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The thyroid is a part of the body. It is a butterfly-shaped gland. It is present in the lower part of the neck. It has two lobes, left and right.
The main function of the thyroid is to produce thyroid hormones -- primarily thyroxine (T4) and triiodothyronine (T3). T4 gets converted into T3 (a more active form) in the blood.

The thyroid also produces calcitonin, which contributes to calcium balance.

Thyroid hormone production is regulated by the pituitary gland (a small gland at the base of the brain).
Thyroid hormones regulate our metabolism and affect weight and energy level. The adequate level of thyroid hormone is essential for proper functioning of all the systems of the body like heart, kidney, brain, reproductive system
The problems occurring with the thyroid gland constitute thyroid diseases.

The overactive thyroid gland is called hyperthyroidism.

The underactive thyroid gland is called hypothyroidism.

The enlargement of the thyroid is called Goiter.

The growths within the thyroid are called a nodule.
Blood tests are usually the first step in diagnosing thyroid disease. Based on physical exam and blood tests your doctor can determine if other studies are needed such as ultrasound, thyroid scan, or biopsy and the appropriate treatment.
It is a myth. There is no thyroid diet. Patient with hypothyroidism taking medicines can eat cabbage and soya been.

Cabbage and soya contain certain chemicals which interfere with the process of thyroid hormone production. But we by giving the thyroid hormones are bypassing the synthesis process hence patient need not worry about it.
No.

No alternative therapy have any proven role in thyroid management. No.

No alternative therapy have any proven role in thyroid management. 
The relationship between hypothyroidism and weight is complex. Severe hypothyroidism causes weight gain mainly due to fluid retention. Mild elevation of TSH does not lead to weight gain.
Yes. The patient with overt hypothyroidism requires lifelong treatment as the problem is lifelong.
In proper dosages, there are no side effects. When the dosages are in an excess patient may develop symptoms of hyperthyroidism.
Mild reactions like itching, skin reactions can occur at the start of treatment. These are self-limiting and do not require discontinuation of treatment.

Serious side effects include – cholestasis, liver failure, neutropenia.

The serious side effects can occur in any patients. These cannot be predicted.
If a patient develops fever, sore throat, yellowish discoloration of eyes, dark-colored urine patient should stop medicines immediately and inform to doctor. These are the warning signs of serious side effects of anti-thyroid medicines.
It is the condition in which excess hormones are produced from thyroid. Common causes of hyperthyroidism include Graves disease, toxic nodule, toxic multinodular goiter. The patient will have symptoms of excess thyroid hormone. In addition to the above-mentioned causes, a patient might have excess thyroid hormone levels in the blood due to other causes like inflammation of the thyroid gland, overtreatment of hypothyroidism. It is important to differentiate between the causes of excess thyroid hormone levels in the blood.
Tremors, excessive sweating, palpitations, weight loss, anxiety, lack of sleep (insomnia ), muscle weakness, heat intolerance, erectile dysfunction in male and menstrual changes.

The number, degree, and severity of these symptoms can provide some clue as to the severity of hyperthyroidism.
It is done by listening to the patient’s complaints, examining him and by ordering the relevant blood test. 

On physical exam, the physician may find that the patient has a rapid heart rate (tachycardia), irregular heartbeats (arrhythmias, including atrial fibrillation), eye symptoms (such as dryness, burning, bulging, double vision), or hand tremors. In addition, the thyroid gland may be larger than normal.

Laboratory testing to confirm the diagnosis of hyperthyroidism will include thyroid function tests. Usually, the TSH level will be lower than normal and the T3 and/or T4levels will be higher than normal.

Subclinical hyperthyroidism is defined as cases where there are no clear symptoms or physical signs of hyperthyroidism on history and physical examination, but the blood level of TSH is low, and T3/T4 levels are normal.

Thyroid uptake scanning is used to determine if the thyroid is making too much thyroid hormone, leading to a high, or "hot" uptake scan versus if the thyroid is being destroyed (as in thyroiditis), in which case the scan will be a low, or "cold" uptake scan.
It is an autoimmune problem where the body's immune system overstimulates the thyroid. It is named as Graves’ disease after the name of Dr. Graves. It is the most common cause of hyperthyroidism. TSH-R Ab, an antibody to the TSH receptor, causes the overproduction of thyroid hormone.

