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Ask the Pharmacist Live Archive, Thursday, February 7, 2008
Our guests were Drug Information and Diabetes Care Specialists from Rite Aid. Marlena DeLaneuville R.Ph., Pharm.D., has been with Rite Aid for 10 years working in Atlanta, GA. She graduated from the University of Georgia in Athens with her doctor of pharmacy degree in 2005. She has experience regarding Diabetes Education, Immunizations, and Medication Therapy Management working at Eckerd`s in Marietta ADA-approved site and at the Good Samaritan Health Center under the leadership of Scott Thurman and Andi Norton. Marlena recently moved to Mobile, AL where she is working to start a similar education site to the one in Marietta. Marlena is a member of ASHP and the Greater Atlanta Diabetes Educator Association and is a Preceptor and adjunct faculty at Auburn University in the state of Alabama. Mark W. Hill, R.Ph., CDE, is a community pharmacist in Huntsville, AL with 25 years of retail experience. He has been actively involved in Diabetes Education for the past 10 years. Michele Seifert, R.Ph., Pharm.D D., is a Drug Information Specialist at the Rite Aid Drug Information Center. She received specialized training in diabetes care through the National Institute for Pharmacist Care Outcomes (NIPCO) Diabetes Care Certificate Program. This live event is designed to provide conversation around common drug therapy issues. If you have a detailed question or a topic that may require some research on our part, please use our Ask The Pharmacist e-mail system. Rite Aid strives to provide the most current drug information available, however new findings are constantly being revealed. The information provided is for informational purposes only and is not meant to substitute for the advice of your physician. We hope your questions have been answered and we look forward to serving you again in the future. If you have a medical emergency dial 911 for immediate help.
ADAModerator: Welcome to ADA Live! Today our guests are Marlena DeLaneuville R.Ph., Pharm.D., Mark W. Hill, R.Ph., CDE, and Michele Seifert, R.Ph., Pharm.D D. from Rite Aid Pharmacy. They will discuss and answer your questions on any aspect of diabetes. It's a pleasure to have you here today Marlena, Mark and Michelle! Marlena__Mark__and_Michelle: Thanks. There are already lots of terrific questions coming in. It's a pleasure to be here. Jacksonville__FL: I have a number of old prescription drugs around. I was told not to thrown them out or flush them in the toilet. What do I do with them? Michelle__Mark__and_Marlena: Disposing of expired or unused medications can be a challenge. There is little information available for appropriate disposal of medications at the patient level. Flushing expired medications down the toilet or sink is a common practice, but it has been found that concentrations of different medications are showing up in treated water because sewage treatment plants aren`t designed to remove drugs. This method is no longer recommended. To determine the regulations for drug disposal in your state or municipality, we suggest contacting your State Board of Pharmacy and/or the local Environmental Protection Agency (EPA) office. As a last resort, you may discard old medications in the trash. However, extra care should be taken to decrease the possibility for abuse, secure privacy, and ensure safety. When disposing of medications in the trash please use the following measures: 1. Keep drug in the original container with the child proof cap on. 2. Remove prescription label. 3. Place liquid medications in a sealed plastic bag so that the medication will still be contained if a breakage should occur. 4. Make the medications unpleasant tasting by adding a nontoxic spice (i.e. cayenne or black pepper) or making the drug not consumable by mixing with water and kitty litter. 5. Disguise medication vial by placing it in a brown paper bag or box. 6. Wait to discard medication until trash pick up day. valley_stream_ny: Dr. has prescribed to test my sugar 7 times a day for one month. I have no insurance and no source of income how can I get free supply of testing strip (one touch code 6 or 9) or obtain supplies on minimum payment. can u pls help me. Michelle__Mark__and_Marlena: It is very difficult to obtain free test strips. You can contact the manufacturer of One Touch test strips to determine if they offer a patient assistance program. Their website address is www.lifescan.com or you can call them at 1-800-227-8862. You can also look in your community to see if there is a clinic that can get you strips. There are also cheaper strips/meters available from the pharmacy using that specific store brand. Also talk to your doctor regarding the problems you are facing obtaining strips--they may be able to provide you samples and lower the amount you should test. There are also programs available to help patients without insurance coverage pay for medications. You can contact them to determine if testing supplies are included. The Partnership for Prescription Assistance (PPA) is a program created to help qualifying patients without prescription coverage obtain medications at a reduced price or free of charge through public or private programs. Their mission is to increase awareness of patient assistance programs and boost enrollment of those who are eligible. You may contact the PPA by phone at 1-888-4PPA-NOW (1-888-477-2669) or though the internet at www.pparx.org. There is also a card called Together RX which allows qualifying patients to save on certain prescription medications. This card is made possible through a coalition of pharmaceutical companies. To enroll, you may call 1-800-865-7211 or enroll online at www.Together-Rx.com. Warren__OH: I am confused about foot care. My father currently has a small ulcer between his toes. He`s been prescribed cream by the foot doctor. He rarely goes out of the house. At home, do you recommend that he wear shoes at all times? He wears athletic socks (not special diabetic socks). Secondly, if he does not wear shoes, should be have socks that leave the toes exposed? Michelle__Mark__and_Marlena: Prevention is the key to good foot health. Any blister, cut, nick, swelling, or redness of the foot should be evaluated by a physician. Because many people with Diabetes have nerve damage in their feet and may not feel pain when injured, it is recommended to wear comfortable shoes or slippers during waking hours. Also the protection of the shoe or slipper protects against stubbed toes, cuts or nicks, or other physical damage to the exposed foot and toes. Socks are better than bare feet, shoes are better than socks. Be careful about slipping on hardwood floors or linoleum flooring if