Ask the Pharmacist Chat Archive 4/3/08 - American Diabetes Association (via Mowser)

Meet the Pharmacist Archive, Thursday, April 3, 2008

The American Diabetes Association is pleased to present ADA Live! - a series of live Q&A sessions on topics related to diabetes and healthy living.

Erica Russell Whyte received her Doctor of Pharmacy from the University of Pittsburgh in 2003 and began working as a Diabetes Care Specialist with Rite Aid Pharmacy. She is currently a site coordinator for Rite Aid’s accredited ADA diabetes education program in Waynesburg. Each week she spends time educating patients about Diabetes, helping them learn about glucose testing, proper medication use, and diet.

The "Ask the Pharmacist " series is brought to you by an unrestricted educational grant from Rite Aid Pharmacy

Forum_Moderator: Welcome to ADA Live. Today our guests are Erica Russell Whyte a site coordinator for Rite Aid's accredited ADA diabetes education program in Waynesburg, PA and Marvin Bouchon, R.Ph. a drug information specialist at the Rite Aid Drug Information Center. It's a pleasure to have you here today Erica and Marvin.

Erica_and_Marvin: Thanks it's good to be here.

Larry: What is the best treatment for dry mouth associated with Type 2 diabetes

Erica: Ask your doctor or pharmacist to check over all your medications, prescription and over-the-counter. Dry mouth may be the side effect of one of your medications. There are several non-prescription mouthwashes, toothpastes, and chewing gum to try and relieve the symptoms of dry mouth.

megan: is it normal for blood sugar to go up and down all the time?

Erica: Blood glucose does go up and down a lot as part of the normal body function. Two hours after a meal you may see the blood glucose rise significantly and then go back down again as you approach fasting. However, if the changes are extreme and you feel poorly please talk to your healthcare professional.

shirl: I am on Weighwatchers now and my numbers have gone up and I am staying on the diet. I have been told it is a good diet for people with diabetes is this true?

Erica: Weight Watchers is a good diet for many reasons..it teaches portion control and lets you track "points" so you don't overeat. But keep in mind that you can reach your number of "daily points" eating a balanced diet of protein, carbs, and fat or by eating just all carbs! The difference is key. Examine your food journal and make sure that your are balancing plenty of veggies and lean protein as well as carbohydrates.

Sandy: I am diabetic and have been for many years, today my hands are a little swollen. Is this from my diabetes?

Erica: If this is the first time your hands are swollen it could be caused by a variety of things. Swelling is a symptom that should not be ignored and needs to be evaluated by your physician.

jas: What is the difference between novolet,penfill,optiset?

Forum_Moderator: There are many different types of insulin pens on the market, designed for different patient populations. Novo makes pens that are reusuable and you insert a new "Penfill" when needed. The also make "Flexpens" which are disposible and you receive a new box of pens when needed. They also make the "Innolet" which has a large dial for easy reading and dosing. The "Innolet" is great for patients with poor eyesight or dexterity. The types of insulin available can also differ per pen.

maria: my name is maria and my 3yrs old son just recently diagnosed with diabetes type 1 and,since im still adjusting the intake of insulin before he eats,how and what will be the effect if i give him more insulin than what he suppose to take?

Erica: Maria, because your son is only 3 years old and has many years of growing to go please make sure you are seeing a registered dietician on a regular basis. Keep in mind that insulin lowers blood sugar and giving too much can cause hypoglycemia a term for bloodsugar lower than 70mg/dl. Carbohydrates in a meal will determine how much the insulin lowers the bloodsugar. The proper mix of carbs and insulin will keep your son in the safe range but too little carbs will cause hypoglycemia as well. The registered dietcian can tell you exactly how many carbs he needs at each meal and snack to prevent problems with blood glucose and keep him growing strong.

meagan: does insurance cover diabetes patients

Mike: Most prescription insurances will cover many of the common medications for diabetes, especially if a generic is available. In addition, many also cover the testing supplies necessary to check your blood sugar on a daily basis. However, the extent of coverage varies widely from plan to plan. To determine if medications or supplies are covered under your plan, your best bet is contacting the plan directly. If you have an insurance card for your plan, it should have a customer service number on the back of the card. Calling this number should put you in contact with someone who can answer questions concerning coverage from your specific plan and for your specific needs.

dippy: I take 5mg of glipizide twice daily. Most mornings I wake up with a higher reading than when I went to sleep. Last night my number was 136 so I split and took a 2.5 mg of glipizide. I woke up at 131. How dangerous is this?

