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While it can be overwhelming to receive a diagnosis of type 2 diabetes, following your doctor’s treatment plan can help you manage the condition and live a healthy and active life. In some cases, lifestyle changes alone can help you keep your blood sugar levels in a healthy range. For other individuals, insulin, oral medication, or a combination of both may also be necessary. Here’s what to know about metformin, one of the most common oral medications used to treat type 2 diabetes.

What to Know About Metformin

Metformin belongs to a class of medications called biguanides, which regulate your blood sugar levels by reducing how much glucose is produced during digestion. Currently, metformin is the only biguanide approved for diabetes treatment in the U.S.

Metformin is taken one to three times a day depending on your dosage and the form of metformin your doctor has prescribed. It is available in the following formulations and strengths:

Immediate-release tablet: 500mg, 850mg, 1000mg 

Extended-release tablet: 500mg, 750mg, 1000mg

Unlike individuals with type 1 diabetes, who are unable to produce any insulin at all and take insulin every day, individuals with type 2 diabetes typically can produce some insulin but experience problems with insulin production. They may not produce enough insulin, or cells in their body may have become resistant to insulin. Metformin does not change the amount of insulin you produce, but it does help counter insulin resistance. If your type 2 diabetes has progressed to a later stage, you may need insulin therapy to manage your blood sugar levels. Metformin is often used alongside insulin therapy at this stage to help the body use insulin more efficiently.

Metformin is also sometimes used off-label to treat polycystic ovary syndrome (PCOS), as insulin resistance may be a symptom of the condition.

Some people experience gastrointestinal issues like nausea and diarrhea as a result of taking metformin, most often when they first begin taking the medication. Taking metformin with meals often helps prevent these side effects. Your doctor may also have you start on a lower dosage of metformin and gradually work up to a larger dosage as an additional precaution against side effects.

There are fewer gastrointestinal side effects associated with the extended-release formulation of metformin. This formulation releases the medication slowly, maintaining a consistent level of the medication in your bloodstream over a longer period of time. If you have concerns about potential side effects of metformin, you may want to ask your doctor if an extended-release formulation of metformin is a good fit for your needs.

Metformin can decrease your levels of vitamin B12, which can lead to anemia — a condition defined by low levels of red blood cells — in rare cases. Your risk for anemia is greater if your diet is low in vitamin B12 and calcium. If you experience symptoms of anemia such as fatigue, dizziness, or lightheadedness, reach out to your doctor for an evaluation of your red blood cell levels.

In rare cases, metformin may lead to lactic acidosis, an uncommon but serious condition in which an accumulation of lactic acid in the body leads to an imbalanced pH level. The chance of this side effect occurring is low, and individuals with impaired kidney function or heart failure are most at risk. To determine if metformin is a good fit for your treatment needs, your doctor will consider your overall health history and possibly order an estimated glomerular filtration rate (eGFR) test, which is a blood test that assesses your kidney function.

Hypoglycemia occurs when your blood glucose levels drop below a healthy range, most often after taking insulin. It is typically caused by not eating enough or exercising too much, and the timing of your insulin doses may also be a factor. These are some common signs of hypoglycemia to watch for:

Coordination problems, clumsiness, and confusion

When taken on its own, metformin typically does not cause hypoglycemia. However, if you take metformin with other diabetes medications including insulin, it’s important to more carefully monitor your blood sugar and be mindful of how your diet, exercise, and alcohol intake can interact with metformin.

To prevent hypoglycemia when taking metformin, be sure to take all of your diabetes medications as prescribed and on schedule, follow your doctor’s recommendations for exercise, and eat a balanced diet. In addition, make sure your doctor has a complete picture of your health history and is aware of all the medications you take.

When your diabetes treatment plan includes multiple medications, staying on top of your prescriptions can be easier said than done. The Alto app can help you manage all of your diabetes needs in one place, and our dedicated diabetes support team is here to offer guidance and make sure you have everything you need for your treatment.

