Author Archive for Pat F. Bass III, MD, MS, MPH – Page 3

Communicating With Patients- 10 Signs Your Doctor Is Good

How Well Are Doctors Communicating With Patients Today?

Good communication, doctor to patient and patient to doctor,  is an essential part of your diabetes care. When doctors do well in communicating with patients, a number of things about your care will be improved. If your doctor is a good communicator:

  • Your problems and concerns will be more directly addressed.
  • You will be more satisfied with your diabetes care.
  • Your instructions will make more sense and you will have opportunity to ask questions.
  • You will achieve more success with behavioral change such as increasing exercise or quitting smoking.
  • You will have less anxiety about your diabetes.

Communicating With Patients – 10 Things Your Diabetes Doctor Should Be Doing

Doctors can do many things to make you feel comfortable and improve communication with patients.  How many of the following does your doctor use regularly? The more of these skills they demonstrate when interacting with you, the better their communication skills.

1. Your doctor asks you about your main diabetes problems, concerns  and then focuses on those issues. Does your doctor:

  • Make eye contact with you and speak directly to you throughout the office visit?
  • Encourage you to explain your diabetes problems and concerns in detail?
  • Talk to you about your perception of your diabetes control and symptoms?

When your doctor asks these things it will help you better communicate your diabetes concerns.

2. In communicating with patients, is your doctor an active listener?

Doctors who are more effective at communicating with patients will use a technique called ‘active listening’ to clarify and better understand your problem. Effective doctors will clarify problems to make sure they understand your concerns and then further explore your diabetes problem as needed. Active listening includes the following components:

  • Hearing: When communicating with patients, does your doctor pay close attention to what you are saying?
  • Interpretation: Does your doctor confirm what they hear so they know they understand?
  • Evaluation: Does your doctor ask questions about what you said?
  • Respond: Does you doctor express, either through words or non-verbal cues that what was said matters and that they will address it?

3. Lets you talk.

Do you know how long the average physician in the U.S. allows a patient to speak before interrupting? Less than 1 minute from most surveys. In communicating with patients, a sign that your diabetes doctor is a good communicator  is if the let you finish speaking or let get out all the information you want to say before interrupting.

 4. Summarizes your main points.

If your diabetes doctor periodically summarizes to make sure they understand what you are saying, chances are your doctor is better than average in communicating with patients. Your doctor may say something like “so for the last 3 weeks you have” … This gives you the opportunity to make sure your diabetes doctor heard what you were saying and to correct any mistakes.

5. In communicating with patients, does your diabetes doctor ask about how your are living with diabetes?

Your diabetes care involves more than just the blood glucose values and does of your medication. If the social and daily living aspects of your diabetes are not addressed, your diabetes will not be under optimal control.

6. Checks for understanding.

Doctors receive years of training and have a wealth of knowledge to give, but doctors who are netter than their peers at communicating with patients will also check for understanding from their patients. For example,  your doctor may ask you to repeat back to them the side effects of a medicine are or what steps will happen as part of a treatment plan.

7. Uses non-verbal communication techniques.

To improve communication with patients, non-verbal skills are really important. If your doctor does these well, you may not even notice.  More likely, you will get a sense that your doctor is a poor communicator  if your doctor does these poorly. For example, when your doctor leans toward you while maintaining direct eye contact, they are using their body language to  convey concern about what you are saying.

What do you think the following say about doctor patient communication? Has this ever happened to you? How does it make you feel?

  • Does your doctor sit down at your level and talk with you, or do they just ask questions and type into a computer screen?
  • Does your doctor allow them-self to be paged and interrupted during your visit?

Non-verbal skills can improve communication with patients or leave a patient feelining like they have not been heard.

8. Seeks your input in developing your diabetes treatment plan.

Have you ever been to see a doctor, have them ask you a bunch of question, and then receive a prescription and the doctor is gone? Doctors who do this will also be surprised if you return to see them and the treatment has not had expected results.

Actively involved patients are not only more satisfied, but they also are more successful. This may be because patients who actively participate in the development of a treatment plan are more likely to follow the treatment plan. While it is very easy for your doctor to tell you to eat better, drink less soda, or quit smoking, it is much more difficult for your doctor to figure out your perspective and adapt your beliefs to a diabetes treatment plan. If your doctor takes this extra step, your doctor is certainly more effective in communicating with patients. If you are thinking about changing doctors, ask other patients question about how their doctor formulates a treatment plan with them.

