Page 49 - Demo

“Complications arising from DPN often occur in the feet. Loss of sensation
in the feet is a major cause of foot ulceration, biomechanical issues and charcot neuroarthropathy. Loss of sensation and proprioception also lead to people being unsteady on their feet, leading to increased falls and fractures risk.
“Acute injury, walking with bare feet or wearing shoes that don’t fit properly can also precipitate ulceration. Early referral and treatment of feet issues involving DPN lead to less severe ulcers, better healing rates and less chance of infection.
“Foot ulcers are managed by specialised foot care, and management includes debridement and wound dressings, pressure offloading, antibiotics for infections and
limb revascularisation.”
They continued: “Treatment for DPN is a multidisciplinary strategy. Use of medication to treat neuropathic pain that may exist with the condition is one option.”
The pair add that first-line medication treatment to treat neuropathic pain includes pain medication such
as “amitriptyline, gabapentin and
pregabalin, and duloxetine”.
“If oral therapy is not tolerated, topical
capsaicin cream may be used,” they said, recommending avoiding use if skin is irritated or broken.
Mr Quigley says that due to its complexity, “there’s no magic solution” when it comes to managing DPN, adding that it seems prevention is a lot better than cure in this case.
“The product I use the most is called lipoic acid and there are lots of studies to back up the improvements in diabetic neuropathy with lipoic acid,” he said.
“I also ask for the levels of vitamin B12 to be checked, because that’s important. There are other things: vitamins D and C play a role, Quercetin plays a role ... For wound healing, zinc and the amino acid L-arginine drive healing internally.”
However, Mr Quigley adds that if a patient comes in with serious ulceration resulting from DPN, “pharmacists shouldn’t be initiating care unless they’d had all the training ... because it’s a specialist area”.
The pharmacist’s role
When it comes to patients with type 2 diabetes and DPN, Ms Itzstein
HEALTH DIABETES 47 and Ms Crow suggest the role of a
pharmacist or assistant is “firstly to recognise when to treat and when to refer”.
They say pharmacists and assistants play an important role in recommending that “people check their feet daily – look at and feel the feet, check for temperature changes”.
“If people with diabetes present with changing feet conditions that are not healing, always refer to a doctor or podiatrist,” they said.
When it comes to diabetes,
Mr Quigley says it’s all about teamwork.
“Pharmacists should be leaders ... and very important partners within the team,” he said. “Managing diabetes doesn’t mean you take someone’s prescription, dispense their medication and give it back to them. It’s more
than that.
“Diabetes is another condition where the pharmacists should develop a prescribing personality. You should have a string of things that you can
go to, and if one doesn’t work you can then move to another, and you have a pattern and you build your professional expertise by maintaining and assessing constantly.”
RETAIL PHARMACY ASSISTANTS • JUL 2020