Reach out any time through in-app secure messaging or by phone at 1-800-874-5881 to learn how Alto can be a partner in your diabetes care.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

With one in ten Americans living with type 1 or type 2 diabetes and more than 88 million adults living with prediabetes, many more people have a connection to diabetes than it may seem. And whether you are living with diabetes yourself or care about someone who is, or if you simply want to know more about diabetes prevention, there’s no shortage of information to learn or actions to take. Thankfully, there are a variety of resources that can help, from online support groups and events to diabetes education programs and advocacy materials. Explore our diabetes resource round-up below to get started.

Diabetes Resource Round-up

With a mission of improving the lives of everyone affected by diabetes, the American Diabetes Association (ADA) is a comprehensive hub for diabetes research, education, advocacy, and support. The national organization also has local offices throughout the U.S. where you can learn about community resources and events.

Beyond Type 1 and Beyond Type 2 are global online communities for individuals living with diabetes, powered by a nonprofit organization (also named Beyond Type 1) that funds a variety of diabetes research and projects.

Focusing on type 1 diabetes, JDRF is a leader in research and advocacy and a destination for type 1 diabetes support and community. Like the ADA, JDRF has many chapters across the U.S. that offer opportunities to connect locally with those affected by type 1 diabetes.

Founded by an endocrinologist living with type 1 diabetes himself, Taking Control of Your Diabetes is a resource hub for individuals and families affected by diabetes as well as medical professionals seeking to stay informed of the latest developments in diabetes care.

ADA engagement platform, with opportunities to take action and raise awareness

Association of Diabetes Care & Education Specialists (ADCES) legislative action center

Beyond Type 1 community table, a monthly conversation series

ADCES diabetes education program directory

JDRF type 1 diabetes daily management page

Getinsulin.org, an insulin access resource

Johnson & Johnson Patient Assistance Program

Lilly Cares Foundation Patient Assistance Program

Novo Nordisk Diabetes Patient Assistance Program

ADA tips on nutrition, fitness, mental health, and more

ADA free type 1 diabetes self-care manual

JDRF type 1 diabetes health insurance guide 

Project Power, the ADA’s free virtual after-school diabetes prevention program for children

ADA summer camps and year-round programming for children with diabetes

ADA resources on school safety and diabetes

With a dedicated diabetes support team, Alto has deep expertise in diabetes management. Our extensive library of diabetes-focused content offers the information you need to manage the condition and live an active life. Here are a few of our top reads:

What’s the Difference between Type 1 and Type 2 Diabetes?

New Diabetes Diagnosis? Here’s What to Know

How to Manage Your Child’s Type 1 Diabetes Diagnosis

We make it simple to manage your diabetes, with free, same-day delivery right to your doorstep, temperature controlled packaging, and automatic savings investigations. And our dedicated diabetes team is here to offer individualized support and walk you through your first insulin doses.

At Alto, we strive to reduce the stress that comes with managing your diabetes however we can. As a pharmacy for all of your diabetes needs, we’re able to sync all of your medications and supplies into a single delivery every month. In fact, you might even be a little surprised by just how much is included in a diabetes delivery, so we put together a short overview of what’s inside the box.

What’s in Your Alto Pharmacy Diabetes Delivery

We recommend unpacking your full package upon delivery and making sure you have everything you need. Carefully check insulated wrappers or ice packs to make sure you don’t miss any medications or supplies, and promptly place any items marked “Refrigeration Needed” in your refrigerator.

A quick note on refrigeration: we understand how important it is that your medications and supplies arrive in good condition, and we use temperature controlled packaging to ensure that insulin is held at the right temperature while it’s on the way to you.

Depending on what your care team has prescribed, you’ll probably have many or all of the following in your Alto delivery:

Diabetes medications in the form of vials, pens, pills, tablets, or inhalation devices

Insulin pumps (small electronic devices that deliver doses of insulin at specific times - common brands include Omnipod®)

Blood glucose meters, test strips, and lancets (common brands include Accu-Chek® and OneTouch®)

Smart insulin pens (a method of insulin delivery that combines insulin and syringe into a single device - common brands include InPenTM)

Continuous glucose meters (CGMs) (a small electronic device that automatically collects glucose readings at regular intervals throughout the day - common brands include Dexcom® and Freestyle Libre®)

Supplies like needles or syringes will be packaged in their own bag with a label that explains their purpose.

