 You have been asking about diabetic medications because most of you are on one or more diabetic medications And yet 90% of you do not know how they work, the benefits, the risks, etc. Hi, I am Dr. Ahmad Ergin. I specialize in endocrinology, diabetes and metabolism. I practice in Florida But I'm passionate enough to help everyone in the world who struggle with diabetes and weight problems After you leave the doctor's office Sometimes you are more confused than ever before because your doctor just threw two new diabetic medications Which could be pills or even injections. First reaction most people have is anxiety, fear and that leads to frantic Google search and Absorbing anything and everything without questioning their validity. Half of the time information is above your head And you end up being more confused or scared. No more This video will tell you everything you need to know about every diabetic medication Watch the entire video so that you know all of your options thoroughly Yes, this is a long video due to all the content that we need to cover But don't worry, I created chapters for you So you can click to jump to a medication class or section that is more of an interest to you But watching the entire video will make you understand the entire diabetes treatment spectrum So if you have time stick with the entire video Let's start with metformin because this is the most commonly prescribed medication worldwide I have many metformin videos So please refer to them for in-depth or specific issues about metformin Today, I will only summarize what it does the benefits and risks of metformin Now metformin is one of the most well-established and successful treatment for time-to-diametries It has the effect of lowering the quantity of glucose in your blood You can tell by your finger sticks your blood sugar numbers It accomplishes this by decreasing the amount of glucose released by your liver and Decreasing the amount of glucose absorbed by your intestines from the food you eat, right? Metformin is also thought to improve your body's response to its own insulin Now metformin is beneficial for almost everyone who has type 2 diabetes It is also a smart option if you're overweight because metformin does not promote weight gain like other diabetic medications or some other diabetic medications Now the efficiency with which it operates is that it reduces the hemoglobin A1c by around 1.5% which is quite significant Now let's talk about the risks or the side effects of metformin That is the thing that sometimes you don't want to hear, right? Well in a lot of cases metformin might cause quite a bit of stomach irritation, can cause diarrhea, bloating, abdominal pain Not so much fun It is possible that you will require a lower dose if you are suffering from kidney difficulties Now some brand names that have metformin in it are Glucophage, GlucophagexR, Rheomet, Fortometh, Glumezza These are some of the branded medications But most people are on generic medications for metformin Metformin was found to lower the risk of death as well in a study of adults with type 2 diabetes Which is good news So overall it is not a bad medication unless you have chronic kidney disease then you have to be careful Now on the other side of the coin There is a natural component called dehydra berberine that works just like metformin That can be used with or without metformin And when used with metformin it actually increases the effect of the metformin As a reminder, our super berberine product has dehydra berberine in it and saline cinnamon at a high concentration So it is a great addition to your metformin or an alternative to metformin if you cannot tolerate metformin at all Next is one of the most popular diabetic medicines so far But my least favorite, Sulfonylureas or megalithonides These medications are like Amaryl or known as Glymopryde Gullicotrol also known as Glypozide, Glynase or Glyboride, the other name Are examples of Sulfonylureas Now the primedin is the generic name Rhepegulonide and starlix is Nathegulonide Are also examples of megalithonides which work similar to Sulfonylureas but they are a little shorter acting After taking these medications, the Sulfonylureas and megalithonides, your pancreas produces more insulin Which in turn lowers the level of Glycozine in your blood Now the problem with them is that they constantly stimulate your pancreas to make insulin Without taking a break, which ends up killing your beta cells Wouldn't you die if you worked 25 hours without taking rest or sleep? These drugs may be beneficial for people using metformin Who cannot afford any other medications or supplements And are not concerned about the possibility of gaining weight and severe low blood sugars I mean it is better than nothing but in my opinion these meds are at the bottom of my preferred medications I said it is better than nothing because just because you cannot afford anything Does not mean that you need to let it go and drop everything and let your blood sugars run high Because high blood sugar as you know can cause much worse diabetes complications So if that is the only thing you can afford, please stick to it But it is good to know your options So that's why we will keep talking about other diabetic medications Tyazolidin deons, a mouthful name right? Well the only medication left in this group is actually Pyoglutazone Also known as octos because the rest of them were banned by the FDA either permanently or temporarily For example Rosiglutazone in 2010 