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ADA Moderator : Welcome to ADA Live!

Today our guests are Brian Marien, R.Ph., BPharm., a pharmacy manager at Rite Aid Pharmacy in Cranberry Twp, PA and a Medication Therapy Management pharmacist at Rite Aid Pharmacy in Shaler, PA. and Lorena Brandl, R.Ph., PharmD., a Drug Information Specialist at the Rite Aid Drug Information Center.

It's a pleasure to have you here today Brian and Lorena!.

Brian and Lorena: Thanks Bob, great to be here, lots of questions already.

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ellenwood ga: I had gestational diabetes but was never tested again after her birth. I think i may still have it. I need to know what the normal range for sugar is in the morning before a meal and what the normal range for it is after a meal. I want to test myself on my monitor at home btu need to know when to test and what lvls are normal. I used to test when i got up and 2 hours after a meal. they then told me any thing over 70 in the morning was high and nything over 119 was high 2 hours after eating will this still be the #'s and testing times to follow?

Brian and Lorena: There is an increased risk for a mother who experienced gestantional diabetes, to develop type 2 diabetes. It would be appropriate for you to contact your physician and do definitive testing. As for the numbers, fasting and post-prandial goals are usually tighter in gestational diabetes. The goals for non-pregnant Type 2 diabetics is fasting <110 mg/dl, and 2 hr post prandial <140 mg/dl.

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Madison, Ga.: Does the A1C have to stay consistant throughout the day?

Brian and Lorena: Hemoglobin Alc is not a test one uses to monitor daily flucuations in blood glucose. An Alc is used by your physician to get an idea what your long term control of blood glucose has been (over the past 2-3 months). An Alc of 6.5% is considered to be the preferred goal for diabetics. Blood glucose is going to fluctuate during the day. When a person fasts (before meals) the readings will be at one level and when he/she eats (post prandial) the blood glucose will rise. This flucuation occurs in all people, even those without diabetes.

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carlstadt nj: can i continue to take my vitamins and chromium picolinate supplements with my diabetic oral medication Glucophage? Also what about tylenol? THANKS

Brian and Lorena: Unlike pharmaceuticals, "natural" products are not required to undergo the FDA (Food and Drug Administration) approval process to demonstrate their safety and effectiveness. The FDA only regulates the package labeling, prohibiting a product from making claims that it is intended to diagnose, treat, cure, or prevent a disease. Taking chromium picolinate and Glucophage can lead to hypoglycemia(low blood sugar). We suggest contacting the physician to determine if chromium is an appropriate supplement for you. Tylenol or acetaminophen does not interact with Glucophage. Vitamins are typically safe with Glucophage however, it depends on the particular ingredients. Vitamins often time have added herbal supplements in their content and could possibly interact with the medication or the disease itself. Check with your local pharmacist to determine if the ingredients in your particular brand vitamins have added ingredients which may interact.

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Belleville, IL: My doctor put me on Metformin 500mg twice a day. I've been on this medicine for a week now. The morning dose is okay, but the evening dose I feel ill about 1 hour after taking it and have stomach cramps, very nausous (to the point of almost but haven't yet thrown up) and diahrea. By morning I'm fine and it starts over again (feeling kind of ill in the morning but becoming rather ill in the evening). Is this common with this mediation or should I talk to my doctor.

Brian and Lorena: Yes this is a common adverse reaction, with metformin. You should discuss this with the physician. Take metformin with meals, in the morning and in the evening. Also there is an extended release form of the drug, metformin XR, that tends to help with the stomach upset and diarrhea. You can discuss with your doctor about getting a possible prescription for this form of metformin.

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las vegas nv: I take 2000mg of medforum (spelling wrong)2 pills with breakfast and 2 pills with dinner My Blood sugar level is fine before lunch and before dinner - however it is between 135 - 145 first thing in the morning. every morning. Why?

