Archive for November, 2021

As November, which was American Diabetes Month, comes to a close, it is important to remember the importance of blood sugar monitoring. Checking your blood sugar is essential to your diabetes care. Consistent blood sugar monitoring helps your providers see the trends in your diabetes and adjust your treatments accordingly.

However, we know that life can sometimes get in the way of consistent and quality readings. In addition, there are barriers that you could encounter that impact your willingness to check your sugars. And for those of you who don’t have a continuous glucose monitor (CGM), we know there are a lot of steps involved in measuring and understanding your blood sugar levels. That is why we want to share some helpful tips to maximize the quality of your blood sugar monitoring routine.

• When it comes to your finger-sticks: location matters.
  • Some patients report issues with finger-sticking to be the biggest barrier in their monitoring routine. Oftentimes, the issue patients have with their finger-sticks is pain. Whenever a patient is reporting excessive pain with lancet use, the location of their finger-sticks is often the culprit. There are two easy ways you can reduce finger-stick pain:
    • Sticking on the sides of your fingertips rather than the center
    • Rotating your fingers for sticking
  • Many patients who have excessive finger-stick pain use their lancet on the center of their fingertips. Now it’s not hard to imagine why this location could present a problem. This is the most sensitive area of your finger! Try using your lancet on the sides of your fingertips and you should notice a big difference in the pain you may experience during finger-sticks.
  • In addition, many patients use the same fingers for their sticking. Repeatedly sticking the same finger presents more opportunities for pain and over time may cause your skin to become calloused. The calloused skin will be difficult to stick and draw enough blood for a reading. That is why it is important to rotate your fingers for lancet sticks.

• If lancets give you needle anxiety, tell your doctor!
  • There can be alternative lancing devices that may be more comfortable for you.
• Find a routine that works for you.
  • Forming a habit of when you check your sugars is one of the easiest ways to have a strong glucose monitoring routine. This routine building starts with your diet and meals. It is important to keep your meal timing and size consistent each day and reduce snacking. Inconsistency with your meals can impact the quality of your blood sugar readings and make controlling your diabetes more challenging.
• Measure your sugars at the right time.
  • Make sure you are measuring at the best times to record your sugar. Generally, there are three great times to be checking your blood sugar that will help your doctor assess your diabetes plan:
    • When you wake up
    • Right before eating a meal or two hours after eating
    • If you are having symptoms of high or low blood sugar
  • Remember your fasting sugar goal, the level you take right when you wake up and before you eat breakfast, is 80 mg/dL – 130 mg/dL.
    • This may also be your goal before eating any meal throughout the day.
  • Your sugar goal two hours after eating is going to be anything less than 180 mg/dL.
• Record everything.
  • Many patients don’t check their sugars as often as their doctor wants because whenever they check their numbers are usually fine. Also, some patients may be afraid of “bad” numbers.
    • Unfortunately, it’s not enough to check your sugars whenever you feel like they are good.
    • Your providers want to see the full picture of your diabetes and the best way to do that is to measure consistently and often.
    • Providers want to see the trends of your sugars. Just because your sugars are good at one time of the day does not mean they are where they need to be at other times.
    • If your sugars run high at other times of the day, your diabetes therapy may need to be adjusted.
    • Finally, there are no such thing as “bad” numbers. You do not need to hide bad numbers from your doctor. Your providers want to know if your sugars are running too high or too low, because this can harm you and may mean a need to optimize your diabetes therapy. Knowing consistent numbers helps individualize your care.
  • Keep a blood sugar reading log.
    • Many patients take readings, but do not log what these readings mean. When they go to the doctor with all their readings, it can be difficult to remember the circumstances surrounding each reading. The numbers are great, but blood sugar monitoring is even more effective when we can start to figure out how blood sugars tend to run.
    • Ask your doctor for a blood sugar monitoring log.
    • Make note of the differences between what you ate or what was happening around each reading.

Ultimately, blood sugar monitoring is vital because it helps you take control of your diabetes and receive the best care from your providers. That is why it’s important to discuss your diabetes care and goals with your doctor so you can get an individualized plan.

