ALWAYS read the PDS
I'm quite open about my health in public. I'm also a bit of a "helicopter pilot*" when it comes to my cycling, too. So, when I saw my cadiologist last week for an annual followup since my poofer went futt back in 2020, a new doc every year (I'm public, not private), I made sure Doc knew the back story, the front story, the story behind the story and the cover story.
I told Doc that my diabetes had been formally retyped, that my "endo" had officially determined that my 2005 type 2 diagnosis was wrong, I'm a type 1. Probably late onset, but things about my childhood and youth health... you know... Maybe I'm latent Type 1, maybe I was a sort of slow burn juvee Type 1. Anyway, Doc acknowledged it, "Ah yes, late onset." I told Doc I've used a bicycle for transport all my life, was a big advocate for cycling for environmental, urban and personal health and that was acknowledged with an enthusiastic, "Very good." Then Doc prescibes [brand name], adding to the ever-growing list of ways to make "Big Pharma" richer by impoverishing poor people**, a Type 2 diabetes med that's often used for A) where Metformin is contraindicated (allergy, etc) and sometimes used with heart failure (my heart problem, possibly genetic, nobody will say one way or t'other), sometimes for both.
So, I picked up my usual first fortnight in the month phamaceutical supplies yesterday, including the new one and, the pharmacist, one of a 3 way team who REALLY look after me, and Pharmy hands me 4 A4 pages of PDS printout with it and says, "You really need to stay hydrated with this one, and watch out for ketoacidosis."
"Hey, I'm a cyclist, you know, we hydrate or we die," I say.
"Oh, there's an increased risk of hypos with exercise, too," I notice it's like there's something Pharmy actually wants to say but feels he needs to keep a professional boundary between his field and cardiology...
By the time I'd walked home (I don't drive, ever if I can humanly avoid it!), I'd forgotten the slightly different demeanour I'm used to at my fave druggery, and I went about the rest of my day. Took last night's meds and went to bed. This morning I got up and thought, "Ah, the PDS..." and read it.
Here's the standout, "[drug name], the active substance in [brand name], can cause a serious side effect called ketoacidosis. This has happened to patients with and without diabetes mellitus who were taking [brand name].” There's some stuff about exercise being a minor contraindication (due to dehydration) and some rare cases of perotonital gangrene... DA FAQ! S'ok, they're very rare, generally very old, very unwell people.
OK, lets roll back to ketoacidosis. <--This, right here is deadly to we of a Type 1 persuasion. If we Type 1s get this, we go straight to A&E, we do not pass go, we do not collect $200! We're allowed to call an ambulance for this shit!!! And according to the USFDA***, this SERIOUSLY precludes the use of [brand name] by Type 1 diabetis and people with renal failure. Thankfully, I don't yet look like developing renal failure, but it's a future risk of diabetes, too, so yeah, great... Things to look forward to, such fun.
Hey Doc, were you paying attention? I ride a bike, equals dehydration and hypoglycemia risk in Australia. I'm a Type 1 diabetic, yeah, late onset, but TYPE. ONE. M'kay? I have one of those cool things on the back of my upper arm that continuously monitors my blood sugar and screams at me (via the phone app) when my bgls go into the keto zone or into the instant-starve-to-death zone. Go to hospital, in the latter case, go directly to Hospital, do not pass Go, do not collect $200! I can't have one of those miracles of modern science and engineering if I'm a Type 2, they still have to finger prick - it's the law! (Well, it may not actually be the law, but if you're not subsidised, Libre2 costs hundreds, and it's only subsidised in "Oz" for Type 1s.)
So, there you have it. Always read the PDA, seriously. Read. Every. Word. Having a little chat with my GP and endocrinologist before I take a single, solitary [brand name] pill. After that, if the pill is still "contraindicated", I might be having words with Doc, too.
*How do you know there's a helicopter pilot next to you? They'll tell you.
**S'all good, I don't mind a good med or two if they keep me alive, I really am happy to take 'em all if I get to live.
***Australia's slight more chill about this, weirdly warning rather than prohibiting. [rubs goateed chin, says hmmm.]