Living with Diabetes

Having diabetes can increase the risk for magnesium deficiency; however, low magnesium levels are more common in people with poorly controlled diabetes.  Clinical studies using magnesium supplements in patients with type 2 diabetes or insulin resistance have had mixed results. According to our research, the best way to obtain necessary vitamins, minerals, and other nutrients is through a healthy diet. Many experts believe that the United States Department of Agriculture’s Food Pyramid is a helpful guide to healthy eating.  The pyramid consists of individualized guidelines regarding the recommended amounts of grains, vegetables, fruits, milk, and meat/beans that should be eaten daily. If you are concerned that you are not eating properly or lacking in any nutrients, please contact your physician for a proper evaluation and they can determine if supplementation is necessary. 

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. 

The answer to this depends on which type of diabetes you have. Patients with type 1 diabetes do not produce any insulin on their own and require permanent insulin treatment to control blood glucose.  Insulin therapy is one of many medication options for treating hyperglycemia (high blood glucose) in patients with type 2 diabetes.  Most patients will start with lifestyle modifications such as watching their diet, exercising and reducing stress, to help decrease glucose levels.  If these modifications are not enough to control blood glucose levels, oral (by mouth) medications are usually added.  When treatment with lifestyle modification and one or two oral agents fail, insulin therapy may be introduced. 

When taken in the amount recommended on the OTC package, Aleve (naproxen) should not pose a problem. However, rare reports of both hyperglycemia and hypoglycemia have been noted with its use. If you are using naproxen, we recommend that you monitor your blood glucose levels closely and notify your physician of any significant changes. If you are concerned that the naproxen affected your test results, make sure your physician is aware that you were taking this product and he/she can determine if retesting may be necessary.

There are many over-the-counter (OTC) cold and sinus medications available to help with symptoms such as nasal congestion and/or a runny nose, but some are not recommended for use in people with diabetes.  

Decongestants, such as pseudoephedrine and phenylephrine, may raise blood glucose levels. They should be used cautiously in people with diabetes and under the direction of a physician.  Saline nasal spray can be used to break up and clear nasal congestion and will not affect blood glucose levels.  

Antihistamines can help to dry nasal secretions and are generally safe for people with diabetes.  OTC antihistamines include diphenydramine, chlorpheniramine, brompheniramine, loratadine, fexofenadine and cetirizine. 

Please discuss your symptoms with your doctor or local pharmacist to determine which OTC products will best relieve your symptoms and will not interact with any medications you are currently taking. 

Test strips can be very expensive; however, it is very important to test your blood sugar as recommended by your physician. Do some research – strip costs can vary between companies and styles of meters.  You may be able to find a comparable meter with less expensive strips.  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 suggest checking with your physician to determine if you are 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.

Actos is a prescription medication used along with diet and exercise to improve blood sugar control in adults with type 2 diabetes.  Actos works by helping your body better use the insulin it makes and also by stopping your liver from making more sugar when it doesn’t need to. This allows the sugar in your blood to get to where it needs to be so it doesn't continue to build up in the bloodstream (causing high blood sugar).

It sounds like you may be injecting cold insulin – which can be painful.  The manufacturer of Lantus recommends that once you start using the Lantus SoloSTAR pen, you should keep it at room temperature only (below 86F).  Open Lantus vials can be refrigerated or kept at room temperature for 28 days after first use.  If you refrigerate the Lantus vial, remove it one to two hours before you inject.  After 28 days, throw your opened Lantus away, even if it still has insulin in it. 

Most insulin injections should not hurt; Rotation of the injection site within a given area from one injection to the next may help to reduce or prevent site pain. Most minor reactions to insulin usually resolve in a few days to a few weeks.

