Managing your meds for diabetes can be tricky. Here’s what you need to know.
If you’ve been diagnosed with diabetes, the first step to getting your condition under control is understanding what it is, and how any medications you’ve been prescribed help you manage your diabetes. In a nutshell: Our bodies produce a hormone called insulin that helps us use glucose, or blood sugar, for energy. In type 2 diabetes, the most common kind, blood sugar rises and insulin production can’t keep up, which leads to an excess of glucose the body can’t absorb. (In type 1 diabetes, the body can’t actually produce insulin, so it must be administered with medication.)
Some cases of type 2 diabetes can be managed with diet, exercise and these diabetes lifestyle changes alone; however if the disease progresses, you may need to take medication, such as pills that help regulate blood sugar (metformin), pills that help the body use and produce insulin (sulfonylurea agents), or injectable insulin itself.
In order to avoid problems when taking your meds, you should know what each medication does—and, importantly, what the pill looks like.
“Many medications can look and sound alike, and may then be mixed up and taken by mistake,” says Agnes Weaver, RN, CDE, a diabetes educator at Piedmont Fayette Hospital. The appearance of the medication—including the size, shape, color, and number inscribed on it—can give the patient information, she says. “It is important to be cognizant of what each medication does so one can know what condition that medicine is prescribed to treat, how it is supposed to be taken, the side effects, any contraindications, and whether it needs to be withheld when certain parameters are met or not met,” Weaver says.
Once you’ve got the basic info down, watch out for these other common errors:
1. Mistake: You don't follow blood sugar testing protocol
One of the many pains (literally) of diabetes is having to test your blood sugar with finger pricks. Although blood sugar testing isn’t pleasant, properly testing and recording your results will help give your doctor a snapshot of how your blood sugar changes throughout the day in order to make medication decisions, Weaver says.
“Testing infrequently, always testing at the same time or testing at the wrong time will give your doctor incomplete data,” she says. “Examples of testing at the wrong times are testing immediately after eating instead of waiting two hours for your post-meal reading, or testing too soon after giving insulin without waiting for that insulin to work or to show maximum effect.”
Check with your doctor to know exactly when you’re supposed to test your blood sugar, as no two diabetes plans are exactly the same.
In addition, you’ll want to use the proper technique when you test your blood sugar. Wash your hands first (don’t use hand sanitizer) to make sure the sample won’t be contaminated. “Milk” your finger to make sure enough blood comes out onto the testing strip. “Avoid pricking the fingertip in the middle where it is more sensitive, and use the side of the fingertip instead,” Weaver says. “Using lancets over and over again can result in more painful sticking as the lancets get dull with frequent use.”
2. Mistake: You don't understand when or if to take your meds with food
Because the foods you eat affect your blood sugar, you should make a plan for eating regularly, and know when to take your meds in relation to when you eat. “Missing meals can throw off the balance between food intake and medication,” Weaver says. “Some diabetes medicines are taken around meal times to reduce blood glucose levels after eating and, if you take them at the wrong time, they may not regulate the blood sugar properly.”
“The right time to take oral diabetes medications varies with the product,” says pharmacist Dave Walker, RPh, MedShadow medical advisory board. “For example, oral glipizide [a sulfonylurea] is fairly fast acting and should be taken before meals and at the same time each day. Other oral diabetes medications like metformin should be taken with or after a meal to prevent upset stomach or other gastrointestinal side effects. Fast-acting insulin injections should be used before meals as prescribed by your physician.”
In addition, ask your doctor, pharmacist, or diabetes educator ahead of time what should you do if you happen to skip a meal—you will likely not need to take your mealtime insulin. You may want to have quick “on the go” replacement snacks or meals available just in case you’re not able to eat but have already taken your medication (such as during a busy work day). Check out these healthy low-carb snacks for diabetes.
3. Mistake: You take the wrong dose or take your medication at the wrong time
“The time a drug starts to work and the duration of its action may determine the best time to take it,” Weaver says. For example, you may have long-acting and short-acting insulin to take at different times of the day. Mixing them up can throw off your blood sugar. (Here’s more info about the different kinds of insulin.)
“As a general rule, rapid-acting insulin can be taken 15 to 20 minutes before or after a meal,” Weaver says. “For most long-acting insulins, you can take it within two hours of when it should have be done and readjust the schedule for the next dose.”
