Example of pharmacy getting fined for improper OTC insulin sales
https://azbop.igovsolution.net/docs/AZBOPDOCS/2018/8/e651f263e69443af940a0bef3d706d408162018.pdf How many times have you discussed U40 vs U100 insulin/syringes with cat owners? Do you ever document that ****? LMAO None of these pharmacies in Mohave County AFAIK got hit with discipline over the last 10-20 years for helping to fuel white American drug-addled angst but this one got hit for some sales associate giving out wrong OTC insulin/syringes. (see... Example of pharmacy getting fined for improper OTC insulin sales (Source: Student Doctor Network)
Source: Student Doctor Network - August 16, 2020 Category: Universities & Medical Training Authors: Sine Cura Tags: Pharmacy Source Type: forums

Cvs Change to broken pack insulin pen policy
Just gonna leave this here (Source: Student Doctor Network)
Source: Student Doctor Network - July 24, 2020 Category: Universities & Medical Training Authors: FarmD711 Tags: Pharmacy Source Type: forums

Codes in known hyperkalemia - best initial approach?
So you have a patient with known hyperkalemia in the admission, lets say it was running in the high 6s with some EKG changes and you have a good reason to think that's why he arrested. You start ACLS and he has no central access or anything. What's the ideal timing and sequence of pushing meds? Immediately giving calcium gluconate (3g) with insulin/dextrose (5 and 25) followed by 100 bicarb? And re-dose calcium subsequently if no success while addressing other possible causes as acls continues? (Source: Student Doctor Network)
Source: Student Doctor Network - April 27, 2020 Category: Universities & Medical Training Authors: MedicineZ0Z Tags: Critical Care Source Type: forums

Walgreens paying $209M settlement for Not Opening Insulin Pen Boxes
Looks like this should clear up any confusion.. lol Walgreens to pay $269 million on claims it overcharged federal programs Wall Street Journal (01/23/19) Thomas, Patrick Walgreens Boots Alliance has agreed to pay more than $269 million to settle federal and state lawsuits that accused it of overbilling federal health care programs. Two separate settlements involving Walgreens were unsealed Tuesday in which the company accepted responsibility for conduct the government... Walgreens paying $209M settlement for Not Opening Insulin Pen Boxes (Source: Student Doctor Network)
Source: Student Doctor Network - March 3, 2020 Category: Universities & Medical Training Authors: Heroic Combo Tags: Pharmacy Source Type: forums

Is Pharmacy still a good choice with Bernie?
Well aware of the problems in pharmacy, but can't this be cured by electing Bernie Sanders? I am fine with making less money out of the gate if I have my loans wiped out. And as far as not finding a job, I will certainly be less stressed in between jobs if I have universal healthcare and am not worried about going bankrupt from my insulin. (Source: Student Doctor Network)
Source: Student Doctor Network - February 24, 2020 Category: Universities & Medical Training Authors: PharmLover234 Tags: Pharmacy Source Type: forums

Ramification of selling insulin syringes?
I am in the camp who believes that we should always sell insulin syringes to anyone; regardless if they using it legitimately or 'shooting' it since we want them to use clean needles.. However, I was talking to my colleague who is really anal about this. He says that since our state law specifically mentions that pharmacist has to make sure about the validity of the syringe transaction (or something to that effect), pharmacy board can come behind you if they find out. Is this true? I... Ramification of selling insulin syringes? (Source: Student Doctor Network)
Source: Student Doctor Network - February 13, 2020 Category: Universities & Medical Training Authors: Chrish Tags: Pharmacy Source Type: forums

Upcoming DAT - Type 1 Diabetic
I hope everyone is doing great! As I prep for the DAT, I've been looking into the 'processes' involved for me taking the exam as a type 1 diabetic and what I need to do to make sure all is okay with items such as insulin pump/having a juice for potential low blood sugar, etc. I know they have to be pretty tight on rules (no phones etc.) but I just want to make sure all would be okay if for instance my insulin pump was alerting me on an upcoming low blood sugar and I had to click the button... Upcoming DAT - Type 1 Diabetic (Source: Student Doctor Network)
Source: Student Doctor Network - February 5, 2020 Category: Universities & Medical Training Authors: tmatt1212! Tags: DAT Discussions Source Type: forums