The thyroid uptake scan will be high, or "hot". On physical exam, patients with Graves' disease may have bulging eyes and violet plaque-like lesions, on the front of their lower legs, which are possibly associated with itchiness.
Hyperthyroidism due to toxic multinodular goiter occurs when one or more nodules (growths) in the thyroid begin to make too much thyroid hormone. In general, the hyperthyroidism tends to be less severe than that seen in Graves' disease. Laboratory diagnosis is the same as in other cases of hyperthyroidism with low TSH and high T4 and T3 levels. Thyroid uptake scans may note several separate "hot" spots corresponding to the hyperactive nodules, while the rest of the gland has decreased activity.
If a single nodule, or a solitary toxic adenoma, in an otherwise normal thyroid gland makes too much thyroid hormone, it can lead to hyperthyroidism. This is a less common cause of hyperthyroidism than either Graves' disease or toxic multinodular goiter. The diagnosis can be made in the same fashion as above.
The treatment of excess thyroid hormone depends upon the cause. If it is due to inflammation of the thyroid gland symptomatic treatment and periodic follow up with thyroid function test is needed.

If excess thyroid hormones are secondary to hyperthyroidism then the options available are 

1) medical therapy

 2) surgery

3) RAI ablation.

The best treatment depends on a number of factors and the treatment plan should be made with the help of experts in thyroid disease (endocrinologist).
 

Medical therapy is given to control symptoms and to prevent excess thyroid hormone production.

Beta blockers are medications that are used to control symptoms such as palpitations, anxiety, and tremors. These medications are usually given until thyroid function has returned to normal.

Antithyroid medications are used to block excess thyroid hormone production

 Usually, patients are put on antithyroid medications for one to two years. At that point, the medication is stopped.

If hyperthyroidism returns, as happens in over 50% of patients, a more definitive treatment to cure the disease is considered.

 The options for definitive treatment of hyperthyroidism are RAI ablation or surgical removal of all or part of the thyroid. Both are effective in the long-term control of hyperthyroidism.

Medical treatment is preferred when the patient is having a mild problem, small goiter, and a young patient, those who are the poor candidate for surgery and before the surgery to control hyperthyroidism.
Surgery for hyperthyroidism usually means removing the entire thyroid gland (total thyroidectomy) with the goal of making the patient hypothyroid and then starting thyroid hormone replacement pills.

Surgery does have the small risk of postoperative complications, but it has the advantages of rapidly fixing the hyperthyroidism with only a 3% recurrence rate. When performed by an experienced surgeon, thyroid surgery is safe.

After a total thyroidectomy, patients absolutely must take thyroid hormone replacement pills because removing the whole thyroid makes them hypothyroid.

 Patients with a large goiter, with significant compressive symptoms, suspicion for thyroid cancer, a moderate or severe eye disease in Graves' disease, and pregnant patients who cannot tolerate antithyroid medications should have an operation.
In RAI ablation, the patient is given a pill that contains radioactive iodine that is absorbed by thyroid cells and destroys them. RAI ablation has the advantage of avoiding thyroid surgery. Currently, most patients are given doses of RAI that are high enough to destroy the entire thyroid and then are started on thyroid hormone replacement pills. This controls the hyperthyroidism sooner and more definitively. With proper treatment, hypothyroidism following RAI ablation should occur within three to six months. In general, the chance of the hyperthyroidism returning (i.e. recurrence) is less than 3%.

A disadvantage of RAI ablation is the potential to worsen thyroid eye disease (ophthalmopathy) associated with severe cases of Graves' disease.

Patients who are pregnant, have large thyroids, suspicious thyroid nodules, risk factors for thyroid cancer, or who have symptoms from a large goiter should not have RAI ablation. In general, most practitioners do not recommend RAI ablation for patients younger than 15 years old.
Hypothyroidism is a problem in which the thyroid is underactive or non-active. It is more often seen in women than in men.
Symptoms of hypothyroidism may include fatigue, daytime sleepiness, weight gain, water retention, thinning hair, dry skin, constipation, difficulty concentrating, menstrual irregularity, erectile dysfunction and others.

Hypothyroidism can range from mild forms that are asymptomatic, and found only via blood tests, to severe hypothyroidism, that is associated with significant symptoms along with abnormal lab results.
 In general, hypothyroidism can be diagnosed by a thorough history, examination and blood tests. History is focused on previously noted risk factors such as a personal or family history of autoimmune diseases, a personal history of head and neck radiation, and a detailed medication history (including non-prescription medications and supplements). Except in cases of longstanding significant hypothyroidism, physical examination will usually not provide any clues to the presence of the disease. The thyroid itself may feel normal.

