Page 36 - RPA Magazine December 2020

34 HEALTH HYPERGLYCAEMIA FROM PAGE 33 “They need to be mindful of the carbohydrates \\\\\\\[choosing the right type and amount\\\\\\\] ... excessive protein can be converted into glucose, and excessive fat can contribute to insulin resistance – it’s got to be balanced: not too high in fat or protein, not too low in carbohydrates or you’ll miss out on the dietary fibre and the vitamins and minerals that ... are in higher carbohydrate foods. “Cutting out discretionary foods as much as people can \\\\\\\[is important\\\\\\\]. People don’t need to have a treat every single day. “If they’re drinking regular soft drinks or other sugar-sweetened drinks, switching to water or a diet soft drink is a better option.” Pointing to “interesting research” from the UK, the DIRECT clinical study, Dr Barclay says one of the findings in terms of weight-loss recommendations is that “with weight loss, the pancreas, which increases in size \\\\\\\[with diabetes\\\\\\\], goes back to normal”. “They’re really pushing that in the UK,” he said. “I think eventually we’ll catch up with the UK and start recommending that for people with type 2 diabetes \\\\\\\[a 15 per cent loss of body weight should be the goal\\\\\\\] ... it’s really quite exciting. It just shows that the body will recover given the right chance.” Ultimately, though, when it comes to dietary advice and the pharmacist’s role, Dr Barclay reinforces that “everybody with diabetes should be seeing a dietitian ... and to encourage that as part of the healthcare team is really important”. “Everybody with diabetes should be seeing a dietitian ... and to encourage that as part of the healthcare team is really important”. Ms Crow says a person may experience the following conditions if hyperglycaemia is left untreated: Diabetes ketoacidosis (DKA) Most commonly, untreated hyperglycaemia causes DKA in people with type 1 diabetes, Ms Crow says. “This occurs when the blood has high and persistent blood glucose levels for six or more hours (>15mmol/lt) and high ketone levels (>0.6mmol/lt),” she said. “A build-up of ketones in the blood makes the blood too acidic and leads to a loss of fluids and body salts. This becomes a hyperglycaemic emergency.” She cites the following signs of DKA: • Nausea, vomiting and/or stomach pain. • Rapid breathing or breathlessness. • Drowsiness, confusion or weakness. • Increased thirst or dry mouth. • Reduced or no urine output. • Breath that smells ‘fruity’. Euglycaemic ketoacidosis (EK) “This is a rare condition that can occur in people with type 1 or type 2 diabetes and are pregnant, patients on a low carbohydrate diet or using sodium-glucose co-transporter 2 inhibitors (SGLT2i) or had recent surgery,” Ms Crow said. “EK occurs when high blood ketones and acidosis occurs in the presence of normal (or minor elevations) of blood glucose levels.” Hyperosmolar hyperglycaemic state (HHS) “HHS is more common in people with type 2 diabetes who experience acute sepsis, a myocardial infarction, stroke or kidney dysfunction,” Ms Crow said. “It’s more likely to occur in the elderly. HHS occurs when a person experiences ongoing and persistent high blood glucose, without ketones in the blood, and is severely dehydrated. People may experience an altered state of consciousness, a dry mouth, thirst and reduced urination. HHS can lead to a coma.” Ms Crow added: “People should seek urgent medical attention if they’re suspected to have any of these symptoms/conditions.” Ms Crow recommends that “if a person presents with hyperglycaemia ... the role of the pharmacist is to support the person”. She says this includes: • Staying calm. • Ensuring they’re cool and hydrated with non-glucose containing fluids. • Understanding if they have type 1, type 2 or gestational diabetes, and how long their BGL level has been high. • Asking if they’re actioning their sick-day management plan and helping them contact their support person. • Ensuring (if the person is using insulin) that they have their insulin to use. • If the person is feeling sick, referring them for medical treatment immediately. • Calling an ambulance if the person is sleepy, has altered consciousness, or requests you to do this. Mr Quigley suggests blood glucose screenings in the community pharmacy setting as a way to help customers. “You’ll find many pharmacies have a blood glucose testing day where they have people come in and they sit down and prick their finger and give them a one-off blood glucose reading,” he said. “At least it gives people an impression. So, if you’ve got elevated blood glucose levels in the middle of the morning or afternoon ... you need to go and have this investigated further by your doctor.” RETAIL PHARMACY ASSISTANTS • DEC 2020