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RELATIONSHIP INTIMACY HIERARCHYThere are many levels of closeness and intimacy with other people order cialis soft 20 mg without prescription. Examples include: marriage cialis soft 20mg sale, closest family and friends cost of cialis soft, close friends purchase cheapest cialis soft and cialis soft, friends, friends for specific needs (eg. There are many differences between different levels of intimacy. The amount of physical and communication intimacy, time spent together, commitment, sharing, helping each other, etc. Every person you contact in your life has some maximum potential level for achieving intimacy with you. Many people have the potential for lower levels of intimacy (such as acquaintance), but few have the potential for the highest levels (such as marriage). The fact that a person only achieves a certain level does not mean that the relationship "failed"--it merely achieved its maximum potential level of intimacy and could go no further. Most people you meet/date will not be a good enough match, so why beat yourself up when the relationships end. Instead, try to understand the reasons the relationship ended. To what degree was it due to differences between the two of you? If you believe that only one person is "right" for you, then you will become extremely dependent upon that person. Putting a person on a pedestal like this will most likely lead to dependent feelings and behavior that actually causes both of you to be unhappy. In turn you will become increasingly unattractive to your "pedestal" person. THE MAIN FACTORS CAUSING A PERSON TO WANT TO BE WITH YOU ARE INHERENT IN WHO YOU ARE! Even though this may seem obvious, this is a very powerful statement! The factors that affect how much one person is attracted to another include the following:General beliefs and values: cultural, religious, moral, political, family, sexual, etc. Background: culture, family, career, education, organizations, etc. Relationship factors: previous history, control style (dominant-submissive or assertive), problem-solver, conversational style, empathy, independence-dependence, emotional expressiveness, playfulness, romantic style, liberated-traditional sex roles, etc. Interests: career, cultural, music, sports, education, romantic, etc. Personal characteristics and habits: honesty, responsibility, ambition, achievement, caring/understanding, openness, emotionality, independence, self-esteem, positiveness, cleanliness, orderliness, stability, assertiveness, adventurousness, sense of humor, etc. Personal problems and bad habits (big TURN-OFFs to almost everyone): addictions, dishonesty, cheating, withdrawal, suspiciousness, irresponsible, cruel, aggressive, extremely dominating or needy, emotionally out of control, etc. The above factors are the kinds of factors that will be the major determinants of whether you and another person will be happy together. Most of these factors are determined by parts of yourself that are highly stable over many years. If you just act naturally, you will reveal these true aspects of yourself to your partner (and vice-versa). Your partner will accept or reject you on the basis of how well these factors match their own factors (and vice-versa). Therefore it should be clear that nature tends to bring people together or apart on the basis of who they really are, so why try to hide? Research and clinical experience shows that overall, the more alike partners are-especially in aspects important to the partners-the more likely the relationship will succeed and be happy. If your partner is "right" for you, he/she will like you as you really are, and they will be attracted to you. Out there somewhere are probably many potential partners who are a lot like you! These are the people who will be naturally attracted to you. How would you feel about being with a partner who is a lot like you in most important aspects? CREATING A HAPPY YOU CREATES A CONFIDENT, ATTRACTIVE YOULearning how to create your own happiness alone is a key part of building self-confidence and overcoming fears of rejection and loneliness. This dependence makes being in a relationship much more important, and therefore increases anxiety about being alone and increases fears of rejection. For example I have had many clients who thought they could only be happy if they get married and have a family. Yet some were fearing age would overtake their ability to have children, and no partner was in sight. They developed a terror of not having their happy family dream come true and living their lives alone. They became very "needy," manipulative, and scared potential partners away. They escaped the catch by learning how to be at peace with the thoughts that they might never be married and might live alone the rest of their lives. They learned how to take care of themselves and how to be happy alone. Because now they were less fearful and "needy" and more confident and relaxed. If you have few interests that you can do alone, because you have spent most of your life either with other people or doing what others wanted you to do, then it is especially important for your own independence that you explore new potential interests. Remember this, if