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Traveling with any type of medication requires advanced planning. For those with diabetes, it’s even more imperative to prepare, as there are additional factors to consider like insulin temperature control and TSA screening of diabetes supplies and equipment. Use the suggestions below to make sure you have everything you need to manage your diabetes while away from home.
Consulting your doctor

Traveling With Diabetes: How to Prepare

Traveling with any type of medication requires advanced planning. For those with diabetes, it’s even more imperative to prepare, as there are additional factors to consider like insulin temperature control and TSA screening of diabetes supplies and equipment. Use the suggestions below to make sure you have everything you need to manage your diabetes while away from home.

Schedule an appointment with your diabetes care provider before your trip to make a plan for diabetes management during your travels. Be sure to cover the following:

How will planned activities impact your care needs?

What is the recommended frequency of blood sugar monitoring?

How might changing time zones impact the timing of your insulin dosage? 

Are there any recommended vaccines for your trip?

Keep in mind that eating and physical activity levels can shift during travel — sometimes unexpectedly — so it’s important to prepare for changes in your blood glucose levels.

Travel doesn’t always go as planned, so it’s important to have extra diabetes supplies and medication on hand. A good rule of thumb is to pack twice as many supplies as you think you’ll need and to bring additional paper prescriptions for insulin or other diabetes medications.

If traveling internationally, be mindful that prescription laws vary by country. It’s a good idea to contact the U.S. embassy of the country you’re visiting for more details. Some countries may only allow a 30-day supply for certain medications and/or require you to carry an official prescription or additional information from your doctor with you.

In addition, keep your health insurance card on you throughout the duration of your travels, and review your policy for travel-related details, including whether your destination is included in your provider network.

Here’s a list of potential diabetes medications and supplies to pack. Depending on your diabetes treatment plan, some may not be relevant for you. If you’re unsure what to bring — or how much to bring — ask your diabetes care team.

Enough insulin and syringes for your trip, plus extra

Enough oral medications for your trip, plus extra

Sources of glucose to restore blood glucose levels in the event of low blood sugar, or hypoglycemia, such as over-the-counter glucose tablets (Lift Glucose Chews, TRUEplus® Glucose Tablets, ReliOn™ Glucose Tablets), over-the-counter glucose gel (Dex4® Glucose Gel, Glutose™ 15/Glutose™ 45, Insta-Glucose®), or carbohydrate-rich snacks like dried fruits, trail mix, honey, or granola bars

For a detailed list of diabetes management essentials, read How to Prepare a Diabetes Emergency Kit.

If you are traveling on a longer flight with meal service, contact your airline and ask if it’s possible to request a meal tailored to your dietary needs, with low sugar, fat, and cholesterol values. Be sure to have other food on hand in case there are any issues with your meal.

Make sure others know that you have diabetes. If traveling with others, inform them of what to do in the event of a hypoglycemia emergency. If traveling alone, have a medical ID bracelet or another form of identification that communicates your diabetes diagnosis. You should also carry a list of your current medications and doses and provider contact information.

It’s always best to pack important medications in your carry-on rather than in a checked bag. Since you’ll be bringing additional supplies and medications as a back-up, make sure at least half of them are in your carry-on.

While the U.S. Transportation Security Administration (TSA)’s current limit on liquids, gels, and creams in a carry-on bag is 3.4 ounces (100 milliliters), there are exceptions for diabetes supplies and medications. Give yourself extra time to allow for additional screening of these items. If you use a diabetes device attached to your body, such as an insulin pump or glucose monitor, it will likely require additional screening as well.

Here are some tips that may help you get through security as efficiently as possible.

Inform the TSA officer that you are carrying more than 3.4 ounces of liquid medication before your screening process begins, if applicable.

Consider printing a TSA notification card describing your condition to hand to the TSA officer.

Bring a copy of your prescription(s) with you.

Keep all medications and supplies in their original packaging.

Put your medications and supplies in a separate, clear bag, as they will need to be separated from the rest of your belongings.

