THE GOOD AND THE BAD Keeping your carbs and insulin in balance 8 - The Healthy Living Magazine for Costco Members - Costco Pharmacy
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The Healthy Living Magazine for Costco Members
THE GOOD AND THE BAD
Keeping your carbs and insulin in balance 8
SPRING//SUMMER 2018
SPRING //SUMMER 2018
Distribution of this magazine has been funded in part by the following sponsors. This funding is independent
of the care you receive as a patient of Costco Pharmacy.
The Healthy Living Magazine for Costco Members
The Healthy Living Magazine for Costco Members
2 Feel good in your skin
Psoriasis: challenges and solutions
THE GOOD AND THE BAD
4 The sweet truth about sugar Keeping your carbs and insulin in balance 8
Navigating through different options SPRING//SUMMER 2018
6 A puzzling condition 178073-18_Wellness-Spring-Summer.indd 1 2018-01-10 3:03 PM
Shedding some light on fibromyalgia WELCOME READERS! With
warmer weather just around the
8 Carb counting corner, it’s the perfect time to get
An effective way to keep your blood sugar levels under control out of your old winter habits and
blossom into a healthier version
10 Staying healthy after 50 of yourself. As you plan for patio
Preventative measures that can help you stay healthy season and outdoor activities, set
aside some time to look through
12 Don’t sweat it the pages of this issue. Inside,
How to keep excessive sweating (hyperhidrosis) at bay
you will find a variety of health-
14 Medication non-adherence related articles with informative
The consequences of non-adherence and finding and useful content to keep you
practical solutions feeling healthy and at your best.
Costco Pharmacy
16 A common brain disorder called epilepsy If you’re one of the 3.5 million
Canadians living with diabetes,
Weighing the treatment options
read our cover story on page 8
to learn about carbohydrate
counting and how you can get
Prescriptions by mail* THE WELLNESS CONNECTION
Editor and Director of Professional Services,
We welcome your feedback on this magazine. Send an email
to magazine@costco.com.
Published semi-annually by Costco Wholesale Canada Ltd.
your blood sugars back on track.
Sticking to your medication
Costco Pharmacy (“Costco”) Copyright © 2018.
Joseph Hanna, B.Sc. Phm., CDE, CGP, RPh. All editorial rights reserved. All articles are medically reviewed and
schedule can be a challenge.
approved by McCann Pharmacy Initiative prior to publication. Our article on page 14 provides
Costco Pharmacy prescriptions by mail offers an easy and McCann Pharmacy Initiative
Writers – Vijay Sarma, Hons.B.Sc.Pharm/Toxicology,
McCann Pharmacy Initiative is solely responsible for everyday tips to help you
cost-effective way of ordering your prescription medications. the content of all articles and educational material unless
B.Sc. Phm., RPh. otherwise indicated. remember to take your medicines
Vanja Adzovic, PharmD, RPh.
Prescriptions and medication refills can be ordered online at
The information in this magazine is intended as an educational as prescribed. While planning
Reviewer – Sandra Carey, B.Sc. Phm., RPh. aid only, not as medical advice for individual conditions or
treatment. This information is not a substitute for a medical vacations are always a big part of
costcopharmacy.ca, 24 hours a day. Your order will be delivered to your Reviewer and Costco Professional exam, nor does it replace the need for services provided by the season, if you have fibro-
home via Canada Post Expedited Parcel™. Shipping is FREE and you will Services Pharmacist medical professionals. Talk to your doctor or pharmacist before
Nancy Bazzi, Pharm. D., RPh. , CDE taking any prescription or over-the-counter drugs (including myalgia, pain and muscle stiffness
receive your prescriptions in three to five business days. any herbal medicines or supplements), or following any
can get in the way. Read our
Copy Editor treatment or regimen. Only your doctor or pharmacist can
Caroline Szpak provide you with advice on what is safe and effective for you. article on page 6 to learn more
You should consult your health care professional if you are
Art Direction and Production Design making significant health-related changes. about this condition and about
To transfer, refill or submit a new prescription, visit Lee-Ann Hall and Allison Prindiville Neither Costco nor McCann Pharmacy Initiative is liable for preventing flare-ups so that you
costcopharmacy.ca and follow the simple instructions. Publishing Project Manager any claims or actions or damages that the reader may have
can enjoy the warmer weather.
through reliance on the magazine’s content respecting the
Julie Kinnear reader’s health.
* Delivery is available in all of Canada, except in the provinces of Quebec and PEI, Publishing Coordinator ®*Registered trademark of Price Costco International, Inc. We hope you enjoy reading our
and in the territories. Isabel Trottier-Levasseur used under license.
TM
Kirkland Signature is a trademark owned by Costco
magazine and wish you all a safe
TM
Expedited Parcel is a trademark of Canada Post Corporation. Production Specialist Wholesale Corporation and is used under licence in Canada. and happy summer.
Élaine Émond 178073-18
Cover/Contents photography: © RomarioIen
www.costcopharmacy.ca 1
© Ternavskaia Olga Alibec
known, having a blood-relative of each other. Some treatments usually recommended sun safety
with this condition may increase may also reduce an overactive tips such as covering up, wearing
your risk of having it.1,2 Certain immune system that may cause sunglasses, and avoiding indoor
triggers can also make psoriasis inflammation. Your doctor can tanning beds should be followed.5
worse. These triggers include determine which will be best for
skin injury, infection, stress, dry you based on the severity of your Living with psoriasis symptoms
or cold weather, and too much symptoms.1,3 can be challenging both physically
sunlight exposure.1,2 and emotionally. If you or a loved
Sometimes the chosen treatment
one is suffering with this condition,
How is it diagnosed may not be effective enough, so
speak to a dermatologist. Feeling
and treated? your doctor may adjust and change
the recommendations as needed. good in your own skin is just
In most cases, it will be enough With many options available, around the corner.
