FAR 192 : SOCIAL AND PUBLIC HEALTH PHARMACY

Name Matriks NumberKeshamalini a/p Gopalsamy 119072

Teh Wan Pei 119158Chia Xin Qi 119056

Rozeliana binti Harun 119144Lee Sin Bei 119076Ng Ling Shi 119101

Veronica anak Kueh 119160Muhammad Hafiz Afizad bin Ismail 119095

Dina Asyikin binti Abdul Rashid 119061Nor Izzatie binti Kamarul Zaman 119109

Nur Syafiqah binti Alwi 119121Nurul Ain binti Mohamed 119131

Title: Diabetes MellitusGroup members:

Diabetes Mellitus

• Brief into of diabetes mellitus• Statistic of diabetes mellitus • Age range of patients with diabetes

mellitus

What is Diabetes Mellitus?

• A chronic disease which result in high level of glucose in the blood.

• Cause damages to the body’s systems, especially the blood vessels, kidney, eyes, heart and nerves.

• Due to the deficiency in producing insulin by the pancreas and the defects of insulin action.

• These may due to the genetic inheritance, mutation in more than one gene or environment factors as well.

There are two principle forms of diabetes:

Type I• Results from autoimmune destruction of

the pancreatic beta, causing the loss of insulin production.

Type II• Results from insulin resistance and abnormal

insulin secretion.Gestational diabetes • A form of diabetes that occurs during pregnancy.

Facts

• The World Health Organization expects that as many as 177 million people in the world have diabetes in 2000.

• Each year, there are about 6 million people are suffering from diabetes.

• Every ten seconds, there is one person will die due to diabetes.

• In a year, there were a total of 4 million deaths.

• Diabetes is now the FOURTH biggest cause of death worldwide.

• People within 40 to 59 is the group with largest number of diabetes cases

• There were 2.9 million people with diabetes in 2011. By 2025, it is estimated that 5 million people will have diabetes in the UK. [1]

• It is estimated that there are around 850,000 people in the UK who have diabetes but have not been diagnosed. [1]

• The UK average prevalence of diabetes in the UK is 4.45% but there are variations between countries and regions. [1]

1-in-5 Malaysians is Diabetic

• This survey was done by the National Health and Morbidity Survey (NHMS 2011), showing that 1-in-5 Malaysians over the age of 30 have diabetes.

• Almost half of the total diabetics are unaware of their diabetic states claimed by Dr Zanariah Hussien, a Consultant Endocrinologist at Putrajaya Hospital.

• Number of young diabetics who between 18 to 40 years old has increased.

• Awareness has to be create among the community towards healthier lifestyle practices, especially with regards to food choices as the Malaysian diet is typically very high in carbohydrates and fat.

http://infolib.bernama.com/doc/mag/1294.pdf

Top five countries with the most diabetes sufferers in 2009 indicated by International

Diabetes Foundation

1. India 50.8 million

2. China 43.1 million

3. USA 26.8 million

4. Russia 9.6 million

5. Brazil 7.6million

Types of diabetes

• There are three main types of diabetes :• Diabetes type 1 : Juvenile-onset diabetes• Diabetes type 2 : Adult-onset diabetes• Diabetes type 3 : Gestational diabetes

(GDM), hybrid diabetes or "brain diabetes"

Diabetes mellitus type 1

• It is classified as an autoimmune disease.• It is the result of immune-mediated destruction

of insulin-secreting pancreatic beta cells.• People suffering from this condition produce

little or no insulin.• May affect people of any age, but usually

develops in children and young people.• Some of the symptoms are excessive urination,

urination at night, thirst and weight loss.

• 5% to 10% diabetics come from type 1 diabetes.• Those who are at risk of suffering from this type

are immune attack, genetics and environment.• Delayed treatment for insulin dependent

diabetes can be fatal.• Insulin injections should be taken before meals

and sometimes additional injections taken at bedtime.

Diabetes mellitus type 2

• Caused by a condition called insulin resistance (IR).• IR is a physiological condition that develops when

the cells in the body become resistant to insulin and are unable to use it as effectively.

• Insulin resistant cells cannot take in glucose, amino acids and fatty acids. Thus, glucose, fatty acids and amino acids 'leak' out of the cells.

• This results in an increased blood glucose level.• Symptoms include blurry vision, cuts that are slow

to heal and extreme fatigue.

