DM Care by pharmacist

Good drug Compliance is essentail

2009-05-06T22:10:00.000-07:00

Drug compliance is vital thing for all DM patients

for Life

2009-02-03T04:45:00.000-08:00

1 Fast walking
2 Low carb
3 all good drugs

The benefit of fast walking in DM patients is enhanced blood sugar and blood pressure control. Finally the optimum fast walking can reduced mortality rate more than 50% in DM patients.

The secrete for diabetes patients

2008-01-13T01:12:00.000-08:00

1 Select the doctor if you can.
The Internal medicine or endocrine specialist is prefer.Because they can should the right drug for you.

2 Check your medicine.

aspirin if your age over 40 or with risk factor
statin if LDL more than 100 mg/dL
ACEI if blood pressure more than 130/90 mm Hg
more DM drug for better life if A1C >7.0 %

3 Fast walking 45 min every day.

fast walking is the best way of excersie that safe and effective

4 Low carb and low fat.

This food can control your blood sugar and lipid for long life survival.

Deep change in diabetes Care

2008-01-08T21:19:00.000-08:00

Effects of Quality Improvement Strategies for Type 2 Diabetes on Glycemic Control

A Meta-Regression Analysis

Kaveh G. Shojania, MD; Sumant R. Ranji, MD; Kathryn M. McDonald, MM; Jeremy M. Grimshaw, MBChB, PhD; Vandana Sundaram, MPH; Robert J. Rushakoff, MD; Douglas K. Owens, MD, MS

JAMA. 2006;296:427-440.

ABSTRACT

Context There have been numerous reports of interventions designed to improve the care of patients with diabetes, but the effectiveness of such interventions is unclear.

Objective To assess the impact on glycemic control of 11 distinct strategies for quality improvement (QI) in adults with type 2 diabetes.

Data Sources and Study Selection MEDLINE (1966-April 2006) and the Cochrane Collaboration's Effective Practice and Organisation of Care Group database, which covers multiple bibliographic databases. Eligible studies included randomized or quasi-randomized controlled trials and controlled before-after studies that evaluated a QI intervention targeting some aspect of clinician behavior or organizational change and reported changes in glycosylated hemoglobin (HbA1c) values.

Data Extraction Postintervention difference in HbA1c values were estimated using a meta-regression model that included baseline glycemic control and other key intervention and study features as predictors.

Data Synthesis Fifty randomized controlled trials, 3 quasi-randomized trials, and 13 controlled before-after trials met all inclusion criteria. Across these 66 trials, interventions reduced HbA1c values by a mean of 0.42% (95% confidence interval [CI], 0.29%-0.54%) over a median of 13 months of follow-up. Trials with fewer patients than the median for all included trials reported significantly greater effects than did larger trials (0.61% vs 0.27%, P = .004), strongly suggesting publication bias. Trials with mean baseline HbA1c values of 8.0% or greater also reported significantly larger effects (0.54% vs 0.20%, P = .005). Adjusting for these effects, 2 of the 11 categories of QI strategies were associated with reductions in HbA1c values of at least 0.50%: team changes (0.67%; 95% CI, 0.43%-0.91%; n = 26 trials) and case management (0.52%; 95% CI, 0.31%-0.73%; n = 26 trials); these also represented the only 2 strategies conferring significant incremental reductions in HbA1c values. Interventions involving team changes reduced values by 0.33% more (95% CI, 0.12%-0.54%; P = .004) than those without this strategy, and those involving case management reduced values by 0.22% more (95% CI, 0.00%-0.44%; P = .04) than those without case management. Interventions in which nurse or pharmacist case managers could make medication adjustments without awaiting physician authorization reduced values by 0.80% (95% CI, 0.51%-1.10%), vs only 0.32% (95% CI, 0.14%-0.49%) for all other interventions (P = .002).

Conclusions Most QI strategies produced small to modest improvements in glycemic control. Team changes and case management showed more robust improvements, especially for interventions in which case managers could adjust medications without awaiting physician approval. Estimates of the effectiveness of other specific QI strategies may have been limited by difficulty in classifying complex interventions, insufficient numbers of studies, and publication bias.

