Diabetes is a group of deases in which the body doesn’t make any insulin or the body cannot make good use of insulin it produces. When any of these things happens, the body is unable to get sugar from the blood into cells. That lead to high blood sugar levels.
There are three main types of diabetes:
Type 1 Diabetes
Type 1 diabetes often develops more quickly and cause symptoms like weight loss, it can develop at any age. but occurs most frequently in children and adolescents. When you have type 1 diabetes, your body produces very little or no insulin, which means that you need daily insulin injections to maintain blood glucose levels under control.
Type 2 Diabetes
Type 2 diabetes is more common in adults and accounts for around 90% of all diabetes cases.it start as insulin resistance. This means your body does not make good use of the insulin that it produces. The cornerstone of type 2 diabetes treatment is healthy lifestyle, including increased physical activity and healthy diet. However, over time most people with type 2 diabetes will require oral drugs or insulin to keep their blood glucose levels under control.
Gestational Diabetes is a type of diabetes that can develop during pregnancy.it is usually diagnosed from a blood test 24 to 28 weeks into pregnancy. That means you have high blood glucose and its associated with complications to both of mother and fetus. this type of diabetes usually disappears after pregnancy but women affected and their children are at increased risk of developing type 2 diabetes later in life.
Types of diabetes treated
For all types of diabetes, you’ll need to work closely with your doctor to keep it under control. The main goal is to keep blood glucose levels within your target range. Your doctor will let you know what your target range should be. Targets vary with the type of diabetes, age, and presence of complications. If you have gestational diabetes, you blood glucoses targets will be lower than people with other types of diabetes. Physical activity is an important part of diabetes management. Ask your doctor how many minutes per week you should devote to exercise. Diet is also crucial to good control.
Treating type 1
All people with type 1 diabetes must take insulin to live because damage to the pancreas is permanent. There are different types of insulin available with different times of onset, peak, and duration. Insulin is injected just under the skin. Your doctor will show you how to properly inject and rotate injection sites. You can also use an insulin pump, which is a device worn outside your body that can be programmed to release a specific dose. There are now continuous blood glucose monitors as well that check your sugar 24 hours a day.
Treating type 2
Type 2 diabetes is managed with diet and exercise, and can also be treated with a variety of medications to help control blood sugar. The most common tablet is metformin but if metformin doesn’t work, your doctor can add other medications or try something different.
Treatment for gestational diabetes
Controlling your blood sugar level is essential to keeping your baby healthy and avoiding complications during delivery. In addition to maintaining a healthy diet and exercising, your treatment plan may include monitoring your blood sugar and, in some cases, using insulin or oral medications. Your doctor also will monitor your blood sugar level during labor. If your blood sugar rises, your baby may release high levels of insulin which can lead to low blood sugar right after birth
- At a glance 2016: Diabetes. (2016).
- Diabetic neuropathy. (n.d.).
- Diabetes UK https://www.diabetes.org.uk/diabetes-the-basics/diabetes-treatments
- Mayo Clinic Staff. (2017). Type 1 diabetes.
Parallel trade or parallel import in pharmaceutical market simply refers to buy medicinal products in a country that sells them at a reasonable price and then to distribute such products outside the distribution channels set up by the drug manufacturer or its recognized distributor in one’s own country of origin. It is named ‘parallel’ as it takes place beside and usually in parallel to the producer’s distribution networks.
The EU Commission’s policy position is that parallel imports increased price competition, and that this in turn increases consumer welfare as the import of goods from a country with lower prices forces sellers in the country of destination to reduce prices. The commission’s overall approach is based on two principles (Competition Policy Newsletter 1, 2007):
- The single market in pharmaceuticals requires the unhindered free movement of products – private companies cannot erect barriers to undermine this without distorting intra-brand competition.
- The efficiency claims defence advanced by the research based pharmaceutical industry is unsubstantiated – i.e. there is no evidence that partitioning the common market would spur on global investment in inter-brand competition.
Parallel Trade in the Pharmaceutical Sector
The Reasons for Parallel Trade in the Pharmaceutical Sector The pharmaceutical industry is a special sector in two respects: Firstly, innovative pharmaceutical companies incur high research and development costs for novel medicines. Secondly, in many cases, the buyer of a pharmaceutical product does not directly pay for it but is reimbursed by a national health system. Prices and reimbursement schemes vary considerably between countries in Europe: Price differentiation allows companies to allocate contributions to research and development costs efficiently among different payers, which improves cost recovery.
