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It’s official: Alto Pharmacy is a great place to work! We’re honored to join the community of Great Place to Work-Certified™ companies based on team member feedback and a rigorous assessment of our company’s culture and benefits.

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. 

Be Part of a Great Place to Work — Join Our Team

Hear first-hand from members of the Alto technology teams.

Read the latest Alto blog posts covering healthcare, family health, managing diseases, and other Alto highlights.

Blog | Alto Pharmacy

When you’re happy, we’re happy. That’s why we put together a quick guide with five tips for a great delivery experience, based on what we’ve learned from making more than a million deliveries to Alto customers just like you.

How to Have an Easy Alto Pharmacy Delivery Experience

When you’re happy, we’re happy. That’s why we put together a quick guide with four tips for a great delivery experience, based on what we’ve learned from making more than a million deliveries to Alto customers just like you.

Share any information needed to access your house or apartment  — for example, your intercom, gate code or apartment number/letter — by verifying your delivery address details and completing the “Delivery Instructions'' section in the Alto app. Head to Account > Delivery Addresses > Edit Address> Delivery Instructions to provide all of the specific info our delivery team needs to find your location. (If you don’t want us to ring the doorbell, this is the place to note that, too!)

2. Review your medication’s signature requirements

For controlled substances and medications of more than $500, either you or an authorized signer will need to be present to sign for your delivery. Many Alto customers with limited mobility choose to designate a caregiver as an authorized signer. Head to Account > Delivery Addresses > Edit Address> Delivery Instructions in the Alto app to add an authorized signer .

When required, you may sign electronically on your phone via a link you’ll receive by text, but your driver will need to physically see you during the delivery handoff. If an authorized signer is receiving medication on your behalf, they will be asked to sign for the medication and share their full name with our driver, who will note it in our delivery tracking system.

3. Designate a safe delivery space (and leave the front lights on!)

If your medication does not require a signature, you may schedule your delivery for a time when you are not at home by designating a safe space in the Alto app. Head to Account > Delivery Addresses > Edit Address >Delivery Instructions to provide all the specific info for your safe space. As a reminder, due to federal law, mailboxes are no longer accepted as safe spaces. Pro tip: you may also designate a separate safe space in case of rain or snow! 

We love pets, but please keep your four-legged friends secured when your delivery arrives, both for our drivers’ comfort and your animal’s safety.

At Alto, we’re more than just a pharmacy — we’re a partner in your health, and we go above and beyond to get you the medication you need at the best price possible.

Delivery is only the beginning. Our pharmacists are available until 9 pm PST on weeknights and 6 pm PST on weekends to answer any questions you have about your medication. We also offer support with insurance and finding the best price possible on your prescriptions.

Reach out any time through in-app secure messaging or by phone at 1-800-874-5881 to learn more or transfer your prescriptions to Alto.

Alto Connect is the industry’s first mobile app for clinical teams to track prescriptions and message with the pharmacy on-the-go.

Introducing Alto Connect

Big news from the team here at Alto: today we launched Alto Connect, the industry’s first mobile app for clinical teams to track prescriptions and message with the pharmacy on-the-go! You’ll also see the new Alto Connect brand on our desktop portal, formerly known as AltoMD: new name, same great pharmacy services.

The Alto Connect mobile app is the next evolution of Alto’s custom-built provider communications center, formerly known as AltoMD. Alto was the first pharmacy in the United States to offer a prescriber-focused pharmacy communication platform when the original desktop-based AltoMD product launched in March 2016. Since then, more than 500 doctors offices have integrated Alto Connect into their daily workflows and prescription management. 

Doctors offices who work with Alto Pharmacy can now access Alto Connect across all of their devices, providing greater flexibility and convenience for monitoring prescriptions on busy days spent juggling patient consultations and other business needs. Instead of spending hours on the phone or fighting with the fax machine, Alto Connect provides instant access to prescription information and pharmacy messaging, and Alto Connect users can move seamlessly between the two platforms throughout their workday.

With Alto Connect, clinical staff can view all current prescriptions at Alto Pharmacy, including delivery status, out-of-pocket costs and refills. You'll never have to wonder if a patient picked up their prescription or stayed on track with their refills between visits - our system tells you exactly where every prescription stands for every patient.

Have a question for our pharmacy team? Curious about insurance coverage, delivery times, or other aspects of our service? Our team is here to help! You can send us a general message or ask a question specific to one of your patient's prescriptions. 

Alto Connect's push and email notifications alert you when a prescription needs additional information to move forward — most commonly, a clinical clarification or additional data needed for a prior authorization. We'll only alert you when we're certain we need your team's input, so you can stay focused on your patients.

Using AltoMD on your computer today? Nothing changes other than the name! Ready to try Alto Connect mobile for yourself? Scan the QR code above to download the app - your AltoMD login works on the mobile app. 

Need help setting up an Alto Connect account or want training for your staff? Reach out to providersuccess@alto.com.

