Smoking and Diabetes

Question: "So...is it bad to smoke if you have diabetes?"

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Yes! I'm glad you asked this question.

The biggest problem with smoking and diabetes is that they tend to cause the same kinds of health problems. Diabetes, especially poorly controlled diabetes (frequently high blood sugars), puts a person at a huge risk for nerve damage, eye damage, high blood pressure and cholesterol which will ultimately lead to heart attacks and/or stroke. Hence why your doc is so worried about blood sugars. People with diabetes are three times more likely to have a heart attack than a person without, and it all has to do with those blood sugar readings.

Smoking also causes, all by itself, a risk of high blood pressure, heart attacks, stroke, and nerve damage. Have you ever talked to a long time smoker that has cold hands? It's because their circulatory system is no longer able to deliver blood as efficiently as it used to, thanks to years of smoking. Have you ever heard of a person with diabetes getting a foot infection that just won't heal? Exact same problem.

So, the bottom line is this:

Smoking + diabetes = twice as likely as other people with diabetes to have circulation and wound healing problems. Do yourself a favor and Google "diabetic foot infections" if you want to know what I'm really talking about.

Smoking + diabetes = 11 times more likely to die from a heart attack or stroke. ELEVEN TIMES!! That's like not wearing your seat belt, and then purposefully driving with your eyes shut! And I'm not talking about a heart attack when you're 80...I'm talking quite possibly in your 30-40's.

A good summary: http://www.diabetesmonitor.com/learning-center/smoking.htm

The good news is, doctors and pharmacists are better trained to help people quit smoking than ever before. If you're interested in quitting, Brooklyn or I can do a whole post on different options for quitting and what kind of help is available, from behavior tricks to actual nicotine replacement. Just let me know!

Drinking and Diabetes

Question: "So...I am a diabetic. I don't want to ask my doctor because Im not 21, but is it ok for me to drink?"

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First off, I have to say this because this is a public website, but we are not supporting drinking underage. BUT the purpose here to be informed no matter what decision you make, so on to the important part:

Yes, people with diabetes can drink alcohol, but there is a greater risk of low blood sugar. Be aware of what you are drinking and how it can affect your blood sugar- for instance, an orange juice and vodka is going to act very differently than a diet coke and vodka. Most importantly, BE SURE to check your blood sugar before drinking, at least once while you drink, and definitely before you go to bed. Alcohol can (will) lower your blood sugar immediately and again 8-12 hours after, so making sure your sugar is in a safe place (100-140) before you sleep is super, duper important.

Here's the American Diabetes Assoc. website that addresses it pretty well: http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/alcohol.html

Thanks for asking!

Ibuprofen Question

Question submitted: "Can you explain Ibuprofen? It seems like everyone takes more than what the bottle says to and its no big deal.. and since it comes in higher doses than just over the counter pills can't you just take more OTC pills and have the same thing?"

Ibuprofen is in a general class of drugs called NSAIDS (non-steroidal anti-inflammatory drugs) and is commonly used for pain or inflammation relief. Yes, there is an over the counter (OTC) and prescription (Rx) strength, and the OTC is just a lower dose of the same medication. The problem with taking more than the bottle says to is that NSAIDS are known to cause stomach ulcers and bleeding and interact with some other prescription medications. The OTC strength is low enough we aren't as worried about the stomach issues except in very rare cases (such as patients with a bleeding risk) or if a patient is taking a prescription medication it interacts with.

If a doctor prescribes you prescription strength ibuprofen, chances are it will be cheaper to use OTC and take more tablets. You're right in one aspect in that it's not the toxicity of ibuprofen we're worried about (very difficult to fatally overdose on ibuprofen, which is why many times it's "no big deal" when people take more than the bottle says) but the risk of stomach ulcers and bleeding in the GI tract is an issue when people take high doses and do it frequently. That's the real reason for the difference in OTC and Rx strength NSAIDS. (Naproxen (Aleve) is the same way)

I might add, to go along with the pattern we've seen so far in this blog, alcohol really aggravates the stomach issues and shouldn't be taken with ibuprofen, aspirin, Tylenol, or naproxen (these are also NSAIDS), no matter if it's OTC or Rx strength.

Xanax

In a world of growing prescription drug abuse, almost everyone has heard of Xanax. Commonly prescribed as an anti-anxiety medication or sleep aid, it is also one of the top abused prescription medications. Sought after for it's "calming effects", it can rapidly turn dangerous when used recreationally. Below is some basic information about Xanax and how to identify an overdose.

