Diabetes Education Voices

Why do I need more than one medication?

When you have diabetes, keeping track of your medication can be overwhelming. There are so many medications used to treat diabetes and its complications, and more are released each year. And most of the time, people have to take a combination of meds to manage their condition.

One medication might be prescribed to treat pre-diabetes and on initial diagnosis of diabetes. And because diabetes is progressive—with insulin production and insulin sensitivity decreasing over time—your healthcare provider adds additional prescriptions to help maintain control of the glucose levels in your blood.

Different diabetes medications have different ways of working (we call it mechanism of action).

The ways that diabetes medications work to improve your glucose:

• Some drugs make your cells more receptive to insulin
• Some drugs make the insulin work better
• Some drugs make the pancreas make more insulin
• Some drugs decrease the amount of glucose your liver makes.

A plan to improve glucose control often includes a drug from more than one group or mechanism of action.

A very common misconception is that one medication will control diabetes or that once someone goes on insulin, they no longer need oral medications. This is not the case!

Because of the different mechanisms of action, even with insulin, it is common to take several oral medications to treat diabetes. (However, the oral medications that are available now are not effective for type 1 diabetes, so insulin and pramlintide are the main medications prescribed.)

Try to learn more about how your medications work. Ask when you get a new prescription if you should make any changes to your current medication plan. Continue the on-going discussions with your healthcare provider about your treatment plan.

And, of course, continue to make healthy lifestyle choices as part of your management plan. This includes: regular physical activity, control of carbohydrates and fats, and weight loss if needed.

--Sharlene

What's on your winter reading list?

For me, winter is a time to spend more time at home (thankfully!), and to delve into many books that have been on my reading list all year. My library and book store are a bottomless source for good reading.

Last month, I saw a woman who told me about her new route to improve her diabetes. She had gone through a long period of trying to lower her glucose, but her A1C remained over 10%. She found a book called Dr. Neal Barnard's Program for Reversing Diabetes, read it and started to incorporate some of the guidelines into her daily plan. And…she started to see improvements.

The same week, I found the book at my local library and decided to learn more. Dr. Barnard has evaluated and assimilated the current research of methods to improve diabetes – in short, he talks about what works. His plan suggests high fiber, low-fat food intake, a vegan diet and supplements that have been shown to be important in diabetes. Activity is also mentioned. Obviously, my client responded to the plan he outlines and has made progress.

But this plan may not be the one for you…or maybe it will be. Everyone is motivated by different things. Reading anything can introduce us to new ideas and concepts we have not considered. There is a lot to read out there. Visit your local bookshop or book websource, have a cup of tea and browse the diabetes-related books, and other books and magazines, too.

A few of my recent reads: Your Brain After Chemo, Our Life in Gardens,  Homer and Langley, and Strength in What Remains.

I have great thanks for the library and library supporters (people, foundations and government) for finding shelf space for some of the books that I read. My shelves are groaning and cannot fit one more book!

I encourage you to make use of these cold days and curl up with a good book. It could end up being good for your health!

--Sharlene

Faith in Diabetes Management

Several times a week, I hear people refer to God or faith in relation to their health. It might be something like, “Thank God” or “I’m going to pray about this.” Recently, I’ve been thinking about the role that faith plays in diabetes management. Two new patients came in my office independently last week, and each had something to say about their health and faith-based beliefs.

Everett, a recently retired guy in his early 60s has had poorly controlled diabetes for several years (A1C-10.2%). He came in for diabetes education because his doctor asked him to, but also because he is searching for ways to avoid the use of medications to control his diabetes.

The doctor has prescribed medications more than once, but Everett has chosen not to use them. This time the doctor’s message was that his diabetes needs treatment NOW, so that motivated him to my office.

I asked if he had started one of his prescriptions - even though two or three medications might have been needed at this point. He answered that he had not started the medication because he believes that his faith in God can help manage his diabetes, and he shouldn’t need any medication.

His response didn’t surprise me, but it made me ask myself a few questions. Why hasn’t he had glucose control in the last few years if he is truly faithful? Must we ask for help to change the situation? What about the provenance of modern health care, medications and treatments: might these be within the realm of your faith? I sure can’t answer these questions, but it feels like blasphemy that I am typing the words. I believe that prayer, faith, and religion CAN have very positive effects on health.

Whether it is the power of positive thinking and problem solving that we are doing when praying or the power of our faith to improve our being – prayer, faith and religion can help health outcomes.

In Everett’s case, I encouraged him to follow his faith, his healthy eating plan, and to add activity. If there is not an appreciable improvement in glucose control in 3 months, I’ve asked him to strongly consider the divinity of prescription medications and other health care interventions that could make a difference.

