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There is conflicting information regarding fish oil’s affect on blood glucose levels.  In most cases, fish oil has not been shown to have a long term adverse effect on blood glucose levels.  However, there have been a few studies that have shown worsening blood glucose control in patients taking high doses of fish oil.  Monitor your blood glucose levels while taking the fish oil and report any changes to your physician to determine an appropriate treatment plan.

Regular-release tablets of metformin 500mg are usually dosed twice a day with meals (breakfast and evening meal).  If you have been prescribed the extended-release tablets of metformin 500mg, the dose is usually administered once daily with the evening meal.

So far nothing is working. Weight gain has been reported in patients taking Actos alone, and in combination with other medications to lower blood glucose.  The reason for weight gain is unclear, but is thought to be dose related and may involve fluid retention and fat accumulation.  If you are experiencing an unusually rapid increase in weight or fluid retention or develop shortness of breath, it is recommended to contact your physician immediately.  These could be signs and symptoms of heart failure. 

Rapid-acting insulin may be given with long acting insulin (24 hour insulin) to help control blood glucose levels throughout the day.  Rapid-acting insulin starts working within minutes to help lower blood glucose levels and is given within 15 minutes before or immediately after your meal.  Your physician will determine the best treatment option for you since hyperglycemia (elevated blood glucose) may be caused by eating too much, lack of physical activity, illness, stress, the body not having enough insulin, the body not being able to use the insulin present, skipping medicine, or exercising less than usual.  Hyperglycemia can be controlled with diet, exercise and/ or change in medication therapy. Please consult with your physician if you are experiencing hyperglycemic episodes.

Preferably, regular insulin should be administered 30—60 minutes before a meal.

 If a woman is diagnosed with diabetes before pregnancy, it is important to have great prenatal care and to find an obstetrician who handles high-risk pregnancies and has cared for other pregnant women with diabetes.  While you are pregnant, your body is constantly changing.  These changes will affect your blood glucose levels.  If you have type 1 diabetes, your body’s need for insulin will increase, especially during the last trimester.  The placenta is making hormones that help the baby grow, but also blocks the action of the mother’s insulin; therefore, the mother’s insulin needs would increase.  Pregnancy may also make it harder to detect hypoglycemia (low blood glucose levels).  Most health care professionals recommend that a pregnant woman test their blood glucose levels at least four times a day to help keep blood glucose levels on target.

Pregnant women who have never had diabetes before but who have high blood sugar (glucose) levels during pregnancy are said to have gestational diabetes. Gestational diabetes develops as a result of insufficient production and use of insulin during pregnancy.  It is usually diagnosed at 28 weeks.  Although it generally disappears after the baby is delivered, gestational diabetes increases the mother’s risk of developing Type 2 diabetes later in life. 

Sanofi-Aventis (the manufacturer of Lantus) and Novo Nordisk (the manufacturer of Novolog) do not recommend pre-drawing or pre-filling a syringe with either insulin and storing it for later use.  Both Novolog and Lantus are available in pre-filled pens.  Consult your physician to determine if the pre-filled pens would be an option for you. 

Heartburn and gas are common side effects with metformin therapy.  These side effects are known to last as long as 4-6 weeks.  While bothersome, these side effects do not usually require the medication to be stopped.  However, that is a decision for you and your physician to make.  To avoid/reduce these side effects, it is recommended to start at the lowest dose of metformin and gradually increase toward the optimum dose.  Additionally, metformin should be taken with food. 

 Normally, diabetes-associated urinary frequency is caused by a high blood glucose level (over 250mg/dL) over a prolonged period of time (over 2 hours).  Glucose is able to pull water with it into the urine, thereby increasing urinary frequency.  The best way to control frequent urination is to maintain tight glycemic control with diet, exercise, proper medication use, and blood glucose level testing.  Other potential causes for changes in urine frequency should be considered such as impaired bladder function, enlarged prostate and medications. Contact your physician to discuss your symptoms for a proper diagnosis and treatment plan.

There is no cure for diabetes however, it is very treatable. The treatments available help control blood glucose levels, which can result in fewer complications and slower disease progression.