Diabetes Pharmacist : Diabetes Pharmacist Blog : Focus Express Mail Pharmacy : Insulin Pumps, Diabetes Supplies and Information

October is American Pharmacist Month and in honor of that, I'd like to remind everyone how important your pharmacist can be; both in the prevention of Diabetes as well as in helping people manage their Diabetes. Pharmacist Services can include:

• Nutrition and Diet Counseling
• Exercise Instruction
• Blood Glucose Monitoring Advice
• Medication Therapy Management
• Healthy Behavior Management
• Guidance in skin care, foot care, dental care, eye care, proper injection technique, etc.

Studies have shown that when a pharmacist is involved in the management and self-care of patients with Diabetes,  both test results and patient outcomes improved. 

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Being a  pharmacist for many years means that I've been "trained" to eat quickly,  before a patient walked into the store. Furthermore, a long time pharmacy "myth" is "if you want people to walk into the store, order a hot meal."  Other than causing a little indigestion, eating fast hasn't bothered me. But now, a new study suggests that fast eaters have a higher risk of developing Type 2 Diabetes.

According to the Japanese study, people who eat food quickly  are twice as likely to develop impaired glucose tolerance, known as pre-diabetes. In impaired glucose tolerance (IGT), blood glucose levels are higher than usual,  but not high enough to cause diabetes. However, without proper treatment, 40 to 50 per cent of people with IGT will develop Type 2 Diabetes within ten years. One theory is that eating quickly increases postprandial blood glucose, the amount of sugar in the blood soon after eating.

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Well, It seems that all of us here in the  Philly area are in the crosshairs of Hurricane Irene as it slowly moves up the east coast of the U.S. . Since this type of thing rarely happens to us here in the NorthEast, I thought it may be a good idea to mention some items on the FDA Hurricane Preparedness Checklist  that would be important to people with Diabetes. It is of utmost importance to read the entire list as well!

1. Drugs Exposed to Water

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Have you seen the new graphics that will soon be appearing on each and every pack of cigarettes..both front and back? Above is one of  9 different pictures that you will see starting in September. For a non-smoker like myself, it's REALLY scary to see what smoking can do to someone's health. But the questions is, will it really help deter those who are truly addicted to smoking?

I mentioned the new labels to a smoker this morning and their response was " Oh, yes, I've seen them and I think Mexico has had warnings like this for awhile".I did not hear that the pictures were gross or horrible or made them sick. I did not hear that the pictures were an exaggeration or propaganda. And, most importantly, I did not hear that they will stop smoking any time soon.

Statistics show that since 1970, the number of Americans who smoke has fallen from 40% to 20% of the population. However, over 46 million people still smoke in ths country and the number decreasing has stalled since 2004. The FDA estimates that 213,000 people will stop smoking because of these new labels by 2013. That, my friends, is less than 0.5% of the total United States smoking population.

Let's just list some facts that decades of research have proven:

1. Each cigarette smoked shortens the user's lifespan by 11 minutes.

2. About half of cigarette smokers die of tobacco-related disease and lose on average 14 years of life.

3. Cigarette use by pregnant women has also been shown to cause birth defects including mental and physical disabilities.

4. Secondhand smoke from cigarettes has been shown to be injurious to bystanders, which has led to legislation that has banned their smoking in many workplaces and public areas.

 You can look up these facts for yourself. In the meantime, if someone you know or love smokes, please urge them to stop. For the sake of EVERBODY'S HEALTH!

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As we enter the Summer months, here are some  important warning signs for Melanoma to be aware of  from the American Academy of Dermatology.

A Melanoma is a skin cancer that frequently develops in a mole or appears suddenly as a new dark spot on the skin. As you thoroughly examine your skin periodically, check for these warning signs:

A- stands for ASYMMETRY: One half of the mole or spot is unlike the other half.

B- stands for BORDER; irregular, scalloped, or poorly defined border.

C- stands for COLOR: varied from one area to another; shades of tan and brown, black; sometimes white, red or blue.

D- stands for DIAMETER; while melanomas are usually greater than 6mm (the size of a pencil eraser), when diagnosed, they can be smaller.

E- stands for EVOLVING; a mole or skin lesion that looks different from the rest or is changing in size, shape, or color.

