Medications

Many anti-hyperglycemic drugs are available to help patients with type 2 diabetes control
their blood sugar levels. Most of these drugs are aimed at using or increasing sensitivity to
the patient's own natural stores of insulin.
For the most part older oral hypoglycemic drugs -- particularly metformin -- are less
expensive than, and work as well as, newer diabetes drugs. They are generally
recommended as first-line drugs to use. Metformin is a safe and effective drug because it
does not cause weight gain or too-low blood sugar. Metformin can also help lower LDL
(bad) cholesterol.
In general, these drugs will reduce hemoglobin A1c levels by 1 - 2%. Adding a second oral
hypoglycemic is usually recommended if inadequate control is not achieved with the first
medication. For the most part, doctors should add a second drug rather than trying to push
the first drug dosage to the highest levels.

BIGUANIDES (METFORMIN)
Metformin (Glucophage) is a biguanide, which works by reducing glucose production in the
liver and by making tissues more sensitive to insulin. Doctors recommend it as a first choice
for most patients with type 2 diabetes who are insulin resistant, particularly if they are
overweight. Metformin may also be used in combination with other drugs.
Metformin does not cause hypoglycemia or add weight, so it is particularly well-suited for
obese patients with type 2 diabetes. Metformin also appears to have beneficial effects on
cholesterol and lipid levels and may help protect the heart. Some research has suggested
that it significantly reduces the risk for heart attack and death from heart disease. It is also
the first choice for children who need oral drugs and is helpful for women with polycystic
ovary syndrome and insulin resistance.
Side Effects. Side effects include:
A metallic taste
Gastrointestinal problems, including nausea, and diarrhea
Interference with absorption of vitamin B12 and folic acid
Rare reports of lactic acidosis, a potentially life-threatening condition, particularly in
people with risk factors for it. Major studies, however, found no greater risk with metformin
than with any of the other drugs used for type 2 diabetes.
Certain people should not use this drug, including anyone with heart failure or kidney or liver
disease. It is rarely suitable for adults over age 80.
SULFONYLUREAS
Sulfonylureas are oral drugs that stimulate the pancreas to release insulin. They are also
first-line oral drugs. For adequate control of blood glucose levels, the drugs should be taken
20 - 30 minutes before a meal. A number of brands are available, including chlorpropamide
(Diabinese), tolazamide (Tolinase), acetohexamide (Dymelor), glipizide (Glucotrol),
tolbutamide (Orinase), glyburide (Micronase), glimepiride (Amaryl), and repaglinide
(Prandin).
Most patients can take sulfonylureas for 7 - 10 years before they lose effectiveness.
Combinations with small amounts of insulin or other oral anti-hyperglycemic drugs (such as
metformin or a thiazolidinedione) may extend their benefits. A combination of glyburide and
metformin in one pill (Glucovance) is available. Glucovance may be particularly beneficial for
patients with unhealthy cholesterol levels and poor control of their blood sugar levels. Some
doctors recommend the combination as first-line treatment.
Side Effects and Complications. In general, women who are pregnant or nursing or by
individuals who are allergic to sulfa drugs should not use sulfonylureas. Side effects may
include:
Weight gain (some sulfonylureas, such as glimepiride, may produce less weight gain
than others)
Water retention

