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.
Well, I have am going away from diabetes on this daily piece. Over the counter (OTC) medications are medications available for purchase without a prescription. OTC ranitidine ( OTC Zantac) has now been discontinued due to impurity of N-Nitrosodimethylamine (NMDA; increases person’s risk of developing cancer) found in some of the products. NMDA within some of the OTC ranitidine increases over time and at temperatures above room temperature. We do not know who long or how these products are stored so discontinuation of OTC ranitidine (OTC Zantac) is best. OTC alternatives for ranitidine within the same drug class (histamine 2 receptor antagonists) are famotidine (Pepcid) and cimetidine (Tagamet). I do advise caution with cimetidine (Tagament) as it interacts with many medications.
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#ranitidine #discontinued #FDA
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We are living in unprecedented days with a real need for resources and vital information. American Diabetes Association and diaTribe have compiled COVID-19 resources for persons with diabetes. Links are provided below.
On a different note, while physically distancing ourselves from friends and family (who do not live in same household) is necessary, we do not have to technically socially distance ourselves because we have lots of virtual resources such as FaceTime, Skype, Google Hangout and Zoom to stay connected. So reach out to a friend or family member by calling or virtually connecting with them today.
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#COVID-19 #resources #diabetes #stay #connected
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While cost of insulin continues to be a challenge, a light of hope is on the horizon. Back in 2009, Congress passed the Biologics Price Competition and Innovation Act which creates a new regulatory pathway of approval for biologics such as insulin. Now it took 10 years of preparation to make sure all stakeholders were prepared. The new pathway is NOW open which will allow for safe and effective biosimilar and interchangable versions of biologics such as insulin. Ultimate this creates opportunity to reduce costs. This is certainly a step in the right direction. To learn more, please click below.
FDA released a new labelling update this week to SGLT-2 inhibitor drug class. Due to the risk of potential ketoacidosis, SGLT-2 inhibitors should be discontinued prior to surgery and reinitiated after surgery once person is able to eat. Specifically, canagliflozin, dapagliflozin and empagliflozin should be discontinued 3 days prior to surgery, and ertugliflozin at least 4 days prior to surgery. For more information, please click below.
I can only imagine how frustrating it must be for a person with diabetes to keep hearing that you are high risk group when it comes to protecting again COVID-19. The reality is that COVID-19 is more real now than ever. I do courage you to stay connected with friends and family via phone calls, social media and FaceTime. Below is guidance from Dr. Anne Peters (a rockstar physician who has a passion for caring for persons with diabetes). Praying for our nation and each person as we face this crisis.
If you are like me, you feel bombarded by news regarding coronavirus. So as a person with diabetes, what are some practical prevention tips? Wash your hands frequently for at least 20 seconds with soap and water or alcohol-based hand sanitizer, and avoid contact with people who sick. Kelly Close with diaTribe has created a wonderful tool kit of information on coronavirus. Please click below to check out this timely, helpful information.
I love the additional hour of daylight as we spring forward this morning for daylight savings time. However, I often forget to adjust my clocks and other devices with time display. So a friendly reminder to spring forward time by one hour on your insulin pump and clocks. Looking forward to spring and beautiful flowers coming soon.
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#spring #forward #insulin #pumps
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Another potential group of persons who could benefit from metformin are persons without diabetes taking long term systemic glucocorticoid (steroid) therapy for chronic inflammatory conditions. Some of the benefits include lowering of fasting glucose, hemoglobin A1c, and total and LDL cholesterol concentrations.
As a person with prediabetes, I have come to appreciate metformin extended release (major benefit of less diarrhea with extended release) although I must admit they are big pills. Good news! The only FDA- approved liquid formulation of metformin extended release (Riomet ER) is now available. The liquid formulation of metformin immediate release (more diarrhea with immediate release) has been available for a good while. Liquid formulation option for the big “horse” pill.
BJ, a 68-year-old male, has been living with diabetes for over 20 years. Recently, BJ was caught off guard when he found out he had developed heart failure and established heart disease. He pondered, how could this have happened? He had been working hard to manage his diabetes and make healthier choices. BJ is not alone out there.
Did you know that diabetes increases
risk of developing heart disease? Heart disease is commonly caused by the
buildup of cholesterol in the blood vessels that supply oxygen and nutrition to
the heart. These cholesterol plaques can break apart or rupture, which the body
will then try to repair the plaque by sending platelets to seal it up. However,
the artery is small, so the platelets could possibly block the flow of blood
and not allow for oxygen delivery and then a heart attack may develop. It could
also result in not enough blood to the brain and cause a stroke, or not enough
blood to the feet, hands, or arms causing peripheral vascular disease. High
blood sugar from diabetes can damage your blood vessels and the nerves that
control your heart and blood vessels over time and the longer you have
diabetes, the higher the chances for you to develop heart disease.
