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By H. Konrad. Massachusetts School of Professional Psychology. 2019.

Eating disorders are serious emotional and physical problems that can have life-threatening consequences for both women and men discount penegra 50mg overnight delivery mens health 6 pack challenge 2012. The following is a list of eating disorders and their symptoms discount penegra 100mg line prostate cancer cure rate. First on the eating disorders list is Anorexia Nervosa buy generic penegra online mens health 30-30 workout. Anorexia is characterized by self-starvation and excessive weight loss. The following are common anorexia symptoms:Refusal to maintain body weight at or above a minimally normal weight for height, body type, age, and activity levelIntense fear of weight gain or being "fat"Feeling "fat" or overweight despite dramatic weight lossLoss of menstrual periodsExtreme concern with body weight and shapSecond on our list of eating disorders is Bulimia nervosa, which centers around the bingeing and purging of food. Bulimia includes eating excessive amounts of food in short periods of time (often in secret), then getting rid of the food and calories through vomiting, enemas, laxative abuse, or over-exercising. Common symptoms include:Repeated episodes of bingeing and purgingFeeling out of control during a binge and eating beyond the point of comfortable fullnessPurging after a binge, typically by self-induced vomiting, abuse of laxatives, diet pills, diuretics, excessive exercise, or fastingHTTP/1. Eating disorders are serious and potentially life-threatening mental illnesses. By honestly answering the questions on the Eating Attitudes Test, you can find out if you should be professionally screened for an eating disorder. If you are looking for a shorter evaluation tool, take the eating disorders quiz. Eating Attitudes Test: About YouIf not enrolled in school, level of education completed:Ethnic/Racial Group: African AmericanDo you participate in athletics at any of the following levels:Please check a response for each of the following statements:1. Have gone on eating binges where I feel I may not be able to stop6. Particularly avoid food with a high carbohydrate content (bread, rice, potatoes, etc. Am preoccupied with the thought of having fat on my body22. Feel uncomfortable after eating sweetsPlease respond to each of the following Eating Attitudes Test questions:1. Have you gone on eating binges where you feel that you may not be able to stop? Have you ever made yourself sick (vomited) to control your weight or shape? Have you ever used laxatives, diet pills or diuretics (water pills) to control your weight or shape? NoTo score the Eating Attitudes Test follow this guide:For all items except #25 on the Eating Attitudes Test, each of the responses receives the following value:For item #25, the responses receive these values:After scoring each item on the Eating Attitudes Test, add the scores for a total that will help answer the question, "do I have an eating disorder? If you responded yes to any of the five YES/NO items on the bottom of the EAT, we also suggest that you discuss your responses with a counselor or your doctor. This eating disorder quiz is designed to help assess whether you may have an eating disorder. This eating disorder quiz will also help you reflect on the impact an eating disorder is having on your life. An eating disorder is a serious and possibly fatal mental illness and those with an eating disorder may not even know they have it. This quiz is designed to detect anorexia, bulimia, and binge eating disorders and may also detect if you are at risk for one of these eating disorders. For a longer evaluation tool, take the Eating Attitudes Test. Keep in mind this eating disorders quiz is not a substitute for a professional diagnosis. Any concerns about eating problems should be taken up with an eating disorder treatment professional. Honestly answer each of the questions in the following eating disorders quiz. Use the eating disorder quiz assessment at the bottom of the eating disorder quiz to evaluate your risk for an eating disorder. Are you inexplicably fatigued or cold in temperature? Do you avoid foods because of the fat, carbohydrate, or sugar content in them? Are you secretive or do you lie about your eating practices, do you think they are abnormal? Do you find you seek approval from people, and/or have a hard time saying "no" and/or a perfectionist, or an overachiever? Do you think you are not good enough, stupid, and/or worthless or people are always judging you in a negative way? Do you think life would be better and/or people would like you more if you were thin/thinner? Do you eat, self-starve, restrict, binge, purge, and/or compulsively exercise when you are feeling lonely, badly, or when you are feeling emotional pressures? While eating, self-starving, binging and/or purging do you feel comforted, relieved, like emotional pressures have been lifted, or like you are in more control? Do you feel guilty following a binge and/or purge episode, after eating or during and/or after periods of restriction/self-starvation? When eating do you ever feel out of control or like you will lose control; do you try to avoid eating because of this fear? Do you find that you bruise easily, have a very high tolerance for pain, and/or you are extremely noise sensitive? Do you spend a lot of time obsessively cooking for others, reading recipes, and/or studying nutritional information on food? Do you use self-injury (cutting yourself, burning yourself, pulling out your own hair) as a way to cope with things? Would you worry about a friend or family member that came to you with similar weight-loss/coping methods? Each of these eating disorder quiz questions can indicate an eating disorder if answered "yes" or "constantly. Print and take this quiz, along with your answers, and discuss the outcome with your health professional. Answering more than three questions with "maybe" or "often" should also be discussed with a health professional. Those answers indicate you may have an eating disorder or be at risk for developing an eating disorder. There are almost as many types of treatment for eating disorders as there are types of eating disorders themselves. This is because different eating disorders require different approaches and the severity of the eating disorder may dictate the treatment method chosen. The key lies in finding the right type of eating disorder treatment that works best for the individual.

