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Monday, February 7, 2022

Can you use multiple discount codes on minted? How can I get discount on Myntra?

Can you use multiple discount codes on minted?

Does Shahid VIP have a free trial?

Does CVS Caremark accept coupons?

How can I get discount on Myntra?

What is the main reason for giving each customer a unique code?

How do I redeem an email gift card?

How do I check my prepaid Mastercard balance?

How do I get a Lowes 20% discount?

Where do JD staff get discount?

What is a coupon is an example of?

How do students get verified at Target?

Can you stack promo codes?

How much do you get off your first Uber eats order?

Can you use more than one Morrisons 5 voucher at a time?



Can you use multiple discount codes on minted?

For Minted More, promotions cannot be stacked or combined with any other non-Minted More credit or offer, including discounted credits for holiday, wedding, or baby and kids products. The 30% off and 20% off promotions cannot both be used within a single transaction.

Does Shahid VIP have a free trial?

Occasionally, and for some eligible customers, We are allowed to enable using Shahid VIP as a free trial. If You are given a free trial, We will inform You of the terms and duration of the trial. Free trial cannot be combined with any other offers. You can review the free trial terms on Shahid Services.

Does CVS Caremark accept coupons?

Pharmacy benefit managers are fighting back at prescription drug copay coupons, cards, and similar discount offers. Earlier this year, CVS Caremark began blocking about 30 drugs whose manufacturers were offering copay coupons. "One is the use of mail order, because our mail-order pharmacies do not accept copay coupons.

How can I get discount on Myntra?

Myntra is providing flat ₹ 500 off to Visa card users on fashion products above ₹ 1,899.The Myntra offer is valid on selected products only.Use Myntra coupon code MNVISA500 to get the discount.

What is the main reason for giving each customer a unique code?

Coupon codes are the industry standard, and for good reason. As opposed to offering a discount on an item, coupon codes emulate the experience of redeeming a physical coupon. Psychologically speaking, coupons are powerful: they've been shown to reduce shopper stress and increase oxytocin levels.

How do I redeem an email gift card?

How to redeem eGift Cards - YouTubeYouTubeStart of suggested clipEnd of suggested clipSystem ask your customer to show you a printed copy of their e-gift card or the barcode from their eMoreSystem ask your customer to show you a printed copy of their e-gift card or the barcode from their e-gift card on their mobile device tap charge then scan your customer's barcode using your barcode.

How do I check my prepaid Mastercard balance?

There are three ways you can keep track of your balance: visit mcgift.giftcardmall.com, or call 1 (877) 322-4710 to make automated balance inquiries 24/7, or track your balance as you spend. Some retailers do not have access to the remaining balance on your Card.

How do I get a Lowes 20% discount?

Accounts opened in store: One-time 20% off discount is not automatic; you must ask cashier to apply discount (barcode) at time of in-store purchase. Accounts opened online, via text-to-apply or QR code: You will receive a one-time coupon/promotional code, which may be used in store or online.

Where do JD staff get discount?

The JD Sports employee discount is 25% off in all of JD Stores and other stores including Size?, Millets and so on.

What is a coupon is an example of?

The part of a savings bond that you can detach and use to redeem interest payments is an example of a coupon. A periodic interest payment due to the holder of a bond. The interest rate of a bond that pays a coupon.

How do students get verified at Target?

To claim this offer you'll first need to sign up for an account at Target.com. Once registered navigate to the settings page and click "Get Verified". Here you can verify your student status with a valid university email and supporting documents.

Can you stack promo codes?

Depending on the promotion, you may be able to apply more than one promotion code to a single online order. For example, if you have a promotion code for free shipping, and another for 10% off an item, you may be able to use both. However, most of our promotions cannot be combined with other offers or discounts. BE

How much do you get off your first Uber eats order?

You can get 20% off your first order when you sign up to Uber Eats. Regular users will usually receive other promos and discounts in their email from time to time.

Can you use more than one Morrisons 5 voucher at a time?

Each voucher code can only be used once and only by one person; apply our vouchers to past orders you have placed with us or otherwise backdate them; redeem our vouchers for cash.

How do you get free queso from Chipotle? How does Coles fuel discount work?

How do I get a Shein discount code?

How do you get free queso from Chipotle?

How does Coles fuel discount work?

Does Walmart sell Victoria's Secret gift cards?

Do coupon codes work in store?

How do I get free food from Uber Eats?

Does Wickes do student discount?

How do you enter a promo code on AutoZone?

How do I get a free Santander Railcard?

How can I get a discount on my Eliquis?



How do I get a Shein discount code?

How to get a Promo Code? If you have registered on our site with a valid email address, you will receive an email from us with a coupon code for your first purchase.

How do you get free queso from Chipotle?

Free Guac or Queso Using the Chipotle Mobile App Get free guacamole or queso with your next order after you download and install the new Chipotle mobile app! Then, a Chipotle coupon code may be sent to you or the discount will automatically apply on your next order through the app.

How does Coles fuel discount work?

Coles Express Fuel Discount vouchers When you spend the qualifying amount of $30 or more in one online shopping transaction, you'll receive a fuel discount voucher with your delivery or collection, just like you do in our supermarkets. Qualifying spend excludes tobacco, tobacco related products and the delivery fee.

Does Walmart sell Victoria's Secret gift cards?

Walmart does not sell Victoria's Secret Gift Cards in-store or online as of 2022. However, customers can buy Walmart and Visa Gift Cards that can be used to buy Victoria's Secret products in Walmart. Alternatively, customers can purchase Victoria's Secret Gift Cards at Kroger and Best Buy.

Do coupon codes work in store?

In most cases, coupons only apply to items the store sells directly. Check the expiration date. A code also won't work if it has already expired. Stores can discontinue codes before the expiration date they provide, or there may not be an exact expiration given, meaning the offer can end at any time.

How do I get free food from Uber Eats?

Sign up for the Uber Eats Pass to get free delivery for a month. Uber Eats Pass is a $9.99/month subscription that waives all delivery fees for orders of at least $15 — plus, it discounts every order 5%. First-time users also get 1 month free with a subscription.

Does Wickes do student discount?

No, Wickes does not currently provide student discounts. However, you will find free advice and inspiration in the 'Ideas and Advice' tab, alongside great deals and discounts on DIY and home improvement in their 'Offers' section where you can save up to 70%.

How do you enter a promo code on AutoZone?

How do I use my AutoZone coupon code?Find the coupon you want to use for your order.Add the items you wish to buy to your virtual cart.Find the box that says "Enter Promo Code."Enter the AutoZone promo code and click "Apply" to see the savings in your cart.5 days ago

How do I get a free Santander Railcard?

How to get your 16-25 RailcardOnce you've opened your 1l2l3 Student Current Account and registered for Online Banking, a unique code will be sent by secure message to your Online Banking within 5 working days of account opening.Use the unique code at our railcard website to order your free 16-25 Railcard.

How can I get a discount on my Eliquis?

How Can I Get a Discount on My Eliquis Prescription?Use Your Health Insurance. Manufacturer's Copay & Free Trial Cards. Buy in Bulk (Get a 90-Day Supply) Fill Your Prescription at a Preferred Pharmacy. Consider Alternative Medications. Patient Assistance Programs & The Rx Advocates.

coupon code shutterfly


* Expiry Date: 09/21/2009

Shutterfly Coupons & Deals

At Shutterfly.com you can create photo books, buy cards & stationery, and share photos with family and friends. Create photo books, buy cards & stationery, and share photos with family and friends at Shutterfly.com. Photo Books, Cards & Stationery, and Photo Share Sites | Shutterfly. Shutterfly makes it easy to express yourself creatively. Enjoy free online photo sharing and unlimited photo storage. Plus, order prints and create personalized greeting cards, photo books, collage calendars, and photo gifts. Enjoy 25 free prints to get started today!

Click through and get 25% discount on wallpapers.

Shutterfly offers the option to order in bulk for photo books and photo products. To place an order in bulk, just go to the designated page for bulk orders and get an instant quote. Once you’ve received your quote, you can customize your order and finalize it at check out.

Returns for reasons unrelated to Shutterfly error are subject to a 50% return fee. To receive a refund, return your order within 60 days after purchase. If you return an order more than 60 days after the original order date, you may receive store credit instead of a refund. Refunds typically take 10 days to fully process.

Create photo books, personalized photo cards, stationery, and share photos with family and friends at Shutterfly. Shutterfly allows you to upload your digital images to create prints in various sizes, create collage posters, and even generate your own personal premium cardstock art prints. Make custom calendars and create home decor items to give as gifts or to grace your own walls.

Shutterfly Coupons, Promo Codes and Cash Back

Create photo books, personalized photo cards, stationery, and share photos with family and friends at Shutterfly. Shutterfly allows you to upload your digital images to create prints in various sizes, create collage posters, and even generate your own personal premium cardstock art prints. Make custom calendars and create home decor items to give as gifts or to grace your own walls.

Transform greeting cards into special keepsakes they'll love and save when you shop through Rakuten.ca where you can earn 2.5 percent or more cash back on every purchase. Flip through all your stunning snapshots with personalized photo books and save on sharing your perfect prints with Shutterfly coupons. Explore free shipping offers and bring all your merry moments to life for less thanks to Shutterfly promo codes. Find discount prices and save with the latest Shutterfly coupon codes plus online rebates when you shop through Rakuten. Don't forget to check out the special offers and combine them with your Shutterfly discount codes so your savings can really add up.

Few gifts can be quite as personal to give to friends and family as custom-created photo books, personalized wine bags, or event photo ornaments for them to trim their trees with. Shutterfly allows you to create personalized photograph gifts for friends and family or for home decor. Create outstanding gifts for holidays, graduations, retirements, weddings, anniversaries, housewarmings, and countless other occasions.

Select items to buy, then head to the checkout page.

FAQs - Frequently Asked Questions about Shutterfly coupon codes

Which products can I get Shutterfly coupon codes for?

There are hundreds of customizable products that you can get from Shutterfly. Here are some of our favorites that you can use Shutterfly codes for:

Shutterfly coupons for prints: Save up to 15% on standard-size prints.

Shutterfly promo codes for calendars: Take up to 50% off of custom calendars.

Shutterfly discounts for photo books: Get small photo books for $15.

How do I use a Shutterfly promo code?

Follow these simple steps to redeem your Shutterfly promo code:

Choose the Shutterfly coupon that saves you the most, and go to the website.

Select items to buy, then head to the checkout page.

Find the promo code box, and enter your code there.

Press the Apply button to see your discount.

What can I do if my Shutterfly coupon isn’t working?

If your code won't work, try these troubleshooting tips:

Have you entered the Shutterfly promo code correctly? Some are case sensitive.

Do you have to purchase a certain amount to qualify?

Has the code expired? Verify that it's still valid.

Does the coupon apply to only a specific item or category?

Can I combine Shutterfly coupon codes?

No, you cannot use more than one Shutterfly coupon for a single order. Some coupons will provide you with extra savings like free shipping and free or discounted items. If you have more than one coupon to use, place separate orders.

Please print this page for your records.

Your Claim Form has been submitted successfully.

HOWEVER, it appears one or more of the documents you uploaded were not successfully received. Please see below for which file(s) had errors and log back in to your existing Claim online to re-upload your document(s). Alternatively, you can send your documents with your Submitted Claim ID to the Settlement Administrator by email to: Info@ShutterflyPromoSettlement.com.

Please print this page for your records.

You will receive momentarily an email confirmation with the information below.

Online only! Get Six dollar standard prints plus free shipping. Valid on prints 10 x 13 or smaller and includes free economy shipping WITH the purchase of four or more qualifying prints

Lifetouch Promo Code

Get your entire digital album for $99.99, online only. Digital album includes the high resolution images photographed in your session with a copyright license to use in modify the images. Exclusions: Enhancement, collages and specialty size is created in the studio are not included in the digital album. ( Expired )

Six Dollar Standard Prints Plus Free Shipping

Online only! Get Six dollar standard prints plus free shipping. Valid on prints 10 x 13 or smaller and includes free economy shipping WITH the purchase of four or more qualifying prints

Exclusions: excluding collages enhance square in panoramic prints ( Expired )

Shutterfly Free Magnet Coupon local time Saturday 8 a.m. 8 p.m. Shutterfly Free Magnet Coupon local time Sunday 8 a.m. 6 p.m. Shutterfly Free Magnet Coupon local time. Additional Phone Numbers. Technical Assistance ; 1-888-833-0209; TDD/TTY for the Hearing Impaired ; 1-888-824-2323; Outside the U.S., Canada and Puerto Rico, Call Collect ; 1-423 .

Common concerns about Shutterfly Free Magnet Promo Code

Does Shutterfly offer Shutterfly Free Shipping Code?

Yes, Shutterfly has Shutterfly Free Shipping Code. See More

Where to find the latest Shutterfly Free Shipping Code?

It is easy to get the latest Shutterfly Free Shipping Code, here are some methods.Come to shutterfly.com and find the Promo Codes on banners or foo. See More

How do I use Shutterfly Free Shipping Code?

Browse Shutterfly product/category list, and add your needed to shopping cart.Check Shutterfly Free Shipping Code list on the page, and save one of. See More

How to save more at Shutterfly?

Shutterfly Free Shipping Code can really help you save at Shutterfly, and also, the other methods are recomended for you.Create an account at shutt. See More

Shutterfly is an online site that offers anyone with a digital camera an easy way to share their photos and videos with friends and family members anywhere in the world. The site actually allows users to do much more than just view and share their memories. They can also transform them into greeting cards, stationery, personalized websites and custom photo books.

Shutterfly Review

Shutterfly is an online site that offers anyone with a digital camera an easy way to share their photos and videos with friends and family members anywhere in the world. The site actually allows users to do much more than just view and share their memories. They can also transform them into greeting cards, stationery, personalized websites and custom photo books.

