People with diabetes often take an array of medications to manage their condition. Some of these medications control insulin and glucose (blood sugar) levels, and others treat symptoms of diabetes-related conditions such as high blood pressure, heart disease, kidney disease and abnormal cholesterol.
Taking several medications at the same time is known as polypharmacy. In some cases, this practice can pose dangers to the patient if medications duplicate or interact with each other. Complications of polypharmacy also occur when:
Dosages are either too high or too low
Medications are incorrectly prescribed or filled
Over-the-counter drugs or supplements interact with medication prescribed by a physician
Patients can take several steps to reduce the risk of developing symptoms or conditions related to polypharmacy. This is especially important for older individuals with diabetes, who often take more medications than younger patients and thus are at greater risk from complications of polypharmacy.
About managing multiple medications
People with diabetes are at risk for suffering health problems when they take multiple medications, a state known as polypharmacy. Different drugs taken at the same time have the potential to interact and cause symptoms in the patient. This is a major concern for diabetic patients, because they often take various medications to:
Control levels of insulin and glucose (blood sugar)
Control complications such as high blood pressure, heart disease, abnormal cholesterol, nerve pain (neuropathy) and kidney disease (diabetic nephropathy)
Treat conditions unrelated to diabetes, which range from arthritis and asthma to headaches and common colds. This is particularly a problem for older diabetic patients, who often take many prescription medicines.
Negative effects associated with polypharmacy are known as adverse drug reactions (ADRs). These can manifest in a variety of ways, including:
Allergic reactions
Depression
Insomnia
Irregular heartbeat
Reduced effectiveness of medications
Medication buildup, leading to toxicity, particularly as it relates to liver, kidney or brain function
These side effects may be more pronounced in older patients as a result of the effect of the aging process on the body. For example, the kidneys process many medications. In older people, especially those with diabetes, kidney function can be dramatically reduced. This can lead to a potentially toxic buildup of drugs in those who are taking several medications.
Many antidiabetic agents and other medications commonly prescribed to diabetes patients may interact with each other or other drugs and supplements. Individuals with diabetes should speak with their physician before taking a new medication or supplement.
In addition to over-the-counter medications and supplements, alcohol and illegal drugs can have serious interactions with medications. Also, some medications should not be taken with grapefruit juice, pomegranate juice, calcium-rich products or certain other foods. Some medicines should be taken with meals, with plenty of water, with milk, without milk or on an empty stomach. A physician or pharmacist can provide details.
Products are available to help remind people when to take their medication, such as wristwatch alarms and other timers. Pill organizers with multiple compartments may be especially helpful for individuals taking several medicines.
Symptoms related to multiple medications
Symptoms related to polypharmacy are often confused with signs of aging, particularly in older patients. Indications of problems in managing multiple medications may include:
Fatigue, sleepiness or lack of alertness
Constipation, diarrhea or incontinence
Lack of appetite
Weakness or incoordination
Dizziness, fainting or falls
Irregular heartbeat
Allergic reaction
Skin rashes
Tremors
Anxiety
Depression or withdrawal
Loss of interest in sex
Confusion or decreased safety awareness
Hallucinations (visual or auditory)
Risk factors when taking multiple medications
Negative consequences associated with polypharmacy, often defined by researchers as taking five or more medications, can occur in all age populations. However, older patients are at great risk for developing such symptoms because they tend to take more medications than younger patients. In addition, they may have conditions associated with aging (such as reduced kidney function) that increase the risk for symptoms related to polypharmacy. Hypothyroidism (low thyroid function), which is also associated with advancing age, can slow the clearance of certain medications from the blood.
Other risk factors include:
Taking dietary supplements, vitamins, over-the-counter medications and homeopathic or herbal remedies in addition to prescription medications.
Getting prescriptions filled at more than one pharmacy.
Having more than one doctor prescribing medications.
Taking medications more often than once daily.
Inability to read drug labels because of poor eyesight. People with diabetes have an increased risk of vision impairment because of diabetic retinopathy, as well as a higher incidence of cataracts and glaucoma.
Difficulty understanding a physician’s or pharmacist’s directions because of poor hearing or language barriers.
Difficulty remembering when to take medications.
Making changes in diet or exercise without clearance from the physician.
Preventing symptoms of multiple medications
People with diabetes can take several steps to reduce the risk of suffering symptoms related to polypharmacy. Many of these preventive measures are simple tasks that patients nonetheless often overlook.
