Ask the Pharmacist Archive
- My 4 year old has diabetes and complains about pains in both legs, is that cause for concern?
- Three days ago my doctor told me I have diabetes. He said the test was an 8, and the maximum is 6. He put me on 850mg of metformin 3x a day. He also said I was to avoid ALL sugar, even bananas and fruits. He will see me in a month. I "guess" I have type 2 diabetes. Is eliminating all fruits rare?
- I've been on the same medication for type 2 diabetes for 11 years. Should I change my medications since I'm having a hard time keeping my numbers in check?
- Is a blood sugar level of 359 an indication of diabetes or prediabetes?
- Can Januvia® be used for children with type 1 diabetes? Can it be used with insulin?
- What is the interaction between metformin and levothyroxine?
- My wife has type 2 diabetes and was prescribed metformin. She has been taking 500mg twice a day. Recently she has begun to lose a lot of weight and is tired all of the time. She dose not have an appetite and has a bad taste in her mouth if she does eat. Is this to be expected with this medicine? What should we do?
- I take oral medication for my diabetes and they say I may have to take insulin and still take the oral medication, is that ok? I sometimes have lows and I am afraid if I take oral and insulin I may have a lot of lows?
- My medication was changed to Lantus® and Novolog® pens. It costs me over $300 for these meds plus needles. Are there assistance programs available? I do have insurance.
- I am 41 years old and was wondering what the range is for normal blood sugar. I was diagnosed last August when I went into the hospital with an abscess on my back. I don’t have an appointment until June 30 and my sugar levels vary from time to time.
- I cannot get a drop of blood from my fingertip. I was just diagnosed as type 2 diabetes. What else can I do?
- I am taking the diabetes medications Janumet® and gliclazide. I recently started taking green coffee bean extract. Is it OK to take green coffee extract with my regular diabetes medicine? I started to take green coffee bean extract to help me lose weight.
- I'm hearing a lot of negative things about Byetta®, I have been taking it for almost two years and my wife is really concerned. Is the negative info accurate and, if so, what are my options for a Byetta replacement?
- I was recently diagnosed with type 2 diabetes. After 4 weeks of metformin 2x/day and diet and exercise, my fasting glucose tests were below 120. Now with some family stress, the last 2 readings were 129 and 131. Does stress increase glucose levels?
- My son has type 1 diabetes and is suffering with allergies. What allergy medicine is safe for him to take? Zyrtec® is what he usually would take, is that still safe?
My 4 year old has diabetes and complains about pains in both legs, is that cause for concern?
Leg pain can have varying causes. Injuries, muscle cramps, and growing pains are common causes of leg pain in children. We would suggest consulting with your child’s physician to determine the cause.
Three days ago my doctor told me I have diabetes. He said the test was an 8, and the maximum is 6. He put me on 850mg of metformin 3x a day. He also said I was to avoid ALL sugar, even bananas and fruits. He will see me in a month. I "guess" I have type 2 diabetes. Is eliminating all fruits rare?
Fruit is a healthy food which contains fiber and many vitamins and minerals. However, fruits contain carbohydrates, which can affect your sugar levels, and need to be included in your meal plan. We suggest speaking with your physician or dietitian concerning the amount, frequency and types of fruits you can eat.
I've been on the same medication for type 2 diabetes for 11 years. Should I change my medications since I'm having a hard time keeping my numbers in check?
In general, oral medications may be added, changed or a dosage adjustment may be necessary if a patient is unable to reach their glucose goals with their current therapy. When treatment with lifestyle modification and one or two oral agents fail, insulin therapy may be introduced. It would be best to consult with your physician regarding your concerns since treatment of diabetes is customized to each individual patient and many factors are taken into account when a physician initiates a treatment plan.
Is a blood sugar level of 359 an indication of diabetes or prediabetes?
The answer to this would depend on what test was given and when. In order to diagnose diabetes your physician must complete at least one of the following blood tests: a fasting plasma glucose test, an oral glucose tolerance test, an A1C test, or a random plasma glucose test. The results will determine if you have impaired glucose tolerance (IGT), also known as pre-diabetes (a relatively high risk for the future development of diabetes), diabetes, or are normal.
• The fasting plasma glucose test measures the blood glucose level first thing in the morning after a person does not eat (fasts) for at least 8 hours (usually overnight). The fasting plasma glucose test defines pre-diabetes as blood glucose levels between 100 and 125 mg/dl and diabetes as blood glucose levels at 126mg/dl or above. The normal fasting blood glucose level is less than 100 mg/dl.
• The oral glucose tolerance test measures blood glucose levels first thing in the morning after a person fasts and then again 2 hours after the person ingests a drink that contains glucose. With this test, pre-diabetes is defined as a 2-hour blood glucose level between 140 and 199 mg/dl and diabetes as a 2-hour blood glucose level at 200mg/dl or above. A normal 2 hour blood glucose level is less than 140 mg/dl.
• The A1C test measures the percentage of glycated hemoglobin, or HbA1C, in the blood. This test measures the average blood glucose over the past 2-3 months. With this test, pre-diabetes is defined as an A1C range of 5.7-6.4% and diabetes as a reading of ≥ 6.5%.