When engineering incidents happen, typical deployment pipelines are just too slow—especially if customers’ medications are on the line. Here’s the speedier rollback process we use at Alto Pharmacy to ship fixes in 3 minutes, flat.

How Alto Reduced Time to Resolution for Production Incidents

Production incidents caused by newly-merged code happen to us all. When they do, most engineering organizations discuss the root cause and how to prevent similar incidents in the future. At Alto, we evaluate two additional metrics:

Time to detection: How quickly did we know something was wrong?

Time to resolution: How quickly did we restore service?

Time to resolution is especially critical for us as a pharmacy, where a long-running incident could block a user from getting their medication on time.

Over 30 times a day, an engineer at Alto hits the merge button, deploying a new build to production. Our well-automated CI/CD pipeline, built by our Infrastructure team, handles the 3-step deployment process:

1. Build: install Ruby & JavaScript dependencies

The average runtime for our standard deployment pipeline is 30 minutes—reasonable for a CI/CD pipeline, but too long when shipping a fix for a production incident.

We introduced a “hotfix” workflow as a first pass at an expedited deployment pipeline for incident response. A hotfix is a commit that introduces new code to address the incident by either removing or reverting the buggy code that introduced the issue in the first place or by shipping new code that fixes the initial issue. 

The hotfix deployment pipeline reduces incident time to resolution by triggering a specific CI job that removes the test step from our standard pipeline, reducing the workflow to just the Build and Deploy steps.

Implementing a hotfix pipeline on top of our standard pipeline in CircleCI was relatively simple—in our `.circleci/config.yml`, any part of our CI workflow that should be skipped in case of a hotfix runs a job called “early_exit_if_hotfix” that will skip the current step if the last commit message of the code being built includes the keyword “[hotfix]”.

early_exit_if_hotfix:
    steps:
      - run:
          name: Early exit if hotfix
          command: |
            git_commit_message=$(git log --format=%B -n 1)
            if [[ $git_commit_message =~ "Merge pull request #" ]]; then
              echo "This is a merge commit. Checking if this is a hotfix deploy"
              git_commit_sha=$(git log --format=%H -n 1)
              git_commit_message=$(git log --format=%B $git_commit_sha^-)
            fi
            if [[ $git_commit_message =~ "[hotfix]" ]]; then
              echo "exiting early for hotfix deploy"
              circleci-agent step halt
            fi
            echo "not a hotfix deploy, continuing"

run_ruby_tests:
  steps:
early_exit_if_hotfix
run_tests

The hotfix workflow reduces time to ship a resolution, once we identify the fix, from 30 minutes to ~18 minutes. It’s faster than our standard pipeline but still requires considerable hands-on work from the engineer performing the hotfix.

To further speed up deployment and reduce manual work, we introduced a workflow that simply rolls back to a previously-built healthy deployment image. In this workflow, the entire pipeline is reduced to just the Deploy step.

To invoke a rollback, an engineer commits a message with the keyword “[rollback]”, followed by the SHA of the commit to rollback to. Similar to the hotfix approach, any build step that should be skipped during a rollback checks the commit message for the “[rollback]” keyword before running:

early_exit_if_rollback:
    steps:
      - run:
          name: Early exit if rollback
          command: |
            git_commit_message=$(git log --format=%B -n 1)
            if [[ $git_commit_message =~ "Merge pull request #" ]]; then
              echo "This is a merge commit. Checking for rollback sha..."
              git_commit_sha=$(git log --format=%H -n 1)
              git_commit_message=$(git log --format=%B $git_commit_sha^-)
            fi
            if [[ $git_commit_message =~ "[rollback]" ]]; then
              echo "exiting early for rollback deploy"
              circleci-agent step halt
            fi
            echo "not a rollback deploy, continuing"

run_ruby_tests:
  steps:
early_exit_if_hotfix
early_exit_if_rollback
run_tests

The rollback workflow looks for a build matching the specified SHA and posts a confirmation message for the engineer, then deploys that build to production. The rollback approach dropped our time to resolution even further, from 30 minutes to ~3 minutes.

There are three edge cases that we’ve also baked into our rollback workflow: potentially stale images, database migrations, and blocking new merges and deployments.

Our script has a special block warning the engineer if a target image is older than an hour. The older the image, the riskier the rollback, as the delta between the image and the latest commit on main is larger.

time_rollback=$(git show -s --format=%ct ${rollback_revision})
time_now=$(date '+%s')
if [ $(($time_now - $time_rollback)) -gt 3600 ]; then
    message="${message}\n\n:warning:The rollback commit is more than an hour old."
    message="${message}\nThe [hotfix workflow](https://www.notion.so/alto/Deploying-a-Hotfix-Rolling-Forward-bb8e9cea05b44c67a64e23ae652653b6) might be a better candidate for this deployment."
fi

We also want to warn engineers if any database migrations have occurred between the current image and the target by checking the diff of the db/migrate directory. Rolling back application code without applying changes to the database can result in the database and application code becoming out of sync, resulting in further problems. Our script will warn engineers if a migration has been detected between the current and target image and provide instructions on how to rollback migrations if required.

