Drugs commonly used for Type 1 Diabetes

Because of the risk of creating confusion and the enormously long list of drugs available, I will only list a few of these drugs. Please be sure to discuss all of your medications and adjustment needs with your physician, before making any changes or decisions.


Please note: All people with Type 1 Diabetes must take insulin by injection. The drugs listed below for type 1 Diabetes are to be administered subQ (subcutaneously - into the fatty tissue under your skin, not the muscle).


Humalog - fast acting
Generic name: Insulin Lispro
Brand name: Humalog Cartridge, Kwikpen, or Pen

Usually given with another long-acting insulin medication. It works by lowering the glucose level in the blood. Comes with multiple warnings, be sure to talk to your doctor about ALL additional medications and/or herbal remedies you are using. Be sure to discuss all allergies. Please refer to label/insert for information regarding drug interactions, adverse effects, and other risks. Talk to your Doctor about pediatric dosages or alternative options.

Novolog - fast acting
Generic name: Insulin Aspart
Brand name: NovoLog, NovoLog FlexPen, NovoLog PenFill

Usually given with another long-acting insulin medication. It works by lowering the glucose level in the blood. Comes with multiple warnings, be sure to talk to your doctor about ALL additional medications and/or herbal remedies you are using. Be sure to discuss all allergies. Please refer to label/insert for information regarding drug interactions, adverse effects, and other risks. Prescribed for adults and children as young as 2 years old.

Levemir - long acting
Generic name: Insulin Determir
Brand name: Levemir, Levemir FlexPen

Comes with multiple warnings, be sure to talk to your doctor about ALL additional medications and/or herbal remedies you are using. Be sure to discuss all allergies. Please refer to label/insert for information regarding drug interactions, adverse effects, and other risks. The Levemir cartridge also works by lowering glucose levels in the blood. Prescribed for adults and children who are at least 2 years old.

Lantus - long acting
Generic name: Insulin Glargine
Brand name: Lantus, Lantus Solostar

Comes with multiple warnings, be sure to talk to your doctor about ALL additional medications and/or herbal remedies you are using. Be sure to discuss all allergies. Please refer to label/insert for information regarding drug interactions, adverse effects, and other risks. The Lantus cartridge also works by lowering glucose levels in the blood.

Lantus Solostar - long acting
Generic name: Insulin Glargine
Brand name: Lantus, Lantus Solostar

Comes with multiple warnings, be sure to talk to your doctor about ALL additional medications and/or herbal remedies you are using. Be sure to discuss all allergies. Please refer to label/insert for information regarding drug interactions, adverse effects, and other risks. The Lantus Solostar cartridge also works by lowering glucose levels in the blood.

Humulin R - fast acting
Generic name: Insulin Regular
Brand name: Humulin R, Novolin R

Comes with multiple warnings, be sure to talk to your doctor about ALL additional medications and/or herbal remedies you are using. Be sure to discuss all allergies. Please refer to label/insert for information regarding drug interactions, adverse effects, and other risks. The Humulin R also works by lowering glucose levels in the blood.


Humulin N - long acting
Generic name: Insulin Isophane
Brand Name: HumuLIN N, HumuLIN N Pen, NovoLIN N


This is a synthetic (man-made) form of a hormone produced in the body, designed to lower glucose levels in the blood.


Apidra - fast acting
Generic name: Insulin Glulisine
Brand name: Apidra

Apidra is a "faster acting" form of insulin than regular human insulin. This medication can be given to adults and children who are at least 4 years old.

Symlin - triple action medication
Generic name: Pramlintide
Brand name: Symlin, SymlinPen 120, SymlinPen 60


~WARNING~ Do not mix Symlin & other insulin in the same syringe. You will need to use a lower dose of insulin than you used before starting Symlin.

Symlin works in 3 ways:
1.) It slows the rate your food moves from your stomach to your intestines. In this action, it can slow your glucose absorption.
2.) It lowers the amount of glucose your sugar produces.
3.) It triggers the feeling of fullness after meals. This will reduce your food intake and help to control your appetite.

