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.
Showing posts with label diabetes medication. Show all posts
Showing posts with label diabetes medication. Show all posts
Sunday, September 23, 2012
Saturday, September 8, 2012
Metformin
As I was considering which diabetes drug to feature in my first 'drug post,' there was only one clear choice. The most prescribed medication for diabetes, and one that literally hundreds of my patients use is...metformin! Metformin is the generic name. Some of the brand names you may be familiar with are Glucophage, Glucophage XR, Fortamet, and Riomet (the liquid form of metformin).
Just a heads-up, remember that I am a pharmacist. So, when describing a drug, I will sound like, you guessed it, a pharmacist. Blame my training. I'll try to make things simple and easy to follow and understand, but if I've ever gone too "scientific" and you'd like things explained another way, or you have questions, feel free to let me know. My email will be available at the end of my post. An important thing to remember before I start: glucose is just a fancy name for sugar. I'll probably use glucose because it is most common for me, so just don't be confused by my terminology - I am referring to sugars. So without further ado...metformin!
How does it lower blood sugar: Something for you to remember: as a diabetic you have sugar (glucose) in your blood - kind of floating around your cells because for some reason it's not getting into them. Sugar in the blood and not in the cell is a bad thing. Normally insulin in your body helps sugar enter your cells, but in diabetics it just isn't doing the trick. Metformin makes your cells more sensitive to allowing sugar to enter - kind of like opening the door for sugar. More sugar in cells means less floating around in your blood, which means lower A1c, which makes for a healthier person.
Is that enough? Ok, so now sugar is going into your cells where it belongs, so we have a perfectly wonderful drug for diabetes and can be happy with that. Do you think that the scientists that made metformin thought that? You guessed it, of course they didn't! They wanted more "bang for their buck," so they thought of another way to keep sugars out of your blood. How did they do that? By not allowing it into your blood in the first place. Metformin is very special - it acts as a sort of bodyguard after you eat a meal. Metformin helps to keep some of the sugars that you eat from entering your bloodstream. If the sugars stay in your stomach and intestines and don't enter your blood, the result is lower blood sugar readings. Pretty simple, huh?
But wait, there's more! Would you believe it - your body actually produces it's own sugar! You see, our bodies need a certain amount of sugar for energy. Your brain lives off of it, as do many other important organs. So your liver has the important job of making sugar when needed. Unfortunately in diabetics, it will do this sometimes even when you have enough already in your blood. So for that reason, the makers of metformin decided to develop their drug so that it would stop the liver from producing that extra sugar.
Look at that - three different ways that metformin helps with diabetes! No wonder it is the drug that is chosen first for most new type 2 diabetics.
The effect on your numbers: So where does that put us? How does this change the numbers you are seeing on your blood tests? With metformin, you can expect to see a decrease in your A1c of at least 1-2% (example: your A1c could decrease from 10 down to 8 or 9 after metformin is started). Remember that A1c tells the story of your average blood sugars over the past 3 months. You could look at the blood sugar readings that you take during the day as photographs, whereas your A1c would be the title of the photo album.
An added bonus of metformin is that it might help to lower your bad cholesterol and increase your good cholesterol. There is a potential for modest weight loss when on metformin, but the average is only about 2.6 pounds, so it is not a "miracle" weight loss drug. However, it is unique because it is a diabetes medication that is weight neutral, meaning it does not cause weight gain. As you will learn later, this is not the case with all diabetes medications.
Dosing: Initially, most patients are started at doses of 500 mg once or twice daily of the immediate release (IR) form of metformin. Immediate release just means that the medication enters your blood all at once, versus slowly releasing all day long (extended release). If a patient is new to metformin and is starting at a dose of 500 mg twice daily, I usually recommend starting at 500 mg once daily for the first three days in order to decrease stomach upset. There is a less commonly used 850 mg dose of metformin that is available, which is started at one tablet daily with breakfast.
For some patients, extended release (ER) metformin is chosen. Metformin ER enters the blood more slowly, which leads to less stomach upset and discomfort. Since metformin ER only needs to be taken once daily, it is a good choice for patients that have trouble with taking a medicine twice daily (can't remember, varied schedules, etc). Patients are generally started on 500 - 1000 mg of metformin ER, taken with the evening meal. Do not cut, crush, or chew metformin ER because it is specifically made to disperse throughout the day, not all at once.
Because of unpleasant stomach upset and side effects, metformin should always be taken with food or immediately following the meal. We start metformin at low doses because of the high potential for side effects. Doses are then increased weekly if needed. Generally we do not see a response with metformin at doses less than 1500 mg per day, so don't be discouraged if your doctor keeps increasing your dosage. It may take up to eight weeks of being on metformin before full effectiveness can be seen, so patience really is a virtue.
Side effects: I have already previewed the major side effect of metformin, which is stomach upset. This includes diarrhea, nausea/vomiting, and gas. As I mentioned, taking the medication with meals and increasing doses slowly over days and weeks can help to minimize this. When starting metformin, patients sometimes complain of an unpleasant or metallic taste. This tends to go away within the first few weeks. More rarely we see skin rashes, itching, and sun sensitivity (sunburning easily) with metformin use.
A very rare (2-10 patients per 100,000 patients on metformin per year) but serious side effect that is caused by metformin is something known as lactic acidosis. Lactic acid is a part of our metabolism that helps us produce energy when we do things like exercising. At high levels, it can be very dangerous. Lactic acidosis can be deadly in up to 50% of cases. If lactic acid levels are too high, dialysis is required to remove the metformin from the body and to correct the increased lactic acid levels. Fortunately physicians and pharmacists are well aware of this side effect, and it is easily preventable if certain patients that are more at risk are not given metformin. Side effects from metformin are very rare and can be easily dealt with and prevented by taking the medicine with food and switching to a different medication if needed.
Last week I had a patient that was switched from metformin to glipizide. While her A1c was okay, her kidneys were not doing very well, which could lead to lactic acidosis. So, her doctor changed her to another medication. This leads me into a discussion of which patients would not be eligible to take metformin.
