Diabetes Self-Management Blog

Older adults in the U.S. use a lot of prescription drugs. We knew that, but the actual numbers are frightening. A study published recently in The Journal of the American Medical Association by Stacy Tessler Lindau, MD, of the University of Chicago Medical Center and others reports that more than half of U.S. adults aged 57 to 85 are using five or more prescription or non-prescription drugs.

That’s right. More than half. Five drugs or more. The study goes on to report that many of the drug combinations people are taking are not safe, with at least 175,000 ER visits a year in the U.S. for drug reactions.

Commenting on the blog eldercare resource, a pharmacist called “Piller of the Community” (cute, huh?) commented:

“As a geriatric consultant pharmacist, this story is so true. With patients seeing multiple physicians/specialists, we see some drug/drug interactions as well as duplication of therapy.

USE one pharmacy that can track all this and screen for interaction problems. And be sure you know what over the counter and alternative medications are doing to your Rx medication. Many can inactivate and make them less or even more effective.”

I know from researching my book Diabetes: Sugar-coated Crisis that some people with Type 2 diabetes are on far more than five medicines — I talked with one man who was on 20. Please watch out for overmedicating doctors, and try to make sure your doctors are talking to each other.

What has been your experience? Do you find the system trying to overmedicate you? Have you had problems with drug interactions, or is everything going well with your meds? Let us know.

Here are a couple of interesting recently published tidbits.

Eat Less, Have Healthier Gums?
A study published in the journal Nutrition reported that male rhesus monkeys who ate less food had less gum disease than those who ate more. This might actually mean something for humans, because the chronic inflammation of gum disease can cause many health problems, including high blood glucose.

Of course, it’s easy to say “eat less” to a monkey in a cage. It’s harder out here in Sugarworld, but study coauthor Mark Reynolds, DDS, PhD, notes that “dietary restriction has been shown to reduce the risk for chronic disease and promote longevity in multiple animal models.”

Stevia Moves Ahead
The search for healthy noncaloric sweeteners may be over as the South American herb stevia gains wider availability in the U.S. market. Coke is planning two new juice drinks in its Odwalla line that use stevia, while Pepsi plans to market its SoBe Lifewater line with stevia as soon as it is approved by the FDA.

The FDA has allowed stevia to be sold as a “dietary supplement,” but not as a “sweetener.” It is unclear what the government’s concerns are. Asian studies in animals found no risks of cancer and no problems with growth and development for three generations in rats and hamsters. In fact, female rats fed high doses of stevia’s active ingredient had lower rates of cancer than the control group. It seems safer than anything else out there. The conspiracy observer in me thinks that perhaps FDA is worried that their pharma friends who make aspartame will lose money.

Have you tried stevia as a sweetener? I was sent a free bottle by a distributor, and I like the way it tastes. But then, free food always tastes better to me…

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Comments
  1. So true about the medications… but I really wonder how well the pharmacists are able to track drug interactions and contraindications — while you do get an info sheet along with the drug, the info sheets don’t list all the adverse issues doctors have seen (even some of the supposedly more-common ones), there is no opportunity for face-to-face consultation via the mail-order pharmacies that most economically handle a number of one’s brand-name prescriptions, and there is no meaningful understanding of dosing requirements and environments, and contraindications, transmitted to an often-forgetful geriatric patient.

    In addition, many doctors ignore patient reports of adverse reactions (even among those of us who are NOT geriatric!), and the insurance companies often try to replace the brand name with generic of a completely different class of drug for the same condition, and with double-strength pills and a pill splitter, rather than pay for the expensive name brand.

    All of these lead up to potential disaster for someone who is not at peak mental processing capability (often because OF the drugs prescribed!) And because geriatric patients’ medical care is usually covered to a great degree by Medicaid and Medicare, there is a good likelihood for them to be considered “expendable cash cows” by the Medical Care Industry. (This is likely to get worse as baby boomers enter their “golden years”.)

    Posted by tmana |
  2. Really good information tmana. Re: drug interactions, I would just add that when you get above five or maybe seven drugs, there is just NO WAY to predict the interactions.
    I think keeping logs of the way you feel and the drugs you take MIGHT help you and your doctor understand how the meds are affecting you.

