Healthy people consult professionals before implementing significant changes in our medications or lifestyle choices
Healthy people are patient and persistent in overcoming health or lifestyle challenges.
Healthy people accept total accountability for our own health, without taking on blame for things beyond our control.
What can you do to improve your AIC when you’re feeling terrible from a variety of symptoms and conditions, many of which are either a direct result of your diabetes, or at least are indirectly impacted by persistent high blood sugars.
There are any number of things you need to deal with in order to make real change. The most important of these things is probably NOT your diabetes. At least not directly.
I’ve been a type two diabetic for many years. Diabetes probably started with me in my twenties although my first symptoms didn’t start to show up until I was nearly forty. I’m now in my sixties and I’ve been on insulin for more than fifteen years. That means I’ve been pricking my finger at least once a day since I was fifty years old, and injecting myself with insulin ever since.
The one thing I can say about my diabetes is that it has progressed in a predictable way, gradually causing negative effects to my body. All the way along the road various doctors have given me a lot of prescription medications, as well as a lot of advice. I’ve been to diabetic clinics where nurses and dieticians have attempted to teach me how to control my blood sugars through diet and exercise.
When I was first diagnosed with diabetes I even received counselling, to try to make sense of Why Me? I think everyone feels victimized by negative health conditions, whether it’s COPD, Heart Disease or Cancer. The answers to Why Me? are both existential and practical.
There are two parts to the answer. First, there is the part of Why Me? over which you have no control, never did, never will have and makes no difference anyway. Whether it’s fate, God, a cruel universe, DNA or the conditions of your life (including a bad diet, smoking, poor or no exercise, etc.) leading up to becoming diabetic none of them actually matter in coming to terms with the emotional fallout of Why Me?
Truthfully, there are many things I could have done differently in the past that might have made a huge difference in my experience of diabetes now and in the future. But for whatever reasons I had, or gave myself, I did what I thought was within my capacity to change in my habits and behaviors.
You can check your blood sugars regularly with you meter tests, get your AIC blood work done in the lab and consult with your doctor as often as she thinks is useful or necessary. You may make changes in your diet and exercise program, and do your best to lose weight and keep it within certain boundaries. And if you do all these things from the beginning, your diabetes will be stable and you will reduce the consequences of this disease.
For most of us, however, no matter how much we say we care about our health, we’re not really willing to do whatever is necessary to fundamentally change our outcomes. We do some of it, maybe ever some of it every day with serious intentions.
This is the Second Part to Why Me?
This is the part of Why Me? you can control if you choose to do so. So how do you change what you do and how you act, to have a real impact on your own health? This goes back to me saying that it’s not actually about diabetes, or even about your physical health.
It’s really about becoming conscious about who and what you want to be in your own life. We’ve all been beat-up by life along the way. Parents, friends, lovers, partners and even strangers have both positive and negative impacts on our self esteem. Why is that? Why do we let anyone else impact how we feel about ourselves, and how we make positive or negative choices about our lives, including those choices about dealing with negative health outcomes resulting from poor choices.
I hate to say this but “Who cares?” It doesn’t matter what happened in the past, or how you allowed yourself to be negatively influenced regarding healthy living. It really doesn’t matter, but only if there is some way you can turn your life around and ultimately take control of those things that you can control.
How to take control and like it.
The first thing is to understand what it is you need to do to make things better. If you don’t know what you need to do, it’s pretty hard to decide what to do. So find out. See you doctors. Read everything you can find out about current treatment alternatives, and inquire from other people their experiences. Read blogs. Get new referrals to diabetic clinics and resources. Talk over alternatives with your specialist. Make a plan of action with on a few, specific steps, done regularly and persistently.
Don’t try to do everything all at once. Set limited goals with realistic objectives. For example: Don’t try to lose a lot of weight in a week or even a month. Lose weight in amounts that can actually be achieved. If you find it too hard to do by yourself, join a club or a weight loss program which comes with monitoring and emotional support. But don’t blame the program if your weight loss isn’t happening. Be totally honest with yourself, and reset your goals. Weight loss is fundamental to improved diabetic outcomes and lowering blood sugar.
If it isn’t happening, then look elsewhere for support, but don’t give up on necessary change. Remember that whatever happened yesterday is no longer relevant unless it results in change today. Guilt is useless unless it is accompanies by a renewed sense of personal accountability.