The TSH level is the best test for diagnosing hypothyroidism. A high TSH level confirms the diagnosis of hypothyroidism in most patients. Typically, the free T4 level is usually low.
Hypothyroidism is most commonly caused by an underlying thyroid disease (i.e. primary hypothyroidism) instead of a problem with TSH production (i.e. secondary hypothyroidism).

The most common causes of primary hypothyroidism are autoimmune thyroiditis (i.e. Hashimoto's thyroiditis or lymphocytic thyroiditis), surgical removal of the thyroid (i.e. thyroidectomy), radioactive iodine treatment, certain medications, and exposure of the neck to significant radiation.
It is the most common cause of hypothyroidism in areas where people get enough iodine in the diet. It is an autoimmune condition. The majority of patients with Hashimoto's have antibodies to thyroglobulin (Anti-TG Ab) and/or thyroid peroxidase (Anti-TPO Ab). These antibodies cause the destruction of thyroid cells which leads to fewer cells making thyroid hormone.

Risk factors for Hashimoto's thyroiditis include female gender, personal history of other autoimmune diseases, and a family history of autoimmune thyroiditis or other autoimmune diseases.
Yes. Antithyroid medications (Methimazole, Propylthiouracil, etc) are designed to cause hypothyroidism and are typically only used to treat hyperthyroidism.

 

Lithium is a medication used in the treatment of certain psychiatric disorders. However, lithium prevents thyroid hormone release and can cause hypothyroidism. This typically happens within the first two years of starting lithium. Patients on lithium should have their thyroid function closely monitored.

 

Amiodarone is a potent medication used in the management of certain types of irregular heart rates or arrhythmias. This drug contains iodine. The typical dose of amiodarone contains 40 times the recommended minimum daily intake of iodine. Patients with autoimmune thyroiditis are at greatest risk for developing amiodarone-induced hypothyroidism.

Anti-tubercular medicines, radiation to neck and surgery can lead to hypothyroidism.
The treatment of hypothyroidism is replacing the body's natural thyroid hormone with a pill form of thyroid hormone.

 During treatment, the patient's TSH level must be monitored to ensure that the correct dose is given. The goal in most cases is for the TSH to be in the normal range. Typically, the starting dose is based on the patient's weight.

There are several situations where the dose may need to be adjusted. For example, in elderly patients, thyroid hormone replacement should be started at a lower dose due to the significant risks of heart problems and increased bone loss.
1 tablet should be kept in bottle tightly closed and away from sunlight.

2 Check expiry date before use.

3 Tablet has to be taken on an empty stomach.

4 Avoid taking food, tea for at least half an hour after taking medicine.

5 Avoid taking other medicines simultaneously like iron, calcium, antacid.
"Goiter" is a term for abnormal enlargement of the thyroid gland. The gland can be generally enlarged or have multiple growths (nodules) leading to enlargement of the whole thyroid gland. A goiter can be associated with an overactive gland, an underactive gland, or a normal thyroid gland.
Multinodular goiter is an enlargement of the thyroid due to the growth of multiple nodules. The number and sizes of the nodules vary amongst individuals. There are two forms of multinodular goiter: 1) nontoxic multinodular goiter and 2) toxic multinodular goiter. If the goiter makes normal amounts of thyroid hormone, it is known as a nontoxic multinodular goiter. If the goiter makes inappropriately high amounts of thyroid hormone, it is known as a toxic multinodular goiter.
Not all goiter require surgery as the growth of goiter is usually slow.

The treatment is surgery in the majority of cases. Goiter need treatment if malignancy is suspected or it is causing pressure symptoms like hoarseness, difficulty swallowing, or difficulty breathing. Surgery is also advised if it is hormonally overactive or causing a cosmetic problem.

After surgery patient may develop hypothyroidism which needs treatment.
A thyroid nodule is a growth within the thyroid gland, which may or may not be felt by physical exam. Some nodules are only found incidentally on imaging of the thyroid. Thyroid nodules are very common and by age 60 almost one-half of all people will have a thyroid nodule. Fortunately, most of these nodules are benign i.e not having cancer and do not cause any symptoms.
We do not know why most thyroid nodules occur, although some conditions, such as Hashimoto's thyroiditis (inflammation of the thyroid), a family history, radiation exposure, and iodine deficiency may increase the frequency of nodules.
If you feel a thyroid nodule, your doctor will initially start the evaluation by a physical exam and laboratory tests to check if your thyroid function is normal.

