Living with Diabetes

The use of naproxen could affect glucose levels, although this is not common.  According to the manufacturer, hyperglycemia has been reported in <3% of patients and in <1% for hypoglycemia. If using naproxen, we recommend that you monitor your blood glucose levels closely and notify your physician of any significant changes.

Generalized Anxiety Disorder (GAD) is generally treated with psychotherapy, medications, or both. There are two types of medications commonly prescribed to treat GAD, anti-anxiety medications and antidepressants. There are many different products that fall into these categories and only your physician can determine which medication or combination of medications would be best to treat your condition.  If you have a list of your diabetes medications and the medication for GAD that your physician would like to consider, we can check for any drug or disease interactions for you.  Please resubmit your question with this information through our “Ask the Pharmacist” service at www.riteaid.com so that we can best answer your inquiry.

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.  According to our references, flaxseed oil is “likely safe” when used orally and appropriately for medicinal purposes on a short-term basis. These supplements have been used safely in studies lasting up to 6 months.  Patients with diabetes should use flaxseed with caution. Theoretically, flaxseed may have additive effects when used with medications for diabetes and could increase the chance of hypoglycemia. Monitor blood glucose levels closely. Before adding any product to your current drug therapy, please consult with your physician.

Diabetes is usually treated by a step-wise approach. The first step in the treatment of type 2 diabetes is often meal planning, weight loss, and exercise, along with medication. If tolerated and not contraindicated, metformin is usually the first-line oral agent prescribed.   After 3-6 months, if the patient’s A1C is not at an acceptable level, then other products may be added, based on the response of the patient.  These may include oral agents (e.g. glipizide), insulin, or newer medications like a GLP-1 receptor agonist.

Disposing of expired or unused medications can be a challenge. The Federal government Office of National Drug Control Policy and a National Public Awareness and Partnership Campaign collaboration between the U.S. Fish and Wildlife Service, the American Pharmacists Association, and the Pharmaceutical Research and Manufacturers of America), called SMARxT DISPOSAL™, have issued the following recommendations for the proper disposal of unused, expired, or unneeded prescription drugs.  These guidelines are designed to reduce drug diversion and to protect the environment.

The drug disposal guidelines urge Americans to:

• Remove the medications from their original containers and put into a plastic bag.
• If the medication is a solid (i.e. pill, liquid capsule, etc), add water to dissolve it. 
• Add an undesirable substance to the bag such as kitty litter, sawdust, coffee grounds, or any other material that mixes with the medication and makes it unpleasant for a child or pet to eat.
• Seal the plastic bag and put it in the trash.
• Remove and destroy any personal information on the original prescription container before recycling them or throwing them away.
• These containers can now be disposed of in the trash.  Wait to discard medication until trash pick up day.

Some areas of the country now offer pharmaceutical take-back locations.  Drugs are accepted at a central location for safe disposal.  To find a location in your area, contact your local city or county trash and recycling service which may be found in the blue pages of your phone book.  If possible, return unneeded, expired or unused medications to these locations.  In addition, throughout the United States, the DEA along with local law enforcement agencies is sponsoring National Prescription Drug Take Back Days www.deadiversion.usdoj.gov/drug_disposal/takeback/index.html. The DEA (Drug Enforcement Agency) does not allow the return of controlled prescriptions to the pharmacy. 

Rite Aid stores (except those in Maine) do participate in the Sharps TakeAway Environmental Return System.  This program provides a secure, convenient, environmentally friendly solution to handle the proper disposal of outdated or unused prescription or over-the-counter medications (excluding controlled substances).  Rite Aid sells the TakeAway envelope for $3.99.  Once purchased, you simply place your unwanted medication in the envelope, seal it, and place it in the U.S. mail.  The return shipping cost and handling charges are included in the purchase price.  Rite Aid cannot accept the return of filled envelopes.

The American Diabetes Association recommends that people with diabetes follow an individualized meal plan based on their lifestyle to manage diabetes and weight.  A registered dietician 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 recommend that you contact a registered dietician for assistance with diet and meal planning.

This “tattoo” is still in the early stages of development at Northeastern University in Boston. The medical tattoo being tested isn't a true tattoo. The prototype would use a single stick from a hollow needle to stain the first few layers of skin yellowish-orange for approximately one week. The yellow-orange dye contains tiny nanosensors which glucose is drawn into and would change color. If the amount of glucose increases, the color of the tattoo would become lighter. If glucose levels decrease, the tattoo would get darker. This change is not visible to the human eye, but a special handheld camera can notice the difference.

Researchers envision patients picking up a pen-like device from the pharmacy and self-administering the tattoo once weekly. To read the tattoo, patients would need a cell-phone sized reader, or possibly just a cell phone.  Human trials are still necessary before this would hit the market and this could take several years.

