Chester Clinic

(microsoft word - cjde brochure - chapitre 2 - anglais- modifi 351.doc)

Educational
program for people
with diabetes
Medication
Inv.: 1-6-14729 (Hôtel-Dieu, Hôpital Fleurimont) CENTRE DE JOUR DU DIABÈTE DE L'ESTRIE. Mieux connaître le diabète, Centre hospitalier universitaire de Sherbrooke, 2002, 121 p. PROGRAMME MÉDECINE - PROGRAMME - CLIENTÈLE DIABÈTE. Mieux connaître votre diabète, brochure # 321-1, Complexe hospitalier de la Sagamie, 202, 17 p. Centre hospitalier universitaire de Sherbrooke website : Version revised by members of the Centre de jour du diabète de l'Estrie team : Josée Arbour, nutritionist France Bégin, pharmacist Suzanne Buteau, nurse BSC Josée Desharnais, clinician nurse Catherine Goulet-Delorme, clinician nurse Julie Dubé, nutritionist Dre Chantal Godin, endocrinologist Dre Ghislaine Houde, endocrinologist Élisabeth Turgeon, kinesiologist We also wish to acknowledge the contribution of al authors of previous editions. August 2012 (revised) – Centre hospitalier universitaire de Sherbrooke TABLE DES MATIÈRES
GENERAL RECOMMENDATIONS
When you take your medication : MEDICATION TO CONTROL DIABETES.7 ♦ Inform yourself about the way it acts and how to take it; ♦ Take it at the time and in the dose indicated on your prescription; 2) Insulinosecretors .9 3) Incretins .10 ♦ Eat three meals a day, at regular hours; 4) Insulin sensitizers .12 ♦ Check your blood glucose several times a day and note the 5) Sugar absorption retardants.13 results in your logbook; THE APPROPRIATE TIME TO TAKE YOUR MEDICATION.15 ♦ Inform your doctor or pharmacist of any side effects that are uncomfortable or bother you; DRUG INTERACTIONS AND THE DRUG CODE .16 ♦ If you change your eating habits, begin a program of physical OVER-THE-COUNTER DRUGS .18 activity or have lost weight, check your blood sugar more often, as it could be lower; NATURAL PRODUCTS.21 ♦ If you have hypoglycemia, talk to your doctor so he can adjust INSULIN AND TYPE 2 DIABETES.21 GENERAL RECOMMENDATIONS .22 ♦ Avoid excessive consumption of alcohol. BIBLIOGRAPHY .23 We hope that this information will help you better understand
your medication.

NATURAL PRODUCTS
Better knowledge of your medication
makes it easier to follow the treatment correctly.
Certain natural products may have an influence on your blood
We recommend that : ♦ You inform your doctor or pharmacist before deciding to take any non-prescription treatment; ♦ You do not replace your medications with "miracle" products which have not been proven to be effective; ♦ You mention to your doctor or pharmacist if you use natural products for other aspects of your health. INSULIN AND TYPE 2 DIABETES
Many persons with type 2 diabetes are able to control their diabetes
with a healthy diet, physical exercise and medication. However, this
combination of measures may not work over time. Insulin injections may then become necessary to maintain your blood sugar at a good Sore throat = Cough drops This is the second chapter of this educational program. It wil be explained to you by your pharmacist or nurse. Its purpose is to ♦ First choice : - CepastatMD without sugar inform you about : - StepsilsMD without sugar ♦ Different medications used in the treatment of diabetes; - ChlorasepticMD ♦ Possible side effects; - Hal sMD without sugar ♦ Appropriate time to take your medication; ♦ Possible drug interactions; ♦ Over-the-counter medications. ♦ First choice ♦ Second choice : Treatment of type 2 diabetes rests in large part on :
♦ Adopting healthy eating habits; Basic measures : - Regular exercise ♦ Maintaining a healthy weight or losing weight; - Eat foods rich in fibre ♦ Exercising regularly; - Drink 6 to 10 glasses of water per day ♦ Managing stress. Drugs wil only be used if the basic measures are tried for 2 to 4 weeks without success. If, in spite of these efforts, your blood glucose level remains high, the ♦ First choice : - MétamucilMD without sugar use of one or several medications may be cal ed for. These - BenefibreMD without sugar medications do not replace a balanced diet, they must be considered as a complement to it. ♦ First choice : - MaaloxMD regular, GavisconMD liquid - DiovolMD regular REMINDER
♦ When you buy footcare products, always ask the pharmacist for The 4 main anomalies caused by
type 2 diabetes

