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A healthy immune system offers protection against the bacteria and viruses that cause illness, deploying antibodies that attack these invaders. An autoimmune disease occurs when the immune system cannot differentiate between outside germs and healthy cells and mistakenly attacks various tissues and organs throughout the body.

What is an autoimmune disease?

A healthy immune system offers protection against the bacteria and viruses that cause illness, deploying antibodies that attack these invaders. An autoimmune disease occurs when the immune system cannot differentiate between germs and the body’s own cells and mistakenly attacks various tissues and organs.

There are more than 80 of these conditions, with variation in the affected area of the body; some of the most common autoimmune disorders involve the joints and muscles, digestive tract, nervous system, and skin. There is also significant variation in day-to-day life with autoimmune disorders. Some, like type 1 diabetes, require daily management, while others may have periods of intensified symptoms known as flare-ups. In all cases, there are treatment options that can reduce discomfort and help you experience a better quality of life. Here’s what to know about the most common types of autoimmune disorders.

Causes and symptoms of autoimmune disorders

Many autoimmune disorders do not have a specific known trigger, but the following factors may play a role in the development of certain conditions.

Genetics — some autoimmune disorders such as lupus and multiple sclerosis run in families and likely have a genetic component.

Sex — of the 23.5 million Americans living with an autoimmune disease, 78% are women. Specific autoimmune disorders that are more common in women than men include rheumatoid arthritis, psoriasis, celiac disease, inflammatory bowel disease, lupus and multiple sclerosis, among others.

Obesity — being overweight or obese may increase an individual’s risk of developing rheumatoid arthritis or psoriatic arthritis.

Smoking — research suggests a connection between cigarette smoking and lupus, rheumatoid arthritis, hyperthyroidism, and multiple sclerosis.

Medications — some medications including blood pressure medications, statins (which are commonly used to treat high cholesterol), and antibiotics may increase a person’s risk for certain autoimmune disorders. Consult with your doctor about medication side effects if you have concerns.

While exact symptoms and treatment options vary by condition, as explained in more detail below, there is also some overlap. Fatigue, joint pain and swelling, rashes and other skin issues, digestive issues, and swollen glands are common signs of a variety of autoimmune disorders.

Most autoimmune disorders do not have one single test to confirm or rule out a diagnosis. With the majority of these conditions, the diagnosis process involves several steps including a physical exam and multiple tests.

If you have potential symptoms of an autoimmune disease, a common first step is an antinuclear antibody (ANA) test. This is a blood test that checks for antinuclear antibodies, the type of antibodies that attack healthy cells. If you have a positive ANA result, your doctor will likely recommend additional tests to identify the specific autoimmune disease.

A negative ANA test does not necessarily mean that you do not have an autoimmune disease. If you have negative ANA results, your doctor may recommend additional tests for other antibodies or inflammation markers depending on your symptoms. Tests used to diagnose autoimmune disorders include:

An erythrocyte sedimentation rate (ESR) test — which examines how quickly your red blood cells sink to the bottom of a test tube — may be used to diagnose rheumatoid arthritis and lupus. Higher rates of settlement may indicate inflammation.

A c-reactive protein (CRP) test — which identifies your blood levels of CRP, an inflammation-linked protein produced in your liver — may be used to diagnose rheumatoid arthritis, lupus, and inflammatory bowel disease.

A rheumatoid factor (RF) test checks for rheumatoid factor, an antibody found in about 80% of individuals with rheumatoid arthritis.

Depending on your symptoms, your healthcare provider may refer you to one of the following specialists:

A rheumatologist who treats autoimmune disorders of the joints and muscles including rheumatoid arthritis and lupus.

A gastroenterologist who treats autoimmune disorders of the digestive system including Crohn’s disease, celiac disease, and ulcerative colitis.

An endocrinologist who treats autoimmune disorders of the endocrine system including Graves’ disease and Hashimoto’s thyroiditis.

A dermatologist who treats skin-related autoimmune disorders including psoriasis.

Common autoimmune disorders and treatment

These are some of the most common types of autoimmune disorders affecting individuals in the U.S. Symptoms, treatment, and diagnostic tests vary by condition.

Rheumatoid arthritis occurs when your immune system attacks the lining of your joints, causing pain and inflammation throughout your body. It is a progressive condition, and getting an early diagnosis and staying proactive about treatment can help prevent more severe damage to your joints.