Note: the specific medications and supplies you have for your injections and diabetes care may look different than what is displayed in these photos. If your physician has instructed you to use a specific device, supply or medication, always follow their instructions.

It’s important to practice safe disposal methods for your needles and other injection or testing supplies. 

Use your red sharps container to safely store your needles after use. Sharps should never be thrown loosely into the trash, in the toilet, or in the recycling bin. Sharps that retract after use or are very small should follow the same disposal method as all other sharps.

Alto does not accept returns of sharps containers - you can find a safe local disposal site here.

If you need a new sharps container, send us a message in the app, and we’ll add it to your next delivery.

We’re a one stop shop for all your diabetes management needs. In addition to auto refills and med syncing, we offer free, same-day delivery and automatic savings investigations. And our team of pharmacists is always here to answer your questions by phone or the Alto app. 

All third party trademarks (including logos and icons) referenced by Alto Pharmacy remain the property of their respective owners. Unless specifically identified as such, Alto’s use of third party trademarks does not indicate any relationship, sponsorship or endorsement between Alto and the owners of these trademarks.

Your thyroid makes the hormones that regulate your metabolism. In this article we'll share tips for supporting your thyroid health as well as what to do when your thyroid is out of balance.

All About the Thyroid

The thyroid is a small butterfly-shaped gland located at the base of your throat. It’s part of the endocrine system—a series of glands that produce and regulate hormones. Hormones are chemical messengers that “tell” certain cells and organs what to do, influencing nearly all of the body’s functions. 

Your thyroid makes the hormones that regulate your metabolism: thyroxine (T4) and triiodothyronine (T3). Metabolism is the process by which your body converts food into energy,  facilitating vital functions such as blood circulation, breathing, and cell repair. Without the thyroid, the body could not break down protein, fats, and carbohydrates for fuel. 

The thyroid gland does not simply act on its own. It receives signals from the pituitary gland, the body’s “master gland,” which is located at the base of the brain and regulates vital body functions. The pea-sized pituitary gland sends its instructions through a hormone called thyroid-stimulating hormone (TSH). TSH levels rise and fall in the blood, telling the thyroid the exact amount of each hormone to secrete. Hormone levels within the body are a delicate balancing act, and several disorders can arise if the thyroid overproduces (hyperthyroidism) or underproduces (hypothyroidism) T4 and T3. 

With hyperthyroidism, the thyroid gland makes too many hormones, accelerating the body's metabolism, which can cause unintentional weight loss and a rapid or irregular heartbeat. According to the Mayo Clinic, other symptoms may include increased appetite, nervousness or anxiety, sweating, fatigue, and difficulty sleeping. Without treatment, hyperthyroidism can lead to serious complications, including heart conditions like congenital heart failure, eye problems, and osteoporosis. 

Hypothyroidism occurs when the thyroid isn’t making enough hormones, and symptoms may not be noticeable at first. Common symptoms of hypothyroidism may include increased sensitivity to cold, fatigue, constipation, weight gain, and dry skin. If left unchecked, the condition can eventually lead to obesity, joint pain, infertility, and heart disease.

Both conditions can be treated, often through the use of synthetic hormones or anti-thyroid medications. If you’re concerned about thyroid health, your healthcare provider can administer a blood test to check your thyroid hormone levels and recommend the appropriate treatment. 

Eating a nutritious, well-rounded diet is essential for thyroid health. Many vitamins and minerals support the thyroid, and iodine is chief among them. This trace mineral is an essential building block of thyroid hormones, but our bodies don’t produce it. Therefore, we need to consume iodine in foods such as iodized salt, seafood, seaweeds, egg yolks, dairy products, and lima beans.

