diabetes dialogue your guide to diabetes medications€¦ · different classes of oral diabetes...

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Easy-to-understand information about yourdiabetes medications

• How they work• What you

should know• What to ask

your doctor

A supplement to Diabetes Dialogue, an official publication of the Canadian Diabetes Association

Your Guide to Diabetes Medications

2 YOUR GUIDE TO DIABETES MEDICATIONS • SPRING 2006 • CANADIAN DIABETES ASSOCIATION

YOUR GUIDE TO DIABETES MEDICATIONS

When you learn that you havediabetes, you need to make imme-diate changes. Choose healthierfoods and increase your activitylevel. Work toward long-term tar-gets for your weight and physicalactivity level. You’ll not onlyimprove your heart and lung fit-ness, you’ll reduce your blood glu-cose levels and insulin resistance,maintain a healthy weight, andimprove your emotional and physi-cal well-being.

Experts agree that reducing yourA1C to 7% (6%, if safely achievable)or lower in six to 12 months andkeeping it at that level will give youthe best chance for a healthy future.The A1C (or glycosylated hemoglo-bin) test gives you an average ofyour overall blood glucose levelsover the past three months. It’s use-ful because it gives a picture of youroverall diabetes control.

To achieve the goal of an A1C 7%or lower, your doctor may want youto start using prescription medica-tions because they’re good tools tohelp you manage your blood glu-cose, blood pressure and choles-terol levels. Use the targets thatyour diabetes care team determinesare right for you as your signpoststo continued good health.

Unfortunately, studies show thatdiabetes is a progressive diseasethat, with time, usually requiresmore intervention to maintain glu-cose control. Over time, your bodyand your blood glucose targets maychange and so may your medica-tions. Don’t feel that you have some-how failed when you need to changeyour medications; you’re merelyresponding to your body’s evolvingneeds. Also, as researchers learnmore about the disease, new med-ications will be developed, offering

more options to people who havethe disease.

It is important to be an informedconsumer of your diabetes med-ications. This guide will answersome of your questions and mayeven help you formulate otherquestions you may want to askyour healthcare team. Knowledgeis powerful medicine, indeed!

Other places to look for moreinformation include the CanadianDiabetes Association’s 2003 Clini-

cal Practice Guidelines for the

Prevention and Management of

Diabetes in Canada (found atwww.diabetes.ca/cpg2003; whichthe healthcare professionals onyour diabetes management teamfollow. Other websites worthchecking include Canada’s Physical Activity Guide to HealthyActive Living at www.healthcanada.ca/paguide and Canada’s FoodGuide to Healthy Eating atwww.healthcanada.ca/foodguide. ❏

Morna Cook is a community pharmacist

in Teulon, Manitoba, a lecturer in

pharmacy and nursing at the

University of Manitoba, and Regional

Chair of the Manitoba/Nunavut

Canadian Diabetes Association.

Knowledge is good medicineDiabetes management depends on understanding your medications

A supplement to Diabetes Dialogue, an official publication of the Canadian Diabetes Association

We know that more than two million Canadians have diabetes.We also know that about half of these individuals already had the diseasefor several years before they were diagnosed, and 20 to 30 per cent alreadyhave complications affecting their eyes, kidneys, feet or heart. Studies showthat even modest reductions in blood glucose levels can help delay or evenprevent these complications.

Editor-in-ChiefAmir Hanna MB, BCH, FRCPCManaging EditorElizabeth GarelPharmacy AdvisorMorna Cook BScPhCoordinating EditorBert VandermoerArt DirectionKathleen Regan-VandermoerProductionIna MacKenzie

PublisherJim Farley

Editorial Advisory BoardBarbara Cleave RN, BSCN, CDEMaryann Hopkins BSP, CDESteve Kelman BSC, MBA, CFASusan MacDonaldTeresa Schweitzer RN, BScN, CDEDana Whitham RD, CDEAdvertisingTim AllenTel: (416) 764-3886 Fax: (416) 764-1207

Project ManagementFiona HendryManaging Editor – PublicationsCanadian Diabetes AssociationTel: (416) 363-0177 Fax: (416) 363-7465E-mail: [email protected]

Editorial Information Special Projects, Rogers PublishingOne Mount Pleasant Road, 12th Floor Toronto, ON M4Y 2Y5Tel: (416) 764-3837 Fax: (416) 764-3943