Who should not take metformin: Patients with kidney disease or kidney failure are more at risk of developing lactic acidosis, since metformin is removed from the body solely by the kidneys (if your kidneys are not good, metformin stays in your body too long, causing problems). Your doctor will do blood tests to determine the health of your kidneys prior to starting you on metformin. If your kidneys are not healthy enough, another medication will be used. As we get older, our kidneys generally do not work as well, so metformin is not recommended in anyone over the age of 80 years old, unless your doctor determines that your kidneys are healthy.
The liver is responsible for regulating lactic acid levels in our bodies, so anyone with liver disease should avoid metformin. Since alcohol has a negative effect on the liver, patients should be advised not to drink in excess (binge drinking, or chronic use of more than two drinks per day or at one sitting). I'm sure that the other effects of alcohol on diabetes will be covered in a future blog post.
Drug interactions: Certain stomach medications used for acid reflux (cimetidine - generic for Tagamet, and ranitidine - generic for Zantac) interact with metformin. Two antibiotics (cephalexin - generic for Keflex, and Bactrim) may increase metformin concentrations. You would think that this is a good thing, but it can lead to more harm than good (increased side effects, stomach discomfort and pain). The fluoroquinolone antibiotics (Levaquin, Cipro) may cause increases or decreases in blood glucose levels, which are also not good things for diabetic patients. There are other medications that I have not included on this list, for sake of space, so please remember to check with your pharmacist or physician, and make sure they are aware of all medications you are taking.
I know this is lot of 'pharmese' so far, but I am a pharmacist so what do you expect? Bottom line is that you need to always let your doctor and pharmacist know what drugs you are taking so any negative interactions can be avoided. Don't forget to ask your pharmacist to check for interactions before you stop to pick up a product from the cough/cold or vitamin section of the pharmacy, because these are also medications and they can interact with other things you are taking. Your doctor and pharmacist should be informed about all prescription and over-the-counter medications that you are using, as well as any allergies you have to medications.
Some folks have more than one doctor - always let all doctors know every medication you are on. And, use only one pharmacy so they can check for interactions. You run risks if you use more than one pharmacy - nobody knows all of the drugs you are taking, so you don't have a safeguard in place. So to sum up: make sure all doctors know about all of your medications, and use one pharmacy. Okay? It's best for you that
way. I'll step off my soapbox now.
Monitoring: Sometimes I have patients ask me why they have to make another appointment with their doctor before they will be given any refills. "I'm a diabetic, and I will be for the rest of my life. Why do they need to see me every year? Aren't they just going to keep me on my meds?"
This is a very valid question. As you can see from what I've been talking about in this post, there are many reasons why metformin (or any other medication) might not be appropriate for a patient. And, our bodies are always changing - what might have been the right medication and dosage for you when you started it might not be appropriate six months or even ten years later. Your kidneys and liver might not be working as well to clear the medication. Your control on diabetes might have improved or, sadly enough, gotten worse.
So at least once yearly, your physician will want you to come in for simple blood testing. This will include a serum creatinine (something that gives us an idea of how well your kidneys are functioning), fasting plasma glucose and A1c (remember the photos and photo album?), and other blood components.
The ADA recommends A1c tests twice a year and a full panel of blood tests once a year. Your doctor should be following that as a minimum. In the early stages of treatment, your doctor might test more often to track progress. And, really, how long does a blood test take? Most labs now allow you to make an appointment online so it's faster and more convenient for you. Sometimes you don't even need to see the doctor - you get lab work and they send in the prescription once they have the results. It's as simple as that. But remember, if they do need to see you, please make the appointment. They really are only trying to make sure they have the right medication and dose for you, and that your diabetes is being taken care of properly. We all want you to live a long and happy and enjoyable life.
Place in therapy for diabetes: Metformin is known as the cornerstone for treatment of type 2 diabetes. The current guidelines that we follow when treating new diabetics state that metformin should be started before any other medication, unless the patient is not able to take it for the few reasons I stated earlier. Metformin is also the only medication that is currently approved for use in pre-diabetics to prevent full-blown diabetes. It is also the only oral diabetes medication approved for use in kids (age 10 and up). Since insulin is the only other diabetes medication that can be used in kids right now (and let's face it, what kid wants to get a shot?!), it is a very popular medication for those very young diabetics. Unfortunately it does not work for type 1 diabetes, which is generally diagnosed in younger people.
If you would like to read more about metformin, here is another good website: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000974/
So there you have it, a review of our most popular diabetes medication, metformin. Next week I will move on to one of the different categories of meds that we use to treat high blood sugars, so you will want to stay tuned.
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.
Please feel free to email me at drk@solutionsfort2diabetes.com if you have any questions on metformin, diabetes medications, or other pharmacy issues. I will attempt to answer all inquiries in a timely manner. Also, if you have a suggestion as to other things you'd like to see me post about, or general pharmacy questions that you think other patients might have, please let me know. Thanks for reading!
Just a heads-up, remember that I am a pharmacist. So, when describing a drug, I will sound like, you guessed it, a pharmacist. Blame my training. I'll try to make things simple and easy to follow and understand, but if I've ever gone too "scientific" and you'd like things explained another way, or you have questions, feel free to let me know. My email will be available at the end of my post. An important thing to remember before I start: glucose is just a fancy name for sugar. I'll probably use glucose because it is most common for me, so just don't be confused by my terminology - I am referring to sugars. So without further ado...metformin!
How does it lower blood sugar: Something for you to remember: as a diabetic you have sugar (glucose) in your blood - kind of floating around your cells because for some reason it's not getting into them. Sugar in the blood and not in the cell is a bad thing. Normally insulin in your body helps sugar enter your cells, but in diabetics it just isn't doing the trick. Metformin makes your cells more sensitive to allowing sugar to enter - kind of like opening the door for sugar. More sugar in cells means less floating around in your blood, which means lower A1c, which makes for a healthier person.
Is that enough? Ok, so now sugar is going into your cells where it belongs, so we have a perfectly wonderful drug for diabetes and can be happy with that. Do you think that the scientists that made metformin thought that? You guessed it, of course they didn't! They wanted more "bang for their buck," so they thought of another way to keep sugars out of your blood. How did they do that? By not allowing it into your blood in the first place. Metformin is very special - it acts as a sort of bodyguard after you eat a meal. Metformin helps to keep some of the sugars that you eat from entering your bloodstream. If the sugars stay in your stomach and intestines and don't enter your blood, the result is lower blood sugar readings. Pretty simple, huh?