It’s important not to go overboard, however. Consuming iodine in excess can negatively affect hormone levels in some individuals. Iodine deficiency is rare in the United States, so if you’re eating a varied diet, you’re likely within the range of the recommended 150 micrograms per day. 

Selenium is another critical mineral for thyroid function that can be found in brazil nuts, fish, meat, poultry, and fortified cereals and grains. Just like with iodine, selenium deficiency in the U.S. is rare, and it can be detrimental to go too far over the recommended 200 micrograms per day. 

Both the Mayo Clinic and Harvard Health recommend eating a variety of healthy foods rather than focusing too heavily on specific foods or supplements for thyroid health. If you have any concerns about your intake of essential nutrients, talk with your doctor about taking a multivitamin with minerals.

A Word of Caution about Thyroid Supplements

Your endocrine system maintains a very precise balance of hormone levels. For that reason, it’s not a good idea to experiment with your hormone health on your own. According to Cleveland Clinic endocrinologist Christian Nasr, MD, taking over-the-counter iodine supplements could result in getting more than the recommended daily value, which may leave you worse off than before. “The effect of iodine supplements can vary by person, causing the thyroid to produce either too much or too little hormone,” he cautioned.

Consumer Reports also issued a warning about thyroid supplements, reporting that many have been found to contain thyroid hormones derived from animal glands—and there’s often no indication on the labels. When researchers randomly tested ten “thyroid support” supplements, they found that nine contained “clinically relevant” levels of thyroid hormones, in some cases at levels that rivaled prescription thyroid medications. Researchers concluded that these supplements posed a “potential danger to public health.” 

Keep in mind that dietary supplements are not reviewed for safety or effectiveness by the FDA, so it’s best to talk with your healthcare provider before beginning a new over-the-counter supplement. Taking “thyroid support” supplements could alter your hormone levels in unpredictable ways and have undesirable health consequences. If you’re at all concerned about your thyroid health, consult your doctor so you can have your hormone levels tested and begin a prescribed treatment plan. 

A healthy thyroid contributes to feeling energized and ready to live life to the fullest. If your doctor determines that your hormone levels are out of balance, taking medication can restore your vitality. Once you develop a treatment plan, we’d be happy to take over the details of managing your medications. We’ll drop them off at your doorstep for free, and your prescription information will always be at your fingertips through our desktop and mobile apps. Plus, our pharmacists will only be a phone call, text message, or in-app chat away if you have questions about side effects or which foods to avoid eating around dosage time. 

Want to learn more about a better pharmacy experience with Alto? Our care team and endocrinology specialists are available to answer your questions from 9 am – 12 midnight ET Monday – Friday, and 10 am – 9 pm ET on weekends; reach out by in-app secure messaging or phone.

We combed through the latest advice from the experts to give you some actionable steps that may help protect your health.  

Managing Diabetes During COVID-19

Pre-existing condition. These two words have echoed across news broadcasts and government briefings about COVID-19, stirring up fears in those living with chronic disease. But as we’ve gathered data and learned more about the novel coronavirus, a clearer picture has emerged. We now better understand how people with underlying medical conditions like diabetes can take careful precautions to decrease their likelihood of getting sick. 

According to the ADA, it does not appear that people with diabetes are more likely to get COVID-19. They do, however, have a higher risk of developing serious symptoms and severe complications that require hospitalization if exposed. This increased risk makes prevention and early detection critical. 

If you are living with diabetes, it’s important to focus on what you can control right now. In addition to following the CDC’s prevention guidelines, which include wearing a mask, washing your hands frequently, and avoiding unnecessary social contact, you can manage your risk by planning ahead. With this in mind, we combed through the latest advice from the experts to give you some actionable steps that may help protect your health.  

The world is full of very real stressors right now. It’s easy to let healthy habits slip when you’re anxious or under pressure, however, it’s more important than ever to stay on top of your health. The ADA advises that your risk of experiencing severe illness from COVID-19 is likely to be lower if your diabetes is well-managed. Dr. Janaki Vakharia, MD, clinical fellow in the Endocrinology Division at Massachusetts General Hospital, explains, "Studies have reported that patients with well-controlled diabetes who have been hospitalized for COVID-19 have a higher rate of survival. Better controlled diabetes is also associated with lower markers of inflammation, which may explain this better rate.” 

