Pharmacists War on Diabetes Month

By Terry Orr

(Type 2 Diabetic)

A War with Diabetes!!!

Why the War?

An estimated 23.6 million Americans have diabetes.  Unfortunately, 5.7 million Americans don't know they have the deadly disease.  Pharmacists are one of the most available health care professionals and have the greatest potential to impact the threat of diabetes. 

Complications of Diabetes:

Heart Disease & Stroke: Diabetics are 2 to 4 times more likely to die from heart disease and stroke than non-diabetics.  Sixty-five percent of diabetics will die of heart disease or stroke.

Blindness: Diabetes is the leading cause of blindness in adults age 20-74.

Kidney Disease: Diabetes is the leading cause of kidney failure.

Nervous System Disease: 60 to 70% of diabetics have a mild to severe form of nervous system damage.  The results of such damage include impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, and other nerve problems.

Amputations: Diabetes is the leading cause of non-traumatic lower limb amputation.  

Complications of Pregnancy: Poorly controlled diabetes can increase the risk of miscarriage or cause major birth defects.

Sexual Dysfunction: Diabetes significantly increases the risk for sexual dysfunction in both men and women. 

Here are some of the new drugs in the War on Diabetes:

Invokana will be sold by Johnson & Johnson and treats patients with type 2 diabetes in a new way, by causing blood sugar to be excreted in the urine. Many existing drugs work by affecting the supply or use of insulin. FDA approved this drug in late March of this year.

Dapagliflozin by AstraZeneca/Bristol-Myers Squibb, The drugs offer a different way than insulin therapy to lower blood sugar, preventing excess sugar in the kidneys from reentering circulation and allowing glucose to exit the body via urine.

LY2605541 - by Eli Lilly/Boehringer Ingelheim, a potential long-acting insulin option.

MK-3102 by Merck & Co., a once-weekly DPP-4 inhibitor.

Taking Control

Mayo Clinic Type 2 Diabetes Prevention: 5 tips for taking control (Changing your lifestyle could be a big step toward diabetes prevention — and it's never too late to start) consider these tips:

Tip 1: Get more physical activity

There are many benefits to regular physical activity. Exercise can help you:

Lose weight

Lower your blood sugar

Boosts your sensitivity to insulin — which helps keep your blood sugar within a normal range

Research shows that both aerobic exercise and resistance training can help control diabetes, but the greatest benefit comes from a fitness program that includes both.

Tip 3: Go for whole grains

Although it's not clear why, whole grains may reduce your risk of diabetes and help maintain blood sugar levels. Try to make at least half your grains whole grains. Many foods made from whole grains come ready to eat, including various breads, pasta products and many cereals. Look for the word "whole" on the package and among the first few items in the ingredient list.

Tip 4: Lose extra weight

If you're overweight, diabetes prevention may hinge on weight loss. Every pound you lose can improve your health. And you may be surprised by how much. In one study, overweight adults reduced their diabetes risk by 16 percent for every kilogram (2.2 pounds) of weight lost. Also, those who lost a modest amount of weight — at least 5 to 10 percent of initial body weight — and exercised regularly reduced the risk of developing diabetes by almost 60 percent over three years.

Tip 5: Skip fad diets and make healthier choices

Low-carb diets, the glycemic index diet or other fad diets may help you lose weight at first, but their effectiveness at preventing diabetes isn't known nor are their long-term effects. And by excluding or strictly limiting a particular food group, you may be giving up essential nutrients. Instead, think variety and portion control as part of an overall healthy-eating plan.

Be sure to see your primary healthcare provider and discus the plan best for you.

References and Links:

http://www.miracledkc.com

http://www.curediabetesblog.com/2013/diabetes-pick-me-ups/tips-for-the-newly-diagnosed-diabetic-some-ideas-but-by-no-means-the-only-way/

http://www.nytimes.com/2013/03/30/business/invokana-wins-fda-approval-for-diabetes-treatment.html?_r=0

http://henhouseforms.mywebgrocer.com/PharmacyNewsletters/2009/04/page2.html

(All images from Google) 

Sea Salt: Age Old Flavor with an Oceanic Twist

By Sunny Hon

Whatever happened to the salt your grandmother used back in the day?  You know… the stuff that came cheaply out of the cylindrical cardboard container, laced with just enough iodine to keep your thyroids happy…?  The recent rise of the gourmet and health food culture, undoubtedly spurred on by the implosion of celebrity chefs and cooking shows on network and cable television, has put forth an aggressive competitor to your grandmother’s salt.  Did we have an issue with the stuff that was in the old shakers?  Were we complaining about it not being salty enough?  Did it not provide our food with enough gastronomical “umph?”  Nevertheless, every trend-conscientious restaurant did away with the old and in its place, replaced it with sea salt.

