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Medical Preparedness – Diabetes

Do you have an extra glucometer in your supplies?

A chronic condition such as diabetes can be life threatening if our fragile medical supply chain is disrupted and medication or supplies to test are not available. Having adequate supplies- an extra glucometer with test trips, batteries, and solution should be in every diabetic’s medical kit. Whether you are type 1, 2 or gestational diabetic having the extra glucometer and supplies is vital. Nowadays, glucometers there are so many high-tech glucometers- ones that use a thin needle under the skin and read glucose levels every few minutes and alert user if levels are out of range, to blood free sensors that use flashing light to take glucose readings- and even more. Even though technology is wonderful, relying on it can be dangerous. Glucometers can fail by giving incorrect readings or stop working altogether. It is important to have another glucometer, preferably one that isn’t as high tech to measure the reading against or in case of altogether failure. In addition, make sure you have an adequate supply of medication- both oral and injectable insulin (along with supplies) in case these drugs aren’t available for an extended period of time. Aim for at least 6-month supply of drugs and supplies. Even more would be better.

Always check with the diabetic and observe for symptoms of hypo/hyperglycemia. If glucose readings are within normal limits established by their care provider but they exhibit symptoms of poor glucose control, retake glucose with alternate glucometer. Contact primary care provider or healthcare professional if needed.

Diabetes testing and lab values

The following are excerpts from the CDC website:

Tests for Type 1 Diabetes, Type 2 Diabetes, and Prediabetes

A1C Test

The A1C test measures your average blood sugar level over the past 2 or 3 months. An A1C below 5.7% is normal, between 5.7 and 6.4% indicates you have prediabetes, and 6.5% or higher indicates you have diabetes.

Fasting Blood Sugar Test

This measures your blood sugar after an overnight fast (not eating). A fasting blood sugar level of 99 mg/dL or lower is normal, 100 to 125 mg/dL indicates you have prediabetes, and 126 mg/dL or higher indicates you have diabetes.

Glucose Tolerance Test

This measures your blood sugar before and after you drink a liquid that contains glucose. You’ll fast (not eat) overnight before the test and have your blood drawn to determine your fasting blood sugar level. Then you’ll drink the liquid and have your blood sugar level checked 1 hour, 2 hours, and possibly 3 hours afterward. At 2 hours, a blood sugar level of 140 mg/dL or lower is considered normal, 140 to 199 mg/dL indicates you have prediabetes, and 200 mg/dL or higher indicates you have diabetes.

Random Blood Sugar Test

This measures your blood sugar at the time you’re tested. You can take this test at any time and don’t need to fast (not eat) first. A blood sugar level of 200 mg/dL or higher indicates you have diabetes.

5 things you can do to improve blood sugar – prediabetic or diabetic

  1. Get moving

Exercise of any form contributes to overall health and is a valuable tool in managing glucose levels. Even a brisk walk has benefits. If you haven’t been exercising, take it slow and easy. The key is to be consistent. If walking, aim for at least 30 minutes a day 5 days a week. Studies reveled that walking 30 minutes a day reduced blood sugar readings by 25 percent. Once you have mastered this, consider HIIT- high intensity interval training-short bursts of intense exercise alternated with low intensity recovery periods. Studies show that this form of exercise has the more powerful effect on glucose control than other forms of exercise. Consult with your primary care provider before embarking on any new exercise regimen.

  1. Reduce stress

High stress hormones prevent the pancreas from producing insulin. When under stress, stress hormones such as glucagon and epinephrine are released and reduce glucose uptake in the muscle. When this happens, more glucose is circulating in the blood, causing hyperglycemia. Ways to manage and reduce stress include journaling, exercise, meditate, connect with others, and my personal favorite, deep breathing. Johns Hopkins Medicine has a good video on deep breathing and stress reduction.

  1. Follow diabetic diet and consider intermittent fasting (IF)- only under the supervision of a healthcare professional

If you are prediabetic or type 2 diabetic intermittent fasting- when you eat in a restricted time frame- for example eat 8 hours and fast 16- has proven health benefits, including the ability to lower blood sugar and in some cases reverse diabetes and insulin resistance (Insulin resistance is when muscles, fat, and liver cells don’t respond well to insulin and can’t easily take up glucose from your blood.)

