Living with Diabetes

Nasal corticosteroids, like Nasonex, can be used to treat allergy symptoms such as congestion, sneezing, and itchy/runny nose, and are not expected to affect blood glucose levels. Antihistamines can temporarily relieve runny nose, sneezing and itching, and do not interfere with diabetes control. Decongestants help to relieve sinus congestion and pressure, but can interfere with diabetes control. Claritin-D contains loratadine (an antihistamine) and pseudoephedrine (a decongestant) and may cause changes in your blood glucose levels. A better option would be an antihistamine-only product such as Claritin® (loratadine). Other antihistamines available over the counter include diphenhydramine, chlorpheniramine, doxylamine, clemastine, cetirizine, and fexofenadine. Alternatives to decongestants include saline nasal spray and nasal strips. Saline nasal spray may be used to help break up and clear nasal congestion. Nasal strips are drug-free devices applied to the outside of the nose to gently open the nasal passages and improve airflow through the nose and relieve nasal congestion.

Drawing up insulin can be especially challenging for blind or visually impaired patients.  There are products available that can help. The Prodigy Count-a-Dose device draws up one unit of insulin at a time and makes a “click” sound with each increment. It can hold one or two bottles of insulin for easy mixing. For more information visit http://prodigymeter.com/?page_id=123. The Safe Shot Syringe Loader, by Borin-Halbich, can be adjusted to a particular dosage to allow you to draw up the same amount of insulin every time. It is appropriate for people on fixed dose regimens. For more information on aids for insulin users, go to  http://forecast.diabetes.org/files/images/v66n01_p62-65_0.pdf

There are many medications that may cause increases in blood glucose levels. Some examples include corticosteroids, select antipsychotics, certain water pills and blood pressure medications. If you would like a pharmacist to review your list of medications to determine if any can cause an increase in blood glucose, visit https://www.riteaid.com/pharmacy/chat-with-a-pharmacist to chat live with a Rite Aid pharmacist, or you may submit a question with a list of your medications through our secure message center at https://cms.riteaid.com.

Victoza (liraglutide) is similar to a hormone made naturally in the body called GLP-1 (glucagon-like peptide-1). When glucose levels are high after a meal, GLP-1 is released from the small intestine and stimulates the pancreas to release insulin. It also helps decrease the amount of sugar made by the liver. If your body does not make enough GLP-1 or isn’t using it correctly, you may not be getting the right amount of insulin needed to move glucose from the blood into the cells. Victoza acts like GLP-1 and may improve blood sugar in adult patients with type 2 diabetes when used along with diet and exercise. It is not recommended as the first medication to treat diabetes and is not for people with type 1 diabetes or people with diabetic ketoacidosis (accumulation of ketones in the blood and urine). For more information visit www.victoza.com.

The glycosylated hemoglobin (HbA1C or A1C) test measures the average blood glucose over the past 2-3 months. The American Diabetes Association recommends an A1C test be performed at least two times a year in patients with stable glucose levels who are meeting treatment goals. In people who are not meeting their glucose goals or have had a change in therapy, the A1C test should be performed quarterly.

Many manufacturers offer discounted or free products to eligible patients in need. Simply contact the manufacturer of your syringes to determine if a patient assistance program is available. The following are examples of some companies with syringe assistance programs: Becton Dickinson (1-866-818-6906) and Allison Medical (1-800-886-1618).    

Metformin is available in regular and extended release formulations. The maximum dosage limits for an adult are 2,550 mg/day for regular-release metformin tablets and oral solution; 2,000 mg/day for all extended-release tablets except Fortamet®, which has a maximum daily dose of 2,500 mg/day. Please remember, you should never adjust your dosage without the advice/consent of your physician.

It is not uncommon for a person with type 2 diabetes to be treated with more than one medication. When a person is first diagnosed with type 2 diabetes, lifestyle modification (e.g. healthy diet, weight loss, exercise) along with metformin (an oral medication) are generally prescribed. If glucose goals are not met after approximately 3 months, a second medication is usually added. This could be an oral diabetes medication, an injectable (non-insulin) diabetes medication, or insulin. If after 3 months the treatment goals are still not achieved, a third agent may be added. 

Glipizide is in a class of drugs called the sulfonylureas. Its structure is similar to that of the sulfa antibiotics. The use of glipizide is not contraindicated for people who are allergic to sulfa antibiotics, but caution should be exercised because an allergic reaction is possible. If you decide to try glipizide, your physician should monitor you closely. Be sure to report any symptoms of an allergic reaction to your doctor. Get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness and/or trouble breathing.

The FlexPen is a prefilled, dial-a-dose insulin pen by Novo Nordisk. There are 3 different types of insulin available in FlexPen:
•    Levemir® (insulin detemir) injection – a long acting insulin
•    NovoLog® (insulin aspart) injection – a rapid acting insulin
•    NovoLog® Mix 70/30 (70% insulin aspart protamine suspension and 30% insulin aspart) injection – a combination of rapid and longer acting insulin

Most companies offer financial assistance for patients. Contact the manufacturer of your insulin pump to inquire about available programs. Additional prescription assistance information is available at http://www.diabetes.org/living-with-diabetes/treatment-and-care/health-insurance-options/prescription-assistance.html

Flushing has been reported as a possible side effect of metformin. If the flushing is bothersome, notify your doctor. A change in therapy may be possible.

Loss of blood glucose control can be caused by a number of factors including a change in your diet or activity level, illness, stress, and/or other medications (side effect of a medication or drug interaction with your current medications). Another cause could be a change in your body’s insulin production or usage due to the fact that over time the pancreas doesn't produce insulin as well which can create a need for other medications and/or the addition of insulin. It is not uncommon for your medication needs to change over time. If you haven’t done so already, contact your doctor to report the change in your glucose levels. 

Adults with diabetes should aim for at least 30 minutes of exercise a day.  Although your family member is limited by her broken toes, she can still exercise while sitting in a chair or on the floor. Stretching exercises can stimulate blood flow to the muscles and keep joints loose. Resistance bands or small weights can be used while sitting to strengthen the muscles of the upper body. For a list of chair exercises, visit http://www.sitandbefit.org/chair_exercises_for_seniors. Please note: she should not begin any exercise program without the consent of her physician.

Smoking is harmful to your health, especially if you have diabetes, because smoking and diabetes cause many of the same problems. Many people with diabetes have artery disease; nicotine also causes artery disease by hardening and narrowing the blood vessels. This can reduce blood flow to different parts of the body. In addition, complications that can occur with both diabetes and smoking include: damage to the heart, increase in blood pressure, increase in cholesterol levels, eye disease, kidney disease, nerve damage and foot problems. For help with smoking cessation, visit https://www.riteaid.com/pharmacy/health-information/quit-smoking.