Medication - JASE Medical

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

Lifesaving Medications

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

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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,


 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


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


  • 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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The Overlooked Vital Sign

As long as man has walked the earth, pain has been part of life.

Pain is defined as a localized or generalized unpleasant bodily sensation or complex of sensations that causes mild to severe physical discomfort and emotional distress and typically results from injury or disease. It is a complex mechanism that alerts us to injury or illness. Pain isn’t a pleasant experience; however, it can save your life.

Why is pain called the 5th vital sign?

In 1995, Dr. James Campbell addressed the American Pain Society urging that health care providers treat pain as the “fifth vital sign” (The other vital signs are blood pressure, heart rate, temperature, and respiratory rate.) highlighting the need for improved pain care. The tide has turned for the better. Historically, care providers hadn’t adequately managed pain. It is now considered a very important part of a patients assessment and well-being.

Pain can be both physical and psychological. In fact,  physical and psychological pain share the same neuro mechanisms and the same regions of the brain where these processes take place. In addition, both physical and psychological pain stems from inflammation and the inflammatory response.

Physical pain-acute and chronic

Acute pain- Acute pain comes suddenly, can be severe and resolves over a short period of time (within a month or so). Injuries, illnesses (such as sore throat), labor and childbirth, dental work, are classified as acute pain.

Chronic pain- Chronic pain is pain that lasts a sustained period, usually lasting 3 or more months. Examples are arthritis, bone healing after break, cancer, back pain, fibromyalgia, autoimmune diseases. Chronic pain can cause tense muscles, lack of energy, depression, and anger, which can lead to psychological pain. An estimated 35-45% of chronic pain sufferers experience depression.

Psychological pain- Rejection, loss of a loved one, loss of job or health and chronic pain are a few ways psychological pain can manifest. These emotions (anger, depression, rejection, loss) can trigger inflammation, which in turn can cause psychological pain. Which then manifests as physical pain.

Assessing pain-verbal and nonverbal/physical cues

Seek medical attention if experiencing abdominal pain, pain from an injury, trauma, pain for unknown causes or a fever for unknown reasons.

Depending on the age and mental capacity of the patient, pain can be expressed in either verbal, nonverbal/physical. Young children, infants, and patients with cognitive deficits (Alzheimer, autistic) won’t be able to adequately report pain. It is important to assess the person’s ability to accurately express their pain. Dementia patients may state they aren’t hurting; however, their body language may reveal otherwise. The same goes for young children. Nonverbal cues should be relied on in these groups. Observe and evaluate.

Verbal expressions- Yelling, crying, tears, hyperventilating, stating they are in pain, moaning, calling out for help are examples of verbal expressions of pain.

Ask:( Verbal patients with no age related (young children and infants) or cognitive impairment)

  • Type of pain? Stabbing, burning, aching, dull, throbbing sharp, cramping?
  • Location (is there more than one place)
  • Duration/activity- How long has it hurt? Does the pain come and go? Is there pain with specific activity- are there activities that make the pain worse? Are there any activities or postures that provide pain relief?

Use the pain scale assessment to determine severity of pain

Nonverbal/physical- Some nonverbal expressions of pain include facial expression of pain, altered gait/limping, rubbing a body area, tense tone/rigidity, decreased movement, guarding a part of the body that is hurting, pacing, rocking, fidgeting, increased heart rate and blood pressure, sweating. This type of assessment will be necessary when working with nonverbal patients and very young children.

Infants pain communication

Infants- Since infants can’t tell you when they are in pain, it is very important to know the signs of distress/pain.

  • They may cry or whimper and be unable to settle.
  • They may be tense, with clenched fists and may keep their arms and legs close to their chest.
  • They may be fidgety, agitated or have a disturbed wake / sleep schedule.
  • They may be pale, flushed or sweaty.
  • They may shut their eyes tightly, furrowing their eyebrows or have larger than normal pupils.

The NIH has developed a neonatal/ infant pain scale, which can be accessed here. This is a handy tool to help determine your child’s level of distress/pain.


(Always check with your care provider if the pain is excessive, unknown in origin and before taking any over the counter medications)

Pain scale

Utilize the pain scale assessment tool. Have them point to which face they feel best describes how they are feeling or use the 1-10 severity of pain level tool.


Since pain causes inflammation, anti-inflammatory drugs such as ibuprofen and naproxen can help. Pain can cause muscles to tense (guarding) which can make the pain worse. Talk to your care provider about therapies or drugs that may help with this.

Nonpharmacological interventions to relieve pain

Both acute and chronic pain sufferers can benefit from several therapies to relieve pain.

Some of these therapies/interventions are:

  • Accupuncture– involves the insertion of extremely fine needles into the skin at specific “acupoints.” This may relieve pain by releasing endorphins, the body’s natural pain-killing chemicals, and by affecting the part of the brain that governs serotonin, a brain chemical involved with mood.
  • Companionship can relieve anxiety and take the focus off the pain.
  • Positioning to relieve pain.
  • Hot/cold therapy Depending on the type of pain (injury or cramp, for instance) heat or cold can be a powerful tool to alleviate pain.
  • Massage therapy- Especially effective if tense from pain.
  • Meditation/prayer can calm the mind and body.
  • Relaxation/guided imagery positive, guided imagery is beneficial by allowing the body to relax-check out this video on guided imagery
  • Deep breathing exercises- check out this video on deep breathing to reduce pain.
  • Transcutaneous Electrical Nerve Stimulation (TENS) is a procedure in which electrodes, placed on a person’s back, give off an electric signal that stimulates nerve cells through the skin. The numb-like feeling that results. It can help some people overcome pain. TENS blocks pain messages to the brain and modifies pain perception.

- 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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