References:

[1] ADA. The Big Picture: Checking your Blood Sugar. American Diabetes Association. Accessed November 24, 2021. https://www.diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/checking-your-blood-sugar

[2] CDC. Monitoring Your Blood Sugar. Centers for Disease Control and Prevention. Updated August 10, 2021. Accessed November 24, 2021. https://www.cdc.gov/diabetes/managing/managing-blood-sugar/bloodglucosemonitoring.html

Images:

[1] https://www.medicalnewstoday.com/articles/best-lancets#_noHeaderPrefixedContent

[2] https://www.statnews.com/2019/10/08/time-in-range-new-metric-diabetes-blood-sugar/

[3] https://www.postertemplate.co.uk/templates/health/blood-sugar-chart-templates/

The weather is getting cold. That only means one thing: flu season is coming.

If you had the flu before like me, it is the worst thing ever and I would not want to experience it again. One of the best ways to protect yourself from the misery of the flu is by getting the influenza vaccine (flu shot).

Here are some of the frequently asked questions I’ve encountered throughout my five years working in pharmacy:

• Can I still get the flu after getting the flu shot?
  • Unfortunately, the flu shot won’t protect you 100% from getting the flu. This is possible for the following reasons:
    • You got the flu shortly after getting the flu shot, so the body did not have time to build up the antibodies yet.
    • You got infected by a different strains of flu virus, which the flu shot does not protect against.
  • Unfortunately, some people can become infected with a flu virus that the flu vaccine is designed to protect against, despite getting vaccinated.
  • However, the 2021 data showed that among adults, flu vaccination was associated with a 26% lower risk of ICU admission and a 31% lower risk of death from flu compared with those who were unvaccinated.
• When is the best time to get the flu vaccine?
  • Since our body needs about two weeks to build up the antibodies for the vaccine, everybody should receive the flu shot as soon as they are available, typically at the end of September or the beginning of October. However, it is never too late to get the flu shot because the peak of flu season is usually in January or February.
• What is the flu vaccine and why do we have to get one every year?
  • The influenza vaccine or flu shot is a vaccine that contains a part of a virus or an inactivated virus so that when they are introduced to the body, the immune system will keep a memory of how the virus looks. When we are exposed to the flu virus, our immune system will have a specific antibody against the virus to prevent us from getting seriously ill.
  • Seasonal flu vaccines are designed to protect against the influenza viruses that research indicates will be most common during the upcoming season. They are quadrivalent, meaning that they contain four strains of flu: 2 influenza A (1 strain of H1N1 and 1 strain of H3N2) and 2 influenza B. It is crucial to get the flu shot each year because the flu virus mutates very quickly, and the flu shot from the previous season will not protect against this year’s virus.
• Can the flu shot make me sick?
  • As mentioned in question one, the flu shot contains a part of a virus or an inactivated virus. Those viruses cannot replicate in your body; hence, they cannot give you the flu. If you experience flu-like symptoms, as well as fatigue after the flu shot, those are side effects of the vaccine, which usually goes away in 1-2 days (while the flu usually lasts up to a week or longer).
• How long should I wait between the COVID booster and flu shot?
  • You can actually receive both the COVID shot and the flu shot at the same time. It used to be 14 days in between the two, but the Centers for Disease Control and Prevention (CDC) released new information that the two vaccines can be safely administered at the same time

Above are five of the most frequently asked questions about the flu shot that I’ve had. If you have any other questions, do not hesitate to ask any of our friendly pharmacists.

Remember: it is never too late to get the flu shot.

We are offering walk-in flu shots. So come on in!

Reference:

“Frequently Asked Influenza (Flu) Questions: 2021-2022 Season.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 23 Nov. 2021, https://www.cdc.gov/flu/season/faq-flu-season-2021-2022.htm.