9. Is your doctor empathetic?

Doctors who express empathy are much more appreciated bu their patients than those who do not. Statements like “It must have been really scary to when your child’s glucose was so low” demonstrate your doctor cares about diabetes affects you. Such statements, even if your doctor has incorrectly understood what happened, show your doctor’s concern of  how diabetes is affecting you.

10.  Persuades rather than tells you what to do.

The decision to follow your doctor’s advice is yours alone, and you are unlikely to do anything just because your doctor tells you to. Doctors who are better at communicating with patients will present plans for diagnosis and treatment as options. The idea is that while your doctor can recommend, the ultimate decision is up to you.

What do you think? Can you think of any other factors that demonstrate a doctor is a good communicator?

Sources:

Gordon GH. Defining The Skills Underlying Communication Competence. Seminars In Medical Practice 2002; 21-28.

Maguire P, Pitceathly C. Key Communication Skills And How To Acquire Them. BMJ 2002;325:697–700.

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Diabetes Basics: The ABCs of Diabetes

 

Do You Know The ABCs of Diabetes?

A: A1C & Aspirin
The HbA1C is a significant part of your diabetes plan. The HbA1C blood test helps you monitor how well your blood sugar is controlled. In terms of diabetes basics, the HbA1C measures your average blood sugar over the last 2-3 months. Your doctor will check your HbA1C at least 2 times per year. The lower your HbA1C the lower your risk of complications from diabetes. The HbA1C test will form the basics of diabetes monitoring for your long term control.

Depending on your risk factors, you may need to be taking aspirin. Not every diabetic needs to be on aspirin as in the past. The more risk factors you have the more likely you may need an aspirin a day.

Learn More

B: Blood Pressure

Keeping your blood pressure under control is an important part of your diabetes ABCs. Poorly controlled blood pressure leads to both complications such as:

  • Eye Problems
  •  Kidney Problems
  •  Heart Problems

Your doctor should measure your blood pressure at every visit. You can also check your blood pressure at home with simple monitoring devices or at many local places such as a pharmacy.

Learn More Diabetes Basics
What Should My Blood Pressure Be?

C: Cholesterol

If you have diabetes, you are more likely to have an elevated cholesterol. Your cholesterol levels are another important part of the ABCs of of diabetes. Elevated cholesterol increases your risk of heart attack and stroke. Treatment of elevated cholesterol in diabetics will attempt to lower your LDL or ‘bad’ cholesterol and elevate your HDL or ‘good cholesterol. Additionally, if your triglycerides are elevated, your doctor will likely try to lower this as well.

•    Your goal LDL should be less than 100 mg/ dl.
•    Your goal for triglycerides should be less than 150 mg/dl.
•    Your goal HDL cholesterol should be > 40 mg/dl.

Knowing your cholesterol and how you can manage it is another key to preventing complications and understanding the basics of diabetes.

D: Diabetes Education and Diabetes Educators

Patients often want a pill to fix their problems, but education is one of the most important diabetes ABCs. Appropriate education is essential to prevent diabetes complications. Diabetes requires significant amounts of self management to get your diabetes under good control. The only way to accomplish this is to arm yourself with appropriate knowledge. Through education you will learn how your diet and activity lead to changes in your diabetes control.

A diabetic educator is a person that has had significant training in the prevention and treatment of diabetes. This person can provide you with self-management skills and provide you with support as you begin your diabetes ABCs.

E: Eye Exam

This letter in  the diabetes ABCs reminds you to get your eye exam to prevent diabetes complications of the eye such as blindness. Diabetes is one of the leading causes of blindness in the U.S. and is totally preventable with good diabetic care and regular eye exams. The type of diabetes you have will determine the frequency and when you should have your first diabetes eye exam.

If you have type 1 diabetes, you need to have a dilated eye exam 3-5 years after your initial diagnosis, while patients with type 2 diabetes should see the eye doctor shortly after being diagnosed. Both should then see the eye doctor annually.

Learn More

  • Eye Exam

F: Foot Exam

The foot exam is another important part of your diabetes basics. This one of the ABCs of diabetes reminds you that you need a foot exam at least annually. Good foot care can prevent ulcers and other complications. The foot exam will alert your doctor to the potential for complications and will provide an opportunity to educate you on how to prevent diabetic foot problems.