Several medications may be used to reduce the pain and inflammation caused by rheumatoid arthritis, including over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil®), aspirin (Bayer®) or naproxen (Aleve®); acetaminophen (Tylenol®); and Janus kinase (JAK) inhibitors such as baricitinib (Olumiant®), tofacitinib (Xeljanz®), and upadacitinib (Rinvoq®). In addition, avoiding or reducing your intake of sugars and refined carbohydrates and gluten can also help reduce inflammation.

Disease-modifying anti-rheumatic drugs (DMARDs) like methotrexate (Rheumatrex®), sulfasalazine (Azulfidine®), and leflunomide (Arava®) and injectable biologic DMARDs like etanercept (Enbrel®), infliximab (Remicade®), adalimumab (Humira®), and certolizumab pegol (Cimzia®) are often prescribed to slow tissue damage.

Type 1 diabetes is an autoimmune condition that occurs when the body mistakenly attacks the pancreas with antibodies. This destroys the pancreas’s insulin-producing cells, so individuals with type 1 diabetes cannot produce any insulin and rely on daily insulin therapy to manage their blood sugar.

For more information on managing type 1 diabetes, read our previous blogs:

What’s the Difference between Type 1 and Type 2 Diabetes?

How to Live with Type 1 Diabetes at Any Age

Psoriasis is a skin disorder that occurs when inflammation caused by an immune response causes new skin cells to grow too quickly. It is characterized by thick patches of skin covered with white or silver scales, also referred to as plaques. There is a genetic component, and psoriasis often runs in families. 

Many individuals with psoriasis experience periodic flare-ups. While not all psoriasis flare-ups can be attributed to a specific cause, skin injury, stress, and cold weather are common triggers.

There are a variety of treatments for psoriasis, including steroid creams; anthralin (Drithocreme HP® and Zithranol®), an anti-inflammatory medication; moisturizers; UV light therapy; vitamin D3 ointment; and vitamin A creams.

Systemic lupus erythematosus (SLE), the most common type of lupus, affects many different parts of the body including the skin, joints, kidneys, brain, and heart. Common symptoms include joint pain and swelling, severe fatigue, and rashes. Without effective treatment, lupus can lead to other health complications over time, including blood clots and inflammation of the heart or kidneys, and increase your risk for a heart attack or stroke. Getting diagnosed early and starting treatment as soon as possible is critical to managing lupus.

Lupus treatment varies depending on the severity of symptoms and which part of the body is affected. Other-the-counter NSAIDs and oral corticosteroids including prednisone (Deltasone®, Prednicot®) may be used to treat joint pain and stiffness. Antimalarial medications including hydroxychloroquine (Plaquenil®) are often prescribed to reduce pain and inflammation, prevent flare-ups, and treat rashes.

Inflammatory bowel disease refers to several autoimmune diseases that affect the digestive tract including Crohn’s disease, which involves any part of the small or large intestine, and ulcerative colitis, which involves the colon, rectum, or both organs.

Common symptoms of both Crohn’s disease and ulcerative colitis include diarrhea, abdominal cramps, bloody stools, fever, fatigue, loss of appetite, and weight loss. Many individuals with these conditions experience periods of time without symptoms, also known as remission. Treatment options include the following:

Antidiarrheal and anti-inflammatory medications such as oral 5-aminosalicylates and corticosteroids

Immunomodulators, a group of medications that act on the immune system to reduce the inflammation that causes Crohn’s

Biologics, a group of medications that are derived from antibodies and used to prevent inflammation in more severe cases, such as adalimumab (Humira®), golimumab (Simponi®), infliximab (Remicade®), tofacitinib (Xeljanz®), ustekinumab (Stelara®), and vedolizumab (Entyvio®)

Other common autoimmune diseases include:

Multiple sclerosis, which affects the nervous system

Addison’s disease, which affects the adrenal glands

Graves’ disease, which affects the thyroid gland in the neck

Celiac disease, which affects the digestive tract

Living with any chronic condition is easier with a reliable pharmacy partner by your side. Our pharmacists have specialized training in the treatment of autoimmune diseases and can answer any questions you may have, from medication side effects to non-pharmacological treatment options and navigating lifestyle changes. In addition, we offer free, same-day delivery and medication management tools like reminders and auto refills in our app to make it as simple as possible to stay on track with your treatment.

To learn more, reach out any time through in-app secure messaging or by phone at 1-800-874-5881.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

All third party trademarks (including logos and icons) referenced by Alto Pharmacy remain the property of their respective owners. Unless specifically identified as such, Alto’s use of third party trademarks does not indicate any relationship, sponsorship or endorsement between Alto and the owners of these trademarks.

