Pioglitazone+metformin

Metformin+pioglitazone should not be used in patients with type 1 diabetes or with diabetic ketoacidosis. Some diabetic patients, while taking Metformin+pioglitazone, might develop a rare but serious condition called lactic acidosis. In this condition, there is too much lactic acid accumulated in the blood that can damage the working of your liver and kidney required for the elimination of excess lactic acid from the blood. Before you start taking Metformin+pioglitazone, tell your doctor if you’ve ever had pancreatitis (inflammation of the pancreas), kidney disease, and low vitamin B12 level. Metformin+pioglitazone, when used with insulin, may extremely lower the blood sugar level leading to hypoglycemia condition, which can be fatal. In this case, your doctor may adjust the dose by lowering the dose of insulin or Metformin+pioglitazone. Prolonged intake of Metformin+pioglitazone may lower your thyroid-stimulating hormone (TSH); hence, an annual check-up of TSH is recommended. In rare cases, you may also develop a serious skin reaction known as bullous pemphigoid that requires immediate medical attention. Tell your doctor if you are going to have a diagnostic test with an injection of dye or X-ray contrast agent. The use of Metformin+pioglitazone should be stopped for a short time before having an X-ray procedure.

Drug-Drug Interaction: Metformin+pioglitazone interacts with heart medications like (propranolol), pain killers (aspirin, ibuprofen, and celecoxib), high blood pressure-lowering pills (nifedipine, captopril, enalapril, lisinopril), thyroid hormones (thyroxine), antacid (cimetidine), or certain medicines affecting the nervous system.

Drug-Food Interaction: Intake of excessive alcoholic beverages may increase the chance of a life-threatening condition known as Lactic Acidosis. So, avoid intake of alcoholic beverages with Metformin+pioglitazone.

Drug-Disease Interaction: People affected with heart, liver, kidney diseases (like congestive heart failure and myocardial infarction), vitamin B12 deficiency, and alcoholism should avoid intake of Metformin+pioglitazone.

• Fill your half plate with starchy veggies, a quarter with proteins, and a quarter with whole grain.
• Eat at regular intervals. Do not take a long gap between a meal or snack.
• Monitor your blood sugar level regularly especially when there are lots of fluctuations.
• Invest at least 150 min of moderate-intensity physical activity or one hour and 15 minutes of high-intensity exercise every week.
• Lose weight gradually to achieve a healthy body mass index (18.5 to 24.9).
• Replace refined carbohydrates containing foods with whole grain foods and increase the intake of fruits and veggies and other fibre-enriched foods.
• Reduce intake of saturated fat (or hidden fats) in food like chips, crisps, pastries, biscuits, and samosas. Choose omega 3 fatty acid-containing oils for daily cooking. For frying, you can use palm oil, mustard oil, groundnut oil, rice bran oil, and safflower oil.
• Do not take stress as it may elevate your blood sugar level. You can adopt stress management techniques like mindfulness to control stress-related blood sugar changes.
• Opt for low-fat dairy products (low-fat yoghurt, fat-free milk, and cheese, etc.).
• Keep your blood pressure as normal (140/90) as possible. As it reduces the risk of cardiovascular diseases in diabetes patients.

Contact your doctor immediately if you have  nausea, vomiting, kussmaul breathing  (laboured and deep), and generalised weakness which are symptoms of Lactic acidosis, a very rare but serious metabolic complication.