Many users endorse Shutterfly because it offers a variety of customized photo gifts. Ordered prints are reproduced on Fuji Crystal Archive paper with the customer choice of a matte or glossy finish. Consumers may have prints delivered directly to them or to one of several retail chain stores for pick up.

The site provides all the tools necessary for individuals to upload photos and edit them with various digital effects. They can organize them into online albums and share them with others, regardless of their location. The photo books and albums offer a convenient and fun way to preserve images and the memories they represent.

Photo Editing

Uploading photos is quick and easy with the Express Uploader application. Users can view and edit images before uploading them straight from the desktop. The site offers free online storage for digital images. Other individuals can view shared images without logging in or signing up on the website. They can directly view a slideshow by clicking on a link in an email.

shutterfly-express-uploader


Customers have the option of having prints delivered right to their door. Enhancement options include the opportunity to add decorative borders to any image. Users have hundreds of colorful borders to choose from and many are themed for special occasions and holidays. They can customize captions or personalize each photo with a short message on the back.

Photobook Software

Shutterfly’s photo book software runs off the site and offers customers Simple Path or Custom Path program options for creating the book. The Custom Path offers more options and gives the user greater flexibility in designing pages. For example, the Simple Path uses up to 400 photos with a maximum of four photos per page while the Custom Path allows up to 1000 photos with a maximum of sixteen photos per page.

shutterfly-photobook-software

Custom Path offers a variety of cover options, including suede, leather die-cut windows and satin. Users can choose to add captions or leave the spaces blank. One downside to the program is it automatically adds page numbers and some users would like to have the option to omit them.

Create Your Own Sharing Website

Share sites provide an online destination for individuals to create and customize web pages. The sites offer ways for users to share photos, videos, schedules, calendars and more. Online registration is easy and requires only a name and valid email address. The interface is intuitive and pages load quickly. The sharing feature is free but guests can view only downsized versions of the image at medium resolution. Users can order reprints of any photos.

When creating your website with Shutterfly you get your own personalized web address (URL) and a large selection of templates to choose a style that suits you. A great feature of these sites is that friends and family members can leave comments on your photos and albums. As well as putting your photos on your site you can also store your photobooks, videos, calendars etc

Huge Product Range

Shutterfly_playing_cards

The range of products available through Shutterfly is very impressive, some of which include

  • Photos
  • Cards and stationary
  • Posters
  • Scrapbooks
  • Playing cards
  • Calendars
  • Ornaments
  • Mugs
  • Photo books
  • Key chains and jewellery
  • Home and office products
  • Clothing and accessories
  • Puzzles and books

Shutterfly’s Main Benefits

Hopefully this review has convinced you how great Shutterfly is, but if you need a little more convincing here is a brief summary of the free services they provide:

  • FREE Unlimited storage for all your photos for a lifetime.
  • FREE sharing of your media online or via email.
  • FREE Express Uploader to upload your photos quickly and easily.
  • FREE Photo border enhancement options including over 400 selections.
  • FREE personalized message on the back of every photo ordered.
  • Daily Shutterfly coupon codes to save up to 50% on purchases.

Conclusion

The site offers a simple and convenient way for users to save, organize and share their favorite photos in a variety of creative ways. The prices are very competitive especially if you make use of their coupon codes to save up to 50 percent sitewide.

Most people love to preserve their beautiful memories and experiences and photographs can make it easier. Due to the digital technology, you can get digital image of your beautiful moments. Just capture the moments in digital photos and preserve them for forever.

Upload, Edit, and Share Your Digital Photos Easily With Shutterfly!

Shutterfly Coupons

Most people love to preserve their beautiful memories and experiences and photographs can make it easier. Due to the digital technology, you can get digital image of your beautiful moments. Just capture the moments in digital photos and preserve them for forever.

Are you looking for a platform where you can take care of your photos with an ease ? Then look no further, Shutterfly Coupon can be your right choice. It is a leading social expression and personal publishing service that enables you share, print and preserve your beautiful memories using its superb platform and manufacturing process. Once you visit the website, you will come to know how it is user-friendly platform to upload and edit your photos online. There are Shutterfly Promotional Codes available which can save you money while availing products and services from Shutterfly.

Life is a journey as the most people say and it is not possible to rewind your beaut iful moments back in your life. You just have to memorize those things you like most which remain as glorious moments in your memory. Due to the technology, you can capture those moments right away using digital cameras. In other words, you can preserve your memories with the help of digital photos. Shutterfly lets you preserve, print and share your memories using its easy-to-use technology-based platform. Shutterfly provides you a huge range of useful products and cordial services that will help you upload, organize, edit, share, print and preserve your beautifully captured digital photos in easy and more creative way. Whatever products or services you wish to get from Shutterfly, there are opportunities of getting discounts and saving your budget. Use Shutterfly coupons and avail of great Shutterfly discount!

So, whey taking so much time to share your memories with your friends and family all over the globe? Avail of the best products and services offered by Shutterfly and complete your task as easily as just few clicks. Also, make use of Shutterfly coupon code and Shutterfly PromoCode and Discount Deals with FreeaShipping Offers to get the best Shutterfly offer online.

Some companies that have been known to do this in the past include –

Free Shutterfly Photo Books Available!

There are currently a couple of offers available for free Shutterfly photo books. In addition to these two online offers, always be on the look out for free coupon code cards from various businesses.

We have gotten the coupon codes from airlines we were flying on as well as in our room at a recent stay at Great Wolf Lodge this past year. If you have not seen any of the coupon cards floating around, here are some options to get your free books online at this time!

One quick tip for taking advantage of free photo books – once you have your pictures all ready to go after an event, trip, etc, make sure to make your photo book in the Shutterfly system & then just keep it stored as a digital photo book in Shutterfly. Some of these free photo book codes may only be available for a short time, so that means you will have your book all ready to go when you find a new code for a free Shutterfly photo book & can take advantage right away.

Groupon Offer for Shutterfly Photobook –

If none of the free photo book offers below work for you, Groupon is currently offering this $5 deal for an 8×8 Shutterfly Photo book too. This is a hard cover photo book, so it is a great deal. Shipping will be an additional cost.

Free Shutterfly Photo Book Offers:

Shutterfly Promo Codes Available

  • New customers can get a free 8×8 photobook with promo code FREEBOOKNEW
  • Get unlimited pages added to your book with promo code PAGES (good through 1/23)
  • Get $9.99 6×6 Hardcover 20 Pages Plus Free Shipping here.
  • Shutterfly – Shutterfly also has up to 39% off photo books + 30% off upgrades offer available right now here.
  • New customers can get 50% off at Shutterfly with code JOLLY50

Sign up for rewards programs, they have been known to send out free Shutterfly photo books as rewards.

Some companies that have been known to do this in the past include –

Verizon Rewards (I got one from them a few months back), Huggies, Pampers, Ikea Family and…

Pillsbury – Pillsbury newsletter recipients have seen a free Shutterfly 8 x 8 photo book when you sign up for the Pillsbury Newsletter here! You will have to pay shipping ($7.99) but that is still a great offer.

Shutterfly free photo book

Shutterfly – Shutterfly is offering a special deal right now where you can get a FREE Shutterfly Photo Book when you give a FREE Photo Book to a friend! To get this offer, go to this page here, and enter your name and email address. You will then be directed to a page where you can enter the email address of the friend (or friends) you want to share one with. Once they redeem their free photo book offer you will be sent a coupon code for yours! You can use the same promotion for 10 free photo cards too.

More about Shutterfly Photo Books:

I love these books. They are super easy to make (you upload your images and then drag and drop, and choose your styling). They make excellent gifts for grandparents. These would also be great to make with pictures of the school year or maybe a family vacation you’ve gone on recently!

One of the things on my to do list is to do a round up of back to school pictures for my kids each year and to do some of our recent vacations in a book. If you have a child in sports, it is also fun to make them a book with pictures of them playing that sport over the years.

I love that there are often these free offers floating around for Shutterfly Photo Books. One thing I have tried to do is to turn each family vacation into a photo book, and although there are many offers out there, it is nice to have some uniformity in my books. Since I know I can consistently find good offers from Shutterfly, then I know I will have books that look uniform when I make them for each vacation. This is just something that I prefer, but there are a number of ways to get your photo books for just the cost of shipping usually.

I also love that they are hardcover books (some of the others are soft cover, which are great too, but these seem to hold up over the long haul a little better).

Another benefit is that you will create a digital photo album online that is then printed into the actual book. Those are stored in your account, so should something happen (like a page getting ripped) you are able to order another copy. I have tried to get some of these books printed in photo sections of local stores, and they are generally $20+, so even with the cost of shipping this is a fantastic deal.

discount card for xultophy

Please click here to go directly to our internal career site to view all our current job opening.

Discount card for xultophy

4 Mail us a self-addressed stamped envelope with a small donation to help us defray costs to: NeedyMeds. 50 Whittemore St. Gloucester, MA 01930. 5 Send a $5 donation or more through Network for Good. Donation. NeedyMeds offers a 30-day money back offer of your donation if you are unhappy with the drug discount card Facing backlash, FDA narrows patient population for Alzheimer's drug With both Biogen and the FDA facing a litany of criticisms, the agency is Novo to buy Prothena heart drug in $1.2B deal Novo Nordisk will acquire a clinical stage heart therapy from U.S. drug

Does Novo Nordisk drug test

Benefits Hiring Process Interviews Working Environment Working Culture Promotion Working Hours Background Check CEO Drug Test Job Opportunities Training Attire Company Future Dress Code Companies > Novo Nordisk, Inc. > Find answers to 'How do they drug test you hair or urine' from Novo Nordisk, Inc. employees. Get answers to your biggest company questions on Indeed Questions and Answers about Novo Nordisk, Inc. Popular topics Benefits Hiring Process Interviews Working Environment Working Culture Drug Test Promotion Working Hours Background Check CEO Job Opportunities Training Attire Company Future Dress Code Life insurance Office Locations Part Time Jobs Work Life Balanc I interviewed at Novo Nordisk Interview I was contacted by a TA manager to schedule the first 30 min long phone screening interview (with the hiring manager and another scientist - discussed previous experiences and questions about tableting and oral drug delivery) about 1 week after my application

Building a Community. Novo Nordisk employee Sebastian shares going from seeking community to building it. Read his story. New treatment for chronic weight management. Novo Nordisk receives FDA approval of a new medicine for adults with obesity. Learn more. MyDiabetesHQ Live. Hosted by Cities Changing Diabetes' Houston and Philadelphia volunteers Our Products. Novo Nordisk has multiple products on the market for the treatment of Diabetes, Obesity, Growth Hormone Disorders, Hemophilia and Rare Bleeding Disorders. Access information and resources on each of our products below. If the information you're looking for is not shown, please Submit a Question 800 Scudders Mill Road Plainsboro, NJ 08536 Tel: 1-609-987-5800. CVR-no. 2425679

How do they drug test you hair or urine Novo Nordisk

  1. phone interview with the hiring manager. Short-listed candidates were then invited for a 2-hr face-to-face interview with the hiring manager, HR partner, and VP of the department at the Copenhagen site. IQ test and personality tests were sent online and the results.
  2. Novo Nordisk is a global healthcare company with more than 90 years of innovation and leadership in diabetes care. This heritage has given us experience and capabilities that also enable us to help people defeat other serious chronic conditions: hemophilia, growth disorders and..
  3. Benefits Hiring Process Interviews Working Environment Working Culture Drug Test Promotion Working Hours Background Check CEO Job Opportunities Training Attire Company Future Dress Code Companies > Novo Nordisk, Inc. >
  4. Because of good salary package only. Answered June 10, 2017. Answer. How does someone get hired at Novo Nordisk, Inc.? What are the steps along the way? Asked June 10, 2017. There is a interview by managers and after finalisation hr will send you offer letter
  5. Novo Nordisk A/S is a Danish multinational pharmaceutical company headquartered in Bagsværd, Denmark, with production facilities in eight countries, and affiliates or offices in 5 countries.Novo Nordisk is controlled by majority shareholder Novo Holdings A/S which holds approximately 25% of its shares and a supermajority (45%) of its voting shares..
  6. Denmark-based pharmaceutical company Novo Nordisk will no longer use live animals in biological batch testing. The company has confirmed the last test involving the use of animals occurred on 28 November, used to test the company's haemophilia product recombinant Factor VII
  7. Novo Nordisk ® NovoSeven® Each vial of lyophilized drug contains the following: Contents 1.2 mg (60 KIU) Vial human lymphocytes) and in vivo studies (i.e., mouse micronucleus test.

Novo Nordisk Interview Questions Glassdoo

  1. A Novo Nordisk internship will provide you with valuable, hands-on work experience with one of the world's leading pharmaceutical companies. As an intern in Novo Nordisk you will be working with experienced colleagues from many different nationalities within various fields. Turn on sound. Internship at Novo Nordisk - bring your career to life
  2. Novo Nordisk is a leading global healthcare company, founded in 1923 and headquartered in Denmark. Our purpose is to drive change to defeat diabetes and other serious chronic diseases
  3. The drug, semaglutide, made by Novo Nordisk, already is marketed as a treatment for Type 2 diabetes. In a clinical trial paid for by the company and published in the New England Journal of..
  4. DoesNovoNordisk's New Diabetes Drug Spell Doom for MannKind Corp? NovoNordisk just filed a new application for a fast-acting insulin, and if it gains approval, it could put a world of hurt on.

Welcome to Novo Nordisk in the U

  1. istration unanimously recommended approval for the treatment, called IDegLira, in May. The Danish drugmaker also has high hopes for another drug in development called semaglutide
  2. g out of Novo Nordisk's production lines. These tests have for years been required by health authorities as part of their approval of the products
  3. Ozempic is a once-weekly injection that Novo Nordisk hopes will take market share from Trulicity, which has been cutting into sales of Novo Nordisk's once-daily Victoza. Novo Nordisk is also developing an oral form of semaglutide. The company said it plans to price the drug at $676 per prescription, which it described as at parity to.
  4. Novo Nordisk (NYSE:NVO) is a $150B pharmaceutical company with a focus on diabetes treatments.Because obesity can be a contributing factor to diabetes, Novo has been working on the development of.
  5. NovoSeven ® RT may cause serious side effects, including:. Serious blood clots that form in veins and arteries with the use of NovoSeven ® RT have been reported; Your healthcare provider should discuss the risks and explain the signs and symptoms of blood clots to you. Some signs of a blood clot may include pain, swelling, warmth, redness, or a lump in your legs or arms, chest pain.

