Diabetes, Types, Gestational, Treatment, Neuropathy, Blood Sugar Levels, Medications, GLP-1 Drugs
Table of Contents
Types of Diabetes
Diabetes is a chronic metabolic disorder characterized by high blood sugar (hyperglycemia). While most people know about Type 1 and Type 2, there are actually several distinct types, each with different causes and treatments.
Main Types of Diabetes
Type 1 Diabetes (T1D) – Autoimmune
- Cause: Autoimmune β-cell destruction in pancreas; insulin-dependent.
- Onset: Usually in childhood/young adulthood (but can occur at any age).
- Treatment: Lifelong insulin therapy (injections/pump).
- Fact: Not preventable; 5–10% of diabetes cases.
Type 2 Diabetes (T2D) – Insulin Resistance
- Cause: Insulin resistance + relative insulin deficiency (pancreas may still produce some).
- Onset: Typically in adults over 40, but rising in younger people due to obesity.
- Treatment: Diet, exercise, oral meds (metformin), and sometimes insulin.
- Fact: 90–95% of diabetes cases; often preventable.
Gestational Diabetes (GDM) – Pregnancy-Related
- Cause: Hormonal changes in pregnancy block insulin action.
- Onset: Develops during pregnancy (usually 2nd/3rd trimester).
- Diagnosed at 24–28 weeks if:
- Fasting ≥92 mg/dL
- 1h post-glucose ≥180 mg/dL
- 2h post-glucose ≥153 mg/dL
- Treatment: Diet control, exercise, sometimes insulin.
- Key Fact: Increases risk of Type 2 diabetes later in life.
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Other Types of Diabetes
LADA (Latent Autoimmune Diabetes in Adults)
- “Type 1.5 Diabetes” – Starts like Type 2 but progresses to Type 1.
- Treatment: Eventually requires insulin therapy.
MODY (Maturity-Onset Diabetes of the Young)
- Cause: Genetic mutation (autosomal dominant inheritance).
- Onset: Before age 25, often mistaken for Type 1 or 2.
- Treatment: Oral meds (sulfonylureas), sometimes insulin.
Secondary Diabetes (Due to Other Conditions)
- Causes:
- Caused by drugs (e.g., steroids), pancreatitis, etc.
- Pancreatic diseases (chronic pancreatitis, cystic fibrosis).
- Hormonal disorders (Cushing’s syndrome, acromegaly).
- Medications (steroids, antipsychotics).
- Treatment: Depends on the underlying cause.
Brittle Diabetes (Unstable Blood Sugar)
- Extreme blood sugar swings (common in long-term Type 1 diabetes).
- Hard to control, often due to hormonal/metabolic issues.
Neonatal Diabetes (Rare, in Infants)
- Cause: Genetic mutation affecting insulin production.
- Onset: Before 6 months of age.
- Treatment: Sometimes oral sulfonylureas instead of insulin.
Blood Sugar Targets for Diabetics (ADA Guidelines)
| Condition | Fasting/Pre-Meal | Post-Meal (2h) | HbA1c Goal |
| Non-Diabetic | <100 mg/dL | <140 mg/dL | <5.7% |
| Prediabetes | 100–125 mg/dL | 140–199 mg/dL | 5.7–6.4% |
| Diabetes (General) | 80–130 mg/dL | <180 mg/dL | <7% |
| Strict Control (Young/Healthy) | 80–110 mg/dL | <140 mg/dL | <6.5% |
| Elderly/High Hypo Risk | 90–150 mg/dL | <200 mg/dL | <8% |
Organizations Involved in Diabetes Management & Releasing Guidelines
Diabetes Diagnostic Criteria (ADA Guidelines)
Four tests can diagnose diabetes (must be confirmed with repeat testing unless symptoms are present):- Fasting Plasma Glucose (FPG) ≥126 mg/dL
- A1C ≥6.5%
HbA1c reflects 3-month average blood sugar - 2-hour OGTT ≥200 mg/dL
OGTT = Oral Glucose Tolerance Test (75g glucose). - Random plasma glucose ≥200 mg/dL with symptoms
Random glucose ≥200 mg/dL + symptoms (thirst, weight loss, fatigue) is diagnostic
| Test | Diabetes | Prediabetes | Normal |
| Fasting Plasma Glucose (FPG) | ≥126 mg/dL | 100–125 mg/dL | <100 mg/dL |
| 2-hr Plasma Glucose (OGTT) | ≥200 mg/dL | 140–199 mg/dL | <140 mg/dL |
| HbA1c | ≥6.5% | 5.7–6.4% | <5.7% |
| Random Plasma Glucose (with symptoms) | ≥200 mg/dL | – | – |
Diabetes Complications
Poorly controlled diabetes leads to serious complications over time due to persistent high blood glucose (hyperglycemia), which damages blood vessels and nerves. Complications are divided into microvascular (small vessels) and macrovascular (large vessels).
