RECALL OF METFORMIN EXTENDED RELEASE

In May 2020, the Food and Drug Administration (FDA) recommended that some makers of metformin extended release remove some of their tablets from the U.S. market. This is because an unacceptable level of a probable carcinogen (cancer-causing agent) was found in some extended-release metformin tablets.

As of October 2021, all of the affected medications have been pulled.

If you currently take this drug, talk with your doctor. They’ll advise whether you should continue to take your medication or if you need a new prescription.

Type 2 diabetes is a chronic medical condition in which the levels of sugar, or glucose, build up in your bloodstream.

Typically, the hormone insulin helps move glucose from your blood to your cells, where it’s used for energy. But with type 2 diabetes, your body’s cells aren’t able to respond to insulin as well as they should. In later stages of the condition, your body may also not produce enough insulin.

Uncontrolled type 2 diabetes can lead to chronically high blood glucose levels, which can cause several symptoms and potentially lead to serious complications.

In type 2 diabetes, your body isn’t able to effectively use insulin to bring glucose into your cells. This causes your body to rely on alternative energy sources in your tissues, muscles, and organs. This is a chain reaction that can cause a variety of symptoms.

Type 2 diabetes can develop slowly. The symptoms may be mild and easy to dismiss at first. The early symptoms may include:

As the disease progresses, the symptoms become more severe and can cause some potentially dangerous complications.

If your blood glucose levels have been high for a long time, the complications can include:

Insulin is a naturally occurring hormone. Your pancreas produces it and releases it when you eat. Insulin helps transport glucose from your bloodstream to cells throughout your body, where it’s used for energy.

If you have type 2 diabetes, your body becomes resistant to insulin. Your body is no longer using the hormone efficiently. This forces your pancreas to work harder to make more insulin.

Over time, this can damage cells in your pancreas. Eventually, your pancreas may not be able to produce any insulin.

If you don’t produce enough insulin or if your body doesn’t use it efficiently, glucose builds up in your bloodstream. This leaves your body’s cells starved for energy. Doctors don’t know exactly what triggers this series of events. It may have to do with cell dysfunction in the pancreas or with cell signaling and regulation.

While lifestyle choices are typically what trigger type 2 diabetes, you may be more likely to be diagnosed with it if:

  • there’s a genetic predisposition to developing type 2 diabetes in your family
  • there’s a genetic predisposition to developing obesity in your family, which can increase the risk of insulin resistance and diabetes
  • you are at least 45 years old
  • you are Black, Hispanic/Latino, Native American, or of Alaska Native descent

While the definitive trigger of type 2 diabetes is your body’s resistance to insulin, there’s usually a combination of factors that increase your risk of that resistance occurring.

Type 2 diabetes can be managed, and in some cases, reversed. Most treatment plans will include checking your blood glucose levels, and your doctor will tell you how often you should do it. The goal is to stay within a specific range.

Additional lifestyle changes your doctor will most likely advise to help treat your type 2 diabetes include:

  • eating foods rich in fiber and healthy carbohydrates — eating fruits, vegetables, and whole grains can help keep your blood glucose levels steady
  • eating at regular intervals
  • learning to listen to your body and learn to stop eating when you’re full
  • manage your weight and keep your heart healthy, which typically means keeping refined carbohydrates, sweets, and animal fats to a minimum
  • get about half an hour of physical activity daily to help keep your heart healthy — exercise can help to control blood glucose, too.

Your doctor will explain how to recognize the early symptoms of blood sugar that’s too high or too low and what to do in each situation.

Additionally, working with a dietician can help you learn which foods can help you manage your blood sugar — and which ones might cause it to become unbalanced.

Not everyone with type 2 diabetes needs to use insulin. If you do, it’s because your pancreas isn’t making enough insulin on its own, and it’s crucial that you take insulin as directed. There are other prescription medications that may help as well.

In some cases, lifestyle changes are enough to keep type 2 diabetes under control. If not, there are several medications that may help. Some of these medications include:

  • Metformin. This can lower your blood glucose levels and improve how your body responds to insulin. It’s the first-line treatment for most people with type 2 diabetes.
  • Sulfonylureas. These are oral medications that help your body make more insulin.
  • Meglitinides. These are fast-acting, short-duration medications that stimulate your pancreas to release more insulin.
  • Thiazolidinediones. These make your body more sensitive to insulin.
  • Dipeptidyl peptidase 4 (DPP-4) inhibitors. These are milder medications that help reduce blood glucose levels.
  • Glucagon-like peptide-1 agonists. These slow digestion and improve blood glucose levels.
  • Sodium-glucose Cotransporter-2 (SGLT2) Inhibitors. These help your kidneys remove sugar in your body through urine.