The next step is usually a thyroid ultrasound. Thyroid ultrasound can help determine the size of the nodule, whether it is solid or fluid-filled (cystic), whether there are any other non-palpable nodules, and if there are any suspicious features. Based on the ultrasound and your thyroid function studies it will be decided whether you need a biopsy, known as a fine needle aspiration.
It is the biopsy of thyroid done with the fine needle. It does not require any special preparation and the patient can return to work and regular activity the same day. Sometimes an ultrasound machine needs to locate the nodule. Usually, 3-6 samples must be taken to give the best chance of finding normal or abnormal cells. The cells taken in the fine needle are examined under the microscope by a pathologist. Depending upon the characteristics of the cell examined pathologist give the report. Endocrinologist then guides the patient regarding the further treatment.
Papillary thyroid cancer (PTC) is the most common type of thyroid cancer making up to 70-80% of all thyroid cancer cases, while Follicular and Hürthle cell cancers represent the second most common.

Medullary thyroid cancer (MTC) accounts for 3 to 10% of all thyroid cancers and grows from specialized thyroid cells called parafollicular or C-cells that make a hormone called calcitonin.

Anaplastic thyroid cancer is a rare, but very aggressive cancer, representing only 1-2% of all thyroid cancers, which usually occurs in older patients.
Most patients with thyroid cancer do not have any symptoms. Typically, patients present with a thyroid nodule that is found to be cancer on further evaluation. As with all thyroid disease, a thorough history is important, such as a family history of thyroid cancer, personal history of radiation exposure, or enlarged lymph nodes.

The endocrinologist will review with you any symptoms such as pain, swelling in the neck, difficulty with swallowing, shortness of breath, difficulty with breathing or changes in your voice. If the nodule is large, it may cause symptoms such as difficulty swallowing, choking sensations, or a large mass in the neck. Rarely, cancer can grow into the nerves (i.e. the recurrent laryngeal nerves) that control the voicebox and cause hoarseness.
Removal of the whole thyroid gland (total thyroidectomy) is almost always recommended as the first step. If the cancer is very small (less than 1 cm) and limited to one side of the thyroid, some surgeons may only remove one half of the thyroid by performing a thyroid lobectomy. PTC can spread to the lymph nodes in the neck which may be felt pre-operatively on examination or seen on ultrasound. Generally, such lymph nodes are removed during the thyroid resection,

Radioactive iodine ablation (RAI) is given weeks to months postoperatively depending on the aggressiveness of cancer based on pathologic findings and whether there is any remaining thyroid tissue.

 After total thyroidectomy, patients need to take thyroid hormone replacement pills for the rest of their life. Patient need long-term follow up after initial treatment as thyroid cancer can reccur.
Removal of the whole thyroid gland (total thyroidectomy) is almost always recommended as the first step.

Follicular or Hürthle cell neoplasm on their thyroid biopsy in a thyroid nodule is initially treated with a thyroid lobectomy (part of the thyroid is removed). It is needed to make a pathological diagnosis which cannot be made on fine needle aspiration (FNA) biopsy. Once such a patient is diagnosed with Follicular or Hürthle cell cancer, he or she usually needs to have the rest of the thyroid removed in an operation called a completion thyroidectomy.

After thyroidectomy, patients need to take thyroid hormone replacement pills for the rest of their life. Radioactive iodine ablation (RAI) is given weeks to months postoperatively depending on the aggressiveness of cancer based on pathologic findings and whether there is any remaining thyroid tissue as demonstrated by a diagnostic uptake scan; Hürthle cell cancers tend not to take up RAI as well as other thyroid cancers.
The best treatment for medullary thyroid cancer (MTC) is surgery to completely remove all disease including the entire thyroid gland, the central neck lymph nodes (located behind the thyroid gland) and all lateral lymph node metastases (located on the side of the neck near the jugular vein and carotid artery).

Calcitonin and CEA are the markers of medullary cancer.  After surgery, blood levels for calcitonin and CEA are monitored routinely, usually every 6 months to a year.

If calcitonin and CEA levels rise above the initial post-operative level, a neck ultrasound and computed tomography (CT) scan, should be performed to look for recurrent disease. If there is recurrent disease, then another operation may be needed.

