Type 1 vs. Type 2 Diabetes….What are we Treating?

Ida Reighard RN, CDESt James Healthcare723-2960/ida.reighard@sjh-mt.org

Objectives:

At the end of this continuing medical education event, participants should be able to:

• Name 2 differences between Type 1 and Type 2 Diabetes

• Name 2 psychosocial concerns related to Type 1 and Type 2 Diabetes

• Identify pharmaceutical therapies for Type 1 and Type 2 Diabetes

Disclosures

• Criteria for Successful Completion:Attendance for at least 80% of the educational event.

• Disclosure of presenter: Ida Reighard RN, CDE has nothing to disclose.

• Disclosures of those in a position to control educational content: Phil Dean RN – Clinical Nurse Educator has nothing to disclose.

You need to know “what” you’re treating:

• Type 1• Absolute Insulin

Deficiency• Treated with insulin• Average age 14-40 at

onset • Typically lean body• Genetically set up• <10% of people with

diabetes

• Pills never worked

• Insulin added quickly

• Ketones in urine or DKA

Before Insulin and After

What is Type 2 Diabetes?

• Defined by a Complex metabolic disorder……

(Both Insulin resistance and deficiency) Include the social, behavioral and

environmental risk factors unmasking the effects of genetic susceptibility.

i.e. it’s complex

You need to know “what” you’re treating:

• Type 2• Relative Insulin Deficiency• Insulin Resistance• Excess sugar from liver• Average age 30-50• Typically heavy• Genetically set up ”survivor” • 90% of people with diabetes

@ Dx: 50% less insulin produced

High BP

High Trigs/

High LDL/

Low HDL

Understanding Diabetes:Type 2

Insulin resistance Insulin

deficiency Excessiv

e hepatic glucose release

Type 2 DiabetesInsulin

resistance

How will you know? “undertall”

Insulin deficiency

How will you know? BS fasting, before

and after eating

Excessive hepatic glucose

releaseHow will you know?

BS fasting

Type 2 DiabetesInsulin

resistance Insulin Sensitizers

Insulin deficiency

Meglinitides Sulfonylureas

AGI’sExcessive

hepatic glucose release

Metformin

Incretins:

Victoza

Byetta

Januvia

Onglyza

Tradjenta

Ooodals of meds- where do we start? ADA Says:

• At diagnosis:• Lifestyle therapy (1-800-DIABETES ED) and Metformin

– If A1c not under 7%:• Add either sulfonylurea or insulin

– But not glyburide or chlorpropamide

– Then intensify insulin therapy• Continue metformin- IT HELPS!!!! ITS CHEAP!!!

WEIGHTLOSS!! • Drop SU once using intensified insulin regimen

ADA Treatment Algorithm

• “Less Well-Validated therapies”(i.e. last ditch effort before insulin)– We can’t prove longterm benefit with these meds– TZDs (Actos, Avandia) – Incretins

• No hypoglycemia• No weight gain, but no weight loss• Similar potency to SU; not more• Expensive

Incretin System

S

mal

l Int

esti

ne

Incretins

Increase insulin secretion Suppresses glucagon secretion FBS & PP blood sugars hunger, slows gastric emptying

GLP-1

“Bad diabetes” is the kind where you take insulin

Hog Wash...• Insulin is not the enemy,

HIGH BLOOD SUGAR is!• Over time, many people

with diabetes need insulin because the pancreas “poops out.”

• Can’t “squirt it out?” Gotta “squirt it in.”

• “Good diabetes” is CONTROLLED diabetes, regardless of the treatment.

Insulin is not the bad guy

• Insulin: “Use Early and Often”• Physiologic timing pattern of normal insulin• Basal-bolus regimens:

– Education required– Allows flexibility

• Consider Co-management with Endocrinology and with Diabetes Education Program

The “5 Rights” of Insulin Therapy

• The Right insulin• Rapid acting, long acting?

• At the Right time• Where is insulin needed? Food? Background?

• In the Right amount• Carb coverage/ Premeal

adjustment/Background

• With the Right device• Short Needles, Small syringes, Pens, Pumps

• For the Right to live life well with diabetes

Insulin Management of Diabetes

Acanthosis Nigricans (AN)Cause- High insulin levels in bloodstream

Cure- Decrease Insulin Levels in Blood

Feelings and Diabetes Some common myths:

Diabetes destroyed my plans and dreams.

Asking for help is a sign of weakness.

I should be able to take diabetes in stride.

I should hide my diabetes from others.

The truth: People with diabetes have

depression almost twice as often as people without.

People want to help- ask!!

Spotting Depression1. Increase in readmissions2. Not sleeping/sleeping too much3. Appetite changes4. Guilt statements, hopeless statements5.  Suicidal thoughts/statements6. Drug/alcohol use7. Less family/friends visiting when they are in the hospital8. Not performing ADLs, not picking up meds at pharmacy, missing

appointments 9. No mention of friends, family, hobbies10. Recent bad news- lost a job, lost a loved one, lost more of their health 11. Use a depression tool/or ASK THEM. "This is a hard disease. It takes a lot of work. You have had it a long

time. Does it get you down?"

Eating Disorders & Diabetes

Diabulemia- a condition when insulin dosing is inadequate for the purpose of losing weight

-Food Hoarding-Lack of Pleasure in eating food

Thank You!

•Any Questions?????