Symlin is also a synthetic form of insulin. If you are prescribed Symlin, be sure to take specifically as prescribed. If you have any adverse effects, be sure to seek medical attention IMMEDIATELY.


Become aware of the symptoms of *low blood sugar: These medications cannot be used when your blood sugar is dangerously low. Please make sure you tell your doctor of all additional health conditions, such as kidney or liver disease. Tell your doctor about other prescribed medications, over the counter medications, as well as herbal/natural remedies you are using. You don't want to create any associated risks of drug interactions.

*Symptoms of low blood sugar: Symptoms of low blood sugar may include headache, hunger, sweating, pale skin, irritability, dizziness, feeling shaky, or trouble concentrating. Watch for signs of low blood sugar. Carry a piece of non-dietetic hard candy or glucose tablets with you in case you have low blood sugar. If you hear someone say you are "Hypoglycemic", this means your blood sugar is too low.

When you are monitoring your blood sugar, also look for symptoms of **high blood sugar. If you hear someone say you are "hyperglycemic", this means your blood sugar is too high.

**Symptoms of high blood sugar: These symptoms include increased thirst, loss of appetite, increased urination, nausea, vomiting, drowsiness, dry skin, and dry mouth. Check your blood sugar levels and ask your doctor how to adjust your insulin doses if needed.

When taking insulin, be sure to make it a part of a complete regimen of lifestyle modification, which addresses dietary and exercise needs.

Help for managing your Asthma

Here are a few links to help you with a little research of your own:

• http://www.cdc.gov/asthma/management.html
  
  
  
• http://www.lung.org/lung-disease/asthma/taking-control-of-asthma/
  
  
  
• http://kidshealth.org/parent/medical/lungs/asthma_mgmt.html

I didn't want to post a full bibliography, so we'll start with those few. There are so many resources for everyone, whether you are a health care provider or someone who is learning about Asthma for the first time, as a patient. My goal is to provide ease of receiving information, which will ultimately allow for improvement of self management. We will talk about Asthma as a chronic pulmonary disease and Asthma as an allergic reaction. Your Pulmonary Medical Team will discuss with you, the many tools and medications available to fit your specific classification of Asthma. You can refer to my first Asthma post, "Asthma Kills", to learn the basics of Asthma Classifications. I chose that title strictly for the purpose of shocking everyone into truly paying attention. Your health is nothing to play with. People with Asthma can lead very active lives, depending on severity and management.
In diagnosing Asthma, your physician will ask you questions which will help determine:

• If you actually have asthma
  
  
  
• What are your Asthma "triggers"
  
  
  
• If you have nocturnal (nighttime) awakenings
  
  
  
• What are your symptoms - (wheezing, persistent cough, chest tightness, shortness of breath/"dyspnea", recurrent "episodes" related to specific triggers, etc.)
  
  
  
• How you respond to Asthma specific therapy
  
  

As health care providers, we categorize these symptoms to determine how they fit into the 4 Asthma classifications. As an airway inflammatory disorder, Asthma will definitely cause you to experience most or all of these symptoms. This is where assessing your lung function with a series of tests come in handy. The moment your primary physician becomes aware of your symptoms, he/she should talk to you about Asthma education and making an appointment with a Pulmonologist, referrals are always welcome!
FYI: In addressing Allergies & Asthma data show:

• There are more than 15 Million asthmatics in America
  
  
  
• 85% react with positive skin tests to specific allergens
  
  
  
• Allergic disease is as common and Hypertension & Diabetes combined

Asthma Triggers
Asthma presents either as a genetic disorder or a response to environmental factors. Genetically, we look at specific tests and parental/familial history. In assessing environmental triggers, the irritants are numerous. There are allergens, diet, air pollutions, tobacco smoke, infections, pests, pets, etc. Be completely open and honest about your living environment when discussing symptoms with your physician and/or medical team.
I promised to discuss medications prescribed for both, management of Asthma and of Diabetes. This will be done in a separate blog.
Next Asthma blog, we will talk more about environmental triggers and lifestyle modification!

