Practical information about medications for people living with diabetes.
Author: drmandyreece1
Hi, I'm Mandy. I am a pharmacist and certified diabetes educator. I love working with patients with diabetes with the goal of empowering people living with diabetes to have the best quality of life.
I will be highlighting insulin for my next couple of Daily Pieces as my heart aches and is heavy for those who have died from a lack of insulin. Fullerton published in Cochrane Database System Review a review of short-acting insulin analogues versus regular human insulin for adult, non-pregnant persons with Type 2 diabetes mellitus. Ten randomized controlled trials met the criteria. The authors’ conclusion, “our analysis found no clear benefits of short acting insulin analogues over regular insulin in people with type 2 diabetes. Overall, the certainty of evidence was poor and patient-relevant outcomes were sparse.” Bottom line: regular human insulin is a viable option especially when cost is an issue. The link to the review is below.
No person should die from a lack of insulin – Relion R insulin (available at Walmart for $25/vial) is an alternative to short acting insulin analogues and Relion NPH insulin (available at Walmart for $25/vial) is an alternative to basal insulin analogues especially if cost is an issue.
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#insulin #alternatives #human #analogue
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An interesting article came out a few days ago in Washington Post on factors to consider when pondering a switch to mail order pharmacy. As a pharmacist who prefers using a local independent pharmacy for my medications, I found the article interesting. I did appreciate that factor that they highlighted the individual wanting convenience and having chronic condition (i.e. high blood pressure, diabetes, hormonal therapy) (i.e. my daughter) might prefer mail order pharmacy as compared to individuals who have antibiotic prescription or prefer the personal touch of a local pharmacist (i.e. myself). One factor missing from the list is that if medication such as insulin sits in someone’s mailbox on a hot June day the insulin will be ineffective. Please click below to read the article.
Tis the season of cold and flu. Being proactive to protect yourself from cold and flu is of the essence. The most basic step to take is to wash your hands with soap and water throughout the day especially after touching door knobs and handles. Cleaning your hands with alcohol is an alternative to hand washing although hand washing is the best. Getting a sufficient amount of sleep (ideally 6 – 8 hours), eating balanced healthy meals and being physically active are also great prevention steps.
For some protection against getting a cold, taking vitamin C 500 mg daily is fine although not proven protection. If you take more than 500 mg of vitamin C at a time, your body will simply eliminate it so more is not better.
Lastly, the flu vaccine is of particular importance. Now a flu shot is not a guaranteed protection against getting the flu. Rather it lessens the severity and duration of the flu – bottom line it is worth it. FluMist, the nasal version of the flu vaccine, has been approved for this flu season but it is not as effective injected (intramuscular) formulation of the vaccine. A commentary published recently in Pediatrics highlights this finding.
This is great news! Why you may ask? It is usually quite difficult to know the cost of medication for the patient when the provider enters it into the electronic health record (EHR). This leads to sticker price shock at the pharmacy. And no, it is certainly not the fault of the pharmacy or pharmacist. Please do not shoot the messenger.
One of the major health information technology companies, Cerner, has collaborated with CoverMyMeds to integrate prescription princes into the electronic health record so both providers and patients can know the cost of medication before is prescribed. Also, know the price allows for a more informed decision on all fronts. Genius!! Time saved and frustrations minimized. Please click on the link below to learn more about his exciting collaboration. Wishing you a great week!
So you may we wondering…why am I writing a daily piece about diet and not medications? Well, when it comes to our health, our nutrition and eating habits is natural medicine for our bodies. Our eating habits matter. I was excited to see that the Meditterranean diet is chosen as the best diet for 2019 according to U.S. News and World Report. This eating plan does not cut out certain food groups or produce magical short term weight loss. Creating sustainable long term changes in our eating habits rather than following the most popular fad diet is vital. To learn more click below.
