Active Low-Carber Forums
Atkins diet and low carb discussion provided free for information only, not as medical advice.
Home Plans Tips Recipes Tools Stories Studies Products
Active Low-Carber Forums
A sugar-free zone


Welcome to the Active Low-Carber Forums.
Support for Atkins diet, Protein Power, Neanderthin (Paleo Diet), CAD/CALP, Dr. Bernstein Diabetes Solution and any other healthy low-carb diet or plan, all are welcome in our lowcarb community. Forget starvation and fad diets -- join the healthy eating crowd! You may register by clicking here, it's free!

Go Back   Active Low-Carber Forums > Main Low-Carb Diets Forums & Support > Low Carb Health & Technical Forums > Dr.Bernstein & Diabetes
User Name
Password
Register FAQ Members Calendar Mark Forums Read Search Gallery My P.L.A.N. Survey


Reply
 
Thread Tools Display Modes
  #46   ^
Old Tue, Jul-19-16, 06:08
JEY100's Avatar
JEY100 JEY100 is offline
To Good Health!
Posts: 10,067
 
Plan: IF Fung/LC Westman/Primal
Stats: 222/171/169 Female 5' 9"
BF:45%/25.3%/24%
Progress: 96%
Location: NC
Default

DietDoctor posted a new interview with Dr. Westman (membership page). A possible new caution for a new drug was mentioned. I have no personal experience with it, but adding that section from the transcript here:

Quote:

This is Dr. Westman's caution for the new diabetes drug. He will not assume something until proven, but he has a concern:

"Well, it's interesting, I mean new drugs came out all the time
and now, we have this drug for diabetes,
which helps you urinate sugar through your kidney and you lose it that way. And actually we're very concerned about the...
even the drug itself can cause ketosis,
it's called the normal glycemic ketoacidosis, it's the drug that does it.
But so, many of my patients are put on that drug
and I don't like that combination. Low-carb and the drug?
Yeah.
-Ketoacidosis warning, huh?
-Yeah.
Well, I don't know if it's any more likely than if you're not on a ketogenic diet, but--I would guess it is.
Although it can be quite effective, right?
So, it's like a double edged sword.
Effective for losing weight or reversing diabetes,
but also there's the risk of ketoacidosis."
Reply With Quote
Sponsored Links
  #47   ^
Old Tue, Jul-19-16, 10:45
JLx's Avatar
JLx JLx is offline
Senior Member
Posts: 1,887
 
Plan: Winging it
Stats: 000/000/000 Female 66
BF:High wt, 276, 255
Progress: 16%
Location: Michigan U.P., USA
Default

Are these the ones he's referring to?


Quote:
The FDA has green-lighted three SGLT2 inhibitors:

Canagliflozin (Invokana), approved March, 2013
Dapagliflozin (Farxiga), approved January, 2014
Empagliflozin (Jardiance), approved August, 2014

Most diabetes drugs target the liver, pancreas, or gut to improve insulin sensitivity, reduce insulin resistance, or stimulate insulin secretion.

But SGLT2 inhibitors work in a different way. They have no effect on insulin. Instead, they target the kidneys to block the reabsorption of sugar, increase sugar excretion, thereby reducing blood sugar levels. http://www.newsmax.com/Health/Headl...3/29/id/635154/

Reply With Quote
  #48   ^
Old Tue, Jul-19-16, 14:37
JEY100's Avatar
JEY100 JEY100 is offline
To Good Health!
Posts: 10,067
 
Plan: IF Fung/LC Westman/Primal
Stats: 222/171/169 Female 5' 9"
BF:45%/25.3%/24%
Progress: 96%
Location: NC
Default

Yes, a few weeks ago FDA strengthened its warnings on them for Kidney injury. That study was mentioned on the People's Pharmacy news round-up but then hearing Dr. Westman say this about drug and diet possible interaction...thought should post it here.

https://www.drugwatch.com/2016/06/2...injury-warning/

Quote:
This latest label change from the FDA is another in a long string of safety concerns linked to Invokana and other SGLT2 inhibitors. Earlier this month, the agency began investigating data from the CANVAS trial that showed an increase in leg, foot and toe amputations in people who used the drug. While the link is not definitive, the agency said 5 to 7 out of every 1,000 patients had a risk of amputation.