Because a rollback deploys an image that’s older than our latest build, we also need to block continuous deployment until we’ve restored the main branch to a safe state — typically by deploying a hotfix as soon as we can identify an appropriate fix. We accomplish this using a Github issue with a specific tag that, when open, triggers a job causing any active CI job to fail. After the incident is resolved, the incident manager closes the issue, which will retrigger the blocked jobs and resume the normal build and deploy workflow.

The expedited rollback process has reduced our overall time to ship a resolution for incidents down to a speedy 3 minutes—a valuable improvement for our internal operations users, as well as for our customers and healthcare providers who rely on Alto’s service to get prescriptions filled. Branching these incident response workflows off of our existing standard deploy pipeline keeps the maintenance cost low for our infrastructure team, and robust automation reduces the risk of manual error for our product engineers when they need to invoke these workflows.

The Engineering Team is hiring! Learn more about open positions here.

Proactively managing COPD with medication and lifestyle changes can help prevent periods of intensified symptoms, referred to as exacerbations or flare-ups. Here’s more on how to recognize, treat, and prevent COPD flare-ups.

How to Manage and Prevent a COPD Flare-Up

Proactively managing chronic obstructive pulmonary disease (COPD) with medication and lifestyle changes can help slow the progression of the chronic lung disease and prevent periods of intensified COPD symptoms, commonly referred to as exacerbations or flare-ups. 

However, these flare-ups may occur even when closely following your doctor’s individualized treatment plan, especially during the more advanced stages of COPD, so it’s important to have a plan in place to quickly address symptoms. Here’s more on how to recognize, treat, and prevent COPD flare-ups.

Recognizing the symptoms of a COPD flare-up

During a COPD flare-up, symptoms like shortness of breath and wheezing quickly intensify and lung function significantly changes. (Lung function refers to how well your lungs work, specifically how much air they can hold and how easy it is for them to empty air.)

Individual experiences of a COPD flare-up may vary, but many people often notice greater amounts of mucus clogging the bronchial tubes in their lungs and sudden tightening of muscles around their airways. Here are key signs and symptoms to be aware of.

More frequent or more intense coughing, wheezing, or shortness of breath

Changes in the color, thickness, or amount of mucus

Using more oxygen than usual, if your treatment plan includes supplemental oxygen

If you experience any of the symptoms above, the best step is to call your doctor right away. Each COPD flare-up can affect your long-term lung function, so it’s important to address symptoms as quickly as possible.

To effectively manage a COPD flare-up, you’ll want to create a COPD action plan with your doctor. Then, if you experience the signs of a flare-up, you’ll have a specific outline of the actions and medications that can help restore your breathing. Here are some of the medications your doctor may include in your individualized COPD treatment plan.

Short-acting medications like bronchodilators relax your airway muscles and open your lungs to quickly reduce discomfort. Albuterol (branded options include ProAir® HFA, Proventil® HFA, Ventolin® HFA) is commonly used to treat COPD exacerbations. This medication is typically taken through an inhaler, but can also be taken as a liquid solution for nebulizer use. (A nebulizer is a device that turns a liquid medication into a mist that you can inhale through a face mask. It allows the medication to travel quickly to your lungs.)

Although not common, potential side effects of bronchodilators include nervousness or shakiness, headache, throat or nasal irritation, and muscle aches. Your doctor can explain more about the risks and benefits of using a bronchodilator to treat COPD exacerbations when building your treatment plan.

Your doctor may also recommend oral corticosteroids, which are fast-acting medications that reduce swelling in your lungs and open your airways so that more air can move in and out of your lungs. They are primarily prescribed for short-term use, typically five to seven days.

Oral corticosteroids commonly used to treat COPD exacerbations include:

Prednisone (Prednisone Intensol®, Rayos®)

Some people experience mild side effects from short-term corticosteroid use, including swollen hands and feet, elevated blood pressure, increased appetite, and shifts in mood.

Many people with more advanced COPD use supplemental oxygen to increase their tolerance for physical activities, while others use it only to relieve shortness of breath during an exacerbation.

If your flare-up is more mild, you may take oxygen at home. When writing your prescription for oxygen therapy, your doctor will explain how and when to use the oxygen. It is important to follow all of your doctor’s instructions, including the flow rate setting (how much oxygen you’ll need per minute). The American Lung Association has resources for anyone starting oxygen therapy.

If your COPD has progressed to a later stage, some flare-ups may require treatment in a hospital setting. This allows healthcare professionals to more closely observe your symptoms and monitor vital signs like your pulse, temperature, and blood pressure. Consult with your doctor about specific symptoms to look out for that may indicate a need for more intensive treatment or monitoring.