If you take insulin, make sure you have what you need to keep it refrigerated. Keep in mind that insulin should not be held at extreme temperatures and storing it in an ice pack can make it unusable. Many people with diabetes use insulated medication bags to hold insulin at an appropriate temperature when traveling.

Read Taking Care of Your Insulin to learn more about safe insulin storage.

It’s important to stay proactive about your diabetes management. There may be times when you have to check your blood sugar even more frequently, for example, if you are more active than usual, and adjust your meal plans accordingly. Keep in mind that hot weather can also impact your body’s insulin use and your blood sugar levels.

Continue to hold insulin at an appropriate temperature during your travels and avoid leaving it in a hot car — including the glove compartment or trunk — or anywhere with direct sunlight. The same applies to other diabetes supplies like your blood sugar monitor and insulin pump.

If you are going on a longer trip, with a full itinerary, try to take it easy for the first few days as your body adjusts. Remember to bring snacks with you on busy days with long activities.

A diabetes pharmacy partner you can rely on

At Alto, we make it as easy as possible to manage your diabetes when traveling. We offer free, same-day delivery of medication and supplies right to your doorstep, and our dedicated diabetes team is here to answer any questions you may have before your trip.

Reach out any time via in-app secure messaging or 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.

We are honored to announce that for the second year in a row, Alto Pharmacy has been recognized by Forbes as one of America’s Best Startup Employers. This award celebrates our commitment to employer reputation, employee satisfaction and growth.

Alto Pharmacy Announced as One of Forbes Best Startup Employers for the Second Consecutive Year!

When Alto’s founders set out to transform the pharmacy experience, they outlined a vision whereby our work could improve the quality of life for everyone who needs medicine. Through this foundation grounded in helping people, we have built a company culture centered in care, inclusion, and impact. 

We are honored to announce that for the second year in a row, Alto Pharmacy has been recognized by Forbes as one of America’s Best Startup Employers. This award celebrates our commitment to employer reputation, employee satisfaction and growth. 

This recognition follows Alto Pharmacy's recent admission as a Great Place to Work-Certified™ company – awarded based on employee feedback and a rigorous assessment of Alto’s culture and benefits. Given the impact we strive to make on the communities we serve, we are humbled to share this most recent recognition alongside other accolades over the past year, including: 

The Healthcare Technology Report: Top 100 Healthcare Technology Companies of 2021 

The Healthcare Technology Report: Top 25 Consumer HealthTech Executives of 2021

The Healthcare Technology Report: Top 25 Women Leaders in Consumer HealthTech of 2021

These recognitions and achievements are only made possible through the hard work and dedication of the entire Alto team. If you are passionate about shaping the future of pharmacy, join us as we deliver our industry-leading pharmacy care to millions of people across the country.

For the full employers list and an overview of the selection methodology, head to the Forbes site.

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.

Alto’s mission is to improve the quality of life for all who need medicine, building a pharmacy experience that serves people of all backgrounds. As we work toward a more inclusive and accessible healthcare system, we recognize the importance of diversity among physicians, pharmacists, nurses, and other public health figures. In honor of Black History Month, take a moment to learn about five influential Black healthcare leaders past and present — those who paved the way and those who continue to break barriers today

Five Black Healthcare Leaders to Celebrate

Alto’s mission is to improve the quality of life for all who need medicine, building a pharmacy experience that serves people of all backgrounds. As we work toward a more inclusive and accessible healthcare system, we recognize the importance of diversity among physicians, pharmacists, nurses, and other public health figures. In honor of Black History Month, take a moment to learn about five influential Black healthcare leaders past and present — those who paved the way and those who continue to break barriers today. (For additional inspiration, revisit the first post in this series.)

Dr. M. Jocelyn Elders: the first Black U.S. surgeon general

As a Black woman born to farmers in a rural, poverty-stricken area of Arkansas, M. Jocelyn Elders encountered numerous obstacles on her path to becoming the first Black U.S. Surgeon General in 1993. At 16, she met a doctor for the first time, but she didn't consider a profession in healthcare until she connected with Edith Irby Jones, the first Black person to attend the University of Arkansas Medical School, during college.