So what prevention steps can be
taken? Remember, the major contributors to heart disease (heart attack and
stroke) are high blood pressure, high cholesterol levels (particularly low-density
lipoprotein (LDL) (or as I call it, lousy cholesterol), and blood clots. The following
are recommended goals and medications for each of these contributors:
Blood pressure management
Goal BP <140/90 mmHg (ADA Guidelines)
Common medications classes for that you may be
on for high blood pressure: (don’t let the long names overwhelm you)
Angiotensin Converting Enzyme Inhibitor
(ACEI):
i.e. Lisinopril (Zestril) or Enalapril (Vasotec)
Angiotensin Receptor Blocker (ARB):
i.e. Valsartan (Diovan) or Losartan (Cozaar)
Thiazide Diuretic:
i.e. Hydrochlorothiazide (Microzide) or Chlorothiazide
(Diuril)
Calcium Channel Blockers:
i.e. Amlodipine (Norvasc) or Nifedipine
(Procardia)
Controlling Bad Cholesterol, Low Density
Lipoprotein (LDL or lousy cholesterol)
Goal LDL: if have established cardiovascular
(heart) disease, goal LDL < 70 mg/dL
Primary medication class for you treating
elevated LDL:
Statin:
Atorvastatin (Lipitor)
These
drugs lower bad cholesterol levels by blocking an enzyme that the liver uses to
make cholesterol
Preventing Blood Clots
Blood clots can form and break off and travel
through the body and cause blockage of blood vessels
If a blockage happens in a blood vessel to the
brain, it can result in a stroke
Medication to prevent blood clots:
Blood
thinner: low-dose Aspirin (81mg)
I encourage you to talk with your health care professional
if you have questions.
Diabetes medications, in particular some sodium glucose
co-transporter 2 (SGLT-2 inhibitors and glucagon-like peptide 1 (GLP-1)
agonists, have shown to have particular benefits in prevention of heart disease
complications. Below you will find a table with the agents/drugs in class and
their indication unique for heart disease.
Drug name
Benefits
Heart Failure (HF) (lower
hospitalization risk for heart failure)
Major adverse cardiovascular event (MACE) reduction (Ex. Heart attack and stroke)
Along with treatment, it is always important to implement non-drug treatment such as your diet, physical activity, and smoking cessation.
For your diet, multiple options for healthy
eating plans are described below and are proven to work for persons with
diabetes. Food is medicine, so what and
how much we eat really matters.
Dietary Approach to Stop Hypertension (DASH)
diet:
Eating plan rich in fruits and vegetables,
low-fat and nonfat dairy, whole grains, along with nuts, beans, and seeds
Also includes some
Cut back on foods high in saturated fat, such as
fatty meats, full-fat dairy foods and tropical oils, as well as sugar-sweetened
beverages and sweets
Limiting salt to less than 2,300 mg per day or
less than 1,500 mg per day
Carbohydrate counting
Working with diabetes care and education specialist
(formerly diabetes educator) learn how to count carbohydrates
Typically recommend 30 – 45 grams of carbohydrates
per meal, and 15 grams of carbohydrates per snack
Healthy Eating Behaviors
Learning portion control
Plate Method: ½ plate nonstarchy veggies, ¼ plate
protein, ¼ plate of starch (carbohydrate), diary product (i.e. milk or yogurt)
and fruit
Mediterranean diet
High in vegetables, fruits, whole grains, beans,
nuts, seeds, and olive oil
Plant based, not meat based
Main components:
Daily intake of vegetables, fruits, whole grains
and healthy fats
Weekly intake of fish, poultry, beans and eggs
Moderate portions of dairy products
Limited intake of red met
Along with diet, moving your body
each day is key for keeping the heart healthy.
The 2020 ADA Standards of Care Guidelines recommends at least 150
minutes a week, that’s less than 22 minutes each day, of moderate-intensity
physical activity such as brisk walking. This will not only help you manage
your weight, but also help lower your blood sugars, blood pressure, and
cholesterol which will essentially help reduce your risk for heart disease and
many other potential complications.
Last but not least, it is important
to stop smoking. Smoking can lead to so many illnesses including lung cancer,
chronic pulmonary disease (COPD) or progressive disease of the lungs, and
atherosclerotic cardiovascular disease or Heart disease.
Lifestyle modifications along with
your treatment therapy will help reduce your risk of heart disease and also
improve your quality of life so you can live out the best possible life!
Back to BJ, he recently met with this primary care provider who placed him on empagliflozin (Jardiance) 25 mg once daily and semaglutide (Ozempic) 0.5 mg once weekly because he has diabetes, heart failure and heart disease. He is relieved that his diabetes medications will help both manage his diabetes and protect his heart.
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#diabetes #heart #connection
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