In some instances, these reactions may be related to factors other than insulin, such as irritants in a skin cleansing agent, cold insulin or poor injection technique. It is important to have the insulin at room temperature, rotate the injection sites and let the alcohol dry before injecting. We suggest consulting with your healthcare professional to review  your injection technique to see if there is anything you can change to ease the pain.  Other tips on how to help decrease pain on injection include the following:
•    Do not bend the needle when removing the cap.
•    Keep the muscles in the injection area relaxed during injection.
•    Never use needles more than once. Reusing a needle can bend or dull the tip, which will increase the pain, and could cause it to break off and become lodged in your skin.
•    Injection of larger insulin doses hurt more than injections of small amounts. If you are injecting a large dose, ask your doctor if you can try injecting more frequently throughout the day with a smaller amount of insulin.
•    Penetrate the skin quickly when injecting.
•    Avoid injecting into muscle by pinching up the skin before injecting and injecting into the fold of skin that is pinched up.
•    Speak with you doctor about using a different needle size or injection device and about injecting into other parts of the body.

Blood glucose (blood sugar) monitoring is the main tool you have to check your diabetes control. This check tells you your blood glucose level at any given time.  Monitoring helps you find out what happens to your blood glucose when you eat certain foods, when you exercise, or when you lose or gain weight. Additionally, it helps you see what happens to blood glucose when you take diabetes medication or insulin, are sick, or are emotionally upset. Keeping a log of your results is vital.  Self monitoring of blood glucose levels is the best way to know if you are reaching your goals. The more you check, the more you learn, which will help you and your health care team find a diabetes care plan that is best for you. Always write down your blood glucose readings and share them with your health care team.

The decision on how often to check your blood glucose and what times of the day to test is up to your health care team.  It is important to follow his/her recommendations.  In general, a person with type 1 diabetes should test at least 3-4 times a day whereas a person with type 2 diabetes should test 1-2 times a day or as necessary.  We recommend that you speak to your doctor to determine how often you should be testing your blood glucose each day.

You are correct; 2ml of Benadryl Children’s Allergy Solution (12.5mg/5ml) contains 5mg of the active ingredient diphenhydramine.

The blood glucose lowering effect of Actos (pioglitazone) can be enhanced by the concomitant administration of insulin. Although this interaction is possible, these drugs are sometimes used concomitantly. In general, if prescribing these products together, your doctor should initiate the lowest dose of pioglitazone possible and increase it gradually after several months of therapy. Both pioglitazone and insulin dosages may need to be adjusted based on individual response.  The risk of edema (swelling), weight gain, or congestive heart failure is increased when higher doses of pioglitazone are used in combination with insulin in patients at risk of heart failure. If your physician has prescribed these products together, you should monitor your glucose levels closely and if you experience rapid weight gain, swelling of the legs or ankles, or develop shortness of breath, contact your physician immediately.

Being diagnosed with pre-diabetes should not stop you from enjoying a wide variety of foods. People with diabetes have the same nutritional needs as anyone else. You should educate yourself on eating well-balanced meals in the correct amounts and staying fit. There is a wealth of information on the American Diabetes Association (ADA) website regarding food and fitness. Visit http://www.diabetes.org/food-and-fitness/food/ to find recipes and tips on what you should eat and meal planning. We recommend that you contact a registered dietician for assistance with diet and meal planning. They can help develop a meal plan that is suitable for you, and determine the appropriate daily amount of sugar, carbohydrates, calories, etc. based on your individual needs.

We would not expect amoxicillin to affect your glucose levels; however, there could be other factors causing these high glucose readings. First, infection causes stress on the body and 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, 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.  Secondly, if you are testing your urine for glucose (not your blood), it is recommended to use glucose tests based on enzymatic glucose oxidase reactions while on amoxicillin treatment because false-positive reactions for glucose in the urine have been observed with other types of urine tests. It is usually recommended to finish the entire course of antibiotic therapy unless you are experiencing an allergic reaction or other serious side effects. Please consult with your physician to determine your best course of action.

Humulin R, Humulin N and Humulin 70/30 insulin VIALS should be stored in the refrigerator when not in use.  When they are in-use (opened), they can be stored unrefrigerated, as long as they are kept as cool as possible.  When unrefrigerated, the vial must be used within 31 days or discarded (even if there is insulin left in the vial). Please make sure to follow the specific storage guidelines provided by the manufacturer of the particular insulin product you are using.

Physicians initiate metformin therapy with low doses to help minimize frequent side effects such as diarrhea, nausea and headaches.  These side effects tend to decline with continued use.