Types of diabetes pills in Malaysia

Many types of diabetes pills can help people with type 2 diabetes lower their blood glucose. Each class of pill helps lower blood glucose in a different way.

Each of the medicines discussed here has side effects as well as warnings and precautions. Some diabetes pills have been associated with increased risk of heart disease. It is important to discuss the risks and benefits of a drug with your doctor before starting any therapy.

1. Sulfonylureas

These pills do two things:

·         Help your pancreas make more insulin.

·         Help your body use the insulin it makes.

For these pills to work, your pancreas has to be able to make some insulin.

Some common sufonylureas are Gliclazide (DIAMICRON), Glibenclamide (DAONILl), Glimepiride (AMARYL).

Some sulfonylureas work all day, so you take them only once a day - usually before breakfast. Others you take twice a day, typically before breakfast and before supper. Your doctor will tell you how many times a day you should take your diabetes pill(s).

Some possible side effects include low blood glucose (hypoglycemia), upset stomach, skin rash or itching, and/or weight gain. 

For a complete list of side effects and precautions about these drugs, visit the National Institutes of Health website: http://www.nlm.nih.gov/medlineplus/druginformation.html.

2. Biguanides

Known under the generic name metformin (GLUCOPHAGE), this drug helps lower blood glucose by making sure your liver does not make too much glucose. Metformin also lowers the amount of insulin in your body.

Metformin can improve blood fat and cholesterol levels and does not cause blood glucose to get too low (hypoglycemia) when it is the only diabetes medicine you take.

Regular metformin is taken 2 to 3 times a day, with meals. Your doctor will tell you which meals to take it with.  There is an extended release version of metformin which is taken once a day.

Some possible side effects of metformin include nausea, diarrhea and other stomach symptoms, weakness or difficulty breathing, or a metallic taste in the mouth. People with kidney problems and people who drink more than 2-4 alcoholic drinks per week should not take metformin. If you are having surgery or any medical test involving dye, tell the doctor. You may be asked to stop taking metformin for a while. 

3. Alpha-glucosidase inhibitors

Known under the generic names acarbose (GLUCOBAY), these medicines block the enzymes that digest the starches you consume. This action causes a slower and lower rise of blood glucose through the day, but mainly right after meals.

Acarbose does not cause hypoglycemia when it is the only diabetes medicine you take.

You take these pills three times a day, with the first bite of each meal. Your doctor might ask you to take the medicine less often at first.

Possible side effects include stomach problems (gas, bloating, and diarrhea). These side effects often go away after you take the medicine for a while.

4. Thiazolidinediones

Sold under the generic names pioglitazone (ACTOS) & rosiglitazone (AVANDIA), these pills help make your cells more sensitive to insulin. The insulin can then move glucose from your blood into your cells for energy.

Pioglitazone is usually taken once a day, while rosiglitazone is taken either once or twice a day, with or without a meal. If taken as the only diabetes pill, they do not cause blood glucose to drop too low.

Possible side effects of pioglitazone or rosiglitazone include weight gain, anemia, and swelling in the legs or ankles. In addition,

1.  It is important for your doctor to check your liver enzyme levels regularly. Call your doctor right away if you have any signs of liver disease: nausea, vomiting, stomach pain, lack of appetite, tiredness, yellowing of the skin or whites of the eyes, or dark-colored urine. 
2.  If you take birth control pills, medicines in this group might make your birth control pills less effective, which increases your chances of getting pregnant.

5. Meglitinides

Known under the generic names nateglinide (STARLIX), this pill helps your pancreas make more insulin right after meals, which lowers blood glucose.

Repaglinide (NOVONORM) works fast and your body uses it quickly. Repaglinide lowers blood glucose the most one hour after you take it, and it is out of the bloodstream in three to four hours. This fast action means you can adjust the dosage according to the times you eat and the number of meals you eat more easily using repaglinide than other diabetes pills.

Repaglinide is taken from 30 mins before to just before you eat a meal. If you skip a meal, you should not take the dose of repaglinide.

Possible side effects include hypoglycemia and weight gain.

6. DPP-4 INHIBITORS and Metformin Combination (JANUMET/GALVUSMET)

DPP-4 Inhibitors and metformin are also combined into single pills. They are taken once or twice a day, with meals.