A study on symptoms that contribute to diabetes mellitus type 2Kaur et al. BMC Family Practice 2013, 14:69http://www.biomedcentral.com/1471-2296/14/69

Diabetes mellitus type 3

• There is no agreed upon definition of type 3 diabetes. This type of diabetes is marked by the lack of adequate insulin production by the brain.

• Gestational diabetes mellitus (GDM), a condition in which women without previous diagnosis of diabetes exhibit high blood glucose levels during pregnancy.

• Hybrid diabetes, meaning a patient has both type 1 and type 2 forms of the disease.

• Common symptoms include increased heart rate, memory loss, confusion and dementia (related to Alzheimer's disease).

Pharmacological Treatment For Each Type Of Diabetes

• Diabetes Type 1• Diabetes type 1 cannot be treated by oral medication

but by injection of insulin and Islet cell transplantation.

• 4 insulin types: Method of injection:

• Short-acting insulin -Fine needle• Rapid-acting insulin - Insulin pen• Intermediate insulin - Insulin pump• Long-acting insulin

• Example

Insulin type Generic and brand names Onset Peak Duration

Rapid-acting Insulin aspart (NovoLog)Insulin glulisine (Apidra)Insulin lispro (Humalog)

15 minutes 30 to 90 minutes 3 to 5 hours

Short-acting Insulin regular (Humulin R, Novolin R)

30 to 60 minutes 2 to 4 hours 5 to 8 hours

Intermediate-acting

Insulin NPH human (Humulin N, Novolin N)

1 to 3 hours 8 hours 12 to 16 hours

Long-acting Insulin glargine (Lantus)Insulin detemir (Levemir)

1 hour No clear peak 20 to 26 hours

Insulin pump

Fine needle

Insulin pen

Diabetes Type 2Diabetes type 2 can be treated by both injection and oral medication .Example:

Injectable medicationsMedications Action Advantages Possible side effects

•Amylin mimeticsPramlintide (Symlin)

Stimulate the release of insulin; used with insulin injections

May suppress hunger; may promote modest weight loss

Hypoglycemia; nausea or vomiting; headache; redness and irritation at injection site

•Incretin mimeticsExenatide (Byetta)•Liraglutide (Victoza)

Stimulate the release of insulin; used with metformin and sulfonylurea

May suppress hunger; may promote modest weight loss

Nausea or vomiting; headache; dizziness; kidney damage or failure

Oral medicationsMedications Action Advantages Possible side effects

•MeglitinidesRepaglinide (Prandin)•Nateglinide (Starlix)

Stimulate the release of insulin

Work quickly Severely low blood sugar (hypoglycemia); weight gain; nausea; back pain; headache

•SulfonylureasGlipizide (Glucotrol)•Glimepiride (Amaryl)•Glyburide (DiaBeta, Glynase)

Stimulate the release of insulin

Work quickly Hypoglycemia; weight gain; nausea; skin rash

•Dipeptidy peptidase-4 (DPP-4) inhibitorsSaxagliptin (Onglyza)•Sitagliptin (Januvia)•Linagliptin (Tradjenta)

Stimulate the release of insulin; inhibit the release of glucose from the liver

Don't cause weight gain Upper respiratory tract infection; sore throat; headache; inflammation of the pancreas (sitagliptin)

Gestational diabetes:Gestational diabetes can be treated by taken oral antidiabetes agents.Example:Type of antidiabetes agent Examples Action

Insulin secretagogues Sulfonylureas

Meglitinide

Limit the production of hepatic glucose and stimulate production of insulin.

Insulin sensitizer Biguanides

Thiazolidinediones

Improve the sensitivity of liver towards glucose and the function of insulin.

Α-Glucosidase inhibitors Decrease uptake of glucose in upper gastrointestinal tract,decrese postprandial glucose excursions.

NON-PHARMACOLOGICAL TREATMENT FOR EACH TYPE DIABETES

Type I

• -Make smart choices from every food group to meet their • caloric needs.

• -Get the most and best nutrition from the calories consumed.

• -Find a balance between food intake and physical activity.

• -Get at least 30 minutes of moderate-intensity physical activity • on most days.

Get the right amount of food.

  Make sure each meal has all the necessary food grade.

  Do exercise regularly.

Lifestyle management is highly efficient in the

prevention and also in the early management of type 2

diabetes. This evidence of lifestyle modification in

diabetes prevention is stronger than for most other

multifactorial diseases.