Millions of individuals with type 1 and type 2 diabetes need insulin every day to keep their blood sugar levels in a healthy range. In recent decades, it has grown increasingly difficult for many to access this life-saving medication, as insulin prices continue to rise.

Managing the Costs of Insulin

Millions of individuals with type 1 and type 2 diabetes need insulin every day to keep their blood sugar levels in a healthy range. In recent decades, it has grown increasingly difficult for many to access this life-saving medication, as insulin prices continue to rise. Take a look at these recent statistics:

The cost of insulin increased by an average of 14% every year from 2012 to 2018.

In 2017, insulin accounted for 20% of all diabetes-related healthcare spending before rebates and discounts and 6.3% after rebates and discounts.

In a 2018 survey on insulin affordability conducted by the American Diabetes Association, 39% of the respondents reported an increase in their insulin costs between 2017 and 2018.

Rising insulin costs can significantly impact an individual’s ability to manage their health. 27% of those surveyed by the ADA said that insulin prices affected how much of the medication they could buy or use. Missed insulin doses can lead to serious health complications including diabetic ketoacidosis.

While insulin access remains a critical issue for many Americans with diabetes, lawmakers have recognized the urgency of lowering insulin costs. In November 2021, the U.S. House of Representatives passed the Build Back Better Act, which caps out-of-pocket copays for insulin at $35 per month. The legislation has yet to pass in the U.S. Senate, but President Joe Biden recently reaffirmed his commitment to lowering insulin costs — and prescription medication costs more broadly — as part of his domestic agenda.

In the meantime, there are a variety of resources to help you manage the costs of insulin, including patient assistance programs and copay savings cards from insulin manufacturers. Here’s more on eligibility for these programs.

The Lilly Cares® Foundation Patient Assistance Program

The Lilly Cares Foundation Patient Assistance Program provides free insulin and glucagon products for individuals who have Medicare Part D or no health insurance coverage and meet certain income requirements.

Learn more about program terms and conditions and the application process.

The Novo Nordisk® Patient Assistance Program

The Novo Nordisk Patient Assistance Program provides insulin and other diabetes medications at no cost to individuals who have Medicare or no health insurance coverage and whose total household income is at or below 400% of the federal poverty level.

Sanofi Patient Connection provides Sanofi medications including insulin at no cost to individuals whose total household income is at or below 400% of the federal poverty level.

The Lilly Insulin Value Program offers all Lilly insulins at $35 per month to individuals with commercial health insurance or no health insurance coverage. Download the copay card here.

Sanofi offers a copay savings card for those with insurance as well as the Valyou Savings Program for those without insurance, which offers Sanofi insulin at $99 per month. Learn more about Sanofi savings opportunities.

Novo Nordisk offers savings cards that reduce copays for a variety of insulin products. Get more details here.

Your financial well-being is our priority

At Alto, we understand how stressful it can be to navigate insurance coverage benefits and savings opportunities. We prioritize your financial wellness, working with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to make your insulin and other medications as affordable as possible. In addition to automatically applying any coupon savings, we’ll connect you with any outside programs that require you to apply directly.

We also offer free, same-day delivery to simplify your diabetes management, and our dedicated diabetes support team is here to answer any questions you may have. Get started or learn more about Alto, reach out any time through in-app secure messaging or by phone at 1-800-874-5881.

While many heart conditions develop gradually over time, there are others that start before birth. Congenital heart disease refers to a variety of structural problems with the heart that happen while a fetus is still developing. (An individual type of congenital heart disease may also be referred to as a congenital heart defect.) It is the most common birth disorder in the U.S., affecting about 40,000 babies each year, with 800,000 adults living with the condition.

Congenital Heart Disease, Explained

There is a spectrum of severity of congenital heart defects. While about 25% of all babies born with congenital heart disease have a critical heart defect (CHD) that requires surgery or other medical treatment, other types are mild. Take a look at some of the most common congenital heart defects.

In some types of congenital heart disease, the specific causes are unknown. Others have a genetic component and are passed through families. A mother’s health history and lifestyle habits can also affect how a baby’s heart develops in the womb. The following risk factors in a mother have been linked to a baby’s development of congenital heart disease.

Having type 1 or type 2 diabetes, hypertension, obesity, thyroid disorders, or epilepsy

Taking certain medications such as phenytoin and retinoic acid

If you are considering starting a family and have concerns about your baby’s risk of a genetic heart defect, ask your doctor about testing options that may detect a congenital heart disorder during pregnancy. In addition, consult with your doctor if you are unsure if a medication is safe to take during pregnancy.