1) This results in considerable price differences between Member States. A price comparison of pharmaceuticals in 16 EU Member States in 2013 shows differences between 25% and 100% for two thirds and between 100% and 251% for one third.
2) Such price differences are a strong incentive for parallel trade: An importer, usually a wholesaler, purchases pharmaceuticals in a low-price country and then sells them in a high-price country.
Parallel Trade of Pharmaceuticals and its Problems in the EU
Parallel trade, on the one hand, lowers expenditure on pharmaceuticals for high-price countries which is, of course, welcomed by them. The larger the share of parallel imported medicines, the greater this effect is. On the other hand, parallel trade adds to the non-transparency of price structures and may cause certain difficulties for pharmaceutical companies regarding cost calculations.
1) Shortages of Medicines
Parallel trade is exports of pharmaceuticals from low-price countries to high-price countries, may lead to shortages in the former unless the manufacturer is willing to make up for it and supply higher quantities of the product.
2) Risk to the safety of pharmaceuticals
Parallel trade can increase the potential risk of falsified pharmaceuticals because extra steps are added to the supply chain through parallel imports. Complex supply chains, routes of transport, changes of outer packaging and relabeling make it difficult for national authorities to trace the history of pharmaceuticals bought and sold by intermediaries in different EU Member States. The EU has taken measures against falsified medicines through the Falsified Medicines Directive. So far, however, this has not eliminated the problem completely.
3) Lack of transparency and calculation problems
Prices in the pharmaceutical sector are not transparent. The negotiated prices that health insurers pay are generally not published. Such lack of transparency protects the producers by blocking price signals to other insurers and other countries.
Parallel trade is a form of arbitrage: A product, sold by the manufacturer in country A at a lower price than in country B, is bought by a dealer in country A and sold in country B. It is particularly relevant for pharmaceuticals in the internal market of the EU.
Parallel trade may lead to pharmaceutical shortages in low-price countries and increase the potential risk of falsified pharmaceuticals. It adds to the non-transparency of pricing of pharmaceuticals and can lead to calculation problems for manufacturers.
There are three basic options for addressing parallel trade: the exclusion of pharmaceuticals from the internal market rules, open redistribution among the national health systems by a subsidisation fund, and a unitary price that has to be paid everywhere in the EU.
Adverse drug effects are especially problematic in the elderly because they have slowed metabolism and excretion of medications. Often such adverse reactions are caused by the use of unnecessary medications, or the use of medications in excessive doses. Adverse drug effects are a widespread problem and can lead to significant injury and even death in the elderly. Physicians, nurses, and pharmacists are all responsible for the medication regimen in the nursing home setting.
The statistics regarding adverse drug effects are shocking. In the November 2006 issue of Clinical Geriatrics, a publication of the American Geriatric Society, the following was noted:
30% more money is spent in the United States on treating adverse drug effects than on all pharmaceuticals combined.
31% of older adults use more than one pharmacy, creating challenges for a comprehensive drug review.
50% of older adults receive prescriptions from more than one prescribing clinician.
One in 12 physician visits for the elderly result in a prescription of medication that is not recommended for them.
6,900,000 elderly persons are currently taking medications not recommended for the elderly.
10.3% of all prescriptions in the United States generate an electronic safety alert to the dispensing pharmacists. Of these alerts, 88% are overridden by the dispensing pharmacist. When interviewed, some pharmacists stated they did not believe the alert was important, was not real, or that they already knew about it.
The Centers for Medicare and Medicaid Services (CMS) have taken note of the high risk of injury related to adverse drug effects. In December 2006, CMS clarified federal mandates to state surveyors regarding the appropriate use of medications in the nursing home setting under F329 of the OBRA regulations. The rules are not new, but facilities are receiving clarification as to what medications should be reduced or eliminated from residents’ medication regimens. The clarification makes facilities responsible for the medication regimen, more so than the physician, nurse practitioner, or physician’s assistant who ordered the medication. State surveyors evaluate compliance with such rulings, and will, in essence, question the facility when rules are not followed. This clarification by CMS should be referred to when questioning whether therapy is recommended for the elderly population.
The following are questions you should ask the nursing home staff or medical provider of your loved one if you suspect medications are unnecessary or causing adverse effects:
Is this medication necessary?
Is the drug contraindicated in the elderly population?
Is the resident taking the lowest effective dose of the drug?
Are medications being used to treat the side effects of other medications? For example, medications for constipation are often given to treat the side effects of certain pain medications.
Can the drug regimen be simplified?
What are the potential drug interactions of the medications currently prescribed?
American Medical Director’s Association
Centers for Medicare and Medicaid Services