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Despite the initial challenges of a type 1 diagnosis, managing your child’s diabetes does get easier. Here’s an overview of the information you need to manage your child’s diagnosis.

How to Manage Your Child’s Type 1 Diabetes Diagnosis

Your child’s type 1 diabetes diagnosis affects the entire family. As a parent, it’s understandable to feel overwhelmed as you get up to speed on their treatment plan, including insulin therapy,  blood glucose testing, and coordinating with your insurance provider.

“There’s so much information thrown at you right away, and we didn’t know what we didn’t know,” shared Lucinda, a Partnership Manager at Alto whose 5-year-old son was diagnosed with type 1 diabetes last year. “Insurance coverage is particularly complicated with diabetes, even for someone who works in healthcare like me, because you’re dealing with so many medications and supplies that aren’t commonly prescribed.”

Despite the initial challenges of a type 1 diagnosis, managing your child’s diabetes does get easier. By staying on top of daily blood sugar management and surrounding your family with a strong support system, your child will be able to have a healthy, active life — and you will be able to find some peace of mind. Here’s an overview of the information you need to manage your child’s type 1 diabetes diagnosis

Type 1 diabetes is an autoimmune disease in which the body mistakenly destroys the pancreas’s insulin-producing cells. Your body needs insulin to properly convert a simple sugar known as glucose into energy. Without insulin, blood sugar levels rise in people with type 1 diabetes, which can cause life-threatening health complications if untreated.

While type 1 diabetes can be diagnosed in adults, the majority of cases develop during childhood (the condition was once referred to as juvenile diabetes). In some cases, symptoms appear in children less than a year old.

Blood sugar levels typically rise very quickly as the condition develops. Some of the common initial symptoms of type 1 diabetes include increased thirst, frequent urination, extreme hunger, weight loss, and fatigue. Your child may feel very sick within two to three weeks following the onset of the condition.

Insulin therapy is the cornerstone of treatment for type 1 diabetes. Since individuals with type 1 diabetes don’t produce any insulin at all, they need to take insulin every day to maintain healthy blood sugar levels.

Insulin is most commonly administered with a syringe, but additional methods of delivery include insulin pumps and pens. There are five main types of insulin categorized by how quickly they work and how long they last: rapid-acting, regular or short-acting, intermediate-acting, long-acting, and ultra long-acting. 

It’s important to work with your child’s healthcare provider to find the right insulin dosage, as taking too much or too little can cause rapid changes in blood glucose levels. Many people with diabetes need to take a combination of rapid or short-acting and long-acting insulins throughout the day. This best replicates the natural actions of a normally functioning pancreas, which releases a continual supply of insulin with additional bursts when you eat.

Read our previous blog to learn more about getting started with insulin therapy.

The goal of insulin therapy is to keep your child’s blood sugar in a healthy range. For people without diabetes, a typical blood sugar range is 70 to 125 mg/dL when fasting. People with diabetes should typically try to stay between 70 to 180 mg/dL. 

Your child’s healthcare provider will let you know what your child’s blood sugar target range is. Individual blood sugar targets will vary depending on factors like age, physical activity, and the severity of the condition. It will likely change as your child grows.

Daily testing is the only way to ensure that your child’s blood sugar is within their target range. It will also offer insight into how food and physical activity affect your child’s blood sugar levels throughout the day.

As with insulin therapy, checking your child’s blood sugar using a blood glucose meter will become routine. You will likely need to check and record your child’s blood sugar several times throughout the day, including before meals and snacks, before and after exercise, and before bed. Logging results from blood sugar tests is very important for noticing patterns and determining if any adjustments to your child’s treatment are necessary. Apps like Glucose and mySugr are helpful tools that allow you to identify trends over time.

Your doctor will advise you on your child’s individual needs with blood sugar monitoring. You may have to check their blood sugar levels more frequently when they are sick, if their routine changes, or if they start a new medication. A continuous glucose monitoring (CGM) device, which measures blood sugar every few minutes through a temporary or implanted sensor inserted under the skin, is helpful for individuals who need to monitor blood sugar levels more closely. Consult with your child’s healthcare provider about whether or not a CGM device is appropriate.