What is sea salt?  What’s so special about it?  For one, sea salt is more natural than your run-of-mill table salt.  Sea salt is obtained by evaporating seawater with minimal processing.  The result is mostly sodium chloride with 2-10% of other minerals (i.e. iron, sulfur, magnesium, and other trace elements).  Depending on the source of the seawater, the percentage of each mineral varies, as does its taste, color and even texture.  Table salt, on the hand, comes from terrestrial salt deposits.  This salt is heavily processed and treated to remove all the other minerals resulting in a product that is 99.9% sodium chloride.  Anti-caking agents, like silicon dioxide, are added to the terrestrial salt to prevent clumping.  Iodine is also added in the production process to provide consumers with a good source of this important mineral.  Because of the high sodium chloride content, table salt is saltier than sea salt.  The better flavoring and texture lies on the side of sea salt due to its mineral content.  It is also considered healthier as the minerals work to balance electrolytes in your body.

Regardless of where your salt comes from, salt intake should be held in check in a healthy diet.  While it provides for great flavoring to food and helps your body function, too much of it can be detrimental to your health.  Daily intake of sodium should be no more than 2,300 milligrams.  Adults over the age of 51 or those have high blood pressure, diabetes, or chronic kidney problems should limit sodium to less than 1,500 milligrams per day.  Processed foods usually contain high amounts of sodium (used as a preservative) and thus should be avoided.  At the end of the day, salt is salt.  Like all things, use it, don’t abuse it!

(All Images from Google) 

National Pet Cancer

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By Terry Orr

For as far back as I can remember, our families have always had pets.  On the farm there we cats in the barn (tending to the mice); dogs that help with some of the chores and notified us when someone was visiting; and a wide variety of other creatures.  Those of us who lived in the city or suburbs had dogs and cats as primary pet – but also had hamsters, guinea pigs, birds, and other interesting pets.

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It wasn’t until Pat and I got our Siamese cats (Bambi and Thumper) in the late 70’s that we became aware of cancer in our pets.  We lost Thumper to a stroke and Bambi to cancer.  A few years later – we lost two other cats to cancer – Lady and Tramp.  Each of these cats for the most part had long and healthy lives and not forgotten.

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Cancer is a disease that all too commonly affects our pets.  While no animal is immune from this disease, there are some things that you can to do lessen your pet’s chances of developing cancer (Source: Plum Street Pet Clinic Blog).

• Provide good nutrition and weight management for your pet.  Overweight animals and people are at an increased risk of developing cancer.
• Know your pet’s risk factors.  If you have a purebred pet, be sure you know what types of cancer are most common in the breed and what signs to watch out for.
• Spay or neuter your pet.  It is never too late, and spaying/neutering has been shown to prevent or reduce the risk of certain types of cancer including breast cancer.
• Try to keep your pet “clean.”  Do not expose your animal to pesticides, herbicides, asbestos, or cigarette smoke.  For that matter, don’t expose yourself, either!
• Keep up on wellness visits.  Make sure your pet comes to see us at least once a year to help catch problems early in process.

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According to WebMD - Cancer and diabetes are two important diseases the veterinarians at The Animal Medical Center treat every day.

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According to VPI, a pet insurance company, their top ten insurance claims for pet cancer treatment include tumors we veterinary oncologists commonly treat.