Here are a few suggestions for permitted medications :
Nasal congestion
Digestive system
Basic measure : Drink 8 to 10 glasses of water or warm liquids a 4. Decrease gastrointestinal hormones (incretins) ♦ First choice : Pancreas
♦ Second choice : - OtrivinMD (Maximum use : 3 to 5 days) 1. Decreased production of (Maximum use : 3 to 5 days) Dry cough (without secretions) 2. Excessive production of ♦ First choice : - Products with a dextrométorphan, represented by the letters DM Muscle and fat
Examples : - Balminil DMMD syrup without sugar - Benylin DMMD syrup without sugar Heavy cough (with secretions) 3. Resistance to insulin Basic measure : HYDRATION (Drink lots of warm liquids) Expectorants : Not advised OVER-THE-COUNTER DRUGS
If your doctor prescribes one or several drugs for diabetes, it wil be General advice
important to continue to do blood glucose self-monitoring so he wil be able to adjust your treatment. ♦ Always inform health care professionals (doctors, dentists and pharmacists) that you have diabetes and tel them about the the medications you are taking. Have your list of al prescribed and non-prescribed medications including natural products, vitamins, WHAT MEDICATION IS USED
products for influenza, etc. You can obtain a list from your TO CONTROL DIABETES ?
♦ Choose your pharmacist careful y and stick with him. Your An oral medication for the treatment of diabetes is a tablet or pil pharmaceutical profile wil thus be complete and the advice you taken by mouth which causes a lowering of blood glucose; it is not
receive can be more personalized. insulin in pill form.
♦ Use only medications prescribed for YOU by the doctor or that are suggested to YOU by the pharmacist. The oral hypoglycemic drugs currently available in Canada act on the 4 main anomalies caused by type 2 diabetes. Products for colds, influenza and foot care
2) Insulinosecretors; ♦ Avoid preparations that contain several drugs (e.g. Neo-citran). 4) Insulin sensitizer; Choose instead a preparation with one single ingredient for one 5) Sugar absorption retardant. symptom, such as a cough syrup to soothe a cough; The majority of people tolerate drugs for diabetes quite wel . Most of ♦ Avoid preparations that contain a lot of sugar. Choose a the related side effects involve the digestive system. It is, therefore, preparation without sucrose. important that you follow the dose prescribed for you by your doctor, and take it at the time you are told to by your pharmacist. 1) METFORMIN
GENERIC NAME
COMMERCIAL NAME

The code letters are associated with warnings. Check your drug code every time you buy over-the-counter medications . Universal code – Applies to everyone
A = DROWSINESS
Action : Decrease the production of sugar by the liver.
Attention. May cause drowsiness and can decrease your reaction time. Avoid the use of alcohol or other tranquilizing Allow the cells to use the glucose (sugar) more
medications, especially if you are driving. efficiently by decreasing the resistance to insulin.
H = DEPENDENCE
Attention. Could become habit-forming. Do not use this product over a long period of time. SIDE EFFECTS
TO PREVENT SIDE EFFECTS
X = S.O.S.
Warning. Consult your pharmacist before using this product. How to use this product needs to be explained to you. Take the drug with food. Personal code – To complete with your pharmacist
FOUL TASTE IN THE MOUTH
Change pharmaceutical B = CONTRAINDICATION
Could be harmful to your health if you suffer from hypertension (high blood pressure), prostatic hypertrophy, hyperthyroidism or if you are taking antidepressants. DISCOMFORT (particularly
Take the drug with food. D = INTOLERANCE
diarrhea)
Gradual y increase the dose. Contains aspirin. Avoid if you suffer from gout, stomach ulcers, asthma or if you take anticoagulants to thin your blood. Attention
E = DIABETES
Not to be taken if you suffer from diabetes. This medication may This medication does not cause weight gain or hypoglycemia. It can cause undesirable side effects. sometimes help weight loss. The drug code is an initiative of the pharmacists of Quebec,
to protect the public.
DRUG INTERACTIONS
2) INSULINOSECRETORS
♦ Certain medications or natural products may increase or decrease the effect of your diabetes medication; this is called GENERIC NAME
COMMERCIAL NAME
drug interaction; ♦ Speak to your doctor or pharmacist before taking any new
medication;
Diamicron MRMD (prolonged action) ♦ There is a drug code for every drug sold in the pharmacy. This code is made up of letters (6 al together), each corresponding to a particular warning; ♦ For diabetics, the letter related to your condition is the letter "E". This means that a product identified with this code should be Action : Stimulate the pancreas to increase the production of
avoided as much as possible by a diabetic person who is insulin.
SIDE EFFECTS
TO PREVENT SIDE EFFECTS
• Monitor blood sugar RISK OF HYPOGLYMIA
• Fol ow schedule and dose • Take 3 meals every day, at INCREASED SENSITIVITY TO
• Apply sunscreen (SPF 15 or • Eat a balanced diet. WEIGHT GAIN
• Be physical y active on a