Although sulfonylureas pose a lower risk for hypoglycemia than insulin does, the
hypoglycemia produced by sulfonylureas may be especially prolonged and dangerous. The
newer sulfonylureas, such as glimipiride, have much less risk of hypoglycemia than older
sulfonylureas.
Some sulfonylureas may pose a slight risk for cardiac events.
Sulfonylureas interact with many other drugs, and patients must inform their doctor of any
medications they are taking, including alternative or over-the-counter drugs.
MEGLITINIDES
Meglitinides stimulate beta cells to produce insulin. They include repaglinide (Prandin),
nateglinide (Starlix), and mitiglinide. These drugs are rapidly metabolized and short-acting.
If taken before every meal, they actually mimic the normal effects of insulin after eating.
Patients, then, can vary their meal times with this drug. These drugs may be particularly
helpful in combination with metformin or other drugs. They may also be a good choice for
people with potential kidney problems.
Side Effects. Side effects include diarrhea and headache. As with the sulfonylureas,
repaglinide poses a slightly increased risk for cardiac events. (Newer drugs, such as
nateglinide, may pose less of a risk.) People with heart failure or liver disease should use
them with caution and be monitored.
THIAZOLIDINEDIONES
Thiazolidinediones, also known as peroxisome proliferator-activated receptor (PPAR)
agonists, include pioglitazone (Actos) and rosiglitazone (Avandia). They improve insulin
sensitivity by activating certain genes involved in fat synthesis and carbohydrate
metabolism. These drugs are usually taken once or twice per day; however, it may take
several days before the patient notices any results from them and several weeks before they
take full effect. Thiazolidinediones are usually taken in combination with other oral drugs or
insulin. Thiazolidinediones available as 2-in-1 pills include rosiglitazone and metformin
(Avandamet), rosiglitazone and glimepiride (Avandaryl), and pioglitazone and glimepiride
(Duetact).
Side Effects. Thiazolidinediones can have serious side effects. They can increase fluid buildup, which can cause or worsen heart failure in some patients. Combinations with insulin
increase the risk. Patients with heart failure should not use them. People with risk factors for
heart failure should use these mediciens with caution. Rosiglitazone may also increase the
risk for heart attack. Patients who take rosiglitazone, especially those who have heart
disease or who are at high risk for heart attack, should talk to their doctor about their
treatment options.
Thiazolidinediones may cause more weight gain than other diabetes medications or insulin.
Any patient who has sudden weight gain, water retention, or shortness of breath should
immediately call their doctor. These drugs have also been linked to increased risks for bone
fracture.
There have been rare reports of rosiglitazone causing or worsening diabetic macular edema.
This is an eye condition associated with diabetic retinopathy that causes swelling in the
macular area of the retina. Symptoms include blurred vision and decreased color sensitivity.
Most patients who had this side effect also had swelling in the feet and legs (peripheral
edema). The condition resolved or improved when patients stopped taking the drug.
Thiazolidinediones can also cause liver damage. Patients who take these drugs should have
their liver enzymes checked regularly.
ALPHA-GLUCOSIDASE INHIBITORS
Alpha-glucosidase inhibitors, including acarbose (Precose, Glucobay) and miglitol (Glyset),
reduce glucose levels by interfering with the absorption of starch in the small intestine.
Acarbose tends to lower insulin levels after meals, a particular advantage, since higher
levels of insulin after meals are associated with an increased risk for heart disease. Some
evidence suggests that early use of these drugs may reduce heart risk factors, including

high blood pressure. Alpha-glucosidase inhibitors are not as effective alone as other single
oral drugs, but combinations, such as with metformin, insulin, or a sulfonylurea, increase
their effectiveness.
Side Effects. These medications need to be taken with meals. Unfortunately, about a third of
patients stop taking the drug because of flatulence and diarrhea, particularly after highcarbohydrate meals. The drug may also interfere with iron absorption.
Alpha-glucosidase inhibitors do not cause hypoglycemia when used alone, but combinations
with other drugs do. In such cases, it is important that the patient receive a solution that
contains glucose or lactose, not table sugar. This is because acarbose inhibits the breakdown
of complex sugar and starches, which includes table sugar.
GLP-1 INHIBITORS (EXENATIDE)
Incretin mimetics belong to a new class of drugs that help improve blood sugar control.
Incretins include glucagon-like peptide-1 (GLP-1) inhibitors and DDP-4 inhibitors.
In 2005, the FDA approved exenatide (Byetta), the first GLP-1 inhibitor drug. Exenatide is an
injectable drug that is a synthetic version of the hormone found in the saliva of the Gila
monster, a venomous desert lizard. Exenatide is injected twice a day, 1 hour before morning
and evening meals. It is prescribed for patients with type 2 diabetes who have not been able
to control their glucose with metformin or a sulfonylurea drug. It can be taken in
combination with these drugs or alone.
Side Effects. Exenatide stimulates insulin secretion only when blood sugar levels are high
and so has less risk for causing low blood sugar (hypoglycemia) when it is taken alone.
However, the risk for hypoglycemia increases when exenatide is taken along with a
sulfonylurea drug. There does not appear to be a risk for hypoglycemia when exenatide is
used along with metformin. Other side effects may include nausea, vomiting, and diarrhea.
Exenatide has been associated with cases of acute pancreatitis, which is sudden
inflammation of the pancreas. Symptoms of acute pancreatitis include severe abdominal
pain that may radiate to the back. The pain may or may not be accompanied by nausea and
vomiting. Patients who feel severe stomach pain that does not go away should seek prompt
medical attention. In rare cases, exenatide has been associated with hemorrhagic and
necrotizing pancreatitis, which can potentially be life threatening.
DPP-4 INHIBITORS (GLIPTINS)
Dipeptidyl peptidase-4 (DPP-4) inhibitors, also called gliptins, are the second class of incretin
drugs. In October 2006, the FDA approved the first DPP-4 inhibitor. sitagliptin (Januvia). It
can be used alone or in combination with metformin or a thiazolidinedione drug. It may also
be used as add-on therapy to a sulfonylurea drug. In 2007, the FDA approved Janumet,
which combines sitagliptin with metformin in one pill. Other DPP-4 drugs being studied
include vildagliptin (Galvus) and saxagliptin.
DPP-4 inhibitors work in a similar way to GLP-1 inhibitors. However, unlike exenatide, which
is given by injection, DPP-4 inhibitor drugs are taken as pills by mouth.
Like exenatide, DPP-4 inhibitors do not cause weight gain, have low risks for hypoglycemia,
and have few severe side effects. The most common side effects include upper respiratory
tract infection, sore throat, and diarrhea.
PRAMLINTIDE (SYMLIN)
Approved in 2005, pramlintide (Symlin) is a new type of injectable drug that may help
patients who take insulin but still need better blood sugar control. Pramlintide is a synthetic
form of amylin, a hormone that is related to insulin. Pramlintide is used in combination with
insulin to lower blood sugar levels in the 3 hours after meals.
INSULIN REPLACEMENT
Insulin replacement may be necessary when natural insulin reserves are depleted. It is
typically started in combination with an oral drug (usually metformin).

