Helping Patients with Pattern Management

Many of my patients understand the importance of monitoring their blood sugars. Many will even write them down and a few will even remember to take them to their diabetes visits with their physician. When I start discussing pattern management with my patients they often give me a blank look. After checking their blood sugars, they seem to know very little about where to go from there.

What do these numbers mean? What is the purpose beyond “that’s what my Dr. wants me to do?” Pattern management is not something that physicians often have the time to teach at their 10 minute encounters, and is one way in which CDEs can be very helpful. Sitting down with a patient and reviewing blood sugar records is of vital importance for patients to better understand their diabetes.

When looking at a blood sugar record keeping it well organized is key to making sense of the maze of numbers. It’s also very important to write the blood value in relationship to a meal. Was it before a meal? After a meal? 2 hours after or 10 minutes after? All these details are very important to understanding a glucose log and working to finding patterns. I’ve found many of my patients will write the time of day they check their blood sugar, but it’s impossible to tell if this is before breakfast, after breakfast, after exercise, etc. These details are so important to pattern management.

I always ask my patients to give me a good idea of their fasting numbers. Once they’ve established a good range or their individualized range, then we typically move on to testing 2 hours after the start of a meal. Also, I ask them to vary the meals they test after to give added information. I have them write all of their values down and return to me for follow-up. When the patient walks in my office we work to begin to “decode” the log. We look at reasons a fasting number might have been high. Next, we look at after meals and evaluate what was eaten to decode the “spike” after dinner. We also look at how stress and exercise affected the numbers.

I can almost see their eyes opening and they begin to understand those numbers versus just writing them down. They start to understand why it was lower and why it may have “spiked.” Those “light bulb” moments are the reason CDEs do the work they do and with passion. Teaching patients to begin working to manage their own disease is the goal. Decoding the numbers and working to understand their diabetes better is rewarding for them. For a patient to really understand why they are checking their blood sugar and what the purpose of each number means helps motivate them toward better care.

I think that sometimes as educators we get caught up in the things we “need to teach.” I find that pattern management is always something we can touch on with our patients no matter the duration of their diabetes or where they’re at now. It’s all about baby steps. You may ask them to begin testing once a week and move up from there. It may not always be the smooth process we envision, but be sure to focus on their accomplishments with their diabetes care. Just the fact that they came to see you shows they’re motivated toward better care!

 

Written by:

Jessica Miller, RD, CDE

Fit4D CDE

Connecting with Patients: My Role as a Fit4D Diabetes Educator

Feeling the need to “re-charge” my diabetes educator batteries, I recently attended a continuing education program which provided several excellent sessions.   Joe Solowiejczyk, RN, MSW, CDE , “Coping and Thriving with Diabetes: It’s just not a numbers game”   presented some very practical suggestions in talking with patients and “connecting” with them. He offered that there are many roles of a diabetes educator, while all are important I believe acting as a facilitator best describes our jobs as Diabetes Health Coaches for Fit4D.

 

Feelings and Emotions

So far, in my experience with Fit4D, emotional issues, in some form or another, are present in almost all of our interactions. Whether a second insulin has been added to their diabetes management, they are newly diagnosed, have financial concerns, worry about long-term outcomes, fearful of disappointing their family or health care providers, or simply “I am doing everything right, and my blood sugars are still not where they need to be”. Probing with the patient to find out the source of their frustrations or negative feelings is essential to being able to provide the best possible information for the patient. Joe’s presentation offered some clues that patients may say can help identify some of these issues:

  • Fear of “giving in” is as a sign of defeat!
  • “If I fall apart, I’ll never pick myself up again”
  • “I have to stay strong for my kid(s), for my family”
  • Pretending is better than Feeling
  • “I’m smart & competent – I should be doing better”
  • Fear of acknowledging feelings of powerlessness

 

Conveying Empathy

As a Fit4D Coach, while I’m talking to the patient, they are my sole focus of attention. They do not have to be strong for me, I am here only for them and want to help them. While this may be somewhat easier to do face-to-face, learning to convey that empathy and compassion over the telephone is skillset in itself. Until the patient knows/feels/senses that empathy and compassion from me, they will not accept the suggestions I have to offer.