1. Microvascular Complications (Small Blood Vessel Damage)
a. Diabetic Retinopathy (Eye Damage)
- Cause: High sugar damages retinal blood vessels → leakage, swelling, new abnormal vessels.
a. Diabetic Nephropathy (Kidney Disease)
- Cause: Kidney filters (glomeruli) get damaged → protein leakage (microalbuminuria) → kidney failure.
c. Diabetic Neuropathy (Nerve Damage)
- Peripheral neuropathy (feet/hands) – numbness, tingling, ulcers, amputations.
- Autonomic neuropathy – digestive issues, erectile dysfunction, dizziness (low BP).
2. Macrovascular Complications (Large Blood Vessel Damage)
a. Cardiovascular Disease (Heart & Blood Vessels)
Increased risk of Heart attack (2-4x higher risk), Stroke, Peripheral artery disease (PAD) → leg pain, poor wound healingb. Diabetic Foot Disease
Causes: Neuropathy (can’t feel injuries) + poor circulation – ulcers, infections, gangrene.3. Other Long-Term Complications
a. Skin Conditions
- Bacterial/fungal infections (diabetics heal slower).
- Acanthosis nigricans (dark, velvety skin patches).
b. Cognitive Decline & Dementia
- Type 2 diabetes increases Alzheimer’s risk by 50-65% (“Type 3 diabetes”).
c. Sexual & Urinary Problems
- Erectile dysfunction (men)
d. Gastroparesis (Delayed Stomach Emptying)
- Symptoms: Nausea, vomiting, bloating.
Type 2 Diabetes Oral Medications List
| Category | Generic Name | Brand Name(s) | Mechanism of Action | Notes |
| Biguanides | Metformin | Glucophage, Fortamet, Riomet |
| First-line therapy (cheap, few side effects). May cause GI issues. |
Sulfonylureas | Glimepiride | Amaryl |
| Low-cost but higher hypoglycemia risk. |
| Glipizide | Glucotrol | |||
| Glyburide | Diabeta, Micronase | Avoid in elderly (severe hypoglycemia risk). | ||
Meglitinides | Repaglinide | Prandin |
| Less hypoglycemia than sulfonylureas. |
| Nateglinide | Starlix | |||
Thiazolidinediones (TZDs) | Pioglitazone | Actos |
| Risks: Weight gain, edema, fractures, bladder cancer (pioglitazone). |
| Rosiglitazone | Avandia | Controversial (CV risks—restricted in some countries). | ||
DPP-4 Inhibitors | Sitagliptin | Januvia |
| Weight-neutral, well-tolerated. |
| Saxagliptin | Onglyza | May increase heart failure risk (saxagliptin). | ||
| Linagliptin | Tradjenta | Renally safe (no dose adjustment). | ||
| Alogliptin | Nesina | |||
SGLT2 Inhibitors | Empagliflozin | Jardiance |
| Benefits: Heart/kidney protection, weight loss. Risks: UTIs, ketoacidosis (rare). |
| Dapagliflozin | Farxiga | |||
| Canagliflozin | Invokana | Higher amputation risk (canagliflozin). | ||
Alpha-Glucosidase Inhibitors | Acarbose | Precose |
| Causes gas/bloating. Rarely used today. |
| Miglitol | Glyset | |||
| Bile Acid Sequestrants | Colesevelam | Welchol | Unclear mechanism (may improve insulin sensitivity). | Also lowers LDL cholesterol. |
| Dopamine Agonists | Bromocriptine (QR) | Cycloset | Resets hypothalamic glucose metabolism. | Rarely used. |
Diabetes Combination Pills
| Brand Name | Generic Name | Drug Classes | Mechanism of Action |
| Janumet | Sitagliptin + Metformin | DPP-4 inhibitor + Biguanide | Increases incretin & lowers glucose production |
| Kombiglyze XR | Saxagliptin + Metformin | DPP-4 inhibitor + Biguanide | Prolongs incretin action, lowers hepatic glucose |
| Jentadueto | Linagliptin + Metformin | DPP-4 inhibitor + Biguanide | |
