Saturday, November 10, 2012
Coupons!
Here I am going to provide a list of websites for obtaining coupons or discounts for type 2 diabetes medications. There are so many coupons out there, but I am choosing to publish only ones that I find through the actual drug manufacturers. This way I can be sure that the links I provide to you are only for legitimate coupons. Remember, each program might have some restrictions (you can't be on Medicaid or Medicare for some coupons, some only provide the first month of treatment, etc) so be sure to read into these.
If I've missed a medication that you'd like me to add, please let me know by email or comment. I've focused on the brand name medications here, because most generics don't have manufacturer's coupons, but if you would like to know about any specific generics, I can look into them for you. This is not an all-inclusive list - check with your local pharmacy to see if they have any coupons on hand. Many times drug reps like to leave us with manufacturers coupons for their products and we are more than happy to provide them to patients.
I should mention that Phil and I, in no way, receive any compensation or "perks" from any of the manufacturers for referencing these discount programs and coupons on our blog. These are merely here for your benefit and because we want to see you thriving with diabetes.
Avandia/Avandaryl/Avandamet: Bridges to Access
Bydureon: Amylin Reimbursement Program
Byetta: Amylin Reimbursement Program
Janumet: Merck Patient Assistance Program
Januvia: Special Offers from Merck
Lantus: Lantus Savings Program
Levemir: Levemir FlexPen Savings ; Novo Nordodisk Diabetes Patient Assistance Program
Novolog: Novo Nordodisk Diabetes Patient Assistance Program
Onglyza: Onglyza Savings Program
Prandin/Prandimet: Novo Nordodisk Diabetes Patient Assistance Program
Symlin: Amylin Reimbursement Program
Victoza: Novo Nordodisk Diabetes Patient Assistance Program
Good luck, and God bless!
Dr K., your virtual pharmacist.
As a disclaimer, I am your "virtual" pharmacist, here to provide you with information and answers to questions. However, I am not your local pharmacist and could, in no way, be aware of your specific medical needs. Remember to always check with your medical provider and pharmacist before stopping or starting any new medications. My posts are based on general pharmacy principles and should not considered as your "first opinion" when it comes to your health. Please consult with your doctor and pharmacist about anything regarding your health.
Thursday, October 11, 2012
Timing is Everything! Like You Didn't Know That
You've heard the phrase, "Timing is everything," right? Sometimes it's used to to explain why something happens. Sometimes it's used instead of a single word, "Luck." But, timing is indeed important when it comes to taking medication.
In life correct timing can make all of the difference between success and failure. And, treating diabetes is no different. In fact, it's far more important than I ever imagined.
Dr. K will go into the best times to take meds sooner or later, because it does matter when you take them. (Like how I volunteered you, K?) Two things have happened recently, and I don't believe in coincidence most of the time, hence this blog entry. You know, even in this, I guess timing is everything. That just occurred to me. Yes, I'm a bit thick sometimes.
The two things:
- In my quest to lower my glucose readings and eventually my A1c, I started looking at the time I took my meds. (Yes, I am a bit analytical.) For most of the last three years I took them in the earlier morning before 6:30, and then again late at night - say about 10:00. It worked pretty well for me since for the last 18 months my A1c has been between 5.9 and 6.2. But, about ten days ago I started taking the medication at night at about 7:00, or so. Guess what? My readings are a bit lower and more consistent, now. I know, for most of you that's more like, "Well, duh!" I'm just a slow learner sometimes.
- The second thing that happened was a comment from a reader about higher readings in the morning two hours after eating than they thought they should have. I forwarded the comment to Dr. K who explained to me that when the medication is taken is incredibly important because different meds get to maximum effectiveness at different times - some get effective faster than others.
So, in both cases, timing is everything. You have to know when to take your meds in order to gain the most from them and to maintain a consistent glucose level in your body. And, since Dr. K is the expert, I know she will address this pretty soon.
Are these two items coincidence? I think not. It was a matter of timing - the reader's comment and my changing the time I take my meds in search of a slightly lower number.
Indeed, Timing is everything!
As always, thank you for reading.
Tuesday, October 9, 2012
More to Life than Diabetes!
I just found out that one of the readers here writes a book review blog. That's great! Diabetes does not rule their life - it's part of their life.
Take a look at their blog: http://grownupbookreports.wordpress.com/
The reviews are fair and written by a reader! One who loves books.
The question is what do you do as you work to control diabetes? Garden? Run? Write? Play pool or billiards? Golf? Let me know - and send me a picture, if you want. There are folks who are fighting to control diabetes that need to know life goes on. Will you help me let them know that? Thanks!