 

Healer NOT a Fixer

One of the most difficult aspects of being a Coach, is wanting to “fix” all the patient’s problems, quickly and effectively. Consciously, I know that this is impossible under any circumstance or in any job. I’ve started to see myself as a healer NOT fixer, and seek to understand that it’s not my responsibility to ‘fix” anyone, but to provide the tools and support to allow the patient to succeed.

 

I’d love to hear your thoughts on how you connect with your patients!

Written by:

Elise Swenson, RPh, MS, MAOM, CDE

5 Tips to Help Your Patients with Diabetes Stay on Track with Their Medication

Health care providers prescribe medications hundreds of times each week, but to a person newly diagnosed with Type 2 diabetes, hearing “I want you to take ____” is a public admission of failure. Failure to lose weight. Not making time for exercise. Inability to change habits like flavored coffee for breakfast or a favorite aunt’s cinnamon buns during family gatherings.

For many people with diabetes , a prescription for oral medication or even worse – insulin – is a sure signal that amputation, blindness, renal failure and death is just around the corner. Often too shocked, scared, or angry to ask questions, your patient leaves your office with prescription in hand but never fills it. Or they fill it, but decide they won’t take it because they hope to make the lifestyle changes that they’ve been putting off for months or years. Sometimes they fill the script but only take the medication when they remember, or when no one else is around so they don’t have to admit they have diabetes, or when they feel like their blood sugar is high.

Here are 5 important strategies we’ve found successful in empowering and motivating people with type 2 diabetes to take their meds as prescribed:
1. WIFM: What’s In It For Me. Explain why the medication is necessary both for short-term management of diabetes as well as prevention of long-term complications. Talk about how the med will address how the person feels on a daily basis, addressing any complaints they talked about during their examination.

2. Describe how the medication works in easily understandable language and provide clear, easy to understand written materials. Often newly diagnosed people with diabetes don’t know the difference between oral meds and insulin, or that oral meds work in a variety of ways. If you don’t provide written information, many people go home and do a Google search which may lead them to inaccurate information or promises of ‘natural’ cures.

3. Talk about possible side effects and how to minimize them. Ask what side effects they’ve heard about, or which ones concern them the most. Weight gain or inability to lose weight and fear of hypoglycemia are two of the most common fears.

4. Know the cost of the medication and if the insurance plan will cover it. People often don’t want to admit that they can’t afford a medication, and take it less often than prescribed or won’t refill the script.

5. Ask open-ended questions that show you are listening to their fears and that you’re working together to improve their health. Examples of questions to encourage an open discussion:
a. How will you manage taking this medication? What is your usual routine for taking medication and how will you add this med to your routine?
b. What have you heard from your family, friends or other people with diabetes about this medication?
c. What might get in the way of taking this med?

If you don’t have time to explain how the medication works and answer questions, assign this task to another member of your health care team. Tell your patient why you’re prescribing the medication and that you will have them meet with this professional to explain how to take the medication and answer all their questions.

We often label people with diabetes non-compliant when they don’t follow-through with prescribed medications. Non-compliance is like an onion: peel away the layers until you find the actual reason why your patient didn’t fill the script or ‘forgets’ to take the med. We can’t assume that people with diabetes take their meds as prescribed, and we also can’t assume that we know why they don’t take their medications. The only way to find out the truth is to have an open and honest discussion.

Written by:

Lynn Grieger, RD, CDE, CPT, CWC

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References:
Medication Adherence. Its Importance in Cardiovascular Outcomes. Ho PM, Bryson CL, Rumsfeld JS. Circulation. 2009; 119: 3028-3035.
Working With Patients to Enhance Medication Adherence. Lin EHB, Ciechanowski P. Clinical Diabetes January 2008 vol. 26 no. 1 17-19.

Helping Patients Find Their Voice: Too Much, Too Fast?

As healthcare providers we tend to give a large amount of information to our patients at one time. It’s not that we don’t care or that we don’t understand adult learning; sometimes there is just a lot of new information that’s important to know. Think about the patient that is new to monitoring their blood glucose and new to insulin. It’s not just learning two new skills (which can be frightening enough for some) but learning how to treat lows, figuring out how to fit testing and injections into their lifestyle, what to do if they miss a dose and on and on. Those “two things” come with a lot of other little things to learn.