This combination pill may cause your blood glucose to drop too low and it is not suitable if you have kidney problems. If you need medical tests that require using dyes, or if you are having surgery, your doctor will tell you to stop taking this medicine for a short time. The pills should not be used by people who often drink alcoholic beverages.

7. DPP-4 Inhibitors

Sitagliptin (JANUVIA) is a once-a-day pill that helps to lower blood sugar in two ways:

1. Increases insulin when blood sugar is high, especially after you eat. This is when the body needs the most help in lowering blood sugar.
2. Reduces the amount of sugar made by your liver after you eat, when your body doesn't need it.

Sitagliptin can be taken alone, or in combination with other diabetes pills such as metformin, sulfonylureas, or a TZD.  Sitagliptin is also combined with metformin into a single pill, sold under the brand name Janumet^®.

When JANUVIA is used with a sulfonylurea, low blood sugar (hypoglycemia) can occur. To avoid this risk, your doctor may prescribe lower doses of the sulfonylurea.

Possible side effects include upper respiratory tract infection, stuffy or runny nose and sore throat, and headache.

Time to register your 5 year old kid for schooling (Malaysia)

Attention for those kids who born between 2-Jan-2011 to 1-Jan-2012 (who are 5 years old now), please take note of the following in order to register for entry to primary 1 in government school in year 2018:

Date: 1 March 2016 to 30 April 2016

Venue: School Office

Time: 

Mon to Thurs 8am-4.30pm (please take note 1-2pm is their lunch time)

Fri 8am-4.30pm (Lunch time 12.15pm-2.45pm)

Documents required: 

1. Fill the form online and printed out the online form @ http://public.moe.gov.my

2. Birth Cert (Original & photocopy 1 copy)

3. Proof of residential address (i.e. utility bills)

4. Photocopy of parents' IC

5. Parents' marriage certificate

6. Self-addressed envelope (4"x9") with 60 cents stamp.

NOTE:

Those children who born between 2 Jan 2012 to 15 Jan 2012 can register for earlier entry to primary 1 through Jabatan Pendidikan Negeri Selangor (or your respective state) from 1 Jun 2016 to 31 July 2016. Several documents have to be submitted including the student's results and a form is required to be filled up before they are selected to sit for an exam between Oct- Dec 2016. For the past few years, the passing rate for this early entry exam is 10%. Frankly speaking, it is not easy for a 5 year old. Those who passed the exam will receive an official letter sent by Jabatan Pendidikan Negeri and the students are not allowed to choose their desired school.

Sugar Content in Our Drinks!!

Think before you drink!!

I found this ALARMING message presented by a dentist in his clinic.

Look at it....
Pediasure for our babies --- 13 teaspoons of SUGAR!
Starbucks Frappucino --- 20 teaspoons of SUGAR!

No wonder so many Malaysians are OBESE and DIABETIC!

Tasty Korea Restaurant (NON-HALAL) @ Taman Connaught, Cheras

Taman Connaught is a paradise for food. Last night, we found a nice restaurant to taste the original Korean food here. Heard that this restaurant was founded by a native Korean, and the exotic dishes are prepared by chefs with more than eight years of experience and furthermore the meals are all served with traditional Korean utensils from sujeo or metal chopsticks and spoon to earthenware pots.

The internal of the Korean restaurant looks simple, tidy and neat.

After browsing through the menu, we decided to pick a few dishes within our budget of RM100.

These free side dishes come with every order. The peanuts ikan bilis was yummy!

Our drinks - Plum juice @ Rm5.90 and Honey Lemon Tea @ RM5.90. The Plum juice was nice, but the honey lemon tea tasted weird.

Korean Ginseng chicken soup set RM29.90.  The soup was served with strong ginseng smell, but the glutinous rice which was stuffed into the chicken made this dish became sticky. We didn't finish it, it did not suit our taste bud.

Kimchi Jjigae set RM14.90 came with rice. This soup made with kimchi, scallions, onions, diced tofu and small amount of pork. Thumbs up for this dish, it was spicy with good taste!

Samgyeopsal (Grilled pork belly) RM19.90. This is the MOST popular Korean dish. A MUST ORDER item in this restaurant, we noticed that all the customers ordered this. This dish consisted of thick, fatty slices of pork belly meat. The meat were neither marinated nor seasoned, and was grilled before serving to us. It was served with ssamjang (쌈장 a thick spicy soybean paste) and lettuce leaves to wrap it in.

