Diabetes awareness month

Diabetes in the United States

Diabetes affects about 25.8 million people in the United States today. About 18.8 million people are confirmed to have diabetes, and about 7 million people do not know that they have diabetes. About 79 million people (25.4 % of population) are categorized as prediabetic and are in danger of developing diabetes. The monetary cost of diabetes for the U.S. economy was about $174 billion in 2007. In 2007 alone, diabetes contributed to about 231,404 deaths in the United States. Clearly, this is a problem that requires serious attention.

What are the types of diabetes?

Type 1 diabetes:

Type 1 diabetes, previously known as insulin-dependent or juvenile-onset diabetes is seen in about 5 to 10% of people with diabetes. It occurs when the body’s immune system destroys cells in the pancreas that produce insulin. As a result, the body produces little to no insulin, resulting in a buildup of sugar in the blood. This form of diabetes is usually seen in children and young adults, but can occur at any age. The majority of the people affected by type 1 diabetes are usually not overweight. There is no known way to prevent type 1 diabetes.

Type 2 diabetes:

Type 2 diabetes, previously known as non-insulin-dependent or adult-onset diabetes, is the most common type of diabetes. It affects 90 to 95% of people with diabetes. Type 2 diabetes occurs when the body is not sensitive to insulin produced by the pancreas which will gradually lead to the pancreas eventually losing its ability to produce insulin. Most people affected with Type 2 diabetes are either overweight or obese.

Gestational diabetes:

This kind of diabetes is only seen in pregnant women and usually occurs in the second half of pregnancy. It is seen in about 7% of all pregnancies in the United States. It is caused by an increase in some hormones during pregnancy that either cause low production of insulin or cause insulin to not work well. This kind of diabetes is mainly seen in women that already have risks for diabetes (see below: who gets diabetes?). Gestational diabetes can adversely affect the baby, and it is important that it is diagnosed early.

What are the signs and symptoms of diabetes?*

Symptoms of diabetes are often ignored because they seem quite harmless.

Type 1 diabetes:

·      Frequent urination

·      Unusual thirst

·      Extreme hunger

·      Unusual weight loss

·      Extreme fatigue and irritability

Type 2 diabetes:

·      Any of the Type 1 symptoms

·      Frequent infections

·      Blurred vision

Gestational diabetes:

·      Frequent urination

·      Unusual thirst

·      Extreme hunger

·      Unusual weight loss

·      Extreme fatigue and irritability

See your primary care provider as soon as possible if you have one or more of these symptoms.

*Note that sometimes, people do not have any symptoms - especially in Type 2 or gestational diabetes. Therefore screening when you are at risk (see below: who gets diabetes?) is important.

Who gets diabetes?

Anyone can have diabetes, but you might be at an increased risk of developing diabetes if you:

·      Are over the age of 45 years old

·      Have a family history of diabetes

·      Are overweight or obese

·      Do not exercise regularly

·      Have been diagnosed with high blood pressure

·      Belong to one of these ethnic groups: Non-Hispanic blacks, Hispanic/Latino Americans, Asian American and pacific islanders, American Indians and Alaska Natives.

·      Are a woman who developed gestational diabetes or had a baby that weighed more than 9 pounds.

How do I know for sure if I have diabetes or not?

Only a healthcare provider can confirm that you have diabetes. If you suspect that you have diabetes or want to be screened for diabetes, make an appointment with your primary care provider. Early detection is imperative in order to avoid complications from diabetes (see below: why treat diabetes?)

How is diabetes treated? Is there a cure?

There is currently no definite cure for diabetes. Ongoing research is targeted at finding a cure for diabetes. People with diabetes however, can live normal lives with appropriate therapy and close monitoring of blood glucose levels.

Type 1 diabetes:

Type 1 diabetes is managed by healthy eating, physical activity and insulin injections. Oral diabetic medications are not helpful in people with type 1 diabetes because their pancreas does not produce insulin, and these drugs need insulin to work. People with type 1 diabetes must balance food intake with an appropriate amount of insulin given by injections or with a pump. Close and frequent blood glucose monitoring is essential.

Type 2 diabetes:

Type 2 diabetes is managed by healthy eating, physical activity and blood glucose testing. In addition to these, oral medications, insulin injections, or both may be necessary to control blood glucose.

Gestational diabetes:

Diet modification with blood glucose testing is usually how gestational diabetes is managed. In some cases, insulin injections or certain oral medications might be needed to control blood sugar.

Note that the ultimate decision on how to manage your diabetes is made by your primary care provider.