| Kazano | Alogliptin + Metformin | DPP-4 inhibitor + Biguanide | |
| Xigduo XR | Dapagliflozin + Metformin | SGLT2 inhibitor + Biguanide | Increases urinary glucose excretion |
| Synjardy / Synjardy XR | Empagliflozin + Metformin | SGLT2 inhibitor + Biguanide | |
| Segluromet | Ertugliflozin + Metformin | SGLT2 inhibitor + Biguanide | |
| Glyxambi | Empagliflozin + Linagliptin | SGLT2 inhibitor + DPP-4 inhibitor | Blocks glucose reabsorption & boosts incretin |
| Qtern | Dapagliflozin + Saxagliptin | SGLT2 inhibitor + DPP-4 inhibitor | |
| Trijardy XR | Empagliflozin + Linagliptin + Metformin | SGLT2 + DPP-4 + Biguanide | Triple-action: excrete glucose, reduce hepatic output, and increase incretin |
| Oseni | Alogliptin + Pioglitazone | DPP-4 inhibitor + Thiazolidinedione (TZD) | Improves insulin sensitivity + incretin effect |
| Duetact | Pioglitazone + Glimepiride | TZD + Sulfonylurea | Stimulates insulin + improves sensitivity |
| Actoplus Met | Pioglitazone + Metformin | TZD + Biguanide | Reduces hepatic glucose + improves sensitivity |
| Avandamet | Rosiglitazone + Metformin | TZD + Biguanide | |
| Avandaryl | Rosiglitazone + Glimepiride | TZD + Sulfonylurea | Insulin release + sensitivity |
| Glucovance | Glyburide + Metformin | Sulfonylurea + Biguanide | Stimulates insulin + reduces hepatic glucose |
| Metaglip | Glipizide + Metformin | Sulfonylurea + Biguanide | |
| Prandimet | Repaglinide + Metformin | Meglitinide + Biguanide | Stimulates rapid insulin + lowers hepatic glucose |
Notes:
- First-line: Metformin (unless contraindicated).
- Cardio/Kidney Benefits:
- SGLT2 inhibitors (e.g., Jardiance, Farxiga) → Reduce heart failure & CKD progression.
- GLP-1 RAs (not oral, but injectables like Ozempic) → Also protect heart.
- Weight Loss: SGLT2 inhibitors, metformin.
- Hypoglycemia Risk: High with sulfonylureas/meglitinides.
Type 2 Diabetes Insulin Drugs List
1. Rapid-Acting Insulins
(Onset: 15–30 min | Peak: 1–2 hrs | Duration: 3–5 hrs)
| Brand Name | Generic Name | Notes |
| Humalog | Insulin lispro | Faster absorption than regular insulin. |
| NovoLog | Insulin aspart | Commonly used in insulin pumps. |
| Fiasp | Insulin aspart (faster) | Contains additives for ultra-rapid onset (mealtime coverage). |
| Lyumjev | Insulin lispro (faster) | Similar to Fiasp, with rapid post-meal glucose control. |
| Apidra | Insulin glulisine | Less commonly used than lispro/aspart. |
2. Short-Acting (Regular) Insulins
(Onset: 30–60 min | Peak: 2–4 hrs | Duration: 6–8 hrs)
| Brand Name | Generic Name | Notes |
| Humulin R | Insulin regular | Requires injection 30–45 min before meals. |
| Novolin R | Insulin regular | Older, less predictable than rapid-acting analogs. |
3. Intermediate-Acting (NPH) Insulins
(Onset: 2–4 hrs | Peak: 4–10 hrs | Duration: 12–18 hrs)| Brand Name | Generic Name | Notes |
| Humulin N | Insulin NPH | Cloudy suspension; requires careful mixing. |
| Novolin N | Insulin NPH | Higher hypoglycemia risk due to pronounced peak. |
4. Long-Acting Insulins
(Onset: 1–2 hrs | Peak: Minimal | Duration: 12–24+ hrs)| Brand Name | Generic Name | Duration | Notes |
| Lantus | Insulin glargine U-100 | Up to 24 hrs | Flat profile, once daily. |
| Basaglar | Insulin glargine U-100 | Up to 24 hrs | Biosimilar to Lantus. |
