diabetes medicines come in several forms
Insulin
If your body no longer makes enough insulin yoursquoll needto take it Insulin is used for all types of diabetes Yourdoctor can help you decide which way of taking insulin isbest for you
l Taking injections Yoursquoll give yourself shots using aneedle and syringe The syringe is a hollow tube witha plunger You will put your dose of insulin into thetube Some people use an insulin pen which lookslike a pen but has a needle for its point
l Using an insulin pump An insulin pump is a smallmachine about the size of a cell phone worn outsideof your body on a belt or in a pocket or pouch The
pump connects to a small plastic tube and a verysmall needle The needle is inserted under the skinand stays in for several days Insulin is pumped fromthe machine through the tube into your body
8
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l Using an insulin jet injector The jet injector whichlooks like a large pen sends a fine spray of insulinthrough the skin with high-pressure air instead of aneedle
l Using an insulin infuser A small tube is inserted just beneath the skin and remains in place for severaldays Insulin is injected into the end of the tubeinstead of through the skin
If your body no longer makes enough insulin yoursquoll need to take it
9
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Types of Insulin
Each type of insulin works at a different speed Forexample rapid-acting insulin starts to work right after you take it Long-acting insulin works for many hoursMost people need two or more types of insulin to reachtheir blood glucose targets
Look at the list of types of insulin on Insert C in thepocket of this booklet Check off the names of thekinds of insulin you take Then write the names of your
insulins under My Insulins in the chart on Insert A
Diabetes Pills
Along with meal planning and physicalactivity diabetes pills help people withtype 2 diabetes or gestational diabeteskeep their blood glucose levels ontarget Several kinds of pills are
available Each works in a different way Many people take two orthree kinds of pills Somepeople take combination pillsCombination pills containtwo kinds of diabetes medicinein one tablet Some peopletake pills and insulin
Diabetes pills help people withtype 2 diabetes or gestationaldiabetes keep their blood glucoselevels on target
11
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Your doctor may ask you to try one kind of pill If it
doesnrsquot help you reach your blood glucose targets yourdoctor may ask you to
l take more of the same pill
l add another kind of pill
l change to another type of pill
l start taking insulin
l start taking another injected medicine
If your doctor suggests that you take insulin or anotherinjected medicine it doesnrsquot mean your diabetes isgetting worse Instead it means you need insulin oranother type of medicine to reach your blood glucosetargets Everyone is different What works best for youdepends on your usual daily routine eating habits andactivities and your other health conditions
For information about the different kinds of pills and what they do see the cards in the pocket of this bookletYoursquoll see the brand name and the generic namemdashthescientific namemdashfor each medicine Find your diabetespills and check off the names Then write the namesof your diabetes pills under My Pills and Injected
Medicines in the chart on Insert A
12
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Injections Other Than Insulin
In addition to insulin two other types of injectedmedicines are now available Both work with insulinmdasheither the bodyrsquos own or injectedmdashto help keep yourblood glucose from going too high after you eat Neitheris a substitute for insulin
See the cards in the pocket of this booklet for moreinformation about these injected medicines Checkoff the kinds you take Then write the names of
your injected medicines under My Pills and InjectedMedicines in the chart on Insert A
Talk with your doctor if you have questions about your diabetes medicines Do not stop taking yourdiabetes medicines without checking with your doctorfirst See Insert B for a list of questions to ask yourdoctor about your medicines
What do I need to know about side effectsof medicines
A side effect is an unwanted problem caused by amedicine For example some diabetes medicinescan cause nausea or an upset stomach when you first
start taking them Before you start a new medicine ask your doctor about possible side effects and how you canavoid them If the side effects of your medicine bother you tell your doctor
13
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For More Information
To find diabetes educatorsmdashnurses dietitians and otherhealth professionalsmdashnear you call the American Association of Diabetes Educators toll-free at1ndash800ndashTEAMUP4 (1ndash800ndash832ndash6874) Or go to wwwdiabeteseducatororg and see the ldquoFind a DiabetesEducatorrdquo section
For additional information about diabetes contact
American Diabetes AssociationNational Service Center1701 North Beauregard Street Alexandria VA 22311ndash1742Phone 1ndash800ndashDIABETES (1ndash800ndash342ndash2383)Fax 703ndash549ndash6995Email AskADAdiabetesorgInternet wwwdiabetesorg
Juvenile Diabetes Research Foundation International 26 Broadway 14th FloorNew York NY 10004Phone 1ndash800ndash533ndashCURE (1ndash800ndash533ndash2873)Fax 212ndash785ndash9595Email infojdrforgInternet wwwjdrforg
14
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15
National Diabetes Education Program
1 Diabetes WayBethesda MD 20814ndash9692Phone 1ndash888ndash693ndashNDEP (1ndash888ndash693ndash6337)TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndepmailnihgovInternet wwwndepnihgov
AcknowledgmentsPublications produced by the Clearinghouse arecarefully reviewed by both NIDDK scientists and outsideexperts This booklet was reviewed by Stuart T HainesPharmD University of Maryland School of PharmacyBaltimore
The US Government does not endorse or favor any specific commercialproduct or company Trade proprietary or company names appearing inthis document are used only because they are considered necessary in thecontext of the information provided If a product is not mentioned theomission does not mean or imply that the product is unsatisfactory
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National Diabetes Information Clearinghouse1 Information WayBethesda MD 20892ndash3560
Phone 1ndash800ndash860ndash8747TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndicinfoniddknihgovInternet wwwdiabetesniddknihgov
The National Diabetes Information Clearinghouse (NDIC) is a serviceof the National Institute of Diabetes and Digestive and Kidney Diseases(NIDDK) The NIDDK is part of the National Institutes of Health of theUS Department of Health and Human Services Established in 1978 the
Clearinghouse provides information about diabetes to people with diabetesand to their families health care professionals and the public The NDICanswers inquiries develops and distributes publications and works closely with professional and patient organizations and Government agencies tocoordinate resources about diabetes
This publication is not copyrighted The Clearinghouse encourages usersof this publication to duplicate and distribute as many copies as desired
This publication is available at wwwdiabetesniddknihgov
This publication may contain information about medications Whenprepared this publication included the most current information availableFor updates or for questions about any medications contact the US Foodand Drug Administration toll-free at 1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332)or visit wwwfdagov Consult your doctor for more information
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Inserts
My Diabetes Medicines Insert A
Questions to Ask about
Your Diabetes Medicines Insert BTypes of Insulin Insert C
Glyset and Precose (Alpha-Glucosidase Inhibitors) Insert D
Glucophage Glucophage XR and Riomet(Biguanides) Insert E
Starlix (D-Phenylalanine Derivative) Insert F
Januvia (DPP-4 Inhibitor) Insert G
Prandin (Meglitinide) Insert H
Amaryl DiaBeta Diabinese GlucotrolGlucotrol XL Glynase PresTab Micronasetolazamide and tolbutamide (Sulfonylureas) Insert I
Actos and Avandia (Thiazolidinediones) Insert J
Actoplus Met Actoplus Met XR Avandamet Avandaryl DuetactGlucovance Janumetand Metaglip (Combination Diabetes Pills) Insert K
Symlin (Amylin Mimetic) Insert L
Byetta (Incretin Mimetic) Insert M
About Low Blood Glucose Insert N
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert BWhat I need to know about Diabetes Medicines
Questions to Ask about Your Diabetes Medicines Ask your doctor these questions when you get a prescription fora medicine Make copies of this card and use one card for eachof your medicines
What are the names of my medicine
Brand name Generic name
What does my medicine do
When should I start this medicine
This medicine is prescribed by
How long will it take this medicine to workWhat is the strength (for example how many milligrams writtenas mg)
How much should I take for each dose
How many times a day should I take my medicine
At what times should I take my medicine
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert B
Should I take it before with or after a meal
Should I avoid any foods or medicines when I take it
Should I avoid alcoholic beverages when I take it
Are there any times when I should change the amount of medicineI take
What should I do if I forget to take it
If Irsquom sick and canrsquot keep food down should I still take my medicine
Can my diabetes medicine cause low blood glucose
What should I do if my blood glucose is too low
What side effects can this medicine cause
What should I do if I have side effects
How should I store this medicine
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Insert CWhat I need to know about Diabetes Medicines
Types of InsulinEach type of insulin has an onset a peak and a duration time
The onset is how soon the insulin starts to lower your blood glucoseafter you take it
The peak is the time the insulin is working the hardest to lower yourblood glucose
The duration is how long the insulin lastsmdashthe length of time it keepslowering your blood glucose
The times shown in the chart are estimates Your onset peak andduration times may be different Yoursquoll work with your health careteam to come up with an insulin plan that works best for you
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert C What I need to know about Diabetes Medicines In
Type of Insulin Brand Name Generic Name Onset Peak Duration
Rapid-acting qNovoLog q Insulin aspart 15 minutes 30 to 90 minutes 3 to 5 hours
q Apidra q Insulin glulisine 15 minutes 30 to 90 minutes 3 to 5 hours
qHumalog q Insulin lispro 15 minutes 30 to 90 minutes 3 to 5 hours
Short-acting q Humulin R
q Novolin R
q Regular (R) 30 to 60 minutes 2 to 4 hours 5 to 8 hours
Intermediate-acting q Humulin N
q Novolin N
q NPH (N) 1 to 3 hours 8 hours 12 to 16 hours
Long-acting q Levemir
q Lantus
q Insulin detemir
q Insulin glargine
1 hour Peakless 20 to 26 hours
Pre-mixed NPH(intermediate-acting)and regular (short-acting)
q Humulin 7030
q Novolin 7030
q 70 NPH and 30 regular 30 to 60 minutes Varies 10 to 16 hours
q Humulin 5050 q 50 NPH and 50 regular 30 to 60 minutes Varies 10 to 16 hours
Pre-mixed insulin lispro q Humalog Mix 7525 q 75 insulin lispro protamine 10 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 25 insulin lispro(intermediate-acting) andinsulin lispro (rapid-acting) q Humalog Mix 5050 q 50 insulin lispro protamine
and 50 insulin lispro10 to 15 minutes Varies 10 to 16 hours
Pre-mixed insulin aspart q NovoLog Mix 7030 q 70 insulin aspart protamine 5 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 30 insulin aspart(intermediate-acting) andinsulin aspart (rapid-acting)
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What I need to know about Diabetes Medicines Insert D
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Taking Glyset or Precose may cause stomach pain gas bloating
or diarrhea These symptoms usually go away after you have takenthese pills for a while
If you take Glyset or Precose What you need to know aboutlow blood glucose
If you take Glyset or Precose only glucose tablets or glucose gel
will bring your blood glucose level back to normal quickly Otherquick-fix foods and drinks wonrsquot raise your blood glucose as quicklybecause Glyset and Precose slow the digestion of other quick-fixfoods and drinks
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
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Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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Medicines for My Diabetes
Ask your doctor what type of diabetes you have andcheck off the answer
I have
q type 1 diabetes
q type 2 diabetes
q gestational diabetes
q another type of diabetes ____________________
Medicines for Type 1 Diabetes
Type 1 diabetes once called juvenile diabetes orinsulin-dependent diabetes is usually first found inchildren teenagers or young adults If you have type 1diabetes you must take insulin because your body no
longer makes it You also might need to take other typesof diabetes medicines that work with insulin
6
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Medicines for Type 2 Diabetes
Type 2 diabetes once called adult-onset diabetes ornoninsulin-dependent diabetes is the most commonform of diabetes It can start when the body doesnrsquot useinsulin as it should a condition called insulin resistanceIf the body canrsquot keep up with the need for insulin you may need diabetes medicines Many choices areavailable Your doctor might prescribe two or moremedicines The ADA recommends that most people
start with metformin a kind of diabetes pill
Medicines for Gestational Diabetes
Gestational diabetes is diabetes that occurs for the firsttime during pregnancy The hormones of pregnancy or ashortage of insulin can cause gestational diabetes Most women with gestational diabetes control it with mealplanning and physical activity But some women need
insulin to reach their target blood glucose levels
Medicines for Other Types of Diabetes
If you have one of the rare forms of diabetes suchas diabetes caused by other medicines or monogenicdiabetes talk with your doctor about what kind ofdiabetes medicine would be best for you
7
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Types of Diabetes Medicines
Diabetes medicines come in several forms
Insulin
If your body no longer makes enough insulin yoursquoll needto take it Insulin is used for all types of diabetes Yourdoctor can help you decide which way of taking insulin isbest for you
l Taking injections Yoursquoll give yourself shots using aneedle and syringe The syringe is a hollow tube witha plunger You will put your dose of insulin into thetube Some people use an insulin pen which lookslike a pen but has a needle for its point
l Using an insulin pump An insulin pump is a smallmachine about the size of a cell phone worn outsideof your body on a belt or in a pocket or pouch The
pump connects to a small plastic tube and a verysmall needle The needle is inserted under the skinand stays in for several days Insulin is pumped fromthe machine through the tube into your body
8
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l Using an insulin jet injector The jet injector whichlooks like a large pen sends a fine spray of insulinthrough the skin with high-pressure air instead of aneedle
l Using an insulin infuser A small tube is inserted just beneath the skin and remains in place for severaldays Insulin is injected into the end of the tubeinstead of through the skin
If your body no longer makes enough insulin yoursquoll need to take it
9
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Types of Insulin
Each type of insulin works at a different speed Forexample rapid-acting insulin starts to work right after you take it Long-acting insulin works for many hoursMost people need two or more types of insulin to reachtheir blood glucose targets
Look at the list of types of insulin on Insert C in thepocket of this booklet Check off the names of thekinds of insulin you take Then write the names of your
insulins under My Insulins in the chart on Insert A
Diabetes Pills
Along with meal planning and physicalactivity diabetes pills help people withtype 2 diabetes or gestational diabeteskeep their blood glucose levels ontarget Several kinds of pills are
available Each works in a different way Many people take two orthree kinds of pills Somepeople take combination pillsCombination pills containtwo kinds of diabetes medicinein one tablet Some peopletake pills and insulin
Diabetes pills help people withtype 2 diabetes or gestationaldiabetes keep their blood glucoselevels on target
11
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Your doctor may ask you to try one kind of pill If it
doesnrsquot help you reach your blood glucose targets yourdoctor may ask you to
l take more of the same pill
l add another kind of pill
l change to another type of pill
l start taking insulin
l start taking another injected medicine
If your doctor suggests that you take insulin or anotherinjected medicine it doesnrsquot mean your diabetes isgetting worse Instead it means you need insulin oranother type of medicine to reach your blood glucosetargets Everyone is different What works best for youdepends on your usual daily routine eating habits andactivities and your other health conditions
For information about the different kinds of pills and what they do see the cards in the pocket of this bookletYoursquoll see the brand name and the generic namemdashthescientific namemdashfor each medicine Find your diabetespills and check off the names Then write the namesof your diabetes pills under My Pills and Injected
Medicines in the chart on Insert A
12
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Injections Other Than Insulin
In addition to insulin two other types of injectedmedicines are now available Both work with insulinmdasheither the bodyrsquos own or injectedmdashto help keep yourblood glucose from going too high after you eat Neitheris a substitute for insulin
See the cards in the pocket of this booklet for moreinformation about these injected medicines Checkoff the kinds you take Then write the names of
your injected medicines under My Pills and InjectedMedicines in the chart on Insert A
Talk with your doctor if you have questions about your diabetes medicines Do not stop taking yourdiabetes medicines without checking with your doctorfirst See Insert B for a list of questions to ask yourdoctor about your medicines
What do I need to know about side effectsof medicines
A side effect is an unwanted problem caused by amedicine For example some diabetes medicinescan cause nausea or an upset stomach when you first
start taking them Before you start a new medicine ask your doctor about possible side effects and how you canavoid them If the side effects of your medicine bother you tell your doctor
13
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For More Information
To find diabetes educatorsmdashnurses dietitians and otherhealth professionalsmdashnear you call the American Association of Diabetes Educators toll-free at1ndash800ndashTEAMUP4 (1ndash800ndash832ndash6874) Or go to wwwdiabeteseducatororg and see the ldquoFind a DiabetesEducatorrdquo section
For additional information about diabetes contact
American Diabetes AssociationNational Service Center1701 North Beauregard Street Alexandria VA 22311ndash1742Phone 1ndash800ndashDIABETES (1ndash800ndash342ndash2383)Fax 703ndash549ndash6995Email AskADAdiabetesorgInternet wwwdiabetesorg
Juvenile Diabetes Research Foundation International 26 Broadway 14th FloorNew York NY 10004Phone 1ndash800ndash533ndashCURE (1ndash800ndash533ndash2873)Fax 212ndash785ndash9595Email infojdrforgInternet wwwjdrforg
14
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15
National Diabetes Education Program
1 Diabetes WayBethesda MD 20814ndash9692Phone 1ndash888ndash693ndashNDEP (1ndash888ndash693ndash6337)TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndepmailnihgovInternet wwwndepnihgov
AcknowledgmentsPublications produced by the Clearinghouse arecarefully reviewed by both NIDDK scientists and outsideexperts This booklet was reviewed by Stuart T HainesPharmD University of Maryland School of PharmacyBaltimore
The US Government does not endorse or favor any specific commercialproduct or company Trade proprietary or company names appearing inthis document are used only because they are considered necessary in thecontext of the information provided If a product is not mentioned theomission does not mean or imply that the product is unsatisfactory
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National Diabetes Information Clearinghouse1 Information WayBethesda MD 20892ndash3560
Phone 1ndash800ndash860ndash8747TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndicinfoniddknihgovInternet wwwdiabetesniddknihgov
The National Diabetes Information Clearinghouse (NDIC) is a serviceof the National Institute of Diabetes and Digestive and Kidney Diseases(NIDDK) The NIDDK is part of the National Institutes of Health of theUS Department of Health and Human Services Established in 1978 the
Clearinghouse provides information about diabetes to people with diabetesand to their families health care professionals and the public The NDICanswers inquiries develops and distributes publications and works closely with professional and patient organizations and Government agencies tocoordinate resources about diabetes
This publication is not copyrighted The Clearinghouse encourages usersof this publication to duplicate and distribute as many copies as desired
This publication is available at wwwdiabetesniddknihgov
This publication may contain information about medications Whenprepared this publication included the most current information availableFor updates or for questions about any medications contact the US Foodand Drug Administration toll-free at 1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332)or visit wwwfdagov Consult your doctor for more information
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Inserts
My Diabetes Medicines Insert A
Questions to Ask about
Your Diabetes Medicines Insert BTypes of Insulin Insert C
Glyset and Precose (Alpha-Glucosidase Inhibitors) Insert D
Glucophage Glucophage XR and Riomet(Biguanides) Insert E
Starlix (D-Phenylalanine Derivative) Insert F
Januvia (DPP-4 Inhibitor) Insert G
Prandin (Meglitinide) Insert H
Amaryl DiaBeta Diabinese GlucotrolGlucotrol XL Glynase PresTab Micronasetolazamide and tolbutamide (Sulfonylureas) Insert I
Actos and Avandia (Thiazolidinediones) Insert J
Actoplus Met Actoplus Met XR Avandamet Avandaryl DuetactGlucovance Janumetand Metaglip (Combination Diabetes Pills) Insert K
Symlin (Amylin Mimetic) Insert L
Byetta (Incretin Mimetic) Insert M
About Low Blood Glucose Insert N
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert BWhat I need to know about Diabetes Medicines
Questions to Ask about Your Diabetes Medicines Ask your doctor these questions when you get a prescription fora medicine Make copies of this card and use one card for eachof your medicines
What are the names of my medicine
Brand name Generic name
What does my medicine do
When should I start this medicine
This medicine is prescribed by
How long will it take this medicine to workWhat is the strength (for example how many milligrams writtenas mg)
How much should I take for each dose
How many times a day should I take my medicine
At what times should I take my medicine
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert B
Should I take it before with or after a meal
Should I avoid any foods or medicines when I take it