Erica: The best way to determine how changes need to be made with diabetes medications is to keep a detailed blood glucose log and take it to your prescribing physician. One blood glucose reading is never enough to initiate a drug change. I would also recommend setting an alarm and taking a blood glucose reading in the wee hours of the morning (2-4am) and letting your doctor analyze. Sometimes our natural body rhythms can be to blame for high morning readings and the physician can use the information to determine if you need more or sometimes less of a medication.

Anita: My husband just got the word from our doctor that he will most probably need to take Insulin shots. He is type 2 diabetic, had a heart attach in 2000 and needs to lose at least 100 pounds. What can I as his wife expect?

Erica: As his wife your most important role is one of support. I've seen many wives who attend diabetes education with their mates and really really want to help. Keep in mind he has a lot of changes to make..learning to use injections as well as good nutrition and plenty of exercise. You can help by learning the proper way to give injections, good nutrition practices, and exercise is always better with a buddy.

Erica: Help your husband set goals he feels are attainable and walk beside him all the way.

Lori: can you tell me where I can get help with the cost of a glucose monitor and the strips

Erica: Many companies will help patients by giving a free meter. You can obtain one at the doctor's office or at a pharmacy. Keep in mind that any free meter may not be what you are looking for because some strips cost more than others. There are many store brand meters that work very well and the strips are reasonable. Ask your pharmacist for details on pricing at your local pharmacy. If you already have a meter..call the 800 number on the back and ask if the company has any programs for those that have qualifying income levels or lack insurance coverage.

Lori: could numbness in the face and lips be a sign that my level is too high

Erica: It could be that your blood glucose is too high or too low. When you feel this way test to see. If you feel this way all the time check with your healthcare professional.

Thomas: Hi, I have been recently diagnosed with type 2 diabetes. The strange thing is that I have been wearing glasses for the last 20 years, way prior to having diabetes. My eyesight in the last month has improved so significanty that the doctor is amazed. Does this have something to do with myself keeping diabetes under control. My counts are usually around 120 consistantly. Thank you.

Mike: It definitely may. Blurry vision or other changes in your sight are common signs of increased blood sugars. If your blood sugars were uncontrolled prior to diagnosis or even after as they adjusted your therapy, you may have experienced a change in vision that your doctor had corrected with glasses. If the blurring of vision was a result of increased blood sugars, an improvement in your blood sugars may have led to the improvement of vision.

Tina: what are the symptoms of type 2 diabetes, if you are a 58yr old man?

Erica: The most common symptoms of type 2 diabetes are increased hunger, increased thirst, and increased urination. Other symptoms you may experience are, fatique, weight loss, blurry vision, frequent infections, and sexual dysfunction.

caregiver: my sister has diabetes and her surgar is always dropping low and she does not catch it.. i always do and i am scared oneday that i will not be home and she will die! what should i do?? why is this happening to her, i cant even sleep at night because i think he surgar is gonna drop and she will die? i dont understand why she dpsent notice when it drops and why she will not do anything?

Erica: Your sister may suffer from hypoglycemia unawareness a condition that can develop after years of having diabetes and especially if she has suffered nerve damage from the disease. The best thing to do is be very diligent and test blood glucose 4-6 times a day and have the doctor prescribe an injectable medication used to treat severe low blood glucose, called glucagon.

cjs: If diabetes becomes manifest at age 50, which type is it (typically)?

Erica: Type 2 diabetes is what most commonly manifests in older adults. It occurs as a result of the pancreas making less insulin or the insulin made isn't working as well as it should anymore. Type 2 is generally treated with diet/exercise/and oral medication. Type 1 diabetes patients must use insulin from onset of the disease. Type 2 patients with diabetes may also need to use insulin at some time.

fuller: can you change the time of your lantas shot

Erica: Lantus is a long-acting insulin injected once daily. It is marketed to be given before bed but I have seen administered at other times of the day, as well. The most important thing is to take it at the same time every day. Do not make any changes to your administration time without your physician's permission. Keep a close watch in your blood glucose, log your glucose readings to catch any changes that occur.

chum: What is the effect of diabetes on the nerves?

