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The Pharmacist Answers Podcast

Have a question for the pharmacist? Get your answers here! Clear explanations about complicated medical topics that anyone can understand. Disclaimer: The information contained in this blog and related podcast are not to be taken as medical advice, they are for informational and educational purposes only. If you resemble anything that is mentioned in this blog or related podcast, contact your doctor. The information contained in this blog and related podcasts is the opinion of the author and does not relfect the views of her employer, Walgreens. If you want to know what Walgreens thinks, ask Walgreens!
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Now displaying: September, 2016
Sep 22, 2016

For someone with diabetes, everything they do in life affects their blood sugar.  They could be eating 100% right and taking their medicine 100% right, and something would cause the blood sugar to be off.

Exercise:  It is well-accepted that exercise is good for you.  Your body will store extra sugar as a large molecule called Glycogen.  Imagine a line of kindergarteners hold hands trying to make it through the museum, Glycogen is just a bunch of glucoses holding hands.  When you’re not eating, your body will snip off a glucose at a time as it needs it.  The liver stores and directs the glycogen most of the time.  Your skeletal muscles also store some glycogen, because when they do work (i.e. exercise), it takes too long for the liver to snip off glucose from glycogen and send it to them.  After exercise, the body replenishes the muscles’ glycogen stores.  This can cause the blood sugar level to drop, for someone with diabetes, this can be dangerous because they can’t “untake” medicine.  When protein and carbohydrates are eaten together, before or after exercise, the blood sugar changes can happen more slowly - the nutrient absorption in the gut causes a “traffic jam” of sorts.

Sleep:  Certain metabolism processes happen only when you sleep.    Some people with diabetes wake up with really high blood sugar, others wake up with really low blood sugar.  Sleep is not restful and restorative if the blood sugar is out of balance, but also if sleep is not restful, then blood sugar levels can be jacked up - not just in the morning, but for the rest of the day.

Stress:  The hormones that are triggered by stress - even something as basic as adrenaline, can cause the body to respond to insulin and glucose differently.  

Sickness:  Your body is going to responds things differently when the immune system is in high gear - that includes insulin, glucose, the food you eat.  An infection requires an antibiotic because you are infected with a bacteria.  Bacteria are living organisms.  Living organisms consume energy sources and produce waste.  This can affect the sugar levels in your bloodstream.  You’re immune system doing work also burns sugar.

Allergies:  Works about the same as sickness.  Your immune system is actively trying to protect you from something (allergens) and so it responds differently.

Smoking:  If you smoke, STOP!  The nicotine and other chemicals make you more resistant to insulin.  This is most troublesome in Type 2 Diabetes.

Hormones:  Especially for women, hormone cycles can affect sensitivity to insulin differently during different times of the month.  Adrenaline can override almost any response to any previous hormone response.

Life is hard.  Life with diabetes is super hard.  Diabetes and other chronic diseases are silent and it doesn’t show on the outside at first sight.  Extend grace, extend compassion.

The Nashville chapter of JDRF is having their annual One Walk on September 24th. Friend of the show and previous guest, Rachel Mayo has been #T1D for over 10 years and she is passionate about the cutting edge research and support JDRF provides for people and their families. Her goal is for her team to raise $5000, you can contribute here:http://www2.jdrf.org/site/TR?team_id=206888&fr_id=6333&pg=team

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"Radio Martini" Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0 http://creativecommons.org/licenses/by/3.0/

Sep 19, 2016

Review:  Your brain is held inside your skull by a tri-layer membrane called the meninges.  These membranes and all the other structures in your brain are nourished by blood vessels, and different circumstances will make these vessels at risk of rupturing.

*ALL BRAIN BLEEDS REQUIRE MEDICAL ATTENTION!* 

Brain bleeds are classified based on the membrane they are closest to.  They can be caused by physiological malformations, stroke or aneurism from age or disease, or trauma.

From the outside in:

Extracranial bleed: (extra = external; cranial = cranium = skull bones), between your skin and your skull.  Doesn’t affect your brain, there is more room for it to stretch.

Intracranial bleed: (intra = internal); bleeds inside the skull increase the intracranial pressure and requires medical intervention.  Main goal is to reduce intracranial pressure so brain cells aren’t pressed on and damaged.

     - Epidural (yep, that place they put the anesthesia for women having babies, except it’s in the spinal cord): Epi = above, Dural = Dura mater, that topmost, durable layer of the meninges.  Between the skull and the dura mater.

     -Subdural: Sub = under; blood leaks in between the dura mater and the arachnoid mater, which are normally in close contact, so the separation causes pain.