Do your best to stick to the care plan you’ve created with your doctor—keep taking your insulin and/or other medication, test and track your blood glucose, exercise at home, and maintain a healthy diet. Make sure you have enough medication on hand to last you several weeks and continue your doctor’s appointments virtually if telemedicine is an option. 

In his FAQs about Diabetes + COVID-19 for Johns Hopkins Medicine, Mohammed Al-Sofiani, MBBS, MSc, writes, “I strongly encourage all people with diabetes to make sure that they have enough supply of insulin and all the tools they typically use to manage their glucose...I also encourage people with diabetes to avoid going to the clinics or pharmacies unless it is for urgent matters.”

You should never have to risk your health to obtain your insulin and other medications. That’s why we offer free contactless delivery when you fill your prescription through Alto. Simply let us know where and when to drop it off, and we’ll make sure your medications and supplies arrive safely. 

We’re about to enter cold and flu season. More viruses going around means more chances of getting sick so experts are urging everyone to get a flu shot. This year, a sore throat or runny nose could produce more anxiety than usual, but try not to let yourself slide into fearful thinking. Stay home and report your symptoms to your doctor, especially if you experience a fever, dry cough, or shortness of breath. There is a wide range of symptoms associated with the onset of COVID-19, but the CDC offers this list as well as an interactive coronavirus self-checker. Mild symptoms can often be managed and monitored from home, but don’t make that decision without your doctor. 

If you develop any emergency warning signs for COVID-19, seek medical attention immediately. According to the CDC, these emergency signs include difficulty breathing, chest pain or pressure, confusion or inability to arouse, or bluish lips or face, though they stress that severe symptoms of any kind should be immediately reported to your medical provider. 

Preparing for the possibility of getting sick is especially important right now. The ADA recommends having enough supplies to last you several weeks in case you are symptomatic and unable to leave your home. If you do get sick and your doctor has recommended that you remain at home, take that as good news and try to focus your attention on resting while keeping an eye on your glucose levels and symptoms. 

Remember—any infection, including COVID-19, will likely cause your blood glucose levels to start rising. It’s important to pay close attention to your blood sugar, continue taking your medications, and drink plenty of fluids to prevent dehydration. If your blood sugar becomes hard to manage and your body doesn’t have enough insulin, you are at risk of developing diabetic ketoacidosis (DKA). The ADA advises that if your blood sugar has registered high (greater than 240mg/dL) more than twice in a row, you should use an over-the-counter kit to test your urine for ketones. If ketones are present, call your doctor right away. 

Continuing to take your insulin and other medications must be your top priority, so be sure that you don’t risk running out. According to ADA, the leading manufacturers of insulin and other supplies are not reporting any impact on their manufacturing and distribution capabilities due to COVID-19. There have been, however, widespread reports of mail delays that could affect the timely delivery of mail-order prescription drugs. 

When you fill your prescriptions through Alto, we’ll coordinate your refills automatically, then one of our couriers will hand-deliver them to your home. Your prescriptions will never change hands during the delivery process and you can designate a safe place for your courier to leave your medications for contact-free drop-offs. 

Finally, if like so many you are currently experiencing unemployment, loss of insurance, or economic hardship, there are options to get help. The ADA offers this list of resources and the team at Alto is always here to help you find options that can save you money. Reach out to us at any time via phone call (1-800-874-5881), or in-app messaging.

So many of us are feeling anxious and uncertain right now, and that can interfere with our ability to sleep well, manage stress, and practice self-care. Be sure to keep in touch with the people you love and talk to them about your fears. Joining an online community for people with diabetes can also help you get the emotional support you need. 

We're here to support you through COVID-19 with free home delivery. Our team is available 6 am - 9 pm PT Monday - Friday and 7 am - 6 pm PT on weekends; call 1-800-874-5881 or download the mobile app for secure messaging.

Empowering Patients By Accelerating Healthcare Innovation

Mattieu Gamache-Asselin, CEO & Co-founder

Editor's Note: This post was updated on November 8, 2021, to reflect the rebrand of AltoMD to Alto Connect.

Today, I’m proud to announce Alto’s Series C round of $50 million. Over the past three years, we’ve proven that Alto’s model works for doctors and patients alike, reducing administration time for physicians and improving drug adherence rates for patients. This new funding will enable us to expand, reaching even more patients, and to further develop our full-stack platform, driving better health outcomes at a lower cost.

Alto removes the complexity from prescriptions to improve patients’ quality of life. Every prescription requires coordination among doctors, insurance companies, pharmaceutical companies, and of course the patient. Traditional brick-and-mortar pharmacies depend on fax, phone and paper, which causes delays, errors in fulfillment, poor adherence rates, and 20 hours of administrative work a week per physician.

We’ve reimagined and completely rebuilt the pharmacy infrastructure to eradicate these problems. Through our provider platform (Alto Connect) and pharmacy management software, doctors and insurers spend less time on administration and more time on patient care. For patients, we offer free same-day prescription delivery, but more importantly, cost transparency, personalized in-app and phone support, and faster coordination with doctors and insurance companies to get patients the care they need. Learn more about our app.

The typical Silicon Valley playbook is to enter many new markets rapidly, throw money at problems, and figure things out on the fly. That’s never been Alto’s approach. Because we’re working with critical, life-saving medications, messing up is not an option. We’ve diligently, methodically built robust systems to make certain we leave no patient behind, and we’ll keep that mentality as we expand. Now that we’ve built our critical foundations — the platforms and clinical expertise — it’s time to scale.

Geographic expansion
We want to make sure all of America can benefit from the Alto experience. Last month, we opened our HQ2 in Denver, where we’ve already hired 60 employees across patient care, pharmacy and clinical operations, as a stepping stone to nationwide expansion.

Therapeutic area expansion
So far, we’ve focused on deeply understanding and serving the retail, dermatology, fertility, biologics, and HIV markets. We’re now bringing the same empathy and customized service to autoimmune, endocrinology, and cardiology — areas where patients are frequently overwhelmed with logistics, paperwork and side effects, and where Alto could offer deep value as a trusted partner.

Pharmacy represents 10% of healthcare spending, a $3.3 trillion market. Most pharmacies focus on just capturing as much of that 10% as possible. A select few are working to eliminate the ineffective portions of pharmacy spending. But even they look at the pharmacy spending in isolation.

The truth is, pharmacy shouldn’t be viewed as a disjoint piece. At Alto, we believe better pharmacy will make all of healthcare more effective and reduce healthcare spending overall. We’ve already seen progress — for instance, Alto’s primary adherence rate is 40% higher than the industry average.

From patients, we’ve heard, “Being able to speak to an Alto pharmacist directly allowed me to figure out how my drugs were interacting and causing painful side effects.” Some patients are cost-sensitive and consider skipping the medications that manage their chronic conditions and prevent hospitalizations. We’ve helped by delivering $11 million in medication savings to our patients so far.

From doctors, a common refrain is: “This is the first time my patients have talked to me positively about a pharmacy, and it’s the first time I can actually see what happens to a prescription after I write it.” This experience is why doctors have been the primary fuel of Alto’s growth. UCSF, One Medical, Stanford, and over 10,000 other providers recommend Alto as their preferred pharmacy.

This early progress is energizing, and only possible because of the dedication of Alto’s hardworking team, investors, and partners. Thank you all! The feedback I’m getting from the health ecosystem is even more inspiring — that our potential is nothing short of transformative for our patients and healthcare as a whole. As far as we’ve come, we’re only just getting started.

Blog

What to Know About Metformin

Diabetes Resource Round-Up

Unboxing Your Alto Diabetes Delivery

All About the Thyroid

Managing Diabetes During COVID-19

Empowering Patients By Accelerating Healthcare Innovation

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