Asthma Kills!

For so long, I have heard people say things to make excuses for not adhering to their health care regimen. "I grew out of my asthma" (that's #1 on the list), "I really don't need all those medications", "I only have an attack once in a while, when I have a cold", "I couldn't find my inhaler", "My inhaler ran out", the list goes on and on.

This is the very reason, we need to be better educated about the effects and dangers of this Inflammatory Process which strong effects our Airways (breathing). I spoke with a woman after her recovery from what is called Status Asthmaticus, and she said, "all I could think about, was getting in one good breath". She arrived by ambulance to the hospital, ended up in our ICU (intensive care unit), breathing with the assistance of a ventilator. She was someone who we caught in time. There was a woman, who figured she could finish up her workday before going to the hospital, knowing she needed to treat the "attack" she felt coming on. She persisted, until someone at work insisted she go. Apparently, she felt she could drive herself, her thoughtful co-worker called an ambulance. Without sharing all the details, after we worked on her for well over an hour, she didn't make it.

I implore everyone who has been diagnosed or shows symptoms of Asthma, to see your doctor and be specific in describing your symptoms. You should be referred to a Pulmonologist to receive specific testing. We will talk about these tests later on in this blog. I want to share with you, the four classifications of Asthma:

• 1.) Mild Intermittent. This classification addresses people who rarely experience an exacerbation (attack) without the presence of an irritant. This person has symptoms less than twice weekly, and nighttime symptoms less than twice monthly. Their FEV (Forced Expiratory Volume, a Pulmonary Function test) greater than 80%.
  
  
• 2.)Mild Persistent. This classification addresses people who experience an exacerbation more than twice a week, but less than daily. So, perhaps this person feels "tightness of the chest" or wheezing from time to time in the course of a week. The nighttime symptoms also occur more than twice monthly. Their FEV is around 80% with a variance of 20 - 30% at onset.
  
  
• 3.)Moderate Persistent. This person has daily symptoms with nighttime symptoms occurring at least once weekly, and absolutely MUST use their "rescue" inhaler daily. This medication is classified as a Beta2 Agonist (i.e., Albuterol), and works immediately on the smooth muscle tissue of the airway to quickly allow for improved airflow. The FEV for this person is definitely ranges between 60% - 80%. 80% is being very optimistic.
  
  
• 4.)Severe Persistent. This person has very little daily activity. Symptoms occur early and a strong medication regimen is required. There are very frequent nighttime symptoms and the FEV of this person is definitely going to remain below 60%.

Let's talk a little bit about these classifications. If you should find yourself between two different classifications, then you should defer to the strongest of the two. For example, during the day, you rarely ever have any symptoms, yet you have problems sleeping at night due to symptoms more than twice a month, you should consider your symptoms as Mild Persistent instead of Mild Intermittent. Once you visit a Pulmonary Specialist, and receive your Asthma Action Plan, you should definitely stick to that plan, as if your life depends on it. After all, it's true. Your life really does depend on your diligence and commitment to this plan. I won't fill this blog with a lot of technical jargon and spirometric values, that will only cause confusion. I will however, strongly urge you to talk openly and specifically to your physician about onset and frequency of symptoms.

Keep in mind, AGE IS NOT A FACTOR for new diagnosis of Asthma. As a matter of fact, there was a time, when we did not diagnose a child with Asthma until that child reached 2 years old. Thank God things have changed and advances in health care have provided for much stronger diagnostic tools and skill sets. On the flip-side of the age chart, don't feel that if you're well over 35 years old, you cannot be diagnosed with new onset Asthma. It's quite possible.

Here are a few statistics for you:

• Prevalence: 20.5 Million Americans are diagnosed with Asthma. 6.2 Million of these 20.5 Million, are children.
• Morbitity (effect of illness): Patients experience a combined 100 Million days of limited activity. There are 485 Thousand hospitalizations annually, with 1.9 Million Emergency Room visits per year.
• Mortality: 4,200 deaths are reported annually.

