Living with Diabetes

There are several blood glucose meters on the market that require only a tiny (0.3 – 1.5 mcL) blood sample. Because there are so many factors to consider when selecting a blood glucose meter, it is best to consult your local pharmacist for assistance. He/she can determine your needs (e.g. small blood sample, alternate site testing, display size, cost, etc.) and identify the best meter for you. 

Below are some tips for obtaining a blood sample from the finger.
a. Rub the hands together under warm water. Let the arm from which the sample will be taken hang down for 10-15 seconds. This will help stimulate blood flow to the finger tips.
b. Gently squeeze the finger for 3 seconds in the area where the sample will be taken.
c. Place the finger on a table or sturdy surface to avoid moving when pricking the finger with the lancet device.
d. If lancet device has depth settings, try setting at the next depth. If set too shallow, the device may not be puncturing deep enough to get blood.
e. Choose a different site on the fingers each time a blood sample is taken. Obtain samples from the sides of the fingers, not the tips or center where more nerve endings are found resulting in increased pain. Choosing the same site each  time can also lead to the formation of calluses, making it difficult to obtain a blood sample.

There are some meters on the market which allow for a blood sample to be taken from the forearm, upper arm, palm, thigh, or abdomen, instead of the fingertips. In general, studies have shown that the results of alternate site testing correspond well with fingertip testing. However, glucose utilization is faster in the fingertips than other sites, such as the arm. Alternate site readings may lag behind when glucose levels are rising rapidly (such as the first hour after a meal) or falling rapidly (as may occur immediately after exercise). This could lead to delayed detection of hypoglycemia or recognition of sharp changes in blood glucose levels.

If you choose to perform alternate site testing, it is important to remember that while blood from your fingertip can be tested at any time, there are times when alternate site testing may not give you the most accurate result due to the “lag time”. Alternate site testing should only be used when blood sugar is stable, such as when you are fasting, immediately before a meal, and near bedtime. You should always use fingertip testing when blood sugar may be changing (e.g. after exercise, following a meal, when you think blood sugar is low).

If you're considering alternate site glucose testing, please remember:
• Never ignore the symptoms of low or high blood sugar.
• If the results of an alternate site blood test don't match the way you feel, confirm with a fingertip test. If the fingertip result still doesn't seem to reflect the way you feel, get in touch with your doctor.
• Check your meter’s manual to determine if it allows for alternate site testing.

Some research suggests that the caffeine contained in green coffee could alter how people with diabetes process sugar. Caffeine has been shown to cause both increases and decreases in blood sugar levels. By increasing blood sugar, green coffee might decrease the effectiveness of diabetes medications. We would not recommend the use of this product until further studies have been completed. If you choose to use green coffee extract, please do so with caution and monitor your blood sugar carefully.

Serious side effects can occur while taking Byetta. The adverse event from this medication which as been in the news is pancreatitis (inflammation of the pancreas) which can be severe and lead to death. The manufacturer does list this in the Important Safety Information section of the package insert and states that you should call your physician right away if you have pain in your stomach area that is severe and will not go away. The pain may happen with or without vomiting and may be felt going from your abdomen to your back.

Byetta belongs to a class of drugs known as incretin mimetics. The only other products currently available in this same class of medications are Victoza® and Bydureon®. Bydureon is a long-acting form of Byetta that is given only once per week. Victoza is given once daily and is used in conjunction with healthy eating and exercise to help manage diabetes. It may be used alone or with other diabetes medications, including biguanides (metformin), sulfonylureas, or thiazolidinediones. It is important to note that ALL of these medications have warnings about pancreatitis; however, it rarely occurs. Bydureon and Victoza also have warnings about possible thyroid tumors; although, these have only been seen in rodents. We suggest discussing your concerns with your physician to determine if you should remain on Byetta or switch to another therapy regimen.

Stress on the body can interfere with blood glucose control. Hormones, which are released to help fight the infection and deal with the stress, can raise blood sugar levels and affect the action of insulin. Therefore, during an illness or other stressful time, you may have a more difficult time keeping your blood glucose levels within target range. It is important to monitor your blood glucose levels more frequently. 

Antihistamines may help in drying and relieving congestion. They are available over-the-counter (OTC) in combination products and/or single agent formulations and include diphenhydramine, chlorpheniramine, brompheniramine, doxylamine, clemastine, loratadine, cetirizine, and fexofenadine. None of the OTC single agent antihistamines are known to worsen diabetes control; therefore, Zyrtec (cetirizine) should be fine. Remember that it is important to also check the inactive ingredients of OTC medications, especially liquid preparations. Many formulations contain some form of sugar which can increase blood glucose levels. Additionally, many contain alcohol which can cause either increases or decreases in blood glucose levels. It is best to look for a sugar-free and alcohol-free preparation to minimize the impact on the blood glucose level.                                       

Unlike pharmaceuticals, "natural" products are not required to undergo the FDA (Food and Drug Administration) approval process to demonstrate their safety and effectiveness.  The FDA only regulates the package labeling, prohibiting a product from making claims that it is intended to diagnose, treat, cure, or prevent a disease. We could not locate any information regarding the use of this product in someone with diabetes; therefore, we do not recommend its use without the consent of a physician.                          

There are many factors that can cause leg cramps such as medications, muscle tightness, loss of potassium and restless leg syndrome. We would suggest informing your physician about this issue so that he/she can determine the cause and come up with a proper treatment plan.

Advil (ibuprofen) or Aleve (naproxen), when taken in the amount recommended on the over-the-counter (OTC) package, should not pose a problem in patients with diabetes. However, rare reports of both hyperglycemia and hypoglycemia have been noted with both products. If you are using these medications, we recommend that you monitor your blood glucose levels closely and notify your physician of any significant changes. In addition, check with your physician or pharmacist to make sure there are no drug interactions with your current prescription therapy and the OTC medication.

Yes, in fact, many people with type 2 diabetes need to try more than one type of treatment plan before they discover what works best for them. This treatment could include a single oral medication, a combination of oral medications, or oral medications plus insulin.

The risk of developing hypoglycemia with metformin is much less than with some other diabetes medications (i.e. sulfonylureas), but is possible. Hypoglycemia caused by metformin is usually mild and does not require discontinuation of the medication; it is more common when metformin is co-administered with other medications for diabetes.