Currently, there is a corporate partnership between Walmart and Novo Nordisk. Walmart has the ReliOn brand of Novolin insulins exclusively, and at a reduced rate. ReliOn Novolin is a human insulin, and it works to bring blood sugars down in a similar way as do other insulins. Each vial contains 10 mL of insulin Novo Nordisk in 2004, Dr Moses has held positions of increasing responsibility in Clinical Development and Medical Affairs and now serves as Senior Vice President and Global Chief Medical Officer. In this role he has responsibilities across the full spectrum of Novo Nordisk's diabetes focus from drug discovery, through drug Danish drugmaker Novo Nordisk will acquire U.S. drug developer Prothena Corp's experimental heart therapy, PRX004, in a deal that could be worth up to $1.23 billion, the companies said on Monday 1 As required by the Sunshine Act, Novo Nordisk will disclose to the Federal government the value of certain educational materials including articles/reprints provided to Physicians and this information may be made publicly available by CMS. Novo Nordisk will also report similar information for healthcare professionals licensed to practice in those states with reporting requirements

Novo Nordisk made the announcement on its Website on Nov. 30, but only drew attention to it on Monday. Novo Nordisk also pledged to keep out of pocket costs low to consumers through patient assistance programs and cheaper forms of insulin, as well as help change up the complicated drug pricing system Combining that with our experience with register-based research and Novo Nordisk's highly specialised competences within drug trials will really help propel the area forward. We are therefore very enthusiastic about this opportunity', says Associate Professor and Deputy Head of Department Theis Lange from the Department of Public Health Novo Nordisk Total R&D spend by the company in 2019 (in millions of dollars): 2,132 Total R&D spend by the company in 2019 (as a percentage of net sales): 11.65 Novo Nordisk also markets another GLP-1 analogue under the trade name Ozempic. Ozempic is designed as a once-daily drug that overall seeks to be an improvement over Victoza

I interviewed at Novo Nordisk (Istanbul) in Mar 2021. Interview. First step was HR specialist on the phone with basic questions. Resume check and brief summary of my career were asked. Second interview was with HR Manager and GM. A short presentation was asked to prepare. Presentation was about personal compass and key achievement in career Do Novo Nordisk, Inc. hire phd biotechnology awarded girls For how long one should wait for the interview results? Asking w.r.t. walk in for drug safety assoc

.A built-in spring mechanism requires low force to inject all doses. When your dose is delivered, youshould hear or feel a clicka Accurate dosing.Turn the dose selector to select the number of units you need to inject, from 1-80 units According to Novo Nordisk, Fiasp, has its maximum effect between 1 and 3 hours after the injection and the effect lasts for 3 to 5 hours. Our goal in developing Fisap was to try and get closer to mimicking the body's own insulin response to food, says Michael Bachner, Associate Director for Product Communications for Novo Nordisk The Food and Drug Administration approved Wegovy, a higher-dose version of Novo Nordisk 's diabetes drug semaglutide. In company-funded studies, participants taking Wegovy had an average weight. Novo Nordisk only conduct trials in countries where they have affiliates with necessary competence to arrange and monitor the trials. Also, they conduct clinical trials globally to test the safety and efficacy of new drug candidates in order to obtain global marketing authorization. These trials always have the same standards at all trial sites

A phase 3 trial program is now being planned to test cagrilintide in combination with semaglutide for weight management, they conclude. Enebo is an employee and shareholder at Novo Nordisk The Food and Drug Administration approved Wegovy, a higher-dose version of Novo Nordisk's diabetes drug semaglutide, for long-term weight management. Advertisemen The FlexPen by Novo Nordisk is a way to deliver your insulin without using the traditional vial and syringe. They've got both insulin determir and insulin aspart covered through their two brand names NovoLog and Levemir, and they've made it all disposable so there's no need to refill them, you just go to the next one Eligible patients. My$99Insulin. You may be eligible to pay $99 for your monthly supply of any combination of Novo Nordisk insulin products (up to 3 vials or 2 packs of pens). Offer is available each month during a calendar year. This cost does not apply to any insurance deductible you may have. a,b

On Friday, September 6, Novo Nordisk announced in a press release that authorized generic versions of NovoLog and NovoLog Mix will be made available on January 2, 2020. The news was part of a broader announcement of more affordable options coming at the start of the year. In addition to the authorized generics, Novo Nordisk will be offering a $99.00 Cash Card program for analog insulin Novo Nordisk's Debt And Its 71% ROE. While Novo Nordisk does have a tiny amount of debt, with debt to equity of just 0.08, we think the use of debt is very modest. When I see a high ROE, fuelled by only modest debt, I suspect the business is high quality As a result of the animal study results, the clinical development program for Victoza included blood tests for a biomarker for medullary thyroid cancer—a blood calcitonin test The insulin does not appear water-clear and colourless. Do not refill a NovoRapid® Penfill® cartridge. NovoRapid® Penfill® cartridges are designed to be used with Novo Nordisk Insulin Delivery Devices, NovoFine®, NovoFine® Plus and NovoTwist® needles as part of The All In-One System®

Novo Nordisk Product Information and Resources Novo

Novo Nordisk India Private Limited. Contact us. Plot No.32, 47-50, EPIP Area, Whitefield Bengaluru 560 066. Phone: +91 80 4030 3200 Fax: +91 80 4112 351 JDRF, Common Issues around Insulin, Insulin Pumps, CGMs and Test Strips Business Insider, Why the life-saving drug insulin for diabetes is so expensive Sep. 23, 202 NOVO NORDISK LEVEMIR FLEXTOUCH Disposable INSULIN Levemir DOSE DELIVERY 1-unit increments, DOSE DELIVERY up to 80 units at a time TOTAL CAPACITY 300 units DETAILS Pen is navy with a green label. Spring-loaded mechanism requires less force for dose delivery. There is an audible click at the end of the dose, but the full dose has not bee

Dr. Alan Moses: From a Novo Nordisk perspective, we were very pleased with how our phase 3 insulin degludec data, as well as data on Victoza, were received. Data presented showed that patients who switched to treatment with once-daily Victoza experienced greater reductions in blood sugar when compared with other commonly used treatments for type 2 diabetes (sitagliptin and exenatide) Novo Nordisk provides patient assistance for those who qualify. Please call 1-866-310-7549 to learn more about Novo Nordisk assistance programs. You are encouraged to report negative side effects of prescription drugs to the FDA Novo Nordisk Patents Synthetic Gut Hormone in Obesity-Drug Plan. Novo Nordisk A/S, the world's biggest maker of insulin for diabetics, has patented a synthetic version of an intestinal hormone.

Novo Nordisk, Inc. and Novo Nordisk Pharma, Inc. Sanofi-Aventis U.S. LLC; Please see the list of Model drugs (PDF) for CY 2022 for more information. Please note that there is a separate list of CY 2021 Model Drugs for CY 2021. Part D Sponsor participants for CY 2021 who are looking to make formulary updates in 2021 should use the CY 2021 Model. They're manufactured by just three different drug makers: Novo Nordisk, Sanofi-Aventis, and Eli Lilly. Some are long-acting insulins, injected once or twice a day; others act rapidly and. But why does Novo-Nordisk have a similar price on its similar acting Novolog? at a local independent Drug Store I paid $2.00 per vial for both U-40 Regular Insulin, and for U-80 NPH Insulin - pig & cow extracts; 10 ml. vials which is the same size as the present day U-100 vial. In the 1950's. a loaf of bread cost 10 cents, a. 1.2 mg dose does not result in acceptable glycemic control, the dose can be increased to 1.8 mg. When initiating Victoza, consider reducing the dose of concomitantly administered insulin secretagogues (such as sulfonylureas) to reduce the risk of hypoglycemia [see Warnings and Precautions (5.3) and Adverse Reactions (6)]

Diabetes Treatments Novo Nordisk U

  1. Just a heads-up. Novo Nordisk has an Instant Savings Card that reportedly will reduce your cost on Levemir, Novolog, FlexPens, etc. to $25 per prescription. BUT You have to have primary insurance coverage first, which it does not say anywhere in the terms and conditions
  2. Signing up for the Novo Nordisk Instant Savings Card allows eligible patients to: Pay as little as $25 per 30-day supply for up to 2 years (maximum savings up to $100 per fill) a Receive 1 FREE box of Novo Nordisk needles (maximum savings of $60)
  3. NovoRapid is a replacement insulin that is very similar to the insulin made by the body but is absorbed faster by the body. This allows it to start acting faster than human insulin. The replacement insulin works in the same way as naturally produced insulin and helps glucose enter cells from the blood. By controlling the level of blood glucose.
  • 7 DRUG INTERACTIONS 7.1 Concomitant Use with an Insulin Secretagogue (e.g. Sulfonylurea) or Insulin 7.2 Oral Medications 8 USE IN SPECIFIC POPULATIONS 8.1 Pregnancy 8.2 Lactation 8.3 Females and Males of Reproductive Potential 8.4 Pediatric Use 8.5 Geriatric Use 8.6 Renal Impairment 8.7 Hepatic Impairment 10 OVERDOSAG
  • NovoLog FlexPen (insulin aspart) is a member of the insulin drug class and is commonly used for Diabetes - Type 1, Diabetes - Type 2, Diabetic Ketoacidosis, and others. NovoLog FlexPen Prices The cost for NovoLog FlexPen injectable solution (100 units/mL) is around $593 for a supply of 15 milliliters, depending on the pharmacy you visit
  • Novo Nordisk's diabetes market share was 27% in 2017, which makes it the biggest diabetes-drug maker in terms of market value. The company's top-selling diabetes medicine is NovoLog, a rapid.

AbbVie does not currently use or intend to use or fund animal forced swim tests. Our Animal Enrichment and Care Program We are dedicated to providing species-appropriate enrichment for all animals. Dedicated animal behavioral specialists manage enrichment to support a variety of animal behavioral needs wit The Novo Nordisk Diabetes Patient Assistance Program The Sanofi Patient Assistance Program Leading pharmaceutical companies have also created the Together Rx Access Card to help people without other prescription drug insurance coverage gain access to savings on prescription products

Working at Novo Nordisk Glassdoo

For Novo Nordisk, the issue is so far limited to China, CEO Lars Fruergaard Jørgensen said in an interview. After its holiday for the Chinese New Year, Novo Nordisk asked employees in China to. Danish drug maker Novo Nordisk's CEO Lars Rebien Sørensen says India's non-communicable disease burden is mainly due to poor regulation and lack of awareness. The top executive of the world's largest insulin maker talks to ET about such challenges and how Novo Nordisk is planning to provide solutions. Edited excerpts: Being the largest diabetes drug maker, how does Novo Nordisk perceive India.

What benefits does Novo Nordisk, Inc

  1. Insulin aspart (Novolog) is used to treat diabetes mellitus, including diabetes type 1 and diabetes type 2.This drug is slightly more popular than comparable drugs. It is available in generic and brand versions. It is not covered by most Medicare and insurance plans, but manufacturer and pharmacy coupons can help offset the cost
  2. Experience Novo Nordisk Pharamaceutical Industries, Inc. August 2013 - Present Novo Nordisk August 2008 - July 2013 Novo Nordisk Delivery Technologies January 2005 - July 2008 Novo Nordisk 1999 - 2004 Skills Pharmaceutical Industry, GMP, Validation, FDA, Medical Devices, Biotechnology, Sop, Biopharmaceuticals, 21 CFR Part 11, Change Control, V.
  3. Novo Nordisk A/S is a Danish multinational pharmaceutical company headquartered in Bagsværd, Denmark, with production facilities in eight countries, and affiliates or offices in 75 countries. Headquarters: Bagsværd, Denmark CEO: Lars Fruergaard Jørgensen (1 Jan 2017-) Revenue: 111.7 billion DKK (2017) Subsidiaries: Ziylo Ltd, Novo Nordisk.

Coq10 Diabetes What Are Diabetic Test Strips Used For ::The 3 Step Trick that Reverses Diabetes Permanently in As Little as 11 Days. Finn nyttig informasjon om behandling rsaker potensmedisiner med mer Wine for type 2 diabetic patients The purpose of this study was to evaluate the effects of dry and sweet wine on the glycaemic control in Type 2. Norditropin NordiFlex 30iu Novo Nordisk $275.00 . Proviron 25 mg Bayer $31.00 . Humatrope Cartridge 36iu Eli Lilly $345.00 . HCG Ovidac 5000iu Cadila Pharmaceuticals $34.00 . HCG HUCOG 2000iu Bharat Serums & Vaccines $17.00 . Dianabol drug test urine, does taking letrozole make you tired. Does taking steroids make you sweat, cheap best steroids. Novo Nordisk to launch two medications for diabetes, weight loss in 2022 Novo Nordisk, the Danish drug maker which holds the largest share in Indian insulin market, is firming up plans to launch two anti-diabetes medications from its global portfolio in 2022 North Carolina's Research Triangle region is the 4th largest life science industry hub in the U.S. and offers unparalleled access to top biomanufacturing talent. The area frequently tops rankings of the best places to live and work in the country. Novo Nordisk operates three manufacturing facilities for diabetes and obesity medicines in the.

