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    Responses to meds
    neesy0225 posted:
    Hey all! Wondering if anyone has had any breathing or heart problems while taking any of the following medications: Metformin, Januvia, Victoza or Glipizides. I have been on all or combination of 2 and have had extreme shortness of breath, heart palpitations, and fast heart rate on and off since being diagnosed a year and half ago with type 2. My doctors keep saying it's not a reaction to the meds, but my gut tells me differently. Anyone have similar responses?

    nutrijoy responded:
    Glypizide is a sulfonylurea drug. As a retired pharmacist and many years of experience interfacing with diabetes patients on sulfonylurea medications, I have never liked drugs in this category. Before continuing, please read the WebMD disclaimers at the bottom of the page. My posts are strictly a matter of personal opinion and do not in any way constitute medical advice. However, there are a few members on these forums that tend to report posts to moderators as being "medical advice" instead of the discussion topics that they really are. With that out of the way, let's focus on just a couple of reasons why I dislike sulfonylureas.

    Sulfonylurea medications work by stimulating insulin secretion from the beta cells of pancreatic islet tissue. Dr. Richard K. Bernstein believes that stimulating already-stressed beta cells will only hasten them to burnout more quickly. However, that is not my own personal objection to the drug class. I have found that too many patients experience difficulty maintaining even levels of blood glucose while on sulfonylurea medication. That's because the drugs promote insulin secretion on the medication's schedule and not based on your meal contents, timing or frequency. If the beta cells secrete too much insulin, the patient may be forced to eat -- whether s/he is hungry or not. And if they don't eat, s/he runs the risk of becoming hypoglycemic. In other words, for far too many patients, sulfonylureas is the dominant factor that exerts control over their diabetes instead of allowing the patient to be the one that's in control.

    And then there are the side effects . The link that I have provided lists some of the major side effects that have been reported for glipizide and yes, rapid heart rate is one of them. Earlier sulfonylurease (1st generation) in fact were directly linked to a significantly higher risk of cardiac-related problems including fatal heart attacks. The challenge that you face is working with your doctor to find safer middle ground. If your beta cells are not producing a sufficient amount of insulin on their own to meet your metabolic needs, your options become more limited. These include:
    1. Reducing your dietary intake of carbohydrates
    2. Increasing your exercise/activity levels
    3. Using insulin that you can control in terms of dosage, timing and need.

    In your previous post, you mentioned that the high deductibles of your current insurance plan virtually eliminates consideration of using insulin on an economical, cost-justifiable basis. That may be because many doctors obtain too much of their "education" from drug sales reps after they have graduated from medical school and actually believe the hype that they are often inundated with; i.e., only the basal and analog insulins can provide the control that their patients need. That simply is not accurate nor factual. "Regular" insulin (Humulin-R, Novolin-R and their NPH equivalents) can provide comparable control. The primary difference is onset of action and the duration of that action. It takes a fair amount of trial and error initially to find out what will work for each individual patient and many patients (as well as their doctors) may not want to invest the time required even though the pay-off can be substantial in the long term.

    Regular insulins (including NPH) can be purchased for less than $25 per vial at Walmart Pharmacy. Quality syringes cost about $12.50 per hundred at Walmart and physically resemble B-D's brand of insulin syringes. That's the total net cost. In contract, just the deductible portion of the cost of basal insulins (Lantus, Levimir) and analog insulins (Humulog, Novolog, Apidra) will run almost the same or higher. The newer insulins can be slightly more convenient to use (available in pens and not just vials) and because of their durations of actions, may be slightly easier to adjust to although individual trial-and-error is still an essential part of the equation.

    brunosbud replied to nutrijoy's response:
    Wow. That was an amazing piece of writing, NJ. Despite your disclaimer, it'll probably get reported, though. What a crying shame that would be, too. Thx!
    auriga1 responded:
    Neesy, Nutrijoy provides some valuable info in his post.

    I was diagnosed with diabetes in 2007 while hospitalized for something else. I was immediately put on insulin because of my very high numbers, including A1c. You saw my numbers in other posts. Two insulins as a matter of fact, Lantus and Humalog. They have both worked and they are extraordinarily convenient because of the luxury of pen form. Also, EXTRAORDINARILY expensive. My husband's insurance rep has me shop around for retail prices at national drug chains. The Humalog at a few retail chains averaged $200 for a box of five pens. My Humalog would last a long, long time because it was used on a sliding scale, 3-6 units per meal. I would use it only at one meal. Everyone's expenses are going to be different because of how much insulins is used/needed. However, the Lantus is a different story because I need that every single day at 30 units a pop. I would go through five pens much faster than the other insulin.

    Nutrijoy beat me to the punch. I was going to tell you about the over-the-counter insulins available from WalMart. No script needed.

    I have never used oral diabetes medications. Many people have a problem with insulin because of the "needle." The needle I am using is just about one of the smallest gauges possible because insulin is injected right under the skin. Not only is it a small gauge (opening at the tip of the needle), it is also very short. Very rarely do I feel anything.

