Hi Lynn — I replied to Ray with a couple of other options BistroMD and Diet-to-Go …I would recommend checking out those reviews if you think they may be something that would work for you and your husband. Diet-to-Go has some really good plans that sound like they could work for you. Their meal plans include a combination of healthy ingredients that make for a wholesome food intake. Eat These 3 Things Instead. This weight management program offers advice to its consumers to maintain a stress free ambience so that they do not let their depression affect them. Receive Analysts' Upgrades and Downgrades Daily.
In the evening, make your own dinner. Prepare what you like and enjoy it with your family. You'll have unlimited access to personal nutrition counseling, certified diabetes educators and weight-loss resources. I have been buying the 5 day Nutrisystem kits at Walmart or ordering online to ship to Walmart, for 5 or 6 months. I have had great success and have lost 30 pounds. Having just gotten back from vacation I called my local Walmart to see if they had the 5day Diabetic Nutrisystem kit I'm not diabetic but I liked the meals in the kit.
The reason I started using Nutrisystem was so that I would not have to deal with making diet dinners. This was the perfect system for me in that it was easy and effective. I took the kit back. This was one of my favorite kits-I will not be purchasing this again. I can only hope to find some left online to order. If not, I'll be looking into starting with Jennie Craig or using Atkins products. Two of my friends who have also had luck with Nutrisystem and are diabetic have also complained to me about this change.
They will not be continuing with Nutisystem. Focus on high-fiber complex carbohydrates—also known as slow-release carbs. They are digested more slowly, thus preventing your body from producing too much insulin. High glycemic index GI foods spike your blood sugar rapidly, while low GI foods have the least effect on blood sugar.
While the GI has long been promoted as a tool to help manage blood sugar, there are some notable drawbacks. If you have diabetes, you can still enjoy a small serving of your favorite dessert now and then. The key is moderation. Reduce your cravings for sweets by slowly reduce the sugar in your diet a little at a time to give your taste buds time to adjust.
Hold the bread or rice or pasta if you want dessert. Eating sweets at a meal adds extra carbohydrates so cut back on the other carb-heavy foods at the same meal. Add some healthy fat to your dessert. Think healthy fats, such as peanut butter, ricotta cheese, yogurt, or nuts. Eat sweets with a meal, rather than as a stand-alone snack. When eaten on their own, sweets cause your blood sugar to spike.
When you eat dessert, truly savor each bite. How many times have you mindlessly eaten your way through a bag of cookies or a huge piece of cake? Can you really say that you enjoyed each bite? Make your indulgence count by eating slowly and paying attention to the flavors and textures. Reduce soft drinks, soda and juice.
For each 12 oz. Try sparkling water with a twist of lemon or lime instead. Cut down on creamers and sweeteners you add to tea and coffee. Buy unsweetened iced tea, plain yogurt, or unflavored oatmeal, for example, and add sweetener or fruit yourself. Check labels and opt for low sugar products and use fresh or frozen ingredients instead of canned goods. Be especially aware of the sugar content of cereals and sugary drinks. Avoid processed or packaged foods like canned soups, frozen dinners, or low-fat meals that often contain hidden sugar.
Prepare more meals at home. You can boost sweetness with mint, cinnamon, nutmeg, or vanilla extract instead of sugar. Refined Carbs and Sugar: Find healthy ways to satisfy your sweet tooth. Instead of ice cream, blend up frozen bananas for a creamy, frozen treat. Or enjoy a small chunk of dark chocolate, rather than a milk chocolate bar. Start with half of the dessert you normally eat, and replace the other half with fruit. And cocktails mixed with soda and juice can be loaded with sugar.
Choose calorie-free mixers, drink only with food, and monitor your blood glucose as alcohol can interfere with diabetes medication and insulin.
Being smart about sweets is only part of the battle. Sugar is also hidden in many packaged foods, fast food meals, and grocery store staples such as bread, cereals, canned goods, pasta sauce, margarine, instant mashed potatoes, frozen dinners, low-fat meals, and ketchup.
