Diabetes is a disease of high blood sugar. When you have diabetes, your blood sugar is out of balance. When you have diabetes, your body is not able to keep your blood sugar level at a healthy balance on its own. Having high blood sugar for a long time can cause health problems.

Sugar can build up in the blood because:

• Your body doesn't make enough insulin, or it cannot use this insulin properly
• Your liver makes more sugar than your body needs

In diabetes, when your blood sugar gets too high, your body tries to bring it back into balance. It does this by sending important messages to your pancreas. In response, your pancreas makes more insulin. Your pancreas also signals your liver to make less sugar. But in people with type 2 diabetes, when fewer messages reach the pancreas, it makes it harder for the body to balance blood sugar.

Too many of these important messages may be blocked in type 2 diabetes. They are blocked by a substance in the body called DPP-4. With DPP-4 blocking these important messages, the pancreas is not able to bring blood sugar into balance.

• For people without diabetes: Between 70 and 120 mg/dL
• For people with type 2 diabetes:
  Fasting(not eating for a period of time): up to 130 mg/dL
  After meals: less than 180 mg/dL

It is important to test your blood sugar regularly. You can do this at home. Write down your results each time. Some people need to test once a day; others need to test several times a day. Your doctor will tell you how many times a day you should test your blood sugar and which method is right for you.

A1C is a blood test done in a doctor's office or in a laboratory. It shows your average blood sugar level over the past 2 to 3 months. Most doctors recommend that you get an A1C test up to 4 times a year. It's important to know your A1C because it tells how balanced your blood sugar level is staying over time.

For most people with diabetes, the American Diabetes Association recommends an A1C of less than 7%. Another group of experts, the American Association of Clinical Endocrinologists, recommends an even lower A1C of 6.5% or less.

You and your doctor will decide what your target A1C should be. If your A1C is on target, good for you! Generally, the lower your A1C, the lower your risk of diabetes problems. In fact, every 1% you bring down your A1C (from 8% to 7%, for example) may lower your risk of certain health problems caused by diabetes by as much as 40%!

To take care of your diabetes, your doctor may tell you that you need to make some lifestyle changes. You might need to:

• Make some changes in the way you eat
• Become more active
• Lose some weight
• Take medicine every day

A well-balanced diet, exercise, and a healthy weight can help balance your blood sugar level.

Taking care of diabetes can be tough. You may not be able to tell when your blood sugar is high because you may not feel different. It's easy to think, "I'll start tomorrow." Unfortunately, you may not feel the damage that high blood sugar is causing either, until the damage is already done.

JANUVIA is a once-daily pill that, along with diet and exercise, helps lower blood sugar levels in people with type 2 diabetes. It's a type of prescription diabetes medicine called a DPP-4 inhibitor (blocker). DPP-4 blockers enhance the body's own ability to control blood sugar levels. A doctor may prescribe JANUVIA alone or together with certain other diabetes medicines to help control blood sugar.

JANUVIA works only when your blood sugar levels are high. When your blood sugar levels are at a healthy balance, JANUVIA doesn't have an effect.

Because JANUVIA stops working before your blood sugar gets too low, it is not likely to lower your blood sugar to a potentially dangerous level (hypoglycemia).

JANUVIA has not been studied with insulin and should not be used to treat patients with type 1 diabetes or diabetic ketoacidosis(increased ketones in the blood or urine) or used if you are allergic to JANUVIA.

When JANUVIA is used with a sulfonylurea, low blood sugar (hypoglycemia) can occur. To avoid this risk, your doctor may prescribe lower doses of the sulfonylurea.

Most people with diabetes struggle with maintaining a healthy weight. This can be very frustrating. So you'll be glad to know that most patients who took JANUVIA did not gain weight. That's because JANUVIA is a different kind of diabetes medicine.

Be sure to follow your treatment plan for healthy eating and exercise while taking JANUVIA or any diabetes medicine.