Erica: Uncontrolled diabetes can damage nerve function throughout the body over time. This may lead to nerve damage related to the hands and feet causing numbness, pain, and stinging. It can also cause damage to the nerves that control digestion and cause slowed emptying of the stomach...constipation.. or sometimes diarrhea. Consult with your doctor if any of these symptoms are bothering you.

shar: does anybody know how all of a sudden a 44 year old can get type 1 diabetes? what casues it?

Erica: What we know about Type 1 diabetes is that the cause is most often autoimmune. Antibodies made in our own bodies attack the pancreas destroying insulin production. Type 1 diabetes does have a genetic link and most often appears in childhood or early adulthood. However, other environmental factors can be blamed..such as infections, chemical agents, dietary agents or injury to the pancreas. Certain medications can lead to diabetes. Chronic pancreatitis and Cystic Fibrosis are other causes.

munga: I am a 42 year old man and it has been 2 years since I was diagnised with type 2 diabetes. I have been taking Metformin 1000mg twice daily for the last twenty two months and the last time my A1C was tested it was 5.6 or ther about. at the same time I've been taking risnopril5mgs once daily and for the last two months I've been havive some ring of the ear just one ear the right side could this be a side effect of any of these meds?

Mike: Tinnitis or ringing in the ears is not listed as an adverse effect for metformin or lisinopril. Therefore, it appears unlikely that the problem is a result of either of these medications. If the problem persists see your physician for an evaluation.

lineman: I fasted for 24 hrs and checked blood sugar and it was 91. Did I fast to long to get an accorrect reading?

Mike: The American Diabetes Association defines fasting as having nothing with calories for at least 8 hours. If you had nothing with calories during those 24 hours, that would definitely be considered fasting, and your reading could be logged as such. However, 8 hours would suffice.

Jenn: What is the highs and lows of diabetes readings?

Mike: According to the American Diabetes Association, your fasting blood sugar and your readings before other meals should ideally be between 90-130 mg/dL. Your blood sugars 2 hours after starting a meal should be at least less than 180 mg/dL. Also, a low blood sugar is generally defined as a reading less than 70 mg/dL. However, you may hear different ranges for these times from different groups, and your doctor may have different goals for your specific situation.

Jenn: My father has been at 500 on his meter for 4 days now should try to get him to a hospital he is 79 years old and very stubborn

Mike: Your father should be seen as soon as possible. I can understand him not wanting to go to the hospital, but if his readings are accurate, they need to be addressed. I would contact his primary doctor as well. Alterations in lifestyle and medications are warranted, and I would have his primary doctor or another health care provider discuss and provide written information detailing the complications of diabetes that result from long-term high blood sugar levels.

dj: if my father has diabetes, then what are the chances of me getting it too?

mike: It is difficult to put a definite number on someone's risk of getting diabetes. Several factors may increase your risk including being overweight, having high blood pressure, and a family history of diabetes. With something like a family history of diabetes, there's really nothing you can do to change that, but you can significantly decrease your chances of getting diabetes by working to achieve and maintain a healthy weight and an appropriate blood pressure. I would try to focus on those things that you can alter to decrease the likelihood of you developing diabetes.

jusvedi: I have been diagnosed with type 2 diabetes I find my fasting glucose is always high. What can I do to improve this?

Mike: Your fasting blood sugar and your blood sugars in general are affected by multiple factors. For example, your fasting readings in particular may change as a result of a bedtime snack. As a whole, though, the content of your meals as well as their size, your exercise habits, stress, and the appropriate medications all impact your blood sugars. Your doctor and the rest of your health care team including a dietitian and pharmacist can help you make healthy food choices, increase exercise if possible, limit stress, and find medications appropriate for you if necessary. This is a process that may require adjustment and multiple readjustments, but with effort can result in lower blood sugars and a healthier lifestyle.

Forum_Moderator: That's it for today. Thanks so much for taking the time to be here Erica, Mike, and Marvin. Thanks to all of you who joined us by asking great questions or by just tuning in. If you wish to continue any of today's discussions please feel free to visit the ADA Message Boards.

Keep up to date with all the ADA Live events and reference the archives here. We hope you found this interesting and informative and that you'll join us again next time here at ADA Live. Our guest will be Rite Aid Pharmacists and diabetes experts, will discuss and answer your questions on all aspects of diabetes at 1:00 p.m. EDT Thursday, May 1, 2008. See you then.

Erica: Lot's of good questions today. Enjoyed it.

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