     - Subarachnoid: under the arachnoid mater. Normally, under the arachnoid layer is the subarachnoid space which contain cerebral spinal fluid (CSF).  People who have had a subarachnoid bleed and survived, describe hearing a “thunderclap”.  Officially called a “thunderclap headache”.  It’s like they can hear the blood vessel pop and experience extreme pain all over their head all at once.  Described as “the worst headache of my entire life”.  Because the pia mater under the subarachnoid space lays directly on top of the brain cells and follows all the grooves and wrinkles of the brain, this type of bleed will require emergent attention and possible surgery.

*ALL BRAIN BLEEDS REQUIRE MEDICAL ATTENTION!* 

 Intracerebral (cerebral = cerebrum, the main part of your brain)

     - Intraparenchymal: Parenchyma = organ tissue, means it’s right up against the brain cells

     - Intraventricular: Ventricles = pockets inside the brain that make, hold, and reabsorb CSF.  The deepest part of the brain.

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"Radio Martini" Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0 http://creativecommons.org/licenses/by/3.0/

Sep 14, 2016

People with chronic diseases don’t get holidays or vacations from their medication.

 

4 ways medication can affect blood sugar:

1. Type of medication:  the goal of the medication that people with diabetes take is to lower blood sugar - either by increasing insulin sensitivity, encouraging the pancreas to make more insulin, or to replace insulin that’s not naturally made anymore.  Metformin is like insulin’s wingman; it helps make the cells ready for insulin when it comes by.  So usually these medications (including insulin) will lower blood sugar no matter if you eat or not.

2. Timing of medication:  Most of the medications should not be taken if a meal is going to be skipped.

3. Dose of medication:  the more sugar you eat, the more insulin you need.  The higher the blood sugar level, the higher the dose is needed.  It needs to stay proportional.  Any form of sugar you eat gets turns into glucose, the complexity of the sugar determines how fast it raises your blood sugar.  Even diabetics are at risk for hypoglycemia.  If one little thing gets out of whack, it can cause a drop in blood sugar and require a “rescue”.  Favorite hypoglycemia rescue “go to” is orange juice (lots of simple sugars).  Regular soda can be used, as well as hard candy or glucose tablets.  NO DIET SODA - artificial sweeteners do not affect sugar enough.  High blood sugar can cause coma, lower blood sugar can cause coma.  Bottom line: Coma is bad.

4. Interaction with medication:  Fluoroquinolones can causes changes in blood sugar control and require a person to check their levels and adjust their medicines more often.  Steroids can also cause blood sugar to be more uncontrolled - this is true for acute (short term) use or chronic (long term - like autoimmune diseases) use.  Beta blockers used for blood pressure control can mask the symptoms of low blood sugar because the symptoms are very similar.  Symptoms of low blood pressure:  tiredness, weakness, dizziness, shakiness, inability to focus.  The only way to know which one you’re experiencing is to check your blood sugar and your blood pressure.

 

The Nashville chapter of JDRF is having their annual One Walk on September 24th. Friend of the show and previous guest, Rachel Mayo has been #T1D for over 10 years and she is passionate about the cutting edge research and support JDRF provides for people and their families. Her goal is for her team to raise $5000, you can contribute here:http://www2.jdrf.org/site/TR?team_id=206888&fr_id=6333&pg=team

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"Radio Martini" Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0 http://creativecommons.org/licenses/by/3.0/

Sep 12, 2016

Meninges = triple-layer membrane that helps hold your brain in place.

 

The inside of your skull bones have many boney processes protruding out.  The meninges surround the brain and provide a cushioning layer around it, and anchor to these processes.  This allows the brain to be suspended inside the skull and not touch the top, sides, or bottom.

 

This setup is partly contributes to concussions.  When the head experiences a large enough impact, the suspended brain crashes into the bone of the skull.

 

Meninges encase your brain and spinal cord to protect them.

 

Three layers:

- Dura mater (mah-ter, not may-ter): durable and thick, contains large blood vessels.  This is the layer that anchors directly to the skull bones.  Membrane that divides hemispheres, separates a few lobes, and coats glands near the brain.

- Arachnoid mater (yes, like spiders): wispy like spider webs - thin & transparent. Directly in contact with Dura mater, but has cellular pillars that connect it to the Pia mater.  The cerebrospinal fluid flows around these pillars. Also overs the outside of the part of the brain as a whole.

- Pia mater - delicate, contains the capillaries that nourish the brain.  Is in direct contact with brain cells - following all the contours and wrinkles of the brain.

 

Subarachnoid space - hold cerebrospinal fluid (a closed fluid system that insulates and cushions the brain and spinal cord).  Doesn’t mix with blood or lymph system.

