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DR. HISTER ON
DIABETES PREVENTION IN SEARCH OF
SLUMBER
ANSWERS TO COMMON
PRESCRIPTION QUESTIONS
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People First contents
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Diabetes Prevention Dr. Art Hister looks at causes of type 2 diabetes and ways to help prevent this growing health concern.
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Manage Diabetes Products to help manage and control diabetes.
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Common Prescription Questions Peoples Pharmacist Ian Lloyd provides answers for the most frequently asked questions in the pharmacy.
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Great selection of sale priced vitamins and supplements.
Support For Diabetes Page 5 From webber naturals, a diabetic nutritional support multivitamin.
Vitamin Savings
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Prescriptions and Rewards Read about the B.C. College of Pharmacists decision to ban reward points on prescriptions.
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In Search of Slumber Darlene Booth offers helpful tips on achieving a good night’s sleep.
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Cheesecake Stuffed Strawberries Brand new feature recipe From Company’s Coming Healthy Family Recipes.
Helping People Live Better Lives
DIABETES PREVENTION When I saw my editor’s “suggested” topic for this month – when my editor or one of my producers “suggests” something, I have long taken it to be much less a recommendation than a command, a bit of insight that as a typical husband, I gleaned nearly as soon as my honeymoon ended - I thought to myself, “Wait a minute, Art. You’ve written this same column so many times in the past. Why bother writing it again?” You see, this month’s “suggested” topic is “diabetes prevention,” and since the elements that go into preventing diabetes are nearly exactly the same ones I’ve noted for you so many times before in articles about preventing other common chronic illnesses such as heart disease, strokes, even many cancers and probably most cases of dementia, too, I figure that you must know all this stuff by now. That said, a recent American survey which appeared in Circulation: Journal of the American Heart Association, concluded that an amazingly large number of people still don’t know – or at least don’t pay any attention to – “heart-healthy” prevention strategies, so my editor is right (as he often has been): it’s never a bad idea to go over preventive strategies again. And besides, there is actually a bit of new information that might be helpful for some of you in preventing diabetes, a condition that afflicts far too many of us, especially as we get older (depending on various factors such as genetics, 25 % or so of people over the age of 65 are battling
Dr. Art Hister
with pre-diabetes or diabetes itself). First, however, as always, a definition. Diabetes is most simply defined as a condition in which a person is prone to elevated levels of blood glucose (commonly referred to as blood sugar). Everyone’s glucose levels go up after eating or drinking (glucose is your body’s source of “energy”), but in non-diabetics, those higher levels come down as your cells extract the glucose they need from your bloodstream. In diabetics, however, glucose levels shoot up higher than they do in non-diabetics, and they stay elevated for longer than in non-diabetics. And unfortunately, elevated blood glucose levels are linked to much higher risks of all sorts of nasty complications such as heart attacks, strokes, several cancers, dementia, amputations, kidney damage, even erectile dysfunction (I bet that made a few men sit up and take notice). That still begs the question, of course, as to why glucose levels rise and stay up in diabetes and the answer to that is that people with diabetes have problems with the hormone insulin, which regulates the entry of glucose into cells. Diabetes is commonly divided into two main types (there are other forms, such as gestational diabetes, the one that can accompany pregnancy, but for most discussions, the two main types are enough). The first type occurs when a person doesn’t produce enough insulin because the insulin-producing cells in the pancreas gradually die. Continued On Page 11
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COMMON PRESCRIPTION QUESTIONS Questions, questions, questions: It seems like all a pharmacist does during a workday is answer questions. Even when we are not working, we are still answering questions. Questions about: medications, medical conditions, pets, costs, side effects and more. The next question is: do we really mind all of these inquiries? The answer – luckily – is no, not at all. Helping people is what we do best. People might feel a bit awkward about asking questions that they believe are simple or trivial. Nonsense! The only dumb question is the one never asked. Peoples Pharmacists love answering questions. It provides us with an opportunity to share and help our patients. Let's look at the most common prescription questions that I get asked. What is the shelf life of prescription drugs? Prepackaged, over the counter medications will have an expiry date stamped on them. You really shouldn't have any unused prescription drugs around the house. Many of these will not have expiry dates because they were intended to be used within three to six months. My general rule is that if more than two years has passed since the date of dispensing, the medication has passed its expiry date. If you have medication to be used at a later date, for travel or just-in-case, ask your Peoples Pharmacist to mark the expiry date on the bottle. Any medication that has passed its expiry date should be disposed of properly. This nicely leads to my next question: How should I dispose of old medications? You can bring medications to ANY BC pharmacy for proper dis6 People First Join us on