| Toujeo | Insulin glargine U-300 | >24 hrs | More concentrated, lasts longer. |
| Levemir | Insulin detemir | 12–24 hrs | May require twice-daily dosing. |
| Semglee | Insulin glargine (biosimilar) | Up to 24 hrs | Interchangeable with Lantus. |
5. Ultra-Long-Acting Insulins
(Onset: 1–2 hrs | Peak: None | Duration: 36–42 hrs)| Brand Name | Generic Name | Notes |
| Tresiba | Insulin degludec | Most stable; lasts >42 hrs (flexible dosing). |
6. Premixed Insulins
(Combines rapid/short + intermediate-acting in fixed ratios)| Brand Name | Generic Name | Ratio | Peak/Duration |
| Humalog Mix 75/25 | Insulin lispro protamine/lispro | 75% NPL / 25% lispro | Dual peaks (mealtime + basal). |
| NovoLog Mix 70/30 | Insulin aspart protamine/aspart | 70% NPA / 30% aspart | Similar to Humalog Mix. |
| Humulin 70/30 | Insulin NPH/regular | 70% NPH / 30% regular | Older, less flexible. |
7. Inhaled Insulin
| Brand Name | Generic Name | Onset/Peak/Duration | Notes |
| Afrezza | Insulin human (inhaled) | 12–15 min onset, 1 hr peak, 3-hr duration |
Ultra-rapid, for mealtime coverage. Not for smokers or lung disease.
|
Only Regular Insulin (Human Insulin) Approved for IV
- Generic Name: Regular Insulin (Human Insulin)
- Brand Names:
- Humulin R (Eli Lilly)
- Novolin R (Novo Nordisk)
Why Only Regular Insulin?
- Stable in Solution: No additives (e.g., protamine, zinc) that could clog IV lines.
- Fast-Acting: Predictable onset (~15-30 mins IV) for acute glycemic control.
- FDA-Cleared: Specifically tested and approved for IV administration.
Key Takeaways:
- Rapid-acting (e.g., Humalog, NovoLog): Best for mealtime coverage.
- Long-acting (e.g., Lantus, Tresiba): Provides basal insulin (background).
- Premixed (e.g., Humalog Mix 70/30): Convenient but less flexible.
- NPH (e.g., Humulin N): Cheaper but higher hypoglycemia risk.
- Ultra-long (Tresiba): Best for stable, flexible dosing.
Insulin Sliding Scale Therapy
Insulin Sliding Scale
insulin sliding scale is a prescribed insulin dosing regimen where the amount of rapid-acting insulin is adjusted based on pre-meal blood glucose readings and sometimes anticipated carbohydrate intake.| Blood Glucose (mg/dL) |
Rapid-Acting Insulin Dose (units)
|
| < 150 | 0 |
| 151-200 | 2 |
| 201-250 | 4 |
| 251-300 | 6 |
| 301-350 | 8 |
| > 350 | 10 + call provider |
Types of Sliding Scales:
- Fixed Scale: Set doses based solely on current BG
- Dynamic Scale: Adjusts for both BG and carbs (Insulin-to-Carb Ratio)
- Bolus Insulin: Rapid-acting (e.g., Humalog, Novolog) adjusted via sliding scale
- Basal Insulin: Long-acting insulin (e.g., Lantus, Levemir) taken at consistent times
Correction Factor
- Additional insulin for high readings (e.g., 1 unit lowers Blood glucose by 50 mg/dL)
GLP-1 Drugs
What are GLP-1 Drugs and how do they work?
GLP-1 (glucagon-like peptide-1) receptor agonists are a class of medications that mimic the action of the natural hormone GLP-1, which is released from the gut after eating. They are primarily used to treat type 2 diabetes (T2D) and obesity due to their ability to:- Stimulate insulin secretion (glucose-dependent – lowers blood sugar without hypoglycemia risk).
- Suppress glucagon release (reduces liver glucose production).
- Slow gastric emptying (promotes satiety, reduces food intake).
- Act on brain appetite centers (reduces hunger, aiding weight loss).