When I graduated many years ago from UBC my school motto was TU UM EST. What I didn’t realize was how powerful an idea that really is.
by bureaucratic delivery of medical devices and services
Two nights ago I went to my local Shoppers Drug Mart in Walnut Grove, Langley to submit my prescription for my new type of FreeStyle Libre sensor and meter, as well as my two new types of insulin. It was a frustrating day yesterday sorting it all out, without yet having received anything… once I come up with the necessary funds. All told about $268.00 out of pocket, with $178.00 eventually refundable from Blue Cross once I send in the receipt showing that I’ve paid it.
My new insulin prescriptions are 85% covered by Blue Cross unlike my previous prescription for insulin which was covered entirely, once my initial 100 deductible is paid for the year. I don’t know why this is so, but is probably a result of this being newer technology and newer method of managing diabetes in BC and, for the moment, is grudgingly covered by Blue Cross under the agreement with my wife’s employer, and then only to 85% of the cost of the newer medications.
Money required for medications and equipment causes a lot of anxiety as money is particularly tight on my government pension, and I’m counting the days to the next pension check for when I’ll have any money to spend, pretty much on anything.
I’m don’t mean to be grumbling about my current financial situation. First of all its mostly my own fault. Secondly, the only person who can do anything about it is me, so there’s not a lot of point in getting angry about it. Still, coming up with an extra $300 all at once, halfway through the month is going to take some doing.
Assuming that I can figure out how to get the money together, it looks like I’ll be starting my new insulin regime tomorrow or the next day, and will start using my new sensor soon. I am both excited and anxious about it.
My endocrinologist has been talking about getting me set up on a whole new system of monitoring my diabetes, in an effort to improve my blood sugar management. It turns out that my Blue Cross administration approved it last fall but nobody told me that they had done so. It was only when I submitted the application again late last month, and it was declined that I found out that it had already been approved, and it was expected that I would start to use, once the approval was provided. Just as a comment, this is a good example of how not to communicate about medical affairs. If I had thought to go to the Blue Cross members page and look, I would have seen that it was approved. However, I seldom, if ever, need to go onto the website and the members area. An email would have helped.
The next step is to return to my General Practitioner for the necessary prescriptions for the machine and the insulin, and whatever ever is required to use the system. Hopefully he will also provide me with instructions on how to do this.
Flash Glucose Monitoring System for Diabetes. … The FreeStyle Libre Pro is a glucose monitoring system intended to replace finger-stick tests; it uses a sensor implanted in the arm that a health care provider scans with a specialized reader for a record of glucose levels, trends, and patterns in people with diabetes.
I am also hoping that with the new system of monitoring and delivering my insulin during the day, that I will need less of the other medications I have been taking for some time. My pharmacist thinks my doctor should eliminate the pills I take to control the diabetes, and use close management of insulin to control the blood sugars.
The reason for this recommendation is that it seems quite likely that a number of adverse symptoms I am experiencing are possibly related to my other diabetes medicines, and if I can stop taking them these side effects may, in fact, go away.
Any, this is a new start for in trying to better control my health and my diabetes, but only one of a number of steps I plan on taking in the next months and years.
I’m also hopeful that I will be able to use my iPhone 6+ as my monitoring device rather than the one from FreeStyle Libre.
I’m worried about my medications, almost as worried as I am about my health problems for which I’m taking the prescriptions
My poor health makes it hard to focus on the various ailments and their causes.
I’m tired of being sick and tired.
Knowing that I need to make changes, and even being aware of some of the changes I need to make, doesn’t mean that I have the energy or clarity of purpose to stay the course and do what is necessary to improve my health.
It is obvious from reviewing my medications and their various side effects in the context of my various ailments that some of my problems may be made worse or even caused by the side effects of one or more of my medications.
I missed a couple of my medications when I listed my prescriptions and side-effects, the most important of which is Humulin 70/30 which I take in the morning with breakfast and a dinner, both 60 units each time.
Humulin 70-30 Insulin
Humulin 70-30 (70% human insulin isophane suspension and 30% human insulin) is a man-made form of a hormone that is produced in the body used to treat diabetes. The most common side effect of Humulin 70-30 is low blood sugar (hypoglycemia). Symptoms of low blood sugar may include headache, nausea, hunger, confusion, drowsiness, weakness, dizziness, blurred vision, fast heartbeat, sweating, tremor, trouble concentrating, confusion, or seizure(convulsions). Other side effects of Humulin 70-30 include: injection site reactions (e.g., pain, redness, irritation), skin thickening or pits at the injection site (lipodystrophy), itching, rash, weight gain, and swelling of your hands and feet.