socks alone are worn. Choosing socks that expose the toe may help the area between the toe stay dry, but offer less protection from trauma than a full sock or shoe. I know this may seem bothersome, but protecting the feet of someone with Diabetes is extremely important! Many amputations result from events that some consider to be insignificant. Be aggressive in protecting and treating foot conditions! viera__fl: what is the target for blood sugar fasting? and 2 hours after meals Michelle__Mark__and_Marlena: Blood glucose level recommendations for nonpregnant patients with diabetes vary depending on the source of the recommendation. General blood glucose level guidelines according to the American Diabetes Association (ADA) are: A1C - Less than 7% (The A1C goal for an individual patient is an A1C as close to normal (<6%) as possible without significant hypoglycemia); Before meals - 90 - 130 mg/dl (5.0-7.2 mmol/l) (plasma/serum blood glucose reading); and Peak after a meal (1-2 hours after the start of a meal) - Less than 180 mg/dl (less than 10 mmol/l)(plasma/serum blood glucose reading). The new general blood glucose level guidelines according to the American College of Endocrinology (ACE) are stricter than the ADA guidelines and include: A1C - Less than or equal to 6.5%; Before breakfast in the morning - Less than 110 mg/dl (less than 6.1 mmol/l)(plasma/serum blood glucose reading); and Two hours after eating a meal - Less than 140 mg/dl (less than 7.8 mmol/l)(plasma/serum blood glucose reading). You should talk to your physician to determine what specific goals are appropriate for you. newark_nj: what is the considered low sugar level(numbers)? Michelle__Mark__and_Marlena: Anything below 70mg/dl is considered hypoglycemic. Some people get symptoms of a low even though their blood sugars are well above this number, and some people have blood sugars below this number with no symptoms at all. bronx__ny: if a known DMII pt who is on 123Units of Lantus QHS and 40Units of Novolog QAC presents with a BS of 57 in am and several BS in 40's during the day, which insulin should be decreased? Michelle__Mark__and_Marlena: First of all, any blood sugar that is under 70mg/dl with symptoms of low blood sugar should be treated with 15 g of quick acting carbs (such as 1/2 cup of juice, 1/2 can of cola,glucose tablets, etc) and check blood sugar 15 minutes later. Secondly, you have to look at how you are eating in relation to the Novolog dosing. Your fasting level is effected by the Lantus, your 2 hour post-prandial would show the effects of the Novolog. You need to talk to your doctor as soon as possible about these ultra low readings you are getting and the possibility of changing your insulin dosing for optimum health care. ellicott_city_maryland: I find that I start to shake and not feel well when my numbers are in the 90's, 140 I feel is really good. I normally run about 180. I see the TV ads that show you at 60 is really good I would crash and burn at that number, what is normal or is it different in everyone? The highest I have had was 200 maybe 220. Michelle__Mark__and_Marlena: Good glucose control is getting as close to normal (nondiabetic) blood glucose levels as possible without adverse effects such as hypoglycemic episodes (lows). Therefore, the ADA recommends levels between 90 and 130mg/dl before meals and less than 180mg/dl two hours after starting a meal. Non diabetic people are able to maintain this range while those with Diabetes cannot. Why they are unable to do so is the 64 thousand dollar question, and scientist are still looking for all the answers. We do know that if your sugars are running high, a sudden drop in those sugars (even if it is still running high) can cause symptoms of a low blood sugar. For example: If your blood sugar is 180mg/dl and you experience a sudden drop to 130mg/dl (50 point drop) you may get shakey, not feel well, sweat, feel like you are going to pass out, etc. But your blood sugar would still be considered elevated. This is not common, but has been known to occur. We know that tight control (staying as close to normal as possible without side effects) prevents or delays long term complications. However, tight control is not appropriate for everyone. You must decide (with your doctors imput) how aggressive you want to be in controlling your Diabetes. Tight control works, but is not without side effects. A constant effort to drive down your blood sugars, may result in severe lows. If you live alone and no one is there to help you recover from a low, you may want to allow your blood sugar to remain a little higher than normal to prevent the possibility of a low. This is a decison that should be made with the help of a clinician who knows you well. new_york_new_york: i was wondering if you eat a lot of sugar say and you pee it out is that a symptom of diebetes? thanks Michelle__Mark__and_Marlena: A large volume of urine is one symptom of uncontrolled diabetes. Sugary substances and other kinds of carbohydrates raise the level of sugar in the blood. The body tries to eliminate the excess through the kidneys, but this requires extra water to carry the sugar away. Because the urine is eliminated from the body extreme thirst may result. (to replace what was lost as urine). Also many people with uncontrolled diabetes are always hungry, no matter how much they`ve already eaten. These 3 symptoms, polyuria (excessive urination), polydipsia (extreme thirst), and polyphagia (extreme hunger) are classic symptoms of Diabetes. Your doctor will rely on a blood test to confirm the diagnosis, but don`t delay your appointment if you suspect that your sugar may be uncontrolled. Lake_Mills__IA: I work at a school and through a wellness check my blood sugar was at 165. The nurse said this is the highest we've had so far. Should I be concerned? I have tried unsuccessfully to find out what the range is for this amount or where I fall on a gauge? I can find everything on diabetes but this. I will be waiting for a response. Michelle__Mark__and_Marlena: To be diagnosed with Diabetes you have to have 2 random blood sugars of 200mg/dl or higher plus one or more of the following symptoms: increased urination, increased thirst, unexplained weight loss, fatigue, blurred vision, increased hunger, and sores that do not heal. Your doctor can also use a Fasting or an Oral glucose tolerance test to check for diabetes. A blood sugar over 140mg/dl, however, could be a sign of prediabetes which if left unchecked can lead to diabetes. Las_Vegas__NV: Hi, I`m a wife of someone who has type 2 diabetes. my husband blood sugar levels are out of control right now. I was wondering if eating beans (pinto) would make his blood sugar go out of control? He`s mexican so he eats a lot