Blood Sugar Testing

2007-12-31T19:59:00.001-08:00

Source: Defeat Diabetes Foundation, Volume IV, Issue 7
Blood Sugar Testing
Questions:
What is a good blood sugar range for a person with diabetes?How do I check my blood sugar?When should I check my blood sugar?What is my A1c Test?What do the results of the A1c mean?
Answers:
What is a good blood sugar range for a person with diabetes?
A good fasting blood sugar (before breakfast) is <110 mg/dl.*A good blood sugar before bedtime is <140 mg/dl.*
*Remember that everyone is different and their reading will vary. Check with your doctor to find out your target blood sugar range.
How do I check my blood sugar?
Wash your hands with soap and water. Use warm water to allow more blood to circulate to the fingers. Dry your hands well before you pierce your finger.
Pierce the side of your finger. The tip of the finger contains more nerve endings and will hurt more than the side of your finger when pierced.
Change which finger you pierce each time you test your blood sugar. Using the same finger will cause the skin to become tough and more difficult to stick.
If you have questions about how to use your monitor call the toll-free telephone number listed on the monitor.
When should I check my blood sugar?
You and your doctor can learn something about your control each time you test and record your blood sugar. The best times to check your sugar are:
In the morning, before breakfast.
2 hours after a meal.
Before you go to bed at night.
Before and after you exercise.
If you are sick, have a fever or diarrhea, or have had changes in your medications, check your blood sugar more often.
Keep a log of your blood sugar levels, including the date and time of measurement. Bring this record with you each time you see your doctor. This will give you and your doctor a chance to check your blood sugar control and make changes in your treatment plan.
What is my A1c Test?
Self blood sugar testing reveals your blood sugar level at a particular moment. A1c is a blood test that reveals your average blood sugar level over the past 2-to-3 months. The result of this test gives you and your doctor a bigger picture of how well your diabetes is being controlled over time.
What do the results of the A1c test mean?
The results of the A1c test are given percentages:
6% = an average blood sugar of 120 mg/dl.
7% = an average blood sugar of 150 mg/dl.
8% = an average blood sugar of 180 mg/dl.
9% = an average blood sugar of 210 mg/dl.
A good A1c reading is below 6.5%.* Studies show that blood sugar levels under 150 mg/dl and A1c readings under 6.5%* reduce the risk of health problems related to poorly controlled diabetes, such as kidney, eye, heart, blood vessel, and nerve damage.
At least once a year show your doctor or diabetes nurse educator your blood glucose monitor and talk about any questions you may have.
*Reflects the new Diabetes Screening and Mangement Guidelines set by the American College of Endocrinology (ACE) and the American Association of Clinical Endocrinologists (AACE), 2001.
Question: What are the normal ranges for the hemoglobin A1c?
Answer: Remember, the hemoglobin A1c result must be compared to the normal range for each particular lab. Eventually that normal range will be standardized to a range of 4-5% but some labs still have ranges that are quite different.
To convert the A1c to average blood glucose, consider the high end of the normal range (e.g. If normal is 4-6%, then 6%) is equal to 120 mg/dl. For each change in 1% of A1c, there is a corresponding increase or decrease of approximately 30 mg/dl average plasma glucose.
Question: What is the best way to measure control?
Answer: The A1c test is the preferred standard for measuring glycemic control. The A1c test measures your average blood glucose level over the past 2-to-3 months. It's the best tool you and your healthcare provider have to assess your overall control--and your risk of developing serious complications.
AACE recommends an A1c target goal of 6.5% or less, and also suggests having an A1c test at least 4 times per year.
You and your physician should determine how often you should test.
In fact, AACE recommends talking to your physician about your A1c during every visit.
A1c testing is not substitute for regular blood glucose monitoring.
Question: If I'm measuring my A1c, is blood glucose self-monitoring also necessary?
Answer: The A1c test and blood glucose monitoring work together. The A1c test shows your average blood glucose over the past 2-to-3 months--while testing with a glucose monitor shows your glucose level at a specific point in time.
If you're not in good control, self-monitoring your A1c and blood glucose can help you better understand your diabetes and how to manage it.
Talk to your physician about self-monitoring--and if a specific monitoring plan may make sense for you.

