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American Diabetes Association

Posted By Bernard Natt RPh, Friday, February 13, 2015



The American Diabetes Association is celebrating its 75th anniversary this year

Originally referred to as diabetes mellitus diabetes has mushroomed into the epidemic it is today.

As opposed to the Juvenile Diabetes Research Foundation, which focuses all of its resources on research, the ADA recognizes the need for outreach programs to help people deal with the daily challenges of diabetes.

People with diabetes can live a far superior lifestyle as a result of the efforts of the ADA.

In 1940 what is today referred to as Type 1 diabetes was called juvenile diabetes since onset was usually during childhood and is related to a deficiency of insulin.

Type 2 was referred to as adult onset diabetes and is most often characterized not by a lack of insulin but an inability to properly utilize insulin.

The terms are no longer valid. Today, to a good degree to the increase of obesity in children today, there is a great increase in Type 2 in children.

One concern is that the ADA does not have recognition as an urgent cause as HIV or cancer do but the numbers of people with diabetes are much greater, thus there is a difficulty in raising the vital funds to carry out its urgent mission.


It would be helpful for pharmacists to reach out to the ADA in their community.

While helping an important cause the pharmacist would be recognized in their area as dedicated to people with diabetes. In addition the person with diabetes spends twice as much on medication as a person of the same age and gender without diabetes.


Go to the site if you wish to heighten community awareness of your commitment

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Posted By Bernard Natt RPh, Friday, December 19, 2014


The complications of diabetes are severe

Diabetes is a leading cause of

  • Cardiovascular disease and cardiovascular deaths
  • Lower limb amputations
  • Stroke
  • Kidney failure leading to dialysis
  • Blindness and retinopathy
  • Hypertension
  • Hypoglycemia
  • Dyslipidemia



As a result aside from the primary care physician a person with diabetes has a greater need for an endocrinologist, cardiologist, urologist, ophthalmologist, podiatrist, neurologist, dermatologist and others


Thus the much greater number of prescriptions generated for the person with diabetes

Once again the importance of focusing on diabetes in your pharmacy










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Diabetes Certification Registration Deadline

Posted By PSSNY Office, Wednesday, December 17, 2014
Updated: Wednesday, December 17, 2014

The deadline to register for the Pharmacist and Patient-Centered Diabetes Care Certificate Training Program is rapidly approached! Register by December 26th, 2014 to be eligible to attend! Register Here!

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Posted By Bernard Natt RPh, Wednesday, October 1, 2014



At one time the thinking was that either a person is diabetic or not in the same manner as  a woman cannot be a little pregnant.

However a major focus today in on pre-diabetes.

People that are pre-diabetic are not yet diabetic

A1C readings over 6.5 indicates diabetes as well as FPG over 126

Pre-diabetes would be in the range of an A1C of 5.7 to 6.5 or FPG of 100-126

These numbers are not absolute.

The importance of the focus on pre-diabetes is to try to help a person before they reach the readings of diabetes.

The first goal would be to institute a dietary program and exercise program appropriate to the individual. This is instituted by the health care provider.

The numbers are daunting.

79 million Americans over the age of 20 are pre-diabetic.. Unless helped 70% will become diabetic.

The incidence of people that are overweight or obese is the driving factor

Pharmacists should consider establishing themselves as diabetes centers as informing the community of their knowledge and dedication..

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Type 2 diabetes

Posted By Bernard Natt RPh, Thursday, August 7, 2014

Type 2 Diabetes

Type 2 diabetes was formally called adult diabetes since symptoms usually occurred  as an adult.  Symptoms may take years to develop thus many people are undiagnosed.

It is usually a result of insulin resistance by which the body produces enough insulin but does not utilize it properly.

Often this is a result of obesity.

The huge increase in Type 2 is due to the epidemic of obesity.

More children are obese today than ever before resulting in Type 2 occurring as children thus adult onset is no longer accurate.

About 90% of the people with diabetes are Type 2

Common Symptoms

  • Thirst
  • Hunger
  • Frequent urination
  • Unexplained weight loss
  • Fatigue
  • Blurred vision
  • Slow healing wounds


Weight control and proper diet are the basic tools of treatment followed by insulin or medication if not eased.


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Posted By Bernard Natt RPh, Thursday, July 3, 2014

Often when speaking to doctors they would rather have glucose readings somewhat high than low.  This is due to the fear of hypoglycemia.

The high readings take their toll inevitably

However hypoglycemia can result in loss of consciousness. Worst case scenario when driving..

People with diabetes should be encouraged to always carry glucose tablets if they are feeling weak.

If at home orange juice is even better since it has a faster response.

Any Type 1 patient and many Type 2 should know the importance of  Glucagon and the means of administration. It is best if someone living with the patient be instructed on the use. Also nurses at schools should be familiar.