Challenging Case Coming Up
Hey all, I have a challenging case coming up and wanted to see how people would approach it: 76yo HTN, CAD (DES in LAD 7yrs ago), iCMY EF: 30-35% (anterior, anteroseptal, apical akinesis on TTE), Severe MR, pHTN w/ PAP 83 but Normal RV and RVSF (This was based on TTE that was obtained as outpatient 3 months ago, so presumptively not in heart failure at the time. No RHC data available. Assuming its from severe MR. systemic BP appears to be normotensive), Mild COPD, DM on insulin, ESRD on PD... Challenging Case Coming Up (Source: Student Doctor Network)
Source: Student Doctor Network - February 1, 2020 Category: Universities & Medical Training Authors: soccerboy2288 Tags: Anesthesiology Source Type: forums

Hyperglycemia In PACU
How are people managing hyperglycemia in PACU. A lot (Obviously not all) of the attendings I work with are very hesitant to give insulin to patients that are hyperglycemic post-op and usually either just discharge them and tell them to resume home medications for outpatients or just let primary team manage it once the patient leaves PACU and gets to the floor. Just wondering how people at other institutions are approaching this: insulin-naive/not naive, blood sugar cut-offs, treatment... Hyperglycemia In PACU (Source: Student Doctor Network)
Source: Student Doctor Network - December 1, 2019 Category: Universities & Medical Training Authors: Beeftenderloin Tags: Anesthesiology Source Type: forums

Medicare B Rx Reimbursements
I was wondering if anyone could provide more information on how much Medicare B reimburses pharmacies for filling prescriptions of diabetic testing supplies, nebulizer solutions, and insulin for pumps. I have worked for a chain pharmacy for years filling these Rxs and just happened upon this article from 2013: [URL... Medicare B Rx Reimbursements (Source: Student Doctor Network)
Source: Student Doctor Network - November 22, 2019 Category: Universities & Medical Training Authors: MilknCheerios Tags: Pharmacy Source Type: forums

Inpatient FM services, what's your census like?
In terms of total size and patients per patient along with patient complexity. We usually run 7-9 patients per intern here. Good number of zebras hit our census. Patient complexity is high and things like insulin drips, amio, etc we have on a daily basis. Curious what other programs are like in this regard. Not something I ever asked about on the interview trail. (Source: Student Doctor Network)
Source: Student Doctor Network - November 18, 2019 Category: Universities & Medical Training Authors: MedicineZ0Z Tags: Family Medicine Source Type: forums

A Win for Patients :).... NYT: "To Drive Down Insulin Prices, W.H.O. Will Certify Generic Versions"
Am I allowed to post the whole article here (for those facing a paywall? Ive posted a portion of it): To Drive Down Insulin Prices, W.H.O. Will Certify Generic Versions About 80 million people with diabetes around the world need the hormone, and half of them can’t afford it. Creating competition could help, the agency said. www.nytimes.com In Today's NYT: GLOBAL HEALTH To Drive Down Insulin Prices, W.H.O. Will Certify Generic Versions "About 80 million people with diabe...
Source: Student Doctor Network - November 14, 2019 Category: Universities & Medical Training Authors: Engrailed Tags: Pre-Medical - MD Source Type: forums

Pharmacist administers insulin at flu shot clinic
Bartlesville Group Home Residents Taken To Hospital After Medication Error, Police Say Bartlesville Police and Fire Department said several residents and a nurse from a group home have been taken to the hospital Wednesday evening. Police said the residents received the wrong medication. www.newson6.com I hope this pharmacist had insurance! (Source: Student Doctor Network)
Source: Student Doctor Network - November 11, 2019 Category: Universities & Medical Training Authors: mentos Tags: Pharmacy Source Type: forums

how to tell medicare co-pay for diabetes drugs
i have a patient with medicare. i don't know his exact prescription plan and i'm not sure if he would know either or how to find out. i need to know what his co-pay costs would be for trulicity and insulin. i need to be able to factor affordability before prescribing. the best tool i can think of medicare compare plans website. does anyone know of a better resource? thank you. (Source: Student Doctor Network)
Source: Student Doctor Network - October 4, 2019 Category: Universities & Medical Training Authors: common man Tags: General Residency Issues Source Type: forums