    Insulin is a natural hormone made by your pancreas. If you cannot get your numbers down, talk with your doctor. Rather than trying everything under the sun, ask your doctor to consider insulin.

    This is getting rather long, so long story short: husband lost his job. Hence, we lost our health insurance. As previously stated, Lantus and Humalog are very expensive as are doctor visits when there is no health insurance. This happened right before Obama Care. Since I have had diabetes since 2007 and have used insulin, I felt comfortable buying over-the-counter insulin. I do use both the Novolin N and the Novolin R. I am very active during the week and use hardly any Novolin R, the rapid-acting insulin. I also use less of the Novolin N than the Lantus I used to use. The Novolin N lasts me 42 days, when it is supposed to expire.

    Neesy, I am not a medical professional and am not advocating you use insulin. Just a thought to bring up to your doctor if you are doing everything you can to bring your numbers down or if the side effects of your oral meds are no longer bearable.

    I liked Nutrijoy's post as it is very informative. I have a pharmacology drug book, but Nutrijoy breaks things down to a level that us mere humans can understand. Drug techies can get very scientific. Hint, hint, Nutrijoy. LOL.
    neesy0225 responded:
    Thanks guys...I was unaware of a Wal-Mart insulin, so I will definitely ask my doctor about that. I have been under the impression insulin would be out of the question due to cost. It's a great relief to know it might not be!
    nutrijoy replied to neesy0225's response:
    Thanks for the encouraging words, Auriga. Neesy, when you talk to your doctor about "Walmart insulin," its really only privately branded/labeled Novolin manufactured by Nordisk Pharmaceuticals. Your doctor will be familiar with Novolin but may not know it under Walmart's label, Reli-On/Novolin. To ensure your doctor doesn't get confused, refer to Walmart's insulin as Novolin-R (Regular) and Novolin-N (NPH) instead. My own endocrinologist was not aware of this and had always labored under the belief that Reli-On insuin was of unknown or questionable quality until I informed him to the contrary and actually showed him an empty carton (the name on the carton is Novolin-R with only a tiny secondary imprint of Reli-On). Prior to the Reli-On's switch to Novolin about 2 years ago, Walmart had previously contracted with Eli Lilly for Humulin-R and Humulin-N. Purchasing "Walmart insulin" back then would provide you with Reli-On/Humulin insulin. The current Walmart contract is for Novolin (for approximately two years now). As Auriga noted, this insulin can be purchased without a prescription. However, the price for the syringes is less expensive with a prescription than without due, I assume, to quantity price breaks. I would recommend that you obtain a prescription for both insulin and syringes anyway because your purchases may count towards satisfying your deductible.
    hootyowl2 replied to nutrijoy's response:
    I have used Walmart brand syringes and prefer them over the B-D brand. However, my insurance will not cover the Walmart brand syringes and only pays for the B-D brand. Since disability is a very small income, I am stuck with the B-D brand syringes. One reason that I prefer the Reli-On syringes is that they are individually packaged, and easier for travel purposes than the bulky 10 packs other brands make. I think the sterility is safer also. Once you open your 10 pack, things can happen, and sterility can easily be compromised.

    I tried discussing this with a B-D rep on the phone once, and got nowhere. I did tell her that I only use that brand because my insurance would not cover Walmart's, and I no longer worked or could afford the Walmart brand.

    Even so, I much prefer using insulin over pills any day. If you can stick your finger to check your blood sugars, then you can give yourself insulin shots. It hurts much less than sticking your fingers.

    Pills work with your pancreas and your liver, and insulin is something you NEED anyway. My A1c's stay between 6 and 7, usually closer to 6 with the insulin. With the pills, my A1cs were more like 8 or so.

    NJ, one question-- are Novolin-R and Novolin-N insulins synthetic human insulins, or are they animal based. One reason, I would not want the animal based insulin, is I do NOT do anything pig for any reason because of my religious preferences. Once upon a time, insulin came from pigs and cattle. I am very happy with the Lantus and Humalog insulins. But if I had to change, that would be an important factor.

    nutrijoy replied to hootyowl2's response:
    Hooty, although animal-sourced insulins are still available, they are no longer manufactured in the States. The two brands available, Humulin (Lilly) and Novolin (Nordisk), are both human insulins manufactured using recombinant DNA technology and genetically-engineered microorganisms. An interesting history and explanation of the process can be found here (it's a worthwhile read). Although far fewer people are allergic to the human insulins compared to animal-sourced insulins, a very small minority are. Most physicians think it is due to the preservatives used rather than the actual insulin itself.

    Reli-On syringes are no longer individually packaged but are bundled in ten-packs like the majority of other brands/types. The only one that I have come across that still packages syringes in sterile, individually-sealed packs is the Monoject brand. To minimize the problem of potential contamination of an opened ten-pack, I always store them in zip-lock bags when traveling. At home, I store opened ten-packs in a cylindrical spice jar that's similar to a small peanut butter jar but much narrower. You can also use the plastic containers that come with other products such as some packages of Crystal Light tea.