Because type 2 diabetes is progressive, many patients eventually need insulin. However,
when a single oral drug fails to control blood sugar it is not clear whether it is better to add
insulin replacement or a second or third oral drug.
Some doctors advocate using insulin as early as possible for optimal control. However, in
patients who still have insulin reserves, there is concern that extra natural insulin will have
adverse effects. Low blood sugar (hypoglycemia) and weight gain are the main side effects
of insulin therapy. It is still not clear if insulin replacement improves survival rates compared
to oral drugs, notably metformin.
Fortunately, studies to date have not reported any adverse cardiac effects in patients with
type 2 diabetes who take insulin. In fact, insulin has been associated, in some cases, with
improvement in heart risk factors. More research is needed to clarify these important issues.
Forms of Insulin. There are two main insulin types:
Fast-Acting Insulins for Surges. Insulin lispro and aspart are fast-acting insulins. They
mimic insulin's response to food intake. They are taken before meals, and their short action
reduces the risk for hypoglycemia afterward.
Slower Insulins for Base Levels. Intermediate forms (including NPH and lente) and
long-acting forms (glargine, ultralente) were developed to provide a steady level of insulin
throughout the day. To date, glargine (Lantus) seems to be the most successful in achieving
this goal in type 2 diabetes.
In general, there is no advantage to dosing insulin more than two times a day for patients
with type 2 diabetes.

Diabetes diet for Indians should have the ratio of 60:20:20 for carbs, fats and proteins.
The doctor explains, "Per day calorie intake should be between 1,500-1,800 calories with a
proportion of 60:20:20 between carbohydrates, fats and proteins, respectively." He adds
that a diabetes diet should "have at least two seasonal fruits and three vegetables in a diet
plan."
Though dry fruits may seem like a healthy snack, it is not a good option for diabetics, as the
fructose can spike your sugar level. Go for fresh fruits rather than dry fruits for diabetes
control (but there are some restrictions... we'll come to it). But you can still opt for nuts as a
healthy snack.
The doctor shares his recipe for diabetes diet for Indians:
- One teaspoon of methi seeds soaked overnight in 100 ml of water is very effective in
controlling diabetes.
- Drink tomato juice with salt and pepper every morning on an empty stomach.
- Intake of 6 almonds (soaked overnight) is also helpful in keeping a check on diabetes.
Rekha Sharma, President and Director of Indian Dietetic Association, shares some major
diabetes diet pointers that one should follow at home or at a restaurant.
Whole grains, oats, channa atta, millets and other high fibre foods should be
included in the meals. If one feels like consuming pasta or noodles, it should always be
accompanied with vegetable/sprouts.

