I am diabetic and i am not bleeding enough to take my blood sugar had to prick my self 6 times to get enough? I had to prick myself 6 times to get enough blood; blood sugar was 437 why was i not bleeding almost nothing.  Please help, Amy

My answer:

Can I have diabetes and anemia at the same time?  I already have anemia but my body started changing lately ,I started going to the bathroom a lot ,drinking lots of water ,and I feel really tired all the time! is it possible that I have diabetes? cuz I had anemia since like 4-5 months only but I used to live normally ,and I never drink that much of water in a day ,now I drink like ,7 or 8 bottles in a day !! i used to drink only 4 in a day ,,PLEASE HELP!!

My reply:

Yes it is quite possible to have diabetes and anemia at the same time. Actually people with diabetes have a higher risk of developing anemia.

Your symptoms of excessive thirst and increased tiredness can be due to many different causes- including diabetes. And the other poster is correct -the only way to be diagnosed with diabetes is to see your physician.

However, in your situation…

I am assuming that you have iron-deficiency anemia (because it is the most common type) – increased thirst and fatigue can be due to a worsening of your anemia. Other symptoms would be dizziness, rapid breathing and sweating.

So, my questions are…1) were you diagnosed by your physician with anemia? 2) did you start taking an iron supplement? 3) did you have your iron levels re-tested?

It sounds like you would need to contact your physician’s office or clinic to have your iron levels re-tested. Please be sure to do so because iron deficiency anemia is important to treat.

Please remember that iron levels can be too high -so you do not want to start taking an iron supplement or increase your iron supplement dose without contacting your doctor.

Just a note -it is best to take your iron pill with some soda or orange juice to help it be absorbed better. Avoid milk products within a few hours of taking the iron pill.

Also, if you were tested 4-5 months ago at your doctor’s office, it is unlikely that you developed diabetes within that time -even if you did the symptoms would not be so extreme.

I hope this helps!

You’ve heard it before but it bears repeating – there are no stupid questions.  We thought it would be fun to post random questions that we are asked throughout our work days and from this site.  So, if you have any random questions J please leave us a comment or send us an email – nova@getpharmacyadvice.com or cate@getpharmacyadvice.com .  We will talk about whatever you are interested in!

What ever happened with the inhaled insulin?!

Exubera, the inhaled insulin was taken off the market.  It never quite took off because of the issues with correct technique of the patient along with irregular absorption into the lungs.  There is a lot of research going on to find a way to deliver insulin without needles!

I heard there are bloodless glucose meters coming out, is that true? (I hope so!)

Perhaps one day, but not yet   There was one bloodless glucose meter that was close but there were so many issues it is not available.  Good news is that there is a lot of research going on with being able to test blood glucose through skin, breath, tears and saliva…but it is going to be awhile. 

This question was a comment on the article Do all Diuretics Contain Sulfa?:   I have to take Edecrin because I am allergic to all other diuretics but my insurance will not cover it…what can I do?

This is when insurance companies can become super frustrating! The best thing to do, if the insurance co has already said they do not cover it is to:
1) Request letter from your physician about your need for a specific medication and why (with specifics)
2) Contact your insurance company directly on phone, email and letter to request drug to be covered
3) Reach out to your insurance agent and request their help -that is what they are there for

Insurance companies can sometimes be difficult to deal with but the truth is we pay them for coverage. If this is your only option, they should cover it -however to get them to do so can be a long, tedious process.

We received a comment on the article Juice and Allegra:  Why was Allegra taken off the market? 

I don’t believe Allegra (fexofenadine) was taken off the market since its release. However, Seldane (terfenadine) was taken off the market because it interacted with some drugs to cause irregular heart rythmes (that could possibly lead to death). When Seldane was taken orally it was broken down into an active drug, fexofenadine.  Fexofenadine was then released as Allegra. It has all the benefits of Seldane without the negative effects on the heart!

Diabetes Type 2 Overview and Actos and Avandia -What’s the Deal?!

There has been a lot of controversy of benefits versus risks with these medications -especially Avandia.  For a while now, Avandia has been considered unsafe because it is associated with higher risk of heart attacks and strokes and worsened cholesterol levels.   

Well, for those who are still on Avandia, I am sure you will soon notice it is SUPER difficult to get it any longer.  Due to heart concerns, after mid-November, there is a new program that you and your physician will need to be enrolled in -just to be able to get Avandia.  It is the Avandia -Rosiglitazone Medicines Access Program (this link will take you to Avandia.com).  Only patients that are already on Avandia or have no other options will be able to get the medication through the program.  Avandia will no longer be available at your local pharmacy -ONLY through the program which will mail the medication to your home.