Carbohydrates increase blood sugar levels more than any other nutrient, so monitoring how many carbs your child consumes every day is another important aspect of blood sugar management.

Advanced meal planning is important, as your child’s daily insulin dosage is based on their insulin-to-carb ratio. They should be able to eat a variety of foods so long as you carefully plan out meals and spread their carb intake throughout the day.

Your child’s healthcare provider can help you determine your child’s target carb ratio. While this is a healthy baseline to aim for, blood sugar naturally fluctuates throughout the day. There may be times when additional carbs are needed to treat low blood sugar, or when extra insulin is required to bring high blood sugar levels down.

By no means should a type 1 diabetes diagnosis prevent your child from staying active. In fact, exercise offers individuals with type 1 diabetes additional benefits like lowering blood sugar and improving insulin sensitivity. 

However, exercise may sometimes cause a drop in blood sugar levels, so it’s important to check blood sugar levels beforehand. Stock up on carbohydrate-rich snacks such as dried fruits, trail mix, or granola bars to treat low blood sugar, keeping in mind that physical activity is often more unplanned and spontaneous with children and adolescents than it is with adults. 

The American Diabetes Association recommends giving 5-15 grams of carbs, depending on your child’s age and weight, for every 30 minutes of sustained physical activity in tandem with frequent monitoring of blood sugar levels.

Low blood sugar is also known as hypoglycemia. For many individuals with diabetes, hypoglycemia occurs when their blood sugar is less than 70 mg/dL. However, diabetes treatment plans are individualized, and your child may have a different blood sugar target range, so be sure to consult with your child’s physician.

There are many reasons why blood sugar may fall, including not eating enough, exercising too much, taking too much insulin, or not taking insulin at the right time. Initial signs of hypoglycemia include feeling sweaty, shaky, and hungry. As blood sugar drops further, additional symptoms include feeling weak, having difficulty walking or seeing clearly, getting disoriented, and having seizures.

If you notice any of these symptoms in your child, check their blood sugar and treat immediately with fast-acting sources of glucose, including fruit snacks, juice boxes, glucose tabs, or glucose gels. In cases of severe hypoglycemia — 55 mg/dL or less for many individuals with diabetes — glucagon can be used to restore blood sugar.

On the other end of the spectrum, a blood sugar of 180 mg/dL or higher is usually considered hyperglycemia or high blood sugar. It frequently occurs when too little insulin is taken for the amount of carbs consumed, but factors like illness, stress, and hormonal changes can also lead to hyperglycemia. Common signs include extreme thirst, frequent urination, or increased hunger.

If you notice any of these hyperglycemia symptoms in your child, check their blood sugar levels and follow the treatment plan your doctor has recommended, which may include a dose of rapid acting insulin, water, or other carbohydrate-free beverages.

A crucial step to preparing for emergency hypoglycemia or hyperglycemia is informing your child’s school of their type 1 diabetes diagnosis. View the JDRF’s back to school checklist for more on what your child’s teachers should know.

You never have to be alone on this journey. In addition to your child’s clinical team, other parents of children with diabetes, who know exactly what you’re going through, are a powerful resource. And for Lucinda and her family, growing a strong support network has been invaluable.

“Your child’s diabetes diagnosis changes everything in your life, and that’s the part that people don’t always get to discuss at the doctor’s office,” she said. “I wish I had known to connect with other parents of children with type 1 diabetes immediately.”

Visit the caregiving section of the American Diabetes Association’s online Support Community to start building your own network of parents who are also managing their children’s diabetes.

It’s also important to have a pharmacy that will advocate for your child’s care, as the condition involves a steep learning curve with medications and supplies.

“I never felt supported by a pharmacy until I used Alto for my son’s diabetes medications,” Lucinda said. “Questions about insurance coverage are handled seamlessly, and as a busy working mom, it’s so helpful to be able to quickly schedule a delivery in the app.”

