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WELL Duquesne University Mylan School of Pharmacy

UPDATE from the Center for Pharmacy Care

March-April 2006



here are more than 20 million people in the United States who have diabetes. While an estimated 14.6 million have been diagnosed with diabetes, unfortunately, 6.2 million people (or nearly one-third) are unaware that they have the disease.

diagnosed in children, teenagers, or young adults. It is estimated that 5-10 percent of Americans who are diagnosed with diabetes have type 1 diabetes. • TYPE 2 DIABETES When the body fails to properly use the insulin produced (otherwise known as insulin resistance) and/or there is a decrease in insulin production, type 2 diabetes is triggered. This means that glucose builds up in the blood, overflows into the urine and passes out of the body – without fulfilling its role as the body’s main source of fuel. Formerly called adult-onset diabetes, it is the most common form. People can develop this type of diabetes at any age, even during childhood. The majority of Americans who are diagnosed with diabetes have type 2 diabetes.

Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone, produced by your pancreas, that is needed to convert sugar, starches and other food into energy needed for daily life.

What are the different types of diabetes? There are 4 major types of diabetes – type 1, type 2, gestational and pre-diabetes. • TYPE 1 DIABETES This condition occurs when a person’s pancreatic cells do not produce any insulin. Insulin is the hormone that “unlocks” the cells of the body, allowing glucose to enter and fuel them. Formerly called juvenile diabetes, it is usually first

Upcoming Events

The Sugarless Lifestyle

• GESTATIONAL DIABETES One of the most prevalent secondary causes of diabetes is pregnancy. Gestational diabetes is defined as any

degree of glucose intolerance with onset or first recognition during pregnancy. Gestational diabetes is caused by the hormones of pregnancy or by a shortage of insulin. This form of diabetes usually resolves after delivery. However, these women are at a greater risk of going on to develop type 2 diabetes in the first five years postpartum Gestational diabetes affects about 4 percent of all pregnant women – about 135,000 cases in the United States each year. • PRE-DIABETES Pre-diabetes, also called impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) is the time period before the onset of type 2 diabetes or the “intermediate stage” where blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. Many people with pre-diabetes will develop type 2 diabetes within 10 years. In addition to the more than 20 million Americans with diabetes, there are nearly 41 million who are pre-diabetic.

Mark Your Calendar WELLNESS MONDAYS • March 13, 20 & 27, April 17 & 24 9:00 a.m.-1:00 p.m. BLOOD PRESSURE SCREENING • March 8 & 22, April 26, 11:00 a.m.-1:00 p.m. Locations: Union Concourse, 3rd Floor – (Mar. 8 & Apr. 26) Union Atrium, 2nd Floor – (March 22)

All events held in the Center for Pharmacy Care, Room 320 Bayer Learning Center, unless otherwise noted.

CENTER FOR PHARMACY CARE — Wellness Mondays Complimentary screenings include: bone density, body composition analysis, facial skin analysis, cholesterol screening & A1c diabetes testing. Please call x5874 for an appointment.

EMPLOYEE BENEFITS FAIR Wed., April 19 - 10 a.m.-2 p.m.. - 4th Floor, Union Ballroom. Offering diabetes risk assessment, plus blood glucose and blood pressure screeenings DIABETES PROGRAM COMING SOON! The center for Pharmacy Care will soon offer a management and counseling program for employees and eligible family members with diabetes. For more information, call x5874. TOBACCO CESSATION PROGRAM Any employee or student interested in joining a group to quit tobacco should call x5874. Dates will be determined after sign-up.

DIABETES: The Sugarless Lifestyle What are the symptoms of diabetes? Polyphagia (increased appetite or excessive hunger) Weight loss Muscle weakness Polyuria (frequent urination) Polydipsia (increased thirst) Pruritus (itching) Increase susceptibility to infection Recurrent vaginal candidiasis (women) Dental caries/ Periodontal disease

What should be tested to determine if I have diabetes? To determine if a patient has pre-diabetes or diabetes, healthcare providers conduct a fasting plasma glucose test (FPG) or an oral glucose tolerance test (OGTT). Either test can be used to diagnose pre-diabetes or diabetes. • FASTING PLASMA GLUCOSE (FPG) Normal < 100 mg/dl Pre-Diabetes 100 to 125 mg/dl Diabetes ≥ 126 mg/dl • ORAL GLUCOSE TOLERANCE TEST (OGTT) Normal < 140 mg/dl Pre-Diabetes 140 to 199 mg/dl Diabetes ≥ 200 mg/dl