On the other hand, we have Actos (pioglitazone), which was considered the “safe” option.  Now, there are some murmurs about increased risk of bladder cancer with use of Actos.   The risk is really quite small, but best to avoid Actos if you have a history of bladder cancer. 

I hope this clears up why there is no Avandia to be found!  If you have any questions about switching to a different diabetes medicine -please leave a comment.  And if you are part of the Avandia program, we would love to hear how that is going for you!

Metformin was first synthesized back in the 1920s but was not seriously considered for use in treating diabetes until the 1950s.  It took another 40 years for it to be released in the United States for treatment in type 2 diabetes.  It is now first line treatment for diabetes as montherapy or concomitantly with insulin or sulfonylureas. 

Metformin is the only antidiabetic medication still on the market that belongs to the drug class biguanides.  It works by decreasing hepatic glucose production, improving insulin sensitivity and decreasing glucose absorption in the intestines.  This leads to a reduction in fasting glucose levels by 60-70mg/dL, which in turn decreases hemoglobin A1c, a test that measures the average blood glucose over 2-3 months.   Also of interest is that metformin has been evaluated in the treatment of polycystic ovarian syndrome and to help delay early menarche in females.

Metformin is available in an oral solution (Riomet), tablet (Glucophage) and extended release tablet (Fortamet, Glucophage XR, Glumetza).  Metformin tablets and extended release tablets are available in generic. 

The most common side effects during the beginning of treatment are headache, nausea, vomiting and diarrhea.  These are usually transient and will stop after a few weeks of therapy.  Taking doses with meals and starting with a low dose and increasing slowly should help decrease the likelihood of these adverse reactions.  Kids often complain of the “fishy” or “sticky” odor associated with some of the generic tablets.  Additional side effects include flushing, myalgia, rash, sweating and flu-like symptoms.  Sometimes, the outer shell of the extended release tablets may be found in the stool. 

Metformin has a black box warning for lactic acidosis.  It is an extremely rare side effect but if it occurs it is a medical emergency.  Because of this risk metformin should not be used in kids with renal or hepatic insufficiency.  Symptoms of lactic acidosis can include anorexia, nausea, vomiting, belly pain, lethargy and decrease in blood pressure.  The actual incidence is extremely low at around 9 incidences in 100,000 years of therapy.

Metformin can interact with many medications, so it is always best to check with the physician and pharmacist for drug interactions.  Drugs that interact with metformin and are common in kids are cephalexin and corticosteroids. 

Metformin has been approved in kids 10 years and older.  Typical starting dose is 500mg twice daily.  This can be increased to a maximum of 2000mg/day.  Metformin will start working within a few days but maximum effect can take up to two weeks. 

Along with lifestyle changes, metformin is a good option to treat type 2 diabetes in kids.  It has been shown to help with weight loss in patients with diabetes and is one of the few antidiabetic medications that does that regularly cause hypoglycemia.  Metformin is an inexpensive and effective way to help treat type 2 diabetes.  

Question: My father in law  takes a lot of medication and we are concerned that no one is keeping an eye on the big picture to make sure the medicines are all compatible.  The list of what he takes is below.  Are you aware of any possible problems associated with this combination of drugs. 
Glyburide 5mg Take 2 tablets twice a day.   Metformin 500mg Take one tablet twice a day   Simvastatin 40mg take one tablet once a day. Cozaar 50 mg take one tablet daily . Doxazosin 4mg   take one & half tablet at bedtime.
Thanks!

Here is my response:

Hi!  Thanks for contacting us!

Glyburide 5mg -2 tablets twice a day–Diabetes
Metformin 500mg -one tablet twice a day–Diabetes
Simvastatin 40mg -one tablet once a day –Cholesterol
Cozaar 50 mg -one tablet daily –Blood Pressure/kidney protectant
Doxazosin 4mg- one & half tablet at bedtime –BPH/ Blood Pressure

There aren’t any major interactions here.  Use of Cozaar, Doxazosin and Glyburide together can increase risk of blood pressure and blood sugar being too LOW.  This is easily monitored with testing blood pressure and sugar.
Also, he can monitor how he feels -low blood pressure: dizzy, fatigue, light-headed especially upon standing up.  Low blood sugar -light-headed, dizzy, sweating, headache.