Congenital heart disease may affect any of the following heart structures:

The right atrium, one of the heart’s two upper chambers which receives blood without oxygen from other parts of the body

The left atrium, the heart’s other upper chamber which receives oxygen-rich blood from the lungs

The right ventricle, one of the heart’s two lower chambers which pumps blood without oxygen from the right atrium to the lungs

The left ventricle, the heart’s other lower chamber which pumps oxygen-rich blood to the rest of the body

Coronary arteries, which supply your heart with oxygen-rich blood

The heart’s four valves, which keep blood flowing properly through the heart

The septum, the wall of tissue separating the left and right sides of the heart

These are the most common types of congenital heart disease affecting U.S. adults. Symptoms, treatment, and diagnostic tests vary by heart defect.

Comprising about 20% of all congenital heart disease cases, ventricular septal defect is the most common congenital heart defect in babies. It is a small or large hole between the ventricles. Treatment depends on the size of the hole. If a hole is larger, surgery may be required within a baby’s first four to six months of life. There is often no additional treatment needed after surgery.

Most infants with ventricular septal defect also have a heart murmur, a swishing sound that is audible with a stethoscope. Other symptoms include fast breathing, high heart rates, frequent sweating, even while at rest, and poor weight gain.

Another common type of congenital heart disease, atrial septal defect is a hole between the atria. Many infants with this defect do not have any symptoms.

In about 80% of cases, the hole closes naturally. If the hole does not close, a child may need surgery or a non-surgical procedure known as an interventional cardiac catheterization. As with ventricular septal defect, this condition typically does not require additional treatment after the first procedure.

Tetralogy of fallot (TOF) is a congenital heart defect in which the wall that separates the ventricles — the ventricular septum — is abnormally positioned, with a hole. It can obstruct the flow of blood through the heart, in some cases causing heart muscle to thicken. All TOF cases require surgery, typically within a baby’s first year of life.

Patent ductus arteriosus involves the connection between the aorta and the heart’s pulmonary artery. While in the womb, a baby’s aorta and pulmonary artery are linked by a blood vessel called the ductus arteriosus, which allows blood to flow directly to the aorta. In healthy babies, the ductus arteriosus naturally closes not long after birth. In babies with this heart defect, the blood vessel remains open, potentially causing heavy blood flow to the lungs. 

There are a variety of treatment options for patent ductus arteriosus, including medications, non-invasive procedures, and surgery. Nonsteroidal anti-inflammatory drugs (NSAIDs) may help close a premature baby’s patent ductus arteriosus but typically aren’t effective for full-term babies, children, or adults. If a baby has minimal symptoms, surgery is often delayed until they are between 6 to 12 months old. However, if a baby is experiencing poor weight gain or rapid breathing, surgery may be recommended during their first six months.

Transposition of the great arteries (TGA)

About 10% of all babies with congenital heart disease have transposition of the great arteries (TGA), a problem with the positioning of the two main arteries that carry blood away from the heart to other organs. Babies born with this condition have low oxygen levels, which may cause a bluish tint to the skin. The condition requires a surgical procedure called an arterial switch operation shortly after birth. In most cases, heart function is restored to normal after surgery.

Aortic valve stenosis is an issue with the aortic valve, from which oxygen-rich blood travels to other parts of the body. In healthy babies, the aortic valve has three flaps that open and shut to accommodate the flow of blood. Babies with this defect may have a small aortic valve or the flaps may not function properly. This structural problem can block the flow of blood from the heart, which can put additional pressure on the left ventricle. Treatment depends on the specific issue with the aortic valve and may include a non-invasive procedure or surgery.

Living with congenital heart disease as an adult

Living with congenital heart disease as an adult varies significantly by individual and by condition, given the wide spectrum of these defects. Most adults with a congenital heart defect are regularly monitored by a cardiologist who specializes in congenital heart disease throughout their lives. In some cases, you may have to take additional precautions to prevent complications related to certain types of congenital heart disease such as the following:

Infective endocarditis, an infection caused by bacteria in the heart lining, or in a heart valve or blood vessel. If untreated, it can lead to a blood clot, heart valve damage, or heart failure

Arrhythmia, an irregular heartbeat which can affect the heart’s ability to pump blood and increase your risk of developing a blood clot

Pulmonary hypertension, high blood pressure in the arteries that run from the heart to the lungs

Care for your heart with support from Alto

At Alto, we make it as simple as possible to manage heart health issues and follow the treatment plan your doctor recommends. We will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to ensure your medications are as affordable as possible. And our team of pharmacists is available to chat whenever questions come up about side effects or how to take your medication properly.

