Diabetes Jessica Tagerman PharmD (modified from presentation by Jessica Johnson, pharmD

What is Type 1 Diabetes?

What is Type 2 Diabetes?

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 throughout 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

What are the risk factors for Type 2 Diabetes?

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

What are the symptoms of hyperglycemia? What is HYPERglycemia? What are the symptoms of hyperglycemia?

Signs and Symptoms of Hyperglycemia The 3 P’s: Polyphagia (excessive hunger) Polydipsia (excessive thirst) Polyuria (excessive urination)

What are the symptoms of hypoglycemia? What is HYPOglycemia? What are the symptoms of hypoglycemia?

Signs and Symptoms of Hypoglycemia

Labs Fasting glucose > 126 mg/dL 2 hour post-prandial glucose (PPG) > 200 mg/dL Glucosuria (glucose in the urine) 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) The A1C test is based on the attachment of glucose to hemoglobin, the protein in red blood cells that carries oxygen. In the body, red blood cells are constantly forming and dying, but typically they live for about 3 months. Thus, the A1C test reflects the average of a person’s blood glucose levels over the past 3 months. The A1C test result is reported as a percentage. The higher the percentage, the higher a person’s blood glucose levels have been. A normal A1C level is below 5.7 percent.

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

Complications

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

Pharmacologic Treatment- Insulin Rapid-Acting Generic Brand Aspart Novolog® Glulisine Apidra® Lispro Humalog® Short-Acting Regular Humulin® R, Novolin® R Intermediate-Acting NPH Humulin® N, Novolin® N Long-Acting (Basal) Detemir Levemir® Glargine Lantus®

Insulin

Insulin Generally, 1 unit of insulin: Disposes from 12-15 grams of carbohydrates Decreases blood glucose by 50 mg/dL (range- 30-100 mg/dL)

Pharmacologic Treatment- Oral Hypoglycemics Generic Brand Sulfonylureas Glyburide Micronase®, Diabeta®, Glynase® Glipizde Glucotrol® Glimepiride Amaryl® Biguanides Metformin Glucophage® Thiazolidinedione Pioglitazone Actos® Rosiglitazone Avandia® DPP-4 Inhibitors Saxagliptin Onglyza® Sitagliptin Januvia®

Oral Hypoglycemics Not limited to list on previous slide! Many combination agents available- used to increase compliance MOAs: increase secretion of insulin from the pancreas, increase the sensitivity of the insulin receptor, many other MOAs!

Health care providers Endocrinologists Nurses Pharmacists Nutritionists/Dieticians

Knowledge check Garfield was diagnosed with type 2 diabetes in 2012. Despite his doctor’s recommendations, he won’t change his diet, he refuses to exercise, and isn’t compliant with his medications. What are some complications that may arise as a result of his untreated diabetes? Acute Diabetic Ketoacidosis (Diabetic coma) Hypoglycemia Chronic Increased risk of heart attack, stroke Decreased healing of wounds (can lead to amputation) Chronic kidney disease Retinopathy, glaucoma, blindness Neuropathy (nerve pain)

Questions?