 

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"Radio Martini" Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0 http://creativecommons.org/licenses/by/3.0/

Sep 8, 2016

Your blood sugar affects how tired you are, your productivity, and your moods.  This is 1000x more true for those with diabetes.

 

Hypoglycemia = Low blood sugar

 

3 main energy sources in your food: Carbohydrates, Fats, and Protein

 

Carbohydrates are some complex form of sugar that your body can turn into glucose very quickly.  Glucose is the main form of sugar that your body uses for energy.  Because your liver is very efficient in this process, you can get a blood sugar spike (sugar high) and then you crash after it’s over.  Insulin is the key to the door to let the glucose in your cells.

 

Fats can be turned into sugar by your liver is your glucose stores are depleted.  So, this can affect your blood sugar levels, although it’s less of an impact that carbohydrates.  Insulin has another job - fat storage.  If there’s a lot of fat, the insulin is being used up storing fat rather than allowing glucose into cells.

 

Proteins are promoted as a counterbalance to the carbs.  It causes a traffic jam in the absorption and metabolism processes that allows the sugars into the blood stream much slower.  The liver does have a process called gluconeogenesis (the creation of new sugar) where it can make sugar out of protein, but it’s a last resort.

 

There is some evidence that shows caffeine causes temporary insulin resistance while it’s in the body.  You still get an “energized” feeling b/c caffeine increases the heart rate but the energy usage is not very efficient because the glucose is not being used well.

 

Alcohol can drop your blood sugar initially, especially if it’s consumed on an empty stomach.  When the liver is steadily detoxing the alcohol out of your bloodstream, the replenishment of the glucose supply slows down.  This contributes to what make you feel sleepy after drinking alcohol.  On the flip side, it will increase your blood sugar because 1) alcohol is usually mixed in a sugary drink (i.e. cocktails) and 2) alcohol is distilled from “high carb” sources (grapes, wheat, barley, rye, corn, etc).

 

Any changes to eating habits need to be exactly that - new habits.  I can’t just be a program that you do once without permanent change.  If you’re cutting out all or most of one of the 3 main energy sources, you have to make sure you keep up with your caloric needs.

 

1 g of Fat = 9 calories

1 g of Carb = 4 calories

1 g of Protein = 3 calories

 

Calories are calories when it comes it energy, so the other nutrients from your foods are a more important to consider when choosing what to eat.

 

There are lots of things your body would have to adjust to when changing eating habits (digestion adjustments, for one) and 30 days may not be enough to get it “normalized”.

 

The Nashville chapter of JDRF is having their annual One Walk on September 24th. Friend of the show and previous guest, Rachel Mayo has been #T1D for over 10 years and she is passionate about the cutting edge research and support JDRF provides for people and their families. Her goal is for her team to raise $5000, you can contribute here: 

Your blood sugar affects how tired you are, your productivity, and your moods.  This is 1000x more true for those with diabetes.

 

Hypoglycemia = Low blood sugar

 

3 main energy sources in your food: Carbohydrates, Fats, and Protein

 

Carbohydrates are some complex form of sugar that your body can turn into glucose very quickly.  Glucose is the main form of sugar that your body uses for energy.  Because your liver is very efficient in this process, you can get a blood sugar spike (sugar high) and then you crash after it’s over.  Insulin is the key to the door to let the glucose in your cells.

 

Fats can be turned into sugar by your liver is your glucose stores are depleted.  So, this can affect your blood sugar levels, although it’s less of an impact that carbohydrates.  Insulin has another job - fat storage.  If there’s a lot of fat, the insulin is being used up storing fat rather than allowing glucose into cells.

 

Proteins are promoted as a counterbalance to the carbs.  It causes a traffic jam in the absorption and metabolism processes that allows the sugars into the blood stream much slower.  The liver does have a process called gluconeogenesis (the creation of new sugar) where it can make sugar out of protein, but it’s a last resort.

 

There is some evidence that shows caffeine causes temporary insulin resistance while it’s in the body.  You still get an “energized” feeling b/c caffeine increases the heart rate but the energy usage is not very efficient because the glucose is not being used well.

 

Alcohol can drop your blood sugar initially, especially if it’s consumed on an empty stomach.  When the liver is steadily detoxing the alcohol out of your bloodstream, the replenishment of the glucose supply slows down.  This contributes to what make you feel sleepy after drinking alcohol.  On the flip side, it will increase your blood sugar because 1) alcohol is usually mixed in a sugary drink (i.e. cocktails) and 2) alcohol is distilled from “high carb” sources (grapes, wheat, barley, rye, corn, etc).