In May 2015, the agency warned that Invokana increased the risk of ketoacidosis ó a potentially fatal condition caused by excess blood acid. In December 2015, the FDA released another safety communication and warned the drug can also lead to blood infections and kidney injuries.

In addition to these concerns, researchers in the ongoing CANVAS trial are investigating drugís heart safety. Data from the trial showed people who took the drug had an elevated risk of stroke in the first month of treatment.

The litany of side effects led some patients to file lawsuits against J&J and its Janssen Pharmaceuticals unit. Plaintiffs say the drug companies failed to properly warn the public about serious side effect risks.


Jeez, is that all? Amputations, ketoacidosis, elevated risk of stroke in ONE month? Yikes!

Last edited by JEY100 : Wed, Jul-20-16 at 01:52.
Reply With Quote
  #49   ^
Old Tue, Jul-19-16, 18:34
JLx's Avatar
JLx JLx is offline
Senior Member
Posts: 1,887
 
Plan: Winging it
Stats: 000/000/000 Female 66
BF:High wt, 276, 255
Progress: 16%
Location: Michigan U.P., USA
Default

Yikes is right. Meanwhile...

No Clear Survival Benefit Seen Among Diabetes Drugs - But meta-analysis hampered by limitations of included studies

Eight different diabetes drug classes examined in a meta-analysis failed to demonstrate improved cardiovascular or all-cause mortality compared with placebo.

http://www.medpagetoday.com/endocri.../diabetes/59182

Also:

Quote:
The analysis of hundreds of clinical trials found no evidence that any one diabetes drug, or drug combination, beats out the others.

Researchers said the results bolster current recommendations to first try an older, cheaper drug -- metformin (Glumetza, Glucophage) -- for most patients with type 2 diabetes.

"There are very few things experts agree on, but this is one of them," said Dr. Kevin Pantalone, a diabetes specialist at the Cleveland Clinic and a member of the Endocrine Society.
http://health.usnews.com/health-car...es-drug-is-best


Quote:
Meta-analysis Supports ADA Guidelines for Type 2 Diabetes Drugs

In a systemic review and network meta-analysis, the available drugs classes for type 2 diabetes were associated with similar odds of cardiovascular and all-cause mortality. Patients receiving metformin monotherapy had lower or similar HbA1c levels as those receiving sulfonylurea, thiazolidinedione, or α-glucosidase inhibitor monotherapy. http://www.medscape.com/viewarticle/866322


The gastrointestinal side effects preventing some patients from using Metformin were mentioned. I really wonder if that reflects the state of their guts.
Reply With Quote
  #50   ^
Old Wed, Jul-20-16, 08:06
jessdamess's Avatar
jessdamess jessdamess is offline
Senior Member
Posts: 3,683
 
Plan: LCHF, 100g
Stats: 252/165/150 Female 69.5 inches
BF:
Progress: 85%
Location: Northeast TN
Default

Metformin gave my mother horrible gastric issues for years. At some point she was taking Invokana. She died of kidney and liver failure on May 28 of this year. She was 70 and recovery would have required transplants, so they sent her home on hospice. However, I cannot say that having poorly managed diabetes for 20 years wasn't what caused her organs to fail instead of the med. She wasn't in good health for years as a result of complications caused by diabetes. That and she refused to eat healthy and would only drink diet soda (no water)...I love that woman, but she was such a stubborn mule sometimes.
Reply With Quote
  #51   ^
Old Wed, Jul-20-16, 08:36
JLx's Avatar
JLx JLx is offline
Senior Member
Posts: 1,887
 
Plan: Winging it
Stats: 000/000/000 Female 66
BF:High wt, 276, 255
Progress: 16%
Location: Michigan U.P., USA
Default

I'm sorry to hear about your mother.

