Do you say to yourself after each doctor visit, “I will do better this month with taking my meds”?
Do you feel “in the dark” about exactly when you’re supposed to be taking your meds?
Do you wonder if that nagging nausea or dizziness could be related to one of your meds?
One of the more common areas that people living with diabetes struggle with is medication compliance. This can include several aspects of medication including knowing when to take medications, remembering to take them at the correct times, and knowing the possible side effects related to each medication. I have several tips and tricks that have worked for many of my patients through the years that may work for you too!
If you go to the doctor for your regular check-ups and your A1C level is above goal or increasing, your doctor will likely want to increase your medication in an attempt to get you to goal. However, if you haven’t actually been taking your meds correctly, it may be that you don’t really need MORE medication, you just need to take the meds you’re currently on more consistently and at the correct time for them to work at their maximum effectiveness. By doing this your A1C and blood sugars will improve without the need for more meds!
One of the topics I spend a lot of time on with my patients is teaching them about each of their diabetes medications: how they work to control blood sugar levels; when they should be taken to maximize effectiveness and minimize possible negative effects; and any possible side effects to be aware of.
Knowing How Each of Your Meds Works
Each class of diabetes medication works in a different way to control blood sugar levels. For example, some tell your pancreas to squeeze out extra insulin, some limit the absorption of carbohydrate in your intestine, and some make your muscles take up more sugar from your bloodstream. Insulins each have a duration of time they last and/or a peak time when they work their strongest. In order to know when to take your meds, it’s important to know how they work. This understanding will make you more motivated to take your meds correctly and will decrease the likelihood of negative or dangerous side effects.
Ask your doctor or Certified Diabetes Educator how each of your meds works. You can also check a website such as Drugs.com which will give you more specific and detailed information about all medications. Also ask your doctor at each visit WHEN to take each medication. Gets specifics such as before or after a specific meal; ask the doctor when your medication is supposed to be taken if you don’t eat a particular meal or only eat one or two main meals a day. If you doctor prescribes a medication in the morning, but you work a night shift and your “morning” is really the night, tell them this. If your doctor says to take a medication “twice a day”, ask for more specifics. With breakfast and dinner? Upon waking and going to bed? If the doctor says to take a medication “in the morning”, should it be with food? Some people skip breakfast or eat very late – this is important to tell your doctor for “morning dosed” medications.
Diabetes medications more than any other class of drugs are interrelated to meals and day/night routines, so these details are important. Informing your doctor of all of the specifics of your lifestyle and eating pattern allows them to better select medications specifically for you and your needs and schedule. Don’t be shy about having this conversation with your health care provider!
Taking meds exactly as they should be taken maximizes the way they control your blood sugars, allowing you to thereby take less medication instead of more. For example, taking a rapid acting insulin such as Humalog, Novolog or Apidra 5-15 minutes before eating each meal will allow its absorption time to match food digestion. What this really accomplishes is that the insulin will be working its hardest when the majority of your meal is turning to blood sugar in your body! With a medication like Acarbose which blocks some carbohydrate from being absorbed in your intestine, it is also imperative to take it with meals. It will do no good if taken without food containing carbohydrate! With long acting insulins like Lantus or Levemir, which last about 20-24 hours, it is important to take it at about the same time each day do give you that “24-hour coverage”. Skipping or omitting a dose of these insulins will lead to higher blood sugars for the next 24 hours.
Tips & Tricks to Remember to Take Your Medications at the Correct Times
Once you understand HOW your medication works, you will have a better understanding of the importance of taking it at the proper time so it works best to control your blood sugars. But remembering to do this may be more difficult than it sounds. It takes up to six weeks for a new behavior to stick and become a habit so using reminders and tools in the beginning can be a real help.
For example, knowing that Metformin (Glucophage) or Acarbose need to be taken with meals/food, try putting the pill bottle on top of your plates in your kitchen cabinet. You will need to knock the pill bottle over when getting your plate, thereby reminding you to open that bottle right then and take that pill! Similarly, taking rapid acting insulins right before meals can be easier to remember if you put your insulin pen on your kitchen table right where you sit to eat. (Did you know that in-use insulin pens do NOT, and in fact should not, be stored in the refrigerator?) Alternatively, many rapid acting insulins are dosed on a sliding scale depending on what your pre-meal blood sugar is, so why not store your insulin pens (or vial and syringe) right next to your Glucometer and do both together before eating? Sticky notes on the cabinet doors or the refrigerator also have worked well for many of my patients as an “in your face” reminder to stop preparing or dishing up the meal and take your medication first.
Longer acting insulins that are taken at bedtime often pose a problem for those patients that fall asleep before remembering to take them (remember if you skip these doses, your blood sugars will be high for the next 24 hours!). If this is a big problem for you, ask your doctor if you can take it earlier in the evening (such as before or after dinner) or possibly change to first thing in the morning when many other meds are taken. Or try putting your insulin pen on your nightstand near your alarm clock that you set each night, or near your toothbrush where you go before bed each night, so you can visually see it and be more likely to remember to take it before you fall asleep.
I also love using smart phones to set alarms that will alert you when it’s time to take your medications, eat or test your blood sugar! Your phone is helping you to be smarter! Just remember, don’t silence that alarm until you’ve actually done the task at hand! No smart phone? Just set an alarm on your home clock if you are at home when meds need to be taken.
Minimizing Side Effects & Risk for Negative Events
Using the same example of the rapid acting insulins Humalog, Novolog or Apidra noted above, if these insulins are not taken WITH a meal, they carry a significant risk of hypoglycemia (low blood sugar). This is because the time when the insulin is working its strongest to lower blood sugar is not matching up with when the food is turning to blood sugar. If you take these meds between your meals, they will pull your blood sugar down when it may be at a normal or even lower level, thereby causing a low blood sugar reaction.
Another example is metformin (brand name Glucophage). This med can carry a significant side effect of nausea and diarrhea if not taken with food. It is imperative to take this medication with a meal: breakfast if it’s dosed once a day and breakfast and dinner if dosed twice a day. Many of my patients who initially thought they couldn’t tolerate or remain on this med due to the unpleasant side effects, end up doing extremely well after they learn to take it correctly!
So knowing how your medications works, when it works strongest, and the possible side effects will allow you to be more compliant with taking meds as they are intended to be taken. This will lead to better blood sugars, less unpleasant side effects, which will lead to even better compliance and lowered A1C results – all while feeling your best and without needing MORE medication at that next doctor visit!
By Kirstin Grant RDN CDE
Cecelia Health Certified Diabetes Educator