Should I avoid alcoholic beverages when I take it
Are there any times when I should change the amount of medicineI take
What should I do if I forget to take it
If Irsquom sick and canrsquot keep food down should I still take my medicine
Can my diabetes medicine cause low blood glucose
What should I do if my blood glucose is too low
What side effects can this medicine cause
What should I do if I have side effects
How should I store this medicine
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Insert CWhat I need to know about Diabetes Medicines
Types of InsulinEach type of insulin has an onset a peak and a duration time
The onset is how soon the insulin starts to lower your blood glucoseafter you take it
The peak is the time the insulin is working the hardest to lower yourblood glucose
The duration is how long the insulin lastsmdashthe length of time it keepslowering your blood glucose
The times shown in the chart are estimates Your onset peak andduration times may be different Yoursquoll work with your health careteam to come up with an insulin plan that works best for you
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert C What I need to know about Diabetes Medicines In
Type of Insulin Brand Name Generic Name Onset Peak Duration
Rapid-acting qNovoLog q Insulin aspart 15 minutes 30 to 90 minutes 3 to 5 hours
q Apidra q Insulin glulisine 15 minutes 30 to 90 minutes 3 to 5 hours
qHumalog q Insulin lispro 15 minutes 30 to 90 minutes 3 to 5 hours
Short-acting q Humulin R
q Novolin R
q Regular (R) 30 to 60 minutes 2 to 4 hours 5 to 8 hours
Intermediate-acting q Humulin N
q Novolin N
q NPH (N) 1 to 3 hours 8 hours 12 to 16 hours
Long-acting q Levemir
q Lantus
q Insulin detemir
q Insulin glargine
1 hour Peakless 20 to 26 hours
Pre-mixed NPH(intermediate-acting)and regular (short-acting)
q Humulin 7030
q Novolin 7030
q 70 NPH and 30 regular 30 to 60 minutes Varies 10 to 16 hours
q Humulin 5050 q 50 NPH and 50 regular 30 to 60 minutes Varies 10 to 16 hours
Pre-mixed insulin lispro q Humalog Mix 7525 q 75 insulin lispro protamine 10 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 25 insulin lispro(intermediate-acting) andinsulin lispro (rapid-acting) q Humalog Mix 5050 q 50 insulin lispro protamine
and 50 insulin lispro10 to 15 minutes Varies 10 to 16 hours
Pre-mixed insulin aspart q NovoLog Mix 7030 q 70 insulin aspart protamine 5 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 30 insulin aspart(intermediate-acting) andinsulin aspart (rapid-acting)
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What I need to know about Diabetes Medicines Insert D
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Taking Glyset or Precose may cause stomach pain gas bloating
or diarrhea These symptoms usually go away after you have takenthese pills for a while
If you take Glyset or Precose What you need to know aboutlow blood glucose
If you take Glyset or Precose only glucose tablets or glucose gel
will bring your blood glucose level back to normal quickly Otherquick-fix foods and drinks wonrsquot raise your blood glucose as quicklybecause Glyset and Precose slow the digestion of other quick-fixfoods and drinks
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
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Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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Medicines for Type 2 Diabetes
Type 2 diabetes once called adult-onset diabetes ornoninsulin-dependent diabetes is the most commonform of diabetes It can start when the body doesnrsquot useinsulin as it should a condition called insulin resistanceIf the body canrsquot keep up with the need for insulin you may need diabetes medicines Many choices areavailable Your doctor might prescribe two or moremedicines The ADA recommends that most people
start with metformin a kind of diabetes pill
Medicines for Gestational Diabetes
Gestational diabetes is diabetes that occurs for the firsttime during pregnancy The hormones of pregnancy or ashortage of insulin can cause gestational diabetes Most women with gestational diabetes control it with mealplanning and physical activity But some women need
insulin to reach their target blood glucose levels
Medicines for Other Types of Diabetes
If you have one of the rare forms of diabetes suchas diabetes caused by other medicines or monogenicdiabetes talk with your doctor about what kind ofdiabetes medicine would be best for you
7
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Types of Diabetes Medicines
Diabetes medicines come in several forms
Insulin
If your body no longer makes enough insulin yoursquoll needto take it Insulin is used for all types of diabetes Yourdoctor can help you decide which way of taking insulin isbest for you
l Taking injections Yoursquoll give yourself shots using aneedle and syringe The syringe is a hollow tube witha plunger You will put your dose of insulin into thetube Some people use an insulin pen which lookslike a pen but has a needle for its point
l Using an insulin pump An insulin pump is a smallmachine about the size of a cell phone worn outsideof your body on a belt or in a pocket or pouch The
pump connects to a small plastic tube and a verysmall needle The needle is inserted under the skinand stays in for several days Insulin is pumped fromthe machine through the tube into your body
8
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l Using an insulin jet injector The jet injector whichlooks like a large pen sends a fine spray of insulinthrough the skin with high-pressure air instead of aneedle
l Using an insulin infuser A small tube is inserted just beneath the skin and remains in place for severaldays Insulin is injected into the end of the tubeinstead of through the skin
If your body no longer makes enough insulin yoursquoll need to take it
9
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Types of Insulin
Each type of insulin works at a different speed Forexample rapid-acting insulin starts to work right after you take it Long-acting insulin works for many hoursMost people need two or more types of insulin to reachtheir blood glucose targets
Look at the list of types of insulin on Insert C in thepocket of this booklet Check off the names of thekinds of insulin you take Then write the names of your
insulins under My Insulins in the chart on Insert A
Diabetes Pills
Along with meal planning and physicalactivity diabetes pills help people withtype 2 diabetes or gestational diabeteskeep their blood glucose levels ontarget Several kinds of pills are
available Each works in a different way Many people take two orthree kinds of pills Somepeople take combination pillsCombination pills containtwo kinds of diabetes medicinein one tablet Some peopletake pills and insulin
Diabetes pills help people withtype 2 diabetes or gestationaldiabetes keep their blood glucoselevels on target
11
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Your doctor may ask you to try one kind of pill If it
doesnrsquot help you reach your blood glucose targets yourdoctor may ask you to
l take more of the same pill
l add another kind of pill
l change to another type of pill
l start taking insulin
l start taking another injected medicine
If your doctor suggests that you take insulin or anotherinjected medicine it doesnrsquot mean your diabetes isgetting worse Instead it means you need insulin oranother type of medicine to reach your blood glucosetargets Everyone is different What works best for youdepends on your usual daily routine eating habits andactivities and your other health conditions
For information about the different kinds of pills and what they do see the cards in the pocket of this bookletYoursquoll see the brand name and the generic namemdashthescientific namemdashfor each medicine Find your diabetespills and check off the names Then write the namesof your diabetes pills under My Pills and Injected
Medicines in the chart on Insert A
12
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Injections Other Than Insulin
In addition to insulin two other types of injectedmedicines are now available Both work with insulinmdasheither the bodyrsquos own or injectedmdashto help keep yourblood glucose from going too high after you eat Neitheris a substitute for insulin
See the cards in the pocket of this booklet for moreinformation about these injected medicines Checkoff the kinds you take Then write the names of
your injected medicines under My Pills and InjectedMedicines in the chart on Insert A
Talk with your doctor if you have questions about your diabetes medicines Do not stop taking yourdiabetes medicines without checking with your doctorfirst See Insert B for a list of questions to ask yourdoctor about your medicines
What do I need to know about side effectsof medicines
A side effect is an unwanted problem caused by amedicine For example some diabetes medicinescan cause nausea or an upset stomach when you first
start taking them Before you start a new medicine ask your doctor about possible side effects and how you canavoid them If the side effects of your medicine bother you tell your doctor
13
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For More Information
To find diabetes educatorsmdashnurses dietitians and otherhealth professionalsmdashnear you call the American Association of Diabetes Educators toll-free at1ndash800ndashTEAMUP4 (1ndash800ndash832ndash6874) Or go to wwwdiabeteseducatororg and see the ldquoFind a DiabetesEducatorrdquo section
For additional information about diabetes contact
American Diabetes AssociationNational Service Center1701 North Beauregard Street Alexandria VA 22311ndash1742Phone 1ndash800ndashDIABETES (1ndash800ndash342ndash2383)Fax 703ndash549ndash6995Email AskADAdiabetesorgInternet wwwdiabetesorg
Juvenile Diabetes Research Foundation International 26 Broadway 14th FloorNew York NY 10004Phone 1ndash800ndash533ndashCURE (1ndash800ndash533ndash2873)Fax 212ndash785ndash9595Email infojdrforgInternet wwwjdrforg
14
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15
National Diabetes Education Program
1 Diabetes WayBethesda MD 20814ndash9692Phone 1ndash888ndash693ndashNDEP (1ndash888ndash693ndash6337)TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndepmailnihgovInternet wwwndepnihgov
AcknowledgmentsPublications produced by the Clearinghouse arecarefully reviewed by both NIDDK scientists and outsideexperts This booklet was reviewed by Stuart T HainesPharmD University of Maryland School of PharmacyBaltimore
The US Government does not endorse or favor any specific commercialproduct or company Trade proprietary or company names appearing inthis document are used only because they are considered necessary in thecontext of the information provided If a product is not mentioned theomission does not mean or imply that the product is unsatisfactory
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National Diabetes Information Clearinghouse1 Information WayBethesda MD 20892ndash3560
Phone 1ndash800ndash860ndash8747TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndicinfoniddknihgovInternet wwwdiabetesniddknihgov
The National Diabetes Information Clearinghouse (NDIC) is a serviceof the National Institute of Diabetes and Digestive and Kidney Diseases(NIDDK) The NIDDK is part of the National Institutes of Health of theUS Department of Health and Human Services Established in 1978 the
Clearinghouse provides information about diabetes to people with diabetesand to their families health care professionals and the public The NDICanswers inquiries develops and distributes publications and works closely with professional and patient organizations and Government agencies tocoordinate resources about diabetes
This publication is not copyrighted The Clearinghouse encourages usersof this publication to duplicate and distribute as many copies as desired
This publication is available at wwwdiabetesniddknihgov
This publication may contain information about medications Whenprepared this publication included the most current information availableFor updates or for questions about any medications contact the US Foodand Drug Administration toll-free at 1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332)or visit wwwfdagov Consult your doctor for more information
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Inserts
My Diabetes Medicines Insert A
Questions to Ask about
Your Diabetes Medicines Insert BTypes of Insulin Insert C
Glyset and Precose (Alpha-Glucosidase Inhibitors) Insert D
Glucophage Glucophage XR and Riomet(Biguanides) Insert E
Starlix (D-Phenylalanine Derivative) Insert F
Januvia (DPP-4 Inhibitor) Insert G
Prandin (Meglitinide) Insert H
Amaryl DiaBeta Diabinese GlucotrolGlucotrol XL Glynase PresTab Micronasetolazamide and tolbutamide (Sulfonylureas) Insert I
Actos and Avandia (Thiazolidinediones) Insert J
Actoplus Met Actoplus Met XR Avandamet Avandaryl DuetactGlucovance Janumetand Metaglip (Combination Diabetes Pills) Insert K
Symlin (Amylin Mimetic) Insert L
Byetta (Incretin Mimetic) Insert M
About Low Blood Glucose Insert N
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert BWhat I need to know about Diabetes Medicines
Questions to Ask about Your Diabetes Medicines Ask your doctor these questions when you get a prescription fora medicine Make copies of this card and use one card for eachof your medicines
What are the names of my medicine
Brand name Generic name
What does my medicine do
When should I start this medicine
This medicine is prescribed by
How long will it take this medicine to workWhat is the strength (for example how many milligrams writtenas mg)
How much should I take for each dose
How many times a day should I take my medicine
At what times should I take my medicine
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert B
Should I take it before with or after a meal
Should I avoid any foods or medicines when I take it
Should I avoid alcoholic beverages when I take it
Are there any times when I should change the amount of medicineI take
What should I do if I forget to take it
If Irsquom sick and canrsquot keep food down should I still take my medicine
Can my diabetes medicine cause low blood glucose
What should I do if my blood glucose is too low
What side effects can this medicine cause
What should I do if I have side effects
How should I store this medicine
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Insert CWhat I need to know about Diabetes Medicines
Types of InsulinEach type of insulin has an onset a peak and a duration time
The onset is how soon the insulin starts to lower your blood glucoseafter you take it
The peak is the time the insulin is working the hardest to lower yourblood glucose
The duration is how long the insulin lastsmdashthe length of time it keepslowering your blood glucose
The times shown in the chart are estimates Your onset peak andduration times may be different Yoursquoll work with your health careteam to come up with an insulin plan that works best for you
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert C What I need to know about Diabetes Medicines In
Type of Insulin Brand Name Generic Name Onset Peak Duration
Rapid-acting qNovoLog q Insulin aspart 15 minutes 30 to 90 minutes 3 to 5 hours
q Apidra q Insulin glulisine 15 minutes 30 to 90 minutes 3 to 5 hours
qHumalog q Insulin lispro 15 minutes 30 to 90 minutes 3 to 5 hours
Short-acting q Humulin R
q Novolin R
q Regular (R) 30 to 60 minutes 2 to 4 hours 5 to 8 hours
Intermediate-acting q Humulin N
q Novolin N
q NPH (N) 1 to 3 hours 8 hours 12 to 16 hours
Long-acting q Levemir
q Lantus
q Insulin detemir
q Insulin glargine
1 hour Peakless 20 to 26 hours
Pre-mixed NPH(intermediate-acting)and regular (short-acting)
q Humulin 7030
q Novolin 7030
q 70 NPH and 30 regular 30 to 60 minutes Varies 10 to 16 hours
q Humulin 5050 q 50 NPH and 50 regular 30 to 60 minutes Varies 10 to 16 hours
Pre-mixed insulin lispro q Humalog Mix 7525 q 75 insulin lispro protamine 10 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 25 insulin lispro(intermediate-acting) andinsulin lispro (rapid-acting) q Humalog Mix 5050 q 50 insulin lispro protamine
and 50 insulin lispro10 to 15 minutes Varies 10 to 16 hours
Pre-mixed insulin aspart q NovoLog Mix 7030 q 70 insulin aspart protamine 5 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 30 insulin aspart(intermediate-acting) andinsulin aspart (rapid-acting)
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What I need to know about Diabetes Medicines Insert D
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Taking Glyset or Precose may cause stomach pain gas bloating
or diarrhea These symptoms usually go away after you have takenthese pills for a while
If you take Glyset or Precose What you need to know aboutlow blood glucose
If you take Glyset or Precose only glucose tablets or glucose gel
will bring your blood glucose level back to normal quickly Otherquick-fix foods and drinks wonrsquot raise your blood glucose as quicklybecause Glyset and Precose slow the digestion of other quick-fixfoods and drinks
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
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Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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Types of Diabetes Medicines
Diabetes medicines come in several forms
Insulin
If your body no longer makes enough insulin yoursquoll needto take it Insulin is used for all types of diabetes Yourdoctor can help you decide which way of taking insulin isbest for you
l Taking injections Yoursquoll give yourself shots using aneedle and syringe The syringe is a hollow tube witha plunger You will put your dose of insulin into thetube Some people use an insulin pen which lookslike a pen but has a needle for its point
l Using an insulin pump An insulin pump is a smallmachine about the size of a cell phone worn outsideof your body on a belt or in a pocket or pouch The
pump connects to a small plastic tube and a verysmall needle The needle is inserted under the skinand stays in for several days Insulin is pumped fromthe machine through the tube into your body
8
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l Using an insulin jet injector The jet injector whichlooks like a large pen sends a fine spray of insulinthrough the skin with high-pressure air instead of aneedle
l Using an insulin infuser A small tube is inserted just beneath the skin and remains in place for severaldays Insulin is injected into the end of the tubeinstead of through the skin
If your body no longer makes enough insulin yoursquoll need to take it
9
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Types of Insulin
Each type of insulin works at a different speed Forexample rapid-acting insulin starts to work right after you take it Long-acting insulin works for many hoursMost people need two or more types of insulin to reachtheir blood glucose targets
Look at the list of types of insulin on Insert C in thepocket of this booklet Check off the names of thekinds of insulin you take Then write the names of your
insulins under My Insulins in the chart on Insert A
Diabetes Pills
Along with meal planning and physicalactivity diabetes pills help people withtype 2 diabetes or gestational diabeteskeep their blood glucose levels ontarget Several kinds of pills are
available Each works in a different way Many people take two orthree kinds of pills Somepeople take combination pillsCombination pills containtwo kinds of diabetes medicinein one tablet Some peopletake pills and insulin
Diabetes pills help people withtype 2 diabetes or gestationaldiabetes keep their blood glucoselevels on target
11
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Your doctor may ask you to try one kind of pill If it
doesnrsquot help you reach your blood glucose targets yourdoctor may ask you to
l take more of the same pill
l add another kind of pill
l change to another type of pill
l start taking insulin
l start taking another injected medicine
If your doctor suggests that you take insulin or anotherinjected medicine it doesnrsquot mean your diabetes isgetting worse Instead it means you need insulin oranother type of medicine to reach your blood glucosetargets Everyone is different What works best for youdepends on your usual daily routine eating habits andactivities and your other health conditions
For information about the different kinds of pills and what they do see the cards in the pocket of this bookletYoursquoll see the brand name and the generic namemdashthescientific namemdashfor each medicine Find your diabetespills and check off the names Then write the namesof your diabetes pills under My Pills and Injected
Medicines in the chart on Insert A
12
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Injections Other Than Insulin
In addition to insulin two other types of injectedmedicines are now available Both work with insulinmdasheither the bodyrsquos own or injectedmdashto help keep yourblood glucose from going too high after you eat Neitheris a substitute for insulin
See the cards in the pocket of this booklet for moreinformation about these injected medicines Checkoff the kinds you take Then write the names of
your injected medicines under My Pills and InjectedMedicines in the chart on Insert A
Talk with your doctor if you have questions about your diabetes medicines Do not stop taking yourdiabetes medicines without checking with your doctorfirst See Insert B for a list of questions to ask yourdoctor about your medicines
What do I need to know about side effectsof medicines
A side effect is an unwanted problem caused by amedicine For example some diabetes medicinescan cause nausea or an upset stomach when you first
start taking them Before you start a new medicine ask your doctor about possible side effects and how you canavoid them If the side effects of your medicine bother you tell your doctor
13
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For More Information
To find diabetes educatorsmdashnurses dietitians and otherhealth professionalsmdashnear you call the American Association of Diabetes Educators toll-free at1ndash800ndashTEAMUP4 (1ndash800ndash832ndash6874) Or go to wwwdiabeteseducatororg and see the ldquoFind a DiabetesEducatorrdquo section
For additional information about diabetes contact
American Diabetes AssociationNational Service Center1701 North Beauregard Street Alexandria VA 22311ndash1742Phone 1ndash800ndashDIABETES (1ndash800ndash342ndash2383)Fax 703ndash549ndash6995Email AskADAdiabetesorgInternet wwwdiabetesorg
Juvenile Diabetes Research Foundation International 26 Broadway 14th FloorNew York NY 10004Phone 1ndash800ndash533ndashCURE (1ndash800ndash533ndash2873)Fax 212ndash785ndash9595Email infojdrforgInternet wwwjdrforg
14
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15
National Diabetes Education Program
1 Diabetes WayBethesda MD 20814ndash9692Phone 1ndash888ndash693ndashNDEP (1ndash888ndash693ndash6337)TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndepmailnihgovInternet wwwndepnihgov
AcknowledgmentsPublications produced by the Clearinghouse arecarefully reviewed by both NIDDK scientists and outsideexperts This booklet was reviewed by Stuart T HainesPharmD University of Maryland School of PharmacyBaltimore
The US Government does not endorse or favor any specific commercialproduct or company Trade proprietary or company names appearing inthis document are used only because they are considered necessary in thecontext of the information provided If a product is not mentioned theomission does not mean or imply that the product is unsatisfactory
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National Diabetes Information Clearinghouse1 Information WayBethesda MD 20892ndash3560
Phone 1ndash800ndash860ndash8747TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndicinfoniddknihgovInternet wwwdiabetesniddknihgov