There may be a specific time to take your other diabetes medication for optimal effectiveness as well, Walker says. “Work with your doctor or pharmacist on compliance or adherence to a medication schedule that fits into your daily routine,” he says. If your diet or exercise habits change—say, you switch from morning workouts to evening ones—make sure to let your doctor know, as this may also affects your medication dose. (And don't miss this advice for preventing low blood sugar during exercise.)
4. Mistake: You miss or skip a dose
When you have diabetes, it’s crucial to know what to do if you miss a dose of medication by accident. Should you take it as soon as you remember, or just wait until the next dosage time? Your healthcare provider can best answer these questions for your specific needs.
You should do everything possible to prevent missing a dose, though—whether that means setting timers on your phone or using an app, putting your meds where you can see them, or using a pill organizer for oral meds.
“Missing or skipping doses means loss of control and elevated blood sugars,” Walker says. “The importance of taking your diabetes medications on a regular schedule cannot be overemphasized.”
5. Mistake: You get your meds confused with each other
In addition to knowing what each of your diabetes medications looks like and what it does, you should also be aware of this info for medications you take for other conditions to avoid interactions and mixups.
“Cholesterol-lowering medications are recommended for many diabetic patients and are usually taken in the evening or at bedtime, often after the dinner dose of other oral diabetic medication,” Walker says. “Most medications for blood pressure or cholesterol can be taken at the same time as oral diabetic medications.” (Here's more info on how diabetes affects your heart health.)
Also, make sure your doctor and pharmacist know every single medication you’re taking—even over-the-counter supplements or drugs—to avoid any contraindications. It’s best to use to use same pharmacy for all your meds so the pharmacist can spot potential problems; and if you notice that a pill or medication looks different than your last refill, be sure to ask the pharmacist.
6. Mistake: You don't tell your doctor if you suspect your meds aren't working as well
If your blood sugar is no longer within the range it’s supposed to be, or if you’re experiencing any unusual symptoms, it may mean your medication is no longer performing optimally.
“If your medications do not seem to work anymore, it is time to discuss with your provider as the dose may have to be adjusted, or the medication changed, or another medication may need to be added to the existing one,” Weaver says.
Changes in your weight, stress, illness, or level of physical activity can all affect how your diabetes medication works. (Here are other factors that can lead to unexpected blood sugar spikes.) It’s also possible that your oral medication may not be enough to control your diabetes anymore, and you’ll need injectable insulin.
7. Mistake: You don't store your meds properly
As with any medication, make sure you follow your pharmacist’s recommendations for storage, which should be on the medication label or leaflet.
“Where a medication is stored can impact its efficacy and shelf life,” Weaver says. “Avoid fluctuations in temperature and high humidity—the bathroom medicine cabinet is not the best place to store medications. A cool, dry place such as a dresser drawer would be better.” In addition, avoid areas near the stove, sink, heat sources or warm electronics. For insulin, Weaver says to store unused vials in the fridge (not the freezer), but the vial you’re currently using can be kept at room temperature.
When you travel, it’s important to keep your meds with you at all times to avoid missing doses and throwing off your blood sugar. “Keep your medications in a carry-on bag so you will always have your them with you in case of flight delays, cancellations, or lost luggage,” Weaver says. “Many travelers invest in an insulated insulin carrying case to keep their insulin cool. Do not put them in your checked luggage because of extreme temperature fluctuations in the baggage compartments of planes.”
In general, it’s best to keep meds in their original childproof container, as they have the label with the name, dose, and expiration date on it.
8. Mistake: You stop taking your meds if you feel better
Some patients with diabetes may think they can cut down a bit on their meds if they feel better, but that’s not the case—it just means the drugs are doing their job. “It is important to continue your medications even though you feel better, as the medications are responsible for keeping your blood sugars under control,” Weaver says. “If you stop taking them, your glucose numbers can rise and get out of control.” Never just quit your meds, even if you’re having side effects. Always talk to your doctor first.
Unfortunately, diabetes is a lifelong illness—but it can be well-managed. “Taking medication does not ‘cure’ diabetes,” Walker says. “The symptoms and the disease itself can only be controlled by regularly taking diabetes medications.” Keeping up with your med plan can help you stay on track for successful treatment.