Studies show that between one-fifth and one-third of patients do not take their medicines as prescribed. Why not? How can you make prescription medicines work for you?
Reasons people don’t take their medicines include:
1. Side effects
Any drug strong enough to help people is strong enough to potentially cause side effects. These range from the possible intestinal discomfort of metformin to the low blood sugars that can be caused by sulfonylureas and insulin to the potential joint pains of DPP-4 inhibitors, along with many other mild-to-severe problems.
There are also “untoward effects,” which may not be noticed when you first take the drugs but that come on over time. Untoward effects include possible muscle weakness caused by statin drugs or potential increased urinary tract infections related to SGLT-2 inhibitors. Some can be severe. You can look up your particular drug or see a list here.
You can often deal with side effects by changing the way you take a medicine — the time of day, with or without food, or extended release versus regular, for instance. Untoward effects are things you need to be aware of and watch out for. Talk with your pharmacist and read up on any drug you are prescribed to find ways to prevent and deal with side effects.
2. Lack of perceived benefit
If a drug doesn’t seem to be doing you any good, you may want to stop taking it, and you may be right. Some drugs, though, don’t have measurable short-term benefits; you take them to keep from getting worse.
Talk with your doctor, pharmacist, or diabetes educator about how a drug works, and what results you should see. Find out what it’s supposed to do, and then check to see if it’s working. Keep records. Ask for printed handouts and check websites such as this one.
Certified diabetes educator Amy Campbell says, “Give your medicines a chance to do their job. But, if after several weeks you don’t see any or much of an improvement in your blood sugars [if that’s what they’re for], let your doctor know.”
3. Knowing or reading about people who have had bad responses
If someone in your family took a drug you are prescribed and got sicker or died, you might blame the drug. This fear keeps a lot of people from taking insulin, but it also applies to other drugs.
Such concerns may be valid, but often there are other reasons for your family member’s bad outcome. Everyone is different, and you may have a very different, more positive reaction to the same drug. You have to talk it over with someone who knows.
4. Expense
Drugs, especially newer brand-name drugs, can cost a lot of money. You may or may not have insurance to cover this, and you may or may not be able to afford the co-pays. Many doctors don’t know about the prices of specific drugs or about what your particular insurance covers.
Unfortunately, many patients are embarrassed to tell their doctor they can’t afford a drug. This is a recipe for disaster. Work with your team to find medicines you can afford — many of the older diabetes medications, including some forms of insulin, are incredibly cheap. And there are often ways to get your prescriptions for less.
5. Drug interactions or fear of them
If you’re taking more than one medicine, there’s always a chance they won’t go together well in your body. This risk goes up the more different medicines you’re on. If you notice vague side effects that you can’t pin down to one particular drug, ask if you might be having drug interactions. There are many drug-interaction checkers online, such as this one from Drugs.com.
6. Difficult regimen
Taking multiple medications can have a major effect on your life. You might be asked to take some with food and some without food. Some can be taken with each other and some can’t. Some may require you to avoid certain foods or drinks. Some may require you to check your glucose levels or your meal content to calculate your dose. It may be difficult to figure out a way to make them all work.
7. Forgetting to take them
Taking pills is not the highlight of most people’s day, so it’s easy to forget. Some people set timers to remind themselves. Others link medications to another task they won’t forget, like brushing their teeth or watching a favorite show. Having a pill dispenser filled out for a week at a time makes it easier to remember all your medicines.
Notice that most of these problems may be resolved by having fewer drugs prescribed. Fewer medicines means less expense, a simpler regimen, less risk of interactions, and fewer side effects. Talk with your doctor about ways to make your drug plan simpler.
8. Difficulty swallowing
Some medications are actually too big for some patients to swallow. If you have difficulty swallowing large pills, ask if your pill can be safely cut in half. If it can’t, see if you can get a smaller, lower-dose pill and take two of them. If not, perhaps an entirely different medicine will work better.
9. Needle phobia, or difficulty managing technology such as pump
If you’re fearful of sticking yourself with a needle, you might find it hard to take insulin or other injectable drugs. However, many insulins and other injectable medicines now come with injection pens that conceal the needle so you never see it. Insulin pumps can eliminate the need for injections altogether. Ask about these devices if needle discomfort is a problem.
All of the issues on this list can be helped by talking with a professional or a support group. Don’t keep problems hidden: speak up about them.
Remember that no drug works if you don’t take it. As with every other part of diabetes self-management, you need to be in control of your medication plan. Either work out a way to follow your medication plan, or change the plan so that it works for you.
Want to learn more about diabetes medicines? Read “Making Your Diabetes Pills Work for You,” by certified diabetes educator Amy Campbell.
