Glimepiride

We'll be finishing up the sulfonylurea class of medications today with the drug glimepiride. There are a few other drugs in the category, but they are so rarely used because of their side effects, so I'm only going to list them for your knowledge. I've never seen them used in my practice. If you do have questions on them, please feel free to message me in the comments below. The other sulfonylureas are:

• acetohexamide (brand name Dymelor)
• chlorpropamide (brand name Diabinese)
• tolazamide (brand name Tolinase)
• tolbutamide (brand name Orinase)

But back to glimepiride, otherwise known by the brand name Amaryl. Yes, it is available as a generic.
If you want a refresher on sulfonylureas, and the other classes of diabetes medications, you can find out more in my previous post here.

How does it lower blood sugar: Like the other sulfonylureas, glimepiride lowers your blood sugar by increasing the amount of insulin that your pancreas puts into your blood. Remember, insulin is the hormone that is put into the blood to "push" sugar into your cells and out of your bloodstream - making your blood sugar lower!

The effect on your numbers: Glimepiride may lower your A1c by 1-2% (so if your starting A1c was 12, it might go down to 11 or 10 after being on glimepiride). Glimepiride is known to cause some weight gain.

Dosing: The starting dose for glimepiride is generally 1 or 2 mg once daily with breakfast or the first meal of the day. We can increase this dose, usually every 1 to 2 weeks, up to a maximum of 8 mg daily. Glimepiride works in your body for 24 hours, so it really only needs to be taken once a day - a good thing because who wants to remember more pills!

As with all of the other meds in this class, glimepiride must be taken with food to avoid hypoglycemia (dangerously low blood sugar). If you want to read more about hypoglycemia, including what it feels like and how to treat it, please visit this link.

Side effects: The most common side effect of glimepiride is hypoglycemia. We want your blood sugar to be a certain level, not too high and not too low, because too low can cause many problems (remember, sugar is energy for your body). The lower your fasting blood sugar is before you start taking glimepiride for the first time, the more likely you will be to have hypoglycemia when on the medication. Also, if you exercise frequently or lose a lot of weight, you may find that you start having too low of blood sugars when on glimepiride. And no, I am not telling you that so that you don't exercise or lose weight - please know that a healthy weight is what I want for you! But know that if you lose the weight and are consistent with your exercise, your doctor might need to change your med at some point.

Who should not take glimepiride: If you have a sulfa allergy, you should not take glimepiride because it contains a sulfa molecule. If your diet is inconsistent or you have a history of low blood sugars, you should probably not take glimepiride because of the chance of hypoglycemia. If you are pregnant, breastfeeding, or have kidney or liver problems, your doctor will probably use a different medication other than glimepiride for your diabetes.

Drug interactions: Some medications that can interact with glimepiride and make it work better or worse include certain blood pressure medications, diuretics (“water pills”), blood thinners, salicylates (like aspirin), and certain antidepressants. You should not drink alcohol when taking this medication.

Remember, check with your local pharmacist or doctor before starting any new medications, both prescription and over-the-counter. And make sure your pharmacy is aware of all medications that you take so that your pharmacist can check for drug interactions when you come in with a prescription.

Monitoring: As always, you will have to check your blood sugars daily while on glimepiride. Your doctor will need to check your A1c once or twice a year at least - this tells them how well your medications and daily habits are working to treat your diabetes.

Place in therapy for diabetes: Glimepiride is usually used when metformin has not worked or is not an option for you. When type 2 diabetes gets severe or progresses, sometimes your body no longer produces insulin, so then glimepiride might not be the option for you.

If you would like to read more about glimepiride, you can do so here.

Next week we will continue into a new class of medications. Aren't you excited? I am! Stay tuned!
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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.

Do You Get Up High?

Really.  Do you get up high in the morning?  Is your glucose reading higher in the morning that when you took it at night.  Then, read on my friend.

When my numbers were coming down during the first six months I was getting higher numbers when I checked in the morning that I saw the night before.  It was driving  me nuts.  How could I be high in the morning?

I went so far as to call the makers of my meter to tell them something was wrong with it. How could my morning number be 30 or 40 points higher than my evening number?  You know what they did?  They sent me another meter!  Did that fix anything?  No!

So, as I continue to not understand this higher reading or what caused it...I get more concerned.  Maybe my meds aren't working right?  I was new to everything at that time - I didn't know what the heck was going on and I was getting worried.

Does this sound familiar at all?

Well, the reason the numbers were higher was because I was taking my reading after the Dawn Phenomenon took place.  It's also called the Dawn Effect - which is easier to type.  So, what is it?  Well, as your body gets ready to get up and start the day it releases...wait for it...sugar!  Sugar goes into your blood as a natural "Let's get up and get going" mechanism.

If there is sugar in the blood, your meter is going to measure it.  So, it becomes important to know when it takes place.  For me, it happens between 6:00 and 6:30 in the morning.  But, it could happen any time between 4:00 and 8:00 am - or so.  Only careful readings will let you figure out when YOUR body releases sugar for the morning.

So, for me it was mystery solved.  But, it drove me nuts for about a month. I really hope this helps you.

I have written more about it here.  But have given you the basics.  Just remember to always test, even if it gives you a crazy number, there will be a reason for it.  Testing is one of the most important tools for you in your battle to control diabetes.