How to lower your risk of COPD exacerbations

There are many steps you can take to lower your risk of a COPD exacerbation and reduce the frequency of COPD-related hospitalizations.

First, it’s important to closely follow your doctor’s recommendations, including taking any maintenance medications exactly as prescribed. (We designed our app to make it as simple as possible to do so, with medication management tools like reminders and auto refills that help you stay on track.)

In addition, try to limit your exposure to leading triggers of COPD exacerbations, including cigarette smoke (this includes secondhand smoke), indoor and outdoor air pollution, cold air, and household dust.

To keep the air inside your home as clean as possible, avoid perfumes and cleaning and hygiene products with strong odors. Use air purifiers and vacuum cleaners with a high-efficiency particulate air (HEPA) filter.

Lastly, the flu and pneumonia can worsen COPD symptoms and potentially lead to a flare-up, so it’s important to get your yearly flu shot and ask your doctor or pharmacist if you are eligible for the pneumonia vaccine.

We’re here to support your COPD treatment

COPD flare-ups can cause discomfort, but we’re here every step of the way to help you manage symptoms and get the medications you need, with free same-day delivery and easy-to-use medication management reminders in our app.

And our team of pharmacists are always here to answer your questions by phone or through the Alto app. Reach out any time by 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.

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.

October is American Pharmacist Month, a time to celebrate the critical role that pharmacists and pharmacy technicians play within healthcare.

Celebrating American Pharmacist Month At Alto

October just might be our favorite month of the year, and for a good reason: it’s American Pharmacist Month, a time to celebrate the critical role that pharmacists and pharmacy technicians play within healthcare.

Pharmacists are one of the most accessible healthcare professionals, seeing people 5 to 8 times more frequently per year than primary care providers. And as such, they are integral to your overall health and well-being. 

You may not realize all the responsibilities that a pharmacist’s role encompasses. In addition to filling your prescriptions, they also educate on medication usage, advocate for changes that improve care, and problem solve clinical, ethical, managerial, economic, and legal compliance issues, becoming a trusted resource to the individuals they care for. Extensive training and education are required to enter the profession: a pharmacist must earn a doctorate in Pharmacy and complete state-specific licensing requirements before becoming licensed to practice pharmacy.

At many traditional retail pharmacies, each pharmacist is expected to tackle a broad assortment of tasks that often leave them feeling overwhelmed and stressed, like managing transactions for customers, answering questions about where non-pharmacy items are stocked, and contacting insurance companies on top of ensuring prescriptions are dispensed properly and safely. At Alto, however, pharmacists align with one of several practice areas — fulfillment, customer care, and onboarding — so that they are able to focus on specific aspects of pharmacist practice and deliver exceptional care to Alto’s customers.

Fulfillment pharmacists are responsible for inventory management, medication preparation, physical quality checks, and dispensing, all to make sure the right medication arrives at your door, on schedule. Our customer care pharmacists review prescriptions for accuracy and for potential complications with other medications on file; provide individualized consultations on dosing, side effects and other concerns; and partner with healthcare providers on clinical recommendations. And our onboarding pharmacists — a relatively new role at Alto — are a bridge to an individual's broader team, supporting healthcare providers and ensuring continuity of care between prescriber and pharmacy.

“At Alto, we are proud of our customer-focused services and forward-thinking means of providing those services,” shares Ashley Lee, Onboarding Pharmacist. “Being a pharmacist at Alto gives me the unique opportunity to not only practice patient care, but also to design it to be meaningful to as many individuals in need as possible. The innovation never stops here at Alto.”

How Alto pharmacists serve our communities

There’s no shortage of opportunities for a pharmacist to support an individual with their medication needs or to be a partner in their health journey alongside their doctor’s office, family and other support networks. Here are just a few of the many roles that Alto pharmacists fulfill.

Literally. Our pharmacists are educators who mentor other pharmacists-in-training. Sandra Aziz, Pharmacy Compliance Program and Training Manager, is responsible for training new Pharmacy Managers and Supervisors at our dispensing sites, ensuring they have the resources needed to be effective managers and to oversee their pharmacy location’s compliance program and daily operations.

Sandra also manages our internship programs for pharmacy students. Alto offers an immersive 10-week Pharmacy Operations Management summer internship program for eligible students at Howard University’s School of Pharmacy (HUCOP). The program provides an opportunity to gain a breadth of experience across clinical pharmacy care, operations, and business development. Students also have the opportunity to actively influence Alto’s software development and implement ideas that further preventative healthcare and pharmacist involvement in community health.

Sandra also launched our Introductory Pharmacy Practice Experiences (IPPE) and Advanced Pharmacy Practice Experiences (APPE) programs, which allow students from pharmacy schools across the country to select Alto as a practice site. While at Alto, they are exposed to highly skilled and entrepreneurial pharmacists, engineers, and operations experts with whom they can partner to challenge, reinvent, and improve pharmacy. 