A Guide to Vitamin D Supplementation

• Vitamin D is important for your bone health. Together with calcium, Vitamin D helps protect older adults from osteoporosis.^[2] Most people do not consume enough vitamin D from their diet alone. That is why you may want to use a vitamin D supplement, especially if your vitamin D levels are running low.
• Vitamin D has evidence suggesting it to be effective with:
  • Helping treat bone disorders.
  • Helping prevent osteoporosis.
  • Helping reduce the risk of multiple sclerosis. ^[3]
• Vitamin D is also being studied to assess its impact on cognitive health and preventing certain cancers. ^[3]
• If you are older than 70 your skin may not create vitamin D as efficiently as it used to. ^[2]
• In foods and dietary supplements, vitamin D comes in two forms:
  • Vitamin D2 (ergocalciferol)
  • Vitamin D3 (cholecalciferol)
    • These two forms differ only slightly in their chemical structure.
    • Both are safe and effective, however, some studies show that vitamin D3 is a bit more effective at raising and maintaining your vitamin D levels. ^[4]
  • When you go to the doctor and they perform tests that can measure your vitamin D, here is what to look for:
    • 25(OH)D is your vitamin D level. ^[2]
    • These charts help you interpret your vitamin D levels and how much vitamin D you need every day.

• Not many foods naturally contain much vitamin D. Foods with some natural sources of vitamin D include:
  • Fish (trout, salmon, tuna)
  • Egg yolks
  • Some mushrooms ^[2]
• Some foods, like milk, may be fortified to have vitamin D in them.
  • Milk usually contains 120 IU/cup. ^[2]
• Of course, you also get vitamin D from the sun.
  • The sun emits UV radiation that your skin uses to make vitamin D.
  • However, depending on your location, the season, and how much time outside you spend, you may not get enough vitamin D from the sun alone–especially not here in Ohio!
  • If you decide to get more time in the sun, make sure you wear enough sunblock! ^[2]
• If you decide that you want to use a vitamin D supplement, you should always consult with your doctor and pharmacist first.
  • You have quite a few options with dosages of Vitamin D, as many brands provide different strengths and formulations.
    • Dosages for the prevention of osteoporosis are typically in the range of 600-1,000 units.
    • You may see higher doses, some as high as 4,000 units.
      • You could take these doses, but be sure to get your vitamin D levels monitored as these are higher doses.
    • Can I take too much vitamin D?
      • Yes! And it could cause high calcium levels that hurt your bones and kidneys. ^[2]
      • Fortunately, even if you take the highest doses available over-the-counter, like 4,000 IU daily, this is not a serious concern. Still, you should always keep your doctor in the loop about your supplementation and monitor your vitamin D levels to prevent excessive amounts.
      • Symptoms of excessive vitamin D toxicity and high calcium are
        • Confusion
        • Fatigue
        • Weakness
        • Nausea and vomiting ^[5]
      • Supplementation tips with vitamin D:
        • Vitamin D can be taken with or without food.
          • However, it is best taken with a meal, as this helps absorption. ^[5]
        • Drug interactions with vitamin D
          • Vitamin D can increase your risk of high calcium when taking a diuretic such as hydrochlorothiazide. ^[5]

References:

[1] Pazirandeh S, Burns D. Overview of Vitamin D. UpToDate. September 23, 2021. Accessed November 15, 2021. www.uptodate.com

[2] NIH Health Information. Vitamin D. Accessed November 15, 2021 https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/

[3] Mayo Clinic. Vitamin D. Accessed November 15, 2021. https://www.mayoclinic.org/drugs-supplements-vitamin-d/art-20363792

[4] Harvard University: The Nutrition Source. Vitamin D. Updated March, 2020. Accessed November 15, 2021. https://www.hsph.harvard.edu/nutritionsource/vitamin-d/

[5] Lexi Drugs: Ergocalciferol. Wolters Kluwer. Accessed November 15 2021. online.lexi.com.

The upcoming week, November 21 to 27, is GERD Awareness Week, so I want to give you some information about GERD.

GERD (gastroesophageal reflux disease, or chronic reflux disease) is a condition where acid in your stomach leaks back to the esophagus (the tube in your throat) causing a burning sensation (heart burn). If this happens for a long period of time, the esophagus will be damaged.

GERD is usually caused by the damaged esophageal sphincter, which can not close as it is supposed to, creating a back flow of stomach acid.