G: Glucose control

Self monitoring of blood glucose is a very important part of your diabetic plan. Depending on whether you are type I or type II and how your control has been, your monitoring plan will be different. If you are type 1, you will probably be testing at least 3 times per day, while testing for type 2 will vary based on your goals.

H: Health Maintenance

There are many things we can do to improve our health, especially when you have diabetes. In the ABCs of diabetes, H is for health maintenance, specifically immunizations. If you have diabetes you need to make sure you get vaccinated against the flu virus and the bacteria associated with a common type of pneumonia.

Every diabetic over the age of 6 months should receive the flu vaccine every year. Diabetics should also receive the “pneumonia vaccine” at least once as an adult. If you were vaccinated before age 65, you should receive a second vaccine dose 5 years after your your 1st “pneumonia vaccine”.

Source

Samuel Abbate. Expanded ABCs of Diabetes. Clinical Diabetes 2009 21:128-132.

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Diabetes Dental Problems

Oral Health and Diabetes: Everything You Need To Know To Protect Your Teeth

Diabetes dental problems are extremely common, but not as well know as complications related to:
• Eyes
• Heart
• Kidneys

Diabetics are at increased risk for periodontal disease or an infection in the gums. If not addressed diabetes dental problems can not only make it more difficult to control your diabetes, but also can lead to an infection in the bone.

Plaque Makes Diabetes Dental Problems Worse
Diabetics are not the only people that have plaque problems, but elevated blood sugar makes it harder to get control of your diabetes oral health. Plaque uses sugar to produce bacteria and acid that eventually leads to a cavity. Because you have higher sugar levels, you run a greater risk of developing a cavity.

Dry Mouth Is Also A Diabetes Oral Health Problem
The elevated blood sugars that you have when you develop diabetes can also lead to a dry mouth. Additionally, it is thought that changes in the parotid gland in diabetics may contribute to this. While this may be mildly irritating to you on a day to day basis, it is actually a risk for diabetes dental problems. Normally, your saliva helps wash away plaque and bacteria from your teeth. When you have dry mouth, you have less saliva to help improve your diabetes oral health. As a result you are at increase risk of cavities. If it becomes sever enough, dry mouth can lead to irritation of your gums.

Fungal Infections and Your Diabetes Oral Health
Your elevated blood sugar also increases your risk for a fungal infection called candidiasis. This diabetic dental problem is also referred to as thrush. You may see white or red spots in the mouth. If you have diabetes you are twice as likely to find Candida in the mouth.

How Can I Improve My Diabetes Oral Health

The most important step in preventing diabetes dental problems and improving your diabetes oral health, is to keep your blood sugar under control. After that the recommendations are similar to those for everyone:

• Brush daily- even better after each meal. Gently brush the gums to keep them healthy.
• Floss daily using a sawing motion between the teeth. This will help remove plaque.
• Get regular dental checkups
• Tell your diabetes oral health provider (dentist or dental hygienist) if your gums hurt or have been irritated
• Quit Smoking

How Do I Know If I Am Developing Diabetes Dental Problems
If you develop any of the following symptoms you need to call or see your diabetes oral health provider:
• Red, swollen painful gums
• Bleeding gums
• Poorly fitting dentures
• Loose teeth
• Sensitive teeth
• Halitosis or bad breath
• Your teeth begin to look longer or you think your gums are receding

Sources
Bartholomew GA, Rodu B, Bell DS. Accessed December 27, 2012. Oral Candidiasis in Patients With Diabetes Mellitus: A Thorough Analysis.

Loe H, Genco RJ. Oral Complications in Diabetes. In Diabetes In America 2nd Edition.

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Diabetes Symptoms: What You Need To Know And Do

 

Common Diabetes Symptoms Explained

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What You Need To Know- Diabetes Symptoms

  • The symptoms of diabetes can be non-specific.
  • Diabetes can affect all parts of your body.
  • Most people with type 1 experience diabetes symptoms, while those with type 2 may not.

What You Need To Do- Diabetes Symptoms

  • If you experience any of these symptoms for more than a few days see your doctor.

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Symptoms of diabetes are similar whether you have type 1 or type 2 diabetes. While most people diagnosed with type 1 diabetes are identified in childhood and are symptomatic, many people have type 2 diabetes are unaware they have diabetes and are without symptoms or do not realize they have symptoms of diabetes because the changes are gradual.