Please understand, this data is available because of recorded reports. The number of people who are not addressing the seriousness of this Airway Disease, remain unknown. I guess we'll continue to count on the mortality rates.

Hold on to your hats, there's much more to come!!!

Ongoing Efforts in Managing Diabetes

Be sure to speak to your doctor openly and honestly about your dietary, exercise and "recreational" practices and habits. It will make a huge difference in how your approach to feeling better works for you. Proper diagnosis and treatment is key to improvement. Over time, it is natural for our bodies to develop into a process called insulin resistance. This occurs over cell development and emergence of systematic changes in our bodies' cellular demands. Excess insulin resistance causes diabetic incidences.



Search the web to find aerobic exercise that works best for you. What your friend or sibling does for exercise, might not be best for your body. Go with what feels comfortable and doesn't cause excessive pain. Never believe pain is a good thing. Pain is an indicator that your body isn't digging what's happening and PLEASE STOP DOING IT. Short lived (less than 48 hours) of muscle pain isn't a bad thing, but when you're experiencing full muscle strains and sprains, it's NOT acceptable. If you find yourself short of breath, stop and take a rest. If you have to take frequent rest periods when getting started, that's fine. Give your body the opportunity to adjust to this new activity you're sending it through. Do not take pain prescription pain medications which were not prescribed to you by YOUR physician. Your neighbor, your sibling, your cousin, your parents all have their own thing to deal with. Think of it as sharing underwear, WE JUST DON'T DO THAT!

Gestational Diabetes

Gestational Diabetes Many are aware of health hazards and risks while pregnant. One additional hazard, which is frequently overlooked, is the development of diabetes while pregnant. The woman’s body is experiencing numerous hormonal changes and extremes at this moment. Diet becomes essential not only for nutritional value, but for your complete health. As I mentioned before, the hormone regulation and protein system of transport that occurs when the body is breaking down sugars, requires a well-functioning organic system. We compromise our body’s organizational plan, when our hormones and diet are off balance.

Typically, when we hear about a friend or family member developing Gestational Diabetes, the condition is present until after the child is born. However, we have to consider the potential permanent risks to both mother and infant, if Gestational Diabetes goes undetected and unmanaged. Symptoms are typically mild, and can be easily overlooked. Increased thirst, fatigue, vaginal infections, frequent urination, & skin irritation are symptoms which are frequently overlooked simply because they can occur with pregnancy anyway. This is why we absolutely MUST keep up with our prenatal visits. Even though Gestational Diabetes specifically occurs during pregnancy, your risk of developing Type 2 Diabetes is increased. Be sure to adhere to your physician’s advice regarding diet, exercise, and possibly medication regimine. Keep in mind, the particular risks to your unborn infant.

Tests done during pregnancy help determine specific dietary needs, detect possibility of birth difficulties, and these tests can help detect specific delivery risks and expectations. Prenatal care is paramount to ensuring the safest delivery possible. I’ve heard women say, “I don’t know why they have to keep drawing blood from me, every time I go to the doctor”. Well, your body is undergoing constant change with each stage of your pregnancy. There is no need to take additional risks, pregnancy is taxing enough on the body, without the help of additional co-morbidities. We will talk more about Pregnancy and Prenatal care in a later blog.

Here is an insert from the Mayo Clinic:



Causes

By Mayo Clinic Staff

Researchers don't yet know exactly why some women develop gestational diabetes. To understand how gestational diabetes occurs, it can help to understand how pregnancy affects your body's normal processing of glucose. Your body digests the food you eat to produce sugar (glucose) that enters your bloodstream. In response, your pancreas — a large gland behind your stomach — produces insulin. Insulin is a hormone that helps glucose move from your bloodstream into your body's cells, where it's used as energy. During pregnancy, the placenta that connects your growing baby to your blood supply produces high levels of various other hormones. Almost all of them impair the action of insulin in your cells, raising your blood sugar. Modest elevation of blood sugar after meals is normal during pregnancy. As your baby grows, the placenta produces more and more insulin-blocking hormones. In gestational diabetes, the placental hormones provoke a rise in blood sugar to a level that can affect the growth and welfare of your baby. Gestational diabetes usually develops during the last half of pregnancy — sometimes as early as the 20th week, but usually not until later.