• Dyslipidemia (HDL cholesterol ≤ 35 mg/dL and/or triglyceride ≥ 250 mg/dL) • History of gestational diabetes or delivery of a baby weighing > 9 lb • Member of a high-risk ethnic group (African American, Latino, Native American, Asian American, Pacific Islander) • Polycystic ovary disease • History of vascular disease

• NEUROPATHY Peripheral nerve disorder causing numbness, pain, or tingling in the feet or legs that may lead to amputation • MACROVASCULAR Peripheral vascular disease Coronary artery disease (myocardial infarction) Cerebrovascular disease (stroke)

What should be monitored How do I prevent complications once diagnosed with diabetes? of Type 2 diabetes? Once diagnosed with diabetes, you will be required to perform routine home blood glucose monitoring. Your physician will also check your hemoglobin A1c (HgA1c). If you have reached your ideal blood glucose level (called your “goal”), you should be tested at least twice a year. However, if your A1c is not at your goal or if you change therapy, you should be tested quarterly. HgA1c reflects glycemic control over a period of three months. According to The American Association of Clinical Endocrinologists, HgA1c should be maintained below 6.5 percent.

• A low-fat, low-calorie diet • Maintain a normal weight (BMI < 25 kg/m2) • Engage in regular physical activity (i.e. walking briskly for 30 minutes, five times a week) • Smoking cessation • Blood pressure control • Management of hyperlipidemia • Check eyes and feet regularly • Immunizations (influenza and pneumococcal) • Maintain normal blood glucose levels

What are the complications of uncontrolled diabetes?

These changes can sharply reduce your chances of developing diabetes as well as the associated complications.

• MICROVASCULAR Retinopathy (blindness) Nephropathy (kidney disease)

The American Diabetes Association recommends FPG screenings every three years beginning at age 45. Screening should be considered at an earlier age or be conducted more frequently if diabetes risk factors are present.

For additional information regarding treatment options for diabetes, please visit our Web site at

RISK FACTORS FOR TYPE 2 DIABETES: • Age ≥ 45 years • Overweight (body mass index, BMI ≥ 25 kg/m2) • First-degree relative with diabetes • Habitual physical inactivity • Previously identified pre-diabetes • Hypertension (≥ 140/90 mmHg)

Newsletter Contributors Nicole Tagliavia, Pharm.D. John G. Lech, Pharm.D. Hilde Berdine, Pharm.D. Christine O’Neil, Pharm.D.

For additional information, please visit the following Web sites: • • • • •

American Diabetes Association (ADA) — Centers for Disease Control and Prevention-Diabetes — National Diabetes Information Clearinghouse (NDIC) — Medline Plus health Information — National Diabetes Education Program (NDEP) —

A publication of the Duquesne University Mylan School of Pharmacy Center for Pharmacy Care & Pharmaceutical Information Center Additional information may be obtained from the Pharmaceutical Information Center by calling x4600 or sending an e-mail to Questions about screenings or programs: Christine O’Neil, Pharm.D, B.C.P.S. , x6417 3/06 309703 CG

Treatment Options for Diabetes: The Sugarless Lifestyle


ost importantly, treatment begins with a healthy diet and physical activity. If lifestyle modifications aren’t enough to achieve the ideal blood glucose level, medication therapy is added. There are five classes of medications that can be used alone or in combination with insulin. 1. SECRETAGOGUES - glipizide (Glucotrol®) - glyburide (Diabeta, Micronase®) - glimepiride (Amaryl®) - repaglinide (Prandin®) 2. BIGUANIDE - metformin (Glucophage®) 3. GLUCOSIDASE INHIBITORS - acarbose (Precose®) - miglitol (Glyset®) 4. THIAZOLIDINEDIONE - pioglitazone (Actos®) - rosiglitazone (Avandia®) 5. COMBINATION THERAPY - glimepiride/rosiglitazone (avandaryl®) - metformin/rosiglitazone (Avandamet®) - glyburide/metformin (Glucovance®)

6. INSULIN - Aspart - Regular - NPH - Ultralente - Glargine The U.S. Food and Drug Administration approved Exubera® (insulin human [rDNA origin]) inhalation powder in January 2006. It is a prescription medication that contains a rapid-acting, dry powder human insulin that is inhaled normally through the mouth into the lungs. When used as a mealtime insulin, the dose of Exubera should be given within 10 minutes before a meal. Exubera is the first inhaled and non-injectable insulin available in the U.S. Patients should not take Exubera if they smoke or have smoked in the six months prior to starting Exubera treatment.


BLOOD PRESSURE SCREENING • March 8 &amp; 22, April 26, 11:00 a.m.-1:00 p.m. Locations: Union Concourse, 3 rd Floor – (Mar. 8 &amp; Apr. 26)...