Frequent Urination Is One Of the Most Common Symptoms of Diabetes
Do you feel that you are always headed to the bathroom? Frequent urination is one of the classic diabetes symptoms. However, many people have a hard time knowing what this really means. Frequency of urination depends on a number of things such as fluid intake, medications you are on, your age, and other health conditions such as an enlarged prostate. If you are urinating more than normal for you or if you are having to get up frequently at night (more than one or 2 times), this could be a symptom of diabetes. As a symptom of diabetes, frequent urination results from the glucose spilling into your urine and drawing water with it.

Extreme Thirst, Hunger, & Weight Loss
Extreme thirst, hunger, and dehydration are all potential symptoms of diabetes. The frequent urination described above will eventually lead to dehydration. As a result of frequent urination, your thirst can increase dramatically. As a result of glucose being lost in the urine, your body gets less calories and you may potentially lose weight. Additionally, when blood glucose is elevated, your body is not able to use calories appropriately and weight loss can result despite feeling hungry all the time and voracious appetite. While weight loss is much more common as a symptom of diabetes in type 1 diabetes, some newly diagnosed patients with type 2 diabetes experience weight loss as a symptom of diabetes.

Fatigue
When your blood sugars are high you just don’t feel right. Many times it is not until after a diagnosis and treatment begins that patients realize how fatigued they were. Additionally, dehydration from frequent urination and interrupted sleep can also contribute to this diabetes symptom.

Symptoms of Diabetes

Symptoms of Diabetes

Vision Changes
With poorly controlled diabetes, you may develop changes in the eyes that result in blurry vision as the initial symptom of diabetes. As a result, a number of patients seek care due to visual changes may end up getting referred to a primary care doctor to diagnose and manage diabetes. On the positive side, with good treatment and control of diabetes, vision usually gets better and does not progress further.

Tingling and Numbness in the Hands and Feet
Many patients have diabetes for a long period of time before a diagnosis. If you are experiencing tingling and numbness in your hands and feet, you have probably had diabetes for nearly 10 years. The symptoms of tingling and numbness is referred to as neuropathy.

Frequent Infections or Slow Healing Wounds
People with diabetes are at greater risk for infection because elevated blood sugars impair your bodies ability to fight infection. Specifically, diabetes is associated with several types of bacterial infections including:
• Boils
• Folliculitis or infections of the hair follicles
• Skin infections
• Styes

Similarly, fungal skin infections can occur in any warm, moist environment. Women may experience fungal infections under the breast or in the vaginal area. Uncircumcised men are also at increased risk of a fungal infection if the foreskin is not cleaned properly. Both men and women may experience ‘jock itch’ or athlete’s foot. While many of us could experience one of these infections, recurrence of these infections should make you consider this could be a symptom of diabetes and consider talking with your health care provider about diabetes. Likewise, elevated blood sugars impair wound healing whether from a planned surgical procedure or just cutting yourself in the kitchen.

Source
National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation. Accessed December 12, 2012. Diabetes Public Health Resource- Basics About Diabetes.

Diabetes and Flu

 

Flu Shots Limit Diabetes Complications From The Flu

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What You Need to Know When You Have Diabetes And Flu

  • When you have diabetes and flu you are at high risk for flu complications.
  • Your risk of hospitalization or dying from the flu is 3 times that for people without diabetes.
  • Small actions everyday can decrease your risk of flu complicating your diabetes.

What You Need to Do When You Have Diabetes And Flu

  • Get a flu shot, not the nasal vaccination.
  • See a doctor at the onset of flu symptoms.
  • Religiously wash your hands or use hand sanitizer.
  • Avoid people who are sick.

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While you may think you just feel bad like everyone else when they get sick, as someone with diabetes and flu, you need to be extra careful. People with diabetes are at higher risk of flu complications and dying from from flu compared to people without diabetes.

Diabetes and Flu
Diabetes and Flu

If you are diabetic, it is not only be harder for you to fight off the flu virus, but it is also more difficult to keep your diabetes under control. Additionally when you are sick with the flu, you change your eating habits leading to to other challenges with your diabetic control.

Why Am I at Higher Risk For Getting An Infection?