The National Diabetes Information Clearinghouse (NDIC) is a serviceof the National Institute of Diabetes and Digestive and Kidney Diseases(NIDDK) The NIDDK is part of the National Institutes of Health of theUS Department of Health and Human Services Established in 1978 the
Clearinghouse provides information about diabetes to people with diabetesand to their families health care professionals and the public The NDICanswers inquiries develops and distributes publications and works closely with professional and patient organizations and Government agencies tocoordinate resources about diabetes
This publication is not copyrighted The Clearinghouse encourages usersof this publication to duplicate and distribute as many copies as desired
This publication is available at wwwdiabetesniddknihgov
This publication may contain information about medications Whenprepared this publication included the most current information availableFor updates or for questions about any medications contact the US Foodand Drug Administration toll-free at 1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332)or visit wwwfdagov Consult your doctor for more information
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Inserts
My Diabetes Medicines Insert A
Questions to Ask about
Your Diabetes Medicines Insert BTypes of Insulin Insert C
Glyset and Precose (Alpha-Glucosidase Inhibitors) Insert D
Glucophage Glucophage XR and Riomet(Biguanides) Insert E
Starlix (D-Phenylalanine Derivative) Insert F
Januvia (DPP-4 Inhibitor) Insert G
Prandin (Meglitinide) Insert H
Amaryl DiaBeta Diabinese GlucotrolGlucotrol XL Glynase PresTab Micronasetolazamide and tolbutamide (Sulfonylureas) Insert I
Actos and Avandia (Thiazolidinediones) Insert J
Actoplus Met Actoplus Met XR Avandamet Avandaryl DuetactGlucovance Janumetand Metaglip (Combination Diabetes Pills) Insert K
Symlin (Amylin Mimetic) Insert L
Byetta (Incretin Mimetic) Insert M
About Low Blood Glucose Insert N
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert BWhat I need to know about Diabetes Medicines
Questions to Ask about Your Diabetes Medicines Ask your doctor these questions when you get a prescription fora medicine Make copies of this card and use one card for eachof your medicines
What are the names of my medicine
Brand name Generic name
What does my medicine do
When should I start this medicine
This medicine is prescribed by
How long will it take this medicine to workWhat is the strength (for example how many milligrams writtenas mg)
How much should I take for each dose
How many times a day should I take my medicine
At what times should I take my medicine
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert B
Should I take it before with or after a meal
Should I avoid any foods or medicines when I take it
Should I avoid alcoholic beverages when I take it
Are there any times when I should change the amount of medicineI take
What should I do if I forget to take it
If Irsquom sick and canrsquot keep food down should I still take my medicine
Can my diabetes medicine cause low blood glucose
What should I do if my blood glucose is too low
What side effects can this medicine cause
What should I do if I have side effects
How should I store this medicine
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Insert CWhat I need to know about Diabetes Medicines
Types of InsulinEach type of insulin has an onset a peak and a duration time
The onset is how soon the insulin starts to lower your blood glucoseafter you take it
The peak is the time the insulin is working the hardest to lower yourblood glucose
The duration is how long the insulin lastsmdashthe length of time it keepslowering your blood glucose
The times shown in the chart are estimates Your onset peak andduration times may be different Yoursquoll work with your health careteam to come up with an insulin plan that works best for you
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert C What I need to know about Diabetes Medicines In
Type of Insulin Brand Name Generic Name Onset Peak Duration
Rapid-acting qNovoLog q Insulin aspart 15 minutes 30 to 90 minutes 3 to 5 hours
q Apidra q Insulin glulisine 15 minutes 30 to 90 minutes 3 to 5 hours
qHumalog q Insulin lispro 15 minutes 30 to 90 minutes 3 to 5 hours
Short-acting q Humulin R
q Novolin R
q Regular (R) 30 to 60 minutes 2 to 4 hours 5 to 8 hours
Intermediate-acting q Humulin N
q Novolin N
q NPH (N) 1 to 3 hours 8 hours 12 to 16 hours
Long-acting q Levemir
q Lantus
q Insulin detemir
q Insulin glargine
1 hour Peakless 20 to 26 hours
Pre-mixed NPH(intermediate-acting)and regular (short-acting)
q Humulin 7030
q Novolin 7030
q 70 NPH and 30 regular 30 to 60 minutes Varies 10 to 16 hours
q Humulin 5050 q 50 NPH and 50 regular 30 to 60 minutes Varies 10 to 16 hours
Pre-mixed insulin lispro q Humalog Mix 7525 q 75 insulin lispro protamine 10 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 25 insulin lispro(intermediate-acting) andinsulin lispro (rapid-acting) q Humalog Mix 5050 q 50 insulin lispro protamine
and 50 insulin lispro10 to 15 minutes Varies 10 to 16 hours
Pre-mixed insulin aspart q NovoLog Mix 7030 q 70 insulin aspart protamine 5 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 30 insulin aspart(intermediate-acting) andinsulin aspart (rapid-acting)
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What I need to know about Diabetes Medicines Insert D
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Taking Glyset or Precose may cause stomach pain gas bloating
or diarrhea These symptoms usually go away after you have takenthese pills for a while
If you take Glyset or Precose What you need to know aboutlow blood glucose
If you take Glyset or Precose only glucose tablets or glucose gel
will bring your blood glucose level back to normal quickly Otherquick-fix foods and drinks wonrsquot raise your blood glucose as quicklybecause Glyset and Precose slow the digestion of other quick-fixfoods and drinks
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
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Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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l Using an insulin jet injector The jet injector whichlooks like a large pen sends a fine spray of insulinthrough the skin with high-pressure air instead of aneedle
l Using an insulin infuser A small tube is inserted just beneath the skin and remains in place for severaldays Insulin is injected into the end of the tubeinstead of through the skin
If your body no longer makes enough insulin yoursquoll need to take it
9
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Types of Insulin
Each type of insulin works at a different speed Forexample rapid-acting insulin starts to work right after you take it Long-acting insulin works for many hoursMost people need two or more types of insulin to reachtheir blood glucose targets
Look at the list of types of insulin on Insert C in thepocket of this booklet Check off the names of thekinds of insulin you take Then write the names of your
insulins under My Insulins in the chart on Insert A
Diabetes Pills
Along with meal planning and physicalactivity diabetes pills help people withtype 2 diabetes or gestational diabeteskeep their blood glucose levels ontarget Several kinds of pills are
available Each works in a different way Many people take two orthree kinds of pills Somepeople take combination pillsCombination pills containtwo kinds of diabetes medicinein one tablet Some peopletake pills and insulin
Diabetes pills help people withtype 2 diabetes or gestationaldiabetes keep their blood glucoselevels on target
11
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Your doctor may ask you to try one kind of pill If it
doesnrsquot help you reach your blood glucose targets yourdoctor may ask you to
l take more of the same pill
l add another kind of pill
l change to another type of pill
l start taking insulin
l start taking another injected medicine
If your doctor suggests that you take insulin or anotherinjected medicine it doesnrsquot mean your diabetes isgetting worse Instead it means you need insulin oranother type of medicine to reach your blood glucosetargets Everyone is different What works best for youdepends on your usual daily routine eating habits andactivities and your other health conditions
For information about the different kinds of pills and what they do see the cards in the pocket of this bookletYoursquoll see the brand name and the generic namemdashthescientific namemdashfor each medicine Find your diabetespills and check off the names Then write the namesof your diabetes pills under My Pills and Injected
Medicines in the chart on Insert A
12
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Injections Other Than Insulin
In addition to insulin two other types of injectedmedicines are now available Both work with insulinmdasheither the bodyrsquos own or injectedmdashto help keep yourblood glucose from going too high after you eat Neitheris a substitute for insulin
See the cards in the pocket of this booklet for moreinformation about these injected medicines Checkoff the kinds you take Then write the names of
your injected medicines under My Pills and InjectedMedicines in the chart on Insert A
Talk with your doctor if you have questions about your diabetes medicines Do not stop taking yourdiabetes medicines without checking with your doctorfirst See Insert B for a list of questions to ask yourdoctor about your medicines
What do I need to know about side effectsof medicines
A side effect is an unwanted problem caused by amedicine For example some diabetes medicinescan cause nausea or an upset stomach when you first
start taking them Before you start a new medicine ask your doctor about possible side effects and how you canavoid them If the side effects of your medicine bother you tell your doctor
13
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For More Information
To find diabetes educatorsmdashnurses dietitians and otherhealth professionalsmdashnear you call the American Association of Diabetes Educators toll-free at1ndash800ndashTEAMUP4 (1ndash800ndash832ndash6874) Or go to wwwdiabeteseducatororg and see the ldquoFind a DiabetesEducatorrdquo section
For additional information about diabetes contact
American Diabetes AssociationNational Service Center1701 North Beauregard Street Alexandria VA 22311ndash1742Phone 1ndash800ndashDIABETES (1ndash800ndash342ndash2383)Fax 703ndash549ndash6995Email AskADAdiabetesorgInternet wwwdiabetesorg
Juvenile Diabetes Research Foundation International 26 Broadway 14th FloorNew York NY 10004Phone 1ndash800ndash533ndashCURE (1ndash800ndash533ndash2873)Fax 212ndash785ndash9595Email infojdrforgInternet wwwjdrforg
14
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15
National Diabetes Education Program
1 Diabetes WayBethesda MD 20814ndash9692Phone 1ndash888ndash693ndashNDEP (1ndash888ndash693ndash6337)TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndepmailnihgovInternet wwwndepnihgov
AcknowledgmentsPublications produced by the Clearinghouse arecarefully reviewed by both NIDDK scientists and outsideexperts This booklet was reviewed by Stuart T HainesPharmD University of Maryland School of PharmacyBaltimore
The US Government does not endorse or favor any specific commercialproduct or company Trade proprietary or company names appearing inthis document are used only because they are considered necessary in thecontext of the information provided If a product is not mentioned theomission does not mean or imply that the product is unsatisfactory
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National Diabetes Information Clearinghouse1 Information WayBethesda MD 20892ndash3560
Phone 1ndash800ndash860ndash8747TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndicinfoniddknihgovInternet wwwdiabetesniddknihgov
The National Diabetes Information Clearinghouse (NDIC) is a serviceof the National Institute of Diabetes and Digestive and Kidney Diseases(NIDDK) The NIDDK is part of the National Institutes of Health of theUS Department of Health and Human Services Established in 1978 the
Clearinghouse provides information about diabetes to people with diabetesand to their families health care professionals and the public The NDICanswers inquiries develops and distributes publications and works closely with professional and patient organizations and Government agencies tocoordinate resources about diabetes
This publication is not copyrighted The Clearinghouse encourages usersof this publication to duplicate and distribute as many copies as desired
This publication is available at wwwdiabetesniddknihgov
This publication may contain information about medications Whenprepared this publication included the most current information availableFor updates or for questions about any medications contact the US Foodand Drug Administration toll-free at 1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332)or visit wwwfdagov Consult your doctor for more information
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Inserts
My Diabetes Medicines Insert A
Questions to Ask about
Your Diabetes Medicines Insert BTypes of Insulin Insert C
Glyset and Precose (Alpha-Glucosidase Inhibitors) Insert D
Glucophage Glucophage XR and Riomet(Biguanides) Insert E
Starlix (D-Phenylalanine Derivative) Insert F
Januvia (DPP-4 Inhibitor) Insert G
Prandin (Meglitinide) Insert H
Amaryl DiaBeta Diabinese GlucotrolGlucotrol XL Glynase PresTab Micronasetolazamide and tolbutamide (Sulfonylureas) Insert I
Actos and Avandia (Thiazolidinediones) Insert J
Actoplus Met Actoplus Met XR Avandamet Avandaryl DuetactGlucovance Janumetand Metaglip (Combination Diabetes Pills) Insert K
Symlin (Amylin Mimetic) Insert L
Byetta (Incretin Mimetic) Insert M
About Low Blood Glucose Insert N
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert BWhat I need to know about Diabetes Medicines
Questions to Ask about Your Diabetes Medicines Ask your doctor these questions when you get a prescription fora medicine Make copies of this card and use one card for eachof your medicines
What are the names of my medicine
Brand name Generic name
What does my medicine do
When should I start this medicine
This medicine is prescribed by
How long will it take this medicine to workWhat is the strength (for example how many milligrams writtenas mg)
How much should I take for each dose
How many times a day should I take my medicine
At what times should I take my medicine
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert B
Should I take it before with or after a meal
Should I avoid any foods or medicines when I take it
Should I avoid alcoholic beverages when I take it
Are there any times when I should change the amount of medicineI take
What should I do if I forget to take it
If Irsquom sick and canrsquot keep food down should I still take my medicine
Can my diabetes medicine cause low blood glucose
What should I do if my blood glucose is too low
What side effects can this medicine cause
What should I do if I have side effects
How should I store this medicine
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Insert CWhat I need to know about Diabetes Medicines
Types of InsulinEach type of insulin has an onset a peak and a duration time
The onset is how soon the insulin starts to lower your blood glucoseafter you take it
The peak is the time the insulin is working the hardest to lower yourblood glucose
The duration is how long the insulin lastsmdashthe length of time it keepslowering your blood glucose
The times shown in the chart are estimates Your onset peak andduration times may be different Yoursquoll work with your health careteam to come up with an insulin plan that works best for you
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert C What I need to know about Diabetes Medicines In
Type of Insulin Brand Name Generic Name Onset Peak Duration
Rapid-acting qNovoLog q Insulin aspart 15 minutes 30 to 90 minutes 3 to 5 hours
q Apidra q Insulin glulisine 15 minutes 30 to 90 minutes 3 to 5 hours
qHumalog q Insulin lispro 15 minutes 30 to 90 minutes 3 to 5 hours
Short-acting q Humulin R
q Novolin R
q Regular (R) 30 to 60 minutes 2 to 4 hours 5 to 8 hours
Intermediate-acting q Humulin N
q Novolin N
q NPH (N) 1 to 3 hours 8 hours 12 to 16 hours
Long-acting q Levemir
q Lantus
q Insulin detemir
q Insulin glargine
1 hour Peakless 20 to 26 hours
Pre-mixed NPH(intermediate-acting)and regular (short-acting)
q Humulin 7030
q Novolin 7030
q 70 NPH and 30 regular 30 to 60 minutes Varies 10 to 16 hours
q Humulin 5050 q 50 NPH and 50 regular 30 to 60 minutes Varies 10 to 16 hours
Pre-mixed insulin lispro q Humalog Mix 7525 q 75 insulin lispro protamine 10 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 25 insulin lispro(intermediate-acting) andinsulin lispro (rapid-acting) q Humalog Mix 5050 q 50 insulin lispro protamine
and 50 insulin lispro10 to 15 minutes Varies 10 to 16 hours
Pre-mixed insulin aspart q NovoLog Mix 7030 q 70 insulin aspart protamine 5 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 30 insulin aspart(intermediate-acting) andinsulin aspart (rapid-acting)
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What I need to know about Diabetes Medicines Insert D
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Taking Glyset or Precose may cause stomach pain gas bloating
or diarrhea These symptoms usually go away after you have takenthese pills for a while
If you take Glyset or Precose What you need to know aboutlow blood glucose
If you take Glyset or Precose only glucose tablets or glucose gel
will bring your blood glucose level back to normal quickly Otherquick-fix foods and drinks wonrsquot raise your blood glucose as quicklybecause Glyset and Precose slow the digestion of other quick-fixfoods and drinks
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
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Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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Types of Insulin
Each type of insulin works at a different speed Forexample rapid-acting insulin starts to work right after you take it Long-acting insulin works for many hoursMost people need two or more types of insulin to reachtheir blood glucose targets
Look at the list of types of insulin on Insert C in thepocket of this booklet Check off the names of thekinds of insulin you take Then write the names of your
insulins under My Insulins in the chart on Insert A
Diabetes Pills
Along with meal planning and physicalactivity diabetes pills help people withtype 2 diabetes or gestational diabeteskeep their blood glucose levels ontarget Several kinds of pills are
available Each works in a different way Many people take two orthree kinds of pills Somepeople take combination pillsCombination pills containtwo kinds of diabetes medicinein one tablet Some peopletake pills and insulin
Diabetes pills help people withtype 2 diabetes or gestationaldiabetes keep their blood glucoselevels on target
11
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Your doctor may ask you to try one kind of pill If it
doesnrsquot help you reach your blood glucose targets yourdoctor may ask you to
l take more of the same pill
l add another kind of pill
l change to another type of pill
l start taking insulin
l start taking another injected medicine
If your doctor suggests that you take insulin or anotherinjected medicine it doesnrsquot mean your diabetes isgetting worse Instead it means you need insulin oranother type of medicine to reach your blood glucosetargets Everyone is different What works best for youdepends on your usual daily routine eating habits andactivities and your other health conditions
For information about the different kinds of pills and what they do see the cards in the pocket of this bookletYoursquoll see the brand name and the generic namemdashthescientific namemdashfor each medicine Find your diabetespills and check off the names Then write the namesof your diabetes pills under My Pills and Injected
Medicines in the chart on Insert A
12
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Injections Other Than Insulin
In addition to insulin two other types of injectedmedicines are now available Both work with insulinmdasheither the bodyrsquos own or injectedmdashto help keep yourblood glucose from going too high after you eat Neitheris a substitute for insulin
See the cards in the pocket of this booklet for moreinformation about these injected medicines Checkoff the kinds you take Then write the names of
your injected medicines under My Pills and InjectedMedicines in the chart on Insert A
Talk with your doctor if you have questions about your diabetes medicines Do not stop taking yourdiabetes medicines without checking with your doctorfirst See Insert B for a list of questions to ask yourdoctor about your medicines
What do I need to know about side effectsof medicines
A side effect is an unwanted problem caused by amedicine For example some diabetes medicinescan cause nausea or an upset stomach when you first
start taking them Before you start a new medicine ask your doctor about possible side effects and how you canavoid them If the side effects of your medicine bother you tell your doctor
13
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For More Information
To find diabetes educatorsmdashnurses dietitians and otherhealth professionalsmdashnear you call the American Association of Diabetes Educators toll-free at1ndash800ndashTEAMUP4 (1ndash800ndash832ndash6874) Or go to wwwdiabeteseducatororg and see the ldquoFind a DiabetesEducatorrdquo section
For additional information about diabetes contact
American Diabetes AssociationNational Service Center1701 North Beauregard Street Alexandria VA 22311ndash1742Phone 1ndash800ndashDIABETES (1ndash800ndash342ndash2383)Fax 703ndash549ndash6995Email AskADAdiabetesorgInternet wwwdiabetesorg
Juvenile Diabetes Research Foundation International 26 Broadway 14th FloorNew York NY 10004Phone 1ndash800ndash533ndashCURE (1ndash800ndash533ndash2873)Fax 212ndash785ndash9595Email infojdrforgInternet wwwjdrforg
14
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15
National Diabetes Education Program
1 Diabetes WayBethesda MD 20814ndash9692Phone 1ndash888ndash693ndashNDEP (1ndash888ndash693ndash6337)TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndepmailnihgovInternet wwwndepnihgov
AcknowledgmentsPublications produced by the Clearinghouse arecarefully reviewed by both NIDDK scientists and outsideexperts This booklet was reviewed by Stuart T HainesPharmD University of Maryland School of PharmacyBaltimore
The US Government does not endorse or favor any specific commercialproduct or company Trade proprietary or company names appearing inthis document are used only because they are considered necessary in thecontext of the information provided If a product is not mentioned theomission does not mean or imply that the product is unsatisfactory
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National Diabetes Information Clearinghouse1 Information WayBethesda MD 20892ndash3560
Phone 1ndash800ndash860ndash8747TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndicinfoniddknihgovInternet wwwdiabetesniddknihgov
The National Diabetes Information Clearinghouse (NDIC) is a serviceof the National Institute of Diabetes and Digestive and Kidney Diseases(NIDDK) The NIDDK is part of the National Institutes of Health of theUS Department of Health and Human Services Established in 1978 the
Clearinghouse provides information about diabetes to people with diabetesand to their families health care professionals and the public The NDICanswers inquiries develops and distributes publications and works closely with professional and patient organizations and Government agencies tocoordinate resources about diabetes