Feel good in your skin
for your doctor to ask about it’s possible to personalize the
your symptoms and examine the References
treatment to target your specific
plaques.3 In rare cases, a diagnosis symptoms. This may require 1. Canadian Dermatology Association. Psoriasis.
of psoriasis may require a skin combining two or more different
Retrieved from: dermatology.ca/public-patients/
skin/psoriasis/
biopsy (sample of your skin to be treatment options to ensure the
taken for further examination).3 best results possible.1
2. NIH. Questions and Answers about Psoriasis.
Mar 2017. Retrieved from: www.niams.nih.gov/
Since psoriasis is a chronic health_info/Psoriasis/default.asp
Sun safety is important in
Challenges and solutions for psoriasis sufferers condition, the main goal of
treatment is to reduce the
symptoms and prevent them from
psoriasis management
Though exposure to the sun can
3. Kim WB, Jerome D, Yeung J. Diagnosis and
management of psoriasis. Canadian Family
Physician. 2017;63 Retrieved from: www.ncbi.nlm.
nih.gov/pmc/articles/PMC5389757/
affecting your quality of life.3 help with psoriasis symptoms,
MORE THAN 1 MILLION What is psoriasis? While the plaques can vary in size The table below highlights the too much sun can worsen your
4. Ely JW, Seabury MS. The Generalized Rash: Part II.
Diagnostic Approach. American Family Physician.
Psoriasis is a chronic (long-lasting), and may appear anywhere on the treatment options available for symptoms, lead to skin damage, 2010;81(6) Retrieved from: www.aafp.org/
CANADIANS live with psoriasis.1 It non-contagious, inflammatory body, the elbows, knees, scalp, people suffering from psoriasis. early aging, and even skin afp/2010/0315/p735.html
skin condition.1,2 Normally, new chest, palms, feet and lower back They work by slowing down cancer.1,5 Plus, some psoriasis 5. Canadian Cancer Society. Being safe in the sun.
is a skin disease that can impact a skin cells “replace” the old ones at are the most common spots.1,2 skin cell turnover, so that new medications can make your skin Retrieved from: www.cancer.ca/en/prevention-and-
screening/live-well/sun-and-uv/being-safe-in-the-
a healthy pace. In psoriasis, new The plaques tend to appear skin cells don’t pile up on top more sensitive to sunburns. The sun/?region=on
person’s quality of life far beyond skin cells pile up on top of each symmetrically—in other words,
other too quickly and mix in with in the same place on the right
cosmetic and physical aspects.1 the older skin cells on the skin and left sides of the body.2 The
surface.2 This leads to thickening of symptoms often go through cycles Type of treatment Examples About
Psoriasis is one of many skin the skin and other uncomfortable where they worsen (flare up),
symptoms.1 and then improve.1,2 Depending Topical Corticosteroids, vitamin D and A products, Available in a variety of potencies/strengths and are
conditions and may be difficult on the severity of the condition, (applied on the skin) and coal tar products often used for mild to moderate symptoms.
While there are different types of psoriasis can also impact a person’s Available in the form of creams, lotions and ointments.
to tell apart from other rashes psoriasis, the most common one, emotional and social well-being, Lotions are ideal for hairy areas like the scalp. While
which affects 80% to 90% of those affecting relationships and ointments are greasy, they can help with very dry skin.
and itchy spots. Here is a quick diagnosed, is plaque psoriasis. self-image.3
It appears as thick, raised, red Some lower-strength steroids are available without
guide to help you recognize and patches with flaking silvery scales What are the causes and are a prescription.
and defined borders.1,2,3 These you at risk?
understand psoriasis, its symptoms patches, also called plaques, may
Psoriasis is considered to be an Internal medication Methotrexate, acitretin, cyclosporine, Available in the form of tablets, capsules
itch or feel sore and may also crack (works inside your body) adalimumab, infliximab and injections.
autoimmune disease. This is when
and the treatment options. and bleed.1,2
your immune system creates an Often reserved for more severe cases.
inflammatory response against These are prescription medications.
your own body and in this case,
Did you know against your skin.1,2 It affects people
of different races and genders, but
is more common among adults.2,3
Light therapy Narrow band UVB phototherapy: involves a UV light that
goes beyond the first layer of the skin
When guided by a dermatologist, sunlight exposure
seems to improve psoriasis symptoms by slowing
Psoriasis can be confused with eczema (atopic dermatitis) as both appear It commonly starts between the PUVA therapy: involves combining a drug called psoralen
down skin cell turnover.
similarly on the skin. In eczema, however, the lesions are not covered ages of 16 to 22, but may also and exposure to a UV light. Psoralen makes the skin more
with dead skin, hence the plaques do not appear silver or whitish as they appear in older adults.3 While sensitive to the UV light, thus making it more effective
may in psoriasis.1,2,4 Also, eczema can have a more intense itch. the exact cause of psoriasis is not
2 The Wellness Connection Spring // Summer 2018 www.costcopharmacy.ca 3
What is sugar? You may have heard the controversy about some
The sweet truth
Sugar is a carbohydrate that adds sweetness to foods artificial sweeteners causing cancers and other
and drinks. There are many different types of sugar, illnesses. However, researchers have been unable to
but as they break down in the body, they all become confirm these reports through clinical studies and
glucose, which is a source of energy. Making sugar Health Canada considers them generally safe.
is a process of extracting it from plants containing A sweet choice
about sugar
naturally high concentrations of it, such as sugarcane
or sugar beet. Sugar can also be made from palm, For the most part, added sugars are high in calories
coconut and other plants. Some sugars are processed while having no health benefits, so it’s best to reduce
for longer periods of time and all the minerals or avoid added sugars. Try making your own meals
and vitamins that naturally occur in the plant are and desserts and substitute sugar with fruit, sweet
removed. Such is the case with the white sugar cereal with oatmeal, and juices and pop with tea
(table sugar) that most of us are familiar with.2 Some and water whenever possible. Also, get in the habit
other examples of sugars are brown sugar, raw sugar, of reading nutrition labels and aim for foods that
honey, agave syrup and stevia. Most of these have are lower in sugar and
Nutrition Facts
higher in fibre.