This is why it is important to check for scoliosis (sideways curvature of the back) before puberty begins buy penegra amex prostate cancer level 7. A slight curve can turn into a much larger one during all that growth cheap penegra 100 mg with mastercard mens health hairstyles. This is discount penegra 100 mg line androgen hormone blocker, of course, when she can never get enough to eat. Fully 50% of ideal adult body weight is gained in puberty. In girls, the proportion of body weight in fat increases from about 16% to nearly 27%. Lean body mass, especially muscle and bones, also increase substantially. Most of you know of the importance of good calcium intake for all women, especially growing teenagers, pregnant women, and nursing mothers. Milk and other dairy products are the least expensive, most convenient sources. Calcium is also available as a nutritional supplement in tablet form, but many teenagers find the tablets too large to swallow comfortably. Your daughter may like the fruit or chocolate-flavored calcium-supplement chews available in drugstores now. The table below summarizes the events at each stage of development. The average (mean) age listed here can vary widely; about 2 years either side of these listed ages will usually be considered normal. The areola (pigmented area around the nipple) enlarges and becomes darker. It raises to become a mound with a small amount of breast tissue underneath. A few long, downy, slightly darkened hairs appear along the labia majora. At the end of this stage, the body fat has increased to 18. Peak height velocity (maximum growth rate) is reached. Development of breast tissue past the edge of the areola. Moderate amount of more curly, pigmented, and coarser hair on the mons pubis (the raised, fatty area above the labia majora). Menarche (first menstrual period) occurs in 20% of girls during this pubic hair stageHair is close to adult pubic hair in curliness and coarseness. Area of pubis covered is smaller than adults, and there are no hairs on the middle surfaces of the thighs. Continued development of breast tissue; in side view, areola and nipple protrude. After menstruation begins, girls grow at most 4-5", usually less. It is normal for some long pigmented hairs to grow on the inner thighs. Parents often have concerns about whether their daughter is starting puberty too early or too late, or whether she is progressing normally. But whenever you are uncertain, it is best to seek out medical advice. No menstrual period by between the ages of 13 m to 14. In a girl who is at Sexual Maturity Rating 3 or higher, cyclic abdominal pain (pain similar to period cramps) every 3 to 5 weeks, but no menstrual periods. Development of pubic hair but no breast development within 6 to 9 months. They are:Asymmetry (one breast much larger than the other): This may be minimal, or it may be visible even when your daughter is dressed. Some girls with asymmetric breast size are embarrassed to wear a swimsuit, regardless of the extent of asymmetry. In severe cases, plastic surgery is the ultimate answer. This can be performed in teenagers after puberty and after the breasts are fully grown. Very large breasts: Very large breasts can be a source of constant embarrassment and self-consciousness from puberty onwards. They can also cause medical difficulties, namely back problems. Remember also that teenagers are famously self-conscious about their appearance. Once your daughter is older, she will hopefully have developed more self-confidence. She will then be in a better position to make an educated decision about breast augmentation. Inverted nipple(s): An inverted nipple means just that: the nipple is pointed inwards, rather than outwards. Looking at the breast from the side, you do not see the tip of the nipple protruding. A new non-surgical treatment has recently become available. Tuberous breast disorder: This is a fairly uncommon disorder that often goes unrecognized until a new mother has difficulty breast-feeding. In this condition, growth at the base of the breast (where it attaches to the chest wall) is restricted by a band of tissue. Breast tissue, therefore, grows outwardly while the base remains narrow. This results in a breast shaped like a tuber (for example, a potato). Tuberous breast disorder is surgicallyHopefully, your daughter is already well-informed about puberty and the menstrual cycle. It is also important at this time that she be well-informed about sexual intercourse and sexuality. I recommend that you and your spouse/partner talk with your daughter about when you think it is acceptable to have sexual intercourse. Please be sure that she is well equipped to decline or refuse sexual intercourse - and that she knows that anyone, including a friend or a date, who forces her to have sex, is committing a crime. She should know that pregnancy and sexually transmitted diseases are the common consequences of teenage sexual activity. And, despite your own recommendations, she needs to know about contraception - including emergency contraception. I suggest that girls make themselves familiar with their bodies by using a hand-held mirror to look at their genitals, early in puberty if possible.

