Taking Some Control Of Chronic Health Conditions

Posted on Wed., September 23, 2009
By Stephen Daniels, MD

MANY PATIENTS CAN LEARN to make changes in the dosage of some of their medicines by themselves at home with guidelines from their doctor, especially when treating their chronic, ongoing medical conditions such as high blood pressure, diabetes and high cholesterol.

For example, most people with diabetes try to keep their blood glucose (sugar) levels between approximately 80 and 120; and always below 150.

Since most diabetics can test their blood sugar at home, they can often gradually increase or decrease their medicine doses, or add additional medicines prescribed by their doctor, to adjust their blood glucose to the ideal range.

With diabetes, low blood sugar (e.g. 30) can kill you in minutes, while high blood sugar (e.g., 200-400) will usually take years to harm you.

So, it's important to lower blood sugars gradually, usually over a few weeks or months, by slowly increasing doses and/or adding medicines. And, when changing medicine dose or adding medicines, it's important to check the sugar at least three to four times a day to be sure the sugar is not dropping too low.

Treating high blood pressure (hypertension) is similar. Blood pressure should usually be kept below 140/90, sometimes even lower.

Doctors generally start a patient on one medicine, usually a diuretic (e.g. hydrochlorothiazide or HCTZ) or an ACE inhibitor (e.g., lisinopril), at a low dose.

Then the doctor will gradually increase the dose until the maximum safe or effective dose is reached, or side effects develop. If necessary, the doctor will add a second, third or fourth medicine.

Patients can often make these changes at home, using detailed guidelines from their doctor.

Similar to diabetes, taking too much blood pressure medicine can cause the blood pressure to fall too low. So, it's important to gradually increase the dose or add medicines, and to check the blood pressure a few times before and after any changes.

Work carefully with your doctor, either by phone or the Internet, since some medicines work quickly, while others take weeks or even months to reach maximum effectiveness. In these cases, take care to not increase the dose too quickly.

Be sure your home blood sugar-testing machine and blood pressure machine are accurate. To ensure this, bring the instruments to your doctor's office, and check your glucometer when the lab is drawing your blood, or your blood pressure machine when the doctor's assistant is checking your blood pressure.

Treating high cholesterol is similar. In most cases, an LDL (low density lipoprotein) cholesterol below 100 is optimal, though 70 or below is recommended for diabetics.

Generally, the doctor will initially prescribe a low dose of medicine, then gradually increase the dose until the LDL reaches the appropriate level, or dangerous or intolerable side effects develop.

So, every six to eight weeks the patient can have their cholesterol (and blood, to monitor for side effects) checked and, when appropriate, gradually increase the dose under the doctor's Internet or telephone guidance.

Always ask your doctor for his or her advice before changing or adding any medicine. And, when in doubt, bring your medicines when you meet with your doctor in person.

Daniels practices family medicine at the Concord, Pittsburg and Martinez Health Centers of Contra Costa Health Services.