Throughout her career, Dr. Elders balanced clinical practice and research, increasing the public’s awareness of adolescent health issues. In 1987, Bill Clinton, then the governor of Arkansas, appointed Dr. Elders as head of the state’s Department of Health. The Arkansas state legislature mandated sexual education and substance misuse prevention programs in the K-12 curriculum in 1989 in large part because of Dr. Elders’ advocacy. During her tenure as Surgeon General, Dr. Elders continued to champion progressive policies, advocating for better sexual education programs, distribution of condoms in schools, and abortion rights. She remains active in the field of public health as a professor emeritus at the University of Arkansas School of Medicine.

Bernard J. Tyson: former CEO of Kaiser Permanente

As chairman and CEO of Kaiser Permanente, Bernard Tyson transformed the company’s services to account for social determinants of health like food access and affordable housing as well as the importance of mental health and wellness. He was also instrumental in the development of the Kaiser Permanente School of Medicine, which trains physicians to be not only clinicians, but patient advocates and innovators, too. By shining a spotlight on how social determinants of health contribute to disparities in health outcomes, Tyson leaves behind a legacy that reaches far beyond Kaiser’s services.

Nadine Burke Harris: first surgeon general of California

A physician, researcher, advocate, and California’s first surgeon general, Dr. Nadine Burke Harris has transformed how our society responds to childhood trauma. While running a health clinic in an underserved San Francisco neighborhood, she observed that preventative health practices and quality treatment didn’t resolve her patients’ risk for poor health outcomes. Drawing upon research from the CDC and Kaiser Permanente on adverse childhood experiences (ACEs), which linked early adversity to higher rates of chronic illness later in life, Dr. Burke Harris studied her own patients and found that more than 67% had experienced at least one ACE. She has helped increase public awareness of ACEs and toxic stress, advocating for universal screening of children and adolescents for signs of trauma. Her 2014 TED Talk, “How Childhood Trauma Affects Health Across the Lifetime,” has been viewed more than 7.5 million times, and she published The Deepest Well: Healing the Long-Term Effects of Childhood Adversity in 2018.

Dr. Patrice Harris: first Black female president of the American Medical Association

Despite not knowing any doctors while growing up in West Virginia, Dr. Patrice Harris’ passion for medicine started early. The board-certified psychiatrist initially planned to pursue pediatrics but shifted her focus after discovering an interest in psychiatry during medical school. Her focus on child psychiatry allows her to merge her passion for children with her expertise in mental health. Throughout her career, Dr. Harris has focused on the role of implicit bias within the medical profession and how unconscious biases among healthcare workers influence health disparities.

Dr. Harris’ involvement in the professional healthcare community spans many leadership positions at state and national organizations. She became the first Black woman elected as president of the American Medical Association in 2020. During her tenure, she focused on a variety of health issues, from opioid addiction to COVID-19. She previously chaired the AMA’s Opioid Task Force, providing evidence-based recommendations to clinicians with the goal of ending the opioid epidemic.

Betty Smith Williams: first Black graduate of the Frances Payne Bolton School of Nursing

Betty Smith Williams was the first Black student to earn a nursing degree from Cleveland’s Frances Payne Bolton School of Nursing, in 1954, and the first Black individual to teach at a higher education institution in the state of California, but her individual accomplishments are only a part of her legacy. Williams has helped ensure that today’s aspiring Black healthcare professionals have the opportunities and support to break down barriers of their own. She was instrumental in developing the National Black Nurses Association and the National Coalition of Ethnic Minority Nurse Associations, Inc. — initiatives that have elevated the voices of Black nurses within the profession. In uniting Black nurses, Williams hoped to create better health outcomes among the Black community. In her own words: "We had no voice, but we understood our culture and our unique needs better than anyone else.”

Join us in delivering our industry-leading pharmacy care to millions of people across the country. As a member of the team, you’ll play an integral role in improving our customers’ quality of life and redefining what’s possible in pharmacy. View our current openings.

Many of us are spending more time on screens than ever before, as a growing number of social interactions take place online, along with work and school for many individuals. This prolonged exposure to digital devices can be hard on the eyes. Perhaps you’ve experienced achy eyes, blurred vision, headaches, or other symptoms of eye strain and screen fatigue yourself. The good news? There are steps you can take to lighten the load on your eyes and protect your vision.

Protect Your Eyes From Screen Fatigue

The causes of eye strain are twofold. First, your eyes have to work harder to see something close up, specifically the ciliary muscle, which contracts to support your focus. Hours of concentration on a single object causes that muscle to ache. This frequently occurs with screen use — which is why eye strain is often referred to as digital eye strain, screen fatigue, or computer vision syndrome — but it can also result from intense use of your eyes in other contexts. (The 20-20-20 rule, explained in more detail below, should come in handy for long reading sessions, too!)

Then there’s the effects of blue light, which is specific to screen-related eye strain. Digital devices like computers and mobile phones emit blue light to enhance the quality of images on your screen and help you stay alert. While this mimics the sun’s natural wavelengths, absorbing this high-energy light up close for an extended period of time strains your eyes. Not only does this contribute to screen fatigue, it can potentially damage your retina, the part of your eye that processes light and communicates to your brain.

Simple precautions can protect your eyes from screen fatigue, from the set-up of your home workspace to nutrition choices. Try the following to start.

The closer you are to a screen, the harder your ciliary muscle is working, so be sure there’s enough distance between your eyes and your computer screen. The American Academy of Ophthalmology recommends sitting about 25 inches from the screen, roughly an arm’s length away.

There are a variety of blue light-blocking tools that minimize its negative effects, including screen protectors for tablets, laptops, TVs, and phones. You may also want to ask your optometrist or ophthalmologist if blue light-filtering glasses would be a good fit for your needs. If you and your doctor have decided that these glasses are right for you, remember to put them on every time you use your computer, TV, or another digital device so that you can experience their full benefits.

Limiting your exposure to blue light becomes even more important later in the night, as it can affect your production of melatonin, potentially disrupting your sleep cycle. Many electronic devices give you the ability to shift your display to warmer colors more conducive to sleep, so be sure to make the switch before scrolling from bed. (Ditching screens before bedtime altogether is even better!)

Along with blue light, glare from a screen can also lead to eye strain. Be mindful of your computer or TV screen’s brightness in comparison to your surroundings, as high contrast between screen brightness and room lighting can strain your eyes. You may have to adjust these settings a couple times each day as the sun changes position. If using a laptop, tilting your screen so that your gaze is pointed downward may also help.

The less time spent staring at a screen, the better — for your eyes, your sleep, and other aspects of your overall health. But if work or school makes it difficult for you to step away from the screen for long periods of time, even short breaks help. Use the 20-20-20 rule to let your eyes rest: take a break every 20 minutes and look at an object 20 feet away for 20 seconds.

A balanced diet can combat the effects of blue light. Omega-3 fatty acids — found in nuts, seeds, and fish like tuna and salmon — and beta carotene — found in vegetables like pumpkin, carrots, and sweet potatoes — are known to boost eye health. Green, leafy vegetables like kale and spinach contain both beta carotene and Vitamin E, another nutrient that can protect your vision.

Stay current with annual vision check-ups

You may be more susceptible to eye strain when other unaddressed vision issues are present, so be sure to go in for regular eye appointments. Even if your vision is strong, it’s still important to have a full check-up every year as part of your overall preventative care.

At Alto, a pharmacist is your partner in health. If you take medication, we will work 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. And our team of pharmacists is available to chat whenever questions come up.

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

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

Beyond Type 1 community table, a monthly conversation series

ADCES diabetes education program directory

JDRF type 1 diabetes daily management page

Getinsulin.org, an insulin access resource

Johnson & Johnson Patient Assistance Program

Lilly Cares Foundation Patient Assistance Program

Novo Nordisk Diabetes Patient Assistance Program

ADA tips on nutrition, fitness, mental health, and more

ADA free type 1 diabetes self-care manual

JDRF type 1 diabetes health insurance guide 

Project Power, the ADA’s free virtual after-school diabetes prevention program for children

ADA summer camps and year-round programming for children with diabetes

ADA resources on school safety and diabetes

With a dedicated diabetes support team, Alto has deep expertise in diabetes management. Our extensive library of diabetes-focused content offers the information you need to manage the condition and live an active life. Here are a few of our top reads:

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

New Diabetes Diagnosis? Here’s What to Know

How to Manage Your Child’s Type 1 Diabetes Diagnosis

We make it simple to manage your diabetes, with free, same-day delivery right to your doorstep, temperature controlled packaging, and automatic savings investigations. And our dedicated diabetes team is here to offer individualized support and walk you through your first insulin doses.

