Diabetes Treatments

Diabetes and Glandular Disease Clinic: American Journal of Therapeutics VOL 8, People with diabetes should, like all Americans, …

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Diabetes and Glandular Disease Clinic: American Journal of Therapeutics VOL 8, issue 4, July 2001, pages 247252

Coping With Your

EMOTIONS

T

he diagnosis of diabetes brings out such a range of emotions that a person with diabetes is often taken by surprise In the flurry of learning basic diabetes information, glucose monitoring, medication changes, and perhaps insulin injections, it is important to stop and pay attention to what having diabetes means to you When confronted with a significant life change, a person normally goes through phases as he or she learns to cope with their situation Probably the most common and recognized phase is denial Denial may be fueled by the fear of not having choices, or
loss of independence, or just fear of the unknown, to name a few

Sometimes the denial is on the part of the family members They may choose to ignore or even sabotage someones eating plan by insisting on foods that are not part of healthy eating Oh, this wont hurt you just once is common This may be especially difficult when friends dont, or wont, understand why the person is limiting alcohol or junk food If the person with diabetes already has shaky resolve, it isnt hard to give in when being pressed To help overcome denial, it is necessary to understand what is behind it If you can recognize these feelings for what they are, you can take the first steps to overcoming your denial

Another emotion is anger The biggest risk with anger is that it can lead to breakdowns in communication Sometimes the people who we are most comfortable with are the ones whom we lash out at It is important to have someone to talk to, but be careful about hurting someone you love Remember, they are probably as frustrated and confused as you are Anger is best dealt with quickly, with the help of a counselor, if necessary One of the harder phases of coping to recognize is bargaining This can be alright at
times since I ate more than usual Ill take an extra walk, or it can be riskier Ill have a few beers and take some extra insulin It is difficult to achieve balance this way, and most often what happens is a yo-yo effect with blood glucose This leads to exhaustion and despair Lots of energy is expended trying to chase the sugar and bring it down, and overall diabetes control suffers While you need not be happy about having diabetes, the goal is to accept it Acceptance decreases your stress, and frees up all that energy formerly spent on denial, anger, bargaining, and depression When you accept that this is now part of your life, it is possible to go on And most importantly, you can be there as an example that even with diabetes, life goes on, and it can be good
Written by Sonia M Gordon, MS, CFNP, CDE

You can learn more about stress at wwwwalgreenscom/stressrelief

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Only Good At

Sugar and Sweets:

ARE THEY OK?
Y
es Todays eating guidelines for people with diabetes make the point-carbohydrate from sugars and sweets dont make blood glucose rise any higher or quicker than other carbohydratecontaining foods Quite a change This guideline
is based on 20 years of research showing that the dont eat sugar and sweets advice was not justified Does that mean you can have a daily sugar fest? Absolutely not People with diabetes should, like all Americans, just sprinkle foods with sugars and sweets here and there After all, foods with lots of sugar lack nutrition Time to Define Sugar sweeteners in the pantry: table sugar, confectioners sugar, molasses, or pancake syrup Sugar sweeteners in foods: high-fructose corn syrup and corn sweeteners Sugary foods: regular soda, hard candy, and jam Sweets: cake, chocolate candy, and pie The calories in sugars and sugary foods are mainly from carbohydrates at 4 calories per gram Sweets are most impact blood glucose, not the type or source most commonly a mixture of sugars and fat And its of carbohydrate the fats that get the calories soaring to 9 calories per Eat similar amounts of carbohydrate each day to gram, not the sugars keep blood glucose in control Keep in mind A Few Strategies: Limit sugary and sweet foods until blood glucose Choose a few of your favorite desserts and satisfy and A1c are within your target range your sweet tooth with small portions If your goal is to
lose weight, then just eat sugars Split desserts in restaurants and sweets, say once a week Take advantage of smaller portions: kiddie, small, If your blood fats total cholesterol, LDL, HDL, or regular at ice cream shops and triglycerides are abnormal, limit sweets to a Check your blood glucose from time to time minimum about 1 to 2 hours after eating sweets to see how Bottom line: high it rises Enjoy sweets in reasonable portions on occasion Base how often you enjoy sweets on your weight, your blood glucose and blood lipid results and goals, and your desire for sweets Its the total amount of carbohydrate you eat that
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Article by Hope S Warshaw, MMSc, RD, CDE