Table 1: Available Medications for Diabetes Management

Class of drug	Examples	How it works
Oral Medications
Biguanides	Metformin	Decreases sugar made by the liver, decreases the amount of sugar absorbed by your body and increases insulin sensitivity
Sulfonylureas	GlipiZIDE, GlyBURIDE	Stimulates insulin production in the pancreas and increases insulin sensitivity
Meglitinides	Nateglinide, Repaglinide	Stimulates insulin production and release in the pancreas
Thiazolidinediones	Rosiglitazone, Pioglitazone	Helps make the cells in the body more sensitive to insulin
Alpha-glucosidase inhibitors	Acarbose, Miglitol	Blocks the enzyme that digest starches, resulting in a slower rise in blood sugar
DPP-IV inhibitors	Saxagliptin, Sitagliptin	Helps increase levels of a hormone that helps the pancreas make more insulin and also decreases sugar made by the liver
Injectable Medications
GLP-1 receptor agonist	Exenatide, Liraglutide	Helps the pancreas make more insulin, decreases sugar make by the liver and helps a person eat less
Amylin analog	Pramlintide	Helps regulate sugar made by liver, helps a person eat less
Insulin (Also available as a pump)	Insulin Lispro, Insulin Regular, Insulin Glargine	Works just like the insulin produced by the body to lower blood sugar

Why treat diabetes?

It is very important to manage your diabetes and control your blood sugar levels because there are many complications that can arise from not treating diabetes. Some complications involve:

·      Heart disease: Heart disease is the #1 killer among those with diabetes.

·      Stroke: People with diabetes are 2-4 times more likely to suffer a stroke than those without diabetes.

·      Kidney problems: Diabetes that is not controlled, especially in combination with high blood pressure, can cause damage to the kidney and lead to dialysis.

·      Eyesight: Uncontrolled diabetes can lead to serious damage to the eyes including blurred vision and blindness.

·      Nerves: High blood sugar can damage nerves in any part of the body.

·      Feet: Uncontrolled blood sugar can lead to damaged nerves and damaged blood vessels in the feet. This can lead to amputation.

·      Stomach: High blood sugar can cause nerve damage in the stomach which will lead to nausea, poor digestion and bloating.

·      Erectile dysfunction: Uncontrolled blood sugar can cause erection problems due to nerve damage and blocked blood vessels.

·      Mouth: High blood sugar can cause gum disease.

How can I prevent complications if I already have diabetes?

It’s not easy to deal with a chronic disease such as diabetes, but learning more about diabetes and how to manage it is the first step towards feeling better and living a longer healthier life. Here are some of the things you can do to prevent complications:

To prevent heart disease:

·      Talk to your healthcare provider to see if aspirin is appropriate for you.

·      Keep your blood pressure and cholesterol levels under control and make sure you are compliant with the therapy recommended by your healthcare provider.

·      Exercise 150 minutes per week (5 days a week for about 30 minutes).

·      Read food labels and limit the amount of sodium to less than 1500 mg a day.

·      Increase the fruits, vegetables and low fat dairy products in your diet.

·      If you smoke, consider smoking cessation.

To prevent foot problems:

·      Have your feet checked at least once a year

·      Avoid wearing shoes that don’t fit well

·      If you notice a wound or open sore on your feet, contact your healthcare provider.

To avoid dental problems:

·      See your dentist at least every 6 months.

·      Notify your dentist or healthcare provider if you are experiencing dry mouth, as that could lead to mouth sores and infection.

·      Brush your teeth after each meal and floss at least once a day.

To prevent eye problems:

·      See your eye doctor at least once a year.

·      Keep your blood sugar and blood pressure under control.

Get vaccinated:

·      Influenza and pneumonia infections are more common and more severe in people with diabetes.

·      Get your flu vaccine every year.

·      Make sure that you have gotten your pneumococcal vaccine. If you are more than 64 years old and it’s been more than 5 years since you last got your pneumococcal vaccine, you need to get another one.

·      You should get you tetanus vaccine once every 10 years.

·      People older than 60 years old should get a Zoster (Shingles) vaccine.

Most of the other complications that come with diabetes can be prevented or delayed by keeping your blood sugar close to the goals set by your provder. Also see your healthcare provider or nutritionist to make sure you are eating appropriately.

Where can I find more information?

Additional information can be accessed at:

www.diabetes.org

www.cdc.gov/diabetes/consumer

www.ndep.nih.gov/index.aspx?redirect=true

Written By:

Obiora Uzoukwu, PharmD Candidate, 2013

University of Illinois at Chicago

UIC Pharmacy

References:

1.     American Diabetes Association. Standards of medical care in diabetes--2012. Diabetes Care. 2012;35 Suppl 1:S11-63.

2.     2011 National Diabetes Fact Sheet. Centers of Disease Control and Prevention. http://www.cdc.gov/diabetes/pubs/factsheet11.htm.  Accessed September 16, 2012.