the most widely prescribed medication in this family The other name is called Avandia was linked to an elevated risk of heart attack and stroke Which severely damaged the safety reputation of Tyazolidin deons overall Nowadays its cousin Pyoglutazone also known as octos is still in the market These drugs lower the level of glucose in your blood by slowing down the amount of glucose Produced by your liver and by assisting your body in responding more effectively to its own insulin Tyazolidin deons or Pyoglutazone in this case particularly beneficial for those who are suffering from insulin resistance They have the potential to reduce Avansi by around 1 percent Which is less than metformin but works in a similar way to metformin and it can be an alternative to metformin Now the biggest problem with these medications the Pyoglutazone especially our fluid retention and possible worsening of heart failure If you already have heart failure And increased risk of bone fractures, especially if used longer than two years There are possible but not confirmed risk of bladder cancer as well FDA has warnings about these that you can find on FDA's website Now our sugar MD super berberine and advanced glucose support are designed to help your body become more insulin sensitive And only produce insulin when you eat which works similar to DPP for inhibitors and glp1 agonists that I will be talking about next And yes, you can take sugar MD super berberine and advanced glucose support together to get the maximum results Our supplements also do not interact with other medications since they are made with natural food ingredients That do not interfere with medications now inhibitors of DPP for And these drugs is a group like some of you are on it like genuvia or known as stagliptin or Tragenta The generic name is lanagliptin or alloglyptin which is the only real generic one in this group They are okay drugs, but they're less effective than most The only advantage to them is that they do not cause low blood sugar unless you also take sulfonylurea that we discussed Or the insulin along with these medications these drugs work by preventing the breakdown of a certain hormone called glp1 or glucagon like peptide 1 So glp1 hormones are like postal service They're producing the intestines and informs your pancreas that there is food and blood sugar is rising So maintaining a higher level of glp1 in the bloodstream allows the body or your pancreas to make more insulin While also slowing the release of glucose from the liver now an important note that these medications are not near as strong Compared to real glp1 agonists, which are synthetic and stronger version of the dpp4 inhibitors And this is similar to what your body naturally produces Now normally increased glp1 levels also help with the weight reduction and reduction in your appetite and slows rate of your stomach Ampidine which keeps you full or longer and they're all beneficial for weight loss However dpp4 inhibitors like genuvia or Tragenta They're not strong enough to produce the weight loss results that you get with the glp1 agonists Which we will talk in a second now dpp4 inhibitors may be beneficial for those who like a little more support with the blood sugar control But do not want the risk of gaining weight by taking the medication such as alternative to sulfonylureas So it's a fair alternative to sulfonylurea But really for mostly for frail and elderly patients who cannot tolerate glp1 agents like ozampic trilocidine Rebalsus orbitoza they have the potential to reduce the hemoglobin a1c by around 0.5 Which is very small as we compared you know as we talk about the efficacy of metformin or pyagilthazone So for the price tag they have around, you know 500 a month I'm not a big prescriber of these medications except for this small specific group of elderly and frail patients Now what are the side effects of these dpp4 inhibitors like genuvia, Tragenta, etc Well, some people experience nausea still and vomiting after taking these drugs Although they are not as strong as glp1 agents, but they also have the potential to cause inflammation of the pancreas On some very rare occasions. We call this pancreatitis It is well known that this family of drugs can actually cause joint pain too in some people And sometimes even congestion in the airway and sometimes upper respiratory infection Now fda warned and issued a warning saying that onglaiza and nesina that I didn't tell you about because I don't even prescribe them But they're also associated with increased risk of heart failure So I do not prescribe them at all and the insurance coverage is very poor. So In the united states, we don't even see people on these medications anymore. Now glp1 agonist is next Now glp1 agonist or glp1 is a hormone as we discussed and these are Trying to attempt or mimic the glp1 activity in your body These medications cause the body to produce more insulin when blood sugar levels rise following a meal Now blood sugar levels drop as a result of more insulin in the body after a meal on the other hand Beauty of these medications is that they will not continue to force your pancreas to make insulin like the sulfonylureas do And they are three times stronger than dpp4 inhibitors Some examples are ozampic, victosa, rebalsis and biterian. The disadvantage of glp1 medications is that all but one Which is rebalsis. They all must be administered to reinjection except rebalsis is the only pill in this group As with any prescription, there is a chance