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12-a46144_rx for success_diabetes m_v1001.pdfCREATED EXCLUSIVELY FOR FINANCIAL PROFESSIONALS Rx FOR SUCCESS
Diabetes Mellitus (DM) is characterized by abnormal sugar metabolism causing hyperglycemia (high blood sugar). Chronic hyperglycemia adversely affects the body. In the vascular system, there can be events such as strokes and heart attacks caused by atherosclerosis. There can also be renal disease, peripheral neuropathy, and blindness. In the United States, DM is a leading cause of end stage kidney disease, leg amputations, and blindness.
Blood sugar enters cells via the action of insulin, which is a hormone produced by the beta cells of the pancreas. Factors that contribute to hyperglycemia include reduced insulin secretion, decreased blood sugar (glucose) usage by the body, or increased glucose production.
Type 1 diabetes, formerly called juvenile-onset or insulin dependent (IDDM), has a peak age at onset
of 12 years old. It is unusual to begin after age 40. Type 1 DM is due to beta cell destruction so that
no insulin is produced and must be replaced by insulin injections. Symptoms include excessive thirst,
excessive urination, and weight loss. Rating for diabetes mellitus depends on 1) age at onset, 2) years
since diagnosis, 3) control of the diabetes, and 4) presence of complications. Ratings increase with
younger ages, longer times since onset, poor control and complications.
TABLE FOR DIABETES MELLITUS - TYPE 1 (BASED ON AGE AND DURATION)*
Type 2 diabetes, was formerly called adult-onset or noninsulin dependent (NIDDM). It is characterized
by 1) variable degrees of resistance to the action of insulin, 2) impaired insulin secretion by the
beta cells, or 3) impaired glucose production. Type 2 DM usually develops over the age of 30, but its
incidence is increasing in children and adolescents especially those who are obese. (Eighty percent
of Type 2 patients are obese. Many have excessive thirst or urination, but most have no symptoms.
Type 2 may also require insulin in the later stages). Type 2 is initially treated with diet and exercise.
If decreased calorie intake and increased exercise does not result in blood glucose control, oral
medication is added. Some oral medications include sulfonylureas, alpha-glucosidase inhibitors,
thiazolidinedione, metformin, and repaglinide. Risk factors for the development of NIDDM are older
age, obesity, positive family history, and history of gestational diabetes.
This material is designed to provide general information about the subject matter covered. It should be used with the understanding that we are not rendering legal, accounting, or tax advice. Such services should be provided by the client’s Securities and Insurance Products: Not Insured by FDIC or Any Federal Government Agency.
professional advisors. Accordingly, any information in this document cannot be used by any taxpayer for purposes of avoiding penalties under the Internal Revenue Code.
Not a Deposit of or Guaranteed by Any Bank or Bank Affiliate.
This material is intended for insurance informational purposes only and is not personal medical advice for clients. Rates and availability will vary based on the satisfaction of our underwriting criteria. Underwriting rules are subject to change at our discretion. This marketing material is subject to an expiration date, and use of this material must be discontinued as of the expiration date.
Insurance issued by The Prudential Insurance Company of America and its affiliates, Newark, NJ.
NOT FOR CONSUMER USE.
2012 Prudential Financial, Inc. and its related entities.
0190541-00003-00 Ed. 12/2012 Exp. 12/28/2014 Rx 12
Rx FOR SUCCESS
Older age diabetes or type II diabetes is increasingly common in the older age populations, affecting
18% of people age 64-75 and 40% of people age 80 or older. It is estimated that nearly half of elderly
diabetics are currently undiagnosed. Complications from diabetes do not appear to be any less in
the elderly. Many older age diabetics already show signs of complications (example, retinopathy-eye
changes) at the time of diagnosis because they had the disease for a number of years prior to the actual
diagnosis. Treatment for diabetes in the elderly includes diet, exercise, oral medication, and insulin.
As many as 40% of older age diabetics are obese and are instructed to follow a diet and an exercise
weight loss program. For those who fail diet therapy, oral medication is started. Insulin is reserved only
for those diabetics whose blood sugars cannot be controlled by oral medication and diet.