1 year subscription and membership $29.95 1 year subscription only $27.951 year membership only $10.00 For address changes, contact:Canadian Diabetes Association,

522 University Ave., Suite 1400,Toronto, ON M5G 2R5Tel: (416) 363-3373

General information about diabetes1-800-BANTING (226-8464)E-mail: [email protected] site: www.diabetes.ca

by Morna Cook BScPh

Monitoring blood glucoselevelsBlood glucose levels are commonlymeasured in two ways — with a lab-oratory blood test and by self-moni-toring with a blood glucose meter.The A1C laboratory test is a meas-urement of the average of yourblood glucose levels over the previ-ous three months. The table belowlists the recommended targets forA1C and blood glucose levels deter-mined through self-monitoring.

Treating high blood glucose levelsTo lower blood glucose levels,lifestyle modifications are impor-tant and provide benefits beyondmanaging diabetes. However,lifestyle changes alone are often notenough to lower blood glucose lev-els to the recommended targets. Ifhealthy eating and increased activi-ty do not bring your blood glucose

levels to target within two or threemonths, the Canadian DiabetesAssociation’s Clinical Practice

Guidelines recommend startingdrug therapy. The longer that bloodglucose levels stay above a healthylevel, the higher the risk of develop-ing complications.

If you have type 1 diabetes, youwill always require insulin. If youhave type 2 diabetes, you will beasked to make lifestyle changes andmay be treated with pills and/orinsulin. As type 2 diabetes resultsfrom both insulin resistance (thebody’s inability to use insulin prop-erly) and insulin deficiency (due tothe pancreas’ inability to secreteenough insulin), it often requirestreating both problems. For thisreason, you may need two or threemedications to manage your bloodglucose levels.

The Clinical Practice Guidelines

recommend the following approaches

to managing high blood glucoselevels in type 2 diabetes. The goal: tolower your A1C to 7% or lower with-in 6 to 12 months.

Getting off to a good startWhen you find out that you havediabetes, your doctor will choosemedications based on how highyour blood glucose levels are. Ifthey’re very high (an A1C of 9% orabove), it’s important to quicklylower them to the target of 7% orlower; this requires immediatetreatment with at least two pills orinsulin. If pills are preferred, theClinical Practice Guidelines rec-ommend using two pills fromdifferent classes of oral diabetesmedications such as, metforminand an insulin sensitizer.

If your A1C is below 9%, met-formin is recommended alone or incombination with a medicationfrom another class, preferably aninsulin sensitizer. Other classes ofmedication may be added or substi-tuted, depending on your responseto therapy and whether you had anyside effects.

The longer you have diabetes, themore challenging it becomes tomaintain optimal blood glucosemanagement. Your treatment willneed to be adjusted and intensifiedover time. ❏

Cynthia Lank is a freelance editor

and writer in Halifax, Nova Scotia.

She was the executive editor of the

Canadian Diabetes Association’s

2003 Clinical Practice Guidelines

for the Prevention and Management

of Diabetes in Canada.


Shoot for the goalDiabetes treatments aim to lower blood glucose and reduce complications

YOUR GUIDE TO DIABETES MEDICATIONS • SPRING 2006 • CANADIAN DIABETES ASSOCIATION 3

Blood glucose targets• A1C: 7% or lower. (Some people with diabetes aim for 6% or

lower, but this should be your target only if you and your doctor feel you can achieve it safely.)

• Blood glucose values before meals: 4 to 7 mmol/L (or 4 to 6 mmol/L if your target A1C is 6% or lower).

• Blood glucose values 2 hours after meals: 5 to 10 mmol/L (or 5 to 8 mmol/L if your target A1C is 6% or lower).

By Cynthia N. Lank

The goal of diabetes treatment is to prevent complications from devel-oping or to slow down their progression. Treatment targets include loweringblood glucose levels and blood pressure, and reducing the LDL (“bad”) cho-lesterol. Use the table on page 4 to learn more about the medications thatcan help you lower your blood glucose levels. Blood pressure and choles-terol-lowering medications are discussed on page 10.