The practical recommendations for DM patientsII

2007-12-27T19:16:00.000-08:00

Check LDL (cholesterol) every year.Control LDL blood level below 100 mg/dL by used statin drug such as simvastatin or Lipitor.

The practical recommendations for DM patients

2007-12-26T18:58:00.000-08:00

If you are hypertension too.

1 You should use ACEI drugs such as enalapril or ramipril.
2 You must control your blood pressure below 130/90 mmHg.

Explanation:
The advantages of ACEI drugs(enalapril 0r ramipril) is to slow progression of kidney failure , heart failure and to increase insulin sensitivity.

Why do you must be use enalapril or ramipril ?

Because its can decreased mortality and mobility rate in DM patients.
This is the next best thing you should to do if you are DM patients.

If you want to know more... see this

META-ANALYSIS:The Impact of ACE Inhibitors or Angiotensin II Type 1 Receptor Blockers on the Development of New-Onset Type 2 DiabetesEffie L. Gillespie, C. Michael White, Michael Kardas, Michael Lindberg, and Craig I. ColemanDiabetes Care, Sep 2005; 28: 2261 - 2266.

Back to basic.

2007-12-22T01:00:00.000-08:00

DM tips, Back to basic.

What is diabetes?

Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar levels, which result from defects in insulin secretion, or action, or both. Diabetes mellitus, commonly referred to as diabetes (as it will be in this article) was first identified as a disease associated with “sweet urine," and excessive muscle loss in the ancient world. Elevated levels of blood glucose (hyperglycemia) lead to spillage of glucose into the urine, hence the term sweet urine. Normally,blood glucose levels are tightly controlled by insulin, a hormone produced by the pancreas. Insulin lowers the blood glucose level. When the blood glucose elevates (for example, after eating food), insulin is released from the pancreas to normalize the glucose level. In patients with diabetes, the absence or insufficient production of insulin causes hyperglycemia. Diabetes is a chronic medical condition, meaning that although it can be controlled, it lasts a lifetime.

What is the impact of diabetes?

Over time, diabetes can lead to blindness, kidney failure and nerve damage. These types of damage are the result of damage to small vessels, referred to asmicrovascular disease. Diabetes is also an important factor in accelerating the hardening and narrowing of the arteries , leading to strokes, coronary heart disease, and other large blood vessel diseases. This is referred to a macrovascular disease. Diabetes affects approximately 17 million people (about 8% of the population) in the United States. In addition, an estimated additional 12 million people in the United States have diabetes and don't even know it. From an economic perspective, the total annual cost of diabetes in 1997 was estimated to be 98 billion dollars in the United States. The per capita cost resulting from diabetes in 1997 amounted to $10,071.00; while healthcare costs for people without diabetes incurred a per capita cost of $2,699.00. During this same year, 13.9 million days of hospital stay were attributed to diabetes, while 30.3 million physician office visits were diabetes related. Remember, these numbers reflect only the population in the United States. Globally, the statistics are staggering.

Diabetes is the third leading cause of death in the United States after heart disease and cancer.

Danger of poor blood sugar control.

2007-12-22T00:39:00.000-08:00

Poor control.

Good blood glucose level is 90-140 mg/dL in fasting stage or before meal and 140-180 mg/dL in after meal.

Keeping your blood glucose as close to normal as possible can be a delicate balancing act. If you don't have a healthy diet, you eat too much and don't follow your meal and exercise plan, you can wind up with high blood sugar and risk complications. At the other end of the spectrum, your blood sugar can go too low and cause problems, even a life-threatening coma.

Hypoglycemia (Low Blood Sugar)

What is hypoglycemia?

If your blood sugar drops too low, you can have a low blood sugar reaction called hypoglycemia. A low blood sugar reaction can come on fast. Generally, a level below about 60 mg/dl is called low blood sugar. It may occur once or twice a week if you have Type 1 diabetes. Hypoglycemia is much less common with Type 2 diabetes, but it can happen especially with some medications. People who have tight control of their diabetes are more at risk for low blood sugar and so are the elderly. Studies have shown that 50 percent of severe low blood sugars occur between midnight and 8 a.m. Talk to your diabetes educator about what to do.

