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Medication Dosage

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Medication Dosage

 Frank Goldman, PharmD.

When you begin a new medication, the key to avoiding side effects is to take the lowest possible dosage that will still give you the benefit you need—whether that intended benefit is relieving arthritis pain, reducing cholesterol levels, or maintaining healthy levels of blood sugar to prevent the long-term complications of diabetes. Unfortunately, there is frequently no "one size fits all" dosage, because people varying their responses to drugs. The dosage must be tailored to you and your specific medical needs. The goal is to identify the minimum effective dosage of the drug;one that provides sufficient benefit with minimum side effects and at the lowest cost. On the other hand, the maximum useful dosage is the point beyond which increasing the dosage offers no additional benefit and, potentially, increases the risk of side effects.

As a rough analogy, consider the process you go through to salt your food. You first sprinkle a bit on, but you can't quite taste the salt. So you sprinkle a little more, and nowit tastes just right- akin to the minimum effective dosage. Add a little more and the food will taste distinctly salty but remain edible, akin to the maximum useful dosage. Finally,give the shaker a few more shakes and the food will be too salty for eating. Now youare experiencing a side effect from too much salt; unpleasant-tasting food.

Finding the minimum effective dosage of a drug depends a lot on the doctor's experience, skill, and judgment. You may also have to undergo tests to determine whether the drug is working as expected.

Last Updated on Friday, 26 December 2014 20:02
 

Diabetes Self Management Education

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Diabetes Self-Management, Diabetes Education and Goal Setting

AADE 7 Self-Management Behaviors

 

The goal of diabetes education is to help people with diabetes practice these behaviors every day. This can be difficult but it does work, by helping lower blood sugar (glucose), blood pressure and cholesterol. Most people with diabetes know self-management is important, but many find it overwhelming. Diabetes education helps by designing a specific plan for each person that includes the tools and support to help make the plan easy to follow.

How does someone receive diabetes education?

Diabetes education is usually prescribed by a primary care doctor who writes a referral for diabetes education (sometimes called diabetes self-management training). Diabetes education programs are found in a variety of places – hospital, pharmacy, outpatient facilities, clinics, doctor’s offices, to name a few – and staffed by diabetes educators. These specialists are healthcare professionals – often nurses, dietitians or pharmacists – who focus on all aspects of diabetes care, and are also skilled in counseling, education and communication.

Diabetes educators have the knowledge and skills to teach people with diabetes how to manage their diabetes to live their healthiest life. For example, diabetes educators explain how foods affect blood sugar, give specific directions for taking medication correctly and offer guidance on how to lower the risk of diabetes-related complications. It can include advice on everything from getting through the excesses of holiday dinners and parties, to coping with the challenges of managing diabetes while traveling for work or fun. 

Diabetes education is not a lecture on what not to do. It’s real-life guidance, coaching and support proven to help people understand exactly how to best manage their diabetes, and to feel less alone while doing it. 

Diabetes education can take place in a group or one-on-one setting as part of a formal or informal format.

Many diabetes educators have achieved the title of Certified Diabetes Educator. A Certified Diabetes Educator® (CDE®) is a health professional who possesses comprehensive knowledge of and experience in diabetes management, pre-diabetes, and diabetes prevention. A CDE® educates and supports people affected by diabetes to understand and manage the condition. A CDE® promotes self-management to achieve individualized behavioral and treatment goals that optimize health outcomes.

The American Association of Diabetes Educators (AADE) has established 7 major areas for patients with diabetes to focus on in their self-management learning.   Diabetes education helps individuals with diabetes learn how to manage their disease and be as healthy as possible. . The seven behaviors educators focus on are; Healthy Eating, Being Active, Monitoring, Healthy Coping, Reducing Risks, Problem Solving, and Taking Medication.

Patients are a encouraged to learn these 7 self-management stills and set their behavior goals around them.  When patients attend a formal education class they are asked to set specific goals for their specific needs.   While almost everyone focuses on nutrition and weight reduction, there are other goals that also can play a large role in successful diabetes management.  Let’s look at a few of them.

Healthy Eating

Have you ever taken any healthy eating classes or carb counting classes? Do you know how certain foods affect your blood glucose? Are there changes that you can make to your diet that will help your diabetes? 
Healthy eating is important when trying to control your glucose levels. If your goal is healthier eating, make it specific.  

Examples of healthy eating goals: I will eat green vegetables nightly at dinner. I will stop drinking soda. I will not go back for seconds.  I will start reading food labels and estimate the carbohydrates I consume each meal. I will find out my daily calorie intake need.

Being Active

What do you like to do? Walking, swimming, and running are examples of being active. Remember when starting a new program, speak with your physician and start slow and gradually increase your activity duration over time. Physical activity can improve cholesterol, blood pressure and glucose levels. Find something you like to do, and move. If being more active is your goal, be specific about how you want to be more active. 

Examples of being active goals: I will join a gym and go three times per week. I will take a walk for 30 minutes three times per week.  I will watch only 60 minutes of TV each evening.  I will use the stairs, rather than the elevator at work.

Taking Medication

It is very difficult to manage your diabetes if you’re not consistent when taking your medication. It is important to work on timing and correct dosing of your medication. Are you taking your insulin correctly? Are you priming your pen? Make sure to ask questions when you meet with your Diabetes Educator.  Remember type 2 diabetes is a progressive disease, and at some point you may need additional medication. If you don’t take your medication consistently, this should be one of your goals.

