Got questions about life with diabetes? You know where to turn (hopefully).  That would be our new diabetes advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois.

{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}

This week, a bit about drug-food interactions, and the crazy things that insulin does in your body sometimes:

   

Ned from Utah, type 2, writes: Recently a friend showed me an article from Cosmopolitan January 2011 stating that the juice of the grapefruit contains chemicals that block enzymes in the digestive system. It messes up the way your body metabolizes a lot of prescription drugs, and it tends to intensify the side effects such as nausea, dizziness, confusion, diarrhea and/or constipation. I actually like grapefruit, so how do I know if it's safe to eat with my diabetes and cholesterol drugs, sleep aids, etc.?

 

Wil@Ask D'Mine answers: True confession: I don't read Cosmo. It's the whole Y-chromosome thing. Plus, I'm about three decades north of their target demographic. But what you are reporting is true, especially for grapefruit and the family of cholesterol medications called statins. Unfortunately grapefruit actually messes up the action of the medication.

Innovation 2015

And the real bummer is that it does so erratically. Some days/weeks/months it turns the statin into a slacker, making it under-perform. This can be bad, because your cholesterol can then shoot up again, putting your heart at risk. But some days/weeks/months grapefruit turns the statin into a stallion, making it over-preform. Unlike other areas of human endeavor, we really don't want our meds over-preforming. Trust me on this one.

So, sorry, grapefruit isn't safe for you to eat if you need cholesterol drugs. As to your diabetes meds, sleep aids, and all the other pills for what ails you, rather than give you a fish — I'm going to teach you how to fish. By that I mean, I'll give you some tips on how to look up drug interactions on your own.

All prescription drugs come with a drug safety information sheet. These are typically printed in a type size that rivals microfilm and are also typically written by lawyers who are married to medical research doctors. That means to read them you need a magnifying glass, a copy of Blacks Law Dictionary, and a medial lexicon. And what that means, of course, is that nobody reads the damn things at all. Knowing this, the FDA is moving ever-so-slowly towards a simplified "at-a-glance" one-page info sheet for consumers. But it's the FDA. So don't hold your breath.

When I need to look up a drug, I use Epocrates on my PDA (yes, I still have a PDA and no flack about that; me and my dumb phone are very happy together). Epocrates gives those of us in the health care trenches a drug database that includes everything from side effects, to contraindications, to method of action, to dosing info, to even which tier a medication is on for various insurance plans. And more. Probably more than you realistically need. Members of the iPhone cult at my clinic like to show me that they can even pull up photos of a medication for reference: Is this the blue pill you've been taking?

For consumers, the FDA actually has a pretty slick little website that lets you look up drugs by name. This site lists both common and more rare side effects. It would take you less than half an hour to look up the 11.5 prescription drugs that the average American takes.

And you should. Because I think it's your duty as a patient to understand the basics of the medications you are taking. At a minimum you should know how to take your medications and what the most common side effects might be. For instance, how many of you who take statins take them at bed time? You're supposed to. Why? 'Cause statins restrict the liver's production of cholesterol, and that happens when you sleep.

Anyway, when you get a new drug, spend a few minutes getting to know it. After all, the two of you are in a relationship together now. You'll want to know if your breakfast choices (like grapefruit!) have any adverse effect. And it wouldn't hurt to review that info once a year. You can do it when you change your smoke detector batteries.

Ummm..... you do change your smoke detector batteries every year.... don't you?

 

Anne from Iowa, type 1, asks: Is it "normal" to go through periods of time where your body just doesn't absorb insulin as well as it could? I start to stress about it, and then I start worrying about developing insulin resistance!

 

Wil@Ask D'Mine answers: Anne, in case you didn't notice, there's nothing "normal" about diabetes! But the answer to your questions is yes, no, sometimes, maybe, and it depends.

So, here are some things to be aware of. First and foremost, different parts of the body absorb insulin at different rates, as do different tissue types. For instance, insulin that starts off in the leg or arm has further to travel to be effective than insulin that starts off in the abdomen. And female pumpers who use "breast sites" frequently report much faster effects of insulin there than when they use stomach sites, as breast tissue seems to absorb insulin much faster.

Of course, any variation in your exercise patterns can change how quickly the insulin gets to work too.

But by far the most common cause of insulin "not working the way it's supposed to" are injection site issues. Be sure to rotate your injection sites, or pump infusion sites, frequently. That means all the freakin' time. And I don't mean back-and-forth between two sites either. You have to find a variety of sites to use, so that each can "rest" a while between uses.

The reason we need to rotate sites is that if you poke a hole in your body in the same place too many times, you can develop scar tissue inside there, and scar tissue is a very poor absorber of insulin.

And here's the deal with insulin resistance: while we generally view this as a "type 2 problem," anyone can develop it. That said, it's most commonly associated with weight. Fat people are more insulin resistant than skinny people, and fat people can become less insulin resistant by becoming skinny people (or by becoming less-fat people, as even a seven-pound weight loss can measurably reduce insulin resistance).

While insulin resistance can change, it's usually a pretty stable thing. It changes slowly over time, like one of those big super tankers that can't turn on a dime. As you mention "periods of time" when things are funky, that tells me your problem is not likely to be insulin resistance.

For T1s like yourself who already take insulin, developing insulin resistance simply means that you'll need to dose a bit more "pancreas juice" to get the job done.

While it might be frustrating to have to figure out new dosing, note that using more insulin has no significant health risk — although it may be a bit harder on your finances!

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.