T:	yes there it goes okay hi I'm Sheila I'll be your pharmacist today um first can you describe by your name and birth date
C:	um my name is carb and my I am 57 years old
T:	okay that's good enough I just wanna make sure I have the right person and so I have three things for you today is that when you're expressing
C:	yes
T:	okay I just wanted to take a minute and go through these with you all right okay great I was like - these are results for you we have the Lance's insulin which is your long-acting insulin and then we have the metformin catalyst cannot look like what you've been picking
C:	yes that's women taking
T:	okay great and so I'm how do you be using these
C:	uh my metformin I take twice a day and then the insulin I just take in the evening
T:	okay great and then on this it says 48 units are you still taking that much or
C:	yes for me
T:	okay and have you noticed any side effects or any problems with these but I can help you in
C:	no the doctor says my diabetes isn't under control
T:	okay all right well it looks like they decided to add another influence and so what this is is novalog which is also called a smart insulin looks like um this one is one that you're gonna actually I should rephrase that and what did your how did your doctor tell you to take this
C:	I guess I have to take that on before I eat carbohydrates
T:	right okay great and um why did your doctor amasses
C:	um because my diabetes is on control teas done
T:	alright okay great so um you're right you're going to use this with meals and you're going to actually try to get before you eat so that may be a little bit difficult because you're going to estimate how much carbohydrate you're going to eat before you actually eat it so it might be a little dicey at first um try to help you with that um what did your doctor tell you to expect with the medication
C:	um that the same thing that you said I'll have to do a certain amount of units for each amount a card
T:	okay now with insulin there's some things that we'd like to that sometimes can be a problem too like hypoglycemia have you experience animal
C:	yeah I have a little bit
T:	okay how have you been managed genius
C:	uh I eat like soda or drink soda sorry or like glucose tablets
T:	oh okay great and usually keep something on you then okay it's going to be even more important now that you're going to be doing it so basically you're going to start with the one unit for 15 grams of carbohydrate and that might be a little bit abstract for you so I don't know if you've ever done carb counting before so I got you some information um this is just a general like nutrition facts thing that you would see on a food label
C:	okay
T:	so they make it really easy for you guys it just says right here a total carbohydrate so this is per serving though so I wanted to draw your attention to the top where it says it's serving size is you might have to do a little bit math here like on this one a serving size is one ounce but there's four servings in there bad
C:	oh
T:	if you ate the whole bag you would have to multiply this by 4
C:	so that'll be four carbs rather than one
T:	umm right for a unit right because this is almost 15 or
C:	4 units
T:	right so you would use for a units of insulin to cover a full bag of it so that's how you do the math
C:	okay
T:	now unfortunately this is more of a general average and since you're just starting on it it's probably not going to be realistic so what you're going to want to do is monitor this monitor your blood sugar and any type of like thing you can sense that you have when you first start this is um mainly a really like a range and some people leave one unit for like 9 grams and cards and some people need one unit for like 30 grams of carbs so it's really going to be dependent on how sensitive you are to insulin
C:	so I might have to go up
T:	yeah you might have to go up or down just depending on how you react so what I would suggest is keeping like a log with you I don't know if you're logging your blood sugar reading and like a paper log or if you're just keeping it in your letter
C:	in my meter yeah
T:	yeah it might be good idea to have like a moment of madness you just when you get started so you can kind of figure out exactly how many units you need per amount of carbs just as far as what you respond to yeah
C:	okay
T:	you know this is just another little thing about when you first start getting used to counting carbohydrates just grant information for you so um I know you've been on the Lantis and it's an injectable how have you been doing the injection
C:	um just in my belly that's that area punching the pan now are you using like the same area on your abdomen or do you kind of use different sauce I rotate it between each side
T:	okay now that we're adding another influence you're going to be adding three more injections a day perhaps so I gave you a little chart here there are other places on your body that you can inject other than your abdomen so it might be a good idea because you really do want to rotate by Senora tation okay um so you're pretty familiar with how to use a syringe then
C:	yes
T:	okay you have a sharps container at home to secure the needles great okay so just to refresh they're only going to be using a couple of units at a time with this so I'm each each mark on here is a one unit and it goes up to 50 so pretty easy at least it's not done by twos or anything
C:	right
T:	okay um so we've gone over a lot of information and just to make sure I didn't leave anything out we've come through a lot of stuff here um can you just tell me how you're going to use these
C:	okay yeah um well my old medications I'm going to continue taking so I'm going to take the metformin twice a day and the nighttime insulin at night and then with the new one I'm going to take one unit for 15 grams of carbohydrates but rotate site so that I don't get any atrophy and then I'm going I think it's a good idea to keep that logbook and monitor my route post levels in case the doctor will need to adjust the dose of that
T:	I think it's actually great and yeah I just wanted to maybe ask another question about um you know what kind of exercise habits we have or how is your blood pressure been I noticed that as far as what information I have it was a little high which is something it concerns us with diet medication so I would have even
C:	um well I have the back pain so I can't exercise that much and lately I just haven't been going to the nutritionist as often as I should
T:	okay what kind of barriers are standing in the way of that
C:	my job I'm a principal I'm pretty busy this time of year
T:	okay um as far as your back pain and what is the root cause of your family you know if it's like something that maybe a chiropractor or massage might help there's the low impact exercise maybe a hope it for you I don't know maybe you can bring it up your doctor or two or Long's we're gonna be getting on something like just walking or like a stationary bike or even swimming if any of those are things that you can implement it'd be a really good improvement come and anyone needs much insulin -
C:	oh okay
T:	one other quick little thing is that um so insulin and your amount of exercising and activity kind of go hand-in-hand so if you start to exercise more all of a sudden you may need less insulin so once you get started on this and you know how much you're going to use per how many carbs it may change with you come around which is a good thing yeah but just keep in mind because you may have more hypoglycemic events if you don't alter
C:	it watch it but maybe I won't have to use as much
T:	yeah exactly so what other questions you have for me
C:	um I just had one question I don't know if you'd answer this or the doctor but my eyesight oh if I get this if I use the insulin and get better control well my eyesight get better or shot getting is worse
T:	um it should hopefully stay blind not get any worse I'm not sure if it will repair at all I don't think it will but it's best to stop it now you know I stopped their progression so the better control you have the better it should be as far as not getting worse but I've definitely something it's gonna be important - especially your occupation so so yeah getting under control - great a great thing
C:	okay thank you
T:	all right well thank you very much and give me a call if anything comes up I have some more information for you here which is very much just what we've gone over but that we can write all right
C:	thanks