Navigating through the options
approximately 15 to 20 calories per teaspoon. Stevia Per 90 g serving (2 slices)
is calorie-free. Note: Look at % Daily
Amount
Calories 170
% Daily Value
Sugars we consume can be divided into two categories: Value (DV) and keep in Fat 2.7 g 4%
Saturated 0.5 g 5%
mind that: + Trans 0 g
• Naturally occurring: in fruit, vegetables and dairy Cholesterol 0 g
• 5% DV or less of total
• Added: in desserts, candy and beverages Sodium 200 mg 8%
carbohydrate per Carbohydrate 36 g 13 %
Foods with naturally occurring sugars are often a serving is low Fibre 6 g 24 %
Sugars 3 g
part of a healthy diet because they also provide fibre, • 20% DV or more of Protein 8 g
IT’S HARD TO BELIEVE that the average vitamins and minerals. But we are often eating too
much additional sugar that is hidden in processed
total carbohydrate per
serving is high
Vitamin A
Vitamin C
Calcium
1%
0%
2%
products or added to our foods and drinks on a daily
Canadian consumes 40 kg of sugar per basis.3 These are usually refined sugars, such as white It’s easy to turn to a
delicious treat when
Iron 16 %
sugar and high-fructose corn syrup. Consuming it in
year, or approximately 26 teaspoons per excess can cause health problems.3 you’re having a sweet craving, but it shouldn’t take
the place of a nutritious healthy meal or snack. Take
What about artificial sweeteners?
day. This is double the recommended limit Artificial sugars (sugar substitutes) are chemically
control of your health and eat nutritious foods that
are low in added sugar whenever possible. Like
everything in life, moderation is key.
of 10% or less of calories obtained from produced and are usually hundreds of times sweeter
than regular sugar, but are essentially calorie- and References
carbohydrate-free, making them a popular choice for
sugar.1 Eating too much sugar can lead people with diabetes.3 1. CBC News. Lower sugar intake to less than 5% of daily calories, WHO says.
Mar 5, 2014. Retrieved from: www.cbc.ca/news/health/lower-sugar-intake-
to-less-than-5-of-daily-calories-who-says-1.2560639
to heart disease, stroke, obesity, diabetes Any dietary changes, such as switching to a new
sugar or sweetener, should be discussed with your 2. Canadian Sugar Institute. Cane Sugar Refining. Retrieved from: www.sugar.ca/
Nutrition-Information-Service/Educators-Students/Purification-of-Sugar.aspx
and cavities. While sugar is naturally dietitian, especially if you have a health condition
that’s impacted by sugar. For example, while
3. Eat Right Ontario. Kids, Sugar and Healthy Eating; What you need to know
about sugar. Oct 9, 2016. Retrieved from: www.eatrightontario.ca/en/Articles/
aspartame is suitable for people with diabetes, it can Childrens-Nutrition/Healthy-Eating-and-Healthy-Weights/Kids,-Sugar-and-
found in many foods, it’s often added cause serious health issues in people with a genetic
Healthy-Eating.aspx and www.sugar.ca/Nutrition-Information-Service/Educators-
Students/Purification-of-Sugar.aspx
condition known as phenylketonuria.4
to other foods as well. Here’s more
4. Dietitians of Canada. Sweet Advice on Sugar Substitutes. Mar 6, 2017.
Retrieved from: www.dietitians.ca/Your-Health/Nutrition-A-Z/Food-Safety/
Artificial-Sweeteners.aspx
on sugar and satisfying your sweet
© Valerii__Dex
tooth the right way! ACCEPTABLE DAILY INTAKE
OF ARTIFICIAL SWEETENERS
(mg/kg of body weight)
40 mg 9 mg 5 mg
4 The Wellness Connection Spring // Summer 2018 www.costcopharmacy.ca 5
© PachetoKZ
What can be done to feel better? By visiting a physiotherapist, people with fibromyalgia
can learn exercises that improve strength, flexibility
The main goals of fibromyalgia treatment are to and stamina.3 As it is challenging to eliminate the
reduce pain and improve function. Treatment pain associated with fibromyalgia, a good treatment
requires a joint effort involving your doctor, a plan helps to restore function through participation
physiotherapist, an occupational therapist, possibly a in activities that promote independence and lower
behavioural therapist and most importantly, yourself.4 stress.2 Counselling can go a long way to reduce
Other goals may relate specifically to your current the negative impact of fibromyalgia on health and
well-being.2 Behaviour therapy is sometimes used
It’s not all
health and to activities you may want to get back
to doing. to help reduce fear of pain and activity.2 Also, by
participating in self-help groups, fibromyalgia
Can medication help? sufferers may feel more comfortable sharing their
in your head
To help manage fibromyalgia, there are a number of experience with people who are in the same situation
medications that may help with pain, sleep and mood. and can listen and provide support.1
The table below provides a quick summary of some As you work towards feeling good again, a gradual
of the options that your doctor or pharmacist may exercise program is recommended with activities
discuss with you. suited to the your abilities and goals.2 Adjusting your
Shedding some light on fibromyalgia Medication options used to treat fibromyalgia pain:2, 3, 5 work environment can also help you avoid activities
that can trigger pain. An occupational therapist is a
© jalcaraz
good partner to provide guidance on making specific
Type of Medication Examples Comments
changes so you can perform tasks with less stress on
Antidepressants Amitriptyline Recommended as first your body.3 People sometimes turn to alternative
ARE YOU HAVING TROUBLE sleeping because of muscle pain? Are you Duloxetine
choice for people who
suffer from fibromyalgia
therapies such as yoga, meditation, acupuncture and
massage therapy.3 Although there are many people
feeling tired for no apparent reason? You may have a chronic condition called and depression or anxiety.
Also improves sleep.
who seek out these alternative methods for their
symptoms, they may not be as effective as the other
options mentioned above.2
fibromyalgia.1 It affects between 2% to 3% of Canadians,2 the majority of Muscle relaxants Cyclobenzaprine Promotes sleep.
Fortunately, fibromyalgia is now recognized as a
whom are women between the ages of 20 to 50. However, men, teenagers and Anti-epilepsy drugs Gabapentin May also help with sleep,
since drowsiness is a
medical condition that can severely impact a person’s
quality of life. With a variety of options available
children can also be affected.1 Pregabalin
potential side effect. for fibromyalgia symptoms, talking to your health
care provider can help you narrow down suitable
Although pain relievers such as acetaminophen treatments. While fibromyalgia can be challenging to
At times, people who have fibromyalgia are made from fibromyalgia may also have difficulty sleeping understand and the treatments complicated, living a
to feel that their symptoms are “all in their head.”3 or focusing on mental tasks.3 The symptoms can vary (Tylenol®) and ibuprofen (Advil®) may be suggested
healthy, productive life is within your reach.
