Diabetes Newsletter

Diabetes Newsletter
Medication, Safety First
New medications are approved almost
every day. After a medication comes
to market, there is continued research
to keep patients safe. The Food and
Drug Administration (FDA) collects
information about the new medication.
This information is focused on adverse
events. Once a medication is approved,
rare side effects can appear. This is
because many more people take the
medication after approval, as compared
to during pre-market research. When a
medication is approved there are many
steps in the process:
A potential medication is first tested in
lab animals.
The FDA then approves testing
in humans.
Phase 1 studies are done in healthy
volunteers. They usually include 20 to 80
subjects. These studies help determine
how safe the product is.
Phase 2 studies are done in people
with the disease the medication is
meant to treat. They usually include
24 to 300 subjects. These studies
help determine how effective the
product is.
Phase 3 studies are also done in
people with the disease the medication
is meant to treat. However, they include
more people, usually 400 to 3,000
2015
Winter 2016
By: Mary Farlow, PharmD Candidate
subjects. These studies help determine if
the medication will work for most people
with the disease.
The FDA looks at all the information
from the Phase 1, Phase 2, and Phase
3 studies. Then they decide if the
medication is safe and effective for
people to use.
The company that created the
medication is required to track safety
information once the drug is on the
market. The information is reported to
the FDA. This is called post-marketing
surveillance.
It is important to talk to your doctor
or pharmacist about your concerns
with your medications. If a rare event
does occur, the FDA will decide if it
is associated with the medication. If
it occurs often enough, the FDA will
release a warning, informing patients,
doctors, and pharmacists, of the new
side effect.
Recently, the FDA released a warning
about the medication class, DPP-4
inhibitors. DPP-4 inhibitors are diabetes
medications. Medications in this class
include: Januvia (sitagliptin), Onglyza
(saxagliptin), Tradjenta (linagliptin), and
Nesina (alogliptin). The warning said
that these medications may cause severe
joint pain. It was found that joint pain
caused by these medications could occur
at any time. In some patients, joint pain
occurred after the first dose. In others, it
occurred after several months. For many,
joint pain was never a problem.
DPP-4 inhibitors help lower blood sugar.
These medications work very well for
patients with high blood sugar after
meals. They are an important part of
treatment for some patients. These
medications work in two ways.
Insulin is produced and released from
the pancreas if blood sugar is high.
Glucose production in the liver
is reduced.
If you have new joint pain that occurs
while taking one of these medications,
do not stop taking it. Instead, talk to
your doctor or pharmacist so they can
determine the best course of action
for you!
References:
Food and Drug Administration. FDA Drug Safety
Communication: FDA warns that DPP-4 inhibitors for
type 2 diabetes may cause severe joint pain. Available
at: http://www.fda.gov/Drugs/DrugSafety/ucm459579.
htm. Accessed September 15, 2015.
Food and Drug Administration. The FDA’s Drug
Review Process: Ensuring Drugs are Safe and
Effective. Available at: http://www.fda.gov/drugs/
resourcesforyou/consumers/ucm143534.htm. Accessed
October 8, 2015.
Sitagliptin. Lexi-Drugs. Lexicomp. Wolters Kluwer
Health, Inc. Hudson, OH. Available at: http://online.
lexi.com. Accessed October 9, 2015.
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Winter 2016
Diabetes
Newsletter
As Far as the
Eye Can See
By: Monet Stanford, PharmD
Persons who are managing their
diabetes properly are preventing many
complications, including damaging
effects on their vision. Diabetic eye
disease can cause permanent issues such
as retinopathy, cataracts, glaucoma, low
vision or even permanent vision loss.
When blood sugar is elevated over a
prolonged period of time it can damage
the tiny blood vessels in the eye on
the retina. The retina is a tissue in the
back of the eye that translates visual
images for the brain. Damage to
the retina from diabetes happens
very slowly. First, the elevated sugar
blocks the blood vessels and cuts off
the retina’s supply of oxygen. The retina
responds by growing new blood
vessels as a source of oxygen. However,
these new vessels break easily and leak
blood in to other structures in the eye.
Slowly, the blood continues to leak
into the eye. This build up blocks light
from entering the eye. For this reason,
patients with elevated blood sugar can
start to see floating spots or even total
darkness. It’s possible that both eyes may
not have the same amount of damage
and sometimes the blood drains by itself.
However, if complications do occur
there are few options other than surgery
that can prevent the progression.
Many people do not start to notice any
changes to their vision until there is
severe damage. For these reasons,
we recommend an eye exam at least
once a year even if your vision is
not an issue for you. Also, if you
do notice any problems, calling an
eye doctor right away is the most
important step you can take.