Flu is one of the infections that doctors believe you are higher risk of getting. There are several reasons for this:

  • High Blood Sugar- When your blood sugar levels are high, your immune system, the part of your body responsible for taking out infections, does not work properly.
  •  Nerve Damage- One of the long term complications of diabetes is nerve damage. The better you keep your diabetes under control, the less likely you will develop this complications. However, once you have developed nerve damage, you might not be able to feel pain in your feet. If you step on an object that cause skin damage, you might unknowingly damage your skin. This skin breakdown can then become a portal for infections to enter your body. The flu virus, however, generally is transmitted via the respiratory system as opposed to through a wound.
  •  Circulatory problems- Diabetes can damage blood vessels. When this occurs your body cannot deliver antibodies and other immune system components that help fight off infection effectively.

The key to getting through diabetes and flu is to have a plan. You need to make sure you know what to do if you develop hypoglycemia or hyperglycemia. Know when to call your doctor. Make sure you and your doctor are on the same page about your diabetes plan.

Why Can’t I Get The Nasal Vaccine?

Because the nasal flu mist vaccine is a live virus vaccine, it is not recommended for people with weakened immune systems. The flu vaccine is well tolerated and flu vaccine side effects are uncommon and generally mild.

Symptoms to Look For With Diabetes And Flu

When you have diabetes be on the look out for the following symptoms:

  • Body Aches
  • Chills
  • Cough
  • Fatigue
  • Headache
  • Runny nose
  • Sore throat

When you have diabetes and flu you need to get treated quickly. Make sure you talk with your doctor about when to call when you have flu symptoms.

Medication When You Have Diabetes And Flu

A class of drugs known as antivirals are used to treat flu. Antivirals are important to decrease keep your diabetes under better control while sick. Antivirals are not available over the counter, so they only available through a prescription form your healthcare provider.

Your health care provider may recommend one or a combination of the following currently available antivirals when you have diabetes and flu:

  • Tamiflu (oseltamivir)
  • Relenza (zanamivir)
  • Flumadine (rimantidine)

Can’t I just Ride It Out- I Don’t Want More Medication

If your doctor makes a diagnosis of flu, either on their clinical suspicion or through a diagnostic test, you should consider antiviral treatment. While most patients with flu need to be treated within 48 hours of developing the flu, diabetes patients may benefit even later- so be sure to contact your doctor as soon as you

What Do I Do If I am Exposed to Flu?

If you have diabetes and you have been exposed to a family member, colleague, or anyone else with flu, you might want to consider chemoprophylaxis. Unlike treatment, your doctor may not offer chemoprophylaxis if more than 48 hours have elapsed since your flu exposure. It is also important to realize that chemoprophylaxis decreases, but does not totally eliminate your chances of developing the flu.

Take Action For Diabetes And Flu

You can keep yourself from getting the flu by getting a flu shot. People can come up with all sorts of crazy rationalizations for not getting the flu shot, but you are just putting yourself at risk. It does not matter if you have type 1 or type 2 diabetes, you need a flu shot and it is the single best thing you can do for yourself. Don’t delay… get your flu shot now.

Sources

Preventing Blindness When You Have Diabetes and Glaucoma

 

Diabetes and Glaucoma: What You Need Know If You Have Diabetes and Glaucoma

Blindness can be one of the most worrisome complications of diabetes. While many diabetic patients are familiar with retinopathy as a complication of diabetes, many diabetic patients are not as familiar with glaucoma. While this is not a sudden cause of blindness in diabetic patients, this condition can lead to blindness over time.

Glaucoma and Diabetes

Glaucoma in diabetes is like hypertension of the eye. With diabetes and glaucoma, the pressure in the eye builds up because fluid gets trapped. The increased pressure may lead to decreased blood flow to the parts of the eye that help you see, the retina and optic nerve. Damage to the retina and optic nerve lead to decreased vision and potentially blindness. This is a progressive disease, which means that without treatment it will get worse. The longer you have had diabetes the more likely you are to develop diabetes and glaucoma together.

Research reported by the University of Michigan Kellogg Eye Center has shown that having high cholesterol or hyperlipidemia may lower the risk of glaucoma when you have diabetes. It is unclear whether it is the hyperlipidemia or the drugs that are used to treat hyperlipidemia, statins, that lead to the decreased risk of glaucoma.

According to the American Diabetes Association, people with diabetes are 40% more likely to develop glaucoma than people who do not have diabetes. This risk of glaucoma with diabetes increases as you get older or if you have other complications of diabetes like diabetic retinopathy.
How Would I Know I have Glaucoma If I Have Diabetes?