• Lymphoma or lymph sarcoma
• Malignant skin cancer
• Splenic cancer
• Bone or joint cancer
• Liver caner
• Chest cancer
• Bladder cancer
• Brain of spinal cord cancer
• Mouth cancer
• Cancer of the cells lining the inside of the chest and abdomen

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10 Common Signs of Cancer in Small Animals according to Veterinary Cancer Society (VCS):

1. Abnormal swellings that persist or continue to grow.
2. Sores that do not heal.
3. Weight loss.
4. Loss of appetite.
5. Bleeding or discharge from anybody opening.
6. Offensive odor
7. Difficulty eating or swallowing
8. Hesitation to exercise or loss of stamina
9. Persistent lameness or stiffness
10. Difficulty breathing, urinating, or defecating

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So fellow pet owners, please ensure your Pet gets their annual check-up!

References and Links:

• http://www.plumstreetpet.com/blog/2011/11/pet-cancer-awareness-month/
• http://blogs.webmd.com/pet-tales/2012/11/national-pet-cancer-awareness-month.html
• http://www.vetcancersociety.org/10-common-signs-of-cancer-in-small-animals/

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Foot Health Issues Related to Diabetes Awareness Month

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By Terry Orr

As a Type-2 Diabetic – my healthcare professionals (primary care, foot, eye, and dentist) each are fully aware of my health-related issues and we pass along any new information regarding diabetes and any changes in my condition or medications.  One positive benefit from doing research on diabetes this month, finding new resource, web/blog-sites and some new information to share and use myself.

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Once again, we were able to find an excellent resource that you should bookmark and review when time permits.  The Institute for Preventive Foot Health (IPFH) has an exceptional wealth of excellent, current and easy to understand information regarding foot health.

Below are some important excerpts from IPFH.ORG website.

According to the American Diabetes Association…

• Nearly 26 million children and adults in the United States have diabetes;
• Another 79 million Americans have pre-diabetes and are at risk for developing type 2 diabetes;
• The estimated total national cost of diagnosed diabetes in the United States is $174 billion.

IPFH strongly advocates that people with diabetes take extra care to help prevent damage to the feet that can result in ulceration and amputation.  Here’s why:

• According to the National Institutes of Health, 60% to 70% of people with diabetes have some form of neuropathy (nerve problems / loss of sensation);
• Neuropathy and other circulatory conditions (such as peripheral arterial disease or PAD) that affect the lower limbs put people with diabetes at high risk for ulceration and amputation;
• According to IPFH's National Foot Health Assessment 2012, the incidence of diabetes in the U.S. adult population is 11%, but that incidence nearly doubles in people age 50 and over (19%);  
• IPFH's National Foot Health Assessment also reported that fewer than half (46%) of people with diabetes have regular foot screenings with their doctor;  
• IPFH's National Foot Health Assessment further reported that only 11% of people with diabetes said that they were properly measured and fitted each time they purchase new shoes (poorly fitted shoes contribute to the formation of sores and lesions on the feet that can lead to ulceration and amputation in people with diabetes).

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Daily Foot Care for People with Diabetes

If you have diabetes, you are at increased risk of foot problems and amputation. Therefore, it is very important that you check your feet—top, bottom, sides, between the toes, toenails—at least once a day.

The best time to inspect your feet is after a bath or shower. When your feet are dry (including between the toes), sit in a well-lit room. If you have trouble seeing the bottom or sides of your feet, use a mirror with an extended handle or any mirror that permits you to see your whole foot.

Look and feel for:

• Bumps, lumps, blisters or bruises.
• Cuts, sores, or cracked skin. Even the tiniest crack can become infected.
• Patches of thin or shiny skin (which can signal lack of blood flow) or areas of redness (especially red streaks, which can signal the presence of infection).
• Temperature differences (one part warm, another cold). This can signal lack of blood flow.
• Pain, tingling, numbness or no feeling at all. These can signal nerve problems.
• Ingrown toenails with red, puffy skin along the nail and tenderness or pain.
• Loss of hair on foot or leg, which also can signal reduced blood flow.

If you have any of these signs or symptoms, seek medical care immediately. Your foot is at risk.

