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Medication overload?

There is a newspaper article about someone having:

• 22 different types of medication, 15 prescription and seven over-the-counter (OTC)
• 10 injections and four blood tests a day
• medication taken 26 times each day, by mouth, injection, inhalation or on the skin

This example is extreme perhaps but people with diabetes do take lots of meds. No wonder they miss doses, don’t fill prescriptions or just stop taking them. The trouble is there are so many medicines and so many times in the day when you take them. The solution is fewer meds and fewer times to take them.

Fewer meds

• Complementary meds or supplements
  Summer 2013 Conquest [page 22] noted that these meds can cost a lot, in many cases have not been shown to work, can have side effects alone or in combination with other meds and, if imported, do not always have the same standards of production as prescription meds. As far as nutritional supplements are concerned, they are only needed for women planning or having a pregnancy and for proven deficiencies (e.g. iron, vitamin D). Consider stopping them, taking fewer pills and saving money.
• Pharmaceuticals
  Two common and unnecessary prescription medications are those for pain or osteoarthritis (non-steroidal anti-inflammatory drugs or NSAIDs) and those for indigestion (proton pump inhibitors, PPIs). Look at the chemical names of your painkiller/ arthritis meds (in smaller type under the brand names on the packaging). If the chemical name ends in ‘en’ (e.g. ibuprofen, naproxen) or ‘ib’ (e.g. celecoxib), it is an NSAID. These can damage your stomach and kidneys, upset the minerals in your blood and increase your risk of a heart attack. Safer alternatives for pain relief include physical therapies (e.g. local heat, special exercises), ointments and safer analgesics (e.g. paracetamol). Check also your
  meds for indigestion: if they end in ‘prazole’ (e.g. omeprazole, pantoprazole), they are PPIs. The National Prescribing Service has strongly recommended that these should only be taken for a short period for symptoms and then stopped, except in special circumstances. If you get the occasional heartburn, take an antacid –
  they work much quicker and are much cheaper.
• Puffers
  If you use your blue puffer (e.g. Ventolin, salbutamol) several times a day, you need to talk to your doctor about a different longer-acting or preventive puffer. The blue puffers are only short-acting and won’t stop you wheezing or coughing later. The longer-acting/ preventive puffers are used once or twice a day, less times and at less cost than the frequent use of a reliever puffer.

Fewer med-taking occasions

• Combining meds
  Manufacturers produce pills that contain different medications (e.g. two or three different types of diabetes, blood pressure or cholesterol meds). Two or even three of your meds could be combined into one, meaning less pills, less cost and fewer times needed to take them. Some people pop pills all day: before meals,
  after or with food, and these others before bed. Some meds do need to be taken at special times but most don’t. You can probably take all your pills on one or two occasions in the day.

Look at your medication list

• Are you taking meds that you don’t need (complementary meds, nutritional supplements, NSAIDs, PPIs, puffers)?
• Are you taking multiple diabetes, blood pressure or cholesterol meds?
• Do you take meds more than once or twice a day?

If so, consider talking to your doctor or pharmacist about a Medication Management Review or Home Medicines Review to see if you can take fewer meds, less often and with less expense.

Are you up-to-date with immunisation?

Every year, thousands of Australians get infections they could have prevented. Some get very ill and end up in hospital and some die. If they had known about the availability and effectiveness of immunisations against these infections, they wouldn’t get ill in the first place.

For people with diabetes, being up-to-date with immunisations is even more important – infections are more common and infections are more serious. For example, if I got the flu I might be sick, achy and get a fever, but if I had diabetes I’d get more sick, my blood glucose level might shoot up and I might get pneumonia.

Immunisations aren’t perfect and even though I had the flu shot I could still get the flu, BUT I wouldn’t get so sick and I’d be much less likely to get pneumonia.

The important immunisations for non-Indigenous Australians with diabetes are summarised in the table below. If you’re not sure, have a look at the website and/or ask your doctor. You can see that in addition to your yearly flu shot, you need other shots at age 50, 60, 65 and 70.

Don’t forget to get up-to-date with your shots and keep a record of when you have them and a reminder of when you’re due for your next one.

Dr Pat Phillips, MBBS, MA, FRACP, Dip Ed Health Economics, is Editor-in-Chief of Conquest and Past Director of the Diabetes Centre and Endocrinology, Queen Elizabeth Hospital & Health Service. Angela Close is a pharmacist

This article was originally published in Conquest Magazine published by Health Publishing Australia