Brian and Lorena: I have two possible ideas, and increase SMBG (self monitoring blood glucose) with your glucometer is needed. First possibility--what is your food consumption in the evening? People that binge in the evenings or especially late night, may have high readings in the morning. Test blood sugar in the evening and at bedtime. Readings should generally be around 140 mg/dl at bedtime to have reasonable blood glucose readings at the morning fast. If the first senario doesn't fit then it might be a situation where your blood glucose is actually falling to low at night, and your liver is converting stored glycogen to blood glucose to correct the hypoglycemia, which results in hyperglycemia in the morning. There is actually a name for this phenomenon--it is called the Somogyi effect or Somogyi rebound. This is caused by hyperinsulinemia. Since most Type 2 diabetics have insulin resistance and high blood insulin levels, this is a real possibility. At night, waking with a night sweat (perhaps combined with a rapid heart beat) is a symptom of the adrenaline and rebound. It might be inconvenient, but one needs to increase the frequency of checking the blood glucose with the glucometer. Again check at bedtime, but also check at different times during the night. Check on different nights, blood glucose readings, 2 hours after bedtime, 4 hours after bedtime, and 6 hours after bedtime. If these levels are falling low during the night this might be the problem. Make sure you keep accurate logs of these readings. If the second senario bears out, take your blood glucose readings/findings to your doctor--these will aide him/her in correcting your condition.

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GUIN, AL: MY DOCTOR STARTED ME ON SYMILIN LAST WEEK, HOW DO MOST PATIENTS USE THIS AND ARE YOU GETTING GOOD RESULTS?

Brian and Lorena: Symlin, is a fairly new diabetes drug and is given by injection. It is a good agent to use in those individuals who are having trouble controlling high blood glucose levels after meals. Below are the listed indications for Symlin as given by the manufacturer. In the type I diabetic patient it is used as an adjunct therapy, in those patients who use mealtime insulin therapy, and who have failed to achieve desired blood glucose control, even with optimal insulin therapy. Type 2 diabetes, as an adjunct treatment in patients who use mealtime insulin therapy and who have failed to achieve desired glucose control despite optimal insulin therapy, with or without a concurrent sulfonylurea agent and/or metformin. The dose is 15 mcg to 60mcg injected subcutaneously immediately prior to each major meal. When Symlin is prescribed, the insulin will need to be adjusted during meal time. Follow the physician's orders on these adjustments very carefully.

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freehold nj: My freind has diabetes we went out for a bike ride when we returned she felt faint and lost her vision for about one minute she vomitted and then felt very cold. I called paramedics they said it might be due to low blood sugar. If her sugar is 270-300 on a daily basis could the excersize have brought it down that low?

Brian and Lorena: Strenuous exercise can result in hypoglycemia, especially if one is not eating before and preparing for the exercise. Individuals with diabetes have an impaired ability to regulate blood glucose levels. Diabetics have to actively control their disease, through proper diet, exercise and if needed medications. Your friend should recognize the importance of testing before exercise and the importance of recognizing and treating the signs and symptoms of hypoglycemia.

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leavenworth, ks: can type 2 diabetes be cured? does it ever go away?

Brian and Lorena: At this point in time there is no cure for diabetes either Type 1 or Type 2: it does not go away. However it can be successfully managed

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St. Augustine, Florida: I have had type 2 diabetes since 2001. I am currently on a weight loss program and have lost 40+ pounds. I was taking 70 units(35 units twice a day)of Humlin 70/30 daily but have had that reduced to 24 units daily. If my weight loss continues as planned is there the possibility of completly being rid of daily insulin injections and is there the possibility of my type 2 diabetes going away forever?

Brian and Lorena: Congratulations on the weight loss. It is not uncommon for insulin requirements to come down as weight is lost. That is why meal planning and exercise are the foundations for successful diabetes management. Since each individual's clinical situation is unique, we are unable to make a conclusion regarding your long term insulin regimen or disease state. Much of the reduction that you have seen in the insulin dosage, can be related to the condition of insulin resistance. People that are overweight/obese, do not use the insulin that is being produced/injected, properly. So as the weight drops the body is better able to utilize the insulin. However that is only the problem with insulin resistance. People as a whole will have a decreasing amount of insulin being produced by the pancreas. The pancreas of individuals with type 2 diabetes, loses insulin production even more quickly.

