Fast Changes

At the end of another week of three 36 hour fasts, I’m contemplating how much my life has already changed, and how much it may still change, as I continue my fasting and attack on diabetes.

Changing your lifestyle is the first key to beating diabetes

First of all, I currently weigh about 30 pounds less than when I started on the low carb high fat program. Fasting started about two weeks later, after I took the time to consult with my endocrinologist about how to manage my blood sugars during my fasting. We had already switched to two different types of insulin, long acting and fast acting, and I’m using the new meter that tests all day long, so he felt that the risk of a dangerous low could be managed.

Secondly, I now know that fasting isn’t really all that hard, for me. I suspect that motivation is a huge part of this, but fasting seems pretty straightforward to me now. Take care of my insulin and blood glucose levels, otherwise just don’t eat. Anything. Instead of it being hard, it’s been pretty easy, and the results so far are gratifying.

Weighing myself every day has become a lifetime habit. Getting my weight to a better levels is one of the keys to improving my diabetes, blood pressure, arthritis, and many other inflammatory problems and diseases.

I made the change to my lifestyle on July 10, and began fasting near the end of the month. It’s now the end of the first week of September so I’m approach two months into the program. My insulin levels are lower than ever as are my glucose readings. I take half of the prescribed dose of long acting insulin these days, and no fast acting insulin at all on my fasting days, and about three quarters of the previous prescibed dose on my non fasting days.

The biggest concern is keeping my blood sugars high enough not to end up in a coma from hypoglycemia from having too much insulin in my system and lowering my blood sugar too much. In more than 20 years of trying to manage my diabetes low blood sugar was never ever a remote possibility, even after being on insulin, as my blood sugars were always higher than desireable.

I recently made two new holes in my belt to keep my pants from falling down, after moving from the last belt hole at the other extreme. I didn’t measure my waist when I started because I was too embarrassed to admit how big I had become. Now I wish that I had because I’m shrinking fast.

When I started this fast, I told myself that I would stay the course for three months, and then re-evaluate where I’m at then, from a health perspective as well as general feeling perspective. I also said that I would be happy if I were to get my weight under 200 lbs or 90 KG by the end of the 90 days of fasting. Today I weigh 217 lbs, down from 244 lbs on July 10th. I believe that I will achieve both goals, at which time I will commit to the next phase of this program.

I wish I could say that there have been no negative effects of fasting. It’s a little early to make that statement. What I can say is that there haven’t been any, so far.

Children and diabetes

I’m current working through the discovery that diabetes and obesity are the evil twins of post-second war American policy in health care and diets. If you read about the history of high carb, low fat diets you soon discover that the United States, and the rest of the world, were conned years ago, about the benefits of high carbs and the dangers of fat, any fat, but especially fat from animal sources. These policies were initiated by the National Health authorities to try to reduce heart disease but instead have led to several generations of increasingly unhealthy populations.

We are taught all the wrong things, for good reasons but terrible outcomes.

Children don’t eat too much. But their choices are influenced by what they are taught by their parents as well as what they see in the media, and on social media. All of the sources of information are tainted by misinformation pumped out by a combination of well meaning but uninformed dieticians, medical doctors, school authorities, health boards and urged on by corporate interests who make money selling foods based on this advice. Eating foods that inevitably bring on obesity, as surely as clouds bring on the rain, is dangerous. Childhood habits encourage the eating of carbs and sugar, rather than healthier alternatives.

Our generation is perhaps the last generation that needs to be poisoned by the demonization of fats and the promotion of carbs and sugars. The recent book by Dr. Jason Fung, the Diabetes Code, should be must reading for everyone responsible for feeding themselves, but especially for anyone responsible for giving advice on healthy eating and living.

Fasting: For my health’s sake

I started an intermittent fast a little over a week ago. By this I mean that three times a week, for 36 hours in the row, I don’t eat anything.

Nothing.

Nada.

On the days between my fasting, I eat less than 150 carbs including sugars, but mostly avoid anything with added sugars. I do eat some fruit in the form of berries, apples, bananas, and other fruits, but no more than two servings (basically half an apple is one serving).

