May 31, 2014

Consumer Reports On Some Oral Medications

This is another of those blogs that I don't like to do, but in this case, I will. The request came from someone connected to Healthline dot com. Since Healthline had stripped the publish date and other publishing information, I spent some time locating the original Consumer Reports publication. Consumer Reports on diabetes oral medications was published during late 2012 and updated in December 2012. It gives information on oral diabetes medications, cost, and some recommendations – best buys.

The cost information is interesting and I find that they are not necessarily accurate because they can depend on the sources used and competition in the area. For prices in my area, Wallmart is difficult to compete with, but one pharmacy does compete and sometimes actually is better.

Of course, the latest class of medications is not part of the report and you should be aware of this. SGLT2 class is the missing class of two approved oral medications.

May 30, 2014

Time to Thank My Readers

I have been blogging for almost five years and I just realized that I have not actually said thank you. Thank you to my readers!

I include especially the members of our support group who supply me with articles from time to time and help with programs for our meetings. I appreciate the doctors that support their groups and have been very supportive of our group. Yes, we have been ask a few times why a doctor is not in charge of our group, but we say that we have a doctor that works with us and has his group that he works with and supports.

Dr. Tom has also affirmed that he backs us up and helps us when we find someone that needs a doctor. The support group he leads has supported us as well and we often attend each other's meetings.

I do appreciate those readers that make comments. I do wish I could remove the captcha to make it easier to post comments, but too many people just populate the comments with their computer-generated spam. I had it off for a few months, but when the number of spam comments became very annoying, I needed to reinstate it.

I also appreciate those that look on my profile page and send emails. I don't mind that some have been very negative, because most are appreciative of a blog and want to thank me for giving them sources to help them.

I also appreciate those that disagree with me when they tell me why as this can make for a good discussion.

I appreciate the readers from other countries, but I don't have the time to cover all the names of diabetes drugs approved in each country. I have been asked by a couple of readers to do this, but time is not available, even with being retired.

Thank you to all readers!

May 29, 2014

Dehydration, 14 Forgotten Causes

I cannot call causes of dehydration surprising, probably because I learned a hard lesson early as a teenager and had several doctors give me a list of dehydration causes and how to avoid them. I have long since lost the list, but it helped me survive while in the military and especially basic training.

Because three of the listed causes of dehydration are common to women only, there are only eleven that are common to both sexes. The three for women are serious and I am not trying to minimize them. The first is a woman's monthly period. The second is pregnancy. The third is breastfeeding. During these times, a women's body often requires more fluids. Read thediscussion here and please take heed or talk to your doctor. The following are those common to both sexes.

#1. Diabetes People with diabetes, especially people who don't yet realize they have diabetes, are at increased risk of dehydration. It is important even for those with diabetes to know when blood glucose levels become too high, the body tries to eliminate the excess through increased urine output.

#2. Prescription medications Check the side effects of your prescription and don't forget the check with your pharmacist. Many medications have a diuretic effect on your body. They increase your urine output and your risk of dehydration. Blood pressure medications are known to cause this. Any drug that lists diarrhea or vomiting can also cause dehydration. Always think of increasing your water intake with these medications.

#3. Low-carb diets Many people are on low-carb meal plans, but forget that in the beginning to increase their water intake as when they decrease their carb intake, they lose water weight first causing dehydration.

#4. Stress That stressor, stress causes your adrenal glands to pump out stress hormones which causes the adrenals to become exhausted. The adrenals also produce the hormone aldosterone which helps regulate the body's levels of fluid and electrolytes. Finding ways to reduce stress is important because lower output of aldosterone causes dehydration and low electrolyte levels. Read my blog on diabetes and stress for suggestions to reduce stress.

#5. Irritable bowel syndrome Those that have had irritable bowel syndrome know that it is bad and if not managed causes nausea and chronic diarrhea which leads to dehydration. Talking to your doctor is advised and increasing water intake is needed to prevent dehydration.

#6. Your workout Most people attempt to stay hydrated when they exercise, but some people think this is for endurance athletes. Don't make this mistake if you are just walking or even swimming. Yes, swimming can lead to dehydration.

#7. Aging Unfortunately, as we age, our body's ability to conserve water declines. This is also true that the sensation of needing water declines. This is the reason the elderly are at higher risk for dehydration. In this, remember that not everyone needs the same amount of water, and often the elderly need more than the recommended eight glasses of water of they are active and exercising regularly.