Can glucosamine lower CVD risk by lowering insulin?
(Source: BMJ Comments)
Source: BMJ Comments - July 22, 2019 Category: General Medicine Source Type: forums

neonate and infant dillutions
What are the best resources for learning how to calculate insulin and enoxaparin dilutions for this population? We get some pretty wacky orders. Are there any calculators for double checking calculaitons? Thank you and I look forward to your responses. (Source: Student Doctor Network)
Source: Student Doctor Network - May 20, 2019 Category: Universities & Medical Training Authors: nampa Tags: Pharmacy Source Type: forums

Re: Continuous subcutaneous insulin infusion versus multiple daily injection regimens in children and young people at diagnosis of type 1 diabetes: pragmatic randomised controlled trial and economic evaluation
(Source: BMJ Comments)
Source: BMJ Comments - April 9, 2019 Category: General Medicine Source Type: forums

Insulin and obesity: Is it time for a paradigm shift?
(Source: BMJ Comments)
Source: BMJ Comments - November 19, 2018 Category: General Medicine Source Type: forums

Accounting for insulin treatment can improve the accuracy of stroke risk estimates.
(Source: BMJ Comments)
Source: BMJ Comments - October 28, 2018 Category: General Medicine Source Type: forums

Re: Gerald “Jerry” M Reaven: the “father of insulin resistance”
(Source: BMJ Comments)
Source: BMJ Comments - June 13, 2018 Category: General Medicine Source Type: forums

Why does Glucagon INCREASE insulin when it's an anti-insulin hormone?
How come Glucagon and growth hormone INCREASE insulin when they're both anti-insulin?? (Source: Student Doctor Network)
Source: Student Doctor Network - April 9, 2018 Category: Universities & Medical Training Authors: StrongBeliever Source Type: forums

ASA status
Not the most important questions but I am curious as to what the community would give to these patients in terms of ASA score. ESRD, Diabetes type 1 insulin dependent I'm curious about above because some people give ESRD an ASA 4 simply due to ESRD, because dialysis is life saving. But the diabetic type 1 patient gets an ASA 2 even though insulin is life saving. Both diseases cause significant consequences later on in life. What are your thoughts? Otherwise healthy guy, bleeding cause he... ASA status (Source: Student Doctor Network)
Source: Student Doctor Network - March 24, 2018 Category: Universities & Medical Training Authors: waterbottle10 Source Type: forums

Turmeric Forskolin REVIEWS FEB 2018 Mumybear.?
The Turmeric Forskolin: the main objective of this diet is to control the body's insulin production by limiting what it eats. It does this by limiting the intake of carbohydrates and increasing protein intake. The drop in carbohydrate intake leads to weight loss in many people. (Source: Student Doctor Network)
Source: Student Doctor Network - February 24, 2018 Category: Universities & Medical Training Authors: Orrison607 Source Type: forums

Insulin doses
When calculating insulin carb ratios, do you do 500 ÷ TDD = units of aspart (Novolog®) or lispro (Humalog®) per 1g of carbohydrate or is it: 500 ÷ (0.5 x TDD) Reason I am confused is because I thought you only give 50% of the TDD as bolus, the other 50% is the basal dose (e.g. Lantus). Would be grateful if @Raryn could provide help (Source: Student Doctor Network)
Source: Student Doctor Network - February 14, 2018 Category: Universities & Medical Training Authors: quickfeet Source Type: forums

evaherbalist com/celluraid/
array celluraid fresh vegetables don't get digested correctly. This type celluraid meals in and celluraid itself shouldn't be fattening. However, you can become so sensitive to the breads and the celery in your meals that you will deposit even the celluraid and proteins to supplement fat. And if you eat a piece celluraid breads or a little plate celluraid nourish, your whole personal body program will send your levels celluraid blood flow blood insulin soaring, reacting as strongly as if you... evaherbalist com/celluraid/ (Source: Student Doctor Network)
Source: Student Doctor Network - February 4, 2018 Category: Universities & Medical Training Authors: interuhakime Source Type: forums

Opioids in exchange for (critical) care
How would you handle this? 20yo F w/ DM1 admitted about twice per month in DKA (perhaps more to other hospitals), never takes her insulin, gives no sh*ts about her health, not even sure she fully understands the risks of her behavior. Her BGs are always ridiculous. The most recent time I admitted her: wide open gap, serum BG was>1,800 (above the upper limit of testing)- the highest I have seen. Requires some 15 to 20L of IVF (not to mention all the lytes and insulin) before she is ready... Opioids in exchange for (critical) care (Source: Student Doctor Network)
Source: Student Doctor Network - January 11, 2018 Category: Universities & Medical Training Authors: ReviewOfSystems Source Type: forums

diabetes vs exercise
i know exercise would decrease blood glucose level by increasing Glut 4 expression is it insulin dependent or independent?...Fa says it is dependent ,but in beckers it is described via AMP dependent kinase pathway can any one plz explain this ,thanks in advance. (Source: Student Doctor Network)
Source: Student Doctor Network - January 8, 2018 Category: Universities & Medical Training Authors: Blind date18 Source Type: forums

Insulin pen, box: open box or not? Rite Aid Old Memo of 2013?
Folks, my friend recalls from memory that Rite Aid sent out a memo in 2013 about them getting audited and fined over 1 million dollars for giving too much insulin pens as 1 box and bill for just 28 days. The argument among pharmacist was that: box of "insulin pen" is not break-able. However, because of the audit and penalty, Rite Aid wanted pharmacies to break box and dispense enough insulin pens. Still, many did not recall reading or seeing that memo. Anyone can please find that old memo... Insulin pen, box: open box or not? Rite Aid Old Memo of 2013? (Source: Student Doctor Network)
Source: Student Doctor Network - November 10, 2017 Category: Universities & Medical Training Authors: HelpfulPharmer1 Source Type: forums

Will you dispense syringes no questions asked?
Assuming that your state laws will allow you to dispense insulin syringes without a prescription, will you do it when it's your decision to do so? As an intern, I abide by what my pharmacist tells me he/she will allow. My personal feeling is that I'd rather sell syringes (never just one syringe) to an IV drug abuser than force them to re-use or borrow syringes and risk infection with a blood-borne pathogen. I think it's a public health issue. What do you guys think? (Source: Student Doctor Network)
Source: Student Doctor Network - September 22, 2017 Category: Universities & Medical Training Authors: twester Source Type: forums

Insulin resistance
This is probably silly question but why is it that more insulin is produced when cells display insulin resistance? What's the point of producing more insulin when the cells are already resistant to insulin? I heard that there is also leptin resistance. Does this also works the same way? Produce more leptin to make up for the resistance? Sent from my iPhone using Tapatalk (Source: Student Doctor Network)
Source: Student Doctor Network - July 17, 2017 Category: Universities & Medical Training Authors: taeyeonlover Source Type: forums

Hate outpatient
MS3 here. I'm interested in a lot of things tbh. I liked neuroscience in preclinical years, but soon realized there was little neuroscience in neurology. I liked radiology, reading studies was amazing. Anesthesia and critical care was brilliant. I liked inpatient medicine and surprisingly, I loved rounds. Now I'm on outpatient medicine and if I have to see another metabolic syndrome patient I will most likely OD on insulin. I posted earlier on how I wanted to pursue a rheumatology... Hate outpatient (Source: Student Doctor Network)
Source: Student Doctor Network - July 1, 2017 Category: Universities & Medical Training Authors: Spodermin Source Type: forums

Re: Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
(Source: BMJ Comments)
Source: BMJ Comments - June 12, 2017 Category: General Medicine Source Type: forums

Can podiatrists handle basic internal medicin issues?
So if a podiatric patient presents to the office for some regarding their lower extremety but have diabetes or a bronchitis or whatever, can the podiatrist prescribe them insulin or antibiotics (Source: Student Doctor Network)
Source: Student Doctor Network - May 18, 2017 Category: Universities & Medical Training Authors: MysteryDiagnosis Source Type: forums

Re: Supporting insulin initiation in type 2 diabetes in primary care: results of the Stepping Up pragmatic cluster randomised controlled clinical trial
(Source: BMJ Comments)
Source: BMJ Comments - May 7, 2017 Category: Journals (General) Source Type: forums

Please check my patient notes
I'm following FA-CS format. Please, let me know what I need to improve on. FA 5th edi- case 6. HPI - Source of information is the patients mother. Pt is 10 yo F who was diagnosed with diabetes 1 month ago. Mother doesn't know which type of diabets. At the time of diagnosis, she had polyuria, polydypsia, polyphagia, & hyperglycemia. She is on insulin 2 times. 1 at meal time and 1 at bed time. At home mother gives the insulin injection & when out side child takes it herself. Child is... Please check my patient notes (Source: Student Doctor Network)
Source: Student Doctor Network - May 1, 2017 Category: Universities & Medical Training Authors: aimskyhigh Source Type: forums

SSI with novolog/humalog vs regular insulin
Hi All, I am used to using humalog/novolog insulin for SSI orders. My hospital has regular insulin SSI. Once injected, Regular insulin takes 30 minutes to begin working, peaks between 2 and 4 hours and hangs on for 6 to 8 hours, long after the meal stopped raising the blood sugar. Humalog and Novolog, on the other hand, begin working in about 10 minutes, peaks at one to one and a half hours and are gone in about three and a half to four hours. Just curious to know if you have seen one work... SSI with novolog/humalog vs regular insulin (Source: Student Doctor Network)
Source: Student Doctor Network - March 18, 2017 Category: Universities & Medical Training Authors: meerkat111 Source Type: forums

Walgreens stars event - customer brought back broke insulin bottle?
Today, a customer brought back a broken glass of insulin and claimed that they got it like that. I suspected that he was lying because the paper box that the glass was in did not show any sign of ever being wet. We gave the customer a new bottle but I did not report this as a star event. Should I have reported it on the product review pharmacist? If not, how would I account for the $100+ worth of insulin? (Source: Student Doctor Network)
Source: Student Doctor Network - March 14, 2017 Category: Universities & Medical Training Authors: a student Source Type: forums

Glut2/Glut4
- How come glut2 is said to be insulin independent if it senses the release of insulin to store glut2 in hepatocytes? - I understand that glut4 has a Km similar to the concentration of glucose so it gets saturated fast but how come glucose influx can still occur if the glut4 receptors are saturated? And what's the relation with it being zero order? Thanks! (Source: Student Doctor Network)
Source: Student Doctor Network - March 9, 2017 Category: Universities & Medical Training Authors: ys2327 Source Type: forums

Is Rx for syringes implied for insulin vial rxs?
If doctor doesn't send an Rx for syringes with the insulin vial do you assume the Dr wants syringes and write an Rx for them under that doctor without making the patient wait till the Dr office opens the next day... Seems reasonable correct? (Source: Student Doctor Network)
Source: Student Doctor Network - March 9, 2017 Category: Universities & Medical Training Authors: Charcoales Source Type: forums

My diabetic patient refuses to regulate his blood sugar and.......
My diabetic patient came with an abscess. he's refusing to regulate his blood sugar with insulin but he's suffering a severe pain because of that abscess I tried to refer him to someone else but he refused that. What should I do? how do I manage his case? how do I drain his abscess without causing any damage to his health? (Source: Student Doctor Network)
Source: Student Doctor Network - January 5, 2017 Category: Universities & Medical Training Authors: Sho-4 Source Type: forums

Question about acromegaly, IGF, glucose intolerance
So for some reason, i'm having difficulty understanding this concept. In growth hormone excess (such as acromegaly), you have an increase in IGF, which apparantly causes hyperglycemia. I don't understand how an excess of IGF causes hyperglycemia, if IGF's function is similar to that of insulin. shouldn't it cause hypoglycemia? (Source: Student Doctor Network)
Source: Student Doctor Network - December 31, 2016 Category: Universities & Medical Training Authors: otacon88 Source Type: forums

Metformin PRN?!?!
Last day of my family medicine rotation and I had a nurse practitioneer for my final patient of the day. Of course, she corrected me when I called her Mrs. instead of "Dr." She had been a diabetic for many years and we went over her insulin regimen. Apparently, she "tweaked" her own sliding scale and told me she takes metformin "as needed" and lispro at bedtime. Wtf? Do they not teach NPs about metformin increasing the sensitivity of insulin action? Did she not know lispro is a... Metformin PRN?!?! (Source: Student Doctor Network)
Source: Student Doctor Network - December 3, 2016 Category: Universities & Medical Training Authors: sun_devil33 Source Type: forums

Epinephrine, glucagon, insulin "big picture" clarification
I have a couple of big picture questions that have come up when reviewing metabolism and I think they reflect some fundamental issues in my understanding. Sorry I couldn't be more concise. 1. I don't understand the purpose of gluconeogenesis/ glycogenlysis. I see the purpose is to "maintain blood sugar levels" but why does blood sugar need to be maintained? Again, I've read the reason is so that the rbcs and brain have a fuel source since they "use glucose". However, to my knowledge,... Epinephrine, glucagon, insulin "big picture" clarification (Source: Student Doctor Network)
Source: Student Doctor Network - October 4, 2016 Category: Universities & Medical Training Authors: dfgyz230 Source Type: forums

Family members treating/loaning medications to patients?
I've recently had a spate of family members loaning antibiotics/insulin/medications to other family members -- most recently today -- had a female patient present for a cough and find out the husband had some Cipro lying around and treated her for 6 days with Cipro. When I inquired about it, I was told "don't try it" -- almost in the sense of questioning his "medical judgement". To my knowledge, they were not a physician --- so -- how do the rest of you handle family members doctoring... Family members treating/loaning medications to patients? (Source: Student Doctor Network)
Source: Student Doctor Network - September 11, 2016 Category: Universities & Medical Training Authors: JustPlainBill Source Type: forums

DPP 4 Inhibitors: cautious friendship with sulphonylurea, but good friendship with metformin and insulin
(Source: BMJ Comments)
Source: BMJ Comments - August 24, 2016 Category: Journals (General) Source Type: forums

How much rounding can one get away with?
Does anyone work for insurance? What if I rounded a Novolog box from 31 days supply to 30 days, will that be charged back during an audit? Is there even a set number days we can round before insurance takes it back? (Source: Student Doctor Network)
Source: Student Doctor Network - July 22, 2016 Category: Universities & Medical Training Authors: ArtificallyFlavored Source Type: forums

Question about hypodermic needle/syringe laws in Texas
Can anyone point me in the direction of where this is? I've looked in the law book for the boards and even online at the state board of pharmacy's website but I have had no luck. I've been told that they need proof of insulin use in their medication profile, but I would like to see the law myself regarding quantities we are allowed to sell, if we need to ID, age restrictions, etc. (Source: Student Doctor Network)
Source: Student Doctor Network - May 27, 2016 Category: Universities & Medical Training Authors: crossurfingers Source Type: forums

scary RN questions
I will start by saying, I love the RN's I work with - well, most of them. I see them and interact with the more than my fellow pharmacists - but dang, every now and then I get one of the questions that scare the hell out of me. (although most MD's would probably say the same about RPh's) - all professionals have those wack jobs and we all have an off day. Lets get a list of some of the funny/scary questions we have gotten. I had this one - from a seasoned RN even. I have this insulin... scary RN questions (Source: Student Doctor Network)
Source: Student Doctor Network - May 2, 2016 Category: Universities & Medical Training Authors: Dred Pirate Source Type: forums

Reimbursements on packaged medications
I am confused about how insurance reimburses packaged medications and would like someone clarify it for me. To my understanding, let's say, creams and solutions which comes in different weights like 15g, 30g should have different reimbursement rates right? Does that work the same for solutions and broken insulin pen packages (e.g. 10ml of Novolog dispensed instead of the 15ml?) Thanks (Source: Student Doctor Network)
Source: Student Doctor Network - April 3, 2016 Category: Universities & Medical Training Authors: ZakMeister Source Type: forums

Do you Recommend Insulin Pump For Type 2 Diabetes
Many debates and ongoing researches have not yet come to a conclusion to weigh between the advantages and disadvantages for Insulin Pump specially for diabetes type 2, however many diabetic patients are rushing to aquire the device, irrespective of the main serious side effects such as infection and DKA I think we need  more researches to finalize the usefulness of Insulin Pump , and proper health education for diabetic patients on this subject (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - March 11, 2016 Category: Cardiology Authors: alaminium Source Type: forums