SVG Pharmacy Council Pharmaceutical Care tips in diabetes
Chairperson, SVG Pharmacy Council
Diabetes is a chronic illness that requires a combination of non-medication and medication measures. The ultimate goal of Pharmaceutical Care is to optimize a patientâs quality of life. Self-monitoring of blood glucose, that is testing and recording blood sugar over time; changes in meals, medication, or physical activity can be made to correct the problems found through self-monitoring of blood glucose; these results can be used to identify problems in diabetes control.{{more}}
People who do not have diabetes are able to make enough insulin to keep their blood sugar at a normal level.
People with Type 1 diabetes cannot make their own insulin. They must take insulin shots or pumps every day to live. They should learn when to inject their insulin, so that it is working its hardest when they have the most glucose in their blood. Insulin takes a little time to start working, which is why you inject it some time before you eat. Insulin is a hormone and it is a protein, and would be digested by the stomach if swallowed. So it has to be injected under the skin.
Each person is different. The amount of insulin you need depends on:
o Body weight
o Body build (how much fat and muscle you have)
o Level of physical activity
o Daily food intake
o Other medicines
o General health
o Amount of stress
1. Insulin should be stored at a temperature of 2˚C to 8 ˚C; do not let it freeze.
2. Keep unrefrigerated insulin as cool as possible and away from heat and light. (Donât leave in a parked car). If you donât have a refrigerator, put the vial in a glass of water.
3. Donât shake your insulin hard. Donât let it get tossed around. Insulin thatâs handled roughly is more likely to clump or frost. Look at it carefully; if it does not look right, it may not work right.
4. Check expiration date, label carefully; know source (human, pork, etc) brand names (Humulin), and strength.
5. In general insulin should be taken 30 minutes before food.
6. Discard the syringe if the needle becomes bent, dull or has touched any surface other than clean skin. Place the entire syringe in a hard plastic container with a cover. Do not place in a container where the needle can puncture through.
7. Keep your insulin with you so it doesnât get lost; when travelling, keep it in the carry-on bag.
8. Insulin pen is easy to carry, less pain and accurate dose administration. It is not suitable for mixed insulin. Useful in children and insulin sensitive patients who require small doses. May benefit people while travelling. Can be confusing to use and dose errors can occur, especially with large doses.
Most people with Type 11 diabetes still make some insulin, but not enough to control their blood sugar or if enough, insulin cannot use it well.
They initially respond to lifestyle modification and/or oral anti-diabetic medications, but eventually may require insulin therapy.
Drugs
Comments:
Drugs are comparatively safe
Taken with meal or 15 to 30 minutes before food. Taken with meal, possible side effects â hypoglycemia. Helps the body make more insulin. Interacts with blood thinners.
Metformin (glucophage) (orabet) Metformin helps reduce LDL cholesterol and triglyceride level. Take during or immediately after a meal. Metformin is the first-line drug of choice for the treatment of type 2 diabetes, in particular, overweight and obese people
Gastro-intestinal disturbances.
Acarbose (glucobay) (glumide)
Swallow whole with liquid before meals or chew with the first few mouthfuls of food
Acarbose blocks the digestion of sucrose to glucose. Sucrose should not be administered if the patient experiences hypoglycemia.
Morning readings of glucose levels can be frustrating. You go to bed with blood glucose of 120mg/dl (6.6 mmol/L) and wake up to blood glucose 170mg/dl (9.4 mmol/L) due to the Dawn Phenomenon or the Somogyi Effect.
Every human being experiences the Dawn Phenomenon. While we sleep, usually around 3-8 a.m., glucose is released in response to the stimulus of some hormones in order to repair and maintain our body; this causes glucose levels to rise.
The Somogyi Effect happens when your blood glucose levels are high in the morning due to hypoglycemia, since your body reacts to low blood glucose levels by increasing the release of glucose from the muscles, liver and fat, therefore causing high glucose levels.
Limit your carbs at night and eat a small snack of fat and protein before bed, like a tbsp of peanut butter, or some cheese and/or meat. No carbs, just protein and fat in that snack. You must always eat breakfast and take your medication, so your body does not feel it is in a state of emergency; the increase in blood glucose after you eat your breakfast will often turn off the release of glucose from liver or muscles, since the body senses the fuel is coming through food.
Hypoglycemia is a condition caused by abnormally low level of blood glucose, caused by taking too much of certain diabetic medicines, missing a meal or delaying a meal, exercising more than usual, or drinking alcohol; it can be classified as initial, intermediate and advanced.
o Initial symptoms may start with sweating, shaking, nausea and vomiting, dizziness, mood change, hunger, weakness and progress
o Intermediate symptoms of confusion, poor coordination, headache and double vision
o The advanced symptoms are unconsciousness and seizures â medical intervention is needed.
Management includes taking:
o half a cup of any fruit juice
o 2 or 3 glucose tablets
o 2 tablespoons raisins
o 1 or 2 teaspoons of sugar or honey
o half cup of regular soft drink or liquid concentrated glucose.
It is easy to overeat during the holidays, so why not go into the season with a plan, stick to smaller plates and servings, split a big portion of anything with someone else, say no to seconds, drink lots of water, have a fresh fruit for dessert.
SVG, greetings and God bless you!
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