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Diabetes metformin guidelines

The following guidance is based on the best available evidence. The full guideline gives details of diabetes metformin guidelines the methods and the evidence used to develop the guidance. 1.1 Individualised care.1.1 Adopt an individualised approach to diabetes care that is tailored to the needs and circumstances of adults with type 2 diabetes, taking into account their personal preferences, comorbidities, risks from polypharmacy, and their ability to benefit diabetes metformin guidelines from longterm interventions because of reduced. Such an approach is especially important in the context of multimorbidity. Reassess the person's needs and circumstances at each review and think about whether to stop any medicines that are not effective. New 2015.1.2 Take into account any disabilities, including visual impairment, when planning and delivering care for adults with type 2 diabetes. New 2015.2 Patient education.2.1 Offer structured education to adults with type 2 diabetes and/or their family members or carers (as appropriate) at and around the time of diagnosis, with annual reinforcement and review. Explain to people and their carers that structured education is an integral part of diabetes care. 2009.2.2 Ensure that any structured education programme for adults with type 2 diabetes includes the following components: It is evidence-based, and suits the needs of the person. It has specific aims and learning objectives, diabetes metformin guidelines and supports the person and their family members and carers in developing attitudes, beliefs, knowledge and skills to selfmanage diabetes. It has a structured curriculum that is theorydriven, evidencebased and resourceeffective, has supporting materials, and is written down. It is delivered by trained educators who have an understanding of educational theory appropriate to the age and needs of the person, and who are trained and competent to deliver the principles and content of the programme. It is quality diabetes metformin guidelines assured, and reviewed by trained, competent, independent assessors who measure it against criteria that ensure consistency. The outcomes are audited regularly. 2015.2.3 Ensure the patient-education programme provides the necessary resources to support the educators, and that educators are properly trained and given time to develop and maintain their skills. 2009.2.4 Offer group education programmes as the preferred option. Provide an alternative of equal standard for a person unable or unwilling to participate in group education. 2009.2.5 Ensure that the patient-education programmes available meet the cultural, linguistic, cognitive and literacy needs within the local area. 2009.2.6 Ensure that all members of the diabetes healthcare team are familiar with the patienteducation programmes available locally, that these programmes are integrated with the rest of the care pathway, and that adults with type 2 diabetes and their family members or carers (as appropriate). 2009.3 Dietary advice.3.1 Provide individualised and ongoing nutritional advice from a healthcare professional with specific expertise and competencies in nutrition. 2009.3.2 Provide dietary advice in a form sensitive diabetes metformin guidelines to the person's needs, culture and beliefs, being sensitive to their willingness to change and the effects on their quality of life. 2009.3.3 Emphasise advice on healthy balanced eating that is applicable to the general population when providing advice to adults with type 2 diabetes. Encourage highfibre, lowglycaemicindex sources of carbohydrate in the diet, such as fruit, vegetables, wholegrains and pulses; include lowfat dairy products and oily fish; and control the intake of foods containing saturated and trans fatty acids. 2009.3.4 Integrate dietary advice with a personalised diabetes management plan, including other aspects of lifestyle modification, such as increasing physical activity and losing weight. 2009.3.5 For adults with type 2 diabetes who are overweight, set an initial body weight loss target of 510. Remember that lesser degrees of weight loss may still be of benefit, and that larger degrees of weight loss in the longer term will have advantageous metabolic impact.

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Metformin and aging

Tech Science, aging diabetes, in a slew of recent flashy endeavors, scientists, academics and exceptionally rich people have metformin and aging taken on the aging process. In 2013, Google launched. Calico, its billion-dollar anti-aging research and development arm, which the following year formed a partnership with pharmaceutical giant AbbVie. Meanwhile, another major drug company, Novartis, is developing a patentable form of rapamycina biological agent discovered in the soil on Easter Islandwhich has been shown to boost immune function, and the company hopes it could become the first viable anti-aging pill. But, according. Nir Barzilai, a scientist based in the Albert Einstein College of Medicine in New York Citys Bronx borough, we might already have the drug we need to slow the aging processand its dirt cheap. Metformin is an old, generic diabetes drug, known for its blood sugarlowering properties and for being quite safe. Its common, and it costs about 35 cents per pill. It has also been found to stall the aging process in animal studies. In June, Barzilai, along with academics from metformin and aging the not-for-profit American Federation for Aging Research (afar approached the Food and Drug Administration with an idea: the Targeting Aging With Metformin (tame) study, to see if metformin could do for humans what it does for animals. It would be the first clinical trial to test if a drug could slow human aging. The FDA said yes, and since that June meeting the media has exploded with excitement over the purported fountain of youth drug, with rumors that it could extend human life span metformin and aging up to 120 years. The problem, though, is that no one has agreed to front the capital required to get tame off the ground. Thats not surprising: There are plenty of reasons Big Pharma wont fund a study that would make a cheaply available, common drug the must-have for the 21st century. Pharmaceutical companies spend big metformin and aging money on drug research and development to bring products to market because they get several years of exclusive marketing rights for any new drug. This guaranteed temporary monopoly in the drug market can be a massive windfall. A pharma company could test generic metformin in clinical trials, get it approved and market it for something other than diabetesand that company would be the only one allowed to do so during the patent period. Companies repurpose drugs all the time.