What causes hypoglycemia?

Hypoglycemia can occur for a number of reasons:

Delaying or skipping a meal

Eating too little food at a meal

Getting more exercise than usual

Taking too much diabetes medicine, especially insulin, sulfonylureas, or meglitinides

Drinking alcohol

Hyperglycemia

What is it?
Too much sugar in the blood is called hyperglycemia. This is a problem that, left uncontrolled, can damage eyes, kidneys, heart, nerves and blood vessels. Causes include eating too much food, too little insulin or other medication, forgetting to take insulin or medication, skipping normal exercise, feeling sick or stressed.

What are the symptoms?
Often there are no signs with hyperglycemia. But if the blood sugar is extremely high, you may experience headache, blurry vision, thirst, hunger, frequent urination, dry skin, upset tummy or a fruity smell on the breath.

What is the treatment?
You should do as your doctor has advised you. You may be told to have an extra dose of short-acting insulin. If your blood glucose is over 240 mg/dl, you may test your urine for ketones, which are made when your body burns fat instead of glucose for energy. You should drink lots of fluids, check your glucose frequently and call a doctor or nurse. If your blood glucose is more than 500 mg/dl and there are signs of ketones in your urine, get to a hospital immediately.

Tips for DM life.

2007-12-21T21:23:00.000-08:00

How to reach tight control?

Test your blood sugar levels several times each day. It is valuable to test blood sugar levels as often as you feel it is giving you meaningful information.

Adjust medication doses according to food intake and exercise.
Follow a diet and exercise plan. For people with Type 2 diabetes, regular exercise and maintaining a healthy weight may forestall the use of medication.
Stay in close contact with a health care provider skilled in helping patients manage diabetes.
Example
Clinic-based pharmacists offered support to patientswith diabetes through direct teaching about diabetes, frequentphone follow-up, medication algorithms, and use of a databasethat tracked patient outcomes and actively identified opportunitiesto improve care.
In conclusion, apharmacist-based diabetes care program integrated into primarycare practice significantly reduced HbA1c among patients withdiabetes and poor glucose control.

Pharmacist Led, Primary Care-Based Disease Management Improves Hemoglobin Aic in High-Risk Patients With Diabetes
Russell Rothman, MD, MPP
Betsy Bryant, PharmD, CDE
Department of Medicine, University of North Carolina, Chapel Hill, NC
Cheryl Horlen, PharmD
School of Pharmacy, Campbell University, Buies Creek, NC
Michael Pignone, MD, MPH
Division of General Internal Medicine, University of North Carolina, Chapel Hill, NC

American Journal of Medical Quality, Vol. 18, No. 2, 51-58 (2003)
DOI: 10.1177/106286060301800202
© 2003 American College of Medical Quality

Fast better tips

2007-12-21T21:06:00.000-08:00

Glucose Control - Benefits

The federal government conducted a landmark study from 1983 to 1993 that profoundly changed the management of diabetes. The study involved 1,441 volunteers with Type 1 diabetes at 29 medical centers in the United States and Canada. The United Kingdom Prospective Diabetes Study in 1998 produced similar results for people with Type 2 diabetes.

The results from both studies proved that the level of blood sugar control predicts the onset and severity of diabetes-related complications for both types of diabetes. This means that if you have diabetes, if you can keep your blood sugar levels as close as possible to normal, you can live a normal life span with few or even no complications at all.

If you can control your blood sugar level, in the short run, you will:

Feel better.
Stay healthy.
Have more energy.
Prevent the signs and symptoms of high blood sugar such as feeling very thirsty and tired, urinating often, losing a lot of weight, having blurred vision, and having cuts and bruises that are slow to heal.

The objectice of this blog.

2007-12-21T20:53:00.000-08:00

The objective of this blog is to help daibetes mellitus patients.

1 For better quality of Life.

2 For more Survival rate.

3 For the good day or Not admitted in hospital.