Here’s a few of things we’ve learned at Fit4D to make a difference in the complex world of diabetes, where there is frequently too much information that’s too fast!

  • Frequent check-ins are a must.  You might be thinking, but that’s not scalable—it’s expensive and certainly not realistic. But wait…check-ins come through online live events like webinars and support groups, texting their Fit4D coach, interacting on CDE led twitter groups, and phone calls when really needed.
  • Most of the questions come after the appointment.  We’ve all heard the stats that patients only retain 50% of the information given once out the door. Once they get home that’s when the questions start.  Sure, some people will call the office, but some people won’t.  Maybe they just called but then thought of another question or they’re embarrassed to call in the first place because they think they should already know the answer.  Having a place to go about “what‘s bugging them the most about their diabetes” is crucial. I’m not talking about a pile of handouts or even a website. What I mean is technology that is smart enough to individualize and yet escalate to their coach when needed.
  • Create a trusted relationship.  It’s important to get patients honest concerns and create an environment to help them feel like it’s OK to ask, in their mind, the “silly” questions. You may be thinking, how can just one question or one small piece of information make a difference?  Timing of medication is one very common mistake patients make.  Depending on type of medication simply helping them simply understand when  (and why) they are taking their medication can make a big difference in blood sugars and increase medication adherence.

I’d love to hear how you make a difference for patients and conquer the “too much, too fast” dilemma. 

Written by:

Sherri Isaak, MS,RD,CDE, BC-ADM

Just ask…

Just ask…..

What are you eating? Are you exercising? How often are you testing your blood sugar? What are your blood sugar results? Are you taking your medications? How is your stress level? Are you doing foot exams? Are you setting goals? Do you smoke? Are you ready to change—today, tomorrow, next week? The list of questions and topics for patients really is exhausting. They’re frequently bombarded with information they may or may not want to hear. Instead, how about focusing on what the patient’s needs are right now. Actually…the one need that’s “bugging them most about their diabetes.”

It’s hard because we as clinicians think to help our patients; we need to cover every topic—now.  Maybe we have a checklist of information we’re supposed to run through. But, is that really what’s best for the patient?  Nope. Helping them focus what’s on the top of their mind, “what’s bugging them” about their diabetes is far more impactful.

One of my patients went through my hospital-based diabetes education course a few years back. It really was a great series of classes with excellent educators. We even made it fun with hands on activities, healthy snacks, and included a multidisciplinary team of nurses, an exercise physiologist and dietitians. A year later she came back into my office and said, “I loved your course but I really didn’t pay much attention to what you said.  There was a lot of information I wasn’t ready for. I was really stressed out and needed to deal with that first. Now I’d like to focus getting on track with my eating.”  Yep—ready to focus on what’s bugging her most.

We have multiple drugs for diabetes, amazing technology, and well trained healthcare providers but if we seek out our plan, not what’s on the forefront of the patient’s mind, all of that really doesn’t matter quite as much.   Think about the patient, smiling and nodding in the office (pretending to listen about the importance of taking medication twice per day), but they are so focused on their only social event out, pizza night, that they think you just took away.  Now that’s something we could easy clear up, if we would have just started with that one question….what’s bugging you?  By doing that, now you have a relieved (and much happier) patient, who learned how to fit pizza into their meal plan!

Other than working on the challenges the patient wants to address first, why does it matter?    It matters because a step-by-step approach can help patients be more adherent to their diabetes care plan. Deal with their initial concerns, gain their trust and weave in the care plan challenges at just the right time for them. That’s what we’ve found that works best anyway

Helping patients focus on what’s on their mind and their top priorities gets better results and a bigger impact. It’s a simple question, “what bugs you most about your diabetes?”.…and let the patient lead from there.

 

Written by:

Sherri Isaak, MS, RD, CDE, BC-ADM

 

Reaching the Unreachable: A Personal Approach to Diabetes

As published by Huffington Post 1/15/14; http://www.huffingtonpost.com/david-weingard/post_6474_b_4466725.html

 

By David Weingard
Shock — is how I felt when I was first diagnosed with diabetes.

I had been training for an eight stage survival race and was in great physical shape. Suddenly I felt weak and lethargic and knew a visit to my physician was necessary. Even getting to the doctor”s office was a physical challenge. It was here where I learned that my drastic weight loss was not a result of athletic training, but instead my body failing to produce insulin. My body was starving itself and I was unaware!

I was in disbelief and looked for resources to help me understand. While there is plenty of information online, I found that it was very basic and didn”t explain to me how to live my own life with the disease. I also couldn”t find the personalized support I needed to manage my health, engage with my family and meet professional demands while living with diabetes.

As I rebuilt my life collecting information and support from wherever I could find it. I made a commitment to find a way to help the diabetes community, so I began racing Ironman triathlons to raise money for diabetes charities. What happened after that was incredible. People started emailing and calling me for advice. I only know about my diabetes and really don”t have the knowledge to help someone else with theirs! This is when I realized that I can assist others by making this a personal journey. By leveraging many positive professional relationships along the way, I began to personalize diabetes management by engaging diabetes educators countrywide with diabetes patients via technology. The ultimate goal is to help people lead rich and fulfilling lives with diabetes.

We are in a state of crisis, people need help, there are almost 26 million people with diabetes in the U.S. and another 79 million adults in the U.S. with pre-diabetes. The financial impact was $245 billion to employers, government and the individual with diabetes in 2012

We”re in this predicament for many reasons and it continues to escalate because diabetes is so complex and difficult to manage. Over 40 percent of patients prescribed a new diabetes medication stop taking it within the first few months. While there are helpful resources online and within communities, it is often challenging to find the relevant information. Also, the people who look for this information and support are the ones motivated to take care of their diabetes. Solving to effectively engage the unmotivated patients is where the big problem lies.

People with diabetes have different experiences, contributing to the People who stopped using buy-detox.com can still feel strong cravings for the drug, sometimes even years later. complexity of managing an already multidimensional disease. I saw these differences in real-time as I had the rare opportunity to participate in focus groups comprised of people with diabetes of varying socio-economic and cultural groups. Interestingly enough I found myself relating to them. We had the same emotion when diagnosed: shock! There were so many beautiful and human moments as people shared their individual challenges and successes living with diabetes. There was also pain and a sense of resignation that diabetes was not going away and that they would need to find ways of coping with it… forever.

Additionally, I had the opportunity to learn from thought leaders who added to this pool of valuable guidance. Each mentor had incomparable perspectives on how to improve our business model and presentation. I look forward to their continued mentorship and the relationships I”ve gained from this experience.

David is founder and CEO of Fit4D, a company whose mission is to improve the lives of people with diabetes and other chronic conditions, worldwide. In his journey as someone with diabetes, David has been fortunate to meet many incredible people with diabetes and their families. It is David”s personal passion to share his experiences, knowledge and positive energy with the diabetes community. With over 20 years of experience in the technology sector at startup and public companies, David decided to devote his energies to helping people with diabetes. David can be reached via e-mail at dweingard@fit4d.com.

Fit4D is one of five semi-finalists in The Merck | Heritage Provider Network Innovation Challenge. The sponsors have called on entrepreneurs, data scientists, designers, health care providers, and big thinkers to create the products or services that will support patients with diabetes and/or heart disease in adhering to their care plans and ultimately improving health. Semi-finalists will be presenting their solutions at Demo Day on January 23rd in NYC. Check out their progress, watch their Demo Day presentations, and find additional open innovation challenges by visiting Health Data Challenges.

This blog series is produced in partnership with Health Data Challenges, creators of The Health Data Challenge Series, a formal initiative of the Health Data Consortium, powered by Luminary Labs. The platform seeks to foster the use of data to drive innovation that will ultimately transform health and healthcare through high-stakes innovation challenges. Learn more at www.healthdatachallenges.com.

Follow David Weingard on Twitter: www.twitter.com/Fit4D

Merck Heritage Provider Network Innovation Contest 5 Questions with Fit4D

5 Questions with…Fit4D

This post is part of a special “5 Questions with…” series, featuring Q&As with the semi-finalists in the Merck | Heritage Provider Network Innovation Challenge.

David Weingard - Fit4D. Semi-finalist in the Merck | Heritage provider network innovation challenge

David Weingardis the CEO and Founder of Fit4D – a personalized program that synthesizes workflow, data capture, device integration, and reporting-enabling personalized service delivery via coaches within its network. He has experienced first-hand the complexities of living life with diabetes and its challenges. Fit4D is one of five semi-finalists in the Merck | Heritage Provider Network Innovation Challenge competing for a $100,000 award. Learn more about Fit4D by tuning in to Demo Day on January 23rd.
 
