The much anticipated change in the Special Benefit Service (SBS) has passed, so how exactly has it impacted health care for diabetics?
There are 7 different classes of drug therapy for available to diabetics in Barbados, of these four (4) are covered under the SBS.
Type I diabetics will use insulin and these, together with insulin syringes and blood glucose testing strips are all still available.
Type I diabetics might also take the Biguanide, Metformin, of which many brands are still readily available on the SBS. A change in brand might result in gastrointestinal side-effects, but these can be minimized by taking the Metformin with food.
Many Type II diabetics would be treated with Sulphonylureas e.g. Gliclazide (Diamicron MR), Glibenclamide (Daonil), Glimepiride (Amaryl), Glipizide (Glucotrol) and Glyburide (Glynase).Of these Glucotrol and Glynase are no longer available on the SBS therefore patients will have to pay for the full supply. Amaryl is not on the Barbados National Drug would be required to pay the full cost. All sulphonuylureas should be taken with food.
The metiglinides, Repaglinide ( Novonorm) and Nateglinide (Starlix) have the shortest action of all the oral medications and are taken just before a meal. Their use is limited to those who are resistant to control on other medications and are not covered by the SBS.
The thiazolidines, Pioglitazone (Actos) may be recommended for patients not adequately controlled on a bigaunide or sulphonylurea. Actos is not supplied on the SBS and may be taken without regard to meals.
Acarbose (Glucar, Glucobay) delays glucose absorption and should be taken with the first mouthful of food; flatulence and diarrhea are possible side-effects. Glucar is available on the SBS, but not the Glucobay brand.
The newest class of anti-diabetic medications is the Dipeptidylpeptidase-4 inhibitors sitagliptin (Janumet) and vidagliptin (Galvus) are more complex in their mode of action. These are not available on the SBS.
All diabetics should know how to test their blood sugar levels; strips may be obtained with an appropriate prescription for those on oral medication every 90 days. This allows for testing approximately three times a week with a few additional strips in case of sickness or a known change of diet. A test can be carried out fasting i.e. first thing in the morning; immediately before a meal or 2 hours after on various days. It is also important to test the blood glucose when any changes to diabetic or other medication is made, even if it is a change in brand.
It is important that diabetics understand that they are managing their disease and not treating it. This article starts the process for some diabetics. Take these notes, go to your pharmacist and ask him/her to explain, what is not understood.
Your Pharmacist is ready and willing to help you control your blood sugar levels.