1. Find the name of your medication in the list below. (Bothgeneric and brand names are listed.)

2. Turn to the page beside your medication name. Eachmedication belongs to a drug family, or class. Medicationsthat have similar actions in the body are grouped in thesame drug class. This guide provides information on drugclasses as well as on the medications within each class.

My prescription label says ..............Turn to page X

Acarbose®..........................................................................page 7

Actos® ................................................................................page 5

Amaryl®..............................................................................page 6

Avandamet® ......................................................................page 7

Avandia®.............................................................................page 5

DiaBeta®.............................................................................page 6

Diamicron®........................................................................page 6

Diamicron MR®................................................................page 6

Euglucon®...........................................................................page 6

Gliclazide...........................................................................page 6

Glimepiride® .....................................................................page 6

Gluconorm®......................................................................page 6

Glucophage® .....................................................................page 5

Glumetza™.........................................................................page 5

Glyburide ..........................................................................page 6

Insulin.................................................................................page 8

Metformin .........................................................................page 5

Nateglinide........................................................................page 6

Orlistat ..............................................................................page 5

Pioglitazone ......................................................................page 5

Prandase®...........................................................................page 7

Repaglinide........................................................................page 6

Rosiglitazone ....................................................................page 5

Starlix® ...............................................................................page 6

Xenical® .............................................................................page 8

Note: Generic drug companies often place a prefix at the begin-ning of drug names, for example, Apo, Novo, Gen and Ratio.Tofind your medication on this list, remove the prefix; for example,Apoglyburide can be found under Glyburide.

How to Use This Table

Diabetes medications work best when they’re

taken exactly as prescribed. Ask your doctor

or diabetes educator these important questions:

◗ How often and when do I need to take my pills

and/or insulin?

◗ Do I take my medications with meals? If so, do I take

them right before each meal or at a certain time after

each meal? (These are particularly significant questions

because some diabetes medications are specifically

designed to work between or after meals.)

◗ When should I expect to see a reduction in my

blood glucose levels?

◗ What should I do if I miss a dose of my medication?

◗ Should I expect any side effects? If so, is there anything

I can do to reduce them?

◗ Do these medications cause hypoglycemia (low blood

glucose levels)? If so, how do I recognize, prevent and

treat hypoglycemia?

◗ How should I store these medications?

◗ Are there generic versions that might cost less?

◗ Will these medications interact with other (non-

diabetes) prescription medications that I’m taking?

◗ Will they interact with herbal remedies or

over-the-counter medications, such as cough syrup?

◗ Can I safely drink alcohol while taking these medications?

◗ If I become pregnant, could these medications be

dangerous to my baby? If so, what are my options

for birth control?

You may need to try several combinations of medica-

tions at different dosages to find what works best for

you. Speak with your doctor or diabetes educator if

you’re having trouble remembering to take your medica-

tions or if you’re bothered by side effects. Medications

will only work if you take them, and your doctor and

diabetes educator can help you find the simplest, most

effective treatment.



Tip Schedule regular appointments with your physician.Report any new symptoms, including mood changes asdepression occurs at a higher rate in people with diabetes.

Questions you should askabout your medications

BiguanidesMedication in this classMetformin is the onlymedication in this class that’savailable in Canada. It’s sold as a generic drug andunder the brand namesGlucophage® and Glumetza™,the latter of which is a slow-release form of the medication.

How this medication worksThis drug acts mainly byhelping the liver reduce glu-cose production. It alsohelps muscles use glucosefrom the bloodstream. Bothof these actions reduceblood glucose levels.

AdvantagesMetformin is the recommended pillfor most people with type 2 dia-betes and is especially recommend-ed for individuals who are over-weight. Metformin does not causeweight gain or hypoglycemia andworks well in combination withsome other diabetes pills andinsulin. There is some evidence thatmetformin can reduce the risk ofheart problems and improve lipid(blood fat) levels.

What you should knowThis medication may cause nausea,diarrhea and gas when you firststart taking it. Taking the pills withmeals and increasing the dose slow-ly can reduce these side effects. Insome people, metformin can affectthe absorption of vitamin B12. If

your B12 levels are low, your doctorwill recommend a vitamin supple-ment. In addition, if used in peoplewith significant heart, kidney orliver problems, metformin cancause a rare but serious conditioncalled lactic acidosis.