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Now that Summer is here and we're all interested in getting that perfect tan at the beach or the pool, please understand that "The Sun is NOT your friend". Please use sunblock and cover your head if you are exposed to the sun for long periods of time. Please take 10 minutes and check your skin for any new lesions  or any changes to existing skin moles or sores.

Please click here and watch this video and then send it to everyone you know and especially to everyone you love.

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The Mercy Wound Healing and Hyperbaric Medicine Center, a National Healing Corporation Wound Healing Center, offers these exercise tips:

• Before starting an exercise program, talk with your health care professional regarding the presence of vascular complications that could worsen with exercise and orthopedic or musculoskeletal conditions that may exempt certain exercises.

• Check your blood glucose before and after exercise to learn how your body responds. Those at risk for low blood glucose should have a source of carbohydrates nearby while exercising.

• Since dehydration is often an issue with diabetes, it is important to drink water early and frequently when exercising.

• For diabetics with reduced sensation, prolonged walking, jogging, using a treadmill and step exercises are not recommended. Instead, try swimming, bicycling, rowing, chair and arm exercises and other non-weight bearing activities.

• Proper footwear is essential. The use of silica gel or air midsoles as well as polyester or cotton/polyester socks will help prevent blisters and keep feet dry.

• The American College of Sports Medicine has demonstrated that resistance training can improve insulin sensitivity to about the same extent as aerobic exercise. The American Diabetes Association recommends that exercising with weights is acceptable for younger individuals but not recommended for older people with long-standing diabetes.

• There are many ways to increase physical activity besides formal exercise, such as: gardening, housecleaning and even marching in place or walking around the house during TV commercial breaks.

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We are honored to announce that Diabetes Pharmacist has been named one of the 100 Best Blogs for Pharmacy Students by Jill Gordon on Nursing Schools.Net., a nursing school network and directory.

Listed under the category "See What the Future Holds", it says that "This blogger offers specific advice for dealing with common questions about diabetes, an increasingly common condition as obesity rates increase" .

It also mentions that some of the blogs on the list are written by pharmacists who are passionate about their work. I hope they know that I am one of them!

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 There are many unpublicized "side effects" to the worsening economy . The lost jobs, plant closings, high food prices, decreasing 401k's, and store bankruptcies are bringing to light horror stories about how people are now cutting back on their medications & supplies as well as doctor visits because they can't afford them.

People are cutting their glucose testing strips in half lengthwise to get two tests instead of one. This totally prevents any possibilty of accuracy. And, because these patients are not getting a true picture of their blood glucose level, they are opening themselves up to the severe complications of diabetes and possible hospital stays.

They're taking their diabetes or heart or blood pressure medications every OTHER day instead of every day, or cutting them in half  or  sometimes skipping them entirely.And they're doing this without consulting their pharmacist or physician.

And, what's more, people who are receiving NEW prescriptions are not getting them filled because they flat out cannot afford to get them filled.

Most of these people are those who have no insurance for their medications and supplies but  suprisingly, those with high co-pays are also cutting back.

Before you do anything drastic like this:

• Ask your doctor for samples of the medication(s) that you need.
• Call around for prices and use generic medications wherever possible .
• Check out the pharmacies that have 30 days of medication for only $4.00. Maybe your medication is on that list.
• See which pharmacies( mostly in supermarkets) are offering FREE antibiotic prescriptions and which antibiotics are on that list.
• Check with the manufacturers of your medications to see if you qualify for deeply discounted prices. Income and insurance are factors.
• Contact the Partnership for Prescription Assistance at 888-477-2669 or www.pparx.org
• Check out www.FreeMedicineFoundation.com
• Above all, consult with your doctor and pharmacist FIRST. They will be able to help you!

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My patients with type 2 diabetes realize that blood sugar control, a balanced diet, weight management, regular exercise, and checkups are essential to their overall health. However,  many don't realize that regular care of EVERY part of their body is extremely important  to avoid serious complications.

Here are the  5 biggest concerns:

• Foot infections
• Chronic skin infections
• Gum disease and tooth loss
• Vision problems 
• Heart disease and blood circulation problems

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Did you know there was a Diabetes Dictionary that can be accessed on-line? This dictionary defines words that are often used when people talk or write about diabetes. It is designed for people who have diabetes and for their families and friends. What a wonderful and useful service!
Provided by the National Diabetes Information Clearinghouse(NDIC), a service of The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NIH

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Summer is almost here and vacation time and outdoor activities will be expanding. A "healthy" suntan looks good but if you take certain prescription and OTC medications, you may be at risk for a sunBURN instead.