of beans, tortillas, etc. He has been eating that all his life. What foods should he stay away from? Thank you, I need all the help I can get. Michelle__Mark__and_Marlena: Any food that has Carbohydrates turns into sugar when metabolized in your body. The mexican diet consists of many high carbohydrate foods including beans, rice, tortilla and cheese. Moderation is key to keep his blood sugar under control. Try to talk to a doctor or nutritionist about a good way to continue eating his native foods while keeping blood sugars under control. It takes some work but isn`t impossible. Adding more vegetables and protein while taking away some of the carbohydrate rich foods is one way to start. Millington__MI: What is the recommended Blood Glucose reading for a non-diabetic 3 hours after a meal? Michelle__Mark__and_Marlena: The normal value for a person without diabetes 2 hours after eating is less than 140mg/dl. At 3 hours after eating, this level would be even less and may return to the normal fasting level which would be less than 100mg/dl in people without diabetes. Moriches__NY: What is a normal blood glucose range? Michelle__Mark__and_Marlena: The normal fasting blood glucose level in someone without diabetes would be less than 100 mg/dl. Kalamazoo_MI: What immunizations, screening and other health maintenance are recommended in a patient with newly diagnosed Type II Diabetes? Michelle__Mark__and_Marlena: The most important immunizations to get would include influenza yearly, pneumonia every 5 years and tetanus every 10 years. Talk to your Doctor regarding any other immunizations he/she may recommend for you. Its important to have at least a yearly physical with your doctor where your A1C, blood pressure, cholesterol and feet are checked. It's also important to have your eyes checked yearly, tell the eye doctor you have diabetes so he/she can do a specific test with you. Also see a dentist every 6 months. San_Diego__CA: Is there a preferred time of day/meal to take Meformin with? I am prescribed 500 mg, once per day. I am trying to get fasting bg lower, and it doesn't seem to matter if I take it am or pm. Michelle__Mark__and_Marlena: You can take it at anytime during the day. It is most important to take it with a meal so that you can avoid the stomach symptoms seen when taken on an empty stomach. Metformin works by helping to block the liver from pumping out sugar when you are in a fasting state, thus lowering your fasting levels. If it hasn`t seemed to help lower those numbers by the time you see your doctor next, they may want to discuss increasing it to twice a day. Penang_Malaysia: Why is it difficult for wounds to heal for diabetic patients? does it have anything to do with clotting factor? thank you Michelle__Mark__and_Marlena: Normally wound healing is more difficult for someone with uncontrolled diabetes due to the amount of sugar in the blood. Like honey, when blood has excess sugar it becomes thick and takes longer to get through the veins and vessels of the body. This can lead to many different complications over time and also makes wound healing more difficult. Long_Beach_CA: My Mother was diagnosed with Diabetes 20 years ago, she takes insulin twice a day but in the last 2 weeks she has had 3 episodes (I assume diabetic related) the last one was last night Jan, 12 where she was rushed to emergency her blood sugar had dropped so low she did not know who we were and she vomited, the ER Dr stated that her body was changing and that she needs to start over agin on what she does with diet and so forth. I am not sure I understand, does that mean she needs to re-evaluate her current way of controlling her diabetes? eating more or less time in between meals and checking her blood sugar more often? does the body change just like that? Michelle__Mark__and_Marlena: Like everything in life, change is common. Your mother 20 years ago isn't necessarily going to require the same treatment as now. As we age, our body changes. Our metabolism slows and our vital organs may not work as well as they once did. That`s why it is necessary to re-evaluate treatment, nutrition and other possible disease progression at least once a year with a doctor. She may need a different regimen to help control her current disease state, as what once worked, isn't anymore. Contact her Diabetes provider for more information and support. anderson_indiana: i am on a exchange diet and do not understand how it works can anyone help me understand it thanks jean Michelle__Mark__and_Marlena: The exchange diet was developed to allow people the freedom to make their own menus. Even though many foods are different (apples vs oranges), the body uses the sugar in each in a similar way. Scientist have determined what quantities of certain foods provide the same nutritional value as other similar foods. If you don`t like one, you may simply exchange it for another similar food. For example: If you lived in the south, you might like grits for breakfast. But if you`re from the north, you might prefer oats or cream of wheat. We know that these foods offer equivalent nutritional values and may be replaced or exchanged with each other or other similar foods. Registered Dietitians have special training in these kinds of calculations. They can help you with equivalent serving exchanges. Set up an appointment soon. A good understanding of this concept will serve you well for many years. Charlotte__NC: What are my limitations,having just been diagnosed with Diabetes 2, and my use of alcoholic drinks? Michelle__Mark__and_Marlena: In most cases, it is ok to drink alcohol in moderation if your blood sugar is under control when you have diabetes. However, if you have certain complications it is not recommended to drink alcohol. Speak with your physician or diabetes educator to determine if alcohol can be part of your meal plan. Moderation for a man is 2 drinks and a woman is 1 drink per day maximum. Be aware that alcohol can cause hypoglycemia by blocking the release of glucose from the liver in a fasting state while the alcohol is metabolizing. This effect can last 8 to 12 hours. Do not drink on an empty stomach! Lac_La_Biche__Alberta: My father has been sick,with headaches, and other things. He went to the emergency to get checked up for swelling on the side of his face. He was told he has infection, and had sugar level tests done. they found out he has diabetes, his sugar is high, along with high blood pressure. last night he had a rough sleep, his body trembled from fever and pain. he went back to the hospital this morning and they only took more tests. im am very concerned for my dad, he is 60 years old. Michelle__Mark__and_Marlena: Infection in the body can cause an elevation in blood sugar. The first