Tell your doctor if you have serious side effects of Humulin 70-30 including signs of low potassium level in the blood (such as muscle cramps, weakness, irregular heartbeat).
Each patient’s diabetes is different, and the injection schedule and use of Humulin 70-30 is individualized. A doctor determines which insulin to use, how much, and when and how often to inject it. Humulin 70-30 may interact with albuterol, clonidine, reserpine, guanethidine, or beta-blockers. Tell your doctor all medications you are taking. Tell your doctor if you are pregnant before using Humulin 70-30. If you are planning pregnancy, discuss a plan for managing your blood sugars with your doctor before you become pregnant. Your doctor may switch the type of insulin you use during pregnancy. This medication does not pass into breast milk. Consult your doctor before breastfeeding. Insulin needs may change while breastfeeding.
The next step is to review the side effects of each medication, and benefits of each, to determine what I should do. At the very least I need to review the interaction of these medications to figure out which of them are making my health worse, and which better.
Already I have some concrete ideas about improving my situation, including getting back into using my CPAP machine, recommitting to losing weight, and concentrate of getting more exercise.
Yesterday I began a critical review of my current health situation, with a view to improve my future results by making some new decisions based on the current facts and trends.
Here is a recap of the situation as I see it now. I am taking the symptoms I listed yesterday and discussing each of them in the context of my current method of dealing with them, and/or discussing the cause of each of them as best I can, given that I’m not a doctor or scientist trained in this.
Frequent urination – especially at night, interrupting my sleep.
The whole issue of urination and bladder control is interconnected with so many of my other underlying issues so it’s probably a good place to start.
Problems with urination are a little bit like the canary in a mine that warns of trouble. One of my earliest indicators that I had a problem, (and it might be diabetes) was having a need to urinate frequently, both during the day and at night. This started in my thirties, almost thirty-five years ago.
Diagnoses of the problems with my urination were complicated by a discovery, in my thirties, that I suffer from a relatively mild form of spina bifida, which despite it not being debilitating does have some significant neurological effects on my lower body, including sexual response and bladder control. This wasn’t great news to hear when I was only in my thirties, but everything the doctor told me about the possible side effects of spinal bifida occulta has surfaced from time to time since then.
Like many other men with any problems with their genitals and urinary systems, including urination or sexual performance, I generally tried to ignore the problem as much as possible. After discussing the potential effects of the problem with my lower spinal column with the back specialist I tended to ascribe any problems to the back and nervous system, including periodic difficulties with both urination and sexual performance.
In the spring of 1985, when I was 32 years old, I also exacerbated the problem, by choosing to undergo a vasectomy, without understanding in advance that the operation could have unintended side effects. Unlike what I had expected, the operation resulted in swelling of my prostate and my testes and an infection in my urethra and bladder. For more than a year I suffered severe pain from both urination and sexual expression, and my soreness persisted for several years before fading away completely. A prescription was given to me to reduce the swelling of my prostate, but it took some time to take effect, and as it was significantly swollen, there were physical effects on both sexual function and urination.
As one might expect, given the pain, there were also emotional effects and a significant impact on my intimate life, in ways I would not have normally expected.
My reasons for having a vasectomy still seem as valid today, as they were at the time, however, part of the decision to go for it turned out to be less true than it is in most cases. My medical results included significant pain, reduced enjoyment of life, and a much higher level of anxiety about the whole subject than was probably warranted.
The argument for having a vasectomy is that it is generally considered a relatively benign surgical procedure, done in the doctor’s office as a day surgery. For a woman to have sterilization surgery is much more invasive, not to mention that it results in huge hormonal changes. My wife and I both thought a vasectomy would be less problematic, and we were probably right, despite how frustrating and painful it turned out to be.
It continues today, as so I suppose I’m used to it. However, continuing declines in muscles and nerves is also contributing to further problems, which require a certain fastidiousness to avoid embarrassment because of weakness in bladder control. It’s not promising for the future, because if it continues to decline I can see a future including adult diapers. It may be already as bad as it is going to get, at least that’s my current hope.
So my problems with sexual function and urination really started then, and it was only somewhat later that I realized that my need to urinate more frequently as I was getting old might have a relationship to diabetes.
Poor sleep – several things wake me up at night, variously including frequent urination, frequent cramps in my feet and calves, pain my shoulders and hips, dry mouth and nasal congestion, sleep apnea, hay fever, and difficulties breathing.