many other people love this activity there must be some fun in it. Many activities are difficult to enjoy until you have learned the basics about how to participate in them. Most sports are that way, but even music and the theater can take some time to appreciate. Give the new activity a chance over a reasonable period of time. Many people hate to do things alone, so they refrain from activities. A common reason is that they are afraid of what others will think about their coming alone. However, if you continue to do activities alone, you can eventually desensitize yourself to most of those fears. Career interests, sports, music and the arts, reading, entertainment events, hobbies, do-it-yourself projects, taking classes, walks, shopping, bike rides, or taking oneself out for dinner are but a few examples of activities people do to entertain themselves. Initiating activities with other people and joining organizations are examples of ways that you can create your own happiness with others without being in an exclusive relationship. Finally, if you are generally happy and enjoy life, your positiveness and happiness can help them be happier as well. And that will make you more attractive to anyone who wants to be happy themselves.. CREATING A HAPPY OTHER CREATES AN ATTRACTIVE YOUYou are attractive to another person to the degree that that person perceives you as potentially contributing to their happiness. You are not responsible for their happiness, you are only being yourself and giving gift of your presence and actions. You are only hoping these gifts will contribute to their happiness. Each person is ultimately responsible for their own happiness. PRACTICE:1) List all of the characteristics you want in another person. PRACTICE: Make a list of the labels that stop you from approaching others or being yourself. Then take each one and decide the degree to which you intend to change it or to accept it as it is. Keep in mind that there are many happily married persons who fit all of the above descriptions and realize that, you are looking for someone who would be happy with a person just like you. External events or commitments that keep you from pursuing a relationship now. The difference between an EXCUSE and a CONSCIOUS CHOICE is whether or not you are being honest with yourself about all of your underlying motives.

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And yet purchase cialis soft 20 mg on-line, when it comes to bipolar disorder and schizophrenia buy 20 mg cialis soft amex, there is little research that blood sugar affects the mania order cialis soft 20 mg on line, depression and psychosis found in the illnesses buy cialis soft no prescription. Wilson notes, "I do see a difference in blood sugar levels and depression, but I have not seen a case that controlling blood sugar helps bipolar disorder or schizophrenia. Julie Foster, a nurse practitioner in Portland, Oregon notes, "Everything a person eats affects all aspects of physical and mental health and thus a dietary and supplement plan that stabilizes the mood plays a large role in psychiatric disorder treatment. For now, the role that blood sugar plays in psychiatric disorders is not conclusive. When people are faced with a diabetes diagnosis, this can lead to depression as they feel a lack of control. However, there is one thing that all mental health professionals can agree on: reducing fat and sugar in order to maintain a healthy weight and balance blood sugar levels is always a good idea. People who are healthy always feel better than those who eat too much and lead a sedentary lifestyle. The challenge is helping those with psychiatric disorders make needed changes. NOTE: This section on Diabetes and Mental Health includes information from interviews with:Dr. Professor of Psychiatry and Director, Inpatient Psychiatric Services Oregon Health and Science UniversityDr. Andrew Ahmann, Director of the Harold Schnitzer Diabetes Health Center at Oregon Health and Science Universityand the research of Dr. John Newcomer, Department of Psychiatry, Washington University and Dr. Peter Weiden, Department of Psychiatry, University of Illinois at Chicago. It may seem that the solution is to put everyone with psychosis on Geodon and Abilify at first and then move to the more risky antipsychotics if needed. Some may get a great deal of relief from a drug with a low diabetes risk, while it may be ineffective for others. What if an antipsychotic drug with a high diabetes risk is truly the best drug for someone? In contrast, Abilify has no known diabetes risk and yet it can be agitating and take time to work in the system. Thus, dealing with the psychosis must come first and the risk of diabetes may have to come second. But if a person is already on a high risk antipsychotic and has gained weight around the stomach, what are the solutions? Diet and exercise are always the first step in treating weight gain associated with an antipsychotic. It may be possible to get the weight, especially around the stomach to a reasonable level so that a person can continue a medication that works for them. However, since this is not always possible, there are two options that a person can try along with weight management