of adverse events some of which may be serious After you have been taking the drug for a while the more typical side effects such as Diarrhea, abdominal pain, some cramps or nausea and vomiting sometimes even headaches tend to happen But they go away in weeks or months. Now low blood sugar hypoglycemia is a risk of glp1 agents Only if you are taking sulfonylureas or insulin along with them Typically when I prescribe a glp1 agonist like ozampic I slowly start lowering the insulin or sulfonylurea pills Same thing applies to our advanced glucosupport and superbure brain. So you should watch your blood sugars And the moment your blood sugar go below 100 milligram per deciliter or 5.6 millimore per liter You should start cutting on your insulin by 10 to 20 percent and every time you see a blood sugar less than that Start taking half a tabular of sulfonylurea for example and eventually stop it again Monitoring your response to these medications or supplements is the key to prevent a low blood sugar especially due to insulin and sulfonylurea Also, if you have a personal or family history of medallary thyroid cancer or multiple endocrine neoplasia You should avoid glp1 medications. These medications have been associated to thyroid cancers in rats in laboratory research But the risk to humans is unknown until more long term studies are done So far studies do not indicate any human harm. If you have had pancreatitis these medications are also not a good idea Well, thankfully you have other pharmaceutical or herbal options Even if you cannot take glp1 agents for one or the other reason next in my list is Sglt2 inhibitors. These medications have been fairly popular Especially recently some of them are you may remember the names jarnians or farciga or stegilatro Or even in mochana they work by making your kidneys to excrete glucose into your urine Lowering the level of glucose in your blood They are popular because some studies indicated that they lower the risk of hospitalization due to heart failure And possible reduction in the risk of overall death due to cardiovascular reasons After participating in a trial involving individuals with type 2 diabetes and chronic renal disease Researchers also discovered that in mochana, jarnians, and farciga lowered the risk of Progression of chronic kidney disease to end stage kidney disease And they also lowered the risk of heart attacks Researchers found that the jarnians could lower the likelihood of dying from any cause and in that research People with type 3 diabetes, especially who had high risk for cardiovascular disease benefited the most as a result People who want to lose weight people with heart failure or history of heart attacks may benefit extra from taking SGLT2 inhibitors while also improving their blood sugar control They have the potential to reduce hemoglobin a1c by around 0.8 percent or 0.8 percent As you can see they are not the most effective diabetic medications either but you know due to extra perks Many physicians prescribe them a lot nowadays. Now, how about risks and side effects of SGLT2 inhibitors? Well, they have the potential to cause vaginal use infections That's fairly common you know retract infections in men and women as well as dehydration related symptoms Because you will be urinating way more often than before and if you do not replace the flu loss It can cause dehydration and that low blood pressure can happen Even kidney failure or acute kidney failure happen if you become dehydrated FDA also has warnings about SGLT2 inhibitors And for this class of drugs FDA has issued a number of warnings now because they have the potential to cause rare But significant problems such as acute kidney injury the acid built up in the blood Which we call ketoacidosis infections in your groin that can sometimes be severe particularly with regard to invocana It has been observed to increase the incidence of bone fractures as well And even the danger of losing a limb or increase risk of food amputations in patients who take a moccana The advantages of these medications frequently outweigh the risks associated with them So it is still worthwhile to discuss them with your healthcare professional if you are considering taking them But for example these meds won't be good for someone who already has Frequent urinary tract infections or someone with advanced kidney disease who have high risk of dehydration Or someone with history of diabetic ketoacidosis. The next on my list is alpha glucosidase inhibitors Now these medications lower the level of glucose in your blood by reducing the absorption of simple sugars By your stomach and intestinal tract some brand names are precoz, glycet But most frequently we use the generic precoz, which is acarbose if you use them at all They have the potential to reduce hemoglobin a1c by only 0.5% So yes, they are also a weak agent. What are the risks of these? Well, they have the potential to produce gas a lot of gas and bloating also due to the possibility of elevated liver enzyme function You need to get your liver enzyme tested regularly if you are taking acarbose On dopamine agonists now when I say dopamine agonists, I don't mean a dope Although name implies that sorry for the disappointment But these medications although they are weaker agents which again lower a1c by 0.5% At best they lower glucose levels in the blood through enhancing the body's reaction to its own insulin Basically improving the insulin resistance nevertheless exact mechanism is really not known