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LEMON GROVE, CA: CAN I FAST (RELIGIOUS) FOR TWO DAYS, I AM TYPE 2

Brian and Lorena: This is something that needs to be addressed with your doctor before the religious fast arrives. Consistent meal planning both in terms of frequency and content are cornerstones of successful diabetes management. Many factors would need to be evaluated for this decision, primarily your clinical status. Fasting solely from the aspect of diabetes management is typically not recommended. Please talk with your physician and he/she can better evaluate your risks associated with your religious practice.

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Kingston, Ma: I was recently told that I had type 2 diabetes and had a reading of 6.2 on my fasting A1c and a reading of 120 on glocose. I am confused as to why I was told I have type 2. I was told by medical people that they look for a number of 5.8 on the A1c and a number under 100 on glocose.This does not seem to corrilate with the ADA numbers. Please help me to understand what is going on and am I being overreactive. Thank you

Brian and Lorena: A person who does not have diabetes will have an A1C of around 5%. Hemoglobin A1C levels less than 7% are beneficial to people with diabetes because they have been associated with decreased rates of long term complications such as eye problems (retinopathy), kidney problems (nephropathy), and nerve problems (neuropathy). In general, the recommended goal for a non-pregnant patient with diabetes is an A1C less than 7%. (The A1C goal for an individual patient may be an A1C as close to normal (<6%) as possible without significant hypoglycemia.) However, this goal may vary from person to person. Hemoglobin A1C level estimates your average blood glucose level over the past 2-3 months. Some physicians do require a tight control on blood glucose levels to avoid long term complications as mentioned above. We suggest you speak to the physician to discuss your concerns regarding your particular goals.

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Muscle Shoals, AL: What is normal fasting blood sugar level and what is normal level after eating?

Brian and Lorena: A normal fasting blood sugar is <100 mg/dl. A normal level after eating (2 hour post prandial) is <140 mg/dl.

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al: i was recently diagnosed with type 2. My question is my sugar reading was 427 went to the doctor the next morning put on pills for sugar. Reading 2nd day after medication is still staying in 342 range. Does it take days to get medication in system. Also i stop eating sugar. Do i need to call doctor and tell him my readings?

Brian and Lorena: The readings are still high. Please call your physician and ask how soon he would like to see your reading at goal (fasting<130 mg/dl, 2 hour after meal<180 mg/dl). Also proper meal plan has a significant impact on your sugar readings. Ask your physician, for a possible referral to a dietician.

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Chicago, Il: At what level is blood sugar to high. Any level above 150 / 200 / 250? At what continued high level will it cause damage to eyes and other organs? Thanks

Brian and Lorena: The ADA recommends a fasting goal of <130 mg/dl and an after meal goal (2 hour post prandial) of <180 mg/dl. ACE (American College of Endrocrinology) guidelines are even tighter with <110mg/dl and <140 mg/dl respectively. These are the guidelines that one is recommended to use. By following tight control of blood glucose levels, one can delay the progression of the disease and the result of organ damage.

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Union City, Georgia: I register a blood sugar of 108 at fasting in the morning. However, after a big meal, 30 minutes or so, I register a blood sugar of 269. Do I have diabetes? Edith Johnson

Brian and Lorena: In order to diagnose diabetes the doctor must complete a blood test, either a fasting plasma glucose test or an oral glucose tolerance test. The results will determine if you have pre-diabetes, diabetes, or are normal. The fasting plasma glucose test measures the blood glucose level first thing in the morning after a person does not eat (fasts) overnight. The fasting plasma glucose test defines pre-diabetes as blood glucose levels between 100 and 125 mg/dl and diabetes as blood glucose levels at 126mg/dl or above. The normal fasting blood glucose level would be less than 100 mg/dl. The oral glucose tolerance test measures blood glucose levels first thing in the morning after a person fasts and then again 2 hours after the person ingests a drink that contains glucose. With this test, pre-diabetes is defined as the 2-hour blood glucose level between 140 and 199 mg/dl and diabetes as the 2-hour blood glucose level at 200mg/dl or above. The normal 2 hour blood glucose level would be less than 140 mg/dl.