and exercise changes:Talk with your prescriber about Metformin (glucophage), a drug used to help monitor type 2 diabetes blood sugar levels. Recent research has shown a connection between starting Metformin along with a high risk antipsychotic in order to minimize weight gain. This is still in the beginning stages, but is definitely something to discuss with your healthcare professional. Switching Antipsychotic Medications: The most effective way to reduce weight gain and thus metabolic syndrome risk from a high risk antipsychotic is by switching to a less risky antipsychotic. Peter Weiden, Professor of Psychiatry, University of Illinois at Chicago, writes, "Switching to Geodon or Abilify is the most direct and effective way to reverse weight gain induced by other second generation antipsychotics (atypicals). Switching takes time and careful monitoring until the person is stabilized on the new drug. It takes a commitment that may not always be possible if the person is psychotic or they are in social services. Not everyone is a candidate for switching, but it should always be explored if antipsychotic weight gain puts a person at risk for diabetes. Type 1 diabetes is treated with insulin, diet and exercise. The good news is that those who lose weight have a much better chance of reversing, managing, and hopefully preventing diabetes. If the person you care about is unable to take care of themselves effectively, the first place to start is somehow getting them in for the tests. It can be hard if a person is on social security or is too ill to see the reason for the tests, but do keep trying. If your loved one is in the hospital, this is a good time to ask to see the test results and ask about metabolic syndrome. If your loved one has extra weight around the middle and you are able to make more nutritious meals for the person, this can make a large difference. How do you feel after reading all of this information? Instead, the goal of this article is for you to know the risks of diabetes and then recognize if you show the signs of pre-diabetes or insulin resistance so that you can stop their progress before they turn into something more serious. If you want a quick review of the basic diabetes information, take our " Understanding Diabetes Test. For specific details on the Relationship Between Diabetes and Mental Illness, including in-depth information on antipsychotic medications and diabetes, please continue on. This article gave you the tools needed to learn about yourself and your risk of diabetes so that you can then ask educated questions of your healthcare professionals regarding tests for diabetes and metabolic syndrome, the risk of any antipsychotics you may be taking and finally, ideas for how you can exercise and manage your weight more effectively. What you do next with these tools can change your life and improve your health forever. What is your first step towards diabetes prevention? Diabetes and mental health concerns are close related, since 1 out of 5 people with a mental illness also ends up with type 2 diabetes as a result of lack of exercise, poor eating choices, and antipsychotic medications that can cause serious weight gain. Additionally, people with diabetes may develop depression and anxiety as a result of coping with a chronic illness. Bill Woods, our guest on the HealthyPlace Mental Health TV Show, talks about his experience with Type 1 diabetes and the complications he has found along the way. We invite you to call us at 1-888-883-8045 and share your experience with diabetes. Have you dealt with the depression and/or anxiety symptoms? Listen to stories of real people who manage their diabetes everyday in this weekly podcast produced by the National Diabetes Education Program. Brenda and her husband, JavierHear why Sorcy talks to her family about her diabetes. Sorcy and her daughter, RinabethHear how Rudy took control of his diabetes. Haywood tells us what he does to manages his diabetes. Haywood and his wife, EllenListen to David discuss the "rules of the game" and his strategies for managing diabetes. If you are unfamiliar with antipsychotics, my article, Psychosis 101, has a detailed descriptionof the medications and how they work. The following information on diabetes risk in antipsychotic medications comes from two papers from the Journal of Clinical Psychiatry: Antipsychotic Medications: Metabolic and Cardiovascular Risk by Dr. Newcomer and Switching Antipsychotics as a Treatment Strategy for Antipsychotic-Induced Weight Gain by Dr. Both researchers show conclusive evidence that the risk of diabetes from certain antipsychotics is high and must be addressed immediately within the entire healthcare community. There are six atypical antipsychotics in use today:(a newer antipsychotic called Saphris was not a part of the metabolic syndrome studies cited in the article. Those atypical antipsychotics with the highest risk for developing diabetes are: In a major NIMH study (the CATIE project), Zyprexa was associated with relatively severe metabolic effects. Subjects taking Zyprexa showed a major weight gain problem and increases in glucose, cholesterol, and triglycerides. The average weight gain over the 18-month study period was 44 pounds.