Pedicure Every Two Weeks
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Foot self-care:

• In addition to doing daily foot inspections, see a foot care professional for regular foot examinations and preventive foot care.
• If you have numbness, tingling or loss of feeling in your feet, be extra cautious. Make sure there are no sharp objects such as broken glass, nails, or exposed sharp edges on floors or in carpeting. Never walk or move around barefoot, even inside your house.
• Wash feet daily using lukewarm, never hot, water. Use your elbow to test water temperature.  After washing, dry feet thoroughly and keep them supple by applying lotion only to the tops and bottoms of the feet. Don’t apply lotion between the toes, since this can create a moist environment that favors fungal growth.
• Do not attempt to cut toenails if you have neuropathy or other foot problems related to diabetes.  See a podiatrist or a foot care nurse regularly for toenail care and foot examinations.  Never attempt to cut or file calluses or other protrusions on your feet.
• Never use wart removers or other harsh chemicals on your feet.

On your feet:

• IPFH suggests wearing only properly selected and fitted, as part of an integrated approach, padded socks with shoes with non-slip outsoles and any inserts or orthotics prescribed or recommended by a doctor or foot health professional.  Peer-reviewed, published studies have shown that wearing clinically tested padded socks can help prevent injuries to the skin/soft tissue of the foot, a major cause of diabetic ulcerations.
• Padded Socks made from acrylic and acrylic blends have been demonstrated by clinical research to be best for the diabetic foot; 100% “natural” fibers (cotton, wool and silk) retain moisture and make feet vulnerable to irritation, lesions, athlete’s foot, blisters and other foot conditions.
• Don’t wear the same pair of shoes every day (if possible, rotate between at least two pairs). Change your padded socks daily—more often if you are active.
• Never depend on shoes to “fit better after they’re worn for a while.”  Trust the foot health professional who analyzes your gait and sizes your feet.  New footwear may “feel” large, but if all components are properly fitted as a system—padded socks, insert/orthotic, shoes—they will provide better protection.
• Check inside shoes daily for sharp points, sharp edges, seams or other rough areas or foreign objects that may lead to cuts, wounds or abrasions on your feet.
• Don’t cross your legs for extended periods, as this can reduce blood flow and create pressure points. For the same reason, don’t sit for more than an hour or two without changing positions.
• Walk as much as possible; doing so enhances circulation to the feet and helps with weight and blood sugar control.

Buy shoes based on the way they feel, not by size:

• You should be able to move your toes comfortably
• There should be a space the width of your thumb nail between your longest toe and the end of the shoe.
• The heel should fit comfortably, with minimal slippage.
• The ball of your foot should fit comfortably into the widest part of the shoe without feeling pinched or tight.
• You should not feel any rubbing or chafing. Remember that your feet tend to get larger from the exertion of daily activities, so make sure there is sufficient room for them to expand and still go through their full range of motion. If possible, shop for shoes near the end of the day, when your feet are larger.

Other significant websites to visit for current, excellent information and resources are the National Institute of Health (NIH) National Diabetes Education Program (NDEP) and the Centers for Disease Control and Prevention.

• Feet Can Last a Lifetime – “A Health Care Provider’s Guide to Preventing Diabetes Foot Problems” is an excellent read and full of good information.
• A Guide for People with Diabetes – Take Care of Your Feet for a Lifetime; and
• ‘Preventive Foot Care in People with Diabetes’ by the American Diabetes Association.

That is a lot of information to absorb so please bookmark it and return another time to refresh your memory.  Also, if you are not taking care of your feet daily – now is a good time to start. 

Do you have any good information to share?  Please let us know – we are always looking for something new.  Thank you.

Happy Feet
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References and Links:

• http://www.grhc.org/docs/FINAL_November_Newsletter.pdf
• http://www.ipfh.org/foot-conditions/diabetes:-foot-concerns/november-is-diabetes-awareness-month/
• http://www.ipfh.org/foot-conditions/diabetes:-foot-concerns/november-is-diabetes-awareness-month/
• http://www.ipfh.org/images/general/IPFH_Integrated_Approach_and_Professional_Fitting_Protocol.pdf
• http://www.ipfh.org/images/general/AADE_2012_Poster.pdf
• http://www.cdc.gov/diabetes/consumer/problems.htm
• http://ndep.nih.gov/media/NDEP4_TextCareFeet-2c_508.pdf
• http://www.diabetes.niddk.nih.gov/dm/pubs/complications_feet/index.aspx
• http://www.ndep.nih.gov/media/Feet_HCGuide.pdf?redirect=true
• http://care.diabetesjournals.org/content/26/suppl_1/s78.full