Page 35 - RPA Magazine December 2020

exercise ... if you really get your adrenal levels pumping, then it can raise blood glucose levels. Moderate exercise is wonderful for healthy people to lower blood glucose levels, but sometimes, if you’re doing really strenuous exercise, that can put your blood glucose levels up. So, people need to be aware of that.” According to Community Pharmacist and Master Herbalist Gerald Quigley, statins are another class of medications that can contribute to high BGLs. “It doesn’t happen to everybody,” he said of this statin effect, “but it certainly can happen, and it really means that we’ve got to be really careful about anybody with blood sugar levels that aren’t making sense – that we absolutely ensure their medications are appropriate.” Ms Crow warns that it’s important not to ignore high BGLs as, “if left untreated ... this can be life threatening”. “If a person has high blood glucose, it should be treated,” she said. “If they have ketones present in their blood over 0.6mmol/lt, they should begin to follow their sick-day management plan or contact their doctor, credentialled diabetes educator or go to the hospital for treatment.” While BGLs may fluctuate, Ms Crow advises that if they “remain high for a few days”, medical management is important. “In type 2 diabetes, blood glucose levels can fluctuate throughout the day,” she said. “If a person notices their blood glucose remains high for a few days, or if they feel sick, they should contact their doctor or diabetes educator for guidance.” In terms of hyperglycaemia symptoms, Dr Barclay says “it depends on how high” someone’s BGLs are. “So, frank diabetes, of course, is the standard – excessive thirst and urination, but ... that’s more of a classical type 1 diabetes diagnosis,” he said. “Some of the more common things may be that your vision is affected, you’re getting more infections – all the things that are signs of developing type 2 diabetes, including feeling tired, lethargic.” When it comes to unintentional weight loss, he says BGLs would have to be “fairly high” for this to happen. “The renal threshold is around 12mmol/lt and then you’re losing glucose in your urine, so that’s where you’re going to start losing weight,” he said. “But that’s relatively high blood glucose levels. Hopefully, it will have been picked up \\\\\\\[before that stage\\\\\\\] ... at least in Australia.” HEALTH HYPERGLYCAEMIA 33 their doctor or credentialled diabetes educator for advice on increasing their dose of short acting insulin at mealtimes. “Extra doses of short acting insulin may also be required to treat the hyperglycaemia and bring down the blood glucose levels. They should also check their blood ketones and follow their sick-day management plan and seek medical treatment if their blood glucose and ketones continue to rise.” For those with type 2 diabetes, Ms Crow says, “ongoing hyperglycaemia can mean that their medication is no longer effective ... and they need to see their doctor”. From a more complementary approach, Mr Quigley suggests a number of other products that can “make a difference”, including olive leaf extract, which “helps our pancreas produce sufficient insulin”, fenugreek, cinnamon, and bitter melon – which he says has been the focus of much research. “A common one in Ayurvedic medicine is called Gymnema,” he said. “It works for all blood glucose issues ... So, they’re the herbal options. Even garlic has a role to play.” From a lifestyle perspective, Ms Crow adds that “sometimes people may have had a change in diet or lifestyle that may cause their blood glucose to be higher”, with Christmas often an occasion during which this happens. “Referral to a dietitian or exercise physiologist for dietary and physical assessment may help to reduce hyperglycaemia episodes,” she said. Dr Barclay said: “First and foremost, there’s very good evidence that by losing 7.5 per cent of your body weight ... you can go back to normoglycaemia within a relatively short period of time ... six to 12 months. So, losing weight should be the first focus. And part of that, of course, is increased physical activity.” He cites the importance of a dietitian in “going through what people are eating and finding those sources of unnecessary calories that might be high in energy but low in other essential nutrients \\\\\\\[such as\\\\\\\] vitamins, minerals and dietary fibre, and other important dietary factors ... what we call discretionary foods – junk foods”. “People with diabetes, like anybody else, need to eat a good balanced diet,” Preventing hyperglycaemia Ms Crow suggests the following measures to help prevent hyperglycaemia: • Taking insulin or diabetes medications as prescribed. • Checking BGLs frequently, especially if feeling sick. • Consuming low-GI carbohydrates. • Maintaining a high-fibre diet with two serves of fruit and five of vegetables daily. • Reducing sugary beverages and highly processed foods. • Being physically active. • Reducing or controlling stress. Mr Quigley says preventing hyperglycaemia goes back to “lifestyle choices”. “If we could get people to understand the role of lifestyle choices on their overall health ... it’s incredibly important – it’s fundamentally important for blood glucose control,” he said. Hyperglycaemia symptoms Ms Crow says symptoms for hyperglycaemia include: • Feeling excessively thirsty. • Dry mouth. • Frequently passing large volumes of urine. • Feeling tired. • Blurred vision. • Infections (eg, thrush, cystitis, wound infections). • Weight loss. • Headache. • Confusion. “If patients have high blood glucose or ketones, they shouldn’t exercise,” Ms Crow said. Hyperglycaemia management The management of hyperglycaemia is multifactorial, often including a combination of medication, diet and exercise, which Dr Barclay refers to as “the three pillars”. Ms Crow said: “For people with type 1 diabetes, they should contact Dr Barclay said. TO PAGE 34 RETAIL PHARMACY ASSISTANTS • DEC 2020