Diabetes, Family and Friends!

Diabetes Does Not Exist In A Vacuum!

Diabetes Does Not Exist In A Vacuum!

Diabetes does not exist in a vacuum.  It’s part of your life – and life gets messy sometimes, doesn’t it?

Spouse or significant other wanting your time – and you want to give it.

Kids needing to be taken to sports, activities, tutoring or enrichment programs…and then they want even more time!

The stress that a job brings.

Aging parents…or, aging in general.

Concern about adult children.

Parties, time with friends, your own activities.

The pressures of just living.

Who has time for Diabetes much less to wage a war on it?

Ideally, you’d be able to make the changes necessary to fight the disease and maintain life as you know it.  But, life is not ideal, is it?  And, fighting to control the disease takes time.  I really do understand.

Complications-graphic

But, and here’s the kicker, if you don’t take the time to control Diabetes, it will win.  Complications like kidneys will stop working because they are diseased from processing so much sugar that you need to go on dialysis.  Three days a week you are tied to a machine instead of doing what you want to do; instead of spending time with your children, or your grandchildren.  That’s the choice you are making today if you are not controlling Diabetes.

So, how can you control the disease and still do everything you are expected, or want to do?

You can introduce new foods into the family’s diet.  Nothing huge.  Maybe start with a few more fresh vegetables and a few less chips.  Work on reducing the carbs the family consumes – they will be healthier for it!  Maybe work to eliminate those sugary drinks by finding other beverages to serve at home.  Heck, look what happened to me on New Year’s Eve – I felt less than healthy for the first time in years!  By the way, my wife has lost 10 pounds in the last year due to diet changes needed for me to control Diabetes…she loves the results!

Make a game out of reading nutrition labels.  Teach kids what to look for and get them educated so they never have to face Diabetes.

Walk a little.  Do a few things to take a few extra steps.  Look, the most obvious and most often recommended it seems is parking your car a bit farther out in the parking lot.  Less obvious is taking a child or spouse with you on your walk.  Make it a time just for them.  Trust me, they will begin to learn it’s their time and remind you about walking.  And, remember, you only need to walk for 30 minutes.

Or, maybe that walk can be your time.

Have trouble remembering your meds?  Give a child or spouse the job or chore of reminding you when it’s time to take them. Attach a reward or allowance to it and you might never forget another dose!

In other words, involve your family in your war.  When you are successful, they are successful.  And, it might just bring you closer together as a family.

Yeah, I know Diabetes does not exist in a vacuum or on a desert island, but with just a little bit of planning, and enlisting others in your War On Diabetes, you will be more successful in your fight.  Remember, you have three weapons in your war: Diet, Exercise and Meds – use them.

As always, thank you for reading and sharing.

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Posted in Diabetes Control

On The Way to New Year’s Eve…

NewYearsEve

Work was winding down on Dec. 31st.  It had not been busy and we were going home early.  I was looking forward to a quiet evening at home – safe and warm.  Had a movie all picked out to watch.  Dinner was planned.  All very quiet and homey.  I assumed I would be up at midnight to wish my wife a Happy New Year and to thank her for the one past.

Then, sometime around 4:00 or 4:30 in the afternoon, I began to get a bit tired.  Okay, more tired than usual.  Downright sleepy, in fact.  Kind of strange, but I shrugged it off realizing I had not had my snack.  So, I ate my snack…and I did not reel any more energetic after having it.  I felt, well, sluggish and had a headache.

Okay, what was going on?  I got home and had dinner.  Still feeling tired.  Very strange for me.

What was going on?  I’ll tell you.  For the first time in four years I was not feeling well.  I was quite literally surprised. Surprised that I was not feeling well and surprised it took me hours to figure it out.  Why so long?

The simple answer is that when I began to eat a bit less and to get a little regular exercise, I stopped getting ill.  No cold.  No flu.  No sinus congestion.  Nothing.  I had been sickeningly healthy.  I used to get ill about twice a year – most of the time due to sinus issues.  I’d miss one or two days of work.  Sleep a lot.  Take a few aspirins, decongestants, and cough meds.  And, then everything was good.

But, was it really?