Although it is typical for a person to occasionally from one person to another, even changing on an for treatment of fibromyalgia pain, they may not
have pain and/or fatigue, when these symptoms hourly or daily basis. Because pain and fatigue are be effective. It is important to understand that References
occur more frequently without an apparent reason symptoms that are common to many other conditions, depending on your medical history and risk factors, 1. Canadian Women’s Health Network. Fibromyalgia. 2012 Retrieved from:
www.cwhn.ca/node/40784
and affect a person’s quality of life, they should be diagnosing fibromyalgia can be a challenge. A physical some of these options may not be the best options.2
investigated. For some people, these symptoms can exam and lab tests are often done to rule out other Consult with your Costco pharmacist about the most 2. Fitzcharles, M.A., et al., 2012 Canadian Guidelines for the diagnosis and
management of fibromyalgia syndrome: executive summary. Pain Res Manag,
also take an emotional toll, leading to anxiety suitable treatment for you. 2013. 18(3): p. 119-26
conditions first.2 Other tests for fibromyalgia may
and depression.1 include a tender point exam to determine the number Can a physiotherapist or counselling 3. The Mayo Clinic. Fibromyalgia. 2017 Retrieved from: www.mayoclinic.org/
diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780
The good news is that fibromyalgia is manageable. of tender points on 18 specific spots on the body and
a questionnaire on symptoms and how they affect the
help me cope? 4. National Institute of Arthritis and Musculoskeletal and Skin Diseases.
There are ways to help manage the pain and keep up Fibromyalgia. 2014 Retrieved from: www.niams.nih.gov/health-topics/
person’s ability to function daily.3 While a variety of medication options are available,
with routine activities such as work, housekeeping, fibromyalgia#tab-overview
childcare or hobbies.1 living well with fibromyalgia often involves a
? Did you know
5. Canadian Pharmacists Association, L. Arman, et al.,CTC 2017. 2017, Ottawa, Canada:
What causes it? combination of medication and lifestyle changes. Canadian Pharmacists Association. p. 1094-1106
What are the symptoms and how can it In some people, fibromyalgia often develops with
be diagnosed? no apparent cause. In others, it may appear after a
People with fibromyalgia have a general feeling of pain traumatic experience such as an accident, stress or
all over their body and a lack of energy. They tend to hormonal changes.1 Even the experts do not fully
describe their pain as a dull ache on both sides of the understand the exact cause of fibromyalgia. Research Coping with pain from fibromyalgia is difficult, but it can be managed. By consulting
body, as well as above and below the waist, usually is being done to answer some of the puzzling with health experts who specialize in pain treatments (e.g., in pain clinics), you can
lasting for at least three months.3 People who suffer questions around this condition. learn ways to cope with sudden pain flare-ups and improve your quality of life.
6 The Wellness Connection Spring // Summer 2018 www.costcopharmacy.ca 7
COVER STORY COUNTING CARBS 3,4
STEP 1 Meal planning the insulin that’s used to cover a
© arigato
carbohydrate meal or snack. Since
© Prostock-studio
The first step to carb counting is sensitivity to insulin depends
creating a healthy and balanced on a number of factors, insulin
30 g meal plan that gives you more to carb ratios often vary from
information on how much carb,
person to person. For example,
protein and fat to eat each day.
people with type 1 diabetes who
+
A registered dietitian can guide
2 slices of bread are very sensitive to insulin may
you through this process and set
(15 g per slice) only require one unit of insulin to
carbohydrate goals in grams for
each meal and snack. In general, cover 20 grams of carbs (ratio of
0g the percentage of total daily 1:20), whereas others who are less
S
sensitive to insulin, such as those
T E
energy from carbs should be
Y DR A with type 2 diabetes or those who
CARBOH TE
between 45% and 60% based on
a 2,000-calorie-a-day diet. This are overweight, may have ratios
Turkey breast
+ represents an intake of about 225 of 1:5.
A
(no carbohydrates)
OV E - H to 300 g of carbs daily. You can Your doctor or diabetes expert can
AL
also check out the “Beyond the estimate this ratio best based on
SHIP
Basics” tool on the Diabetes Canada
N
RELATIO
your daily insulin requirements
0.5 g website (diabetes.ca) to learn more and other factors.
rbs
about meal planning and learning
yo u r c a to create one on your own.
Keeping n in balance
Going back to the previous example,
i
1 slice of cheese + 2 Carb counting if your insulin to carb ratio is 1:10,
and insul
STEP for a 64 gram carb meal, you will
Next, you will need to count need about six units of mealtime
3.5 g insulin (64 g /10 g = 6.4 units) to
the amount of carbs in the foods
you consume at each meal and cover the carbs in the meal. Keep
snack. You can often get the carb in mind that your ratio may change
THERE ARE MORE THAN 3.5 MILLION Canadians living with diabetes, People with diabetes may be
content of a food from reading the with weight loss or gain, and any
+
prescribed insulin to help manage
and this number is estimated to increase to 5 million by 2025.1 Having their blood sugar. This is typical in ½ of a tomato Nutrition Facts Table on the label. changes in fitness level.