InsulinSensitizersMedications in this classThere are two medications in thisclass: rosiglitazone, which is soldunder the brand name Avandia®,and pioglitazone, which is soldunder the brand name Actos®.

How these medications workThese medications increase thebody’s sensitivity to its own insulin, allowing the cells to use

glucose more efficiently.The pills are recommend-ed in combination withother diabetes pills. Forpeople who are over-weight and unable to reachtheir blood glucose targets,the Clinical Practice

Guidelines recommend aninsulin sensitizer in combi-nation with metformin. Forindividuals who have very high blood glucoselevels when they’re diag-nosed, the Clinical

Practice Guidelines rec-ommend this combinationas the initial treatment.

AdvantagesInsulin sensitizers do notcause hypoglycemia (low

blood glucose levels). New evidencesuggests that insulin sensitizers canpossibly reduce the risk of heartdisease. As well, a major clinicalstudy (called ADOPT) is underwayto determine whether insulinsensitizers can also preserve theability of the pancreas to secreteinsulin in humans.

What you should knowIt can take up to three months forinsulin sensitizers to reach fulleffectiveness. Take the pills exactlyas prescribed, even if there is noimmediate improvement in yourblood glucose.

Many doctors try other medica-tions before prescribing an insulinsensitizer, because insulin sensitizersare more expensive than other dia-betes pills. However, there is evi-


Tip Meet regularly with your diabetes healthcare team.They can teach you how best to take your insulin or pills, and monitor your blood glucose levels.


dence that these pills have the mostbenefit if taken earlier, rather thanlater, in the course of type 2 diabetes.

Insulin sensitizers can causefluid retention and increase totalbody fat, thereby contributing toweight gain.

People with congestive heart fail-ure or significant liver disease mustnot take these medications. Yourdoctor may order liver functiontests to rule out active liver diseasebefore prescribing this medication.

The use of insulin sensitizers inpeople who already take insulin isnot an approved combination inCanada. The combination isapproved in the U.S., however. Ifyour doctor prescribes insulin andan insulin sensitizer in combination,he or she will explain that there maybe an increased risk of fluid reten-tion or congestive heart failure andmay monitor your health for anyearly changes.

A few cases of macular edema(swelling of the retina in the arearesponsible for central vision) havebeen reported with rosiglitazone.The risk of this happening is verylow. In most cases, the conditionimproved or returned to normalwhen the dose was reduced or thedrug was stopped. If you notice achange in your vision after startingan insulin sensitizer, inform yourdoctor and have your eyes checked.

InsulinSecretagoguesAlthough these pills are commonlyprescribed for diabetes, theCanadian Diabetes Association’s

Clinical Practice Guidelines rec-ommend them only as a thirdchoice. The Association recom-mends that for most people, met-formin and insulin sensitizersshould be tried first.

Insulin secretagogues fall intotwo classes: sulfonylureas andnon-sulfonylureas.

How these medications workSecretagogues work by stimulatingthe pancreas to secrete moreinsulin. All secretagogues reduceblood glucose levels equally well,except for Starlix®. (See below.)

SulfonylureasMedications in this classThere are three medications in thisclass that are sold in Canada: gly-

buride (sold as a generic and underthe brand names DiaBeta® andEuglucon®), gliclazide (sold as ageneric and under the brand namesDiamicron® and Diamicron MR®)and glimepiride (sold under thebrand name Amaryl®). Two otherdrugs, chlorpropramide and tolbu-tamide, are available in Canada butare rarely used.

How these medicationsdiffer from one anotherThese medications work in the sameway, but differ in how long they taketo work. Amaryl™ and DiamicronMR® are long-acting and need to betaken only once a day. Compared toglyburide, they cause less weight gainand less hypoglycemia. Glyburide ismore likely to cause weight gain andvery low blood glucose levels (hypo-

glycemia); it is not the medication ofchoice for people who are at high riskof hypoglycemia (such as the elderly).

What you should knowAll of the sulfonylureas can causehypoglycemia; however, there isusually less risk using gliclazide orglimepiride. If you are taking a sul-fonylurea, learn how to recognize,prevent and treat low blood glucoselevels. In addition, there is a smallchance of an allergic reaction if youare allergic to sulfa antibiotics. Ifyou are prescribed a sulfonylurea,make sure you let your doctor knowif you have a history of allergic reac-tion to other types of sulfa drugs.