To Fry or not to Fry!
How often have you heard that question? How often have you walked up to the counter to order just a burger and walked away with a burger and a large fries and a large drink? Trust me - not a good thing for a diabetic.
I had seen this as a bill board next to the freeway last week and could not take a picture of it. The sign really took me by surprise. I mean, french fries. Really? To lose weight get a smaller bag of fries. There are so many other things they could have put on that poster that would be just as appealing.
How about skipping the fries entirely? Then you could probably keep the bigger, better burger? What kind of soda is that? Why not iced tea? How would you change the picutre?
I don't know about you, but I will admit that every once in a long while certain french fries are very appealing. But, I learned early on that just five (5!) can effect my glucose readings. And, since I was more scared of diabetes than I liked fries, fighting diabetes won. But, that was my decision and my fight to control. Now, fries can be on the table and I just don't touch them.
What's your decision? To fries or not to fries? Or, do you downsize to a small fry and ease yourself away from them. You will find that you might enjoy that great hamburger more if you don't have fries. (Okay, maybe I was going over board with that one!)
As always, thank you for reading.
Sunday, October 7, 2012
Actos
This will be the first time I'm using the brand name for a medication in my post. If you remember from a few weeks ago, I told you that Actos is now available as a generic called pioglitazone. Since the generic is so new and most of you will still know this drug by the name Actos, I'm going to make things easier and call it by its brand name. Actos is one of two drugs in the category known as the TZDs. I won't bother spelling out the name of the class for you here, because quite frankly it is just a mouthful, but if you are curious you can read my previous post about it here.
How does it lower blood sugar: Actos lowers the amount of glucose in your blood by making your cells more sensitive to insulin. As a reminder, insulin is the hormone that opens the door to your cell, allowing glucose in. Think of insulin as a butler and the glucose in your blood as guests wanting to get into the house (cell). In type 2 diabetes, your cells do not recognize insulin very well (the butler is left out in the cold, and so are the guests!). But Actos helps the cell recognize the insulin so that it can do its job, kind of like the maid opening the door for the butler (forgive my pathetic analogy, but I bet you'll remember how Actos works now!).
Another interesting thing about Actos is how it affects your fat cells. We have two types of fat in our bodies - subcutaneous and visceral. Subcutaneous fat exists right underneath your skin. Visceral fat is deeper in your body and surrounds your organs (liver, stomach, and even streaking in your muscles). This visceral fat is the "bad" kind of fat - big amounts of it are related to type 2 diabetes and heart disease. Visceral fat cells are less sensitive to insulin, and subcutaneous fat cells are more sensitive. Actos actually cause your body to produce less visceral fat cells and more subcutaneous fat cells! This means that more glucose can be pulled out of your blood!
The effect on your numbers: Actos can lower your A1c by 1-2% (an A1c of 9.5 could go down to 8.5 or 7.5 with Actos). However, it does take at least 4-8 weeks to see an affect on your A1c, and it might even take up to 16 weeks to see the full effectiveness of the medicine. What's the other number that Actos can affect? Weight. Actos can cause weight gain of about 12 pounds, or more depending upon what other diabetic medications you are taking.
Dosing: Actos is usually started at a dose of 15 mg once daily. You can take Actos with or without food (Actos does not cause hypoglycemia like some of the meds I've already talked about!). If your A1c does not come down far enough after 6-8 weeks, then we will increase the dose or try another medication. Doses can be increased up to a maximum of 45 mg taken once daily. However, doses over 30 mg are not usually effective and may cause more side effects.
Side effects: So what are the side effects of Actos? I've already mentioned one - weight gain. This is due mainly to a buildup of fluid in your body (usually legs and feet) called edema. Fortunately this stabilizes after you've been on Actos for about six months, but your doctor might put you on a "water pill" to help get that extra fluid out of your body. Other side effects that you might notice when on Actos are headache, upper respiratory infection, and bone fracture.
A unique side effect of Actos is that it can cause ovulation and menstruation in women that previously were not ovulating or menstruating. This includes women who are premenopausal and those with polycystic ovary syndrome (PCOS). It is important that women taking Actos are aware of this because Actos should not be taken when pregnant, so doctors will advise them to take adequate precautions.
Who should not take Actos: The most major precaution with Actos has to do with the heart. If you have congestive heart failure, talk to your doctor about whether or not Actos is right for you. Actos can cause fluid to build up in the lungs, or even lead to heart failure, in patients with a bad heart. This has found to be even more of a concern with the other drug in this class (Avandia) that I will talk about next week, but it is important to know about Actos. Generally we can control this fluid buildup by adding a "water pill" and decreasing your Actos dose, but sometimes we will have to try other medications instead of Actos.
