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.

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.

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.

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