Jessica johnson, pharm. D. Diabetes Jessica johnson, pharm. D.

Etiology (causes) Type 1 Diabetes Type 2 Diabetes Gestational Diabetes Formerly called Juvenile Diabetes Due to destruction of pancreatic beta cells, which are responsible for creating insulin Produce NO insulin; therefore sometimes referred to as “insulin dependent” Type 2 Diabetes Formerly called Adult-Onset Diabetes Cells through-out body have decreased sensitivity to insulin Still produce insulin, but cells are resistant to the insulin Gestational Diabetes Occurs during pregnancy Usually tested between weeks 24-28

Risk factors (type 2 only) Age > 45 Overweight Physical inactivity Family history (1st degree relatives) Certain ethnic groups (African American, Latino, Native American, Asian) History of gestational diabetes or macrosomia (baby > 9 lbs at delivery) Hypertension and High Cholesterol

Signs and symptoms Three P’s Lethargy and weakness Labs Polyphagia (excessive hunger) Polydipsia (excessive thirst) Polyuria (excessive urination) Lethargy and weakness Labs Fasting glucose > 126 mg/dL 2 hour post-prandial glucose (PPG) > 200 mg/dL Glucosuria A1c > 6.3%

Monitoring SMBG A1C Self-monitored blood glucose Absolutely necessary for good control A1C Measured every 3 months Gives an average for the blood glucose level over the last 3 months Goal < 6.5% (< 7% in individuals who have a high risk associated with hypoglycemia, usually children and elderly)

Complications Acute Chronic Diabetic Ketoacidosis Hypoglycemia Increased risk of heart attack, stroke Decreased healing of wounds (can lead to amputation) Chronic kidney disease Retinopathy, glaucoma, blindness Neuropathy (nerve pain)

Non-Pharmacologic Treatment Diet Limit carbohydrate intake Increase fiber intake Exercise At least 30 minutes per day most days of the week Routine examinations Eyes Feet Kidneys

Health care providers Endocrinologists Nurses Pharmacists Nutritionists/Dieticians