Reach out any time through in-app secure messaging or by phone at 1-800-874-5881.

For many individuals, the journey of living with type 2 diabetes starts early. Once referred to as adult-onset diabetes due to its prevalence among middle-aged and older Americans, the condition has become more common in children, adolescents, and young adults, due in part to growing childhood obesity rates. While some aspects of type 2 diabetes management, like glucose monitoring and healthy lifestyle choices, are important for all age groups, other parts of treatment may change with time. Here’s a snapshot of what type 2 diabetes may look like at each stage of life and tips for living with the condition.

Managing Type 2 Diabetes at Any Age

All type 2 diabetes treatment plans include healthy eating, frequent physical activity, and blood sugar monitoring regardless of age. Depending on a child or adult’s blood sugar levels and overall health, they may also need diabetes medication or insulin therapy to supplement these lifestyle changes. In addition to insulin, two other diabetes medications may be used to treat type 2 diabetes during childhood: metformin, an oral medication, and liraglutide, an injectable medication.

Younger children will need assistance with blood sugar monitoring, and if your child takes insulin, they will also need help with insulin administration. It’s important that teachers or other school staff are able to provide support during school days. Make sure that someone at the school is prepared to administer glucagon if your child’s blood sugar falls below a healthy range (known as hypoglycemia).

Inform your child’s teacher and/or other school staff of your child’s type 2 diagnosis before classes begin. Be sure to discuss daily treatment needs like blood sugar monitoring, insulin therapy, or other medication needs, as well as how to spot the signs and symptoms of low blood sugar. The American Diabetes Association (ADA) has resources that can help you start these conversations.

Living with type 2 diabetes as a young child can be emotionally challenging. It often helps to build connections with other children who are on the same journey. Explore programming for children with type 2 diabetes, like the ADA’s summer camps.

If your child is overweight, their doctor may recommend that you focus on slowing weight gain rather than losing weight since they are still growing. Follow your doctor’s recommendations and look for simple but impactful changes, like swapping carbohydrate-rich foods for a snackable fruit or vegetable, or trading soft drinks and fruit juices for water.

Whether you’ve had type 2 diabetes since childhood or are newly diagnosed, living with the condition as a young adult requires you to take an active role in the management of your health. It’s important to build a relationship with a care team that you trust to avoid any gaps in your treatment. Depending on your treatment plan, you may also have to learn about the logistics of filling prescriptions, ordering diabetes supplies, and coordinating with your insurance company.

Taking on additional responsibilities and navigating life more independently doesn’t mean that you’re completely on your own in managing your diabetes. If parents or another relative previously helped you with blood sugar monitoring, scheduling doctor’s appointments, or other aspects of care, use them as a resource during this transitional period as you become more confident managing your health. You may also want to expand your support system by working with a certified diabetes educator or connecting with other young adults living with type 2 diabetes.

Make sure you understand how other health issues can affect diabetes. For example, the common cold or flu can impact your calorie intake and blood sugar levels, so it’s important to be prepared to manage other illnesses. Alcohol safety is also extra important when living with type 2 diabetes, as alcohol is a factor in your blood sugar levels. For those taking insulin, be mindful of how alcohol use affects insulin therapy.

Build a diabetes care team you trust. In addition to seeing a primary care physician for general health issues, search for an endocrinologist who specializes in diabetes treatment.

Familiarize yourself with all aspects of managing type 2 diabetes, from navigating health insurance to monitoring blood sugar. Consider working with a certified diabetes educator. These are healthcare professionals with extensive knowledge of the condition who can offer individualized support. You can also search for a diabetes education program.

Find opportunities to connect with other young adults learning how to manage type 2 diabetes, like the Beyond Type 2 community.

The progression of type 2 diabetes varies significantly by individual. While many individuals are just beginning the journey of living with the condition in their 30s or 40s, diabetes management may feel like second nature for those who were diagnosed at an earlier age. It’s also possible for a person’s treatment needs to evolve at this stage of life. If lifestyle changes and other medications are effective, you may be tapering off of insulin. Conversely, you may need to begin taking additional medications, such as insulin, in order to manage your diabetes even more effectively. As always, follow your care team’s recommendations for your specific needs.

Regardless of what type 2 diabetes looks like for you, one thing’s for certain: it’s important to stay on top of your care and put your health first even when life is at its busiest. Make sure there’s plenty of room in your calendar for physical activity and doctor’s appointments. If you take insulin, find the right delivery method for your schedule and lifestyle. Many people who work long days in a physical setting find insulin pumps and pens convenient as they eliminate the need to remember the timing of injections.

