Diabetes tech program_final

Editor's Notes

• #4: I’d like to start by providing a brief overview of the program. We’ll first describe the origin of insulin and discuss insulin’s function in the body; we will review the different types of diabetes including Type 1, Type 2, and Gestational Diabetes; describe various classes of medication used in the treatment of diabetes; and we will discuss lifestyle recommendations for patients at risk for diabetes.
• #5: Diabetes’ first reference was discovered in a tomb in Egypt (1500 BCE), which described a sickness accompanied with passing of large quantities of sweet urine and extreme thirst (Klandorf & Stark, 2014). In 1870, it was noted by French physicians that the widespread famine during war times had a beneficial influence on patients with diabetes (Klandorf & Stark, 2014). In the 1920s the only way to treat diabetes was through a diet low in carbohydrates and sugar, and high in fat and protein. Allowing diabetics to live for about a year after diagnosis (Brar, 2010). The exact cause of diabetes was still unknown until 1921 when Canadian researchers purified insulin and proved that diabetes is an insulin deficiency disease (Brar, 2010). ++++++++++++++++++++ So let’s go ahead and get started! First, it’s important to review the history of diabetes. Diabetes mellitus has been a medical condition for at least 3500 years. In the early 1920s, researchers strongly suspected that diabetes was caused by a malfunction in the digestive system related to the pancreas gland, the small organ that sits on top of the liver. Diabetes’ first reference was discovered in a tomb in Egypt in 1500 BCE, which described a sickness accompanied with passing of large quantities of sweet urine and extreme thirst. In 1870, it was noted by French physicians that the widespread famine during war times had a beneficial influence on patients with diabetes. In the 1920s the only way to treat diabetes was through a diet low in carbohydrates and sugar, and high in fat and protein. Allowing diabetics to live for about a year after diagnosis. The exact cause of diabetes was still unknown until 1921 when Canadian researchers purified insulin and proved that diabetes is, indeed, an insulin deficiency disease.
• #6: In 2010, diabetes remained to be the 7th leading cause of death in the United States (National Diabetes Statistics Report, 2014.). The diabetes disease places a great deal of strain on patients, on their families, and on society as a whole (Shane-McWhorter, 2005). The estimated total costs of diagnosed diabetes had risen to $245 billion in 2012 from $174 billion in 2007 signifying a 41 percent increase over five years (cited by: The cost of diabetes, 2014). ++++++++++++++++++++++++++++ Today’s diabetes slightly differs from diabetes of past years as we know so much more about it. Diabetes affects about 20 million people in the United States and while it occurs most often in adults, it is the second most chronic disorder to affect children in the United States with about 200,000 children and teenagers diagnosed as having diabetes. In 2010, diabetes remained to be the 7th leading cause of death in the United States. Diabetes places a great deal of strain on patients, on their families, and on society as a whole. The estimated total costs of diagnosed diabetes had risen to $245 billion in 2012 from $174 billion in 2007 signifying a 41 percent increase over five years. The modern American lifestyle is a factor in the rise of diabetes as it includes less activity and unhealthy diets compared with the past. Diabetes is a serious, lifelong disorder that is incurable as of today.
• #7: Most of the food we eat is broken down by the digestive juices into chemicals including a simple sugar called glucose. After digestion, the glucose passes into the bloodstream where it is available for body cells to use for growth and energy. For the glucose to get into the cells, insulin must be present. Insulin is a hormone produced by the pancreas. (Shane-McWhorter, 2005) ++++++++++ Diabetes is a disorder of metabolism. Metabolism is the way in which the body uses digested food for growth and energy. So, think about it, every time you take a bite of food, metabolism is happening in your body. Most of the food we eat is broken down by the digestive juices into chemicals including a simple sugar called glucose. After digestion, the glucose passes into the bloodstream where it is available for body cells to use for growth and energy. For the glucose to get into the cells, insulin must be present. Insulin is a hormone produced by the pancreas. For more information on the pancreas, lets pass it to Kevin.    