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.

To automate a manual, error-prone pharmacy workflow, we turned to event streaming. Here’s what we learned from one of the first Kafka use cases at Alto.

How We Used Kafka to Build an Event-Driven Automation Pipeline and Scale Our Pharmacy

Imagine this: You're at the doctor’s office, and your doctor just wrote you a new prescription. Minutes later, before you even check out with the receptionist, you already have a notification from Alto Pharmacy on your phone that your prescription is ready. All you have to do is pick the date and time that works best for your free courier delivery.

This is the future we’re building at Alto: a future where a prescription can be transcribed, billed, and verified by a pharmacist in five minutes, flat. To get there without dramatically increasing Alto’s head count, we need to automate much of the process, starting with the first step: transcribing, or intaking, a prescription.

As a pharmacy, we receive prescriptions in many different forms. Some are sent electronically, in a structured format, but others are handwritten, phoned in, or even faxed. To represent all of these forms in a single table, we previously required every incoming prescription to be transcribed by an Alto team member, who would answer questions like:

Whom is this prescription for? Is this customer already in our system?

Where did this prescription come from? Who wrote it?

What is the relevant prescription information (medication to dispense, quantity, days supply, directions, etc.)?

This manual process is both time-consuming and prone to human error, which, if uncaught, could impact our ability to process the prescription downstream. Furthermore, at our busiest times, it could take up to two hours for a team member to get through the pending intake queue — unacceptable if we hope to have prescriptions ready to schedule before people even leave their doctor’s office. 

Automating intake required close collaboration between three teams:

Data Science, who built the decision-making algorithms 

Data Engineering, who served up the results of those algorithms

Product Engineering, who used those results to automatically intake prescriptions 

To allow the teams to operate in parallel without toe-stepping — and in the language most suitable for each (the Data Science and Data teams prefer Python, while product engineers work mainly in Ruby) — we separated the code into two environments: 

1. Data Prod Interface (DPI), where the code for generating automation results lives

2. Wunderbar (our proprietary pharmacy operations platform), where the code for requesting and using those automation results lives

The key question: to establish robust communication between these two environments, should we use an API-based approach, or an event-driven one? Each has its pros and cons. 

Legacy approach everyone at Alto is familiar with

Existing enforcement of strong types and data

Difficult to scale with increased data & requests

Requires ongoing authorization / authentication

Infrastructure relevant to other business areas

Automatic retries, reprocessing, and queueing

Our existing infrastructure currently utilizes a hefty API-based structure, so there was a natural tendency to go down this path, but we knew that beginning to migrate services towards an event-based architecture with Kafka at its heart would help us in the long term.

Kafka is a framework implementation developed by LinkedIn, now open-source with the Apache Software Foundation. It aims to provide a unified, high-throughput, and low-latency platform for handling real-time data feeds. 

Alto uses Amazon Web Services as our cloud provider, and luckily, they offer an out-of-the-box managed solution for Kafka, MSK. To configure Kafka with our system, our infrastructure team worked with AWS to set up managed instances to comply with our business requirements. Our Infrastructure team will share more details about this work in an upcoming blog post. 

Kafka offers many benefits. The asynchronous nature of the message system allows for retries, reprocessing, and queueing as well as easy recovery from outages. In addition, the infrastructure work done for setting up the managed cluster would be a one-off workstream. When complete, we’d be able to re-use the same setup and configurations across various business needs to streamline other projects that leverage Kafka. 

Setting up for success: defining a strict contract

One element we had to get right from the start was the data contract. As we send messages between DPI and Wunderbar, we need to ensure messages are produced with the correct schema, so that downstream consumers know what to expect.