priority is to get the infection resolved that is causing the swelling in his face. Very soon, though, we must begin to make a plan to get his blood sugar under control. More test are necessary to determine how high his blood sugars have been in the last few months. This will determine how aggressive the treatment must be. Also it is very important to address the elevated blood pressure. High blood pressure and Diabetes are serious conditions when they occur by themselves. In combination, they can be lethal if left untreated. You are right to be concerned about your dad, but the good news is that both of these conditions are controllable with good effort by your medical team. We know that many people with Diabetes and Hypertension lead healthy and happy lives well beyond their 60`s. The key is getting the right treatment plan from your doctor. Unfortunately, this isn`t always quick and easy. Be patient and keep talking to your doctor. Good communication with him/her is the key here! Portland__OR: How much does insulin cost? Michelle__Mark__and_Marlena: TYhe cost of insulin can range from $45 per vial to over $200 depending on the type of insulin. Leesburg__Ga: I was recently diagnosed with type 2 diabetes. I knew enough about the disease and the symptoms I bought an inexpensive meter and began testing myself before actually calling a doctor etc. At the time of purchase I found a great bargain on supplies and paid out of pocket. I have insurance and it is my understanding that they help pay for diabetic supplies. How does this work? I need help, do I have to get the doctor to write a prescription for strips? I hate to sound ignorant, but I PAY 100% of insurance out of pocket, and with a family supplies get expensive. What do I DO? Michelle__Mark__and_Marlena: The best way to find out how much your insurance will pay for diabetic supplies is to call your insurance provider. Each company is a little different in what they pay and which meter may be preferred. Normally the insurance company number is on the back of your card. To be able to run it through insurance you do need a prescription from the doctor. Strips can become expensive since most cost about $1/each without insurance. Getting a healthcare provider on board will also help you know more information on when to test and different diabetes management guidelines for you to use. brentwood_Maryland: my mom just got diagnosed with diabetes sugar level 173 how often should i check her sugar? Michelle__Mark__and_Marlena: A good starting point for checking blood sugars is twice a day, one in the morning before she eats or drinks anything (fasting), and once 2 hours after her largest meal (post-prandial). In some cases it is necessary to test more often. Speak with her physician to determine exactly how often she should be testing. Fasting levels give a good idea of her overall blood sugar control (ADA Goal 90-130mg/dl) and post-prandial tells how the foods she is eating are affecting her blood sugar (ADA Goal less than 180mg/dl). The American College of Endocrinology (ACE) recommends stricter goals than the ADA (fasting less than 110mg/dl and post-prandial less than 140mg/dl). Check with your mother's physician to determine what goals are appropriate for her. prineville___Oregon: I have a 11 year old daughter that was over 9 pounds when she was born . Her mother is overweight ..... her mom's whole side of the family is over weight. Recently she said that she has been getting bloody noses that wont stop right away. I know she does not get a lot of exercise and I feel she is over weight . She is under 5 ft tall and weighs over 120lbs. Is she prime for diabetes? Michelle__Mark__and_Marlena: Given many different factors: being a high birth weight baby, and currently overweight, she is at an increased risk for diabetes. Based on a recent study, 1 out of every 4 kids in the United States is considered high risk for diabetes. Trying to get her to eat better and exercise now will help her not only lose weight, but decrease the risk of developing diabetes. Talk to a doctor about a sound nutrition and exercise program for someone her age and also about the bloody nose issue. pasadenatexas: what does it mean when a diabetic just wants to sleep? Michelle__Mark__and_Marlena: Normally that is a sign of increased blood sugars. When your body isn`t able to properly utilize the sugar in your blood for energy in your cells, sugar becomes overabundant and you will feel a lack of energy or constantly tired. Keeping your blood sugar under tighter control through diet, exercise, and medications can help your body use the sugar in your blood efficiently and help your energy level. Milwaukee__WI: What's the complete story on Zetia/Vytorin. My doc recently put me on Vytorin...do I need to just throw it out? Michelle__Mark__and_Marlena: No. The ENHANCE study that the media has recently been paying attention to is only specific for one endpoint. Many of the details of the study have not been reported in the media. The study is still being evaluated and other studies are being performed to answer clinical questions that this study did not address. The American College of Cardiology (ACC) recommends that major clinical decisions not be made based on the ENHANCE trial. They recommend that physicians speak with their patients and discuss the issue. They do not recommend discontinuing the medication. Although the media has made this a major issue, the ACC feels it is not an urgent situation. Until results of the other studies are available, ACC feels that Zetia and Vytorin (a combination of Zocor and Zetia) should remain options for patients. The combination has shown to have a greater effect on lowering LDL than Zocor alone by also decreasing the absorption of cholesterol from foods you eat. If you still have reservations on taking Zetia or Vytorin, speak with your doctor to determine what is best for you. Walker__La: My doctor took a non fasting blood/sugar test sticking my finger it was 140, I am over weight, he said I`m in trouble.. well would it help any if I would take chroumin? and then really watch the food intake, and is there a list of foods that is good like veggies/meats like a eat and dont eat list cause the reading labels and figureing carbs want be my cup of tea. Michelle__Mark__and_Marlena: A non fasting blood sugar of 140mg/dl doesn't meet the official requirement for a diagnosis of Diabetes, but it does tell us that you are moving in that direction. There are several things you can do that may delay or prevent the onset of this disease. First, work hard to lose that extra weight. We know that extra weight increases your chances of developing Diabetes, high blood pressure, and heart disease. Even five pounds can be significant. Secondly, try