• #8: Blood glucose is the main sugar that the body makes from the food in the diet. Glucose is carried through the bloodstream to provide energy to all cells in the body. Cells cannot use glucose without the help of insulin (Rees, 1997). Glucose is a simple sugar (a monosaccharide). The body produces it from protein, fat and, in largest part, carbohydrate. Ingested glucose is absorbed directly into the blood from the intestine and results in a rapid increase in blood glucose. Glucose is also known as dextrose (Rees, 1997).
• #9: The pancreas is enclosed in a thin connective tissue capsule. The pancreas is an accessory gland of the digestive system, and is an exocrine gland. Scattered within the tissue of the pancreas are small distinct regions known as the islets of Langerhans (which are a part of the endocrine system). (O’Connor, 2013)
• #10: Although insulin is best known for its action on glucose, it also stimulates the uptake of amino acids and fatty acids from the bloodstream during periods of adequate nutrition. (O’Connor, 2013). We need glucose….just not too much
• #11: Before I address this next slide, I have a challenge question for you….. Type in the chat box a drug you would normally see written by an endocrinologist. We’ll leave the chat box open for your answers for everyone to see, and I’ll comment on your answers at the end of this slide. So back to the pancreas. Another reason the pancreas is amazing is that it functions as an exocrine gland and an endocrine gland. Functioning as an exocrine gland, the pancreas excretes enzymes to break down the proteins, lipids, carbohydrates, and nucleic acids in food. Functioning as an endocrine gland, the pancreas secretes the hormones insulin and glucagon to control blood sugar levels throughout the day as we discussed in the previous slide. The most common endocrine disease is diabetes. Most diabetics are under the care of endocrinologist, who specialize in endocrine disorders, primarily this involves diabetes or thyroid hormone disorders. Its important as a pharmacy technician to know what drugs an endocrinologist would normally prescribe. Also I should mention Diabetes mellitus may be further classified as insulin-dependent (commonly called juvenile diabetes or type 1), non-insulin-dependent or adult-onset diabetes (type 2), gestational diabetes (occurs during pregnancy), or secondary diabetes (diabetes that results as a consequence of another condition). We’ll discuss these more in later slides. Now let me check your answers to the challenge question…. Now lets move onto the next slide, which is a poll question.
• #13: Have you ever heard someone say they have “the sugars”. That is something you may hear in clinics that serve older or less educated people in rural or inner city areas. Diabetes has been long known as a sugar disorder and as a result that slang term has been used by patients. Has someone ever called you “Sugar”? That sounds a whole lot better than being called “diabetes”, doesn’t it? So you have to understand the context the word sugar is being used in the medical field! But as a review, In healthy people, the pancreas automatically produces the right amount of insulin to use or store blood glucose. In people with diabetes, however, the pancreas either produces little or no insulin, and glucose is unable to be absorbed by skeletal muscles and fat tissue. As a result, glucose builds up in the blood and since it is not being utilized properly, the body loses its main source of fuel even though the blood contains large amounts.
• #14: When blood glucose rises above a certain point, the kidneys can pass the extra glucose in the urine. However, a urine test alone is not sufficient to diagnose diabetes. Oral glucose tolerance test: blood test used to check for diabetes. Sometimes it can detect diabetes when a simple blood test does not. Normally, the glucose in a person's blood rises quickly after the drink and then falls gradually again as insulin signals the body to metabolize (break down) the glucose. In someone with diabetes, blood glucose rises and remains high after consumption of the liquid. A doctor can decide, based on these tests and a physical exam, whether someone has diabetes. If a blood test is borderline abnormal, the doctor may want to monitor the person's blood glucose regularly. If a person is overweight, he or she probably will be advised to lose weight. The doctor also may monitor the patient's heart, since diabetes increases the risk of heart disease (Rees, 1997).
