It's easy to feel overwhelmed with the medications required for diabetes and its complications. Surveys show that a significant number of people don't take their medications as prescribed, which may lessen their effects and invite dangerous side effects. Simeon Margolis, M.D., an endocrinologist at The Johns Hopkins School of Medicine, offers practical, safe solutions for managing your medications.

Know your meds
Keeping careful track of the medications you are taking can help you stick to a schedule and enable your doctor to keep you safe from possible drug interactions. Keep an up-to-date list of your drugs and dosages. Or simply show your doctor the drugs you take. "I ask patients to put everything in a bag and bring it in," Margolis says. Keep all medications in their original containers; the labels will tell your doctor more than the pills themselves.

"Make absolutely sure your doctor knows everything you're taking—not only what they're prescribing but what other doctors are prescribing, too," Margolis says. That includes dietary supplements and over-the-counter drugs.

Patronizing the same pharmacist or pharmacy chain for all your prescription medications can help you avoid miscommunication about your medications. Each time you purchase a new medication or refill, the pharmacist will have access to information about all the other medications you are taking and can let you know about any possible interactions or side effects.

Simplify a complex drug regimen
Of course, the best way to simplify your medication regimen is to reduce your need for some medications by adopting a healthier lifestyle that includes a low-fat diet and regular exercise. But if you can't reduce your need for medication, there are safe ways to make a complex drug regimen more manageable, Margolis says.

First, make sure your doctor reviews your medication regimen at least once a year to see if your medication needs have changed. Some drugs can be taken with others as one pill or in once-a-day dosages to reduce the number of pills you take. (See table for examples of combination medications.)

Be sure to tell your doctor if you frequently forget to take your medications. This information will help your doctor determine if combination medications would work for you. If you feel you can't afford important medicines, ask your doctor about cost-saving programs available from some pharmaceutical companies or visit the company Web site.

Another way to simplify your medication regimen is to get a pillbox with separate compartments for the week or month.

Don't pick and choose your medicines
The decision to eliminate certain prescribed medicines—perhaps they are too expensive or you don't like their side effects—can be a deadly one. "Patients may take the drugs that give them immediate relief from symptoms, and ignore the ones that will protect them from dying," Margolis says.

Consider, for instance, drugs prescribed to control high blood pressure and cholesterol, two conditions that cause no symptoms. You might be tempted to eliminate drugs prescribed to control them because you don't feel any different when you take them. However, stopping these medications without your doctor's approval increases your risk for potentially fatal heart attacks.

Side effects from common drug combinations
You can minimize uncomfortable or even dangerous side effects by being aware of the possible effects of some drug combinations. Some drugs can interfere with insulin or oral medications you take to control your blood glucose levels, rendering them less effective. Other combinations, especially of drugs that increase insulin levels, can cause hypoglycemia. Here are combinations and side effects to watch for:

• Insulin plus a sulfonylurea: hypoglycemia (low blood glucose)
  
• Insulin plus thiazolidinedione: hypoglycemia
  
• Sulfonylurea plus thiazolidinedione: hypoglycemia
  
• Any drug that causes hypoglycemia plus a beta-blocker: beta-blockers block the symptoms of hypoglycemia so you won't know when your blood glucose is too low
  
• Any statin plus gemfibrozil (Lopid®): myositis (muscle pain) and rhabdomyolysis, a severe muscle disorder that can lead to kidney damage
  
• Any statin plus cyclosporine, antifungal drugs or erythromycin: muscle pain or rhabdomyolysis
  
• Any blood pressure drug plus tamsulosin (Flomax®) or other alpha-receptor blockers used to treat benign prostatic hyperplasia: excessive lowering of blood pressure.

In addition, says Margolis, steroids (prednisone is one) and other drugs can interfere with the action of insulin or oral medications. While you can't be expected to know all of the potential adverse reactions that result from mixing certain medications, your doctor should.

Top tips for managing a multiple medication regimen

• Make sure your doctor knows every drug and supplement you are taking to avoid potentially dangerous drug interactions.
  
• Never pick and choose which of your prescribed drugs to take, even if you don't feel any difference when you take them.
  
• If your drug regimen feels unmanageable, ask your doctor how you can simplify it. Tell your doctor if you forget or can't afford to take some medications.
  
• Talk to your doctor about combination medications or once-a-day dosages to reduce the number of pills you take.

© 1996-2006, Johns Hopkins University. All rights reserved. All information presented here is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen. Use of this information is subject to the disclaimer and the terms and conditions of this Web site. Johns Hopkins abides by the terms of the HONcode principles of the Health On the Net Foundation.

The information presented here is compiled by Johns Hopkins University School of Medicine with editorial supervision by one or more members of the faculty of the School of Medicine pursuant to a license agreement with LifeScan under which the School of Medicine and faculty editors receive payment for services rendered within the scope of the license agreement.

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