Pajeon (Korean green onion seafood pancake) RM11.90 without rice, but a bowl of yummy sea kelp soup was given instead. It was a pancake made from a batter of eggs, wheat flour, rice flour, green onions,and squids. It tasted really nice, my kid loved it. But it was a bit too oily and the starch was a bit too much, it would tasted better by reducing the starch inside.

All the dishes in one glance. The Korean meal were full of bowls and plates which scattered all over our table. Our total bill was RM99.35 after the 10% service tax.

Overall, this restaurant served nice local Korean food. Their prices are standard, and the price listed in the menu has include the 6% GST. If you can get a good deal at Groupon, it is really worth for a try.

Where is this?

Tasty Korea Restaurant

No 6, Jalan Waras 1, Taman Connaught,

56000 Cheras,

Kuala Lumpur.

Opening hours: Tue - Sun: 11am - 3pm / 5pm - 9pm (including public holidays).

SOP in Retail Community Pharmacy (Malaysia)

STANDARD OPERATING PROCEDURE (SOP) in Retail Community pharmacy, Malaysia.

We can hardly find the standardized Standard Operating Procedures (SOP) in Malaysia for private sectors especially in the retail community pharmacy industry. Below is a sketch of what i think should be able to cover most of the essential parts in retail pharmacy set up.

Supply of Prescribed Medicines:

Upon receive of the prescription, check the following:

*Patient's details (verification).

*Prescription is legally valid.

*Dosage form.

*Route of administration is appropriate.

*Appropriate for patient's condition.

*Dosage within the therapeutic range.

*Drug interactions.

*Possible side-effects.

*Risk of adverse drug reactions.

*Contraindications.

Processing the Prescription:

·       Pharmacy staff may receive the prescription and assess the prescription first before passing it over for filling by other staff.

·       The pharmacist should be consulted immediately if there are any doubts or discrepancies.

·       Counter-checking procedure should be established so that the final checking of the prescription by a pharmacist would be conducted before dispensing the medicines to the patient/ customer by the pharmacist.

·       Procedures for intervention and problem solving should be specified, e.g. clarify details with prescriber or liaise with other health professionals or the patient.

·       All interventions should be recorded in appropriate forms/ records books or enter into the computer.

·       Information from various sources may enable the pharmacist to assess the prescription, e.g. information obtained from the patient or representative, the patient medication record (PMR).

Labeling of Dispensed Medicines:

·       Labels should be appropriately printed, if possible. If hand-written, it should be neat and legible.

·       Do not clutter the label. Include only the most relevant and important information such as:

1.      *Patient's name.

2.      *Name of medicine (generic name, plus trade name if possible).

3.      *Strength and quantity per unit dosage form (such as mg/ml for liquid, mg/g for semi-solid preparations).

4.      *Dosage form.

5.      *Direction for use: dose, frequency and duration.

6.      *Special precautions or cautionary labels.

7.      *Date of supply.

8.      *Name, address and contact number of the pharmacy.

9.      *The word 'controlled medicine' or 'ubat terkawal' should be used for all the dispensed medicines.

·       Check that the name of the medication matches the prescription.

·       Appropriate records should be made and kept for a minimum of 2 years or as required by legislations.

·       Health, hygiene and safety procedures are observed at all times.

·       Use of child resistant containers should be considered except for cardiac medicines and certain conditions.

·       Appropriate packaging: consider the stability of the medicines.

·       Include patient information leaflet, if appropriate.

·       Extemporaneous dispensing--refer to SOP on this service. 

Checking Procedures:

·       The final check should be done by a second person who is a pharmacist.

·       Self-checking is not recommended.

·       The medicines and label should be checked against the stock bottle and the prescription.

Transfer of Dispensed Medicines to the Patient:

·       Ensure that the completed prescription is received by the correct person--check via name and address and the number given when the prescription was received by the pharmacy staff.

·       Appropriate medication counseling should be provided verbally and in written form to the patient or the patient's representative.

·       Ensure that the recipient of the information understands the information/ instructions provided --eg obtain recipient's feedback.

·       Compliance aids, such as measuring spoons or syringes, should be provided for the appropriate dose required.

Documentation

·       Necessary documentation should be completed by pharmacy staff:

1.      *Enter the prescription details into Record book(s)/ computer.

2.      *Keep patient medication record (PMR), if possible using pharmacy information system.

·       Legal and professional requirements for record keeping and record management should be adhered to at all times --confidentiality and security of patient data should be considered.