Diabetes in Mississippi: The Questions Every Patient Should Ask Their Pharmacist

What diabetes actually is, briefly

Diabetes is a condition in which your body either does not make enough insulin (type 1) or cannot use the insulin it makes effectively (type 2). The result is too much glucose circulating in the blood, which over years damages blood vessels, nerves, kidneys, and eyes. The goal of treatment is to keep blood sugar in a target range that minimizes that long term damage.

Most adults diagnosed in Mississippi have type 2 diabetes. This article focuses there, though most of what follows applies to type 1 as well.

The medications you may be on or considering

Metformin

The most prescribed diabetes medication in the world. Inexpensive, well tolerated for most patients, and effective. Common starting dose is 500 mg once or twice daily, often increased to 1000 mg twice daily. Taking it with food significantly reduces GI side effects. Long term use can reduce vitamin B12 levels, which is why many patients on metformin benefit from periodic B12 monitoring.

GLP-1 receptor agonists

Semaglutide (Ozempic injectable, Rybelsus oral) and tirzepatide (Mounjaro) belong to this newer category that has reshaped diabetes management in the last several years. They lower blood sugar, support weight loss, and have demonstrated cardiovascular and kidney protection benefits. They are typically once weekly injections (or daily oral semaglutide) and side effects, mostly GI, are managed by gradual dose increase.

SGLT-2 inhibitors

Empagliflozin (Jardiance) and dapagliflozin (Farxiga). They lower blood sugar by causing glucose to be excreted in urine. They also reduce cardiovascular events and protect kidney function in many patients.

Insulin

Long acting (glargine, degludec, detemir) and short acting (lispro, aspart, glulisine) insulins are still essential for many patients, including all patients with type 1 diabetes and many with advanced type 2. Insulin pen technology has made administration significantly easier than it used to be.

Sulfonylureas

Glipizide, glimepiride, glyburide. Older medications that stimulate insulin release from the pancreas. Effective and inexpensive, but they carry a higher risk of hypoglycemia and may cause weight gain compared with newer options.

Questions every diabetes patient should ask their pharmacist

• Are any of my other medications affecting my blood sugar?
• When should I take each diabetes medication relative to meals?
• What should I do if I miss a dose, and does the answer differ for each medication I take?
• If I have a stomach bug or cannot eat normally, should I still take all my diabetes meds at the regular dose?
• Are my supplements interacting with my diabetes medication?
• Is there a way to simplify my refill schedule so all my prescriptions arrive on the same day?
• What are the signs of low blood sugar I should know, and what do I do when I notice them?
• Am I on the most appropriate medication for my situation, or should I ask my prescriber about newer options?

The mistakes I see most often

Five recurring problems explain a large fraction of poorly controlled diabetes in Mississippi.

• Skipping metformin because of GI side effects, instead of taking it with food and titrating up slowly.
• Stopping a GLP-1 medication during a side effect window without telling the prescriber or pharmacist.
• Not checking blood sugar consistently, so the medication’s actual performance is unknown.
• Forgetting that decongestants, steroids, and some psychiatric medications can raise blood sugar.
• Letting refills lapse and not catching up, especially with injectable medications.

Where pharmacy helps

Diabetes is one of the most pharmacy intensive chronic conditions. Most patients take more than one diabetes medication, plus medications for blood pressure, cholesterol, and often a statin and an antiplatelet. The interactions and the schedule together require a coordinator. That is the role we fill at Fairview.

We provide free medication therapy management for diabetes patients. We help align your refills so you do not run out of one medication while waiting on another. We can help you find patient assistance programs for the more expensive medications, including the GLP-1s, when affordability is a barrier. Serving Hattiesburg, the Pine Belt, Central Mississippi, and South Mississippi.

When to call a pharmacist

• You were just diagnosed with diabetes or prediabetes.
• You are starting a GLP-1, insulin, or any new diabetes medication.
• Your A1C has not moved in six months.
• You are pregnant, breastfeeding, or planning pregnancy with diabetes.
• You take a steroid, decongestant, or antibiotic and you have noticed changes in your blood sugar.
• You are uncertain about how to handle missed doses or sick day adjustments.

This article is for general information only and is not a substitute for personalized medical advice. Before starting or changing any medication, including over the counter products and supplements, talk with your pharmacist or physician about your specific situation.