By Joshua J. Neumiller, PharmD, CDE, CGP, FASCP; medically reviewed by Amy Campbell, MS, RD, LDN, CDE
Let’s face it: We all forget things from time to time. Often, the consequences are relatively minor, such as when we forget to pick up the dry cleaning or take out the trash on garbage day. But forgetting to take prescribed medicines — or taking them incorrectly because you’ve forgotten when or how to take them — can have quite serious consequences. Studies show that adherence to taking medication is about 50 percent. Not taking medication as prescribed can impact the quality and length of life, health outcomes and health-care costs. As the former Surgeon General C. Everett Koop once stated, “Drugs don’t work in patients who don’t take them.”
People with diabetes often have a lot to remember: not only to take their medicines on time and in the right doses, but also to check their blood glucose level up to several times a day, possibly to monitor their blood pressure and, in many cases, to keep a record of food and exercise. It’s no surprise that some things can occasionally get overlooked.
But if you’re forgetting to take your medicines more than occasionally, forgetting to get prescriptions refilled or often having trouble carrying out parts of your diabetes care plan because it’s so complicated, it’s time to think about setting up a system that will help you remember to do what you need to do. Getting help from your health-care team, a family member or a friend can help you set up a plan and get back on track with diabetes self-care.
If taking your diabetes medicine is an issue for you, fortunately, there are number of techniques, devices, services and other resources that can help you keep your medicines straight and take them at the right times.
One of the most effective ways to remember to take your medicines is to make a mental connection between taking your medicines and performing some other part of your daily routine. For example, many medicines are supposed to be taken with certain meals, so the meal itself can serve as a reminder to take the medicine. For medicines taken at bedtime, brushing your teeth, changing into your pajamas or getting your nighttime glass of water can be the cue that reminds you to take your medicine.
Here are some ways to make these mental connections with your medicines easier:
Keep your medicines out and readily accessible where you are most likely to take them. For example, if you are supposed to take a medicine with breakfast and you have toast every morning, placing the medicine bottle near the toaster may help you remember to take it in the morning. Or you might keep all of your medicines in a high-traffic area in your home, such as the kitchen or dining room, that you pass through frequently during the day. A great way to remember taking medicines at bedtime is to keep them right on your bedside table.
Keep in mind, however, that keeping your medicines in accessible places could pose a risk if you have small children or pets in your home. You may need to choose less accessible places that children and pets cannot reach, or keep your medicines out of sight.
If keeping your medicines in visible places is not possible or practical for you — or if it’s not enough of a reminder — try posting notes to yourself on the refrigerator, on the bathroom mirror or next to your computer. Use bright colors to help the notes catch your eye. You may also have a calendar application on your computer (or connected to your e-mail program) that can be set up to automatically display daily reminders on your desktop. Or you could set up an online calendar (such as a Google calendar) to send you reminders by e-mail or as text messages to your cell phone. Smartphone apps are available, too, that can send you notifications that it’s time to take your meds. Medisafe, PillPack, Dosecast and MedHelper are apps to check out.
Your friends, family members or caregivers may be willing to help you manage your medicines, either by helping with organization, such as filling your pillboxes every week, or by reminding you in person or with a phone call when it’s time to take something. They may also be willing to help you remember to request refills on time.
For people who take more than a couple of medicines on a daily basis, organization is often the key to effective medicine management. These time-tested tools are easy to use and can lead to significant improvement in your ability to manage your medicines.
Make a list of all the medicines you take on a daily basis, and keep it up to date. Medicine lists can help you remember the names of your medicines, what you take them for, what they look like and when you are supposed to take them. There are several useful Internet resources that you can use to create and continually update your medicine list, but an effective list does not necessarily require recent technology — it can be as simple as a piece of notebook paper. However, it may help to add certain elements to your list, such as a timetable for taking each medicine and a chart to check off a medicine once you take it. For medicines that you take less often than daily, a calendar can also be an invaluable tool.
Numerous studies have shown that by keeping a simple list of your medicines and sharing it regularly with your health-care team, you can put yourself at a lower risk for drug interactions, side effects and other problems related to your medicines. Not only will a list help you manage your medicines more effectively, but sharing it with your doctors, pharmacist and other health-care professionals could also improve the quality of care that you receive.
People with diabetes often take multiple medicines every day, and having to handle a large number of pill bottles can lead to confusion about whether you have taken a medicine. It is not uncommon for people to mistakenly take extra doses of a medicine or to miss a dose because they thought they already took it.