Protocol Buffers, or Protos, is an open-source, cross-platform data format used to serialize structured data. Developed by Google, Protos allow you to define how you structure your data once and then use generated code to easily write and read the structured data in a variety of different languages. 

At Alto, we’ve been using Protos for the past few years to speed up development with auto-generated code and ensure data continuity between our Ruby on Rails backend and JavaScript / React / React Native frontend. Protos may seem antithetical to JavaScript and Ruby since they’re both dynamically typed languages, but in practice, they have saved us countless hours of debugging and back-and-forth Slack messages. 

For this project, we turned again to Protos to define the schema for messages produced by DPI and Wunderbar. We defined IntakeAutomationRequest and IntakeAutomationResult messages in Go and generated the types (Sorbet, Flow, etc.), which both DPI and Wunderbar now refer to when producing or consuming messages.

Because Wunderbar is already configured to run on AWS and houses our existing intake logic, it was easy enough to send a prescription to DPI for automation. Where we would normally create a task for an operations team member to manually transcribe the prescription, we instead produce a message to our “request automation” Kafka topic using the ruby-kafka library.

Our consumer, instantiated in an executable that runs on a dedicated worker, consumes messages from a “receive automation” Kafka topic. First, the consumer verifies that a given message corresponds to a prescription we previously sent to DPI. Then, it persists any automation results included in that message. If the automation results are sufficient, we skip intake altogether. Otherwise, we create an intake task to be handled by an operations team member.

Because this project was among our early use cases for Kafka, we wanted to be prepared for the worst-case scenario: we produce a message requesting automation results, and for whatever reason—maybe DPI is down—we don’t hear back. For us, we defined a reasonable time frame as fifteen minutes, in order to avoid building up a large backlog of work that would have to be offloaded back onto our operations team.
To this end, we store metadata about the automation lifecycle in an intake_automation_results table, which includes timestamps representing when we sent a message to DPI and when we received a response back. A cron job runs every minute to check that table for rows where received_at is blank, and sent_at was more than fifteen minutes ago. If this occurs, we flag the prescription to be manually intaken by an operations team member.

The diagram below illustrates our intake automation architecture.

Intake automation is now live at Alto. We’re seeing prescriptions fly through in just a few minutes — during which time our automation creates a user profile if one doesn’t already exist, links the new prescription to that profile, and finds and bills the user’s insurance; a pharmacist reviews the prescription for clinical accuracy; and the user receives a text message to schedule their delivery. This single flow, prior to intake automation, once took up to four hours to complete!

Going from zero to one is quite a feat, and it wouldn’t have been possible without an event-based approach. Now that intake automation has laid the groundwork, we know that Kafka will only continue to provide exponential value to Alto as we grow and migrate more of our services to this event-based architecture. 

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Working from home offers many benefits. The lack of commute to and from the office can mean more quality time with family, mid-day workouts, or a load of laundry over lunch. And with fewer distractions, the environment of a home office is a productivity boost for certain work styles.

How to Say Healthy While Working From Home

At the same time, some individuals may find it more difficult to concentrate outside of a physical office, and remote work can also impact your mental health. In a recent public opinion poll conducted by the American Psychiatric Association (APA), nearly two-thirds of the respondents reported feeling isolated or lonely at least sometimes as a result of working from home, while 17% said that they experience isolation and loneliness all the time. And a majority of the respondents who partially work from home said that they find it difficult to step away from work at the end of the day.

With remote work on the rise — the number of U.S. adults who work from home increased from 22% to 42% between 2019 and 2020 — it is important to prioritize your mental and physical well-being and create boundaries between work and social life. Here are steps you can take to stay sane and healthy while working from home.

A physical office space naturally incorporates structure into your day. Simply sitting down at your desk and seeing colleagues allows you to mentally shift into work mode. This is important for not only productivity, but also for work-life balance — just as you are able to jump right into your to-do list once you enter the office, the clear boundary between work and home means you’re less likely to revisit that list once the day is over. Plus, watching a coworker take a break may be a much needed reminder that it’s time to grab lunch or get some fresh air.

