to learn the side effects of drugs. how to decrease the drugs when patient is on plant based natural diet. Dr Paawan Wadhawan is a Diabetologist who reverses the diabetes with diet only.

1. Diabetic Drugs
Adverse effects , Tapering and
Complications
DR Paawan Wadhawan
MBBS,MD(Medicine)
Consultant Physician
Diabetologist
Critical Care Specialist
Sujok Therapist

2. Anti Diabetic Drugs –OHA’s
• Alpha-Glucosidase Inhibitors
• These medications help lower blood glucose by assisting the body
with breaking down starchy foods and table sugar. For the best
results, they’re taken before meals. Options include:
1. acarbose (Precose)-50 -100 mg
2. miglitol (Glyset)-25,50, and 100 mg
3. Voglibose-0.2 and 0.3 mg.

4. Biguanides
• Biguanides decrease glucose
production in the liver. They
decrease intestinal glucose
absorption and increase insulin
sensitivity. They also help
muscles absorb glucose.
• The most common biguanide is
metformin -500,1000
SR(Glyciphage,Gluconorm).
• Metformin can also be combined into a single
medication with other type 2 medication types.
It is included as an ingredient in:
• •metformin-alogliptin (Kazano)
• •metformin-canagliflozin (Invokamet)
• •metformin-glipizide
• •metformin-glyburide (Glucovance)
• •metformin-linagliptin (Jentadueto)
• •metformin-pioglitazone (Actoplus)
• •metformin-repaglinide (PrandiMet)
• •metformin-rosiglitazone (Avandamet)
• •metformin-saxagliptin (Kombiglyze XR)
• •metformin-sitagliptin (Janumet)
• •glyburide-metformin (Glucovance)

9. DPP-4 Inhibitors(Dipeptidyl peptidase-4 inhibitor)
• DPP-4 inhibitors help the body preserve insulin production by inhibiting
the enzyme which deactivate Incretins. They work by reducing blood
glucose without causing hypoglycemia. Options include:
• alogliptin (Nesina)-6.25,12.5, and 25 mg
• linagliptin (Trajenta,Ondero)-5 mg
• saxagliptin (Onglyza)-2.5 and 5 mg
• sitagliptin (Januvia)-25,50 and 100 mg.
• Vildagliptin(Jalra,Galvus)-50 mg
• Tenlegliptin-20 mg

13. Glucagon-Like Peptides
• These are similar to the natural hormone incretin.
Options include: Inj.-s/c
•albiglutide (Tanzeum)-30 mg,50 mg single dose pen
•dulaglutide (Trulicity)-0.75,1.5 mg
•exenatide (Byetta)-2 mg
•liraglutide (Victoza)-0.6,1.2,1.8 mg

20. Meglitinides
•These medications stimulate insulin release.
Repaglinide- (Prandin,Eurepa)- 0.5, 1 and 2 mg.
•Nateglinide(Starlix)-60 and 120 mg.

22. SGLT2 Inhibitors
• Sodium glucose transporter (SGLT) 2 inhibitors work by preventing the
kidneys from holding onto glucose. Instead, SGLT2 promotes
excretion through the urine. The forms of this medicine available are:
• Dapagliflozin (Farxiga)-5 and 10 mg
• Canagliflozin (Invokana) -100 and 300 mg.
• Empagliflozin (Jardiance) -10 and 25 mg.

26. • High risk of foot amputation

27. Sulfonylureas
• These are among the oldest diabetes medications still used today.
They work by stimulating the pancreas with the help of beta cells. In
turn, more insulin is produced. Sulfonylureas come in the form of:
•Glimepiride-1,2 and 4 mg (Amaryl,G1,G2,Glador,Zoryl,Gemer)
•Gliclazide -60,80 mg(Reclimet,Diamicron)
•Glipizide (Glucotrol)-5,10 mg
•Glibenclamide-2.5 and 5 mg (DiaBeta, Glynase,Daonil, Micronase)

31. Thiazolidinediones
• These medications work by decreasing glucose in the liver, while also
promoting insulin efficacy in fat cells.
• Pioglitazone (Pioz or P in any tablet) -7.5 and 15 mg.
• Many combinations in market-TRI-----
P

35. Insulin –Anabolic Hormone
• T2DM -------HYPERINSULINEMIA-high IGF
• Exogenous INSULIN-----Cells Overgrowth---
• OBESITY
CANCER

38. • Lancet Oncology (2010), the women with high concentration of
insulin and IGF in the blood have seven times higher chances of
suffering from cancer than the women with low concentration of
insulin and IGF in the blood.
• Journal of National Cancer Institute (2000, 2002), men who produce
high level of IGF are nine times more likely to have prostate cancer.

