September 9, 2019

Staying Current with Diabetes Education

By Brett Peterson, PharmD

Contributing Author: Kelli Charlton, Director of Education and Community Engagement

 

While attending pharmacy school, Brett developed a sudden and intense interest in diabetes prompted when his wife was diagnosed with type I diabetes, a diagnosis that changed their lives and was a catalyst for focusing his studies. Brett is the pharmacist-in-charge at the Stapley Pharmacy downtown location.

Both type I and type 2 diabetes have the same final result: an increased amount of sugar in the blood. This increase in sugar is harmful to the body. If left untreated, it can lead to serious health problems, such as heart disease, vision loss, and irreversible kidney disease. 

Type I diabetes is caused by an autoimmune disorder that causes the body’s immune system to mistakenly attack the cells in the pancreas that make insulin. This is the molecule that signals to the cells in the body that sugar is available. Type I diabetics can no longer make their own insulin. 

On the other hand, type 2 diabetes occurs when the cells in the body become resistant to the messenger (insulin) telling them that sugar is available in the blood. This means that a type 2 diabetic can still produce insulin but often has elevated levels of insulin because the cells in the body just aren’t listening. Because of this distinct difference, type 2 diabetics have more treatment options.When treating type 2 diabetes, the goal is to: 

  • increase the amount of insulin in the body.
  • increase the sensitivity of the body’s cells to insulin.
  • decrease the amount of sugar in the blood. 

While we have many new and exciting medications in the treatment of diabetes, one of the first medications found to increase sensitivity to insulin was metformin. Metformin was used as a medication in France starting in 1957, so we have forty years of data on it. To this day, Metformin is still considered a first line medication. First line medications are the first line of treatment. Other medications that have great track records are glipizide, which focuses on signaling the body to create more insulin. The drawback with these medications is that they signal the body to make insulin whether it needs insulin or not.

Newer medications increase insulin but have a much lower chance of causing low blood sugar or of helping the body get rid of sugar that is already in the blood. New medications that increase insulin include injectable medications such as bydureon, victoza, and trulicity and oral medication such as januvia, onglyza, and tradjenta.

The other main class of medication prevents the reuptake of sugar from the kidneys. This allows the sugar to be excreted in the urine and therefore lowers the amount of sugar in the blood. These medications include farxiga, invokana, and jardiance, to name a few. While we have many new and exciting medications for the treatment of type 2 diabetes, the most effective treatment in combating the effects of diabetes is still diet and exercise. In fact, type 2 diabetes is one of those chronic diseases that sometimes can be cured with diet and exercise alone. Each pound that we can lose has a profound effect on our body’s control of its sugar level. As a pharmacist, I always tell my patients that we should use medications after we have explored all other options. The best part is that we don’t have to choose between medication or diet and exercise. I honestly can’t think of one diabetic medication that interacts negatively with diet and exercise!Type I diabetes differs from type 2 in that the body can no longer make any insulin. This means that the only option we have is to replace the insulin by injection. Type I diabetics must count every carbohydrate they eat so that they can inject the correct amount of insulin in order to keep their sugar level normal. Many type I diabetics are not-so-patiently waiting for their “artificial pancreas.” This is a combination of a continuous glucose (sugar) monitor (known as CGM) and an insulin pump. When the sugar in a type I’s body goes up or down, the CGM signals the insulin pump. The insulin pump then either increases or decreases the amount of insulin that is being delivered to the patient in order to keep their sugar level within normal ranges. This technology has the potential not only to improve the health of these patients but also to drastically increase their quality of life.

Through advances in medicine and technology, both type I and type 2 diabetics are experiencing an improved quality of life. Please don’t hesitate to contact your favorite pharmacist about your diabetic health concerns, and remember, your pharmacist is your most accessible medical professional.

 

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