Novo Nordisk - Wikipedi

  • A recall is a voluntary action taken by a company at any time to remove a defective drug product from the market. Novo Nordisk : 05/04/2021: Hospira, Inc. 0.5% Bupivacaine Hydrochloride.
  • Any new drug requires heavy lobbying to the drug tested and. Novo has made sure that the new drug it has found out for diabetes does very strong lobby at centre and the FDA for its approval. Though drug manufacture and use is strictly the basis of integrity, it is a must that drug lobby is
  • Stanford University Case Study: Novo Nordisk 1. Stanford University Graduate School of Business S-SM-22 Rev. July 1995 Novo Nordisk (A) In 1981, Novo was the second largest producer of insulin preparations in the world supplying about 25% of the world's insulin demand, and was the world's market leader in industrial enzymes
  • With this program, pay $99 for a monthly supply of any combination of Novo Nordisk insulin products (up to 3 vials or 2 packs of pens). Offer is available each month during a calendar year. This cost does not apply to any insurance deductible you may have. b

Novo Nordisk to end animal testing - Drug Development News

1 How to adjust insulin doses Firstly it is important to understand how the different types of insulin work. Basal insulin -usually Lantus or Levemir This is the background insulin, it keeps the blood glucose levels stead What does Novo Nordisk focus on? Novo Nordisk is a world leader within diabetes care and has been producing insulin since 1923, however we are also very proud of our work within haemophilia, growth hormone therapy and obesity. Since the company was founded in Denmark more than 90 years ago, we have been focused on improving diabetes care Novo Nordisk Issues Voluntary Nationwide Recall of Levemir, Tresiba, Fiasp, Novolog and Xultophy Product Samples Due to Improper Storage Temperature Conditions. May 10, 2021 -- Novo Nordisk is voluntarily recalling 1,468 product samples listed in the table below of Levemir®, Tresiba®, Fiasp®, Novolog®.. The Brand Rankings by Category! Annual ranking published by Pharmacutical Executive. The Top Global Pharma Companies ranking is based on sales in the previous year Brand/Generic Name Reviews Rating; bamlanivimab Generic Drug class: miscellaneous antivirals Lartruvo Generic name: olaratumab Drug class: miscellaneous antineoplastics silver nitrate Generic Drug class: ophthalmic anti-infectives For ratings, users were asked how effective they found the medicine while considering positive/adverse effects and ease of use (1 = not effective, 10 = most effective)

NovoSeven Coagulation Factor VIIa (Recombinant

Novo nordisk vision statement under ifrs and mission too big role of auessays is happening is a large western united nations guiding nnit as. The novo nordisk way of the executives. And ingrain their approach by doing all the private sector to work within diabetes treatment of drug, mission and novo nordisk vision statement was realised Note for people with Extra Help If you get full Extra Help, your set copayment for insulin is lower than the $35 copayment for a month's supply under the Senior Savings Model.If you get partial Extra Help, you may pay up to a $9 2 deductible and 15% coinsurance, which may be higher or lower than the $35 copayment under the model. Contact 1-800-MEDICARE if you need help checking the level of. Leading a healthier life with TYPE 2 DIABETES may not be as tough as you think.. Cornerstones4Care ® has gathered expert advice and inspiration to help you stay motivated and independent—bite‑sized, everyday lessons on eating better, moving more, and treating diabetes that take under 5 minutes Manufacturers can test insulin batches to ensure none of the bacteria's E. coli proteins are mixed in with the insulin. They use a marker protein Insulin patches are another drug delivery system in development. Patches would release insulin continuously into the bloodstream. Novo Nordisk Diabetes Web Page

Internship programme - Novo Nordis

  • the United States. The greatest disparity was with Japan, where the average drug price was only 15 percent that of the U.S., meaning that the U.S. on average spends seven times what Japan pays for the same drugs. Denmark represented the closest average price, where average drug prices were 39.1 percent of the average U.S. drug price
  • With type 1 diabetes, the body does not make any insulin and therefore insulin has to be injected regularly every day to stay alive. With type 2 diabetes, the body does not make enough insulin, or the insulin that is made does not work well. Insulin injections are sometimes needed to manage blood glucose levels. Starting on insuli
  • Novo Nordisk said Thursday it will establish a new obesity research unit in Seattle that's expected to employ 60 by the end of 2016. The new unit, initially employing 10, reflects the global.
  • ClinicalTrials.gov is a resource provided by the U.S. National Library of Medicine. IMPORTANT: Listing a study does not mean it has been evaluated by the U.S. Federal Government.Read our disclaimer for details.. Before participating in a study, talk to your health care provider and learn about the risks and potential benefits

Novo Nordisk A/S (NYSE:NVO) ESG Conference Call November 30, 2020 10:00 AM ET. Company Participants. Lars Jørgensen - CEO. Camilla Sylvest - EVP, Commercial Strategy & Corporate Affairs. Henrik. NovoLog Insulin 100U/ml - 10ml Multi Dose Vial. Unfortunately our full catalog may not be displayed in your state. If you contact our Customer Support by one of the methods below, we will be able to assist you in locating the product you are looking for. Customer Support. Phone: 1-800-748-7001 Novartis in Society 2020 US Report. Novartis is striving every day to help patients, strengthen communities, drive sustainability, and build a more equitable and responsive healthcare system for all. Read More All four products were recalled. The presence of milk in dark chocolate products with dairy-free claims is a potentially serious health concern since individuals allergic to milk are likely to.

Novo Nordisk, driving change to defeat diabete

4 Mail us a self-addressed stamped envelope with a small donation to help us defray costs to: NeedyMeds. 50 Whittemore St. Gloucester, MA 01930. 5 Send a $5 donation or more through Network for Good. Donation. NeedyMeds offers a 30-day money back offer of your donation if you are unhappy with the drug discount card Facing backlash, FDA narrows patient population for Alzheimer's drug With both Biogen and the FDA facing a litany of criticisms, the agency is Novo to buy Prothena heart drug in $1.2B deal Novo Nordisk will acquire a clinical stage heart therapy from U.S. drug

'A Game Changer': Drug Brings Weight Loss in Patients With

  • Novo is a powerfully simple business banking platform with no hidden fees built for small business owners. Simplify your business finances with Novo
  • Lilly unites caring with discovery to create medicines that make life better for people around the world
  • Novo Nordisk's top competitors include Eli Lilly, AstraZeneca and Biocon. See the full list of Novo Nordisk competitors, plus revenue, employees, and funding info on Owler, the world's largest community-based business insights platform

Does Novo Nordisk's New Diabetes Drug Spell Doom for

Novo Nordisk, Inc. Victoza® Victoza® N/A NovoLog® Mix FlexPen® NovoLog® Mix 70/30 N/A NovoPen® Junior Novo Nordisk PenFill 3ml N/A Novo Pen® 3 Novo Nordisk PenFill 3ml N/A Levemir® FlexPen® Levemir® N/A Owen Mumford AutoPen® N/A N/A *As of August, 2011 †Tested with adults of BMI 20-49 The FDA posts Medical Device Safety Communications to describe the FDA's current analysis of an issue and contain specific regulatory approaches and clinical recommendations for patient management Novo Nordisk has expanded both its global insulin volume market leadership, as well as its GLP-1 market leadership. This has resulted in the previously mentioned, expansion of Novo Nordisk global diabetes market leadership, now at 28.7%. Obesity care sales grew by 30%, with both operating units contributing to growth

***Full disclosure: I would make 5 to 10 times more selling the discount card than I would a traditional insurance plan, even though the insurance plan costs more! But I don’t sell discount cards because that sale is only slightly more honorable than purse snatching.***

Discount Cards: Scams?

Discount Card Scams

With money tight and the loss of health insurance for many families, there has been major growth in the health services discount cards industry. These cards, for a monthly fee, purport to pass along savings to consumers for items such as dental, vision, physician visits, labs, and imaging services. They claim HUGE, HUGE, HUGE discounts off the contracted service providers fee schedule.

In most instances, this claim is more rancid than sun baked baloney. These cards are advertising in reverse. Instead of the service providers paying to advertise, the consumers are paying to see a Special list of providers. Supposedly, these dentists, optometrist, and physicians are going to give you an extra discount off of their prices. 75% off a price inflated by 200% is no bargain.

Some cards do have some real value tucked inside. More often than not, you can get the same benefit for less money somewhere else. The time it takes to determine which benefit is bogus and which is legitimate versus the costs virtually nullifies any value these cards may present to the general public.

Health industry providers do have special contracted rates with insurance companies. You can get close, if not better pricing, by flashing green money at the time of service. Providers cut deals with insurance companies to:

  1. Get a steady stream of patients, lowering their marketing costs.
  2. Get paid in a timely manner.

The discount card industry will tell you the cards are not insurance, but it is usually in the fine print. My local newspaper did a gushing review of a dental discount card recently. For $79 a year ($6.58 per month) you can get a particular dental discount card. Heck, for $168 a year ($14 per month) I can get you Dental HMO plan that offers:

  • $5 office visits
  • Initial exam, no charge.
  • Yearly x-rays, no charge.
  • Twice yearly cleanings, no charge.
  • Amalgam surface filling, no charge after 6 months.
  • A complete list of all procedures costs and copays.

***Full disclosure: I would make 5 to 10 times more selling the discount card than I would a traditional insurance plan, even though the insurance plan costs more! But I don’t sell discount cards because that sale is only slightly more honorable than purse snatching.***

Certainly, the extra $90 per year for the dental insurance is recovered with the yearly services the plan provides. The review of this particular discount card was done in the business section of the newspaper where I expect a little more critical analysis, just not a regurgitation of the press release submitted by the discount card company.

A better investment for your $79 would be to invest in the company directly. If their marketing is successful and they suck enough people into it, they will make money hand over fist on these discount cards. What are their costs? They certainly are not reimbursing the dentists, like real insurance companies do. Their big cost is marketing on the internet and whatever they pay for item placement advertising in newspapers.

If you do not have dental insurance and can’t afford it, I won’t sell it to you. But if you need some dental work, I can provide you with the negotiated fee schedule included with most dental insurance plans. Take the fee schedule and your cash into your local dentist and start negotiating. You will get good pricing without having to buy a discount card.

This medication should be swallowed whole, usually once daily with or without food, or as directed by your doctor. Use this medication regularly in order to get the most benefit from it. Remember to take it at the same time each day. This drug is not effective if you use it only when chest pain occurs. It is very important to take this medication regularly as prescribed to help prevent chest pain. It is important to continue taking this medication even if you feel well. Most people with high blood pressure do not feel sick. Do not stop taking this medication without consulting your doctor. Your chest pain may worsen if the drug is abruptly stopped. Your dose may need to be gradually decreased.

Precautions

Before using this medication, tell your doctor or pharmacist your medical history, especially of: heart disease, liver disease, any allergies. Limit intake of alcohol while taking this drug. Caution is advised when using this drug in the elderly because they may be more sensitive to the side effects of the drug. This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor. It is not known whether this drug passes into breast milk. Breast-feeding is not recommended while using this drug.

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Monitor Closely (1) dulaglutide, saxagliptin. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

Administration

SC Preparation

Inspect visually before use; solution should appear clear and colorless; do not use if particulate matter or coloration observed

SC Administration

Administer once weekly at any time of day

May take with or without food

Inject SC in abdomen, thigh, or upper arm; rotate injection site with each dose

If needed, can change day of weekly administration if last dose was administered ≥3 days before

Coadministration with insulin

  • When using with insulin, administer as separate injections and never mix
  • May inject dulaglutide and insulin in same body region, but injections should not be adjacent to each other

Missed dose

  • ≥3 days until next scheduled dose: Administer as soon as possible
  • Patient Education
    dulaglutide subcutaneous

COMMON BRAND NAME(S): Trulicity

WARNING: This medication can cause a certain type of thyroid tumor (thyroid C-cell tumors) in rats. It is unknown if this medication can cause similar tumors in humans. Talk with your doctor about the benefits and risks of treatment with this medication. Do not use this medication if you have a certain inherited disease (multiple endocrine neoplasia syndrome type 2 or MEN 2) or if you have a personal/family history of a certain type of cancer (medullary thyroid carcinoma). While using this medication, tell your doctor right away if you notice any signs or symptoms of thyroid tumors, including unusual growth or lump in the neck, difficulty swallowing, shortness of breath, persistent hoarseness.

USES: Dulaglutide is used with a proper diet and exercise program to control high blood sugar in people with type 2 diabetes. Controlling high blood sugar helps prevent kidney damage, blindness, nerve problems, loss of limbs, and sexual function problems. This medication is also used to lessen the risk of a major cardiovascular event (such as heart attack or stroke) in people who already have, or are at high risk for heart/blood vessel disease.Dulaglutide is similar to a natural hormone in your body (incretin). It works by causing insulin release in response to high blood sugar (such as after a meal) and by decreasing the amount of sugar your liver makes.Dulaglutide is not a substitute for insulin if you need insulin treatment.

HOW TO USE: Read the Medication Guide and Instructions for Use provided by your pharmacist before you start using dulaglutide and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Before injecting each dose, clean the injection site with rubbing alcohol. Change the injection site each time to lessen injury under the skin.Inject this medication under the skin in the thigh, abdomen, or upper arm as directed by your doctor, usually once every 7 days. Do not inject into a vein or muscle. It may be used with or without meals.If you are also using insulin, give dulaglutide and insulin as separate injections. Do not mix them. You may inject these medications in the same area of the body, but the injection sites should not be next to each other.Do not share your pen device with another person, even if the needle is changed. You may give other people a serious infection, or get a serious infection from them. Learn how to store and discard medical supplies safely.Use this medication regularly to get the most benefit from it. To help you remember, use it on the same day each week. It may help to mark your calendar with a reminder. Carefully follow the medication treatment plan, meal plan, and exercise program your doctor has recommended.The dosage is based on your medical condition and response to treatment. Your doctor will start you on a low dose first to decrease your risk of stomach/abdominal side effects, and gradually increase your dose. Follow your doctor's instructions carefully.Tell your doctor if your condition does not improve or if it worsens (such as if your blood sugar remains high or increases).