Non-sulfonylureasMedications in this classThere are two medications in thiscategory that are available inCanada: repaglinide (sold underthe brand name GlucoNorm®) andnateglinide (sold under the brandname Starlix®).

How these medications workLike the sulfonylureas, non-sulfo-nylureas work by stimulating thepancreas to secrete more insulin;however, they are designed to dothis for four to five hours, justcovering mealtime.

AdvantagesThese non-sulfonyl-ureas work quicklyand lower blood glu-cose levels after a meal.They are especially useful



Tip Keep an updated medication list that includes all yourprescription drugs, over-the-counter remedies, natural products,eye drops, patches, creams or any other remedies you may use.


Tip Make and keep appointments with your dietitian, animportant member of the diabetes healthcare team.


for people who have irregu-lar meals, such as shiftworkers, and for thosewhose blood glucose levelstend to be high after meals.As well, they are less likelyto cause hypoglycemia thansulfonylureas.

What you shouldknowBoth GlucoNorm and Starlixneed to be taken with every meal, which can bechallenging for some peo-ple. If you have to skip ameal, do not take the pillplanned for that meal. Ashypoglycemia is a risk, peo-ple taking this medicationneed to learn how to recog-nize, prevent and treat lowblood glucose levels.

The main difference betweenGlucoNorm® and Starlix® is thatStarlix® isn’t as effective in loweringblood glucose levels.

CombinationPillsCombination pills, which mix com-mon diabetes medications into asingle pill, reduce the number ofpills you need to take. They can alsosave you money because you payonly one pharmacy dispensing fee.

The fixed combination of doses,however, means there is less flex-

ibility to tailor dosages to indi-vidual needs.

The only combinationpill currently available in

Canada is Avandamet®

[Avandia® (rosiglitazone) plus met-formin]. It’s available in severalfixed-dose combinations.

Alpha-glucosidaseInhibitorsMedication in this classThe only medication in this class isacarbose, sold under the brandname Prandase®.

How this medication worksPrandase® lowers blood glucoselevels after meals. Taken with thefirst bite of a meal, Prandase®

works in the intestine to block anenzyme that breaks complex carbo-hydrates (such as those found in

bread and potatoes) intoglucose, which is a simplecarbohydrate. This slowsdown the absorption of glu-cose from these foods, giv-ing the pancreas more timeafter meals to secreteenough insulin to lowerblood glucose levels.

AdvantagesPrandase® does not causehypoglycemia and there areno serious side effects. Onemajor study has shown thatthe medication can helpprevent the development ofdiabetes in people withprediabetes. It can be used incombination with other oraldiabetes medications andwith insulin.

What you should knowPrandase® can cause unpleasantside effects such as gas, bloatingand flatulence. To reduce theseside effects, a low starting dose canbe prescribed, and then the dosecan be slowly increased. AlthoughPrandase® won’t cause hypo-glycemia, many people who take italso take other diabetes medica-tions that can cause hypoglycemia.If hypoglycemia develops whiletaking Prandase®, it must be treatedwith dextrose tablets, honey ormilk. Because of the way Prandaseworks, some typical treatments forhypoglycemia – such as table sugar,regular soft drinks or fruit juice –are not effective. People withchronic intestinal disease shouldnot take Prandase®.

Anti-obesityDrugsMedication in this classAlthough there are other weight-lossmedications, only orlistat (soldunder the brand name Xenical®) isapproved for the treatment of dia-betes in people who are obese.

How this medication worksXenical® is taken with meals andworks in the intestine to decreasethe absorption of the fat fromfoods. The undigested fat is theneliminated in the feces.

AdvantagesXenical® is typically recommendedfor individuals who are obese and aspart of a strategy to lose weight andavoid regaining lost weight, whileimproving blood glucose levels.

What you should knowMost people who take Xenical® losemodest amounts of weight if theyalso reduce their caloric intake andadopt a regular exercise program.The medication is not a replace-ment for a healthy meal plan andregular activity. Those who takeXenical® must adhere to a low-fatdiet and divide their fat, carbohy-drate and protein intake over threemeals per day. With a high-fat diet,excess fat in the intestine can resultin fatty or oily stools or even in theinability to control bowel move-ments. This medication can reducethe absorption of some vitamins, soa multivitamin is usually recom-mended. Although Xenical® isapproved as a medication to lower

blood glucose levels, itseffect is modest. Becauseof its weight-loss andblood glucose-loweringeffects, though, Xenical®

can help some peoplewith prediabetes avoiddeveloping diabetes.