#8. Dietary supplements Don't laugh this off. Just because it may be natural, does not mean that it can't send your bladder into overdrive. Parsley, celery seed dandelion, and watercress have all been known to increase urine output, which can cause dehydration. If you are consuming these or any dietary supplement, talk to your doctor about dehydration.

#9. High altitudes Traveling to high altitudes or living at high altitudes, your body adjusts by speeding up your breathing and increasing your urine output. Both are necessary to a healthy adjustment to the altitude and its oxygen levels; however, the constant urinating and panting causes you to exhale more water vapor than usual. Until you have adjusted to the altitude change, you are at increased risk of dehydration.

#10. Drinking alcohol Do you like to consume alcoholic beverages and do so past the point of becoming dehydrated. Many people do and people with diabetes should limit the amount of alcohol. Alcohol prevents or inhibits an antidiuretic hormone that would normally send some of the fluid you are consuming back into your body and instead sends it to your bladder for elimination.

#11. Eating too few fruits and vegetables The author is really pushing five servings of vegetables and fruit each day to help you stay hydrated. If you do not, then you are supposed to drink extra water. Dehydration may be the result if you don't eat five servings.

With all the above, make sure that you stay hydrated. Drink water until you feel satisfied, not just the recommended eight glasses per day. Some need more and others may need less. As you age, be careful and adjust accordingly. Contrary to what you may have been advised by doctors, when you are in periods of dehydration, consuming salt may be the boost you need. Salt helps hold water in your body and prevent severe dehydration.

May 28, 2014

Are RDNs Being Taught Proper Nutrition?

If you don't believe that registered dietitian nutritionists (RDNs) are in the pocket of Big Food, you need to read this blog. The Academy of Dietetics and Nutrition (AND) keeps setting themselves up as the only organization to educate people about nutrition, but it fact are just parroting what Big Food and Big Government wants them to say.

The annual conference of the California Dietetic Association demonstrates just how in bed with Big Food the group is. I suggest that you read this article by Kiera Butler, who attended the conference and had some real interesting comments about the sponsors. They included the Wheat Council, Hershey's, McDonalds, the International Food Information Council, Coca-Cola, Abbott Nutrition, Pepsi, General Mills, and Kellogg’s.

The RDNs were told that GMOs are perfectly safe and environmentally friendly. Unfortunately, the jury is still out on this and many proposed studies have been stonewalled and funds withheld. This is how the USDA and Big Agriculture protect their vested interests. The Wheat Council hosted a presentation about how gluten intolerance was just a fad, not a real medical problem. For those that live with Celiac Disease, it is a real medical problem and whole grains are permanently off the menu.

Lest you think that all members of AND are in agreement with Big Food, they are not. They have formed a new organization named Dietitians for Professional Integrity (DPI). This group is presently trying to work within AND. It will be interesting to see if they are successful, which I have big doubts considering the leadership of AND and the activities at the state level to have laws passed to make criminals out of other professional nutritionists with more nutrition education.

Take time to thoroughly explore the link above and learn what some members are trying to do. I wish them well in their endeavor. Attempting to work within AND will require a lot of effort and cause problems for them which they may have difficulty overcoming.

May 27, 2014

Can Blood Pressure Become Too Low?

Are you aware of low blood pressure and what the consequences can be? Many people are not and wonder why they feel dizzy and have falls. All the news has been about high blood pressure and what this causes and to take medications for it. Yet most doctors ignore low blood pressure and do nothing to help people correct low blood pressure.

Many people with type 2 diabetes have high blood pressure and like me are taking medications for this. Yet I have a non-diabetes friend that has low blood pressure. He has had two falls in the last three months and he does not understand why. He takes no prescription drugs, but does take a daily multivitamin. He is very active and exercises at least four times a week for varying amounts of time.

After this blog appeared, I called him and asked him to come over. We covered the blog and terms to give him a better understanding. Another term for low blood pressure is hypotension. If your blood pressure is on the high end, you many think low blood pressure could be a good thing, but in reality, hypotension can be a serious condition for some people. Hypotension may be a sign that there is an underlying medical condition. If you blood pressure suddenly drops or if you have the following symptoms, please contact your doctor.
  1. Dizziness or lightheadedness
  2. Fainting
  3. Fast or irregular heartbeat
  4. Feeling weak
  5. Feeling confused
  6. Lack of concentration
  7. Blurred vision
  8. Cold, clammy skin
  9. Nausea
    10. Rapid, shallow breathing
    11. Depression
    12. Dehydration
As we covered the twelve items above, he said that number 3 and 12 above might apply at times. We continued reading the blog.