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Symptoms of overdose may include drowsiness and slurred speech buy generic cialis soft 20mg. Other symptoms may include may include somnolence buy genuine cialis soft on-line, mydriasis buy cialis soft with american express, blurred vision purchase cialis soft 20 mg without a prescription, respiratory depression, hypotension, and possible extrapyramidal disturbances. Usual Dose -- Oral olanzapine should be administered on a once-a-day schedule without regard to meals, generally beginning with 5 to 10 mg initially, with a target dose of 10 mg/day within several days. Further dosage adjustments, if indicated, should generally occur at intervals of not less than 1 week, since steady state for olanzapine would not be achieved for approximately 1 week in the typical patient. When dosage adjustments are necessary, dose increments/decrements of 5 mg QD are recommended. Efficacy in schizophrenia was demonstrated in a dose range of 10 to 15 mg/day in clinical trials. However, doses above 10 mg/day were not demonstrated to be more efficacious than the 10 mg/day dose. An increase to a dose greater than the target dose of 10 mg/day (i. The safety of doses above 20 mg/day has not been evaluated in clinical trials. Dosing in Special Populations -- The recommended starting dose is 5 mg in patients who are debilitated, who have a predisposition to hypotensive reactions, who otherwise exhibit a combination of factors that may result in slower metabolism of olanzapine (e. When indicated, dose escalation should be performed with caution in these patients. Maintenance Treatment -- While there is no body of evidence available to answer the question of how long the patient treated with olanzapine should remain on it, the effectiveness of oral olanzapine, 10 mg/day to 20 mg/day, in maintaining treatment response in schizophrenic patients who had been stable on ZYPREXA for approximately 8 weeks and were then followed for a period of up to 8 months has been demonstrated in a placebo-controlled trial ( see CLINICAL PHARMACOLOGY ). Patients should be periodically reassessed to determine the need for maintenance treatment with appropriate dose. Usual Monotherapy Dose -- Oral olanzapine should be administered on a once-a-day schedule without regard to meals, generally beginning with 10 or 15 mg. Dosage adjustments, if indicated, should generally occur at intervals of not less than 24 hours, reflecting the procedures in the placebo-controlled trials. When dosage adjustments are necessary, dose increments/decrements of 5 mg QD are recommended. Short-term (3-4 weeks) antimanic efficacy was demonstrated in a dose range of 5 mg to 20 mg/day in clinical trials. The safety of doses above 20 mg/day has not been evaluated in clinical trials. Maintenance Monotherapy -- The benefit of maintaining bipolar patients on monotherapy with oral ZYPREXA at a dose of 5 to 20 mg/day, after achieving a responder status for an average duration of two weeks, was demonstrated in a controlled trial ( see Clinical Efficacy Data under CLINICAL PHARMACOLOGY ). The physician who elects to use ZYPREXA for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient. Bipolar Mania Usual Dose in Combination with Lithium or Valproate -- When administered in combination with lithium or valproate, oral olanzapine dosing should generally begin with 10 mg once-a-day without regard to meals. Short-term (6 weeks) antimanic efficacy was demonstrated in a dose range of 5 mg to 20 mg/day in clinical trials. The safety of doses above 20 mg/day has not been evaluated in clinical trials. Administration of ZYPREXA ZYDIS (olanzapine orally disintegrating tablets)After opening sachet, peel back foil on blister. Immediately upon opening the blister, using dry hands, remove tablet and place entire ZYPREXA ZYDIS in the mouth. Tablet disintegration occurs rapidly in saliva so it can be easily swallowed with or without liquid. Usual Dose for Agitated Patients with Schizophrenia or Bipolar Mania -- The efficacy of intramuscular olanzapine for injection in controlling agitation in these disorders was demonstrated in a dose range of 2. If agitation warranting additional intramuscular doses persists following the initial dose, subsequent doses up to 10 mg may be given. However, the efficacy of repeated doses of intramuscular olanzapine for injection in agitated patients has not been systematically evaluated in controlled clinical trials. Also, the safety of total