Diabetes Self-Management Articles

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How Well Do You Know Your Diabetes Management Plan?

by Allison Blass

Do you know what to do if you miss a dose of your medicine?
If your answer to this question is no, ask your doctor about this at your next appointment, and write down the answer.

What to do about a missed dose will depend on what drug you forgot to take, when you realize you missed a dose, and how long it is until your next scheduled dose. Don’t assume that you should take your dose immediately upon remembering it or that you should take a double dose at the time of your next scheduled dose. Either of these moves could have negative, even serious, side effects.

If you miss a dose and don’t have instructions from your doctor on what to do, read the drug information that came with your medicine. If it doesn’t tell you what to do, call your doctor or pharmacist for advice.

Do you know how the medicines you use work?
Knowing how your medicines work can be helpful in the event of a missed dose, in sorting out blood glucose control difficulties, and in determining whether a new symptom may be a drug side effect. This information may be particularly important when first starting a new drug.

Insulin directly lowers your blood glucose level by enabling glucose in your bloodstream to enter the cells in your body. The main differences among types of insulin are their “action times,” or how quickly they start lowering blood glucose after being injected or infused into your subcutaneous tissue, when they reach their peak blood-glucose-lowering effectiveness, and for how many hours they continue lowering blood glucose after being injected or infused. The package insert that comes with your insulin contains some information about these times, but there is individual variation from person to person. You can discover your own action times through careful monitoring. The most common side effect of insulin is low blood glucose.

The oral medicines taken for Type 2 diabetes work in a number of ways to lower blood glucose. Some cause the pancreas to release more insulin, some slow the rate at which the liver releases glucose into the bloodstream, some enable muscle and fat cells to better use insulin, and some slow the rate at which certain types of carbohydrate are absorbed. Some work quickly and are meant to be taken just before meals (and skipped if a meal is skipped), while others stay in the body for a longer time and are meant to be used continuously. Side effects vary from drug to drug.

Two injected drugs, exenatide (brand name Byetta) and pramlintide (Symlin), are taken before meals and lower blood glucose levels by suppressing the release of glucagon, a hormone that signals the liver to release glucose, and by slowing the rate at which food moves through the stomach. Byetta additionally signals the pancreas to release insulin when blood glucose levels are high; Byetta is taken only by people with Type 2 diabetes. Both are known to cause nausea, which often subsides with continued use.

Dr. Edelman says, “People with diabetes need to know about the drugs and insulins they take. This would include how they work, who they are intended for, what to expect with their control, and the side effects that are most common. They need to be careful not to ‘get all of the symptoms they read about’ and stop the medicine without talking to their primary-care physician.”

When was the last time you updated your list of medicines?
Having a list of the medicines and doses you take is only useful if it’s current. Is yours? If you only have small changes to make, you don’t need to rewrite the whole thing; just cross out the old information and write in the new. (Don’t forget about updating your various photocopies, too.) If you have a computer, consider making an electronic file of your medicines; it’ll be easier to update and reprint than rewriting by hand.

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