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) 

November is Diabetic Eye Disease Month

(Google Image) 

By Terry Orr

As a Type II Diabetic, seeing my eye doctor at least twice a year is mandatory and just plain common sense. I am a visual person – and my eye sight is extremely important to me and the source of my livelihood for the better part of five decades.

(Google Image) 

Diabetic eye disease is one of the major causes of vision loss in adults. When the sugar levels in the blood are high, it is very stressful on the blood vessels all over the body, putting individuals at high risk for heart attack, stroke, and kidney disease. In the eye, blood vessels can start to leak or bleed in reaction to high blood sugar. This swelling in the retina can decrease vision, so it's best detected and treated early.

According to the National Eye Institute (NEI) of the National Institute of Health (NIH) the following highlights are provided:

(Google Image) 

What is diabetic eye disease?

Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of diabetes. All can cause severe vision loss or even blindness.

Diabetic eye disease may include:

• Diabetic retinopathy—damage to the blood vessels in the retina.
• Cataract—clouding of the eye's lens. Cataracts develop at an earlier age in people with diabetes.
• Glaucoma—increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision. A person with diabetes is nearly twice as likely to get glaucoma as other adults.

What can I do to protect my vision?

If you have diabetes get a comprehensive dilated eye exam at least once a year and remember:

• Proliferative retinopathy can develop without symptoms. At this advanced stage, you are at high risk for vision loss.
• Macular edema can develop without symptoms at any of the four stages of diabetic retinopathy.
• You can develop both proliferative retinopathy and macular edema and still see fine. However, you are at high risk for vision loss.

Current Research

What research is being done?

The National Eye Institute (NEI) is conducting and supporting research that seeks better ways to detect, treat, and prevent vision loss in people with diabetes. This research is conducted through studies in the laboratory and with patients.

Your eye care professional can tell if you have macular edema or any stage of diabetic retinopathy. Whether or not you have symptoms, early detection and timely treatment can prevent vision loss.

(Google Image) 

See your eye doctor at least once a year – play it safe!

References and Links:

• http://www.nei.nih.gov/health/diabetic/retinopathy.asp
• http://www.idf.org/fact-sheets/diabetes-eye-disease
• http://www.webmd.com/eye-health/eye-problems
• http://www.medicinenet.com/diabetes_and_eye_problems/article.htm
• http://www.theeyecenter.com/educational/pdfs/Facts%20About%20Diabetic%20Eye%20Disease.pdf
• http://www.emedicinehealth.com/diabetic_eye_disease/page3_em.htm

Helen Keller Deaf Blindness Awareness Week - 2012

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By Diane Forrest

There is a movie called The Miracle Worker.  It is the story of a woman who became the tutor of a young girl.  No one believes this child could learn anything.  You see she was both deaf and blind as a result of a childhood illness, probably scarlet fever or meningitis.  Had she been born to another family, we might never have come so far so fast in the field of teaching the deaf and blind how to communicate.  Her father was the editor for an Alabama newspaper, and her family line included Robert E. Lee, and Charles Adams, a general for the Confederate Army during the Civil War.

(Google Image) 

They would not allow their daughter to be put in some institution to live the remainder of her life, instead they hired Anne Sullivan to move in with them and tutor their daughter.  Her name - Helen Keller.  Through time, patience and meticulous instructions, Helen was able to learn to communicate with those around her.  Ms. Sullivan remained with Helen until her death.

(Google Image) 

Helen went on to become an advocate for people with disabilities, she was a suffragette, and went on to become a writer who supported the working class.  She met every president from Grover Cleveland to Lyndon B. Johnson and was friends with many famous figures, including Alexander Graham Bell, Charlie Chaplin and Mark Twain.

(Google Image) 

Medical Science has made great strides since the days of Helen Keller.  There are many medical solutions as well as scientific solutions for helping those who are deaf and blind.