“It’s been really rewarding to see more pharmacy students expressing interest in our programs,” Sandra said. “We have a rare opportunity to give students an experiential learning experience that you won’t find at any other pharmacy. At Alto, our pharmacists work cross-functionally across operations, engineering, and design to build a better, more intuitive community pharmacy from the ground up. We focus on challenges faced by patients, providers, and payers, and find solutions that optimize experience, transparency, and health outcomes.”

Read our previous post, 'From Pharmacist to Professor: Sandra Aziz Spotlight'.

They’re also here to teach you! Our pharmacists are happy to chat on the phone for however long you need to offer individualized support. Many customers use these one-on-one consultations to learn how to give themselves injections as part of fertility treatment or diabetes management or to confirm special storage or dosing instructions, but our pharmacists are happy to share their expertise on any question related to your prescriptions or health needs.

For example, did you know that our pharmacists are experts on managing side effects? As a bridge between you and your doctor, our pharmacists review all of your current medications to identify any potential symptoms or medication interactions, and they’re available to talk through any questions or concerns.

Lawmakers in several states have recognized the accessibility of pharmacists and their potential to play an even larger role in healthcare, specifically in the HIV prevention space. California became the first state to allow pharmacists to prescribe HIV prevention medication like pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) in 2019, and Colorado became the second in November 2020. 

“As healthcare providers in the community, there is a big opportunity for us as pharmacists to play a critical role in HIV prevention and help increase accessibility to medications like PrEP and PEP,” explains Susan Sun, Specialty Pharmacist. “It’s been wonderful to see growing recognition of a pharmacist’s impact even outside of the healthcare community, and the recent legislation that allows pharmacists to prescribe in some states is just a start. It’s a privilege for pharmacists to be a part of these exciting changes and make HIV prevention easier for others.”

In honor of American Pharmacist Month, we’d like to say a big and heartfelt thank you to our incredible team of 175+ pharmacists. Each of you plays a critical role in the wellbeing of our customers, the strength of our provider relationships and the quality of our service — we’re grateful for your hard work all year long. 

Here are just a few of the faces responsible for providing exceptional pharmacist care at Alto!

Editor’s Note: This post was originally published in October 2021 and has been updated for accuracy and completeness.

There are 1.6 million Americans living with type 1 diabetes, including about 200,000 young people under 20 and 1.4 million adults aged 20 years old and older. Here is a high-level guide to living with type 1 diabetes at any age.

How to Live with Type 1 Diabetes at Any Age

There are 1.6 million Americans living with type 1 diabetes, including about 200,000 young people under 20 and 1.4 million adults aged 20 years old and older. While type 1 diabetes is typically diagnosed during childhood or adolescence (it was once referred to as juvenile diabetes), a diagnosis can come at any age 

Living with type 1 diabetes is a lifelong journey, and insulin therapy and blood glucose monitoring will remain constant. Some aspects of diabetes management, though, apply only to certain age groups, like coordinating with school staff about a child’s type 1 diabetes care plan or prioritizing heart disease prevention as you get older (more about that later).

Below, we’ve highlighted  things to be mindful of with type 1 diabetes treatment for various age groups. This is intended to be a high-level guide to living with type 1 diabetes at any age, and your diabetes care team (or your child’s) will help you develop an individualized treatment plan with recommendations for insulin dosage, blood sugar targets, and blood sugar monitoring frequency.

Type 1 diabetes and children: blood sugar monitoring at school

Individuals with type 1 diabetes are unable to produce any insulin, a hormone produced in the pancreas which helps convert sugar, or glucose, into energy. Getting started with insulin therapy is one of the first steps after a type 1 diagnosis, and is an important part of living with type 1 diabetes at any age. Daily insulin therapy, along with blood sugar monitoring and meal planning, allows people with type 1 diabetes to maintain healthy and consistent blood sugar levels.

While the goal of insulin therapy is to keep your blood sugar levels as steady as possible throughout the day, fluctuations are natural. Checking blood sugar levels several times each day allows you to stay within a healthy range. Younger children with type 1 diabetes will need help with both insulin administration and blood sugar monitoring, and during the school day you may need teachers and other school staff to provide support. It’s also important that someone at the school understands how to administer glucagon if your child’s blood sugar falls too low (known as hypoglycemia).

Here are some steps you can take to simplify your child’s treatment needs and make sure you’re prepared for an emergency.

Communicate with your child’s teacher and/or other school staff before classes begin to make sure they’re aware of your child’s type 1 diabetes diagnosis. 

Discuss daily treatment needs like blood sugar monitoring and insulin therapy as well as potential complications that may arise, like low blood sugar, and how to spot the signs and symptoms.