SIDE EFFECTS: See also Warning section.Nausea, diarrhea, vomiting, abdominal pain, stomach upset, decreased appetite, tiredness, or weakness may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: slow/irregular heartbeat, signs of kidney problems (such as change in the amount of urine), vision changes.Persistent vomiting/diarrhea may result in dehydration and kidney problems. Contact your doctor promptly if you notice any symptoms of dehydration, such as unusual decreased urination, unusual dry mouth/thirst, fast heartbeat, or dizziness/lightheadedness.Get medical help right away if you have any very serious side effects, including: signs of pancreatitis (such as persistent nausea/vomiting, severe stomach/abdominal/back pain).Although dulaglutide by itself usually does not cause low blood sugar (hypoglycemia), low blood sugar may occur if this drug is prescribed with other diabetes medications. Talk with your doctor or pharmacist about whether the dose(s) of your other diabetes medication(s) needs to be lowered. Drinking large quantities of alcohol, not getting enough calories from food, or doing unusually heavy exercise may also lead to low blood sugar. Symptoms may include sudden sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness, or tingling hands/feet. It is a good habit to carry glucose tablets or gel to treat low blood sugar. If you don't have these reliable forms of glucose, rapidly raise your blood sugar by eating a quick source of sugar such as table sugar, honey, or candy, or drink fruit juice or non-diet soda. Tell your doctor right away about the reaction and the use of this product. To help prevent low blood sugar, eat meals on a regular schedule, and do not skip meals. Check with your doctor or pharmacist to find out what you should do if you miss a meal.Symptoms of high blood sugar (hyperglycemia) include thirst, increased urination, confusion, drowsiness, flushing, rapid breathing, and fruity breath odor. If these symptoms occur, tell your doctor right away. Your dosage may need to be increased.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

PRECAUTIONS: See also Warning section.Before using dulaglutide, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, disease of the pancreas (pancreatitis), stomach/intestinal disorders (such as gastroparesis), a certain eye problem (diabetic retinopathy).You may experience blurred vision, dizziness, or drowsiness due to extremely low or high blood sugar. Do not drive, use machinery, or do any activity that requires alertness or clear vision until you are sure you can perform such activities safely.Limit alcohol while taking this medication because it can increase your risk of developing low blood sugar.It may be harder to control your blood sugar when your body is stressed (such as due to fever, infection, injury, or surgery). Consult your doctor because this may require a change in your treatment plan, medications, or blood sugar testing.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.Pregnancy may cause or worsen diabetes. Discuss a plan with your doctor for managing your blood sugar while pregnant. Your doctor may change your diabetes treatment during your pregnancy (such as diet and medications including insulin).It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Beta-blocker medications (such as metoprolol, propranolol, glaucoma eye drops such as timolol) may prevent the fast/pounding heartbeat you would usually feel when your blood sugar falls too low (hypoglycemia). Other symptoms of low blood sugar, such as dizziness, hunger, or sweating, are unaffected by these drugs.Many drugs can affect your blood sugar, making it harder to control. Before you start, stop, or change any medication, talk with your doctor or pharmacist about how the medication may affect your blood sugar. Check your blood sugar regularly as directed and share the results with your doctor. Tell your doctor right away if you have symptoms of high or low blood sugar. (See also Side Effects section.) Your doctor may need to adjust your diabetes medication, exercise program, or diet.

OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

NOTES: Do not share this medication with others.Attend a diabetes education program to learn more about how to manage your diabetes with medications, diet, exercise, and regular medical exams.Learn the symptoms of high and low blood sugar and how to treat low blood sugar. Check your blood sugar regularly as directed.Lab and/or medical tests (such as kidney function, fasting blood glucose, hemoglobin A1c, eye exams) should be done while you are using this medication. Keep all medical and lab appointments.

MISSED DOSE: If you miss a dose, use it as soon as you remember. If it is within 3 days of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.

STORAGE: Store in the refrigerator. Do not freeze. This medication may also be stored at room temperature but must be used within 2 weeks. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

Pharm. Class.
pancreatics

insulin degludec

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Pronunciation:
in-soo-lin deg-lu-dek

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  • Tresiba
  • Tresiba FlexTouch

Pharm. Class.
pancreatics

See insulins and insulin therapy for more information concerning insulins

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in-soo-lin deg-lu-dek

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  • Tresiba
  • Tresiba FlexTouch

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pancreatics

See insulins and insulin therapy for more information concerning insulins

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These are not all the possible side effects of BELBUCA. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. For more information go to dailymed.nlm.nih.gov.

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Help you and your doctor decide if BELBUCA is the right treatment option

Prepare you for starting your BELBUCA treatment with easy-to-understand guidance

Provide valuable tips to make sure you get the most from BELBUCA

APPROVED USE

*BELBUCA ® (buprenorphine buccal film) is:

A strong prescription pain medicine that contains an opioid (narcotic) that is used to manage pain severe enough to require daily, around-the-clock, long-term treatment with an opioid, when other pain treatments such as non-opioid pain medicines or immediate-release opioid medicines do not treat your pain well enough or you cannot tolerate them.

IMPORTANT SAFETY INFORMATION about BELBUCA ®

WARNING: ADDICTION, ABUSE, AND MISUSE; RISK EVALUATION AND MITIGATION STRATEGY (REMS); LIFE-THREATENING RESPIRATORY DEPRESSION; ACCIDENTAL EXPOSURE; NEONATAL OPIOID WITHDRAWAL SYNDROME; and RISKS FROM CONCOMITANT USE WITH BENZODIAZEPINES AND OTHER CNS DEPRESSANTS

See full prescribing information for complete boxed warning.

APPROVED USE

*BELBUCA ® (buprenorphine buccal film) is:

  • A strong prescription pain medicine that contains an opioid (narcotic) that is used to manage pain severe enough to require daily, around-the-clock, long-term treatment with an opioid, when other pain treatments such as non-opioid pain medicines or immediate-release opioid medicines do not treat your pain well enough or you cannot tolerate them.
  • A long-acting opioid pain medicine that can put you at risk for overdose and death. Even if you take your dose correctly as prescribed, you are at risk for opioid addiction, abuse, and misuse that can lead to death.
  • Not for use to treat pain that is not around-the-clock.

Important information about BELBUCA:

  • Get emergency help or call 911 right away if you take too much BELBUCA (overdose). When you first start taking BELBUCA, when your dose is changed, or if you take too much (overdose), serious or life-threatening breathing problems that can lead to death may occur. Talk to your healthcare provider about naloxone, a medicine for the emergency treatment of an opioid overdose.
  • Taking BELBUCA with other opioid medicines, benzodiazepines, alcohol, or other central nervous system depressants (including street drugs) can cause severe drowsiness, decreased awareness, breathing problems, coma, and death.
  • Never give anyone else your BELBUCA. They could die from taking it. Selling or giving away BELBUCA is against the law.
  • Store BELBUCA securely, out of sight and reach of children, and in a location not accessible by others, including visitors to the home.

Do not use BELBUCA if you have:

  • severe asthma, trouble breathing, or other lung problems.
  • a bowel blockage or have narrowing of the stomach or intestines.

Before taking BELBUCA, tell your healthcare provider if you have a history of:

  • head injury, seizures
  • heart rhythm problems (long QT syndrome)
  • liver, kidney, thyroid problems
  • pancreas or gallbladder problems
  • problems urinating
  • abuse of street or prescription drugs, alcohol addiction, opioid overdose, or mental health problems

IMPORTANT SAFETY INFORMATION about BELBUCA ®

WARNING: ADDICTION, ABUSE, AND MISUSE; RISK EVALUATION AND MITIGATION STRATEGY (REMS); LIFE-THREATENING RESPIRATORY DEPRESSION; ACCIDENTAL EXPOSURE; NEONATAL OPIOID WITHDRAWAL SYNDROME; and RISKS FROM CONCOMITANT USE WITH BENZODIAZEPINES AND OTHER CNS DEPRESSANTS

Addiction, Abuse, and Misuse

BELBUCA exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death. Assess each patient’s risk prior to prescribing BELBUCA, and monitor regularly for these behaviors and conditions.

Risk Evaluation and Mitigation Strategy (REMS)

  • complete a REMS-compliant education program,
  • counsel patients and/or their caregivers, with every prescription, on safe use, serious risks, storage, and disposal of these products,
  • emphasize to patients and their caregivers the importance of reading the Medication Guide every time it is provided by their pharmacist, and
  • consider other tools to improve patient, household, and community safety.

Life-Threatening Respiratory Depression

Serious, life-threatening, or fatal respiratory depression may occur with use of BELBUCA. Monitor for respiratory depression, especially during initiation of BELBUCA or following a dose increase. Misuse or abuse of BELBUCA by chewing, swallowing, snorting, or injecting buprenorphine extracted from the buccal film will result in the uncontrolled delivery of buprenorphine and poses a significant risk of overdose and death.

Accidental exposure to even one dose of BELBUCA, especially in children, can result in a fatal overdose of buprenorphine.

Neonatal Opioid Withdrawal Syndrome

Prolonged use of BELBUCA during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated. If prolonged opioid use is required in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available.

Risks from Concomitant Use with Benzodiazepines Or Other CNS Depressants

Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing for use in patients for whom alternative treatment options are inadequate; limit dosages and durations to the minimum required; and follow patients for signs and symptoms of respiratory depression and sedation.

Tell your healthcare provider if you are:

  • pregnant or planning to become pregnant. Prolonged use of BELBUCA during pregnancy can cause withdrawal symptoms in your newborn baby that could be life-threatening if not recognized and treated.
  • breastfeeding. Not recommended during treatment with BELBUCA. It may harm your baby.
  • Living in a household where there are small children or someone who has abused street or prescription drugs.
  • taking prescription or over-the-counter medicines, vitamins, or herbal supplements. Taking BELBUCA with certain other medicines can cause serious side effects and could lead to death.

When taking BELBUCA:

  • Do not change your dose. Apply BELBUCA exactly as prescribed by your healthcare provider. Use the lowest effective dose possible for the shortest time needed.
  • See the detailed Instructions for Use for information about how to apply BELBUCA.
  • Do not apply BELBUCA if the package seal is broken or the film is cut, damaged, or changed in any way.
  • After the film has adhered to your cheek, avoid eating or drinking until the film has completely dissolved, usually within 30 minutes.
  • Avoid touching or moving the buccal film with your tongue or fingers.
  • Do not chew, swallow, snort or inject BELBUCA. This will result in uncontrolled delivery of buprenorphine and may cause you to overdose and die.
  • Call your healthcare provider if the dose you are using does not control your pain.
  • Do not stop using BELBUCA without talking to your healthcare provider.
  • Dispose of expired, unwanted, or unused BELBUCA by removing the BELBUCA film from the foil packaging, and promptly flushing down the toilet (if a drug takeback option is not readily available). Visit www.fda.gov/drugdisposal for additional information on disposal of unused medicines.

While using BELBUCA DO NOT:

  • Drive or operate heavy machinery, until you know how BELBUCA affects you. BELBUCA can make you sleepy, dizzy, or lightheaded.
  • Drink alcohol or use prescription or over-the-counter medicines containing alcohol. Using products containing alcohol during treatment with BELBUCA may cause you to overdose and die.

The possible side effects of BELBUCA are:

  • nausea, constipation, headache, vomiting, dizziness, and sleepiness. Call your healthcare provider if you have any of these symptoms and they are severe.

Get emergency medical help if you have:

  • trouble breathing, shortness of breath, fast heartbeat, chest pain, swelling of your face, tongue or throat, extreme drowsiness, light-headedness when changing positions, feeling faint, agitation, high body temperature, trouble walking, stiff muscles, or mental changes such as confusion.

These are not all the possible side effects of BELBUCA. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. For more information go to dailymed.nlm.nih.gov.

Please see full Prescribing Information, including Boxed Warning, and Medication Guide, or speak to your healthcare provider if you have questions about BELBUCA.

A long-acting Insulin with a flat profile that lasts >24 hours. Basal is meant to meet fasting insulin needs. Normally, endogenous basal insulin from the pancreas and glucose from the liver are always being made and is required for living, whether the person is eating not. Therefore in relative insulin deficiency (type 2 diabetes) or with absolute insulin deficiency (type 1 diabetes), replacing basal insulin is essential.

A rapid acting insulin, which generally peaks within an hour and is mostly finished in 2-4 hours. The quick peak is meant to handle glucose absorbed at a meal. All type 1 patients and some patients with type 2 diabetes have lost the ability to mount an insulin response to a meal. These patients will require bolus insulin.

A BASAL-BOLUS Analogy

Suppose you have to travel three days across a desert. Where will the glucose come from to give you the energy needed to make it across the desert? Answer: You either eat it, make it, or break it down.

Blood glucose sources:

  • Food- Glucose is absorbed by the gut upon carbohydrate ingestion
  • Gluconeogenesis- Glucose production by the liver and kidneys.
  • Glycogenolysis- breakdown of the body’s glucose stores

Without food in the middle of the desert, energy must come from the liver or kidneys from either glucose breakdown or glucose production. This glucose fulfills fasting energy requirements. Insulin that utilizes fasting glucose is called BASAL insulin and without it, glucose will remain in the bloodstream.

Additionally, if in the middle of the desert if you find & eat a coconut, you will get a large BOLUS of glucose all at once. Your pancreas will need to BOLUS or give quick rapid acting insulin to match the rapidly absorbing glucose you’ve just ingested. This BOLUS insulin will allow the glucose from your food to enter your cells where it can be used, thus helping to maintain a normal blood glucose concentration.

You must think like a pancreas. When replacing insulin, you must give Basal and Bolus insulin like the body would have, if it could have.

This information was researched from web sites of various plans. It is subject to change and I cannot guarantee accuracy.

Diabetes Control Center

Up to 85% of people with “mild” Covid-19 (not requiring hospitalization) report long lasting symptoms affecting their lives in a recent study. Long haul Covid-19 was defined as symptoms lasting longer than 6 weeks. The study was reported in the Annals of Clinical and Translational Neurology.