Metformin dosage

Medically reviewed on January 15, 2018. Applies to the following strengths: 500 metformin dosage mg; metformin dosage 750 mg; 850 mg; 1000 mg; 500 mg/5. Usual Adult Dose for: Usual Pediatric Dose for: Additional dosage information: Usual Adult Dose for Diabetes Type. Immediate-release : Initial dose: 500 mg orally twice a day or 850 mg orally once a day. Dose titration: Increase in 500 mg weekly increments or 850 mg every 2 weeks as tolerated. Maintenance dose: 2000 mg daily in divided doses. Maximum dose: 2550 mg/day, extended-release : Initial dose: 500 to 1000 mg orally once a day. Dose titration: Increase in 500 mg weekly increments as tolerated. Maintenance dose: 2000 mg daily, maximum dose: 2500 mg daily, comments: -Metformin, if not contraindicated, is the preferred initial pharmacologic agent for treatment of type 2 diabetes mellitus. Immediate-release: metformin dosage Take in divided doses 2 to 3 times a day with meals; titrate slowly to minimize gastrointestinal side effects. In general, significant responses are not observed with doses less than 1500 mg/day. Extended-release: Take with the evening meal; if glycemic control is not achieved with 2000 mg once a day, may consider 1000 mg of extended-release product twice a day; if glycemic control is still not achieve, may switch to immediate-release product. Use: To improve glycemic control in adults with type 2 diabetes mellitus as an adjunct to diet and exercise. Usual Pediatric Dose for Diabetes Type 2 10 years or older : Immediate-release: Initial dose: 500 mg orally twice a day. Maintenance dose: 2000 mg daily, maximum dose: 2000 mg daily, comments: Take in divided doses 2 to 3 times a day with meals. Titrate slowly to minimize gastrointestinal side effects. Safety and effectiveness of metformin extended-release has not been established in pediatric patients less than 18 years of age. Use: To improve glycemic control in children with type 2 diabetes mellitus as an adjunct to diet and exercise. Obtain eGFR prior to initiating therapy : -eGFR less than 30 mL/min/1.73 m2: Use is contraindicated -eGFR 30 to 45 mL/min/1.73 m2: Initiating therapy is not recommended -eGFR that falls below 30 mL/min/1.73 m2 during therapy: Discontinue therapy -eGFR that falls below 45 mL/min/1.73. Iodinated contrast procedure : -For patients with eGFR between 30 and 60 mL/min/1.73 m2: Stop this drug at the time of, or before imaging procedure; re-evaluate eGFR 48 hours after procedure; restart therapy only if renal function is stable. Liver Dose Adjustments, not recommended in patients with liver impairment. Dose Adjustments -Elderly, debilitated, and malnourished patients: Titration to the maximum dose is generally not recommended. Concomitant Insulin therapy: When initiating treatment in patients currently receiving insulin, metformin should be started at 500 mg orally once a day and titrated in 500 mg increments weekly. When fasting blood glucose levels decrease to less than 120 mg/dL, consider decreasing the insulin dose by 10. Therapeutic drug monitoring/range: Steady-state plasma concentrations are achieved within 24 to 48 hours and are generally less than 1 mcg/mL. Metformin levels greater than 5 mcg/mL have been implicated as the cause of lactic acidosis. Precautions US boxed warning: lactic acidosis -Postmarketing case of metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias. The onset is often subtle, accompanied only by nonspecific symptoms such as malaise, myalgias, respiratory distress, somnolence, and abdominal pain. Metformin-associated lactic acidosis has been characterized by elevated blood lactate levels (greater than 5 mmol/L) anion gap acidosis (without evidence of ketonuria metformin dosage or ketonemia an increased lactate/pyruvate ratio, and metformin plasma levels generally greater than 5 mcg/mL. Risk factors for metformin-associated lactic acidosis include with renal impairment, concomitant use of certain drugs (e.g., carbonic anhydrase inhibitors such as topiramate age 65 years old or greater, having a radiological study with contrast, surgery, and other procedures, hypoxic states (e.g., acute congestive heart failure.

Metformin

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Metformin dose for pcos

29.12.2016

Kävimme parisen viikkoa sitten pelaamassa ystäviemme kanssa pakohuonepeliä. Pelissä oli tarkoituksena ratkaista yhdessä erilaisia tehtäviä ja arvoituksia. Näitä ratkomalla oli mahdollisuus siirtyä pelissä eteenpäin ja selvitä pois huoneesta. Selvitä pois huoneista helpottuneena ja iloisena onnistumisesta. Vuosi 2016 oli minun elämäni oikea pakohuonepeli. Arjen todellinen Escape Room. Escape Room, josta en olisi todellakaan selvinnyt ulos yksin. Tämän pakohuoneen käsikirjoitus meni suunnilleen näin.