But wait, there's more! Would you believe it - your body actually produces it's own sugar! You see, our bodies need a certain amount of sugar for energy. Your brain lives off of it, as do many other important organs. So your liver has the important job of making sugar when needed. Unfortunately in diabetics, it will do this sometimes even when you have enough already in your blood. So for that reason, the makers of metformin decided to develop their drug so that it would stop the liver from producing that extra sugar.
Look at that - three different ways that metformin helps with diabetes! No wonder it is the drug that is chosen first for most new type 2 diabetics.
The effect on your numbers: So where does that put us? How does this change the numbers you are seeing on your blood tests? With metformin, you can expect to see a decrease in your A1c of at least 1-2% (example: your A1c could decrease from 10 down to 8 or 9 after metformin is started). Remember that A1c tells the story of your average blood sugars over the past 3 months. You could look at the blood sugar readings that you take during the day as photographs, whereas your A1c would be the title of the photo album.
An added bonus of metformin is that it might help to lower your bad cholesterol and increase your good cholesterol. There is a potential for modest weight loss when on metformin, but the average is only about 2.6 pounds, so it is not a "miracle" weight loss drug. However, it is unique because it is a diabetes medication that is weight neutral, meaning it does not cause weight gain. As you will learn later, this is not the case with all diabetes medications.
Dosing: Initially, most patients are started at doses of 500 mg once or twice daily of the immediate release (IR) form of metformin. Immediate release just means that the medication enters your blood all at once, versus slowly releasing all day long (extended release). If a patient is new to metformin and is starting at a dose of 500 mg twice daily, I usually recommend starting at 500 mg once daily for the first three days in order to decrease stomach upset. There is a less commonly used 850 mg dose of metformin that is available, which is started at one tablet daily with breakfast.
For some patients, extended release (ER) metformin is chosen. Metformin ER enters the blood more slowly, which leads to less stomach upset and discomfort. Since metformin ER only needs to be taken once daily, it is a good choice for patients that have trouble with taking a medicine twice daily (can't remember, varied schedules, etc). Patients are generally started on 500 - 1000 mg of metformin ER, taken with the evening meal. Do not cut, crush, or chew metformin ER because it is specifically made to disperse throughout the day, not all at once.
Because of unpleasant stomach upset and side effects, metformin should always be taken with food or immediately following the meal. We start metformin at low doses because of the high potential for side effects. Doses are then increased weekly if needed. Generally we do not see a response with metformin at doses less than 1500 mg per day, so don't be discouraged if your doctor keeps increasing your dosage. It may take up to eight weeks of being on metformin before full effectiveness can be seen, so patience really is a virtue.
Side effects: I have already previewed the major side effect of metformin, which is stomach upset. This includes diarrhea, nausea/vomiting, and gas. As I mentioned, taking the medication with meals and increasing doses slowly over days and weeks can help to minimize this. When starting metformin, patients sometimes complain of an unpleasant or metallic taste. This tends to go away within the first few weeks. More rarely we see skin rashes, itching, and sun sensitivity (sunburning easily) with metformin use.
A very rare (2-10 patients per 100,000 patients on metformin per year) but serious side effect that is caused by metformin is something known as lactic acidosis. Lactic acid is a part of our metabolism that helps us produce energy when we do things like exercising. At high levels, it can be very dangerous. Lactic acidosis can be deadly in up to 50% of cases. If lactic acid levels are too high, dialysis is required to remove the metformin from the body and to correct the increased lactic acid levels. Fortunately physicians and pharmacists are well aware of this side effect, and it is easily preventable if certain patients that are more at risk are not given metformin. Side effects from metformin are very rare and can be easily dealt with and prevented by taking the medicine with food and switching to a different medication if needed.
Last week I had a patient that was switched from metformin to glipizide. While her A1c was okay, her kidneys were not doing very well, which could lead to lactic acidosis. So, her doctor changed her to another medication. This leads me into a discussion of which patients would not be eligible to take metformin.
Who should not take metformin: Patients with kidney disease or kidney failure are more at risk of developing lactic acidosis, since metformin is removed from the body solely by the kidneys (if your kidneys are not good, metformin stays in your body too long, causing problems). Your doctor will do blood tests to determine the health of your kidneys prior to starting you on metformin. If your kidneys are not healthy enough, another medication will be used. As we get older, our kidneys generally do not work as well, so metformin is not recommended in anyone over the age of 80 years old, unless your doctor determines that your kidneys are healthy.
The liver is responsible for regulating lactic acid levels in our bodies, so anyone with liver disease should avoid metformin. Since alcohol has a negative effect on the liver, patients should be advised not to drink in excess (binge drinking, or chronic use of more than two drinks per day or at one sitting). I'm sure that the other effects of alcohol on diabetes will be covered in a future blog post.
Drug interactions: Certain stomach medications used for acid reflux (cimetidine - generic for Tagamet, and ranitidine - generic for Zantac) interact with metformin. Two antibiotics (cephalexin - generic for Keflex, and Bactrim) may increase metformin concentrations. You would think that this is a good thing, but it can lead to more harm than good (increased side effects, stomach discomfort and pain). The fluoroquinolone antibiotics (Levaquin, Cipro) may cause increases or decreases in blood glucose levels, which are also not good things for diabetic patients. There are other medications that I have not included on this list, for sake of space, so please remember to check with your pharmacist or physician, and make sure they are aware of all medications you are taking.
I know this is lot of 'pharmese' so far, but I am a pharmacist so what do you expect? Bottom line is that you need to always let your doctor and pharmacist know what drugs you are taking so any negative interactions can be avoided. Don't forget to ask your pharmacist to check for interactions before you stop to pick up a product from the cough/cold or vitamin section of the pharmacy, because these are also medications and they can interact with other things you are taking. Your doctor and pharmacist should be informed about all prescription and over-the-counter medications that you are using, as well as any allergies you have to medications.