The 10 most common complaints among study participants were:

Brain fog, 81%

Headache, 68%

Numbness or tingling, 60%

Loss of taste, 59%

Loss of smell, 55%

Muscle pain, 55%

Dizziness, 47%

Pain, 43%

Blurred vision, 30%

Tinnitus (ringing in the ears), 29%

In addition, many reported non-neurologic symptoms, including:

Fatigue, 85%

Depression or anxiety, 47%

Shortness of breath, 46%

Chest pain, 37%

Insomnia, 33%

Variation of heart rate and blood pressure, 30%

Gastrointestinal complaints, 29%

Our patients also report loss of balance and hallucinations. Not enough is known about this problem. One simply has to wait it out as of now, there is no specific treatment. Symptoms seem to improve with time. If these problems interfere with daily living, or are prolonged and debilitating, I suggest you check with your primary care provider.

Once a week Basal insulin?

Once a week basal insulin is not available yet but studies show promise that it is just as effective as once-daily insulin at a recent Endocrine Society meeting.

People with type 1 diabetes and some insulin-requiring type 2s (not using insulin pumps) require two types of insulin. A long acting insulin (basal), generally given once daily + a rapid insulin (bolus) given several times a day. Bolus insulin is generally given for food and/or to correct high blood sugar.

The new basal insulin being studied is currently called “basal insulin Fc (BIF)”. It will get a new name if it comes to market. BIF was compared to once daily Tresiba® (degludec) and had similar results. Looks like fewer shots on the horizon.

Semglee a cheaper Lantus-like insulin

$110.04 for a vial or $161.61 for 5 pens of a Lantus–like insulin, CASH. A new insulin, called Semglee is said to be very similar (biosimilar) to insulin glargine or Lantus–Basaglar. It has now been approved in the US by the FDA and is available in pharmacies.

Semglee is manufactured by Mylan and Biocon Biologics India Ltd. It has been available on Europe, Australia and other countries for some time. Semglee was studied by Dr. Thomas Blevins, MD of Texas Diabetes in Austin. The primary goal of his study (INSTRIDE 1 phase III) was to determine if once-daily Semglee (MYL-1501D) was non-inferior to once-daily insulin glargine (Lantus or Basaglar) when given in combination with mealtime insulin lispro (Humalog or Admelog). The average 52-wk A1c change for Semglee was 0.14% and 0.11% for glargine – very similar. The occurrence of low blood sugar and other side effects was similar for both insulins.

If one wishes to try this insulin instead of Lantus or Basaglar, remember it must NOT go through your insurance to get the price noted above (GoodRx). In addition, the manufacturer has applied to FDA for a “biosimilar” designation for Semglee. If this is granted, very likely, an insurance company or pharmacist may substitute a prescription for Lantus or Basaglar to Semglee.

FDA approves higher dose Trulicity

Taking the max available dose of Trulicity but still not at A1c goal? Trulicity is approved at 2 doses (0.75 and 1.5 mg) for treatment of type 2 diabetes, now the FDA approved doses of 3 and 4.5 mg. These higher doses seem to be more effective. But at what risk?

A study (357-OR from AWARD-11), published in the American Diabetes Association journal “Diabetes” showed better A1c response after 1 year (over 70% had A1c less than 7% at the highest dose) but also increased nausea, diarrhea and vomiting.

Caveat: patients in the study were previously treated only with Metformin, therefore, a 1 st exposure to Trulicity or any new drug is likely to have a greater effect. Someone now taking 1.5mg may not get as great an effect as someone never exposed to it. See results and side effects form study (https://diabetes.diabetesjournals.org/content/69/Supplement_1/357-OR)

Ultra fast insulin Lyumjev

Major insulin manufacturer, Eli Lilly announced the results of an ultra-rapid insulin trial at a recent American Diabetes Association meeting. Why is this important? Faster insulins are better. Why is faster better? Fewer highs, fewer lows and better A1c. “Many people taking mealtime insulin are not meeting their A1C goals while also experiencing high blood glucose levels after eating. This may create worry about their ability to achieve good control,” said Bruce Bode, MD, FACE, diabetes specialist at Atlanta Diabetes Associates. The new insulin is called Lyumjev (LOOM-jehv). In studies, Lyumjev was faster in and faster out than Fiasp and Humalog. Please see a short video on the subject.

Getting a Flu shot this year?

8/20/2020. The prospect of getting flu (up to 20%) and COVID-19 at the same time is scary. The CDC recommends getting a yearly flu vaccine before flu season starts, so early fall is prime time, but which flu shot should I get?

CDC recommends: “use of any licensed, age-appropriate influenza vaccine during the 2019-2020 influenza season, including inactivated influenza vaccine [IIV], recombinant influenza vaccine [RIV], or live attenuated influenza vaccine (LAIV). No preference is expressed for any influenza vaccine over another.” Not helpful. It seems to make sense to protect against 4 over 3 viruses, but is which is the one you will get?

Walgreens pharmacy advertises FREE flu shots, but the subtitle indicates “no cost to you with most insurance”. “Vaccines subject to availability. State-, age- and health- related restrictions may apply.” Other pharmacies e.g. CVS have similar programs.

Vaccine for younger folks. FLUMIST QUADRIVALENT is a vaccine sprayed into the nose to help protect against influenza. It can be used in people 2 through 49 years old. FLUMIST QUADRIVALENT may not prevent influenza in everyone who gets vaccinated. NOTE: not for older folks. Price about $25.

Vaccines for us older folks. Older folks do not have an immune system as strong as the young. Therefore, a higher dose flu shot is needed to produce protection. A clinical trial of more than 30,000 (over age 65) participants showed 24% fewer cases of influenza illness with the high-dose vaccine versus the standard dose. The overall effectiveness of flu vaccine indicates a greater than 60% reduction in flu illness in people over 65 yrs.

Fluzone High Dose contains 4 times as much flu virus antigen as regular flu shots. According to GoodRx the cash price varies from $45-$55 with GoodRx savings card. Average Medicare co-pay $57.00

FLUAD is a standard-dose, three-component (trivalent) inactivated flu vaccine, manufactured by Seqirus (Holly Springs, NC) containing a product to promote a better immune response (an adjuvant). FLUAD is approved for use among people 65 years and older, who often have a lower protective immune response after flu vaccination compared to younger, healthier people. Cash cost $70 -$110 per dose. Average Medicare co-Pay about $60.

5 myths about the flu vaccine (from WHO)

One shot and one co-pay instead of two

/> />There are two products currently on the market combining insulin and a Glp-1RA.

Glp-1 Receptor Agonists are agents used in type 2 diabetes to help control blood sugar. They work by mimicking the functions of a natural hormone that lowers blood sugar after eating. These functions include stimulating the release of insulin by the pancreas after eating, slowing stomach emptying time, decreasing appetite and are frequently associated with weight loss.

Glp-1 RAs come in both a short-acting and a long-acting form.

Long-acting GLP1 agents include Bydureon, Trulicity and Ozempic t hese can be given once-weekly. They can be used with insulin but not combined in one shot.

Short acting GLP1 products include Byetta, Adlyxin and Victoza. Adlyxin or Victoza are available combined with a long acting insulin.

If a person needs both insulin and a GLP1, combination products can be given as a once daily injection. These are Soliqua and Xultophy. The two active ingredients in Soliqua and Xultophy work to control fasting and post-meal glucose by regulating carbohydrate metabolism. Long acting insulin acts on the liver, skeletal muscle, and adipose tissue to reduce blood sugar.

Hand sanitizers

FDA found methanol some sanitizers, mostly made in Mexico by Eskbiochem SA de CV. Unfortunately, labels are only required to indicate the major ingredient is alcohol. It does not make a distinction between methanol alcohol and ethyl alcohol which is approved. Canada banned even more sanitizers because they contained industrial strength ethanol which may cause skin irritation. Methanol is an entirely different story because it can cause permanent damage and death.

FDA warnings apply specifically to the following:

All-Clean Hand Sanitizer (NDC: 74589-002-01)

Esk Biochem Hand Sanitizer (NDC: 74589-007-01)

CleanCare NoGerm Advanced Hand Sanitizer 75% Alcohol (NDC: 74589-008-04)

Lavar 70 Gel Hand Sanitizer (NDC: 74589-006-01)

The Good Gel Antibacterial Gel Hand Sanitizer (NDC: 74589-010-10)

CleanCare NoGerm Advanced Hand Sanitizer 80% Alcohol (NDC: 74589-005-03)

CleanCare NoGerm Advanced Hand Sanitizer 75% Alcohol (NDC: 74589-009-01)

CleanCare NoGerm Advanced Hand Sanitizer 80% Alcohol (NDC: 74589-003-01)

Saniderm Advanced Hand Sanitizer (NDC: 74589-001-01)

FDA tested samples of Lavar Gel and CleanCare No Germ. Lavar Gel contains 81 percent (v/v) methanol and no ethyl alcohol, and CleanCare No Germ contains 28 percent (v/v) methanol. Methanol is not an acceptable ingredient for hand sanitizers and should not be used due to its toxic effects.

Methanol can be absorbed through skin. It can also create devastating effects if inhaled or ingested. Significant methanol exposure can cause nausea, headache, vomiting, blurred vision, permanent blindness, seizures, coma and permanent damage to the nervous system or death.

A New Medicare Program to Limit Insulin Costs to $35/month.

I nsulin Cost-Saving Resource Guide for those NOT on Medicare or Medicaid from the Association of Diabetes Care and Education Specialists Click here

According to the New York Times, Medicare is instituting a pilot program to lower the cost of insulin to $35 per prescription for Medicare patients. The New York Times article indicated that insulin manufacturers must agree (rumor has it they have). People utilizing Medicare could save an average of $446 starting in January next year–2021.

Insulin and the Medicare Part D Senior Savings Model. Starting January 2001, some types of insulin may be available at a maximum $35 co-pay per month. According to The Association of Diabetes Care & Education Specialists (ADCES); Beginning January 1, 2021, Part D sponsors participating in the Model will offer plan choices that provide access to some insulins at a maximum $35/mo. copay through the Part D coverage gap.

My comment: why can’t government make things simple? As I read this, insurance companies offering Part D plans in 2021 MAY provide choices including the $35/mo. max co-pay. Does that mean one must choose a plan including the option during open enrollment (October 15, 2020 to December 7, 2020) in order to participate in 2021? Remember, insurance companies must produce profits else stock process fall and Wall Street slaps their hands. There is a chance some plans may offer the $35/mo. insulin option and exclude something else you may need like other high-end medicines. I think it’s a good idea to consider an insurance broker (not an agent) to walk through the many options. There are two main differences between insurance agents and brokers: Agents represent insurers, while brokers represent consumers. Agents can complete insurance sales, while brokers cannot.

Medicine increases the risk of COVID-19

Is there increased risk from coronavirus COVID-19 if being treated with biologics like Humira (adalimumab), Remicade (infliximab), and Rituxan (rituximab) or Enbrel (etanercept)?

The human immune system is extremely complex with a mission to seek out and kill invaders such as viruses, bacteria, fungus and parasites. This is a great thing, but an excessive immune response can cause an “autoimmune attack” resulting in type 1 diabetes, thyroid disease, asthma, psoriasis, rheumatoid arthritis, Crohn’s disease and others.

A relatively new class of drugs called biologicals reduce the immune response. These drugs are being used in several of the diseases listed above, especially rheumatoid arthritis and psoriasis. There are studies on the use of Biologics in type 1 diabetes, results have been disappointing so far.

Since all Biologics suppress the immune system, there is an increased risk of infection. The question therefore arises: Is there an increased risk of severe problems or death from coronaviruses like COVID-19 if taking these drugs? Click here for expanded list .

Non-biologic drugs that reduce immunity include corticosteroids (e.g. prednisone), methotrexate, antimalarial drugs, Mycophenolate, Azathioprine.

At this time there is no guidance from the Centers of Disease Control (CDC) or any other public health agency as to how patients taking biologic medications should respond to the coronavirus COVID-19.

One physician, Dr. Jeffery Sobell from www.skincarephysicians.net indicates “For patients who have been healthy on their biologic up to now with no obvious increase in infection rate, continuing therapy LIKELY WILL NOT increase their risk of contracting the virus. Furthermore, if an infection should occur, it is NOT LIKELY that their ability to fight the infection will be affected. But, of course, as with any significant infection, patients should hold future doses until they fully recover.” He further points out that if patients are concerned and would rather hold the biologic medication for now it is a reasonable option, however it is likely the disease (e.g. psoriasis) will recur within three to six months. Restarting the biologic after a long break may not be as effective as before.

Vitamin D and vitamin C

Is there anything you can do to boost your immune system?

Vitamin D has been shown to improve the immune system. Patients with autoimmune problems frequently have a low vitamin D level. According to the Mayo clinic, research indicates that getting enough vitamin D reduces the risk of bone thinning diseases such as osteoporosis. People with frequent falls, multiple sclerosis, rheumatoid arthritis, chronic pain, diabetes, high blood pressure, heart disease and some cancers are found to have low vitamin D levels. Did the low vitamin D cause a problem? No one knows. The Recommended Dietary Allowance for vitamin D is 600 international units per day. Up to 2000 IU is considered safe. Maintaining the RDA for vitamin D is a good idea. Will 2000 IU decrease chances of COVID-19 infection? Probably not, but its not likely to cause harm and maybe. . .

Vitamin C is said to contribute to immune defense by supporting various cellular functions of both the innate and adaptive immune system. Several claims of vitamin C benefits have been deemed unscientific.

Zycam (Zinc) nasal products have been reported to cause a complete loss of smell to the FDA.

Humira, Biologic

Remicade infliximab

Another weight-loss drug bites the dust.