) INCRETINS
(Increase in the gastro-intestinal hormones)
THE APPROPRIATE TIME TO TAKE YOUR
DIABETES MEDICATION
GENERIC NAME
COMMERCIAL NAME
♦ Always take your medication with a meal; ♦ Do not ever take it at bedtime; ♦ Never double the dose (even if you are eating a heavy meal or you have forgotten a dose). If you forget to take a dose and you realize it : Action : Decrease the production of sugar by the liver.
1) Less than 30 minutes after the end of the meal : Take the dose;
Stimulate the pancreas to increase the production of
2) More than 30 minutes after the end of the meal : Wait until the
insulin.
next meal to take the dose. If you should be taking
Liraglutide/Exenatide : Slow gastric emptying.
another dose at the next meal, do not take the dose you forgot (do not double the dose). SIDE EFFECTS
TO PREVENT SIDE EFFECTS
NONE REPORTED FOR
SITAGLIPTIN, SAXAGLIPTIN
AND LINALIPTIN
Increase the dose gradual y. NAUSEA AND DIARRHEA
Listen to your satiety signals (LIRAGLUTIDE AND EXENATIDE
If nausea occurs between meals, have a little snack (such as biscuits). HEADACHES
Take analgesic medication (acetaminophen, if needed).

3) INCRETINS
(Increase in the gastro-intestinal hormones)
Mechanisms to improve blood glucose readings
Attention
Sitagliptin, saxagliptin and linagliptin cause neither weight gain nor Pancreas
Decrease appetite : Increase the release Liraglutide and exenatide may help lose weight and do not cause - Insulinosecretors; IMPROVEMENT OF
Decrease production Intestine
Decrease absorption - Insulin sensitizer. - Insulin sensitizer. - Sugar absorption intestinal hormones : 4) INSULIN SENSITIZER
5) SUGAR ABSORPTION RETARDANTS
GENERIC NAME
COMMERCIAL NAME
GENERIC NAME
COMMERCIAL NAME
Action : Allow the cells to use glucose (sugar) more efficiently
Action : Lower glycemia after meals by delaying the
(decrease the resistance to insulin).
absorption of sugars in the intestine.
Decrease the production of sugar by the liver.
SIDE EFFECTS
TO PREVENT SIDE EFFECTS
SIDE EFFECTS
TO PREVENT SIDE EFFECTS
DISCOMFORT
SWELLING (EDEMA) AND
WEIGHT GAIN
DIARRHEA
Increase the dose gradual y. HEADACHES
Tel your doctor if you have any undesirable side effects. Flatulence (gas)
MENOPAUSAL WOMEN)
Attention
Eat a balanced diet. The drug causes neither weight gain nor hypoglycemia. WEIGHT GAIN
Be physical y active on a It is recommended that you take this drug with the first mouthful of Attention
If you must take an insulinosecretor drug with GlucobayMD and your become hypoglycemic, take glucose tablets or milk; any other
The drug does not cause hypoglycemia. solutions (sugar, soft drink, juice) wil be much less effective.
The drug begins to act 1 to 4 weeks after the beginning of treatment,
and reaches its maximum effect in 6 to 12 weeks after beginning the
Taking this drug is contraindicated for those with heart failure.

Source: http://www.chus.qc.ca/fileadmin/doc_chus/Patients_visiteurs/Documents_aux_patients/Diabete/ENG_CHUS_Chap2_Diabetes.pdf