Hope you are well.  And, as always, thank you for reading.

Cheerio! And, A Coupon

My favorite meal of the day is breakfast.  And, I normally do not have the time to prepare steel cut oatmeal in the mornings.  Sound familiar?  So, I have had to find foods I like, are light in fats and carbs, and are easy to prepare.  I'm still half-asleep when fixing breakfast - it has to be EASY.

I've had peanut butter sandwiches on low carb, high fiber toast - a breakfast that I truly enjoy, but a bit high in fats.  I have eaten granola type cereals - a bit too high in carbs - and some are really high in fats.  Still like it sometimes, though.  But the favorite day-in-day-out go-to breakfast food is...wait for it...Cheerios.  Low fat.  Low carbs.  Taste pretty good.  Just watch the portion control.  Did the picture at the top of the page give it away?

You might find you like it, too.  So, to make it a bit easier, I found this coupon at the Betty Crocker (another General Mills brand) site.  Go ahead, go get it.  The Cheerios coupon is located in the left column a little way down.  Click on the clip it, then go down to the bottom the the page on the right side and click Print Coupons.  Not a huge savings, but it will help.

The facts: : For a 3/4 cup portion (measure it) there are 22 - 26 carbs (based on flavor) and 1.5 grams of fat.  Not bad. Plus, the family will eat them, too.  It's important to me to eat the food my family eats as much as I possibly can - and it works most of the time.  I don't want to have a separate shelf for 'my food' or separate myself from my family because of diabetes.

You can start with the 22 carbs, add about 6 to 8 carbs for milk, maybe a slice of toast or piece of fruit for another 15 to 20 carbs and a cup of coffee with milk for about 3 carbs.  What does that add up to?  53 carbs at the most.  What do I have?  Cheerios with milk, low carb yogurt and coffee.  Total carbs are under 45.  And, my hunger is satisfied.

How do I know it works for me?  Well, my average glucose reading for the last 90 days taken at various times of the day is 99.  If the Cheerios work for me, they might work for you.  Use the coupon and give it a try.

By the way, I actually called General Mills to find out if there was a coupon I could offer here.  They directed me to the site I gave you a link to above.  Of course, that won't stop me from asking again and again and again when I think you might like some of the foods I eat.  Remember, the goal of this blog is to help you "survive and thrive" while controlling diabetes.  You can.  I know it.

By the way, the coupons change at the Betty Crocker site every month, or so.  Check back. I will try to remember to remind you to do so.

Just a reminder that what works for me might, or might not work for you.  Body chemistry is different.  So, always remember to take your glucose readings to know how you are doing.

As always, thank you for reading.  I think about you everyday and how I might help you.  If you have any suggestions, please let me know.

Really? This Is Exercise? NEAT!

Wouldn't you like to be on that beach?  Far away. Contemplating the sand, water and resting?  Reading the latest novel or, heaven forbid - sleeping?  And, wouldn't you like to look and feel your best? To have diabetes under control? (I just liked the picture - I had to work it around to the topic.)

By now you all know I believe in exercise.  I believe it's important in any strategy to control or beat diabetes.  It's part of The Diabetes Treatment Triangle (I just made that up!  I know I will use it again.)

Anyway, not everyone will get out and either walk or exercise in some way.  Like I am telling you something you don't know.  The bigest exercise you have going might be using the remote or getting up from the couch.  I get it.  I used to be that way.  But, wait, there's a way for you to get your necessary movement (new word for exercise) and stay on, or near the couch!

It's called NEAT.  Non-Exercise Activity Thermogenesis.  Good thing they came up with an easy to remember acronym, huh?  Otherwise, it sounds like something out of Star Trek.

So, the big idea is that any movement - any movement - during the day adds up; that it burns calories and will result in a weight loss.  This is nothing new; I've written about it before.  But, now they have applied science to it.  Very exciting!  And, it's a great way to ease into other forms of exercise if you are just beginning.  The important issue is that you do something, anything - again, I am telling you something you already know.

What movement/activity counts?  Just about anything.  Walking to a meeting.  Making a bed.  Lifting your legs up and down while watching TV.  (Unfortunately, I am not sure that remote control mastery counts.)  Taking the stairs for a floor, or two, instead of using the elevator - you can always catch it on the second or third floor.

You can read a decent introductory article here and look at another one here. then do a web-search to learn more.  Exercise, NEAT or not, is important for everyone - but especially important if you are going to control diabetes.

As always, thank you for reading.

Inside a Diabetic's Head

I messed up yesterday night and deleted a blog entry I found...I am soooo sorry.  If you haven't seen it, take a look at What Goes On In A Diabetic's Head.  It's creative...witty...and so very, very true!  Thank you to Jenna Rachel for posting it!  Check out her blog. 

As always, thank you for reading - and again, I do apologize for deleting the posting.

A Bit of Style for Diabetics!

Okay, so maybe diabetes wasn't lacking style. Maybe everybody really does like those black little cases for testing meters and, if you need them, insulin pumps.  I mean, black does appeal to both sexes and all age groups, right?  It goes with everything - kind of.

NOT.

