Living with Diabetes

Many manufacturers of insulin or other diabetes medications/supplies have patient assistance programs. However, most of these programs are only available through a physician. We would suggest having her check with her physician to determine if she is eligible. In addition, The Pharmaceutical Research and Manufacturers of America, and its member companies, sponsor an interactive website with information about drug assistance programs at www.PPARx.org.

Since programs for the homeless sometimes provide aid, another option is to contact a shelter in your area to determine if they have information regarding how to obtain financial assistance with medical supplies. The number of the nearest shelter may be listed in the phone book under Human Service Organizations or Social Service Organizations.

Singulair (montelukast) is a prescription medication used to relieve symptoms of indoor and outdoor allergies, prevent asthma attacks and for the long-term treatment of asthma in adults and children 12 months and older. The prescribing information for Singulair does not list any contraindications, precautions, or warnings concerning people with diabetes.

Sudafed (pseudoephedrine) is a different medication than Singulair.  It is a decongestant and is not recommended for those with diabetes.  If a decongestant is needed for treatment, a topical decongestant product is usually preferred.  Talk to your daughter’s doctor to determine the appropriate treatment for her condition.

When a physician prescribes Zyprexa (olanzapine) they should consider the risks and benefits in patients who currently have diabetes or in patients who have borderline increased blood glucose (sugar) levels (fasting 100-126 mg/dL, non-fasting 140-200 mg/dL). While taking olanzapine, patients should be monitored regularly for worsening of glucose control. Patients starting treatment with olanzapine should undergo fasting blood glucose testing at the beginning of treatment and periodically during treatment. They should also be monitored for symptoms of high blood glucose (hyperglycemia) such as excessive thirst, frequent urination, excessive eating, and weakness. If you develop any symptoms of hyperglycemia during treatment, you should undergo fasting blood glucose testing. In some cases, the hyperglycemia resolves when the olanzapine is discontinued; however, some patients required continuation of anti-diabetic treatment despite discontinuation of the suspect drug.

Blood glucose levels are usually reported in mg/dL and “normal” fasting blood glucose levels are usually less than 100 mg/dL.  If you are referring to your A1C when you state that your BSL is sometimes 6, 5, 4 or 3, then those numbers would be good.  One of the American Diabetes Association’s (ADA) criterion for the diagnosis of diabetes is an A1C of 6.5 or higher.

Some of the symptoms you are experiencing, such as dry mouth and frequent urination, could be a side effect of the medication itself and may not be indicative of diabetes. We suggest letting your physician know about the symptoms you are experiencing so he/she can determine the proper cause and treatment options.

We contacted Mission Pharmaceuticals, the manufacturer of CitraNatal Assure, and they stated that they would not expect this product to cause hyperglycemia (high blood glucose levels). Gestational diabetes is a type of diabetes that only develops during pregnancy, usually disappears upon delivery and affects about 18% of pregnancies. It is usually diagnosed around the 24th week of gestation. This diagnosis doesn't mean that you had diabetes before you conceived, or that you will have diabetes after giving birth; however, having it does increase the risk that the mother will develop diabetes later in life. Make sure to follow your physician’s instructions for a safe and healthy pregnancy for both you and your baby.

Headache is a listed adverse reaction for glipizide and occurs in approximately 2% of patients taking the immediate release product and 8.6% of patients taking glipizde XL. Some experts feel that neurologic type side effects such as this could be due to decreased blood glucose (sugar) levels. These symptoms are usually transient and rarely require discontinuation of treatment; however, if the headaches persist you should inform your physician.  If the headaches are from the medication, sometimes decreasing the dosage can alleviate them. Do not adjust your dosage without the consent of your physician.

Metformin is no longer contraindicated in heart failure patients; however, it does carry the warning that patients with congestive heart failure (CHF) requiring medication therapy, in particular those with unstable or acute CHF who are at risk of hypoperfusion (decreased blood flow) and hypoxemia (low oxygen levels), are at an increased risk of lactic acidosis. Lactic acidosis is a serious (sometimes fatal) condition.  Symptoms include unusual tiredness, dizziness, severe drowsiness, chills, blue/cold skin, muscle pain, fast/difficult breathing, slow/irregular heartbeat, stomach pain with nausea, vomiting, or diarrhea.

When metformin is used in these patients, close monitoring for exacerbations of CHF is vital. In patients who experience an exacerbation of CHF, a temporary discontinuation of metformin therapy may be needed until the exacerbation is resolved.

It is very important to follow your insulin regimen exactly as directed.  Do not miss any doses or take more insulin than prescribed.  If you have injected too much insulin, you are at risk for developing hypoglycemia (low blood sugar). Since Lantus is a long-acting insulin, we would suggest monitoring your blood glucose levels for 24 hours and talk to a member of your health care team about any changes in your diabetes management that may be needed for the day. 

