Living with Diabetes

There is some evidence to support the use of chromium in diabetes.  Because chromium may decrease blood glucose levels, there is an increased risk of hypoglycemia (low blood glucose) when it is combined with other diabetes medications such as metformin. If your physician approves the use of chromium, you should monitor your blood glucose levels closely. Dose adjustments to your medication may be necessary. It is important to remember that, 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.                          

Over the counter pain relievers approved for use in children include acetaminophen and ibuprofen. Both are effective for treating headaches and each person may respond differently to a particular product. Select the product that works best in treating your son’s headaches. When choosing a product, be sure to check the list of inactive ingredients because many formulations contain some form of carbohydrate content which can affect blood glucose levels. Illness can also cause fluctuations in blood glucose levels; make sure your son is monitoring his levels frequently while not feeling well and while taking over the counter products.

Lantus starts to lower blood glucose approximately 1.5 hours after it is injected, and lasts about 24 hours. It may take a few months and several dose adjustments to find the dose of Lantus that is right for you. Continue to take your medication and test your blood glucose as directed, and be sure to report any episodes of consistently high or consistently low blood glucose levels to your doctor.

Peak postprandial plasma glucose levels occur 1-2 hours after the beginning of the meal, so testing 90 minutes or 2 hours after a meal are both appropriate. In general, the recommended postprandial glucose level for non-pregnant adults with diabetes is less than 180 mg/dL. More or less stringent goals may be recommended for some people.

Consult your doctor to determine the level appropriate for you.

• The Partnership for Prescription Assistance (PPA) which was 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 888-4PPA-NOW (888-477-2669) or through the Internet at www.pparx.org.
• The Together RX Access program 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 800-444-4106 or obtain the form to enroll online at www.togetherrxaccess.com.
• The Rite Aid Rx Savings Card and prescription savings program provides eligible Rite Aid customers the ability to save money on their prescription drugs immediately at the time of service with no enrollment fee.  You may contact your local Rite Aid store, our Customer Service department at 800-RITEAID (800-748-3243) or visit www.riteaid.com/pharmacy/rx_savings.jsf for further information.

You may also contact the manufacturer of your medication directly in order to obtain information about available patient assistance programs.

If lifestyle modifications, such as diet and exercise, are not enough to control blood glucose levels, oral (by mouth) medications are usually added. Metformin is typically the first line treatment after lifestyle modifications and then additional oral medications may be added if the patient is unable to reach their glucose goals. When treatment with lifestyle modification and one or two oral agents fail, insulin therapy may be introduced. While the thought of insulin may be scary, it is an effective treatment. Discuss your concerns about starting therapy with your healthcare provider. With proper training your fears should be alleviated. Insulin pens, smaller needle tips and adjustable lancing devices help ease managing diabetes with insulin.  
 

According to the 2011 National Diabetes Fact Sheet, 25.8 million children and adults in the United States (8.3% of the population) have diabetes. After adjusting for population age differences, the 2007-2009 national survey data for people diagnosed with diabetes, aged 20 years or older include the following prevalence by ethnicity:
•    7.1% of non-Hispanic whites
•    8.4% of Asian Americans
•    12.6% of non-Hispanic blacks
•    11.8% of Hispanics

According to our references, beet juice is considered to be “likely safe” when consumed in amounts commonly found in foods. We could not locate any information regarding its effect on people with diabetes or on sugar levels; therefore, we would recommend monitoring your blood sugar levels if you choose to consume beet juice.

Medications known as beta-blockers, such as propranolol, may interfere with the actions of some diabetes medications, including Amaryl. Beta-blockers can mask the symptoms of low blood sugar. If your physician has decided that taking these medications together may benefit you, make sure to check your blood sugar levels regularly and learn to recognize the signs of low blood sugar. Having a sulfa (sulfonamide) allergy is not a contraindication with Amaryl, but the medication should be used with caution. It is recommended that people with a history of hypersensitivity to sulfonamides be monitored for a reaction; however, treatment with a nonantibiotic sulfonamide (such as Amaryl) may not need to be withheld as long as the person is monitored appropriately.