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David: Besides meditation generic penegra 50mg fast delivery prostate gland secretion, are there any other helpful tools that one can use to improve their mental health? Anil Coumar: Understanding the nature of time is helpful cheap penegra online american express prostate cancer fighting foods. Most of the time buy generic penegra 50 mg mens health pdf, we are worrying about the future or regretting the past. Both past and future are non-existent, meaning one cannot go into the past or future. This is important to understand, since most of our problems are caused by not being in the present. However, it is difficult, if not impossible, to force the mind to be in the present. What we can do is to understand the content of the mind. Other things apart from meditation that can help us to remain in the here and now are taking a walk, being in nature, listening to music, or whatever activities you like. A person can think about a soothing activity for each sense organ. For example, if we take the eyes, we can look at the beautiful sunset or mountain or even watch TV mindfully. We need to be flexible to come up with an activity that is soothing to us because the same technique is not going to work each time. Each emotion that comes up is not going to be dealt with the same way. I would like to do many things now, in the present, but therapy concentrates on dealing with the past. I would like to overcome this and live in the present. You can click on this link and sign up for the mail list at the top of the page so you can keep up with events like this. If he pays attention to the present, which is to learn the content of the book in front of him, he will take care of the future. Worrying about the future is not the same as planning for the future. Planning is good as long as we are flexible because the future is so unpredictable we need to be flexible. Anil Coumar: Could you tell me, Nerak, what you mean by getting your spirituality back, because you never lost it. David: Nerak, can you tell us what you mean by that? See what happens and how it affects you when you believe that assumption is a fact. You begin to dislike yourself even more, so it is important to examine our assumptions. Though we lose our faith at times, God always remains faithful to us! It is something we can say we do not believe, but it is there, all the same. Montana: I felt I had lost it, but it was just buried underneath my past, in my sacred territory. Once I worked through some of those issues, I began to get connected with my spirituality which helped me resolve much more, and I began to have love of self and live in the serene present. Like, I believe other people can talk and pray and get a response, but I am too... David: So, maybe as we begin to heal and feel better about ourselves, we begin to feel more worthy and more connected. Anil Coumar: First of all, it is something that is difficult to express through words. What happens when we shine the flashlight unto ourselves? What I mean by that is to look at the source of the problem, which is the I. If you are true to yourself, you nurture your spirit and, in return, are happy with yourself. You feel better about yourself and will find yourself worthy of anything, including a high power. To me, we are not human beings experiencing a spiritual experience, we are spiritual beings experiencing a human experience. Montana: Connection of mind, body, and spirit/wholeness/oneness. Can your mind really make you believe you have symptoms? So because the subject believed that the coin was hot, his body produced a reaction as if there was a burn. Do you think it is a good idea to see a therapist in more than one role? However, in small towns and communities, this may not be possible. It is important to find out if there is any pressure from the therapist to join the prayer group, gigi. Anil Coumar: The spirit can be felt only when the mind is somewhat clear of the pain that you are describing. I encourage you to go and talk to a professional so that you can have some mental peace to welcome the spirit. Coumar, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. We have a very large and active community here at HealthyPlace. I invite you to stay and chat in any of the other rooms on the site. Frank Patton is a psychologist who specializes in Thought Field Therapy (TFT). This technique reportedly eliminates emotional distress and gives immediate relief for PTSD, addictions, phobias, fears and anxieties. Phyllis is our support group manager as well as a host for one of the anxiety disorders support groups on our site. She has been coping with moderate to severe anxiety for some time and has tried "Thought Field Therapy" with Dr. Patton has a Doctor of Psychology degree from Baylor University.