Different people bring different backgrounds, experiences and beliefs to their health management. Another patient of mine, Clara, discussed how her faith influenced her diabetes management. She said, “I get strength to take care of my diabetes everyday. God helps me through this and has given me so many opportunities to take better care of myself through my doctor and you and my family.” She was opening new doors to take better care of herself, and in her view, “We don’t always live up to his model.”

Once again my work has brought light to my life. It has helped me to ask questions, to accept help and to be open to interventions from wherever they come - in health, in work and at play. In this New Year that we are lucky to begin, I hope that you find answers that fulfill your life and improve your health and relationships...from wherever the providence.

--Sharlene

Manage your holiday stress

Sometimes stress levels get so high that there is no room in your head to concentrate on what has to be done. That seems to be a universal theme during holiday time and large family gatherings. I’ve been feeling it myself and hearing about stress from my co-workers and my patients who are dealing with the holidays and diabetes management.

Now is the time when holiday tasks are added and people get overwhelmed. People tell me their glucose log is showing signs of holiday eating, but I wonder how much of the glucose elevation is due to stress.

How do you deal with stress? Is this an overwhelming time because of the added responsibilities? Making time for stress reduction activities now seems like it might be one more straw on the camel’s back, but...reducing your stress levels today can help you maintain healthy glucose levels and enjoy the season more fully.

First, try to identify what is causing stress in your life. Here are some options that might help reduce your stress levels:

1. Think carefully when someone asks you to do something. Say “no” if you do not want to do it.
2. Try to organize your priorities. Recognize what is important and what doesn’t really need to be done just now. Identify the pressures that you are placing on yourself.
3. At all times, and especially when you are under stress, it is important to find time to sleep. Try to go to bed at the same time every night and to get at least 7 hours of sleep.
4. Take care of yourself by eating well, taking your medications and finding some time for a walk or other activity.
5. Share work with others with whom you like to spend time. Cook together, clean together, shop together, walk, etc. Then, these tasks are more pleasant and you have a chance to visit while you work or achieve your daily activity.
6. Are you too busy “making” the holiday that you cannot enjoy it? Step back and consider what you want from the holiday. Make a date to hear holiday music, attend a religious gathering, or donate your time or energy to something important to you.
7. Schedule at least 30 minutes a day of pleasurable activity. This helps you to put things in perspective.

These are only a few of the options that can help you to problem solve and to reduce stress. It is holiday time and near the start of a new year. This is the time to make small changes and to start thinking about changes you wish to make for a healthier you. 

Find out more about the symptoms and effects of stress and some tips for managing stress.

Have a happy and low-stress holiday!

--Sharlene

Quick tip for saving money on insulin

More people than ever are visiting their primary care office with questions about how they might save money on their prescriptions. Here's one tip that might help.

Some people who use insulin run out of insulin before the month is over - requiring them to pay another co-payment to get more insulin. Prescribers sometimes write the prescription for one vial or one pen, not knowing how much you need to get through the month. Being a savvy consumer can help you get the right amount of insulin and perhaps avoid extra copays.

If you take insulin, you can calculate how much insulin you need every month and let your prescriber know what you need. Your prescriber or your pharmacist can do this too.

Use this formula to calculate how many units of insulin you need each month:
Dose x How many times a day x 31 days/month=Number of units every month

Example 1: Rebecca D. takes 42 units of Lantus every night.
42 X 1 X 31= 1,302 units every month
(Dose X How many times a day X 31 days= Number of units every month)

Example 2: David S. takes Novolog 70/30 35 units twice daily.
35 X 2 X 31= 2,170 units every month
(Dose X How many times a day X 31 days= Number of units every month)

Example 3: Sam H. takes 15 units Humulin R three times a day with meals.
15 X 3 X 31= 1,395 units per month
Dose X How many times a day X 31 days= Number of units every month 

Calculate your own dose:

_________ X_____________X 31 days = _____________ 
(Dose X Times per day X 31 =  Number of units needed every month)

Once you know the number of units you use per month, you can follow the chart below to determine how many glass vials or insulin pens you need and ask your provider for a prescription for a month or 3 month supply.

 

This is just one way you might be able to save some money this holiday season!

--Sharlene

World Diabetes Day is November 14

Have you heard the bells clanging and the sirens wailing to announce World Diabetes Day? You will on November 14th.  The International Diabetes Federation has named Diabetes Education and Prevention as the theme of the 2009-2013 period.

Rah, rah, rah. Go education! Yay for prevention!

This is a very significant step. We know that diabetes changes occur in the body long before diabetes is diagnosed--this is a stage called pre-diabetes. In our country, most insurers will not pay for diabetes and nutrition education unless you already have the diagnosis.