Diabetes and Glaucoma: Symptoms

Most patients with diabetes do not have symptoms of glaucoma. If your diabetes and glaucoma is beginning to lead to vision loss, you would expect to see things at the center of your eye without any differences, while things on the periphery or off to the side may be blurry or not seen as well. Glaucoma generally does not cause eye pain or redness. If you have these symptoms, blurry vision, nausea or other problems with your eyesight, call your eye professional for an appointment.
Preventing Complications Of Diabetes and Glaucoma

Every diabetic patient needs to see an eye professional every year. Your eye professional will screen you for glaucoma as part of your regular diabetes eye checkup. If you have an elevated eye pressure or other abnormality, you may need to see your eye professional more frequently.

When you see your eye care professional they will look into the back of your eye to see if there is any damage to the retina and optic nerve. They will also use special tools to measure the pressure and determine if it is elevated. They may also test both your central and peripherla vision to see if there are any problems. Unfortunately, taking vitamins does not prevent glaucoma when you have diabetes as it does for some other eye conditions like age related macular degeneration.
Treatments with you You Have Glaucoma and Diabetes

Diabetes and Glaucoma: Treatment

There are 2 main types of eye drops used in the treatment glaucoma when you have diabetes. The drugs lower the pressure in the eye. The classes are:

Prostaglandins
Beta Blockers

There are 2 other types of treatments that may lower the pressure of glaucoma when you have diabetes. The 2 treatments are laser therapy and surgery. Both of these treatments improve drainage of fluid from the eye and decrease the pressure. In general, your doctor will likely recommend surgery only after the eye drops have not successfully lowered the eye pressure when you have diabetes and glaucoma.

[box] What You Need To Know When You Have Diabetes and Glaucoma

You are at higher risk for glaucoma if you have diabetes.

What You Need To Do When You Have Diabetes and Glaucoma

You need to see your eye professional every year or if you develop eye symptoms.

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Sources:

American Diabetes Association. Eye Complications. Accessed January 14, 2013.

Metformin- Indications, Uses, Precautions, and Side Effects of Metformin

Everything You Need To Know When You Take Metformin

Why Is Metformin Prescribed?

Metformin is usually the first medication prescribed after a new diagnosis of type 2 diabetes. Metformin helps lower your blood sugar through several different pathways. Metformin improves how your body utilizes insulin, decreases the amount of sugar your body absorbs from food, and also decreases the amount of sugar created by your liver.

Metformin is not used in the treatment of type 1 diabetes.

How Should I Use Metformin

Metformin is usually started once per day with either your morning or evening meal for 1-2 weeks. A second dose is generally added so that you take 1 pill with your morning meal and a 2nd dose with your evening meal. Alternatively, there is a long acting form of metformin that can be taken just once per day. There are also a number of different medications that combine metformin with other drugs.

Name Brands and Combination Metformin Products

Metformin brand names include:

  • Fortamet®
  • Glucophage®
  • Glumetza®
  • Riomet®

Metformin combination products include:

  • Actoplus Met® (Metformin + Pioglitazone)
  • Avandamet® (Metformin + Rosiglitazone)
  • Janumet® (Metformin + Sitagliptin)
  • Metaglip® (Glipizide + Metformin)

Are There Any Special Precautions With Metformin

  • Do not split, chew, or crush if you are taking a long acting or extended release form of metformin.
  • Metformin does not cure diabetes. To get benefit you must continue to take your metformin.
  • Metformin needs to be stopped before surgery or receiving contrast dye (e.g. getting a CT scan)

What Are The Side Effects of Metformin

While metformin is generally well tolerated, there is a risk for potential side effects with any medication. The most common side effects when beginning metformin are related to your gastrointestinal system. Diarrhea, bloating and abdominal discomfort are fairly common. To combat this, your doctor may start you on a low dose once per day and slowly increase the dose and frequency to twice a day dosing of metformin. Your body may adjust to the metformin after 1-2 weeks with an associated decrease in these gastrointestinal side effects. Additionally, a rare, but serious side effect of metformin is lactic acidosis. Build up of lactic acid in your system can lead to sever fatigue, muscle cramping, and shortness of breath.