© PhotoHouse, O.Bellini, Sergiy Kuzmin, bokissphoto, Mr. Nakorn, Yanas, SoleilC, DBtale
type 1 diabetes (where no insulin For foods without a label, such
diabetes may make daily meal planning more challenging, especially is produced by the pancreas), but as fruits and vegetables, you can Although counting carbs allows for
0g get this information by using an greater flexibility in your diet, it
if you are using insulin. Fortunately, there is an effective way to help may also apply to some people
online carb tracker tool or a food doesn’t mean that you can abandon
with type 2 diabetes (where some a healthy lifestyle and eat as many
keep your blood sugar levels under control and find a perfect balance insulin is still produced). The two
composition book. In general,
carbohydrates as you like. With the
+
grains and starches, fruits and
between the carbohydrates you consume and your insulin dose. general categories of insulin that are Lettuce milk and alternatives have about right balance of carbs and insulin,
often prescribed are called basal (negligible amount of carbs) 15 grams of carbs in one serving carb counting can help you obtain
Carbohydrate (carb) counting is a flexible and effective way to plan your and bolus insulin.2 Basal insulin healthy, stable blood sugar levels
while most meat and alternatives,
meals to keep your diabetes under control. It focuses on counting the works slowly and for a longer time and minimize your risks for future
15 g 15 g vegetables and fats have little to no
amount of carbs you consume in a meal or snack and matching that to to keep blood glucose levels in the carbs. To accurately count carbs complications.
your insulin dose so that your blood sugars stay in balance. While it “normal” range between meals based on portion size, consider
may seem confusing at the beginning, once you get the hang of it, it and overnight, while bolus insulin using measuring tools such as a References
can lead to better diabetes management, and you’ll find it easier to fit a works quickly to even out blood
wider variety of foods into your diet.2 In this article, we will look at carb sugar soon after meals.2
counting in more detail and explain how you can incorporate it into
17 g of carbs
minus 2 g of fibre*
+ food scale or measuring cups.
Let’s say you’re planning on
1. Diabetes Canada. Diabetes statistics in Canada.
Retrieved from: www.diabetes.ca/how-you-can-
help/advocate/why-federal-leadership-is-essential/
diabetes-statistics-in-canada
Carbs are found in many foods, (PER COOKIE) consuming a turkey sandwich and
your daily diabetes treatment plan. 2. Diabetes UK. Carb Count: An introduction to
such as fruits, vegetables, grains two cookies for lunch. In the left carbohydrate counting and insulin dose adjustment.
The role of carbs and insulin in diabetes and dairy, and are an important side bar is an example of counting 2011. Retrieved from: www.imperialendo.co.uk/
carb2012.pdf
Diabetes is a condition in which your body does not properly control the part of a balanced diet. When you the total carb content for this meal.
3 Insulin to carb ratio
3. Yale University. Diabetes: Carbohydrate Food List.
amount of sugar in the blood, often resulting in blood sugars that are too eat carbs, your digestive system Retrieved from: www.diabetes.yale.edu/
high. It is caused by not having enough, or not responding to insulin to breaks them down into sugar. STEP diabetes101/Nutrition/Carbohydrate%20Food%20
List_120799_284_15002_v1.pdf
64 g
meet the needs of your body. Insulin is a hormone that acts as a “key” Since carbohydrates have the This tells you how many grams
that allows the blood sugar to enter the cells of the body where it can be greatest effect on your blood sugar of carbs will be covered by 4. Canadian Diabetes Association. Beyond the Basics:
Basic carbohydrate counting for diabetes management.
used as energy or stored for future use. If not managed properly, diabetes level, carb counting allows for one unit of mealtime insulin. Sep 2008. Retrieved from: www.diabetes.ca/CDA/
can, over time, affect your quality of life and possibly lead to heart, flexibility with meal planning and Only mealtime, bolus insulin media/documents/clinical-practice-and-education/
professional-resources/carbohydrate-counting-
kidney, eye, blood vessel and nerve damage.2 improving blood sugar control. Total net carbs is considered because this is resource-english.pdf
sandwich and 2 cookies
8 The Wellness Connection Spring // Summer 2018 *Note: Since dietary fibre does not raise blood glucose, it’s subtracted from the total carbohydrate content. 9
Healthy
and fight specific bacteria and Regular screening
Screening test
© pixelheadphoto digitalskillet, PPVector
viruses if you encounter them in
While a healthy diet and regular
the future.5 While some vaccines
exercise can help keep you healthy, recommendations
provide lifelong protection, others
require booster shots to maintain regular visits to your doctor and
AGING
immunity. They can help to screening tests can help detect FOR HIGH BLOOD PRESSURE
protect you from getting sick and current medical conditions, and Blood pressure reading: at each
spreading the infection to those assess your risk of future disease. appointment and at home
around you.5 According to the College of FOR HIGH CHOLESTEROL
Family Physicians of Canada, Blood tests:
In your 50s, your immune system Cholesterol levels are generally measured
can get weaker, and diseases such this list outlines some common
screening tests recommended in men and women over 40, and measured
as the flu can make you more sick again every 1 to 5 years, depending on
than before.5 You may be at a for healthy men and women
risk factors
higher risk for:5 aged 50 and over.4 Depending
on your risks and if you have a FOR DIABETES (high blood sugars)
• Herpes zoster (shingles): caused chronic condition, your doctor Blood tests:
Learning more by reactivation of the Varicella
zoster virus (the chickenpox
may recommend earlier or more
frequent testing, or a different test
Fasting blood sugar and/or A1C
measurements (3-month average of your
virus); can result in painful skin
about your health
blood sugars); the frequency depends on
rashes and blisters, usually on one not listed here. your health status and risk for diabetes
side of the body
after 50
Your health needs may change as FOR OSTEOPOROSIS
• Influenza (flu): caused by the you move through each decade of Bone density scan: a type of x-ray to
influenza A or B virus; can result life, but knowing this as you enter determine the density of the bones and
in fever, chills and muscle pain your 50s can empower you to potential for fractures. It’s recommended
• Diphtheria: caused by take the necessary steps to staying for all men and women 65 years of age
YOU MAY HAVE HEARD the phrase “With age • Vitamin D: key in maintaining healthy levels of
Corynebacterium diphtheriae
bacteria; can result in trouble
healthy. Maintaining a healthy and older and may be recommended
in younger individuals with risk factors
lifestyle and getting regular
comes wisdom.” When it relates to your body, calcium and phosphorous in the blood. Involved in swallowing and nerve damage
checkups will help you embrace
for fractures
strengthening bones, as it also helps with calcium
however, older age may also mean your risk for absorption1
• Tetanus (lockjaw): caused by
Clostridium tetani bacteria; can
your 50s and keep you strong, FOR COLON CANCER
some diseases are increased. But getting older active, and at your best. Fecal immunochemical testing (FIT)
While it is recommended to get your calcium from result in jaw stiffness, painful
or a fecal occult blood test (FOBT):
doesn’t automatically mean poorer health.1 The food sources, this may not always be possible, and muscle spasms and even death References detects blood in your stool sample, and is
a supplement may be required. The recommended The good news is that shingles, recommended every 2 years
following is a guide outlining some important amount of “usable” or “elemental” calcium (through the flu, diphtheria and tetanus are
1. American Association of Retired Persons. AAARP
Health. Retrieved from: www.aarp.org/health/
screening tests and preventative measures that can food and supplements) for those over 50 is 1000 mg vaccine-preventable diseases.2 FOR BREAST CANCER
to 1200 mg per day (approximately 3 to 4 glasses of 2. Seniors and Aging – Osteoporosis. Accessed from:
Mammogram: uses x-ray to see signs of
help adults over 50 stay healthy and maintain the cow’s milk).3 • The shingles vaccine can be www.canada.ca/en/health-canada/services/
healthy-living/your-health/diseases/seniors-aging- breast cancer, and is recommended every
given to adults starting at age 50, 2 years
life they want. Your body makes vitamin D from sunlight, but especially in those with a history
osteoporosis.html
3. Osteoporosis Canada. Retrieved from:
Age-appropriate vitamins and minerals Canada has short summers and long winters, during of herpes zoster disease.2 www.osteoporosis.ca/
FOR CERVICAL CANCER
the course of which you may not be producing • The flu shot is recommended Pap smear: uses a sample taken from the
Your bones are continuously undergoing breakdown 4. The College of Family Physicians of Canada.