The first step is to spot hidden sugar on food labels, which can take some sleuthing:. Manufacturers are required to provide the total amount of sugar in a serving but do not have to spell out how much of this sugar has been added and how much is naturally in the food. The trick is deciphering which ingredients are added sugars. Aside from the obvious ones— sugar, honey, molasses —added sugar can appear as agave nectar, cane crystals, corn sweetener, crystalline fructose, dextrose, evaporated cane juice, fructose, high-fructose corn syrup, invert sugar, lactose, maltose, malt syrup , and more.
A wise approach is to avoid products that have any of these added sugars at or near the top of the list of ingredients—or ones that have several different types of sugar scattered throughout the list.
Metformin is safe in pregnancy and women with gestational diabetes treated with metformin have less weight gain during pregnancy than those treated with insulin.
Metformin appears to be safe and effective in counteracting the weight gain caused by the antipsychotic medications olanzapine and clozapine.
Metformin may reduce the insulin requirement in type 1 diabetes. According to the prescribing information , heart failure in particular, unstable or acute congestive heart failure increases the risk of lactic acidosis with metformin. Metformin is recommended to be temporarily discontinued before any radiographic study involving iodinated contrast agents, such as a contrast-enhanced CT scan or angiogram , as the contrast dye may temporarily impair kidney function, indirectly leading to lactic acidosis by causing retention of metformin in the body.
The most common adverse effect of metformin is gastrointestinal irritation, including diarrhea , cramps, nausea, vomiting, and increased flatulence ; metformin is more commonly associated with gastrointestinal side effects than most other antidiabetic medications.
Metformin has also been reported to decrease the blood levels of thyroid-stimulating hormone in people with hypothyroidism. In a clinical trial of subjects, Gastrointestinal upset can cause severe discomfort; it is most common when metformin is first administered, or when the dose is increased. The discomfort can often be avoided by beginning at a low dose 1. Long-term use of metformin has been associated with increased homocysteine levels  and malabsorption of vitamin B The most serious potential adverse effect of biguanide use is metformin-associated lactic acidosis MALA.
Though the incidence for MALA is about nine per , person-years,  this is similar to the background incidence of lactic acidosis in the general population. A systematic review concluded no data exists to definitively link metformin to lactic acidosis. Phenformin , another biguanide, was withdrawn from the market because of an increased risk of lactic acidosis rate of per , patient-years.
Lactate uptake by the liver is diminished with metformin administration because lactate is a substrate for hepatic gluconeogenesis , a process that metformin inhibits. In healthy individuals, this slight excess is cleared by other mechanisms including uptake by unimpaired kidneys , and no significant elevation in blood levels of lactate occurs.
Because metformin decreases liver uptake of lactate, any condition that may precipitate lactic acidosis is a contraindication.
Metformin has been suggested as increasing production of lactate in the large intestine, which could potentially contribute to lactic acidosis in those with risk factors. Lactic acidosis is initially treated with sodium bicarbonate , although high doses are not recommended, as this may increase intracellular acidosis. A review of metformin overdoses reported to poison control centers over a five-year period found serious adverse events were rare, though the elderly appeared to be at greater risk.
The most common symptoms following overdose include vomiting, diarrhea , abdominal pain, tachycardia , drowsiness, and, rarely, hypoglycemia or hyperglycemia. Extracorporeal treatments are recommended in severe overdoses. Metformin may be quantified in blood, plasma, or serum to monitor therapy, confirm a diagnosis of poisoning, or assist in a forensic death investigation. Chromatographic techniques are commonly employed.
The H 2 -receptor antagonist cimetidine causes an increase in the plasma concentration of metformin by reducing clearance of metformin by the kidneys;  both metformin and cimetidine are cleared from the body by tubular secretion , and both, particularly the cationic positively charged form of cimetidine, may compete for the same transport mechanism. Metformin also interacts with anticholinergic medications, due to their effect on gastric motility.
Anticholinergic drugs reduce gastric motility, prolonging the time drugs spend in the gastrointestinal tract. This impairment may lead to more metformin being absorbed than without the presence of an anticholinergic drug, thereby increasing the concentration of metformin in the plasma and increasing the risk for adverse effects. Metformin's main effect is to decrease liver glucose production. Metformin decreases high blood sugar , primarily by suppressing liver glucose production hepatic gluconeogenesis.