I’m not sure that I’m doing this analysis in the right order, but this is the order I listed my symptoms yesterday, so I will follow this list and get to the underlying stuff as it comes.
I have a lot of trouble sleeping through the night. I have a CPAP machine to help me deal with my sleep apnea, with which I have been having problems. The problems with the CPAP machine aren’t really with the machine itself, but with on again off again sinusitis that makes it almost impossible to sleep with the device forcing me to breath through my nose. So when I’m congested I don’t put it on. So it doesn’t do anything if I don’t use it.
So one of the new decisions I’m making as I do this analysis is to start using the damned CPAP every night possible. When I was using it, it did improve my blood sugars and I suppose it improved my sleep, although I didn’t feel much more rested then that I do now. In other words I’m still exhausted most days, regardless of the CPAP.
The problem with cramping in my legs and feet is another thing that wakes me up in the middle of the night fairly frequently, although not every night. When it first started up a few months ago, I asked a doctor and she advised me to use Magnesium and Calcium together to help. I started taking them every day, and my cramps in my calf muscles has been reduced to once or twice a month, instead of every night. However, this remedy has not improved the cramping in the arches of my feet, or the muscles in my toes.
Other body pain and neuropathic pain are also problematic in getting a decent night’s sleep. Arthritis and rotator cup problems wake me at various times in the night, and make it difficult to get back to sleep. Neuropathic pain which is merely irritating during daylight hours seems far more painful when I am at rest. Ergo, more interrupted sleep and more pain.
Chronic pain during waking hours – moderate to severe pain in my feet, neuropathic pain as well as mechanical distress, including pain caused by walking on supersensitive soles of my feet, as well as my toes.
I am taking Gabapentin, an anti-seizure medication which has shown to help with neuropathic pain. It may be providing me with some relief from the neuropathic pain, but the benefits are still uncertain to me. Would the neuropathic pain be worse if I were to wean off of Gabapentin, due to the numerou side effects cited in the literature?
Also… periodic moderate pain in my back and shoulders, and more serious pain in my lower back and hips when walking more that 1,000 to 2,000 steps.
Various types of chronic pain plague my waking moments, including arthritis in my hands, shoulders, hips and legs. Tendonitis has my hands bound up with pain. Inflation combines with ongoing pain.
Persistent breathing problems – mild to severe asthma on a continuing basis, almost always somewhat symptomatic but much worse when exercising or physically stressed. Sometimes exacerbated by emotional stress or conflict. Of all my symptoms my breathing problems are the most intrusive, making ordinary activities difficult or impossible. I am currently taking three separate inhalers to remediate the asthma and borderline COPD. All of them have side effects which make my sinus and throat problems worse, and while they help me breathe, they make my singing voice harsh.
Chronic physical exhaustion and fatigue – comes and goes during the day but is worse during periods of relative inactivity (sense of exhaustion) and during periods of exercise (weakness and muscle fatigue).
Addressing these symptoms is something I haven’t really been able to address, yet.
To close the blog for the day, I’ve decided to stop here and pick it again tomorrow or Friday. All of this thinking is making my head hurt, but I realize that I haven’t really given enough thought to the role of the many drugs in my system, and how their many potential side effects may be effecting me.
There can be no time more suitable than the present to make
better choices for my future health and well-being. New choices mean reviewing and carefully
considering alternatives not previously pursued, or if previously pursued,
inadequately. In some respects, this
analysis reflects a continuing and necessary re-evaluation based of my current
state of health, not as a snapshot, as it were, but rather as a streaming and
changing set of conclusions and actions based on them. However, this analysis is specifically about
now and the immediate future, with a clear understanding that nothing is ever
completely settled in these issues, and there is new information available on
an ongoing basis.
More simply put – This self-analysis is about resetting how
I go about living my life with due consideration to what I have learned about the
conditions and diseases that currently plague me. How to do better and improve my health for
the future – this is my object.
Much of what will be expressed here rests on certain
persisting patterns of behavior which require significant modification. In other words, I must change if there is to
be any real improvement in my health reality. And based on what I know about
achieving anything of consequence in my life, it will need to be outlined in a
program of specific steps, which depend upon my own actions rather than on
others. My physicians can only provide
me with information and treatment within what I’m willing or able to do
myself. My partner, as supportive as she
has tried to be over the years, is not responsible for any part of this,
despite my tendency to try to lay responsibility at her door particularly for
my dietary habits and lack of blood sugar control.