If you are unsure about the directions on your metformin prescription, please contact your doctor for clarification.  The usual starting dose of metformin tablets is 500 mg twice a day or 850 mg once a day, given with meals. Dosage increases should be made in increments of 500 mg weekly or 850 mg every 2 weeks, up to a total of 2000 mg per day, given in divided doses. Patients can also be titrated from 500 mg twice a day to 850 mg twice a day after 2 weeks. For those patients requiring additional glycemic control, metformin may be given to a maximum daily dose of 2550 mg per day. Doses above 2000 mg may be better tolerated given 3 times a day with meals.  Again, we recommend you contact your doctor to clarify the directions on your prescription.

Exercising, taking your medications as prescribed, and eating well balanced, regularly scheduled meals throughout the day are all important for maintaining normal blood glucose levels.  There are certain oral medications that should only be taken if a meal is eaten, and not taken if a meal is skipped.  These medications are repaglinide (Prandin®) and nateglinide (Starlix®).  If you are unsure about the directions on your prescriptions, please contact your doctor for clarification.

The following are the American Diabetes Association's general plasmaserum blood glucose level guidelines for non-pregnant patients with diabetes:

• A1C: Less than 7% [The A1C goal for an individual patient is an A1C as close to normal (<6%) as possible without significant hypoglycemia].
• 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)

There are a few different NatureMade multivitamins for women. We cannot safely assess the potential for drug interactions or make further recommendations until the product is identified more clearly. Please resubmit your question with the exact product name through our “Ask the Pharmacist” service at www.riteaid.com and we will make every effort to assist you.

Urinary tract infections (UTIs) are usually caused by bacteria and are characterized by a strong persistent urge to urinate, pain upon urination, passing frequent, small amounts of urine that is cloudy and has a strong odor. UTIs are treated with antibiotics, which require a prescription.

Phenazopyridine is a medication available over the counter to help reduce the pain, burning and discomfort associated with urinary tract infections. It is not a cure for a urinary tract infection; it simply provides symptom relief and should only be taken for 2 days when used in combination with an antibiotic medication. It is also recommended to drink plenty of water to help dilute your urine and flush out the bacteria. Avoid coffee, alcohol, and soft drinks because they may irritate your bladder, causing a frequent urge to urinate. Phenazopyridine is not expected to alter blood glucose levels.       

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.

More studies are needed to determine the effectiveness of bitter melon and gymnema sylvestre in patients with diabetes. There is some evidence that shows that chromium could be possibly effective in people with diabetes; however, not all evidence is positive due to the small number of trials and inconsistent, small patient populations. Bitter melon, gymnema sylvestre and chromium may enhance the blood glucose lowering effects of diabetes medications, increasing the risk of hypoglycemia (low blood sugar).   If you would like to use one or more of these supplements, check with your doctor.  If approved, you should monitor your blood glucose levels closely and report any changes to your doctor. Adjustments to your diabetes medications may be needed.

Magnesium could be possibly effective in people with diabetes. It is not expected to affect blood glucose levels, but diabetes increases the risk for magnesium deficiency.  High glucose levels lead to the loss of magnesium in the urine.  People with poorly-controlled diabetes may benefit from magnesium supplements. 

It is important to remember that, unlike prescription medications, "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. Always check with your doctor before adding any over-the-counter products or supplements to your current medication regimen.

According to the prescribing information, Humalog should be administered within 15 minutes before a meal or immediately after a meal.   You should select the time that works best for your meal schedule. 

Glucophage (metformin) was approved for use by the Food and Drug Administration (FDA) in March of 1995.  New medications must be proven safe and effective by the FDA before companies can put them on the market.

It is important to remember that no regulated product is totally risk-free. The FDA's product evaluation decisions are a judgment about whether a new product's benefits to consumers will outweigh its risks. The FDA reviews the results of laboratory, animal and human clinical testing done by manufacturers to determine if the product they wish to market is both safe and effective. Additional information on how the FDA regulates products can be found at http://www.fda.gov/RegulatoryInformation/default.htm.

The most common side effects that may occur with metformin include nausea, vomiting, stomach upset, diarrhea, weakness, or a metallic taste in the mouth. Most of these side effects subside after a few weeks; however, if any of these effects persist or worsen, tell your physician promptly. Metformin can RARELY cause a serious (sometimes fatal) condition called lactic acidosis. Symptoms of lactic acidosis include unusual tiredness, dizziness, severe drowsiness, chills, blue/cold skin, muscle pain, fast/difficult breathing, slow/irregular heartbeat, stomach pain with nausea, vomiting, or diarrhea. Lactic acidosis is more likely to occur in patients who have certain medical conditions (i.e. kidney or liver disease, recent surgery, a serious infection, conditions that may cause a low level of oxygen in the blood or poor circulation, heavy alcohol use, dehydration, or X-ray or scanning procedures that require an injectable iodinated contrast drug).

Tell your doctor immediately if any of these conditions occur or if you notice a big change in your overall health. You may need to stop taking this medication temporarily. The elderly are also at higher risk, especially those older than 80 years who have not had kidney tests. 

For additional information on metformin visit http://www.riteaid.com/pharmacy/monographs/ and select “metformin hcl” from the drug list.