 

 1.  What is your concept? Tell us about it in two sentences or less.

Fit4D solves for patients with poorly managed diabetes.  We use technology to make a personal diabetes educator (CDE) coach scalable and affordable.

2.  How did you hear about the Challenge and what prompted you to enter?

We learned about the challenge through Luminary Labs and appreciate the ‘real world’ approach they take to healthcare.  We entered as part of our mission to improve the lives of people with diabetes — it is our passion and reason for being.

3.  What have been your biggest successes and challenges in the last year?

Fit4D started with telephonic coaching, similar to a call center model.  We learned quickly that this method doesn’t scale.   We began to search for alternate ways to help patients including mobile or web-based apps.  Although there are some very cutting-edge apps we found that they worked for the motivated patients, though they are not the problem    It is important to use a real person to help motivate people, by building a therapeutic alliance, especially for those people who are not motivated or feeling very overwhelmed by their diabetes.

This is where the personal CDE coach comes in!   On to the amazing part; technology is at a point where we use it to scale our CDEs and reach more people   And, we communicate in the way patients want to communicate – across mediums such as email, text, online support groups, webinars, phone, Skype and our web platform.  This optimized mix of human and electronic touch points enable us to engage patients (the motivated and the unmotivated) and improve their health.

In the past year we’ve improved the way we measure results by integrating the data from payers/PBMs (e.g. for medication adherence) and medical devices (e.g. A1C kits, blood glucose meters).   Robust tracking and reporting on this data ensures that we deliver on key performance metrics and provides immediate validation.  It’s a true comprehensive patient support program.

4.  What is the main problem you are looking to solve with your solution?

We are solving for those having the biggest challenges with diabetes self-care, and giving them a helping hand when they need motivation or hit a bump in the road.  Ultimately giving a patient a much needed ‘high five’ when they stay on that path or providing personalized support that motivates them to overcome challenges.  (e.g. taking their medication).  Diabetes is hard; it’s an everyday thing, everyday!  Everyone with diabetes is different; not only coming from different social-economic and cultural backgrounds but also facing different hurdles – so the interventions must be personalized.

In addition to supporting patients getting healthier, we’re reducing healthcare costs, improving patient / provider communication, increasing medication adherence and overall improving the lives of those living with diabetes.  40% of the cost of diabetes is associated with those patents with A1C values above 9.   These high A1Cs put a patient at higher risk for heart attacks, strokes, kidney disease, neuropathy and circulation problems. All expensive to treat complications.

5.  Your team has entered into the Virtual Accelerator period, which includes a design, prototyping, and business modeling Boot Camp. What is the biggest insight you uncovered during Boot Camp?

The boot camp, especially the focus groups, reinforced how everyone with diabetes is different and that personal interventions will provide an immediate impact on the patient.  The virtual accelerator has helped us recognize our individual assets as a team and how to leverage them in many ways.

Make sure to register for Demo Day, taking place on January 23rd in New York City.  Click here for your free tickets!

 

 

 

Questions you always wanted to ask your pharmacist….but didn’t!

Fit4D Pharmacist, Sara Wortman, Pharm D, CDE, give answers and tips on getting refills, generic drugs, and more!

 

Why does it take so long for the pharmacist to fill my prescription?
Pharmacies operate on first come first serve basis.  Pretend 10 other people come before you, one of whom may have had 15 prescriptions to fill.  Even though yours may be something that seems easy and doesn’t need to be counted out and just needs a label, like a nasal spray, you still need to wait.

Example:  You wouldn’t go to McDonalds and get to jump to the front of the line because you want a chocolate shake and the person in front of you ordered food for 15 people.

You may not see all the people in front of you in line, often people drop off their prescriptions and walk away to shop or find something else they need to purchase.  Pharmacies also have physicians calling in to talk to the pharmacist, patients wanting to talk to the pharmacist, and prescriptions being faxed and e-scribed in that also need to be processed, all with various levels of priority.   While it may seem like there is often an army of people working behind the pharmacy counter, there are usually only one or two pharmacists.  Everything that goes out of the pharmacy needs to be verified, checked for accuracy, and checked against your other prescriptions for interactions, all things only a pharmacist can do.  If you think about it, there is a lot that happens between the time you drop off your prescription and when you pick it up, even when there are no problems.