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The Perkins Institute, where Helen was a student and the first deaf/blind person to receive a Bachelor's degree, is still in existence and is still teaching those who are deaf and blind.  The Helen Keller institute not only helps those who are deaf and blind, but also does research for these conditions as well.  This week is Helen Keller Deaf Blindness Awareness Week.  Please visit these sites and find out ways you can support this important research.

http://www.hknc.org/

http://www.helenkeller.org/

http://www.perkins.org/news-events/news/deafblind-awareness.html

American Diabetes Month - Diabetic Eye Disease

By Akindman,

Eye Problems and Diabetes

If you have diabetes, regular visits to your ophthalmologist for eye exams are important to avoid eye problems. High blood sugar (glucose) increases the risk of diabetes eye problems. In fact, diabetes is the leading cause of blindness in adults age 20 to 74.

If you have eye problems and diabetes, don't buy a new pair of glasses as soon as you notice you have blurred vision. It could just be a temporary eye problem that develops rapidly with diabetes and is caused by high blood sugar levels.

High blood sugar in diabetes causes the lens of the eye to swell, which changes your ability to see. To correct this kind of eye problem, you need to get your blood sugar back into the target range (90-130 milligrams per deciliter or mg/dL before meals, and less than 180 mg/dL one to two hours after a meal). It may take as long as three months after your blood sugar is well controlled for your vision to fully get back to normal.

Blurred vision can also be a symptom of more serious eye problem with diabetes. The three major eye problems that people with diabetes may develop and should be aware of are cataracts, glaucoma, and retinopathy.

A cataract is a clouding or fogging of the normally clear lens of the eye. The lens is what allows us to see and focus on an image just like a camera. Although anyone can get cataracts, people with diabetes get these eye problems at an earlier age than most and the condition progresses more rapidly than in people without diabetes.

If you have a cataract with diabetes, your eye cannot focus light and your vision is impaired. Symptoms of this eye problem in diabetes include blurred or glared vision.

Treatment is usually surgery followed by placement of a lens implant, with glasses or contact lenses as needed to further correct vision.

Glaucoma and Diabetes

When fluid inside the eye does not drain properly from a buildup of pressure inside the eye, it results in another eye problem with diabetes called glaucoma. The pressure damages nerves and the vessels in the eye, causing changes in vision.

In the most common form of glaucoma, there may be no symptoms of this eye problem at all until the disease is very advanced and there is significant vision loss. In the less common form of this eye problem, symptoms can include headaches, eye aches or pain, blurred vision, watering eyes, halos around lights, and loss of vision.

Treatment of this eye problem in diabetes can include special eye drops, laser procedures, medicine, or surgery. You can prevent serious eye problems in diabetes problems by getting an annual glaucoma screening from your eye doctor.

Diabetic Retinopathy

The retina is a group of specialized cells that convert light as it enters though the lens into images. The eye nerve or optic nerve transmits visual information to the brain.

Diabetic retinopathy is one of the vascular (blood-vessel related) complications related to diabetes. This diabetes eye problem is due to damage of small vessels and is called a "microvascular complication." Kidney disease and nerve damage due to diabetes are also microvascular complications. Large blood vessel damage (also called macrovascular complications) includes complications like heart disease and stroke.

The microvascular complications have, in numerous studies, been shown to be related to high blood sugar levels. You can reduce your risk of these eye problems in diabetes complications by improving your blood sugar control.

Diabetic retinopathy is the leading cause of irreversible blindness in industrialized nations. The duration of diabetes is the single most important risk for developing retinopathy. So the longer you have diabetes, the greater the risk of this very serious eye problem. If retinopathy is not found early or is not treated, it can lead to blindness.

People with type 1 diabetes rarely develop retinopathy before puberty. In adults with type 1 diabetes, it is also rare to see retinopathy before five years' duration of diabetes. The risks of retinal damage increase with progressive duration of diabetes. Intensive control of blood sugar levels will reduce your risks of developing retinopathy. The DCCT, a large study of people with type 1 diabetes showed that people with diabetes who achieved tight control of their blood sugars with either an insulin pump or multiple daily injections of insulin were 50%-75% less likely to develop retinopathy, nephropathy (kidney disease), or nerve damage (all microvascular complications).

People with type 2 diabetes usually have signs of eye problems when diabetes is diagnosed. In this case, control of blood sugar, blood pressure, and blood cholesterol with diabetes have an important role in slowing the progression of retinopathy and other eye problems.