Each type of medication listed above can cause side effects. It may take some time for you and your doctor to find the best medication or combination of medications to treat your diabetes.

If your blood pressure or cholesterol levels are also not ideal, you may need medications to address those needs as well.

If your body is unable to make enough insulin, you may need insulin therapy. You may only need a long-acting injection you can take at night, or you may need to take insulin several times per day.

Learn about medications that can help you manage diabetes.

Diet is an important tool to help maintain optimal heart health and blood glucose levels that are within a safe range.

The diet recommended for people with type 2 diabetes is the same diet just about everyone should follow. It boils down to a few key actions:

  • Choose a variety of foods that are high in nutrients and low in empty calories.
  • Work on being mindful about portion sizes and stopping eating when you’re full.
  • Read food labels closely to understand the amount of sugar or carbs you could be ingesting in a serving size.

Foods and beverages to limit

If you’ve been diagnosed with type 2 diabetes, or even if you’re trying to avoid diabetes and manage your weight, there are certain foods and beverages that you should limit if possible. These include:

  • foods heavy in saturated or trans fats (like red meat and full-fat dairy products)
  • processed meats (like hotdogs and salami)
  • margarine and shortening
  • refined baked goods (like white bread and cake)
  • high-sugar, highly processed snacks (packaged cookies and some cereals)
  • sugary drinks (like regular soda and some fruit juices)

While no one food, enjoyed every so often, should knock you off your healthy path, it’s a good idea to talk with your doctor about dietary restrictions based on your blood sugar levels. Some people may need to monitor their glucose more carefully than others after eating these foods.

Foods to choose

Being diagnosed with type 2 diabetes does not mean carbs are off the table. Healthy carbohydrates can provide you with energy and fiber. Some options include:

Fat is not off the table, either. Instead, it’s about choosing the right types of fat. Foods with heart-healthy omega-3 fatty acids include:

You can get healthy monounsaturated and polyunsaturated fats from a number of foods, including:

Talk with your doctor about your personal nutrition goals. They may recommend you connect with a dietician who’s well-versed in optimal diets for diabetes. Together, you can come up with a diet plan that tastes great and suits your lifestyle needs.

While there are some risk factors for type 2 diabetes that are out of your control (like your age and heritage, as mentioned above), there are certain lifestyle choices that can also put you at a greater risk of developing type 2 diabetes. Some of these include:

  • Living with excess weight. When you’re living with excess weight, you most likely have more fatty tissue, which can make your cells more resistant to insulin.
  • Living a more sedentary lifestyle. Regular physical activity helps your cells respond better to insulin.
  • Eating a lot of highly processed foods. Highly processed foods can have a lot of hidden sugar and refined carbs. If your life requires a more “grab-and-go” type of eating style, talk with your doctor or a dietician about nutritious swaps.

You may also be at increased risk if you’ve had gestational diabetes or prediabetes, two conditions caused by elevated glucose levels.

Whether or not you have prediabetes, you should see your doctor right away if you think you may be experiencing symptoms of diabetes. Your doctor can get a lot of information from blood work. Diagnostic testing may include the following:

  • Hemoglobin A1C test. This test measures average blood glucose levels for the previous 2 or 3 months. You don’t need to fast for this test, and your doctor can diagnose you based on the results. It’s also called a glycosylated hemoglobin test.
  • Fasting plasma glucose test. This test measures how much glucose is in your plasma. You may need to fast for 8 hours before taking it.
  • Oral glucose tolerance test. During this test, your blood is drawn three times: before, 1 hour after, and 2 hours after you drink a dose of glucose. The test results show how well your body deals with glucose before and after the drink.

If you have diabetes, your doctor will provide you with information about how to manage the disease, including:

  • how to monitor blood glucose levels on your own
  • dietary recommendations
  • physical activity recommendations
  • information about any medications that you need

You may need to see an endocrinologist who specializes in the treatment of diabetes. You’ll probably need to visit your doctor more often at first to make sure your treatment plan is working.

While you can’t always prevent type 2 diabetes, there are a few lifestyle tweaks can help delay, or even prevent, the onset. This is true even if you have increased risk factors like prediabetes.