I know I don't deal with insulin pumps here.  But a lot of folks do, and one Dad, David Winegar, took it on himself to design a cool insulin pump case for his son.  And, he thought that others might like it, too.  So, he started a little business.  No clue what level of success he is achieving; I just really like the fact he is trying to make life for his son as good as it can be.

So, take a look at Rad's Blog.  There's a link to his website on the right.  And, if we are really good, he might even start designing better cases for the rest of us!  I mean, does anyone even have a pink case?  Or, a red case for their meter?  Or, one with monsters or fairies on it?  Wouldn't it be great if you smiled each time you looked at your case instead of approaching with a bit of dread?  (Yes, there are days when I just don't want to see the thing!)

Really, have any of you seen any meter case that wasn't black?  If so, let me know!  Please. Put it in comments.

And, I REALLY hope that David does not mind me taking the image from the blog.  If so, let me know and I will remove it from the posting.  I just think it's great how much you are showing your love for your son - and for anyone carrying an insulin pump.

As always, thank you for reading.

Burger and Fries (NOT!)

There are days every once in a while when all I can think about is a hamburger.  Hot and fresh.  A toasted bun.  Grilled onions.  A bit of this and that...My mouth is watering right now!  In fact, I had one for dinner...and it was glorious!

So, I decided that tonight was hamburger night and went out to my favorite place.  I ordered my burger, and any time you order a burger you get some form of the question:

Would you like fries?

Fries?  Really? I know that even three french fries - those golden, slightly crispy, warm and salted delicacies turn up in an increased blood sugar reading.  Three.  Three little fries can make all of the difference in the world.

Of course, it wasn't always this way.  I'd have cheese, fries, super size it and be very happy.  But, it was adding pounds and pounds and contributing to me becoming a diabetic.  I have really come to believe that the most dangerous questions to public health are:

1. Can I supersize it for you; can I make it jumbo for you?
2. Would you like a combo?

The answer to both questions should always, always, always be no.  Always.  Look, I know the fries taste great.  I know it's a nearly automatic response to say yes.  But you have to think about the price you will pay if you do so.  Those great tasting fries come with a very heavy price.  Increased blood sugar and perhaps weight gain.

You know, a hamburger by itself isn't so bad for me.  Two hours after the burger, I checked my blood glucose - 97.  Three hours it was 86.  So, there don't appear to be any adverse effects.  Then again, I am careful about where I get a hamburger and it's only from those places that make it fresh and do not use a lot of sauces.  I am fortunate to be in Southern California where I have a number of places from which to choose.

Of course, when I was first diagnosed, I stayed away from burgers completely for several months as I got my sugar under control.  I had to learn what I could and could not eat.  I read nutrition guides everywhere and online to know what I could eat.  And, you know what?  Just about every restaurant has their nutrition guides online - so you can be prepared.

When you choose to eat out, make good choices.  My doc has told me several times, "You have diabetes, but you still have to live.  Be smart."

Glipizide

Today I'm going to talk about another diabetes medication in the same class as glyburide. I'd like to introduce you to glipizide, also known by the brand name Glucotrol. This is a 'younger' student in the class (and when I say younger, that is only relative to the 'older' drug glyburide - glyburide was developed in 1966 and glipizide in 1984). If the names are starting to get confusing, that's not a surprise - all of the most common sulfonylureas used today for diabetes start with the letters "gl".

If you want a refresher on sulfonylureas, and the other classes of diabetes medications, you can find out more in my previous post here.

How does it lower blood sugar: Like the other sulfonylureas, glipizide lowers your blood sugar by increasing the amount of insulin that your pancreas puts into your blood. Insulin is put into the blood so that it can "push" sugar into your cells and out of your bloodstream. To a small extent, glipizide may make your cells more sensitive to insulin, but mostly glipizide just increases the amount of available insulin. As I discussed last week, since the pancreas sometimes stops producing insulin as the disease gets worse, glipizide might not always work for you.

The effect on your numbers: Glipizide may lower your A1c by 1-2% (so if your starting A1c was 11, it might go down to 10 or 9 after being on glipizide). Glipizide may cause weight gain.

Dosing: We generally start patients at a dose of 5 mg once daily and then after some time this can be increased, up to a maximum of 40 mg daily. Glipizide also comes in an extended release tablet, which means that the medication will release into your body more slowly. The extended release glipizide cannot be cut, chewed, or crushed.
Just as I mentioned with glyburide, glipizide must be taken with food. If you take glipizide on an empty stomach, your blood sugar will drop and could get dangerously low. If you want to read more about low blood sugar (hypoglycemia) including what it feels like and how to treat it, please visit this link.

Side effects: The major side effects of glipizide are low blood sugar and weight gain. Aside from these, you may have some nausea and diarrhea, which can be avoided by using a lower dosage of glipizide. Some patients may get a rash, itching, and sun sensitivity (sunburning easily) from glipizide. Glipizide does not stay in the body quite as long as glyburide does, so if you had side effects with glyburide, you might not have the same side effects with glipizide.

Who should not take glipizide: If you have a sulfa allergy, you should not take glipizide. If your diet is inconsistent or you have a history of low blood sugar problems, you should probably not take glipizide because of the chance of hypoglycemia. Pregnant and breastfeeding women should not use glipizide. Those with severe liver or kidney failure should also not take glipizide.