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Ian Lloyd Peoples Pharmacist
posal. If a medication or over the counter product was purchased in a pharmacy, chances are that it can be returned there. The exceptions are cosmetics, sharps and household chemicals. Some pharmacies accept needles and other medical sharps for disposal, but it is best to check with your local Peoples Pharmacist about this service before bringing any in. Another small bit of advice; always purchase small bottles of over the counter medications unless you use it regularly. While it is true that larger sizes can be more economical, these savings are lost when 90% of the bottle expires. I dispose of many large supplement bottles with only a few tablets missing. How should prescription medications be stored? The first part of this answer is: always out of the reach of children and pets. They should also be kept in a dry place, away from heat, humidity and light. Perhaps the worst place to store medication is the bathroom. It is generally bright, moist, warm and cabinets are easily accessible by anyone. I think the best place to store medications is in an upper cabinet in the kitchen. They should also be stored in their original containers. Do not combine different medications into the same bottle. The exception to this is if you place them in a weekly pill box (dossette), which is a great idea. Don't forget to ask your Peoples Pharmacist if there are any special storage requirement for your medications. I sometimes forget to take my medications, what should I do? This is perhaps the most troublesome and least asked question. While taking medications Continued On Page 8
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o d...Continued From Page
regularly might be necessary for maintaining your health, it is not a natural act like eating or sleeping. The solution is to make taking your medication part of your daily routine. One trick to begin any new habit is to attach it to an already established habit. If you always make coffee in the morning, place a sticky note on the coffee machine to remind you to take your medications. If you are a hi-tech person, download one of the many free medication reminder apps for iPhone or Android. Do you always wear a watch? Place a bright red elastic band around it as a reminder. Often it only takes a week to establish a new habit; both good or bad. If you take multiple medications, make a list of which ones should be taken at which time. Ask your Peoples Pharmacist for a medication review. This service is free and can be helpful to learn about your medications and when they should be
taken. Are generic medications just as good as the brand name drugs? In a few words, the answer is: yes. In Canada, when a new drug is introduced to the market it has about 20 years of patent protection. This means that only the patent holder, the brand name drug company who created it, can produce and sell it. After the patent expires, other generic drug manufacturers can apply to Health Canada to sell the same drug. These generic companies must prove scientifically that their generic drugs are just as safe and effective as the brand name product. BC Pharmacists are allowed by legislation to substitute a generic drug for the brand name drug; we usually ask you first. Most people welcome the idea of saving money by switching to a generic drug. What can you do if your medication tastes bad? Continued On Page 1
Flu Vaccinations Flu season is coming and Peoples Drug Mart is committed to helping you stay healthy all season long. Getting the flu vaccination is your best defense against seasonal flu and many Peoples Drug Mart and Peoples Pharmacy locations offer convenient flu vaccination services. It’s easy and can help you beat the flu bug.
Peoples Locations That Administer Flu Vaccinations Abbotsford Ashcroft Burnaby Campbell River 0 2 Chase Chetwynd Cranbrook Golden Kelowna 8 People First Join us on
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Revelstoke Salmo Sooke Sparwood Surrey - Ocean Park Trail Ucluelet Vancouver (Champlain) Vancouver (West 5 th Ave.)
Victoria Cadboro Bay) Victoria (1594 Fairfield) Victoria (12 2 Fairfield) Victoria ()uadra St) Victoria (Shelbourne) White Rock
Notice to All People First Rewards Members The following change to the People First Rewards program will go into effect December 2, 2013
College of Pharmacists (BC) Banning Reward Points On Prescriptions The College Of Pharmacists Of British Columbia is prohibiting inducements ( reward points ) on all prescriptions effective December 2, 2013. By the orders of the College, no rewards may be given on any prescription or pharmacy service. While we do not agree with the prohibition of points, Peoples must abide by the College’s decision to ban points. This new bylaw applies to all pharmacies in British Columbia. Peoples Drug Mart and Peoples Pharmacy are your trusted sources for pharmaceutical care and we look forward to providing you valued services and trusted advice for all your health and wellness needs. Please speak to a Peoples staff member if you have any questions about the December 2nd change.