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Augusta, GA: Blood Sugar What is normal? In what range should I try to keep my blood sugar count on my Diabetes Monitoring Kit? At what level is considered unhealthy? I have just been diagnosed 2 days ago I know nothing and I am 58 Years old. Active type person

Brian and Lorena: According to the American Diabetes Association (ADA) the before meals levels should be 90 - 130 mg/dl (5.0-7.2 mmol/l) (plasma/serum blood glucose reading) The peak after a meal (1-2 hours after the start of a meal) should be less than 180 mg/dl (less than 10 mmol/l)(plasma/serum blood glucose reading). The new general blood glucose level guidelines according to the American College of Endocrinology (ACE) are stricter than the ADA guidelines and include: Before breakfast in the morning ? Less than 110 mg/dl (less than 6.1 mmol/l)--(plasma/serum blood glucose reading) Two hours after eating a meal - Less than 140 mg/dl (less than 7.8 mmol/l)--(plasma/serum blood glucose reading). Talk with your physician and with the aide of your community pharmacist, set up a blood glucose monitoring program. They will explain to you the importance of keeping a log of your meal plan along with results of your blood glucose monitoring. Also contact your local hospital. They often have educational programs on diabetes and can explain what the disease is and how best to manage the disease. Some Rite Aid pharmacists are trained Diabetes Specialists. You may call the local Rite Aid store in your area to locate a pharmacist that is trained in discussing your diabetes management.

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viersen germany: my husband tested with a portable machine that picks your finger then gives a reading. It said 133 on the machine. But there was no info. He was dizzy this morning and complained of tunnnel or unclear vision I gave him some candy and then he laif down he turned sort of pale and said he had a real bad headache. So I went to the pharmacist and got this tester. I suspected diabietes because his mother and grandma have it. But what does 133 mean? The pharmiscist only said anything above 110 was high.

Brian and Lorena: What the pharmacist meant was that a fasting blood glucose (before meals) above 110, according to ACE (American College of Endocrinology)guidelines is high. Was the 133 reading taken first thing in the morning or 2 hours after a meal? If it was discovered 2 hours after a meal then it would not be considered a high blood glucose level. I would strongly suggest that your husband see a physician and for an evaluation of his symptoms. If the diagonis of diabetes mellitus is made, then the physician, along with your pharmacist and a dietician, can explain best how to manage the disease through proper meal plan, blood glucose monitoring, exercise and if needed medication.

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lansdale,pa: I am a 66 year old male who was recently diagnosed with type 2 diabetes. I take insulin four times per day and my glucose readings are almost always in the 90-130 range desired by my doctor. I take fast acting insulin before meals and long lasting lantus (50 units) before bed. Every morning about 3-4 AM. I am awakened with extremely painful cramps and/or muscle spasms in the back of my thighs. These end my sleep for the night. During the day I have mild pain in the back of my legs. How can I get relief from these cramps that are about a level 9 on a scale of 1 to 10? I have heard others complain of similar conditions.

Brian and Lorena: Has this condition been relayed to your physician for his/her evaluation? You need to do this, so he/she can rule out different conditions. Are you on any other medications for other conditions such as high cholesterol. Often times, physicians will aggresively treat high lipid levels with individuals with diabetes. "Statins" (a class of medications such as simvastatin or atorvastatin) are most often used for the treatment of high cholesterol. These medications may cause leg or muscle cramps. We would suggest that you contact your physician about your symptoms for an evaluation.

