Niacin is a naturally occurring vitamin. The value of Niacin in Diabetes is that it improves Lipids (blood fats) and in particular improves the type of abnormality that is seen in Diabetes. There is normally a balance in the body between Cholesterol, LDL (bad cholesterol) and HDL(good cholesterol). The HDL (High Density Lipoprotein) protects against heart disease and stroke so we want to achieve a high level of HDL (preferably above 1.2). Things that affect HDL (good cholesterol) levels are smoking which lowers HDL, and inactivity or sedentary lifestyle which lowers HDL. HDL can be improved by stopping smoking and exercising. If these measures are not enough then we can give drugs. There are 2 classes of drugs which raise HDL, the Fibrates (such as Bezalip, Gemfibrozil, Lipidil) and Niacin.
Niacin is a very effective drug to raise good cholesterol but it is hard to take becasue it causes flushing and other uncomfortable side effects. One also has to take a lot of pills (sometimes up to 20 a day). In large doses it may worsen glucose control.
We are going to try small doses of Niacin, starting with a 1 tab (100mg) with supper. If this is tolerated well, than after a week, increase to 1 tab with breakfast & supper. If this is tolerated well then increase to 1 tablet with each meal. We need to gradually increase to 2 tablets with each meal. If side effects such as flushing or nausea become a problem, drop back to the previous dose for a few weeks and then try increasing again.
Keep monitoring glucose and if control becomes worse then call or arrange to see me.
If you are able to tolerate 2 tablets with each meal then we will recheck your Lipids (Cholesterol etc) at the next visit, it is therefore preferable if you can come fasting to your next visit.