Frequent urination – especially at night,
interrupting my sleep.
Poor sleep – several things wake me up at night,
variously including frequent urination, frequent cramps in my feet and calves, pain
my shoulders and hips, dry mouth and nasal congestion, sleep apnea, hay fever, and
Chronic pain during waking hours – moderate to severe
pain in my feet, neuropathic pain as well as mechanical distress, including
pain caused by walking on supersensitive soles of my feet, as well as my
toes. Also… periodic moderate pain in my
back and shoulders, and more serious pain in my lower back and hips when
walking more that 1,000 to 2,000 steps.
Periodic breathing problems – mild to severe
asthma on a continuing basis, almost always somewhat symptomatic but much worse
when exercising or physically stressed.
Sometimes exacerbated by emotional stress or conflict.
Chronic physical exhaustion and fatigue – comes and
goes during the day but is worse during periods of relative inactivity (sense
of exhaustion) and during periods of exercise (weakness and muscle fatigue)
Dizziness upon standing – it is sometimes acute
and sometimes minor
Mental fatigue and a sense of a loss of acuity
and sharpness – I am finding it difficult to concentrate on mental tasks which
require the application of my intellectual skills and professional skills. I still feel capable of creative work for
relatively brief periods, but fatigue quickly overtakes me, and I must put
things aside, while I attempt to recover my energies and focus.
Forgetfulness and feelings of anxiety regarding
Visual deficiencies – lately I can only read or
work on the computer for a certain period before my eyes begin to become less
effective, making it necessary for me to interrupt my work or reading, and brake
completely from work that require visual acuity. Eye fatigue contributes to my overall sense
of fatigue and exhaustion. Note: I probably need new glasses, something
I will discuss with my ophthalmologist on Friday when I next visit her.
Conditions and/or diseases
Slightly elevated cholesterol
Asthma and bronchitis (borderline COPD)
Evidence of diabetic damage to my eyes
Arthritis in hips, hands, shoulders, lower back
Tendonitis in hands and wrists
High and low blood pressure
Allergies to a broad band of common allergens
including pollens, animal dander, dust and others. Anaphylactic reaction to Cipro and Penicillin
I have had recent visits with my family doctor, my Endocrinologist
and my Respirologist (Pulmonologist), plus an upcoming CT Scan in early June at
Burnaby General, and an eye exam this Friday.
I’m clearly a heavy draw on the medical system with all these frequent
appointments to deal with various ailments.
Clearly I’d like to see less of them, and they would like to see less of
me. All we have to do to accomplish this
feat is to improve my health sufficiently so that they wouldn’t need to see me
Diabetes blood sugar and neuropathy management
My most recent visit with my Endocrinologist, as usual, thorough,
with a significant discussion about changing my medications, in particularly,
moving to two different types of insulin every day, with a long acting insulin
injected in the morning with design purpose of bringing my premeal and fasting
insulin down to ideally 7.0mml or below and then having me take fast acting
insulin with each meal, dividing up the insulin between the meals, more or less
based on the prorated amount of food being ingesting at each meal.
In order to manage this much more intensive insulin regime,
it will be necessary for me to check my Blood sugar levels first thing each
morning, as well as 2 hours after each meal.
The goal of the fast-acting insulin is to return my blood sugars to
10mml or below within the two hours.
In order to maintain such a frequent reading of my blood
sugar levels, I need to have a new form of monitor with a patch blood reader
that sends the information to a monitoring device, either my iPhone or one that
comes with the patch. I submitted the
request to Blue Cross two weeks ago and am currently awaiting approval. Note: I
should follow up with them before Friday to make sure they are working on this.
The Endocrinologist wrote me prescriptions for the insulin
and the device, as well as had his assistant prepare the forms for Blue
Cross. Once I have approval, I will need
to deliver these forms to the Pharmacy for processing.
The Endocrinologist and I had a fairly long conversation
regarding various aspects of my diabetes including the need for me to have my
eyes re-examined, thus an appointment this Friday with Chui Luca, my Ophthalmologist. We also discussed my weight gain since being
diagnosed with diabetes with him expressing some thought that while weight loss
would be desirable many type two diabetics in my circumstances find it very
difficult to lose weight while taking insulin.
Not only does insulin contribute to weight gains, but so do Jentadueto
and Invokana my other diabetes treatment medications.
