Diabetes

Video transcripts reprinted with permission from Dr. Allison Jorgensen, RP (registered pharmacist)

"Hi, and welcome to Health Wise. I'm Ally Jorgensen.

Today we are going to talk about diabetes mellitus. When we talk about diabetes, and most of you just call it 'diabetes,' there are a couple of words that we need to pay careful attention to. Did you know there are actually two kinds of diabetes? The first is diabetes mellitus. That is a problem with the sugar in your blood. That is the disease we are going to talk about today.

There is a completely different disease called diabetes insipidus that is kidney damage. It is very rare, but sometimes if we just stop short and say the word 'diabetes' we can get confused. However, most of you with sugar diabetes, or diabetes mellitus, always use the short form and just say diabetes. That is fine. Your doctor and your pharmacist will know what you are talking about because we are helping you monitor the disease all along. Actually, the disease 'diabetes mellitus' simple means you cannot control high blood sugar. The sugar in your blood is higher than is healthy or safe for you. And there is something about your body that cannot control it alone.

Type 1 diabetes, we used to call that 'juvenile onset diabetes' or 'kids' diabetes,' or even long ago we called that 'skinny diabetes.' Those people make no insulin. It is very easy to understand what their problem is. We need insulin to get our blood sugar to go down. If they do not make any, they cannot make that happen. They tend to be children, because people who do not make insulin get diagnosed very quickly.

The second kind of diabetes mellitus is Type 2. That makes sense if the first one is Type 1. Type 2 diabetes used to be called 'adult onset diabetes.' We do not call it that anymore because children get the disease. We also used to call it 'fat diabetes'. We do not call it that anymore because it hurts people's feelings. But the truth is, most people with Type 2 diabetes, get the most benefit when they lose weight. Those people also probably still make some insulin. They just do not make enough to do the job.

When we talk about treating diabetes, even though I'm a pharmacist, even though I think it is important that people take drugs wisely, the first two most important parts of treating diabetes do not have anything to do with my pharmacy. Patients with diabetes, patients who cannot control their own blood sugar have to control their diet. That is, when you were diagnosed with diabetes, your doctor or your nutritionist talked to you about how you should eat, when you should eat and what you should eat. Those instructions are for life. If you were told that you will be safest if you eat six tiny meals a day, do not go back to eating three big meals a day when you feel better until someone tells you that is all right.

Making good diet choices actually start at your shopping cart, not in your kitchen. If there are foods that are so tempting, you know if you buy them, you will take them home and you will eat them. Do not buy them to start with. My problem are those chocolate cookies. I know that if I take them home, I am going to eat them all. So, I have to be smart when I am at the grocery store, and just not buy them in the first place. Those kinds of plans are difficult to get used to. But once, they become habit, you will make much better choices. And...everyone in your household will be healthier because you did.

The second thing you do to treat diabetes also has very little to do with my pharmacy...that is exercise. Some people can exercise by running five miles a day. Other people exercise by walking around the living room and pushing the vacuum. It doesn't matter how you exercise. What matters most is that you do it faithfully at least five times a week. It may be something as simple as carrying the laundry up and down the steps. It may be something as complicated as swimming 25 laps in the pool at the nearest gym. Your doctor and sometimes your physical therapist will help you decide which exercise is best for you.

There are some interesting things that happen in a diabetic patient when they begin to exercise. Sometimes they lose weight and usually, especially with Type 2 diabetes, that helps. The other thing that happens is muscles that get exercise, eat more sugar, so the sugar in your blood goes down. Interestingly, muscles demand energy, that is, they pull sugar out of your blood even when they are not working. Muscles demand energy even when they are at rest. So, exercising now, building your muscles up, you do not have to look like you just walked off the beach. You just have to improve your muscle tone. Those muscles will eat sugar more often that muscles that do not get used in exercise.

