First post in a series…

When I started writing this post two days ago, I had intended it to be just a “quick” post.

SIGH

Well, it is turning into quite the project.  And waaaaaaaaay too long for a single post.  So, here is the “introduction” and the 411 on Invokana.

For those who aren’t hip to all the current jargon…  “411” is what the kid’s these days call “information.”

Questions! I got Questions!

Because of a recent doctor’s visit, I have a bunch of questions.  And I went online and started doing some research, trying to get answers to those questions.

After a little bit, it occurred to me that I should put the information I found into a blog post.  Sort of a one-stop shop with links, where I use my searching skills to save you folks a lot of time.

I know that I’ve had a recent surge of new subscribers who found my blog because of the Diabetes information that I’ve posted.

So, if any of you folks have answers  or comments based on your own experience then, please SHARE them in the comments at the end of this post.

Standard Disclaimer:
I am NOT a doctor.  I am not offering medical advice. You should ALWAYS consult your doctor before making any medical decisions.

A bit of background…

I was diagnosed with diabetes in June of this year.  I started taking Invokana and Janumet in mid-June and started testing my AM fasting blood sugar levels in late June.

I’m visiting my doctor once a month right now so that my doctor can keep a close watch on things not only because I’m a newly diagnosed diabetic, but because I’m “obese” (workin’ on that!) and I have high blood pressure (workin’ on that too!)

One bonus of going to see my doctor monthly is that it really helps me; just knowing that I’m going to weigh in and will have my blood pressure checked, keeps me on track.  To date, I’ve lost 27-30 lbs since my heaviest weight of 333 lbs.  Yay!

My weight fluctuates a little, of course.  This morning I weighed 305 which gives me a 28lb loss to date.  But the good news is that I’m nearing at a threshold / plateau breaker of 300 lbs.  Unfortunately my body is resisting going past that hurdle.  Grrrrrrrrrr

At last month’s regular visit, about four weeks ago, I had a really BIG blood work panel done when I was at my doctor’s office.  That visit was the 3 month anniversary of my diabetes diagnosis; which is why she did the big blood work panel  — 3 months after I had been taking the two diabetes medications.

Well, last week, at this month’s doctor visit, she gave this multi-page report that were the results from the blood work.

OMG!  It was huge.

Who knew that you could discover so much about a person just from their blood!  A bit overwhelming actually.

Good & Bad News in the Report

Well, my doctor was happy that my A1C numbers which are WAY better now than they were back when I was first diagnosed back in June.  Yay!

She said that my A1C numbers were not quite yet where she wants them to be but they are headed in the right direction.  Hooray!

And she was very happy about my increased activity levels, increased flexibility, my upcoming return to the dance studio and my continued weight loss. Yay!  Yip, Yip and more Yay!

There was a LOT of other stuff in the report which I won’t go into here.  Honestly I don’t remember all that she told me.  [sheepish grin]

Thank goodness I have a paper copy of the report and the “explanation booklet” that came with it.  I’m slowly I’m working my way through it and doing online research to understand just what is going on inside my innards.

Based on the information in the report is that my doctor ordered me to do three things:

1. I need to start eating on regular schedule.  *sigh*  *SIGH*  Siiiiiiiiggggggggggghhhhhhhh!!!!!  To say that doing this is going to be a challenge is like saying that kids now-a-days text a little bit.
2. I need to start taking an Aspirin a day  — easy to do.
3. I need to take a daily mega-doses of vitamins / supplements to correct some issues she saw in the report.  — much more complicated but also not too difficult to do.
   

Moving my body…

I’ve already been increasing my activity level for a while now.

We won’t grace that increased activity with the word “exercise” … actually I should say: we won’t burden that activity with the word exercise.

Because I hate exercise.

What I’ve been doing to date is just “stuff around the house” — laundry, dishes, cooking, etc.  Which is actually way more impressive than it sounds.

“Why?” I hear the teeming masses crying out…

Because until recently, taking two bags of trash from the kitchen, down the stairs, across the parking lot to the dumpster then making my way back across the parking lot, up the stairs and staggering down the hall to my bedroom was a major ordeal.

I would be huffing and puffing and my face would be red and I’d have to sit down and rest.  Literally.  With no exaggeration. It was a case of “sit down or fall down” because that amount of effort was absolutely the maximum that my body was capable of doing.

Another “movement” related project that has been occupying my time is:  I’ve been going through a ton of stuff that I moved out of my storage unit.  And let me tell ya…that’s work!

When I’m done everything will (1) sold for cash because it is unneeded clutter and has some cash value (2) given away because it is unneeded clutter and has no cash value or (3) neatly filed away because it has some sort of sentimental value and I just can’t throw it away (e.g. scrapbook stuff, photos, souvenirs from trips, dance trophies, etc)

Watch my blog for posts as I sell some of the cooler bits in an “Online Garage Sale”  🙂

All that movement counts as “beneficial” — my body is changing as if I had done the evil E-word — notice that I didn’t call it “exercise” — I hate exercise.