The FDA requested withdrawal of Belviq, Belviq XR (lorcaserin) of this weight-loss drug from the U.S. market. A clinical study showed an 8.1% increase in cancer for patients taking Belviq versus placebo. Different cancer types were noted including pancreatic, colon and lung. We avoid use of weight-loss drugs because of an increased risk of side effects. A review at Diabetes Control Center indicates no patients taking Belviq. If you are ready to try a program without drugs, check our crazy diet.

Weight-loss medication

Approved for

How it works

Common side effects

Warnings

Orlistat NIH external link (Xenical)

Available in lower dose without prescription (Alli)

Adults and children ages 12 and older

Works in your gut to reduce the amount of fat your body absorbs from the food you eat

· leakage of oily stools

Rare cases of severe liver injury have been reported. Avoid taking with cyclosporine NIH external link. Take a multivitamin pill daily to make sure you get enough of certain vitamins that your body may not absorb from the food you eat.

Acts on the serotonin receptors in your brain. May help you feel full after eating smaller amounts of food.

Tell your doctor if you take antidepressants or migraine medications, since some of these can cause problems when taken together. May increase the risk of cancer based on early results from a clinical trial.

Available by injection only

May make you feel less hungry or full sooner. At a lower dose under a different name, Victoza, FDA-approved to treat type 2 diabetes.

May increase the chance of developing pancreatitis. Has been found to cause a rare type of thyroid tumor in animals.

This is a partial list take directly from NIDDK.gov. The full chart can be viewed at https://www.niddk.nih.gov/health-information/weight-management/prescription-medications-treat-overweight-obesity

Why is my medicine so expensive? What can I do about it? Jan. 7, 2020.

This is how it works; pharmacy benefit managers (PDMs) create formularies of “covered or preferred drugs”. To get on the covered formulary, drug manufacturers must give the PDM a discount (kickback). The pharmacy benefit managers then create a high deductible and a high copay, so the patient ends up with huge out of pocket expenses. PDM’s are discouraged from listing lower priced drugs on their formularies because there is less opportunity for a discount. Follow the $.

Everybody’s talks about the price of insulin but hardly anybody is doing anything about it. A bipartisan bill was introduced in July known as Insulin Price Reduction Act. It was endorsed by the American Diabetes Association and JDRF. The bill provides incentives for manufacturers to reduce the list price of all insulin products to their 2006 list price. Importantly, these lower-priced products would not be subject to deductibles or PDM rebates. It was read twice in the Senate and referred to the Finance Committee and hasn’t been heard from since. In December the House passed a bill that would require Medicare to negotiate the price of 50 to 250 prescription drugs they say would lower consumer drug spending by 55% and save the federal government nearly $400 billion. The FDA now fast tracks approval for generics. Generics have been approved for lispro (Humalog), aspart (Novolog) and dapagliflozin (Farxiga). Should be available soon.

What can you do?

Regular commercial insurance

Use manufacturer discount cards. Be sure to request these from your prescriber.

Shop pharmacy prices, they can vary quite a bit.

Request generics when available.

Consider cash price with discount card. NeedyMeds offers a drug discount card that provides a savings up to 80% on many medicines. The card is free and available to everyone. There is no registration and your entire family can use the same card. GoodRx offers multiple discounts with its prescription discount card including prescription coupons on a prescription-by-prescription basis. Get even deeper discounts for around $5.99 per month with GoodRx Gold. Freestyle Libre retails for $142 at CVS with GoodRx Gold $112.79.

I searched GoodRx for cash price of GENERIC Novolog (FDA approved): 5 Flexpens $123.9 Walgreens; $262.20 CVS; $258.98 Walmart.

Medicare Part D

Consider cash price with discount card. GoodRx has a coupon that can be used with Medicare if paying cash. Sometimes the discounted cash price is less than the copay. The pharmacist MUST not file the prescription with Medicare in this instance.

Gabapentin for nerve pain - safe or not?

Gabapentin is often the first line of treatment for diabetic neuropathy pain. It has been around since 1993, originally approved for the treatment of epilepsy. The FDA warns that serious life-threatening and fatal respiratory problems may occur from the drug, especially if used at the same time as opioids or antidepressant/anxiety medications. Gabapentin is not an opioid and is not a controlled substance but requires a prescription. The nonopioid feature makes it a good starting point for diabetic polyneuropathy and other nerve related pain. The main treatment for diabetic neuropathy, however is control of the diabetes. Gabapentin and Lyrica work by reducing the excitement of nerves, one of the mechanisms of pain. The problem is that it works anywhere there are nerves including the brain. The most common reported side effects are dizziness, somnolence and swelling of the legs and feet. Only 20% of patients reported improvement in a study of patients taking gabapentin for diabetic neuropathy.

Generally safe when compared to other pain medications and opioids.

Generic formation available, generally cheap.
CONS

Should be used very carefully in patients with chronic obstructive lung disease COPD and elderly patients.
Should not be used with central nervous system depressions e.g. opioids, anti-anxiety medications such as benzodiazepine drugs e.g. Xanax, Valium

Coronavirus

The coronavirus is coming. As of 1/26/2020, cases were positively identified in Washington, Illinois and California. This morning there is a report of a suspected case in North Carolina. There is no doubt, it will be here. There are 50 suspected cases still under investigation as of January 24, 2020.

Do you remember SARS (Severe acute respiratory syndrome)? SARS (SARS-CoV) is a coronavirus. The current virus, 2019-nCoV, also known as MARS-CoV, is a new coronavirus in the same class. Illness from 2019-nCoV was first detected in Wuhan, China. Several confirmed cases have been identified in the US with over 60 suspected ones still under investigation.

SYMPTOMS: Patients with confirmed infection had a mild respiratory illness much like a common cold. It progresses to fever, cough and shortness of breath. A good number of patients advanced to pneumonia with a high fatality rate.

TRANSMISSION: Coronal viruses spread primarily from mouth and lung droplets produced when an infected person coughs or sneezes. Influenza spreads in a similar manner. It can likely be passed by an infected person who coughs in the hand then shakes the hand of a susceptible person. The virus infects the second person when she/he scratches the nose or somehow gets infected material in the respiratory tract.

  • Wash hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer.
  • Avoid touching eyes, nose, and mouth with unwashed hands.
  • Avoid close contact with people who are sick.
  • Stay home when sick.
  • Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
  • Clean and disinfect frequently touched objects and surfaces.
  • Bump fists rather than shake hands (my idea).
  • Source CDC.

Tips to keep your sugar from going off the chain over the Holidays.

holiday food raises blood sugar

  1. Check sugar more often than usual, especially if driving or adjusting insulin or medication.
  2. Be party smart. At a party, try the vegetable-based appetizers 1st then carbohydrates and/or fat. Place your appetizers on a napkin instead of a plate, that limits the amount you can get at one time😊.
  3. Be careful with alcohol. Moderate alcohol can reduce your blood sugar, don’t drink on an empty stomach. A recommendation for alcohol intake with diabetes is “have no more than 1 drink per day for women and no more than 2 for men.” Generally, 1 drink equals 4 ounces of wine, 12 ounces of beer or 1 ounce of whiskey.
  4. Eat smart. You may not be able to control what food you’re served, and you’re going to see other people eating tempting treats. If you have a high carb treat, cut back on other carbs (like potatoes and bread) during the meal. If you slip up, get right back to healthy eating with your next meal.
  5. Be kind to yourself. Have fun. It’s okay to make mistakes, to forget things, and fall off track sometimes. It’s part of life and life isn’t perfect. Be gentle with yourself and remember that doing your best is all you can ask of yourself. The most important thing about this time of year is that you can enjoy the festivities and the company of your loved ones. Believe in yourself and show yourself the unconditional love, self-care, and nourishment you deserve! (CDC)

I hate shots

Do you just HATE shots? With type 2 diabetes there is something new.

The newly available drug is called Rybelsus. It is in a class called GLP1 receptor agonist. There are several of these available on the market for injection. Examples include Victoza, Bydureon, Trulicity and Ozempic. Rybelsus Is the first one to be taken by mouth.

Rybelsus must be taken once daily in the morning, at least 30 minutes before food or other medications and followed by a full glass of water. It has the same warnings as the injectable GLP1 products including the potential increased risk of thyroid c-cell tumors. People who have had medullary thyroid carcinoma (MTC) or who have a family member who has had MTC are advised not to use Rybelsus or any GLP1 product. There are also has warnings about pancreatitis (inflammation of the pancreas), diabetic retinopathy (damage to the eye’s retina), hypoglycemia (low blood sugar), acute kidney injury and hypersensitivity reactions.

Rybelsus may be slightly less effective than the injection GLP1 products. It comes in 3, 7 and 14 milligram sizes. It is recommended that a patient take the lower dose for a full month before advancing to in the higher doses.

Should I take Cinnamon to help my blood sugar?

One study shows that cinnamon reduces fasting blood glucose, but only by small amounts. Cinnamon in these studies reduced blood sugar by approximately 8.6 MG/DL with a range +/- 3 MG/DL. Therefore, taking cinnamon might reduce your morning fasting blood sugar by 11.6 or 5.6 MG/ DL. If morning sugar 220, at best to 208 or at worse to 214. Not much bang for the Buck$.

Another study from Pakistan showed that several grams of cinnamon per day could lower the fasting blood sugar as well as cholesterol and other fats but strangely enough there was no effect on A1C. In an analysis of several studies on cinnamon with either type 1 or type 2 diabetes did not show any significant changes in A1C, fasting blood sugar or blood fats in comparison to patients receiving placebo.

The bottom line is that cinnamon will not cause problems if one does not have severe liver disease but taking it is probably not worth the trouble.

We all would like something natural, cheap, without the need for prescription and easy to use to reduce blood sugar. However, nothing beats plain old diet and exercise☹

Genteel Lancet Device

If you just can’t stand the pain of picking your finger, this device may be for you. It can also check sugar on sites other than the fingertip. Remember blood from some alternate sites may give a result several minutes behind the actual blood sugar, especially if it is changing rapidly. The same is true for continuous glucose monitors such as the Dexcom and Abbott Freestyle Libre System. It uses regular lancets and creates a vacuum to draw blood when activated. Downsides: it is larger and heavier than of the devices. Cost is $129 but on sale for $99 on Amazon and eBay. It is not likely to be covered by insurance.

Genteel Lancet device

Medtronic pump "recalls".

Recall number one involves older Medtronic products including 508, 511, 512, 515, 522, 523, 712, 722, 723K, 712 the, 554 and 754. “The FDA has become aware that an unauthorized person (someone other than a patient, patient caregiver, or health care provider) could potentially connect wirelessly to a nearby MiniMed insulin pump with cybersecurity vulnerabilities. This person could change the pump’s settings to either over-deliver insulin to a patient, leading to low blood sugar (hypoglycemia), or stop insulin delivery, leading to high blood sugar and diabetic ketoacidosis.” This is more of a warning that pumps in this class have the potential for cyber security risk. According to the FDA “Patients with diabetes using these models should switch their insulin pump to models that are better equipped to protect against these potential risks.”

My understanding is these pumps are designed to communicate by radio waves. Therefore, a cyber attacker would need to be reasonably close to hack your pump. There is a good chance the hacker would need to have the serial number of your pump to hack.

Keep your insulin pump and the devices that are connected to your pump within your control at all times whenever possible.

Do not share your pump serial number.

  • Be attentive to pump notifications, alarms, and alerts.
  • Monitor your blood glucose levels closely and act appropriately.
  • Immediately cancel any unintended boluses.
  • Connect your Medtronic insulin pump to other Medtronic devices and software only.
  • Disconnect the USB device from your computer when you are not using it to download data from your pump.

Get medical help right away if you:

  • Have symptoms of severe hypoglycemia (such as excessive sweating, feeling very tired, dizzy and weak, being pale, and a sudden feeling of hunger).
  • Have symptoms of diabetic ketoacidosis (such as excessive thirst, frequent urination, nausea and vomiting, feeling very tired and weak, shortness of breath).
  • Think your insulin pump settings or insulin delivery changed unexpectedly.

The 600 series “recall” is a safety notification involving the 670G, 640G, 632 and 630G Medtronic insulin pumps. In this case, the keypad buttons may become unresponsive when atmospheric pressure goes up or down quickly such as takeoff and landing during air travel. A letter sent to patients indicates “If this happens, in most cases you may not even notice because the pump will resolve this on its own”. In case the problem occurs, buttons on the pump will become temporarily unresponsive. We believe that all patients with using insulin pumps should have backup insulin and pens or syringes when traveling.

In a related item, Medtronic has launched a clinical trial of the 780g advanced hybrid closed loop system. The system is designed to automate bolus deliveries based on “user experiences, or is predicted to experience” or prolonged high glucose levels based on sensor readings.

Another medicine hits the dust because of (probable) cancer causing contamination. This time it’s ranitidine (Zantac), designed to decrease stomach acid. The problem is the same contaminant (NDMA)) that caused recalls in several blood pressure medicines over the past couple of years.

This medication Is taken by millions of people to treat heartburn, GERD, ulcers etc. NDMA (N-Nitrosodimethylamine) has been found in many common products including cooked meats. It can be found in bacon. The FDA has stated it is reasonably safe to consume as much as 1 microgram of NDMA daily. According to Bloomberg, blood pressure pills were recalled for containing as much as 17 micrograms . One set of testing found as much as 3000 micrograms in Zantac pills and ranitidine generics.

What to do, stop taking Zantac or ranitidine. Contact your healthcare professional for a substitute if you need it. It is probably not a good idea to continually take these stomach acid tablets of any sort because they decrease the absorption of calcium which can lead to several problems.

Blood Pressure Medicine Recalls

2018 – 2019 seem to be the years of blood pressure medicine recalls. The “SARTAN” group were hardest hit. These are a group of medicines called angiotensin II receptor blockers (ARBs). Recalls include losartan, Irbesartan and valsartan. They are used for blood pressure control. Somewhere in the range of 70 – 75% of patients with diabetes also have high blood pressure. Most guidelines recommend either ACE inhibitors (all end in “pril” e.g. quinapril) or ARBs for kidney protection. A good number of diabetes patients are therefore likely taking an ARB.