You can learn more about nutrition at wwwwalgreenscom/nutrition
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ERECTILE DYSFUNCTION
What Men Need To Know
What can you do? You can speak to your healthcare provider or Walgreens pharmacist about the new medications now available for ED Another option is a mechanical vacuum device that causes an erection by creating a partial vacuum around the penis, which draws blood into the penis, engorging it and expanding it The devices have three components: a plastic cylinder, in
which the penis is placed; a pump, which draws air out of the cylinder; and an elastic band, which is placed around the base of the penis, to maintain the erection after the cylinder is removed and during intercourse by preventing blood from flowing back Men with either type 1 or type 2 diabetes were near- into the body One variation on the vacuum device ly twice as likely to have erectile dysfunction ED as option is a product available without a prescription at non-diabetic men Among men with type 2 diabetes, Walgreens pharmacy: a semi-rigid rubber sheath that ED risk rose with the duration of the diabetes And is placed on the penis and remains there after achievoverall, ED was more prevalent among men with type ing an erection and during intercourse 1 diabetes 618 than with type 2 diabetes 452 Article from the National Institutes of Health Also important to note: men with both diabetes and heart disease or high blood pressure were most likely to have ED he August, 2002 issue of the Journal of Diabetes Care reports new research led by Dr Constance Bacon of Harvard School of Public Health Her team of researchers suggest that the longer a man has had type 2 diabetes, the greater his
chances of erectile dysfunction Their conclusions are based on data from more than 30,000 men, aged 53 to 90

T

Erectile Dysfunction Update:

Obviously, Johns diabetic impotence affected both of us
Of all the side effects of Johns diabetes, impotence was certainly the most difficult to accept Fortunately, his doctor recommended the RejoynTM Vacuum Therapy System — an easy-to-use medical grade system that improves both firmness and duration John learned that vacuum therapy has a proven satisfaction rate of greater than 90, with results in less than five minutes Perhaps best of all, the Rejoyn Vacuum Therapy System is available today without a prescription Thanks to Rejoyn, diabetes doesnt interfere with the intimacy John and I have always cherished For more information about the Rejoyn Vacuum Therapy System, You may contact us at: wwwrejoyncom or by calling 1-800-578-6916
Receive your 15 rebate by mail by sending your name, address and proof of purchase to Pos-T-Vac, 1701 N14th Ave, Dodge City, KS 67801-W

15

BY M AIL

S AV E

W

e cant tell you exactly how many pounds to lift or how steep a hill you should climb to reach a moderate or vigorous level of exercise What is easy for
one person may be strenuous for another We can, however, give you some advice that is based on scientific research: Listen to your body The level of effort you feel you are putting into an activity is likely to agree with what actual physical measurements would show In other words, if your body tells you that the exercise you are doing is moderate, measurements of things like how hard your heart is working would probably show that you are working moderately One way you can estimate how hard to work is by using the Borg Scale, shown in the right column You can use the numbers on the left of the scale to describe how hard you feel you are working For endurance activities, you need to gradually work your way up to level 13 - the feeling that you are working at a somewhat hard level Some people might feel that they are at level 13 when they are walking on flat ground; others might feel that way when they are jogging up a hill Both are right for them Only you know how hard your exercise feels to you Strength exercises are higher on the Borg Scale Gradually work your way up to level 15 to 17 - hard to very hard - to build muscle effectively You can tell how hard an effort you make by
comparing it to your maximum effort How hard does your current effort feel compared to when you are

How hard should I

lifting the heaviest weight you can lift? Once you start exerting more The Borg Rating Scale than a moderate amount of effort in Least Ef for t your muscle-building exercises, your 6 strength is likely to increase quickly 7 very, very light As your body adapts and you 8 become more fit, you can gradually make your activities more challeng- 9 very light ing You might find, for example, that 10 walking on a flat surface used to make 11 fairly light Endurance you feel like you were working at 12 Training level 13 on the Borg Scale, but that 13 somewhat hard now you have to walk up a mild hill to Zone feel like you are working at level 13 14 Strength Later, you might find that you need to 15 hard walk up an even steeper slope Training 16 The Borg Scale is simple to use Zone 17 very hard But if you feel that your level of effort doesnt match the numbers you see 18 on the scale - for example, if you feel 19 very, very hard you are doing exercises correctly, but 20 you arent progressing or you feel Maximum Ef for t exhausted by your effort - review your exercise plan
with your healthcare provider You can learn more about staying fit at
Article from the National Institutes of Health

EXERCISE?

wwwwalgreenscom/fitness
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How did you manage diabetes before InDuoTM?