• #15: Treatment is necessary during pregnancy to make sure the diabetes doesn't harm the mother or fetus. A woman who knows she has diabetes should keep her condition under control before she becomes pregnant, so that her diabetes won't increase the risk of birth defects. A woman whose diabetes isn't well controlled may have an unusually large baby. Diabetes also increases the risk of premature birth and problems in the baby, such as breathing difficulties, low blood sugar and occasionally, death. (Rees, 1997)
• #16: Regular checkups can ensure that if a woman does develop diabetes later, it will be diagnosed and treated early (Rees, 1997). The rates of gestational diabetes are rising in the United States as well, predominantly in the African American, Hispanic, Asian American, American Indian and Alaskan native communities. However, any woman can develop gestational diabetes during a pregnancy (Gestational diabetes, 2015). Oral diabetes drugs aren't given during pregnancy because the effects of these drugs on the unborn baby aren't known (Rees, 1997). insulin provides better control of diabetes during pregnancy.
• #17: The decrease in insulin supply is caused by a decrease in functional beta cells in the islets of Langerhans. Evidence indicates that the beta cells are damaged or destroyed by an autoimmune reaction, which may follow a viral infection. Type 1 diabetics often have other endocrine disorders that are a result of autoimmunity. (O’Connor, 2013)
• #18: Although theses symptoms are true for all types of diabetes, they are typically more pronounced in patients with type 1 diabetes. Because people with type 1 diabetes lack insulin, glucose builds up in the blood. The kidneys, trying to remove the excess sugar, excrete large amounts of water and essential body elements, causing frequent urination and thirst. Because the body cannot use glucose (its first source of energy) it turns to stored fat and protein for fuel. As the body uses fat and protein, weight is lost. (which is why type 1 diabetics, especially those who are uncontrolled, appear thin in stature Breakdown products of fat collect in the blood and raise its acid content. If levels of these products are high enough, a critical condition called ketoacidosis can develop, requiring prompt treatment. (Rees, 1997)
• #19: Research shows that most, if not all, people with type 1 may inherit traits that put them at risk for diabetes. However, not everyone who inherits these traits develops diabetes (Rees, 1997) In some cases, the trigger may be a viral infection. Scientists have, in a few cases, been able to link the onset of diabetes with a virus. In most cases, however, the trigger for diabetes is unknown (Rees, 1997).
• #20: More and more people are also using home blood glucose monitoring devices to measure their blood glucose during the day. In this way, they can tailor the insulin dose more closely to changes in their hour to hour blood glucose. Blood glucose monitoring is a more accurate way to monitor diabetes treatment than urine testing. Eating the right foods at the right time is an important part of treatment. A person with type 1 needs to time meals with insulin doses to keep blood glucose from getting too high or low. The foods you choose can play a role in controlling blood glucose levels, too. Increasing the proportion of fiber and complex carbohydrates in your diet and avoiding refined sugar may aid in reducing drastic changes in blood glucose and may, in some people, permit lowering of insulin dose. Foods containing fiber include beans, whole grains, and some fruits, while complex carbohydrates, or starches, include potatoes, rice, and pasta. With daily insulin shots and a careful diet, however, most people with type 1 can lead active lives with the same ambitions and challenges as those without diabetes. (Rees, 1997)
• #21: Exercise needs to be done carefully, though. Strenuous exercise increases the muscles' use of glucose, so it can lower glucose in the blood. At the same time, exercise also stimulates the body to release glucose and fats for use as energy. This stimulus can have the effect of raising blood glucose. In order to exercise safely, one should balance insulin dose, meals, and the timing of exercise to keep blood glucose levels from getting too high or too low. (Rees, 1997)
• #22: In people with noninsulin dependent diabetes the pancreas usually produces some insulin, but the body's tissue don't respond very well to the insulin signal and, therefore, don't metabolize the glucose properly, a condition called insulin resistance. Insulin resistance is an important factor in noninsulin dependent diabetes. (O’Connor, 2013) Most people who develop diabetes are overweight. Scientists do not fully understand why obesity increases someone's chances of developing diabetes, but they believe obesity is a major factor leading to noninsulin dependent diabetes (Rees, 1997).
• #23: There is no simple answer to what causes type 2 diabetes. While eating sugar, for example, doesn't cause diabetes, eating large amounts of sugar and other rich, fatty foods, can cause weight gain (Rees, 1997). Most people who develop diabetes are overweight. Scientists do not fully understand why obesity increases someone's chances of developing diabetes, but they believe obesity is a major factor leading to noninsulin dependent diabetes (Rees, 1997).