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My plan is to do this for at least three months, or until I don’t need to do it to get rid of my diabetes. I’ve had diabetes for a long time, and have been on insulin for about 10 years or so. I’ve been told all of my life that diabetes is incurable, but treatable with diet and exercise. My doctors have always told me that it is a progressive disease. Over time it gets worse and worse. Which it has in my case. That is, gotten worse and worse.

My doctor and I decided to try the new patch and Free Style Meter, along with long lasting insulin and fast acting insulin. Basically my previous insulin regime had caused me to increase my weight to 245 pounds. I’d already been diagnosed as obese by my family doctor for more than twenty years, and I’d never weighed more that 220 prior to going on insulin. This new meter and new type of insulin is supposed to be an improvement over the previous mixed insulin (Humulin 30/70). The doctor said that he hoped that it would lower my AIC by reducing my base blood sugar to 7, and cause my blood sugar to fall to 10mml within two hours of eating, after taking fast acting insulin.

He felt that the change in metering by blood sugars and changing to two different types of insulin, might result in better A1C after ninety days.

Wow! Was he surprised when he saw me after 90 days, during which I’d only had the meter and new meds for about three weeks. My AIC was down from 9.9 to 8.1. My weight was down to 234 pounds from 244. My blood pressure was stable. This represented a major change in direction. For the first time in 20 years of having diabetes my weight was going in the right direction without me having to spend a month in the hospital. My blood sugars had also dropped so that my every day blood sugar range was then 5-8 mmls routinely, with only periodic spikes up to 9 or higher.

In the past I would have been ecstatic with these results, but reading Dr. Jason Fung’s “Diabetic Code” has taught me that not only can diabetes be controlled, it can be beaten altogether. But only by following a regime that allows the liver and internal organs to cleanse themselves of internal fat, will I get rid of diabetes for myself. And that regime is intermittent fasting. As the doctor indicates in his book there are many ways to achieve the results desired by different fasts but he recommends the fasting schedule and routing I’m following.

Close-up of female nurse showing heart shape with hands isolated on white background

Starting eleven days ago, I have been fasting, and following Dr. Fung’s advice. And yes, it’s been a bit of a challenge. But mostly convincing my family and friends that I’m not out of my mind and am endangering my life with such a radical change, and so quickly.

This is my fifth day of fasting, and I couldn’t be happier with my results, even after such a short period. My blood sugars have gone down and down, now typically in the target range of 5.8 to 7.8 every day. I now control my insulin, reducing the amount given to the amount needed to maintain my blood sugars in the optimal zone. On fasting days I take a 20 unit shot at midnight, and during the day watch my blood sugar coast along at 4.5. I’m almost ready to cut it again. But before I do that I think I will cut out one of my oral medications first, and set what effect this has on my sugars.

Diabetes is controllable and probably to a degree that it is no longer evident at all. But even if all I could hope to achieve was my current results, I would have been very satisfied with myself.

But I’ve just started.

So, my faithful reader, keep reading. I keep shrinking, and getting healthier.

The Diabetes Code: Prevent and Reverse Type 2 Diabetes Naturally

I’m reinventing myself again. My goal is to eliminate or radically reduce prescription medications for diabetes, and a whole host of inflammatory diseases caused by the same thing that causes diabetes. 

Change doesn’t come easily when one is used to surrendering autonomy to the medical profession and simply being the obedient patient. It is NOT SAFE to simply trust that doctors know what is best for us. We already know this, but it is no surprise when we obediently follow their advice. Like everything else in life, you need to check the information out for yourself, and ask a lot of questions.

It seems that diabetes is actually caused by the thing that is supposed to cure it – insulin. In his book, The Diabetes Code, Dr. Jason Fung has coined the word diabesity – combining the words diabetes with obesity, to indicate that diabesity is caused by excess glucose in the body stored as fat, particularly in the internal organs, particularly the liver. There is a cycle in the body, controlled by the liver, that triggers the production of excessive blood sugar and results in insulin resistance.