cervix to screen for cancer. Recommended
enough of this sunshine vitamin.2 Since the need every fall for those 6 months of Preventative Care Checklist Forms. Retrieved from:
and renewal, which is a natural process in maintaining for vitamin D increases after 50, and it is often www.cfpc.ca/ProjectAssets/Templates/Resource. every 3 years. Screening may no longer be
healthy bones. As we get older, this process changes age and older.2
difficult to get enough vitamin D from food alone, a aspx?id=1184 needed after age 70
such that the building of bone slows down and the • A combination tetanus
supplement is suggested.3 5. Health Canada: Vaccination for Adults, accessed
breakdown continues; this imbalance results in and diphtheria booster is from: www.canada.ca/en/public-health/services/
FOR BENIGN PROSTATIC HYPERTROPHY
increased bone loss.2 In post-menopausal women, To meet your vitamin D needs, Osteoporosis Canada recommended every 10 years.2 vaccination-adults.html (BPH)
recommends supplementing with 1000 IU/day, in Digital rectal exam (DRE): is generally
?
this can be worsened by lower levels of estrogen,
which would normally have helped with calcium addition to eating vitamin-D-rich foods such as cow’s recommended in men over 50 and who
milk, salmon and egg yolk.3 show signs of an enlarged prostate
absorption.1 Loss of bone density can cause
osteoporosis, where bones become weak and more
prone to fractures.2 Vitamins and minerals required
to keep your bones strong include:
How does my ability to fight disease change
in my 50s? Did you know
Pharmacists are able to administer flu shots and the shingles
FOR PROSTATE CANCER
PSA test: simple blood test in which
higher levels of PSA may indicate a prostate
Your immune system is responsible for protection condition or cancer (only recommended
• Calcium: a mineral with many important roles, against bacteria and viruses that can cause disease.5 vaccine, among several other vaccines, when they dispense your for men 40 and over with a higher risk,
including building strong bones and teeth (also Vaccines contain dead or weakened germs that vaccine prescription, saving you a trip back to the doctor’s office. including family history)
involved in heart function)1 when taken, help your immune system recognize See your Costco pharmacist for more information.
10 The Wellness Connection Spring // Summer 2018 www.costcopharmacy.ca 11
no sweat
odour.4 Higher-strength antiperspirants (e.g., Drysol)
© hobitnjak
can be tried next if sweating is still an issue.
• Physical or surgical treatments: Through a process
Using antiperspirants4 called iontophoresis, reduction of sweat may be
achieved by the delivery of low-level electric current
to the hands and feet. Although it’s a generally
safe procedure, it’s not recommended for pregnant
• A single application is most effective women or those with a pacemaker. Surgical options
if used prior to bedtime (may depend are also available but are usually reserved for people
How to keep
on the product) who have failed the options above.5
If excessive sweating is getting in the way of
ting
excessive swea
• Apply to dry skin only your day-to-day activities, talk to your doctor or
to avoid irritation pharmacist. They can help you find answers and get
is) at bay
you back to the life you want.
(hype r hi dros
• For a sweaty face,
References
consider applying 1. International Hyperhidrosis Society. Know sweat. What is hyperhidrosis? Retrieved
along your hairline from: www.sweathelp.org/home/types-of-hyperhidrosis.html#
2. Canadian Dermatology Association. Hyperhidrosis. 2017 Retrieved from:
• For sweaty feet, dermatology.ca/public-patients/skin/hyperhidrosis/
aerosol products are 3. National Health Services UK. Hyperhidrosis. June 1, 2015 Retrieved from: www.nhs.
uk/conditions/excessive-sweating-hyperhidrosis/
particularly useful 4. International Hyperhidrosis Society. Tips for Best Results-OTC. Retrieved from:
SWEATING IS A NATURAL PROCESS that cools our body and
www.sweathelp.org/hyperhidrosis-treatments/antiperspirants/tips-for-best-
results-otc.html
Why do people get
hyperhidrosis and how prevents us from overheating.1 However, excessive sweating, 5. Mayo Clinic. Hyperhidrosis Causes. Aug 8, 2015 Retrieved from: www.mayoclinic.
org/diseases-conditions/hyperhidrosis/basics/definition/con-20030728
does it affect them? also known as hyperhidrosis, is a condition in which the body
People may sweat too much sweats more than necessary to regulate body temperatures. It
Costco
©Monkey Business Images
without any particular reason.
It may also happen because is a common condition affecting about 950,000 Canadians.2
of certain medical conditions If you think you’re suffering from this condition, there are
(e.g., infection, diabetes),
ways to identify and manage it.
Pharmacy
medications (e.g., some
antidepressants), or even hot
flashes in menopausal women.