Blood pressure that drops upon standing is called orthostatic or postural hypotension. This type of low blood pressure is common in older adults. Blood pressure that drops after eating is called postprandial hypotension, and this type is also more common in older adults, as well as in people who have high blood pressure or Parkinson disease.”

The cause of low blood pressure for one person may be different for someone else. In other words, some people naturally have low blood pressure and are perfectly healthy. However, certain medical conditions can cause low blood pressure, including:

Pregnancy. This is obviously not applicable for him.

Prolonged bed rest. This he felt this did not apply as he has trouble getting his eight hours of sleep.

Heart problems. Heart failure, heart valve problems, and heart attack can lower blood pressure. He said he would ask the doctor about these, but doubted they would apply

Dehydration. Dehydration reduces blood volume, thus lowering blood pressure. He felt this could be a problem although he tries to stay hydrated.

Blood loss. Blood volume and, therefore, blood pressure, drops as a result of internal bleeding. He doubted this was the cause, but again would talk to the doctor about this.

Endocrine problems. Thyroid disease, Addison disease, low blood glucose, and nerve damage from diabetes may lower blood pressure. He was not aware of any problems this would affect.

Severe infection. If an infection enters the bloodstream, this can lead to a life-threatening drop in blood pressure called septic shock. Again, he felt this was not applicable.

Severe allergic reaction. An allergic reaction to medicine, foods, or, say, a bee sting can cause a drop in blood pressure, along with difficulty breathing, hives, and itching. This is called anaphylactic shock. My friend said no to this one.

Medicines. Since he is not on medications except for the daily multivitamin, he will discuss this with the doctor.

Vitamin B12 and folic acid deficiency. A lack of either of these B vitamins can cause anemia, which, in turn, can lead to low blood pressure. After talking about this, he said he will talk to the doctor, as he could be low in B12.

Treating low blood pressure requires doctors understand this. Sometimes low blood pressure does not need to be treated, especially if there are no symptoms or if the symptoms are very mild, such as a brief spell of dizziness upon standing. If you have any of the above-mentioned conditions that may be causing low blood pressure, your doctor needs to treat the underlying cause, such as heart failure or diabetes, or possibly change the type of medicine that you take, if you are taking any blood pressure medications.

Other treatments for low blood pressure include:
  1. Drinking more fluids
  2. Adding more salt to your diet
  3. Avoiding or limiting alcohol
  4. Wearing compression stockings
  5. Taking certain medicines, such as fludrocortisone or midodrine (Orvaten)
  6. Going very slowly from a sitting to a standing position
When we covered the above points, he admitted that he was possibly not getting enough salt and would return to adding salt when cooking. I suggested that he consider purchasing a home blood pressure monitor to help track his blood pressure regularly, and especially if he had any of the symptoms. Always let your doctor know if you have symptoms of dizziness or fainting. Just like high blood pressure, low blood pressure is treatable. I also suggested he consider purchasing a finger pulse oximeter to use to check his heart rate and oxygen use. We looked both up for cost and he felt that both the BP cuff and finger pulse oximeter were tools he should have.

He asked me to print out my blog and the blog in the link so he could reread them and take them with him to discuss with his doctor.

May 26, 2014

More on Prescription Drug Interactions

Please, please check the medications with your pharmacist when adding a new prescription to your medications. Why? To prevent being hospitalized because of conflicts among medications. This article on Diabetes Health points out what can happen and this happened because a hospital could not or I should say would not check.

It was the pharmacist that discovered the conflict, but instead of picking up the telephone and making a call, sent a letter which was not opened until the patient was back in the hospital. It was corrected then, but should not have happened in the first place.

The FDA and the manufacturer do check with some drugs, but not every drug that a patient may be taking. Prescription drugs aren't tested in big studies using age, the speed of a person's metabolism, or other clinical variables. Interaction warnings are included with every prescription filled at drugstores. What patients do with this warning is shameful, as many people just toss it in the trash.

A recent study by the Mayo Clinic declares 70 percent of Americans use one prescription drug while half the population uses two prescription drugs. The Consumer Reports National Research Center prescription drug poll revealed an average of just over 4 prescription drugs are taken by Americans while 14 percent take 7 or more prescription drugs. Then consider that many patients see more than one doctor who may not be communicating with each other. This makes a prescription drug problem rather obvious. Now consider how many people go from one pharmacy to another pharmacy for their prescriptions, and it is a wonder there are not many more problems.