Some folks have more than one doctor - always let all doctors know every medication you are on. And, use only one pharmacy so they can check for interactions. You run risks if you use more than one pharmacy - nobody knows all of the drugs you are taking, so you don't have a safeguard in place. So to sum up: make sure all doctors know about all of your medications, and use one pharmacy. Okay? It's best for you that
way. I'll step off my soapbox now.
Monitoring: Sometimes I have patients ask me why they have to make another appointment with their doctor before they will be given any refills. "I'm a diabetic, and I will be for the rest of my life. Why do they need to see me every year? Aren't they just going to keep me on my meds?"
This is a very valid question. As you can see from what I've been talking about in this post, there are many reasons why metformin (or any other medication) might not be appropriate for a patient. And, our bodies are always changing - what might have been the right medication and dosage for you when you started it might not be appropriate six months or even ten years later. Your kidneys and liver might not be working as well to clear the medication. Your control on diabetes might have improved or, sadly enough, gotten worse.
So at least once yearly, your physician will want you to come in for simple blood testing. This will include a serum creatinine (something that gives us an idea of how well your kidneys are functioning), fasting plasma glucose and A1c (remember the photos and photo album?), and other blood components.
The ADA recommends A1c tests twice a year and a full panel of blood tests once a year. Your doctor should be following that as a minimum. In the early stages of treatment, your doctor might test more often to track progress. And, really, how long does a blood test take? Most labs now allow you to make an appointment online so it's faster and more convenient for you. Sometimes you don't even need to see the doctor - you get lab work and they send in the prescription once they have the results. It's as simple as that. But remember, if they do need to see you, please make the appointment. They really are only trying to make sure they have the right medication and dose for you, and that your diabetes is being taken care of properly. We all want you to live a long and happy and enjoyable life.
Place in therapy for diabetes: Metformin is known as the cornerstone for treatment of type 2 diabetes. The current guidelines that we follow when treating new diabetics state that metformin should be started before any other medication, unless the patient is not able to take it for the few reasons I stated earlier. Metformin is also the only medication that is currently approved for use in pre-diabetics to prevent full-blown diabetes. It is also the only oral diabetes medication approved for use in kids (age 10 and up). Since insulin is the only other diabetes medication that can be used in kids right now (and let's face it, what kid wants to get a shot?!), it is a very popular medication for those very young diabetics. Unfortunately it does not work for type 1 diabetes, which is generally diagnosed in younger people.
If you would like to read more about metformin, here is another good website: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000974/
So there you have it, a review of our most popular diabetes medication, metformin. Next week I will move on to one of the different categories of meds that we use to treat high blood sugars, so you will want to stay tuned.
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.
Please feel free to email me at drk@solutionsfort2diabetes.com if you have any questions on metformin, diabetes medications, or other pharmacy issues. I will attempt to answer all inquiries in a timely manner. Also, if you have a suggestion as to other things you'd like to see me post about, or general pharmacy questions that you think other patients might have, please let me know. Thanks for reading!
Sunday, September 2, 2012
Let's Start at the Very Beginning: Classes of T2 Diabetes Medications
For my first post, I'm going to give a brief overview of the various classes of medications used to treat type 2 diabetes. Within our bodies, blood sugar levels are controlled by various mechanisms. This is a good thing, because it allows us to "attack" diabetes from various angles.
For any of you footbal fans out there, you could compare this to what your favorite coach does. In order to gain yards and score touchdowns, do they always use the same plays for every team they encounter? Of course not! Some plays are more effective against different defensive lines, and all circumstances can change from one snap of the football to the next.
This is the same when it comes to treating diabetes. Every person is unique and has their own body chemistry. This is the same reason why an allergy medication might work well for one person, but not another. Pharmaceutical scientists have studied these differences and have developed a wide variety of drugs to treat the causes of high blood sugar (glucose) at every stage. In future posts I will breakdown each of the currently available type 2 diabetes medications and give you the "need to know" information. But for now, let's start with the basics.
Biguanides
Don't let this name intimidate you. Biguanides, like most other classes of medications, are simply named for the molecule that is part of their chemical structure. In fact, to make things even simpler for you, the biguanide "class" of medications only contains one diabetic medication. One! Metformin, a drug that most type 2 diabetics are very familiar with, is the only biguanide currently available in the US that is used for diabetes.
Biguanides use a few methods for lowering blood glucose levels. The first method is by making the cells of your body more sensitive to insulin. If you are unfamiliar with it, insulin is the hormone made by your pancreas that is responsible for "pushing" glucose into your cells. More glucose in your liver, muscle, and fat tissue = less glucose floating around in the blood. Too much glucose in your blood, and not in your cells, is what causes diabetes. In type 2 diabetics, the body starts to not respond to insulin as well as it should, so metformin helps the cells "recognize" insulin again.
The other way that metformin lowers blood glucose levels is by decreasing the amount of glucose produced by the body. One of my pharmacy professors liked to use the phrase "the liver is a giver." Your liver is responsible for a wide variety of functions, among which is production of glucose. During times of fasting or starvation, the liver does this to prevent dangerous drops in blood glucose. But in diabetics, the extra glucose is not necessary, so metformin stops this.
Another exciting thing about metformin is its ability to produce small decreases in cholesterol. This is something that I will discuss in future posts. As you will see, this is uncommon and part of the reason why metformin is the go-to medication for new diabetics.
Sulfonylureas
Another long name based on a chemical structure. Glyburide, glipizide, and glimepiride are the most well-known students in this class. Compared to the two different mechanisms of action of the biguanides, sulfonylureas do not provide as much "bang for the buck." Their main action comes from the ability to stimulate the pancreas to release more insulin. This causes glucose to enter the cells, decreasing the amount of glucose in the blood.
Meglitinides
This is a category of medications that we see used much less commonly than the two previously mentioned. The two meds in this group are Prandin and Starlix, which are currently only available in their brand name form. Meglitinides are essentially the same as sulfonylureas, except they don't contain a sulfa molecule. This is important for our patients with sulfa allergies. They work the same way as the sulfonylureas (increasing insulin release from the pancreas).