Milk is the right combination of carbohydrates and proteins and helps control blood sugar
levels. Two servings of milk in a daily diet is a good option.
Diabetes Control: Diabetic Diet Tips
High fibre vegetables such as peas, beans, broccoli and spinach /leafy vegetables should
be included in one's diet. Also, pulses with husk and sprouts are a healthy option and should
be part of the diet.
Pulses are important in the diet as their effect on blood glucose is less than that of most
other carbohydrate containing foods. Vegetables rich in fibre help lowering down the blood
sugar levels and thus are healthy.
Good fats such as Omega-3 and monounsaturated fats (MUFA) should be consumed as
they are good for the body. Natural sources for these are canola oil, flax seed oil, fatty fish
and nuts. These are also low in cholesterol and are trans fat free.
Fruits high in fibre such as papaya, apple, orange, pear and guava should be consumed.
Mangoes, bananas, and grapes contain high sugar; therefore these fruits should be
consumed lesser than the others.
Small frequent meals:
A large meal gives rise to higher blood sugar in one's body, therefore it is essential to take
small frequent meals to prevent both higher and very low blood sugar values and keep them
constant. Small in between snacks can be dhokla, fruit, high fibre cookies, butter milk,
yogurt, upma/poha with vegetables etc.
A person with diabetes should follow a diet which is low in carbohydrates, high in fibre and
contains adequate amounts of proteins, vitamins and minerals; and avoid fatty foods and
sweets. He/she should also take frequent small meals (5 meals pattern).

Millets - Millets or Siruthaniyam varieties are all about today post. I use millets
for a long time though not all the millets that I am going to talk about today but
3-4 millets are very regular and I always keep stock, about that I will talk later in
that post. Millets are not very popular other than Bajra, Jowar and Ragi and in all
the millets Bajra (Pearl Millet) is most popular. Now a days millets are again
gaining it's movement and people bringing more aware of it and today we going
to learn about few millets which we can include in our diet, there are plenty of
other millets too which hopefully I can cover some time soon.
About Millets
Millets are a group of highly variable small-seeded grasses, widely grown around
the world as cereal crops/ grains. Millet is tiny in size and round in shape and
can be white, gray, yellow or red like you can see in pictures. Millets are very
high in their nutrition content. Each millets are three to five times nutritionally
superior to rice and wheat in terms of proteins, minerals and vitamins. Millets
are rich in B vitamins, calcium, iron, potassium, magnesium, zinc, also glutenfree and has low-GI (Glycemic index) thus millets are suitable for people
allergies/intolerance of wheat. Also for diabetic, weight loss millets are excellent.
For thousands of years, millets has been growing such as Pearl millet, Barnyard
millet, Sorghum, Foxtail millet, Little millet, Kodo millet, Proso millet and now ANI
(Millet Network of India) promotes milets as Nutri-cereals instead of Coarse
Cereals. Here some interesting facts about millets other than that they are
gluten-free, highly nutritious, millets need very little water for their production,
short growing period under dry, high temperature conditions and that's why in
India, Africa, Asia millets are more popular. Millets also required rich soils for
growth, no millet attracts any pest hence they have no or low fertilizer usage
and pest-free. I did lot of research to write more about these millets, main
sources are from google, wiki, whfoods.
Millets Types and Name in Different Languages
English

Pearl
Millet

Hindi

Bajra

Tamil

Kambu

Telugu

Sajjalu

Finger
Millet
Nachani,
Mundua,
Mandika,
Marwah
Kezhvarag
u,
Kelvaragu,
Keppai,
Ragi
Ragula,

Foxtail
Millet

Kodo
Millet

Little
Millet

Barnyard
Millet

Sorghu
m

Kangni,
Koden, Kutki, Jhangora,
Kakum,
Jowar
Kodra
Shavan Sanwa
Rala

Thinai

Varagu

Kuthiravali
Saamai (Kuthiraivoll Cholam
y)