Actos can cause liver toxicity, so patients with liver problems should not take Actos. Actos is not effective for patients with type 1 diabetes or those type 2 diabetics that are no longer producing their own insulin. Due to a risk of potential bladder cancer caused by long periods on Actos and high doses, patients with active or prior bladder cancer should not take this medicine.
Drug interactions: It is possible that Actos may decrease the effectiveness of oral birth control. Other medications that can interact with Actos include the cholesterol medications Lipitor and gemfibrozil, the antibiotic ketoconazole, and thyroid medications. As always, this is not the full list and every patient is different, so consult with your local doctor and pharmacist regarding other medications that you are taking.
Monitoring: As always, you should be checking your blood sugars on a daily basis when on Actos. Your doctor will also be checking your A1c to see how your diabetes is being controlled. Also, you can expect liver tests when taking Actos, to make sure that it is not causing problems. We will also watch for fluid buildup in your legs and feet and will monitor bone health, especially in elderly women, to try to prevent fractures.
Place in therapy for diabetes: Currently Actos is considered the second step for a patient after diet, exercise, and metformin have failed. We will usually give metformin a trial run for three months and then switch to either insulin, one of the sulfonylureas that I've already talked about, or a TZD like Actos. Actos is considered for patients that have trouble with low blood sugars, because the sulfonylureas and insulin cause more hypoglycemia. And now that Actos is generic, it will soon become a cost-effective choice. However, be aware that up to 25% of patients not see any effect on their A1c from Actos, so we might have to try another medication.
If you'd like to read more about Actos (and see a really cool video showing how it works!), visit the manufacturer's website here.
Next week I will talk about the other TZD. This is the medication that you might be seeing on television commercials, and not for a good reason! So come back next week and I will break down the rumors and truths about Avandia.
As always, if you have any questions concerning type 2 diabetes and medications, feel free to leave a comment or email me at DrK@solutionsfort2diabetes.com
——————————————————————————————
As a disclaimer, I am your “virtual” pharmacist, here to provide you with information and answers to questions. However, I am not your local pharmacist and could, in no way, be aware of your specific medical needs. Remember to always check with your medical provider and pharmacist before stopping or starting any new medications. My posts are based on general pharmacy principles and should not considered as your “first opinion” when it comes to your health. Please consult with your doctor and pharmacist about anything regarding your health.
How does it lower blood sugar: Actos lowers the amount of glucose in your blood by making your cells more sensitive to insulin. As a reminder, insulin is the hormone that opens the door to your cell, allowing glucose in. Think of insulin as a butler and the glucose in your blood as guests wanting to get into the house (cell). In type 2 diabetes, your cells do not recognize insulin very well (the butler is left out in the cold, and so are the guests!). But Actos helps the cell recognize the insulin so that it can do its job, kind of like the maid opening the door for the butler (forgive my pathetic analogy, but I bet you'll remember how Actos works now!).
Another interesting thing about Actos is how it affects your fat cells. We have two types of fat in our bodies - subcutaneous and visceral. Subcutaneous fat exists right underneath your skin. Visceral fat is deeper in your body and surrounds your organs (liver, stomach, and even streaking in your muscles). This visceral fat is the "bad" kind of fat - big amounts of it are related to type 2 diabetes and heart disease. Visceral fat cells are less sensitive to insulin, and subcutaneous fat cells are more sensitive. Actos actually cause your body to produce less visceral fat cells and more subcutaneous fat cells! This means that more glucose can be pulled out of your blood!
The effect on your numbers: Actos can lower your A1c by 1-2% (an A1c of 9.5 could go down to 8.5 or 7.5 with Actos). However, it does take at least 4-8 weeks to see an affect on your A1c, and it might even take up to 16 weeks to see the full effectiveness of the medicine. What's the other number that Actos can affect? Weight. Actos can cause weight gain of about 12 pounds, or more depending upon what other diabetic medications you are taking.
Dosing: Actos is usually started at a dose of 15 mg once daily. You can take Actos with or without food (Actos does not cause hypoglycemia like some of the meds I've already talked about!). If your A1c does not come down far enough after 6-8 weeks, then we will increase the dose or try another medication. Doses can be increased up to a maximum of 45 mg taken once daily. However, doses over 30 mg are not usually effective and may cause more side effects.
Side effects: So what are the side effects of Actos? I've already mentioned one - weight gain. This is due mainly to a buildup of fluid in your body (usually legs and feet) called edema. Fortunately this stabilizes after you've been on Actos for about six months, but your doctor might put you on a "water pill" to help get that extra fluid out of your body. Other side effects that you might notice when on Actos are headache, upper respiratory infection, and bone fracture.