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Dr. Hister...Continued From Page 4
This is known as Type 1 diabetes, although it used to be known as juvenile-onset diabetes (or insulindependent diabetes) because it generally comes on early in life as a result of some factor – perhaps an infection, perhaps another environmental insult in a genetically predisposed person – that triggers an auto-immune reaction in the pancreas that results in the death of the insulin producing cells (beta cells). So please make note of that very important point (which also serves as a key distinction between Type 1 and Type 2 diabetes), namely, that Type 1 diabetes is an auto-immune condition that as far as we know is not preventable by healthy lifestyle choices. Also, as is true for all other auto-immune disorders, people with Type 1 diabetes have a significantly higher risk than average of developing other auto-immune problems such as (my own) celiac disease, or MS, or psoriasis. By the way, the reason I am making a to-do about Type 1 diabetes being an auto-immune disorder and not a lifestyle-driven condition is that over the years, I have received numerous heated emails (mostly from aggrieved parents of kids with Type 1 diabetes) informing me that they had been impolitely told – clearly, by poorly-informed people – that their child’s illness was a result of poor lifestyle choices. Not true. Period. Type 2 diabetes occurs when people become resistant to their own insulin. (Type 2 diabetes used to be known as adult-onset diabetes because it was rarely seen in anyone under age 40; these days, however, mostly for reasons we will get into in a while, Type 2 diabetes is routinely being diagnosed in teenagers and even pre-teens). So, in Type 2 diabetes, people produce enough insulin (at least at first) but their cells can no longer mop up enough circulating glucose because the cells have become “resistant” to insulin, so blood glucose levels stay higher for longer periods. (I hate to hit you with too much medicalese, but you might be interested to learn some experts believe that there are actually several different forms of Type 2 diabetes, and they are clamoring for yet
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Dr. Hister...Continued on Page 13
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Dr. Hister...Continued From Page 11
another name-change for this condition, not that changing what you call it would alter change any diabetic’s circumstances, of course, but hey, it would probably make the experts happier). Anyway, it’s Type 2 diabetes that we generally focus most attention on for two main reasons. First, Type 2 diabetes is by far the most common type and accounts for roughly 90-95 % of all diabetes cases. Second, though, and equally important, Type 2 diabetes is intimately connected to the lifestyle choices we make, the most important of which are the four same-old, same-olds connected to lowering the risk of nearly every chronic health condition, namely, not smoking, doing some exercise regularly, eating a healthy diet, and maintaining a normal weight. (And that’s also, of course, why Type 2 diabetes has increased so much among young people – they’re fatter, less active, and often have worse diets than was the case in the past). But, as promised, here’s some new lifestyle information about preventing Type 2 diabetes that is likely to appeal to some: try sleeping more. You see, in an intriguing study presented at the recent annual meeting of the American Endocrine Society, researchers took 19 men who were chronically sleep-deprived (they averaged 6 hours sleep a night during the week, pretty standard for many workers, of course) and got them to sleep over 10 hours for 3 nights in a row, and apparently, these sleep-deprived guys’ insulin sensitivity improved dramatically as a consequence of catching up on their sleep deficit. This news comes on top of another recent report that melatonin levels – that hormone intimately connected to our sleep-wake cycle – may also have a large role to play in insulin sensitivity. The bottom line, then: better sleeping more may help you reduce your risk of Type 2 diabetes. And the nice thing for me there is that because I hate hectoring you as much as I have to do, telling you to sleep more doesn’t make me feel nearly as much of a nag as telling you to exercise more. But you should exercise more, too, you know. Sorry, couldn’t help myself. Dr. Art Hister can be heard on CKNW and other Corus Radio Network stations on House Calls on Saturdays at 10 AM, as well as seen on Global TV news on Saturday mornings at 9:20.