You may also want to consider an insulin pump. They have become increasingly common in diabetes treatment, especially with children, due to their convenience, ease of use, and automated timing of insulin injections 

The American Diabetes Association has resources that you can share with school staff to help them understand how to support your child’s diabetes care plan. And the JDRF has a back to school checklist, which includes all the information your child’s teachers should know.

Read our previous blog to learn more about managing your child’s type 1 diabetes.

Teens and young adults: managing diabetes away from home

Learning how to navigate life with greater independence and less structure as you enter your late teens and twenties often takes on additional importance if you have type 1 diabetes. You may now be responsible for aspects of your own diabetes treatment that parents or other adults previously helped with.

For many young adults living with type 1 diabetes, this transitional period requires learning about the logistical aspects of diabetes care, like filling prescriptions, ordering supplies, and scheduling appointments. And whether you’re living far from home or nearby, it may be time to find a new doctor, as many young adults switch from seeing a pediatrician to an adult healthcare provider around the ages of 18 - 21.

To avoid any gaps in your diabetes treatment, plan ahead and work with your pediatrician and your support system, including your parents or other relatives, to create a plan for finding an adult healthcare provider. Make sure that you also have the information you need to stay on track with your diabetes management, like how to navigate health insurance, or how to use diabetes supplies like a continuous glucose monitoring device (CGM)  or insulin pump. 

It’s understandable if other challenges related to your diabetes care needs arise for the first time during this stage of life. For many young adults, there’s a learning curve with handling other illnesses when you’re away from home. For example, the flu can become more complicated if you have diabetes, since it may affect your calorie intake, which in turn may affect your blood sugar levels. Once you’ve found a primary care provider, ask them about additional steps to take when you’re sick, like checking your blood sugar levels more frequently or consuming carbohydrate-rich soft food and liquids .

It’s also important to understand how alcohol use can interact with insulin therapy and affect your blood sugar levels. Ask your doctor for recommendations about drinking safely when living with type 1 diabetes, and be honest with them about your alcohol consumption so that they can best address your individual health needs.

You may also benefit from working with a certified diabetes educator during the transition from your teens to adulthood. A diabetes educator is a healthcare professional with extensive knowledge of diabetes who has been certified to coach individuals living with the condition. They can make sure you have all the necessary information to successfully manage your diabetes.

Maintaining a balanced life with type 1 diabetes

It may feel like life has only gotten faster during your late twenties and into your thirties and forties. However, staying on track with your diabetes management is as important as ever — and for some individuals, you may be first learning of your type 1 diabetes diagnosis during this busy time.

A common challenge of living with type 1 diabetes in adulthood is fitting daily treatment needs into a busy schedule. If you work long days in a physical setting, it may feel inconvenient to take insulin and check your blood sugar while on the job. You may find that an insulin pump is a good option for you since you won’t have to worry about remembering the timing of your injections.

Ultimately, deciding how much of your health situation to share with an employer is a personal choice, but at least one person should be prepared to offer support in the event of an emergency if you work on site. Make sure they know the signs of low blood sugar, how to administer emergency glucagon, and where you keep your supplies.

If you are a woman living with type 1 diabetes and considering starting a family, sharing your family planning goals with your primary care physician can help you have a healthy pregnancy. Your A1C levels — your average blood sugar levels over a period of two to three months, which your doctor will check periodically during your regular visits — are even more important in the months before pregnancy. This is because your blood sugar levels can impact the development of your baby’s organs during the first 8 to 12 weeks of your pregnancy.

Ask your doctor to clarify your A1C goals and how long to maintain them before pregnancy. And once you find out you are pregnant, contact your healthcare provider as soon as possible to find out if you need to make any changes to your treatment.

Your risk for many conditions like heart disease, high blood pressure, high cholesterol, and dementia all increase as you age. When living with type 1 diabetes, preventative care and healthy lifestyle choices are even more important, as many aging-related health risks intersect with potential diabetes-related complications.

Men and women living with type 1 diabetes have a higher risk of developing heart disease than those without the condition. High blood pressure is common in older adults with diabetes, which can lead to a greater risk for strokes and heart attacks and may also affect your vision and kidney function.

It’s important to keep track of your blood pressure and cholesterol levels and follow your doctor’s recommendations for treatment, which may include lifestyle changes and medications. And depending on your overall health, you may need a loved one’s support with managing certain aspects of your diabetes care, like administering insulin and recording blood sugar readings.

Living with diabetes at any age is easier with a reliable pharmacy partner. At Alto, we’re committed to making it as simple as possible to manage your diabetes, with free same-day delivery and medication management tools like reminders and auto refills in our app. And our dedicated diabetes support team is here to ensure that you have all the information you need to follow through on your individualized treatment plan.

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

Infertility is often thought of as exclusively a women’s health issue, but the truth is that it can affect anyone regardless of gender. We explain more including male infertility causes, symptoms, and treatment options.

Male Infertility: Causes, Symptoms, and Treatment

Infertility is often thought of as exclusively a women’s health issue, but the truth is that it can affect anyone regardless of gender. About one-third of infertility cases include factors exclusively related to male reproductive function.