There are downsides to intermittent fasting. If you are taking medication to lower blood glucose IF could potentially cause a hypoglycemic episode. In addition, with type 1 diabetics, IF can cause hyperglycemia and hypoglycemia.

  1. Get good quality sleep- at least 7 hours a night

Too little sleep can affect glucose levels by:

  • Increasing insulin resistance.
  • Make you hungrier the next day and reduce how full you feel after eating and causes the hunger hormone grehlin to increase
  • Make you more likely to reach for junk foods—those that are high in carbs and sugar.
  1. Stay hydrated and don’t get overheated

Dehydration can lead to an increase in blood glucose because the blood is more concentrated.

Also, extreme heat can cause blood vessels to widen, which in turn causes insulin to absorb more quickly, leading to low blood sugar.

- Brooke Lounsbury, RN

Medical Content Writer

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The Ongoing Adderall Shortage

The ongoing Adderall shortage seems to have no end. Teva, the largest manufacturer of Adderall, is experiencing “ongoing intermittent manufacturing delays” due to increased demand. Every year, the DEA sets a quota — a limit on the amount of raw materials for many controlled substances, like Adderall. This is based in part on the Food and Drug Administration’s estimate of the need for the drug: For 2023, the FDA estimated just over 38,000 kilograms of amphetamine would be sufficient to meet the demand for Adderall and its generics – and the DEA set the quota at 42,400 kilograms, according to a DEA spokesman.

What is Adderall?

Adderall is a combination medication of Amphetamine/dextroamphetamine, used to treat attention deficit hyperactivity disorder – ADHD (attention deficit hyperactive disorder) and narcolepsy, a sleep disorder that makes one drowsy and unable to stay awake during the day.

Adderall is classified as schedule ll drug because its potential for abuse is high, due to its addictive nature. Other drugs that fall in this category are Vicodin, cocaine, fentanyl, oxycodone and Ritalin.

The Adderall shortage is affecting a large part of the U.S. population

According to the CDC:

CDC scientists found that, as of 2016, 6.1 million children aged 2-17 years living in the U.S. had been diagnosed with attention-deficit/hyperactivity disorder (ADHD), which is similar to previous estimates. Researchers also found that children living in rural areas were more likely to have been diagnosed with ADHD and less likely to receive behavioral treatment in the past year compared with children living in urban or suburban areas.

Among all children 2-17 years of age with ADHD, researchers also found:

  • 6 out of 10 (62%) were taking medication for their ADHD, and represent 1 out of 20 of all U.S. children;
  • Just under half (47%) received any behavioral treatment for their ADHD in the past year. Among the youngest children (2-5 years of age), the number increased to over half (60%);
  • Nearly two-thirds (64%) also had another mental, emotional, or behavioral disorder, such as conduct disorder, anxiety, depression, autism, and Tourette syndrome.

During the pandemic, prescriptions for ADHD medications increased significantly

Relative annual percent change in percentage of persons aged 5–64 years with at least one stimulant prescription fill, by sex and age group — MarketScan commercial databases, United States, 2016–2021

How Adderall works

It is a stimulant that works by increasing the amounts of dopamine and norepinephrine in the brain. Dopamine is a neurotransmitter that plays a role in the “reward” center of the brain. It is released during pleasurable activities such as eating, sex, regular exercise and any activity that involves expectation of reward.

Norepinephrine affects how the brain responds to events, particularly how it pays attention and the speed with which it reacts to outside stimuli., belongs to a class of drugs known as stimulants. It can help increase your ability to pay attention, stay focused on an activity, and control behavior problems. High levels of norepinephrine activate the “fight or flight” part of the sympathetic nervous system, leading to fear and anger responses.

What non pharmaceutical interventions you can do to increase dopamine and norepinephrine

There are a wide variety of treatments available for ADHD, including medication, counseling and behavior therapy, and lifestyle changes.