Keep in mind that having heart burn or acid reflux does not mean that you have GERD, since everybody will experience heart burn now and then. However, if you experience heart burn more than twice weekly, discuss with your doctor since that may be a sign for GERD.

GERD is very common. About 20% of the US population has GERD.

Some risk factors of getting GERD are:

• Age: >40 years
• Obese or overweight
• Pregnant
• Smoking (including secondhand smoke)
• Medications that cause GERD:
  • Iron supplements
  • Potassium
  • Antibiotics: especially tetracyclines and clindamycin
  • Bisphosphonates (osteoporosis medications) which include:
    • alendronate (Fosamax)
    • ibandronate (Boniva)
    • risedronate (Actonel, Atelvia)

Symptoms of GERD include:

• Heart burn
• Regurgitation (food comes back into your mouth from the esophagus)
• The feeling of food caught in your throat
• Coughing
• Chest pain
• Problems swallowing
• Vomiting
• Sore throat and hoarseness

***Keep in mind that people often confuse the chest pain from a heart attack with that from heart burn. The image above from the University of Washington Medicine does a very good job of comparing the symptoms of heart burn and heart attack.

Treatment options:

• Lifestyle modification:
  • Lose weight if you’re overweight or obese.
  • Elevate your head during sleep by placing a foam wedge or extra pillows under your head and upper back to incline your body and raise your head off your bed 6 to 8 inches.
  • Have the last meal of the day about two hours before bedtime.
  • Quit smoking, if you smoke.
  • Reduce consumption of foods that can cause GERD including:
    • acidic foods, such as citrus fruits and tomatoes
    • alcoholic drinks
    • chocolate
    • coffee and other sources of caffeine
    • high-fat foods
    • mint
    • spicy foods
  • Take medications that help with heart burn and reduce acid:
    • Antacids: mild heart burn can be relieved by taking antacids; however, antacids should not be used on a regular basis without the advice of doctors. Antacids could decrease the absorption of some medications such as levothyroxine, ciprofloxacin, etc…, so they should be taken about two hours apart from these medications.
    • H2 blockers: famotidine (Pepcid) is preferred over cimetidine (Tagamet) because it has fewer drug interactions. These medications could help lower the amount of acid in your stomach.
    • Proton Pump Inhibitors (PPI) including pantoprazole (Protonix), omeprazole (Prilosec), lansoprazole (Prevacid): These medications could lower the acid in your stomach much better than H2 blockers; however, they need about 2-3 days until you feel the difference. PPIs should not be taken for more than 14 days unless instructed otherwise by your doctor. Studies have shown that taking PPIs for a long period of time could increase the risk of fracture and clostridium difficile (C. diff ) infections.

If you have any questions, do not hesitate to call any of our friendly pharmacists. We are more than happy to answer any questions.

References:

• Badillo R, Francis D. Diagnosis and treatment of gastroesophageal reflux disease. World Journal of Gastrointestinal Pharmacology and Therapeutics. 2014;5(3):105–112. doi: 10.4292/wjgpt.v5.i3.105
• GERD (Chronic Acid Reflux): Symptoms, Treatment, & Causes. (n.d.). Retrieved from https://my.clevelandclinic.org/health/diseases/17019-gerd-or-acid-reflux-or-heartburn-overview
• (n.d.). Retrieved from https://healthlibrary.uwmedicine.org/Library/Wellness/Prevention/85,P00381
• Treatment for GER & GERD. (n.d.). Retrieved from https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/treatment

You may have seen commercials for medications or heard about a condition called Chronic Obstructive Pulmonary Disease or COPD. Since November is COPD awareness month, we here at Plain City Druggist wanted to give you a rundown of what COPD is, how you can prevent it, and how it is typically treated. For those patients of ours who already have COPD, we have included some helpful tips for you to be mindful of.