Finally, insulin injection and blood glucose testing, all in one InDuoTM helps you manage your diabetes with a single device Outside , InDuoTM is a OneTouch UltraTM meter for accurate, less painful testing in just 5 seconds Inside, its a Novo Nordisk insulin delivery system that remembers the time and amount of your last dose Together thats the power of 2 Ask your healthcare professional or visit Walgreenscom
Allows for a less painful stick when used with OneTouch UltraSoftTM Automatic Blood Sampler and OneTouch UltraSoftTM Lancets Memory indicates time elapsed since last dose and amount of last dose Six-second countdown tells when dose is fully delivered OneTouch and InDuoTM are trademarks of LifeScan, Inc Distributed by LifeScan, Inc Milpitas, CA USA 95035 with Novo Nordisk A/S 2880 Bagsvaerd, Denmark 2002 LifeScan/Novo Nordisk 9/02 125526 AW 058-266C

Outside: A glucose meter

Inside: An insulin delivery system

New To
Diabetes?

Diabetes

MEDICIN

I

f you have type 2 diabetes, your pancreas usually makes plenty of insulin But your body cannot correctly use the insulin you make You might get this type of diabetes if members of your family have had diabetes You might also get type 2 diabetes if you weigh too much or do not exercise enough After you have had type 2 diabetes for a few years, your body may stop making enough insulin Then you will need to take diabetes pills or insulin Its important to know as much as possible about How do I know if my diabetes medicines are all the medicines you take Speak with your health- working? Learn to check your blood glucose Ask your doccare provider, diabetes educator, or Walgreens phartor or diabetes educator about the best testing tools macist about the following: for you and how often to test After every time you When to take your diabetes medicines; before a check your blood glucose, write down your blood meal and if so, how long before, with a meal, or glucose test results Then ask your doctor or diabetes after a meal? Or find out if it matters educator if your diabetes medicines are working A How many times a day to take your medicines? good blood
glucose reading before meals is between 90 and 130 mg/dL Ask your doctor or diabetes edu If its important to take your medicines at the cator about how low or how high your blood glucose same time each day? should get before you take action For many people, What the possible side effects may be? What to blood glucose is too low below 70 mg/dL and too do if you have any of these side effects? high above 190 mg/dL Another number to know is What to do if you forget to take a dose? the result of a blood test your doctor does called What to do if you are sick and cant eat? What to do if you cant eat due to medical tests? One, Two, or More Pills More than likely your healthcare provider will start you on a small dose of one diabetes pill He or she will determine if a small dose of one type of pill keeps your blood glucose in control If one pill does not control you r blood glucose, your healthcare provider may increase your dose, add another pill or insulin, switch you to another pill, or ask you to take insulin without any pills hemoglobin A1c or glycated hemoglobin It shows your blood glucose control during the past 2 to 3 months For most people, a good hemoglobin A1c is 7 percent
or less When You Forget To Remember Taking A Pill Sounds like it should be the easiest thing in the world, right? Everyone forgets their pills now and then But if you forget too often your blood glucose may be paying the price Think about why you miss so often Do you just forget? Are side effects a problem? Do you feel worse or the same when you take
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64

ES
them? Or, are pills just one more chore to do, and its just too much? If you find that you are simply forgetting, here are some tips to help you remember: 1 Ask your Walgreens pharmacist to help you create a medication calender to fit your lifestyle 2 Ask your Walgreens pharmacist whats the best time to take your oral diabetes pills 3 If you carry a supply of your medications with you, keep them in airtight containers with labels on each bottle 4 Learn how to use a medication organizer to keep you on track with your medication regimen 5 Set an alarm watch, etc to remind you to take your medicines Eat Healthy Stay Active - Still a Must If you take oral medications to control your diabetes, view them as extra help to control your blood glucose More than likely you need to shed a few
pounds, improve your blood fats, and blood pressure Healthy eating and exercise can help you achieve these goals as well
Written by Hope S Warshaw, MMSc, RD, CDE and Martha M Funnell, MS, RN, CDE