    Posted by David Spero RN |
  3. Every time I go to the doctor I take a complete list of my medicines, vitamins, inhalers, etc. and give it to my doctor for their files so they will always have my medicine list and know what I am taking. Remember to revise the list when dosages and deletions or additions have been made.
    This helps everyone.

    Posted by Trish S |
  4. My Other Half and I also keep track of all our meds and supplements, but depending on which nurse does our pre-exam history and measurements (blood pressure, pulse, weight, etc.), the entire list may not be added into the record. But we, like Trish, are proactive in this respect. And again, we are “middle-aged”, not “elderly”. Contrast this with my mother, who takes the doctor’s word as Gospel and questions nothing — or The Other Half’s aunt, who forgets when the doctor changes her medication doses, maintains old information, and becomes argumentative when her daughter (who accompanies her to the doctor) tries to remind her that the regimen has changed. And mind you we are talking about people who have other humans as a support network. Contrast this with the stereotypical elderly person who lives alone, whose children (if any) live half-way across the country, and who is barely able to maintain a marginal standard of living between Social Security, Medicaid, Medicare, and whatever state and local subsidies and elder-help programs might be available…

    Posted by tmana |
  5. Dear David.

    Eating less and a low carb diet seems to help my notoriously bad gums.

    Posted by CalgaryDiabetic |
  6. I take a hand full of pills every day, some of these two times and this bothers me greatly. I am going to talk with my doctor my next visit about my meds but am nor sure that she will change any of them. There’s gotta be a better way or at least a less pill way to treat me and people like me. Stroke, heart attack, stints, high cholesterol,diabetic.help

    Posted by Bob |
  7. My husband and I always take a list of our meds and supplements — and allergies (not just drug allergies) — and tell the intake person who’s doing our vital signs, etc. that they can have the list and just slip it into our charts.

    As for how do pharmacists keep track of drug interactions, there are computer programs at every pharmacy that do the checking. This is why it’s essential to give the pharmacy a full list of all the meds and supplements you take — and allergies — as well as medical conditions. Another helpful step is to get all of your meds at one pharmacy, though that’s often not an option, most especially due to costs.

    We get our meds at one of three places, depending on what each is. For the ones that the military carries, we get them at the local base. For the ones that the base doesn’t carry, we get from a mail-order place. Only one medication do we get at a retail pharmacy. This helps us save the most money.

    We can call the mail-order pharmacy and talk to a pharmacist if we need to, but so far, there has been no problem.

    I think that one reason for this is that we use an online drug-interaction site. One is
    http://www.medscape.com/druginfo/druginterchecker?src=ads. There are others, too, but this is the one we’ve used, mostly out of habit. I’ve gone there a few times when we get a new prescription.

    Yes, these are steps that might be too much for an older person. My solution to this would be for a department in the pharmacy where a person could take in all their meds and their daily-pill boxes to have them filled. However, I do realize that this is a pipe dream, due to cost and probably liability.

    I have no problem with getting a double-strength dose and a pill splitter. If it saves money anywhere along the line, it ought to save me some, too.

    I know that oftentimes insurance companies try to substitute what the doctor orders. If it’s just to a generic, that’s really not a problem because in 99% of the cases, there really is no difference. If the insurance company denies a certain med that the doctor feels is necessary, he can fill out a form (or have an office worker do it, and he signs it) asking for an exception from the insurance company. Usually, with adequate documentation, this is granted.

    If you have an adverse reaction to a medication, you can contact the FDA yourself and fill out one of their forms.

    Gosh, Life is sure getting complicated! But, then, we’re benefitting from those things that make it so.

    Posted by YumaMamaLama |
  8. Hey Bob,
    As I write about in next week’s blog, cholesterol, sugar, blood pressure are usually just symptoms of insulin resistance. (These symptoms may also include depression.)

    Doctors treat all these symptoms with pills, but never touch the disease itself. The best treatments for insulin resistance are stress reduction, exercise, and healthy eating. For many who post here, “healthy” means eating less and going low-carb. I think activity is the most important part. Ask your doctor if you can have a simpler medication plan in exchange for walking or moving more.

    And don’t forget to relax! Meditate, play with a pet, enjoy life.

