Diabetes


More than 25 million Americans have diabetes. This is a chronic condition that produces high blood sugar levels.1 Another 79 million have prediabetes, which makes them 5 to 15 times more likely to develop diabetes. But many of these people – whether they have prediabetes or diabetes – have no idea they’re at risk.2 Could you be one of them?

Well, to begin, here are some questions to ask yourself. Are you:

  • 45 or older
  • Overweight
  • The child or sibling of someone who has diabetes
  • An African American, Hispanic/Latino Native American, Asian American, or Pacific Islander
  • Someone who had diabetes while pregnant or gave birth to a baby weighing 9 pounds or more
  • Physically active less than three times a week2

The more boxes you checked, the higher your risk for prediabetes. Talk with your doctor to see if you should have a blood test, especially if you’re 45 or older and overweight.2

How else can you know if you’re at risk? If diabetes develops slowly, you may not have any symptoms. But with have high levels of blood sugar, you may one or more of these symptoms:

  • Extreme thirst
  • Blurry vision
  • Tingling in hands in feet
  • Fatigue
  • Frequent peeing
  • Increasing hunger
  • Unexplained weight loss 3,4

Left untreated, diabetes can lead to serious problems. Blindness, serious infections, nerve or kidney damage – to name a few. And, diabetes can contribute to cardiovascular problems, making a heart attack or stroke more likely.3 That’s why you should pay special attention to blood glucose levels if your blood pressure is also high.5

But I’m here to tell you not to throw your hands up in despair. You can do a lot to prevent or delay the onset of diabetes – at least the type that more often occurs in adulthood (Type 2 diabetes). Even losing just 5 percent of your weight can make a big difference. 2 For someone who weighs 180, for example, that’s just 9 pounds. You can do that, now, can’t you?

In case you’re still skeptical, you should know that the benefits of modest weight loss is backed up by research. The Diabetes Prevention Program (DPP) trial found that reducing fat and calories and increasing physical activity led to modest weight loss and a 58 percent reduction in type 2 diabetes in high-risk adults. Better yet? The benefits of these lifestyle changes lasted over several years. It had the biggest bang for the buck in people 60 and older.6

Other simple diet changes may make a huge difference as well. For example, blueberries and applies are tied to a lower diabetes risk.7 And, one recent study showed a strong link between white rice and diabetes, with a 10 percent increase in risk for each additional serving eaten!8 Instead, explore the world of whole grains – brown rice, barley, quinoa, or buckwheat. You may find you’ve been missing some nutritious – and delicious – alternatives.

Still perplexed? Not sure what to do? Remember to check out the resources at www.healthmart.com.Nothing herein constitutes medical advice, diagnosis or treatment, or is a substitute for professional advice.  You should always seek the advice of your physician or other medical professional if you have questions or concerns about a medical condition.

Sources

  1. CDC: “2011 National Diabetes Fact Sheet.” Available at: http://www.cdc.gov/diabetes/pubs/factsheet11.htm. Accessed March 27, 2012.
  2. CDC: “Prediabetes: Am I at risk?” Available at: http://www.cdc.gov/diabetes/prevention/prediabetes.htm. Accessed March 27, 2012.
  3. PubMed Health: “Diabetes.” Available at: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002194/. Accessed March 27, 2012.
  4. WebMD: “Diabetes Testing.” Available at: http://diabetes.webmd.com/guide/diagnosing-type-2-diabetes. Accessed March 27, 2012.
  5. U.S.Preventive Services Task Force: “Screening for Type 2 Diabetes Mellitus in Adults.” Available at: http://www.uspreventiveservicestaskforce.org/uspstf/uspsdiab.htm. Accessed March 27, 2012.
  6. NIH News: “NIH study finds interventions to prevent type 2 diabetes give good return on investment.” Available at: http://www.nih.gov/news/health/mar2012/niddk-22.htm. Accessed March 27, 2012.
  7. MedlinePlus: “Blueberries and apples tied to lower diabetes risk.” Available  at: http://www.nlm.nih.gov/medlineplus/news/fullstory_123054.html. Accessed March 27, 2012.
  8. MedlinePlus: “As White Rice Intake Rises, So May Your Risk for Diabetes.” Available at:  http://www.nlm.nih.gov/medlineplus/news/fullstory_123031.html. Accessed March 27, 2012.