  • Diet. The best kind of diet to prevent type 2 diabetes is a diet rich in fruits, vegetables, healthy carbs, healthy fats, and very little refined sugar.
  • Exercise. According to the 2018 Physical Activity Guidelines for Americans, the optimal amount of exercise a week for adults is 150 minutes, which can translate to 30 minutes a day, 5 days a week. The Physical Activity Guidelines also recommend a combination of muscle strengthening and aerobic activity.
  • Weight management. Keeping a moderate weight is a good way to avoid chronic complications, including type 2 diabetes.

For many people, type 2 diabetes can be effectively managed. If not properly managed, it can affect virtually all of your organs and lead to serious complications, including:

Hypoglycemia

Hypoglycemia can occur when your blood sugar is low. The symptoms can include shakiness, dizziness, and difficulty speaking. You can usually remedy this by having a “quick-fix” food or beverage, like fruit juice, a soft drink, or hard candy.

Hyperglycemia

Hyperglycemia can happen when blood sugar is high. It’s typically characterized by frequent urination and increased thirst. Monitoring your blood glucose carefully, and staying active, can help prevent hyperglycemia.

Complications during and after pregnancy

If you have diabetes while you’re pregnant, you’ll need to monitor your condition carefully. Diabetes that’s poorly controlled may:

It can also increase your baby’s risk of developing diabetes during their lifetime.

Managing type 2 diabetes requires teamwork. You’ll need to work closely with your doctor, but a lot of the results depend on your choices.

Your doctor may want to perform periodic blood tests to determine your blood glucose levels. This will help determine how well you’re managing the condition. If you take medication, these tests will help gauge how well it’s working.

Your doctor may also recommend a home monitoring system to test your own blood glucose levels between visits. They’ll explain to you how often you should use it and what your target range should be.

Because diabetes can increase your risk of cardiovascular disease, your doctor may want to monitor your blood pressure and blood cholesterol levels. If you have symptoms of heart disease, you may need additional tests. These tests may include an electrocardiogram (ECG or EKG) or a cardiac stress test.

It may also be helpful to bring your family into the loop. Educating them about the warning signs of blood glucose levels that are too high or too low will allow them to help in an emergency.

Type 2 diabetes in children is a growing issue. According to the American Diabetes Association (ADA), around 193,000 Americans under age 20 have type 1 or type 2 diabetes.

One 2016 study found that the incidence of type 2 diabetes in youth has increased to about 5,000 new cases per year. Another study from 2017 also showed a significant increase, particularly in minority races and ethnic groups.

If your child has been diagnosed with diabetes, their doctor will need to determine if it’s type 1 or type 2 before suggesting a specific treatment.

In the same way that lifestyle choices can help adults manage or even reverse their type 2 diabetes diagnosis, you can help lower your child’s risk by encouraging them to eat well and to be physically active every day.

The Centers for Disease Control and Prevention (CDC) report the following statistics about diabetes in the United States:

  • Over 30 million people have diabetes. That’s around 10 percent of the population.
  • 1 in 4 people has no idea they have diabetes.
  • Prediabetes affects 84.1 million adults, and 90 percent of them are unaware of it.
  • Non-Hispanic Black, Hispanic, and Native American adults are about twice as likely to have diabetes as non-Hispanic white adults.

The ADA reports the following statistics:

  • In 2017, diabetes cost the United States $327 billion in direct medical costs and reduced productivity.
  • The average medical expenses for people with diabetes are about 2.3 times higher than they’d be in the absence of diabetes.
  • Diabetes is the seventh leading cause of death in the United States, either as the underlying cause of death or as a contributing cause of death.

The World Health Organization (WHO)Trusted Source reports the following statistics:

  • The 2014 global prevalence of diabetes was 8.5 percent for adults.
  • In 1980, only 4.7 percent of adults worldwide had diabetes.
  • Diabetes directly caused about 1.6 million deaths worldwide in 2016.
  • Diabetes nearly triples the risk of heart attack and stroke in adults.
  • Diabetes is also a leading cause of kidney failure.

Type 2 diabetes is a condition that’s created when glucose levels build up in your bloodstream. It’s a common condition that’s often triggered by certain lifestyle choices. But the likelihood of a diagnosis can also be increased by genetics, age, and heritage.

Type 2 diabetes can be managed — and even reversed — with certain lifestyle changes. For more severe cases, medication is available.

If you’ve been diagnosed with type 2 diabetes, talk with your doctor about developing a treatment plan that works for your lifestyle. Because this condition is so common, there’s a plethora of resources and first-person accounts to help you on your journey towards managing — or breaking free from — type 2 diabetes.

Read this article in Spanish.