Diabetic Patient

By Monica Zatarski
Pharm.D., R.Ph.
MDCustomRx
Brookfield, Wisconsin

Diabetes occurs in epidemic proportions in the United States;over 17 million people in this country have the disease. The incidence of diabetes and the frequency of complications are both on the rise. The compounding pharmacist is well equipped to meet the unique needs and multiple co-morbidities of the diabetic patient.

Diabetic Neuropathy

Diabetic neuropathy, a peripheral nerve dysfunction, affects approximately 50% of all people with diabetes. Neuropathies are characterized by decreased nerve conduction and sensory function that often creates a tremendous amount of pain. The patient may describe the pain as feelings of pinpricks, tingling, burning, electric, jabbing, deep aching, squeezing or shooting pain. The pain from this syndrome can be unremitting and may result in depression, sleep disturbance and a general decrease in the quality of life. Oral analgesics are associated with the possibility of nephrotoxicity. Narcotic analgesics may cause physiological dependence, and the tricyclic antidepressants may cause anticholinergic effects.

These undesirable side effects can be avoided through the use of transdermal gels. The transdermal delivery method also increases efficacy by delivering pain relieving medication directly to the painful site and allowing several therapies to be combined into a single agent. Three or more pain modifying medications are combined into a single penetrating gel and can then be adjusted accordingly to provide pain relief for each individual.

Impotence

Approximately 35% to 50% of men with diabetes experience erectile dysfunction (ED) because of the damage that this disease exerts on nerves, arteries, smooth muscle and fibrous tissue. ED has a tremendous impact on the quality of life and personal well-being of afflicted individuals. Oral phosphodiesterase inhibitors have their shortcomings: for maximum effectiveness they must be taken at least one hour prior to sexual activity, and high-fat meals may decrease the absorption rate and plasma concentrations of the drug. In order to bypass these downfalls, sublingual dosage forms can be compounded, which bypass the problem with high-fat meals and result in an onset of action of 10-15 minutes. Intracorporeal administration of vasoactive alprostadil has proven extremely reliable, with an erectile response rate of 60% to 90%. However, 15% to 75% of patients report an unpleasant to severe burning effect. Compounding a combination of alprostadil, papaverine and phentolamine (Trimix) has been reported to reduce the burning effect because the synergism ofthe three drugs allows for the reduction in the dose of alprostadil.

Diabetic Ulcers

More than 60% of non-traumatic lower limb amputations in the United States are performed on people with diabetes. Seventy to 90 percent of these episodes begin with an ulceration of a site on a lower limb, followed by an infection. Peripheral neuropathy and peripheral vascular disease are major risk factors for ulcer formation. Because there is little to no pain at the site of ulceration, the infection and worsening of the ulceration can go unnoticed until well into the advanced stage. The treatment of an ulceration should address the issues of improving vascularization (nifedipine, pentoxifylline),increasing granulation (phenytoin'), promoting healing (misoprostol, beta 1, 3 glucan), and preventing or treating infection (tobramycin, metronidazole). Prescription compounding allows for multiple agents, addressing each of these issues, to be combined into a single topical agent, allowing for increased efficacy and patient compliance.

Other needs of the diabetic patient that can be met through prescription compounding are moisturizers for rough, dry skin; sugar-free preparations; sterile ophthalmics; chlorhexidine mouthwash and toothpaste to combat periodontal disease; and electrolyte troches to increase saliva production. The compounding pharmacist is in a great position to help meet the unique medication needs of the diabetic patient. Having prescription compounding as an available option results in an extremely successful practice and brings a much-improved quality of life to the diabetic patient.

For more information on options for the diabetic patient, please contact the pharmacists at MD Custom Rx, a state-of-the-art compounding-only pharmacy, at 262.373.1050

Keywords: diabetes,diebetic,Diabetic neuropathy,Neuropathies,depression,sleep disorders,diabetic ulcers,impotence,Peripheral neuropathy,amputation