Xanax, generic name alprazolam, is part of a drug class called benzodiazepines (you may have heard the term "benzos"). It is used as an anti-anxiety drug and works by acting in the brain, slowing down the nervous system and calming patients. While there is not a "high" from using Xanax, this calming effect can be a goal of abuse and leads to the addictive nature of Xanax.

The dangers come into play when Xanax is not used as intended by a doctor. Because it is a "calming" medication, too much can depress a person's mental function to the point of confusion, slurred speech, drowsiness, and slowed reflexes. Rarely, a person can take so much that it causes respiratory depression, which is your body slowing down so much you cannot breath on your own, coma, or death. This usually happens when Xanax is taken with other agents that depress the brain and body.

Like alcohol. The dangerous thing about prescription drugs used for recreation is they are often mixed with alcohol. Xanax and alcohol have additive effects that can lead to respiratory depression and a person slipping into a coma much faster than normal. Under no circumstances should you mix Xanax and alcohol, or you may end up like a girl I knew in college: being carried out of the bathroom at the bar on a stretcher because you passed out after a few drinks and didn't wake back up.

Other "benzos" that this information also applies to: (not an inclusive list, just the common ones)

Ativan (lorazepam)

Vallium (diazepam)

Klonopin (clonazepam)

Restoril (temazepam)

Be Careful

Hey everybody, I know it has been a while since we have last posted, but I wanted to bring some attention to something that has been on my mind this week. One of my friends told me a story about a boy from her home town and how he passed away from a drug overdose. He had snorted a crushed up tablet and mixed it with alcohol. He was in his early 20's. It really hurt to listen to her story and it reminded me that this is why Rebecca and I started this website in the first place, to prevent things like this from happening. The truth is, there are so many people out there that are taking prescription drugs and mixing them with alcohol and other medications even though they do not understand how it will affect them.
I am not writing just because I am on my soap box about drug abuse. I am writing because I watched how her family as well as our entire town was affected by Haley's death and I really do not want to see this happen again. Staring at her picture, I see a beautiful young girl that seemed to have it all, and she lost everything because no one told her how dangerous her choices were.
Be careful out there guys, and remember, if you ever have a question or are not sure if you should be experimenting with prescription drugs and/or alcohol and illegal drugs, please post something here. You do not have to put your name and we are not here to report you to the police, we just want to make sure this doesn't happen again.

Hookah: is it safer than cigarettes?

Many clinicians have been getting questions about the health effects of hookah, a type of pipe. Is this method of inhaling smoke less harmful than cigarette smoking?

Response from Darrell Hulisz, PharmD:

Hookah is a waterpipe used for smoking tobacco. Hookah smoking, also known as narghile, shisha, and goza, originated in ancient Persia and India and has been used for over 4 centuries. Hookah tobacco is often flavored with molasses, mint, chocolate, honey, or fruit, such as cherry or apple. Relative to cigarettes, hookah has a sweeter smell and a more appealing taste.Hookah bars are becoming increasingly popular, especially with older teens and the college crowd. There is a general perception among these young people that tobacco inhaled via a hookah pipe is relatively safe, or at least safer than cigarettes.

In a typical hookah bar, patrons can purchase flavored tobacco and rent a waterpipe to smoke it. Hookah smoking is a social event, allowing users to visit with each other as they pass the pipe around. Many hookahs bars or cafes also serve food and drinks; some serve alcohol too. Hookah smoke is generated by burning charcoal on top of the flavored tobacco. When the smoker inhales through the hookah pipe, a pressure gradient forces air past the heating source and heats the tobacco, giving off smoke. The smoke is then pulled away from the tobacco and passes through the water and into the smoke chamber, where it is inhaled by the user.

The demographic characteristics of waterpipe smokers were obtained via mailed self-reported questionnaires. The questionnaires were completed by 871 adults, 18-24 years of age, in Montreal, Canada. In this study, 23% of participants reported using a waterpipe in the previous year. Independent factors increasing the odds of waterpipe use included younger age, male gender, English language, not living with parents, and higher household income. Waterpipe use was significantly higher in those who had smoked cigarettes, used other tobacco products, consumed alcohol, or abused other illicit drugs in the previous year.

In a survey of 235 hookah users, 58.3% believed that hookah is less harmful than cigarette smoking. However, numerous publications have documented the harmful effects of hookah. For example, a single session of waterpipe smoking (which may last about an hour) may deliver as much tar as an ENTIRE PACK OF CIGARETTES. As with cigarette smoking, the user inhales nicotine, carbon monoxide, benzene, toluene, arsenic, lead, formaldehyde, and other carcinogens. Concern has been raised over a lack of warning labels of waterpipe tobacco products and accessories.