She added, “With diabetes, any pharmacy missteps like improper medication packaging or storage can be life-threatening. It brings me so much peace of mind to know that I never have to worry about that with Alto.”

A diabetes pharmacy partner you can rely on

Alto is with you every step of the way in managing your child’s diabetes. We make it simple to follow the treatment plan your child’s doctor recommends, with proper packaging of temperature-controlled medications and free same-day delivery right to your doorstep.

We also offer extra support to address the challenges that are specific to managing diabetes, like getting started with insulin therapy. Our pharmacists are available to walk you through your child’s first insulin doses and discuss any symptoms or side effects to determine if an adjustment is needed.

And since a diabetes diagnosis brings lots of new insurance terminology related to your child’s medications and supplies, we compiled a guide that breaks down the key insurance terms you’re likely to encounter. We’ll tackle the administrative legwork, too, coordinating with your doctor’s office and submitting any necessary paperwork, so that you can focus on your child’s care instead of phone calls with your insurance provider.

Get started or learn more about Alto by reaching out at any time via text or phone at 1-800-874-5881, or in-app messaging.

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.

We answer common questions about insurance coverage for prescription medications, including how we go above and beyond to ensure that you’re receiving your medications on time and at the lowest price possible.

How does Alto Pharmacy work with insurance?

Getting the medication you need often involves more than just receiving a prescription from your doctor and filling it at a pharmacy. And navigating the complexities of insurance coverage, from copays and deductibles to formularies and medication tiers, can be a particularly big source of stress.

A great pharmacy partner makes sure you’re never alone in working through the details of your insurance plan’s pharmacy benefits. At Alto, we tackle all of the insurance-related legwork for you and give you the information you need to understand the process.

Below, we’ve answered some common questions about insurance coverage for prescription medications, including how we go above and beyond to ensure that you’re receiving your medications on time and at the lowest price possible.

How do I know how much my medication will cost at Alto?

When you get started with Alto, we’ll automatically pull in any insurance information we can find. If you have additional coverage, just let us know and we’ll add it to your profile. For each prescription, we’ll check with your primary (and secondary) insurance plan to pull your copay amount — the amount you owe out of pocket for your medications — including any possible savings. (More about that below!)

Sometimes paying cash for your medications, separate from insurance benefits, will be cheaper than your copay. If that’s the case, we’ll let you know the different pricing options so you can make an informed choice.

By checking every available savings option, automatically, every time! Unlike traditional pharmacies, Alto is proactive about applying potential sources of savings like manufacturer coupons, patient assistant programs, and copay cards wherever applicable. We’ll automatically start looking for these opportunities the minute we receive your prescription, and we’ll keep you informed of any savings options that require you to apply directly with the program or manufacturer.

Learn more about how Alto saves you money on your prescriptions.

Here’s another way we’re different from traditional pharmacies: we’ll continue searching for less expensive medication options even after we’ve researched savings opportunities.  You’re in the driver’s seat, and if you would like support in identifying other medication options that may be covered by your insurance at better rates, we’ll work with your doctor to evaluate those choices.

Insurance companies categorize medications into tiers based on various factors such as whether the medications are generic or brand-name and how frequently they are prescribed. Medications in higher tiers generally include non-preferred brands and specialty medications for rare conditions, and these typically cost more than medications from a lower formulary tier.

Keep in mind that generic medications use the same active ingredients as their brand-name counterparts, and they must meet the same standards for safety, quality, and results in order to get FDA approval.

I’ve heard of an insurance “formulary.” What does that mean?

Every health insurance plan has a list of covered generic and brand-name medications, called a formulary, which you can locate online or by calling your plan. It includes the tiers mentioned above, indicating which medications are preferred by your insurer and therefore offered at a lower out-of-pocket cost.

When deciding whether to renew your current health insurance coverage or select a different plan for the new year, you may want to check the formularies to determine if your current medications will be covered. Read our previous blog to learn more about what to consider when reviewing insurance coverage options every year.

What if my insurance denies coverage of my medication?