In addition, gabapentin, which has been prescribed for my
neuropathy due to diabetes, also leads to weight gain along with other symptoms
I am experiencing.
The more common side effects
of gabapentin include:
abnormal eye movements that are continuous,
uncontrolled, back-and-forth, or rolling
clumsiness or unsteadiness
drowsiness or tiredness
Talk with your doctor about
precautions you can take for side effects from gabapentin:
Ask your doctor for advice on diet and
exercise to help manage your weight if you are concerned about possible weight
gain from gabapentin.
Don’t drive or operate heavy machinery until
you know you can function normally while taking gabapentin.
Talk to your pharmacist about
over-the-counter medications that can help relieve some of the more common
digestive system side effects.
Gabapentin side effects may
make you want to stop taking the drug. However, don’t stop taking it without
first talking to your doctor.
Stopping gabapentin suddenly
can cause serious problems, such as withdrawal symptoms or the return of
seizures. Your doctor will help you stop taking the drug safely.
Medically reviewed by Lindsay Slowiczek, PharmD on December 20,
2016 — Written by University of Illinois-Chicago, Drug Information Group
In addition to the two new forms of insulin, and the
gabapentin for treatment of the diabetic Neuropathy I also take two other
2.5/1,000 MGs – taken twice daily prior to morning and evenings
Medical Editor: John P.
Cunha, DO, FACOEP
Last reviewed on RxList
Jentadueto (linagliptin and
metformin hydrochloride) is a combination of two 2 oral antihyperglycemic drugs
indicated as an adjunct to diet and exercise to improve glycemic control in
adults with type 2 diabetes mellitus when treatment with both linagliptin and
metformin is appropriate. Common side effects of Jentadueto are:
Get medical help immediately
if you have severe side effects of lactic acidosis (symptoms include muscle
pain or weakness, numb or cold feeling in your arms and legs, trouble
breathing, dizziness, lightheadedness, tiredness, weakness, stomach pain,
nausea with vomiting, or slow or uneven heart rate.
Jenadueto is available in the
following strengths: tablets containing 2.5 mg linagliptin and 500 mg metformin
hydrochloride or 850 mg metformin hydrochloride or 1000 mg metformin
hydrochloride. The maximum recommended dose is 2.5 mg linagliptin/1000 mg
metformin twice daily. Jenadueto should be taken daily with meals, with gradual
dose escalation to reduce the gastrointestinal side effects due to metformin.
300 MG – taken once daily prior to the morning meal.
Medical Editor: John P.
Cunha, DO, FACOEP
Last reviewed on RxList
Invokana (canagliflozin) is a
sodium-glucose co-transporter 2 (SGLT2) inhibitor used to control blood sugar
in people with type 2 diabetes mellitus, in addition to diet and exercise.
Common side effects of Invokana include:
sensitivity to sunlight,
reactions (including skin redness, rash, itching, hives, and swelling),
The recommended starting dose
of Invokana is 100 mg once daily, taken before the first meal of the day. Doses
may be increased to 300 mg in patients who are able to tolerate Invokana at 100
mg doses. Invokana may interact with rifampin or digoxin. Tell your doctor all
medications you use.
Asthma and Bronchitis Medications and treatments
After spending 10 days in the hospital in 2016 with severe
pneumonia, when I was discharged my Respirologist at Centrio Medical Centre diagnosed
me with COPD and prescribed three different inhalers to treat the disease.
Spiriva 2.5 mg
Spiriva 2.5 mg – two puffs with morning medications
Medical Editor: John P.
Cunha, DO, FACOEP
Last reviewed on RxList 2/12/2018
(tiotropium bromide) Inhalation Powder is an anticholinergic drug used to
prevent bronchospasm (narrowing of the airways in the lungs) in people with
bronchitis, emphysema, or COPD (chronic obstructive pulmonary disease). Common side
effects of Spiriva HandiHaler include:
Tell your doctor if you have
any serious side effects of Spiriva HandiHaler including:
or painful urination, or
The recommended dose of
Spiriva HandiHaler is two inhalations of the powder contents of one Spiriva
capsule, ONCE DAILY, with the HandiHaler device. Spiriva may interact with
atropine, belladonna, cimetidine, clidinium, dicyclomine, glycopyrrolate,
hyoscyamine, mepenzolate, methantheline, methscopolamine, propantheline, or
scopolamine. Tell your doctor all medications you use. During pregnancy,
Spiriva should be used only when prescribed.