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They are angrier purchase penegra us prostate yeast, more impulsive cheap penegra 50mg otc mens health bodyweight workout, and more confused about their identity than are people with a histrionic personality best penegra 100 mg prostate cancer foods to avoid. Borderline personality becomes evident in early adulthood but becomes less common in older age groups. People with a borderline personality often report being neglected or abused as children. Consequently, they feel empty, angry, and deserving of nurturing. They have far more dramatic and intense interpersonal relationships than people with cluster A personality disorders. When they fear being abandoned by a caring person, they tend to express inappropriate and intense anger. People with a borderline personality tend to see events and relationships as black or white, good or evil, but never neutral. When people with a borderline personality feel abandoned and alone, they may wonder whether they actually exist (that is, they do not feel real). They can become desperately impulsive, engaging in reckless promiscuity, substance abuse, or self-mutilation. At times they are so out of touch with reality that they have brief episodes of psychotic thinking, paranoia, and hallucinations. People with a borderline personality commonly visit primary care doctors. Borderline personality is also the most common personality disorder treated by therapists, because people with the disorder relentlessly seek someone to care for them. However, after repeated crises, vague unfounded complaints, and failures to comply with therapeutic recommendations, caretakers including doctors often become very frustrated with them and view them erroneously as people who prefer complaining to helping themselves. They have a strong desire for affection and acceptance but avoid intimate relationships and social situations for fear of disappointment and criticism. Unlike those with a schizoid personality, they are openly distressed by their isolation and inability to relate comfortably to others. Unlike those with a borderline personality, they do not respond to rejection with anger; instead, they withdraw and appear shy and timid. Avoidant personality is similar to generalized social phobia (see Anxiety Disorders: Social Phobia ). They lack self-confidence and feel intensely insecure about their ability to take care of themselves. They often protest that they cannot make decisions and do not know what to do or how to do it. This behavior is due partly to a reluctance to express their views for fear of offending the people they need and partly to a belief that others are more capable. People with other personality disorders often have traits of a dependent personality, but the dependent traits are usually hidden by the more dominant traits of the other disorder. Sometimes adults with a prolonged illness or physical handicap develop a dependent personality. They are reliable, dependable, orderly, and methodical, but their inflexibility makes them unable to adapt to change. Because they are cautious and weigh all aspects of a problem, they have difficulty making decisions. They take their responsibilities seriously, but because they cannot tolerate mistakes or imperfection, they often have trouble completing tasks. Unlike the mental health disorder called obsessive-compulsive disorder (see Anxiety Disorders: Obsessive-Compulsive Disorder (OCD )), obsessive-compulsive personality does not involve repeated, unwanted obsessions and ritualistic behavior. People with an obsessive-compulsive personality are often high achievers, especially in the sciences and other intellectually demanding fields that require order and attention to detail. However, their responsibilities make them so anxious that they can rarely enjoy their successes. They are uncomfortable with their feelings, with relationships, and with situations in which they lack control or must rely on others or in which events are unpredictable. Passive-Aggressive (Negativistic) Personality: People with a passive-aggressive personality behave in ways that appear inept or passive. However, these behaviors are actually ways to avoid responsibility or to control or punish others. People with a passive-aggressive personality often procrastinate, perform tasks inefficiently, or claim an implausible disability. Frequently, they agree to perform tasks they do not want to perform and then subtly undermine completion of the tasks. Such behavior usually enables them to deny or conceal hostility or disagreements. Cyclothymic Personality: People with cyclothymic personality alternate between high-spirited buoyancy and gloomy pessimism. Mood changes occur regularly and without any identifiable external cause. Many gifted and creative people have this personality type (Depression and Mania: Symptoms and Diagnosis). Depressive Personality: This personality type is characterized by chronic moroseness, worry, and self-consciousness. People have a pessimistic outlook, which impairs their initiative and disheartens others. They may unconsciously believe their suffering is a badge of merit needed to earn the love or admiration of others. In-depth look at Antisocial Personality Disorder - signs and symptoms, diagnosis, causes, and treatment. Antisocial personality disorder is a condition in which people show a pervasive disregard for the law and the rights of others. People with antisocial personality disorder may tend to lie or steal and often fail to fulfill job or parenting responsibilities. The terms "sociopath" and "psychopath" are sometimes used to describe a person with antisocial personality disorder. Early adolescence is a critical time for the development of antisocial personality disorder. People who grow up in an abusive or neglectful environment are at higher risk, and adults who suffer from the disorder were usually showing behavioral problems before the age of 15. Antisocial personality disorder affects men three times as often as it does women and is much more prevalent in the prison population than in the general population. Antisocial personality disorder is a chronic condition and represents one of the most difficult personality disorders to treat. However, psychotherapy and some medications may help alleviate symptoms. In many cases, the symptoms of antisocial personality disorder decrease as the person reaches middle age. The classic person with an antisocial personality is indifferent to the needs of others and may manipulate through deceit or intimidation. He or she shows a blatant disregard for what is right and wrong, may have trouble holding down a job, and often fails to pay debts or fulfill parenting or work responsibilities.