New as of 6/12/2019:

  • Two lots of 50 mg strength losartan potassium tablets USP 50 mg. The tablets are green, film-coated, oval-shaped biconvex tablets with “LK 50” on one side and “>” on the other side.
  • Four lots losartan potassium tablets, USP 100 mg. The tablets are dark green, film-coated, oval-shaped biconvex tablets with “LK100” on one side and “>” on the other side.

So, what’s all the fuss about? Traces of NDMA (n-Nitrosodimethylamine) was found in the recalled drugs. It is classified as a probable human cancer-causing agent. It is associated with cancer in test animals. NDMA was used to make rocket fuel but was discontinued after unusually high levels were found in air, water, and soil samples near a rocket fuel manufacturing plant. NDMA is, however, unintentionally formed during various manufacturing processes. “The primary sources of human exposure to NDMA are tobacco smoke, chewing tobacco, diet (cured meats [particularly bacon], beer, fish, cheese, and other food items), toiletry and cosmetic products (for example, shampoos and cleansers), interior air of cars, and various other household goods, such as detergents and pesticides. In addition, NDMA can form in the stomach during digestion of alkylamine containing foods. Alkylamines are naturally occurring compounds which are found in some drugs and in a variety of foods.” This, according to the CDC.

And the beat goes on. February 28, 2019 recall of losartan. Camber Pharmaceuticals, Inc. is recalling 87 lots of Losartan Tablets USP 25 mg, 50 mg, and 100 mg. The U.S. Food and Drug Administration released a warning letter issued to Zhejiang Huahai Pharmaceutical Co. Ltd. (ZHP), in Linhai, Taizhou Zhejiang China. It is confusing because not all these products have been recalled, just some from certain manufacturers, frequently overseas.

What NOT to do is abruptly stop taking your medicines.

If you are taking losartan, valsartan or Irbesartan alone or in combination with other drugs such as hydrochlorothiazide or amlodipine there may be some risk.

  1. Check with your pharmacist to see if your prescription is in the recalled lot number. Your physician or NP is not likely to know.
  2. Request a change in medicine.

ARB drugs NOT YET involved with a recall (as far as I know) are:

Some “sartan” products a not recalled. FDA has a web site listing valsartan agents NOT recalled. See list.

Losartan recall. Sandoz Inc. is voluntarily recalling one lot of Losartan Potassium Hydrochlorothiazide Tablets, USP 100mg/25mg manufactured in Ljubljana, Slovenia. The recall is because of trace amounts of an impurity, N-nitrosodiethylamine (NDEA) that occurs naturally in certain foods, drinking water, air pollution, and industrial processes, and has been classified as a probable human carcinogen.

The product can be identified as Losartan Potassium Hydrochlorothiazide, 100 mg/25 mg tablets in 1000-count plastic bottles, NDC 0781-5207-10, Lot number JB8912; Exp. Date 06/2020. This product was distributed nationwide to distributors. The affected product was not distributed prior to October 8, 2018. RECOMMENDATION: If you have had a refill or new prescription for Losartan HCT in since October 8, 2018, check the lot number (JB8912) or call your pharmacist. Patients with questions regarding this recall can contact Sandoz Inc. at 1-800-525-8747 Monday-Friday 8:30 AM – 5:00 PM (EST) or email usdrugsafety.operations@novartis.com

Why you might need insulin several times a day? (click to read more)

Inhaled insulin

A different way to take insulin

Prescription drug prices diving you mad??

This information was researched from web sites of various plans. It is subject to change and I cannot guarantee accuracy.

Commercial Prescription Plan Deductibles

The most popular prescription plans in South Carolina are Blue Cross Blue Shield; South Carolina PEBA, Cigna and Express Scripts.

Deductibles for Blue Cross Blue Shield PEBA $490 individual and $980 family +$14 for physician office or video visit; $175 for emergency care; $105 for outpatient facility services.

Cigna. Deductibles for in-network and out-of-network providers: $2,000/individual or $4,000/family for out-of-network providers: $2,000/individual or $4,000/family Amount your employer contributes to your account: Up to $400/individual or $800/family.

How can I get help with out of pocket expenses with commercial insurance?

Tips for getting help with out of pocket expenses with commercial insurance.

  1. Ask your medical professional for discount cards.
  2. Shop around. Pharmacies have different prices Check with GoodRX,com for best prices in your area.
  3. Check with agencies that can help you with pharmaceutical company discounts. Download list here .

Medicare Part D Deductibles

Deductibles vary between Medicare drug plans. No Medicare drug plan may have a deductible more than $415 in 2019. Some Medicare drug plans don’t have a deductible.

How soon will the 2019 doughnut hole appear? Soon enough!

Initial Coverage Limit (ICL): $3,820

Out-of-Pocket Threshold (or TrOOP): $5,100

You’re in the doughnut after your total cost of medication (to the plan) reaches $3820.

You’re out of the donut hole once you have spent $5100.

TIP: Ask for cash price. Sometimes cash price is lower than Co-pay. If paying cash insist the pharmacy does NOT run it through your insurance. Medicare Part D is a voluntary program, my understanding is you can opt out for specific prescriptions at any time. If you pay cash, the retail cost of the drug doesn’t count toward the doughnut hole.

Check with Medicare.gov

How can I get help with out of pocket expenses with Medicare Part D? Download list here.

Diet soda linked to stroke.

An article published in the Journal Stroke (Feb.14, 2019) indicated an increased risk of stroke and heart disease in women having more than 2 diet drinks per day. Women using the diet drinks were twice as likely to have a stroke or heart problem. On the day the article was released Coca-Cola stock dropped 8.38% and Pepsi 1.34%. This may not be significant when compared to stock price swings. It will be interesting to see what happens over the next several days.

The risk of stroke in diabetics (type I or 2) is 1.5 times greater than a similar person without diabetes. It is not known if that is in addition to the risk from diet drinks. People with diabetes tend to use artificially sweetened products. According to the American Diabetes Association the risk of stroke is even greater if you:

  • Are older than 55 years.
  • Have a family background is African-American.
  • Have already had a stroke or TIA.
  • Have a family history of stroke.
  • Have heart disease.
  • Have high blood pressure.
  • You are overweight.
  • Have high cholesterol.
  • Are not physically active.

What’s in diet soda?

A 12 ounce can of diet Pepsi lists the following ingredients: carbonated water, Caramel coloring, phosphoric acid, potassium benzoate, sucralose, acesulfame potassium, caffeine, natural flavor and citric acid.

Note there are 2 sweeteners in this soda. Sucralose is 200 times as sweet as sugar and acesulfame potassium is 650 times sweeter. Some believe that use of highly sweet products dulls the senses to sweetening therefore making people crave sugary, high-calorie foods.

What to do? All things in moderation. A teaspoon of sugar contains about 5 g carbohydrate, a slice of bread contains about 15 g, 12 ounces of regular Pepsi 41 g. If you use 2 teaspoons of sugar in your coffee the effect on your blood sugar will be less than eating a piece of bread.

Glaucoma

Glaucoma. If you are older and or African American or have diabetes you are more likely to have glaucoma. The most common form, open-angle glaucoma, accounts for 19% of all blindness among African Americans compared to 6% in Caucasians. Glaucoma is often treated with eye drops. When you run out of your glaucoma medicine, you run the risk of increased eye pressure and damage your vision. If you’re in a bind and no drops come from the bottle, there are a few tricks for a short-term work around.

  • Store your “empty” eye drop bottle upside down (we use a wine glass). />
  • Place the bottles in the refrigerator.

Often, when you run out of regular drops, these upside-down stored bottles will yield one or two drops. Why the refrigerator? Chemicals breakdown at a lower rate when cold therefore remain effective longer.

Diabetes Pills Action and Side Effects

Medicine
Action
Side effects

Lowers glucose (sugar) released from the liver

Stomach problems, usually diarrhea.

Sulfonylureas. Glimepiride (Amaryl), glyburide (DiaBeta), glipizide (Glucotrol)

Stimulate the pancreas to release more insulin.

Low blood sugar. Long acting, if sugar is low and corrected it’s likely to go low again in several minutes. Promotes weight gain.

Meglitinides. Repaglinide (Prandin), nateglinide (Starlix)

Stimulate the pancreas to release more insulin.

Short acting, taken just before meals, less likely to cause low blood sugar. Promotes weight gain.

Thiazolidinediones TZDs. Pioglitazone (Actos).

Makes insulin work better. Increases carbohydrate uptake by muscle and fat.

Weight gain, swelling, fluid retention. Might make heart failure worse.

DPP-4s. Sitagliptin (Januvia); saxagliptin (Onglyza) linigliptin (Tradjenta)

Increases insulin level but only if blood sugar is elevated.

Rare. Stomach discomfort, diarrhea

Inhibitors. Acarbose (Precose);

Absorbs carbohydrate from the GI tract.

Gas, gas, gas. Rarely diarrhea, upset stomach, abdominal pain.

Bile acid sequestrants. Colesevelam (WelChol). Pills or powder.

Controversial. It may improve insulin action by decreasing free fatty acids from the liver. Lowers LDL cholesterol

Gas, diarrhea, constipation, rarely nausea. Interferes with other medications, must be taken several hours away from other pills.

SGLT2 inhibitors. Canagliflozin (Invokana); dapagliflozin (Farxiga); empagliflozin (Jardiance); ertugliflozin (Steglatro)

Blocks reabsorption of sugar in the kidney. This effectively pulls sugar from the blood and places it in urine.

Increased urination, genital yeast infection, urinary tract infections, ketoacidosis, dehydration. Rarely decreased kidney function; Necrotizing fasciitis*

Bromocriptine, (Cyloset) Rarely used.

Increases brain dopamine D2 and reduces sympathetic nerve action

Nausea, asthenia, constipation, dizziness, weakness.

*Recently the FDA issued a warning about necrotizing fasciitis of the perineum occurring in patients taking SGLT2 inhibitors. Necrotizing fasciitis, also called Fournier’s gangrene is an extremely rare but life-threatening bacterial infection of the tissues around the genitals. It generally occurs in males between ages 50 and 79 and is estimated to occur in a little over 3 patients per 100,000 taking this class of medication.

Metformin recall updated 1/9/2022

Where I stand on extended release metformin (ER).

Metformin ER is convenient but is it worth the risk? It has the advantage of reduced GI upset because it is slowly released in the gut. Immediate release metformin is active for about half a day therefore it must generally be taken twice daily. The manufacturing process of metformin ER involves enclosing the active product in a matrix that delays its release. The problem: the manufacturing process of the matrix traps substances like NDMA, a potential cancer-causing agent.

The good news is you can take ER 1 time daily. The unwelcome news 😢 is you may run a cancer risk. But how serious is the risk?

There is extraordinarily little research on this subject. I was not able to find a report of a single cancer caused NDMA in a drug, there are lawsuits. There are cases of death, not cancer, by caused by purposely poisoning with NDMA. A 1991 study of rats indicated a 25% increase in liver cancers after 2 years of adding NDMA to drinking water. A 2018 BMJ article noted: “Among Danish valsartan users, exposure to NDMA contaminated valsartan was not associated with a markedly increased risk of overall cancer (adjusted hazard ratio 1.09, 95% confidence interval 0.85 to 1.41) Future studies are, however, required to evaluate the risks for single cancer outcomes as well as long term effects.”

The FDA has not found NDMA in immediate release metformin. It has not been found in ALL batches of metformin ER; however, we continue to get recalls of the extended-release metformin because of this problem.

Gossip, lies, fake news and misconceptions about metformin.

All medicines have the potential for side effects. Any substance must change something in the body to have an effect. What is a good effect for some may be detrimental for others. One must weigh the potential benefits versus possible bad effects for any medication. Metformin, introduced in 1957, has stood the test of time. Since its introduction, several side effects have been observed. The most common complaint we hear about metformin is diarrhea or some other GI problem. Other listed side effects include physical weakness, gas, muscle pain, low blood sugar, abdominal pain, low levels of vitamin B12.

Fallacy #1: Metformin will kill your kidneys

Before 2006, patients with mild kidney problems such as />a creatinine of 1.5 were supposed to avoid metformin. This idea came from experience with the first drug in the class, phenformin (marketed as DBI by Ciba-Geigy). Phenformin caused lactic acidosis and bumped off a lot of folks before it was taken from the market. In the old days,

50% of folks with Lactic acidosis did not survive. Metformin is different. The newer recommendations state metformin can be taken until the patient has stage 4 or even stage 5 chronic kidney disease.

Fallacy #2: Metformin leads to dementia.

There conflicting studies on this issue. The Alzheimer’s Drug Discovery Foundation has studied the problem. They found 3 studies reporting a decreased risk of dementia in diabetic patients taking metformin. Another study looking at pooled information (meta – analysis) suggested a trend for reduced risk of dementia with metformin. Three other studies reported an increased risk for impaired intellectual performance compared to those taking other medication. Only one study reported that longer metformin use was associated with an increased risk of dementia.

The causes of intellectual decline are multiple. Diabetes associated with Alzheimer’s has been dubbed “type 3 diabetes”. Long-standing high blood sugar damages blood vessels. The brain does not function well if it doesn’t get an adequate blood supply. This results in something called “vascular dementia”.

Some studies suggest a relation between Alzheimer’s disease and the brain’s ability to get usable insulin. Several small studies show improved brain function with inhaled insulin.

Long-term use of metformin has been associated with low vitamin B12 levels

Fallacy #3 Metformin is bad for your heart.

This rose out of the earlier experience with phenformin which was associated with lactic acidosis and resulted in its removal from the market. The thinking was that decreased oxygenation and changed metabolism would increase the risk of lactic acidosis. Metformin is eliminated by a different mechanism than phenformin. Numerous studies have failed to find that metformin carries a high risk of lactic acidosis.