Injectable GLP-1 Receptor Agonists
Here’s a complete list of GLP-1 receptor agonists (GLP-1 RAs) used for diabetes and/or weight loss.
| Brand Name | Generic Name | FDA Approval Diabetes | FDA Approval Weight Loss | Dosing Frequency | Weight Loss Efficacy | Notes |
| Adlyxin | Lixisenatide | Yes (2016) | No | Once daily | Minimal | Less effective for weight loss. |
| Victoza | Liraglutide | Yes (2010) | Yes (2014) | Once daily | High (~7-12 lbs) | Saxenda (higher dose) is FDA-approved for obesity. |
| Byetta | Exenatide | Yes (2005) | No | Twice daily | Moderate (~5-10 lbs) | First GLP-1 RA; shorter-acting. |
| Bydureon | Exenatide ER | Yes (2014) | No | Once weekly | Moderate (~5-10 lbs) | Long-acting version of Byetta. |
| Mounjaro | Tirzepatide | Yes (2022) | No | Once weekly | Highest (~20% body weight) | Dual GLP-1 + GIP agonist (more potent). |
| Ozempic | Semaglutide | Yes (2017) | No | Once weekly | High (~15 lbs for T2D) | Same drug as Wegovy (higher dose for obesity). |
| Trulicity | Dulaglutide | Yes (2014) | No | Once weekly | Moderate (~6-10 lbs) | Popular for CVD risk reduction. |
| Wegovy | Semaglutide | No | Yes (2021) | Once weekly | Very high (~15% body weight) | Higher dose than Ozempic (2.4 mg vs. 1-2 mg). |
| Zepbound | Tirzepatide | No (2023) | Yes (2023) | Once weekly | Highest (~20% body weight) | Same drug as Mounjaro (higher doses for obesity). |
T2D = Type 2 Diabetes
Oral GLP-1 Receptor Agonists
Here’s a complete list of oral GLP-1 receptor agonists (GLP-1 RAs) used for diabetes and/or weight loss.
| Brand Name | Generic Name | Diabetes FDA Approval | Weight Loss FDA Approval | Dosing Frequency | Weight Loss Efficacy | Notes |
| Rybelsus Oral Tab) | Oral semaglutide | Yes (2019) | No | Once daily | Moderate (~8-10 lbs) | Only oral GLP-1 RA. |
Key Differences:
Diabetes vs. Weight Loss Approval:
- T2D-only: Byetta, Bydureon, Adlyxin, Trulicity, Rybelsus.
- T2D + Obesity: Victoza (Saxenda for obesity), Ozempic (Wegovy for obesity), Mounjaro (Zepbound for obesity).
Weight Loss Efficacy:
- Moderate: Exenatide, Liraglutide (Victoza), Dulaglutide, Oral Semaglutide.
- High: Semaglutide (Ozempic/Wegovy).
- Very High: Tirzepatide (Mounjaro/Zepbound).
Dosing Frequency:
- Daily: Byetta, Victoza, Adlyxin, Rybelsus.
- Weekly: Ozempic, Wegovy, Trulicity, Mounjaro, Zepbound, Bydureon.
Cardiovascular Benefits:
- Proven CVD risk reduction: Ozempic, Trulicity, Victoza.
- Mounjaro (tirzepatide) shows superior A1C and weight loss but CVD data pending.
FDA-Approved for Obesity (Weight Loss):
- Wegovy (semaglutide 0.25mg, 0.5mg, 1.0mg, 1.7mg, 2.4 mg) Once Weekly
- Saxenda (liraglutide 3.0 mg) Once Daily
- Zepbound (tirzepatide 2.5mg, 5mg, 7.5mg, 10mg, 12.5mg, 15mg) Once Weekly
Oral GLP-1 Drug
- Rybbelsus Tablet (Semaglutide) 3mg, 7mg, 14mg
FDA-Approved for Obesity (Weight Loss):
- Wegovy (semaglutide 0.25mg, 0.5mg, 1.0mg, 1.7mg, 2.4 mg) Once Weekly
- Saxenda (liraglutide 3.0 mg) Once Daily
- Zepbound (tirzepatide 2.5mg, 5mg, 7.5mg, 10mg, 12.5mg, 15mg) Once Weekly
GLP-1 drugs Side Effects:
- Common: Nausea, vomiting, diarrhea (usually improves over time).
- Rare but serious: Pancreatitis, gallbladder disease, thyroid C-cell tumors (in rodents; human risk unclear).