Radioactive iodine ablation does not work for MTC; external beam radiation or chemotherapy is reserved for patients with very advanced or severe disease.
In simple word diabetes means excess glucose in the blood. It is an endocrine disorder where your body fails to utilize the glucose. So excess glucose accumulate in the blood and get deposited into various organs resulting in the damage to those organs.
Every cell in your body requires sugar for normal function. Insulin is the hormone that helps the sugar to be taken up by the cells. It is due to inadequate action of insulin in the body. In case of less Insulin or if the body stops responding to Insulin, the levels of sugars in the blood shoots up. Then a person is said to be suffering from Diabetes.
There are 2 main types of diabetes- type 1 and type 2.
In type 1 diabetes, the body makes little or no insulin. It generally affect children and young adult. These patients require lifelong insulin.
In Type 2 diabetes initially the body does not respond to Insulin(medical term- Insulin resistance) and later on the production of insulin also decreases. Nearly half of the type 2 diabetes patients require insulin in their life.
Other types include –pancreatic diabetes, gestational diabetes, monogenic diabetes, diabetes secondary to hormonal disorders and drugs.
Pancreatic diabetes occur due to diseases of the pancreas. It is brittle diabetes and generally requires insulin.
Gestational diabetes is the diabetes first detected during pregnancy. It increases the chances of complications during pregnancy. Patient with gestational diabetes are at increased risk of future diabetes.
It can be managed well with diet, exercise and medicines.
Diabetes can also occur secondary to the use of medicines like steroid, antipsychiatry medicines and other hormonal disorders like Cushing disease, acromegaly.
Ceretain syndromes are associated with diabetes like maturity onset diabetes of young where single gene defect can result in the diabetes.

Nearly 50% patients with diabetes do not have any symptoms. Hence it is known as “silent killer”. Rest patient may have any of the following symptoms:
  • Intense thirst
  • Fatigue
  • Urinating frequently
  • Losing weight
  • Blurred vision
  • Burning in the hand and feet
  • Itching over the body
  • Wound that does not heal properly
  • Difficulty in sexual life
Few patients present directly with the complications of diabetes like heart attack, paralysis, kidney disease.
Patient with Type 1 diabetes can present with complication like diabetic ketoacidosis.
Blood tests are done to determine the amount of sugar in your blood .This test will show if you have diabetes . Your doctor may ask you to do HbA1c, fasting sugar or 75 gram oral glucose tolerance test.
Treatment for type 1 diabetes involves 2 key parts:
?Monitoring your blood sugar frequently , to make sure it does not get too high or too low.
?Using insulin injections or an insulin pump to keep your blood sugar levels within the normal range. People with type 1 diabetes also need to carefully plan their meals and activity levels. That's because eating raises blood sugar, while being active lowers it. Despite the need to plan, people with diabetes can have normal diets, be active, eat out, and do all the things that most other people do. 
You may need to see your doctor at least 3 or 4 times an year. The frequency of visits will depend upon how well your sugar is controlled. During your visits your doctor may want to test your average sugar control over the last few months (A1C testing),other parameters like blood pressure,cholesterol,tests for kidney function,eye examination and nervous system evaluation.
Having high blood sugar can cause serious problems over time. It can lead to nerve damage,kidney disease,vision problems (or even blindness),pain or loss of feeling in the hands and feet,the need to have fingers, toes, or other body parts removed (amputated),heart disease and strokes. Having low blood sugar can cause problems, too. It can increase your heart rate, cause sweating or shivering. People with very low blood sugar can get serious problems as headaches, drowsiness, unconsciousness or even have seizures.
People with diabetes have a much higher risk of heart disease and strokes than people who do not have diabetes. Keeping blood pressure and cholesterol low can help lower those risks. If your doctor or nurse puts you on blood pressure or cholesterol medicines, be sure to take them. Studies show that these medicines can prevent heart attacks, strokes, and even death.
Many women with type 1 diabetes have healthy pregnancies. If you want to have a baby, make sure you control your blood sugar really well before and during pregnancy. This will protect you and your baby from problems.
Type 2 diabetes might not cause any symptoms initially but can give rise to serious complications if left uncontrolled over a period of time. It can cause:
?Heart attacks
?Strokes
?Kidney disease
?Vision problems (or even blindness)
?Pain or loss of feeling in the hands and feet
?The need to have fingers, toes, or other body parts removed (amputated)
Treatment of Type 2 diabetes—It is treated with oral tablets and injections depending on the sugar levels and duration of disease.
Sometimes, people with type 2 diabetes also need medicines to reduce the problems caused by the disease. For instance, medicines used to lower blood pressure can reduce the chances of a heart attack or stroke. Along with medicines one has to follow certain lifestyle modifications such as regular exercise,diet control, cessation of smoking, regular sugar check up
and adhering to the correct prescription and advice by the doctor.