Thiazolidinediones
Sometimes you wonder if we are making these names up, don't you? It's pretty obvious why we abbreviate this class to the term "TZD". The two current TZDs available in the US are Avandia and Actos. The main effect of these medications comes from the ability to sensitize the muscles, liver, and fat tissue to insulin. This allows more glucose to enter the cells and leave the blood stream. They also show some effectiveness in decreasing the amount of glucose that is released by the liver.
Alpha-Glucosidase Inhibitors
This is a newer class of medications that contains the drugs Precose and Glyset. Maybe this shows my "nerdy" side a bit, but I find the mechanism of this class to be quite exciting. Alpha-glucosidase inhibitors work in the small intestine by delaying and preventing complex carbohydrates from being absorbed from what you eat. This means that the carbohydrates don't enter the bloodstream, and your after-meal (postprandial) glucose readings are much lower.
DPP-4 Inhibitors
Januvia, Onglyza, and Trajenta are the current US available medications in this category. These medications cause insulin to be produced and released by the pancreas as blood glucose levels rise. They also decrease the production of glucagon, a hormone that causes the body to break down glucose storage units and dump glucose back into the blood when blood glucose is too low (during periods of fasting or between meals). Finally, DPP-4 inhibitors improve the function of beta cells in the pancreas, which allows them to better produce the insulin that is needed to keep blood glucose levels at normal levels.
Insulin
Most people are familiar with the use of insulin in type 1 diabetics. They require insulin because their bodies are no longer able to produce it. However, insulin is also used as a very effective treatment in type 2 diabetics when oral medications and lifestyle changes are not effective enough at lowering blood glucose.
I have already discussed insulin a bit within the other drug categories, but let's cover it as its own category, to be thorough. At low levels, insulin causes the liver to stop producing glucose. As you increase the insulin dose, that causes the muscles in your body to start taking glucose out of the blood.
Insulin is categorized based on how fast it starts working in the body, and for how long it works (rapid, intermediate, or long acting). In a future post I will discuss the different types of insulins and injection regimens, but for now this is a good place to start.
Incretin Mimetics
The injectible drugs Byetta and Victoza are the two drugs currently within this category. These medications work to lower blood glucose by increasing insulin production in response to high blood glucose levels. They also are unique because they stop glucagon (mentioned earlier) from being released after you eat.
Other ways that incretin mimetics work to lower blood glucose are by improving the function of beta cells in the pancreas (responsible for making insulin) and causing a feeling of fullness (making the patient eat less and lose weight).
Amylin Analogs
Currently the injectible drug Symlin is the only amylin analog. Amylin is a hormone that is released by the body, with insulin, to control glucose levels after you eat. In diabetics, amylin levels are too low. Symlin acts like amylin in the body; it causes glucose to be absorbed into the body more slowly from the food you eat and also makes you feel fuller faster, leading to less calories eaten and more weight loss.
---So there we have it, a basic overview of the many classes of medications available for treating type 2 diabetes. In my next series of posts, I will discuss each medication individually, and give you the most important "need to know" information. As a reminder, every diabetic is different. I will continue to present information in a general format, but always consult with your personal physician and pharmacist before making any changes in your medications. I invite you to feel free to ask me any questions you might have regarding diabetes and medications. Eventually we might have a section of "frequently asked pharmacy questions" in which I answer your questions or address things that I've read about or been asked within my practice recently. I'm here for you, as a part of your virtual care "team." Feel free to help me customize my posts to help your needs.
Dr. K, PharmD
For any of you footbal fans out there, you could compare this to what your favorite coach does. In order to gain yards and score touchdowns, do they always use the same plays for every team they encounter? Of course not! Some plays are more effective against different defensive lines, and all circumstances can change from one snap of the football to the next.
This is the same when it comes to treating diabetes. Every person is unique and has their own body chemistry. This is the same reason why an allergy medication might work well for one person, but not another. Pharmaceutical scientists have studied these differences and have developed a wide variety of drugs to treat the causes of high blood sugar (glucose) at every stage. In future posts I will breakdown each of the currently available type 2 diabetes medications and give you the "need to know" information. But for now, let's start with the basics.
Biguanides
Don't let this name intimidate you. Biguanides, like most other classes of medications, are simply named for the molecule that is part of their chemical structure. In fact, to make things even simpler for you, the biguanide "class" of medications only contains one diabetic medication. One! Metformin, a drug that most type 2 diabetics are very familiar with, is the only biguanide currently available in the US that is used for diabetes.
Biguanides use a few methods for lowering blood glucose levels. The first method is by making the cells of your body more sensitive to insulin. If you are unfamiliar with it, insulin is the hormone made by your pancreas that is responsible for "pushing" glucose into your cells. More glucose in your liver, muscle, and fat tissue = less glucose floating around in the blood. Too much glucose in your blood, and not in your cells, is what causes diabetes. In type 2 diabetics, the body starts to not respond to insulin as well as it should, so metformin helps the cells "recognize" insulin again.
The other way that metformin lowers blood glucose levels is by decreasing the amount of glucose produced by the body. One of my pharmacy professors liked to use the phrase "the liver is a giver." Your liver is responsible for a wide variety of functions, among which is production of glucose. During times of fasting or starvation, the liver does this to prevent dangerous drops in blood glucose. But in diabetics, the extra glucose is not necessary, so metformin stops this.
Another exciting thing about metformin is its ability to produce small decreases in cholesterol. This is something that I will discuss in future posts. As you will see, this is uncommon and part of the reason why metformin is the go-to medication for new diabetics.
Sulfonylureas
Another long name based on a chemical structure. Glyburide, glipizide, and glimepiride are the most well-known students in this class. Compared to the two different mechanisms of action of the biguanides, sulfonylureas do not provide as much "bang for the buck." Their main action comes from the ability to stimulate the pancreas to release more insulin. This causes glucose to enter the cells, decreasing the amount of glucose in the blood.
Meglitinides
This is a category of medications that we see used much less commonly than the two previously mentioned. The two meds in this group are Prandin and Starlix, which are currently only available in their brand name form. Meglitinides are essentially the same as sulfonylureas, except they don't contain a sulfa molecule. This is important for our patients with sulfa allergies. They work the same way as the sulfonylureas (increasing insulin release from the pancreas).