I much prefer to “move my body” in pursuit of some other goal: relaxing, having fun, or doing “chores”  Thus I am metaphorically killing two birds with one stone.

For “fun” and “relaxation” I love to dance, and ride my bike.  These activities too are not “exercise” for the sake of “exercise.”  The primary reason to do them is not the benefit to my body.  They are something I enjoy doing in and of themselves.  The “exercise” is an added bonus.

And get your applause hands ready:  So.. this coming week, I will be going to the dance studio three times to practice dance!  Yay!  Yay!

Eventually that will increase to 5 practices a week and ultimately I’ll be teaching dance as well.

At some point in the process I’ll start cycling again for fun and relaxation.  I really enjoy getting out on the trails and riding my bike.  Yay!

More questions: I have this “ringing in the ears”…

Over the past few weeks (no I can’t be more specific than that)  sigh — I’ve noticed an increasing level of “ringing” in my ears.  This, I’ve learned is called Tinnitus.  Here’s an article on WebMD about it:  Tinnitus

Which makes me wonder “why?”  There are apparently LOTS of possible reasons, including possible drug side effects.  Ugh!

I go to an ear doctor on Tuesday, which because I’ve reached my Out of Pocket Maximum for the year, the doctor’s visit and any tests he runs are now covered at 100%  Yay!

Thank you Mr. Obama and all the folks who worked to pass the Patient Protection and Affordable Care Act more commonly known as the ACA or “Obamacare.”

Without it, I would not be getting healthy again.  To the contrary, I’d be getting worse and headed to a early death.    Think what you will, in my book the P.P.A.C.A is an awesome thing!

So, Now do you see why I have questions…?

Well, for two days in a row, I’ve been taking those supplements which my doctor ordered me to take and I’ve noticed a few things:

• That is a hell of a lot of pills.  Sheesh!
• My fasting blood glucose levels for two mornings in a row have been HIGH – 30 points higher which is NOT good.
• The batch of pills at night that I’m taking, well one of them “revs me up” — kinda like taking a huge hit of caffeine.  Since I have noticed this “rev up” only with the batch at night, I figured that a pill I was taking only at night is the culprit.  So…I looked at the piles-o-pills side by side and moved the “likely suspect” from the PM to AM pile. Most of the supplements are 2 times a day but some supplements and the Invokana are 1 time per day doses.  So now I have all my 1 time per day medications and supplements in the AM.

Which now that you have the background brings me to the actual questions [drum roll please]!  In no particular order

1. Is one of the drugs I take causing the ringing in my ears?
2. Will the supplements interfere with any of the drugs I take?
3. What the heck is all these supplements supposed to be doing?
4. Have I split the AM/PM piles in a good way?
5. Should I take the medications and/or supplements with food?  By themselves?  Before meals?  After meals? During meals?
6. And WHY is my blood glucose levels suddenly higher?  – For two mornings in a row?  Is it because of the supplements or is it because I was bad and snacked just before bed the last two nights?
7. When should I take my AM dose of Janumet? With breakfast?  Before Breakfast?
8. When should I take my PM dose of Janumet?  With the evening meal?  Exactly 12 hours after taking the first dose?
9. When should I take my AM dose of Invokana? With Breakfast?  Before Breakfast?  If before, then how long before?
10. Just how important is it anyway to eat on a regular schedule?  And what about snacks?

So, what I’m going to do from this point forward in the post is share links to articles which have information about the different medications and supplements that I’m taking, and information about Blood Glucose Testing.

I’m a retired Librarian

I know what I’m doing when I search for information on the Internet

Information on the Internet should not be accepted at face value.

Part of my professional training is how to evaluate the reliability and validity of sources of information both in print and electronic form.

These links below, in my professional opinion, have valid information.

Standard disclaimer: with all medical and fitness information, you should always consult with your doctor before doing anything based on what you read online.

That’s what I’m going to do.  First I’m doing my homework by doing this research so I can ask intelligent questions.  Bottom line though: the next time I see my doctor, I’ll talk to her and ask her what should I do.

Reliable websites:

Sites that in my professional opinion are reliable sources of Medical & Fitness Information:

• MedLine Plus (National Library of Medicine) — http://www.nlm.nih.gov/medlineplus
• MedLine Plus Drug & Supplement Database (National Library of Medicine) — http://www.nlm.nih.gov/medlineplus/druginformation.html
• US Food and Drug Administration (FDA) — http://www.fda.gov
• WebMD — http://www.webmd.com
• Healthcare.gov (Patient Protection & Affordable Care Act Portal) — http://www.healthcare.gov

Note: these are the sites that I used in this particular post.  I’ll add to this as this series develops.  In the final post of the series, I’ll compile all the individual postings into a single combined list.