 

Any changes to eating habits need to be exactly that - new habits.  I can’t just be a program that you do once without permanent change.  If you’re cutting out all or most of one of the 3 main energy sources, you have to make sure you keep up with your caloric needs.

 

1 g of Fat = 9 calories

1 g of Carb = 4 calories

1 g of Protein = 3 calories

 

Calories are calories when it comes it energy, so the other nutrients from your foods are a more important to consider when choosing what to eat.

 

There are lots of things your body would have to adjust to when changing eating habits (digestion adjustments, for one) and 30 days may not be enough to get it “normalized”.

 

The Nashville chapter of JDRF is having their annual One Walk on September 24th. Friend of the show and previous guest, Rachel Mayo has been #T1D for over 10 years and she is passionate about the cutting edge research and support JDRF provides for people and their families. Her goal is for her team to raise $5000, you can contribute here: http://www2.jdrf.org/site/TR?team_id=206888&fr_id=6333&pg=team 

 

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"Radio Martini" Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0 http://creativecommons.org/licenses/by/3.0/

Sep 5, 2016

Headaches vary in their severity.  If you’ve had more than one headache in your life, you know this to be true.  This variation is dependent on the type of headache, but also a person’s body chemistry.

5 Types of Headaches

1. Tension headache: come on if you’re stressed or having to hold your body in an uncomfortable or unnatural position.  Neck and shoulder tension can cause the headache to hurt in the back of your head (and can radiate to your eyes due to the location of the optic area of the brain).  Intense facial expressions (including crying) can hurt in the front or sides of your head.  Obsessive personality types are more prone to tension headaches.  OTC pain meds help turn off pain receptors.  Using a warm compress to loosen and soften muscles and then doing stretches can relax the muscles and relieve tension.  Some people find that ice packs can help because the cold decreases the inflammation in the area that is tense and painful.

2. Cluster headaches: happen in groups or cycles. Mild to moderate pain.  One-sided headache accompanied by water eye, sinus pressure, and runny nose on that same side.  Don’t be fooled into thinking that it’s a sinus headache.  The pain from cluster headaches will make you restless - “If I can just stay busy, I won’t think about the pain and will be ok”.  This type of headache can be treated with OTC medications.

3. Sinus headache: your sinuses (tunnels in your head and face bones) are lined with mucous membranes.  They can become inflamed if they are fighting off a virus (cold), infected by bacteria (sinus infection), or from overproduction due to a severe allergy attach.  The inflammation, in itself, can cause pain.  But if they swell shut and the air inside can’t even out pressure with the outside (just like your ears when you change altitude), it can cause pain. Antihistamines and decongestants can help, and again, OTC pain relievers.

4. Rebound headache: if you use a medication for a prolonged period of time, your body chemistry will adjust to it always being there.  So, if you stop taking it, your body notices the gap and responds by sending pain signals.  This happens with headache medications as well as other pain medications.  Can be an indication of medication overuse. 

5. Migraine: must meet a specific set of criteria to be diagnosed.  And because they are most affected by brain chemistry, OTC medications rarely work, thus require prescription medications.

     Diagnosis criteria

     - 5 or more debilitating episodes

     - an episode lasts 4-72 hrs

     - At least 2 of the following:

          + one-sided

          + throbbing (feel the pulse or heartbeat)

          + Moderate to severe

          + Interferes or prohibits daily activity

          + Daily activity makes it worse

          +Sensitivity to light and/or sound

     - With or without aura (visual disturbances - halo, floaters; hand numbness)

          If your brain knows something is going on, it may preemptively redirect blood and nutrients to the vial organs and thus your extremities get neglected.

Still not 100% sure what causes migraines. Neurologists can do brain scans to look for patterns in electrical signals and misfirings. So far, we know it has something to do with neurotransmitters.  Hormones can affect the brain chemistry so strongly, that each menstrual cycle can come with migraine.  Pregnancy hormones can cause migraines - either temporarily or permanently.  Serotonin, which is your “happy” chemical, is produced when your eyes are stimulated by sunlight.  If it gets out of balance, the brain responds.  Triptans (a class of medications used to treat migraines) affect serotonin levels to try and rebalance it.  Even though OTC and home remedies don’t work for migraines.  Some people do get relief with ice packs.  Again, the ice helps reduce any inflammation, but it can also just numb the nerves so they don’t feel as much pain.  **Ice must be used conservatively because too much ice contact can damage the skin**  Other people find that warm compresses hurts because the muscles around the painful area get tense and the warmth can help them relax.

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"Radio Martini" Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0 http://creativecommons.org/licenses/by/3.0/

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