This publication is not copyrighted The Clearinghouse encourages usersof this publication to duplicate and distribute as many copies as desired
This publication is available at wwwdiabetesniddknihgov
This publication may contain information about medications Whenprepared this publication included the most current information availableFor updates or for questions about any medications contact the US Foodand Drug Administration toll-free at 1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332)or visit wwwfdagov Consult your doctor for more information
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Inserts
My Diabetes Medicines Insert A
Questions to Ask about
Your Diabetes Medicines Insert BTypes of Insulin Insert C
Glyset and Precose (Alpha-Glucosidase Inhibitors) Insert D
Glucophage Glucophage XR and Riomet(Biguanides) Insert E
Starlix (D-Phenylalanine Derivative) Insert F
Januvia (DPP-4 Inhibitor) Insert G
Prandin (Meglitinide) Insert H
Amaryl DiaBeta Diabinese GlucotrolGlucotrol XL Glynase PresTab Micronasetolazamide and tolbutamide (Sulfonylureas) Insert I
Actos and Avandia (Thiazolidinediones) Insert J
Actoplus Met Actoplus Met XR Avandamet Avandaryl DuetactGlucovance Janumetand Metaglip (Combination Diabetes Pills) Insert K
Symlin (Amylin Mimetic) Insert L
Byetta (Incretin Mimetic) Insert M
About Low Blood Glucose Insert N
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert BWhat I need to know about Diabetes Medicines
Questions to Ask about Your Diabetes Medicines Ask your doctor these questions when you get a prescription fora medicine Make copies of this card and use one card for eachof your medicines
What are the names of my medicine
Brand name Generic name
What does my medicine do
When should I start this medicine
This medicine is prescribed by
How long will it take this medicine to workWhat is the strength (for example how many milligrams writtenas mg)
How much should I take for each dose
How many times a day should I take my medicine
At what times should I take my medicine
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert B
Should I take it before with or after a meal
Should I avoid any foods or medicines when I take it
Should I avoid alcoholic beverages when I take it
Are there any times when I should change the amount of medicineI take
What should I do if I forget to take it
If Irsquom sick and canrsquot keep food down should I still take my medicine
Can my diabetes medicine cause low blood glucose
What should I do if my blood glucose is too low
What side effects can this medicine cause
What should I do if I have side effects
How should I store this medicine
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Insert CWhat I need to know about Diabetes Medicines
Types of InsulinEach type of insulin has an onset a peak and a duration time
The onset is how soon the insulin starts to lower your blood glucoseafter you take it
The peak is the time the insulin is working the hardest to lower yourblood glucose
The duration is how long the insulin lastsmdashthe length of time it keepslowering your blood glucose
The times shown in the chart are estimates Your onset peak andduration times may be different Yoursquoll work with your health careteam to come up with an insulin plan that works best for you
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert C What I need to know about Diabetes Medicines In
Type of Insulin Brand Name Generic Name Onset Peak Duration
Rapid-acting qNovoLog q Insulin aspart 15 minutes 30 to 90 minutes 3 to 5 hours
q Apidra q Insulin glulisine 15 minutes 30 to 90 minutes 3 to 5 hours
qHumalog q Insulin lispro 15 minutes 30 to 90 minutes 3 to 5 hours
Short-acting q Humulin R
q Novolin R
q Regular (R) 30 to 60 minutes 2 to 4 hours 5 to 8 hours
Intermediate-acting q Humulin N
q Novolin N
q NPH (N) 1 to 3 hours 8 hours 12 to 16 hours
Long-acting q Levemir
q Lantus
q Insulin detemir
q Insulin glargine
1 hour Peakless 20 to 26 hours
Pre-mixed NPH(intermediate-acting)and regular (short-acting)
q Humulin 7030
q Novolin 7030
q 70 NPH and 30 regular 30 to 60 minutes Varies 10 to 16 hours
q Humulin 5050 q 50 NPH and 50 regular 30 to 60 minutes Varies 10 to 16 hours
Pre-mixed insulin lispro q Humalog Mix 7525 q 75 insulin lispro protamine 10 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 25 insulin lispro(intermediate-acting) andinsulin lispro (rapid-acting) q Humalog Mix 5050 q 50 insulin lispro protamine
and 50 insulin lispro10 to 15 minutes Varies 10 to 16 hours
Pre-mixed insulin aspart q NovoLog Mix 7030 q 70 insulin aspart protamine 5 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 30 insulin aspart(intermediate-acting) andinsulin aspart (rapid-acting)
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What I need to know about Diabetes Medicines Insert D
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Taking Glyset or Precose may cause stomach pain gas bloating
or diarrhea These symptoms usually go away after you have takenthese pills for a while
If you take Glyset or Precose What you need to know aboutlow blood glucose
If you take Glyset or Precose only glucose tablets or glucose gel
will bring your blood glucose level back to normal quickly Otherquick-fix foods and drinks wonrsquot raise your blood glucose as quicklybecause Glyset and Precose slow the digestion of other quick-fixfoods and drinks
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
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Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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Types of Insulin
Each type of insulin works at a different speed Forexample rapid-acting insulin starts to work right after you take it Long-acting insulin works for many hoursMost people need two or more types of insulin to reachtheir blood glucose targets
Look at the list of types of insulin on Insert C in thepocket of this booklet Check off the names of thekinds of insulin you take Then write the names of your
insulins under My Insulins in the chart on Insert A
Diabetes Pills
Along with meal planning and physicalactivity diabetes pills help people withtype 2 diabetes or gestational diabeteskeep their blood glucose levels ontarget Several kinds of pills are
available Each works in a different way Many people take two orthree kinds of pills Somepeople take combination pillsCombination pills containtwo kinds of diabetes medicinein one tablet Some peopletake pills and insulin
Diabetes pills help people withtype 2 diabetes or gestationaldiabetes keep their blood glucoselevels on target
11
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Your doctor may ask you to try one kind of pill If it
doesnrsquot help you reach your blood glucose targets yourdoctor may ask you to
l take more of the same pill
l add another kind of pill
l change to another type of pill
l start taking insulin
l start taking another injected medicine
If your doctor suggests that you take insulin or anotherinjected medicine it doesnrsquot mean your diabetes isgetting worse Instead it means you need insulin oranother type of medicine to reach your blood glucosetargets Everyone is different What works best for youdepends on your usual daily routine eating habits andactivities and your other health conditions
For information about the different kinds of pills and what they do see the cards in the pocket of this bookletYoursquoll see the brand name and the generic namemdashthescientific namemdashfor each medicine Find your diabetespills and check off the names Then write the namesof your diabetes pills under My Pills and Injected
Medicines in the chart on Insert A
12
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Injections Other Than Insulin
In addition to insulin two other types of injectedmedicines are now available Both work with insulinmdasheither the bodyrsquos own or injectedmdashto help keep yourblood glucose from going too high after you eat Neitheris a substitute for insulin
See the cards in the pocket of this booklet for moreinformation about these injected medicines Checkoff the kinds you take Then write the names of
your injected medicines under My Pills and InjectedMedicines in the chart on Insert A
Talk with your doctor if you have questions about your diabetes medicines Do not stop taking yourdiabetes medicines without checking with your doctorfirst See Insert B for a list of questions to ask yourdoctor about your medicines
What do I need to know about side effectsof medicines
A side effect is an unwanted problem caused by amedicine For example some diabetes medicinescan cause nausea or an upset stomach when you first
start taking them Before you start a new medicine ask your doctor about possible side effects and how you canavoid them If the side effects of your medicine bother you tell your doctor
13
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For More Information
To find diabetes educatorsmdashnurses dietitians and otherhealth professionalsmdashnear you call the American Association of Diabetes Educators toll-free at1ndash800ndashTEAMUP4 (1ndash800ndash832ndash6874) Or go to wwwdiabeteseducatororg and see the ldquoFind a DiabetesEducatorrdquo section
For additional information about diabetes contact
American Diabetes AssociationNational Service Center1701 North Beauregard Street Alexandria VA 22311ndash1742Phone 1ndash800ndashDIABETES (1ndash800ndash342ndash2383)Fax 703ndash549ndash6995Email AskADAdiabetesorgInternet wwwdiabetesorg
Juvenile Diabetes Research Foundation International 26 Broadway 14th FloorNew York NY 10004Phone 1ndash800ndash533ndashCURE (1ndash800ndash533ndash2873)Fax 212ndash785ndash9595Email infojdrforgInternet wwwjdrforg
14
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15
National Diabetes Education Program
1 Diabetes WayBethesda MD 20814ndash9692Phone 1ndash888ndash693ndashNDEP (1ndash888ndash693ndash6337)TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndepmailnihgovInternet wwwndepnihgov
AcknowledgmentsPublications produced by the Clearinghouse arecarefully reviewed by both NIDDK scientists and outsideexperts This booklet was reviewed by Stuart T HainesPharmD University of Maryland School of PharmacyBaltimore
The US Government does not endorse or favor any specific commercialproduct or company Trade proprietary or company names appearing inthis document are used only because they are considered necessary in thecontext of the information provided If a product is not mentioned theomission does not mean or imply that the product is unsatisfactory
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National Diabetes Information Clearinghouse1 Information WayBethesda MD 20892ndash3560
Phone 1ndash800ndash860ndash8747TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndicinfoniddknihgovInternet wwwdiabetesniddknihgov
The National Diabetes Information Clearinghouse (NDIC) is a serviceof the National Institute of Diabetes and Digestive and Kidney Diseases(NIDDK) The NIDDK is part of the National Institutes of Health of theUS Department of Health and Human Services Established in 1978 the
Clearinghouse provides information about diabetes to people with diabetesand to their families health care professionals and the public The NDICanswers inquiries develops and distributes publications and works closely with professional and patient organizations and Government agencies tocoordinate resources about diabetes
This publication is not copyrighted The Clearinghouse encourages usersof this publication to duplicate and distribute as many copies as desired
This publication is available at wwwdiabetesniddknihgov
This publication may contain information about medications Whenprepared this publication included the most current information availableFor updates or for questions about any medications contact the US Foodand Drug Administration toll-free at 1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332)or visit wwwfdagov Consult your doctor for more information
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Inserts
My Diabetes Medicines Insert A
Questions to Ask about
Your Diabetes Medicines Insert BTypes of Insulin Insert C
Glyset and Precose (Alpha-Glucosidase Inhibitors) Insert D
Glucophage Glucophage XR and Riomet(Biguanides) Insert E
Starlix (D-Phenylalanine Derivative) Insert F
Januvia (DPP-4 Inhibitor) Insert G
Prandin (Meglitinide) Insert H
Amaryl DiaBeta Diabinese GlucotrolGlucotrol XL Glynase PresTab Micronasetolazamide and tolbutamide (Sulfonylureas) Insert I
Actos and Avandia (Thiazolidinediones) Insert J
Actoplus Met Actoplus Met XR Avandamet Avandaryl DuetactGlucovance Janumetand Metaglip (Combination Diabetes Pills) Insert K
Symlin (Amylin Mimetic) Insert L
Byetta (Incretin Mimetic) Insert M
About Low Blood Glucose Insert N
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert BWhat I need to know about Diabetes Medicines
Questions to Ask about Your Diabetes Medicines Ask your doctor these questions when you get a prescription fora medicine Make copies of this card and use one card for eachof your medicines
What are the names of my medicine
Brand name Generic name
What does my medicine do
When should I start this medicine
This medicine is prescribed by
How long will it take this medicine to workWhat is the strength (for example how many milligrams writtenas mg)
How much should I take for each dose
How many times a day should I take my medicine
At what times should I take my medicine
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert B
Should I take it before with or after a meal
Should I avoid any foods or medicines when I take it
Should I avoid alcoholic beverages when I take it
Are there any times when I should change the amount of medicineI take
What should I do if I forget to take it
If Irsquom sick and canrsquot keep food down should I still take my medicine
Can my diabetes medicine cause low blood glucose
What should I do if my blood glucose is too low
What side effects can this medicine cause
What should I do if I have side effects
How should I store this medicine
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Insert CWhat I need to know about Diabetes Medicines
Types of InsulinEach type of insulin has an onset a peak and a duration time
The onset is how soon the insulin starts to lower your blood glucoseafter you take it
The peak is the time the insulin is working the hardest to lower yourblood glucose
The duration is how long the insulin lastsmdashthe length of time it keepslowering your blood glucose
The times shown in the chart are estimates Your onset peak andduration times may be different Yoursquoll work with your health careteam to come up with an insulin plan that works best for you
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert C What I need to know about Diabetes Medicines In
Type of Insulin Brand Name Generic Name Onset Peak Duration
Rapid-acting qNovoLog q Insulin aspart 15 minutes 30 to 90 minutes 3 to 5 hours
q Apidra q Insulin glulisine 15 minutes 30 to 90 minutes 3 to 5 hours
qHumalog q Insulin lispro 15 minutes 30 to 90 minutes 3 to 5 hours
Short-acting q Humulin R
q Novolin R
q Regular (R) 30 to 60 minutes 2 to 4 hours 5 to 8 hours
Intermediate-acting q Humulin N
q Novolin N
q NPH (N) 1 to 3 hours 8 hours 12 to 16 hours
Long-acting q Levemir
q Lantus
q Insulin detemir
q Insulin glargine
1 hour Peakless 20 to 26 hours
Pre-mixed NPH(intermediate-acting)and regular (short-acting)
q Humulin 7030
q Novolin 7030
q 70 NPH and 30 regular 30 to 60 minutes Varies 10 to 16 hours
q Humulin 5050 q 50 NPH and 50 regular 30 to 60 minutes Varies 10 to 16 hours
Pre-mixed insulin lispro q Humalog Mix 7525 q 75 insulin lispro protamine 10 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 25 insulin lispro(intermediate-acting) andinsulin lispro (rapid-acting) q Humalog Mix 5050 q 50 insulin lispro protamine
and 50 insulin lispro10 to 15 minutes Varies 10 to 16 hours
Pre-mixed insulin aspart q NovoLog Mix 7030 q 70 insulin aspart protamine 5 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 30 insulin aspart(intermediate-acting) andinsulin aspart (rapid-acting)
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What I need to know about Diabetes Medicines Insert D
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Taking Glyset or Precose may cause stomach pain gas bloating
or diarrhea These symptoms usually go away after you have takenthese pills for a while
If you take Glyset or Precose What you need to know aboutlow blood glucose
If you take Glyset or Precose only glucose tablets or glucose gel
will bring your blood glucose level back to normal quickly Otherquick-fix foods and drinks wonrsquot raise your blood glucose as quicklybecause Glyset and Precose slow the digestion of other quick-fixfoods and drinks
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
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Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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Your doctor may ask you to try one kind of pill If it
doesnrsquot help you reach your blood glucose targets yourdoctor may ask you to
l take more of the same pill
l add another kind of pill
l change to another type of pill
l start taking insulin
l start taking another injected medicine
If your doctor suggests that you take insulin or anotherinjected medicine it doesnrsquot mean your diabetes isgetting worse Instead it means you need insulin oranother type of medicine to reach your blood glucosetargets Everyone is different What works best for youdepends on your usual daily routine eating habits andactivities and your other health conditions
For information about the different kinds of pills and what they do see the cards in the pocket of this bookletYoursquoll see the brand name and the generic namemdashthescientific namemdashfor each medicine Find your diabetespills and check off the names Then write the namesof your diabetes pills under My Pills and Injected
Medicines in the chart on Insert A
12
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Injections Other Than Insulin
In addition to insulin two other types of injectedmedicines are now available Both work with insulinmdasheither the bodyrsquos own or injectedmdashto help keep yourblood glucose from going too high after you eat Neitheris a substitute for insulin
See the cards in the pocket of this booklet for moreinformation about these injected medicines Checkoff the kinds you take Then write the names of
your injected medicines under My Pills and InjectedMedicines in the chart on Insert A
Talk with your doctor if you have questions about your diabetes medicines Do not stop taking yourdiabetes medicines without checking with your doctorfirst See Insert B for a list of questions to ask yourdoctor about your medicines
What do I need to know about side effectsof medicines
A side effect is an unwanted problem caused by amedicine For example some diabetes medicinescan cause nausea or an upset stomach when you first
start taking them Before you start a new medicine ask your doctor about possible side effects and how you canavoid them If the side effects of your medicine bother you tell your doctor
13
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For More Information
To find diabetes educatorsmdashnurses dietitians and otherhealth professionalsmdashnear you call the American Association of Diabetes Educators toll-free at1ndash800ndashTEAMUP4 (1ndash800ndash832ndash6874) Or go to wwwdiabeteseducatororg and see the ldquoFind a DiabetesEducatorrdquo section
For additional information about diabetes contact
American Diabetes AssociationNational Service Center1701 North Beauregard Street Alexandria VA 22311ndash1742Phone 1ndash800ndashDIABETES (1ndash800ndash342ndash2383)Fax 703ndash549ndash6995Email AskADAdiabetesorgInternet wwwdiabetesorg
Juvenile Diabetes Research Foundation International 26 Broadway 14th FloorNew York NY 10004Phone 1ndash800ndash533ndashCURE (1ndash800ndash533ndash2873)Fax 212ndash785ndash9595Email infojdrforgInternet wwwjdrforg
14
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15
National Diabetes Education Program
1 Diabetes WayBethesda MD 20814ndash9692Phone 1ndash888ndash693ndashNDEP (1ndash888ndash693ndash6337)TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndepmailnihgovInternet wwwndepnihgov
AcknowledgmentsPublications produced by the Clearinghouse arecarefully reviewed by both NIDDK scientists and outsideexperts This booklet was reviewed by Stuart T HainesPharmD University of Maryland School of PharmacyBaltimore
The US Government does not endorse or favor any specific commercialproduct or company Trade proprietary or company names appearing inthis document are used only because they are considered necessary in thecontext of the information provided If a product is not mentioned theomission does not mean or imply that the product is unsatisfactory
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National Diabetes Information Clearinghouse1 Information WayBethesda MD 20892ndash3560
Phone 1ndash800ndash860ndash8747TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndicinfoniddknihgovInternet wwwdiabetesniddknihgov
The National Diabetes Information Clearinghouse (NDIC) is a serviceof the National Institute of Diabetes and Digestive and Kidney Diseases(NIDDK) The NIDDK is part of the National Institutes of Health of theUS Department of Health and Human Services Established in 1978 the
Clearinghouse provides information about diabetes to people with diabetesand to their families health care professionals and the public The NDICanswers inquiries develops and distributes publications and works closely with professional and patient organizations and Government agencies tocoordinate resources about diabetes
This publication is not copyrighted The Clearinghouse encourages usersof this publication to duplicate and distribute as many copies as desired
This publication is available at wwwdiabetesniddknihgov
This publication may contain information about medications Whenprepared this publication included the most current information availableFor updates or for questions about any medications contact the US Foodand Drug Administration toll-free at 1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332)or visit wwwfdagov Consult your doctor for more information
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Inserts
My Diabetes Medicines Insert A
Questions to Ask about
Your Diabetes Medicines Insert BTypes of Insulin Insert C
Glyset and Precose (Alpha-Glucosidase Inhibitors) Insert D
Glucophage Glucophage XR and Riomet(Biguanides) Insert E
Starlix (D-Phenylalanine Derivative) Insert F
Januvia (DPP-4 Inhibitor) Insert G
Prandin (Meglitinide) Insert H
Amaryl DiaBeta Diabinese GlucotrolGlucotrol XL Glynase PresTab Micronasetolazamide and tolbutamide (Sulfonylureas) Insert I
Actos and Avandia (Thiazolidinediones) Insert J
Actoplus Met Actoplus Met XR Avandamet Avandaryl DuetactGlucovance Janumetand Metaglip (Combination Diabetes Pills) Insert K
Symlin (Amylin Mimetic) Insert L
Byetta (Incretin Mimetic) Insert M
About Low Blood Glucose Insert N
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert BWhat I need to know about Diabetes Medicines
Questions to Ask about Your Diabetes Medicines Ask your doctor these questions when you get a prescription fora medicine Make copies of this card and use one card for eachof your medicines
What are the names of my medicine
Brand name Generic name
What does my medicine do
When should I start this medicine
This medicine is prescribed by
How long will it take this medicine to workWhat is the strength (for example how many milligrams writtenas mg)
How much should I take for each dose
How many times a day should I take my medicine
At what times should I take my medicine
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert B
Should I take it before with or after a meal
Should I avoid any foods or medicines when I take it