Types of Retinopathy in Diabetes:

• Background retinopathy. Sometimes the blood vessel damage exists, but there is no vision problem. This is called background retinopathy. It's important to carefully manage your diabetes at this stage to prevent background retinopathy from progressing to more serious eye disease.
• Maculopathy. In maculopathy, the person has developed damage in a critical area called the macula. Because this occurs in an area that is critical to vision, this type of eye problem can significantly reduce vision.
• Proliferative retinopathy. New blood vessels start to grow in the back of the eye. Because retinopathy is a microvascular complication of diabetes, a disease of small vessels, this type of retinopathy develops because of an increasing lack of oxygen to the eye from vascular disease. Vessels in the eye are thinned and occluded and they start to remodel.

Here, it is important to address the risks factors that can worsen the occluded vessels. Smoking cessation, high blood pressure control, cholesterol management, and blood sugar control must take place in order to stop the progression of new vessels from forming into the orbit of the eye. These are fragile vessels that can bleed and eventually cause a clot to form in the orbit, which scars and causes detachment of the retina. This eventually leads to irreversible vision loss.

Treatment of diabetic retinopathy may involve laser procedures or surgery. In a study of people with diabetes with early retinopathy, laser therapy to burn the fragile vessel resulted in a 50% reduction of blindness.

To prevent retinopathy with diabetes, have your eye doctor screen your eyes annually. Women with diabetes who later become pregnant should have a comprehensive eye exam during the first trimester and close follow-up with an eye doctor during the rest of their pregnancy to avoid serious eye problems with diabetes. (This recommendation does not apply to women who develop gestational diabetes, since they are not at risk for retinopathy.)

Preventing Eye Problems with Diabetes

The American Diabetes Association offers these eye care guidelines for people with diabetes to help prevent eye problems:

• People with type 1 diabetes should have a dilated eye exam by an ophthalmologist or optometrist within three to five years after diagnosis.
• People with type 2 diabetes should have a dilated eye exam by an ophthalmologist or optometrist shortly after diagnosis.
• Annual eye exams should be done with both type 1 and type 2 diabetes by an ophthalmologist or optometrist; more frequently if necessary.
• When considering pregnancy, women with a history of diabetes should have an eye exam prior and during pregnancy. This does not pertain to women with gestational diabetes.
• To prevent eye problems in diabetes, you should:
• Control your blood sugar
• Control high blood pressure

When to Contact Your Doctor About Eye Problems in Diabetes

If you have diabetes, contact your doctor about any eye problems in if any of the following occur:

• Black spots in your vision.
• Flashes of light.
• "Holes" in your vision.
• Blurred vision.

Diabetes is the Leading Cause of Adult Blindness!

American Diabetes Month - Overview

Diabetes Overview

By Akindman,

November is American Diabetes Month along with Diabetic Eye Disease Month, Foot Health Issues Related to Diabetes Month and Diabetes Education Week each will be covered throughout November.  We will also share one additional related article on ‘Diabetes Diet’. 

This is a very dangerous disease that continues to increase in new cases each year.  These new cases will not only increase the bad health and mortality rate of the victims, but also increases the cost of medical care and expenses.  Our goal this month is to inform you about the disease, how to avoid it when possible, and how to control it if you have it.

What is diabetes?

• Diabetes, the most common disorder of the endocrine (hormone) system, occurs when blood sugar levels in the body consistently stay above normal. It affects more than 23 million people in the U.S. alone.
• Diabetes is a disease brought on by either the body's inability to make insulin (type 1 diabetes) or by the body not responding to the effects of insulin (type 2 diabetes). It can also appear during pregnancy. Insulin is one of the main hormones that regulates blood sugar levels and allows the body to use sugar (called glucose) for energy. Talk with your doctor about the different types of diabetes and your risk for this disease.

What are the main types of diabetes?