Drug interactions: Glipizide will make your body not tolerate alcohol very well, so do not drink alcohol while on glipizide. Side effects of drinking alcohol while on glipizide include nausea, flushing of the skin, vomiting, shortness of breath, and very low blood pressure. But the most important thing that happens is that it can increase the effect of low blood sugar, which can be very dangerous.

Other medications that can interact with glipizide and make it work better or worse are certain blood pressure medications, diuretics (“water pills”), blood thinners, salicylates (like aspirin), and certain antidepressants. Remember, check with your local pharmacist or doctor before starting any new medications, both prescription and over-the-counter. And make sure your pharmacy is aware of all medications that you take so that your pharmacist can check for drug interactions when you come in with a prescription.

Monitoring: You will have to monitor your blood sugars throughout the day. Watch for signs of low blood sugar (feeling like your heart is racing, headache, confusion, increased sweating, hunger, shakiness, tingling in the mouth, and a feeling of anxiety). If you start to feel any of these, check your blood sugar immediately. If it is too low, have a 15 gram carb snack followed soon by a meal of complex carbohydrates.

Place in therapy for diabetes: Glipizide is usually given to a patient when metformin doesn't work fast enough, or if they can't take metformin. Glyburide and glipizide are both about the same price and work the same way, so it is up to your doctor as far as which one you should try first. After some time, your pancreas might stop making insulin, so your doctor will need to choose another medication.

If you want to read more about glipizide, you can learn about it here.

Next week I will discuss the last of the commonly used medications in the class of sulfonylureas. You won't want to miss it!

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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.

A New Generic!

I won't be fully discussing Actos for a few more weeks, but I wanted to let you know that it is now available as a generic! What does this mean? Lower price for the same medicine!

You can access the article here.

The generic for Actos, pioglitazone, has now been approved by the Food and Drug Administration (FDA) for sale within the United States. You see, when medications first come out for use in the US, they can only be produced by one company. The company that spent the money developing the drug and applying for approval by the FDA is allowed to market their drug exclusively for a certain amount of time, under a brand name. After a certain number of years, this patent expires and other companies can apply to the FDA for approval of their generics to the original drug.

Many patients do not have a full understanding of generic medications. I have many customers that will only buy brand name medications because their belief is that generics are inferior products. And I can understand the confusion. Think about it, you buy store brand facial tissue and it doesn't ever seem to hold up as well as Kleenex, does it? Generic cereal never tastes the same as the brand name product, right? In these cases, generic sometimes signals "low quality."

This isn't the case with medications. The FDA requires all generic medications to be held to as high of standards as brand name medications. They go through an approval process that requires manufacturers to prove that the drug in the generic product is the same as in the name brand. The active ingredient, the "drug," must be identical chemically in both products.

The next time you are in the store, pick up a box of Aleve and a box of its generic "naproxen". Turn to the part where it lists the active ingredients. On both, you will find the words "naproxen sodium 220 mg." This is the main ingredient, the drug that is helping with your pain. Your generic facial tissue company can use as much or little paper to make their product as they want, but if a box says it is generic for Aleve, it will have 220 mg of naproxen in it.

You will notice that the inactive ingredients might be a bit different between the two boxes. Inactive ingredients are basically just fillers - they give the tablet its shape, color, and form. They are considered inactive because they do not do anything to change how the active ingredient, the naproxen in this case, works. Each company uses different fillers to make their tablets, but they don't affect how the medicine works. If they did, they would not be approved by the FDA as a "generic" product.

The most important thing to know is that all generics, before being sold in the US, have to be proven to be equivalent to the original brand name product. They can't work "almost as well" as the original - the makers of the generic have to show that they work the same way as the original. The same amount of the drug must reach the patient's blood in the same amount of time in both the name brand and generic for it to be considered equivalent. The generic has to be just as strong, pure, and stable (meaning it does not expire any sooner than the brand name medicine sitting next to it in your medicine cabinet) as the original brand name drug, or it will not be approved.
If you want to read more about what the FDA has to say about generic medications and the approval process, there is a wonderful article on their website here.

What I like to remind people is that generics have been around for many years. When you look at a list of the top 200 medications that were prescribed this year, the vast majority of them are generic medications. Chances are, you are currently taking a generic medication on a daily basis and have probably thought nothing of it. Metformin, our drug of choice for type 2 diabetics, is a generic. Most blood pressure medications that we commonly use are generic (lisinopril, atenolol, metoprolol, amlodipine - any sound familiar? all generics). Cholesterol medications are usually generic too (statins such as simvastatin, pravastatin, lovastatin, and the newest generic atorvastatin).

Most insurance companies won't cover a brand name medication once a generic is available, unless your doctor fills out some paperwork stating why the brand name medication must be used. And with the recent recalls of over-the-counter brand name medications such as Tylenol, generics have become the more easily accesible option for many patients. They are less expensive and work just as well as the brand name products.

So patients on Actos, rejoice because there is now a cheaper alternative! If you haven't been switched to the generic yet, talk to your pharmacist about when it might be available to you. Some insurance companies take about a month to six months to officially "recognize" the generic and add it to their plan, so it might take a bit of patience. But soon, you will be saving money and living a better life!

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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.

This I Believe - You Can Do It!