Should I avoid alcoholic beverages when I take it
Are there any times when I should change the amount of medicineI take
What should I do if I forget to take it
If Irsquom sick and canrsquot keep food down should I still take my medicine
Can my diabetes medicine cause low blood glucose
What should I do if my blood glucose is too low
What side effects can this medicine cause
What should I do if I have side effects
How should I store this medicine
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Insert CWhat I need to know about Diabetes Medicines
Types of InsulinEach type of insulin has an onset a peak and a duration time
The onset is how soon the insulin starts to lower your blood glucoseafter you take it
The peak is the time the insulin is working the hardest to lower yourblood glucose
The duration is how long the insulin lastsmdashthe length of time it keepslowering your blood glucose
The times shown in the chart are estimates Your onset peak andduration times may be different Yoursquoll work with your health careteam to come up with an insulin plan that works best for you
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert C What I need to know about Diabetes Medicines In
Type of Insulin Brand Name Generic Name Onset Peak Duration
Rapid-acting qNovoLog q Insulin aspart 15 minutes 30 to 90 minutes 3 to 5 hours
q Apidra q Insulin glulisine 15 minutes 30 to 90 minutes 3 to 5 hours
qHumalog q Insulin lispro 15 minutes 30 to 90 minutes 3 to 5 hours
Short-acting q Humulin R
q Novolin R
q Regular (R) 30 to 60 minutes 2 to 4 hours 5 to 8 hours
Intermediate-acting q Humulin N
q Novolin N
q NPH (N) 1 to 3 hours 8 hours 12 to 16 hours
Long-acting q Levemir
q Lantus
q Insulin detemir
q Insulin glargine
1 hour Peakless 20 to 26 hours
Pre-mixed NPH(intermediate-acting)and regular (short-acting)
q Humulin 7030
q Novolin 7030
q 70 NPH and 30 regular 30 to 60 minutes Varies 10 to 16 hours
q Humulin 5050 q 50 NPH and 50 regular 30 to 60 minutes Varies 10 to 16 hours
Pre-mixed insulin lispro q Humalog Mix 7525 q 75 insulin lispro protamine 10 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 25 insulin lispro(intermediate-acting) andinsulin lispro (rapid-acting) q Humalog Mix 5050 q 50 insulin lispro protamine
and 50 insulin lispro10 to 15 minutes Varies 10 to 16 hours
Pre-mixed insulin aspart q NovoLog Mix 7030 q 70 insulin aspart protamine 5 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 30 insulin aspart(intermediate-acting) andinsulin aspart (rapid-acting)
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What I need to know about Diabetes Medicines Insert D
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Taking Glyset or Precose may cause stomach pain gas bloating
or diarrhea These symptoms usually go away after you have takenthese pills for a while
If you take Glyset or Precose What you need to know aboutlow blood glucose
If you take Glyset or Precose only glucose tablets or glucose gel
will bring your blood glucose level back to normal quickly Otherquick-fix foods and drinks wonrsquot raise your blood glucose as quicklybecause Glyset and Precose slow the digestion of other quick-fixfoods and drinks
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
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Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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Injections Other Than Insulin
In addition to insulin two other types of injectedmedicines are now available Both work with insulinmdasheither the bodyrsquos own or injectedmdashto help keep yourblood glucose from going too high after you eat Neitheris a substitute for insulin
See the cards in the pocket of this booklet for moreinformation about these injected medicines Checkoff the kinds you take Then write the names of
your injected medicines under My Pills and InjectedMedicines in the chart on Insert A
Talk with your doctor if you have questions about your diabetes medicines Do not stop taking yourdiabetes medicines without checking with your doctorfirst See Insert B for a list of questions to ask yourdoctor about your medicines
What do I need to know about side effectsof medicines
A side effect is an unwanted problem caused by amedicine For example some diabetes medicinescan cause nausea or an upset stomach when you first
start taking them Before you start a new medicine ask your doctor about possible side effects and how you canavoid them If the side effects of your medicine bother you tell your doctor
13
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For More Information
To find diabetes educatorsmdashnurses dietitians and otherhealth professionalsmdashnear you call the American Association of Diabetes Educators toll-free at1ndash800ndashTEAMUP4 (1ndash800ndash832ndash6874) Or go to wwwdiabeteseducatororg and see the ldquoFind a DiabetesEducatorrdquo section
For additional information about diabetes contact
American Diabetes AssociationNational Service Center1701 North Beauregard Street Alexandria VA 22311ndash1742Phone 1ndash800ndashDIABETES (1ndash800ndash342ndash2383)Fax 703ndash549ndash6995Email AskADAdiabetesorgInternet wwwdiabetesorg
Juvenile Diabetes Research Foundation International 26 Broadway 14th FloorNew York NY 10004Phone 1ndash800ndash533ndashCURE (1ndash800ndash533ndash2873)Fax 212ndash785ndash9595Email infojdrforgInternet wwwjdrforg
14
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15
National Diabetes Education Program
1 Diabetes WayBethesda MD 20814ndash9692Phone 1ndash888ndash693ndashNDEP (1ndash888ndash693ndash6337)TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndepmailnihgovInternet wwwndepnihgov
AcknowledgmentsPublications produced by the Clearinghouse arecarefully reviewed by both NIDDK scientists and outsideexperts This booklet was reviewed by Stuart T HainesPharmD University of Maryland School of PharmacyBaltimore
The US Government does not endorse or favor any specific commercialproduct or company Trade proprietary or company names appearing inthis document are used only because they are considered necessary in thecontext of the information provided If a product is not mentioned theomission does not mean or imply that the product is unsatisfactory
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National Diabetes Information Clearinghouse1 Information WayBethesda MD 20892ndash3560
Phone 1ndash800ndash860ndash8747TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndicinfoniddknihgovInternet wwwdiabetesniddknihgov
The National Diabetes Information Clearinghouse (NDIC) is a serviceof the National Institute of Diabetes and Digestive and Kidney Diseases(NIDDK) The NIDDK is part of the National Institutes of Health of theUS Department of Health and Human Services Established in 1978 the
Clearinghouse provides information about diabetes to people with diabetesand to their families health care professionals and the public The NDICanswers inquiries develops and distributes publications and works closely with professional and patient organizations and Government agencies tocoordinate resources about diabetes
This publication is not copyrighted The Clearinghouse encourages usersof this publication to duplicate and distribute as many copies as desired
This publication is available at wwwdiabetesniddknihgov
This publication may contain information about medications Whenprepared this publication included the most current information availableFor updates or for questions about any medications contact the US Foodand Drug Administration toll-free at 1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332)or visit wwwfdagov Consult your doctor for more information
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Inserts
My Diabetes Medicines Insert A
Questions to Ask about
Your Diabetes Medicines Insert BTypes of Insulin Insert C
Glyset and Precose (Alpha-Glucosidase Inhibitors) Insert D
Glucophage Glucophage XR and Riomet(Biguanides) Insert E
Starlix (D-Phenylalanine Derivative) Insert F
Januvia (DPP-4 Inhibitor) Insert G
Prandin (Meglitinide) Insert H
Amaryl DiaBeta Diabinese GlucotrolGlucotrol XL Glynase PresTab Micronasetolazamide and tolbutamide (Sulfonylureas) Insert I
Actos and Avandia (Thiazolidinediones) Insert J
Actoplus Met Actoplus Met XR Avandamet Avandaryl DuetactGlucovance Janumetand Metaglip (Combination Diabetes Pills) Insert K
Symlin (Amylin Mimetic) Insert L
Byetta (Incretin Mimetic) Insert M
About Low Blood Glucose Insert N
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert BWhat I need to know about Diabetes Medicines
Questions to Ask about Your Diabetes Medicines Ask your doctor these questions when you get a prescription fora medicine Make copies of this card and use one card for eachof your medicines
What are the names of my medicine
Brand name Generic name
What does my medicine do
When should I start this medicine
This medicine is prescribed by
How long will it take this medicine to workWhat is the strength (for example how many milligrams writtenas mg)
How much should I take for each dose
How many times a day should I take my medicine
At what times should I take my medicine
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert B
Should I take it before with or after a meal
Should I avoid any foods or medicines when I take it
Should I avoid alcoholic beverages when I take it
Are there any times when I should change the amount of medicineI take
What should I do if I forget to take it
If Irsquom sick and canrsquot keep food down should I still take my medicine
Can my diabetes medicine cause low blood glucose
What should I do if my blood glucose is too low
What side effects can this medicine cause
What should I do if I have side effects
How should I store this medicine
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Insert CWhat I need to know about Diabetes Medicines
Types of InsulinEach type of insulin has an onset a peak and a duration time
The onset is how soon the insulin starts to lower your blood glucoseafter you take it
The peak is the time the insulin is working the hardest to lower yourblood glucose
The duration is how long the insulin lastsmdashthe length of time it keepslowering your blood glucose
The times shown in the chart are estimates Your onset peak andduration times may be different Yoursquoll work with your health careteam to come up with an insulin plan that works best for you
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert C What I need to know about Diabetes Medicines In
Type of Insulin Brand Name Generic Name Onset Peak Duration
Rapid-acting qNovoLog q Insulin aspart 15 minutes 30 to 90 minutes 3 to 5 hours
q Apidra q Insulin glulisine 15 minutes 30 to 90 minutes 3 to 5 hours
qHumalog q Insulin lispro 15 minutes 30 to 90 minutes 3 to 5 hours
Short-acting q Humulin R
q Novolin R
q Regular (R) 30 to 60 minutes 2 to 4 hours 5 to 8 hours
Intermediate-acting q Humulin N
q Novolin N
q NPH (N) 1 to 3 hours 8 hours 12 to 16 hours
Long-acting q Levemir
q Lantus
q Insulin detemir
q Insulin glargine
1 hour Peakless 20 to 26 hours
Pre-mixed NPH(intermediate-acting)and regular (short-acting)
q Humulin 7030
q Novolin 7030
q 70 NPH and 30 regular 30 to 60 minutes Varies 10 to 16 hours
q Humulin 5050 q 50 NPH and 50 regular 30 to 60 minutes Varies 10 to 16 hours
Pre-mixed insulin lispro q Humalog Mix 7525 q 75 insulin lispro protamine 10 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 25 insulin lispro(intermediate-acting) andinsulin lispro (rapid-acting) q Humalog Mix 5050 q 50 insulin lispro protamine
and 50 insulin lispro10 to 15 minutes Varies 10 to 16 hours
Pre-mixed insulin aspart q NovoLog Mix 7030 q 70 insulin aspart protamine 5 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 30 insulin aspart(intermediate-acting) andinsulin aspart (rapid-acting)
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What I need to know about Diabetes Medicines Insert D
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Taking Glyset or Precose may cause stomach pain gas bloating
or diarrhea These symptoms usually go away after you have takenthese pills for a while
If you take Glyset or Precose What you need to know aboutlow blood glucose
If you take Glyset or Precose only glucose tablets or glucose gel
will bring your blood glucose level back to normal quickly Otherquick-fix foods and drinks wonrsquot raise your blood glucose as quicklybecause Glyset and Precose slow the digestion of other quick-fixfoods and drinks
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
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Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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For More Information
To find diabetes educatorsmdashnurses dietitians and otherhealth professionalsmdashnear you call the American Association of Diabetes Educators toll-free at1ndash800ndashTEAMUP4 (1ndash800ndash832ndash6874) Or go to wwwdiabeteseducatororg and see the ldquoFind a DiabetesEducatorrdquo section
For additional information about diabetes contact
American Diabetes AssociationNational Service Center1701 North Beauregard Street Alexandria VA 22311ndash1742Phone 1ndash800ndashDIABETES (1ndash800ndash342ndash2383)Fax 703ndash549ndash6995Email AskADAdiabetesorgInternet wwwdiabetesorg
Juvenile Diabetes Research Foundation International 26 Broadway 14th FloorNew York NY 10004Phone 1ndash800ndash533ndashCURE (1ndash800ndash533ndash2873)Fax 212ndash785ndash9595Email infojdrforgInternet wwwjdrforg
14
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15
National Diabetes Education Program
1 Diabetes WayBethesda MD 20814ndash9692Phone 1ndash888ndash693ndashNDEP (1ndash888ndash693ndash6337)TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndepmailnihgovInternet wwwndepnihgov
AcknowledgmentsPublications produced by the Clearinghouse arecarefully reviewed by both NIDDK scientists and outsideexperts This booklet was reviewed by Stuart T HainesPharmD University of Maryland School of PharmacyBaltimore
The US Government does not endorse or favor any specific commercialproduct or company Trade proprietary or company names appearing inthis document are used only because they are considered necessary in thecontext of the information provided If a product is not mentioned theomission does not mean or imply that the product is unsatisfactory
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National Diabetes Information Clearinghouse1 Information WayBethesda MD 20892ndash3560
Phone 1ndash800ndash860ndash8747TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndicinfoniddknihgovInternet wwwdiabetesniddknihgov
The National Diabetes Information Clearinghouse (NDIC) is a serviceof the National Institute of Diabetes and Digestive and Kidney Diseases(NIDDK) The NIDDK is part of the National Institutes of Health of theUS Department of Health and Human Services Established in 1978 the
Clearinghouse provides information about diabetes to people with diabetesand to their families health care professionals and the public The NDICanswers inquiries develops and distributes publications and works closely with professional and patient organizations and Government agencies tocoordinate resources about diabetes
This publication is not copyrighted The Clearinghouse encourages usersof this publication to duplicate and distribute as many copies as desired
This publication is available at wwwdiabetesniddknihgov
This publication may contain information about medications Whenprepared this publication included the most current information availableFor updates or for questions about any medications contact the US Foodand Drug Administration toll-free at 1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332)or visit wwwfdagov Consult your doctor for more information
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Inserts
My Diabetes Medicines Insert A
Questions to Ask about
Your Diabetes Medicines Insert BTypes of Insulin Insert C
Glyset and Precose (Alpha-Glucosidase Inhibitors) Insert D
Glucophage Glucophage XR and Riomet(Biguanides) Insert E
Starlix (D-Phenylalanine Derivative) Insert F
Januvia (DPP-4 Inhibitor) Insert G
Prandin (Meglitinide) Insert H
Amaryl DiaBeta Diabinese GlucotrolGlucotrol XL Glynase PresTab Micronasetolazamide and tolbutamide (Sulfonylureas) Insert I
Actos and Avandia (Thiazolidinediones) Insert J
Actoplus Met Actoplus Met XR Avandamet Avandaryl DuetactGlucovance Janumetand Metaglip (Combination Diabetes Pills) Insert K
Symlin (Amylin Mimetic) Insert L
Byetta (Incretin Mimetic) Insert M
About Low Blood Glucose Insert N
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert BWhat I need to know about Diabetes Medicines
Questions to Ask about Your Diabetes Medicines Ask your doctor these questions when you get a prescription fora medicine Make copies of this card and use one card for eachof your medicines
What are the names of my medicine
Brand name Generic name
What does my medicine do
When should I start this medicine
This medicine is prescribed by
How long will it take this medicine to workWhat is the strength (for example how many milligrams writtenas mg)
How much should I take for each dose
How many times a day should I take my medicine
At what times should I take my medicine
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert B
Should I take it before with or after a meal
Should I avoid any foods or medicines when I take it
Should I avoid alcoholic beverages when I take it
Are there any times when I should change the amount of medicineI take
What should I do if I forget to take it
If Irsquom sick and canrsquot keep food down should I still take my medicine
Can my diabetes medicine cause low blood glucose
What should I do if my blood glucose is too low
What side effects can this medicine cause
What should I do if I have side effects
How should I store this medicine
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Insert CWhat I need to know about Diabetes Medicines
Types of InsulinEach type of insulin has an onset a peak and a duration time
The onset is how soon the insulin starts to lower your blood glucoseafter you take it
The peak is the time the insulin is working the hardest to lower yourblood glucose
The duration is how long the insulin lastsmdashthe length of time it keepslowering your blood glucose
The times shown in the chart are estimates Your onset peak andduration times may be different Yoursquoll work with your health careteam to come up with an insulin plan that works best for you
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert C What I need to know about Diabetes Medicines In
Type of Insulin Brand Name Generic Name Onset Peak Duration
Rapid-acting qNovoLog q Insulin aspart 15 minutes 30 to 90 minutes 3 to 5 hours
q Apidra q Insulin glulisine 15 minutes 30 to 90 minutes 3 to 5 hours
qHumalog q Insulin lispro 15 minutes 30 to 90 minutes 3 to 5 hours
Short-acting q Humulin R
q Novolin R
q Regular (R) 30 to 60 minutes 2 to 4 hours 5 to 8 hours
Intermediate-acting q Humulin N
q Novolin N
q NPH (N) 1 to 3 hours 8 hours 12 to 16 hours
Long-acting q Levemir
q Lantus
q Insulin detemir
q Insulin glargine
1 hour Peakless 20 to 26 hours
Pre-mixed NPH(intermediate-acting)and regular (short-acting)
q Humulin 7030
q Novolin 7030
q 70 NPH and 30 regular 30 to 60 minutes Varies 10 to 16 hours
q Humulin 5050 q 50 NPH and 50 regular 30 to 60 minutes Varies 10 to 16 hours
Pre-mixed insulin lispro q Humalog Mix 7525 q 75 insulin lispro protamine 10 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 25 insulin lispro(intermediate-acting) andinsulin lispro (rapid-acting) q Humalog Mix 5050 q 50 insulin lispro protamine
and 50 insulin lispro10 to 15 minutes Varies 10 to 16 hours
Pre-mixed insulin aspart q NovoLog Mix 7030 q 70 insulin aspart protamine 5 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 30 insulin aspart(intermediate-acting) andinsulin aspart (rapid-acting)
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What I need to know about Diabetes Medicines Insert D
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Taking Glyset or Precose may cause stomach pain gas bloating
or diarrhea These symptoms usually go away after you have takenthese pills for a while
If you take Glyset or Precose What you need to know aboutlow blood glucose
If you take Glyset or Precose only glucose tablets or glucose gel
will bring your blood glucose level back to normal quickly Otherquick-fix foods and drinks wonrsquot raise your blood glucose as quicklybecause Glyset and Precose slow the digestion of other quick-fixfoods and drinks
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
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Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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15
National Diabetes Education Program
1 Diabetes WayBethesda MD 20814ndash9692Phone 1ndash888ndash693ndashNDEP (1ndash888ndash693ndash6337)TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndepmailnihgovInternet wwwndepnihgov
AcknowledgmentsPublications produced by the Clearinghouse arecarefully reviewed by both NIDDK scientists and outsideexperts This booklet was reviewed by Stuart T HainesPharmD University of Maryland School of PharmacyBaltimore
The US Government does not endorse or favor any specific commercialproduct or company Trade proprietary or company names appearing inthis document are used only because they are considered necessary in thecontext of the information provided If a product is not mentioned theomission does not mean or imply that the product is unsatisfactory
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National Diabetes Information Clearinghouse1 Information WayBethesda MD 20892ndash3560
Phone 1ndash800ndash860ndash8747TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndicinfoniddknihgovInternet wwwdiabetesniddknihgov
The National Diabetes Information Clearinghouse (NDIC) is a serviceof the National Institute of Diabetes and Digestive and Kidney Diseases(NIDDK) The NIDDK is part of the National Institutes of Health of theUS Department of Health and Human Services Established in 1978 the
Clearinghouse provides information about diabetes to people with diabetesand to their families health care professionals and the public The NDICanswers inquiries develops and distributes publications and works closely with professional and patient organizations and Government agencies tocoordinate resources about diabetes
This publication is not copyrighted The Clearinghouse encourages usersof this publication to duplicate and distribute as many copies as desired
This publication is available at wwwdiabetesniddknihgov
This publication may contain information about medications Whenprepared this publication included the most current information availableFor updates or for questions about any medications contact the US Foodand Drug Administration toll-free at 1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332)or visit wwwfdagov Consult your doctor for more information
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Inserts
My Diabetes Medicines Insert A
Questions to Ask about
Your Diabetes Medicines Insert BTypes of Insulin Insert C
Glyset and Precose (Alpha-Glucosidase Inhibitors) Insert D
Glucophage Glucophage XR and Riomet(Biguanides) Insert E
Starlix (D-Phenylalanine Derivative) Insert F
Januvia (DPP-4 Inhibitor) Insert G
Prandin (Meglitinide) Insert H
Amaryl DiaBeta Diabinese GlucotrolGlucotrol XL Glynase PresTab Micronasetolazamide and tolbutamide (Sulfonylureas) Insert I
Actos and Avandia (Thiazolidinediones) Insert J
Actoplus Met Actoplus Met XR Avandamet Avandaryl DuetactGlucovance Janumetand Metaglip (Combination Diabetes Pills) Insert K
Symlin (Amylin Mimetic) Insert L
Byetta (Incretin Mimetic) Insert M
About Low Blood Glucose Insert N
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert BWhat I need to know about Diabetes Medicines