Pillboxes are a relatively inexpensive and effective strategy for managing a large or small number of medicines. A variety of pillbox designs are available; most can be filled on a daily or weekly basis. Different pillboxes can be purchased to accommodate the number of times a day you take your various medicines: For example, some boxes have three compartments for each day of the week, providing a place to store morning, lunchtime and evening medicines separately. Pillboxes can be purchased online or at any pharmacy.
Some pharmacies will package your medicines upon request into blister-packs that are labeled specifically with the times of day and days of the week to take each medicine. There is often a fee charged for this service, but it can be very useful for people who have trouble remembering whether or not they took their pills for the day.
Another frequent cause of missed doses is running out of medicine. It is often difficult to tell how many pills are left in a bottle or how many days’ supply of insulin is left in an insulin vial or pen. Developing a system to remind yourself to refill your prescriptions before you run out can help prevent missed doses. Issues with insurance billing and other barriers may limit how early you can refill your medicines, so providing yourself with a reminder at just the right time is important.
Refill reminders can be as simple as a note on your calendar once every month (or as often as necessary). Most major pharmacies also provide refill reminders by phone upon request, and some will automatically refill your prescription and let you know when it’s ready. Most mail-order pharmacies and pharmacy benefit managers (which provide prescriptions by mail directly through insurance plans) also offer refill reminders by e-mail, phone or regular mail. And some pharmacies can provide you with a note each time you pick up or receive your prescription medicines letting you know when you can next request a refill or whether you are out of refills and need to contact your doctor.
A number of electronic devices — some fairly simple, some more sophisticated — may be helpful if you have trouble remembering to take your medicines. Many common items – including some watches, personal digital assistants, cell phones, blood glucose meters and insulin pumps – can be set to sound an alarm, vibrate or flash a light when it is time to take your medicine. While some of these devices can be set to sound only one alarm per day, many can be set for multiple alarms. Alarms are also useful as reminders to check your blood glucose.
Small tape recorders and some cell phones can be used to record instructions from your doctor on how to take your medicines. A recording can be particularly helpful if you have low vision or trouble reading, but it can come in handy if you regularly carry your cell phone with you.
Also available are sophisticated pill dispensers that can be set to dispense medicines at specific times. Some pill dispensers will even alert caregivers and/or family members if doses of medicines are missed or skipped. Talk to your pharmacist or check out some of the websites listed on the “Resources” page for more information on electronic devices that may be useful for managing your medicines.
Most of this article has focused on self-management strategies and products to assist with medicine management, but there are services available for help, as well. While pillboxes can be a very valuable tool for managing medicines, the process of filling them may be tedious and even confusing for some people. Some pharmacies will fill pillboxes for a small fee, and some will even deliver them to your home. Other services, such as the one provided by www.aprexis.com (see “Resources”), can provide reminders to take your medicines and to refill prescriptions on time.
There are many resources available to help answer any questions you have about your medicines. It is always best to discuss your health and medicines with professionals who are familiar with you as an individual. Your doctor is, of course, a great resource for questions of a medical nature. But you can also discuss such issues as difficulty remembering to take medicines, difficulty affording them or difficulty fitting them into your daily routine with your doctor. It may be possible for a prescription to be changed to one that requires fewer daily doses, costs less or otherwise fits better with your schedule and lifestyle.
Another great resource for questions about taking medicines is your pharmacist. Particularly if you get all of your medicines from one pharmacy, your pharmacist should be familiar with your medical history and the medicines you take and can answer questions about them. Even a pharmacist who doesn’t know you personally can give you written information about the medicines you use (in large print, if necessary), check for drug interactions and offer in-person or phone-based counseling.
If you cannot readily reach your doctor or pharmacist when a question about your medicines arises, a variety of consumer websites may be able to provide the information you need. Websites such as as www.iodine.com and www.webmd.com/drugs/2/index can act as a quick reference for basic drug information free of charge. Some websites can even perform drug interaction checks as well as help identify medicines based on their color, shape and markings.
While these resources can be helpful, the information they provide may not always apply to you, specifically. It is important not to start, stop or alter the way you take your medicines without first discussing such a change with a qualified health-care provider.
Want to learn more about the role of medicines in treating diabetes? Read diabetes educator Amy Campbell’s piece “Making Your Diabetes Pills Work for You,” then see her eight-part series on diabetes drugs, covering metformin, sulfonylureas, meglitinides, thiazolidinediones, DPP-4 inhibitors, SGLT2 inhibitors, alpha-glucosidase inhibitors, bile acid sequestrants and dopamine receptor agonists, non-insulin injectable diabetes medications, and insulin.
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