which is interesting that FDA approved a medication That we don't even know how it works, but it is there So they have the potential to cause nausea as well as dizziness headaches and drowsiness Now the only medicine in this group is cycloset and it is still branded still very expensive. The coverage is poor And if you issued warnings on this medication as well because they have the potential to create low blood pressure and perhaps cause of or perhaps a loss of consciousness Next is bile acid sequesterance, which are substances that prevent the absorption of bile acid Although it is unclear again how these medications lower the amount of blood glucose in your blood We still use them. We don't know how they work, but they do lower your blood sugar somewhat Studies show that they can actually improve the blood sugar when used in conjunction with other diabetic treatments as well Which is encouraging again better than nothing when combined with other diabetes drugs They have been shown to reduce the havency by around 0.5 percent Again, not your strongest medicine now when you combine a lot of medications, although they are weak They can get you to your goal, especially along with lifestyle changes Also, they have the potential to reduce also nausea constipation and upset stomach But also when combined with some other medications, these medications can actually raise the triglyceride levels So if you already have high triglyceride in your blood, you have to be careful and keep an eye on your cholesterol level If you are taking these medications and well-cold is the most well-known medication in this group Last in my list is inhaled insulin Now I will not talk about injectable insulins in this video except this one because insulin is insulin, right? It's harder to understand and they're more complex and most insulins are tailored to specific needs of patients So I would let your doctor to handle that preferably an endocrinologist I am talking about inhaled insulin today because most people are not aware of that option My goal is to increase awareness and show you your options that may not have been presented to you before Now the only brand out there for this purpose is called afreza Most people haven't even heard about inhaled insulin But it can be a very good alternative to short acting insulins Most important features of this type of insulin is that you do not have to inject But inhale and afreza work immediately, which means that it shows up in your blood immediately While the regular injectable insulins may take up to 30 minutes to even show up and start showing any effect Afreza does not stay in your system more than three hours either Compared to five to six hours of shorter acting insulins Which can lead to low blood sugar at three to five hour mark Using an inhaler This medication is inhale insulin lowers the level of glucose in your blood pretty much immediately And it may be beneficial for people who require typically less than 12 Units or less per meal because the largest cartridge unfortunately that they come in is 12 units Although some of my patients will take like two of the 12 units back to back Or they will combine for eight and 12 unit cartridges depending on their needs I see this insulin being popular among type 1 diabetics, especially young type 1 diabetics People can see how fast it gets in their blood also Especially when they are using dexcom or libre that allows you to see a minute to minute changes in your blood sugars Problems with afreza include number one sore throat number two coughing fits Especially in the beginning while you are getting used to it FDA also issued warnings about afreza This medication should not be taken by anyone who have lung problems People who use a drug must have their lung function tested on a regular basis and at the start of the treatment Which includes breathing examinations that are fairly quick to do We do FEV1 testing in our clinic, which is a quick test if you are planning to use afreza But it can lower your lung function in time. So we sometimes you know, we not sometimes every six months We need to check your lung function now keep this in mind Due to the fact that diabetes continues to be a rising concern throughout the world There is a constant demand for new treatments to assist in blood sugar control Remember medications are not to replace lifestyle improvements But rather to support you if your lifestyle changes are not enough Also, remember there are some supplements that you can rely on and some you cannot Unfortunately supplements just like medications differ in their efficacy and potency Give a try to our advanced glucose support and super berberine and let us know how they worked for you Advanced glucose support is stronger, but super berberine can be used with it as well If you only need to lower your blood sugar 10 to 20 points I would say go for the super berberine first If your blood sugar is in the 200s or 11 millimole or more I would suggest going for advanced glucose support first and then adding super berberine if the effect is not enough Again, thank you for watching everyone I hope you are now more knowledgeable about the diabetic medications that you are taking or you are planning to take And I hope it will help you achieve diabetes control and even get you in remission Remember to check our diabetes reversal program as well If you are a motivated individual that will greatly help you to reverse your diabetes. 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