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IN SEARCH OF SLUMBER Whatever happened to the days of yore when being a child gave you licence to sleep – often and deeply? Recently, I read a news article highlighting the fact that a high percentage of our youth are sleep deprived because of their addiction to texting and easy access to screen time. Many youth are still technologically connected long after their parent’s have entered dreamtime. The result of taking in too much technology before bed is a revved up brain that has trouble winding down. Sleep deprivation affects memory, cognition, performance, concentration, metabolism and much more. If I had just one word of advice to youth today it would be to put down the cell phone, turn off the computer or TV and worship your slumber because sleep is pretty much an uphill struggle from here. From the moment we are born, sleep becomes a major focus in life. Society has structured itself so the dark hours are reserved for sleeping but somewhere in the night a hungry infant nurses in the arms of a sleep-deprived parent. The focus of the parent at this point is to help move the child into a sleep pattern that supports optimal health for both the growing child and the tired caregiver. Of course, that being said, children by their very nature seem to be wired to challenge this as often as they can. As the teen years approach, the hormonal changes that come with puberty can greatly affect their circadian rhythms. This can impact sleep patterns, which begin to shift toward later nights and a tendency toward wanting to sleep in. However, due to the demands of living in a fast paced society, we have places to be and schedules to keep so too many teens are walking around in a chronic state of sleep deprivation. It is a sad state of affairs to think that a young individual is chronically sleepy before they even enter into their tenuous twenties; the twenty something rite of passage honours burning the candle at both ends and they seem to have the stamina to pull it off. I urge all parents to teach their child good sleep hygiene habits in the early hours of infancy, as this will set the stage for their overall performance and well being in the future. These good habits are not just limited to children and can be adopted for all ages:
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1.Begin with having a regular sleep schedule that fits with the family’s/individual lifestyle. While optimal hours may vary for individuals, our younger folk should be getting between 8 to 10 hours of sleep per night. You want to keep these hours as consistent as possible. 2. Use the hour before bedtime to create a transition away from stimulation and towards relaxation. Turn off the computer and the TV. This is a good time for a warm bath, cuddling up with a good story and listening to relaxing music. 3. Create optimal sleeping conditions in the bedroom. A cooler, consistent room temperature, minimal lighting and relative quietness along with comfortable clothing and sleeping surfaces really do set the stage for a good night’s sleep. 4. Diet and lifestyle can also affect sleep hygiene in different ways. Avoid too much caffeine and other stimulants in the diet; have an awareness that emotional stress from too much screen time, family upsets or social influences can interfere with sleep; make time for fresh air and moderate exercise each day. Avoid eating heavy meals too close to bedtime. If you must snack before bed, carbohydrates, tryptophan and calcium all help to induce a sleepy state. Turkey, crackers and some yogurt might be your ticket to dreamland. Somewhere in our thirties, we begin to value what we had access to in our 20’s but for many people it comes too late. When you are the sleepy parent pacing the floor at midnight, you begin to wonder if you will ever sleep again. In a perfect world, the answer would be yes. However, for a large majority of people, the transition to the middle ages and senior years becomes synonymous with sleep interruptions. This may be due to health conditions, medications, hormonal imbalances, diet, lifestyle choices or life stressors. If you are not getting the sleep that you need, you are not living your best life. If you implement these strategies and sleep is still elusive, talk with your health care professionals to see how you might gain easier access to dreamland and enjoy the ride. Good health to you!
Cheesecake Stuffed Strawberries Sweet, creamy strawberries stuffed with a simple cheesecake. As tasty as they are pretty, these treats are easy to prepare and loved by all.
Cheesecake Stuffed Strawberries
20 whole fresh strawberries 3/4 cup (175 mL) light cream cheese, at room temperature 1 tsp (5 mL) vanilla extract 1 Tbsp (15 mL) balsamic vinegar 1/8 cup (30 mL) chopped walnut 1/2 cup (125 mL) dark chocolate, melted Cut off stems and core strawberries with a paring knife or tomato shark. Set aside. In a medium bowl, whip cream cheese until fluffy. Fold in vanilla and balsamic vinegar. Using a piping bag, fill strawberries with cream cheese. Roll the end of each strawberry in chopped walnuts, and drizzle with melted chocolate. Serve chilled. Tip: For the fluffiest results, allow your cream cheese to warm to room temperature before whipping it. 1 serving: 50 Calories; 3.5 g Total Fat (0 g Mono, 0 g Poly, 2 g Sat); 5 mg Cholesterol; 4 g Carbohydrate; trace Fibre; 1 g Protein; 45 mg Sodium
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The articles published in People First are for the general information of the reader. While effort is made to reflect accepted medical practice and knowledge, articles should not be relied upon for the treatment or management of any specific medical concern or problem and People First accepts no liability for reliance on the articles. For proper diagnosis and medical care, you should always consult your family physician promptly. Opinions expressed in sponsored articles by, Dr. Art Hister, Ian Lloyd, and Darlene Booth are paid editorials and are not necessarily shared by Peoples Drug Mart stores or Peoples Drug Mart (B.C.) Ltd. Some advertised products are not available in all stores. We reserve the right to substitute products or limit quantities. Prices effective while quantities last. Sale in retail quantities only.