39. Insulin types

40. Insulin Degludec

41. Protocol for stopping OHAs

43. My Experience
•Type 1 Diabetes –Insulin tapering
•Unpredictable
•20-30 percent cure rate
•Earlier the patient comes better
• Maintainance diet is better then
raw diet

44. Case study
• Amaryl M2 forte BD +
• Jalra M 50/500 OD +
• Invokana 300 mg Od

45. Case 2
• Injection Insulin Tresiba 30 U HS
• Inj. Insulin Human Actrapid-
10,10,10
• Tab Trajenta Duo 5/500 OD
• Fasting sugar is high
• PP is High

46. Case 3
• Tab Geminor MP2 BD
• Injection Insulin Lantus 30 U HS
• Tab Jardiance 25 OD

47. Case 4
• Injection Victoza 0.6 mg Od
• Tab pioz 15 BD
• Tab Glyciphage 500 BD
• Tab Teniva 20 mg OD

48. Case 5
• Injection Insulin Mixtard 30/70-
40-----0--------35
Tab Amaryl M 2 OD
Tab Pioz 15 OD
• Patient has CAD
• LFT is high

49. Case 6
• Injection Insulin Mixtard 30/70
• 25 -----0--------20
• Tab Metformin 500 BD
• Serum Creatinine is 2.5
• Repeated episodes of
hypoglycemia

50. Cholesterol Lowering Drugs-Statins

54. • Stop all Cholestrol Drugs
• Educate the patient about Indo-Vietnam medical board guidelines
• Be careful if Patient has Hypothyroid
• If the patient was taking drugs for a long time –be slow.
• Thyroid drugs should be tapered very slowly

55. Case study
• Tablet Glador M 2 Forte BD
• Tab Januvia 100 mg Od
• Tablet Farxiga 10 mg OD
• Tab Rosucor –F 20 HS
• Tab Thyronorm 100 ug OD
• FBS is 350
• Lipid are High
• TSH is 6.5

56. Case study
• Tab zerofat BD
• Tab Atorva –F 40 BD
• Tab Triexer 3 BD
• Tab Olanax F OD

57. Antihypertensive Drugs

62. DIURETICS

63. Beta Blockers

64. Nebivolol
•2.5/5 mg

65. Renin and ACE Inhibitors

66. ARBs

67. Calcium Channel Blockers

68. Calcium Channel Blockers

69. Miscellanious

71. Tapering Antihypertensives
• Intense Raw BRC diet salt free
• 5drugs ------3 drugs (21 d)
• 3------------1(21 d)
• 1------------0(21 d)
• Vegan BRC diet
• 5 drugs-----------4
• Wait for 21 days
• 4-----------3(21 days)
• 3------------2(21 d)
• 2----------1(21 d)
• 1---------0(21 d)

72. Blood thinners in Heart patients
• Aspirin 75 -100
mg,Prasugrel(10), Ticagrelor 30-
60 mg), and Clopidogrel(75)
• If post stenting less then 1 year-
Continue same
• If more then 1 year-only Aspirin
• If stable patient only Aspirin
• Try to substitute warfarin or
Pradaxa(Dabigatran) with eliquis
(Abcixiban)tabs.

73. Key points
• Always try to stop beta blockers first but slowly .
• Shift from others to Nebivolol
• Chlorthalidone and Hydrochlorthiazide are toxic for pancreas
• If kidney patient stop very very slowly.

74. Case study
• Tab Telma Am 40/5 BD +
• Tab Aten 50 BD
• Tab Lasix 40 BD
• Tab Clavix AS 75/75 OD
• Tab Atorva 40 mg OD

75. Case study -T2DM –CAD –Stenting one month
Ago
• Tab Brillinta 90 BD
• Tab Atorva 40 HS
• Tab Metolar XL 25 BD
• Tab Cardace 5 BD
• Tab Gemer MP2 BD
• Tab Jalra M OD
• Tab COQ 300 OD

76. Case 3----Serum Creatinine is 8.0
• Tab Arkamine 0.1 mg TDS
• Tab Clavix As 75/75 OD
• Tab Folvite 5 OD
• Tab Alpha D3 ).5 OD
• Tab Shelcal 500 TDS
• Tab Trajenta 5 OD
• Injection Insulin R 7-7-7
• Tab Aten 25 BD
• Tab Amlodipine 5 BD
• Tab Thyronorm 100 OD
• Tab Ultracet BD
• Tab Zolfresh 10 HS

77. Patients referred to Specialist
• Kidney patient
• Cancer
• Autoimmune problem
• Type 1 Diabetes
• DVT

78. Diabetes Emergency-Diabetic ketoacidosis
Treatment -5 litre Water, cooked diet ,Drips,Insulin

79. Hyperosmolar Coma

80. Hypoglycemia
• Glucagon Injection -1 mg IM/SC
• Give sweets
• Always Warn the Patient On BRC
diet.

81. Chest pain
• Refer

82. Stroke

83. Breathlessness

84. •500 sugar without any
symptoms is not emergency

85. •ONLY GOD CAN GIVE GUARANTEE
•WE CAN ONLY HELP

86. •Smile Thanks