For some patients, diet changes, exercise changes, aren't enough. For those patients, we use drugs. And, I would like to talk to you a little about those drugs, because sometimes we do not use the right words again. Clearly, the first drug that we use to treat diabetes is insulin. If you have Type 1 diabetes, the one we used to call 'juvenile onset' diabetes, that is our only choice. If your body does not make insulin, we have to give it to you. Right now the only available insulin is available by injection...that is, you have to put the insulin through your skin with a needle. Science is working very hard to create insulin that we may use as a nasal spray. Somebody is working on insulin that we may use as eye drops. They are just not on the market yet. So for right now, patients who use insulin need to get it through their skin somehow. Most patients use a vial of insulin and a needle and a syringe. Some patients use specially calibrated dosing [pens] where you just push a button like you push on a ball point pen and a little needle pricks through your skin and you get a pre-measured dose of insulin. Still other patients who use insulin have a pump that constantly pumps insulin into their blood stream. Usually it sits somewhere on their belly, most of the time we cannot see it, but we're still putting the insulin through their skin. Insulin, if you would swallow it, would get digested by your stomach and it would never do you any good. So, when people tell you they are swallowing insulin, they are not, they are just using the wrong words.

The oldest drugs that we have for Type 2 diabetes, 'adult onset' diabetes, are called sulfonylureas (SULFO NEEL U REAS), a very long fancy pharmacy word. And what it really means is drugs that help get the sugar out of your blood. It is interesting when we look at how these drugs work. They are not insulin. What they do is a number of things. Sugar cannot just leave your blood. Somebody has to open the doorway in the muscle for it to get out. Sometimes we think of the sulfonylureas as drugs that hold the door open, so that the sugar can get through. Sometimes, the problem is not that we cannot get the door open, it is that we do not have enough doors. That is when people gain lots weight, and then their blood sugar gets out of control. So, if we give them sulfonylureas, we can also think of them as building extra doors for the sugar to leave your blood. If they build extra doors, and they hold those doors open extra long, their blood sugar should go down. And that is true, it does.

The sulfonylureas, though, can cause us a problem. They can work too well. Every one of them can make your blood sugar too low. And blood sugar too low is very dangerous. Blood sugar too high takes time to hurt you. When you have diabetes, your eyes are in danger, your kidneys are in danger, your blood vessels are in danger, and your heart is in danger. When you have blood sugar that is too low, either because you use too much insulin, because we did not get the right dose of the sulfonylureas, or because you took your medicine and forgot to eat, blood sugar too low can hurt your brain. And it can hurt your brain quickly. It is very difficult to think when your blood sugar is too low. And we need you to be careful of that.

Everyone with diabetes should know the signs of their blood sugar being too high and their blood sugar being too low. When your blood sugar is too high, it generally does not hurt until it is very high. Then you tend to get tired and you tend to yawn a lot. You also get a fruity kind of smell to your breath, even after you just brushed your teeth. So it is important that you know those things.

When your blood sugar is too low, you feel panicked. You may feel hungry. Your heart may beat extra quickly. The palms of your hands may sweat and you feel like you have to go somewhere or do something and you do not know why. If you have diabetes and you ever get that feeling, it is very important if you can that you eat. If your blood sugar was too high the little bit that you just ate won't hurt you much. If your blood sugar is too low, the little bit that you just ate can save your life.

I am sure if you are using one of the sulfonylureas, someone has already told you this. They told you at the doctor's office, the dietitian reminded you, the pharmacist reinforced that - that it is important that you know that drugs that can lower your blood sugar sometimes can work too well and then they can make you sick.

In diabetes, we have a number of other drugs, other than insulin, other than the standard sulfonylureas that we use to lower blood sugar. One of them is called [acarbos, or precose]. That drug makes you absorb sugar from your stomach very slowly. It is a little bit tricky to take, because you have to take it with your first bite of breakfast every morning. That means, you need to keep this one on the kitchen table so that it is available after your first bite of breakfast every morning.