If you are considering starting a family, your doctor can help you plan to have a healthy pregnancy. Get clarity on your A1C targets — your average blood sugar levels over several months — and how long to maintain them before pregnancy. Once you become pregnant, make a doctor’s appointment as soon as possible to learn about any potential changes to your treatment plan.

Revisit your fitness routine, if needed, to find the right activities for your schedule. If you find it challenging to fit enough exercise into your life — ideally 150 minutes of moderate-intensity aerobic activity per week — try to fit shorter bursts of physical activity into your day. 

If you take insulin, consult with your doctor about insulin delivery options to find the best fit for your needs.

Choose a diabetes pharmacy partner that simplifies your treatment. At Alto, we consolidate all of your medications and supplies into a single monthly delivery, and our mobile app can help you manage all of your diabetes needs in one place.

Preventative care and healthy lifestyle choices take on additional importance when you’re living with diabetes, which increases your risk for other chronic conditions like heart disease, high blood pressure, high cholesterol, and dementia.

Many older adults with diabetes also have high blood pressure, which is linked to a higher risk for strokes and heart attacks as well as vision and kidney function. Stay on top of key numbers like your blood pressure and cholesterol levels, and follow your doctor’s recommendations for treatment. You may also want to ask your doctor about additional screenings related to your mental health or cognitive health, as older adults with diabetes are more likely to experience depression or cognitive impairment. (If caring for an older adult with diabetes, watch for the signs of depression and dementia.)

Stay current with vaccines, including the annual flu shot and the pneumonia vaccine. If you are unsure which vaccines you need, ask your doctor.

Ask your doctor about the recommended frequency of screenings for other health conditions, including cancer screenings and kidney function tests.

Find a loved one to help with insulin administration and recording blood sugar readings, if needed.

Managing diabetes is easier at any age with the right pharmacy partner by your side. The Alto app can help you manage all of your diabetes needs in one place, and our dedicated diabetes support team is here to offer guidance and make sure you have everything you need for your treatment.

Reach out any time through in-app secure messaging or by phone at 1-800-874-5881 to learn how we can support your diabetes care.

Heart failure, which affects approximately 6.2 million U.S. adults, can be a confusing term. Contrary to what many people assume, it does not mean that your heart no longer works, or has stopped beating, but rather that this vital organ cannot pump blood and oxygen as well as a healthy heart.

What to Know About Heart Failure

Heart failure, which affects approximately 6.2 million U.S. adults, can be a confusing term. Contrary to what many people assume, it does not mean that your heart no longer works, or has stopped beating, but rather that this vital organ cannot pump blood and oxygen as well as a healthy heart. While heart failure is a progressive condition with the potential for serious health complications, it can be managed through lifestyle changes and medication. Read on to learn about heart failure symptoms, causes, and treatment options.

In all cases of heart failure, the heart cannot deliver enough blood and oxygen to the rest of your body. Sometimes this is because weakened heart muscle leaves the heart’s main pumping chambers — the ventricles — unable to carry out their pumping function. This type of heart failure is called heart failure with reduced left ventricular function (HF-rEF). In other cases, the ventricles are too stiff to fill with enough blood between beats. This type of heart failure is called heart failure with preserved left ventricular function (HF-pEF).

Ejection fraction (EF) is an important measurement of heart function for those who have heart failure with reduced left ventricular function. Expressed as a percentage, EF measures the amount of blood pumped from the left ventricle when it contracts. An EF of 55 to 70% is considered a healthy range.

Since heart failure is a progressive condition, your EF gives your doctor insight into any changes in your heart function. An echocardiogram is the most common way to measure your EF, but a magnetic resonance imaging (MRI) scan or nuclear stress test may also be used.

Despite the importance of EF, it is not the sole determinant of heart function. Those who have heart failure with preserved left ventricular function may have a normal EF. These cases of heart failure are often caused by high blood pressure, which gradually thickens the ventricles. Stiff ventricles cannot relax enough to fill to their full capacity, which is why they do not pump out enough blood.

Heart failure can affect many other organs, including the lungs, liver, and kidneys. The potential for additional health complications increases as heart disease progresses, which is why it’s important to stay proactive about your health and follow your doctor’s recommendations for treatment.

Heart failure primarily occurs as the result of other health conditions that weaken or stiffen the heart. Coronary artery disease, the most common type of heart disease, is the leading cause of heart failure. The condition gradually narrows and thickens the arteries that supply your heart with blood and oxygen. Severe blockages in the arteries can prevent the heart from pumping enough blood, leading to the development of heart failure.

High blood pressure is another common cause of heart failure, particularly cases of heart failure with preserved left ventricular function (HF-pEF). If you have high blood pressure, your heart has to work harder to deliver blood to the rest of your body. Over time, this can make your left ventricle too stiff to properly pump out blood.

Both type 1 and type 2 diabetes are linked to heart failure, as high blood sugar can affect your blood vessels and cardiac nerves. Heart failure may also be caused by a variety of heart health conditions including cardiomyopathy, congenital heart disease, heart valve disease, and arrhythmias.

Lifestyle factors such as smoking, eating a high-cholesterol or high-sodium diet, heavy alcohol consumption, and a lack of physical activity may increase your risk for heart failure, especially if you have one of the conditions above.

These are some of the most common symptoms of heart failure:

Shortness of breath when exercising or lying down

Fatigue and a feeling of weakness in your legs

Swelling in your ankles, legs, and abdomen

A persistent dry, hacking cough or wheezing

There is a spectrum of severity of heart failure cases, and treatment varies by individual depending upon symptoms and heart function, as well as the underlying cause. If you have early-stage heart failure, your doctor may recommend lifestyle changes and prescribe medications that can alleviate symptoms and prevent the condition from progressing.

The following medication classes, many of which lower blood pressure, are commonly used to treat early stages of heart failure.

Angiotensin converting enzyme (ACE) inhibitors

Often used to treat high blood pressure, ACE inhibitors block production of a hormone that causes blood vessels to narrow, helping constricted blood vessels expand so that more blood can flow through.

Like ACE inhibitors, ARBs protect blood vessels from a hormone that causes them to narrow, lowering blood pressure.

Another medication class commonly used in the treatment of high blood pressure, beta blockers cause the heart to beat more slowly, which lowers your blood pressure and opens up your veins and arteries.

Calcium channel blockers prevent calcium from entering the smooth muscle cells of the heart and blood vessels so that the heart can beat with less force. This opens up narrowed blood vessels and lowers blood pressure.

If you have atrial fibrillation — an irregular heart rate condition — or another heart health condition, your treatment plan for heart failure may include anticoagulants, medications that reduce the blood’s ability to form new clots and prevent existing clots from growing.

Cholesterol-lowering medications such as statins may be used to treat those who have early-stage heart failure and high cholesterol.

Many people with heart disease retain fluid. Diuretics, also referred to as water pills, can help eliminate excess water and sodium, which reduces the heart’s workload.

Small lifestyle changes are an important part of managing mild to moderate cases of heart failure. They can help alleviate symptoms and slow the progression of the condition. Here are some of the lifestyle changes your doctor may recommend.

Avoiding or limiting your caffeine intake

Anyone can benefit from these lifestyle changes, even those who do not have heart failure. Heart-healthy living is a lifelong practice, and the best way to prevent health issues like heart failure in the future is to prioritize your heart health today.

Some individuals with more advanced heart failure may need a procedure such as coronary bypass surgery or an angioplasty, both of which target a blocked coronary artery. Pacemakers may also be used to help control the rhythm of their heart, often in tandem with a bypass surgery and medications. 

Protect your heart with support from Alto

At Alto, we make it as simple as possible to manage your risk for heart health issues and follow the treatment plan your doctor recommends. We will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to ensure your medications are as affordable as possible. And our team of pharmacists is available to chat whenever questions come up about side effects or how to take your medication properly.

While it can be overwhelming to receive a diagnosis of type 2 diabetes, following your doctor’s treatment plan can help you manage the condition and live a healthy and active life. In some cases, lifestyle changes alone can help you keep your blood sugar levels in a healthy range. For other individuals, insulin, oral medication, or a combination of both may also be necessary. Here’s what to know about metformin, one of the most common oral medications used to treat type 2 diabetes.

What to Know About Metformin

Metformin belongs to a class of medications called biguanides, which regulate your blood sugar levels by reducing how much glucose is produced during digestion. Currently, metformin is the only biguanide approved for diabetes treatment in the U.S.

Metformin is taken one to three times a day depending on your dosage and the form of metformin your doctor has prescribed. It is available in the following formulations and strengths:

Immediate-release tablet: 500mg, 850mg, 1000mg 

Extended-release tablet: 500mg, 750mg, 1000mg

Unlike individuals with type 1 diabetes, who are unable to produce any insulin at all and take insulin every day, individuals with type 2 diabetes typically can produce some insulin but experience problems with insulin production. They may not produce enough insulin, or cells in their body may have become resistant to insulin. Metformin does not change the amount of insulin you produce, but it does help counter insulin resistance. If your type 2 diabetes has progressed to a later stage, you may need insulin therapy to manage your blood sugar levels. Metformin is often used alongside insulin therapy at this stage to help the body use insulin more efficiently.