  • Eat tyrosine rich foods

Tyrosine is a non-essential amino acid, meaning the body can synthesize it, and is a precursor to norepinephrine and increases dopamine availability. Tyrosine rich foods include:

Beef, pork, fish chicke4n, firm tofu, milk, low fat ricotta cheese, large white beans, squash and pumpkin seeds and wild rice

  • Regular exercise

Regular, consistent exercise has been proven to increase dopamine levels in the brain. In addition, regular exercise is widely known to improve mood.

  • Balance gut health

Recent research is proving the important role your digestive system has in producing many neurotransmitters, including dopamine. Healthy microbiota in the gut leads to dopamine, serotonin and other neurotransmitters increase. Fermented foods which are rich in probiotics, kefir,yogurt with active cultures and fiber rich fruits and vegetables contribute to overall health.

  • Get good quality sleep

Sleep allows the body to repair and rejuvenate. Sleep is one of the most important and underrated activities we engage in. When rested, your body is able to hand stressors and remain more alert and focused.

  • Practice meditation or prayer

 According to a study “Increased dopamine tone during meditation-induced change of consciousness” two sets of participants were evaluated. One  set had eyes closed, and not instructed to do anything. The other set practiced focused meditation. The focused meditation group had a  65% increase in endogenous dopamine release. An increase in dopamine also occurred during a 7-day spiritual retreat.

- Brooke Lounsbury, RN

Medical Content Writer

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Everyone should be empowered to care for themselves and their loved ones during the unexpected.

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Keeping you informed and safe.

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What is Discontinuation Syndrome?

You may have heard or been told by your care provider to never stop taking your antidepressant medication abruptly and wondered why. The side effects of suddenly stopping your antidepressant can be severe and last for months or even years.

What are antidepressants?

Antidepressants are prescription drugs used to treat clinical depression. They are one of the most commonly used medications on the market. 11% of Americans over the age of 12 take antidepressant medication.

They also are used to treat:

  • Anxiety disorders
  • Obsessive compulsive disorder (OCD)
  • Panic disorders
  • Serious phobias, such as agoraphobia and social anxiety (social phobia)
  • Bulimia
  • Post-traumatic stress disorder (PTSD)
  • Help ease symptoms associated with nicotine or methamphetamine withdrawal

How antidepressants work

It’s thought that antidepressants work by increasing neurotransmitters. These are chemicals in the brain like serotonin and noradrenaline. They can improve mood and emotion, although this process isn’t fully understood.

Types of antidepressants

Selective serotonin reuptake inhibitors (SSRI)

SSRIs are the most widely prescribed antidepressant. SSRIs work by increasing serotonin levels in the brain. Serotonin is a neurotransmitter (a messenger chemical that carries signals between nerve cells in the brain). It’s thought to have a good influence on mood, emotion and sleep.

After carrying a message, serotonin is usually reabsorbed by the nerve cells (known as “reuptake”). SSRIs work by blocking (“inhibiting”) reuptake, meaning more serotonin is available to pass further messages between nearby nerve cells.

A few examples are:

  • citalopram (Celexa)
  • paroxetine (Paxil)
  • sertraline (Zoloft)
  • fluoxetine (Prozac)

Serotonin and norepinephrine reuptake inhibitors (SNRI)

SNRIs are similar to SSRIs. Evidence suggests that some people respond better to SSRIs, while others respond better to SNRIs. They are sometimes used to treat anxiety disorders and long-term (chronic) pain, especially nerve pain.

Examples of SNRIs include:

  • duloxetine (Cymbalta)
  • venlafaxine (Effexor)
  • desvenlafaxine (Pristiq)

Tricyclic antidepressant (TCA)

TCAs are an older type of antidepressant. They’re no longer usually recommended as a first-line treatment for depression. This is because they can be more dangerous if an overdose is taken. They also cause more unpleasant side effects than SSRIs and SNRIs.

People with severe depression who fail to respond to other treatments may be prescribed TCAs. TCAs may also be recommended for other mental health conditions, like OCD and bipolar disorder.

Examples of TCAs include:

  • amitriptyline
  • imipramine
  • nortriptyline
  • Some types of TCAs, like amitriptyline, can also be used to treat chronic nerve pain.

Atypical antidepressants

Atypical antidepressants work in a manner different than other antidepressants. They change the levels of one or more neurotransmitters, such as dopamine, serotonin or norepinephrine.