Almost 60,000 people will get a diagnosis of melanoma this year. It's the most serious form of skin cancer and it can lead to death. Serious sunburn is the key risk for developing melanoma.

For starters, you need to use an ample amount of sunscreen -- enough to fill a shot glass. It needs to be applied 20 minutes before heading out of doors.

Even if you do all that, you may still get burned. The trouble could be that certain drugs can make your skin much more sun sensitive. Check this list from from Carol & Richard Eustice to see if YOU may have a problem this summer. 

These drugs are associated with photosensitivity reactions:
Antibiotics
Doxycycline (Vibramycin and others)
Floxin
Minocycline
Tetracycline
Trimethoprim

Disease-Modifying Agents (to treat rheumatoid arthritis and lupus)
Dapsone
Gold
Hydroxychloroquine (plaquenil)
Methotrexate
Sulfasalazine (Azulfidine)

NSAIDs
Piroxicam (Feldene)
Ibuprofen (less likely)
Naproxen and others

Antihypertensives
Captopril
Diltiazem
Methyldopa
Nifedipine

Hypoglycemics
Glipizide
Glyburide
Tolbutamide

Antidepressants
Amitriptyline
Desipramine
Doxepin
Imipramine
Nortriptyline
Trazodone

Antihistamines
Benadryl and others

Diuretics
Chlorothiazide (Diuril)
Furosemide (Lasix)
Hydrochlorothiazide

Others
Oral contraceptives
Xanax

Remember, the sun is NOT your friend when it comes to your skin. Take the proper precautions and you'll have a wonderful summer!

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What would you find if you went through your medicine cabinet today? How old are those prescription cold capsules that you put away after you had the flu? And, how about those over-the-counter cough syrups that you've had "forever"?

It's high time to go through your medicine cabinet and dispose of old medications.

In an article by Kaitlyn Syring in the University of Kansas Daily Kansan, the following important questions are answered:  

1. Where is the best place to store medications?
2. Does expired medicine still work?
3. Is expired medicine harmful?
4. How do I dispose of expired medications?
   

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Randy Jackson, of American Idol, is holding a casting call for people living with Type 2 diabetes. Randy has partnered with the American Heart Association to speak on behalf of The Heart of DiabetesTM, a national campaign to help those living with type 2 diabetes manage the disease and learn about its connection to cardiovascular disease (CVD). He also has some tips that he wants to share that have helped him manage his own diabetes and lead a healthier life.MORE......

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At  Focus Express Mail Pharmacy, we are asked many questions everyday, by our patients, regarding their medications. Our pharmacists answer questions regarding dosing, interactions, side effects, and more. We will try, on a weekly basis, to share some of those questions with you that we feel are most interesting, informative, and educational.                                                                

Overwhelmingly the most questions that we get involve dosing. Below are some common questions and their answers. Glad we can help!

What does twice daily mean?
A: Take your dose twice during the 24-hour day, which means every 12 hours. For example, take one dose at 7 a.m. and one dose at 7 p.m.
What does three times a day mean?
A: Take your dose three times during the 24-hour day, which means every eight hours. For example, take one dose at 7 a.m., another at 3 p.m., and the last at 11 p.m. (or at bedtime, if you go to sleep before 11 p.m.).
What exactly does four times a day mean?
A: Take your dose four times during during your waking hours, about six hours apart. 
What does two tablets daily mean?
A: Take two tablets at the same time once a day.
What does two tablets twice daily mean?
A: Take two tablets every 12 hours, for a total of four tablets each day.
What does the medicine label mean when it says to take at bedtime?
A: It usually means take it 30 minutes to one hour before bedtime. 
What does take with food mean?
A: It means to take the dose during the meal or right after eating a meal.
What does take on an empty stomach mean?
A: It usually means to take the dose at least one hour before or two to three hours after eating.

Sources:
Mayo Clinic Family Health Book. William Morrow & Co., 1996.
Applied Therapeutics: The Clinical Use of Drugs. Applied Therapeutics, 1995.

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