It can involve the underarms, • Sweating more than normal • Lifestyle changes: Bathe
at least once a week for no regularly with soap and water
palms, feet and face. Your doctor
apparent reason
or pharmacist may be able to help
you figure out what is causing • Excessive sweating is interfering
and wear light fabrics (e.g.,
cotton) that are breathable and Order your prescriptions by phone
your excess sweating. with your daily activities, won’t trap sweat. Wear socks and
including your job and social life shoes made of natural materials. Call 24 hours a day, seven days a week and pick up
Sweating more than normal, Rotate shoes regularly, change your prescriptions at your convenience.
whatever the cause, can get in the What can I do if I have socks often and air your feet as
way of daily activities and may hyperhidrosis? much as possible. Consider the
also be embarrassing. Those who People often do not recognize use of underarm liners or shoe IT’S EASY!
suffer from hyperhidrosis may excessive sweating as a condition inserts to absorb sweat. Limit Have your prescription bottle(s) ready
keep to themselves, and spend that can be treated. In fact, more spicy foods, alcohol and hot
a lot of time dealing with their than half of people who have drinks (e.g., tea and coffee) since Dial the Costco Pharmacy telephone number printed on the label
sweat by frequent showering and hyperhidrosis don’t seek advice they can trigger sweating. Follow the instructions carefully to place your order
changing their clothes. on their condition from a health
care professional.2 The good • Medications: Non-prescription Wait to hear when your prescription will be ready for pickup
While it is difficult to tell what a news is that treatment options (over-the-counter) antiperspirants and simply hang up when you are done
normal amount of sweat is, if you are available that can help control are often recommended first.
find yourself experiencing the excessive sweating.3 Your doctor Antiperspirants have ingredients
following situations, you may be or pharmacist can provide advice to help stop sweat, whereas Visit costcopharmacy.ca to learn more.
suffering from hyperhidrosis:3 on the following treatments: deodorants mainly help with
12 The Wellness Connection Spring // Summer 2018 www.costcopharmacy.ca 13
DRUGS DON’T WORK FOR PEOPLE
WHO DON’T TAKE THEM
Understanding medication non-adherence and finding practical solutions
To make it easier to take your
medications, try Costco Pharmacy’s
prescriptions by mail service.
Your new prescriptions and refills
can be ordered online, 24/7
through the Costco Pharmacy
Things to remember:
• Bathroom cabinets are not a
good place to store medication
due to temperature and humidity
changes. Keep your medications
Medication can help you get healthy
and stay healthy—but it won’t help
if you don’t take it! Choosing to
stay on track with your medication
treatment is an important
at www.costcopharmacy.ca. in a cool dry place, away from commitment that will help ensure
Simply create an online account children and animals. you are in charge of your own
Non-adherence is a complex health issue. The first step to finding a and request to have your • Some medications, like insulin and health and well-being.
APPROXIMATELY 50% OF
solution is stopping the “blame game” and realizing the importance of prescriptions transferred. If you’re liquid antibiotics, require special
PEOPLE with a chronic
regular, open communication with the health professionals you trust. visiting your doctor’s office, ask storage, such as refrigeration References
disease may not be taking Once you make a list of what is “getting in the way” him or her to fax in any new (for example, between 2 °C and 1. Mary De Vera, PhD for BC Medical Journal.
their medication regularly or as of taking your medication as prescribed, you can prescriptions to the mail-order 8 °C). Most insulins are only How do you solve a problem like medication
start searching for solutions to overcome these pharmacy. Once your order non-adherence? Retrieved from: www.bcmj.org/
prescribed.1 Non-adherence, stable for 28 to 30 days at room blog/how-do-you-solve-problem-medication-
challenges and improve your health. wis received, it will be shipped
or not taking your medication securely (at no additional cost) temperature (15 °C and 25 °C). non-adherence
as advised by a medical Talk to your pharmacist to your home in three to • Return unused, expired or 2. British Columbia Pharmacy Association (BCPhA).
Your pharmacist can play a vital role in five business days. damaged medication to your Clinical Service Proposal. Medication Adherence
professional, can result in the Services. Retrieved from: 72.4.147.202/uploads/
the success of your treatment. Pharmacists local pharmacy for proper
worsening of a disease, health
can offer, at no charge to you, a thorough
How to store medication disposal. Do not throw your
Medication_Adherence.pdf
3. U.S. Food & Drug Administration. Why You
complications, lower quality of medication review to help you get the Proper storage of medication is just as medication in the garbage or Need to Take Your Medications as Prescribed or
life, significant expenses and most benefit from your prescription important as taking your medication flush them down the toilet Instructed. Retrieved from: www.fda.gov/drugs/
and non-prescription medications. as prescribed. A medication that is as they can be harmful to the resourcesforyou/specialfeatures/ucm485545.htm
even death.2 While there are
Call your local Costco pharmacy to not stored correctly may not work environment. 4. Ontario Pharmacists Association. Tips for
many barriers to adherence, well.4 Read the label carefully and
set an appointment for a one-on-one proper storage of medications. Retrieved from:
there are helpful techniques and appointment with your pharmacist store your medication as instructed. www.opatoday.com/medication-storage-tips
tools that can help you stay on to discuss the medications that
track when it comes to taking you take and any medication-
related issues you may have.
your prescription and non- Understanding your medications
prescription medication. is the first step to taking
them correctly. Ask as many
Tips that can help you stay adherent
questions as you can during Here are a few helpful techniques and tools you can use to follow your treatment plan:3
your appointment or when
filling your prescription at the 1. T ry to take your medication at the B) Ask your Costco pharmacy to organize your 5. W
hen travelling, bring enough
Reasons for medication pharmacy to understand the same time each day medicines in a blister pack. medication to last the entire trip
non-adherence following: Link taking your medication with a daily routine Pack your medication in your carry-on bag,
Failing to take your medication as These are a monthly supply of your
such as placing your medication next to an item in case of lost luggage.
prescribed and not following the • Medication name and dose medicines, conveniently organized to remind
you use every day (e.g., your alarm clock or
advice of your prescriber may be • What the medication does you when to take each dose. Each package Keep your medicines in their original, labelled
cell phone).
due to many factors, including:2 • Proper way to take the has seven rows for each day of the week, pharmacy containers with a complete
medication (how and when) 2. Keep a medicine calendar and note with different time slots throughout the day medication review list from your pharmacy to
• Forgetfulness
• Warnings, precautions, side each time you take your dose for breakfast, lunch, dinner and bedtime avoid delays through security checkpoints.