• What is COPD
  • Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease that makes it difficult to breathe.^[1] People with COPD often compare it to feeling like they are breathing through a straw.
  • Over 16 million people have COPD in the US.^[1]
  • It is the fourth leading cause of death in the US.^[1]
  • The symptoms of COPD include:
    • Constant coughing
    • Coughing up sputum (sputum is like mucus)
    • Wheezing
    • Shortness of breath
    • Chest tightness
  • If you are experiencing any of these symptoms or are finding it harder to breathe and you are a current/former smoker or exposed to irritants at work, you should follow up with your doctor and request a lung function test.
  • COPD affects your lung function; it makes it harder for your lungs to take in air and give oxygen to your blood.
    • Your lungs contain tubes that air moves through called bronchial tubes. These bronchial tubes have many branches of smaller tubes called bronchioles which have tiny round air sacs at the ends called alveoli, which is where oxygen is taken up into the blood. COPD can involve both the bronchial tubes of your airways and the alveoli sacs^[1]
  • COPD includes two different kinds of lung diseases you may have heard of: chronic bronchitis and emphysema.
    • Bronchitis – when the bronchial tubes and bronchioles are inflamed, tighter, and clogged with mucus.
    • Emphysema – when the alveoli air sacs are damaged, they lose their ability to stretch and get air in and out.
  • Risk Factors – COPD is often preventable but there are some common risk factors.
    • Smoking – the leading cause of COPD
    • Long-term exposure to lung irritants other than smoking – causes up to 25% of COPD cases!^[1] Often these non-smoking lung irritants end up causing COPD through prolonged exposure through a person’s occupation. These irritants include things like:
      • Pollution
      • Chemical fumes
      • Dust
    • Women are also at a higher risk of developing COPD.
      • Women are 30% more likely to have COPD than men.^[1]

• Remember: COPD is not just a smokers’ disease!
  • If you work on a farm, in a factory, or other kinds of labor you may be at risk of developing COPD.
  • If you find you are having a harder time breathing and have any of the symptoms of COPD, you should follow up with your doctor.
• Treatment for COPD
  • Unfortunately, COPD cannot be cured and the lung damage cannot be reversed. However, proper medication therapy and lifestyle changes can slow its progression and improve your quality of life.
  • The most important lifestyle changes you can make to treat your COPD is to stop smoking and to avoid lung-irritants wherever possible. If you are frequently exposed to lung-irritants at work, ensure you wear a mask with particle filters to help reduce the number of irritants you breathe.
  • The most common medications for COPD are inhalers. There are many different kinds of inhalers, often with many different combinations of inhaled medications. The most common kinds of medications found in an inhaler for COPD are:
    • Bronchodilators – these can include either anticholinergic or beta-receptor blocking medications that widen your airways.
    • Steroids – control the lung inflammation that can make it harder to breathe.
  • There are other options your provider may use to help your breathing such as oxygen therapy or pulmonary rehabilitation.

For those who already have COPD, there are some helpful tips we’d like to share with you.

• Ensure proper inhaler use
  • If you have COPD and use inhalers, you should always make sure you are using your inhalers properly. Always review new inhalers with your doctor and pharmacist to ensure proper use.
  • You may be on multiple inhalers for your COPD. Oftentimes, one inhaler is a controller or “maintenance” inhaler and the other is known as a rescue inhaler that you use as needed for sudden symptom control. Your maintenance inhaler is scheduled for use at certain times and should be used as instructed, not as needed.
  • If you do not have a rescue inhaler, talk to your doctor about getting one. Even if you have not needed one in the past, we recommend that patients have one in case their symptoms were to suddenly get worse.
• Get vaccinated!
  • If you have COPD, you’ll want to be vaccinated and protected against illnesses that could cause a lot of issues for your lungs. The most important vaccines to make sure you get are your annual flu shot and your pneumococcal (pneumonia) vaccine. You should also be vaccinated for COVID.
• Reduce exposure/Stop smoking
  • This is one of the best ways to slow the progression of your COPD and improve your quality of life.
  • Talk to your doctor or pharmacist about smoking cessation programs and tips.

References:

[1] NIH National Heart, Lung, and Blood Institute. COPD. National Institutes of Health. United Sates. Accessed November 7, 2021. https://www.nhlbi.nih.gov/health-topics/copd