The TV was on as I was getting ready for work this morning.  One of the updates was about Robin Roberts, co-anchor of Good Morning America, who is going through a bone marrow transplant.  Talk about dignity and grace under pressure!  You do know the whole bone marrow transplant is still experimental, don't you?

I was struck by Ms Roberts' thoughts, prayers - for certainly some of her words are prayers for others, as well as herself, and belief.  Paraphrasing her words: It starts with belief.  Believe you can do it.  Believe you will be better.  Believe that you can make the necessary changes... 

She might as well have been talking to diabetics.  I won't belabor the point, but your control of diabetes, beating diabetes, starts with believing you can.  Believing you can overcome.  Believing you can beat it.  I was lucky when I was diagnosed.  My doctor told me that, "Phil, you have diabetes and there is a good chance you will be on meds for the rest of your life.  You need to lose a little weight.  And, we need to get your A1c down as soon as possible.  You are going to need to see a dietician to learn new ways to eat.  And, you are going to have to track your blood sugar.  Sugar is the enemy."

He went on to explain what diabetes was and the effect it could have on my body if I did not control it.  But, he also went on to explain that he had one patient who beat it; who is no longer taking medication of any kind and he told me how she did it.  Well, I am still pressing on toward that goal.  But, the important issue is that he made me believe that I could control the disease.  I listened, and because I am incredibly afraid of how diabetes can effect me, I took the necessary steps.

The BIG point?  I BELIEVED.  And I believe you can control diabetes, too.  I truly believe it from the bottom of my heart.  I believe you can make the necessary changes in your life - the food you eat, taking your meds all of the time, and doing a bit of exercise.  You can do it.

And, if you don't believe it, let me know, because my belief in you; my belief that you can manage the beast called diabetes is strong and deep.

You can follow Robin Roberts' progress here.

Just How Many Diabetics Are There?

Well, in a word - lots.  I was amazed to learn how many folks have diabetes.  So, to remove the stress of not knowing the answer, I will let you in on the 'secret number.'

But, before I tell you, that's a map of the population of the United States, not a wireless carrier's coverage map.  White = very few people. Darker red = a lot of folks!  Just thought you might be interested.  Is the suspense killing you, yet?  Well, without further ado...

According to the American Diabetes Association:

25.8 million people have diabetes.  (25,800,000 - looks like a bigger number when written out.)

18.8 million have been diagnosed.  (18,800,000)

7 million are not yet diagnosed.  (7,000,000) Read about the symptoms.

79 million have Pre-diabetes. (79,000,000) And, read about Pre-diabetes.

Total is 104 million.  (104,000,000)

The population of the USA is 311 million according to the most recent census.  So, basic arithmetic tells me that 33.4% have some form of diabetes.  One third!  Look around you.  One person in three has some form of diabetes.  Count off - one, two, three - one of you has diabetes.  That's mind boggling.  We are the biggest 'secret society' in the world!

Why secret?  Because it's so personal for some.  I have read in so many blogs about people getting these looks of pity from others when they found out the person had diabetes.  I have received them!  But, you know what?  I don't care.  Maybe I can help a person or two not become a diabetic, or help them live successfully with the disease.  I know I have never felt better in the last twenty years than I do right now - with diabetes - and you can, too.

So, how does diabetes stack up against, say, cancer?  I am glad you asked.  11.9 million (11,900,000) have cancer.  Got it from the American Cancer Society.  That's all forms of cancer including breast, colon, etc.  For those of you who are mathematically inclined, that's 11.4% of those who have some form of diabetes.

Diabetes is all around you.  The effects of the disease is all around you.  Persistent infections.  Foot and toe removal.  Organ failure.  Look around and you will see it.  If you have diabetes, start taking it seriously.  Live to see your grand children and your great grand children!  Fight it.  Beat it.  Control diabetes, or it will control you because it's a relentless enemy that has only one goal: Destruction.

If you want to know whether or not you have diabetes, get screened.  Sam's Club offers free screenings.

Take heart.  The numbers show you are not alone - not by a long shot.  My name is Phil, and I am a diabetic.  How can I help you?

As always, thank you for your time.

The Beach, Kites and Atlas

I went to the beach yesterday.  It was a glorious day.  The breeze was just right for kite flying.  In fact I shared a bench with a stranger and just watched folks enjoying their time.  A mother and daughter in particular were having a wonderful time flying a kite on the breeze.  It swooped up and then dived.  And, then back up.  No, I am not going to make any great analogies to life - you can do that for yourself.  It was just fun watching them with their kite and the simple amazement the little girl had at the magic a kite brought into her life.

They were living life in spite of anything that might be going on in it.  No matter how bad other parts of their life might have been, and I have no way of knowing about their life, all was forgotten when flying their kite.  They were living!

And, then there was the guy on the bench next to me.  He was speaking on his phone and between the soft conversations he was having that I couldn't hear, he told me I could not imagine the problems he had.  In looking at him, I noticed several symptoms of diabetes: extra weight, no hair on his legs from mid-calf down, and he was a member of a group that has a higher instance of diabetes.  Whatever was going on in his life, it was consuming him and weighing him down to the point that I thought of the statue of Atlas with the world on his shoulders.

When he left the bench, he very slowly walked down the boardwalk.  Even being at such a lovely place, he could not put down the burdens he was carrying even for a minute.