Taking penicillin by mouth should not affect your blood sugar levels. However, it is important to remember that when people are sick the body is under stress. During this time, hormones are released to help fight disease and to deal with the stress. These hormones can raise blood sugar levels and affect the action of insulin. Therefore, when you are sick, you may have a more difficult time keeping your blood glucose levels within target range. During times of illness, it is important to monitor your blood glucose levels and urine ketones more frequently. Ketones are more likely to build up when you are sick and lead to a condition called ketoacidosis. You should contact your doctor immediately if your blood glucose levels remain high and/or you test positive for ketones in your urine. Often an increase in your insulin is needed. We recommend talking to your physician about developing a “sick day plan” before you become ill.

Type 1 diabetes is usually diagnosed in children and young adults, and was formerly called juvenile diabetes. When someone has type 1 diabetes, their body does not produce any insulin. Type 2 diabetes is the most common form of diabetes. In people with type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin that the body produces. Tests can be run to determine the type of diabetes. Ketones in the urine suggest type 1 diabetes and blood tests can check for autoantibodies that are common in type 1.

Metformin belongs to the class of drugs known as biguanides. It works by helping to restore the body's proper response to the insulin it naturally produces and by decreasing the amount of sugar that the liver makes and the stomach/intestines absorb. Metformin is the only medication in the biguanide drug class. Metformin is recommended as the initial therapy in the prevention of diabetes and as an initial medication, in addition to diet and exercise, in the treatment of many patients with type 2 diabetes. Gastrointestinal side effects are the most common in people taking metformin. These side effects tend to decline with continued use and can be minimized by starting therapy with a low dose and titrating up gradually. We would suggest that your father-in-law speak with his physician to determine if another type of diabetes medication would be appropriate, or if his dosage could be decreased.

There are 2 types of long-acting insulin products on the market, Lantus and Levemir®. Both products are available in both a vial and a pen. In most cases, the vial form of a product is less expensive than the pen formulation; however, keep in mind that you will need draw up the insulin dose and purchase syringes for the injection. Check with your local store for pricing comparisons on these products. We did find that Lantus Solostar offers a patient support service called Sanofi Patient Connection™. This service can assist in helping patients find additional services and resources such as copay assistance and prescription savings programs. You can reach this support center at 1.888.847.4877 Monday through Friday from 9am-8pm EST.  

Acarbose works by slowing the breakdown of starch (carbohydrates) from the food you eat into sugar, so that your blood sugar level does not rise as much after a meal. 

There are numerous products available to help with the symptoms of colds; however, some of these products can interfere with diabetes. 

Decongestants containing pseudoephedrine or phenylephrine can worsen diabetes control and should not be used unless directed to do so by a physician. Alternatives to decongestants include nasal strips and saline nasal spray. When properly applied, the strip can open the nostrils slightly, and may be sufficient to allow airflow through the nostrils. Saline nasal spray may be used to help break up and clear nasal congestion. If a nasal decongestant is needed, propylhexedrine (e.g., Benzedrex Inhaler) is not contraindicated with diabetes and may be effective.

Antihistamines may help in drying and relieving congestion. These products are available OTC and include diphenhydramine, chlorpheniramine, brompheniramine, loratadine, cetirizine, clemastine, and fexofenadine. (Please note: brompheniramine is available OTC only in combination products and as a single agent by prescription). None of the OTC antihistamines are known to worsen diabetes control.      
                                                                       
Guaifenesin is an expectorant available OTC for facilitating the thinning and removal of bronchial secretions.  Guaifenesin is not known to affect diabetes and is useful for productive coughs (a cough in which you bring up phlegm).                     

Dextromethorphan is a cough suppressant available OTC for the relief of a dry, hacking cough. This product should not be given for a productive cough, unless the cough is disrupting sleep at night. This product is not expected to interfere with diabetes. 
                                                                      
It is important to also check the inactive ingredients of cough and cold medications. 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 an alcohol-free preparation to minimize the impact on blood glucose levels. Have your husband check with his doctor or pharmacist before adding any over the counter product to his current drug regimen.