Risk factors

By Mayo Clinic Staff

Any woman can develop gestational diabetes, but some women are at greater risk. Risk factors for gestational diabetes include:

• • Age greater than 25. Women older than age 25 are more likely to develop gestational diabetes.
• • Family or personal health history. Your risk of developing gestational diabetes increases if you have pre-diabetes — slightly elevated blood sugar that may be a precursor to type 2 diabetes — or if a close family member, such as a parent or sibling, has type 2 diabetes. You're also more likely to develop gestational diabetes if you had it during a previous pregnancy, if you delivered a baby who weighed more than 9 pounds (4.1 kilograms), or if you had an unexplained stillbirth.
• • Excess weight. You're more likely to develop gestational diabetes if you're significantly overweight with a body mass index (BMI) of 30 or higher.
• • Nonwhite race. For reasons that aren't clear, women who are black, Hispanic, American Indian or Asian are more likely to develop gestational diabetes.

Complications

By Mayo Clinic Staff

Most women who have gestational diabetes deliver healthy babies. However, gestational diabetes that's not carefully managed can lead to uncontrolled blood sugar levels and cause problems for you and your baby, including an increased likelihood of needing delivery by C-section.

Complications that may affect your baby: If you have gestational diabetes, your baby may be at increased risk of:

• • Excessive birth weight. Extra glucose in your bloodstream crosses the placenta, which triggers your baby's pancreas to make extra insulin. This can cause your baby to grow too large (macrosomia). Very large babies are more likely to become wedged in the birth canal, sustain birth injuries or require a C-section birth.
• • Early (preterm) birth and respiratory distress syndrome. A mother's high blood sugar may increase her risk of going into labor early and delivering her baby before its due date. Or her doctor may recommend early delivery because the baby is growing so large. Babies born early may experience respiratory distress syndrome — a condition that makes breathing difficult. Babies with this syndrome may need help breathing until their lungs mature and become stronger. Babies of mothers with gestational diabetes may experience respiratory distress syndrome even if they're not born early.
• • Low blood sugar (hypoglycemia). Sometimes babies of mothers with gestational diabetes develop low blood sugar (hypoglycemia) shortly after birth because their own insulin production is high. Severe episodes of hypoglycemia may provoke seizures in the baby. Prompt feedings and sometimes an intravenous glucose solution can return the baby's blood sugar level to normal.
• • Jaundice. This yellowish discoloration of the skin and the whites of the eyes may occur if a baby's liver isn't mature enough to break down a substance called bilirubin, which normally forms when the body recycles old or damaged red blood cells. Although jaundice usually isn't a cause for concern, careful monitoring is important.
• • Type 2 diabetes later in life. Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life.

Untreated gestational diabetes can result in a baby's death either before or shortly after birth.

Complications that may affect you

Gestational diabetes may also increase the mother's risk of:

• • High blood pressure, preeclampsia and eclampsia. Gestational diabetes increases your risk of developing high blood pressure during your pregnancy. It also raises your risk of preeclampsia and eclampsia — two serious complications of pregnancy that cause high blood pressure and other symptoms that can threaten the lives of both mother and baby.
• • Future diabetes. If you have gestational diabetes, it's more likely to happen again during a future pregnancy. You're also more likely to develop type 2 diabetes as you get older. However, making healthy lifestyle choices such as eating healthy foods and exercising can help reduce the risk of future type 2 diabetes. Of those women with a history of gestational diabetes who reach their ideal body weight after delivery, fewer than one in four develop type 2 diabetes.

I hope the information provided here proves to be very helpful. Whether you are expecting a child now or plan to in the future, be sure to consider all associated health risks. Diabetes is very prevalent in our “minority” communities. Join the fight against Diabetes by arming yourself with understanding, management, and prevention!