Where am I going with this?  Well, you have a choice.  You have diabetes, or are in danger of getting it (prediabetes), or there is someone close to you who has just been diagnosed. It's not a death sentence.  Diabetes can be fought.  You can win the battle against the disease.

You see, you have a choice.  Carry diabetes around with you like a disease and lose the battle, or go out and fly a kite.  Accept that you have diabetes in your life, but DO NOT let it define your life.  Enjoy that kite, sand castle, walk, hike, movie, book or whatever you do and live your life.  And, while you are at it, beat the hell out of diabetes!a

Glyburide

So the last time you were at your doctor's office, they told you that you have diabetes and started you on metformin.  You went home and started taking it, and tried to improve your diet and exercise.  Now you are back in the clinic for your first lab tests.  The doctor checks your A1c and it is still not to where it needs to be (less than 7% is the goal).  So what do we do?  Since so many problems can come from diabetes that is not under control, your doctor is going to want to start you on another medication quickly to bring your numbers down faster.

Which medication will they choose?  The American Diabetes Association, as well as other medical organizations, have come up with a "roadmap" of how to treat diabetes using medication.  From my blog last week on diabetes, you know that metformin, combined with lifestyle changes in diet and exercise, is our starting point on the journey.  If your A1c is not low enough at the next visit, doctors have three main options: insulin, sulfonylureas, or TZDs.  If you need a refresher on these categories, or if you are tuning into my blogs for the first time, please read my blog on the different classes of diabetes medications here.

Each option has its own pros and cons, but I'm going to start with the sulfonylureas, since they are the least expensive and most common options, second to metformin.  The first sulfonylurea I'll be covering is glyburide, which also goes by brand names DiaBeta, Micronase, and Glynase.

How does it lower blood sugar: Glyburide helps your body release insulin into the blood.  Remember, insulin is the hormone in your body that helps take the sugar out of your blood and puts it into your cells.  So glyburide puts the insulin where it needs to be - in the blood where your sugars are.  In a very small way, glyburide also makes your cells more sensitive to insulin ("opening the door of the cell" for sugar to enter), but this is not the most consistent way that glyburide works.  Unfortunately, as type 2 diabetes progresses, the body sometimes can no longer make its own insulin.  At that point, glyburide is no longer effective because there is no more insulin there to "move."  But in newly diagnosed type 2 diabetics, glyburide can be very effective.

The effect on your numbers: Like metformin, glyburide also lowers your A1c by about 1 - 2% (a patient with an A1c of 9 could go down to an A1c of 8 or 7 when on glyburide).  Glyburide really doesn't seem to lower a patient's cholesterol levels, which was a benefit that we saw with metformin.

Dosing: Glyburide is usually taken once daily, in doses from 2.5 to 20 mg.  Usually patients are started at 2.5 or 5 mg daily and then increased as needed.  Just like with metformin, your doctor can change your dose every 1-2 weeks if needed.  Glyburide should always be taken with the first meal of the day (within about 30 minutes before).  It is important to always take glyburide with food because otherwise the medication will cause your blood sugar to drop too low (hypoglycemia).  So it's important to state again, always take glyburide with food.

Side effects: Hypoglycemia (dangerously low blood sugar) is one of the most dangerous side effects.  Weight gain can also be a possibility with glyburide (obviously not ideal in most diabetics).  Glyburide is the medication in this class with the most likelihood of these side effects, since it takes the longest to leave your body once it is in there.  The other side effects you might have from glyburide are a feeling of stomach fullness (as if you've just finished eating a big meal), heartburn, rashes/itching, and nausea.  Very rarely, glyburide can cause liver problems (hepatitis).

Who should not take glyburide: Any patients with a "sulfa" allergy should not take glyburide, or any other sulfonylureas (which I will be covering in the next few weeks), because they contain the thing that you are allergic to.  Because of the risk of low blood sugar if not taken correctly, anyone that has a very inconsistent diet or has a history of low blood sugar episodes might not be an ideal candidate for this medicine.  Glyburide should not be used in any patient that is pregnant or breastfeeding.  Also, if you have severe liver or kidney problems, your doctor will avoid using this class of medications.

Drug interactions: The most important thing that I want to stress here is that alcohol must be avoided when taking glyburide.  A simplified way to look at it is that glyburide causes your body to not tolerate alcohol.  You could experience side effects such as nausea, flushing of the skin, vomiting, shortness of breath, and very low blood pressure.   But the most important thing that happens is that it can increase the effect of low blood sugar, which can be very dangerous.  Other medications that can interact with glyburide and make it work better or worse are certain blood pressure medications, diuretics ("water pills"), blood thinners, salicylates (like aspirin), and certain antidepressants.  Remember, check with your local pharmacist or doctor before starting any new medications, both prescription and over-the-counter.  And make sure your pharmacy is aware of all medications that you take so that your pharmacist can check for drug interactions when you come in with a prescription.

Monitoring: Just like with metformin, your doctor is going to monitor your A1c, and you will need to monitor your blood sugar levels daily.  Because of the chance of low blood sugars with this medication, you need to be even more consistent with monitoring your blood sugars, and watching if they are too low.  Signs of low blood sugar include feeling like your heart is racing, headache, confusion, increased sweating, hunger, shakiness, tingling in the mouth, and a feeling of anxiety.