Diabetes Medications Questions Answers
Q: How does insulin work? A: Insulin is a hormone that helps glucose get inside your bodys cells Your cells use glucose for energy If you have type 1 diabetes, your pancreas no longer makes insulin, or it makes only a tiny amount If you have type 2 diabetes your pancreas still makes insulin, but it doesnt make enough, or your body has a hard time using the insulin or both Q: How can I limit the number of diabetes pills I need to take? A: If you have recently been diagnosed and you are overweight, you may be able to limit the need for diabetes pills for a while Follow a healthy eating plan, lose weight, and become more active Q: Why do diabetes pills stop working? A: Diabetes pills can only work if your pancreas makes enough insulin to let the pills work The pills dont stop working, your pancreas does If your pancreas no longer makes insulin, you must take insulin by injection to control your blood glucose Q: Will I have to go on insulin? A: Not
necessarily, but type 2 diabetes is a progressive disease It is common for a person to control their blood glucose with healthy eating and activity the first few years then progress to needing one or more types of pills to control blood glucose for several more years Then after several more years, the pills no longer control blood glucose, and insulin by injection is needed Its important to control blood glucose to keep type 2 diabetes from progressing Q: Why am I taking more than one type of diabetes medication? A: There are five different classes of diabetes pills on the market today and several different pills within each class The classes of pills each work differently For example, one type of pill helps your pancreas to make more insulin and another helps the insulin to work better The advantage of taking more than one class of pill is that they may work well together to give you more bang for your buck

You can learn more about diabetes at wwwwalgreenscom/diabetes
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65

I am stronger than diabetes

FOR PEOPLE WITH TYPE 2 DIABETES

As long as there are stories to share, Ill take care of my diabetes
Its our special time–reading
together on the porch Bobby never gets tired of hearing his favorites I never get tired of seeing him smile Im not going to let type 2 diabetes keep me from sharing many more stories with my grandson Ive switched to a healthier diet Even my wifes on it For exercise, I walk a mile a day but I still needed some help So my doctor added Avandia for my type 2 diabetes It makes my body more responsive to its own natural insulin, so I can control my blood sugar more effectively My blood sugar levels have improved with Avandia And while not everyone has the same results, Ive kept my blood sugar down for over a year Now thats a great story Avandia, along with diet and exercise, helps improve blood sugar control It may be prescribed alone, with Glucophage metformin HCl tablets or with sulfonylureas When taking Avandia with a sulfonylurea, you may be at risk for low blood sugar Ask your doctor whether you need to lower your sulfonylurea dosage Some people may experience tiredness, weight gain or swelling with Avandia Avandia in combination with insulin may increase the risk of serious heart problems Because of this, talk to your doctor before using Avandia and insulin together Avandia may
cause fluid retention, or swelling, which could lead to or worsen heart failure, so tell your doctor if you have a history of these conditions If you experience an unusually rapid increase in weight, swelling or shortness of breath while taking Avandia, talk to your doctor immediately Avandia is not for everyone If you have severe heart failure or active liver disease, Avandia is not recommended Also, blood tests to check for serious liver problems should be conducted before and during Avandia therapy Tell your doctor if you have liver disease, or if you experience unexplained tiredness, stomach problems, dark urine or yellowing of the skin while taking Avandia If you are nursing, pregnant or thinking about becoming pregnant, or if you are a premenopausal woman who is not ovulating, talk to your doctor before taking Avandia See important patient information on the adjacent page
ASK YOUR HEALTHCARE PROFESSIONAL ABOUT

FOR MORE INFORMATION CALL

1-800-AVANDIA 1-800-282-6342
OR VISIT WWWAVANDIACOM

AVANDIA HELP USE THE NATURAL INSULIN IN YOU

2002 The GlaxoSmithKline Group of Companies All rights reserved AVD227RA Avandia is a registered trademark of GlaxoSmithKline Glucophage is
a registered trademark of LIPHA sa, licensed to Bristol-Myers Squibb Company