TABLE FOR DIABETES MELLITUS - TYPE 2 (BASED ON AGE AND DURATION)*
* Age based credits (50 – 100%) are given for excellent control (HbA1c>7%). Debits are added for major complications such as proteinuria, retinopathy, or neuropathy.
Secondary diabetes can result from pancreatic disease, hormonal syndromes (Cushing’s syndrome),
drug-induced disease (thiazide diuretics, steroids, phenytoin) or those associated with syndromes such
as hemochromatosis and acromegaly.
Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) are also termed subclinical or
borderline diabetes. Patients generally have no symptoms. Many go on to develop diabetes. There is
also an increased risk of cardiovascular disease.
Gestational diabetes is diagnosed when glucose intolerance is discovered during a pregnancy. It is
associated with increased perinatal complications. Risk factors for the development of gestational
diabetes are older age, overweight, previous large or stillborn babies, or positive family history of
diabetes. Women with a history of gestational diabetes have an increased risk of developing Type 2
diabetes (as high as 50% within 10 years and 70% within 20 years).
NOT FOR CONSUMER USE.
Rx FOR SUCCESS
Diabetes is a progressive disease that can be slowed by meticulous control of blood sugar, weight control, and exercise. Diabetes control is monitored by testing glycosylated hemoglobin in the blood and by home monitoring of blood sugar. Normal glycosylated hemoglobin is a value of <6 (though range of normal varies among testing laboratories). The goal for known diabetes is <7. Glycosylated hemoglobin over >8 is evidence of poor control.
DIAGNOSTIC CRITERIA FOR DIABETES
Fasting blood glucose: 2 readings ≥ 126 mg/dl 75 gram oral glucose tolerance test: Diabetes: 2-hour sample > 200 mg/dl Impaired glucose tolerance: 2-hour sample between 140–200 mg/dl A positive 100 gram glucose tolerance test for pregnant women to screen for gestational Other laboratory studies used to monitor diabetes include glycosylated hemoglobin (HbA1c) and fruc-tosamine. HbA1c gives an indication of glucose control over the preceding 60 days, and fructosamine (glycosylated protein) measures glucose control over a 20-day span.
To get an idea of how a client with a history of Diabetes Mellitus would be viewed in the underwriting process, use the Ask “Rx”pert Underwriter on the next page for an informal quote. NOT FOR CONSUMER USE.
Rx FOR SUCCESS
Ask “Rx”pert Underwriter (Ask Our Expert)
After reading the Rx for Success on Diabetes Mellitus, use this form to Ask “Rx”pert Underwriter for an informal quote. The rating for DM depends on the age of onset, the duration, treatment, control of the blood sugar, and complications if any.
Producer _________________________________________ Phone ________________________________ Fax ___________________________ Client _________________________________________ Age/DOB ______________________________ Sex __________________________ If your client has had Diabetes Mellitus, please answer the following: 1. Please list date of first diagnosis.
_________________________________________________________________________________________________________________ 2. How often does your client visit their physician (Also note date of last visit.)?
_________________________________________________________________________________________________________________ 3. The client’s diabetes is controlled by:
Diet alone Insulin (Medication and dose.) _____________________________________ Oral medication ___________________________ Other (Medication and dose.) ______________________________________ 4. Is your client on any medications?
Yes. Please give details. __________________________________________________________________________________________ 5. Please give the most recent blood sugar and hemoglobin A1c readings.
__________________________________________________________________________________________________________________ 6. Please check if your client has had any of the following:
7. Has your client smoked cigarettes in the last 12 months?
8. Does your client have any other major health problems (e.g., cancer, etc.)?
Yes. Please give details. __________________________________________________________________________________________ 9. Please tell us your client’s height and weight.
NOT FOR CONSUMER USE.
Eur J Vasc Endovasc Surg xx, 1e7 (xxxx)doi:10.1016/j.ejvs.2006.04.033, available online onChronic Venous Disease Treated by Ultrasound GuidedAim. To report the outcome of a series of patients with chronic venous disease due to incompetence of saphenous trunksmanaged by ultrasound guided foam sclerotherapy (UFS). Patients and methods. A group of 808 patients comprise this series. CEAP clinical