Can type 2 diabetes be prevented?
Yes, it can. To reduce your chances of getting type 2 diabetes, the most important thing you can do is control your weight. If you already have the disorder, losing weight can improve your health and blood sugar control.
Insulin is a medicine that helps lowering the blood sugar level that is used in the treatment of Diabetes. Diabetes is a disorder in which sugar does not enter the cells and remains elevated in the blood.
Are there different types of insulin? 
There are different types of Insulin which control blood sugar levels. Some types of insulin start working faster or has a longer duration of action than other types. Many people use 2 different types of insulin every day so that their blood sugar level is controlled both at day and night.
How many times should I use insulin? 
It depends on your blood sugar control and the duration of treatment. Your doctor will work with you to
make a treatment plan that tells you:
? When to use insulin
? What type of insulin to use
? How much insulin to use.
Some people use the same type and dose of insulin 1 or 2 times a day, at the same time each day. But many people use insulin, 3 or more times a day, usually before each meal. Using insulin, 3 or more times a day can control a person's blood sugar level better.
An insulin pump is a device that slowly releases insulin into the body. The insulin goes through a thin tube from the pump into the body through an opening in the skin. The device keeps working all day and night.
An insulin pump is a device that slowly releases insulin into the body. The insulin goes through a thin tube from the
pump into the body through an opening in the skin. The device keeps working all day and night.
Checking your blood sugar level is important because it can tell you:
?If your blood sugar level gets too low or too high – If you use too much insulin, your blood sugar level can get too low. If you do not use enough insulin, your blood sugar level can get too high. Levels that are too low or too high can lead to serious problems.
?What changes to make in your next insulin dose – Knowing your blood sugar level will help you choose your next insulin dose.
?How well your treatment is working – One goal of diabetes treatment is to keep your blood sugar at or near a normal level. This can prevent health complications later in life.
How do I know if I am using the right amount of insulin?
To know, if you are using the right amount of insulin, you can check your blood sugar level at home. Most doctors recommend that people who use insulin check their blood sugar level at least 4 times a day.
How do I check my blood sugar level at home?
You can use a device called a "blood glucose monitor". Prick your skin to get a drop of blood. Then you will put the drop of blood into the monitor. After a few seconds, the monitor will show your blood sugar level.
Another device that people can use to check their blood sugar level is called a "continuous glucose monitor." These monitors check the user's blood sugar level every few minutes using a tiny sensor that is put under the skin. This is
then recorded as a graph by which the sugar levels can be monitored and dose adjustments of medications can be made accordingly.
Type 2 diabetes can be treated with:
Diet changes,Lifestyle changes,Medicines and Testing.
What diet and lifestyle changes might be part of my treatment?
As part of your treatment, your doctor or nurse might recommend that you: Lose weight, Eat healthy foods,Get regular exercise and not smoke. Making these lifestyle changes is as important as taking your medicines. Medicines used to treat type 2 diabetes — Different medicines can be used to treat type 2 diabetes. The first medicine that most people with type
2 diabetes take is a tablet called metformin .
You can find out that your treatment is working by checking your blood sugar level either in a lab or at home with a device called blood glucose meter.
Your doctor can also do a blood test called an “A1C.” This test checks what your blood sugar level has been over the past 2 to 3 months.
If your blood sugar level is still higher than normal after you have been taking metformin for 2 to 3 months, your doctor might add a second medicine to your treatment.
There are different medicines your doctor can prescribe. The choice will depend, in part, on your weight, your other health problems, and if you want to use an injectable medicine.Some of these medicines can cause low blood sugar as a side effect.

Symptoms of low blood sugar can include:
Sweating,shaking,feeling hungry or worried.Low blood sugar should be treated quickly because it can cause unconsciousness. Your doctor or nurse will tell you ahead of time how to treat low blood sugar.

Sometimes, people with type 2 diabetes need medicines to treat health problems that often affect people with diabetes. For example, people who have high blood pressure might take medicines to lower their blood pressure. This can reduce their chances of having a heart attack or stroke
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