daily doses greater than 30 mg, or 10 mg injections given more frequently than 2 hours after the initial dose, and 4 hours after the second dose have not been evaluated in clinical trials. Thus, it is recommended that patients requiring subsequent intramuscular injections be assessed for orthostatic hypotension prior to the administration of any subsequent doses of intramuscular olanzapine for injection. The administration of an additional dose to a patient with a clinically significant postural change in systolic blood pressure is not recommended. If ongoing olanzapine therapy is clinically indicated, oral olanzapine may be initiated in a range of 5-20 mg/day as soon as clinically appropriate ( see Schizophrenia or Bipolar Disorder under DOSAGE AND ADMINISTRATION ). Intramuscular Dosing in Special Populations -- A dose of 5 mg per injection should be considered for geriatric patients or when other clinical factors warrant. Administration of ZYPREXA IntraMuscular ZYPREXA IntraMuscular is intended for intramuscular use only. Directions for preparation of ZYPREXA IntraMuscular with Sterile Water for Injection Dissolve the contents of the vial using 2. The resulting solution should appear clear and yellow. ZYPREXA IntraMuscular reconstituted with Sterile Water for Injection should be used immediately (within 1 hour) after reconstitution. The following table provides injection volumes for delivering various doses of intramuscular olanzapine for injection reconstituted with Sterile Water for Injection. Withdraw total contents of vialPhysical Incompatibility Information ZYPREXA IntraMuscular should be reconstituted only with Sterile Water for Injection. ZYPREXA IntraMuscular should not be combined in a syringe with diazepam injection because precipitation occurs when these products are mixed. Lorazepam injection should not be used to reconstitute ZYPREXA IntraMuscular as this combination results in a delayed reconstitution time. ZYPREXA IntraMuscular should not be combined in a syringe with haloperidol injection because the resulting low pH has been shown to degrade olanzapine over time. The 15 mg tablets are elliptical, blue, and debossed with LILLY and tablet number. The 20 mg tablets are elliptical, pink, and debossed with LILLY and tablet number. The tablets are available as follows:(unit dose medication, Lilly)ZYPREXA ZYDIS (olanzapine orally disintegrating tablets) are yellow, round, and debossed with the tablet strength. The tablets are available as follows:ZYPREXA is a registered trademark of Eli Lilly and Company. ZYPREXA IntraMuscular is available in:NDC 0002-7597-01 (No. VL7597) - 10 mg vial (1s)Store ZYPREXA tablets, ZYPREXA ZYDIS, and ZYPREXA IntraMuscular vials (before reconstitution) at controlled room temperature, 20` to 25`C (68` to 77`F) [ see USP]. Reconstituted ZYPREXA IntraMuscular may be stored at controlled room temperature, 20` to 25`C (68` to 77`F) [ see USP] for up to 1 hour if necessary. Discard any unused portion of reconstituted ZYPREXA IntraMuscular. The USP defines controlled room temperature as a temperature maintained thermostatically that encompasses the usual and customary working environment of 20` to 25`C (68` to 77`F); that results in a mean kinetic temperature calculated to be not more than 25`C; and that allows for excursions between 15` and 30`C (59` and 86`F) that are experienced in pharmacies, hospitals, and warehouses. Protect ZYPREXA tablets and ZYPREXA ZYDIS from light and moisture. Protect ZYPREXA IntraMuscular from light, do not freeze. Panic attack symptoms reach their peak after approximately 10 minutes, but the entire panic attack can endure for 20 to 30 minutes ??? rarely lasting more than 60 minutes. The symptoms are so extreme and intense that people who suffer from panic attacks live in constant fear that they will have another, which negatively impacts their quality of life over time. Common panic attack symptoms develop abruptly and can occur anywhere, usually without warning. You may have a panic attack while shopping in the mall with friends, driving your car, on your morning jog, or while sitting at the dinner table at home. Panic attack symptoms come with a host of intense physical sensations. Symptoms you may feel include:numbness or tingling sensationsYou could also have an intense fear of:having a heart attack or choking to deathThese symptoms, especially when occurring abruptly and out of the blue, indicate that you are probably in the midst of a full blown panic attack.