Since being diagnosed with Type 2 Diabetes and making a change here and there, I now know I was looking at the world through a slight haze.  My life was kind of like that commercial where things are blurry, you take a med and life is clear and in focus.

in focus

Well, life is in focus and clear.  And, it has nothing to do with meds and everything to do with how I eat and what I eat; it’s because I have Diabetes under control – and so can you.  No special “get healthy diet;” I just eat a balanced diet and watch portion size.  It really is that easy!  Eat a bit less.  A few more fresh vegetables and fruit; fewer carbs; add a dash of exercise (trust me, I don’t over do it in any manner) and do you know what you have?  Health and you are controlling Diabetes!

How great is that?

You have heard it before: You are what you eat.  If you eat a balanced diet of smaller meals and snacks; add a bit of exercise; you give your body a chance to be at its best.  You will just naturally lose weight; it’s inevitable. You see, I didn’t know what being truly healthy was for some 25+ years.  That all changed when I was diagnosed with Type 2 Diabetes because I took the disease seriously and made a few little changes.

Win your War On Diabetes and not only do you control a disease – your quality of health can be great.

As always, thank you for reading and sharing.

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Posted in Diabetes Control

Diabetes Risk Test

risk test

There are 78,000,000 people in the United States with Prediabetes.  Are you one of them?  Don’t have a clue?

Well, I came across the Diabetes Risk Test the other day when I was doing a little research.  It’s quick.  Easy.  And, will give you an idea if you, or a loved one, is at risk to get Diabetes.  Please take it.

Share the test with your friends; show your friends that you really care about them!  The sooner folks know their risk, the faster than can take the steps to prevent, delay or control Diabetes.

If you find you have a risk, contact your doctor and have an A1c test done.  It’s painless.  A bit of blood is taken, analyzed and in a day or two your doctor will have the results.   Once you know, you can act and fight your War On Diabetes, if required.

If you are told you have Prediabetes, know it can either be beat or Diabetes can be delayed.  But, you must take action.

If you find you have Type 2 Diabetes, first, don’t panic.  You can control Diabetes!  You can fight and declare War!  A good place to start is by reading the Diabetes Survival Guide.  Read it. And, know you can beat the disease.

As always, thank you for reading and sharing.

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Posted in Prediabetes

News & Views

News and Views

 

 

It’s Friday and I just can’t wait to get started…

New Drug, Farxiga, approved by the FDA. The FDA approved a new drug for the treatment of Type 2 Diabetes this week.  It’s been prescribed in Europe under the name Forxiga, which our pharmacist Katherine, has written about.  The same drug will be marketed in the US under the name Farxiga. The lnks are to great posts that provide a good understanding of the drug, how it works, and possible side-effects.  We presented Forxiga here months before FDA approval because we seek to keep you informed and a significant part of our audience is in places where Forxiga has been available.

New Type 2 (Diabetes) Drugs Change Treatment Decisions.  Metformin, the cornerstone in treating type 2 diabetes, saw an increase in usage among type 2s from 23 percent of that population in 1997 to 53 percent in 2012. But that increase has since plateaued due to the introduction of additional drugs that target insulin secretion and glucose regulation.” There are a wide range of drugs that work in different ways available for the treatment of Type 2 Diabetes.  It seems fitting that a review of them should appear this week, don’t you think?

Type 2 Drugs in the Pipeline: an Update.  “If you Google “type 2 diabetes drugs,” one website lists the names of 92 drugs that medical professionals have prescribed at one time or another to treat diabetes…You’d think that the diabetes apothecary has a more than a sufficient number of drugs for treating type 2. But scientists and pharmaceutical companies continue looking for new drugs to add to the diabetes medicine cabinet, including novel approaches to controlling blood sugar and weight.” A lot about drugs this week, huh?  Well, just in case you think Forxiga/Farxiga is by itself, you should know there are new types of drugs being developed all of the time.  This article provides a summary of the approaches being taken.

Walnuts Improve Blood Vessel Function. “If you’ve resolved to improve your diet in 2014, there’s one small step you can take that will reap big rewards, according to new research from the Yale-Griffin Prevention Research Center: incorporating walnuts into your diet.”  New drugs.  Newer drugs being researched. Isn’t it great to know that there are those folks who are looking at the benefits we can get from…wait for it…food!  A few walnuts can make a difference!  Find out how.