• Major life changes or Get your refill a few days before you run out. doses. It helps you keep track of when to take
effects and what to do
financial limitations 6. D ownload and use an app
about them Ask your pharmacist about synchronizing your your medicines; you can easily see if a dose
• Reading level or language barrier to remind you
• What you should avoid refills so that you have fewer visits to make to has been taken.
• Complex treatment and/or There are many free applications available on
• When to see your doctor the pharmacy.
misunderstanding the illness 4. U se the same pharmacy your phone to help you track your medications.
or pharmacist 3. Organize your medicines in a pill box whenever possible Try MyMedSchedule®, MyMeds®
(e.g., stopping the medication
when symptoms go away) A) Weekly or monthly pill boxes can help Using one pharmacy will ensure that your and RxmindMe.
• Fear of side effects or not believing keep your medications together in dosing information is in one place. The pharmacist will
the medication will work compartments for time of day and/or day of be better able to manage your medications for
• Other health issues (including the week; it can be refilled on the same day your safety.
mental health or behavioural of the week or month.
problems) © Metropolis Marc Fowler
© ayarx oren © Grant Collier
14 The Wellness Connection Spring // Summer 2018 www.costcopharmacy.ca 15
Preventing Most medications for epilepsy need to be taken at least
twice a day and, in some cases, up to four times a day.2
and managing
Pharmacists can be valuable resources to help manage
a person’s epilepsy medication and to offer possible
solutions that make it easier to remember to take the
© vasara
the unexpected
medication as prescribed. If drugs are not successful,
surgery, a special diet, or other therapies may be tried.5
With many options available to treat epilepsy, a
neurologist is often needed to find the most suitable
treatment.5 The more knowledge one has about the
condition, the less intimidating treatment becomes.1
Revealing the mysteries of epilepsy © Lisa S.
For more information and advice on how to manage
epilepsy, speak to a Costco pharmacist and visit
Preventing injury due to seizures Epilepsy Canada at epilepsy.ca.
If someone you know is having a seizure, gently roll the person References
EPILEPSY is a seizure disorder that affects people of all ages, nations and races.1 In fact, one in every on one side and put something soft under their head.
1. Epilepsy Toronto. Epilepsy 101. Accessed October 3, 2017. Retrieved from:
100 Canadians has epilepsy.1 It can affect quality of life, including a person’s ability to work and drive.2 epilepsytoronto.org/about-epilepsy/learn-about-epilepsy/epilepsy-101
DO NOT:3 2. Schulze-Bonhage, A. Kuhn, A. Unpredictability of Seizures and the Burden of
The good news is that epilepsy is treatable and many people can achieve good control of their seizures
✘
Epilepsy. 2008.
Try to force something into the mouth of someone having a
3. Epilepsy Canada. Myths and Misconceptions about Epilepsy. Accessed October 4,
seizure. This can chip the person’s teeth or even break their jaw.
with medication. 2017. www.epilepsy.ca/myths--misconceptions.html
✘ Restrain someone having a seizure. The seizure will run its course 4. Epilepsy Ontario. What is Epilepsy? Accessed October 26, 2017. Retrieved from:
epilepsyontario.org/about-epilepsy/what-is-epilepsy
and you cannot stop it.
What is epilepsy? Epilepsy most often starts in child- person, but there are several 5. Goldenberg, M. M. (2010). Overview of Drugs Used For Epilepsy and Seizures:
Etiology, Diagnosis, and Treatment. Pharmacy and Therapeutics, 35(7), 392–415.
The brain is made up of billions hood or in seniors, but anyone options available.
of cells called neurons that can develop it at any time. In most
cases, the cause is unknown.1 A Most people with epilepsy take
control our thoughts, feelings medication every day over a
person needs to experience two
and movements by sending period of years.2 Medication
or more seizures in order to be
electrical messages to each other. will not cure epilepsy, but it can ®
diagnosed with epilepsy.
Normally, the neurons pass these help control or even eliminate
electrical messages in an ordered Epilepsy impacts each person seizures.2 Two out of three people
way. However, with epilepsy, differently. Depending on the with epilepsy will get control of
the neurons send many messages severity of the seizures, it can their seizures with medication.4 ®
all at once and in a disorganized lead to:
pattern, which can overwhelm There are over 10 medication
the brain and lead to a seizure.1 • Physical injury: Because seizures options currently available to treat
Depending on where the seizure occur at random times, people epilepsy. Some of these can treat
with epilepsy are at risk of falling many different types of seizures,
occurs in the brain, symptoms
down and injuring themselves.2 while other medications treat only
can include:
• Mood problems: The unpredictability one specific type.
• Unusual behavior (blank stares, of seizures may result in anxiety
grunting) or movement (jerking or depression.2
of the arms and legs) • Low self-image: The stigma
1 100
• Loss of consciousness associated with seizures can lower
• Sudden mood changes an individual’s confidence and
• Drooling or frothing at
the mouth
self-esteem.2
Treating epilepsy
in
There are different types of
seizures. Most last less than a few
The goal of epilepsy treatment is
to stop the seizures with as few
Canadians
minutes and some symptoms are
obvious while others are subtle.
side effects as possible. Epilepsy
control varies from person to
has epilepsy.
16 The Wellness Connection Spring // Summer 2018 www.costcopharmacy.ca 17SAVING DOESN’T HAVE
TO MEAN COMPROMISING
At APOTEX, we don’t just look out for the DID YOU KNOW?
well-being of Canadians. We look out for Generic medications include the same:
their financial health too. That’s why, for
40 years, we’ve ensured all Canadians have active ingredients
access to quality, affordable medicines. efficacy
Ask your pharmacist if there’s a quality
generic equivalent available for manufacturing standards
your prescription needs.
but at a much lower cost than the brand name.
www.apotex.comYou can also read