Quick Tip:  To avoid long waits, going to the pharmacy at off hours is a good plan.  Off hours are generally early morning, late afternoon, and late evening hours, depending on the pharmacy’s hours of operation.

 

Say I forget to call my doctor to get a refill and  run out of my medication.  Why can you give me an emergency supply for some medications but not others?
If it’s a maintenance drug (like a pill for diabetes) that is considered necessary and stopping it abruptly could be detrimental to you, pharmacists will often dispense a 3 to 4 day supply to avoid interrupting treatment  and causing a worsening in your health condition.  It’s considered a good faith fill. Typically this happens for (but not limited to) medications taken for diabetes, cholesterol control, heart disease/high blood pressure, and other chronic disease states.  There are certain medications that pharmacists won’t be able to give an emergency supply like controlled substances such as pain medications. Keep in mind, when you fill your prescription, it will be less the days the pharmacist kindly filled in good faith.

Example:  Your doctor may call in a 30 day supply, if the pharmacist good faith filled 3 days, you will only get 27 days when you pick up the prescription for this month.

Quick tips:

  • Mark your calendar 5 days in advance of when you need to call your doctor to fill your script so you make sure you have it in time.
  • You must regularly get your prescriptions filled at a pharmacy to be provided a good faith fill.

 

Why am I allowed to fill my prescription with my local pharmacy and then, out of nowhere, I have to utilize a mail order pharmacy?
This is an insurance company policy.  Typically, this is for maintenance medications for a long-term condition or something like birth control.  It’s cheaper for the insurance company for you to get 3 months at a time at a mail order pharmacy.  In the long run, it’s often cheaper for you too!

When this happens, keep in mind, the pharmacy can’t just send the prescription to your insurance company.  You must have the doctor send it in the method appropriate for your state. Your local pharmacy can transfer prescriptions from mail order but never to a mail order pharmacy.  They require new prescriptions directly from your doctor.  If you transfer to a local pharmacy from mail order, the 90 days supply prescription is now “broken” and will require a new prescription sent or faxed to from your doctor.

Quick tip:  Have your doctor write 2 prescriptions.  One for one month and one for mail order.  This way your physician can send in the prescription to the mail order for processing and you can take the other one month prescription to your local pharmacy to have filled right away.  This way you have your medication while you are waiting for the mail order to arrive.

 

Why do you need my address?
Generally it’s because they need it to verify demographic information.  It isn’t being used in any other way than to make sure pharmacies are doing things right.  It’s not that they are selling your info but might send you targeted info from the pharmacy.

Example:  Let’s say your pharmacy only has a partial month’s supply for your diabetes pills and you don’t return to pick up the remainder of your medication once it is ready.  Your insurance already paid for it, and the pharmacy has no right to keep it.  Therefore, they might mail it to you so that it doesn’t sit on their shelves for too long.*

 

Why do you need my ID?
Not every prescription requires ID to be filled or picked up.  It depends on the state in which you live, whether the pharmacy knows you by name as a regular customer, and what kind of medication is being filled.  In general, an ID is used to verify that you are the correct person, especially if it’s a controlled substance (like pain medication).  This decreases amount of fraud and theft, and is actually meant to protect both you and the pharmacy.

What must be on the prescription?
This varies by state.  Typically, your name, date, the doctor’s signature, drug name, quantity, and directions. This can vary for controlled substances as well.

To know exactly what must be on the prescription you should check with your state rules and regulations.  For controlled substances and in many states it is required to have a diagnosis code written as well.  The diagnosis is often written as a number.  For example, 250.00 is one of the diagnosis codes for diabetes.

Quick Tips:

  • This is important to remember if you are traveling out of state and haven’t filled your prescription.  The state you travel to may have different laws about what must be on the prescription.  It is definitely best to get everything you will need filled BEFORE you travel.
  • It’s always best to double check with your doctor to ensure  that everything that is necessary to fill the prescription is written before you leave your healthcare providers office.