Korra

Arikelu,

Sama,

Udalu,

Jonna

Ragi Chodi
Kannada

Sajje

Ragi

Arika
Navane

Malayala Kamba
m
m

Panji Pullu Thina

Marathi

Bajri

Nagli,
Nachni

Punjabi

Bajra

Kang,
Rala

Harka

Samalu Kodisama
Saame,
Oodalu
Save

Jola

Koovarag
Chama Kavadapullu Cholam
u
Sava,
Jowari,
Kodra
Halvi, Jondhal
Vari
a

Mandhuka,

Gujarati

Bajri

Bengali

Bajra

Mandhal
Nagli,
Bavto
Marwa

Kangni

Kodra

Kang

Kodra

Swank
Gajro,
Kuri
Sama

Swank

Jowar
Jowari,
Juar
Jowar

Kaon
Kodo
Shyama
Kanghu,
Oriya
Bajra
Mandia
Kangam, Kodua
Suan
Khira
Juara
Kora
Where to buy and store - Millets are available in Organic shops and also in
some super markets specially in India. Store millet in an airtight container in a
cool, dry and dark place, where it will keep for several months.
Millets Benefits
Millets are rich in B vitamins, calcium, iron, potassium, magnesium, zinc, also
gluten-free
Helps to lower type 2 diabetic and reduces the risk of heart disease
Millets are a great source of starch, making it a high-energy food. It is also an
excellent source of protein and fiber.
Millets are mostly pest-free and low fertilizer used in growth (widely comes in
Organic form)
Millets Recipes - Millets can be cooked as we make rice and serve with dal,
sambar, rasam or any curry of our choice. We can also make various dosa, idli,
upma, pongal, pulao, sweets from millets, they can also be use in baking. I will
post few millets recipe regularly so we can include millets in our diet in more
exciting way.

Millets Nutrition Facts per 100gms

Crop / Protein(
Nutrient
g)

Fat
(g)

Fiber(g)

Minerals
Calcium( Calories
Iron(mg)
(g)
mg)
(kcal)

Pearl Millet

10.6

4.8

1.3

2.3

16.9

38

378

Finger
Millet

7.3

1.5

3.6

2.7

3.9

344

336

Foxtail
Millet

12.3

3.3

2.8

31

473

Kodo Millet

8.3

3.6

2.6

0.5

27

309

Little Millet

7.7

5.2

7.6

1.5

9.3

17

207

Barnyard
Millet

11.2

3.9

10.1

4.4

15.2

11

342

Sorghum

10.4

3.1

1.6

5.4

25

329

Proso Millet

12.5

2.9

2.2

1.9

0.8

14

356

Rice

6.8

2.7

0.2

0.6

0.7

10

362

Wheat

11.8

1.2

1.5

5.3

41

348

Pearl Millet | Bajra | Kambu

Pearl millet is the most widely grown type of millet and India is largest producer
of pearl millet. Pearl millet is a rich source of phosphorus, which plays an
important part in the structure of body cells. Consumption of pearl millets helps
in minimizing the risk of type 2 diabetes. Being a good source of magnesium,
millets act as a cofactor in a number of enzymatic reactions.

Finger Millet | Nachani | Kezhvaragu

Also known as African finger millet, red millet, ragi and very popular millet
specially in Southern India. It is rich in calcium and protein and also have good
amount of iron and other minerals. Ragi tops in antioxidant activity among
common Indian foods, Ragi also has some good number of Essential Amino Acids
(EAA) which are essential for human body.

Foxtail Millet | Kangni | Thinai

Foxtail millets are high in Iron content and these millets are totally pest-free.
Foxtail not only not need any fumigants, but act as anti pest agents to store
delicate pulses such as green gram. They also control blood sugar and
cholesterol levels & increase HDL cholesterol.

Kodo Millet | Kodra | Varagu

Kodo millets contain high amounts of polyphenols, an antioxidant compound,
they also has high on fibre, low on fat. Kodo millet inhibited glycation and crosslinking of collagen. Kodo millets are good for diabetes.

Little Millet | Kutki | Saamai

Little Millets seeds are smaller than other millets, like foxtail millet, little millet
also high in Iron content, high in fibre like Kodo and has high antioxidant activity.
It helps in diabetes and diseases related stomach.

Barnyard Millet | Jhangora | Kuthiravali

Barnyard millets are high in fibre content, phosporous and calcium. Bardyard
has low glycemic index and thus helps in type 2 diabetes, cardiovascular
disease with regular intake of this millet.

Sorghum | Jowar | Cholam

Sorghum is another one of the ancient cereal grain, and grown mostly for their
fodder value. Sorghum has high nutritional value, with high levels of
unsaturated fats, protein, fiber, and minerals like phosphorus, potassium,
calcium, and iron. It's also high in calories and macronutrients, jowar has more

antioxidants than blueberries and pomegranates. Sorghum helps to improve

metabolism.