InsulinsPeople with type 1 dia-betes require insulinevery day of their life.People with type 2 dia-betes often need insulinto help them meet theirblood glucose goals. Intype 2 diabetes, insulincan be taken alone orwith diabetes pills.

Insulins are classifiedby their duration of action(how long they work).They also differ in theironset of action (howquickly they start work-ing) and when this action peaks(when they are most effective).Insulin is measured in units. Byunderstanding how your insulinworks, you can time your meals,snacks and exercise. If you takeinsulin, you need to monitor yourblood glucose levels regularly.

The insulin regimen your doctorprescribes will depend on yourtreatment goals, lifestyle, diet, age,general health, risk of low blood glu-cose and financial circumstances.The goal of any insulin regimen is tomimic, as closely as possible, insulinsecretion in people without dia-betes. In people without diabetes,

the pancreas provides a constantsupply of insulin (called basalinsulin) and secretes extra insulinwhen needed, such as when you eat(called bolus or meal insulin). Yourinsulin regimen, therefore, will havea basal component to provide somelevel of insulin at all times, as wellas a bolus component to lowerblood glucose levels after meals.

The best wayto learn aboutinsulin is by consulting a diabetes educa-tor. Ask your doctor for a



Tip A dietitian can help you develop a meal plan thataccommodates your lifestyle and is flexible, while respectingyour ethnic background and religious requirements.

referral. A diabetes educator willhelp you learn about injectionoptions (syringes, jet injectors,pens, pumps), how to adjust yourinsulin dose based on your moni-toring results, how to time yourmeals and snacks, how to matchyour carbohydrate intake to yourinsulin dose, the effects of exer-cise, and how to care for andstore your insulin. Importantly,you will learn how to prevent, rec-

ognize and treat low blood glu-cose levels (hypoglycemia).

Many people with type 2 diabetesresist taking insulin. They feel thattaking insulin means that they’resick or have somehow “failed” tomanage their diabetes. Needinginsulin does not mean that you havefailed in any way. Some people findit helpful to think of insulin therapyas a natural hormone replacementtherapy. In other words, insulin

injections simply replace a naturalhormone that the body can no longerproduce in sufficient quantities.

Other individuals resist takinginsulin because they’re afraid ofneedles or feel it will be embarrass-ing to give themselves injections inpublic. Insulin pens are an excellentalternative to syringes; they’re virtu-ally painless and can be used dis-creetly. Also, using an insulin pencan help reduce dosing errors. ❏

Adapted from the Canadian Diabetes Association’s 2003 Clinical Practice Guidelines


Tip Keep a logbook of your blood glucose levels and medications, and review the results regularly with your healthcare professional.


Types of insulinInsulin type/action Brand names Basal/bolus Dosing schedule(appearance) (generic name

in brackets)

Rapid-acting analogue (clear) Humalog® Bolus Usually taken right Onset: 10–15 minutes (insulin lispro) before eatingPeak: 60–90 minutes NovoRapid® or to lower Duration: 4–5 hours (insulin aspart) high blood glucose

Short-acting (clear) Humulin®-R Bolus Taken aboutOnset: 0.5–1 hour Novolin®ge Toronto 30 minutes beforePeak: 2–4 hours eating, or to lowerDuration: 5–8 hours high blood glucose

Intermediate-acting (cloudy) Humulin®-N Basal Often taken atOnset: 1–3 hours Novolin®ge NPH bedtime, or twice Peak: 5–8 hours a day (morning Duration: up to 18 hours and bedtime)

Extended long-acting analogue Lantus® Basal Usually taken(Clear and colourless) (insulin glargine) once or twice

Onset: 90 minutes Levemir® a dayPeak: none (insulin detemir)Duration: 24 hours

Premixed (cloudy) Humalog® Mix 25TM Combination Depends onA single vial contains a fixed Humulin® (20/80, of basal and the combinationratio of insulins (the numbers 30/70) bolus insulinsrefer to the ratio of rapid- or Novolin®ge (10/90,fast-acting to intermediate-acting 20/80, 30/70,insulin in the vial) 40/60, 50/50)