Questions to Ask about Your Diabetes Medicines Ask your doctor these questions when you get a prescription fora medicine Make copies of this card and use one card for eachof your medicines
What are the names of my medicine
Brand name Generic name
What does my medicine do
When should I start this medicine
This medicine is prescribed by
How long will it take this medicine to workWhat is the strength (for example how many milligrams writtenas mg)
How much should I take for each dose
How many times a day should I take my medicine
At what times should I take my medicine
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert B
Should I take it before with or after a meal
Should I avoid any foods or medicines when I take it
Should I avoid alcoholic beverages when I take it
Are there any times when I should change the amount of medicineI take
What should I do if I forget to take it
If Irsquom sick and canrsquot keep food down should I still take my medicine
Can my diabetes medicine cause low blood glucose
What should I do if my blood glucose is too low
What side effects can this medicine cause
What should I do if I have side effects
How should I store this medicine
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Insert CWhat I need to know about Diabetes Medicines
Types of InsulinEach type of insulin has an onset a peak and a duration time
The onset is how soon the insulin starts to lower your blood glucoseafter you take it
The peak is the time the insulin is working the hardest to lower yourblood glucose
The duration is how long the insulin lastsmdashthe length of time it keepslowering your blood glucose
The times shown in the chart are estimates Your onset peak andduration times may be different Yoursquoll work with your health careteam to come up with an insulin plan that works best for you
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert C What I need to know about Diabetes Medicines In
Type of Insulin Brand Name Generic Name Onset Peak Duration
Rapid-acting qNovoLog q Insulin aspart 15 minutes 30 to 90 minutes 3 to 5 hours
q Apidra q Insulin glulisine 15 minutes 30 to 90 minutes 3 to 5 hours
qHumalog q Insulin lispro 15 minutes 30 to 90 minutes 3 to 5 hours
Short-acting q Humulin R
q Novolin R
q Regular (R) 30 to 60 minutes 2 to 4 hours 5 to 8 hours
Intermediate-acting q Humulin N
q Novolin N
q NPH (N) 1 to 3 hours 8 hours 12 to 16 hours
Long-acting q Levemir
q Lantus
q Insulin detemir
q Insulin glargine
1 hour Peakless 20 to 26 hours
Pre-mixed NPH(intermediate-acting)and regular (short-acting)
q Humulin 7030
q Novolin 7030
q 70 NPH and 30 regular 30 to 60 minutes Varies 10 to 16 hours
q Humulin 5050 q 50 NPH and 50 regular 30 to 60 minutes Varies 10 to 16 hours
Pre-mixed insulin lispro q Humalog Mix 7525 q 75 insulin lispro protamine 10 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 25 insulin lispro(intermediate-acting) andinsulin lispro (rapid-acting) q Humalog Mix 5050 q 50 insulin lispro protamine
and 50 insulin lispro10 to 15 minutes Varies 10 to 16 hours
Pre-mixed insulin aspart q NovoLog Mix 7030 q 70 insulin aspart protamine 5 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 30 insulin aspart(intermediate-acting) andinsulin aspart (rapid-acting)
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What I need to know about Diabetes Medicines Insert D
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Taking Glyset or Precose may cause stomach pain gas bloating
or diarrhea These symptoms usually go away after you have takenthese pills for a while
If you take Glyset or Precose What you need to know aboutlow blood glucose
If you take Glyset or Precose only glucose tablets or glucose gel
will bring your blood glucose level back to normal quickly Otherquick-fix foods and drinks wonrsquot raise your blood glucose as quicklybecause Glyset and Precose slow the digestion of other quick-fixfoods and drinks
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
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Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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National Diabetes Information Clearinghouse1 Information WayBethesda MD 20892ndash3560
Phone 1ndash800ndash860ndash8747TTY 1ndash866ndash569ndash1162Fax 703ndash738ndash4929Email ndicinfoniddknihgovInternet wwwdiabetesniddknihgov
The National Diabetes Information Clearinghouse (NDIC) is a serviceof the National Institute of Diabetes and Digestive and Kidney Diseases(NIDDK) The NIDDK is part of the National Institutes of Health of theUS Department of Health and Human Services Established in 1978 the
Clearinghouse provides information about diabetes to people with diabetesand to their families health care professionals and the public The NDICanswers inquiries develops and distributes publications and works closely with professional and patient organizations and Government agencies tocoordinate resources about diabetes
This publication is not copyrighted The Clearinghouse encourages usersof this publication to duplicate and distribute as many copies as desired
This publication is available at wwwdiabetesniddknihgov
This publication may contain information about medications Whenprepared this publication included the most current information availableFor updates or for questions about any medications contact the US Foodand Drug Administration toll-free at 1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332)or visit wwwfdagov Consult your doctor for more information
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Inserts
My Diabetes Medicines Insert A
Questions to Ask about
Your Diabetes Medicines Insert BTypes of Insulin Insert C
Glyset and Precose (Alpha-Glucosidase Inhibitors) Insert D
Glucophage Glucophage XR and Riomet(Biguanides) Insert E
Starlix (D-Phenylalanine Derivative) Insert F
Januvia (DPP-4 Inhibitor) Insert G
Prandin (Meglitinide) Insert H
Amaryl DiaBeta Diabinese GlucotrolGlucotrol XL Glynase PresTab Micronasetolazamide and tolbutamide (Sulfonylureas) Insert I
Actos and Avandia (Thiazolidinediones) Insert J
Actoplus Met Actoplus Met XR Avandamet Avandaryl DuetactGlucovance Janumetand Metaglip (Combination Diabetes Pills) Insert K
Symlin (Amylin Mimetic) Insert L
Byetta (Incretin Mimetic) Insert M
About Low Blood Glucose Insert N
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert BWhat I need to know about Diabetes Medicines
Questions to Ask about Your Diabetes Medicines Ask your doctor these questions when you get a prescription fora medicine Make copies of this card and use one card for eachof your medicines
What are the names of my medicine
Brand name Generic name
What does my medicine do
When should I start this medicine
This medicine is prescribed by
How long will it take this medicine to workWhat is the strength (for example how many milligrams writtenas mg)
How much should I take for each dose
How many times a day should I take my medicine
At what times should I take my medicine
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert B
Should I take it before with or after a meal
Should I avoid any foods or medicines when I take it
Should I avoid alcoholic beverages when I take it
Are there any times when I should change the amount of medicineI take
What should I do if I forget to take it
If Irsquom sick and canrsquot keep food down should I still take my medicine
Can my diabetes medicine cause low blood glucose
What should I do if my blood glucose is too low
What side effects can this medicine cause
What should I do if I have side effects
How should I store this medicine
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Insert CWhat I need to know about Diabetes Medicines
Types of InsulinEach type of insulin has an onset a peak and a duration time
The onset is how soon the insulin starts to lower your blood glucoseafter you take it
The peak is the time the insulin is working the hardest to lower yourblood glucose
The duration is how long the insulin lastsmdashthe length of time it keepslowering your blood glucose
The times shown in the chart are estimates Your onset peak andduration times may be different Yoursquoll work with your health careteam to come up with an insulin plan that works best for you
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert C What I need to know about Diabetes Medicines In
Type of Insulin Brand Name Generic Name Onset Peak Duration
Rapid-acting qNovoLog q Insulin aspart 15 minutes 30 to 90 minutes 3 to 5 hours
q Apidra q Insulin glulisine 15 minutes 30 to 90 minutes 3 to 5 hours
qHumalog q Insulin lispro 15 minutes 30 to 90 minutes 3 to 5 hours
Short-acting q Humulin R
q Novolin R
q Regular (R) 30 to 60 minutes 2 to 4 hours 5 to 8 hours
Intermediate-acting q Humulin N
q Novolin N
q NPH (N) 1 to 3 hours 8 hours 12 to 16 hours
Long-acting q Levemir
q Lantus
q Insulin detemir
q Insulin glargine
1 hour Peakless 20 to 26 hours
Pre-mixed NPH(intermediate-acting)and regular (short-acting)
q Humulin 7030
q Novolin 7030
q 70 NPH and 30 regular 30 to 60 minutes Varies 10 to 16 hours
q Humulin 5050 q 50 NPH and 50 regular 30 to 60 minutes Varies 10 to 16 hours
Pre-mixed insulin lispro q Humalog Mix 7525 q 75 insulin lispro protamine 10 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 25 insulin lispro(intermediate-acting) andinsulin lispro (rapid-acting) q Humalog Mix 5050 q 50 insulin lispro protamine
and 50 insulin lispro10 to 15 minutes Varies 10 to 16 hours
Pre-mixed insulin aspart q NovoLog Mix 7030 q 70 insulin aspart protamine 5 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 30 insulin aspart(intermediate-acting) andinsulin aspart (rapid-acting)
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What I need to know about Diabetes Medicines Insert D
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Taking Glyset or Precose may cause stomach pain gas bloating
or diarrhea These symptoms usually go away after you have takenthese pills for a while
If you take Glyset or Precose What you need to know aboutlow blood glucose
If you take Glyset or Precose only glucose tablets or glucose gel
will bring your blood glucose level back to normal quickly Otherquick-fix foods and drinks wonrsquot raise your blood glucose as quicklybecause Glyset and Precose slow the digestion of other quick-fixfoods and drinks
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
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Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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Inserts
My Diabetes Medicines Insert A
Questions to Ask about
Your Diabetes Medicines Insert BTypes of Insulin Insert C
Glyset and Precose (Alpha-Glucosidase Inhibitors) Insert D
Glucophage Glucophage XR and Riomet(Biguanides) Insert E
Starlix (D-Phenylalanine Derivative) Insert F
Januvia (DPP-4 Inhibitor) Insert G
Prandin (Meglitinide) Insert H
Amaryl DiaBeta Diabinese GlucotrolGlucotrol XL Glynase PresTab Micronasetolazamide and tolbutamide (Sulfonylureas) Insert I
Actos and Avandia (Thiazolidinediones) Insert J
Actoplus Met Actoplus Met XR Avandamet Avandaryl DuetactGlucovance Janumetand Metaglip (Combination Diabetes Pills) Insert K
Symlin (Amylin Mimetic) Insert L
Byetta (Incretin Mimetic) Insert M
About Low Blood Glucose Insert N
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert BWhat I need to know about Diabetes Medicines
Questions to Ask about Your Diabetes Medicines Ask your doctor these questions when you get a prescription fora medicine Make copies of this card and use one card for eachof your medicines
What are the names of my medicine
Brand name Generic name
What does my medicine do
When should I start this medicine
This medicine is prescribed by
How long will it take this medicine to workWhat is the strength (for example how many milligrams writtenas mg)
How much should I take for each dose
How many times a day should I take my medicine
At what times should I take my medicine
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert B
Should I take it before with or after a meal
Should I avoid any foods or medicines when I take it
Should I avoid alcoholic beverages when I take it
Are there any times when I should change the amount of medicineI take
What should I do if I forget to take it
If Irsquom sick and canrsquot keep food down should I still take my medicine
Can my diabetes medicine cause low blood glucose
What should I do if my blood glucose is too low
What side effects can this medicine cause
What should I do if I have side effects
How should I store this medicine
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Insert CWhat I need to know about Diabetes Medicines
Types of InsulinEach type of insulin has an onset a peak and a duration time
The onset is how soon the insulin starts to lower your blood glucoseafter you take it
The peak is the time the insulin is working the hardest to lower yourblood glucose
The duration is how long the insulin lastsmdashthe length of time it keepslowering your blood glucose
The times shown in the chart are estimates Your onset peak andduration times may be different Yoursquoll work with your health careteam to come up with an insulin plan that works best for you
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert C What I need to know about Diabetes Medicines In
Type of Insulin Brand Name Generic Name Onset Peak Duration
Rapid-acting qNovoLog q Insulin aspart 15 minutes 30 to 90 minutes 3 to 5 hours
q Apidra q Insulin glulisine 15 minutes 30 to 90 minutes 3 to 5 hours
qHumalog q Insulin lispro 15 minutes 30 to 90 minutes 3 to 5 hours
Short-acting q Humulin R
q Novolin R
q Regular (R) 30 to 60 minutes 2 to 4 hours 5 to 8 hours
Intermediate-acting q Humulin N
q Novolin N
q NPH (N) 1 to 3 hours 8 hours 12 to 16 hours
Long-acting q Levemir
q Lantus
q Insulin detemir
q Insulin glargine
1 hour Peakless 20 to 26 hours
Pre-mixed NPH(intermediate-acting)and regular (short-acting)
q Humulin 7030
q Novolin 7030
q 70 NPH and 30 regular 30 to 60 minutes Varies 10 to 16 hours
q Humulin 5050 q 50 NPH and 50 regular 30 to 60 minutes Varies 10 to 16 hours
Pre-mixed insulin lispro q Humalog Mix 7525 q 75 insulin lispro protamine 10 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 25 insulin lispro(intermediate-acting) andinsulin lispro (rapid-acting) q Humalog Mix 5050 q 50 insulin lispro protamine
and 50 insulin lispro10 to 15 minutes Varies 10 to 16 hours
Pre-mixed insulin aspart q NovoLog Mix 7030 q 70 insulin aspart protamine 5 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 30 insulin aspart(intermediate-acting) andinsulin aspart (rapid-acting)
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What I need to know about Diabetes Medicines Insert D
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Taking Glyset or Precose may cause stomach pain gas bloating
or diarrhea These symptoms usually go away after you have takenthese pills for a while
If you take Glyset or Precose What you need to know aboutlow blood glucose
If you take Glyset or Precose only glucose tablets or glucose gel
will bring your blood glucose level back to normal quickly Otherquick-fix foods and drinks wonrsquot raise your blood glucose as quicklybecause Glyset and Precose slow the digestion of other quick-fixfoods and drinks
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
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Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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Insert BWhat I need to know about Diabetes Medicines
Questions to Ask about Your Diabetes Medicines Ask your doctor these questions when you get a prescription fora medicine Make copies of this card and use one card for eachof your medicines
What are the names of my medicine
Brand name Generic name
What does my medicine do
When should I start this medicine
This medicine is prescribed by
How long will it take this medicine to workWhat is the strength (for example how many milligrams writtenas mg)
How much should I take for each dose
How many times a day should I take my medicine
At what times should I take my medicine
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert B
Should I take it before with or after a meal
Should I avoid any foods or medicines when I take it
Should I avoid alcoholic beverages when I take it
Are there any times when I should change the amount of medicineI take
What should I do if I forget to take it
If Irsquom sick and canrsquot keep food down should I still take my medicine
Can my diabetes medicine cause low blood glucose
What should I do if my blood glucose is too low
What side effects can this medicine cause
What should I do if I have side effects
How should I store this medicine
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Insert CWhat I need to know about Diabetes Medicines
Types of InsulinEach type of insulin has an onset a peak and a duration time
The onset is how soon the insulin starts to lower your blood glucoseafter you take it
The peak is the time the insulin is working the hardest to lower yourblood glucose
The duration is how long the insulin lastsmdashthe length of time it keepslowering your blood glucose
The times shown in the chart are estimates Your onset peak andduration times may be different Yoursquoll work with your health careteam to come up with an insulin plan that works best for you
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert C What I need to know about Diabetes Medicines In
Type of Insulin Brand Name Generic Name Onset Peak Duration
Rapid-acting qNovoLog q Insulin aspart 15 minutes 30 to 90 minutes 3 to 5 hours
q Apidra q Insulin glulisine 15 minutes 30 to 90 minutes 3 to 5 hours
qHumalog q Insulin lispro 15 minutes 30 to 90 minutes 3 to 5 hours
Short-acting q Humulin R
q Novolin R
q Regular (R) 30 to 60 minutes 2 to 4 hours 5 to 8 hours
Intermediate-acting q Humulin N
q Novolin N
q NPH (N) 1 to 3 hours 8 hours 12 to 16 hours
Long-acting q Levemir
q Lantus
q Insulin detemir
q Insulin glargine
1 hour Peakless 20 to 26 hours
Pre-mixed NPH(intermediate-acting)and regular (short-acting)
q Humulin 7030
q Novolin 7030
q 70 NPH and 30 regular 30 to 60 minutes Varies 10 to 16 hours
q Humulin 5050 q 50 NPH and 50 regular 30 to 60 minutes Varies 10 to 16 hours
Pre-mixed insulin lispro q Humalog Mix 7525 q 75 insulin lispro protamine 10 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 25 insulin lispro(intermediate-acting) andinsulin lispro (rapid-acting) q Humalog Mix 5050 q 50 insulin lispro protamine
and 50 insulin lispro10 to 15 minutes Varies 10 to 16 hours
Pre-mixed insulin aspart q NovoLog Mix 7030 q 70 insulin aspart protamine 5 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 30 insulin aspart(intermediate-acting) andinsulin aspart (rapid-acting)
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What I need to know about Diabetes Medicines Insert D
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Taking Glyset or Precose may cause stomach pain gas bloating
or diarrhea These symptoms usually go away after you have takenthese pills for a while
If you take Glyset or Precose What you need to know aboutlow blood glucose
If you take Glyset or Precose only glucose tablets or glucose gel
will bring your blood glucose level back to normal quickly Otherquick-fix foods and drinks wonrsquot raise your blood glucose as quicklybecause Glyset and Precose slow the digestion of other quick-fixfoods and drinks
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
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Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
8122019 meds_508
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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Insert BWhat I need to know about Diabetes Medicines
Questions to Ask about Your Diabetes Medicines Ask your doctor these questions when you get a prescription fora medicine Make copies of this card and use one card for eachof your medicines
What are the names of my medicine
Brand name Generic name
What does my medicine do
When should I start this medicine
This medicine is prescribed by
How long will it take this medicine to workWhat is the strength (for example how many milligrams writtenas mg)
How much should I take for each dose
How many times a day should I take my medicine
At what times should I take my medicine
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert B
Should I take it before with or after a meal
Should I avoid any foods or medicines when I take it
Should I avoid alcoholic beverages when I take it
Are there any times when I should change the amount of medicineI take
What should I do if I forget to take it
If Irsquom sick and canrsquot keep food down should I still take my medicine
Can my diabetes medicine cause low blood glucose
What should I do if my blood glucose is too low
What side effects can this medicine cause
What should I do if I have side effects
How should I store this medicine
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Insert CWhat I need to know about Diabetes Medicines
Types of InsulinEach type of insulin has an onset a peak and a duration time
The onset is how soon the insulin starts to lower your blood glucoseafter you take it
The peak is the time the insulin is working the hardest to lower yourblood glucose
The duration is how long the insulin lastsmdashthe length of time it keepslowering your blood glucose
The times shown in the chart are estimates Your onset peak andduration times may be different Yoursquoll work with your health careteam to come up with an insulin plan that works best for you
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert C What I need to know about Diabetes Medicines In
Type of Insulin Brand Name Generic Name Onset Peak Duration
Rapid-acting qNovoLog q Insulin aspart 15 minutes 30 to 90 minutes 3 to 5 hours
q Apidra q Insulin glulisine 15 minutes 30 to 90 minutes 3 to 5 hours
qHumalog q Insulin lispro 15 minutes 30 to 90 minutes 3 to 5 hours
Short-acting q Humulin R
q Novolin R
q Regular (R) 30 to 60 minutes 2 to 4 hours 5 to 8 hours
Intermediate-acting q Humulin N
q Novolin N
q NPH (N) 1 to 3 hours 8 hours 12 to 16 hours
Long-acting q Levemir
q Lantus
q Insulin detemir
q Insulin glargine
1 hour Peakless 20 to 26 hours
Pre-mixed NPH(intermediate-acting)and regular (short-acting)
q Humulin 7030
q Novolin 7030
q 70 NPH and 30 regular 30 to 60 minutes Varies 10 to 16 hours
q Humulin 5050 q 50 NPH and 50 regular 30 to 60 minutes Varies 10 to 16 hours
Pre-mixed insulin lispro q Humalog Mix 7525 q 75 insulin lispro protamine 10 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 25 insulin lispro(intermediate-acting) andinsulin lispro (rapid-acting) q Humalog Mix 5050 q 50 insulin lispro protamine
and 50 insulin lispro10 to 15 minutes Varies 10 to 16 hours
Pre-mixed insulin aspart q NovoLog Mix 7030 q 70 insulin aspart protamine 5 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 30 insulin aspart(intermediate-acting) andinsulin aspart (rapid-acting)
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What I need to know about Diabetes Medicines Insert D
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Taking Glyset or Precose may cause stomach pain gas bloating
or diarrhea These symptoms usually go away after you have takenthese pills for a while
If you take Glyset or Precose What you need to know aboutlow blood glucose
If you take Glyset or Precose only glucose tablets or glucose gel
will bring your blood glucose level back to normal quickly Otherquick-fix foods and drinks wonrsquot raise your blood glucose as quicklybecause Glyset and Precose slow the digestion of other quick-fixfoods and drinks
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
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Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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What I need to know about Diabetes Medicines Insert B