Multiple potential mechanisms of action have been proposed, including; inhibition of the mitochondrial respiratory chain complex I , activation of AMP-activated protein kinase AMPK , inhibition of glucagon-induced elevation of cyclic adenosine monophosphate cAMP with reduced activation of protein kinase A PKA , inhibition of mitochondrial glycerophosphate dehydrogenase , and an effect on gut microbiota.
Activation of AMPK was required for metformin's inhibitory effect on liver glucose production. In addition to suppressing hepatic glucose production, metformin increases insulin sensitivity, enhances peripheral glucose uptake by inducing the phosphorylation of GLUT4 enhancer factor , decreases insulin-induced suppression of fatty acid oxidation ,  and decreases absorption of glucose from the gastrointestinal tract. Increased peripheral use of glucose may be due to improved insulin binding to insulin receptors.
AMPK probably also plays a role in increased peripheral insulin sensitivity, as metformin administration increases AMPK activity in skeletal muscle.
The usual synthesis of metformin, originally described in , involves the one-pot reaction of dimethylamine hydrochloride and 2-cyanoguanidine over heat. According to the procedure described in the Aron patent,  and the Pharmaceutical Manufacturing Encyclopedia ,  equimolar amounts of dimethylamine and 2-cyanoguanidine are dissolved in toluene with cooling to make a concentrated solution, and an equimolar amount of hydrogen chloride is slowly added.
Steady state is usually reached in one or two days. Metformin has acid dissociation constant values pKa of 2. The metformin pKa values make metformin a stronger base than most other basic medications with less than 0. Furthermore, the lipid solubility of the nonionized species is slight as shown by its low logP value log 10 of the distribution coefficient of the nonionized form between octanol and water of These chemical parameters indicate low lipophilicity and, consequently, rapid passive diffusion of metformin through cell membranes is unlikely.
As a result of its low lipid solubility it requires the transporter SLC22A1 in order for it to enter cells. More lipophilic derivatives of metformin are presently under investigation with the aim of producing prodrugs with superior oral absorption than metformin.
Metformin is not metabolized. It is cleared from the body by tubular secretion and excreted unchanged in the urine; metformin is undetectable in blood plasma within 24 hours of a single oral dose.
The biguanide class of antidiabetic medications, which also includes the withdrawn agents phenformin and buformin , originates from the French lilac or goat's rue Galega officinalis , a plant used in folk medicine for several centuries.
Metformin was first described in the scientific literature in , by Emil Werner and James Bell, as a product in the synthesis of N , N -dimethylguanidine. Interest in metformin resumed at the end of the s. In , metformin, unlike some other similar compounds, was found not to decrease blood pressure and heart rate in animals. Garcia  used metformin he named it Fluamine to treat influenza; he noted the medication "lowered the blood sugar to minimum physiological limit" and was not toxic.
Garcia believed metformin to have bacteriostatic , antiviral , antimalarial , antipyretic and analgesic actions. Instead he observed antiviral effects in humans. French diabetologist Jean Sterne studied the antihyperglycemic properties of galegine , an alkaloid isolated from Galega officinalis , which is related in structure to metformin and had seen brief use as an antidiabetic before the synthalins were developed.
Sterne was the first to try metformin on humans for the treatment of diabetes; he coined the name "Glucophage" glucose eater for the medication and published his results in Metformin became available in the British National Formulary in It was sold in the UK by a small Aron subsidiary called Rona.
Broad interest in metformin was not rekindled until the withdrawal of the other biguanides in the s. Metformin was approved in Canada in ,  but did not receive approval by the U. Liquid metformin is sold under the name Riomet in India.
Metformin IR immediate release is available in , , and mg tablets. All of these are available as generic medications in the U. Metformin SR slow release or XR extended release was introduced in It is available in , , and mg strengths, mainly to counteract common gastrointestinal side effects, as well as to increase compliance by reducing pill burden.
No difference in effectiveness exists between the two preparations.