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This model offers a community-based intervention for serious and chronic offending delinquents discount penegra 50mg visa prostate cancer walk. Therapeutic foster parents are carefully selected and supported with research-based procedures for working with serious and chronic delinquents in their homes order penegra discount prostate 22. This intervention results in fewer runaways and fewer program failures than the usual placement in group homes is less expensive buy cheapest penegra prostate 90cc, and is dramatically more effective in reducing delinquency than traditional group homes. The Foster Family-based Treatment Association, developed under NIMH leadership, now has some 400 members across the U. As important as the problem of violence is, there will be no quick, inexpensive, and fail-safe solution. Recent years have witnessed a strong growth in our understanding of the risk factors and processes that contribute to and shape child and adolescent antisocial behavior. Yet gaps remain in our scientific understanding of how child, family, school/community, and peer factors interact, and which are the most appropriate targets for prevention and early intervention in different settings. We are also learning that being "at risk" does not doom any one child to become violent; conversely, the apparent absence of certain risk does not necessarily render any one child immune from problem behavior. Successful programs that produce long-term sustained effects may need to involve long-term intense interventions to target the multiple factors that can lead to negative outcomes such as family conflict, depression, social isolation, school failure, substance abuse, delinquency, and violence. The fundamental premise of some of these interventionsCwhich separate youth with problem behaviorsCchallenges the policies, programs and procedures that currently bring problem youth together. Continued research is needed to determine the most appropriate targets for prevention and early intervention that will produce lasting change. Answers are emerging about which programs are most successful, but assessments need to be made about their costs, as well as if they will work for all groups of children and adolescents. The NIMH is committed to encouraging and supporting this research, and has a long and enduring history of support for research and research training on violence. In 1966, NIMH created a Center for Studies of Crime and Delinquency, which was the locus of pioneering research on aggressive, antisocial, and violent behavior and its consequences. NIMH-supported research has generated information needed to identify, treat, and prevent not only the causes of violent behavior but also the effects of violence on victims, for example, child abuse. Celebrate Love is designed to help people fit the pieces of the relationship puzzle together in a healthy way. This website is updated several times with new relationship articles and other good "stuff" to help you and your friends maintain healthy love relationships. Sooooooo, you might want to consider bookmarking this site so you can come back for another visit real soon. To offer experience, strength, and hope to those seeking a better understanding of themselves and co-dependency by sharing real-life recovery stories and discussing recovery issues. The content of this web page does not constitute or imply any formal affiliation between the author and Co-Dependents Anonymous, Inc. All original material is intended for private use only, and should not be substituted for CoDA approved literature, attending recovery meetings, or seeking professional help. Note: In the tradition of Alcoholics Anonymous and Codependents Anonymous, the author of these articles prefers to remain anonymous and therefore goes by the initials PC. Conrad Hilton, who created a business empire with his Hilton Hotels, once overheard his father say to his mother: "Mary, I do not know what will become of Connie. He thought his son was drifting into a life of sin and idleness. She was always whining that her children neglected her, and she was especially enraged when her son George ran off to command the army for the American Revolution. She honestly believed it was his duty to stay home and take care of her. After Leonard became famous, his father was asked about that, and he answered, "Well how was I supposed to know he was the Leonard Bernstein?! Often their efforts are only attempts to protect you from failure. If you keep going, a "failure" is just another learning experience. And besides, giving up on a heartfelt