Should I take it before with or after a meal
Should I avoid any foods or medicines when I take it
Should I avoid alcoholic beverages when I take it
Are there any times when I should change the amount of medicineI take
What should I do if I forget to take it
If Irsquom sick and canrsquot keep food down should I still take my medicine
Can my diabetes medicine cause low blood glucose
What should I do if my blood glucose is too low
What side effects can this medicine cause
What should I do if I have side effects
How should I store this medicine
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Insert CWhat I need to know about Diabetes Medicines
Types of InsulinEach type of insulin has an onset a peak and a duration time
The onset is how soon the insulin starts to lower your blood glucoseafter you take it
The peak is the time the insulin is working the hardest to lower yourblood glucose
The duration is how long the insulin lastsmdashthe length of time it keepslowering your blood glucose
The times shown in the chart are estimates Your onset peak andduration times may be different Yoursquoll work with your health careteam to come up with an insulin plan that works best for you
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert C What I need to know about Diabetes Medicines In
Type of Insulin Brand Name Generic Name Onset Peak Duration
Rapid-acting qNovoLog q Insulin aspart 15 minutes 30 to 90 minutes 3 to 5 hours
q Apidra q Insulin glulisine 15 minutes 30 to 90 minutes 3 to 5 hours
qHumalog q Insulin lispro 15 minutes 30 to 90 minutes 3 to 5 hours
Short-acting q Humulin R
q Novolin R
q Regular (R) 30 to 60 minutes 2 to 4 hours 5 to 8 hours
Intermediate-acting q Humulin N
q Novolin N
q NPH (N) 1 to 3 hours 8 hours 12 to 16 hours
Long-acting q Levemir
q Lantus
q Insulin detemir
q Insulin glargine
1 hour Peakless 20 to 26 hours
Pre-mixed NPH(intermediate-acting)and regular (short-acting)
q Humulin 7030
q Novolin 7030
q 70 NPH and 30 regular 30 to 60 minutes Varies 10 to 16 hours
q Humulin 5050 q 50 NPH and 50 regular 30 to 60 minutes Varies 10 to 16 hours
Pre-mixed insulin lispro q Humalog Mix 7525 q 75 insulin lispro protamine 10 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 25 insulin lispro(intermediate-acting) andinsulin lispro (rapid-acting) q Humalog Mix 5050 q 50 insulin lispro protamine
and 50 insulin lispro10 to 15 minutes Varies 10 to 16 hours
Pre-mixed insulin aspart q NovoLog Mix 7030 q 70 insulin aspart protamine 5 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 30 insulin aspart(intermediate-acting) andinsulin aspart (rapid-acting)
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What I need to know about Diabetes Medicines Insert D
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Taking Glyset or Precose may cause stomach pain gas bloating
or diarrhea These symptoms usually go away after you have takenthese pills for a while
If you take Glyset or Precose What you need to know aboutlow blood glucose
If you take Glyset or Precose only glucose tablets or glucose gel
will bring your blood glucose level back to normal quickly Otherquick-fix foods and drinks wonrsquot raise your blood glucose as quicklybecause Glyset and Precose slow the digestion of other quick-fixfoods and drinks
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
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Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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Insert CWhat I need to know about Diabetes Medicines
Types of InsulinEach type of insulin has an onset a peak and a duration time
The onset is how soon the insulin starts to lower your blood glucoseafter you take it
The peak is the time the insulin is working the hardest to lower yourblood glucose
The duration is how long the insulin lastsmdashthe length of time it keepslowering your blood glucose
The times shown in the chart are estimates Your onset peak andduration times may be different Yoursquoll work with your health careteam to come up with an insulin plan that works best for you
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert C What I need to know about Diabetes Medicines In
Type of Insulin Brand Name Generic Name Onset Peak Duration
Rapid-acting qNovoLog q Insulin aspart 15 minutes 30 to 90 minutes 3 to 5 hours
q Apidra q Insulin glulisine 15 minutes 30 to 90 minutes 3 to 5 hours
qHumalog q Insulin lispro 15 minutes 30 to 90 minutes 3 to 5 hours
Short-acting q Humulin R
q Novolin R
q Regular (R) 30 to 60 minutes 2 to 4 hours 5 to 8 hours
Intermediate-acting q Humulin N
q Novolin N
q NPH (N) 1 to 3 hours 8 hours 12 to 16 hours
Long-acting q Levemir
q Lantus
q Insulin detemir
q Insulin glargine
1 hour Peakless 20 to 26 hours
Pre-mixed NPH(intermediate-acting)and regular (short-acting)
q Humulin 7030
q Novolin 7030
q 70 NPH and 30 regular 30 to 60 minutes Varies 10 to 16 hours
q Humulin 5050 q 50 NPH and 50 regular 30 to 60 minutes Varies 10 to 16 hours
Pre-mixed insulin lispro q Humalog Mix 7525 q 75 insulin lispro protamine 10 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 25 insulin lispro(intermediate-acting) andinsulin lispro (rapid-acting) q Humalog Mix 5050 q 50 insulin lispro protamine
and 50 insulin lispro10 to 15 minutes Varies 10 to 16 hours
Pre-mixed insulin aspart q NovoLog Mix 7030 q 70 insulin aspart protamine 5 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 30 insulin aspart(intermediate-acting) andinsulin aspart (rapid-acting)
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What I need to know about Diabetes Medicines Insert D
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Taking Glyset or Precose may cause stomach pain gas bloating
or diarrhea These symptoms usually go away after you have takenthese pills for a while
If you take Glyset or Precose What you need to know aboutlow blood glucose
If you take Glyset or Precose only glucose tablets or glucose gel
will bring your blood glucose level back to normal quickly Otherquick-fix foods and drinks wonrsquot raise your blood glucose as quicklybecause Glyset and Precose slow the digestion of other quick-fixfoods and drinks
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
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Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
8122019 meds_508
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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What I need to know about Diabetes Medicines Insert C What I need to know about Diabetes Medicines In
Type of Insulin Brand Name Generic Name Onset Peak Duration
Rapid-acting qNovoLog q Insulin aspart 15 minutes 30 to 90 minutes 3 to 5 hours
q Apidra q Insulin glulisine 15 minutes 30 to 90 minutes 3 to 5 hours
qHumalog q Insulin lispro 15 minutes 30 to 90 minutes 3 to 5 hours
Short-acting q Humulin R
q Novolin R
q Regular (R) 30 to 60 minutes 2 to 4 hours 5 to 8 hours
Intermediate-acting q Humulin N
q Novolin N
q NPH (N) 1 to 3 hours 8 hours 12 to 16 hours
Long-acting q Levemir
q Lantus
q Insulin detemir
q Insulin glargine
1 hour Peakless 20 to 26 hours
Pre-mixed NPH(intermediate-acting)and regular (short-acting)
q Humulin 7030
q Novolin 7030
q 70 NPH and 30 regular 30 to 60 minutes Varies 10 to 16 hours
q Humulin 5050 q 50 NPH and 50 regular 30 to 60 minutes Varies 10 to 16 hours
Pre-mixed insulin lispro q Humalog Mix 7525 q 75 insulin lispro protamine 10 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 25 insulin lispro(intermediate-acting) andinsulin lispro (rapid-acting) q Humalog Mix 5050 q 50 insulin lispro protamine
and 50 insulin lispro10 to 15 minutes Varies 10 to 16 hours
Pre-mixed insulin aspart q NovoLog Mix 7030 q 70 insulin aspart protamine 5 to 15 minutes Varies 10 to 16 hoursprotamine suspension and 30 insulin aspart(intermediate-acting) andinsulin aspart (rapid-acting)
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What I need to know about Diabetes Medicines Insert D
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Taking Glyset or Precose may cause stomach pain gas bloating
or diarrhea These symptoms usually go away after you have takenthese pills for a while
If you take Glyset or Precose What you need to know aboutlow blood glucose
If you take Glyset or Precose only glucose tablets or glucose gel
will bring your blood glucose level back to normal quickly Otherquick-fix foods and drinks wonrsquot raise your blood glucose as quicklybecause Glyset and Precose slow the digestion of other quick-fixfoods and drinks
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
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Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
8122019 meds_508
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
8122019 meds_508
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
8122019 meds_508
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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What I need to know about Diabetes Medicines Insert D
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Taking Glyset or Precose may cause stomach pain gas bloating
or diarrhea These symptoms usually go away after you have takenthese pills for a while
If you take Glyset or Precose What you need to know aboutlow blood glucose
If you take Glyset or Precose only glucose tablets or glucose gel
will bring your blood glucose level back to normal quickly Otherquick-fix foods and drinks wonrsquot raise your blood glucose as quicklybecause Glyset and Precose slow the digestion of other quick-fixfoods and drinks
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3154
Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
8122019 meds_508
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5054
What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
8122019 meds_508
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8122019 meds_508
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
8122019 meds_508
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What I need to know about Diabetes Medicines Insert D
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Taking Glyset or Precose may cause stomach pain gas bloating
or diarrhea These symptoms usually go away after you have takenthese pills for a while
If you take Glyset or Precose What you need to know aboutlow blood glucose
If you take Glyset or Precose only glucose tablets or glucose gel
will bring your blood glucose level back to normal quickly Otherquick-fix foods and drinks wonrsquot raise your blood glucose as quicklybecause Glyset and Precose slow the digestion of other quick-fixfoods and drinks
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3154
Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3254
8122019 meds_508
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3454
Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
8122019 meds_508
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
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Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
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8122019 meds_508
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
8122019 meds_508
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3554
Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3654
What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
8122019 meds_508
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3854
What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
8122019 meds_508
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4154
What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4254
What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4354
What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4454
What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
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8122019 meds_508
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5054
What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
8122019 meds_508
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
8122019 meds_508
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
8122019 meds_508
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3154
Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
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8122019 meds_508
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
8122019 meds_508
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3554
Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4454
What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4854
8122019 meds_508
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5054
What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5154
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5254
How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5354
4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5454
8122019 meds_508
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What I need to know about Diabetes Medicines Insert E
Sometimes yoursquoll need to stop taking this type of medicine for a short
time so you can avoid developing lactic acidosis If you have severe
vomiting diarrhea or a fever or if you canrsquot keep fluids down call your
doctor right away You should also talk with your doctor well ahead oftime about stopping this type of medicine if
983148 yoursquoll be having special x rays that require an injection of dye
983148 yoursquoll be having surgery
Your doctor will tell you when itrsquos safe to start taking your medicine
again
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3154
Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3254
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3354
What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
8122019 meds_508
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
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Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
8122019 meds_508
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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Insert FWhat I need to know about Diabetes Medicines
D-Phenylalanine (dee-FEN-il-AL-uh-neen)
Derivative (duh-RIV-uh-tiv)
Brand Name Generic Name
q Starlix (STAR-liks) q nateglinide(nuh-TEG-lih-nyd)
What does this type of pill doThis type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Starlix
Talk with your doctor about whether to take this type of pill if
l you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Possible side effects are
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l dizziness
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
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8122019 meds_508
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
8122019 meds_508
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3554
Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3654
What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
8122019 meds_508
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3854
What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3954
What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
8122019 meds_508
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4154
What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
8122019 meds_508
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4354
What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4454
What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
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8122019 meds_508
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
8122019 meds_508
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
8122019 meds_508
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
8122019 meds_508
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3554
Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
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What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
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What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
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What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
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What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
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What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
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What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
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What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
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Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
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What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5054
What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
8122019 meds_508
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8122019 meds_508
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
8122019 meds_508
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4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
8122019 meds_508
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What I need to know about Diabetes Medicines Insert G
What are the possible side effects
This type of pill doesnrsquot cause low blood glucose by itself But yourrisk of having low blood glucose goes up if you also take
l diabetes pills that cause low blood glucose
l insulin
Your doctor may ask you to take a lower dose of your other diabetesmedicines while you take this type of pill
Possible side effects are
l a cold
l runny nose
l sore throat
l headache
If you take Januvia and have kidney problems your health careprovider might order blood tests to see how well your kidneys are working
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3454
Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3554
Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3654
What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
8122019 meds_508
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What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3854
What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3954
What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4054
What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4154
What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4254
What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4354
What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4454
What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
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8122019 meds_508
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4754
Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4854
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4954
What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5054
What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5154
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5254
How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5354
4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
8122019 meds_508
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8122019 meds_508
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Insert HWhat I need to know about Diabetes Medicines
Meglitinide (meh-GLIH-tih-nyde)
Brand Name Generic Name
q Prandin (PRAN-din) q repaglinide(ruh-PAG-luh-nyd)
What does this type of pill do
This type of pill helps your body make more insulin for a short periodof time right after meals The insulin helps keep your blood glucosefrom going too high after you eat a common problem in people with diabetes
Who should not take Prandin
Talk with your doctor about whether to take this type of pill ifl you are pregnant planning to get pregnant or breastfeeding
l you have liver disease
What are the possible side effects
Prandin can cause
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l weight gain
l upset stomach
l back pain or a headache
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3554
Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3654
What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3754
What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3854
What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3954
What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4054
What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4154
What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4254
What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4354
What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4454
What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4554
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4654
What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4754
Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4854
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4954
What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5054
What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5154
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5254
How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5354
4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5454
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3554
Insert IWhat I need to know about Diabetes Medicines
Sulfonylurea (SUHL-foh-nil-yoo-REE-uh)
Brand Name Generic Name
q Amaryl (AM-uh-ril) q glimepiride (gly-MEP-ih-ryd)
q DiaBeta (dy-uh-BAY-tuh) q glyburide (GLY-buh-ryd)
q Diabinese (dy-AB-ih-neez) q chlorpropamide
(klor-PROH-puh-myd)q Glucotrol (GLOO-kuh-trohl) q glipizide (GLIP-ih-zyd)
q Glucotrol XL(GLOO-kuh-trohl)(EKS-EL)
q glipizide (GLIP-ih-zyd)(long-acting)
q Glynase (GLY-nayz) PresTab q glyburide (GLY-buh-ryd)
q Micronase (MY-kroh-nayz)
q glyburide (GLY-buh-ryd)
Available only in generic form
q tolazamide (tahl-AZ-uh-myd)
q tolbutamide(tahl-BYOO-tuh-myd)
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3654
What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3754
What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3854
What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3954
What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4054
What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4154
What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4254
What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4354
What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4454
What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
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8122019 meds_508
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What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4754
Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4854
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4954
What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5054
What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5154
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5254
How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5354
4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5454
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3654
What I need to know about Diabetes Medicines Insert I
What does this type of pill do
This type of pill helps your body make more insulin The insulinhelps lower your blood glucose
Who should not take sulfonylureas
Talk with your doctor about whether to take this type of pill if
l you are allergic to sulfa drugs
l you are pregnant planning to get pregnant or breastfeeding
What are the possible side effects
Possible side effects include
l low blood glucose also called hypoglycemia(HY-poh-gly-SEE-mee-uh)mdashfor more information see Insert N
l upset stomach
l skin rash
l weight gain
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3754