3.     Triplitt CL, Reasner CA. Chapter 83. Diabetes Mellitus. In: Talbot RL, DiPiro JT, Matzke GR, Posey LM, Wells BG, Yee GC, eds. Pharmacotherapy: A Pathophysiologic Approach. 8^th ed. New York: McGraw-Hill;2011. http://www.accesspharmacy.com/content.aspx?aID=7990956. Accessed September 16, 2012.

4.     Funk JL. Chapter 18. Disorders of the Endocrine Pancreas. In: Funk JL, ed. Pathophysiology of Disease: An Introduction to Clinical Medicine. 6^th ed. New York: McGraw-Hill;2012. http://www.accesspharmacy.com/content.aspx?aID=5371010. Accessed September 16, 2012.

5.     Powers AC, D’Allesio D. Chapter 43. Endocrine Pancreas and Pharmacotherapy of Diabetes Mellitus and Hypoglycemia. In: Chabner BA, Brunton LL, Knollman BC, eds. Goodman & Gilmans’s The Pharmacological Basis of Therapeutics. 12^th ed. New York: McGraw-Hill;2011. http://www.accesspharmacy.com/content.aspx?aID=16674366. Accessed September 16, 2012.

National COPD Awareness Month

November is National COPD Awareness Month

What is COPD?

Chronic obstructive pulmonary disease, or COPD, is a common lung disease where airflow is limited making it difficult for a patient to breathe. COPD is chronic, irreversible, and worsens over time. Currently, there is no cure available but it is preventable and the symptoms are treatable.

How common is COPD in the US?

According to the Centers for Disease Control and Prevention (CDC), COPD is the 3rd leading cause of death in the United States. It is estimated that more than 12 million Americans are affected by COPD. In the past it was more common in men; however, since 2000, women have exceeded men in the number of deaths caused by COPD. According to the US Department of Health and Human Services, in 2010, COPD cost the nation $49.9 billion in direct and non-direct medical costs.

What is the difference between chronic bronchitis and emphysema?

COPD refers to two lung conditions, chronic bronchitis and emphysema. Chronic bronchitis and emphysema may both be present in a patient.

Chronic Bronchitis	Emphysema
§  Inflammation of the airways occurs and leads to scarring of the bronchial tubes in the lungs §  Mucus-producing cough is present that  occurs consistently for 3 months at a time for at least 3 months out of a year and seen in 2 consecutive years §  It is typically diagnosed when other causes of lung dysfunction have been excluded	§  Caused by damage to the alveoli (air sacs) in the lungs §  Results in destruction to the walls of the alveoli §  Destruction leads to a reduction in gas exchange in the lungs

What are the most common risk factors for developing COPD?

Major risk factors for COPD include cigarette smoking, air pollution, occupational exposures (dust or chemicals), or genetic disorders. Cigarette smoking is the most common cause of COPD. According to US Department of Health and Human Services, cigarette smoking accounts for 75% of deaths caused by COPD. A genetic disorder, α1-antitrypsin deficiency, may decline a patient’s lung function leading to increased risk of developing COPD.  Patients with α1-antitrypsin deficiency lack a protein that protects damage to the lungs. Overall, most risk factors may be modified and can be avoided, which will reduce the risk of developing COPD.

What are the signs and symptoms of COPD?

Various signs and symptoms are characteristic of COPD and may help distinguish the severity of the disease.  Typical symptoms include cough (with or without sputum), shortness of breath, and wheezing. On physical exam, certain signs are present but may not be seen until later in the disease or in more severe cases. Signs include cyanosis of mucosal membrane (bluish discoloration due to lack of oxygen), barrel-shape chest (deformity of chest wall) due to excess air trapped inside the lungs, increased respiratory rate and shallow breathing, and changes in normal breathing such as pursed (puckered) lips or use of accessory respiratory muscles. Patients may need to stand in a “tripod” position with their hands placed on their knees bending forward in order to breathe more effectively.

How is COPD diagnosed?

Several factors aid help to diagnose COPD. These factors include the patient’s age (> 40 years), constant and worsening shortness of breath, chronic cough with production of sputum, decline in normal activity, and being positive for risk factors of COPD. Typically, when COPD is suspected a patient will undergo spirometry testing. Spirometry is a common pulmonary function test, which measures a person’s breathing. Spirometry assesses a patient’s lung capacity and volume. It is typically done to confirm the presence of airflow limitation and it is very useful in determining a patient’s disease severity.

How do you treat COPD?

The goals of treatment include relieving symptoms, slowing disease progression, prevention and treatment of any complications or exacerbations, improvement of normal activity, and improvement of overall health status. However, since no cure exists, the major focus should be prevention.