Too much sugar and the body develops insulin resistance because the body simply can’t absorb any more sugar into the cells. To make matters worse, the medical profession prescribes increased insulin, or even just metformin, which helps the body to try to consume even more sugar.

Dr. Fung’s prescription for the elimination of diabetes is contained in a book called the Diabetes Code. Read it and weep, but understand that it calls for regular fasting to reset the diabetes cycle. 

This week I’m seeing my endocrinologist, and am going to be seeking support to follow Dr. Fung’s program. I’m curious as to what he will say.

Will he continue to prescribe insulin, Janumet, and Invokana to address my extreme diabetes? Or will he support a major lifestyle readjustment along with a fasting program to eliminate the disease altogether, eventually? I have already started to substantially reduce my carbohydrates and sugars in preparation for the revised program, and have already lost over 10 lbs in just under ten days.

I started writing about my diabetes and this journey several months ago, when I decided to review the prescription medications and their side effects, as a result of finally getting fed up with being sick, and seeming to get worse and worse and the years roll by.

With the encouragement of my middle son, Don, I began to look at diet as a major issue in my illnesses, as well as my diabetes. Sure, I went to many diabetes dietician clinics years ago when I first became aware that I was a diabetic. They always talked about reducing carbohydrates and sugars, and using diet and exercise to control my weight, and therefore help control my blood sugars.

As noted by Dr. Fung in his book, diet and exercise programs have been a massive failure, all over the world, in controlling or preventing diabetes or obesity. There are many reasons for this failure, but the medical professional continues to support this old and tired cant, that doesn’t actually work. I think the real reason that nobody wanted to actually examine diabetes and obesity with new eyes is that the old views are very profitable, to the pharmaceutical industry, the vegetable oil industry, even the health and diet industry itself.

But you’d have thought that somebody would have noticed that it didn’t work. And finally somebody has.

Anyway. Wish me luck on this new direction in my journey to solve my diabetes, and eliminate the side effects of so many medications by eliminating my need for them at all.

Finally, my wife Katherine has been diagnosed with Type 2 Diabetes in the past month, and has begun the journey through this ugly territory as well. Hopefully we can solve the riddle of the disease for both of us, and she never has to go through the years of pain and agony I am experiencing as a result of having poorly controlled blood sugar for the past twenty five years.

A Critical Medical Self-Analysis

Part Two

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.

Current Symptoms

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.

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  • 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.

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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.

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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.

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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.

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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.

A Critical Medical Self-Analysis

Purpose of this exercise

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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.

Current Symptoms

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  • 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 difficulties breathing.
  • 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 memory
  • 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.
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Rain Coast Review Blog author

  Conditions and/or diseases

  • Diabetes
  • Slightly elevated cholesterol
  • Sleep apnea
  • Asthma and bronchitis (borderline COPD)
  • Diabetic Neuropathy
  • Evidence of diabetic damage to my eyes
  • Fatty liver
  • Obese
  • Arthritis in hips, hands, shoulders, lower back
  • Tendonitis in hands and wrists
  • Eczema
  • 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
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Discussion

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 so often.

Diabetes blood sugar and neuropathy management

Endocrinologist

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
  • constipation
  • diarrhea
  • difficulty speaking
  • drowsiness or tiredness
  • dry mouth
  • nausea
  • vomiting

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

Other diabetes Medications

In addition to the two new forms of insulin, and the gabapentin for treatment of the diabetic Neuropathy I also take two other diabetes medicines.

Jentadueto

2.5/1,000 MGs – taken twice daily prior to morning and evenings meals.

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 08/28/2017

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:

  • cough,
  • sore throat,
  • sinus pain,
  • stuffy nose,
  • upset stomach,
  • weight gain,
  • pancreatitis,
  • diarrhea, and
  • low blood sugar (hypoglycemia).

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.