    Posted by David Spero RN |
  9. I have tried Stevia and haven’t been able to get it down into a small enough “dose” to prevent over doing it. I have both liquid & powder. I can’t drink cofee without sugar, and I’m allergic to ALL the artificial sweeteners; I’m also diabetic (no meds) and trying to GAIN weight. It’s an interesting situation. I would love to find a way to use Stevia and would appreciate any ideas in making it more controlable for small items,like a single cup of coffee.

    Posted by Joye |
  10. I have tried Stevia and do not like it at all. Every form I have tried from every company — about 8 different types — has a strong and unpleasant licorice-like flavor to me. I have even grown my own (though I did not inhale). <grin>

    I have heard from one of the Stevia companies that a small percentage of people are sensitive to this licorice flavor. I guess I’m in that small percentage.

    Posted by Beth |
  11. Have you tried an eye dropper for the liquid Stevia?
    D

    Posted by David Spero |
  12. I not only take a list with all prescriptions and over the counter meds I keep all my pill bottles in one bag. Every time I go to the doctor or ER I take my pill bag with me. I had a severe allergic reaction to a blood pressure medication and the ER doctor was glad that I had brought it with me. He was able to look at all the meds I take and he was able to determine which medication caused the reaction. My husband and son both know that if they ever need to take me to the ER they need to grab my pill bag!

    Posted by airbornemom |
  13. 1) I’m 48 years old. I have more medical conditions and take more pills, inhalers, nose sprays et al than my “senior citizen” mother.
    I do the following to try to prevent harmful interactions.
    a) always use the same pharmacy and tell them about my otc meds and allergies
    b) always take my list to my appointments

    3)STEVIA!!Yep, I’m a big stevia fan. I’m so glad to see the corporate world finally catching on!

    Posted by Ephrenia |
  14. I’ve been a diabetic (type II) for 2 years, I had a strong family history but didn’t show positive until I was nearly 59. It appears to be medication induced because I was experiencing severe respiratory issues and was on repeated hi-dose prednisone.

    I also suffer from fibromyalgia, another autoimmune disease, very mild degenerative arthritis and hypothyroid.

    I finally resorted to alternative medicine. As I had nothing but bad health to lose, I went to a naturopath. She was able to get me off of all respiratory and allergy meds. In two years I have not had a respiratory attack. Fortunately, my Dr. of 20 years has been very supportive.

    My diabetes is under control,(last A1C was 5.8)
    with metformin and a tincture of gymnea selvestre, bitter melon, and tecoma stans.
    Exercise is difficult due to pain issues and thus I still needs to lose another 50 pounds.

    I was a firefighter/EMT for 22 years and recently had to resign because of the Fibro.

    I wanted to share about a med that I was on with nearly disastrous side effects. I took cymbalta for two years, I continued because of its pain-blocking abilities. It raised my blood pressure and resting heart rate was a 100. Mild exertion caused high heart rate and respiratory distress. There were other side effects and I was showing elevated liver enzymes. I would like to encourage anyone taking that med to consider other options.

    I, like many older people, take multiple vitamin and mineral supplements. The question is, what is
    enough and what is too much?

    Milly/ OBrien OR

    Posted by milly |
  15. is there a website that can tell me if the meds i’m now taking may cause a danger to me

    Posted by bill |
  16. And Bill, talk with a pharmacist. They might know about your drugs.

    Posted by David Spero RN |

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Alternative Medicine/Complementary Therapies
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Acupuncture Improves Diabetic Gastroparesis (05/31/13)
Magic Melon for Diabetes (03/27/13)
Magnesium: The Forgotten Healer (03/20/12)

Oral Medicines
FDA Panel Votes in Favor of Inhalable Insulin; Diet Drug Recalled (04/09/14)
Many Americans Taking Meds That Work Against Each Other (03/14/14)
New Type 2 Diabetes Drug Approved (01/10/14)
Metformin Affects Hearts of Men and Women Differently (01/03/14)

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The Tooth, the Whole Tooth, and Nothing but the Tooth (03/12/13)
Are We Flossing Yet? (11/16/11)
Diabetes and Your Gums (10/05/11)
First It's This, Then It's That… (09/06/11)

 

 

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