Reading List / Links to Articles

Patient Protection and Affordable Care Act

Q: When is Open Enrollment start for next year?

A: Open Enrollment for 2016 begins on Novemember 1, 2015

Affordable Care Act
Information / Articles / Links

Health Care Reform: Health Insurance & Affordable Care Act (WebMD)
Link: http://www.webmd.com/health-insurance/default.htm

Healthcare.gov (Portal where you can locate your state exchange or apply for coverage if your state does not have an insurance exchange)
Link: http://www.healthcare.gov

Healthcare Reform Information from the White House
Link: http://www.whitehouse.gov/healthreform

Invokana (Canagliflozin)

Q: When and how should I take Invokana?

A: The instructions say to take “before breakfast;” note to self — ask Doctor how long “before” breakfast should I take this drug?

The Pharmacist at Walgreen’s said to take this 5-10 minutes in advance of eating; basically take it just as I start cooking breakfast.

I emailed my doctor and she replied, on a Sunday!  Wow!  Is my doctor cool or what?  *grin*   My doctor said to take it 10 minutes before eating.  So there you have it:  the answer is “10 minutes before eating!”

Q: Are there any drug interactions and/or side effects which I should be on the lookout?

A: Yes, as with most drugs there is a big long list of possible interactions.

I discovered that, for me, there is one drug interaction which may apply. My high blood pressure medication, Enalapril (Vasotec) is specifically mentioned followed by a cautionary note to ask your doctor about it.

I also discovered that Niacian might affect the effectiveness of Invokana if taken together.  And since I’ve noticed that an increase in my blood sugar levels since I started taking all the supplements, I am definitely going to talk to my doctor about that possibility when I see here next.

So… note to self: ask my doctor about these two on my next visit.

Invokana (Canagliflozin)
Information / Articles / Links

Canagliflozin (MedLine Plus)
Link: http://www.nlm.nih.gov/medlineplus/druginfo/meds/a613033.html

Canagliflozin (Mayo Clinic)
Link: http://www.mayoclinic.org/drugs-supplements/canagliflozin-oral-route/description/drg-20060957

Canagliflozin (WebMD)
Link: http://www.webmd.com/drugs/2/drug-163872/canagliflozin-oral/details

Invokana (website mantained by the drug’s manufacturer)
Link: http://www.invokana.com/
Note: Yes, you can get lots of information on the manufacturer’s website.

However, when using any manufacturer’s website, you need to put on your “buyer beware” hat.  Think about it:  the company is a business which means that it is to their advantage to emphasis the positives and minimize the negatives even as they do everything the law requires them to do in terms of disclosure of risks.

Trust, but verify be thy motto when reading information provided by the manufacturer.

Discount ($0 copay program / Savings Card for Invokana)
Note: I am on this program. The application process is easy to complete.  Basically the program works like a coupon when you pick up your monthly prescription at the pharmacy.  My copay for this drug is $100.  The pharmacy rings up $100 then they apply the “coupon” and Tah-DAH, my balance due is zero.
Link: http://www.invokana.com/patient-support/savings-card

Special Note: When I was prescribed Invokana, my doctor gave me a card which was good for a 30 day free trial of the drug.  It worked like a coupon at the register at the pharmacy.  I had to have the clerk ring up the Invokana all by itself to get the coupon to work, but it was worth the hassle because neither my insurance company nor I had to pay for a full month’s supply of the drug.

I checked on the Invokana website and could not find a link for the “free trial” so ask your doctor to see if they have one of the “coupon cards” for the one month free trial.  Good luck!

Recent News (Sept 2015):

FDA strengthens warning on bone risks with canagliflozin
(Pharmacy Today, American Pharmacists Association, pharmacist.com)
Link: http://www.pharmacist.com/fda-strengthens-warning-bone-risks-canagliflozin

Invokana and Invokamet (canagliflozin): Drug Safety Communication – New Information on Bone Fracture Risk and Decreased Bone Mineral Density (FDA.gov)
Link: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm461876.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery

Summary and preview of coming attractions:

Because I realize that this is a very long post, I’m stopping with only the Invokana and the ACA links.

I am not going to do the rest of the supplements and drugs for now.

I’m going to try and post one article / reading list a day over the coming week.  Each post  will list one or perhaps two drugs and/or supplements which I am currently using along with my questions and the answers I find.

See ya on the dance floor!

P.S.  If you find any of this information valuable, please “Like” and “Share” it with your friends on Facebook, Twitter etc.

P.P.S.  If you found this information REALLY helpful and/or valuable then please consider helping me out by making a small donation via PayPal to help me

• pay for my medications,
• pay for vitamins & supplements,
• and/or to help me pay for practice fees as I return to the dance floor.

See ya on the dance floor!