Invokana

300 MG – taken once daily prior to the morning meal.

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 11/12/2018

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:

  • urinary tract infections,
  • increased urination,
  • yeast infections,
  • vaginal itching,
  • thirst,
  • constipation,
  • nausea,
  • fatigue,
  • weakness,
  • skin sensitivity to sunlight,
  • hypersensitivity reactions (including skin redness, rash, itching, hives, and swelling),
  • bone fractures, and
  • kidney problems.

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

Spiriva HandiHaler (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:

  • dry mouth,
  • constipation,
  • upset stomach,
  • vomiting,
  • cold symptoms (stuffy nose, sneezing, sore throat),
  • nosebleed, or
  • muscle pain.

Tell your doctor if you have any serious side effects of Spiriva HandiHaler including:

  • difficult or painful urination, or
  • fast heartbeat.

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

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 1/22/2018

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:

  • headache,
  • throat irritation,
  • nausea,
  • vomiting,
  • stomach upset,
  • diarrhea,
  • back pain,
  • stuffy nose,
  • muscle or joint pain, or
  • changes in your voice.

Tell your doctor if you experience unlikely but serious side effects of Symbicort including:

  • white patches on tongue or in mouth,
  • signs of infection (such as fever, persistent sore throat),
  • mental/mood changes (such as nervousness),
  • trouble sleeping,
  • vision problems (such as blurred vision),
  • increased thirst or urination,
  • muscle cramps, or
  • shaking (tremors).

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

Salbutamol 100ug – two puffs as required

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 2/7/2019

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:

  • nervousness,
  • shaking (tremor),
  • palpitations,
  • headache,
  • mouth/throat dryness or irritation,
  • cough,
  • hoarseness,
  • sore throat,
  • runny or stuffy nose,
  • nausea,
  • vomiting,
  • dizziness,
  • sleep problems (insomnia),
  • muscle pain,
  • changes in taste, or
  • diarrhea.

Seek medical help immediately if you have rare but serious side effects of Ventolin HFA, including:

  • chest pain or
  • irregular heartbeat.

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 10/24/2018

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 adult patients.

Common side effects of Protonix include

  • injection site reactions (redness, pain, swelling),
  • headache,
  • nausea,
  • vomiting,
  • abdominal or stomach pain,
  • diarrhea,
  • gas,
  • dizziness,
  • joint pain,
  • weight changes,
  • drowsiness,
  • tired feeling, or
  • sleep problems (insomnia).

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 4/23/2019

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:

  • constipation,
  • diarrhea,
  • nausea,
  • fatigue,
  • gas,
  • heartburn,
  • headache, and
  • mild muscle pain.

Contact your doctor if you experience serious side effects of Lipitor including:

  • muscle wasting and muscle breakdown (rhabdomyolysis),
  • confusion or memory problems,
  • fever,
  • dark urine,
  • increased thirst or hunger,
  • drowsiness,
  • loss of appetite, or
  • yellowing 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:

  • dizziness or faintness due to low blood pressure
  • cough
  • dizziness
  • chest pain
  • nausea
  • vomiting
  • diarrhea
  • weakness or tiredness
  • Serious side effects

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:

  • low blood pressure. This is more common when you’re starting the drug or increasing doses. Symptoms include:
  • dizziness
  • lightheadedness
  • allergic or hypersensitivity reaction (angioedema). Symptoms include:
  • swelling of your face, lips, tongue, or throat
  • trouble breathing
  • stomach pain with or without nausea and vomiting
  • liver problems (jaundice). Symptoms include:
  • yellowing of your skin or the whites of your eyes
  • stomach pain
  • fatigue
  • swelling (edema). Symptoms include:
  • swelling of your feet, legs, or hands
  • low white blood cell count. Symptoms include:
  • sore throat
  • fever
  • purple spot on your skin caused by internal bleeding (purpura)
  • fast or abnormal heart rate or palpitations. Symptoms include:
  • feeling like your heart is fluttering
  • high potassium levels. Symptoms include:
  • weakness
  • arrhythmia (irregular heart rate)
  • worse kidney function. Symptoms include:
  • nausea and vomiting
  • decreased urine output when urinating
  • fatigue
  • loss of appetite

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 and older)

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.

Special considerations

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 years)

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.