During its early stages, symptoms
rarely occur but as retina problems
worsen, symptoms might include:
• Blurry or double vision
• Rings, flashing lights, or blank spots
• Dark or floating spots
• Pain or pressure in one or both eyes
• Trouble seeing out of the corners of
your eyes
The main test that an eye doctor will
use to test if a patient is developing
eye disease is called a dilated eye exam.
In the beginning of the appointment,
eye drops will be placed in your eye to
enlarge your pupils (or the center of
the dark circle of your eye). A special
magnifying glass will then be used to
check for any impending damage in or
around your eyes. While waiting for your
pupils to dilate your eye doctor should
be checking for the pressure in your eyes,
side or peripheral vision and how well
you can see objects at various distances.
The best ways to keep your vision in
check is to continuously keep your
blood glucose numbers as close to
your target range as possible. At Fagen
Pharmacy we work with our patients
to set target blood glucose numbers
and teach them what to do when
numbers are too high or too low.
Reference:
National Institute of Health. National Institute of
Diabetes and Digestive Kidney Disease. “Keeping
your eyes healthy” http://www.niddk.nih.gov/healthinformation/health-topics/Diabetes/prevent-diabetesproblems/Pages/keep-eyes-healthy.aspx
INSIDE
• Diabetes, Colds, and
High Blood Pressure
• Medication Safety
• The ABCs of Diabetes
• Flu Shots & Statins
Diabetes Newsletter
The ABCs of Diabetes
By: William Sahy, PharmD Candidate
Diabetes is a condition where your body
has trouble regulating the level of sugar
in your blood. So, the primary focus of
diabetes care is managing your blood
sugar, but we also focus on other areas
as well to prevent any complications.
The ABC’s of diabetes addresses three
of the most important considerations in
patients with diabetes.
which increases the risk for having a
heart attack, stroke, and kidney disease.
Normal blood pressure is 120/80 mmHg,
but the goal for patients with diabetes is
140/90 mmHg.
C: Cholesterol
There is “good” and “bad” cholesterol.
High-density lipoprotein (HDL), or
“good” cholesterol, helps keep your
A: Hemoglobin A1C
heart healthy and can be increased
This is a measurement of how well blood by exercise. Low-density lipoprotein
sugar levels have been managed over
(LDL), or “bad” cholesterol, can clog
the past three months. This is related to, your blood vessels and can be decreased
but still different from blood sugar levels. through diet, exercise, and medication
When a blood sugar level is measured it
therapy. Patients with diabetes are at an
is a snapshot of how much sugar is in the increased risk of having high cholesterol
blood at that time. A1C can be thought
(“bad” cholesterol), which can increase
of as an average of what the blood
the risk for having a heart attack
sugar levels have been over the past
or stroke.
three months. For patients with diabetes Managing blood sugar is the
the standard A1C goal is less than 7%.
cornerstone of diabetes care, but it
B: Blood Pressure
Patients with diabetes are at higher risk
of developing high blood pressure, and
many patients already have high blood
pressure when they are diagnosed with
diabetes. High blood pressure puts
more strain on our hearts and kidneys,
is important to look at other health
conditions as well. By keeping your
blood sugar controlled as well as
keeping an eye on your blood pressure
and cholesterol you can live a healthy
life and avoid complications that can be
caused by diabetes.
Diabetes Education Class Schedule
Fagen Pharmacy’s Diabetes Education
February:
Program is recognized by the American
•Tuesdays 10am-noon: 2/2, 2/9, 2/16, 2/23
Diabetes Association. We offer comprehensive
• Wednesdays 6-8pm: 2/3, 2/10, 2/17, 2/24
group and individual diabetes education.
Ask a member of the Fagen Pharmacy staff for
March:
more information.
•Tuesdays 10am-noon: 3/1, 3/8, 3/15, 3/22
January:
•Tuesdays 10am-noon: 1/5, 1/12, 1/19, 1/26
• Wednesdays 6-8pm: 3/2, 3/9, 3/16, 3/23
• Wednesdays 6-8pm: 1/6, 1/13, 1/20, 1/27
Classes located at Fagen Pharmacy: 3400 N. Calumet Avenue, Valparaiso, IN 46383
For more info, contact: Marjie Laciak, PharmD, BC-ADM | 219-462-4381 x12026 | diabetes@fagenpharmacy.com
Flu Shots & Statins
So, What’s the Deal?
By: Whitney Tooley, PharmD
Each and every year, it is likely that you
receive several reminders from your
doctor, pharmacist, and other healthcare
professionals about the importance of
getting a flu shot. Although this year
is no different, it seems as though new
information has also surfaced and is
being promoted by various social
media avenues, including television and
the radio. What is the topic of this new
media gossip? Flu shots and statins.
So, what’s the deal?
Recent study data seem to suggest
that statins, which are commonly
used to lower cholesterol levels, may
decrease the effectiveness of flu
vaccines. Although clinical researchers
are acknowledging that this may be
the case, they have an important
message for those who may be affected.