If you start to experience any of these, or if you just don't "feel quite right," check your blood sugar immediately.  You will need to have a snack available right away to eat that contains at least 15 grams of carbohydrates, in order to raise your blood sugar to a safe level immediately.  A list of these types of snacks, as well as other information about hypoglycemia can be found here.  I've copied the list over for your reference, to make it easier:

• 4 oz (1/2 cup) of juice or regular soda
• 2 tablespoons of raisins
• 4 or 5 saltine crackers
• 4 teaspoons of sugar
• 1 tablespoon of honey or corn syrup

Choose what will work for you.  Read labels and find something that is appropriate for your  lifestyle.  It needs to be something that is readily accessible by anyone, especially if you are not feeling well enough to get to it.  Remember, regular soda is needed here, not diet.  When we are trying to raise blood sugar quickly, we need to have sugar, not something that is "diabetes friendly."

Once you've had your 15 grams of carbs, you still need to eat a meal containing complex carbs that will help your body get back up to a normal level.  The foods I just mentioned are simple carbohydrates - your body processes them quickly, your blood sugars rise quickly, and then they are gone.  Complex carbs are things like vegetables, brown rice, whole grain breads, and wheat pasta.  Don't stop with just the 15 gram snack or you might be in the same low blood sugar situation within a few hours.

Place in therapy for diabetes: Glyburide is considered one of the first or second choices for treating type 2 diabetics (second usually to metformin).  This is because it is inexpensive, not a shot like insulin is, and only has to be taken once or twice a day.  It is important to mention that some patients just don't see any results with glyburide, or the other medications in this class, so we try it and then have to switch to something else.  As diabetes progresses and your body changes, sometimes glyburide (and any of the other diabetes medications taken by mouth) does not work as well.  About 5-10% of diabetics every year have this happen.  If it does, we can sometimes switch you to another medication within the same class.  Next week I will be talking about another one within this class, so don't miss it!

In case you are curious and want to know more about glyburide, you can find more information here.

If this turns out to not be the right drug for you, don't worry.  As you will see, we have plenty of options.  And as Phil has talked about, you do not have to be a "victim" of diabetes.  You can make changes in your own life that will help to fight back the disease.  They won't cure it, but they will make our medications much more effective, and will keep you living the healthy and happy life that you deserve.  I'm thinking about you, each and every one of you, and wishing you all the best in your fight!  Keep up the good work!

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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.

Diabetes Diet Alternative

There was a reader here recently, Somer, who liked several posts.  Somer is another blogger who writes about vegans; the benefits of being a vegetarian.  Now, folks, I am not a vegan, but I know there are some of you who would consider it - and there are a lot of benefits.

What are those benefits?  Very low carbs if you pay attention to what you are eating.  There are a lot of fruits that are high in sugar, and therefore high in carbs, so some care is needed.  Very high in fiber.  Loaded with vitamins and minerals.  As a result, if you choose to be a vegan, your blood sugar should come down pretty fast.  And, vegans can eat out almost anywhere - big plus.

If you think you want to be a vegan, or even if you want great suggestions on how to prepare vegetables, you have to take a look at Somer's blog.  She has a sense of humor that is really refreshing and an approach that is gentle.  Vegetables are probably (should be) going to be a big part of your diet if you are going to manage the disease.  Why not make them as good to eat as possible?

Diabetes Survival Guide!

You've been told you have Type 2 Diabetes.  Your A1c is something higher that 6.5.  So, now what?  You have three basic tools to control Type 2 Diabetes: medication, exercise and diet.  Using all three, you can control and manage the disease.  But, what in the world is diabetes?

(I have used survival guides most of my professional life.  A survival guide gives you just enough information to 'get your work done' if everything is normal and is a reference resource until you gain experience.  And, I probably should have written this a while back, but it just occurred to me that it might be needed.  Plus, it also helps that I have a number of the pieces in place to which to refer.  Could it be seredipity?)

Your doctor has told you that you will probably have to take some medication to lower your A1c.  No surprise.  The doctor wants to get your A1c down ASAP - think of it as getting the poison out of your system.  So, meds are a very normal route.  In fact, they might start you on metformin, one of the most widely prescribed drugs fo diabetics.

Dr. K has written about metformin, and you should read it to understand the drug and  how it works.

But, what if you don't want to take a medication?  Well, there are those who decide they want to control diabetes through diet and exercise - and some are successful!  Some control and beat back the disease through the diet and exercise route.  But, the number who are successful is limited - very limited.

The first goal is to get your A1c down as soon as you can.  You can always stop taking meds if you see your numbers dropping and getting an A1c under 5.5; there is no rule that states you have to take them forever.  This is a decision you should make after talking with your doctor.  So, think about taking the medication.

For me, it was a no brainer.  I knew diabetes could cause serious damage and could lead to death.  I chose to take the meds to get myself back to 'normal.'  Diabetes normal is not good enough for me.  Normal is normal is normal, even if it's done with the aid of medication!

