Living with Diabetes

Symptoms of hypoglycemia (low blood sugar) 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. Glucose tablets are a quick source of sugar and are used in the treatment of low blood sugar levels. We would suggest consulting with your physician for an examination and appropriate testing to determine why you are experiencing these symptoms and what the best treatment options would be. 

Metformin works by helping to restore your body's proper response to the insulin you naturally produce. It also decreases the amount of sugar that your liver makes and that your stomach/intestines absorb. It is thought that the chlorogenic acid component in green coffee affects how the body handles blood sugar and metabolism, thus promoting weight loss. Some research indicates that consuming green coffee extract (80-200mg/day) may cause modest weight loss over a period of 12 weeks; however, this research is of poor quality, short-term and in the very early stages. Other research implies 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. 

There are some instances where extend-release products may leave a “ghost tablet” in the stool. These tablets contain no medication and this is just the shell of the product. We are not aware of a product call “glimbset”; however, there is a medication for diabetes called Glyset® (miglitol). If this is the medication you are referring to, we could not find information that this product normally leaves a “ghost tablet’ in the stool. We would suggest contacting your physician to report this event as they may want to report this to the manufacturer. If this is not the medication you are referring to, please resubmit your question through our ”Ask the Pharmacist” service at www.riteaid.com and provide the names of the medications your husband is taking and we can further research to determine if any of them would leave a “ghost tablet” in the stool. 

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. Although the clinical significance is not known, melatonin may theoretically increase blood glucose levels in people with diabetes and it may decrease the ability of hypoglycemic medications, such as insulin, to decrease blood glucose. We did not see any information regarding the use of melatonin with levothyroxine. Please check with your physician to determine if this product is safe for you to use. If he/she does approve its use, make sure to check your glucose levels frequently.

Starlix (nateglinide) was approved by the Food and Drug Administration (FDA) in December of 2000 and is indicated for people with type 2 diabetes who have not been controlled by diet and exercise alone. Nateglinide is commonly used in combination with metformin, but it is not used as a substitute for metformin.

In the United States, the Center for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) provides recommendations regarding the routine administration of vaccines. The ACIP recommends that 2 or more “inactivated” vaccines may be administered at the same time or at any interval between doses. There are 2 pneumococcal vaccines currently on the market and both are “inactivated” products. The flu “shot” is also an inactivated product, so we would see no reason why these two products could not be given a few days apart. The ACIP does recommend waiting a minimum of 28 days between two or more “live” vaccines if they are not administered at the same time. We are unsure of why you would be instructed to wait a month between the above mentioned vaccines, unless there is an unforeseen circumstance we are not aware of. Please check back with the person making this recommendation to determine why they wanted you to wait a month between vaccinations.

Toprol (metoprolol) is a type of medication called a beta-blocker. Beta-blockers, such as metoprolol, can occasionally increase blood sugar levels. However, there are many other factors besides the metoprolol that may affect your blood glucose levels. Some of these factors could include diet, other medications, weight loss/gain, and medical conditions. Please consult with your physician to determine the cause of your rising glucose levels.   

Back pain is listed as an adverse reaction with Levemir (insulin detemir) therapy. Weight gain can occur with any type of insulin therapy; however, the benefits from improved glucose control usually outweigh the harmful effects of weight gain. In clinical trials, patients taking insulin detemir with type 1 diabetes did not experience appreciable gains in weight while patients with type 2 diabetes experienced less weight gain than those treated with NPH insulin.

Glyburide and metformin are oral medications, not insulin. At this time, insulin is only available as an injection. Glyburide lowers blood sugar by stimulating the pancreas to release more insulin.  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.

Metformin does not list blurred vision as an adverse reaction; however, high blood glucose levels can cause blurry vision which resolves when glucose levels are back in target range.  Since people with diabetes are at a higher risk for eye complications (i.e. glaucoma, cataracts, retinopathy) any visual changes should be reported to your eye care professional.  We suggest contacting your physician as soon as possible to report your blurred vision.

People with diabetes should never use hot water bottles, heating pads, or electric blankets. They can burn their feet without realizing it due to poor circulation and/or neuropathy (nerve damage). Many factors could be the cause of his leg cramps. We would suggest that he inform his physician about this issue so that he/she can determine the cause and come up with a proper treatment plan.

There are several programs which offer prescription assistance for patients without insurance coverage. 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 1-888-4PPA-NOW (1-888-477-2669) 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 1-800-444-4106 or obtain the form to enroll online at www.togetherrxaccess.com. Finally, you may also contact the manufacturers of your medications directly in order to obtain information about available patient assistance programs.

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 maximum dosage limits for an adult are 2550 mg/day for regular-release metformin tablets and oral solution; 2000 mg/day for extended release metformin tablets. Please remember, you should never adjust your dosage without the advice/consent of your physician.

Diabetes can cause changes in the skin of the feet, including severe dryness, peeling and cracking. This occurs because the nerves that control the oil and moisture in the feet may no longer work.  To help combat this issue, we suggest thoroughly drying the feet and sealing in the remaining moisture with a thin coat of plain petroleum jelly or an unscented hand cream after bathing. Remember not to put oils or creams between the toes; extra moisture there can lead to an infection. Your husband should be inspecting his feet every day. He should be looking for red spots, calluses, blisters, cuts and swelling. If he does have a foot injury, he should seek medical care early to help prevent further complications. In addition, make sure his physician checks his feet at least once a year, or more often if he has any foot complications.