There are several ways to give yourself structure while working from home. First, mimic the experience of going to work. It may be tempting to stay in pajamas and check emails from bed, but many remote employees find it easier to concentrate — and to leave work behind at the end of the day — by creating a morning routine and using a designated workspace that’s not in your bedroom.

In addition, having a clear plan for the day can boost both productivity and mental health, as you will have carved out time for high-priority tasks and breaks. For some individuals, planning the day the night before makes it easier to jump into work the next morning, so consider incorporating this into your end of day routine if you find it helpful. There are a variety of ways to lay out what needs accomplishing, from organizing your day entirely on a calendar to using a task management tool. Increasing focus and productivity while working from home is all about finding the system that’s right for you.

It’s just as important to consider your personal preferences and work habits when planning breaks. The frequency of your breaks should correlate to how long you can maintain a state of deep focus. Taking breaks every 75 to 90 minutes may be realistic for some individuals, but others may find shorter bursts of work more helpful. The pomodoro method has become a common approach to time management. You will focus on a single task for 25 minutes then take a five minute break, repeating the pattern three more times before taking a 15 minute break.

Whichever system you choose for breaks, remember to use some of that time for physical activity. Exercise affects both your physical and mental health and may help reduce some of the stress and isolation that often comes with remote work.

Having a designated workspace can help you create boundaries between work and social life. Working from home can contribute to burnout, and using your bedroom as the office can often lead to a workday that stretches well past eight hours. If you can, make a workspace in another room. If you don’t have space to use as a designated home office, try the kitchen table or living room.

In addition to supporting your mental health, working in a space that’s set aside for work can help minimize distractions and maximize productivity, particularly if you live with family members or roommates. Young children or anyone who’s never worked from home themselves may not know to avoid interrupting you during your workday. You can set boundaries by informing everyone at home of your working hours and communicating your expectations.

The design of your workspace can also impact your emotional well-being and physiological health. Exposure to sunlight is linked to higher levels of serotonin, a hormone believed to regulate your mood and lower anxiety. If possible, use a workspace that gets a lot of natural light, and use part of your break time to soak up some sun. Add some greenery to your home office too — research has found that having plants nearby as you work can increase productivity.

Maintaining good posture while you work can prevent tightness in your neck or back pain. If working while seated, keep your feet flat on the ground beneath your knees. Avoid working from a chair that’s too tall and prevents your feet from reaching the ground. If you can, use an ergonomic office chair or a standing desk, which offers many health benefits. If using an office chair, remember that each person’s physiological needs are different, so take time searching for the right fit.

The repetitive motion of typing in a seated position has been linked to carpal tunnel syndrome — numbness and tingling in your hand, wrist, and/or arm caused by pressure on your median nerve. A hunched posture can put strain on your wrists and hands, so using an ergonomic chair or standing desk is already a step toward preventing carpal tunnel syndrome. Be mindful of your arm and wrist position as well. Work with your elbows bent by your side and keep your forearms stretched out in front of you parallel to the floor. Using an external computer monitor or keyboard can make it easier to maintain this position.

Working in silence by yourself can lead to greater concentration and productivity in some cases, but too much isolation and loneliness affects your mental health. An office environment allows for natural socialization and conversation throughout the day, and recreating this experience at home requires a bit more intention.

If you work on a team, use workplace messaging tools to maintain connections with coworkers. Take the initiative in setting up virtual or in-person events like happy hours. And if you’re located in the same area as your colleagues, schedule a coworking session in a local coffee shop. Remote work is also a great opportunity to expand your professional network by joining a coworking space.

It’s important to maintain other social connections, too. Schedule after-work plans with friends and family, and don’t forget to pause notifications and sign off for the day.

Let Alto support your health and wellness

Practicing good self-care while working from home involves prioritizing your physical health. Alto is here to support you with exceptional pharmacy care at every step of the way. We make it simple to stay on top of your medications with free, same-day delivery and medication management tools like reminders and auto refills in our mobile app.

How to Stay Healthy While Working From Home

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