·      Lifestyle Changes: Smoking cessation (quit smoking) is the most important step to take in order to prevent and slow the progress of COPD. Smoking cessation is the only confirmed intervention that has been proven to affect long-term decline in lung function. If you or someone you know is having trouble quitting, ask your local pharmacist about treatments available to help quit. Also, if possible, avoid any lung irritants such as air pollution, dusts, or chemicals because they are risk factors for developing COPD.

·      Pulmonary Rehabilitation: This is a wellness program that aims at improving a person’s overall health status. The program includes exercise training, behavioral modifications, nutritional and disease management education, and emotional support. It is a supervised program typically 3 days per week for a total of 6 to 12 weeks.

·      Oxygen Therapy: This may be an option for patients who have severe COPD and low levels of oxygen. Oxygen therapy has been shown to increase the ability to perform daily activities and exercise, improve quality of life, and increase survival. Oxygen is administered nasally typically through prongs or masks and given for > 15 hours per day.

·      Immunizations: The CDC recommends patients with COPD receive an annual influenza vaccine due to serious complications that may occur with the flu in a patient with COPD. Because patients with COPD are at an increased risk of pneumonia, it is also recommended for patients ages 2 to 64 years with a chronic lung disease to receive the pneumococcal vaccine once. In patients > 65 years, a second vaccination is recommended if it has been longer than 5 years since receiving the pneumococcal vaccine.  

Drug Therapy

Bronchodilators: used to relax and enlarge the airways, making breathing easier.

Typically, patients will begin treatment with a short-acting bronchodilator as needed; however, if the disease worsens patients may need a long-acting bronchodilator daily. Short-acting bronchodilators (e.g. albuterol, ipratropium) are only used for immediate relief of symptoms when needed. Short-acting bronchodilators begin working within 5 minutes and work for about 4 to 6 hours. Long-acting bronchodilators (e.g. salmeterol, formoterol, tiotropium) are used when short-acting agents do not provide enough relief and patients experience symptoms on a regular basis. Long-acting bronchodilators work for about 12 hours and are typically given twice a day. Both classes of bronchodilators are given by inhalation using an inhaler. Generally, they are well tolerated with minimal side effects.

Inhaled glucocorticoids (Steroids): used to help reduce inflammation in the airways.

Inhaled glucocorticoids (e.g. fluticasone, budesonide) are never used alone but are combined with bronchodilators; therefore, patients who begin taking a glucocorticosteroid must also be taking a bronchodilator. They are typically given to patients when symptoms or severity of disease worsens. Inhaled glucocorticoids may be limited to short-term therapy because they are associated with more side effects, such as headache, hoarseness, sore throat, and oral candidiasis (mouth infection).

What is the prognosis of COPD?

COPD prognosis is poor if symptoms are left untreated and patients do not make the necessary lifestyle changes such as smoking cessation. Decline in lung function may lead to disease progression, poor quality of life, and possible disability and death. The primary causes of death due to COPD are respiratory failure, cardiovascular events or diseases, and lung cancer. It is important to make lifestyle changes, stay up-to-date on immunizations, and adhere to medications in order to prevent and reduce any complications.

Where can I find more information?

Several resources are available that will provide patients with useful information about COPD. You may also discuss any questions or concerns about COPD with your local pharmacists.

American Lung Association

www.lung.org

Global Initiative for Chronic Obstructive Pulmonary Disease

www.goldcopd.org

National Heart Blood and Lung Institute

http://www.nhlbi.nih.gov/health/public/lung/index.htm#copd

World Health Organization

http://www.who.int/topics/chronic_obstructive_pulmonary_disease/en/

Written by:

Michelle Dudek, PharmD Candidate, 2013

Chicago State University

References:

1.            Chronic Obstructive Pulmonary Disease. National Heart, Lung, and Blood Institute.  http://www.nhlbi.nih.gov/health/health-topics/topics/copd/treatment.html; Updated June 2012. Accessed September 13, 2012.

2.            Chronic Obstructive Pulmonary Disease. American Lung Association. http://www.lung.org/lung-disease/copd/. Accessed September 12, 2012

3.            Chronic Obstructive Pulmonary Disease. Centers for Disease Control and Prevention. http://www.cdc.gov/copd/; updated March 2012. Accessed September 13, 2012.

4.            Williams DM, Bourdet SV. Chapter 34. Chronic Obstructive Pulmonary Disease. In: Talbert RL, DiPiro JT, Matzke GR, Posey LM, Wells BG, Yee GC, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. New York: McGraw-Hill; 2011. http://www.accesspharmacy.com/content.aspx?aID=7975888. Accessed September 13, 2012.

Why its important to get a flu shot.