aspiration is worse than failing. So listen politely to the worries and criticisms of your friends and family, and do your best to put their minds at ease, but then carry on. Remember the last time you heard someone make a comparison about you. They might have said: "You look better today" or "You are smarter than Charlie. Remember the last few comparisons you made in your own mind. Even "I know more than he does" feels a little bad because you know you will be making the same kind of judgments again in the future and the conclusion might just be the opposite tomorrow. Comparisons are only helpful when they are used to evaluate progress on a self-selected improvement program. For example: There is no need to frequently weigh yourself unless you have decided on your own that you will lose or gain weight. Spend a long time (maybe a month) simply noticing all of the comparisons you hear or make in your life. It will be relatively easy to notice comparisons made by others. It will be harder to notice when you make them internally. As you observe all of these comparisons, notice how they work. Learn how people get hurt by them, and how they lower self-esteem. Step #2: Make A Conscious Decision About Each Comparison. If you catch yourself wanting to tell one of your children that they are better at something than another child, STOP! Ask yourself these same questions when you start to make internal comparisons. Step #3: Allow Yourself To NATURALLY Stop Making Comparisons. Now you can simply count on learning to take over and put you on automatic pilot. By completing the first two steps, you will have learned so much about how comparisons work and about how damaging they are, that you will probably automatically and naturally stop most of them! In a short time you will have stopped making most comparisons, and the few that are left will be much easier to evaluate and change. If you ask most therapists to help you to stop making comparisons, they will understand. I know I just suggested a whole lot of hard mental work for you.

The greater efficacy response of the combination group was achieved at a lower daily repaglinide dosage than in the Prandin monotherapy group (see Table) cheap penegra 100 mg otc mens health ideal body weight calculator. Prandin and Metformin Therapy: Mean Changes from Baseline in Glycemic Parameters and Weight After 4 to 5 Months of Treatment*7 50mg penegra free shipping mens health 9 best apps. Numbers of patients treated were: Prandin (N = 61) discount penegra 50 mg prostate cancer ku medical center, pioglitazone (N = 62), combination (N = 123). Prandin dosage was titrated during the first 12 weeks, followed by a 12-week maintenance period. Combination therapy resulted in significantly greater improvement in glycemic control as compared to monotherapy (figure below). The changes from baseline for completers in FPG (mg/dL) and HbA1c (%), respectively were: -39. In this study where pioglitazone dosage was kept constant, the combination therapy group showed dose-sparing effects with respect to Prandin (see figure legend). The greater efficacy response of the combination group was achieved at a lower daily repaglinide dosage than in the Prandin monotherapy group. Mean weight increases associated with combination, Prandin and pioglitazone therapy were 5. Subjects with FPG above 270 mg/dL were withdrawn from the study. Pioglitazone dose: fixed at 30 mg/day; Prandin median final dose: 6 mg/day for combination and 10 mg/day for monotherapy. A combination therapy regimen of Prandin and rosiglitazone was compared to monotherapy with either agent alone in a 24-week trial that enrolled 252 patients previously treated with sulfonylurea or metformin (HbA> 7. Combination therapy resulted in significantly greater improvement in glycemic control as compared to monotherapy (table below). The glycemic effects of the combination therapy were dose-sparing with respect to both total daily Prandin dosage and total daily rosiglitazone dosage (see table legend). A greater efficacy response of the combination therapy group was achieved with half the median daily dose of Prandin and rosiglitazone, as compared to the respective monotherapy groups. Mean weight change associated with combination therapy was greater than that of Prandin monotherapy. Mean Changes from Baseline in Glycemic Parameters and Weight in a 24-Week Prandin/Rosiglitazone Combination Study*Final median doses: rosiglitazone - 4 mg/day for combination and 8 mg/day for monotherapy; Prandin - 6 mg/day for combination and 12 mg/day for monotherapyKnown hypersensitivity to the drug or its inactive