Equation for Success: Diabetes Medication, Diet, and Exercise

Author(s):

Melinda J. Throm, PharmD, BCPS

One in 14 people have diabetes. People with blood glucose levels (also known as blood sugar levels) not at goal are at increased risk for developing long-term complications that may lead to death. In the next 30 years, more and more people will experience complications from their diabetes.

Luckily, prevention of these complications is simple. Prevention involves balancing diet, exercise, and appropriate medication use on a daily basis. Achieving this balance is as easy as learning your ABCs and 123s. Also, more people are using prefilled insulin pens.

How Can I Control My Diabetes?

To prevent long-term complications of diabetes, it is important to achieve and maintain ABC goals (see the Table).

Why May I Not Achieve My Goals?

Half of the people with diabetes do not meet their goal ABCs. There may be several reasons why. Many pills for type 2 diabetes must be taken with food, have side effects (such as stomach upset, diarrhea, or damage to the kidneys or the liver), and may be expensive. One quarter of the people with diabetes do not take their diabetes pills on a daily basis.

Most people with type 1 diabetes require up to 3 or 4 daily insulin injections. Some people with type 2 diabetes may need a once-daily injection of insulin taken alone or with their diabetes pills. If pills for type 2 diabetes stop working, 3 or 4 daily injections of insulin may be needed. Many people who use insulin draw it up from a vial in special syringes. Only about three quarters of those who take insulin use it as recommended. However, prefilled insulin pens help make taking their insulin more convenient.

About half of the people with diabetes eat a healthy diet and exercise daily. If you have diabetes, high blood cholesterol, and high blood pressure, you probably take at least 4 medications each day, check your blood sugar levels up to 4 times daily, and see your health care provider up to 4 times each year. It is not surprising that many people with diabetes have a hard time with adherence.

What Is Adherence?

A person with diabetes who takes medications on a daily basis, eats a well-balanced diet, and exercises on a regular basis to achieve blood sugar, blood pressure, and blood cholesterol goals is said to have good adherence.

What About My Diet?

It is important to eat the right amount of healthy foods:

Whole grain breads
Calcium-rich dairy products
Fresh fruits and vegetables
Low-fat or lean meats, chicken, fish

The Food Pyramid (see the Figure) or a special food expert (a dietitian) can help you decide what to eat. You should limit high-salt and high-fat foods.

How Much Exercise Is Enough?

At least 30 to 60 minutes of moderate physical activity most days of the week is best. Regular exercise can help you lose weight and reach your ABC goals.

Who Can Help Me Achieve My Goals?

You work with many health care professionals to achieve your goals. Pharmacists are easily accessible and trustworthy. It is estimated that patients see their pharmacist 7 times as often as they see their doctor. Your pharmacist wants you to achieve your ABC goals to prevent complications.

How Can Taking My Medications Be Made Easier?

Medication reminder charts, special pill containers, and caregiver or health care provider prompts are some ways to help you remember. For expensive medications, patient assistance programs are available.

Whether you have type 1 or type 2 diabetes, drawing up insulin doses from a vial with a needle and a syringe may be inconvenient, time-consuming, and embarrassing. Prefilled insulin pens are an alternative. New needles used with the pens are practically pain-free. For each dose, you simply dial the appropriate number of insulin units. Insulin pens, such as the FlexPen, are:

Discreet and convenient (they safely fit in your pocket or purse)
Easy to handle (they are prefilled and they are disposable)
Easy to use (you dial the dose, insert the needle, and push the button)
Accurate (they have a large, clear scale for setting and adjusting the accurate dose)

Using insulin pens may keep you from having to visit your doctor or a hospital and thus lower your health care costs.

My Adherence Checklist?

In order to prevent the long-term complications of diabetes, it is important to adhere to the ABCs of diabetes care: