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Hypercoagulation, or excessive blood clotting, can be treated with anticoagulants — a class of medications that reduce the blood’s ability to form new clots and prevent existing clots from growing.

How Anticoagulants Prevent Blood Clots From Forming

Blood clotting to stop bleeding, or coagulation, is a normal part of the body’s healing process after a cut or other type of injury. However, excessive blood clotting, or hypercoagulation, may occur when clots form too easily while blood moves normally through the body. Hypercoagulation can be serious: when a blood clot develops in the arteries, it may lead to a stroke, heart attack, leg pain, or other serious health complications.

Some people are born with a tendency to form blood clots, while in other cases the condition may develop as a result of surgery, trauma, a medical condition, or prescription medication usage.

Medical conditions that may lead to hypercoagulation include:

Atrial fibrillation, an irregular heart rate condition 

Heart attack, congestive heart failure, stroke, and other illnesses that lead to less physical activity

Antiphospholipid syndrome, a condition in which the immune system mistakenly creates antibodies that make your blood more likely to clot

Previous history of deep vein thrombosis — typically a blood clot in the deep veins in your legs — or pulmonary embolism — a blood clot in the arteries in your lungs

Bone marrow and blood diseases including polycythemia vera, a blood cancer that thickens your blood, and essential thrombocytosis, a rare disorder in which your body produces too many platelets

Paroxysmal nocturnal hemoglobinuria, a rare blood condition in which your immune system attacks red blood cells

Nephrotic syndrome, a kidney disorder in which the urine contains too much protein

Medications that may lead to hypercoagulation include:

Supplemental estrogen, including birth control pills and hormone replacement therapy

Certain cancer medications such as tamoxifen, a breast cancer medication that activates estrogen in bone and liver cells; bevacizumab, a medication used to treat a variety of cancers and which blocks a protein responsible for blood vessel production; thalidomide, a medication used to treat a variety of cancers of which blood clots are a known side effect, particularly for patients 65 and older; and lenalidomide, a medication used to treat certain blood cancers of which blood clots are a known side effect

With many of these medications, the risk of developing blood clots is low, but individuals with a previous history of blood clots or an underlying condition linked to hypercoagulation face a greater risk. 

If you are prescribed one of these medications, be sure to inform your doctor of your medical history, including any other medications you currently take, and ask about the potential benefits and risks of using them. And if you experience any of the primary signs of a blood clot — shortness of breath, chest pain, or leg pain or swelling — contact your doctor immediately.

Hypercoagulation can be treated with anticoagulants, a class of medications that reduce the blood’s ability to form new clots and prevent existing clots from growing. These medications are primarily prescribed when a blood clot develops in a vein or artery or as a preventative measure for people who face a higher risk for blood clots due to an underlying medical condition. They work by interrupting the body’s natural blood clotting process.

There are three main types of anticoagulant medications that act on different parts of the blood clotting process to prevent irregular blood clots: vitamin K antagonists, direct oral anticoagulants (DOACs), and low-molecular weight heparins.

Vitamin K, commonly found in green leafy vegetables such as broccoli and spinach, helps your blood clot. Warfarin (brand name options include Coumadin® and Jantoven®) — one of the most common treatments for blood clotting disorders — is a vitamin K antagonist that prevents your liver from processing vitamin K into “factors,” or proteins that control your bleeding and help form blood clots. It is taken orally as tablets.

Warfarin is so commonly prescribed because of its proven effectiveness: it has been in use longer than other anticoagulants and reduces the rate of stroke in people with atrial fibrillation by 60%. It is also easier than other anticoagulants to reverse if you experience sudden bleeding from an injury or during surgery.

Because warfarin is so effective at preventing blood clotting, one of the main side effects is bleeding. The risk of serious bleeding is low, but you may bleed or bruise more easily after even small injuries. Difficulty stopping a nosebleed is also common.

Contact your healthcare provider if you experience heavy bleeding or bruising, including heavier than normal menstrual bleeding, and seek immediate medical attention if you experience any of the following symptoms:

Joint pain, discomfort or swelling, especially after an injury

Bruising that develops without an injury you remember

You will need to get frequent blood tests when taking warfarin to evaluate blood clotting and the medication’s effectiveness. Your doctor may choose to adjust your dosage based on your test results, which is why it's important to stay up to date with lab appointments.

Here are additional tips to avoid side effects and complications while taking warfarin:

Wear a medical ID bracelet to ensure that you receive proper medical care in an emergency situation.

Anticoagulants can interact with other medications. Speak to your doctor before taking any other medication, including over-the-counter medications or supplements.

Warfarin is not safe to take during pregnancy. If you are planning to become pregnant, speak with your doctor about switching to an alternate medication.

Consult with your doctor about dietary recommendations, as certain foods, particularly those that are high in vitamin K, can affect how warfarin works.

Direct oral anticoagulants (DOACs) like apixaban (Eliquis®), betrixaban (Bevyxxa®), dabigatran (Pradaxa®), edoxaban (Savaysa®), and rivaroxaban (Xarelto®) directly block the blood’s ability to form clots. They are the newest class of anticoagulants, having been first introduced into the market in 2010.

These medications offer some advantages in contrast to other anticoagulants. Unlike warfarin, they do not require regular lab work. They are also less likely to interact with food, so there aren’t any dietary restrictions. There are FDA-approved antidotes for dabigatran, apixaban, and rivaroxaban to stop excessive bleeding in the event of trauma or emergency surgery.

On the other hand, DOACs are shorter-acting than vitamin K antagonists, so missing even one dose can make you vulnerable to blood clot formation.

The most serious side effect to watch for is uncontrolled bleeding, though it is rare. Contact your healthcare provider if you experience heavy or unusual bleeding or bruising.

Some studies also suggest that DOACs may be unsafe to take while pregnant. If you are planning on getting pregnant, speak with your healthcare provider about alternate medications.

Avoid taking nonsteroidal anti-inflammatories (NSAIDs) like aspirin, ibuprofen, and naproxen while taking a DOAC, and wear a medical ID bracelet to ensure proper medical treatment in the event of an emergency.

This medication class, which includes dalteparin (Fragmin®) and enoxaparin (Lovenox®), is primarily used for short periods of time to treat or prevent a deep vein thrombosis — a blood clot in the body’s deep veins, often in the legs. It can also reduce your risk of pulmonary embolism, a blockage in your lung arteries as the result of a blood clot.

In contrast to other anticoagulants, LMWHs are often used as a bridge to longer-term use of another anticoagulant such as warfarin, though some people take LMWHs for longer periods of time. They can be administered via IV drip in hospitals or doctors’ offices or through subcutaneous injections at home once or twice a day. No blood tests are required.

Redness, irritation, and bruising at the site of infection

Consult your doctor about the potential risks and benefits of taking an LMWH, and make sure they are aware of any other medications you take. In particular, NSAIDs can increase your risk of bleeding while taking LMWHs.

Choose a reliable and flexible pharmacy partner

Alto makes it as simple as possible to follow the treatment your doctor recommends. We offer same-day delivery and medication management tools like dose reminders and auto refills in our app. Our team of patient care pharmacists is also available to walk you through dosage instructions and answer your questions. Reach out by phone at 1-800-874-5881 or in-app messaging to get started.

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.

EMD Serono has several patient assistant programs designed to reduce the cost of fertility treatment, including special opportunities for military veterans and cancer survivors.

A Guide to EMD Serono’s Financial Assistance Programs for Fertility Medication

Fertility preservation treatments like egg freezing and IVF are significant investments, both emotionally and financially. Fertility medications used to support egg production, retrievals and implantations often contribute to these expenses. 

At Alto, we support your financial well-being alongside your physical health, working with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to make your 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.

If Alto is your fertility pharmacy, your fertility medication protocol likely includes medications manufactured by EMD Serono. EMD Serono has several patient assistant programs designed to reduce the cost of fertility treatment, including special opportunities for military veterans and cancer survivors.

Read on to learn more details about eligibility for EMD Serono patient assistant programs and how to apply. You can also read our previous post on managing the costs of fertility treatment to learn about Alto’s additional financial support for fertility treatment and medications.

The EMD Serono Compassionate Care program provides discounted medication to eligible self-pay patients pursuing fertility treatment based on financial need or military status. 

Compassionate Care provides discounts off the self-pay price of EMD Serono fertility medications, including: 

for income-based eligible patients, savings of up to 50%

for active, retired, and veteran military, a minimum of 10% off based on income up to 50% off. 

Eligibility is based on your annual gross household income and first-time participation in the Compassionate Care program. 

Compassionate Care covers the following treatments: 

Gonal-f® RFF* Redi-ject™ pen 300 IU, 450 IU and 900 IU

Gonal-f® Multi-Dose vial 450 IU and 1050 IU

The Compassionate Care program is available only at participating pharmacies and patients must present a valid prescription for an eligible drug. The program is available for multiple cycles each calendar year for eligible patients. You must reapply each year.

View additional program details and apply here.

The EMD Serono Compassionate Corps program provides free medication to eligible, uninsured veterans injured in the line of duty or their spouses. To be eligible, you must be a retired military veteran or the spouse of a veteran who meets the following criteria:

Is infertile due to a service-related injury

Is not privately or publicly insured for infertility medications

Has been diagnosed by a physician as infertile and requiring in-vitro fertilization (IVF)/assisted reproductive technology (ART)

Is not eligible for coverage under the Fertility Veterans Act

The program is available for up to two cycles per calendar year. You must reapply each year.

Download the Compassionate Corps application.

If you’re a veteran who does not qualify for Compassionate Corps, you may still qualify for the Compassionate Corps program to receive up to 50% off your medications through the Compassionate Care program.  

Certain types of cancer can affect fertility in both men and women, whether it’s due to the removal of organs related to reproduction or a change in hormone levels following treatment. If you are considering starting a family after your cancer treatment, fertility preservation options can make it easier to conceive.

To help ease the financial burden of this process, EMD Serono donates fertility medications to eligible cancer survivors diagnosed during their reproductive years through the Livestrong Fertility Discount program.

Start the application process on Livestrong’s website to learn if you are eligible.

A fertility pharmacy partner you can rely on

Alto is here to make your experience with fertility preservation treatments as stress-free as possible. We offer free same-day delivery of your medications and fertility resources like personalized injection guide videos and one-on-one consultations with fertility-trained pharmacists.

To get a price quote specific to your fertility medication protocol, complete our online form.

Editors's note: this post was originally published in August 2021 and has been updated for accuracy and completeness.

EMD Serono’s Financial Assistance Programs for Fertility Medication

With effective treatment, including blood pressure medications, you can live an active life. Learn about the common blood pressure medications and their side effects.

Common Types of Blood Pressure Medications

High blood pressure, which affects nearly half of all U.S. adults, occurs when the force of the blood flowing through your arteries is consistently too high, forcing the heart to work harder. Over time, high blood pressure can damage major organs including the heart, brain, kidneys, and eyes and lead to life-threatening issues like heart disease, heart attack, and stroke.

With effective treatment, including both heart-healthy lifestyle habits and prescription blood pressure medications, you can control your blood pressure and live an active life. There are a variety of blood pressure medications, and it may take some time for you and your doctor to determine the best treatment for your needs. The good news is that with so many available and effective medications, you’re likely to find one that’s right for you. Read on to learn more about the most common classes of blood pressure medications and their side effects.

Diuretics lower blood pressure by helping the body get rid of excess sodium and water, reducing the volume of fluid in blood vessels. They are often a frontline treatment for high blood pressure, as research studies have found them to be one of the most effective blood pressure medication classes at preventing stroke and heart attack fatalities.

Diuretics commonly used to treat high blood pressure include:

Chlorthalidone (Thalitone®, Tenoretic®, and Clorpres®)

Hydrochlorothiazide (HydroDiuril®, Microzide®, and Esidrix®)

Common side effects of diuretics include dehydration, thirst, low sodium levels, headaches, and dizziness. In some cases, drinking more fluids isn’t enough to treat dehydration. Contact your doctor if you experience severe thirst, mouth dryness, or constipation; if your urine is a deep yellow; or if you have a bad headache. Taking multiple medications may exacerbate these side effects. To minimize medication interactions, speak with your doctor about the ideal timing of doses for each medication.

Some diuretics decrease your potassium levels, in which case you may experience weakness, leg cramps, or fatigue. Eating potassium-rich foods can help combat these side effects. Consult with your doctor about taking potassium supplements if you experience any of these symptoms.

Diuretics may increase blood sugar levels in people with diabetes. Adjusting your diet or the dosages of your diabetes medication(s) often addresses this issue. Learn more about how Alto can support your diabetes treatment.

Beta blockers cause the heart to beat more slowly and less forcefully, lowering your blood pressure. They also help improve overall blood flow by opening up your veins and arteries.

Beta blockers commonly used to treat high blood pressure include:

Common side effects from taking beta blockers include:

Beta blockers may block signs of low blood sugar such as a rapid heart rate in people with diabetes. If you have diabetes and take insulin, it’s important to check blood sugar levels often while taking beta blockers.

These medications may also affect your cholesterol and triglyceride levels. Most often, they cause a modest increase in triglycerides, a type of fat found in your blood, and a slight decrease in HDL (high-density lipoprotein), or “good” cholesterol. These changes are usually temporary.

Beta blockers aren’t typically used by people with asthma, as they may trigger severe asthma attacks. Abruptly stopping use of beta-blockers may increase your risk of a heart attack or other health complications, especially if you have been taking the medication for a long time. Consult with your healthcare provider about the potential risks and benefits of treating your hypertension with beta-blockers.

ACE inhibitors lower blood pressure by blocking production of a hormone called angiotensin II, which causes blood vessels to narrow. These medications help constricted blood vessels expand so that more blood can flow through.

ACE inhibitors commonly used to treat high blood pressure include:

A chronic dry, hacking cough is one of the most common side effects of ACE inhibitors, affecting as many as 35% of people who take these medications. Researchers aren’t entirely sure why some people experience this side effect and not others, but the following factors may contribute to it:

Gender — women tend to be more susceptible

Studies have found that a combination of two or more of the factors above is needed to produce the side effect.

Cough medicines typically aren’t effective at treating an ACE inhibitor-related cough. In some cases, this side effect may improve on its own. If you are experiencing a cough from taking ACE inhibitors, the best course of action is to discuss the pros and cons of switching to another medication with your doctor.

Additional possible side effects of ACE inhibitors include:

ACE inhibitors can harm both mother and baby during pregnancy. If you’re taking an ACE inhibitor and think you might be pregnant, speak with your doctor immediately.

Like ACE inhibitors, angiotensin II receptor blockers (ARBs) also protect blood vessels from the hormone angiotensin II. Angiotensin II must bind with a receptor site to constrict blood vessels. ARBs block the receptors to prevent blood vessels from tightening, which lowers blood pressure.

ARBs commonly used to treat high blood pressure include:

ARBs may produce harmful interactions with other medications. This medication class should not be taken with an ACE inhibitor, as the combination can lead to a greater risk for low blood pressure, kidney damage, and high potassium levels. Speak with your doctor before taking painkillers like ibuprofen or naproxen, as these medications may interact with ARBs to increase your potassium levels.

ARBs are not safe to take during pregnancy, as they can severely harm a developing fetus. If you think you might be pregnant, consult with your doctor immediately.

Calcium channel blockers prevent calcium from entering the smooth muscle cells of the heart and blood vessels. Decreasing the calcium in these cells makes the heart beat with less force, opening up narrowed blood vessels and lowering blood pressure.

Calcium channel blockers commonly used to treat high blood pressure include:

Diltiazem (Cardizem CD®, Cardizem SR®, Dilacor XR®, Tiazac®)

Verapamil (Calan SR®, Covera HS®, Isoptin SR®, Verelan®)

Possible side effects of calcium channel blockers include:

The body releases hormones called catecholamines in response to stress. When these hormones bind to parts of cells called alpha-receptors, blood vessels narrow, causing the heart to beat faster and more forcefully. This leads to an increase in blood pressure.

Alpha blockers prevent catecholamines from binding to alpha-receptors so that blood can flow more freely, which also helps the heart beat more normally. This helps control blood pressure.

Alpha blockers commonly used to treat high blood pressure include:

Possible side effects of alpha blockers include:

A drop in blood pressure when you stand up

Consult your doctor about the potential risks and benefits of taking an alpha blocker. These medications have been known to interact with other medications like beta blockers, calcium channel blockers, and medications for erectile dysfunction, increasing or decreasing their effects. Make sure your doctor is aware of any other medications you take.

When combined, alpha blockers and beta blockers prevent catecholamine hormones from binding to both alpha and beta receptors. These medications decrease the constriction of blood vessels and make the heart work less forcefully.

Alpha-beta blockers commonly used to treat high blood pressure include:

Common Types of Blood Pressure Medications 

With effective treatment, including both heart-healthy lifestyle habits and prescription blood pressure medications, you can control your blood pressure and live an active life. Read on to learn more about the most common classes of blood pressure medications and their side effects.

Chronic obstructive pulmonary disease (COPD) is a progressive and long-term inflammatory lung condition characterized by a persistent cough and shortness of breath. Read on to learn more about the stages of COPD, including the symptoms and treatment options for each stage.

What to Know About the Four Stages of COPD

Chronic obstructive pulmonary disease (COPD) is a progressive and long-term inflammatory lung condition characterized by a persistent cough and shortness of breath. While COPD is caused by smoking 85-90% of the time, exposure to secondhand smoke, air pollution, and industrial dust and fumes also contributes to cases. It’s the third leading cause of death in the U.S. and affects more than 15 million Americans.

Detecting COPD early on is critical to slowing the progression of the disease and avoiding serious complications. Doctors use a system called the GOLD Criteria to determine how severe each person’s COPD is. There are four distinct stages of COPD: mild, moderate, severe, and very severe. Your physician will determine your stage based on results from a breathing test called a spirometry, which assesses lung function by measuring how much air you can breathe in and out and how quickly and easily you can exhale. They will also consider the severity of your symptoms and the frequency of flare-ups.

As a progressive lung disease, COPD symptoms gradually become more severe over time, and people with COPD also grow increasingly susceptible to complications such as heart problems, pulmonary hypertension, and lung cancer. But while there is no cure for the condition, it is treatable: you can slow the progression by working with your doctor to establish a treatment plan and maintaining healthy lifestyle habits like avoiding cigarette smoke, exercising regularly, eating a healthy diet, and getting your yearly flu shot.

Read on to learn more about the stages of COPD, including the symptoms and treatment options for each stage.

The main symptoms of stage 1 COPD are shortness of breath and an ongoing cough, which may be accompanied with mucus. However, these symptoms are so mild that you may not realize you are experiencing them. 

Though stage 1 COPD symptoms are easy to miss, damage to the lungs still occurs. If you have any concerns that you may have COPD, speak with your doctor about an assessment. And if you currently smoke, try to quit as soon as possible to protect your lungs.

In addition to smoking cessation, your doctor may also prescribe a bronchodilator medication, which relaxes airway muscles to ease breathing and is typically taken through an inhaler. Common side effects include dry mouth, dizziness, tremors, runny nose, and throat irritation. If you experience severe side effects like blurry vision, a rapid or irregular heart rate, or an allergic reaction with a rash or swelling, contact your healthcare provider.

You should also stay up to date with yearly flu shots and pneumonia vaccines to avoid worsening of respiratory symptoms and other health complications.

In this stage, previously existing symptoms from stage 1 intensify as airflow limitations progress. Shortness of breath during physical activities is more noticeable, and coughing and mucus production may increase. Other symptoms include wheezing, fatigue, and trouble sleeping.

This is often the stage where you may first become aware of symptoms and seek treatment. Your doctor may prescribe a bronchodilator medication if they haven’t already, along with recommending breathing exercises. Techniques like pursed lip breathing and coordinated breathing can help you exert yourself less during physical activities and maintain an active lifestyle.

In addition to your medications, pulmonary rehabilitation is another common component of treatment for stage 2 COPD. It gives people living with COPD the tools they need to manage their condition, reducing the severity of symptoms and improving their quality of life. At these outpatient exercise and education programs, physical therapists, dietitians, nurses, and other healthcare professionals will share breathing techniques, coping strategies, nutritional advice, and exercise recommendations. Your doctor can help you determine if pulmonary rehabilitation is right for you.

The frequency of your doctor’s appointments depends on the severity of your condition. If symptoms are mild, you may have follow-up appointments every six months, while more severe symptoms will require more frequent monitoring.

At stage 3, lung function has significantly decreased. As the walls of the air sacs in the lungs continue to weaken, it becomes more difficult to take in oxygen and remove carbon dioxide while exhaling.

Previous symptoms are more intense and more noticeable: shortness of breath has worsened, coughing or wheezing occurs more frequently, and you may produce thicker mucus.

You may also experience the following symptoms:

In this stage, you may experience flare-ups when symptoms suddenly become more severe and lung function dramatically changes. During these exacerbations, you may feel greater amounts of mucus clogging your bronchial tubes and sudden constrictions of the muscles around your airways.

Flare-ups are the leading cause of COPD-related hospitalizations, and it’s important to take immediate action if you experience symptoms of a flare-up. Watch out for the following signs:

Wheezing or whistling noises when you breathe

Cognitive impairment including confusion, depression, or memory lapses

As part of your COPD treatment, your doctor will help you develop an action plan for managing flare-ups, including medications. Oral steroids including prednisone, methylprednisolone, and dexamethasone can treat acute COPD exacerbations. Side effects from short-term use of these medications are typically minor, if they occur. 

If you have frequent flare-ups, your doctor may prescribe inhaled corticosteroids including Flovent® HFA and Qvar Redihaler®; expectorants, which thin and loosen mucus; or oxygen therapy. You may also need to see your doctor every two weeks to a month for ongoing monitoring of symptoms.

In stage 4 of COPD, lung function is very low. Stage 3 symptoms worsen and become more persistent. Shortness of breath and chest tightness occur with everyday activities, and it becomes a big effort just to breathe. Hospitalizations for breathing complications, lung infections, or respiratory failure are common during stage 4 COPD, and sudden flare-ups can be life-threatening.

Pulmonary hypertension, a form of high blood pressure that affects the arteries in your lungs and the right side of your heart

There are various treatment options for severe COPD symptoms, including supplemental oxygen, pulmonary rehabilitation, and steroids taken orally, intravenously, or via inhaler. Potential side effects from steroids include swelling in the airways and mouth, muscle weakness, weight loss, fatigue, and increased risk for pneumonia. Read our previous blog to learn more about managing medication side effects, and speak with your doctor if you have questions or concerns.

Supplemental oxygen, or oxygen therapy, helps get more oxygen into your lungs and increases your tolerance for physical activities. There are several devices for oxygen therapy. The most common is a nasal cannula, a device with two small tubes that fit into your nostrils and a connected oxygen tank. Adjusting to supplemental oxygen is a process, but you’ll come to feel more and more comfortable with time. The American Lung Association has helpful resources for anyone starting oxygen therapy.

Lung surgery or lung transplants are also options for some people with severe COPD. Eligibility is based on many factors, including participation in a pulmonary rehabilitation program, lung function tests, and additional considerations such as whether you are strong enough for the procedure and if you smoke. (You cannot be a current smoker for lung surgery eligibility.) Your doctor can help you determine if lung surgery is right for you.

Detecting and treating early-stage COPD is essential to slowing the progression of the disease. If you are experiencing any early warning signs like shortness of breath and a persistent cough, make an appointment with your doctor to determine what’s causing your symptoms. Early COPD screening is especially important if you smoke since you face a greater risk of developing this lung disease.

Many people struggle with quitting smoking, so don’t be afraid to ask your doctor for resources that can help, including nicotine replacement products or medications. The CDC has a variety of smoking cessation resources to help as well.

Get the treatment you need to slow the progression of COPD

Sticking to the treatment your doctor has recommended is critical to avoiding COPD flare-ups and slowing the progression of the disease. At Alto, we make that as easy as possible by offering free hand-delivery, automatic savings investigations, and easy medication management tools through our website and app. And our team of pharmacists is always here to answer your questions by phone or in-app messaging. 

To learn how Alto can support your COPD treatment plan, you can reach out via phone at 1-800-874-5881 or in-app messaging. 

In the event of a hypoglycemia emergency, a hormone called glucagon can help people with diabetes restore their blood sugar to a healthy range. Here’s what to know about hypoglycemia and the purpose of glucagon in diabetes treatment.

The Purpose of Glucagon in Diabetes Treatment

For people with diabetes, monitoring blood sugar levels is a balancing act. In general, diabetes causes higher levels of blood sugar because the body lacks insulin. Without the right treatment, high blood sugar can lead to serious health complications in the long term, including cardiovascular disease, kidney disease, and vision loss.

At the same time, people with diabetes who take insulin as part of their treatment face an increased risk for low blood sugar, or hypoglycemia. This is a serious health concern in its own right, as severe hypoglycemia episodes can lead to seizures or the loss of consciousness.

The role of insulin in diabetes treatment

Insulin can help manage both of the two main types of diabetes, type 1 and type 2 diabetes. People with type 1 diabetes, which often begins during childhood or adolescence, cannot produce any insulin at all, so they need insulin injections every day to control their levels of blood glucose.

Type 2 diabetes, which develops gradually due to a mixture of genetic, lifestyle, and environmental factors, involves two key problems with insulin production: cells in the body become resistant to insulin, and the pancreas cannot produce enough insulin to regulate levels of blood glucose. It may be possible to manage early-stage type 2 diabetes with oral medication and healthy lifestyle habits, but many people with more advanced type 2 diabetes take insulin injections to manage their blood sugar.

Insulin must be injected into the fatty tissue under your skin to reach the bloodstream. It may be administered with a syringe, pen, or pump. Read our previous blog for an overview of insulin in diabetes treatment.

Blood sugar targets and insulin reactions

Blood sugar naturally fluctuates throughout the day depending on calorie intake, physical activity, and other factors including stress and sleep. The goal of insulin therapy is to keep your insulin levels as steady as possible to avoid rapid changes in your blood glucose levels. However, blood sugar can fall outside of the healthy range, even with the right dosage of insulin.

An insulin reaction — also referred to as hypoglycemia — is when your blood glucose levels drop below a healthy range after taking insulin. The main causes of hypoglycemia are not eating enough or exercising too much. The timing of your insulin dose can also cause blood sugar to drop.

For many people with diabetes, hypoglycemia occurs when their blood sugar is less than 70 mg/dL. However, diabetes treatment plans are individualized, and you may have a different blood sugar target range. Your healthcare provider can help you develop your own targets and determine what too low means for you.

Individual reactions to low blood sugar vary, so it’s important to take note of your symptoms as they occur and learn your own signs of hypoglycemia. Below are common signs to watch for.

Coordination problems, clumsiness, and confusion

The only way to confirm that you are experiencing hypoglycemia is to check your blood sugar with a blood glucose meter or a continuous glucose monitor (CGM). However, if you are experiencing signs of low blood sugar and unable to check blood sugar levels, treat symptoms with high-sugar foods or drinks.

The 15-15 rule for treating mild hypoglycemia

Generally speaking, mild hypoglycemia occurs when your blood sugar is between 55-69 mg/dL. It can often be treated by following the 15-15 rule: eat fifteen grams of carbohydrates to restore blood sugar levels to a healthy range and check your levels again after fifteen minutes. If your blood sugar is still below 70 mg/dL or your own personal target, eat fifteen more grams of carbohydrates. Repeat these steps until your blood sugar is back to normal, then eat a meal or snack to maintain it.

Consuming the following items may help raise your blood sugar:

4 ounces (½ cup) of juice or regular soda (not diet)

Young children with diabetes typically need less than 15 grams of carbohydrates to raise low blood sugar. If your child has diabetes, work with your healthcare provider to develop an individualized treatment plan.

Severe hypoglycemia and the purpose of glucagon

Severely low blood sugar — 55 mg/dL or less for many people with diabetes — cannot be treated with the 15-15 rule. This is where glucagon comes into play. The purpose of glucagon is to restore blood sugar during these episodes of severe hypoglycemia.

Ideally, working with your doctor to monitor blood sugar levels can help you avoid severe hypoglycemia. However, it’s important to be prepared in the event of an emergency. Glucagon is available by prescription and can be administered as a nasal spray or injection. There are several FDA-approved medication options for glucagon, including GlucaGen®, Eli Lilly’s Glucagon Emergency Kit for Low Blood Sugar, Gvoke®, ZEGALOGUE®, and a generic option approved in December 2020.

 If you have a glucagon prescription, check the expiration date and make sure there’s at least a year of remaining shelf life. Friends, family, co-workers, and anyone else you spend a lot of time with should know where to find your glucagon and how to administer it. Make sure they also know to contact a doctor immediately after emergency glucagon administration.

Blood sugar monitoring and preventing hypoglycemia

Regular monitoring of blood sugar can help you stay within your target range and understand how factors like food, physical activity, medications, and stress affect your blood sugar levels. Depending on your insulin dosage, you may need to check and record your blood sugar multiple times a day, including before and after meals and at bedtime. Your doctor will let you know when to check your blood sugar. It's important to follow the schedule your doctor has recommended and to keep a daily record of your blood sugar levels.

If you find that your blood sugar often falls below your normal range, share your blood sugar numbers with your healthcare provider, along with any relevant information on physical activity and diet. They can help you identify patterns and recommend adjustments to your treatment to keep your blood sugar in balance.

We’re here to support your diabetes care plan

We understand how overwhelming diabetes treatment may feel at first. While health risks like hypoglycemia can be serious, a strong care team can help you stay on top of blood sugar monitoring and confidently manage your diabetes.

Alto is more than just a pharmacy — we’re a partner in your diabetes care. We have a dedicated diabetes support team to ensure that you have everything you need to follow through on your individualized treatment plan. Learn more here or reach out at any time by phone at 1-800-874-5881 or in-app secure messaging.

Managing your fertility medications can be stressful but learning more about their purposes and side effects can help with peace of mind. Let’s take a closer look at the main types of fertility medications.

Fertility Medications 101

There are many paths to parenthood. For some, the journey includes fertility treatments like egg freezing or in vitro fertilization (IVF), which help millions of individuals preserve their fertility options or conceive. And while these procedures can help you start the family you’ve always dreamt of, the process can sometimes feel like an overload of information and new things to learn.

Fertility medications are often one of the more overwhelming parts of the journey as they are prescribed on a tightly-timed schedule with specific doses based on hormone levels. Your doctor may decide to change your prescriptions throughout the process based on ultrasounds and bloodwork.

Managing your medications, which are often taken as nightly injections, can be stressful and may take some getting used to. However, learning more about the purposes and side effects of your fertility medications can help with peace of mind. Let’s take a closer look at the main types of fertility medications used for egg freezing and IVF.

The main goal of egg freezing is to retrieve as many mature eggs as possible from your ovaries: the more eggs you have, the higher your chances are of fertilizing one or more eggs and becoming pregnant as a result of IVF. This process involves ovary stimulation to induce follicle growth and egg production.

Stimulation medications used in egg freezing contain three important hormones that cause the ovaries to mature and release eggs: follicle stimulation hormone (FSH), luteinizing hormone (LH), and human chorionic gonadotropin (hCG). Your doctor may prescribe some of the following commonly used stimulation medications:

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