There is a Boxed Warning associated with metformin products. Please scroll down for Important Safety Information.

A Patient Guide to Type 2 Diabetes

When your goal is a healthy blood sugar level, control is the key. If you've recently been diagnosed with type 2 diabetes, or even if you have had it for some time, you may have questions about what it is and what you can do about it. The information below will assist you in learning more about type 2 diabetes and the steps you can take to help manage it.

What is type 2 diabetes?

Type 2 diabetes, the most common form of diabetes, is also referred to as high blood sugar. Your sugar level is controlled by insulin, which is produced by your body. Insulin is what lets your body turn the food you eat into energy.

Type 2 diabetes occurs when the body does not produce enough insulin, or your body ignores the insulin it makes. When this occurs, your body cannot turn the food you eat into energy and high levels of sugar remain in your bloodstream. Over time, constant high sugar levels can cause damage to your eyes, heart, kidneys, and nerves.1

Back to top

How common is type 2 diabetes?

If you have type 2 diabetes, you are not alone. There are over 20 million Americans with type 2 diabetes, and approximately 15 million are being treated. Type 2 diabetes is, by far, the most common form of diabetes.1

Back to top

What are the common signs of type 2 diabetes?

For many people, the signs or symptoms associated with diabetes develop gradually and are often not recognized for some time. Some people with type 2 diabetes have no symptoms at all. Common symptoms of diabetes include1:

You should let your doctor know if any of these symptoms continue, even if you are already taking medication to treat your diabetes.

Back to top

Controlling your blood sugar is the goal

Keeping your blood sugar level as close to normal as possible will help you feel better. But more importantly, it will reduce your risk of developing other health problems, including heart disease, blindness, kidney damage, and nerve damage that is associated with high levels of blood sugar over a long period of time.

Back to top

How is blood sugar measured?

There are two tests your doctor may order to measure your blood sugar levels. One is called the Fasting Plasma Glucose (FPG) test. An ideal fasting plasma glucose level is less than 100 mg/dL.1

The other is called the A1C, or “glycosylated” hemoglobin test. Your A1C level should be less than 7 percent.1 Your physician will instruct you on how often you should check your blood sugar or A1C.

Back to top

How do I keep my blood sugar levels normal?

Start today and gain control! One easy way to help control your blood sugar level is by staying active and eating right. Exercising 30 minutes every day with light walking, dancing, swimming, or bicycle riding and eating healthy balanced meals can be a great start to gaining control of your diabetes. Check with your doctor to find out how much exercise is right for you.

Back to top

The diabetes food pyramid

Try following the diabetes food pyramid,1 choosing most of your foods from the bottom sections and fewer from the top sections.

Back to top

Recommended range of servings for each food group

Here is the recommended range of servings for each group of the diabetes food pyramid.

Six or more servings of grains, beans or starchy vegetables every day
It's as simple as eating:
- 3/4 cup dry cereal or
- 1/2 cup cooked cereal or pasta or
- One slice of bread, or four to six crackers

Three to five servings of non-starchy vegetables every day
One serving could be:
- 1/2 cup tomato or vegetable juice or
- 1/2 cup cooked vegetables like spinach or
- One cup raw vegetables like celery and zucchini

Two to four servings of fruit every day
Check your serving sizes. One serving could be:
- One small fresh fruit, like an apple
- 1/2 cup canned fruit, like canned peaches
- 1/2 cup fruit juice, like orange juice

Two to three servings of milk products every day
One serving could be:
- One cup low fat or skim milk
- One cup plain yogurt (try adding a sugar substitute)

Two to three servings of meat or other protein every day
One serving could be:
- Two to three ounces of cooked lean meat, chicken, turkey, or fish
- Two to three ounces of cheese (try low fat cheese)
- Two tablespoons peanut butter
- One egg

Limit fats, sweets and alcohol as much as possible
If you like nuts, a serving is about 10 almonds, walnuts, or peanuts a day.

Look for low fat versions of these foods:
- One tablespoon cream cheese or salad dressing
- One teaspoon butter, margarine, oil, or mayonnaise
- One small cupcake or muffin

For additional examples of food to eat, please visit the ADA website at: http://www.diabetes.org

Back to top

Avoiding complications

With type 2 diabetes you have an increased risk for other complications such as heart disease, blindness, kidney damage, and nerve damage. Here are some steps you can take to gain control of your diabetes and reduce the risk of developing these complications:

Stay active
Almost anything that gets you moving, such as walking, dancing, or working in the yard can provide health benefits. When you're physically fit, you have the strength, flexibility, and endurance needed for your daily activities. Being active also helps:

- Lower blood glucose (sugar)
- Lower blood pressure and cholesterol
- Reduce the risk of heart disease and stroke

Take good care of your feet
It is important that you pay special attention to your feet, especially if you have loss of feeling or changes in the shape of your feet. Some common steps to take in caring for your feet are:

- Check and wash your feet every day
- Check for cuts, sores, red spots, swelling, and infected toenails
- Rub a thin coat of body lotion over the tops and bottoms of your feet, but not between your toes
- Always wear socks and shoes

Back to top

Taking your medication as prescribed by your doctor

Unfortunately, even with a healthy diet and plenty of exercise, diabetes can be hard to control, so your doctor may add medication to improve control of your blood sugar. If you are taking diabetes medicine, you should still eat right and exercise. Medication for diabetes works even better when added to a healthy diet and exercise routine. It also works better when taken exactly as prescribed by your physician.

Remember… Control is the KEY!

Back to top

Indication

FORTAMET, used as a once-per-day monotherapy, is indicated as an adjunct to diet and exercise to lower blood glucose. FORTAMET can be used concomitantly with a sulfonylurea or insulin to improve glycemic control in adults. FORTAMET is indicated in patients 17 years of age or older as either monotherapy or in combination therapy.

There is a black box warning associated with metformin products. Lactic acidosis due to metformin accumulation during treatment with FORTAMET is a rare but potentially fatal occurrence. Lactic acidosis may also occur in association with a number of pathophysiologic conditions and whenever there is significant tissue hypoperfusion and hypoxemia. Patients with congestive heart failure requiring pharmacologic management, in particular those with unstable or acute congestive heart failure who are at risk of hypoperfusion and hypoxemia, are at increased risk of lactic acidosis. The onset of lactic acidosis often is subtle, and can be accompanied only by nonspecific symptoms. The patient and the patient's physician must be aware of the possible importance of such symptoms and the patient should be instructed to notify the physician immediately if they occur. The risk of lactic acidosis increases with the degree of renal dysfunction and the patient's age. Treatment should not be initiated in patients ≥ 80 years of age unless renal function is not reduced. The risk of lactic acidosis while on FORTAMET therapy may be significantly decreased by: Initial and regular monitoring of renal and liver function; using the minimum effective dose of FORTAMET; promptly withholding FORTAMET in the presence of any condition associated with hypoxemia, dehydration, or sepsis; avoidance of FORTAMET in patients with hepatic disease; cautioning patients against excessive alcohol intake, either acute or chronic; and temporarily discontinuing FORTAMET prior to any intravascular radiocontrast study or surgical procedure. Lactic acidosis is a medical emergency requiring immediate discontinuation of FORTAMET and prompt institution of general supportive measures. Because metformin is dialyzable, prompt hemodialysis is recommended to correct the acidosis and remove the accumulated metformin.

Important Safety Information

FORTAMET is contraindicated in patients with renal disease or renal dysfunction (e.g., as suggested by serum creatinine levels of ≥ 1.5 mg/dL in males, ≥ 1.4 mg/dL in females, or abnormal creatinine clearance), congestive heart failure, known hypersensitivity to metformin, acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma.

FORTAMET should be temporarily discontinued in patients undergoing radiologic studies involving intravascular administration of iodinated contrast materials, because use of such products may result in acute alteration of renal function.

In pooled phase II and III studies (N=424), the most frequent adverse events associated with FORTAMET were infection (20.5%), diarrhea (16.7%), nausea (8.5%), accidental injury (7.3%), dyspepsia (4.2%), and rhinitis (4.2%). In controlled studies, 4.7% of patients treated with FORTAMET (N=424) were discontinued as a result of an adverse event.

FORTAMET should be avoided in patients with impaired hepatic function or excessive alcohol intake (chronic or acute). In elderly patients, particularly those ≥80 years of age, renal function should be monitored regularly and, generally, FORTAMET should not be titrated to the maximum dose. FORTAMET should be withheld in the presence of any condition associated with hypoxia, dehydration, or sepsis.

FORTAMET alone does not usually cause hypoglycemia, although it may occur when FORTAMET is used in conjunction with oral sulfonylureas and/or insulin. When initiating combination therapy, the risks, symptoms, and treatment of hypoglycemia, as well as conditions that predispose its development, should be explained to patients and responsible family members.

The safety and efficacy of FORTAMET has not been evaluated in pediatric patients or pregnant women.

Back to top

There is a Boxed Warning associated with metformin products. Click here for full Prescribing Information.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.FDA.gov/medwatch or call 1-800-FDA-1088

References

1. American Diabetes Association. Available at http://www.diabetes.org/diabetes-basics/type-2/. Accessed February 26, 2010.