    Insulin is both thermal- and photo-sensitive. Although manufacturer's state that opened bottles do not require refrigeration for the 28/30 days period before it is discarded, the potency can be extended if the insulin is kept refrigerated. Protecting it from light is also important and I use non-opaque plastic vials that older test strips used to be packaged in. The latter are almost the perfect height and diameter and the insulin so stored retains its potency for at least 60 days. I have personally used opened vials up to 90-days old with no noticeable loss of potency in terms of its impact on my BG control. That's three times the 30-day period most manufacturers recommend for discarding vials of insulin after they have been opened. Of course, you do have to follow simple aseptic techniques to ensure that it does not get contaminated from careless handling. Hope this helps.
    hootyowl2 replied to nutrijoy's response:
    That is too bad that Reli-On syringes are no longer individually packaged. I thought that was a huge plus in their favor.

    The plastic vials for the One Touch Ultra Test Strips are not big enough for a vial of Lantus Insulin. I keep mine in the fridge.

    I am glad to know that Humalin and Novolin are both synthetic human insulins if I ever need to change my insulin.

    I try to be careful about not contaminating my syringes or vials of insulin. Who needs another infection?


    auriga1 replied to nutrijoy's response:
    You are welcome, Nutrijoy.

    I just had a doctor appointment Tuesday. As usual, they go through all the meds the patient is taking. She asked about the Lantus and Humalog insulins, dosages, etc. I said I was taking ReliOn. I don't know why that came to mind. It says right on the box Novolin. Duh. She asked me what ReliOn was and I apologized and said it was Novolin N and Novolin R. She was aware of Novolin.

    The syringes are available in a package of 10 at $1.99 per package at WalMart. Here in Illinois, you can only buy two packages at one visit. State law. It is like this in most states; I researched that one. Some states will allow a few more.
    nutrijoy replied to auriga1's response:
    Auriga, you should ask your doctor's office to provide you with prescriptions for both your insulin and your syringes. Although Reli-On insulin and syringes can be purchased OTC (over-the-counter without a Rx), purchasing them via a prescription may count towards satisfying insurance deductibles. However, even more important, you can purchase syringes by the carton on Rx (boxes containing ten 10-packs) and the price that I pay at my Walmart is ~$12.50 per hundred. If purchased without a Rx (i.e., OTC), the cost is $1.89 per ten pack. The OTC limit of 2 or 3 packs varies by State due to fears of illicit drug use but there is no limit when purchasing it via Rx (I can purchase 3 or more boxes every 3 months). You also don't need to have your doctor's office mail you the written Rx or drive to their office to pick it up. Walmart pharmacies have a very efficient Prescription Faxing system that allows physicians in most states to simply fax the Rx directly to the pharmacy. When it has been filled, Walmart's automated system will contact you by phone (robotic voice) to notify you that "Prescription for someone in your household" are ready for pickup. You will also be told the specific dollar amount of the transaction. I just did this myself this morning following a visit to my endo and my own A1c is continuing to hold steady in the 4.x range. The really surprising thing (to my endo) was the fact that the data dump from my BG meter showed that I did not experience any lows below the sixties and even those were limited in number/frequency (I did have lots of readings in the seventies, however, but 70's are still within the "normal." range). One another advantage to having a Rx for syringes is that there is no sales tax (at least not in my state) on Rx's.
    nutrijoy replied to hootyowl2's response:
    Hooty, the primary danger of contaminating insulin vials is not infection but degradation of the unused insulin in a vial. I only use one syringe a day but inject up to six times per day. Yes, that means I do the unthinkable (in the minds of purists) and re-USE my syringes for the day. I exercise great care not to let the needle come into contact with anything other than the rubber stopper of the vial and the skin at the injection site. I NEVER inject anything into the vial, not even air, with a used syringe. To counteract the gradual vacuum buildup, I inject air into the vial the next time that I use a virgin (unused, new) syringe. This has worked flawlessly for nearly a decade and I have never experienced loss of potency in my insulin. I have also never experienced an infection even though I do not use alcohol swabs (my opened insulin vials are all stored in non-opaque, air-tight plastic vials). I also use another trick to extend the life of insulin but that's a topic for another post.
    auriga1 replied to nutrijoy's response:
    Thanks for the info, Nutrijoy. I will do that with my doctor. Follow-up visit to both docs in six weeks. My BP meds were changed, so the hospital is bugging me to get into the office.

    Illinois has a sales tax of 1% on RX's.
    nutrijoy replied to neesy0225's response:
    Didn't mean to hijack your post Neesy but hopefully the supplemental information will be pertinent if you go the insulin route yourself. There is a great deal for you to learn if you do start on insulin and much of the path will require individual trial-and-error. Its virtually impossible to get good control over your blood glucose levels using static (rigid, unchanging) doses of mealtime insulin and learning how and what works for you will gradually help you control this disease and instead of having it control you.
    neesy0225 replied to nutrijoy's response:
    No worries! I enjoy ready any and all real life experiences! Every bit of info can be helpful!!

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