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People who have type 2 diabetes do not make enough insulin or do not respond normally to the insulin their bodies make buy generic cialis soft 20mg on line, causing a buildup of unused sugar in the bloodstream purchase cialis soft 20mg amex. Metaglip helps remedy this problem in two ways: by causing your body to release more insulin and by helping your body use insulin more effectively purchase cheap cialis soft online. Metaglip could cause a very rare?but potentially fatal?side effect known as lactic acidosis buy cialis soft 20mg without a prescription. It is caused by a buildup of lactic acid in the blood. The problem is most likely to occur in people whose liver or kidneys are not working well, and in those who have multiple medical problems, take several medications, or have congestive heart failure. The risk also is higher if you are an older adult or drink alcohol. Lactic acidosis is a medical emergency that must be treated in a hospital. Notify your doctor immediately if you experience any of the following:Symptoms of lactic acidosis may include:Dizziness, extreme weakness or tiredness, light-headedness, low blood pressure, low body temperature, slow or irregular heartbeat, rapid breathing or trouble breathing, sleepiness, unexpected or unusual stomach discomfort, unusual muscle painDo not take more or less of Metaglip than directed by your doctor. Metaglip should be taken in divided doses with meals to reduce the possibility of nausea or diarrhea, especially during the first few weeks of therapy. However, if it is almost time for your next dose, skip the one you missed and return to your regular schedule. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue using Metaglip. It should be avoided if you have kidney disease or your kidney function has been impaired by a condition such as shock, blood poisoning, or a heart attack. You should not use Metaglip if you need to take medicine for congestive heart failure. Do not take Metaglip if you have ever had an allergic reaction to glipizide or metformin. Do not take Metaglip if you have metabolic or diabetic ketoacidosis (a life-threatening medical emergency caused by insufficient insulin and marked by excessive thirst, nausea, fatigue, pain below the breastbone, and fruity breath). Some studies suggest that the glipizide component of Metaglip may lead to more heart problems than treatment with diet alone, or diet plus insulin. In a long-term trial of a similar drug, researchers noted an increase in heart-related deaths (though the overall mortality rate remained unchanged). Your risk also increases if you miss meals or fail to eat after doing strenuous exercise. Combining Metaglip with other diabetes medications can also cause blood sugar to drop. Symptoms of a mild case include cold sweats, dizziness, shakiness, a light-headed feeling, and hunger. Check with your doctor immediately if you notice any of these warning signs, since severe low blood sugar can occasionally lead to seizures or coma. Before you start therapy with Metaglip, and at least once a year thereafter, your doctor will do a complete assessment of your kidney function. If you develop kidney problems while on Metaglip, your doctor will discontinue Metaglip. If you are an older person, you will need to have your kidney function monitored more frequently, and your doctor may want to start you at a lower dosage. You should temporarily stop taking Metaglip for 2 days before and after having an X-ray procedure (such as an angiogram) that uses an injectable dye. Also, if you are going to have surgery, except minor surgery, you should stop taking Metaglip. Once you have resumed normal food and fluid intake, your doctor will tell you when you can start drug therapy again. Avoid drinking too much alcohol while taking Metaglip. Heavy drinking increases the danger of lactic acidosis and can also trigger an attack of low blood sugar. Because poor liver function could increase the risk of lactic acidosis, your doctor may decide to check your liver function before prescribing Metaglip