Q and A From a Diabetes Practice – Medication

Another week educating patients about their diabetes has made me realize that many of you may have the same questions and concerns about medications. This week, I met with multiple patients that decided to stop taking their medications for various reasons.

Each patient thought they had a valid reason to stop taking their medications, such as an increase in drug co-payment, side effects like bloating and weight gain, as well as not making time to stop and pick up the medication. None of these patients shared this with their health care provider. The bottom line is that medication serves a useful purpose when taken as prescribed along with your positive life style changes; good results can’t be expected when the medications are taken incorrectly or not at all. Let’s discuss what needs to be addressed about your medications.

1. Stay ahead with your medications – Try to be on an automatic refill program through your local or mail order pharmacy so that there is no lapse in taking any of your medications. Some medications may take up to eight weeks to fully be effective and when you stop taking them they don’t work the way they are intended to. Some medications are truly dangerous to stop taking during treatment and may need to be tapered down. If you choose not to do automatic refill always reorder about 5-7 days before you run out and make time for the actual pick up. Any pharmacy will tell you medications are filled and left in the store for weeks with no pick up. If you are drawing insulin from a bottle make sure to have extra bottles available.
2. If co-payment is a concern – Think about having your health care provider order you a higher dosage that can be cut in half and last you twice as long. Make sure you check with your pharmacist before splitting any medications since not all pills can be split. Scored pills without a special coating can usually be split. Purchase a pill cutter so each dose is consistent; it is not good practice to cut a 40 mg tablet incorrectly – 10 mg one night and 30 mg another night when the daily dose should be 20 mg. Special pill coatings can control absorption rate and where in the body the pill is absorbed – these medications should not be split. Capsules that are covered in a thin film of plastic should not be split. Many big pharmaceutical companies now have loyalty programs as well as financial assistance programs, so check online or with an 800 phone number if payment or co-payment is an issue.
3. Keep a CURRENT list of medications – With market and generic names, dosages and reasons why you take them and bring them to every medical visit. Know the best time of day to take the pill – sometimes it really makes a difference, like with statin medications. Even your optometrist, podiatrist or dentist should have a full and up to date list of medications. This week a patient brought a list and not one of the 8 medications was current; he did not know what he was presently taking and had forgotten to update the list for years. I also had a male patient who counted on his wife to keep the list in her purse. The problem was she did not bring her purse since he drove. Become responsible for yourself.
4. Ask if the medication should be taken with or with out food – One patient was not eating regularly and thought she could only take the medication if she ate. This particular pill was not related to food at all. Some pills need to be taken after you eat. If you are unclear always ask – there are no silly questions and every question has an answer when it concerns your medication.
5. Talk to your physician – If you decide the medication is not right for you, if you have side effects, if you can not afford the medication – share that with your health care provider. They assume you are doing what they told you to do and expect certain results from these medications. They can’t help you if you keep them in the dark. You need to work as a team when you are in the visit and when you leave.
6. Bring a pad and pencil, a tablet or a smart phone – Sometimes you are overwhelmed at an office visit and hear almost nothing. If you can, bring an advocate with you. If you are going alone, be able to write down things so you are perfectly clear before you leave and you can refer to written instructions at a later date.

Some of these tips seem so elementary, but when faced with an unknown situation – especially around taking medication – nothing is simple. You can play an active role in your diabetes care and part of that care requires knowing about your medication. Stay informed!