A unique side effect of Actos is that it can cause ovulation and menstruation in women that previously were not ovulating or menstruating. This includes women who are premenopausal and those with polycystic ovary syndrome (PCOS). It is important that women taking Actos are aware of this because Actos should not be taken when pregnant, so doctors will advise them to take adequate precautions.
Who should not take Actos: The most major precaution with Actos has to do with the heart. If you have congestive heart failure, talk to your doctor about whether or not Actos is right for you. Actos can cause fluid to build up in the lungs, or even lead to heart failure, in patients with a bad heart. This has found to be even more of a concern with the other drug in this class (Avandia) that I will talk about next week, but it is important to know about Actos. Generally we can control this fluid buildup by adding a "water pill" and decreasing your Actos dose, but sometimes we will have to try other medications instead of Actos.
Actos can cause liver toxicity, so patients with liver problems should not take Actos. Actos is not effective for patients with type 1 diabetes or those type 2 diabetics that are no longer producing their own insulin. Due to a risk of potential bladder cancer caused by long periods on Actos and high doses, patients with active or prior bladder cancer should not take this medicine.
Drug interactions: It is possible that Actos may decrease the effectiveness of oral birth control. Other medications that can interact with Actos include the cholesterol medications Lipitor and gemfibrozil, the antibiotic ketoconazole, and thyroid medications. As always, this is not the full list and every patient is different, so consult with your local doctor and pharmacist regarding other medications that you are taking.
Monitoring: As always, you should be checking your blood sugars on a daily basis when on Actos. Your doctor will also be checking your A1c to see how your diabetes is being controlled. Also, you can expect liver tests when taking Actos, to make sure that it is not causing problems. We will also watch for fluid buildup in your legs and feet and will monitor bone health, especially in elderly women, to try to prevent fractures.
Place in therapy for diabetes: Currently Actos is considered the second step for a patient after diet, exercise, and metformin have failed. We will usually give metformin a trial run for three months and then switch to either insulin, one of the sulfonylureas that I've already talked about, or a TZD like Actos. Actos is considered for patients that have trouble with low blood sugars, because the sulfonylureas and insulin cause more hypoglycemia. And now that Actos is generic, it will soon become a cost-effective choice. However, be aware that up to 25% of patients not see any effect on their A1c from Actos, so we might have to try another medication.
If you'd like to read more about Actos (and see a really cool video showing how it works!), visit the manufacturer's website here.
Next week I will talk about the other TZD. This is the medication that you might be seeing on television commercials, and not for a good reason! So come back next week and I will break down the rumors and truths about Avandia.
As always, if you have any questions concerning type 2 diabetes and medications, feel free to leave a comment or email me at DrK@solutionsfort2diabetes.com
——————————————————————————————
As a disclaimer, I am your “virtual” pharmacist, here to provide you with information and answers to questions. However, I am not your local pharmacist and could, in no way, be aware of your specific medical needs. Remember to always check with your medical provider and pharmacist before stopping or starting any new medications. My posts are based on general pharmacy principles and should not considered as your “first opinion” when it comes to your health. Please consult with your doctor and pharmacist about anything regarding your health.
Wednesday, October 3, 2012
Made Meters
Do you know what the folks at Consumer Reports did in the current issue? They evaluated blood glucose meters! You can read about their testing procedures and what qualities make a good meter here. It's worth reading.
Their top five picks in alphabetical order are:
- Accu-Chek Aviva
- Accu-Chek Conpact Plus
- Bayer Breeze 2
- FreeStyle Freedom Lite
- FreeStyle Freedom
I don't use their order because it's their work, and I respect it. But, these are the top five out of twenty-one meters evaluated.
By the way, there is no implied endorsement of any meter; I just hope you test using a meter several times a day to manage, control and beat down diabetes!
As always, thank you for reading.
Tuesday, October 2, 2012
Tag It - Help
I am a big believer in wearing a medical alert tag. So big, I wrote an entire post on the topic. And, while I continue to believe that the folks at MedicAlert provide the best tag, not everyone can afford the $50+ to get one.
So, I need a bit of help in finding an inexpensive tag for folks so emergency medical personnel can quickly identify they are working with a diabetic. There are a lot of folks selling the tags on the internet, and some are kind of inexpensive, but from the comments I have read about the tags, they are cheap.
So, does anyone know of a site I can recommend for folks to go to to get a tag or bracelet that won't break the bank? Decent quality with a decent chain that will last for years. There has to be someone who just wants to help. Let me know.
As always, thank you so very much.
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