Examples of atypical antidepressants include:

  • Bupropion (Wellbutrin SR, Wellbutrin XL, others)
  • Mirtazapine (Remeron)

What is half life?

A half-life is the time it takes for a drug in your body to reduce by half. Half-life does not change depending on the dosage a person is taking or the amount of time they have been on medication. Half-life can vary from person to person according to their overall health and other factors.

Every drug has its own unique half-life. For instance,

SSRIs

 Most SSRIs have a half life or a day or so, except Prozac

  • Prozac (fluoxetine) has a longer half life than many other antidepressants. Depending on individual metabolism and health, it can take 1-4 days to reach half-life, and up to 30 days to be completely removed from the body.
  • Sertraline(Zoloft)-22 to 36 hours
  • Citalopram (Celexa)-36 hours
  • Paroxetine (Paxil)-24 hours

SNRIs

  • Duloxetine (Cymbalta)- 8 to 17 hours
  • Venlafaxine (Effexor)-4 to 7 hours
  • Desvenlafaxine (Pristiq)-about 11 hours

TCAs   

  • Amitriptyline- 9-25 hours
  • Imipramine- 19 hours
  • Nortriptyline-36 hours

Atypical antidepressants

  • Bupropion (Wellbutrin SR, Wellbutrin XL, others)- 33-37 hours
  • Mirtazapine (Remeron)- 20-40 hours

Discontinuation syndrome

Never go off or change the dose of your antidepressant without the guidance of your care provider.

Discontinuation syndrome occurs when an antidepressant is stopped suddenly. Depending on the half life of the drug, the symptoms can be more severe and longer lasting. Withdrawal symptoms usually come on within a few days of stopping the medicine and can last from 1 week to several months or more. Some people have severe withdrawal symptoms that last for years.

Withdrawal symptoms

Neurotransmitters are not only active in the brain but the entire body. Abruptly stopping antidepressants causes changes to neurotransmitter levels that can be felt throughout the body.

There are many mental and physical symptoms when coming off /abruptly stopping antidepressants including:

  • Mood swings, agitation, manic feelings, depression, irritability, confusion, paranoid, suicidal
  • Irritable, anxious, confused
  • Balance: dizziness, light-headedness, vertigo
  • Unusual sensations: numbness, sound hypersensitivity, “brain-zap”, which is a feeling of an electric shock to the head
  • Stomach cramps, loss of appetite, nausea, vomiting
  • Insomnia, vivid dreams or nightmares
  • Restless legs, uneven gait
  • Slurred speech
  • Heat sensitivity, sweating

Given the severity of symptoms from abruptly stopping antidepressants, be sure you have enough in case of supply chain disruption. Review your medications with your care provider and have a plan in place for enough medication in the event your medication is in short supply.

- Brooke Lounsbury, RN

Medical Content Writer

Lifesaving Medications

Everyone should be empowered to care for themselves and their loved ones during the unexpected.

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“Normal” Won’t be Returning Anytime Soon

5 Steps to Help You Navigate These Challenging Times

You are not alone. We are all feeling tensions both globally and at home. We are on the precipice of World War 3, out of control energy and food prices, still reeling from the pandemic, layoffs, consumer debt hitting record highs, severe weather extremes, supply chains disrupted leading to drug and medical supply shortages- these are affecting all our lives. No one is immune to this assault.

To overcome and eventually prosper in this ever changing landscape, we must be solution oriented. Difficult times are here, and it doesn’t look like our “normal” will be returning anytime soon. Our families, communities and our very lives depend on how we face the challenges we are experiencing and will be experiencing over the coming months and years.

Below are 5 steps to guide you through these rocky times. 

  1. Focus on solutions
  • “We become what we think about” Earl Nightingale
  • “When you focus on problems, you get more problems. When you focus on possibilities, you have more opportunities.” Zig Ziglar
  • “Good health is true wealth.” – Urijah Faber “

What challenges are you and your family facing right now? Financial? Health related? Whatever the challenge is there is a solution. We need to acknowledge our problems, shortcomings and unexpected turns our lives take. Absorb and realize the impact these have in our daily living. However it isn’t healthy for you or anyone around us to dwell too long in this. Focus on possibilities. This will lead to opportunities.