Regardless if you are taking medication, or not, you should start to exercise.  Read about my post on exercise to get a beginning point.  I still just walk, but a lot faster than I did at the beginning.  If you are going depend on exercise to gain more control, you will need to use cardio exercise and resistance training (aka weightlifting).  And, plan to spend about an hour a day, five or six days a week of exercise time if you have the weights at home.  If you go to a gym during a busy period, figure at least two hours a day.

You are going to have to start glucose testing at least twice per day.  Most of the instruction I have seen is either incomplete, or really cause pain.  For complete instructions on how to get a good reading without pain, read this.

And, you are going to examine your diet. Chances are it will change.  Mine did - a lot.  I started a lower carb diet and over the course of nine months I lost about 60 pounds between diet and exercise.  Diet is so very, very important as you work to control diabetes.

And, to bring it all together, I have strongly recommeded a food diary.  Keeping one was so helpful in the beginning as I was lowering my A1c - it told me what I could and could not eat if I paid attention to my meter readings.  The food diary continues to be a tool for success and something I go back to when I see my numbers creeping up.  You can read about it here and then download it by following the instructions in the post.

Just so you know, I started my diabetes journey with an A1c of 13 - that's pretty high.  My most recent test gave me a 6.1.  Blood pressure 114/80.  Weight seven pounds up over a year's time, which I am losing - I got a bit cocky when I had a test result of 5.9!  I lose the weight, keep up with my diet and meds, and I should be at about a 5.8 or lower when tested again.  I mention all of that just so you know I have first hand knowledge of what you are facing - and KNOW you can be successful!

As always, thank you for reading.  God Bless and know you can beat the enemy; you CAN control diabetes.

Please feel free to send me your comments.

Keep Veggies Fresh Longer - A Simple tip

You are going to be eating more salads now, right?  Or, you want to eat more salads, but the lettuce gets kind of slimy before you can finish it.  I know the feeling.  Well, I KNEW the feeling.

A very simple thing to do to keep any green leafy vegetable (lettuce varieties, spinach, etc.) fresh longer is to put a paper towel in with the item.  You see, water is the big culprit  here, so if you reduce the water, these foods will last longer - far longer.  When you get home from the store, and before you put the vegetables into the refrigerator, just fold a paper towel into quarters and put it in the bag.  It's that simple.  don't forget to check the paper towel in a couple of days - you might need to change it in the event it gets wet.  It might be damp, but that seems to be okay.

So, don't be afraid to buy that good food - it won't spoil in three days and you will have time to eat it.  You are changing your diet, right?  This will help - it did for me.  And, you oon't need to buy any extra containers or bags - just use the bags your put the vegetables in when you bought them.

As always, thank you for reading.  You can control and manage diabetes!

Sam's Club - Free Diabetes Screening

I know I posted this at the end of the previous blog, but it's so important, I thought it needed a posting of its own.

Did you know free diabetes screening is available?  It is.  Sam's Club locations have free diabetes screenings once a month.  Call your closest location to find out when it's going to happen and get screened.  The screening will tell you if you need to see your doctor for a more sophisticated test and treatment.

The next testing day is Saturday, October 13th from 11:00 to 3:00 pm.

Don't know where the closest Sam's Club is?  Check here.

If you know of anywhere else that offers free diabetes screening, please leave a comment, or let me know.

As always, thank you for reading and please feel free to leave me a comment.

Do You HaveDiabetes? Symptoms

It just occurred to me that I have never written about the symptoms of diabetes.  You know, it is a disease, so it does have symptoms - it can't exist without having an effect.  Symptoms are nothing more than the effects diabetes could be having on your body; these are effects that you will feel and/or know about.

Symptoms of diabetes (both type 1 and type 2) are:

• Fatigue.  Being tired pretty much all of the time.  Now, just because you are tired does ont mean you have diabetes.  You might be the parents of three children under five years old - you have a right and a reason (three of them) to be tired.
• Unexplained weight loss.  You can't process the food you eat correctly, so a lot of it just kind of goes through you without gaining any benefit. And, with this might come...
• Near constant hunger. If your body can't process the food you put in it, it will want more. It's just that simple.
• Excessive thirst.  I know about this one first hand!  I used to drink about two gallons of water a day.  Why?  Because my body could not deal with the sugar - could not process it -  which led to excessive urination which led back to thirst.  See a cycle here?
• Excessive urination.  See above.  I sued to get up five or six times a night to urinate.  You know, you'd think I would know something was wrong, right?  But, I worked hard, perspired and figured I was just putting water back in my body which led to the urinating.  Clearly, I'm not too smart.  Please be smarter than I was.
• Wounds don't heal very well.  You know the scratches and bruises you get from everyday life - that kind of wound.  High blood sugar does not let healing take place.

There are some others, but these seem to be the ones most people experience.  If you even suspect you might be diabetic, get tested.  Please get tested.

More on the symptoms of diabetes from The Mayo Clinic.

Did you know free diabetes screening is available?  It is.  Sam's Club locations have free diabetes screenings once a month.  Call your closest location to find out when it's going to happen and get screened.  The screening will tell you if you need to see your doctor for a more sophisticated test and treatment.  The next testing day is Saturday, October 13th from 11:00 to 3:00 pm.

Don't know where the closest Sam's Club is?  Check here.

If you know of anywhere else that offers free diabetes screening, please leave a comment, or let me know.

As always, thank you for reading and please feel free to leave me a comment.