Scholarly reviews have found similar adverse health consequences with waterpipe and cigarette smoking. Pregnant women who use waterpipes are more likely than abstainers to give birth to babies with low birthweights, low Apgar scores, and respiratory distress syndrome. Studies have shown that hookah smoking increases the chances of periodontal disease, and may be associated with adverse cardiovascular effects, such as tachycardia (increased heart rate) and increased blood pressure.

Debate is ongoing about the addictive nature of hookah relative to cigarettes. This is an area with little research to support firm conclusions. With regard to hookah, the addictive potential is influenced by the properties of smoke emitted, duration and frequency of use, type of tobacco used, volume of smoke inhaled, and the contribution of charcoal. As with cigarette smoking, it is plausible that hookah might act as a gateway to nicotine addiction. Earlier experimentation with waterpipes may lead to addiction in minors and complicate long-term nicotine abstinence. Surprisingly, one Florida survey found that 4% of middle school and 11% of high school students reported some use of a waterpipe.

Some researchers have suggested that the public health implications of hookah smoking have not been fully addressed. Clinician advocates of tobacco control must address the specific issue of waterpipe smoking and integrate both the prevention and the cessation messages into current anti-tobacco initiatives.

The World Health Organization and the American Lung Association have released advisory statements indicating that many of the long-term adverse consequences of hookah smoking, including increased risk for cancer, mimic those of cigarette smoking.

The content and packaging of waterpipe tobacco are not currently regulated by the US Food and Drug Administration. Hookah use is increasing in the United States, especially among young people. This same group erroneously believes that waterpipe smoking is considerably safer than cigarette smoking. Multiple factors contribute to the addictive potential of hookah. As with cigarettes, the quantity, frequency, and longevity of smoking determine the development of nicotine dependence. Thus, health professionals should send an unequivocal message about the harmful effects of hookah and especially discourage its use in minors.

(Information from www.WebMD.com)

Current article in Men's Health: Alcohol

My Uncle John emailed me the link to this article and I thought maybe it would be helpful.

-Brooklyn



Under the influence: Do you have an alcohol problem?
By Michael W. Rosen, M.D.


Drinking too much can harm you both physically and mentally. Excessive alcohol use can:

* Increase the risk of stroke and certain cancers
* Damage the liver and pancreas
* Cause impotence and infertility
* Turn into alcohol dependence or addiction
* Increase the risk of injury, drunk driving or unsafe sex
* Strain personal and professional relationships
* Lead to financial trouble and criminal charges

Cause for concern
Those who choose to drink alcohol should do so in moderation. That means no more than two drinks a day for men and no more than one drink a day for women.

Do you tend to drink more than this? Should you be concerned? Your answers to the following questions could indicate that your alcohol use is a problem. In the past year, have you:

* Had times that you drank more or longer than you intended?
* Been at risk of getting hurt or hurting someone else because of drinking?
* Continued to drink even though it has caused distress in your family or with your friends?
* Gotten in trouble at your job because of alcohol use?
* Tried to cut down or quit drinking but couldn’t?
* Felt you needed a drink first thing in the morning?

Ready to make a change
It can be difficult to face a problem with alcohol. But, the sooner you act, the better. Alcohol abuse is a harmful pattern of drinking. If it goes on, it can lead to alcohol dependency or alcoholism.

Try taking a first step toward getting help and go from there. Begin by talking frankly with your doctor about your alcohol use. Ask what treatments or therapies could help you make a change. Be sure to check your benefit plan to see which services are covered.

Here are some additional resources:

* Substance Abuse Treatment Facility Locator. Visit www.findtreatment.samhsa.gov. Or, call 1-800-662-HELP.
* Alcoholics Anonymous. Visit www.aa.org.
* Al-Anon/Alateen. Visit www.al-anon.alateen.org. Or, call 1-888-425-2666.

Dr. Michael Rosen is board-certified in internal medicine and hematology. He has been a medical director for OptumHealth for more than 13 years. Dr. Rosen has also had extensive experience in private practice and the field of clinical epidemiology. He currently coordinates the clinical review of health care-related consumer resources created by OptumHealth. In addition, Dr. Rosen provides leadership for OptumHealth’s Cancer Support program, a comprehensive oncology disease management solution

Drug of the Week: K2 "Synthetic Marijuana"

A hot topic for debate right now is over the "Synthetic Marijuana" known as K2, which is commonly called spice, genie, skunk, or spice diamond on the streets. Currently it is being sold legally as herbal incense not intended for human consumption.

