Basics&of&Diabetes&and&Medications& Educational&Handouts&

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1 BasicsofDiabetesandMedications ShirleyFleishman,N,CDE UniversityofVirginia DiabetesEducaDonand ManagementProgram EducationalHandouts! BasicsofDiabetesandMedicaDons(handoutofslides)! Hyperglycemia! Hypoglycemia! FootCare 1

2 ClassTopics " BasicsofDiabetesandMedicaDon " Whatdiabetesis;howitisdiagnosed " Targetbloodglucoseranges " WhybloodglucosemaPers;complicaDons " DiabetesmedicaDons:oralandinsulin " NutriDonBasics " lucosecontrol,acdvity,andstress " EatSmart,ChangeYourLifestyle HowareDiabetesandPre:diabetesDiagnosed?! Diabetes # A1c>6.5% * # FasDngbloodglucose 126mg/dl * # Twohourbloodglucose 200mg/dlduringanoralglucose tolerancetest * # andombloodglucose 200mg/dlplusclinicalsymptoms! Pre]diabetes # FasDngbloodglucose100to125mg/dl *Shouldberepeatedinabsenceofclinicalsymptoms 2

3 3 CommonTypesofDiabetes " Type1diabetes $ 5%to10%ofdiagnosedcasesofdiabetes " Type2diabetes $ 90%to95%ofdiagnosedcasesofdiabetes Normal'Func,on' No'Diabetes'

4 4 Type'2'Diabetes' nsulin'esistance' Type'1'Diabetes' or' Late'Stage'Type'2' Li=le'or'No'nsulin'

5 TargetBloodlucoseoals! Beforemeals: 80]130mg/dl! Abermeals: Lessthan180mg/dl (aimfornomorethan50mg/dlincrease frommeals) ComparisonChartofA1Candlucose A1C'%' Es,mated'Average'lucose'

6 WhyDoesBloodlucoseMatter?! Toreducetheshort]termsymptomsofhigh bloodglucosevalues.! Toreducelong]termcomplicaDons. LargeVesselComplications! Heartdisease(Cardiovasculardisease)! Stroke/TA(Cerebrovasculardisease)! PoorcirculaDontolegsandfeet(Peripheral vasculardisease) 6

7 TeststoDiscusswithYourHealthCareProvider Test' ADA'ecommended'Value' Frequency' Bloodpressure Nomorethan140/80 Ateveryvisit A1c Lessthan7% 2]4Dmesperyear Microalbuminuria (urinekidneytest) Lessthan30mg Onceperyear Cholesterol Lessthan200 Onceperyear Triglycerides Lessthan150 Onceperyear HDL LDL Men:40orhigher Women:50orhigher Lessthan100(lowrisk) Lessthan70(withCVD) Onceperyear Onceperyear SmallVesselComplications! Eyedisease! Kidneydisease # Microalbumintest! Nervedisease # Autonomicneuropathy " Stomach " ntesdnes " BladderandsexualfuncDon " Bloodpressure # Peripheralneuropathy " Footcareisimportant! 7

8 DiabetesMedications TwoformsofmedicaDonavailableforpersonswithdiabetes: " Oralpills(medicaDon) $ Usedintype2diabetes $ FivedrugclassesoforaldiabetesmedicaDons " njectablemedicadons $ nsulin requiredfortype1diabetes;maybenecessaryfor type2diabetesasdiseaseprogresses $ MimeDcs twodrugclasses;oneclasscanbeusedbypeople witheithertype1diabetesortype2diabetesoninsulinto improveglucoselevels;theotherclassisjustfortype2diabetes OralMedication: Sulfonylureas, " lyburide'(diabeta,'micronase,'lynase)' " lipizide'(lucotrol/lucotrol'xl)' " limepiride'(amaryl)' $ Howtheywork:theysDmulatethepancreastoproducemore insulin $ isk:potendalforlowbloodglucose takebeforeameal,and donotskipmeals! 8

9 OralMedication: Biguanides, " MeOormin'(lucophage)' " iomet'(lucophage)' " MeOormin'Extended'elease'(lucophage'X)' " Fortamet'(lucophage'X)' " lumetza'(lucophage'x)' $ Howtheywork:theycausethelivertoproducelessglucose $ isk:maycausedistress(nausea,diarrhea);usuallylastsfor7]10 days;startonlowdoseandadvanceslowly $ Benefit:mayhelpwithweightlossandreducedappeDte;notlikely tocauselowbloodglucose;cost]effecdve OralMedication: nsulin,sensitizers, " Pioglitazone'(Actos)' $ Howtheywork:theyhelpthebodybecomemoresensiDveto insulin;maytake4]6weekstoseeposidveeffectsonblood glucose $ isk:mayhavesomeswelling(fluidretendon)inlegsandfeet 9

10 OralMedication: DPP64,nhibitors, " Sitaglip,n'(Januvia)' " Janumet'(sitaglip,n'+'meformin)' " Saxaglip,n'(Onglyza)' " Linaglip,n'(Tradjenta)' " Aloglip,n'(Nesina)' $ Howtheywork:increasessecreDonofinsulinwhenblood glucoseiselevated,soithelpstoloweraber]mealrisesin bloodglucose $ Benefit:theydonotcauseweightgainandmayhavea posidveeffectoncholesterollevels $ isk:shouldnotusewithkidneyorliverdisease OralMedication SLT2,(sodium6dependent,glucose,transporter),nhibitors,, " Canagliflozin'(nvokana)' " Dapagliflozin'(Farxiga)' $ Howtheywork:transportsglucoseintokidneytubules;thisresults inimprovedglucoselevelsbyexcredonofglucoseinurine;itcreates adiuresis]likeeffect $ Benefit:decreaseA1clevels;mayhelpwithweightloss;lowers systolicbloodpressurelevels $ isk:ncreaseinurinaryinfecdons;increaseinbloodpotassium levels 10