Examples of taking medication goals: I will put my pills in a pill box. I will carry my insulin with me. I will put a reminder note to bring my medication near the front door.  I will utilize my pharmacy’s compliance packaging.


Healthy Coping

Are you dealing with a lot of stress and or depression? These things can make it substantially more difficult to manage your diabetes. Have you lost your motivation? Is it a challenge to do every day activities like taking your medication or checking your glucose? Discuss your feelings with health care provider. If you have difficulty with depression or anxiety, make healthy coping one of your goals. Depression is common in people with diabetes, 1 in 3 people with diabetes suffer from depression.

Examples of healthy coping goals: I will make time for myself. I will discuss my feelings with my doctor. I will be proactive with my mental health.

Blood Sugar Monitoring

Do you know how food, exercise and medication affect your glucose levels? Are you checking your glucose daily? Do you know the best times to check your glucose? Do you carry your meter with you? Do you know your glucose goals? If you can’t answer ‘Yes’ to each of these questions, monitoring should be one of your goals.

Examples of monitoring goals: I will check my fasting glucose daily. I will check my blood glucose 2 hours after my largest meal. I will check my glucose before each meal. I will know my blood glucose goals and strive for them daily. 

Reducing Risks

Have you had a recent flu shot, or an eye, dental or foot exam? Have you had your yearly physical? It significantly helps prevent complications from diabetes, by having routine exams. If routine exams and appointments with certified diabetes educators, your primary doctor and specialty doctors aren’t typical for you-make reducing risks one of your goals.

Examples of reducing risks goals: I will schedule an eye exam. I will schedule a dental exam. I will visit the podiatrist. I will make my appointment for a yearly physical.

Problem Solving

You live with Diabetes on a day-to-day basis. Do you know how to problem solve effectively; what to do if your glucose is high or low?  Have you problem solved lately? It’s important to know what to do when certain situations arise. If you aren’t sure what to do if your glucose is low, or high, or how to treat it; problem solving should be one of your goals.

Examples of problem solving goals: I will learn how to treat low glucose properly. I will check my glucose 2 hours after certain foods to see what happens.  I will check my blood sugar before driving my car.  I will meet with a counselor to find the best health care plan for me to afford my medications.

Diabetes self-management, as you see, is about more than just watching what you eat.  It’s about a total lifestyle “makeover”.  Virtually every aspect of our lives can or does influence our diabetes.  Invest the time necessary to meet with your diabetes educator.  Most classes require a commitment of 9-10 hours; this is significant, but well worth the effort in “paybacks”.  To find the nearest Certified Diabetes Educator, enter your zip code in the following link:


https://nf01.diabeteseducator.org/eweb/DynamicPage.aspx?Site=AADE&;WebCode=AADEDiaEduDirectory

 
















 

 

 

Diabetes and Smoking

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Diabetes and Smoking

            Diabetes is a serious disease which affects nearly twenty million Americans.  It is a disease which results when the body does not produce enough insulin to use sugar as it should. Insulin is a hormone produce by the pancreas in order to store and use blood glucose, or sugar found in our blood, which comes from the food we eat. Over time this high blood sugar could result in complications such as heart disease, eye disease, nerve damage, circulatory disease or kidney failure (1). There are two main types of diabetes which are classified as Type 1 and Type 2.    

Type 1 affects ten to fifteen percent of Americans diagnosed with diabetes. Type 1 is defined as when the body makes little to no insulin at all. It was previously categorized as “juvenile diabetes” because it used to be found mostly in children and young adults (2). It is managed with insulin therapy, diet, exercise, and other medications as needed.

            Type 2 diabetes is more common than Type 1 diabetes. Nearly ninety to ninety-five percent of Americans diagnosed with diabetes fall under this category. Type 2 differs from Type 1 in that the body does produce some insulin, but does not produce enough or the body’s cells are resistant to the action of insulin. In this case blood glucose levels rise and become harmful to the body. Type 2 diabetes is more common in people who are over the age of 40, are overweight, and have a family history of diabetes.

            Smoking cigarettes may increase the risk of developing Type 2 diabetes (3).  This is because smokers become insulin resistant which affects the body’s blood glucose levels.  Individuals that have diabetes and smoke are at higher risk for the complications of diabetes.  By quitting smoking, individuals with diabetes could gain better control of their blood sugar levels and reduce the risks of complications.

            Diabetes can be prevented and controlled. The greatest prevention of diabetes is healthy living. Regular exercise or physical activity for thirty minutes a day at least five days a week can reduce the risk of diabetes (1). Also eating healthy and regular doctor visits help to prevent diabetes early on. For smokers, the greatest prevention to diabetes is to quit smoking now!  The Great American Smokeout is an annual event held on the third Wednesday in November to encourage Americans to stop tobacco smoking.  The event challenges people to give up smoking for 24 hours, hoping that this decision will help them stop smoking completely.  For help with quitting smoking visit the Great American Smokeout at www.tobaccofree.org.  For more information on diabetes go to www.diabetes.org

  1. 1.Tri-County Diabetes Alliance, (2014). http://www.tridiabetes.org/index.php/about-diabetes
  2. 2.American Diabetes Association, (2014) http://www.diabetes.org/diabetes-basics/type-2/
  3. 3.Center for Disease Control and Prevention, (2014). http://www.cdc.gov/tobacco/campaign/tips/diseases/diabetes.html#how_related

Written by: Courtney Harris, Office of Prevention and Health Communications, Wicomico County Health Department

 
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