Now consider supplements – many people take them and do not tell their doctor or pharmacist that they are taking supplements. The FDA only regulates supplement products without conducting studies to investigate how it reacts with prescription medications. Mixing some supplements with prescription drugs is not only risky, but can be fatal. Yet most people consider them as natural and do not consider them as adding risk.

What can you do? Always maintain a list of current prescriptions and supplements you are taking. Make sure that each pharmacist and doctor has this list and keep it current.

There are also some foods that interactwith certain medications. Grapefruit and grapefruit juice reacts with at least 85 different prescription drugs as latest count. Since many people with diabetes are also taking statins, this is one bad combination, as are some of the cancer drugs and heart disease drugs.

There are many online resources, so consider keeping a list of websites in your wallet or purse. Or add them to your Smartphone In Case of Emergency (ICE) setting. You may want to consider one of many apps that are now available for prescription lists in the event you end up in the hospital.

The FDA constantly updates its website using reports from medical professionals about problematic side effects of not just prescriptions, but food, medical devices and even cosmetics:

The FDA also identifies potential problems for users of supplements:

The ASHP website provides information regarding drug interactions, precautions, as well as dosage advice:

The National Institutes of Health (NIH) MedlinePlus website provides information about adverse effects between prescriptions, supplements, as well as herbal ingredients. Just click on "Drugs & Supplements" and type in the product name.

Two additional online resources are provided by this national pharmacy:

May 25, 2014

Cross-Contamination Errors Using Insulin Pens

Some hospitals are taking cost containment to extremes, at least at the nurse levels.  This involves the reuse or multiple use of insulin pens among several patients. I have even been a victim of this. When I could not be sure that the insulin pen had not been used previously, I refused to let them use it on me. The nurse became angry and said their was no danger of cross-contamination. I said that the needle could do this by itself and that I would not allow this. The nurse became indignant and walked out.

Since I had my own insulin and insulin syringes, I waited until shift change and the nurse that came on then. She came in and asked why I had refused to let the nurse use the insulin pen. I explained that I could not tell how many people the pen had been used on and I was just protecting my health. I then asked her which insulin was in the pen. When she stated Levemir, I stated that I was on Lantus and Novolog and did not like Levemir. I explained that the pharmacist had approved my supply that I had with me and I would use that.

At that point, she insisted that she use their meter and lancet device and since she started with inserting a new lancet, I had no problems with that. After she had read my blood glucose and I had recorded it in my notebook, I opened my briefcase and took out my Novolog and started loading a new syringe. She asked why so much insulin and I explained that was my ratio because of insulin resistance and she would see what the reading showed when it was time for my Lantus.

Later, when it was time for my Lantus, the reading was right where I said it would be and she asked how many units I was taking. I told her and she questioned why I was stacking Lantus. I explained that the doctor had agreed to the splitting of the dosage between AM and PM because I was only obtaining about 18 to 20 hours of the duration of the 24-hour Lantus. I told her the hospital pharmacist had called the endocrinologist and confirmed this.

The safety of insulin pens had become the subject of a New York study in which 2,814 patients had reportedly been affected by insulin pen misuse. Then a Texas study in which 2,113 patients was reportedly exposed to disease transmission risk. These studies were presented by the Institute for Safe Medical Practices (ISMP) and in the process were used to recommend the return to vials and syringes for insulin injection.

This discussion is presented by a CDE that feels nurse education could mitigate the errors in the use of insulin pens and avoid the problems of insulin vials and syringes being misused. It is true that many abuses of vials of the wrong insulin and even problems of the incorrect syringes was and still is a problem in many hospitals, less attention is paid to the type of insulin pens used is also a problem. Many errors happen when the wrong type of insulin is injected because the nurses grab and go and forget to check that the pen is the correct type of insulin. The blog author thinks that insulin pens are important for patient satisfaction. This is one CDE that had better not cross paths with me, a confirmed vial and syringe user.

This is a reason to check and recheck what the nurse is injecting in you. I don't care that the nurse thinks she knows, I still insist on seeing the vial or pen to check that it is the correct insulin and what I use. Levemir is not a substitute for Novolog and diabetes management is important. Hospitals can make a mess out of this.