Blood Glucose Monitoring
What is Blood Glucose Monitoring
Blood Glucose Monitoring (BGM) is the measurement of glucose concentration in the blood, typically performed to:
- Diagnose diabetes or prediabetes
- Manage glycemic control in people with diabetes
- Detect/prevent hypoglycemia or hyperglycemia
Blood Glucose Monitoring Methods
1. Self-Monitoring of Blood Glucose (SMBG)
- Method: Fingerstick blood test with glucometer
Frequency:
- Type 1 Diabetes: 4-10x/day (before meals, bedtime, occasionally postprandial)
- Type 2 Diabetes: 1-4x/day (varies by treatment regimen)
Advantages:
- Immediate results
- No prescription needed (for most devices)
- Lower upfront cost
- Limitations:
- Painful finger pricks
- Only provides single-point data
- Misses trends between tests
2. Continuous Glucose Monitoring (CGM)
- Devices: Dexcom G6/G7, Freestyle Libre 2/3, Medtronic Guardian
- Method: Sensor measures interstitial glucose every 1-5 minutes
- Data Provided:
- Real-time glucose values
- Trend arrows (showing rate of change)
- Alerts for highs/lows
- Advantages:
- No fingersticks (except for calibration with some models)
- Reveals glucose patterns and trends
- Helps identify nocturnal hypoglycemia
Limitations:
- Lag time (5-15 minutes behind blood glucose)
- Higher cost (sensors replaced every 10-14 days)
- Requires prescription
3. A1C Testing
- Measures: Average blood glucose over 2-3 months
- Frequency:
- Well-controlled: 2x/year
- Uncontrolled/changing therapy: Quarterly
- Limitations:
- Doesn’t show daily variability
- Affected by anemia/hemoglobin variants
- Misses hypoglycemia episodes
Comparison
| Feature | SMBG | CGM | A1C |
| Data Type | Single-point | Continuous | 3-month average |
| Hypo Detection | Only if tested | Real-time alerts | Misses most |
| Cost | $ | $$$ | $ |
| Pain/Inconvenience | Fingersticks | Sensor insertion | Blood draw |
| Best For | Budget-conscious | Pattern management | Long-term control |
Diabetes Drug Interactions, Contraindications & Natural Products Guide
Metformin avoid with:
- Contrast dyes (risk of lactic acidosis; stop 48h before imaging).
- Alcohol excess (↑ lactic acidosis risk).
- Cimetidine (↑ metformin toxicity).
Sulfonylureas (e.g., Glimepiride, Glyburide) avoid with:
- Alcohol (↑ hypoglycemia risk).
- Beta-blockers (mask hypoglycemia symptoms).
- Warfarin (↑ bleeding risk).
SGLT2 Inhibitors (e.g., Jardiance, Farxiga) avoid with:
- Diuretics (↑ dehydration risk).
- Ketoacidosis triggers (very low-carb diets, prolonged fasting).
GLP-1 RAs (e.g., Ozempic, Trulicity) avoid with:
- Slow gastric emptying meds (e.g., opioids, anticholinergics).
Insulins avoid with:
- Beta-blockers (mask hypoglycemia).
- Thiazolidinediones (TZDs) (↑ fluid retention/heart failure risk).
Natural Products to AVOID with Diabetes Drugs
| Natural Product | Interacts With | Risk |
| Bitter melon | Insulin/Sulfonylureas | Severe hypoglycemia |
| Ginseng | Warfarin/Insulin | Alters blood sugar & clotting |
| Cinnamon (high doses) | Diabetes meds | Liver toxicity, unpredictable glucose effects |
| Fenugreek | Anticoagulants | ↑ Bleeding risk |
| Aloe vera (oral) | Diuretics/Laxatives | Electrolyte imbalance |
| St. John’s Wort | Metformin/Sulfonylureas | Reduces drug effectiveness |
Natural Products That MAY Help Diabetes
| Natural Product | Potential Benefit | Caution |
| Berberine | ↓ A1C (similar to metformin) | Avoid with cyclosporine, monitor liver enzymes |
| Omega-3s (EPA/DHA) | ↓ Triglycerides | High doses may ↑ blood sugar |
| Magnesium | Improves insulin sensitivity | Avoid in kidney disease |
| Probiotics | May improve gut microbiota | Choose strains like L. reuteri |
| Apple cider vinegar | ↓ Post-meal spikes | Dilute to prevent enamel erosion |
| Chromium | Mild glucose control | Avoid in kidney disease |