• Type 1 diabetes, previously known as juvenile diabetes, the body’s immune system destroys insulin-producing cells in the pancreas.
• Type 2 diabetes is the most common type of diabetes accounting for 90%-95% of people with diabetes. It’s been seen more in children with diabetes too. How can too much insulin (insulin resistant) result in this disease?
• Gestational diabetes occurs during pregnancy and affects about 4% of all pregnancies. It increases complications for mother and baby.

Complications

• Learn the Importance of Diabetes Foot Care - Uncontrolled diabetes may damage nerves, making it harder to notice foot problems due to diabetes that can eventually require amputation.
• Infections and Diabetes - Diabetes may make the body more vulnerable to skin infections and other illnesses.
• Insulin Resistance - Find out about insulin resistance and its dangerous ties to heart disease.
• Skin Problems and Diabetes - Up to a third of diabetes patients have diabetes-related skin problems at some point in their lives.
• Eye Problems – Blindness, Diabetic Retinopathy
• Blood Sugar Disorders - Hyperglycemia, hypoglycemia and ketoacidosis
• Diabetes and Heart Disease - Learn about the link between diabetes and heart disease and helps you determine your risk.

What is the impact of diabetes?

• It affects 23.6 million people-7.8 percent of the U.S. population.
• It is a leading cause of death and disability.
• It costs $174 billion per year.

Who gets diabetes? People of any age people with a family history of diabetes; others at high risk for type 2 diabetes: elderly, overweight and sedentary individuals, African Americans, Alaska Natives, American Indians, Asian Americans, Native Hawaiians, some Pacific Islander Americans, and Hispanics/Latinos.

The Toll on Health

• Two out of three people with diabetes die from heart disease or stroke.
• Diabetes is the leading cause of kidney failure.
• Diabetes is the leading cause of new cases of blindness among adults.
• The rate of amputation for people with diabetes is 10 times higher than for people without diabetes.
• About 60-70% of people with diabetes have mild to severe forms of nerve damage that could result in pain in the feet or hands, slowed digestion, sexual dysfunction and other nerve problems.

Cost of Diabetes

• The American Diabetes Association estimates that the total national cost of diagnosed diabetes in the United States is $174 billion.
• Direct medical costs reach $116 billion, and the average medical expenditure among people with diabetes is 2.3 times higher than those without the disease.
• Indirect costs amount to $58 billion (disability, work loss, premature mortality).
• Further published studies suggest that when additional costs for gestational diabetes, pre-diabetes, and undiagnosed diabetes are included, the total diabetes-related costs in the U.S. could exceed $218 billion.
• The cost of caring for someone with diabetes is $1 out of every $5 in total healthcare costs (from American Diabetes Association - www.diabetes.org)

The National Health Information Center offers a very informative ‘Toolkit’ that you can download at http://www.healthfinder.gov/nho/PDFs/NovemberNHOtoolkit.pdf

Despite encouraging data that type II diabetes may be a largely preventable disease, the twenty-first century is seeing it in epidemic levels in the United States and worldwide.  As reported by the Center for Disease Control (CDC), from 1980 through 2007, the number of Americans with type II diabetes has more than tripled (from 5.6 million to 18 million) and continues to rise to now nearly 26 million.  Projections from the new 2010 census data by the CDC are even more grim with an expected 25% of the population being diabetic by 2040). Worldwide Type II diabetes is reaching pandemic proportions, with no sign of abating.

Summary

The best documented strategy to avoid diabetes or to improve its course is to maintain a healthy body weight and to exercise.  This common knowledge continues to be backed by medical research.  Excellent evidence that even modest weight loss and exercise reduces the risk of type II diabetes is provided by many studies.

The current recommendation of the American Diabetes Association is for diabetics to engage in 150 minutes per week of moderate to brisk physical activity. The exercise should be spread out over at least three days a week, with no breaks of longer than two days.

The known modifiable risk factors for type II diabetes are excessive body weight and sedentary lifestyle. Increasing age and a history of relatives having the disease also increase the likelihood of its development.  There is no drug or dietary supplement that has been shown to prevent diabetes.

(Natural Health Research Institute - http://www.naturalhealthresearch.org/nhri/?p=5550) Published March 1, 2011 and posted on May 4, 2011)

Next Article – Diabetes Education Week