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Woodbridge, Virginia: I'm recently diagnosed type II, I went to a college football game this weekend and upon arrival became aware that there was nothing that I could eat at the game for lunch. I was anxious because it was time to eat and I had to take my meds. We arrived at 1:30 and the post game activities were over by 7 pm... too long a time to go without eating and meds. How could I have been better prepared for this situation. Tricia

Brian and Lorena: You are correct in realizing the importance of meals and meal planning in the management of your disease. Being consistent is of upmost importance in the management of a chronic disease. It is best for you to set up a reliable meal plan in terms of both frequency and content. This is particularly important if one is taking oral hypoglycemic medications that stimulate the release of insulin from the pancreas. It is good to be consistent with your food intake and medication regimen, so you will keep blood glucoses in the normal range without falling too low. A well planned breakfast, lunch, dinner and snack at bedtime is vital in good blood glucose management. If you are unable to eat your meals at home on occasion, it is best to prepare ahead by taking a small snack with you, such as peanut butter crackers, or one of the commercial products such as Glucerna bars. Remember meals raise blood glucose and medications lower blood glucose. Careful meal planning is essential in keeping them in balance.

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conyers,ga: all of a suuden i feel extremly weak and feel as if ia goin to pass out,is my sugar high or low?

Brian and Lorena: When the blood sugar level drops below 70 mg/dl it is defined as hypoglycemia. Symptoms of hypoglycemia include shakiness, dizziness, inability to concentrate, headache, sweating, hunger, fast or pounding heart, fatigue, paleness, weakness, fainting, sudden moodiness or behavior changes, tingling sensations around the mouth, clumsy or jerky movements, and poor or blurred vision. Symptoms of hyperglycemia (high blood sugar levels) include confusion, drowsiness, rapid breathing, fruity breath odor, increased urination, unusual thirst, low blood pressure, high levels of sugar in the urine, blurred vision, fatigue, headache, nausea, difficulty concentrating, or changes in mental status.

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Concord,CA: Is there a study to show that Chromium or Fenugreek has any effect on blood sugar control? If it is true,then what is the dosage for diabetic,who does not take any drugs?

Brian and Lorena: Unlike pharmaceuticals, "natural" products are not required to undergo the FDA (Food and Drug Administration) approval process to demonstrate their safety and effectiveness. The FDA only regulates the package labeling, prohibiting a product from making claims that it is intended to diagnose, treat, cure, or prevent a disease. There is insufficient reliable information available to rate the effectiveness of fenugreek for the use in diabetes or in lowering blood glucose levels. There is some evidence that chromium picolinate can lower fasting blood glucose levels. We recommend contacting the physician to determine if these supplements are appropriate for you.

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Warangal: patient with sulfa drug sensitivity ,can we give sulfanyl urea anti daibetic drug ? a daibetic patient already on Ace inhibitor/Arb anti hipertensive drug can we check micro albumini urea ?

Brian and Lorena: It is suggested to use caution when giving a sulfonylurea medication to a person with a known sulfonamide hypersensitivity. The risk of a cross-sensitivity reaction may be low but has been reported.

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Nantucket, MA: there are several different oral medications for Type 2 diabetes- I understand that their actions are each different- some help produce moreinsulin/some help cells carry more insulin/some help liver not store or convert so much sugar/ some only kick in when sugary foods are ingested. My question is how do Doctors know which one- with what action- to prescribe? In the case of my husband it seems to be trial and error. Hasn't lab science evolved to the point where the correct RX can be given from the git go?

Brian and Lorena: Much in the knowledge and treatment of type 2 diabetes has evolved in recent years. Type 2 diabetes in now understood to be a disease of insulin resistance, meaning that the pancreas is quite often producing insulin, just not being utilized by the body properly. With that said each patient's clinical presentation is unique. Is the patient overweight/obese? Has diet and exercise been utilized to the fullest extent? Is the hyperglycemia (high blood sugar) more of a problem before meals (fasting) or after meals (post-prandial? Is one keeping a detailed log of meal plan and SMBG (self monitoring blood glucose)? This information is very valuable to the medical practioner in evaluating which drugs to use in treating that person's unique type 2 diabetes. The more information that one can supply to the physician, pinpointing the correct oral medication/insulin can be achieved.