Such tips include:
Read labels carefully. Information about potential drug interactions and other side effects can substantially reduce risks related to polypharmacy.
Use one pharmacy to fill all medications. Most pharmacies keep a database of a patient’s prescriptions. This helps the pharmacist spot potential drug interactions in the medications prescribed for a patient.
Take medications exactly as prescribed. In addition, patients should ask a physician what to do if they accidentally miss a dose.
Make a list of medications. These can provide important information for patients, physicians and pharmacists and help prevent potential drug interactions. Include all prescription and over-the-counter medications, supplements, homeopathic remedies and vitamins. Keep this list updated, and bring it (and all pill bottles) along during visits to physicians.
Do not take glucose-altering substances without a physician’s approval. Many medicinal herbs and supplements may affect the level of glucose (blood sugar). These may include bitter melon, fenugreek, gymnema, vanadium, ginseng, karela, devil’s claw, licorice, ma huang, garlic, ginger, cinnamon and chromium. Some physicians may approve these as part of treatment plan, but patients are advised not to start taking them on their own.
Be knowledgeable about medications. Patients should know the names and doses of their medications and why they take them. Drug reference books may be helpful and are available at libraries and bookstores.
Learn which medications can affect diabetes. Drugs that can cause hyperglycemia, insulin resistance and secondary diabetes include corticosteroids, other immunosuppressives, estrogens, injected contraceptives, antiretroviral (HIV) drugs, beta blockers (a class of antihypertensives), diuretics, certain anticonvulsants, antipsychotics and chemotherapy drugs. Beta blockers can also increase the risk of glaucoma, an eye disease that is more common in diabetic patients than nondiabetics. Beta blockers may also block the symptoms of low blood sugar, making it more difficult to know when a snack is needed.
Share drug information with all physicians. Patients should be sure to tell all physicians on their care team about medications prescribed by other physicians.
Discuss possible drug interactions with a physician or pharmacist. Never take a new medication – prescription or over-the-counter – without first discussing it with an expert.
Ask about the safety of aspirin. People with diabetes have an increased risk of heart conditions, and many people with cardiovascular risk factors are advised by their physician to take daily low-dose aspirin. However, aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can impair kidney function and damage the stomach. People with gastrointestinal diseases such as peptic ulcers, or kidney conditions such as proteinuria, diabetic nephropathy or end-stage renal disease, are advised to ask their physician whether it is safe for them to take aspirin and other NSAIDs.
Ask about drugs that serve more than one purpose. For instance, many people with diabetes have high blood pressure and have or are at risk for kidney disease. A physician may prescribe medicines such as ACE inhibitors or angiotensin-II receptor blockers to address both concerns. Other examples:
The cholesterol drugs known as statins may help prevent cataracts, delay age-related memory loss (dementia) and reduce the risk of certain cancers, according to recent research.
A recently approved medication combining a statin with a calcium channel blocker (type of antihypertensive) can fight two common conditions in diabetic patients.
A new type of antidiabetic agent called incretins has helped many people lose weight.
A biguanide (metformin), approved to treat type 2 diabetes, may also help prevent atherosclerosis and treat polycystic ovarian syndrome.
Avoid combination medications, such as cold products that mix an antihistamine and a decongestant, if only one is needed. Instead, patients could ask a pharmacist for help in selecting the medication that treats their specific symptoms.
Do not store different medications in the same container. This can lead to confusion about which drugs have been taken.
Consult a physician before making changes in diet and exercise. Meal planning and physical activity influence control of glucose. Improvements in nutrition and activity may reduce a patient’s need for some medications, as determined by the physician.
Have a sick-day plan in place for dealing with illnesses and the medications they may require.
Questions for your doctor
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about managing multiple medications:
Are there potential harmful interactions from the medications I take?
Are there any medications I should take less of or stop taking?
Am I a candidate for a drug that can meet more than one of my treatment goals?
Do I need to change how or when I take insulin because of other drugs I take?
Do you need to know whenever I start taking an over-the-counter drug, vitamin or other supplement?
Can any of the supplements I take affect my glucose control?
Can any of the over-the-counter drugs I take interact with my other medication or affect my diabetes?
Should I take daily low-dose aspirin for my heart, or do I need to avoid aspirin because of concerns about my kidney function or other reasons?
Do you recommend any particular timers, organizers or other products to help me remember when to take my medications?
What is the best way to notify you if my medication is changed or new medication is started by other physicians?