It's very sad when diabetics can't manage effective dietary changes. It doesn't help that there is so little societal support for diabetics not eating sugar, white flour and tons of other carbs.

What I'm wondering is if a robust prebiotic/probiotic intervention or other measures to improve gut health would enable people to take Metformin.

When I was diagnosed the endocrinologist prescribed Metformin, a sulfonylurea and diabetic teaching. I only took the Metformin and got a new doctor who supported a low carb diet.
Reply With Quote
  #52   ^
Old Wed, Jul-20-16, 16:55
Mycie14's Avatar
Mycie14 Mycie14 is offline
Senior Member
Posts: 474
 
Plan: Dr. Bernstein, IF
Stats: 200/161/155 Female 68
BF:
Progress: 87%
Location: Southern California
Default

I started on regular metformin and a low carb diet. Not sure what the state of my gut was/is, but I was eating full fat yogurt with live cultures. Anyway, my gut never adjusted to the metformin even with a slow ramp up in dose. Luckily, my insurance did cover glumetza and that worked great for me. Now I take the generic glumetza (has the same special coating, not nearly as expensive), still works great.

In the beginning, I did ask about victoza and other drugs to help me lose weight/lower blood glucose as I didn't think it was happening fast enough. Thankfully, my doctor and the pharmacist counselor said just to give it more time before trying anything else.

On reflection, I don't see how peeing out excess sugar can be healthy. It certainly doesn't give incentive to change one's diet, and I would imagine a lot of bladder infections are involved.
Reply With Quote
  #53   ^
Old Fri, Jul-22-16, 18:50
deirdra's Avatar
deirdra deirdra is offline
Senior Member
Posts: 3,811
 
Plan: HF/vLC/GF,CF,SF
Stats: 197/136/150 Female 66 inches
BF:
Progress: 130%
Location: Alberta
Default

Scary! It will just encourage people to sustain or increase their consumption of sugar, which starts being absorbed by the mucous membranes of the mouth. So there are a lot of places the sugar can feed cancer on its way through your system. I wonder if it will cause urinary leakage similar to how Olestra increased underwear sales? No thanks.
Reply With Quote
  #54   ^
Old Sat, Jul-23-16, 15:05
katmeyster's Avatar
katmeyster katmeyster is offline
Senior Member
Posts: 918
 
Plan: Keto (LCHFMP) + IF
Stats: 265/188/150 Female 61 inches
BF:Highest weight 290
Progress: 67%
Location: Las Cruces, New Mexico
Default

I think there is evidence that 2 tablespoons of apple cider vinegar before each meal (not sure about the dosage) is said to mimic the effects of metformin in some people. I put it in water and find it to actually be quite tasty if diluted enough (I use the Braggs' organic). I think that would be much easier on the gut.
Reply With Quote
  #55   ^
Old Tue, Sep-06-16, 04:16
JEY100's Avatar
JEY100 JEY100 is offline
To Good Health!
Posts: 10,067
 
Plan: IF Fung/LC Westman/Primal
Stats: 222/171/169 Female 5' 9"
BF:45%/25.3%/24%
Progress: 96%
Location: NC
Default

Dr Eenfeldt has added a new guide:
Starting Low Carb with Diabetes Medications

http://www.dietdoctor.com/low-carb/...tes-medications

He covers insulin and also the limited risks with some of the pills by brand name.

Quote:
So you have diabetes and you want to try a low-carb diet? Congratulations! It may be the single best thing you could ever do for your health. It can start to reverse your type 2 diabetes, and dramatically increase your blood sugar control with type 1 diabetes. However, you need to know what you are doing. Once you start eating low carb you may instantly have to lower any insulin doses, a lot.

Avoiding the carbohydrates that raise your blood sugar decreases your need for medication to lower it. Taking the same dose of insulin as you did prior to adopting a low-carb diet might result in hypoglycemia (low blood sugar). You need to test your blood sugar frequently when starting this diet and adapt (lower) your medication. This should ideally be done with the assistance of a knowledgeable physician.