What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3854
What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3954
What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4054
What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4154
What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4254
What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4354
What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4454
What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4554
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4654
What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4754
Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4854
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4954
What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5054
What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5154
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5254
How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5354
4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5454
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3754
What I need to know about Diabetes MedicinesInsert J
Thiazolidinedione (THY-uh-ZOHL-ih-deen-DY-ohn)
Brand Name Generic Name
983153 Actos (AK-tohss) 983153 pioglitazone(py-oh-GLIH-tuh-zohn)
983153 Avandia (uh-VAN-dee-uh) 983153 rosiglitazone(rohss-ih-GLIH-tuh-zohn)
If you are currently taking the thiazolidinedione medicine pioglitazone
(Actos) or a combination diabetes pill containing pioglitazone See theUS Food and Drug Administration (FDA) announcement on thenext page about this pill
Discuss treatment options with your doctor before stopping your
diabetes medicines Stopping your diabetes medicines without talking with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert K for more information about combination diabetes pillsthat contain pioglitazone or rosiglitazone
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3854
What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3954
What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4054
What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4154
What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4254
What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4354
What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4454
What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4554
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4654
What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4754
Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4854
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4954
What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5054
What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5154
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5254
How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5354
4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5454
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3854
What I need to know about Diabetes Medicines Insert J
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with caution
in people with a history of bladder cancer This warning also
applies to the combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact see Insert K
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3954
What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4054
What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4154
What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4254
What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4354
What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4454
What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4554
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4654
What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4754
Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4854
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4954
What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5054
What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5154
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5254
How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5354
4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5454
8122019 meds_508
httpslidepdfcomreaderfullmeds508 3954
What I need to know about Diabetes Medicines Insert J
What does this type of pill do
This type of pill helps treat insulin resistance With insulin resistance your body doesnrsquot use insulin the way it should Thiazolidinedioneshelp your insulin work properly Then your blood glucose levels stay ontarget and your cells get the energy they need
Who should not take this type of pill
People with heart failure also called congestive heart failure shouldnot take this type of pill
This type of pill can cause heart failure or make it worse
Heart failure is a condition in which your heart no longer pumpsproperly Then your body keeps too much fluid in your legs anklesand lungs
Call your doctor right away if you have signs of heart failure Warningsigns include
983148 having swelling in your legs or ankles
983148 gaining a lot of weight in a short time
983148 having trouble breathing
983148 having a cough
983148 being very tired
People being treated for bladder cancer should not take Actos orcombination pills containing pioglitazone
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4054
What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4154
What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4254
What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4354
What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4454
What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4554
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4654
What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4754
Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4854
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4954
What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5054
What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5154
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5254
How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5354
4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5454
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4054
What I need to know about Diabetes Medicines Insert J
If you have a history of bladder cancer and are taking Actos talk with your doctor
You should also talk with your doctor about whether to take this typeof pill if
983148 you are pregnant planning to get pregnant or breastfeeding
983148 you have liver disease
What are the possible side effects
Heart failure is a serious side effect
Bladder cancer may be more likely to occur in people who take Actosfor more than 1 year Call your doctor right away if you have symptomsof bladder cancer while taking Actos
983148 pink red or cola-colored urine indicating the presence of blood
983148 an urgent need to urinate or pain while urinating
983148 pain in your back or lower abdomen
This type of pill doesnrsquot cause low blood glucose by itself But your riskof having low blood glucose goes up if you also take
983148 diabetes pills that cause low blood glucose
983148 insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of pill
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4154
What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4254
What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4354
What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4454
What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4554
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4654
What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4754
Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4854
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4954
What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5054
What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5154
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5254
How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5354
4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5454
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4154
What I need to know about Diabetes Medicines Insert J
Other possible side effects are
983148 anemia (uh-NEE-mee-uh) a condition that can make you feel verytired
983148 an increased risk of getting pregnant even if yoursquore taking birthcontrol pills
Women who take Actos Avandia or combination diabetes pillscontaining pioglitazone or rosiglitazone may have an increased risk ofbone fractures
If you take Actos or Avandia your health care provider should make
sure your liver is working properly Call your doctor right away if you have any signs of liver disease nausea vomiting stomach paintiredness dark-colored urine or loss of appetite
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4254
What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4354
What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4454
What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4554
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4654
What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4754
Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4854
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4954
What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5054
What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5154
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5254
How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5354
4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5454
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4254
What I need to know about Diabetes MedicinesInsert K
Combination Diabetes Pills
Many people with diabetes need more than one medicine to controltheir diabetes If you need more than one type of diabetes pill yourhealth care provider may prescribe a combination pill Combinationpills contain two different types of diabetes medicines so you can takeone pill instead of two separate pills
Combination pills available include the following
See warning below these medicines containpioglitazone (Actos)
983148 Actoplus Met
983148 Actoplus Met XR
983148 Duetact
983148 Avandamet983148 Avandaryl
983148 Glucovance983148 Janumet
983148 Metaglip
If you are currently taking a combination diabetes pill containing the
thiazolidinedione medicine pioglitazone (Actos) See the US Food andDrug Administration (FDA) announcement on the next page aboutthis pill
Discuss treatment options with your doctor before stopping yourdiabetes medicines Stopping your diabetes medicines without talking
with your doctor can cause serious short-term health problems andcould increase the risk of long-term diabetes-related complications
See Insert J for more information about the thiazolidinedionemedicines
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4354
What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4454
What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4554
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4654
What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4754
Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4854
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4954
What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5054
What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5154
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5254
How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5354
4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5454
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4354
What I need to know about Diabetes Medicines Insert K
In June 2011 the FDA warned that use of Actos for more than
1 year may be associated with an increased risk of bladder cancer
The FDA recommended that people receiving treatment for bladdercancer should not take Actos and Actos should be used with
caution in people with a history of bladder cancer This warning
also applies to combination diabetes pills containing pioglitazonemdash
Actoplus Met Actoplus Met XR and Duetact
Visit wwwfdagovDrugsDrugSafetyucm259150 or call the FDA at1ndash888ndashINFOndashFDA (1ndash888ndash463ndash6332) for more information about
the FDArsquos warning on the use of Actos
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4454
What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4554
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4654
What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4754
Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4854
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4954
What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5054
What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5154
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5254
How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5354
4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5454
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4454
What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Actoplus Met (AK-toh- 983153 pioglitazone (py-oh-GLIH-tuh-
pluhss)(met) zohn) + metformin (met-FOR-983153 Actoplus Met XR
min)
983153 Avandamet (uh-VAN-duh-met)
983153 rosiglitazone (rohss-ih-GLIH-tuh-zohn) + metformin (met-FOR-min)
What does this type of pill do Actoplus Met Actoplus Met XR and Avandamet are a combination oftwo types of pills One type lowers the amount of glucose made by yourliver Both types help your insulin work the way it should ActoplusMet XR contains an extended release form of metformin along withpioglitazone
To learn more about the types of pills in Actoplus Met Actoplus Met
XR and Avandamet see983148 Insert J for information about pioglitazone and rosiglitazone
(thiazolidinediones)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4554
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4654
What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4754
Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4854
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4954
What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5054
What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5154
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5254
How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5354
4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5454
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4554
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4654
What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4754
Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4854
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4954
What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5054
What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5154
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5254
How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5354
4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5454
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4654
What I need to know about Diabetes Medicines Insert K
Brand Name Generic Name
983153 Janumet (JAN-yoo-met) 983153 sitagliptin (sih-tuh-GLIP-tin)
+ metformin (met-FOR-min)
What does this type of pill do
Janumet is a combination of two types of pills One type helps yourbody make more insulin when itrsquos needed especially right after mealsIt also helps keep your liver from putting stored glucose into yourblood The other type lowers the amount of glucose made by your liver
and helps your insulin work the way it should
To learn more about the types of pills in Janumet see
983148 Insert G for information about sitagliptin (a DPP-4 inhibitor)
983148 Insert E for information about metformin (a biguanide)
Brand Name Generic Name983153 Metaglip (MET-uh-glip) 983153 glipizide (GLIP-ih-zyd) +
metformin (met-FOR-min)
What does this type of pill do
Metaglip is a combination of two types of pills One type helps your
body make more insulin The other type lowers the amount of glucosemade by your liver and helps your insulin work the way it should
To learn more about the types of pills in Metaglip see
983148 Insert I for information about glipizide (a sulfonylurea)
983148 Insert E for information about metformin (a biguanide)
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4754
Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4854
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4954
What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5054
What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5154
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5254
How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5354
4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5454
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4754
Insert LWhat I need to know about Diabetes Medicines
Amylin (AM-ih-lin) Mimetic (mih-MET-ik)
Brand Name Generic Name
o Symlin (SIM-lin) o pramlintide (PRAM-lin-tyd)acetate (ASS-ih-tayt)
What does this medicine do
Symlin helps keep your blood glucose from going too high after youeat a common problem in people with diabetes It works by helpingfood move more slowly through your stomach Symlin helps keep your liver from putting stored glucose into your blood It also mayprevent hunger helping you eat less and maybe lose weight
Symlin is for people who already take insulin However you shouldalways use a separate syringe to inject Symlin Symlin is not used inplace of insulin But taking Symlin may change the amount of insulin you take
Who should not take Symlin
Talk with your doctor about whether you should take this type ofmedicine if
l you canrsquot tell when you are having low blood glucose a conditioncalled hypoglycemia unawareness
l you have recently had severe low blood glucose
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747 wwwdiabetesniddknihgovdmpubsmedicines_ezindexhtm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4854
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4954
What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5054
What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5154
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5254
How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5354
4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5454
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4854
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4954
What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5054
What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5154
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5254
How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5354
4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5454
8122019 meds_508
httpslidepdfcomreaderfullmeds508 4954
What I need to know about Diabetes MedicinesInsert M
Incretin (in-KREE-tin) Mimetic (mih-MET-ik)
Brand Name Generic Name
Byetta (by-YAY-tuh) exenatide (eks-EN-uh-tyd)
What does this medicine do
Byetta helps your body make more insulin when itrsquos needed It helpskeep your blood glucose from going too high after you eat a commonproblem in people with diabetes It works by helping food movemore slowly through your stomach Byetta helps keep your liver fromputting stored glucose into your blood It also may prevent hungerhelping you eat less and maybe lose weight
Byetta is not used in place of insulin
Who should not take Byetta
Talk with your doctor about whether you should take this type ofmedicine if
you have severe stomach or digestive problems
you have any symptoms of kidney disease or are on dialysis
you are pregnant planning to get pregnant or breastfeeding
you have type 1 diabetes
Byetta has not been studied for use in children
National Diabetes Information Clearinghouse bull 1ndash800ndash860ndash8747www diabetes niddk nih govdmpubsmedicines ezindex htm
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5054
What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5154
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5254
How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5354
4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
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8122019 meds_508
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What I need to know about Diabetes Medicines Insert M
What are the possible side effects
Byetta can cause
nausea and vomitingmdashmost often when you first start taking Byetta
headache
diarrhea
dizziness
Byetta also can cause an acid stomach or make you feel nervous
If you take Byetta What you need to know about problemswith your kidneys
Talk with your doctor right away if you notice any of the following
changes in the color of your urine how often you urinate or
the amount you urinate
swelling of your hands or feet tiredness
changes in your appetite or digestion
a dull ache in your mid to lower back
This type of medicine doesnrsquot cause low blood glucose by itself
But your risk of having low blood glucose goes up if you also take diabetes pills that cause low blood glucose
insulin
Your doctor may ask you to take a lower dose of your other diabetes
medicines while you take this type of medicine
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8122019 meds_508
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How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5354
4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5454
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5154
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5254
How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5354
4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5454
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5254
How will I feel if I have low blood glucose
Low blood glucose can make you feel
l hungry
l dizzy
l nervous
l shaky
l sweaty
l sleepy
l confused
l anxious
l weak
Low blood glucose can also happen while you sleep You might cry
out or have nightmares sweat a lot feel tired or confused when you
wake up or have a headache when you wake up
What should I do if I have low blood glucose
Follow these steps
1 If you feel like your blood glucose is low check your bloodglucose level with your blood glucose meter
2 If your blood glucose is below 70 mgdL have a serving of aldquoquick fixrdquo food or drink right away See the list of Quick-fix
Foods and Drinks for Low Blood Glucose on the next page If
you canrsquot check your blood glucose but you feel like your blood
glucose level is low have something from the quick-fix list
3 After 15 minutes check your blood glucose again If itrsquos stillbelow 70 mgdL have another serving of a quick-fix food ordrink
What I need to know about Diabetes Medicines Insert N
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5354
4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5454
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5354
4 Check your blood glucose again 15 minutes later If itrsquos 70 mgdLor above yoursquoll feel better soon If your blood glucose is still
low have another serving of a quick-fix food or drink Keep
doing so until your blood glucose is 70 mgdL or above
5 When your blood glucose has reached 70 mgdL or above thinkabout when your next meal will be If it will be more than an
hour before your next meal have a snack
What I need to know about Diabetes Medicines Insert N
Quick-fix Foods and Drinks for Low Blood Glucose
l 3 or 4 glucose tablets
l 1 serving of glucose gelmdashthe amount equal to 15 grams ofcarbohydrate
l 12 cup (4 ounces) of any fruit juice
l 12 cup (4 ounces) of a regularmdashnot dietmdashsoft drink
l 1 cup (8 ounces) of milk
l 5 or 6 pieces of hard candy
l 1 tablespoon of sugar or honey
Always carry a quick-fix food or drink You also can keep quick-
fix foods in your car at work or wherever you go Then yoursquoll be
ready to take care of yourself if your blood glucose dips too low
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5454
8122019 meds_508
httpslidepdfcomreaderfullmeds508 5454