by Peter J. Nebergall, PhD
We've been around this bush before, but it really does matter. All this may sound like a lot to master, but you really need to -- it's your body.
Most diabetics are taking more than one medication. Some of your pills may be pretty harmless, by themselves, like aspirin, but one pill may alter the action of another. Prescription and "over-the-counter" meds may interact, and that magical "natural organic" herbal supplement you bought at the health food shop, the one you're too embarrassed to tell your doctor about? It can interact with your meds, too.
There are lots of horror stories. Rezulin, the now-banned diabetes drug, caused a few premenopausal women to become fertile again. Herbal "cure-all" St. John's Wort seriously interfered with prescription medications for depression (not a happy result!), and a whole slew of heart medications interact with the sulfonylureas (standard type 2 diabetes "oral meds"), raising the risk of hypoglycemic events.
Grapefruit is supposed to be good for you. But if you take the statins (for cholesterol reduction) or calcium channel blockers (for blood pressure and angina, heart pains), grapefruit can cause these medications to be more efficient -- with some unexpected consequences -- as in overdose.
A number of medications interact with alcohol, and in some cases, that otherwise harmless glass of wine can even cause kidney damage. Read the label -- and respect it.
If you're taking an ACE inhibitor (a blood pressure med given to many diabetics to protect kidney and eye function), it can interact with potassium supplements. Even regular aspirin, taken with certain warfarin-based anti-clotting agents (like Coumadin), can cause problem interactions.
And, last but not least, if your kidney function is diminishing, if you're heading toward ESRD, end stage renal disease, medications you've been taking successfully for years may suddenly rear up and bite you. Many medications "clear through the kidneys," and if/when the kidneys grow less efficient, these drugs (including insulin) can suddenly last longer in your body -- and your regular dose can start acting like an overdose.
These interactions aren't supposed to happen -- but instead of placing blind trust in your doctor and your health care team, how about becoming a more active partner? Can you make a list of all the medications you're taking? Do you know what each is supposed to do? Have you discussed this list with your pharmacist? With your doctor? Does your primary care physician know ALL the medications you are taking?
There's no time like right now.