Thiazolidinediones
Sometimes you wonder if we are making these names up, don't you? It's pretty obvious why we abbreviate this class to the term "TZD". The two current TZDs available in the US are Avandia and Actos. The main effect of these medications comes from the ability to sensitize the muscles, liver, and fat tissue to insulin. This allows more glucose to enter the cells and leave the blood stream. They also show some effectiveness in decreasing the amount of glucose that is released by the liver.
Alpha-Glucosidase Inhibitors
This is a newer class of medications that contains the drugs Precose and Glyset. Maybe this shows my "nerdy" side a bit, but I find the mechanism of this class to be quite exciting. Alpha-glucosidase inhibitors work in the small intestine by delaying and preventing complex carbohydrates from being absorbed from what you eat. This means that the carbohydrates don't enter the bloodstream, and your after-meal (postprandial) glucose readings are much lower.
DPP-4 Inhibitors
Januvia, Onglyza, and Trajenta are the current US available medications in this category. These medications cause insulin to be produced and released by the pancreas as blood glucose levels rise. They also decrease the production of glucagon, a hormone that causes the body to break down glucose storage units and dump glucose back into the blood when blood glucose is too low (during periods of fasting or between meals). Finally, DPP-4 inhibitors improve the function of beta cells in the pancreas, which allows them to better produce the insulin that is needed to keep blood glucose levels at normal levels.
Insulin
Most people are familiar with the use of insulin in type 1 diabetics. They require insulin because their bodies are no longer able to produce it. However, insulin is also used as a very effective treatment in type 2 diabetics when oral medications and lifestyle changes are not effective enough at lowering blood glucose.
I have already discussed insulin a bit within the other drug categories, but let's cover it as its own category, to be thorough. At low levels, insulin causes the liver to stop producing glucose. As you increase the insulin dose, that causes the muscles in your body to start taking glucose out of the blood.
Insulin is categorized based on how fast it starts working in the body, and for how long it works (rapid, intermediate, or long acting). In a future post I will discuss the different types of insulins and injection regimens, but for now this is a good place to start.
Incretin Mimetics
The injectible drugs Byetta and Victoza are the two drugs currently within this category. These medications work to lower blood glucose by increasing insulin production in response to high blood glucose levels. They also are unique because they stop glucagon (mentioned earlier) from being released after you eat.
Other ways that incretin mimetics work to lower blood glucose are by improving the function of beta cells in the pancreas (responsible for making insulin) and causing a feeling of fullness (making the patient eat less and lose weight).
Amylin Analogs
Currently the injectible drug Symlin is the only amylin analog. Amylin is a hormone that is released by the body, with insulin, to control glucose levels after you eat. In diabetics, amylin levels are too low. Symlin acts like amylin in the body; it causes glucose to be absorbed into the body more slowly from the food you eat and also makes you feel fuller faster, leading to less calories eaten and more weight loss.
---So there we have it, a basic overview of the many classes of medications available for treating type 2 diabetes. In my next series of posts, I will discuss each medication individually, and give you the most important "need to know" information. As a reminder, every diabetic is different. I will continue to present information in a general format, but always consult with your personal physician and pharmacist before making any changes in your medications. I invite you to feel free to ask me any questions you might have regarding diabetes and medications. Eventually we might have a section of "frequently asked pharmacy questions" in which I answer your questions or address things that I've read about or been asked within my practice recently. I'm here for you, as a part of your virtual care "team." Feel free to help me customize my posts to help your needs.
Dr. K, PharmD
Welcome Dr. K!
When I started this blog, the title Solutions for Type 2 Diabetes seemed to be a bit grandiose. I knew I wanted to offer practices that I had found to be effective, and share some of my frustrations. My hope was that I would inspire you to fight the battle against the disease. Now, this blog can offer more to help you fight and win the battle.
I am very pleased to announce that a pharmacist will start writing for you and posting here. Dr. Katherine King, licensed pharmacist who manages the pharmacy department in a large retail location, will start posting every Sunday. Her first entries will have to do with the drugs used to fight diabetes - very likely she will review the drug you are using sooner or later.
Dr. K is one smart person who cares about her patients and wants to serve them. You have become a virtual patient of her's and she takes your success in fighting diabetes very seriously. In the very near future there will be an address to which you can email your specific questions to her. Just be aware that she might not be able to get to every question - she does have a pharmacy to run, but she will answer them as she is able within the blog.
I look forward to learning from Dr. K, too.
By the way, Dr. K's posts will be based on her education and experience and will reflect her opinion based on that. Since she cannot know your personal situation, you should always consult with your physician and pharmacist on treatment matters.
And, as always, thank you for reading.
I am very pleased to announce that a pharmacist will start writing for you and posting here. Dr. Katherine King, licensed pharmacist who manages the pharmacy department in a large retail location, will start posting every Sunday. Her first entries will have to do with the drugs used to fight diabetes - very likely she will review the drug you are using sooner or later.
Dr. K is one smart person who cares about her patients and wants to serve them. You have become a virtual patient of her's and she takes your success in fighting diabetes very seriously. In the very near future there will be an address to which you can email your specific questions to her. Just be aware that she might not be able to get to every question - she does have a pharmacy to run, but she will answer them as she is able within the blog.
I look forward to learning from Dr. K, too.
By the way, Dr. K's posts will be based on her education and experience and will reflect her opinion based on that. Since she cannot know your personal situation, you should always consult with your physician and pharmacist on treatment matters.
And, as always, thank you for reading.
Thursday, August 30, 2012
You Can Win the War...You Can Be In Control!
I have found there is so much in life I really can't control. If you work, there are aspects about your job you don't control. If you are married, do you think you can control your spouse? Can you control how much homework a teacher might assign? Heck, I can't even control how long it takes me to drive somewhere due to traffic. Think about it.
There are so many health related concerns you can't control. Cancer. A failing back. Even getting a cold is something we can't seem to control.
But, there is some good news - YOU can control diabetes. I know I have hammered this home before, but it's worth doing again and again. You can control and manage diabetes. What does it take? A few simple steps.