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Madison, Wi: Once you have been diagnosed with diabetes, can you through exercise and diet become not a diabetic??

Brian and Lorena: Once a person has been diagnosed with diabetes, diet and exercise are among the most important steps in managing one's diabetes. It is the foundation on which all other treatment rests. It is critical that one with diabetes, develop a meal plan (dietician consult is recommended) and an exercise routine. There is no cure for diabetes, however for some individuals diet and exercise may be the only necessary management for the disease without using medication or insulin and to prevent further progression of the disease.

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mesa az.: where do you dispose of used needles in mesa az.

Brian and Lorena: There are limited disposal solutions for used needles in the home setting. This poses a serious health risk to solid waste workers, neighbors, and the entire community because the majority of needles will end up in household trash. Prior to December 2004, the U.S. Environmental Protection Agency (EPA) used to recommend disposal of needles in the home setting by placing them in a sturdy household container and throwing them in the regular trash. However, in December 2004, the EPA introduced new recommendations suggesting that patients participate in either a community program or a national disposal program. Community programs include drop-off centers, residential ?special waste? pick-up services, household hazardous waste facilities, or syringe exchange programs. National programs include sharps mail-back programs and at-home needle destruction devices. Some states offer community programs for their residents including California, Florida, Massachusetts, New Jersey, New York, and Wisconsin. We recommend that you contact your local municipality or Board of Health to determine if any of these programs are available in your area. You may also speak with your local Rite Aid pharmacist for assistance. Additionally, the Coalition for Safe Community Needle Disposal has a website at www.safeneedledisposal.org. On this website, you may search by your zip code to determine which programs are available in your area.

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Elkins,wva: when i check my sugar with the accu check,it was 230 is that high or low? is it to high or low? I just found out i was a diabetic 3 months ago Any help would be greatly appreciated thanks

Brian and Lorena: You mentioned that the BG was 230. Was this fasting or post prandial (after a meal)? In either case the value is high and needs to be evaluated by your physician. For the preprandial (before meal) glucose level the general guideline according to the ADA is 90-130 mg/dl. The postprandial glucose levels (1-2 hours after start of a meal) should be less than 180 mg/dl.

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Eugene, Oregon: Is it okay for an 11 year old boy to run 300-400 sugar levels, with negative ketones, and not receive insulin? What are the short term and long term effects on this child?

Brian and Lorena: I would say that it is not OK for an 11 year old boy to run these blood glucose levels even with negative ketones. He needs to be evaluated by his pediatrician to determine if he is a type 1 or type 2 patient. The child's weight was not listed, however research now shows that childhood obesity is leading to type 2 diabetes in younger individuals. Some short term (days to weeks) effects are: increased urination, increased thirst, weight loss, blurred vision, fatigue, nausea, and can also lead to many fungal and bacterial infections. Long term (years) effects could lead to coronary artery disease, skin breakdown, infections, peripheral vascular disease which may lead to amputation of limbs, loss of vision, numbness and tingling in the extremities, feet problems, skin ulcers, joint problems, and kidney problems. It is very important to have the child seen as soon as possible.

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Cleveland, TN: I have type 2 diabetes and my doctor has me on janument, I was on avandia and metformin, but I have had liver problems in the past, so they changed it. I also take tricor, and lipitor both. 1st question: What can I take instead of janument that is cheaper. My insurance money get used up and I still have 5 months left to pay at $500 a month with only 1 person retirement money. My insurance is blue cross blue shield. 2nd question do I need to take both tricor and lipitor. Thanks for your help. Barbara

Brian and Lorena:

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akron ohio: Can you count be as high as 2000? Or would you go into como and shock before it got that high.