By Cynthia N. Lank

According to the CanadianDiabetes Association’s Clinical

Practice Guidelines, reducing therisk of cardiovascular diseaseshould be the first priority in pre-venting diabetes complications. Asdiscussed earlier, achieving bloodglucose targets through lifestylechanges and medications is animportant first step. However, it isequally important to lower bloodpressure and LDL cholesterol (the“bad” cholesterol) to healthy tar-gets, as summarized in the table onpage 11. The closer you can get tothese targets, the more you canreduce your risk of complications.Every little bit helps!

Achieving blood pressuretargetsA healthy lifestyle plays an impor-tant role in managing blood pres-sure. Try to achieve (and maintain)a healthy weight, eat a balanced dietand exercise regularly. It can help tolimit your intake of salt and alcohol.

You will also likely need medica-tions to lower your blood pressure.The Clinical Practice Guidelines

recommend a number of medica-tions that can help you lower yourblood pressure. They state thatwhich medication to use first isprobably less important than the

fact that more than one medicationis often needed.

There are more than 50 bloodpressure medications available inCanada. Your doctor will chooseyour particular medications basedon a number of factors, includingyour current blood pressure, youroverall risk of cardiovascular andkidney disease, and what you canafford. You may need to take sever-

al different medications in order tomanage your blood pressure andreach your target.

Lowering your blood pressurehas the added benefit of reducingyour risk of other diabetes compli-cations, such as kidney and eye dis-ease. Your doctor will take yourblood pressure every time you visitto discuss your diabetes manage-ment. Be sure to ask for and recordyour results.

Achieving cholesterol targetsA healthy lifestyle can help youmanage your cholesterol levels, butit can be difficult to reach choles-terol targets with lifestyle changesalone. More and more studies arepointing to the importance of low-

Targeting complicationsMedications to Prevent Heart Disease and Stroke



People with diabetes are at high risk of heart disease, heart attacks andstroke. High blood glucose levels are a risk factor for these problems, butmany people with diabetes also have other risk factors such as high bloodpressure and abnormal blood fat levels. Obesity, an inactive lifestyle, smok-ing, kidney disease, and a family history of heart disease or stroke raise therisk of cardiovascular diseases even more.

ering LDL cholesterol in people with and without diabetes.The medications of choice belong to the drug class called

statins. They include lovastatin (sold as a generic and underthe brand name Mevacor®), pravastatin (sold as a genericand under the brand name Pravachol®), simvastatin

(Zocor®), rosuvastatin (Crestor®), fluvastatin (Lescol®)and atorvastatin (Lipitor®). To lower LDL cholesterol lev-els, there are several other drug classes that can be usedalone or in addition to statins. You may also require medica-tions to raise your HDL (“healthy”) cholesterol and lowerother blood fats called triglycerides. Your doctor might pre-scribe other medications to control your blood fats if thestatins are not enough to do so or if you have rare abnor-malities of your blood fats. Most people with diabetes (andanyone taking cholesterol medications) should have a bloodtest to monitor their cholesterol levels at least once a year.

ASA therapyLow-dose daily acetylsalicylic acid (ASA or Aspirin) therapyhas been shown to reduce the risk of heart attacks and isrecommended for most people with diabetes. ASA, though,is not safe for all people. Take it only on the advice andunder the supervision of your doctor. If you would benefitfrom ASA but can’t tolerate it, the prescription medicationclopidogrel (sold under the brand name Plavix®) may beanother option.

SmokingIf you smoke cigarettes and want to quit, ask your doctor forhelp. There is no safe level of smoking and no easy way tokick the habit, but quitting smoking is one of the best waysto help your heart, improve your overall health and reducethe risk of diabetes complications. ❏

Memo to myselfWHEN YOU HAVE DIABETES, you have a loton your mind: when to eat, when to test,medication schedules. Now there is a new toolavailable to help you remember the habits thatkeep you healthy.

MemoText™ is a text-messaging service thatcan help people better manage their healthregimen while supporting the work of theCanadian Diabetes Association. The web-basedprogram allows users to send themselves (orothers) mobile phone text messages at pre-scheduled dates and times. People can use theservice to remind themselves or family membersto take diabetes medications and check bloodglucose levels. Studies conducted at the JoslinDiabetes Center (Harvard University, Boston,Massachusetts) indicate that people who receivetext-message reminders to check their blood glu-cose levels, do so more often than those usingother reminders.

