[20mg tab - twice daily] Used to treat high blood pressure, and in some cases, heart failure. It works by decreasing certain chemicals that tighten the blood vessels, so blood flows more smoothly and the heart can pump blood more efficiently.
[25mg tab - mornings] Used to treat high blood pressure. It causes the kidneys to get rid of unneeded water and salt from the body into the urine. May reduce the level of potassium in your blood.
[0.1mg tab - bedtime] (Dr. Chin instructed to take 3 pills at bedtime) Treats high blood pressure. Also treats attention deficit hyperactivity disorder (ADHD). Belongs to a class of drugs called antihypertensives.
Asprin (Low Dose)
[81mg tab - bedtime] Often prescribed to prevent blood clots. This effect reduces the risk of stroke and heart attack.
[25mg tab - Every other morning] A diuretic (water pill) that prevents your body from absorbing too much salt, but without affecting potassium levels. Also treats fluid retention (edema) in people with congestive heart failure,
Amlodipine (no longer taking)
[5mg tab - morning] (Added by Dr. Zheng)
[Discontinued by Dr. Chin on 1/8/18] Amlodipine is in a group of drugs called calcium channel blockers. Amlodipine relaxes (widens) blood vessels and improves blood flow.
[25mg tab - twice daly] Belongs to a group of drugs called beta-blockers. Beta-blockers affect the heart and circulation (blood flow through arteries and veins). Carvedilol is used to treat heart failure and hypertension (high blood pressure). It is also used after a heart attack that has caused your heart not to pump as well.
[10-40mg tab - evening] Reduces levels of "bad" cholesterol (low-density lipoprotein, or LDL) and triglycerides in the blood, while increasing levels of "good" cholesterol (high-density lipoprotein, or HDL).
[10mg tab - morning] Used to keep the platelets in your blood from coagulating (clotting) to prevent unwanted blood clots that can occur with certain heart or blood vessel conditions.
[100mg tab - evening] Used along with diet and exercise and sometimes with other medications to lower blood sugar levels in patients with type 2 diabetes. Januvia works by increasing the amounts of certain natural substances that lower blood sugar when it is high.
[500mg - 2 tabs - twice daily] Used to treat type 2 diabetes. Metformin decreases the amount of glucose (sugar) you absorb from your food and the amount of glucose made by your liver. Metformin also increases your body's response to insulin.
Novolog Flexpen (short-term)
[inject as needed] A fast-acting and works to help control blood sugar spikes when you eat. Eat within 5 to 10 minutes after injecting; you don’t have to wait 30 minutes before you eat, like you would with regular human insulin. Novolog can help lower your A1C when taken with a long-acting insulin.
Toujeo (Long-term Insulin)
[58 units - evening] Insulin glargine is used to treat type 1 and type 2 diabetes. Insulin glargine is long-acting and helps move sugar from the blood into other body tissues where it is used for energy. It also helps the body break down carbohydrates, fats, and proteins from the diet.
Allopurinol (for Gout)
[300mg tablet - morning with food] Used to treat gout, high levels of uric acid in the body. Allopurinol is in a class of medications called xanthine oxidase inhibitors. Allopurinol works by reducing the amount of uric acid made by the body. Taken regularly, it can stop attacks of gout and help prevent damage to your joints. It is best to drink a full glass of water with each dose and at least 8 more glasses (8 ounces each) of fluid a day. For the treatment of gout, it may take up to several weeks for this medicine to have an effect. During a gout attack, it can exacerbate the painful effects of gout. As a result, it is advised that you temporarily discontinue use until the gout flare up has subsided. During the first few weeks of taking allopurinol, your blood levels of uric acid may rise for a short while before they fall. Allopurinol and Colchicine can be taken at the same time with no negative interactions.
Colchicine (for Gout)
[0.6mg tablet - morning] works by decreasing swelling and lessening the build up of uric acid crystals that cause pain in affected joint(s). May also be helpful as an anti inflammatory if needed for swollen joints. Avoid the use of grapefruit products while taking colchicine. Common side effects may include: nausea, vomiting, stomach pain; or diarrhea.
HDL (good) cholesterol protects against heart disease, so for HDL, higher numbers are better. A level less than 40 mg/dL is low and is considered a major risk factor because it increases your risk for developing heart disease. HDL levels of 60 mg/dL or more help to lower your risk for heart disease.
Triglycerides can also raise heart disease risk. Levels that are borderline high (150-199 mg/dL) or high (200 mg/dL or more) may need treatment in some people. Niacin can be taken to lower cholesterol and triglycerides in the blood.