Brian and Lorena: Yes, it is possible for your blood glucose level to go as high as 2000 mg/dl. This is a life-threatening situation and needs immediate treatment. There is a condition associated with this level called Diabetic Ketoacidosis (DKA). DKA is associated with blood glucose levels from 200-2,000mg/dL. This condition is also known as diabetic coma and occurs when the body lacks insulin and breaks down fats for energy. When this occurs the body produces ketones which can be found in the urine. Ketoacidosis occurs when the body does not get rid of all the ketones in the urine and they build up in the blood. Symptoms of DKA include unexplained blood glucose greater than 250mg/dL, fruity smelling breath, dry mouth, nausea, vomiting, fever, abdominal pain, low blood pressure, shortness of breath, dehydration, increased heart rate, shock, and coma. Medical assistance is needed from hospital staff. Treatment includes insulin infusions, fluid replacement, and potassium replacement.

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Philadelphia, MS: I am 64 years old, disabled, and on pain medication - hydromorphone. Could this medication bring my blood pressure down - and maybe my blood sugars, also?

Brian and Lorena: Hydromorphone has been reported to cause a decrease in blood pressure. Although uncommon, it is documented also to cause an increase in blood sugar levels.

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Penang, Malaysia: What is the appropriate time to take Glyburite? Before or after food?

Brian and Lorena: It is best to take glyburide with the first meal of the day, typically breakfast.

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Carneys Point, New Jersey: All of a sudden I am having a problem keeping my glucose in an acceptable range. Even when I don't eat my glucose level will go up-why? I checked my level at 6 AM and it was 127,then I checked it before my insulin and my breakfast and it was 168-how-when I have nothing to eat or drink. Is it something serious?

Brian and Lorena: Some patients do have high before-breakfast blood glucose levels because of hormones that are released in the early part of sleep (called the Dawn Phenomenon). Typically, the blood glucose level rises between 4 AM and 8 AM. Check your blood glucose level in the middle of the night (around 3 AM). If your blood sugar is high, you may be experiencing the dawn phenomenon. If it is low, it may be a rebound hyperglycemia (high blood glucose) causing your high blood glucose levels in the morning. This occurs if you have low blood glucose levels at night and your body is releasing hormones as a defense mechanism against low blood sugar. It would be best to consult your physician for proper diagnosis and treatment.

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ADA Moderator : Janumet is a recently FDA (Food and Drug Administration) approved medication. Since it is new, there are no generic versions available. This makes it a costly medication. It is difficult to determine which substitute medication would be appropriate for you. Your physician is the best person to determine an alternative medication. We recommend talking with your physician if there are less expensive alternatives appropriate for your condition. Additionally, there is a card called Together RX which allows qualifying patients to save on certain prescription medications. This card is made possible through a coalition of pharmaceutical companies. To enroll, you may call 1-800-865-7211 or enroll online at www.Together-Rx.com. Also, you may also contact the manufacturer of the medication (Janumet) directly in order to obtain information about available patient assistance programs. Janumet is made by Merck and Co. Their phone number is 1-800-609-4618. Finally there are situations where both Tricor and Lipitor are given together. Tricor's mechanism aims at lowering triglyceride levels in those individuals who have cholesterol disorders with high triglycerides. Lipitor is very good at lowering LDL (bad) cholesterol. The combination may get the results the physician wants for your particular condition.

That's it for today. Thanks so much for taking the time to be here Brian and Lorena.

Thanks to all of you who joined us by asking great questions or by just tuning in. If you wish to continue any of today's discussions please feel free to visit the ADA Message Boards.

Keep up to date with all the ADA Live events and reference the archives here.

We hope you found this interesting and informative and that you'll join us again next time here at ADA Live. Our guest will be Jackie Newgent, RD, CDN, a registered dietitian and chef and an expert in both culinary and nutrition topics. Jackie will discuss and answer your questions on how to makeover both your everyday and especially your holiday meals for the whole family. at 1:00 p.m. EST Tuesday, November 7, 2007. See you then.