If a medication isn’t on the formulary at all, you may have the option of submitting a prior authorization to prove the medical necessity of the medication and gain coverage from your insurance plan.

If a prior authorization is needed, we can work with your doctor to submit the necessary paperwork. We’ll keep both you and your doctor in the loop throughout the process so you know the current status of the request until your insurance provider has made a decision. If your prior authorization request is denied, we will work with your doctor to either process an appeal or find a different treatment option.

Read our previous post, ‘What is a Prior Authorization?’ to learn more about how Alto can help you navigate this process.

A pharmacy partner that’s always on your side

At Alto, we go above and beyond to help you stay on track with your doctor’s recommendations, getting you the medication you need at the best price possible.

Switch to a better pharmacy for free same-day delivery and support with insurance and savings opportunities. Reach out any time via text or phone at 1-800-874-5881, or in-app messaging.

How does Alto Pharmacy work with insurance? We answer your top questions.

How Alto Pharmacy works with health insurance

What Updated CDC Guidelines Mean for PrEP Access

For the first time since 2017, the U.S. Centers for Disease Control and Prevention (CDC) is updating its guidelines for PrEP, a medication that can lower risk of sexual transmission of HIV by 99% when taken daily. The new guidelines — which inform local healthcare policies and doctors’ decision-making processes — address key barriers to PrEP access, including a lack of provider awareness about PrEP and patient reluctance to disclose sexual activity or drug use. 

Moving forward, the CDC has recommended that healthcare providers share information about PrEP with any patient who is sexually active, and that any patient can receive a prescription for PrEP if requested.

Here is some additional context about the forthcoming updates, which should go into effect before the end of the year, pending revisions based upon feedback from experts.

According to the Human Rights Campaign, 1 in 3 healthcare providers has not heard about PrEP. There are countless others who are aware of the medication but don’t have all the facts.

Under current guidelines, many doctors only share information about PrEP with patients who presently have multiple partners or a partner who is HIV-positive or unsure of their HIV status. In reality, more people could benefit from PrEP, including those who are single and sexually active.

Some healthcare professionals also falsely believe that PrEP and condom use are mutually exclusive. Many people have felt shamed when asking for PrEP due to their healthcare provider’s stigmatized perceptions of traditional PrEP users. 

Under the new, soon-to-be-implemented federal guidelines for PrEP, anyone who is sexually active should receive PrEP information from their healthcare provider, including adolescents. Given that many traditional sex education programs in schools throughout the U.S. aren’t providing LGBTQIA+ youth with the resources they need to stay safe and healthy, the new guidelines are an important step toward more inclusive sexual education.

Opening up the conversation about HIV prevention to more individuals aligns with what Dr. Lisa Sterman, MD, MPH, shared during a conversation with Alto in October 2020.

“A lot of people may think, ‘I’m not at risk’ or, ‘that’s not my group of people,’” Sterman said. “The way I teach it is: if you’ve ever had sex, you’re at risk for HIV. If you’ve ever shared drug needles, you’re at risk for HIV. Everyone should know their status.”

Addressing fear of discrimination or stigma at the doctor’s office

Under current CDC guidelines, patients must share personal details about their sexual health or drug use with their doctors to get a PrEP prescription. However, many people at risk of contracting HIV don’t feel like they can speak openly with their healthcare providers, particularly LGBTQIA+ people of color, who face multiple forms of discrimination. 

Too often, this leads to negative health outcomes and disparities in HIV rates. The CDC’s new proposed guidelines for PrEP account for the fact that some patients may not feel comfortable disclosing personal information about their sexual health or drug use. 

While conversations between doctors and patients about PrEP will initially cover a patient’s sexual health history, the CDC is recommending that any patient can receive a prescription for PrEP if requested. This means that you can get PrEP without disclosing personal information related to your risk for HIV, another big step forward for PrEP access and HIV prevention.

There are more FDA-approved medication options for PrEP than ever before: Truvada®, Descovy®, and a generic for Truvada, which became available in October 2020. The following resources can connect you with a provider who will prescribe PrEP for you:

Alto will coordinate with your doctor and your insurance provider to ensure you’re receiving the best PrEP option for your needs at the most affordable price. And you can connect directly with pharmacists who have expertise in HIV prevention and treatment through phone, text, or within the Alto app.