No drugs If you have diabetes and youíre treated either by diet alone or just with Metformin there is no risk of low blood sugar on low carb. You can get started right away. Insulin As a general guide you may need to lower your doses by 30-50% or more when starting a strict low-carb diet.

So you have diabetes and you want to try a low-carb diet? Congratulations! It may be the single best thing you could ever do for your health. It can start to reverse your type 2 diabetes, and dramatically increase your blood sugar control with type 1 diabetes.

However, you need to know what you are doing. Once you start eating low carb you may instantly have to lower any insulin doses, a lot.

Avoiding the carbohydrates that raise your blood sugar decreases your need for medication to lower it. Taking the same dose of insulin as you did prior to adopting a low-carb diet might result in hypoglycemia (low blood sugar).

You need to test your blood sugar frequently when starting this diet and adapt (lower) your medication. This should ideally be done with the assistance of a knowledgeable physician.

No drugs

If you have diabetes and youíre treated either by diet alone or just with Metformin there is no risk of low blood sugar on low carb. You can get started right away.

Insulin

As a general guide you may need to lower your doses by 30-50% or more when starting a strict low-carb diet.

Unfortunately thereís no way to know the doses required in advance. Youíll have to test your blood sugar frequently and adapt (lower) insulin doses. This should ideally be done with the assistance of a knowledgeable physician.

Note that as a general rule itís easier to err on the low side, and take more insulin later if needed. Thatís fine. If instead you overdose and get low sugar youíll have to quickly eat or drink more carbohydrates, and that obviously reduces the effect of the low-carb diet.

Insulin in type 1 diabetes
The advice on insulin above generally applies to type 1 diabetes too. A low-carb, high-fat diet can be fantastic for empowering people with type 1 diabetes to get steady blood sugars. It results in much fewer and milder highs or hypos (when insulin doses are adapted).

If you get regular hypos you should consider lowering your insulin.

One word of warning though: A strict low carb diet results in ketosis, a normal physiological state. A very strict low-carb diet that also restricts protein to moderate amounts can result in quite high, but still physiological, ketone levels (>1.5 mmol/L).

This is fine for healthy people, but in type 1 diabetes this means youíre uncomfortably close to ketoacidosis (usually at least 10-15 mmol/L). All thatís needed then is forgetting an insulin shot or two, or an insulin pump malfunction, and you might end up very sick in the hospital.

Thus itís probably best in type 1 diabetes to try a more moderate low-carb diet, with a minimum of around 50 grams of carbs a day, so that you stay out of deeper ketosis (>1.5 mmol/L).

Do not do a strict low-carb diet (below 20 grams a day) unless youíre certain of how to handle this risk. Adding for example a fruit or two a day to it is probably wise, if you have type 1 diabetes. Just to be safe.

pills for type 2 diabetes work by releasing more insulin in the pancreas. These can also result in low blood sugar on a low-carb diet, even if the risk is slightly smaller than with injected insulin.

These pills are called sulfonylureas and include Minidiab, Euglucon, Daonil, and Glibenclamide.

You may need to reduce the dose or stop these drugs on a low-carb diet, as you may rapidly become too healthy for them. Discuss it with your doctor in advance.

Metformin

Metformin tablets can be safely taken on a low-carb diet. Thereís no risk of low blood sugar if youíre only on Metformin.

GLP-1 agonists (e.g. Victoza) and DPP-4 inhibitors (e.g. Januvia)

These drugs should rarely lead to low blood sugar on a low-carb diet by themselves. But be observant, check your blood sugar often and discuss it with your doctor as needed.

SGLT2 inhibitors (e.g. Farxiga, Jardiance, Invokana)

These drugs1 are a good way to treat type 2 diabetes, but as a known side effect they increase the risk of a dangerous condition called ketoacidosis. Itís likely that this side effect could become more common on a strict low-carb diet. Proceed with caution and discuss it with your doctor.