Form you team. The best way to fight diabetes and win the war is to have an engaged team. Your team should include your doctor, pharmacist and you.
Take your medication. This is so simple. Do not miss a dose. Take what your doctor prescribes, when he prescribes it to be taken, how it's prescribed to be taken. This is such an easy step. But, in order to take your meds, you have to have them. My pharmacist tells me about 30% or prescriptions that are filled don't get picked-up. 30%! Please, be part of the 70% and pick-up your medication so you can take it.
Diet. And, by diet I mean what you eat. This probably has to change. My big diet change was to limit the carbs I would have during a meal to 55 to 60 carbs. This means eating different foods and less of them. As I look back, I must have been having 150 to 200 carbs per meal. No wonder I am a diabetic. Now, I normally have about 50, and sometimes less.
Let me tell you that a lower carb diet helped me to lose about 60 pounds and dropped my sugar levels. I went from an AIc of about 13.0 to 6.1. My lowest A1c was 5.9 - so I know it's attainable and it my next goal. That will probably require a change in my diet to both low carb and low fat (basically it means I will have to start counting calories).
Exercise. I can't stress this enough. There is something about exercise that makes it easier for your blood cells to receive sugar - glucose. And, what will that do? Lower your daily glucose reading! And, you will lose more weight if you exercise than if you just try to do it by reducing what you eat.
Form your team. Take your medication. Change your diet and realize it will be a way of life. And, exercise. You will be on your way to controlling diabetes instead of it controlling you. You really can do this.
A great way to get started is by downloading and using the Food Diary Plus to act as a reminder and keep track of your progress.
I know, that was a shameless plug, but it's your Food Diary that will form the basis for your fight. You will gain so much information and will know how your body is responding. And, it's a great way to keep track of what you eat and the effect it has on your blood sugar.
Are you ready? You can battle the disease and win your war with diabetes.
Fight on!
There are so many health related concerns you can't control. Cancer. A failing back. Even getting a cold is something we can't seem to control.
But, there is some good news - YOU can control diabetes. I know I have hammered this home before, but it's worth doing again and again. You can control and manage diabetes. What does it take? A few simple steps.
Form you team. The best way to fight diabetes and win the war is to have an engaged team. Your team should include your doctor, pharmacist and you.
Take your medication. This is so simple. Do not miss a dose. Take what your doctor prescribes, when he prescribes it to be taken, how it's prescribed to be taken. This is such an easy step. But, in order to take your meds, you have to have them. My pharmacist tells me about 30% or prescriptions that are filled don't get picked-up. 30%! Please, be part of the 70% and pick-up your medication so you can take it.
Diet. And, by diet I mean what you eat. This probably has to change. My big diet change was to limit the carbs I would have during a meal to 55 to 60 carbs. This means eating different foods and less of them. As I look back, I must have been having 150 to 200 carbs per meal. No wonder I am a diabetic. Now, I normally have about 50, and sometimes less.
Let me tell you that a lower carb diet helped me to lose about 60 pounds and dropped my sugar levels. I went from an AIc of about 13.0 to 6.1. My lowest A1c was 5.9 - so I know it's attainable and it my next goal. That will probably require a change in my diet to both low carb and low fat (basically it means I will have to start counting calories).
Exercise. I can't stress this enough. There is something about exercise that makes it easier for your blood cells to receive sugar - glucose. And, what will that do? Lower your daily glucose reading! And, you will lose more weight if you exercise than if you just try to do it by reducing what you eat.
Form your team. Take your medication. Change your diet and realize it will be a way of life. And, exercise. You will be on your way to controlling diabetes instead of it controlling you. You really can do this.
A great way to get started is by downloading and using the Food Diary Plus to act as a reminder and keep track of your progress.
I know, that was a shameless plug, but it's your Food Diary that will form the basis for your fight. You will gain so much information and will know how your body is responding. And, it's a great way to keep track of what you eat and the effect it has on your blood sugar.
Are you ready? You can battle the disease and win your war with diabetes.
Fight on!
Tuesday, August 7, 2012
Diabetes Week Two
I made it through the first week of diabetes. My life changed in the same way you turn a light on - within a moment. Was I still scared? Oh, yeah. In fact today, almost three years later I am still scared of diabetes if I was being completely honest. I have a deep and abiding respect for what the disease can do if not managed and controlled.
The good news is that it can be controlled with a bit of effort which was my big "AHA!" during Week Two.
Anyway, back at Week Two. I had begun to take my meds - Metformin twice a day 1.000 mg each time. Pretty standard starting treatment. And, it was just the Metformin. I know many may have two pills to take, which for some proves to be very effective. It's kind of like a one-two punch and when you are in a war with diabetes, you want to throw as many punches as possible to get your glucose, and subsequently your A1c, down somewhere in normal range. If you need to see the a chart for A1c values and how they compare to your blood glucose readings, look here for a pretty easy to read chart.
Remember not to use one reading, but look at your average reading. Even then, it depends on when you take it. More on that at some point in the near future.
Again I got a bit side tracked. Week Two - I had begun my walking. Every evening for 30 minutes. I know I have written here before I don't like exercise, but we were talking about my life here. So, that walk became one of my best friends. I didn't try to walk fast or go very far at first. I used shoes that were about five or six years old and just walked. One foot in front of another. For 30 minutes - which seemed like forever the frist few days, but by the time Week Two started, the time seemed to go a little faster, but not much.
And, I was getting more ideas of what I could and could not eat. Think about it, we get near immediate feedback with our glucose readings. If it's not the right food, up it goes. If it is the right food, it dips a little bit. Take your readings twice a day, more often if your doctor will authorize it, so you will know what your blood sugar (glucose) is doing. You should be on a steady downward trend. And, keep a record of your readings as well as diet (everything you eat and when) in a food diary. You will really learn what is working and will be able to spot trends faster. If you spot the trend, you can make adjustments.
Me? I just liked seeing the numbers go down. I started with seeing glucose numbers of 300+. It was an exciting morning when I hit 297. During the second week I saw it get down to 275. I was making progress! Fear was gone because I was taking action. I knew the meds would not make me go too low - fat chance when you are in the high 200's. Things were beginning to work and I felt empowered; that I could get this disease under control. Hey, I even found I lost my first couple of pounds during Week Two,
What was I doing?