Why do I have to bring the actual written prescription for some drugs but not others?
It depends on the drug.  Any highly controlled substance (level C-II) must be given to the pharmacist in its originally written format from your healthcare provider.  It cannot be called, faxed, or e-scribed.

Why can’t I have name brand drugs if I want them?
Insurance companies want to save the you money.  They have a set list of medications called a formulary that they use to keep costs down.  Part of the cost of brand name drugs is due to the years and years of research and development for approval and the marketing that it takes to get the drug to market.  When the generic comes out, drug is cheaper because they didn’t put the same time and money into it the original manufacturer did.  The generic has the same therapeutic affect as the brand name medication, it legally has to.

Note:  Many patients say they are allergic to the generic drug.  It’s not that one is allergic to the generic drug itself but could be allergic to its other properties, such as the time release factor or the coating.  These things don’t have to be the same as the name brand.  Be assured the active ingredient must always be exactly the same.

Example:  Ever tried a generic Tums?  Many are awful and chalky.  They have the same affect but their taste make up is much different!

 

*The pharmacy will only mail medications in certain cases.  Do not expect your pharmacy to mail your medication unless you set up a process to do so.  This is not something a pharmacy is required to do.

Diabetes Technology: Friend or Foe?

Today I finished the Philadelphia Marathon, proud at “toughing it out” and running the whole time – though slower than expected and with way more diabetes challenges than necessary.

In the last 14 years of my life with type 1 diabetes, and as a runner/triathlete, I have learned that “winging it” with diabetes usually doesn’t work.  To have a great race, it’s always better to be prepared for all the crazy moments diabetes can toss into the mix.

I’ve found that simulating the race day environment beforehand with the same clothes, food and insulin teaches me what will work best.  Diabetes doesn’t always work logically though these training efforts illustrate patterns that I can adjust and retest before race today.  This strategy has enabled me to successfully finish numerous marathons and Ironman triathlons – even getting faster despite aging.

Well, I’m a crazy busy person (like everyone, right?)… and this time I didn’t use the discipline to do what had served me so well in the past.  Additionally, I realized that I had become dependent on my Dexcom CGM.   Well, if it is moving in the wrong direction, I can fix it, can’t I????

 

Before today’s race, I took more carbs in than normal through an electrolyte drink and too little insulin.   I spiked to 365 by race start and it took me 7 miles to get it down into the low 200s.  By then, the damage was done.  I was out of it, dehydrated and started to slow down.  I stabilized my BG and the next 6 miles were OK.  Then I started going low and averaged a blood sugar of 60 for the last 9 miles of the race.  How could this happen with this great technology?  Here is what I learned today and humbly share with those of you athletes, or family members/friends of athletes with diabetes.

  1. Most athletic events, whether a marathon or after school soccer workouts need to be treated as a big deal, especially with diabetes.  To succeed requires focus, concentration and determination.  With all the things to think about during the event (clothing, weather, hydration, nutrition, logistics, pace, etc.), mental bandwidth is stretched.   There isn’t enough time to continually monitor every aspect of diabetes with all this other stuff going on.
  2. I forgot to turn on the alert feature of the CGM which may have helped me correct the problems I was having sooner (reference bandwidth problem in #1).
  3. We are responsible for ourselves.  I own my experience today based on what I did.
  4. A CGM, (while a great tool), shows trends.   It is not an accurate representation of what is happening at the actual moment.  By the time the extreme high or low has happened, chances are it has been that way for a while.
  5. While using diabetes technology like a CGM enabled me to not stop and “waste time” testing my blood sugar during a race, it also gave me a false sense of control and bravado about not being as prepared through simulations.
  6. Testing my BG during a race forced me to focus on diabetes completely for that moment rather than glance at a CGM screen and moving on.  In the end my high and low blood sugars cost me more time than stopping to test.
  7. If I want to race the best that I can, I need to take my diabetes planning as seriously as I do my training.  That means, simulations, recording notes in my logbook, fixing, repeat…over and over so I can control it…not let it control me in a race.
  8. And, despite all of these issues, today I finished a marathon while living with diabetes.     Something to be proud of and something to share.

In the spirit of us all being in this together, I hope that sharing my race experiences today will help you in successfully achieving yours.

Written By:

 David Weingard
Fit4D
CEO, Type 1