ingredients. Prandin is not indicated for use in combination with NPH-insulin (See ADVERSE REACTIONS, Cardiovascular Events )There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with Prandin or any other anti-diabetic drug. All oral blood glucose-lowering drugs including repaglinide are capable of producing hypoglycemia. Proper patient selection, dosage, and instructions to the patients are important to avoid hypoglycemic episodes. Hepatic insufficiency may cause elevated repaglinide blood levels and may diminish gluconeogenic capacity, both of which increase the risk of serious hypoglycemia. Elderly, debilitated, or malnourished patients, and those with adrenal, pituitary, hepatic, or severe renal insufficiency may be particularly susceptible to the hypoglycemic action of glucose-lowering drugs. Hypoglycemia may be difficult to recognize in the elderly and in people taking beta-adrenergic blocking drugs. Hypoglycemia is more likely to occur when caloric intake is deficient, after severe or prolonged exercise, when alcohol is ingested, or when more than one glucose-lowering drug is used. The frequency of hypoglycemia is greater in patients with type 2 diabetes who have not been previously treated with oral blood glucose-lowering drugs (nas_ve) or whose HbA1c is less than 8%. Prandin should be administered with meals to lessen the risk of hypoglycemia. When a patient stabilized on any diabetic regimen is exposed to stress such as fever, trauma, infection, or surgery, a loss of glycemic control may occur. At such times, it may be necessary to discontinue Prandin and administer insulin. The effectiveness of any hypoglycemic drug in lowering blood glucose to a desired level decreases in many patients over a period of time, which may be due to progression of the severity of diabetes or to diminished responsiveness to the drug. This phenomenon is known as secondary failure, to distinguish it from primary failure in which the drug is ineffective in an individual patient when the drug is first given. Adequate adjustment of dose and adherence to diet should be assessed before classifying a patient as a secondary failure. Patients should be informed of the potential risks and advantages of Prandin and of alternative modes of therapy. They should also be informed about the importance of adherence to dietary instructions, of a regular exercise program, and of regular testing of blood glucose and HbA1c. The risks of hypoglycemia, its symptoms and treatment, and conditions that predispose to its development and concomitant administration of other glucose-lowering drugs should be explained to patients and responsible family members. Primary and secondary failure should also be explained. Patients should be instructed to take Prandin before meals (2, 3, or 4 times a day preprandially). Doses are usually taken within 15 minutes of the meal but time may vary from immediately preceding the meal to as long as 30 minutes before the meal. Patients who skip a meal (or add an extra meal) should be instructed to skip (or add) a dose for that meal. Response to all diabetic therapies should be monitored by periodic measurements of fasting blood glucose and glycosylated hemoglobin levels with a goal of decreasing these levels towards the normal range. During dose adjustment, fasting glucose can be used to determine the therapeutic response. Thereafter, both glucose and glycosylated hemoglobin should be monitored. Glycosylated hemoglobin may be especially useful for evaluating long-term glycemic control. Postprandial glucose level testing may be clinically helpful in patients whose pre-meal blood glucose levels are satisfactory but whose overall glycemic control (HbA1c) is inadequate. In vitro data indicate that Prandin is metabolized by cytochrome P450 enzymes 2C8 and 3A4. Consequently, repaglinide metabolism may be altered by drugs which influence these cytochrome P450 enzyme systems via induction and inhibition. Caution should therefore be used in patients who are on Prandin and taking inhibitors and/or inducers of CYP2C8 and CYP3A4. The effect may be very significant if both enzymes are inhibited at the same time resulting in a substantial increase in repaglinide plasma concentrations. Drugs that are known to inhibit CYP3A4 include antifungal agents like ketoconazole, itraconazole, and antibacterial agents like erythromycin. Drugs that are known to inhibit CYP2C8 include agents like trimethoprim, gemfibrozil and montelukast. Drugs that induce the CYP3A4 and/or 2C8 enzyme systems include rifampin, barbiturates, and carbamezapine. See CLINICAL PHARMACOLOGY section, Drug-Drug Interactions.