28-16_last_dawn

People with Type 2 Also Suffer from Dawn Phenomenon.  “Researchers have found that the dawn phenomenon, a rise in blood glucose in the early morning hours, affects both people with type 1 and people with type 2 diabetes…Previously it was thought to only affect people with type 1 diabetes, but in a recent study that examined data from the past 30 years, researchers determined that the dawn phenomenon occurred frequently among patients with type 2 diabetes.”  I don’t know what to say.  Once again, we presented the Dawn Phenomenon as an issue that effects all Diabetics almost a year ago. Yeah, I know, I am patting ourselves on the back.  It’s nice to know there is science to support what we knew existed.

9 Ways to Cut Diabetes Complication Risk. ““The good news is that a lot of the diabetic complications people are worried about are avoidable,” says Robin Goland, MD, codirector of the Naomi Berrie Diabetes Center at Columbia University Medical Center. “And you can certainly delay them.” Control of three health measures is essential—A1C (glucose), blood pressure, and cholesterol. Getting lab tests and checks as directed can help you and your health care provider spot problems early and ramp up prevention and treatment.””  A great reminder that complications from Diabetes do not have to happen.  You are in control of whether or not you suffer from the complications.  Here are some easy steps to avoid those complications.

Wow…a lot to learn about.  And, I am only scratching the surface.  To see more articles go to Diabetes News.

As always, thank you for reading and sharing.

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Posted in Diabetes Control, Exercise & Diet, Meds and More!

Farxiga (Forxiga) Approved for Use in the United States

Greetings from Dr K, your War on Diabetes pharmacist.  Today I’m coming to you with news of a new medication for diabetes that will now be available in the United States.  If you’ve been reading our blog for awhile, you will know that I talked about a medication named Forxiga.  Forxiga was the first medication in its class – it helps to lower your blood sugar levels by helping you release more glucose from your body in your urine.  Well today, we learned that Forxiga will now be available in the United States, but it will be called Farxiga (to make it less confusing, I will be calling it Farxiga for the remainder of this post).

In November of 2012, Farxiga was approved for use in the European Union.  The manufacturers tried to get it approved in the United States at that time, but the Food and Drug Administration (the organization that approves or denies medications for use in the United States) requested more research trials be conducted before approval.  There were concerns about Farxiga being linked to the development of tumors and cancers.

In April the FDA approved a similar drug in the United States called Invokana.  Invokana works the same way as Farxiga.  Farxiga will join Invokana as the second in its class, known as a sodium-glucose co-transporter 2 (SGLT2) inhibitor.

The concerns about tumors and cancers with Farxiga have not completely gone away.  The FDA does not recommend Farxiga for patients with active bladder cancer and states that patients with a history of bladder cancer should discuss this with their physician prior to starting Farxiga.  The FDA also mentioned that patients with kidney impairment, end stage renal disease, or those on dialysis should not take Farxiga.  Also, the FDA is requiring six additional post-marketing studies to be conducted by the manufacturers.  They are:

  • A trial to determine the cardiovascular risk of Farxiga in patients who are at high risk of developing cardiovascular disease
  • A thorough assessment of bladder cancer risk in patients participating in the above study
  • A study in animals to  evaluate Farxiga’s effects on urinary flow and rate and bladder tumor promotion
  • Two studies to evaluate the medication in pediatric patients – at what rate does the medication pass through their bodies and how, is it effective, and is it safe?
  • An extensive program to monitor any reports of  liver problems and how Farxiga affects pregnancy

The most common side effects seen with Farxiga in trials are genital fungal infections and urinary tract infections.

This is big news for American type 2 diabetics.  Since this is a new drug, we do not have the extensive history in regards to safety and effectiveness that we do in our standards like metformin and insulin.  But, for patients who are not at their A1c goal and would like to try another option, Farxiga might be a good choice.  As always, discuss all medication changes with your local physician.

If you want to read the official statement from the FDA, it can be found here.

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Posted in Meds and More!

Big Landmark Yesterday

20k views

Yesterday, January 6, 2014, at about 8:20 am PST, this blog was viewed for the 20,000 time. That’s remarkable to me.  And, before I go any further, thank you.  We would not have made it without you.

I won’t bore you with numbers, growth, statistics, or any of the information I sometimes find so very interesting.  I will tell you that we will work to provide the information, encouragement, hope, and if required – cajoling, you need to Prevent, Delay and Control Type 2 Diabetes; that we will continue to provide you with the weapons you need to fight and win your War On Diabetes.  And, if you are like me and your weight is linked to Diabetes, we will offer common sense tips for losing and then maintaining a healthy weight.