Dr. Carol Ott, Purdue clinical assistant professor of pharmacy practice, stated in the Purdue student newspaper, "Synthetic marijuana is kind of a misnomer. It works at the same receptor site but it's not the same chemical at all. It has many of the same euphoric effects that marijuana users enjoy."

She later mentioned, "The problem is that we don't know all of the other effects." Some of these effects include hallucinations, anxiety, increased heart rate, lowered potassium levels that increase the risk for seizure and possible drug interactions.

Dr. Ott also stated that there have been some reports of death associated with K2 use. The dangers of this drug do not necessarily come from the plant itself, but the solvent it is dissolved in.

Lt. Gary Sparger of the West Lafayette Police Department stated that a female used K2 on Purdue's campus and then began to hallucinate and experience anxiety and was taken to the hospital. "She acted as if she was on LSD," Sparger said. "It (referring to K2) is different from marijuana. I've dealt with hundreds of people with marijuana and it's never had this sort of reaction."

Currently the West Lafayette and Lafayette city councils are working to draft a ban as soon as October that will constitute a $250 fine, as the first offense, for selling K2.

(A more in depth article can be found at www.purdueexponent.org)

Drug of the Week: Dextromethorphan

Our friends, Rebecca and Brooklyn, are off in a land with little to no internet during their summer breaks, so they are graciously allowing me to make a celebrity post to keep you informed over the summer. My name is Nick and I am in my 6th and final year of pharmacy school at Purdue University, and today I'd like to give you some information on dextromethorphan (or DXM.)

When taken correctly, DXM is an effective cough suppressant that can be purchased over the counter. Due to the long, science-y name, you will rarely find it labeled as such and you may have to check the active ingredients on the package to find it. A brand name you may be familiar with is "Robitussin" and store brands are generally labeled as "cough suppressant."

DXM is a product commonly abused by adolescents because it is easily available as an over the counter product. If taken in doses larger than the recommended medical use, DXM behaves similar to drugs like PCP and ketamine and can cause euphoria (extreme, artificial happiness or feelings of wellness), psychosis (hallucinations and other psychedelic effects), and dissociation (out of body experiences and alterations in the perception of time.) Abusers call this "robo-tripping" or "tripping-cees" which stems from the brand names of the products.

Abuse of DXM has many unwanted effects, including nausea, vomiting, diarrhea, and headaches. One of the biggest dangers is that DXM almost never comes alone in any over the counter product. When abusers take high doses of DXM, they are also taking unsafe doses of things like acetaminophen (Tylenol) and antihistamines, which leads to more side effects and drug interactions. Overdosing on acetaminophen causes liver damage and failure, especially when mixed with alcohol, as abusers are likely to do. Mixing high doses of DXM with certain prescriptions that affect serotonin, like antidepressants, can lead to a serious and deadly reaction called serotonin syndrome. This does not happen when DXM is taken at normal doses though.

For the safest use of DXM, you should speak with your doctor or pharmacist (it's what we're here for!) when considering using DXM products. We can help you to take the correct dose, make sure that the medication will actually help you, and ensure that there isn't something else out there that might help you more.

Thanks for reading! Have great summers and be sure to apply sunscreen thoroughly and often!

Nick

Drug of the Week: "Pharm Parties"

For this week, we decided to discuss the topic of "Pharm Parties." Having never been to one, neither one of us have much experience with what actually takes place. But, we thought we would give some advice based on what we know and note some information most people probably do not think about at these parties.

Be careful when taking random prescription medications and throwing them all in one bowl. This will most likely create side effects no one would want to experience.

For example, a drug called Flagyl (an antibiotic) can cause someone to become violently ill and vomit if taken even 3 days before drinking alcohol.

Other antibiotics, such as amoxicillin, can decrease the effectiveness of birth control. So, if a girl takes a handful of pills with any of these in there, her birth control may not work and she should seek alternate forms of contraception.

Xanax, Klonopin, Ativan, and other related drugs with depressant effects can cause extreme sedation when mixed with alcohol.

There are a lot of medications out there, and NUMEROUS medications interact with each other and can cause very harmful side effects and even death when taken together.

Before you bring that pill to your mouth, think for a second and understand that not every drug works the same way, and before you know how that one works, do not use it!