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It is essential for patients with diabetes or a history of gestational diabetes to maintain good metabolic control before conception and throughout pregnancy effective penegra 50mg mens health gay. Insulin requirements may decrease during the first trimester order penegra american express prostate cancer young man, generally increase during the second and third trimesters purchase cheapest penegra prostate oncology 2017, and rapidly decline after delivery. Careful monitoring of glucose control is essential in such patients. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. It is unknown whether insulin glargine is excreted in significant amounts in human milk. Many drugs, including human insulin, are excreted in human milk. For this reason, caution should be exercised when Lantus is administered to a nursing woman. Lactating women may require adjustments in insulin dose and diet. Safety and effectiveness of Lantus have been established in the age group 6 to 15 years with type 1 diabetes. In controlled clinical studies comparing insulin glargine to NPH human insulin, 593 of 3890 patients with type 1 and type 2 diabetes were 65 years and older. The only difference in safety or effectiveness in this subpopulation compared to the entire study population was an expected higher incidence of cardiovascular events in both insulin glargine and NPH human insulin-treated patients. In elderly patients with diabetes, the initial dosing, dose increments, and maintenance dosage should be conservative to avoid hypoglycemic reactions. Hypoglycemia may be difficult to recognize in the elderly (see PRECAUTIONS, Hypoglycemia). The adverse events commonly associated with Lantus include the following:Skin and appendages: injection site reaction, lipodystrophy, pruritus, rash (see PRECAUTIONS ). In clinical studies in adult patients, there was a higher incidence of treatment-emergent injection site pain in Lantus-treated patients (2. The reports of pain at the injection site were usually mild and did not result in discontinuation of therapy. Other treatment-emergent injection site reactions occurred at similar incidences with both insulin glargine and NPH human insulin. Retinopathy was evaluated in the clinical studies by means of retinal adverse events reported and fundus photography. The numbers of retinal adverse events reported for Lantus and NPH treatment groups were similar for patients with type 1 and type 2 diabetes. Progression of retinopathy was investigated by fundus photography using a grading protocol derived from the Early Treatment Diabetic Retinopathy Study (ETDRS). In one clinical study involving patients with type 2 diabetes, a difference in the number of subjects with ?-U3-step progression in ETDRS scale over a 6-month period was noted by fundus photography (7. The overall relevance of this isolated finding cannot be determined due to the small number of patients involved, the short follow-up period, and the fact that this finding was not observed in other clinical studies. An excess of insulin relative to food intake, energy expenditure, or both may lead to severe and sometimes long-term and life-threatening hypoglycemia. Mild episodes of hypoglycemia can usually be treated with oral carbohydrates. Adjustments in drug dosage, meal patterns, or exercise may be needed. More severe episodes with coma, seizure, or neurologic impairment may be treated with intramuscular/subcutaneous glucagon or concentrated intravenous glucose. After apparent clinical recovery from hypoglycemia, continued observation and additional carbohydrate intake may be necessary to avoid reoccurrence of hypoglycemia. Its potency is approximately the same as human insulin. It exhibits a relatively constant glucose-lowering profile over 24 hours that permits once-daily dosing. Lantus may be administered at any time during the day. Lantus should be administered subcutaneously once a day at the same time every day. For patients adjusting timing of dosing with Lantus, see WARNINGS and PRECAUTIONS, Hypoglycemia. Lantus is not intended for intravenous administration (see PRECAUTIONS ). Intravenous administration of the usual subcutaneous dose could result in severe hypoglycemia. The desired blood glucose levels as well as the doses and timing of antidiabetes medications must be determined individually. Blood glucose monitoring is recommended for all patients with diabetes. The prolonged duration of activity of Lantus is dependent on injection into subcutaneous space. As with all insulins, injection sites within an injection area (abdomen, thigh, or deltoid) must be rotated from one injection to the next. In clinical studies, there was no relevant difference in insulin glargine absorption after abdominal, deltoid, or thigh subcutaneous administration. As for all insulins, the rate of absorption, and consequently the onset and duration of action, may be affected by exercise and other variables. Lantus is not the insulin of choice for the treatment of diabetes ketoacidosis. Intravenous short-acting insulin is the preferred treatment. Lantus can be safely administered to pediatric patients ?-U6 years of age. Administration to pediatric patients, package of 5 (NDC 0088-2220-52)Cartridge systems are for use only in OptiClik? (Insulin Delivery Device)Unopened Lantus vials and cartridge systems should be stored in a refrigerator, 36?F - 46?F (2?C - 8?C). Lantus should not be stored in the freezer and it should not be allowed to freeze. Opened vials, whether or not refrigerated, must be used within 28 days after the first use. If refrigeration is not possible, the open vial can be kept unrefrigerated for up to 28 days away from direct heat and light, as long as the temperature is not greater than 86?F (30?C). The opened (in-use) cartridge system in OptiClik? should NOT be refrigerated but should be kept at room temperature (below 86?F [30?C]) away from direct heat and light. The opened (in-use) cartridge system in OptiClik? kept at room temperature must be discarded after 28 days.

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