2. Plan success = Reduce stress

Solutions start with a realistic plan 

Take time out, away from the noise of media, work, and technology each week. Set priorities to work on during the week. Start each day reviewing this list, set aside time for tasks that take precedent over others. Review your plan and goals. Make sure they are realistic and allow enough time to implement them. What can you do NOW that can make your day run smoother and more efficiently? Prioritize your days tasks; work towards accomplishing them. Move undone tasks to the next day. And so on.

Download our Goal Setting PDF to help you make and track your goals!

Finances-a major stressor

The out-of-control gas, energy and food prices have caught many off guard. You are not alone.

Financial Stress Has a Surprising Link to People’s Health, Relationships, Sleep, and More according to a white paper by Thriving Wallet, Discover and Thrive Global. Their survey included 3,000 adults. 90 percent stated that finances played a major part in wellbeing and stress levels. 

U.S. credit card debt jumps 18.5% and hits a record $930.6 billion 

If you are experiencing financial struggles, there are agencies that can help you budget and plan your finances. Consumer Review lists the top 7 financial consolidation companies. They work with you to consolidate and work with companies you owe money to. Some offer financial coaching and budget planning and clasess on financial education.  

Health

If you are having difficulty affording your prescription drugs, paying for insurance and copays, office visits, etc check with your local care provider and county health and welfare offices for any programs you may qualify for. 

Physical health-If you are out of shape, work on an exercise and diet program with your healthcare provider. Many chronic health conditions respond positively to lifestyle and food choices. Reduce or eliminate alcohol. Alcohol has empty calories and is a depressant.  In some cases, lifestyle changes can reduce or eliminate the need for prescription drugs. 

 Check out online exercise classes- You Tube has many classes geared for beginner to advanced levels. These are free, easily accessed and can be done around your schedule. Plan meals. Restaurant food is convenient but expensive and in many cases not as good tasting or nutritious as a home cooked meal. Make a meal plan and grocery list and don’t shop when hungry. 

Emotional health– If you are experiencing anxiety, are depressed, or feeling stressed talk your healthcare provider. Find meaningful work, volunteer, or take up a hobby. Plan a coffee date with a friend. We are wired for connection. Deep breathing exercises along with mediation or prayer can have profound effects on our health. 

Be prepared for minor emergencies

Urgent care visits may or may not be entirely covered by your health insurance. Depending on deductible you may have to pay out of pocket for the visit. As of this writing, the cost of an urgent care visit, without tests or treatments is a minimum of 75 dollars. Having basic knowledge and supplies for minor emergencies can reduce cost, exposure to diseases, travel time and cost(gas). Enroll in a basic first aid and cpr class if you aren’t medically trained. Keep an updated list of medications, medical conditions and allergies for all members of the family readily available. Look into telehealth visits for minor emergencies. Keep your medical supply kit stocked. In addition, a Jase case , contains antibiotics that cover a wide variety of infections, along with a consultation with a doctor if you have questions. This alone can keep you or your loved one out of the doctor’s office and on the road to recovery.

3. Implement plan- the most important step

A well thought out plan will free up time in your day to reach your goals. Taking charge of your finances will reduce stress and free up cash for necessities. Health is wealth, don’t neglect your health! Carve out time each day to put your plan in place. Stick to the plan, revise as necessary. The most important part is consistency.

4. Assess plan-weekly

Set aside time for assessing your plan. Did you reach your goals? If not, why? What barriers did you encounter? What went well? Were you able to free up time in your day for exercise or hobby? Assess your plan at least once a week will help you tweak and improve your plan and reach your goals.

5. Adjust and revise as necessary- or the only thing consistent in life is change

Plans are not meant to be set in stone. What worked well one day or week may not work at all for the following week. Schedules change- planned and unplanned events and life-come and go. If you get off track, jump back in. You will reach your goals!

- Brooke Lounsbury, RN

Medical Content Writer

Lifesaving Medications

Everyone should be empowered to care for themselves and their loved ones during the unexpected.

Recent Posts

Keeping you informed and safe.

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