Metformin is also sometimes used off-label to treat polycystic ovary syndrome (PCOS), as insulin resistance may be a symptom of the condition.

Some people experience gastrointestinal issues like nausea and diarrhea as a result of taking metformin, most often when they first begin taking the medication. Taking metformin with meals often helps prevent these side effects. Your doctor may also have you start on a lower dosage of metformin and gradually work up to a larger dosage as an additional precaution against side effects.

There are fewer gastrointestinal side effects associated with the extended-release formulation of metformin. This formulation releases the medication slowly, maintaining a consistent level of the medication in your bloodstream over a longer period of time. If you have concerns about potential side effects of metformin, you may want to ask your doctor if an extended-release formulation of metformin is a good fit for your needs.

Metformin can decrease your levels of vitamin B12, which can lead to anemia — a condition defined by low levels of red blood cells — in rare cases. Your risk for anemia is greater if your diet is low in vitamin B12 and calcium. If you experience symptoms of anemia such as fatigue, dizziness, or lightheadedness, reach out to your doctor for an evaluation of your red blood cell levels.

In rare cases, metformin may lead to lactic acidosis, an uncommon but serious condition in which an accumulation of lactic acid in the body leads to an imbalanced pH level. The chance of this side effect occurring is low, and individuals with impaired kidney function or heart failure are most at risk. To determine if metformin is a good fit for your treatment needs, your doctor will consider your overall health history and possibly order an estimated glomerular filtration rate (eGFR) test, which is a blood test that assesses your kidney function.

Hypoglycemia occurs when your blood glucose levels drop below a healthy range, most often after taking insulin. It is typically caused by not eating enough or exercising too much, and the timing of your insulin doses may also be a factor. These are some common signs of hypoglycemia to watch for:

Coordination problems, clumsiness, and confusion

When taken on its own, metformin typically does not cause hypoglycemia. However, if you take metformin with other diabetes medications including insulin, it’s important to more carefully monitor your blood sugar and be mindful of how your diet, exercise, and alcohol intake can interact with metformin.

To prevent hypoglycemia when taking metformin, be sure to take all of your diabetes medications as prescribed and on schedule, follow your doctor’s recommendations for exercise, and eat a balanced diet. In addition, make sure your doctor has a complete picture of your health history and is aware of all the medications you take.

When your diabetes treatment plan includes multiple medications, staying on top of your prescriptions can be easier said than done. The Alto app can help you manage all of your diabetes needs in one place, and our dedicated diabetes support team is here to offer guidance and make sure you have everything you need for your treatment.

Reach out any time through in-app secure messaging or by phone at 1-800-874-5881 to learn how Alto can be a partner in your diabetes care.

With one in ten Americans living with type 1 or type 2 diabetes and more than 88 million adults living with prediabetes, many more people have a connection to diabetes than it may seem. And whether you are living with diabetes yourself or care about someone who is, or if you simply want to know more about diabetes prevention, there’s no shortage of information to learn or actions to take. Thankfully, there are a variety of resources that can help, from online support groups and events to diabetes education programs and advocacy materials. Explore our diabetes resource round-up below to get started.

Diabetes Resource Round-up

With a mission of improving the lives of everyone affected by diabetes, the American Diabetes Association (ADA) is a comprehensive hub for diabetes research, education, advocacy, and support. The national organization also has local offices throughout the U.S. where you can learn about community resources and events.

Beyond Type 1 and Beyond Type 2 are global online communities for individuals living with diabetes, powered by a nonprofit organization (also named Beyond Type 1) that funds a variety of diabetes research and projects.

Focusing on type 1 diabetes, JDRF is a leader in research and advocacy and a destination for type 1 diabetes support and community. Like the ADA, JDRF has many chapters across the U.S. that offer opportunities to connect locally with those affected by type 1 diabetes.

Founded by an endocrinologist living with type 1 diabetes himself, Taking Control of Your Diabetes is a resource hub for individuals and families affected by diabetes as well as medical professionals seeking to stay informed of the latest developments in diabetes care.

ADA engagement platform, with opportunities to take action and raise awareness

Association of Diabetes Care & Education Specialists (ADCES) legislative action center

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Congenital Heart Disease, Explained

Managing Type 2 Diabetes at Any Age

What to Know About Heart Failure

What to Know About Metformin

Diabetes Resource Round-Up

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