Indian Pharmaceutical Association Indian Pharmaceutical Association

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1 55 th National Pharmacy Week November 20 th to 26 th 2016 Theme Pharmacists for a Healthy India: Role in Prevention and Management of Diabetes Indian Pharmaceutical Association Indian Pharmaceutical Association

2 Current Scenario in India India had 69.2 million people living with diabetes (8.7%) as per the 2015 data. Of these, it remained undiagnosed in more than 36 million people. According to statistics from the International Diabetes Federation (IDF), India has more diabetics than any other nation of the world. If you think the disease has already reached endemic proportions in the country, consider this. By the year 2030, over 100 million people in India are likely to suffer from diabetes, say researchers. Prevalence of diabetes has more than doubled for men in India and China (3.7 per cent to 9.1 per cent in India). It has also increased by 50 per cent among women in 80 per cent among women in India (4.6 per cent to 8.3 per cent)

3 What is Diabetes? Diabetes is a condition that affects your body s ability to produce/use insulin. (Insulin is a hormone which helps transport energy produced by the food we eat to the cells,). Category Normal (mg/dl) Prediabetic (mg/dl) Diabetic (mg/dl) Fasting Blood Glucose Levels Post Prandial Blood Glucose Levels (2 hours after meal) >130 < > 200 Hb A1C test- It is the GLYCOSYLATED HEMOGLOBIN test which shows the average blood sugar level over 8-12 weeks period. Normal: <6 Elevated levels: 7-10 Seriously elevate levels: >10

4 Types of Diabetes Type 1 Also known as Juvenile diabetes It occurs when the immune system mistakenly attacks and kills the beta cells of the pancreas. No or very little insulin is produced by the body. It has to be treated with insulin. Type 2 Occurs when the body can t properly utilize the insulin that is released Glucose builds up in the blood instead of being used as energy It can be managed by physical activity, meal planning and medications Gestational It is a temporary condition that occurs during pregnancy. It affects approximately 2 to 4 per cent of all pregnancies and involves an increased risk of developing diabetes for both mother and child.

5 Importance of knowing about diabetes

6 Complications Of Uncontrolled Diabetes If your Diabetes remains uncontrolled for long, it can cause several complications. It is very important to manage your diabetes and live a healthy life

7 High blood glucose levels cause neuropathy to the blood vessels High blood glucose levels cause damage to tiny blood vessel that bring oxygen and nutrients to the nerves and hence, damage to the blood vessels cause damage to the nerves resulting in diabetic neuropathy. Additionally, alcohol and smoking can worsen the situation.

8 High Blood Glucose Level Leads to Retinopathy in the Eyes Diabetic retinopathy involves changes to retinal blood vessels that causes them to swell, bleed, leak fluid and thus distort vision It can also lead to blindness or blurred vision.

9 Effects of high blood glucose on the Heart and Blood Vessels Atherosclerosis - High blood glucose level contributes to formation of fatty deposit in blood vessels causing hardening of blood vessels Hypertension It causes hypertension, high blood pressure

10 Effects of high blood glucose on Heart and Blood Vessels (contd.) Angina Hyperlipidemia Heart attack

11 High Levels Of Blood Glucose Levels Causes Diabetic Nephropathy It causes damage to the kidney by improper filtration of waste causing Polyuria Protein in urine Kidney failure

12 Effects of High Blood Glucose Levels on Brain High Blood Glucose levels causes narrowing of the blood vessels and their blockade causes Stroke Alzheimer s disease

13 Effect of High Blood Glucose Levels on Foot Foot ulcers, Gangrene which may result in foot amputation in future. Delayed wound healing. Gangrene

14 Effect of High Blood Glucose Levels on Skin and Mouth Diabetes patients can get bacterial infections of eyelids, boils (infection of hair follicles. Fungal infection in warm folds of skin. Diabetic patients develop blisters on fingers, hands, toes, feet, legs, fore arms. Digital sclerosis resulting in hardening of fingers and toes. Eruptive Xanthomatosis causes yellow bumps with red ring.