If you get symptoms of ketoacidosis: extreme thirst, nausea, vomiting, confusion etc. you should stop the medication, eat carbs and contact a doctor immediately.
Reply With Quote
  #56   ^
Old Wed, Sep-07-16, 09:41
diabetic_d diabetic_d is offline
New Member
Posts: 19
 
Plan: Bernstein
Stats: 255/230/215 Male 72
BF:
Progress:
Default

Janet, thank you for bringing up this thread, which I've overlooked until today. I've been waiting too long to join the DietDoctor membership, so today I'm heading over there to join. I've been looking at the SGLT-2 drugs, especially since Dr. Fung thinks highly of them. However, the ketoacidosis warnings leave me too startled to bring it up with my doctor. During allergy season and during injuries my numbers head up, so my doctor recently added Actos to my meds. Don't like it a bit, but in spite of all my exercise, fasting schedule, eating and drinking right, I still need help. So, half a dose of Actos it is until I can get numbers down. Thanks for the link info.
Reply With Quote
  #57   ^
Old Wed, Sep-07-16, 14:08
JEY100's Avatar
JEY100 JEY100 is offline
To Good Health!
Posts: 10,067
 
Plan: IF Fung/LC Westman/Primal
Stats: 222/171/169 Female 5' 9"
BF:45%/25.3%/24%
Progress: 96%
Location: NC
Default

Glad this article helped. With your Diet Doctor membership, watch Dr Westman's newer talk, LCHF and Diabetes, Theory and Clinical experience. It has a number of patient experiences...start doses, meds, how long diabetic, and how he reduces insulin in a clinic.
http://www.dietdoctor.com/member/pr...ons/westman-lcc
Reply With Quote
  #58   ^
Old Wed, Sep-07-16, 18:16
Robin120's Avatar
Robin120 Robin120 is offline
Senior Member
Posts: 3,987
 
Plan: low carb
Stats: 171/125/145 Female 5'9
BF:
Progress: 177%
Location: DC
Default

Janet!!!!!! I was on invokana and went DKA with normal BG just under a year ago, at which time i was taken off the drug.
I had been on it about 15 months, when due to stress, i basically ate nothing for 3 days and promptly went DKA. It was terrifying and I spent several days in an ICU recovering.
it now carries FDA warning label for type I's that it it can have this effect.
i knew it was a small risk, but as a very well controlled diabetic, i never imagined it could happen without high blood sugar. the warning i got was "it might increase risk of DKA." I wish i knew it meant "can cause DKA without high BG."
Reply With Quote
  #59   ^
Old Tue, May-23-17, 15:35
JEY100's Avatar
JEY100 JEY100 is offline
To Good Health!
Posts: 10,067
 
Plan: IF Fung/LC Westman/Primal
Stats: 222/171/169 Female 5' 9"
BF:45%/25.3%/24%
Progress: 96%
Location: NC
Default

Starting with the concerns in post #46, the conclusion is that the FDA has added a "black box" warning to Invokana as of this week.

http://forum.lowcarber.org/showthre...13&page=1&pp=15

Knowing Robin's story and the high increased risk for amputations, this drug should have been pulled from market. Do you think the drug detail sales teams will highlight this warning to doctors? User be aware of risks with SGLT2 inhibitors.

*********

Most of this thread is about adjusting DIABETES medications.

Be aware that BLOOD PRESSURE also needs to be monitored carefully and possibly BP medications may need to be reduced.

https://www.dietdoctor.com/low-carb...-blood-pressure

Quote:
If youíre on blood pressure medication and start a low-carb diet thereís a risk of getting low blood pressure. You may relatively quickly become too healthy for your medication.

This blood pressure lowering effect on low carb can happen within days, but it may also take months or even a year to reach full effect.

If you feel weak, tired, dizzy etc. you should check your blood pressure. If itís low, e.g. below 120/80, you should contact your doctor to discuss lowering or stopping your medication.
Reply With Quote
Reply

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

vB code is On
Smilies are On
[IMG] code is On
HTML code is Off



All times are GMT -6. The time now is 23:32.


Copyright © 2000-2018 Active Low-Carber Forums @ forum.lowcarber.org
Powered by: vBulletin, Copyright ©2000 - 2018, Jelsoft Enterprises Ltd.