If you’ve experienced infertility, you’re not alone: about 9% of men and 11% of women in the U.S. have faced fertility challenges. And while these challenges may feel overwhelming, they do not necessarily mean that you won’t be able to start a family one day — there are a variety of fertility treatment options for both men and women to support your family building journey.

Below, we explain more about male infertility, including causes, symptoms, and treatment options that can help you build or add to your family.

Male infertility most often stems from issues with sperm production. In some cases, it may be a problem with the quality of your sperm, like how fast or how well your sperm move. In other instances, it’s a matter of sperm quantity: you may not be able to produce any sperm, or you may have a low sperm count (the threshold is typically a sperm count under 15 million sperm per milliliter of semen.)

Issues with sperm production or function may be caused by the following:

Hormone, pituitary gland, or immune system problems

Hemochromatosis, a condition in which you have an excess of iron in your system

Lifestyle and environmental factors can also play a role: heavy smoking (20 or more cigarettes per day), consistent heavy drinking or binge drinking (for men, five or more drinks in a two-hour timeframe), drug use, and exposure to toxins like endocrine disruptors contained in plastics and pesticides have been linked to male infertility.

Beyond issues with sperm production, anything that blocks a reproductive organ can interfere with the flow of semen, including inflammation from a sexually transmitted infection, scar tissue from surgery, or swollen veins in any of your reproductive organs. Additional factors in male infertility include erectile dysfunction, premature ejaculation, liver or kidney disease, and treatment for seizure disorders.

You may have a greater chance of experiencing fertility issues if you have had any of the following:

Inflammation of your prostate or genital infections

Certain prescription medications may also increase your risk of infertility, including:

5-alpha-reductase inhibitors, a medication class used to treat prostate enlargement and hair loss, which includes finasteride (Propecia®) and dutasteride (Avodart®)

Alpha blockers like silodosin (Rapaflo®), tamsulosin (Flomax®), alfuzosin (Uroxatral®), terazosin (Hytrin®), and doxazosin (Cardura®), which are used to treat prostate enlargement

Some selective serotonin reuptake inhibitors (SSRIs) used to treat depression and anxiety, including sertraline (Zoloft®) and paroxetine (Paxil®)

Spironolactone, which may be used to treat high blood pressure or acne

Cimetidine, which is used to treat acid reflux and gastroesophageal reflux disease (GERD) 

If you and your partner are unable to conceive after trying for at least a year, one or both of you may be experiencing infertility. If you have experienced any of the following symptoms, you may wish to consult with your doctor about a potential diagnosis of male infertility:

Problems with ejaculation, including delayed ejaculation

If you have previously had surgery in your genital area, you should also consult with a doctor about potential infertility issues.

To evaluate you for an infertility diagnosis, your doctor will first ask questions about your medical history, including your sexual history and any other factors that may affect your reproductive health and fertility. They may also do a physical exam to check your genitals for any abnormalities.

The next step is typically a semen test, sometimes called a sperm count. Your doctor will ask you for a sample of semen. During their evaluation, they will look at how many sperm you produce and whether the sperm are normal in shape and movement — healthy sperm have an oval head and long tail.

Your doctor may recommend additional tests, including blood tests to evaluate your hormone levels and to rule out other health conditions, and genital ultrasounds to identify potential reproductive health issues.

Thanks to the medical community’s advances in fertility treatment and technology, infertility issues do not mean that you won’t be able to build a family. There are a range of treatment options that can help increase your chances of conception. Your doctor will make recommendations for the best course of treatment based on the underlying cause of your fertility issues.

Oral medications such as the following are the firstline treatment for most cases of male infertility.

Clomid® is an oral medication that can increase testosterone and sperm production as well as improve sperm motility.

Letrozole (Femara®) is an oral medication that can improve sperm count and motility. A non-steroidal aromatase inhibitor, it functions by decreasing estrogen production.

Anastrozole (Arimidex®) is another oral non-steroidal aromatase inhibitor used to increase sperm count and improve sperm motility. It can also help restore the testosterone-estrogen balance for some men experiencing infertility.

Additionally, tadalafil (Cialis®, Adcirca®), vardenafil (Levitra®, Staxyn®), and sildenafil (Viagra®, Revatio®) may be used to treat erectile dysfunction, a factor in male infertility.

An evaluation is typically scheduled after 3-6 months of treatment. If oral medications haven’t been effective by this point, a provider may recommend injectable gonadotropin therapy or assisted reproductive technology (ART) treatments.

There are two types of hormones used in injectable gonadotropin therapy: human chorionic gonadotropin (hCG) and follicle stimulating hormone/luteinizing hormone (FSH/LH).

hCG treatment triggers the testes to produce testosterone, which leads to production of new sperm. Common hCG medications used to treat male infertility include Pregnyl®, Novarel®, and Ovidrel®. 

