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

2. What is Type 1 Diabetes?

3. What is Type 2 Diabetes?

4. 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

5. What are the risk factors for Type 2 Diabetes?

6. 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

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

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

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

10. Signs and Symptoms of Hypoglycemia

11. Labs Fasting glucose > 126 mg/dL
2 hour post-prandial glucose (PPG) > 200 mg/dL
Glucosuria (glucose in the urine)
A1c > 6.3%

12. 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.

14. 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)

15. Complications

16. 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

17. 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®

18. Insulin

19. Insulin Generally, 1 unit of insulin:
Disposes from grams of carbohydrates
Decreases blood glucose by 50 mg/dL (range mg/dL)

20. 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®

21. 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!

22. Health care providers Endocrinologists Nurses Pharmacists
Nutritionists/Dieticians

23. Knowledge check
Garfield was diagnosed with type 2 diabetes in 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)

24. Questions?