One of the challenges with Diabetes is that it’s an invisible disease and is not always well understood.  Unless you have a wonderful support system, you can feel very alone, which makes it even tougher to fight.  There are no meetings.  No handshakes.  No tokens, medals or recognition are awarded when we are controlling the disease. And, while your friends and loved ones can be sympathetic – they don’t always understand.  Yeah, it can be a very lonely, quiet disease even if there are millions and millions of us out there.

But, it does not matter how many Diabetics there are in the country or world.  The most important one is you.  Our goal and reason for existing is to serve you; to help you win your War On Diabetes.  If you have an idea of how we can serve you better, please do not hesitate to let us know.

Stay tuned. 2013 was great. 2014 is going to be better!

As always, thank you for reading and spending a bit of time with us.  We appreciate it so very much.

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Posted in Diabetes Control

All Things New – New Guidelines for Treating High Cholesterol

Dr. K. here, your War on Diabetes pharmacist, with a new lesson for a new year.  I was at work the other day reviewing the new cholesterol guidelines. New guidelines?  Yes.  Every few years, the American Heart Association and American College of Cardiology publish new guidelines that are used as a recommendation for treating patients with high cholesterol.  Since I have been doing a series of posts here on cholesterol recently, I wanted to see if the guidelines said anything about treatment for cholesterol in diabetics.  What I found in the changes made me stop and take a step back – the new guidelines are a complete revamping of the way that we have been treating all patients with high cholesterol, which is why I thought it was so important to make a formal post about these changes.

At the end of this posting I will provide a link to the full cholesterol guidelines, for the sake of completeness and because I know we have friends of diabetics that read our blog and should know how the recommendations affect them.

The ‘Old’ Way

Up to this point, the treatment of high cholesterol was based on numbers.  You got a blood test for lipids.  The doctor received a report with your numbers and, based on those numbers, developed a treatment plan.  It was a pretty cut and dried approach that everyone could understand.  Those were the past guidelines.

If you have read my previous cholesterol posts, you might remember words like LDL, HDL, triglycerides, good cholesterol, bad cholesterol, and so on.  In fact, if you’ve been on cholesterol medications for awhile, you might even know what your goals are based on your many blood tests through the years.  Well, what I’m about to say could effectively wipe all of the things you’ve learned off of the chalkboard.  If you’ve looked for my simvastatin and lovastatin posts recently, you’ll notice we’ve taken them down – that’s because the changes are significant enough to make me rewrite portions of my articles in order to keep them accurate relative to the new model.

New Guidelines

Have I kept you on the edge of your seat long enough?  Well, let’s end the suspense now.  The newest recommendations from the American Heart Association/American College of Cardiology abandon the standard LDL goal numbers in favor of giving an appropriate statin medication at the correct dose based on a patients risk of developing heart disease or complications.  You will notice that I said a statin medication – the new guidelines focus more on treating with statins only, saving non-statin medications as last-ditch options or for particular patients with high trigylcerides alone.

This should come as no surprise to you from reading my posts – statins have always been known as the best cholesterol-lowering medications with some of the lowest amount of side effects and greatest benefits on improving overall health.  I have not, and will continue to not recommend over-the-counter products such as fish oil for the majority of patients with high cholesterol.  Contrary to what has been reported on medical shows on television and in the news recently, adding medications like fish oil, krill oil, flax seed, niacin, or even prescription fibrates (gemfibrozil, fenofibrate) has not been shown to have any effect on decreasing strokes, heart attacks, or death from heart-related causes.  Remember, if it sounds too good to be true, it probably is.

The old days of starting on a low dose of a statin and working your way up to a dose that gets you to your goal cholesterol levels are over.  As a diabetic, you will know that we treat diabetes that way – start at one dose  mg/and work your way up until your A1C is where we want it.  The treatment of high cholesterol is now a whole different ballgame.  It has been found that there is no need to start a patient on a low dose of a cholesterol medication and work up to a higher dose, so from now on we will start you at the recommended dose for your risk factors (which I will discuss later) and lower the dose if muscle aches become a problem.  Starting at a low dose and increasing slowly has not been shown to decrease the muscle aches that some experience with statins.