15 High Blood Glucose Levels lead to Digestive Problems Diabetes makes it hard to completely empty the stomach (Gastroparesis) which causes rise in blood glucose. Diabetic Hyperglycemic Hyperosmolar Syndrome Constipation Acidity Dysphagia

16 Other Complications related to uncontrolled Blood glucose levels Diabetic Ketosis: An underlying infection: such as Urinary tract infection (UTI), Gastroenteritis, Flu or Pneumonia. Metabolic Acidosis Colorectal Cancer Uterine Cancer

17 Hypoglycemia Low blood glucose (blood sugar) levels- usually less than 70 mg/dl Hypoglycemia may also be referred to as an Insulin reaction, or insulin shock Make sure patients inform the people around them of these symptoms and what to do!

18 Hypoglycemia management? It can be treated quickly and easily by: Check your blood sugar level & place 4-5 sugar crystals below your tongue Eat Glucose tablets (hard candy) or Table sugar Drink fruit juice Management of Hypoglycemia Note: Wait 15 minutes and then re-check blood glucose. If blood glucose is not above 60 mg/dl seek immediate medical care.

19 Preventing Hypoglycemic Reactions Due to Insulin 1.Hypoglycemia may be prevented by maintaining regular exercise, diet and insulin 2.Early symptoms of hypoglycemia should by recognized and treated 3.Carry at all times some form of simple carbohydrate (orange juice, sugar, candy) 4.Extra food should be taken before unusual physical activity or prolonged periods of exercise 5.Between-meal and bedtime snacks may be necessary to maintain a normal glucose level

20 Management of Diabetes Diabetes is not fatal, it needs to be managed

21 Medications for Diabetes There are two types of medicines for treatment of Diabetes. Injections Insulin and few other medicines are given by way of injection Oral medication Many of the medications are given in the form of tablets

22 Things to REMEMBER Follow the diet, exercise and treatment schedule as prescribed by the physician. Medicines do not cure the disease and need to be taken on regular basis for controlling diabetes. Never stop the treatment without consulting physician for any reason. Do not become victims of some advertisements claiming to cure Diabetes. Do not take some herbal or other types of alternate medicines,without consulting the medical experts.

23 Things to REMEMBER Avoid low blood sugar level (hypoglycemia) and carry sugar source at all time. Take medicines regularly at the same time of the day and do not to miss the dose. In case of missed dose, take it as soon as you remember, but if it is almost time for the next dose, skip the missed dose and return to regular scheduled dose. Never take double dose. Keep all your medicines away from heat,moisture,sunlight,children and pets. Diabetes and Tuberculosis (TB) have been shown to have close connection. Do not ignore any symptoms of TB, especially cough (symptom of Pulmonary TB) of any duration.

24 Talk to your pharmacist Registered Pharmacist is a professional who has formal education in the field of pharmacy. Pharmacist is a medicine expert. Your Pharmacist in a medical store (community pharmacy) or in a hospital /health center set up can help you in various ways for management of your Diabetes. Pharmacist can provide you Information about various aspects of Diabetes

25 Talk to your pharmacist Pharmacists can help in early detection and monitoring of Diabetes by checking your blood glucose in the pharmacy. Pharmacist can give you advice regarding the best use of medicines, whether to take before/after or with food, its possible side effects, storage etc and can also help you to take your medicines as per the treatment schedule. There are various types of Insulins and Its important to use the type and dose of insulin prescribed to you by your doctor. Pharmacist can help you to use Right Insulin, Right Dose, Right Syringe, Right Injection technique.

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27 Conclusion

28 Some of the Useful websites (World Health Organisation ) (National Health Portal) (American Diabetes Association) (international Diabetes Foundation) (Posters and Handbook on Responsible Use of Medicines under CARUM)

29 Theme Pharmacists for a Healthy India: Role in Prevention and Management of Diabetes Indian Pharmaceutical Association