and periodically thereafter. If you develop liver problems, your doctor may stop treatment with Metaglip. Metaglip occasionally causes a mild deficiency of vitamin B12. Your doctor will check for this with yearly blood tests and may prescribe a supplement if necessary. You should stop taking Metaglip if you become seriously dehydrated, since this increases the likelihood of developing lactic acidosis. Tell your doctor if you lose a significant amount of fluid due to vomiting, diarrhea, fever, or some other condition. While taking Metaglip, you should check your blood or urine periodically for abnormal sugar levels. If Metaglip is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Metaglip with the following:Antibiotics known as sulfonamides, including sulfamethoxazoleAntidepressants known as MAO inhibitors, including phenelzine and tranylcypromineAntifungal drugs that are taken orally, such as fluconazole and miconazoleAnti-inflammatories that contain salicylates, such as aspirin, diflunisal, and mesalamineBeta-blocking blood pressure medicines such as atenolol, metoprolol, and propranololCalcium channel blockers (heart medications) such as nifedipine and verapamilDecongestant, airway-opening drugs such as albuterol and pseudoephedrineIsoniazid, a drug used for tuberculosisThyroid hormones such as levothyroxineTranquilizers such as chlorpromazineWater pills (diuretics) such as hydrochlorothiazideDo not drink too much alcohol, since excessive alcohol consumption can cause low blood sugar and increase the risk of developing lactic acidosis. If you are pregnant or plan to become pregnant, tell your doctor immediately. Metaglip has not been adequately studied in pregnant women and should not be taken during pregnancy unless the potential benefit outweighs the potential risk. Since studies suggest the importance of maintaining normal blood sugar levels during pregnancy, your doctor may prescribe insulin injections instead. It is not known whether Metaglip appears in human breast milk. Therefore, you should discuss with your doctor whether to discontinue the medication or to stop breastfeeding. If the medication is discontinued and if diet alone does not control blood sugar levels, your doctor may prescribe insulin injections. Your doctor will start therapy at a low dose and increase it until your blood sugar levels are under control. For patients not previously treated with diabetes medicationsThe recommended starting dose is 2. If your fasting blood sugar levels are particularly high, you doctor may have you take 2. The daily dosage can be increased by one tablet every 2 weeks until blood sugar levels are controlled. The maximum daily dose is 10 milligrams of glipizide with 2,000 milligrams of metformin. For patients previously treated with glipizide (or a similar drug) or metforminThe recommended starting dose of Metaglip is either 2. The maximum daily dose is 20 milligrams of glipizide with 2,000 milligrams of metformin. For patients on combination therapy taking separate doses of glipizide and metforminThe maximum daily dose should not exceed your current doses of glipizide and metformin. The maximum daily dose is 20 milligrams of glipizide with 2,000 milligrams of metformin. Children should not take Metaglip, since the safety and effectiveness of the drug have not been studied in this group. An overdose of Metaglip can cause an attack of low blood sugar requiring immediate treatment. If you experience any of the symptoms listed in "Special warnings about Metaglip," see a doctor immediately. An excessive dose of Metaglip can also trigger lactic acidosis. If you begin to notice the warning signs listed in "Most important fact about Metaglip," seek emergency treatment. Type 1 diabetes results from a complete shutdown of normal insulin production and usually requires insulin injections for life, while type 2 diabetes can usually be treated by dietary changes, exercise, and/or oral antidiabetic medications such as Micronase. This medication controls diabetes by stimulating the pancreas to produce more insulin and by helping insulin to work better.