to increase your activity level. We know that intense exercise aids in weight loss and improves your body`s ability to use insulin. A good exercise program may delay the onset of Diabetes. Just 30 minutes 3 times a week is helpful. Thirdly, try to replace unhealthy food with things you know are good for you. Instead of a candy bar, how about an apple? Instead of a piece of cake try a lowfat cup of yogurt. Sometimes little changes you make every day can have a big effect over time. Lastly, try to learn as much as you can about Diabetes and it`s treatment. There is currently no cure for Diabetes but we are making great strides in this direction. Stay informed! It may also be beneficial to meet with a registered dietician to discuss dietary changes that you can make. There is not a set "eat and don`t eat" list but a dietitian can assist you in choosing foods that may be more beneficial for you. cardington_OHIO: I have type II diabetes, I have been experiencing pain in my hip that travels down my leg..doctor said he thought it was just a pinched nerve...gave me prescription for Ibuprofen 600 anti inflammatory...It does dull the pain but it is still constantly there..I feel I have neuropathy forming and wondering WHAT I CAN DO OR USE TO MAKE IT NOT HURT SOOOO MUCH any suggestions? Michelle__Mark__and_Marlena: Usually neuropathies develop in the ends of the nerves first. I would expect pain from Diabetic neuropathies to show up in you toes and fingers before your hips. Ibuprofen is a good pain reliever that also reduces swelling. Sometime pressure on a nerve causes minute swelling that causes a shooting pain. The ibuprofen may relieve the swelling just enough to relieve the pain. Large doses are hard on your stomach and kidneys. Tylenol may be a second choice for the pain, but will not offer the same relief from the swelling. kilifi: What is the best current insulin regimen in management of DM? Michelle__Mark__and_Marlena: This is an extremely unique question. There is no one right regimen for all people with Diabetes. You may have heard the old saying: "if you`ve seen one, you`ve seen `em all!" There`s a humorous twist to this old saying we use in Diabetes management that goes like this: "If you`ve seen one Diabetic, you`ve seen exactly one Diabetic!" The point is that what works for one individual, doesn`t automatically work for another. Each case must stand alone. Some people need a single daily dose of insulin, others need 2-6 per day, others may even need a constant infusion of insulin (every few seconds by way of an insulin pump). Work with your physician to develop a plan that fits your unique life! Coast: What is the Insulin dosage of newly DX patients? Michelle__Mark__and_Marlena: The dose is variable depending on many factors. These include weight, patient response, daily activity, and insulin sensitivity. Speak with your physician to determine an appropriate dosage for you. Jacksonville_Florida: I have type 2. Why do blood sugar readings spike to higher numbers shortly after eating, then go to lower numbers 2 or 3 hours after eating? Thank You Michelle__Mark__and_Marlena: Everyone, including people without Diabetes have an initial spike in their blood sugars shortly after eating. This is what signals the body to produce hormones to help regulate and lower your blood sugar. For this reason you see a lower blood sugar 2 hours after eating, also known as postprandial blood sugar. Winnipeg__MB: I was diagnosed with Diabeties a year ago. At that time my 3 mth average levels were at 10.9 With diet I have brought it down to 6.2. But now I quit smoking and my levels are up again. This whole time my Dr want to put me on Insulin. My question is what are the long term effects on Insulin. I have read a lot on the pills but can not find any thing on Insulin. Michelle__Mark__and_Marlena: Insulin is a hormone that is actually produced in your body along with amylin, and glucagon and many others to help regulate your blood sugar. People that have Type 2 diabetes sometimes may need more insulin than what the body is producing to keep up with the amount of glucose in our blood. Since insulin is naturally produced in your body the effects seen from exogenous injection is minimal. One short-term side effects of insulin is low blood sugars. Another side effect you can see is increased weight gain. Raleigh__N_C_: I am to start using an insulin pen, what are the how to`s, need refrigerated and how to put on needles? Michelle__Mark__and_Marlena: Insulin pens are very user-friendly. Most pens come either prefilled or with a set of cartridges to place into the individual pen. It is best to keep the pens or cartridges in the refrigerator when they aren`t being utilized. When you start using a pen, the time you can keep that individual pen at room temperature will vary depending on the type of insulin. Be sure to ask your pharmacist how long the pen is stable at room temperature. The pen needles are sold seperately from the pen and normally pop into the top of the pen and then twist on. If you have any other specific questions regarding the pen, don`t hesitate to ask your local pharmacist. JASPER_AL: what makes one sleep all the time with diabetes? Michelle__Mark__and_Marlena: High blood sugars can make you feel tired and want to sleep all the time. This occurs when sugar is remaining in your blood instead of being transported to your cells to create energy. dallas_tx: Being unemployed and uninsured how can i get resources and help with my diabetic supplies? Michelle__Mark__and_Marlena: Many Medicaid programs cover meters and supplies. You may be eligible for public assistance if you meet certain requirements. Most state programs, receive federal matching money to care for their citizens. Additionally, many pharmaceutical companies offer prescription assistance for patients without insurance coverage. The Partnership for Prescription Assistance (PPA) is a new program created to help qualifying patients without prescription coverage obtain medications at a reduced price or free of charge through public or private programs. Their mission is to increase awareness of patient assistance programs and boost enrollment of those who are eligible. You may contact the PPA by phone at 1-888-4PPA-NOW (1-888-477-2669) or though the internet at www.pparx.org. There is also a card called Together RX which allows qualifying patients to save on certain prescription medications. This card is made possible through a coalition of pharmaceutical companies. To enroll, you may call 1-800-865-7211 or enroll online at www.Together-Rx.com. Finally, you may also contact the manufacturers of your medications directly in order to obtain information about available patient assistance programs. In