Symbicort 200 mg – two puffs with
morning medications and two puffs with dinner medications
Medical Editor: John P.
Cunha, DO, FACOEP
Last reviewed on RxList
Symbicort (budesonide and
formoterol fumarate dihydrate) is a combination of a steroid and a long-acting
bronchodilator used to prevent bronchospasm in people with asthma or chronic
obstructive pulmonary disease (COPD). Common side effects of Symbicort include:
joint pain, or
Tell your doctor if you
experience unlikely but serious side effects of Symbicort including:
patches on tongue or in mouth,
infection (such as fever, persistent sore throat),
changes (such as nervousness),
problems (such as blurred vision),
thirst or urination,
For patients 12 years of age
and older, the dosage of Symbicort is 2 inhalations twice daily (morning and
evening, approximately 12 hours apart). Symbicort may interact with
antibiotics, antifungal medication, MAO inhibitor, antidepressants,
beta-blockers, or diuretics (water pills). Tell your doctor all medications you
are taking. During pregnancy, Symbicort should be used only when prescribed.
Budesonide passes into breast milk. It is unknown if formoterol passes into
breast milk. Consult your doctor before breastfeeding.
Salbutamol 100ug – two puffs as required
Medical Editor: John P.
Cunha, DO, FACOEP
Last reviewed on RxList
Ventolin HFA (albuterol
sulfate inhalation aerosol) is a bronchodilator used to treat or prevent
bronchospasm in people with reversible obstructive airway disease. Ventolin HFA
is also used to prevent exercise-induced bronchospasm. Ventolin HFA is
available in generic form. Common side effects of Ventolin HFA include:
dryness or irritation,
Seek medical help immediately
if you have rare but serious side effects of Ventolin HFA, including:
The dose of Ventolin HFA for
adults and children for treatment of acute episodes of bronchospasm or
prevention of symptoms associated with bronchospasm is 2 inhalations repeated
every 4 to 6 hours. More frequent administration or a larger number of
inhalations is not recommended. For exercise-induced bronchospasm, the dose is
2 inhalations 15 to 30 minutes before exercise. Ventolin HFA may adversely
interact with diuretics (water pills), digoxin, beta-blockers, antidepressants,
MAO inhibitors, or other bronchodilators. Tell your doctor all medications you
are taking. During pregnancy, Ventolin HFA should be used only when clearly
needed. Discuss the risks and benefits with your doctor. It is unknown if this
medication passes into breast milk. Consult your doctor before breastfeeding.
Other Medications Prescribed or recommended
Tecta 40 MG
Medical Editor: John P.
Cunha, DO, FACOEP
Last reviewed on RxList
Protonix Delayed-Release Oral
Suspension and Delayed-Release Tablets (pantoprazole sodium) is a proton pump
inhibitor (PPI) used for short-term treatment (less than 10 days) of
gastroesophageal reflux disease (GERD) and a history of erosive esophagitis in
Common side effects of
site reactions (redness, pain, swelling),
or stomach pain,
The recommended adult dose of
Protonix is 40 mg once daily. Protonix may interact with atazanavir,
nelfinavir, ampicillin, blood thinners, digoxin, diuretics (water pills),
ketoconazole, iron, or methotrexate. Tell your doctor all medications and
supplements you use. Protonix is not expected to be harmful to a fetus. Tell
your doctor if you are pregnant or plan to become pregnant during treatment
with Protonix. Protonix passes into breast milk and may harm a nursing baby.
Consult your doctor before breastfeeding.
APO-atorvastatin 40 mg
Medical Editor: John P.
Cunha, DO, FACOEP
Last reviewed on RxList
Lipitor (atorvastatin) is a
statin used for the treatment of elevated total cholesterol, LDL,
triglycerides, and to elevate HDL cholesterol. Side effects of Lipitor include:
Contact your doctor if you
experience serious side effects of Lipitor including:
wasting and muscle breakdown (rhabdomyolysis),
or memory problems,
thirst or hunger,
of the skin or eyes (jaundice).
The recommended dose of
Lipitor is 10-80 mg daily. Erythromycin (E-Mycin), ketoconazole (Nizoral),
itraconazole (Sporanox), cyclosporine (Sandimmune), indinavir (Crixivan) and
ritonavir (Norvir) decrease elimination of Lipitor. Lipitor increases the
effect of warfarin (Coumadin) and cholestyramine (Questran) decreases the
absorption of Lipitor. Lipitor should not be taken during pregnancy because the
developing fetus requires cholesterol for development, and Lipitor reduces the
production of cholesterol. Lipitor passes into breast milk and could harm a
nursing baby. Breastfeeding while taking Lipitor is not recommended.