We have heard lots of news about sodium-glucose transporter type 2 (SGLT2) inhibitors over the last year or so. Canagliflozin being the first drug in this class has been highlighted in many of the studies. In one the two trials of the Canagliflozin Cardiovascular Assessment Study (CANVAS) program, a 56% increased fracture risk with canagliflozin was seen. The question that this study left was whether the increased fracture risk was limited to patients in study with high baseline risk.
However, an interesting recent systematic review of clinical trial data found no association between canagliflozin and increased fracture risk. It is worth noting that these patients with Type 2 diabetes were relatively young in this review. To read more about this systematic review, please click on link below.
Metformin is usually the first prescribed medication for a person with Type 2 diabetes upon diagnosis. Usually an additional medication is added to the diabetes medication regimen. Several classes of diabetes medications are available for second line treatment (medications added on the initial medication regimen) of Type 2 diabetes. A number of factors such as cost, effect on weight, liver and kidney function, and etc impact the selection of the second line treatment. A major factor in determining preference of second line is the medication’s cardiovascular effect (or effect on the heart). A recent retrospective analysis found that use of insulin or sulfonylureas as second line treatment is associated with cardiovascular harm. To read more about this interesting anaylsis, click below.
So I have made a BIG decision this year. No more new year’s resolutions. That is right. No more new year’s resolution. Instead I am a making a few goals that are very specific (who, what, when, where, how) that stretch me a bit out of my comfort zone. Please share your goal(s) for 2019. Wishing each of you a great 2019!
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#goal #new #year #2019
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This is Mandy with Reece’s Pieces in a Diabetes World wishing you and yours a very Merry Christmas and Happy New Year. If you are interested in learning more about the story of Christmas, please click below to read Luke 2:1-21.
https://www.bible.com
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#Christmas #story #hope
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Unfortunately, blame and guilt seem to be a frequent reality for people with diabetes. Meet Beth who comes to see me for her monthly diabetes education visit. Honestly, Beth shares that she comes for accountability and support in an environment that neutralizes guilt and blame at least for the visit time. It isDecember when Beth comes for her visit and she seems a bit deflated. She states, “…you know I almost cancelled my appointment because I feel so guilty because I have not been taken my diabetes medications this week.” On the surface, it is so easy to brush Beth off as a “non-compliant patient”. Yes, this term induces blame and does not address the why Beth is struggling with taking her diabetes medications.
In our fast paced healthcare environment, where volume is often more price than value, it is so easy and convenient to simply label a person with diabetes as“non-compliant” or “non-adherent” then move onto the next person on our schedule. It is like the analogy of the iceberg where you see the tip and not the massive base underneath the water. Back to Beth, I challenge the notion that she is simply “non-compliant” rather she struggles with anxiety and her diabetes takes a back seat when life gets overwhelming.
With regards to medications, the statement, “Beth takes her diabetes medication about 75% of the time,” quantifies the frequency of her taking her medication. Then it is possible to build upon the fact that she is doing well taking her medications a majority of the time, and now simply focus on building upon the frequency Beth is taking her medications.
What are alternative terms to “compliant” and“adherent”? When focusing on terms that emphasize the vital and active role people with diabetes play in self managing this condition, Utilizing terms such as engagement, participation, and involvement of the person with diabetes are much more ideal. Why is this? Diabetes is not a disease where a person is simply told what to do to better manage their treatment method, but rather it is a disease that requires ongoing engagement of the person with diabetes being active in the treatment decision making process. The person knows their body best and is the team captain. The bottom line is all about empowering the person with diabetes by focusing on their strengths and building upon what they are doing well. My call to action for readers is to drop the words compliant, adherent, non-compliance and non-adherence.
Good news! Beth was open to discussing tools and resources that could assist in her taking her medications more consistently as she sees clearly the benefit that her medication provides. She leaves her appointment strengthened and more confident in managing her diabetes.
Special thanks to Jane Dickinson, Susan Guzman, Melinda Marynik, Catherine O’Brian, Jane Kadohiro, Richard Jackson, Nancy D’Hondt, Brenda Montgomery, Kelly Close and Martha Funnell who wrote Use of Language in Diabetes Care and Education
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#avoid #diabetes #blame #game
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