Meds. Diet. Walking. Testing. Recording. If I was really bright, I'd come up with some sort of catchy acronym, but alas and alack, I am not that bright. I am open to ideas, though. You know what my meds were. I was on a low carb diet. I was walking 30 minutes a day, six days per week. And, I kept records. All of this really began to come together during the second week.
You can do this. It's all about little steps that collectively make a journey. You can take the small steps without fear - a lot of folks have gone before you.
The good news is that it can be controlled with a bit of effort which was my big "AHA!" during Week Two.
Anyway, back at Week Two. I had begun to take my meds - Metformin twice a day 1.000 mg each time. Pretty standard starting treatment. And, it was just the Metformin. I know many may have two pills to take, which for some proves to be very effective. It's kind of like a one-two punch and when you are in a war with diabetes, you want to throw as many punches as possible to get your glucose, and subsequently your A1c, down somewhere in normal range. If you need to see the a chart for A1c values and how they compare to your blood glucose readings, look here for a pretty easy to read chart.
Remember not to use one reading, but look at your average reading. Even then, it depends on when you take it. More on that at some point in the near future.
Again I got a bit side tracked. Week Two - I had begun my walking. Every evening for 30 minutes. I know I have written here before I don't like exercise, but we were talking about my life here. So, that walk became one of my best friends. I didn't try to walk fast or go very far at first. I used shoes that were about five or six years old and just walked. One foot in front of another. For 30 minutes - which seemed like forever the frist few days, but by the time Week Two started, the time seemed to go a little faster, but not much.
And, I was getting more ideas of what I could and could not eat. Think about it, we get near immediate feedback with our glucose readings. If it's not the right food, up it goes. If it is the right food, it dips a little bit. Take your readings twice a day, more often if your doctor will authorize it, so you will know what your blood sugar (glucose) is doing. You should be on a steady downward trend. And, keep a record of your readings as well as diet (everything you eat and when) in a food diary. You will really learn what is working and will be able to spot trends faster. If you spot the trend, you can make adjustments.
Me? I just liked seeing the numbers go down. I started with seeing glucose numbers of 300+. It was an exciting morning when I hit 297. During the second week I saw it get down to 275. I was making progress! Fear was gone because I was taking action. I knew the meds would not make me go too low - fat chance when you are in the high 200's. Things were beginning to work and I felt empowered; that I could get this disease under control. Hey, I even found I lost my first couple of pounds during Week Two,
What was I doing?
Meds. Diet. Walking. Testing. Recording. If I was really bright, I'd come up with some sort of catchy acronym, but alas and alack, I am not that bright. I am open to ideas, though. You know what my meds were. I was on a low carb diet. I was walking 30 minutes a day, six days per week. And, I kept records. All of this really began to come together during the second week.
You can do this. It's all about little steps that collectively make a journey. You can take the small steps without fear - a lot of folks have gone before you.
Monday, July 30, 2012
Take Your Meds, Please
If you have diabetes, taking your prescribed medication would seem to be an obvious step toward controlling it, right? And, yet not everyone does.
Taking the prescribed medicine is one of the easiest ways to control and manage diabetes. It's one of the most basic steps we can take. So, why aren't people taking their meds?
You know, I don't have a clue why prescriptions aren't picked up. Or, why people don't take their meds. I know taking meds is a huge step toward control. And, face it, if you don't control diabetes, it will control you. One way or another, if you don't take your meds, diabetes will win - it's only a matter of time.
So, please, please take your meds as prescribed so you can win over diabetes. It's an easy step to take. I want you to see and play with your children and grand-children. I want the best possible life for you - and it begins with taking your meds.
Thank you, as always, for reading.
Taking the prescribed medicine is one of the easiest ways to control and manage diabetes. It's one of the most basic steps we can take. So, why aren't people taking their meds?
You know, I don't have a clue why prescriptions aren't picked up. Or, why people don't take their meds. I know taking meds is a huge step toward control. And, face it, if you don't control diabetes, it will control you. One way or another, if you don't take your meds, diabetes will win - it's only a matter of time.
So, please, please take your meds as prescribed so you can win over diabetes. It's an easy step to take. I want you to see and play with your children and grand-children. I want the best possible life for you - and it begins with taking your meds.
Thank you, as always, for reading.
Friday, July 27, 2012
Summer - Great for the Beach; Bad for Meds
The summer is here...and it's only going to get warmer...okay, hot. And just like babies and animals, meds should not be locked up in hot cars!
I was talking with my friendly pharmacist who does to want to be identified by name (but works at the Target in Anaheim at Euclid and Lincoln) and he reminded me that meds (pills and capsules) should not be exposed to high heat - like that in a closed car or car trunk. Why? He said they lose potency - something happens to the meds that is caused by heat that makes them less effective. It does not make them dangerous (unless they are supposed to be refrigerated).
What do meds need to retain their strength? Meds need to be kept at room temperatures - about 80 to 85F. The interior of a locked car can easily get to 120F. And, a closed car trunk can get crazy hot. If you are taking that big road trip this Summer, carry the meds with you in the air conditioned car.
By the way - this applies to all meds - diabetic meds, antibiotics, even aspirin!
There's more information for you to read here.
As always, thank you for reading!
I was talking with my friendly pharmacist who does to want to be identified by name (but works at the Target in Anaheim at Euclid and Lincoln) and he reminded me that meds (pills and capsules) should not be exposed to high heat - like that in a closed car or car trunk. Why? He said they lose potency - something happens to the meds that is caused by heat that makes them less effective. It does not make them dangerous (unless they are supposed to be refrigerated).
What do meds need to retain their strength? Meds need to be kept at room temperatures - about 80 to 85F. The interior of a locked car can easily get to 120F. And, a closed car trunk can get crazy hot. If you are taking that big road trip this Summer, carry the meds with you in the air conditioned car.
By the way - this applies to all meds - diabetic meds, antibiotics, even aspirin!
There's more information for you to read here.
As always, thank you for reading!
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