  



Diabetic Testing

Diabetes is a condition which effects nearly 1 in 8 patients in the state of Delaware.1 In order to recognize patients who may be at risk for diabetes or to help those already diagnosed manage their diabetes, blood glucose testing is often performed. Blood glucose testing reveals how much sugar is present in the blood at that particular time. Glucose is a type of sugar that the body prefers for its source of energy. This sugar is broken down from foods that contain carbohydrates such as breads, sweets, and fruit to name a few. The ability to control glucose levels in the blood depends on the body’s capability to produce insulin. Insulin is a hormone produced in the pancreas that is released when the body senses a rise in blood glucose after a meal.2 Problems arise when the body does not produce enough insulin or the body does not respond to insulin as it should. It is necessary to test blood glucose levels, because prolonged uncontrolled blood glucose levels can cause damage to nerves, blood vessels, eyesight, skin, and in severe cases may lead to death.
To determine if a patient is diabetic, a blood glucose test is done after a fasting period of 8 hours to identify how well the body is controlling the blood sugar levels. The American Diabetic Association (ADA) has determined that a normal blood sugar level after an 8 hour fast should be below 110 mg/dL. Along with other tests, diabetes can also be diagnosed by an HbA1C level of >6.5. This test measures the blood sugar level based on an average of 3 months. For individuals who have already been diagnosed with diabetes, the range that the ADA recommends is to keep the blood sugar level between 80-130 mg/dL before a meal is consumed and to keep the level less than 140 mg/dL after a meal.
To test blood glucose levels, an individual will need several items to perform the test correctly. The patient will need a meter (glucometer), a test strip specific to the meter, a lancet and lancet device, an alcohol swab, a bandage if necessary, and a special container to dispose of the lancet after use. It should be noted that there are several different manufacturers available (i.e. Accu-Check, Freestyle and One Touch) that provide meters, and it is recommended that the consult with their physician or pharmacist to choose the best one that suits their lifestyle or that may be covered by the patient’s insurance.
When it is time to test the blood glucose level, first prepare the meter by ensuring the device is properly working by inserting the appropriate test strip into the device. If the device is working correctly, the screen should turn on with the appropriate display asking for a sample. Be sure to insert the end of the test strip containing the chip directly into the device and the other end for the blood sample exposed. Note that each meter and strips are unique to each manufacturer, so please refer to your pharmacist or provider to ensure appropriate device usage. Once the device is prepared, the patient will first clean their hands with soap and warm water or may use an alcohol swab to adequately sanitize the finger being tested. Once the finger is completely dry, the patient will use the lancet on the side of the finger away from the nailbed on their non-dominant hand. It may be necessary to hang the arm down to the side or rub the finger for a few seconds to allow proper blood flow to the area before activating the lancet. This will help ensure that an adequate blood sample is produced. Once the blood sample is obtained, gently move the strip that has been inserted correctly into the activated meter against the drop of blood. The strip will draw up the sample and the device will begin to calculate the patient’s blood glucose level. After a few seconds, the meter will display the patient’s results on the screen. Please be sure to use a new test strip and lancet for each test performed.
The results from the test will tell the patient what action needs to be taken. If the patient is on an insulin regimen, they will use those numbers to adjust what dosage of insulin is required prior to a meal. For further information on how to select an appropriate device, proper blood glucose testing administration, or other questions pertaining to the management of diabetes please consult your physician or local pharmacist. 




Diabetic Medications

If you or someone you love has diabetes, you know how important it is to manage it well. What happens if you don’t? You’re at risk for serious complications that can affect your heart, kidneys, eyes, and nerves—to name a few.1

Some people can manage diabetes with meal planning, weight loss, and exercise alone. Others also need medication. Pills to lower blood sugar levels are one type of drug used to treat diabetes.2

Can diabetes pills help you? Not if you have type 1 diabetes. Do you have type 2 diabetes? Then, you’re more likely to benefit if you’ve had diabetes for less than 10 years and your body still makes insulin. That’s the hormone that regulates sugar levels in your blood.2,3

There is more than one type of diabetes pill, and the FDA has approved several new ones in the recent past. Sometimes combining more than one type is the best solution.  Or, your doctor may prescribe pills plus insulin. 2,3

There are many classes of diabetes pills. They help you control your diabetes in different ways. These drugs may do one or more of these things:

  • Stimulate the pancreas to release more insulin
  • Decrease the amount of sugar the liver produces
  • Make muscle tissue more sensitive to insulin
  • Help insulin work better
  • Lower blood sugar, but only when it gets too high in your body
  • Help the kidney get rid of extra sugar, which lowers levels in your blood
  • Block the breakdown of starches such as pasta and potatoes, and slow the breakdown of certain sugars, which slows the rise of sugar levels after eating
    • Both lower cholesterol and reduce blood sugar2,4,5

Isn’t it amazing how many different ways these drugs work? If one doesn’t work well for you or if it stops working, another may be more successful.2,3 That’s because doctors and scientists think that the cause of type 2 diabetes is not the same for all people with the disease.6

If your doctor has prescribed one of these drugs, I can provide you with more information. To help avoid interactions with other drugs, print a list of all your medications, both prescription and over the counter. Bring that list with you when you come to talk to me.