order to provide you with the name and phone number of the manufacturer, we would need the name of the diabetic supplies that you use. You may resubmit your question to our "Ask The Pharmacist" service with this information and we would be happy to assist you with the company's phone number. Pulaski__TN: Can effexor cause elevated fasting glucose levels in a person who was never diagnosed with diabetes? Michelle__Mark__and_Marlena: Based on the medication profile of adverse events hyperglycemia (or high blood glucose) is an infrequent event and Diabetes Mellitus is a rare event seen with Effexor use. If you notice an increase in your blood glucose, contact your doctor, you should not discontinue Effexor suddenly as this can lead to withdrawal. farmington_mo: i am recently diagnosed diabetic and i am on adderall is this safe i am also on a narcotic pain killer is this safe? Michelle__Mark__and_Marlena: There is no contraindication for a patient with diabetes and Adderall. The narcotic pain killer may or may not have a contraindication. There are many types of pain killers with different additives; Ibuprofen, for example, is not always recommended for people with diabetes due to the effects seen on the kidneys and possibility of fluid retention. We recommend that you speak with your pharmacist or physician to determine if the narcotic pain reliever you use is appropriate for people with diabetes. Plano__TX: The dawn phenomenon is common in diabetics. I have heard that changing up insulin regimen can help avoid this problem. Is there anything you can do form a dietary stand point? If you eat a high CHO meal right before bed will that affect high blood sugars in the morning? Michelle__Mark__and_Marlena: The dawn phenomenon is very common among many patients with diabetes. This occurs when your blood sugar goes too low in the middle of the night and your liver begins pumping sugar into your blood to counteract this, leading to highs in the morning. Rather than eat a high carb meal right before going to bed and overwhelming your body try to eat a balanced meal for dinner and then a snack (around 15g of Carbs) at bedtime. Salt_Lake_City__Utah: What is the most inexpensive meters and strips? Michelle__Mark__and_Marlena: There are many meters on the market today. Very often you may obtain one for free with a promotional coupon at most drugstores. The expensive part is buying the strips which are usually in the range of a dollar per strip. Many insurance companies pay for these supplies, but they may have some limits based on formulary restrictions. I would encourage you to make a list of the features that are important to you before you go to the store. (Speed, memory capacity, downloadable capability, sample size, ease of use, etc) Once armed with this priority list seek the meter than best meets your needs for the best price. Your pharmacist can offer helpful advice if you get confused! Sacramento__California: My grandfather suffers from Type 2 Diabetes and recently he has been experiencing strange things and i wanted to know if it could be a result of his diabetes or possibly something worse. He informed me that some nights he wakes up in bed and has no clue where he is at and when he gets up to go to the bathroom located right next to his bed, he forgets how to get there. Even more strange than that he informed me that just the other day a phone call came into his home telephone and he picked up his cordless phone and just stared at it because he said in his mind he had temporarily forgot how to answer or speak into the telephone. Is this a cause for concern that we should consult his physician about or are these typical symptoms of those with this type of Diabetes? Thank you in advance for your time and thought. Michelle__Mark__and_Marlena: There can be problems with memory seen with extreme lows in blood sugar, but they are transient. It would be in your grandfather`s best interest to talk to a doctor regarding these new developments in his mental status. McClusky__ND: When taking insulin, how long between injections do I wait? Also, do I need to wait to eat after an injection? Michelle__Mark__and_Marlena: This will depend on the kind of insulin you are using. Some insulin works very fast (10-15 minutes) and only last 4 hours. Other insulins have a slower onset of action (30-45 minutes) and a longer duration of action (from 8-24 hours). Some insulins should be given with the first bite of food (like lispro), while others may be given with little regard to meal times (glargine).This is an important concept to understand. Your Diabetes Educator can help you understand the different properties, restrictions, and precautions associated with the many kinds of insulin on the market today. Schedule an appointment soon! New_Jersey: How valuable is the urine dipstick reading to reveal diabetes in healthy individuals who have no symptoms or risk factors other than being over 70? Michelle__Mark__and_Marlena: Urine dipsticks only reveal the absence or general level of sugar in the urine. Because the reading must be determined by matching a color on the strip to a sample color on the container the value is somewhat subjective and is usually given as a range, rather than an exact number.(as with a blood glucose monitor) A healthy individual who does not have Diabetes, should have no sugar in the urine. The test may have limited use to determine the absence of sugar in the urine but offers little information about the current level of sugar in the blood. If the test is positive an appoitment should be immediately scheduled with a physician to determine how high the sugar level actually is. It should be noted that a low blood sugar will reveal the same result as a normal sugar (negative for sugar in the urine) columbus_ohio: I have been a diabetic for 4 years. I weigh 375 pounds. I am desperate. How many calories a day should I have if I want to lose weight? Michelle__Mark__and_Marlena: First we must establish your BEE (Basal Energy Expenditure). This is the amount of energy in calories that your body needs to maintain your current weight. Several factors are needed to calculate this number. (Age, gender, and height) Once this number has been determined a healthy goal is to reduce your intake by 500 calories per day. This will give you a combined caloric deficit of 3500 calories per week, which will result in 1 pound of weight loss. This translate into 52 pounds per year. An increase in exercise will speed up the pace of weight loss even more. Registered Dietitians have special training in this area. Make an appointment with a local RD as soon as possible. Small changes over a long time can have dramatic effects. Be patient and stick to your plan. You can do it! Gaithersburg__Maryland: I am 60 years old and have type 2 diabetes and control it through medications (glipizide and metformin), meal planning and exercise. I was diagnosed 18 months ago. I have been normal weight (BMI about 23) all my life. A lot of the information I have read about Type 2 diabetes deals with body weight issues relating to persons who are overweight. Is there anything I should know that applies to normal weight Type 2?s that might help me to better manage this disease? Michelle__Mark__and_Marlena: The fact that you have maintained a normal body weight works in your favor. Proper diet and exercise are crucial for good control for all people with Diabetes. Extra weight makes it more difficult to exercise and also decreases your body`s ability to utilize insulin (insulin resistance) Most people with type 2 Diabetes are overweight and are trying to get where you already are. Continue taking your medication, stick to your meal plan, and be faithful in exercising. These 3 things will keep you on the right road to good health. ADA_Moderator: Although this chat is scheduled to end now, it will continue due to the volume of questions that we have. Thanks for joining us today! lakeland__fl: What is the difference between byetta and insulin? Michelle__Mark__and_Marlena: Insulin is a natural hormone secreted by the pancreas that helps the body utilize the food it takes in. Without insulin, sugar remains in the blood stream and cannot cross over into the cells of the body. Byetta is compound derived from the saliva of the Gila monster that is similar in activity to a naturally occuring hormone called GLP-1. (Glucagon Like Peptide-1). The role of this compound is to increase insulin secretion, slow gastric emptying, and reduce food intake. Some people experience a weight loss with Byetta, while many experience a slight weight gain with insulin. Rolfe__Iowa: Why is my reading the highest before breakfast : Why is my reading the highest before breakfast? Also, is a 160 reading at this time high enough to bring on serious complications. I`m 85 years old. Thanks Michelle__Mark__and_Marlena: There may be several reasons why your blood sugars are high each morning. If you use insulin, it maybe time to adjust the dose at bedtime. But this can be a little tricky. The first thought may be to increase the amount of insulin you use at bedtime so the morning readings are lower, but sometimes too much insulin at bedtime may actually causes a nocturnal hypoglycemic reaction (low blood sugar between midnight and 4:00 am). When your body attempts to correct the low, it may overcompensate, which might cause the high before breakfast. We`d like to get a few 3 am readings to rule this out before attempting any change in insulin dosage. This is one reason why a bedtime snack is often recommended as a part of a healthy meal plan. There is also another possibility to consider. In anticipation of the requirements for the day, your body begins to ready itself before you wake. One of the characteristics of this phenomenon is an increase in blood sugar. This is known as the dawn phenomenon. A third possibility may be related to the properties of the drugs you take to control your Diabetes. If you take oral medications to control your blood sugar, the medication may need to be increased. Some of the new medications are given just once a day. We expect them to work about 24 hours. However, some people metabolize drugs faster than others. If the duration of action for these fast metabolizers is only 21 to 23 hours, then we would expect your blood sugars to climb as the medication is being depleted from your body. This might account for the early morning rise in your blood sugars. I would encourage you to find a Diabetes Educator who can ask more questions from you to unravel this mystery. The second part of your question asks about complications. We know that tight control of your blood sugar prevents or delays complications of Diabetes. The gold standard for determining good control is the HbA1c test. This test is ordered by your physician and tells him/her what your average level of blood sugar has been for the past few months. The ADA recommended goal is below 7%. We know that complications begin to arise when the values consistently exceed 7%. A one time reading of 160mg/dl doesn`t give us a lot of information. But it is a sign to look further. I would encourage you to know your HbA1c level. It`s the best predictor of future complications. The goals of an 85 year old are different than those of an adolescent. I think a session with a Diabetes educator would be well worth your time. Schedule an appointment soon! Richmond___Va: How high can your blood sugar go, before you need to contact your doctor? Mine has been 211 for the past 2 days and my heart has been racing and feeling like I`m smothering. I also feel very weak can't hardly hold my arms up. Michelle__Mark__and_Marlena: It`s time to go see your doctor! The normal range for blood sugar before meals is between 90 and 130mg/dl according to the ADA. You are well above this number. The weak feeling may be the result of the elevated blood sugar, but we can`t rule out something else. There is a blood test your doctor can order called an HbA1c. This test tells him/her the average blood glucose level over the last few months. Sometimes an elevated sugar can be brought on by high doses of cortisone, or an illness. This test might help your doctor get an idea how long your sugar has been elevated. The racing heart and smothering feeling you describe concern me and should be evaluated immediately by your physician. Don`t delay, it`s time to see your physician! Stockholm__NJ: Are there certain symptoms that you may be a sign that diabetes or pre-diabetes may be a concern? Michelle__Mark__and_Marlena: The symptoms of diabetes can be vague: Tiredness, hunger, excessive thirst, excessive urination, excessive hunger. The test to determine if you have Diabetes is simple and can be performed in your doctor`s office. Many physicians routinely screen for Diabetes each year when conducting the annual physical, but if you have any of the above listed symptoms see your doctor right away. Early detection is crucial to preventing complications. mesquite_tx_: how does drinking beer affect diabetes? is any amount of beer ok to drink? my husband was just diagnosed with as he said mild diabetes. he drinks beer at night, a couple of cokes during the day, eats sweets at night. his hands are numb and cold all the time. the dr gave him glipizide 5 mg. 1 a day. what can i do to help him? Michelle__Mark__and_Marlena: One of the most important ways to successfully manage Diabetes is to follow a solid, well balanced meal plan. In the past few years we`ve come to understand that