Ramapril 10 MG
Ramipril side effects
Ramipril oral capsule doesn’t
cause drowsiness. However, it can cause other side effects.
More common side effects
If these effects are mild,
they may go away within a few days or a couple of weeks. If they’re more severe
or don’t go away, talk to your doctor or pharmacist. The more common side
effects that occur with ramipril include:
or faintness due to low blood pressure
Call your doctor right away if
you have any of these serious side effects. Call 911 if your symptoms feel
life-threatening or if you think you’re having a medical emergency. Serious
side effects and their symptoms can include the following:
pressure. This is more common when you’re starting the drug or increasing
doses. Symptoms include:
or hypersensitivity reaction (angioedema). Symptoms include:
of your face, lips, tongue, or throat
pain with or without nausea and vomiting
problems (jaundice). Symptoms include:
of your skin or the whites of your eyes
(edema). Symptoms include:
of your feet, legs, or hands
blood cell count. Symptoms include:
spot on your skin caused by internal bleeding (purpura)
abnormal heart rate or palpitations. Symptoms include:
like your heart is fluttering
potassium levels. Symptoms include:
(irregular heart rate)
kidney function. Symptoms include:
urine output when urinating
Disclaimer: Our goal is to
provide you with the most relevant and current information. However, because
drugs affect each person differently, we cannot guarantee that this information
includes all possible side effects. This information is not a substitute for
medical advice. Always discuss possible side effects with a healthcare provider
who knows your medical history.
Senior dosage (ages 65 years
As you age, your kidneys may
not work as well as they used to. This can cause your body to process drugs
more slowly. As a result, more of this drug may stay in your body for a longer
time. This increases your risk of side effects. Your doctor may start you on a
lowered dose or a different schedule. This can help keep levels of this drug
from building up too much in your body.
Kidney problems: 1.25 mg once
per day. Your doctor may increase your dose to 5 mg taken once per day if
needed for blood pressure control.
Renal artery stenosis or
dehydration: The starting dose is 1.25 mg taken by mouth once per day. Your
doctor may change your dose as needed.
Dosage to reduce the risk of
heart attack, stroke, or death
Adult dosage (ages 18–64
2.5 mg taken by mouth once
per day for 1 week. Then 5 mg taken once per day for 3 weeks. Your doctor will
increase your dose as tolerated to 10 mg taken once per day.
I have not been diagnosed with fibromyalgia, at least not yet. However, the development of chronic pain has paralleled my diabetes over the past twenty-five years. For most of these years I have taken metformin or other compounds including metformin, which may have been providing some mitigation of the numerous forms of pain I have battled with over the years.
So, in addition to the pain potentially caused by “dysfunction within the brain’s small blood vessels” caused by insulin resistance, as noted in the report on this study, I think researchers should also study the link between inflammatory diseases and diabetes, to determine any causality, either way.
Having had a lifetime of inflammatory issues, starting with chronic allergies to a multiplicity of substances, arthritis, tendonitis, asthma among other painful inflammatory symptoms have laid the groundwork for neuropathy and muscular inflammation. The pain in my feet and hands has nearly become disabling from a combination of pain from neuropathy, arthritis and tendonitis.
In the meantime, my medical practitioners have their hands full trying their best to assist me in dealing with the symptoms, as well as with the underlying issues related to diabetes. My muscle and skeletal pain issues are largely untreated while I struggle with diabetes, as an insulin dependant diabetic.
From this report, among other studies I’ve read, it is clear that there is little that can be done to reduce my experience of chronic pain that does not also improve my A1C levels on an ongoing basis.
Three things need to change in order for there to be a significant reduction in both – a substantial reduction in my current weight, exacerbated by using insulin, better A1C blood sugar management, which may be a result of changing the form and administration of insulin to a much more intense dose management more closely related to my blood sugar levels and meal times, and a more appropriate combination of reduced caloric intake with a physical exercise regime which focuses as much on increasing flexibility of my skeletal and muscular systems, as on weight loss or caloric output.
I think, from my own experience, that the cited report offers some valuable clues to fibromialgia, its causes and some potential treatments. But I also think that these relationships are more complicated that they appear on the surface, and may require much more than a magic bullet to help deal with the pain.