Dr. Robert Atmar, a clinical research
professor at Baylor College of Medicine,
states that “there is a clear-cut benefit
to persons taking statins, so patients
should not stop statin use because of
the study results, even for a short time.
And flu vaccines provide at least some
protection in people who take statins, so
patients should still receive an influenza
vaccine to be protected.”
Ultimately, more studies are needed
before a clear-cut answer is available.
For now, guidelines still recommend the
flu shot for everyone 6 months of age
and older. The bottom line:
flu shots and statins…take them both.
Winter 2016
Diabetes, High Blood Pressure,
and Colds, Oh My!
By: Angela Schuman, PharmD Candidate
Cold and flu season is here.
Many people come to the pharmacy
looking for relief from cough,
congestion, and other symptoms.
For someone who has high blood
pressure or diabetes, selecting an
appropriate medication can be a
tricky task. Let’s look at some of these
common symptoms and appropriate
medications to help alleviate them.
Cough: dextromethorphan, menthol
Dextromethorphan is an anti-cough
medicine found in many cough syrups.
These syrups are usually full of sugar,
which can cause blood sugar to rise.
Look for sugar-free options such as
Diabetic Tussin or Scot-Tussin.
Cough drops containing menthol may
be used, but many also contain lots
of sugar. Look for sugar-free options
such as Halls Sugar Free, Fisherman’s
Friend, or Ricola Sugar Free.
Be careful about using too many sugarfree products. The sugar-free products
can have a laxative effect if used too
much or too often.
Congestion/sinus pressure:
pseudoephedrine, guaifenesin
Pseudoephedrine (Sudafed) should
not be used if you have high blood
pressure. It can cause blood pressure to
spike dangerously high, making a heart
attack or stroke more likely. It is okay
for patients with diabetes without high
blood pressure to use pseudoephedrine.
If you are on medicine for high blood
pressure, and your blood pressure is
normal, this medicine is okay to take.
Guaifenesin is safe for anyone with high
blood pressure or diabetes to use.
It works to thin or break up mucus in the
lungs, making it easier to cough up.
Another safe option for high blood
pressure is Coricidin HBP. Coricidin
HBP comes in Chest Congestion &
Cough, Cough & Cold, Maximum
Strength Flu, and Cold & Flu products.
These all have more than one medicine
in them, so ask your pharmacist to
make sure you are not doubling up on
any medications.
Runny nose: antihistamines
Antihistamines are good for drying
runny noses and calming itchy or
watery eyes. Alone, all are safe for
people with high blood pressure
or diabetes. Some may make you
more sleepy than others. It may be
helpful to take these at bedtime.
• Will make you most sleepy:
chlorpheniramine, diphenhydramine
(Benadryl)
• Will make you sleepy: cetirizine
(Zyrtec), loratadine (Claritin)
• Will not make you sleepy:
fexofenadine (Allegra)
Headache/sore throat, pain, fever:
acetaminophen (Tylenol)
Tylenol is a safe option for anyone with
diabetes or high blood pressure. Since it
is commonly used in combination cold
and cough products, be sure to look at
the ingredients to make sure you are not
taking too much. You should not have
more than 3,000 mg per day.
Medicines like ibuprofen (Motrin, Advil)
or naproxen (Aleve) should not be
used regularly to help with pain or fever.
These medications leave the body
through the kidneys, and people with
diabetes are more likely to have kidney
issues. With long-term use, they can
increase blood pressure and affect the
heart. If you choose to use one of
these, be sure it is only as needed.
Some things to remember:
Being sick puts your body under stress
and can spike your blood sugar and
increase your blood pressure. Be sure to
check your blood sugar more frequently.
Tablets or capsules are better options
than liquids (such as syrups) to keep
blood sugar under control. Always use
a tablet or capsule instead of a liquid
if possible.
Follow the dosing directions on
the container. Do not use more
than recommended.
Getting the flu shot is also a good way
to protect yourself!
If you are sick for 10 or more days, have
thick, colored, or excessive mucus, or
a fever over 103° F, you should see
your doctor.
If you have any questions about what
medicine would be best for you or you
have symptoms that are not mentioned
on this list, ask your pharmacist!
References:
Diabetic Living. Cold medicines that are safe for
diabetics. Available at: http://www.diabeticlivingonline.
com/medication/oral/cold-medicines-are-safediabetes?page=0%2C1. Accessed: November 12, 2015.
Roscoe R. Treating the common cold and type 2
diabetes. Available at: http://www.diabetescareguide.
com/treating-common-cold-type-2-diabetes/.
Accessed: November 13, 2015.
Bayer. Coricidin HPB. Available at: http://www.
coricidinhbp.com. Accessed: November 13, 2015.