Go Ahead, Ask the Pharmacist!

As a National Sponsor of the American Diabetes Association, Rite Aid supports the diabetes community in many ways.

One of these is the “Ask the Pharmacist” feature on the Association’s web site, diabetes.org, where Rite Aid pharmacists answer your pharmacy-related diabetes questions.  So far, Rite Aid experts have answered hundreds of inquiries about diabetes management, medication and supplies.

Have you ever wondered about morning blood glucose highs or which vaccinations to take? Here are some of the most popular questions and answers.


What are the normal ranges for blood glucose?

The following are general plasma/serum blood glucose level guidelines for non-pregnant patients with diabetes according to the American Diabetes Association:
A1C: Less than 7% [The A1C goal for an individual patient is an A1C as close to normal (<6%) as possible without significant hypoglycemia]

Before meals: 70-130 mg/dl

Peak after a meal (1-2 hours after the start of a meal): Less than 180 mg/dl

Why is my blood glucose high in the mornings when I first get up but then okay during the day?

Some people with diabetes experience high before-breakfast blood glucose levels due to hormones released in the middle of the night. This is known as the dawn phenomenon and occurs when hormones trigger the liver to secrete glucose into the blood. If there is insufficient insulin to combat the glucose, blood glucose levels rise.

Typically, the blood glucose level rises between 4 and 8 a.m. Check your blood glucose level in the middle of the night (around 3 a.m.). If your blood glucose is high, you may be experiencing the dawn phenomenon. If your blood glucose is low around 3 a.m., you may be experiencing the Somogyi effect and rebound hyperglycemia.

Long-acting insulin or skipping your bedtime snack can result in extra insulin in the blood before bedtime. Low blood glucose levels at night trigger your body to release hormones, which cause the liver to release glucose into the blood. This defense mechanism against low blood glucose can result in high glucose levels.

It is best to discuss your results with your healthcare team to determine if any adjustments in your current treatment are needed.

Can you explain the meaning of A1C?

Hemoglobin A1C, or glycosylated hemoglobin, estimates average blood glucose level over the past two to three months. Hemoglobin is found inside red blood cells and carries oxygen through the body. Hemoglobin will link up with sugars such as glucose if they are present in the blood. If diabetes is uncontrolled, you will have too much glucose in the blood. This extra glucose will link up with the hemoglobin inside the red blood cells. The more glucose in the blood, the higher the glycosylated hemoglobin (A1C).

If I am using insulin, in what parts of the body should I inject the shot?

Insulin should be injected into subcutaneous tissue, the tissue between the fat layer just under the skin and the muscles under the fat. The most common areas for insulin injections are the upper outer area of the arm, the front and outer sides of the thighs, the abdomen (except for a two-inch area around the navel), the upper outer area of the buttocks and the upper hips.

Be sure to rotate injection sites every day to avoid tissue damage. It is best to choose a site for each injection that is at least one to two inches away from the previous injection site.

Aside from insulin, is there anything I can do to safely lower my blood glucose levels?

The answer to this depends on which type of diabetes you have. Patients with type 1 diabetes do not produce any insulin on their own and require permanent insulin treatment to control blood glucose.

Insulin therapy is one of many medication options for treating hyperglycemia (high blood glucose) in patients with type 2 diabetes. Most patients will start with lifestyle modifications such as watching their diet, exercising and reducing stress, to help decrease glucose levels. (Remember to check your blood glucose often after exercising because the effects of exercise on your blood glucose can last for up to 24 hours.) If these modifications are not enough to control blood glucose levels, oral (by mouth) medications are usually added. When treatment with lifestyle modification and one or two oral agents fail, insulin therapy may be introduced.

Are there any other vaccinations besides flu and pneumonia that a person with diabetes should receive on a regular basis?

Receiving an influenza vaccine annually and the pneumococcal (pneumonia) vaccine when due according the current CDC Immunization Guidelines is recommended. All immunizations should be kept up to date, unless contraindicated, regardless of whether or not you have diabetes.

For more information, you can visit www.CDC.gov/vaccines or ask a Certified Immunizing Pharmacist at your local Rite Aid.

Can my cold, and resulting fever and cough, impact my blood glucose?

When people are sick, whether it is an infection or virus, the body is under stress. During this time, hormones are released to help fight disease and to deal with the stress. These hormones can raise blood glucose levels and affect the action of insulin.

Therefore, when you are sick, you may have a more difficult time keeping your blood glucose levels within target range. During times of illness, it is important to monitor your blood glucose levels and urine ketones more frequently. Ketones are more likely to build up when you are sick and lead to a condition called ketoacidosis. You should contact your doctor immediately if your blood glucose levels remain high or you test positive for ketones in your urine.

We recommend talking to your physician about developing a “sick day plan” before you become ill.


Thank you to Rite Aid for being on call to answer these diabetes-related questions! Visit our website for the full archive of “Ask the Pharmacist” Q&A.

If you do not see the answer you need, you can submit a new question. And don’t forget to check back regularly for new information from each of our experts—we have an “Ask the Dentist” and “Ask the Nutrition Expert” series too!

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