Approximately 40-50% of the total daily insulin dose is to replace insulin overnight, when you're fasting and between meals. This is called background or basal insulin replacement. The other 50-60% of the total daily insulin dose is for carbohydrate coverage (food) and high blood sugar correction. This is called the bolus insulin replacement. The insulin-to-carbohydrate ratio represents how many grams of carbohydrate are covered or disposed of by 1 unit of insulin. Generally, one unit of rapid-acting insulin will dispose of 12-15 grams of carbohydrate. This range can vary from 4-30 grams or more of carbohydrate depending on sensitivity to insulin.
The bolus dose for high blood sugar correction is defined as how much one unit of rapid-acting insulin will drop the blood sugar. Generally, to correct a high blood sugar, one unit of insulin is needed to drop the blood glucose by 50 mg/dl. For some, however, this drop in blood sugar can range from 15 to 100 mg/dl or more, depending on individual insulin sensitivities, and other circumstances.
Total Daily Insulin Requirement
First, you need to figure out your total daily insulin requirement. To do this, divide your current weight by 4. If you weigh 160 lbs, your total daily insulin requirement would be 40 units of insulin/day. If your body is very resistant to insulin, you may require a higher dose.
Establish a Basal/Background (Overnight) Dose
If your body is very resistant to insulin, you may require a higher dose. Your basal/background dose is generally 40 to 50 percent of your total daily insulin requirement (TDI).
Figuring Out Your Carb/Insulin Ratio (CHO)
Use the “Rule of 500”: 500 divided by your total daily insulin (TDI). If you weight 160 pounds and your TDI is 40, then 500 ÷ 40 = 12. Therefore, your carb/insulin ratio would be 1 unit of insulin to every 12 grams of carb, or 1:12. Some ratios change throughout the day, Your morning ratio might be 1:15 and your evening ratio might be 1:8.
Figuring Out Your High Blood Sugar Correction Factor
Use the “Rule of 1800”: Correction Factor = 1800 ÷Total Daily Insulin Dose = 1 unit of insulin will reduce the blood sugar by so many mg/dl.
Assuming your total daily insulin dose (TDI) = 160 lbs ÷ 4 = 40 units
1800 ÷ 40 units = 45, meaning that 1 unit of insulin will reduce your current blood sugar level by 45 points. Most people round this number to 40 or 50.
Please keep in mind, the estimated insulin regimen is an initial “best guess” and the dose may need to be modified to keep your blood sugar on target.
Also, there are many variations of insulin therapy. You will need to work out your specific insulin requirements and dose regimen with your medical provider and diabetes team.
Glycemic Index (GI) VS. Clycemic Load (GL)
The Glycemic Index or GI Index ranks carbohydrates based on how they make your blood sugar rise. Blood sugar (glucose) is what your body uses for fuel. It comes from the breakdown of carbohydrates. Simple sugars, (simple carbs), go right into your blood stream without having to be broken down or "digested." Complex carbohydrates need to be digested — in the mouth, the stomach or small intestine BEFORE they enter the blood stream. There is a simple way to track which foods cause fast or slow rises in your blood sugar.
Drippers have a low glycemic index between 0 and 55, while flooders have an index of over 70. These numbers are relative to Pure Glucose which has a glycemic index of 100. The higher the glycemic index, the faster your blood sugar will rise. This means that the flooders are easily digested and push glucose into the blood stream faster than drippers.
People with diabetes have high blood sugar. Scientists have discovered that proper (more evenly consistent) blood sugar levels are better. Too high = not good. Too low = not good.
Drippers cause blood sugar levels to rise slowly and it gives your body time to release the proper amount of insulin. For diabetes, managing blood sugar levels gives your body a chance to respond to a recently eaten meal. Flooders are not that kind; they overwhelm your sytem and lead to spikes and crashes in your blood sugar.
The glycemic load (GL)
The GI value tells you only how rapidly a particular carbohydrate turns into sugar. It doesn't tell you how much of that carbohydrate is in a serving of a particular food. You need to know both things to understand a food's effect on blood sugar. That is where glycemic load comes in. The carbohydrate in watermelon, for example, has a high GI, but there isn't a lot of carbohydrates in a watermelon, so it's glycemic load is relatively low.
The GI and GL of a food are related by the amount of available carbohydrates in a fixed serving of the food. The glycemic load of a food is calculated by multiplying the absolute GI value by the grams of available carbohydrate in the serving, and then dividing by 100. For example, a 225 g (1 cup) serving of Bananas with a GI of 52 and a carbohydrate content of 45.5 g (51.4 g total carbohydrate - 5.9 g fiber) makes the calculation GL = 52 x 45.5 / 100 = 24, so the GL is 24.
How to Switch to a Low GI Diet
The basic technique for eating the low GI way is simply a "this for that" approach - ie, swapping high GI carbs for low GI carbs. You don't need to count numbers or do any sort of mental arithmetic to make sure you are eating a healthy, low GI diet.