• The random (or casual) plasma glucose test is taken at any time, regardless of the timing of the last meal. A person with classic symptoms of hyperglycemia (excessive thirst, frequent urination, weight loss, sometimes with extreme hunger, and blurry vision) or hyperglycemic crisis (condition of extremely high blood glucose levels requiring emergency care) can continue to be diagnosed with a random plasma glucose test. A level of 200mg/dl or higher in these patients indicates a diagnosis of diabetes.
It is at the physician’s discretion and the availability and practicality of the tests to determine which is used to diagnose diabetes. Patients with test results diagnostic of diabetes (who do not have symptoms of hyperglycemia or hyperglycemic crisis) should have a repeat test to rule out laboratory error and confirm the diagnosis.
If you are concerned about developing diabetes, that you have diabetes, or are having any of the symptoms of diabetes, we recommend that you speak with your doctor for an examination and appropriate testing.
Can Januvia® be used for children with type 1 diabetes? Can it be used with insulin?
Januvia is a medication that, along with diet and exercise, helps lower blood glucose levels in adults with type 2 diabetes. It is not approved for use in children by the Food and Drug Administration (FDA). Januvia can be used with insulin; however, the incidence of hypoglycemia (low blood sugar) is increased when Januvia is added to insulin therapy and a lower dose of insulin may be needed to decrease the risk of hypoglycemia. Please consult with your physician regarding the use of these products together.
What is the interaction between metformin and levothyroxine?
Although an interaction is possible, metformin and levothyroxine are often safely used together. However, as your low thyroid condition corrects with the use of a thyroid hormone (such as levothyroxine) changes in blood glucose may occur. We recommend monitoring your blood sugar periodically and alerting your physician to any changes; especially when therapy is added, dosage is changed, or a product is discontinued, as your diabetes medication may need to be adjusted.
My wife has type 2 diabetes and was prescribed metformin. She has been taking 500mg twice a day. Recently she has begun to lose a lot of weight and is tired all of the time. She dose not have an appetite and has a bad taste in her mouth if she does eat. Is this to be expected with this medicine? What should we do?
Mild weight loss has been reported with metformin therapy along with taste disturbances, such as a metallic taste in the mouth. Metformin can also rarely cause a serious condition called lactic acidosis. Symptoms of this condition can be unusual tiredness, dizziness, severe drowsiness, chills, blue/cold skin, muscle pain, fast/difficult breathing, slow/irregular heartbeat, stomach pain with nausea, vomiting, or diarrhea. We suggest letting her physician know immediately of her tiredness so he/she can determine if it is due to this medication. If her side effects persist, the physician may need to lower her dosage or change her to another medication.
I take oral medication for my diabetes and they say I may have to take insulin and still take the oral medication, is that ok? I sometimes have lows and I am afraid if I take oral and insulin I may have a lot of lows?
Yes, when treatment with lifestyle modification and one or two oral agents fail, insulin therapy is typically introduced. While the thought of insulin may be scary, it is an effective treatment. You may need to increase the number of times per day you monitor your glucose levels to help prevent highs and lows from occurring. Please discuss your concerns about starting therapy with your healthcare provider. He/she can teach you how to recognize the symptoms of high and low glucose levels and how to treat these conditions should they occur.
My medication was changed to Lantus® and Novolog® pens. It costs me over $300 for these meds plus needles. Are there assistance programs available? I do have insurance.
Both product manufacturers offer assistance programs for the above mentioned medications; however, certain restrictions do apply. We suggest visiting each of the products websites where you will be able determine if you are eligible and enroll in their respective programs. Below are the links for the sites:
• Novolog: https://www.novolog.com/user/register.aspx?copay=true
• Lantus: https://www.lantus.com/sign-up/copay-registration.aspx?mo=1
I am 41 years old and was wondering what the range is for normal blood sugar. I was diagnosed last August when I went into the hospital with an abscess on my back. I don’t have an appointment until June 30 and my sugar levels vary from time to time.
General plasma/serum blood glucose level guidelines according to the American Diabetes Association (ADA) for non-pregnant people with diabetes are as follows:
• Before meals: 70-130 mg/dl (3.9-7.2 mmol/l)
• Peak after a meal (1-2 hours after the start of a meal): Less than 180 mg/dl (less than 10 mmol/l)
We suggest that you consult with your physician to determine what specific goals are appropriate for you.
I cannot get a drop of blood from my fingertip. I was just diagnosed as type 2 diabetes. What else can I do?
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.
I am taking the diabetes medications Janumet® and gliclazide. I recently started taking green coffee bean extract. Is it OK to take green coffee extract with my regular diabetes medicine? I started to take green coffee bean extract to help me lose weight.
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.
I'm hearing a lot of negative things about Byetta®, I have been taking it for almost two years and my wife is really concerned. Is the negative info accurate and, if so, what are my options for a Byetta replacement?
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.
I was recently diagnosed with type 2 diabetes. After 4 weeks of metformin 2x/day and diet and exercise, my fasting glucose tests were below 120. Now with some family stress, the last 2 readings were 129 and 131. Does stress increase glucose levels?
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.
My son has type 1 diabetes and is suffering with allergies. What allergy medicine is safe for him to take? Zyrtec® is what he usually would take, is that still safe?
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.
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