Changing the tide of diabetes has to happen on national and international fronts. Campaigns to educate about healthy eating, regular physical activity, and stress management have to take place early and often. It takes money to do this, but early education, infrastucture changes and prevention activities lower the overall cost of treating diabetes and other health complications.

Now if only my community will hear this call and require sidewalks in new developments: people might walk the one mile to the store, post-office or café.

Messages about diabetes are being sounded in online and print news sources. An article in the Belfast Telegraph announced that Northern Ireland is a ticking time-bomb of type 2 diabetes. The diabetes time bomb can have farther reaching implications on life in Ireland than the other kind of bombs. There are articles like this coming from both developed and underdeveloped countries.

The United Nations (UN) acknowledges the importance of diabetes prevention and care by declaring November 14th as World Diabetes Day. Diabetes advocates have called on the UN to go beyond acknowledging the day to developing a platform for developed and undeveloped countries to focus on prevention and early treatment.

The smallest and largest countries in the world are affected by this disease--but the biggest burden is borne by the person who has the disease. This is the time to learn more about diabetes if you have the disease and even if you don’t have it, you can be an educator and ambassador in your community.

Your voice at home, in your workplace, in local, state and national government can help prevent and educate. A simple message such as “30 minutes of exercise a day can reduce your risk for diabetes by 40%” can be profound.

So start thinking about how you can spread the message of World Diabetes Day...and tell us about it!

--Sharlene

Omega 3 Fatty Acids: How can something "fatty" be healthy?

You've probably heard about the health benefits of Omega 3s...but it still seems too good to be true, right? How can something that is called "fatty" be good for you? Is this something that you should take as a supplement, or is it better to get Omega 3s from foods? What do they really do for your health?

Omega 3 fatty acids are substances that are naturally found in fatty fishes: salmon, trout, cod, herring, tuna, halibut, mackerel, and black cod. Plant based foods are also a source of Omega 3s--including hemp seeds, dark green leafy vegetables, flaxseed oil, ground flaxseed meal, walnuts and other nuts, canola oil, and soybean products.

Omega 3s have especially been connected with heart health, prevention of strokes and heart attacks.

How do they improve heart health? Omega 3 fatty acids improve the condition of cell walls throughout the body. They are known to improve cholesterol and triglyceride levels in the blood. The American Heart Association and American Diabetes Association are among other health organizations that have developed guidelines for Omega 3 fatty acid intake. Both organizations recommend at least two servings of foods that contain Omega 3s per week.

To get a little more technical--there are three types of omega 3 fatty acids that are nutritionally important: alpha-linolenic acid, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Alpha linolenic acid is essential in that our bodies cannot produce it and must get it from food. EPA and DHA can be gotten directly from foods such as cold-water fish including salmon, tuna, halibut, and herring. It is a great idea to add some of the foods mentioned above to your diet.

Some clever food scientists are adding Omega 3s to prepared foods including beverages and infant formula. You can also take Omega 3s in the form of capsules or liquid oils (canola, cod liver or flaxseed). Some of the resources that I’ve mentioned suggest how much you need.

However, be sure to speak with your health care provider about your conditions and medications--especially if you are taking blood thinners or other anti-clotting drugs because Omega 3s can have a blood thinning effect. Mercury is also present in some fish and intake may have to be modified for some groups including: children, lactating women and women who may become pregnant.

My sister-in-law is one of the healthiest and most beautiful middle-agers I know. She studies brain health and strongly promotes the use of Omega 3s. I’ve been losing my glasses, phone and other portable devices but I have been remembering the Omega 3s. Learn more.

Anyone have advice on how to incorporate more Omega 3s into your diet? Share with us!

--Sharlene

An Apple a Day...

Do you ever wonder where this saying came from?

It came to mind today as I was shopping in my favorite farm market. Huge old and scarred wooden boxes are once again scattered throughout the farm store. Each contains one variety of apple.

It is obvious to see that each apple looks a bit different from the others: round, oval, green, stripes, candy red, yellow, flat, speckled and some as big as a softball.

A few are marked as good for baking, but most are marked as good eating apples. My niece in Arizona, ever wailing about being unable to find a good apple in her state, loves Cortland apples. My favorites are Fuji, Winter Banana and Golden Delicious.

Well, we know they taste good, but do apples really help keep the doctor away? Let’s look at the nutrition value of an apple.

Apples have lots of fiber, a good amount of Vitamin C and potassium for a low calorie food. Is it these nutrients that account for the innumerable health claims attributed to apples, or perhaps it is the magical combination of all of these and more.

Health claims include cancer and heart disease prevention, stronger bones, bowel regularity and better lung functioning. Eating an apple provides good flavor and texture, keeps you full and freshens your breath. Apples are available fresh, dried, as applesauce and in juice form.