there are no "forbidden" foods for people with Diabetes. We just have to know how to account for the nutritional value each substance provides. In general, one beer provides 12 grams of carbohydrate, no fat, little protein, no fiber, and 150 calories. A six pack of beer provides over 1000 calories or energy to the body. This is about the same number of calories in 12 apples. Because of the high number of calories in beer, it would not be wise to drink an unlimited amount. Your local dietitian has special training in setting up healthy menus that are unique for each person. Even beer can be worked into the plan in most cases. Keep in mind that beer will affect the blood sugar. Initially, the blood sugar could rise because carbohydrates are quickly absorbed in the blood and then cause elevated blood sugar, this elevation can vary depending on how much a person drinks. Additionally, alcohol can cause low blood sugar levels especially if your husband uses insulin injections or takes oral medications. Therefore, he should never drink alcohol on an empty stomach, be sure he eats his meals and snacks and drinks in moderation. The ADA suggests that women have no more than 1 drink a day and men no more than 2 drinks per day. Lite beer is better than regular and there is even a low carb beer on the market that has fewer carbohydrates than the lite beer. But again, this is dependent on how much is consumed and if food was eaten with it. Additionally, some people with diabetes should not drink at all. Alcohol can aggravate some diabetes complications such as nerve damage and eye conditions. Consult with your husband`s physician (or dietitian) about adding alcohol in his meal plan. High, uncontrolled blood sugars can cause nerve damage in the hands and feet. I`m uncertain if this is what`s happened to your husband, but I am sure that a well balanced menu consisting of fruits, vegetables, whole grains, adequate protein, and moderate amounts of fat, will give him the best chance to live a long and healthier life. Try to schedule an appointment with a local RD (registered dietitian) soon. This is important! For more information on alcohol use, simply type "alcohol" into the search field on the ADA website. Bangalore__India: Which is the best glucometer to buy? Michelle__Mark__and_Marlena: There is no one best meter for all people. There are many features and advantages to consider for your unique situation. For example: Ease of use, sample size, downloadable features, size of the display,etc. Your pharmacist can offer helpful information on making this decision. Make a list of the things that are important to you, then make a trip to the drug store to see what`s available. From time to time companies offer free meters with the purchase of strips. You should also check with your insurance company to determine if there are particular meters that they will pay for (meter and/or supplies). Having this information with you when you talk with the pharmacist can help you choose a monitor that is covered by your insurance carrier. In order to bill the insurance company, you will need to obtain prescriptions from your physician. Silver_Creek__New_York: Can a person have low blood sugar levels(below 70) and not be on any diabetic medicines. My wife got dizzy and faint and I happen to be taking my glocuse level as I`am diabetic. So I took hers and it was 66 I guess I;am asking can your pancreas make to much insulin? Michelle__Mark__and_Marlena: You're right that an over production of insulin can cause a low blood sugar. This is called hypoglycemia. Many people with Diabetes experience these episodes when they overshoot their targeted blood sugars while trying to drive down an elevated blood sugar. However, some people who are not on diabetic medications also develop hypoglycemia. This may be an indicator of a faulty pancreas (the organ that naturally secretes insulin). But is may also be a symptom of other medical conditions like certain cancers, serious illnesses, or hormone deficiencies. Your wife should be seen by a doctor to determine the cause of her low blood sugars. While awaiting her appointment with the doctor, I think it would be a good idea to continue to monitor her blood sugars at different times of the day, particularly noting how long after eating the test was done. This will be valuable information to take with you to that visit. Many people with chronic hypoglycemia seem to do better on smaller more frequent meals ( 6 small meals, about every 2-3 hours) than the traditional 3 meals per day. You may also purchase a small travel size of glucose tablets to keep with you in case an episode occurs away from home. One or two of these tablets cause a rapid rise in blood sugar in only a few minutes (3-10 min) knoxville__tn: is it true that if you do not have hair on your toes that you do not have good circulation in your feet? Michelle__Mark__and_Marlena: Hair loss on the toes may be a sign of poor circulation, but it`s not the only one. Poor circulation in the foot may be detected by a lack of a pedal pulse (large vessel that runs along the top of the foot) A pale color of the foot when elevated may also be observed. Other symptoms of poor circulation include: cold feet, thinning or shiny skin, blue toes, dark red feet, or slow healing ulcers. Prompt attention to these signs is essential to maintain healthy feet. Early and aggressive treatment of circulation problems in the feet can prevent amputations. If you are ever unsure about the condition of your feet, see your doctor immediately! It`s better to be safe than sorry.
Brooklyn__NY: Hello I'd like to know what type of doctor should I look for to help me treat my high blood sugar problem? I'm trying to find a doctor online but I don't know what type of doctor exactly please respond ASAP thank you very much. Michelle__Mark__and_Marlena: A general doctor or internal medicine doctor is normally very experienced in dealing with Diabetes. For a specialist; an endocrinologist specializes in all endocrine disorders, which includes diabetes. That's it for today. Thanks so much for taking the time to be here Marlena, Mark and Michelle. Thanks to all of you who joined us by asking great questions or by just tuning in. If you wish to continue any of today's discussions please feel free to visit the ADA Message Boards. Keep up to date with all the ADA Live events and reference the archives here. We hope you found this interesting and informative and that you'll join us again next time here at ADA Live. Our guest will be Rite Aid Pharmacists and diabetes experts, will discuss and answer your questions on all aspects of diabetes at 1:00 p.m. EDT Thursday, March 6, 2008. See you then. |
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