Upon a prescription for insulin ask the doctor for a prescription for Glucagon. Let the patient be aware of the expiration date and that he/she should let their doctor know if they had a hypoglycemic experience. If the customer requests a new Glucagon ask if they used the original one and why. Also ask if they contacted their doctor. If not let the doctor know.


Bernie Natt

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insulin presriptions

Posted By Bernard Natt RPh, Friday, May 30, 2014



The commonly used insulins today are rapid-acting, intermediate acting, long acting or pre-mixed combinations.


Rapid acting- Novolog, Humalog or Apidra

have onsets of 15 minutes, peaks of 30 to 90 minutes and a duration of 3 to 5 hours


Intermediate-acting are Humulin N and Novolin N

Onset of 1-3 hours, peak of 8 hours and a duration of 12-16 hours


Long acting insulins are Lantus and Levemir

Onset 1 hour, peakless and duration of 20 to 26 hours


Bolus- insulin secreted by pancreas in response to a meal


Basal insulin- constant low dose of insulin secreted to keep glucose readings level


There are various combinations combining the qualities of the different insulins


Rapid insulins are used with insulin pumps. It is important that the patient knows that with a 15 minute onset it should be given just prior to a meal otherwise there may be a hypoglycemic episode. Can act as a bolus.


Long acting insulins act as a basal insulin


Thus rapid acting in response to a meal and long acting replicate the normal insulin response

Generic versions of insulin are near. It would be interesting to see acceptance. Many doctors insist on Synthroid, not the generic.. Would the same apply to insulin?



Important precautions by a pharmacist when dealing with insulin:

  • Always refer to provider to make sure that the dosage is current
  • If new prescriber patient must use new dosage
  • Some patients require U-500. calibrate syringe with the new, 5 times as potent insulin
  • Make sure that in conjunction with a vial of insulin syringes are provided
  • Make sure that with a pen needles are provided.
  • Dosage must be in units, not mls.
  • Various expirations are from 1 month to three months
  • Do not substitute similar insulins within a type such as Novolog for Apidra- a dose change may be needed. Check with prescriber.



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Posted By Bernard Natt RPh, Thursday, May 1, 2014

Before I go further in describing the types of diabetes, which I am sure most of you are familiar with, let me show where I intend to go with the diabetes blog.

The numbers are daunting with the growth of diabetes and also obesity which goes hand in hand.

I would like to help you, as a volunteer, establish a larger footprint for your customers with diabetes and their families.

The pharmacist is the professional that most people come into contact with for their health needs

I will strive to increase your knowledge of insulin pumps, and CGM and the disposables associated with these products. This can be an additional source of income if we can, as a group, negotiate better pricing.

A free standing diabetes section, if you have space, would be helpful.

At this point please answer the following.

Do you think a 101 course in diabetes would be helpful?

Are there any areas where you would like me to focus?

Do you access the diabetes blog which is new?

Any other questions or suggestions for the diabetes blog?



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type 1 diabetes 101

Posted By Bernard Natt RPh, Thursday, April 24, 2014

Type 1 diabetes 101

previously referred to as juvenile diabetes since onset is often early in life due to the destruction of the beta cells in the pancreas. It is an autoimmune condition in which the body’s immune system destroys the islet cells of the pancreas. Currently it effects about 5-10% of people with diabetes

Insulin is essential to maintain health

There is much research including beta cell transplants. A main concern is hypoglycemia due to poor control. This can be due to overdosage of insulin, improper food intake or exercise without proper replenishment

Symptoms of type 1

  • Excessive thirst
  • Frequent urination
  • Extreme hunger
  • Unexplained weight loss
  • Fatigue
  • Tingling in extremities
  • Blurry vision
  • Dry itchy skin
  • Slow healing of cuts


Typically insulin pumps target type 1 patients. This is an ever increasing industry which may possibly offer opportunities for pharmacies.


Since this is a new posting for PSSNY please let me know if a 101 program is helpful and any suggestions for topics or other suggestions would be very welcome.



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Posted By Bernard Natt RPh, Thursday, March 27, 2014
Welcome to the new diabetes blog at PSSNY hosted by a PSSNY member since 1974, a pharmacist since 1967 and Certified Diabetic Educator since 1992. With the expected national expenditure of over 3 trillion dollars by 2020 for diabetes enormous research and progress are being applied. Everyone is familiar with glucose meters. There is great emphasis in insulin pumps, continuous glucose monitoring (CGM) telehealth and apps. Also one of the greatest areas of focus for medications is the area of diabetes with many medications in the pipelines. I will provide areas of interest and updates to pharmacists and welcome greatly your views. Bernard Natt RPh CDE

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