If you experience any of the following side effects after starting metformin and they do not go away, worsen, or concern you discuss them with your doctor:

  • Constipation
  • Cough
  • Headache
  • Heartburn
  • Runny nose
  • Sneezing

While uncommon, metformin could cause hypoglycemia. If you develop any hypoglycemia symptoms, make sure you follow your doctor’s instructions about what to do.

Additionally, call your doctor if you have any of these symptoms of high blood sugar:

  • Dry mouth
  • Fast heart rate
  • Shortness of breath
  • Nausea
  • Vomiting
  • Fruity smelling breath
  • Altered mental status or decreased alertness

Other Metformin Uses Beside Diabetes

Your doctor may also use metformin for the following “off label” use?

  • Weight loss
  • Polycystic ovary syndrome
  • Gestational diabetes
  • HIV lipodystrophy syndrome.

Sources:

National Diabetes Information Clearinghouse. Accessed November 4, 2010. What I need to know about Diabetes Medicines

Aspirin and Diabetes- Do I Need To Take Aspirin When I Have Diabetes?

Will Aspirin Lower My Risk For Diabetes Complications?

Should I Take Aspirin Daily If I Have Diabetes?
You may have heard that you should take an aspirin every day to prevent a heart attack. The American Heart Association and the American Diabetes Association recommend that diabetics:

Take aspirin as primary prevention. This means that you will take aspirin  daily to prevent an initial  heart attack, stroke, transient ischemic attack, or angina if you have an elevated risk. Your risk is elevated if you are a man older than 50 or woman older than 60 and you have one of the following risks:

•    Smoker
•    Elevated blood pressure or hypertension
•    Obesity
•    Elevated cholesterol
•    Family history of heart disease

You should talk with your doctor to determine your risk. If you are younger than the ages stated above and do not have other medical problems that increase your risk, aspirin may not be indicated for you as your risk of side effects may be greater than any benefit.

Take aspirin as secondary prevention. This means that you take aspirin daily to prevent heart attack, stroke, transient ischemic attack, or angina after you have previously had one of these events in the past. If you have previously had one of these events, there is good evidence aspirin may help prevent another event.

Aspirin and Diabetes- What Aspirin Dose?
In patients that are going to take aspirin, the American Diabetes Association recommends a dose between 75–162 mg/day. If you have an aspirin allergy, clopidogrel (75 mg/day) can be used.

Aspirin and Diabetes- What Are the Side Effects?
Bleeding is the main side effect that you need to worry about with aspirin use. The most common for of bleeding is from the gastrointestinal tract.

Source
American Diabetes Association. Accessed November December 27, 2012. Standards of Diabetes Care-2012

5 Diabetes Travel Tips To Make Your Trip Go Smoothly

Traveling With Diabetes Doe Not Need To Be A Hassle

Your diabetes travel experiences can be wonderful with a little planning. When you are traveling with diabetes a little planning can relieve your stress tremendously. These 5 diabetes travel tips may make your next trip a success.

1) Get a check up before traveling with diabetes. See your doctor before you leave. A pre diabetes travel check up is especially important if you are going to be traveling outside of your home country. Make sure that you have had a recent HbA1C and that your blood pressure is under control.
Make sure your doctor gives you a letter saying what medications you are on and what supplies you might have with you. This will be important in case there are any questions at security check points. Make sure you have enough medication to last longer than your trip in case there are any delays. You may also want to bring an extra prescription in case of lost medication

2) Where a medical ID bracelet that states you are diabetic. If you are going out of your home country, a bracelet that states you are a diabetic in the local language would be ideal. You do not want any medical problems because someone could not read your medical ID.

3) Keep all of your medication and diabetic snacks in your carry on bag. Your bag can get lost, so you will want to keep it with you at all times. You will need to make sure that you pack not only your medication, but your testing supplies, foods to combat hypoglycemia for your diabetes travel. It is also a good idea to keep your medication in its original packaging. This can prevent a misunderstanding as to why you are caring syringes or insulin

4) Keep your medication in its original box, complete with pharmacy labels. It will prevent misunderstandings about why you are carrying drugs and, if you are on insulin, syringes.

5) Be aware of time zone changes, especially when altering your watch. Remember when you travel east your day becomes shorter; if you travel west your day becomes longer. You may need to alter the timings of your medication.

Traveling need not be traumatic. A sensible attitude and a bit of pre-travel planning can make things go far more smoothly.

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