• #24: When there is extra glucose in blood, one way the body gets rid of it is through frequent urination. This loss of fluids causes extreme thirst. Since the symptoms appear less severe and build gradually, there is often a delay in diagnosis for type 2 diabetics. This is one reason why yearly physicals at the doctors office that include blood work are very important….to screen for things like diabetes where the symptoms are not severe enough for a patient to seek help. A doctor also may suspect a patient has diabetes if the person has health problems related to diabetes. For instance, heart disease, changes in vision, numbness in the feet and legs or sores that are slow to heal, may prompt a doctor to check for diabetes (Rees, 1997).
• #25: There are several risk factors for developing type 2 diabetes. Most of these can be controlled to try to prevent the disease. Despite controlling these factors, some patients may still develop diabetes.
• #26: In people who are overweight, losing weight is the one treatment that is clearly effective in controlling diabetes. The treatment a doctor suggests depends on the person's age, lifestyle, and the severity of the diabetes Experts say that losing just 5% to 10% of your total weight can help you lower your blood sugar considerably, as well as lower your blood pressure and cholesterol levels. (Rees, 1997).
• #27: Many people with diabetes can control their blood glucose by losing weight and keeping it off. Myths and facts about diabetes and diet MYTH: You must avoid sugar at all costs. Fact: The good news is that you can enjoy your favorite treats as long as you plan properly. Dessert doesn’t have to be off limits, as long as it’s a part of a healthy meal plan or combined with exercise. MYTH: A high-protein diet is best. Fact: Studies have shown that eating too much protein, especially animal protein, may actually cause insulin resistance, a key factor in diabetes. A healthy diet includes protein, carbohydrates, and fats. Our bodies need all three to function properly. The key is a balanced diet. MYTH: You have to cut way down on carbs. Fact: Again, the key is to eat a balanced diet. The serving size and the type of carbohydrates you eat are especially important. Focus on whole grain carbs since they are a good source of fiber and they are digested slowly, keeping blood sugar levels more even. MYTH: You’ll no longer be able to eat normally. You need special diabetic meals. Fact: The principles of healthy eating are the same—whether or not you’re trying to prevent or control diabetes. Expensive diabetic foods generally offer no special benefit. You can easily eat with your family and friends if you eat in moderation.  8 principles of low-glycemic eating Eat a lot of non-starchy vegetables, beans, and fruits such as apples, pears, peaches, and berries. Even tropical fruits like bananas, mangoes, and papayas tend to have a lower glycemic index than typical desserts. Eat grains in the least-processed state possible: “unbroken,” such as whole-kernel bread, brown rice, and whole barley, millet, and wheat berries; or traditionally processed, such as stone-ground bread, natural granola or muesli breakfast cereals. Limit white potatoes and refined grain products such as white breads and white pasta to small side dishes. Limit concentrated sweets—including high-calorie foods with a low glycemic index, such as ice cream—to occasional treats. Eliminate sugar-sweetened drinks. Eat a healthful type of protein at most meals, such as beans, fish, or skinless chicken. Choose foods with healthful fats, such as olive oil, nuts (almonds, walnuts, pecans), and avocados. Limit saturated fats from dairy and other animal products. Completely eliminate partially hydrogenated fats (trans fats), which are in fast food and many packaged foods. Have three meals and one or two snacks each day, and don’t skip breakfast. Eat slowly and stop when full. Whole grain starches provide carbohydrates, vitamins, minerals, and fiber. Vegetables give you vitamins, minerals, and fiber. They are low in carbohydrates. Fruit gives you energy, vitamins, minerals, and fiber. Milk provides carbohydrates, protein, calcium, vitamins, and minerals. Meat and meat substitutes provide protein, vitamins, and minerals. Limit the amount of fats and sweets you eat. Try having sugar-free popsicles, diet soda, fat-free ice cream or frozen yogurt, or sugar-free hot cocoa mix.
