This blog tracks updates to the Blood Sugar 101 Web site.

Tuesday, December 19, 2017

Generic repaglinide may act much more slowly than Prandin, making hypos more likely

Page Changed: Glipizide, Glyburide, Repaglinide etc: Drugs that Stimulate Insulin Secretion

Added text:

Generic Repaglinide May Not Have the Same Speed of Action as Name Brand Prandin

By using a FreeStyle Libre Flash Glucose Monitor, I was able to see exactly how repaglinide works for me, and discovered that it appears to activate much more slowly than the brand name Prandin version that I used to use before the drug was available as a generic. My pharmacist confirms this is likely. If your insurance will let your doctor prescribe the name brand version, use it. Otherwise, you may have to take repaglinide 1 to 2 hours before eating to get it to lower the peak caused by a meal. If you take it at meal time, as directed by the label, you may get a peak one hour after eating, followed by a potentially serious low an hour or two later. The branded version can be taken at mealtimes and peaks at 1 hour after it is taken.

Friday, December 15, 2017

A Link to the Ongoing Reivew of the FreeStyle Libre CGM Added to Main Site

Page Added: Testing the FreeStyle Libre Flash Glucose Monitor

Text Added:
I am reporting on my trial of the FreeStyle Libre Flash Glucose Monitoring System that Abbott, the manufacturer, sent me for review. Disclosure: I received the $70 reader and two $40 sensors for free. I have subsequently filled a prescription and paid for three more sensors myself.

To read my reports in sequence, visit this blog page:

When my trial concludes I will write up a page about this extremely useful device, which I think could revolutionize the way that people with Type 2 Diabetes use the Test, Test, Test Strategy for acheiving normal blood sugars.

Wednesday, October 18, 2017

New Fast Acting Insulin Fiasp and new GLP-1 Agonist Semaglutide Mentioned in Relevant Web Pages

Pages changed: GLP-Agonists and Insulin for Type 2 Diabetes

Brief mention made of the upcoming approval of semaglutide, the first GLP-1 agonist in pill form and of Fiasp, a new fast-acting insulin which is similar to Apidra in that it can be injected just after eating and still be effective.

Thursday, May 25, 2017

Link Added to Gary Scheiner's Review on the Afrezza Page of Blood Sugar 101

Page Changed: Inhaled Insulin: Afrezza

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A review of Afrezza written by Gary Scheiner, a Certified Diabetes Educator whose book I have often recommended, came out in May of 2017 and may be helpful to people considering trying this insulin. I trust Scheiner a lot more than I do random people tweeting, who may or may not be on the payroll of the company making this stuff. You can read his review in his newsletter, HERE. Unfortunately, there is still no one with this kind of preexisting credibility in the online diabetes community reporting on their use of Afrezza for Type 2 Diabetes. This may simply be because doctors are so resistant to prescribing fast acting insulin to people with Type 2 diabetes.

Tuesday, May 16, 2017

FDA Puts Warning of Doubled Risk of Amputation on Invokana Label

Page changed:  SGLT2 Inhibitors, Farxiga, Invokana, Jardiance.Dangerous New Drugs
Note: "Questionable" has been changed to "Dangerous in this page title.

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Doubled Risk of Lower Limb Amputations

On May 16, 2017 the FDA ordered that a black box warning be added to the prescribing information for Invokana saying that it doubled the risk of experiencing an amputation. You can read the report about this very important warning in this Medscape news bulletin.

Monday, February 13, 2017

EMA Orders SGLT-2 Drug Labels to Warn of Increased Risk of Lower Limb Amputations

Page Changed: SGLT2 Inhibitors, Farxiga, Invokana, Jardiance. Questionable New Drugs

Added Text: 

Increased Risk of Lower Limb Amputations

As reported on Medscape The European Medicines Agency (EMA) which is the European equivalent of the FDA announced on February 10, 2017 that a warning stating that the sodium glucose cotransporter 2 (SGLT2) inhibitors for type 2 diabetes may increase the risk for lower-limb amputation should be included in the prescribing information for all drugs in this class.

In Medscape's words, "The warning from EMA's Pharmacovigilance Risk Assessment Committee (PRAC) issued today cites data from two ongoing clinical trials with canagliflozin (Invokana, Vokanamet, Janssen) in patients at high risk for cardiovascular events, Canagliflozin Cardiovascular Assessment Study (CANVAS) and a related study of renal end points, CANVAS-R."

Quoting the EMA the article points out that "In a 4.5-year interim analysis of CANVAS, the independent monitoring committee for the trial found that the rate of amputations per every 1000 patients was equivalent to seven for 100 mg/day and five for 300 mg/day of canagliflozin compared with three per 1000 patients taking placebo. Most of the amputations were of toes." Note that this means that there were from one and two thirds more to more than twice as many amputations in the group taking the drug as occurred in the placebo group.

As you can see if you read the comments to the Medscape new release, some people claiming to be doctors and a pharmacist immediately argued that this was because the patients given the SGLT-2 inhibitors were sicker and more likely to have amputations. People posting comments on Medscape are not required to reveal if they are on the payroll of the companies who are earning several billion dollars a year selling these heavily advertised new drugs. Nor are they required to validate their identity, so any employee of a drug company could post these comments using a made up doctor's name.

Lest you be swayed by their arguments against believing the EMA's experts, note that this data was from a controlled study. This means that both the group taking the drug and the group taking a placebo were matched for characteristics which would have included their blood sugars, age, and time since diagnosis. Since the groups had the same characteristics, the higher rate of amputations is very likely to be a result of something the drug does to the blood supply of the toes. The EMA doesn't lightly decide to add a serious warning to the label of a drug.

New Brazilian Portuguese version of the "How To Lower Your Blood Sugar" Flyer uploaded

Page Changed: How to Lower Your Blood Sugar

Added a link to a Brazilian Portuguese translation of the flyer.
The PDF can be downloaded here: .