Written by Sergio Petrillo

November is National Diabetes Awareness Month. Perhaps you, a family member, or a friend has diabetes. By reading this article, you can share this information and/or use it yourself to help manage diabetes. The first step to effective management is a good understanding of the diabetes disease process. From there, you can build upon that foundation to know signs or symptoms, how to monitor, knowing when to call your provider before symptoms worsen, importance of provider follow up, and most importantly adhering to the non-pharmacological (diet and exercise) and pharmacological prescribed regimens. This article will focus on four key questions surrounding diabetes and diabetes management.

1) How does diabetes affect Americans?
In 2019, 37.3 million Americans, or 11.3% of the population, had diabetes. Nearly 1.9 million Americans have type 1 diabetes, including about 244,000 children and adolescents.1 1.4 million Americans are diagnosed with diabetes every year, making the U.S. #3 in countries with the highest rate of Diabetes.2

2) What are the different types of diabetes?

Type 1 Diabetes:
Type 1 diabetes is a disease that starts when the pancreas stops making enough of a hormone called insulin. Insulin helps the body use sugar from food as energy or store it for later use. If there isn’t any insulin, too much sugar stays in the blood. Over time, high blood sugar can harm many parts of the body. These include the eyes, heart, blood vessels, nerves, and kidneys.
Type 1 diabetes can occur at any age, but it usually starts in children or young adults. It’s a lifelong disease. But with treatment and a healthy lifestyle, people can live a long and healthy life.3

Gestational Diabetes:
Gestational diabetes is high blood sugar that first occurs during pregnancy. High blood sugar can cause problems for you and your baby. But with treatment, most women can control their blood sugar and have healthy babies. Blood sugar levels usually go back to normal after the baby is born.4

Prediabetes:
Prediabetes is a warning sign that you are at risk for getting type 2 diabetes. It means that your blood sugar is higher than it should be, but not high enough to be diabetes. Prediabetes is also called impaired glucose tolerance or impaired fasting glucose. Most people who get type 2 diabetes have prediabetes first.5

Type 2 Diabetes:
Type 2 diabetes is a condition in which you have too much sugar (glucose) in your blood. Glucose is a type of sugar produced in your body when carbohydrates and other foods are digested. It provides energy to cells throughout the body. Normally, blood sugar levels increase after you eat a meal. When blood sugar rises, cells in the pancreas release insulin, which causes the body to absorb sugar from the blood and lowers the blood sugar level to normal.When you have type 2 diabetes, sugar stays in the blood rather than entering the body’s cells to be used for energy. This results in high blood sugar. It happens when your body can’t use insulin the right way. Over time, high blood sugar can harm many parts of the body, such as your eyes, heart, blood vessels, nerves, and kidneys. It can also increase your risk for other health problems (complications).6

3) What are some potential complications associated with diabetes?
There is no cure for diabetes. Management of diabetes is important to prevent and/or delay long term complications (risk for getting other health problems). This is especially true if your blood sugar levels stay high. Over time, high blood sugar can damage many parts of your body. It can lead to a variety of problems, including problems with your:

Eyes: High blood sugar levels may cause temporary blurred vision. Blurry vision, floaters, or flashes of light may be a sign of diabetic retinopathy, which can lead to severe vision loss. Having diabetes also puts you at risk for cataracts and glaucoma.
Heart and blood vessels: High blood sugar damages the lining of blood vessels. This is called hardening of the arteries, or atherosclerosis. It can lead to stroke, heart attack, peripheral arterial disease, or heart failure. Erection problems can be an early warning sign of blood vessel disease and may mean a higher risk of heart disease.

Nerves: High blood sugar levels can damage nerves throughout your body. This damage is called diabetic neuropathy. There are different types of neuropathy. They may be caused by damage to nerves that sense things like pain or touch or that control things like your heartbeat, digestion, or blood pressure. Nerve damage can be painful, especially in the feet.
Feet and skin: You may have less feeling in your feet. This means that you can injure your feet and not know it. Common infections from blisters, ingrown toenails, small cuts, or other problems can quickly become more serious when you have diabetes.

Kidneys: High blood sugar can damage tiny blood vessels in your kidneys that help filter waste from your blood. This kidney damage is called diabetic kidney disease (sometimes called diabetic nephropathy). You may not have any symptoms until the damage is severe. Then you may notice swelling in your feet or legs or all over your body.

Infections related to diabetes: High blood sugar from diabetes can affect the body’s immune system. The immune system is the body’s natural defense system that helps fight infections.
People with high blood sugar from diabetes can be more severely affected by common infections, such as influenza and pneumonia. They also are more likely to be infected with unusual organisms, such as Gram-negative bacteria or fungi.7

4) What can you or someone you know do to help prevent and/or manage diabetes?

Prevention – You can help prevent or delay complications by keeping your blood sugar in a target range. You also need regular medical checkups to look for early signs of complications. If complications are treated early, the damage may be stopped, slowed, or reversed. 7

Management of diabetes –
• Follow up with your physician. Your physician will monitor lab values (hemoglobin A1C) (defined below), kidney function tests, and others as needed/warranted] on a routine basis. Eye and foot exams are also recommended to be performed every year.
• Stay up to date with recommended vaccinations.
• Keep up on latest education, treatments for diabetes. Diabetic educators are available to assist and educate with diabetes. The ADA (American Diabetic Association) is a great resource.
• Monitor your blood sugar based on your physician’s treatment plan.
• Understand the signs and/or symptoms of low and/or high blood sugar.
• Diet, nutrition, exercise – follow your physician’s suggestions. Coaches, Dieticians, Care managers, and/or Diabetic educators are available to assist, check with your health plan for benefit coverage.
• Take your medications/insulin as prescribed by your physician.
• Utilize your smart phone application(s) that help with managing Diabetes.
• Joining a support Group (online and/or in person sessions) may be beneficial in connecting with others that are affected by Diabetes.

  • List of Sources:
    1) American Diabetes Association. Website url: https://diabetes.org/about-us/statistics/about-diabetes. Accessed 10/19/22
    2) Medical News Today. Website url: https://www.medicalnewstoday.com/articles/diabetes-rates-by-country#type-2. Accessed 10/23/22
    3) Healthwise: Website url link: Type 1 Diabetes (healthwise.net). Accessed 10/19/22
    4) Healthwise: Website url link: Gestational Diabetes (healthwise.net). Accessed 10/19/22
    5) Healthwise: Website url link: Prediabetes (healthwise.net). Accessed 10/19/22
    6) Healthwise: Website url link: Type 2 Diabetes (healthwise.net). Accessed 10/19/22
    7) Healthwise: Website url link: Diabetes Complications (healthwise.net). Accessed 10/19/22
    List of additional Resources:
    1) https://www.heart.org/en/health-topics/diabetes/diabetes-tools–resources
    2) https://professional.diabetes.org/search/site?f%5B0%5D=im_field_dbp_ct%3A32&retain-filters=1

    Sergio Petrillo is a clinical pharmacist on the Magellan Rx Navigate team. Over the past 15 years since graduating from Northeastern University with a PharmD, Sergio has worked in a variety of settings, including retail, in-home pharmacist consultations, IV home infusions, designing/implementing/managing a pharmacist led transitions of care program, and most recently on the Magellan Rx Navigate team, performing both care management and utilization management duties. All of his combined experience has provided Sergio with vast understanding of issues that occur for patients transitioning from one point of care to the next.