• #28: Frequent heavy drinking can cause liver damage over time. Because the liver stores and releases glucose, blood glucose levels may be more difficult to control in a person with liver damage from alcohol. Frequent heavy drinking also can raise the levels of fats in blood, increasing the risk of heart disease. (Rees, 1997)
• #29: as we have already alluded to……… Walking is great exercise, especially for an inactive person, and it's easy to do. A person can start off walking for 15 or 20 minutes, three or four times a week, and gradually increase the speed or distance of the walks. The purpose of a good exercise program is to find an enjoyable activity and do it regularly. People taking oral drugs or insulin need to remember that strenuous exercise can cause dangerously low blood glucose and they should carry a food or drink high in sugar for medical emergencies. People with diabetes who have lost sensitivity in their feet can enjoy exercise as well. They should choose shoes carefully and check their feet regularly for breaks in skin that could lead to infection. Swimming or bicycling can be easier on the feet than running. (Rees, 1997)
• #30: All Type 2 diabetes medications have the same goal of controlling blood glucose levels over time. However, each medication attains that goal in a unique way.  Each diabetes medication primarily targets a specific process or organ. When necessary, several of these medications can be combined to target multiple organs or processes that affect blood glucose levels.
• #31: Weight control is essential for insulin to be effective. A doctor is likely to prescribe insulin if diet, exercise, or oral medications don't work, or if someone has a bad reaction to oral medicines. (Rees, 1997)
• #32: Various types of insulin are available that differ in purity, concentration, and how quickly they work In the past, all commercially available insulin came from the pancreas glands of cows and pigs. Today, human insulin is available in two forms: one uses genetic engineering and the other involves chemically changing pork insulin into human insulin. The best sources of information on insulin are the company that makes it. (Rees, 1997) You may recognize the names common insulins used
• #33: Decreases the body’s need for insulin by decreasing the amount of sugar produced in the liver and increasing the amount of sugar that the muscles absorb. By reducing the amount of sugar made and the amount free in the blood, metformin can lower blood sugar significantly in many diabetics.
• #34: All sulfonylurea drugs work in similar ways to effect blood glucose levels, but they have different side effects, differ in how often they are taken, and differ in their interactions with other drugs. (What are my options?, 2014)
• #35: Thiazolidinediones are medications that assist insulin to better work in the muscle and fat of the body. These medications also work to reduce glucose production in the liver. Rosiglitazone and combination medicine using rosiglitazone are available only for people specially qualified to take them. These medicines are available only through certified pharmacies. The FDA has announced possible safety issues with the drugsrosiglitazone (Avandia) and pioglitazone (Actos). Some studies have shown that people who take Avandia may raise their chance of having a heart attack, and people who take Actos may raise their chance of bladder cancer. The FDA recommends that people with bladder cancernot take Actos for diabetes. Alpha-glucosidase inhibitors help the body lower blood glucose levels by blocking the breakdown of starches, like bread or pasta, in the intestine as well as some sugars, like table sugar. Alpha-glucosidase inhibitors slow the rise in blood glucose levels after an individual eats a meal and should be taken at the initial bite of a meal
• #36:  (What are my options?, 2014)
• #37: (What are my options?, 2014)
• #40: (What are my options?, 2014). Should we add a list (for recognition purposes) of commercially available combo meds)??????
• #41: changes in the small blood vessels and nerves are common. These changes may be the first step toward many problems that diabetes causes. Scientists can't predict who among people with diabetes will develop complications, but complications are most likely to occur in someone who has had diabetes for many years. However, because a person can have diabetes without knowing it, a complication may be the first sign. (Rees, 1997) Left untreated, or not controlled properly, diabetes can lead to very serious health problems including, but not limited to: Skin complications Eye complications Foot complications High blood pressure Ketoacidosis (DKA) Stroke Neuropathy Heart disease Kidney disease Gastroparesis (stomach doesn’t move food through well)
• #42: In addition, pharmacists and their technicians may provide ongoing recommendations to the patients and their providers to enhance diabetes care. These factors place pharmacists with a great impact on the health outcomes and quality of life for patients with diabetes (Shane-McWhorter, 2005).
• #43: Pharmacists and pharmacy technicians working together with other health care providers are able to address the rising economic and health dangers of diabetes mellitus. (Scott, Boyd, Stephan, Augustine, & Reardon, 2006), (Sease, Franklin, & Gerrald, 2013)