FSH/LH treatment triggers production of new sperm. Common FSH/LH medications used to treat male infertility include Gonal-f®, Follistim®, and Menopur®.

hCG treatment can be used alone to stimulate sperm production, but FSH/LH treatment must be used in tandem with hCG treatment. If hCG treatment is not successful after six months, FSH/LH treatment may be added to a medication protocol.

While injectable therapies are effective, they take time to work. The length of treatment ranges from six months to 1-2+ years. Keep in mind that once new sperm is produced, it takes an additional 3-4 months before it is available. 

Assisted reproductive technology treatments

There are several fertility treatment options that can increase your chances of conceiving a child, including in vitro fertilization (IVF) using a technique called intracytoplasmic sperm injection (ICSI) and different forms of artificial insemination like intrauterine insemination (IUI).

In intracytoplasmic sperm injection (ICSI) a single sperm can be injected directly into an egg. This procedure is often incorporated into an IVF cycle for many couples affected by male infertility. IVF is a process in which eggs and sperm are fertilized in a laboratory and then placed into the uterus with the potential outcome of a pregnancy. Women trying to conceive may undergo IVF treatment if their partner is experiencing male infertility to increase their chances of conceiving. ICSI can be the fertilization method used in IVF.

In IUI, sperm that have been washed and concentrated are placed directly into your partner’s uterus around the time that they are ovulating, helping your sperm reach an egg more easily.

Since lifestyle habits like heavy smoking or alcohol use can affect sperm production, you may be able to increase your sperm count with healthy choices like exercising regularly and abstaining from cigarettes, alcohol, and drugs.

A fertility pharmacy partner you can rely on

At Alto, we understand that there are many paths to parenthood, and that each individual or couple’s needs are different. Our team of pharmacists is experienced in male infertility treatment options, and we’ll be here at every step of the way if fertility medications become part of your plan. 

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

Editor’s Note: This post was originally published in April 2022 and has been updated for accuracy and completeness.

Insulin pumps have become increasingly widespread in diabetes treatment in recent years due to their convenience and ease of use. Read on for more information about these devices.

The Role of Insulin Pumps in Diabetes Treatment

Both type 1 and type 2 diabetes involve complications with the body’s production of insulin, a hormone produced in the pancreas that converts sugar into energy. People living with type 1 diabetes do not produce any insulin at all, so they have to take insulin every day to keep their blood sugar levels in a healthy range.

Insulin therapy may also play a role in managing type 2 diabetes, since individuals with the condition do not produce a sufficient amount of insulin to regulate blood sugar levels. However, some individuals with early-stage type 2 diabetes are able to manage their blood sugar with other medications and healthy lifestyle habits — make sure to consult with your doctor on the best course of treatment given your needs.

There are several methods available for delivering insulin into the body, including syringes,  insulin pumps, and pens. Insulin pumps have become increasingly widespread in diabetes treatment in recent years due to their convenience and ease of use.

There are a variety of insulin pump options to choose from. Read on for more information about these devices.

What is an insulin pump and how does it work?

An insulin pump is a small electronic device that delivers doses of insulin at specific times. It mimics the activities of a normally functioning pancreas by delivering small, continuous doses of insulin throughout the day and surges of insulin while you eat. You set the schedule, and it is easy to make adjustments if your dosage changes or if you eat or exercise more than usual on any given day.

While an insulin pump’s consistent delivery of insulin is effective in keeping your blood sugar levels within a healthy range, it is still important to check your blood sugar throughout the day using either a blood glucose meter or a continuous glucose monitor (CGM). Some newer insulin pumps are connected to a CGM, which allows for both automated glucose monitoring and insulin delivery.

Many people who use insulin pumps find them to be more convenient than insulin injections, particularly while on the go. Insulin pumps offer the flexibility to work, socialize, or engage in just about any other activity without stepping aside to give yourself an insulin injection. And their automated, adjustable delivery makes it simple to maintain healthy blood sugar levels: not only do you not have to worry about missing a dose, but you can easily add, remove or modify a dose depending on your calorie intake and level of physical activity.

Most insulin pumps are designed to store dosing data, so you and your doctor’s office will have easy access to details about your insulin regimen should you need to make any adjustments to your treatment plan. 

Blog

How to Have an Easy Alto Pharmacy Delivery Experience

Introducing Alto Connect

How Alto Reduced Time to Resolution for Production Incidents

How to Manage and Prevent a COPD Flare-Up

Celebrating American Pharmacist Month At Alto

How to Live with Type 1 Diabetes at Any Age

Male Infertility: Causes, Symptoms, and Treatment

The Role of Insulin Pumps in Diabetes Treatment

What to Know About Using PEP to Prevent HIV Infection

When to See a Healthcare Specialist for Allergy Treatment

Spotlight on Men Having Babies & Dr. Guy Ringler

What to Know About Dry Powder Inhalers

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