If you are counting carbohydrates, you might consider weighing your apple or calculating the weight of apples based on how many are in the bag. There can be great variation in size and consequently in carbohydrates. If you are looking at glycemic index, apples have a low glycemic index.

Apples are the perfect portable food. A cook with basic skills can find a use for apples in every meal course…and don’t forget to add the cinnamon! Take a moment to look at some recipes for apples here and here.

An apple a day saying is derived from the old English saying, "Ate an apfel avore gwain to bed, make the doctor beg his bread." There is probably no one food that will help you get to 100 years without a health problem, but apples are probably in the top 10 for smart food choices.

Enjoy the apple season!

--Sharlene 

Corticosteroids may raise blood sugar, but do have health benefits

There have been a lot of reports and news items in the last few years about steroid use in sports. So, let me say up front: prescription steroids are NOT the same as the steroids that some athletes and body builders take to bulk up their muscles.

Prescription steroids, also called corticosteroids, are different from anabolic steroids (the kind some athletes use). Corticosteroids are in a class of medications that are legally used to treat inflammatory problems such as rheumatoid arthritis, asthma, poison ivy, Crohn’s Disease, and allergic type rashes.

The mechanism of action of these drugs mimics the action of cortisone and hydrocortisone that is made in the adrenal glands of our bodies. These substances decrease inflammation, affect immunity and help to control stress.

One of the side effects is that they may elevate the blood glucose especially when used for more than few days. These medications cause insulin resistance and your insulin doesn’t work as well so in most cases the glucose rises - requiring more medication. Glucagon production from the pancreas can also be increased causing an elevation of blood glucose.

“My doctor told me that I have to take corticosteroids, but if it’s going to raise my blood sugar, why would I want to take it?” The positive effects of corticosteroids can be extremely beneficial in treating many conditions and even life-saving: even if you have diabetes. These medications can be given in oral, inhaled forms, skin preparations or by injection. Oral and injected medications may have the most impact on your blood glucose.

What should I do to prevent problems when taking corticosteroids?

• Check your blood glucose more frequently - at least four times daily.
• Keep a written record of your blood glucose or download your meter daily to try to identify patterns of elevated readings.
• If your glucose levels are rising in spite of healthy eating and regular medication use - call your health care provider.
• Most people who take insulin and/or oral medications will need medication adjustment during this period.
• Do no abruptly stop corticosteroid medication without discussion with your health care provider. These types of medications are usually tapered down before discontinuation.
• Be prepared, at all times, to treat low blood glucose (hypoglycemia).

Decreases in corticosteroid medication may cause a rapid decrease in blood glucose. You may never need these medications, but if you do be prepared for the changes in your blood glucose.

September, the month of the full corn moon, is expected to be a cooler than usual month. If you’re cleaning up the yard, avoid the brightly colored poison ivy. You will avoid the itching, the discomfort and the corticosteroid prescription.

--Sharlene

Vacations: Family, Fun and Food

 

The beginning of August -vacations are in full force before school, college and universities reconvene. Many retirees wait until September and October when the crowds thin. Are you planning to travel this summer?  From a simple survey of the people around me, more at having staycations and taking a few of those days to visit local attractions.

 

Changing schedules, routines and locations can affect health, blood glucose, weight, activity, medication, sleep and so on.  My cousin Larry carries his “peepers” (eye shades) and ear plugs to help him get a good night of sleep wherever he goes. Without a good night of sleep you may not feel ready for the next day’s activities.  Injuries, blisters and sunburns can be a real downer: not the way you want to spend you well earned time off.  Another downer is the cost associated with medical care away from home if your insurance is not paying but your wallet is. 

 

If you are traveling out of your area, out of the state or out of the country check with your insurer about health coverage in different areas.  My health insurer offers special phone support to help you find care and clarify insurance coverage if you are more than 50 miles away from home. Check with your insurer before you leave home.  The toll free phone number is usually listed on your insurance card.

 

Traveling with diabetes may offer challenges because of the variabilities of vacation.  Blood glucose control may be much different than it is at home.  An active vacation or Porchville: differences may be cause for changes in glucose.  Stress on vacation…..NEVER.  Well maybe! Your meter can help you make decisions about eating and activity.  Getting out of the routine makes it hard to remember medication.  Bring your medication and make a plan. More activity, caring for your feet to prevent problems, good food, family and friends-sounds like fun.  Summer-I’m thinking of beaches, sun, walking, lobster and flowers.  Whatever you’re doing this summer-have fun!

 

-- Sharlene

 

Some helpful travel resources:

Diabetes travel guidelines (National Diabetes Education Program)

Travelling with diabetes supplies (American Diabetes Association)