11 CombiningOralMedication " ThedifferentclassesoforalmedicaDonsworkindifferentways tolowerbloodglucoselevels;somedmes,theyworkbeperin combinadontoimprovebloodglucosecontrol " ThemostcommoncombinaDonoforalmedicaDonsisa biguanideandasulfonylurea " SwitchingfromonesinglepilltoanotherisnotaseffecDveas addinganothertypeofdiabetesmedicine(oralmedicadonor insulin) njectablemedication: Mimetic,(ncretin), " Exena,de'(Bye=a) 'injecdon2xdaily;forpersonswith type2diabetes " Liraglu,de'(Victoza)['injecDon1xdaily;forpersonswith type2diabetes " Exena,de'extended'release'(Bydureon)'['injecDononce weekly;forpersonswithtype2diabetes' $ Howtheywork:slowsemptyingfromstomach; sdmulatesinsulinrelease $ Benefit:decreasesappeDte;helpsinweightloss $ isk:transientnausea 11

12 FrequentlyAskedQuestionsAboutnsulin " Willhavetobeoninsulinforeveroncestartit? " DoestakinginsulinmeanmydiabeteshasgoPen worse? " WillinsulininjecDonshurt? " sthisasignthat mafailureatdiabetesself] management? " Dohavetocarryacoolerwithmyinsulinsupplies? 12

13 Plasmansulin 2/4/16 nsulin Purpose: " Toallowglucosefromthebloodstreamtomoveintothecellsof thebody " Toprovidefuelandenergy " AdministeredbyinjecDononly $ Type%1]requiresinsulininjecDons;ideally,given4Dmesdaily beforemealsandbeddme $ Type%2 mayneedinsulinasdiseaseprogressesandthebody s insulinbecomesdeficient;diet,exercise,andoralmedicadon becomeineffecdveforbloodglucosecontrol;inidally,givenonce dailyatbeddme. NormalnsulinProfile,Simplified 75 Largeinsulinrise Biggerinsulinrise 50 Smallinsulinrise Smallinsulin rise 25 Basal nsulin Level Small' breakfast' Bigger' lunch' Small' snack' Big'' dinner' 4AM 7AM 10AM 1PM 4PM 7PM 10PM 1AM 4AM Time 13

14 Effective(nsulin(Therapy " Basal'Dose(NPH,Lantus,Levemir) $ BackgroundinsulinforbloodglucosecontrolwhennoteaDng " Bolus'or'Meal'Dose'(egular,Humalog,Novolog,Apidra) $ Tocoverglucoserisefromfood(mainlycarbohydrates) $ ivebeforeorabermeals " Correc,onDose'(egular,Humalog,Novolog,Apidra) $ Tocorrecthyperglycemiapre]meal,ifneeded $ ivebeforemeals Types(of(nsulin((Action( apid-acting - aspart (Novolog) - lispro (Humalog) - glulisine (Apidra ) nsulin Onset Peak Duration 5 minutes 1 to 2 hours 4 to 6 hours Short-acting (egular) 30 minutes 2 to 4 hours 6 to 10 hours ntermediate-acting (NPH) Long-acting - glargine (Lantus) - detemir (Levemir) 1 to 2 hours 4 to 8 hours 10 to 20 hours 1 to 2 hours 1 to 3 hours flat 8 to 10 hours 24 hours 18 to 24 hours 14

15 nsulin(njection(sites( " Abdomen(avoidarea2inchesaroundnavel) $ Preferredsite $ FastestrateofabsorpDon $ MoresubcutaneousDssue " Arms " Thighs " BuPocks nsulin(storage( " 36 O to86 O F(donotstorenearextremeheatorcold) " oomtemperatureifdiscardedaber28daysof beingopened " larginemustbediscardedaber28daysofuse (refrigeratedornot) " Levemir goodfor42daysaberopenedatroom temperature " Pre]filledsyringes(30days) 15

16 NeedleLengthsofnsulinSyringes! 4'mm''''''''''''6'mm ''''8'mm'''''''12.7'mm '' BarrelCapacityofnsulinSyringes 30 units 50 units 100 units 16

17 TypesofnsulinPens Novolograpid]acDnginsulin Humalograpid]acDnginsulin Apidrarapid]acDnginsulin Lantuslong]acDnginsulin Levemirlong]acDnginsulin NPHintermediate]acDngpen AdvantagesofnsulinPens Easy, accurate dosing Compact Fewer supplies required Less errors Smaller amount of insulin in cartridge (300 versus 1000 cc) 17

18 TreatmentofHypoglycemia! Lowbloodsugar(hypoglycemia) 70mg/dlorless! Treatment(15]15ule)! Takein15gramsofcarbohydrate:! 4glucosetablets! ½cupfruitjuice! 1cupofskimmilk! 2Tbsp.raisins! Wait15minutesandrecheckbloodglucose! fsdllbelow100mg/dl,repeat15gramscarbohydrate! Followtreatmentwithalightsnackofproteinandcarbohydrate (peanutbuperandcrackerso½sandwichonutsandfruit) HowDoYouManageYourDiabetes?! MedicaDon! NutriDon! Exercise! StressManagement 18