We have a couple of other drugs that lower your blood sugar but cannot make it go too low. That is, it will only remove extra sugar from your blood. Most of those drugs can jeopardize your liver sometimes. So, when we give you drugs that lower your blood sugar, but not too low, we often need to test your blood, both for sugar to see how the drug is doing, and for liver enzymes to make sure that the drug hasn't hurt you. You have heard that one of those drugs was removed from the market. That is true, and it is gone, and it is never coming back. All of the drugs that are out there now, are much, much safer. But no drug is perfectly safe, especially when you have diabetes and we want to be sure that we lower your blood sugar, but not too much. And that we do it quickly, but not too fast.

There are some things that will need to monitor. As you change, as you get older, as you increase your exercise, as you lose weight, the doses of all of these drugs may change. In fact, we know that some people who lose a significant amount of weight and keep that weight off, can stop taking drugs to treat Type 2 diabetes sometimes. Please, do not try to lose weight without talking to your doctor or your dietitian. Please, do not take drugs over the counter or herbal products that say they can help you lose weight. Most of them do not work for more than three days. But, more importantly, those drugs can damage your eyes, and your heart and your kidneys, just like diabetes can damage your eyes, and your heart and your kidneys. You do not want to put that kind of stress on your body. If your doctor wants you to lose weight, if your pharmacist thinks that is a good idea, the dietitian is the person to help you decide which diet (or) how many calories to cut out. The physical therapist or the physician are the people to help you increase your exercise, lose weight slowly and keep it gone and your diabetes will be under much better control.

It is also important that you know how to take care of your own monitoring. Clearly, if you are going to go to the doctor's office, they are going to draw blood. And you know they are going to look both at your blood sugar and at a little piece of your blood called hemoglobin A1C. Remember, that tells us how good your blood sugar has been under control for about the last 80 days. The doctor is also going to look for some other things in your blood. But, you need to do monitoring all by yourself at home. Monitor your own blood sugar. If they have told you to monitor every morning, monitor it every morning. If you have been instructed to monitor it three times a day, monitor it three times a day. And carefully write down the numbers you have found. Those pieces of information are important.

It is also important that you know what to do with those numbers. If it's ever over 300, or your blood sugar is ever under 80, you should call your doctor or your pharmacist immediately. There will be other numbers that your doctor and your pharmacist will tell you are warning numbers, when they want you to call or they want you to do something else. You should know what those warning numbers are so that you can write down your blood sugar.

Remember, you need to help with the monitoring. You need to remember to check your own feet. When you go do the doctor and you have diabetes, every time you go into the exam room, take off your shoes and socks, so that the doctor has a chance to check your feet. If you have been asked to monitor your blood sugar once a day or four times a day, you need to do that.

You need to carefully remember to go see your dentist and your eye doctor at least once a year because having diabetes makes it difficult for your teeth and your eyes to stay healthy as well. A lot of people are going to be involved in helping you take care of your diabetes. You may have a special eye doctor, a special dentist, a podiatrist, a cardiologist, an endocrinologist, a dietitian and a pharmacist, in addition to your regular physician. All of these people are very important.

But the most important person in treating diabetes, is you. You need to stick with the diet that has been recommended for you. You need to do as much exercise as you can safely do. You need to take your drugs carefully and on time. You need to plan ahead so that you have drugs available in case the weather gets really bad and you cannot get to the pharmacy. Please remember that a number of drugs to treat diabetes are not safe in the mail. They cannot tolerate being that cold, or that hot. Be sure that you have a supply on hand so that you are never in an emergency situation. If you are diabetic and your life depends on using your using insulin or other drugs, carry that insulin or those other drugs with you. Do not pack them in a suitcase that could get lost in the belly of an airplane. Make sure that you have them with you so that you can always stay safe.

Diabetes is remarkably complicated. It is a lifelong disease; you will never be cured, but you can be well treated and well controlled. In fact, you can live your life as if you did not have the disease as long as you take your drugs, follow your diet and exercise properly. When you have questions about your very complicated disease, please talk to your doctor or pharmacist. They will be happy to help you.

For Health Wise, I'm Ally Jorgensen. Thank you for listening."