The service costs about $6 a month, and aportion of the proceeds from each MemoTextsubscription will be donated to the CanadianDiabetes Association. For more information, visit www.diabetes.ca, click on “About Diabetes,”then the “Offers and Promotions” link. •



Know Your ABCsA1C: 7% or lower. (Some people with diabetes aim for

6% or lower, but this should be your target only if you

and your doctor feel you can achieve it safely)

Blood pressure: 130/80 mmHg or lower

Cholesterol: LDL lower than 2.5 mmol/L*

* New clinical practice guidelines that may recommend a

lower target will be issued later in 2006.

Tip If you are sick, as with a cold or flu, it’s important that you continue to take your diabetes medications as prescribed.Also,check your blood glucose levels more frequently when you’re ill.

By Rosalyn Wosnick

Sometimes, this is easier saidthan done. It can be a challengekeeping track of the many drugsyou may have to take every day. The good news is that there areplenty of resources available tohelp you stay on top of yourmedication routine, and they’re asclose as a phone call to your doctoror diabetes educator.

For example, your doctor may beable to adjust your medicine dosageand/or timing to simplify your rou-tine. If you are taking the same drugtwice each day, find out if it’s possi-ble to combine them into a once-daily dose. Also, ask if the schedulefor taking your medication can bepegged to certain events of the day,such as mealtimes, first thing in themorning or just before bedtime. Thismakes it much easier to remember.

Chances are your pharmacist canhelp you manage a complicateddrug schedule by providing specialmedication packaging. Blisterpacks (where all the pills to betaken in the morning, afternoon, orevening are combined in separate“bubbles”), or dosettes (pill boxes)that organize a day’s pills intoindividual compartments, are bothhandy tools. You can even getpackages with clocks attached that sound an alarm when it’s time totake your medicine.

“Educating yourself is the key,”advises Tino Montopoli, a pharma-cist and Certified DiabetesEducator in Orono, Ontario, whohas been living with type 1 diabetessince the age of nine. “The moreyou know about your diabetes, theeasier it will be to stick to yourmedication plan and keep thingsunder control.”

Find a diabetes educator youfeel comfortable with, he suggests,and don’t hesitate to ask questionsor talk about your medication

concerns. This can help clear upany difficulties you may be havingand even prevent problems beforethey arise.

Make sure you don’t run out ofyour medication before contactingyour doctor or pharmacist for afresh supply. Always be aware ofhow many refills you have, andallow enough time to see your doc-tor (if a renewal is needed) or tocover any unforeseen supply delaysat the pharmacy. To save time,Montopoli advises taking all yourmedication containers to the doc-tor’s office when you go; that way,you can get renewals on other soon-to-expire prescriptions at one visit.

“Taking your diabetes medicationis like buckling up your seatbelt,”he says. “It’s a great thing, but it canonly help you if you use it.” ❏

Prescription for successThe more closely you follow your medication plan, the better it will work

Medication management

Life can be hectic, and stayingon top of your medication

schedule requires special atten-tion. Here are a few ideas thatmight help:◗ Make sure you understand each

medication you’re taking andwhy you’re taking it. If you’re notcertain, ask your doctor or diabetes educator to explain.

◗ Find out what side effects might be associated with your drugs, and whichsymptoms should be reported.

◗ Never stop taking a prescribed medication without checking with your health-care provider, even if you don’t feel any effect from it. Many drugs, especiallyblood pressure or cholesterol pills, make a difference you usually can’t detect.

◗ Deal with one pharmacy for all your medications, and be sure to talk to yourpharmacist before taking any drugs, including over-the-counter (non-pre-scription) and herbal products. This will help prevent medication-relatedproblems, such as drug interactions, and lead to a closer relationship withyour pharmacist – an accessible and valuable healthcare resource. •



Mary Poppins may have believed that a spoonful of sugarmakes the medicine go down, but we all know that’s not necessarily a goodidea, especially for people with diabetes. In real life, the best way to ensureyou get the medication you need – and get the most from it – is to take itexactly as directed.

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