Medically reviewed by Pat F. Bass III, MD, MPH
diabetes medication safety tips
Because diabetes
is a complicated condition, you might need to take more than one medication to help manage it. According to information from the National Institutes of Health, only 16 percent of people with diabetes manage the condition without medication. By contrast, 58 percent are on oral medications, 12 percent take insulin only, and the remaining 14 percent need both insulin and oral medications. Diabetes medication can help your body control blood sugar levels more effectively, but combination therapy — taking more than one drug — is needed for many people to achieve full diabetes control. You might also be taking medications for another health condition, such as high blood pressure or high cholesterol
. All together, it's a lot to juggle, and medication safety is a priority. Educating yourself about the diabetes medications you take is a good place to start.
Oral Medications for Diabetes
There are six drug classes for oral diabetes medications:
* Sulfonylureas help beta cells in your pancreas to produce more insulin, an important hormone for blood sugar (glucose) control
. This is one of the oldest classes of drugs for diabetes, dating back to the 1950s. They’re taken before meals.
* Meglitinides also cause beta cells to produce more insulin. They, too, are taken before meals.
* Biguanides lower blood sugar by reducing the amount of blood sugar produced by your liver.
* Thiazolidinediones enable your muscles and fat to use insulin more effectively. They also affect your liver’s production of blood sugar.
* Alpha-glucosidase inhibitors lower blood sugar by affecting the way your intestine digests starch from bread, potatoes, pasta, and even table sugar. As a result, blood sugar rises more slowly after meals. These medications must be taken with food.
* DPP-4 Inhibitors are a new class of drugs for diabetes that allows A1C — the measurement of blood sugar control over a period of two to three months — to improve without resulting in low blood sugar. These drugs stop your body from breaking down a naturally occurring compound called GLP-1. GLP-1 lowers blood sugar naturally, but goes away quickly. DPP-4 inhibitors keep GLP-1 working in your body longer.
Oral Medication Safety Tips:
* Make sure your doctor is aware of all medications and supplements you’re taking, even over-the-counter products. This is the best way to prevent dangerous drug interactions.
* Follow your doctor’s instructions accurately. Your doctor will tell you what dose to take, when to take it, and how to take it. If you have questions or concerns about any aspect of taking a prescribed medication, call your doctor.
* Monitor your blood sugar carefully. Drugs that cause your body to make more insulin can sometimes cause low blood sugar, a potentially dangerous situation you want to guard against. Be aware of your blood sugar level so you can take action if it starts to dip too low.
* Limit or avoid alcohol. Many diabetes medications don’t mix well with alcohol.
* Store medications safely. Most medications do best in a cool, dark place or at room temperature. Don’t keep medications in your car in the heat, for example.
* Check expiration dates. You’ll probably be refilling prescriptions and using them up fairly regularly, but periodically check expiration dates on products you've had around for awhile and be sure to discard any that are past their expiration date.
* Get all needed blood tests. Your doctor will want to see blood sugar tests from a lab at least quarterly and might require other blood tests, such as tests of your liver function, to make sure your medications are working well without doing any damage. These are important appointments to keep.
Taking Insulin
Insulin treatment
may be needed because your body either isn't making any insulin or isn't making enough. Insulin is probably the medication most commonly associated with diabetes treatment and the one people have many concerns about, says Charmaine D. Rochester, PharmD, CDE, an associate professor and faculty fellow at the Center for Innovative Pharmacy Solutions at the University of Maryland School of Pharmacy in Baltimore. People may be concerned that taking insulin is automatically connected with severe diabetes and complications, but this isn't true. “Insulin is a natural hormone that everyone needs for long-term glucose control,” she emphasizes. For people who require supplemental insulin, Dr. Rochester says, “it’s important to monitor blood sugar levels on insulin because it can cause low blood sugar if it’s in excess, if you take it without eating, or if you increase your physical activity.”
There are five types of insulin:
* Long-acting insulin is given in a daily shot to help your body manage blood sugar levels throughout the day. This insulin takes 6 to 10 hours to have an effect and lasts for 20 to 24 hours.
* Short-acting insulin is taken before you eat to control the release of blood sugar in response to the meal. It reaches your blood in 30 minutes, peaks about two to three hours after injection, and lasts three to six hours.
* Intermediate-acting insulin works faster than long-acting insulin and lasts longer than short-acting.
* Rapid-acting insulin works very quickly, reaching your blood about five minutes after injection and peaking in about an hour. It is commonly used at meal times.
* Pre-mixed insulin contains long- and short-acting insulin.
Insulin Safety Tips:
* Store it safely. Insulin must be kept cool but not frozen. That means if you’re going to be outdoors or on the road with your insulin, you’ll need a small cooler or cold pack to keep it within the desired temperature range. You can keep a bottle at room temperature for one month, but it should be kept in the refrigerator if you want to use it beyond then. For your own comfort, allow insulin to warm up to room temperature before injecting it.
* Check expiration dates. Do not use expired insulin products.
* Visually inspect your insulin. If you see any cloudiness or crystals in your insulin, don’t use it.
* Monitor your blood sugar carefully. It’s common to check your blood sugar when you get up in the morning, before and after meals, before bed, and before other certain activities, such as exercising or driving. If you’re taking insulin, this is an important step to help avoid taking too little or too much insulin.
* Eat when you take insulin. When taking insulin, especially short-acting insulin, putting food in your body is critical. “One of the biggest mistakes people make is to take their insulin and then plan on eating when they get to work,” Rochester says. Traffic or other factors can delay you, sending blood sugar too low before you have a chance to eat something. Make sure you keep appropriate snacks on hand.
* Reuse syringes with care. Reusing syringes is safe if you make sure to keep the syringe capped between uses and keep the needle from touching anything other than your clean skin and your insulin. Once needles are dull or touch something other than skin or insulin, they must be thrown away safely (usually you can take used needles back to your pharmacy or doctor’s office for proper disposal). If your immune system is compromised, however, or you get skin sores, don’t reuse your syringes.
What to Ask Your Pharmacist
In addition to her academic duties, Rochester works in a busy clinic where she counsels people about their medication use. “Many of the people I see take 15 to 20 medications,” she says. Beyond your diabetes medications, you might also need guidance about medication for high blood pressure, cholesterol, acid reflux, asthma, and other conditions
. The problem, Rochester says, is that pharmacists can seem very busy, so people don’t want to ask for help, even if they‘re confused. Here’s her advice:
* Keep a running list of all of the medications and supplements you’re taking.
* Make an appointment to sit down with your pharmacist and go over all of your medications and supplements. You can bring them all in a bag or just bring a list with the specific drug name and dose. This will help you figure out your daily and weekly medication schedule.
* Watch for unexpected interactions. For example, Rochester points out that seemingly harmless over-the-counter medications, such as antacids, could be negatively affecting your diabetes treatment plan. Antacids work well to reduce acidity in your body, but at the same time, they might be changing the way your body absorbs some medications. Some dietary supplements, such as iron and calcium, could affect drug absorption, too. Discuss all of your over-the-counter medications with your pharmacist.
Finally, if you experience new symptoms from a drug or you aren't seeing the results you and your doctor discussed, make sure to let your doctor and your pharmacist know to make sure everything is on track with your medications.