I can answer other questions you might have about your medication, such as:

  1. Are there special instructions for this medication?
  2. Do I need to take the medicine with meals or at certain times of day?
  3. Should I avoid taking this medication with any foods, vitamins, or supplements?
  4. What are the most common short-term and long-term effects of this drug? 7

As you can see, the arsenal for fighting diabetes just keeps growing – and we haven’t even touched on new injectable and inhaled medications. Let’s save that for another day!

Nothing herein constitutes medical advice, diagnosis or treatment, or is a substitute for professional advice.  You should always seek the advice of your physician or other medical professional if you have questions or concerns about a medical condition.

Sources: 

  1. WebMD: “The Risks and Complications of Uncontrolled Diabetes.” Available at: http://www.webmd.com/diabetes/risks-complications-uncontrolled-diabetes Accessed September 27, 2014.
  2. American Diabetes Association: “Oral Medication.” Available at: http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/oral-medications/ Accessed September 27, 2014.
  3. Joslin Diabetes Center: “Who Can Take Diabetes Pills?” Available at: http://www.joslin.org/info/new_who_can_take_diabetes_pills.html Accessed September 27, 2014.
  4. EveryDay Health: “Meet the New Generation of Type 2 Diabetes Drugs.” Available at: http://www.everydayhealth.com/diabetes/meet-the-new-generation-of-diabetes-drugs.aspx Accessed September 27, 2014.
  5. Joslin Diabetes Center: “Spotlight on New Diabetes Treatments.” Available at: http://www.joslin.org/info/Spotlight_on_New_Diabetes_Treatments.html Accessed September 27, 2014.
  6. MerckEngage: “Taking Medicines for Diabetes.” Available at: http://www.merckengage.com/common/article.aspx?ID=568 Accessed September 27, 2014.
  7. Joslin Diabetes Center: “Oral Diabetes Medications Summary Chart.” Available at: http://www.joslin.org/info/oral_diabetes_medications_summary_chart.html Accessed September 27, 2014.




Juvenile Diabetes

Diabetes is no stranger to many children. A life-long disease causing high levels of blood sugar, diabetes is one of the most common chronic conditions in children and teens. Recent evidence suggests that a common family of viruses may help trigger diabetes, especially in children. Sadly, diabetes is becoming familiar to an increasing number of children. The nation’s largest study of diabetes in young people found diabetes is on the rise in every racial and ethnic group studied.

What exactly is diabetes?

Often called juvenile diabetes, type 1 diabetes is an autoimmune disorder. This means the immune system goes a little haywire. It mistakenly destroys pancreas cells that make insulin, a hormone that normally helps the body make energy from food. People with this type of diabetes must take daily injections of insulin for life.

With type 2 diabetes, the pancreas cells still produce insulin, but they don’t work the way they should. This type was formerly known as adult-onset diabetes because it mainly occurs in adults 40 and older. Now it is showing up in more and more children. Lifestyles that favor junk food and video games over exercise and healthy food choices may be a big part of the problem. Children or teens most at risk are overweight or obese and have a family history of the disease. American Indians, African Americans, Latinos, Asian Americans, and Pacific Islanders are also at increased risk.

Type 2 diabetes may be hard to detect in children. That’s because they don’t always have symptoms. Once diagnosed with blood tests, though, diabetes is often well managed with weight loss, exercise, and changes in diet.

When symptoms of diabetes do appear, they may include:

  • Frequent peeing
  • Extreme hunger or thirst
  • Unusual weight loss
  • Increased physical or mental fatigue
  • Irritability, jitteriness, or moodiness
  • Blurry vision

So what’s the big deal about diabetes? What damage can it cause? Left untreated, diabetes can lead to serious complications, such as:

  • Nerve damage
  • Damage to the eyes, which can cause blindness
  • Kidney disease
  • Heart disease

Doctors once thought these complications were unavoidable. Today, we know that controlling blood sugar can reduce or prevent them altogether. Doing this well does involve some big changes for your child – and possibly the whole family. And getting your child or teen on board at first may be tough. But you can do it!

To begin, you must check your child’s blood sugar often and keep accurate records. If your child takes insulin, you’re likely to check about four times a day, but you must test with either type of diabetes. It’s the only way to know what blood sugar levels are. You may need to do this more often on certain days, such as when your child is sick. Remember that our pharmacy staff can help answer your questions about these tests.