Patient Information about AVANDIA rosiglitazone maleate 2 mg, 4 mg, and 8 mg Tablets
What is Avandia? Avandia is one product in a class of prescription drugs called thiazolidinediones thigh-a-zol-a-deen-die-owns or TZDs It is used to treat type 2 diabetes by helping the body use the insulin that it is already making Avandia comes as pills that can be taken either once a day or twice a day to help improve blood sugar levels How does Avandia treat type 2 diabetes? If you have type 2 diabetes, your body probably still produces insulin but it is not able to use the insulin efficiently Insulin is needed to allow sugar to be carried from the bloodstream into many cells of the body for energy If insulin is not being used correctly, sugar does not enter the cells very well and builds up in the blood If not controlled, the high blood sugar level can lead to serious medical problems, including kidney damage, blindness and amputation Avandia helps your body use insulin by making the cells more sensitive to insulin so that the sugar can enter the cell How quickly will Avandia begin to work? Avandia begins to reduce
blood sugar levels within 2 weeks However, since Avandia works to address an important underlying cause of type 2 diabetes, insulin resistance, it may take 8 to 12 weeks to see the full effect If you do not respond adequately to your starting dose of Avandia, your physician may increase your daily dose to improve your blood sugar control How should I take Avandia? Your doctor may tell you to take Avandia once a day or twice a day in the morning and evening It can be taken with or without meals Food does not affect how Avandia works To help you remember to take Avandia, you may want to take it at the same time every day What if I miss a dose? If your doctor has prescribed Avandia for use once a day: As soon as you remember your missed dose, take one tablet anytime during the day If you forget and go a whole day without taking a dose, dont try to make it up by adding another dose on the following day Forget about the missed dose and simply follow your normal schedule If your doctor has prescribed Avandia for use twice a day: As soon as you remember the missed dose, take one tablet Take the next dose at the normal time on the same day Dont try to make up a missed dose from the
day before You should never take three doses on any single day in order to make up for a missed dose the day before Do I need to test my blood for sugar while using Avandia? Yes, you should follow your doctors instructions about your at-home testing schedule Does Avandia cure type 2 diabetes? Currently there is no cure for diabetes The only way to avoid the effects of the disease is to maintain good blood sugar control by following your doctors advice for diet, exercise, weight control, and medication Avandia, alone or in combination with other antidiabetic drugs ie, sulfonylureas or metformin, may improve these other efforts by helping your body make better use of the insulin it already produces

Can I take Avandia with other medications? Avandia has been taken safely by people using other medications, including other antidiabetic medications, birth control pills, warfarin a blood thinner, Zantac ranitidine, an antiulcer product from GlaxoSmithKline, certain heart medications, and some cholesterol-lowering products You should discuss with your doctor the most appropriate plan for you If you are taking prescription or over-the-counter products for your diabetes or for conditions
other than diabetes, be sure to tell your doctor Sometimes a patient who is taking two antidiabetic medications each day can become irritable, lightheaded or excessively tired Tell your doctor if this occurs; your blood sugar levels may be dropping too low, and the dose of your medication may need to be reduced What should I discuss with my doctor before taking Avandia? Avandia in combination with insulin may increase the risk of serious heart problems Because of this, talk to your doctor before using Avandia and insulin together Avandia may cause fluid retention or swelling which could lead to or worsen heart failure, so tell your doctor if you have a history of these conditions You should also talk to your doctor if you have liver problems, or if you are nursing, pregnant or thinking of becoming pregnant If you are a premenopausal woman who is not ovulating, you should know that Avandia therapy may result in the resumption of ovulation, which may increase your chances of becoming pregnant Therefore, you may need to consider birth control options What are the possible side effects of Avandia? Avandia was generally well tolerated in clinical trials The most common side effects
reported by people taking Avandia were upper respiratory infection cold-like symptoms and headache As with most other diabetes medications, you may experience an increase in weight You may also experience edema swelling and/or anemia tiredness If you experience any swelling of your extremities eg, legs, ankles or tiredness, notify your doctor Talk to your doctor immediately if you experience edema, shortness of breath, an unusually rapid increase in weight, or other symptoms of heart failure Who should not use Avandia? You should not take Avandia if you are in the later stages of heart failure or if you have active liver disease The following people should also not take Avandia: People with type 1 diabetes, people who experienced yellowing of the skin with Rezulin troglitazone, Parke-Davis, people who are allergic to Avandia or any of its components and people with diabetic ketoacidosis Why are laboratory tests recommended? Your doctor may conduct blood tests to measure your blood sugar control Blood tests to check for serious liver problems should be conducted before starting Avandia, every 2 months during the first year, and periodically thereafter It is important that you call
your doctor immediately if you experience unexplained symptoms of nausea, vomiting, stomach pain, tiredness, anorexia, dark urine, or yellowing of the skin How should I store Avandia? Avandia should be stored at room temperature in a childproof container out of the reach of children Store Avandia in its original container

2001 The GlaxoSmithKline Group of Companies All rights reserved Printed in USA AV0638 August 2001

Make the Smart Choice
TM

Rob Crosby, R Ph Walgreens, San Antonio, Texas

When Mary Ann told me shed been diagnosed with diabetes, I wanted to make sure she got a reliable, affordable blood glucose monitoring system I recommended the Walgreens IQ Blood Glucose Monitoring System, because it carries our trusted brand name Its the smart choice for performance and value, and Mary Ann can purchase our test strips at any Walgreens in the US The Walgreens IQ Blood Glucose Monitoring System an unmatched combination of accuracy, ease, and affordability, and its covered by Medicare and many private insurance plans

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Source:diabetesdigest.com