Gestational Diabetes Eating a healthy meal plan designed by a registered dietitian or

other healthcare provider (known as medical nutrition therapy)

Getting regular, moderate physical activity

Maintaining healthy weight gain

Keeping a daily log of dietary intake, physical

activity, and glucose levels

Use of an insulin pen• What is an insulin pen?

• One type of tool for getting the lifesaving medicine into our body that have same

function as a vial and syringe .

• -to inject insulin for the treatment of diabetes.

• Introduced and marketed as Novopen by the Danish company Novo Nordisk in 1985.

• Two types of insulin pen systems which is prefilled pen and reusable pen.

• 1.A prefilled pen is entirely disposable. The disposable kind comes prefilled with

insulin and should be stored in the refrigerator before use then stored at room

temperature once opened. When the insulin is used up, these pens are discarded.

• 2.A durable pen uses a replaceable insulin cartridge. While the cartridges can be

stored in the refrigerator prior to use, the reusable pens should not be put in the

refrigerator at any time.

Ways to use the insulin pen

1. Uncapped the pen.

2) Steril the rubber cap with the alcohol swap.

3) Remove the needle protector.

4) Tighten the needle to the insulin pen.

7) Adjust the dosage in selecting the needed unit.

8)Make sure that the needle is in upward position then press the push button.

9) Adjust the dosage to the unit number that you want to inject.

10) Put the needle into the skin and inject the dosage by pressing the push button until the

number 0 is equivalent with the dosage pointer.

11) Let the needle in the skin for about 6 seconds and keep pressing the push button until the

needle is out from the skin.

12) Pull out the needle by loosen it and dispose the needle.

13) Put on the cap back and store it in an appropriate place.

Advantages of using insulin pen• Portable

- Examples:Easy to carry and as more and more people are taking rapid-acting insulin before each

meal, the insulin pen’s portability makes this regimen easier to follow.

• Decreased the pain

-The process is so much simpler, and patients that using insulin pens don’t anticipate the stick of the

needle as much, and thus feel like the shot itself hurts less.

• Better social acceptance/ Prevent dosage errors

-Its intrinsically more accurate for dosing, they do end up being more accurate in regular use by

regular people.

• Ease of Training and Use

- doctors and nurses can train new patients on the proper use of insulin pen injectors.

- patients using insulin pens understand how to use them much faster, and report that using the

pens is much easier.

• The insulin in pen and cartridge are more expensive than in the bottles that are

for the syringe.

- If the patients are supplied with insulin pen every month and happen to be a

damage on the insulin pen, the patients have to pay for that.

• A small amount of insulin is wasted after the pen is used.

-1 or 2 unit of insulin will be wasted after the pen is opened before the injection

process and small amount of wastage in the pen after the injection process.

• The insulin pen is only for self-use.

- The needle must be pull out every time after the injection, and there are no ways in

preventing the person who give the injection from being struck by the needle.

• 2 different type insulin cannot be mixed in 1 insulin pen.

- In meaning that if the patient need a mixed insulin and the premixed insulin is not

available, 2 injection must be taken- 1 for each injection.

References • 1. Diabetes in the UK 2012- Key statistics on diabetes; Diabetes UK, April 2012• en.wikipedia.org/wiki/diabetes_mellitus• www.medicinenet.com/diabetes_mellitus/article.htm • www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002194

• http://pmr.penerangan.gov.my/index.php?option=com_content&id=642:jenis-jenis-kencing-manis-diabetes-mellitus

• "Type 1 Diabetes Mellitus". Retrieved 4 August 2008• http://www.biomedcentral.com/141-2296/14/69• http://www.mayoclinic.com/health/insulin/DA00091• http://www.mayoclinic.com/health/diabetes-treatment/DA00089• http://care.diabetesjournals.org/content/30/Supplement_2/S206.full

• https://www.ghc.org/all-sites/guidelines/diabetes1.pdf

• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811487/

• http://www.dlife.com/diabetes/gestational/treatment

• http://en.wikipedia.org/wiki/Insulin_pen

• http://timesulin.com/theblog/five-benefits-of-using-an-insulin-pen/

• http://voices.yahoo.com/the-pros-cons-using-insulin-pen-blood-11594256.html?cat=5

• http://www.wikihow.com/Use-an-Insulin-Pen