Reach out any time to get started via text or phone at 1-800-874-5881, or in-app messaging.

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.

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.

Given how accessible pharmacies are in many communities, there’s growing recognition that expanding the role of pharmacists in HIV prevention can help increase PrEP usage. Here’s a high-level overview of the process for getting PrEP from a pharmacy without a doctor’s prescription.

PrEP, or pre-exposure prophylaxis, has tremendous potential to save lives: the HIV prevention medication can lower risk of sexual transmission by 99% when taken daily. But ever since PrEP was first approved by the FDA in 2012, barriers like affordability, lack of access to healthcare systems, and fear of stigma have contributed to low usage rates. According to the American Journal of Public Health, fewer than 10% of people who could benefit from PrEP are taking it.

For many people at risk of contracting HIV, getting PrEP from a primary care provider isn’t an option. They may live far from a doctor, or they may not have a doctor they’re comfortable speaking with about their sexual health. Pharmacists have an opportunity to fill a critical need in expanding access to PrEP, as most people visit a pharmacy 35 times a year on average, and more than 90% of people in the U.S. live within five miles of one. 

Given how accessible pharmacies are in many communities, there’s growing recognition that expanding the role of pharmacists in HIV prevention can help increase PrEP usage. California became the first state to allow pharmacists to prescribe PrEP in 2019, and Colorado became the second in November 2020. Nevada passed a law in June, expected to be implemented in the near future, that will allow pharmacists to prescribe PrEP and provide related services including HIV testing. A handful of other states now have similar legislation underway.

Getting PrEP from a pharmacy under the new laws

If you live in a state with expanded PrEP access, here’s a high-level overview of the process for getting PrEP from a pharmacy without a doctor’s prescription.

A negative HIV test and baseline testing for sexually transmitted infections, hepatitis B, and kidney disease are required to start PrEP. Under the new guidelines, your pharmacy can order the lab work directly through your insurance. If it’s safe for you to start PrEP based on the lab results, your pharmacist will contact you for a consultation to discuss usage and side effects and answer any questions you have.

Most of the legislation limits pharmacist-prescribed PrEP to a 60 or 90-day supply. After that, you will need a doctor’s prescription to continue with PrEP. Check local guidelines for the latest information in your state. The following resources can connect you with a provider who will prescribe PrEP:

There are several FDA-approved medication options for PrEP: Truvada®, Descovy®, and a generic for Truvada, which became available in October 2020. PrEP may be right for you if you have a partner who is HIV-positive or unsure of their HIV status, or if you have multiple partners. It also reduces the risk of getting HIV from intravenous drug use by about 74%. Consult with a healthcare professional if you have any questions about whether PrEP is the right choice for you.

In addition to the initial baseline testing, you will also have to visit a healthcare provider for follow-up testing while taking PrEP, including:

Sexually transmitted infection testing every 3 to 6 months

Pregnancy testing and discussion of pregnancy plans every 3 months

HBV DNA testing every 6 to 12 months while taking PrEP if you have hepatitis B

We’ll help you get PrEP at the most affordable price

PrEP is now more accessible and affordable than ever, no matter which state you live in. Excited? We are, too! We’ll update this post when Alto pharmacists at our California and Colorado locations are able to prescribe PrEP.  

Until then, we’re still the best option to fill and deliver your PrEP prescription. We will coordinate with your doctor and your insurance provider to ensure you’re receiving the best PrEP option for your needs at the most affordable price. In addition to our AAHIVP-certified pharmacist team, you can expect:

Discrete, private packaging and free, same-day delivery

Med syncing support and in-app reminders to stay on track

Pharmacists directly available through phone, text or within the Alto app

Expanded PrEP Access at Pharmacies: What to Know

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, text, or chat.

Reach out via text or phone at 1-800-874-5881 or in-app messaging to learn how Alto can support your COPD treatment plan.

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

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