Benefits-Driven Dosages

The new guidelines rank cholesterol medications and doses based on how “strong” they are (what percentage of cholesterol-lowering you can expect from them): high intensity, moderate intensity, and low intensity.  Which category of statin you will be taking is based upon how much benefit you are expected to receive from taking a statin.  How do they determine that?  A new risk calculator has been developed which will help predict if you are likely to have in the next ten years a stroke, heart attack, or death from heart related problems.  The more at risk you are, the more benefits you will receive from statins (because they have been shown to decrease the risk of these health events), so the stronger the medication you should receive.

To try the risk calculator for yourself, follow this link.

There are four groups of people who are classified as “statin benefit groups” because these groups have been found to have more of the heart related problems that I just discussed and statins can help prevent these problems, if given at the proper dose.  People in these groups should be on a statin medication.  If you are a diabetic between the ages of 40 and 75 with LDL between 70 and 189 mg/dL (1.8 to 4.9 mmol/L), you fall into one of the statin benefit groups.  If you are outside of those age ranges, you might fall into one of the groups if you have other conditions (such as very high cholesterol, heart disease, or if your risk on the risk calculator is greater than 7.5%).  Essentially, they recommend that almost all diabetics between the ages of 40 and 75 should now be on a statin.

The recommended statin is based on how “strong” it is, or how much cholesterol-lowering potential it has been proven to display.  High-intensity statins (those that can lower LDL by over 50%) should be used for diabetics who receive 7.5% risk or higher on the risk calculator above.  High-intensity statins are:

  • Atorvastatin (Lipitor) 80 mg once daily (40 mg if 80 mg not tolerated)
  • Crestor 20 mg to 40 mg once daily

Moderate-intensity statins (those that lower LDL by 30-50% on average) should used for diabetics who receive less than a 7.5% risk on the risk calculator.  The moderate-intensity statins are:

  • Atorvastatin 10 to 20 mg once daily
  • Fluvastatin 40 mg twice daily or 80 mg (XL) once daily
  • Lovastatin 40 mg once daily
  • Pitavastatin 2 to 4 mg once daily
  • Pravastatin 40 to 80 mg once daily
  • Rosuvastatin 5 to 10 mg once daily
  • Simvastatin 20 to 40 mg once daily

There is another category of low-intensity statins (lower your LDL by less than 30%), but these are specifically reserved as last-choice options because they have not been proven as effective at lowering your risk of heart attacks, stroke, and death.  They should be only used if you have tried all of the options in the high or moderate-intensity categories and are still having muscle problems.  The low-intensity statins are:

  • Fluvastatin 20 to 40 mg once daily
  • Lovastatin 20 mg once daily
  • Pitavastatin 1 mg once daily
  • Pravastatin 10 to 20 mg once daily
  • Simvastatin 10 mg once daily

Notice, there are very specific doses given on some of these medications.  These are the doses that have been shown, in clinical studies, to have the desired risk-lowering benefits necessary for diabetic patients.  If you are taking one of these medications, but at a lower dose than is recommended above, you might not be receiving the necessary benefit your medication.  Talk with your doctor about the new guidelines and go over your risk assessment at your appointment.  Remember, the risk assessment shows how likely you are to have a stroke, heart attack, or death from a heart-related condition within the next ten years.  The right dose really could save your life (remember, heart disease tops the list as the number one killer of American adults, stroke is number four).

The guidelines also stress that medication alone should not be the solution to fending off heart attacks and stroke.  Proper nutrition and exercise, as they are in the War on Diabetes, are two of your weapons when trying to lower your risk of heart disease.

Another note, these guidelines are called recommendations for a reason.  They cannot be considered an across-the-board standard for all patients.  Every person is different, which is why you and your doctor should be the ones to determine whether or not you should start a statin.  A good thing about new guidelines is, it keeps the conversation fresh and pushes us to develop the best plans based on the current research available.

If you are a prediabetic or a non-diabetic, the guidelines address you as well.  You can read all about them here.

For a more lively discussion, and to hear about the criticisms that the guidelines have faced so far, visit this article.

As a disclaimer, I am your “virtual” pharmacist, here to provide you with information and answers to questions. However, I am not your local pharmacist and could, in no way, be aware of your specific medical needs. Remember to always check with your medical provider and pharmacist before stopping or starting any new medications. My posts are based on general pharmacy principles and should not considered as your “first opinion” when it comes to your health. Please consult with your doctor and pharmacist about anything regarding your health.

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Posted in Meds and More!
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