Managing diabetes well also involves exercise and meal planning. Your child will likely need to change what and when she or he eats. For example, healthy food choices require a careful balance and correct portion sizes of carbohydrates, proteins, and fats. And, it’s important for your child to eat meals and snacks timed around insulin peaks. Sound complicated? With time, both you and your child can master these lifestyle changes. And, you can do it without depriving your child or teen of sleepovers, family vacations, extracurricular activities, and fun with friends. 




Type 2 Diabetes

“Not me.” Those may be the first words that come to mind if you’re diagnosed with type 2 diabetes. It isn’t news anyone wants to hear. It’s true—you will need to make some changes, but your life sure isn’t over. And, with so many diabetes resources online and in your community, you don’t have to go it alone.

First, it may help to get a little clearer about what diabetes is. Your body needs insulin to break down sugar (glucose) into energy. If you have type 2 diabetes, your body either doesn’t have enough insulin or doesn’t use it well. So glucose stays in your blood, causing problems.1There isn’t a cure for type 2 diabetes. But you can learn to manage it well. You can keep your blood glucose in a safe range by balancing the food you eat with exercise—and medicine, if your doctor prescribes it.

Be sure to make all your doctor appointments. You may also need to learn how to check your blood glucose.2Here are six tips to get you started taking better care of yourself.

  1. Get clear about the roles of your diabetes care team: This may include your doctor, nurse, dietitian, diabetes educator, and me, of course—your pharmacist.1 You can also ask your doctor to refer you to a diabetes education program.2
  2. Learn about healthy eating. Diabetes diets aren’t as restrictive as they once were. The key thing is to eat a variety of healthy foods—not too much and not too much of one type of food. Don’t skip meals, and space your meals throughout the day.3
  3. Try the “Plate Method” for planning your meals. Divide your plate in half, and then divide one side in half again. Fill the largest section with non-starchy vegetables. In one small section, put starchy foods such as whole-grain breads, rice, potatoes, or cereal. In the other small section, put meat or meat substitutes. Add eight ounces of nonfat or low-fat milk and a piece of fruit.4
  4. Look for ways to be active throughout the day. Need to make phone calls? Get up and move around while talking. Taking the bus? Get off a stop early and walk. Ask your doctor how much aerobic activity you need daily. This can help your insulin work better. If you need to lose weight, try for more than 30 minutes a day of aerobic activity.5 Dropping just 10 or 15 pounds makes a big difference.6
  5. Has your doctor prescribed medication to keep your blood glucose in a healthy range? If so, get clear about how many to take and how often. Also, learn how to prevent side effects and what to do if you have any. 7
  6. Learn how to check your blood glucose at home if your doctor asks you to. Your doctor or diabetes educator can help you select a meter that works well for you and is covered by your insurance.8

Remember: I’m part of your diabetes care team. You can think of me as your “go-to” person for answering any questions you have about your diabetes medications.

You can do this!  Nothing herein constitutes medical advice, diagnosis or treatment, or is a substitute for professional advice.  You should always seek the advice of your physician or other medical professional if you have questions or concerns about a medical condition. 

Sources 

  1. “Getting Started with Diabetes.” ADA. Available at: http://www.diabetes.org/living-with-diabetes/recently-diagnosed/where-do-i-begin/getting-started-with-diabetes.html Accessed January 28, 2013.
  2. “Taking Care of Your Diabetes.” ADA. Available at:  http://www.diabetes.org/living-with-diabetes/recently-diagnosed/where-do-i-begin/taking-care-of-your-diabetes.html Accessed January 28, 2013.
  3. “Choosing What, How Much, and When to Eat.” ADA. Available at: http://www.diabetes.org/living-with-diabetes/recently-diagnosed/where-do-i-begin/choosing-what-to-eat.html Accessed January 28, 2013.
  4. “Create Your Plate.” ADA. Available at: http://www.diabetes.org/food-and-fitness/food/planning-meals/create-your-plate/?loc=ContentPage-lwt2d-public-choosingwhattoeat Accessed January 28, 2013.
  5. “Aerobic Activity.” ADA. Available at: http://www.diabetes.org/living-with-diabetes/recently-diagnosed/where-do-i-begin/aerobic-activity.html?loc=ContentPage-wheredoibegin-public-aerobic Accessed January 28, 2013.
  6. “Weight Loss.” ADA. Available at: http://www.diabetes.org/living-with-diabetes/recently-diagnosed/where-do-i-begin/weight-loss.html Accessed January 28, 2013.
  7. “Medicines.” ADA. Available at: http://www.diabetes.org/living-with-diabetes/recently-diagnosed/where-do-i-begin/medicines.html Accessed January 28, 2013.
  8. “Checking Blood Glucose.” ADA. Available at: http://www.diabetes.org/living-with-diabetes/recently-diagnosed/where-do-i-begin/checking-blood-glucose.html Accessed January 28, 2013.