He may want to consider adding…
1.  OTC CoEnzyme Q10.  This will help replace the CoQ10 that is decreased from the simvastatin.
2.  OTC B12 (or B-complex).  This will replace the B12 that is decreased from metformin
3.  Talk to physician about adding OTC calcium and vitamin D supplements -for general health and to counteract calcium depletion by Cozaar.

Lastly, are these medications working for him?  Are they controlling his
blood pressure, cholesterol and blood sugar/ A1c?

Hope this helps!  Please contact us with any questions/comments.

There you have it!  Of course, this is quite specific for this patient but if you have questions about your or your family member’s medications -please leave us a comment, submit a question or send an email at nova@getpharmacyadvice.com .

What causes halitosis? 

90% of the time it is due to bacteria build-up in the mouth.  The bacteria is usually found inbetween teeth and at the very back of the tongue.  The odor mostly arises from bacteria breaking down food debris, outer layer of skin on the tongue and postnasal drip (mucus dripping down the back of the throat).  Unclean dentures and gingivitis can also be blamed.

The second most likely cause of bad breath is actually in the nose!  Nose infections -like sinusitis can lead to funky breath.  This is the number one cause in kids -due to kids sometimes liking to stick random things in their noses.

Third main cause is in the tonsils.  This often comes with “stones” in the tonsils that are related to “bad breath” when coughing.

Recently, it has become a popular belief that bad breath starts from the belly and throat -possible but rare.

There are literally a ton of other reasons people suffer from bad breath -including lung infections, carcinomas, diabetes, liver failure, kidney failure…the list continues…

JUST A NOTE: Did you know that 25% of people who fear they have bad breath -do not!  People with this fear are called halitophobics.  A sign you may have bad breath is a metallic taste in the mouth.

How do I treat bad breath?

1.  Take care of that mouth!  Floss and brush those teeth and see the dentist regularly.  This may sound odd -but you can smell the dental floss to see which areas of the mouth may be causing the bad breath.  Also, scrape that tongue!  Tongue scraping gets rid of bacteria and mucus off the tongue- especially the back of the tongue. Then gargle with mouthwash.

2.  Eat high fiber foods -especially at breakfast.

3. Decrease alcohol and coffee intake and increase water intake (dry mouth often worsens bad breath).

4.  Chew sugar free gum for about 5 minutes after eating.

5.  Keep dentures clean.

6. Consider taking probiotics like acidophillus or lactobacillus (in pill or yogurt form) daily.

Do you suffer from bad breath?  What are your secrets to clean breath?  Please leave a comment!

Just a note:  One remedy I talk about in the video (little  spoiler alert) is pilocarpine 2% eye drops mixed with water and taken orally.  Ryan took time to leave a comment below -he was concerned that people may mistake pilocarpine 2% eye drops with a typical OTC eye drop (like Visine-which is dangerous when taken orally).    I could totally see this happening so I wanted to make a note that the only eye drops that would work for dry mouth are PILOCARPINE 2% -so talk with your physician or pharmacist about it. 

Note #2: Isn’t Toshi (the shih tzu) too cute?

I would love to hear all about your dry mouth remedies…please leave a comment!

Want to learn more about iron?  See Iron Deficiency Anemia in Women.

Want to learn some more about vitamin D?  We have two articles: Vitamin D and Vitamin D and Kids.  If you have another vitamin that you want to learn more about -just holla at us and we will be glad to give you the 4-1-1!

Avandia and Actos are the only two medications in the class of oral hypoglycemic drugs called thiazolidinediones.  Big enough word for ya?   These meds work by increasing insulin sensitivity in the body. 

If this is confusing and you want some background on diabetes -please see the Diabetes Type 2 Overview article.

So, if you need to be on a thiazolidinediones -what do you do?

Here is the breakdown between Avandia (rosiglitazone) and Actos (pioglitazone). 

• Avandia is associated with higher risk of heart attacks and strokes (Actos is not)
• Avandia increases LDL (bad cholesterol) and triglycerides but Actos lowers triglycerides and raises HDL (good cholesterol). 
• Avandia has increased risk of side effects then Actos.

So, my recommendations are use other meds first -there are other options out there!  Only start on Actos or Avandia as a last resort.  If you need to use one of these, Actos appears to be safer.  If you are currently taking Avandia talk to your physician about switching over to Actos. 

I would love to hear what you think!  If you want to learn more about diabetes -please see our folder of diabetes articles.