As always, watch for signs/symptoms of hypoglycemia which include shakiness, dizziness, inability to concentrate, headache, sweating, hunger, fast or pounding heart rate, fatigue, paleness, weakness, fainting, sudden moodiness or behavior changes, tingling sensations around the mouth, clumsy or jerky movements, and vision changes.  If your blood glucose drops very low you may develop slurred speech, confusion, seizures, or pass out.  It is important to remember that your warning signs may be different from those of someone else who has diabetes. You may even have low blood glucose levels without any warning signs, especially if you have had diabetes for a long time or are taking certain heart medications that hide these symptoms.

It is important to know the symptoms of hypoglycemia and treatment options in order to prevent worsening of hypoglycemia. Contact your physician to develop a plan on how to handle hypoglycemic episodes.  Additional information on the treatment of hypoglycemia can be found at www.diabetes.org. 

The use of Devil's Claw may decrease blood glucose (sugar) levels and have additive effects with diabetes medications. Before taking this product, please have your father consult with his physician.  While using this supplement (if approved by the physician), your father should monitor his blood glucose levels closely and report the results to his doctor. Dosage adjustments in his medication therapy may be necessary.

Some people with diabetes experience high before-breakfast blood glucose levels due to hormones released in the middle of the night.  This is known as the dawn phenomenon and occurs when hormones trigger the liver to secrete glucose into the blood. If there is insufficient insulin to combat the glucose, blood sugar levels rise. Typically, the blood glucose level rises between 4 AM and 8 AM. Check your blood glucose level in the middle of the night (around 3 AM). If your blood sugar is high, you may be experiencing the dawn phenomenon.

If your blood sugar is low around 3 AM, you may be experiencing the Somogyi effect and rebound hyperglycemia.  Long-acting insulin or skipping your bedtime snack can result in extra insulin in the blood before bedtime.  Low blood glucose levels at night trigger your body to release hormones, which cause the liver to release glucose into the blood.  This defense mechanism against low blood sugar can result in high glucose levels.  It would be best to discuss your blood sugar results with your physician to determine if any adjustments in your current treatment are needed.

To help prevent eye complications, the American Diabetes Association (ADA) recommends contacting an eye care professional if any of the following occur:

•    blurry vision
•    trouble reading signs or books
•    seeing double
•    pain in one or both eyes
•    reddening of the eyes that does not go away
•    pressure in the eye
•    seeing spots or floaters
•    noticing straight lines do not look straight
•    decrease in peripheral vision

Metformin does not list eye discomfort as a side effect.  We recommend contacting your father’s eye care professional.

According to the Centers for Disease Control and Prevention (CDC), diabetes was listed as the underlying cause of death on 71,382 death certificates and was listed as a contributing factor on an additional 160,022 death certificates in 2007. This means that diabetes contributed to a total of 231,404 deaths. Overall, the risk for death among people with diabetes is about twice that of people of similar age but without diabetes.

According to the Pittsburgh Epidemiology of Diabetes Complications (EDC) study, the life expectancy at birth for someone diagnosed with type 1 diabetes between 1965 and 1980 was estimated to be 68.8 years compared to 72.4 years for the general population. However, for people diagnosed with type 1 diabetes between1950 and 1964 the estimated life expectancy at birth was just 53.4 years. This increase in life expectancy is thought to be due to the improvements in diabetes care throughout recent years.

Metformin works by decreasing the amount of sugar that the liver produces and the intestines absorb. It also helps to make your body more sensitive to the insulin that you naturally produce.  It is not uncommon to see metformin used with other medications to gain better blood sugar control in patients with type 2 diabetes.

A sliding scale is a set of instructions for adjusting insulin on the basis of blood glucose test results, meals, or activity levels. Since these are based on individual results, only a member of your healthcare team (i.e. physician, diabetes educator) can develop a sliding scale regimen for your specific needs. 

A physician is the best person to determine when a person with type 2 diabetes should consider initiating insulin therapy.   One of the major determining factors is when a person with diabetes can not maintain their A1C at 7% or below with their current therapy.  This can be due to the progressive loss of beta cell function (beta cells are cells in your pancreas that produce insulin).  Other factors that may lead to the initiation of insulin therapy may include:

•    Liver disease
•    Kidney disease
•    Cardiovascular disease; congestive heart failure 
•    Overeating or excessive weight gain
•    Acute infections or serious illnesses
•    Pregnancy
•    Major surgery
•    Other medications (e.g. steroids, psychiatric medications)