Istut maton päällä ja leikit tyttäresi kanssa. Leikissä Sylvanian Families perheen suklaapupu-Isillä on oma koti. Kodissa on uuni ja paistinpannu. Kodissa on surullinen suklaapupu-Isi. Isi, joka lopettaa leikin. Pakkaa urheiluvarusteensa Ikean siniseen kassiin. Antaa ison pusun ja sulkee oven perässään. Sinne oven taakse sulkeutui myös kaikki haaveet ja suunnitelmat tulevaisuudesta. Mielessä pyörii pakohuonepelin ensimmäinen arvoitus: Miten h######ä minä tästä selviän? Miten rakennan kaikki palaset taas aivan alusta? Ensimmäisestä huoneesta selviytymiseen on kysyttävä apua. Apua ihmiselle, jonka tunnekäsittelytaidot olivat ihan puhdas nolla. Nollalla alkoi myös psykiatrin ja psykoterapeutin puhelinnumerot.

Seuraavaan huoneeseen siirrytäessä onkin jo lumet sulaneet. Huoneessa on 30 neliötä. Huoneessa on eriväriset verhot ikkunoissa. Huoneessa on pieni keittiönurkkaus. Keittiönurkkauksen edessä on pieni taso. Taso, josta on hyvä hypätä pellehyppyjä sänkyyn. Pieni pellehyppääjä tekee pomppujaan ja nauramme. Nauramme yhdessä. Nauramme yhdessä, mutta yksin ei vielä naurata. Onneksi huoneessa on myös langaton bluetooth-kaiutin ja televisio. Tämän huoneen idea olikin opettaa pelaaja olemaan myös yksin. Yksin omien ajatustensa kanssa. Rakentaa pelaajasta vahva ja omilla jaloillaan seisova ihminen. Mielessä pyörii pakohuonepelin toinen arvoitus: Kuinka kauan ihminen elää pähkinöillä ja proteiinijuomilla? Oli kysyttävä apua läheisiltä ja kavereilta. Kavereilta, jotka olivat tukena ja veivät rokkifestivaaleille auringonpaisteeseen. Halasivat ja kuiskasivat korvaan: ” Sulla on kaikki hyvin. Jätkä on jo paljon paremmassa iskussa!”

Kolmas huone. Arki ja syksy. Kolmanteen huoneeseen siirryttäessä taustalle syttyy kirkasvalolamppu ja jalkaan on laitettava kumisaappaat. Kolmannessa huoneessa vuorokaudessa on noin kuusi tuntia valoisaa aikaa. Kolmannessa huoneessa sinut laitetaan myös töihin. Töihin työpaikkaan, jossa sinulla on todella hyvä olla. Työpaikkaan, jossa sinua pitävät virkeänä reilut kaksikymmentä iloista pientä ihmistä. Kotona sinua pitää virkeänä yksi pieni ihminen. Pieni ihminen, jonka kanssa ratkotte yhdessä erilaisia eskarivihosta löytyviä tehtäviä ja arvoituksia. Yhteinen sävel alkaa löytymään ja kolmannen huoneen idea olikin: Kuinka oppia hoitamaan uudenlainen vanhemmuus niin hyvin kuin mahdollista? Mielessä pyörii pakohuonepelin kolmas arvoitus: Haluaisin oman turvallisen kotisataman. Kuinka minulla koskaan on varaa ostaa asunto tästä kaupungista? Oli kysyttävä apua henkilökohtaiselta pankkineuvojalta. Pankin tarjoama kova hedelmäkaramelli suussa saan myöntävän lainahakemuksen. Puraisen kieleen, mutta selviän neljänteen huoneeseen.

Neljäs huone. Huone muodostuu kahdesta pienestä tilasta. Tilassa on kaikki uutta. On vaalea parketti ja kylpyhuoneessa led-valot. On pieni keittiönurkkaus ja pienelle ihmiselle suunniteltu salakaappi. Huoneet ovat täysin tyhjiä. Huoneisiin tulee rakentaa uusi elämä. Uusi elämä, jossa pelaajalla on hyvä olla. Pelaajalla, joka heilahti pois pelikentältään. Meni rajojen ulkopuolelle. Irtosi omalta pelipaikaltaan. Pelasi elämänsä vaikeimman kauden. Pieni ja muutama isompi pelaaja palauttivat tämän pelimiehen takaisin elämän parrasvaloihin. Tulevilla kausilla tämä pelaaja taas nauttii onnistumisista. Laulaa ja tanssii, mutta sisustaa ensimmäisenä. Mielessä pyöriikin neljännen huoneen arvoitus: Kuinka ihminen voi kävellä Ikeasta ulos ostamatta mitään?

Jään mielelläni tuonne neljänteen huoneeseen. Suurella mielenkiinnolla odotan minkälaisia arvoituksia tämä Escape Room vielä tuo tullessaan?

-Esko-

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