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Understanding Diabetes Diabetes » Vol. 1 PEHP Integrated Care Newsletter Understanding Diabetes Millions are affected by high blood glucose, but many cases remain undiagnosed In 2011 it was estimated remember this disease that 25.8 million people affects millions of people in the United States were and, if needed, support diabetic, with nearly groups are available. one-third remaining This In The Know newsletter undiagnosed. will be highlighting the The overall incidence of differences in type 1 and diabetes increases with type 2 diabetes, common age to more than 1 in 4 of treatment regimens, helpful patients age 65 years and reminders to remain Not alone » 25% of patients 65 older. So if you feel all compliant on therapy and a or older have diabetes. alone with your condition diabetic friendly recipe. Type 1 and type 2: What is the difference? Inside Type 1 and type 2 diabetes Type 1 diabetics are generally Diabetes comprise the largest population younger with a large majority being treatment of diabetic patients in the United diagnosed before age 10 compared » Page 2 States. Type 1 patients are to an average age of onset of 40 Blood sugar characterized by a lack of insulin years old in type 2 diabetes. testing » Page 3 secretion, while type 2 diabetics Only 10% of patients with type 1 generally have insulin resistance. Diabetes and diabetes have a family history of the the Enhanced Other ways to distinguish between disease, but up to 90% of patients Pharmacy type 1 and type 2 diabetes include: with type 2 diabetes have a close Benefit » Page 4 family history and age of onset. relative with the same condition. 6/25/14 Diabetes PEHP Integrated Care Newsletter Distinct Diseases Type 1: Fewer cases, Type 2: Three classes of oral meds insulin dependence Depending on your group of medications baseline HbA1c your is called sulfonylureas Because type 1 diabetics have little provider may start you to no insulin secretion, they are and includes glyburide, out on a variety of oral treated with replacement insulin. glipizide, and medications. Multiple insulin products are glimepiride. available and include short acting Most patients starting These medications insulin (e.g., Novolog) which is oral medication are rapidly work to reduce generally considered mealtime treated with metformin. It your HbA1c but have works by helping to move insulin and long-acting insulin been associated with low sugar into cells and out of (e.g., Lantus). blood sugars and a small the blood and to prevent These products, when used increase in weight. in combination, mimic the the release of stored sugar The third medication is normal action of the pancreas. in the liver. called pioglitazone, which Unfortunately, shots must be given Patients unable to 3-4 times daily for short-acting take metformin often works very similar to insulin and 1-2 times daily for long- take another group metformin and provides acting insulin. of medications that slightly less reduction in HbA1cs but offers some Despite giving multiple shots per increase the amount of day some patients still have high insulin released from other beneficial effects on blood sugar values or experience the pancreas. This cholesterol levels. substantial side effects from the Type 2 medications insulin, resulting in dramatic swings of their blood glucose Medication A1c Advantages Disadvantages Formulary reduction placement values. These patients may qualify Metformin 1-2 No weight Requires slow Tier 1 for additional support of their gain, highly adjustments (generic) diabetes management in the form recommended because of of an insulin pump or continuous stomach complaints glucose monitor. PEHP covers Pioglitazone 0.5-1.5 Decreases Small weight Tier 1 many different insulin pumps and cholesterol gain (generic) continuous glucose monitors, but Glimepiride 1-2 Work quickly Small weight Tier 1 offers an enhanced benefit for the gain (generic) t:slim and Omnipod insulin pumps Glipizide 1-2 Work quickly Small weight Tier 1 and the Dexcom G4 continuous gain (generic) Glyburide 1-2 Work quickly Small weight Tier 1 glucose monitor. For more gain (generic) information, contact the PEHP Tradjenta/ 0.5 No weight gain, Not very Tier 2 Pharmacy Department at 801-366- Onglyza minimal side effective (preferred) 7555 option number 3. effects In the Know » PEHP Integrated Care Newsletter» Diabetes » Vol. 1 » Page 2 Diabetes PEHP Integrated Care Newsletter Decreasing blood glucose values Target HbA1c for most patients is 7% values. An average of your blood glucose value for the Because type 1 and type 2 past 3 months is known as a diabetes are distinct diseases, hemoglobin A1c (HbA1c). they will also be treated with A blood sugar tested at home medications differently. with your glucometer is your Type 1 diabetics require level at a particular moment, insulin early in their disease but an HbA1c indicates your whereas patients with type 2 blood sugar level over the diabetes are generally treated course of 3 months. with oral medications first. To minimize long-term But because it is a progressive complications, the American disease, many patients with Diabetes Association type 2 diabetes will ultimately recommends most patients be treated with insulin. target an HbA1c of less than The goals for managing 7%, but HbA1c goals are diabetes are to minimize Be aware » Are you testing individualized – some are long-term complications by blood glucose often enough? slightly more or less than the decreasing blood glucose 7% target recommendation. Treatment adherence decreases complications Make a routine Compliance to a compliance improves you know you will of taking your medication seems HbA1c by nearly 0.4 see it and take it medicine. easy enough, but points. » Ask family studies have shown The number 1 reason members to help only 60% of patients for non-compliance Use a pillbox remain compliant » is forgetfulness. on their diabetic (for a free pill Here are a few medications. box contact the helpful hints some PEHP Pharmacy Adherence to the patients have used Department 801- prescribed treatment to remember to take decreases overall 366-7555 option #3) their medication: costs and could » Apps on smart prevent long-term » Set an alarm phones (such as complications. Every » Place the RXmindme and 25% increase in medication where medcoach) In the Know » PEHP Integrated Care Newsletter» Diabetes » Vol. 1 » Page 3 Diabetes PEHP Integrated Care Newsletter Blood sugar testing Enhanced Pharmacy Benefit Beginning in 2014 PEHP has expanded our In order to safely and effectively Enhanced Pharmacy Benefit to include long- manage your diabetes, it’s important to understand your blood glucose acting insulin (i.e. Lantus). Medications Cost With this expansion the levels. Freestyle test strips $10* Enhanced Pharmacy Testing recommendations from the Novolog vials $10* American Diabetes Association Benefit now includes Lantus vials $10* range from testing 8-12 times daily insulin vials, both short- Novolin vials $10* in patients on complicated insulin and long-acting, and *Limited to vials, diabetic test strips for a enrollment in Integrated regiments, to only occasionally in Care and retail pharmacies. some type 2 diabetics on medications Tier 1 copayment through Costs are based on tier the retail pharmacy after 1 copayments and after that are not associated with low applicable deductible. blood glucose values (e.g., metformin, applicable deductible. Onglyza, pioglitazone). For more information and how to enroll Discuss with your provider how often in the program, please visit www.pehp.org you should be testing your blood under the members tab and Integrated Care or sugar. contact Integrated Care at 801-366-7400. Grilled Mango Chicken Watching blood sugar? Here’s a recipe for you INGREDIENTS DIRECTIONS » 4 (4-ounce) boneless, skinless chicken breast cutlets (1 pound total) » In a large resealable plastic » 2 tablespoons mango chutney or mango salsa storage bag, combine chicken with remaining ingredients. Place » 2 tablespoons fresh lime juice in refrigerator and marinate » 2 teaspoons grated fresh ginger, or ½ teaspoon ground ginger 8 hours or overnight, turning » 1 tablespoon olive oil halfway during marinating time. » ¼ cup orange juice » Preheat grill to medium-high heat. Place chicken on grill, » 1 teaspoon minced fresh oregano or ¼ to ½ teaspoon dried oregano discarding excess marinade. Grill » ½ teaspoon hot pepper sauce chicken 4 to 6 minutes per side, » 2 garlic cloves, minced or until cooked through. From Hello Taste, Goodbye Guilt! by Mr. Food Test Kitchen If you prefer not to receive future mailings, contact PEHP Integrated Care at 855-366-7400 to opt out. In the Know » PEHP Integrated Care Newsletter» Diabetes » Vol. 1 » Page 4.
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