DIABETES
Diabetic issues:
patient education vital
aS a PharmacISt, YoU WILL BE VErY famILIar WIth thE ProBLEmS PoSED BY thE hYPogLYcaEmIa ExPErIEncED BY YoUr PatIEntS LIVIng WIth DIaBEtES. conSULtant DIaBEtoLogISt, Dr hamISh coUrtnEY, tELLS PIf hoW YoU, aS a PharmacISt, haVE a VItaL roLE to PLaY In thE managEmEnt of thESE EPISoDES.
a
sk any patient with diabetes about their major concerns in the management of their
condition, and you can be sure that hypoglycaemic episodes – or ‘hypos’ as they are more commonly known – will get a mention!
With statistics showing that people with type 1 diabetes are likely to experience up to two hypos per week, and between 30 and 40 per cent experiencing a severe episode each year, you can appreciate how problematic these episodes can be in a patient’s life.
typically, people with type 2 diabetes have fewer issues with hypoglycaemia but, if they are treated with insulin for more than five years, then it is likely that their hypoglycaemia rate will approach that of type 1 diabetes patients.
In the case of type 2 diabetes, those patients, who are treated with
34 - PharmacY In focUS
sulphonylureas, such as gliclazide, are also prone to hypos. Sulphonylureas increase insulin secretion in the body and, as such, they increase the risk of hypos.
Definition of a hypo If you look in the dictionary, a hypo will generally be defined for someone living with diabetes as ‘blood glucose less than 4mmol/l’, but, according to Dr hamish courtney, there are two practical definitions of a hypo which are recognised.
‘as blood glucose falls,’ he told Pif, ‘the sympathetic nervous system – the adrenaline response – is switched on and symptoms will develop. these most usually present as palpitations, a pounding heart, sweating and shaking.
‘In terms of severity, a hypo is referred to as ‘mild’ when the patient can actually clearly recognise what is happening and can treat themselves.
In contrast, a hypo is defined as ‘severe’ when third-party assistance is required.
‘In most patients, these symptoms will kick in when the blood glucose reading is between 3 mmol/l and 4 mmol/l.
‘as healthcare professionals, you will most likely have heard your patients talking about their ‘warning signs’. these vary from patient to patient but, in most cases, patients will, at this point, take carbohydrate to correct this blood glucose reading in order to ward off any deterioration of the situation. In the event that they don’t take definitive action at this point, or don’t recognise the signs of an oncoming hypo, then their blood glucose level will continue to fall and the situation may spiral out of their control rapidly.
‘If a patient doesn’t respond adequately or quickly enough, then
their brain will begin to display the effects of a lack of glucose. this usually occurs when the blood glucose level is around 3 mmol/l, and tends to manifest itself in the impairment of higher function skills, such as fine motor skills.
‘Should the sugar continue to fall, then the effects become much more obvious. In addition to increasing confusion and agitation, the patient may begin to experience seizures. to the onlooker they may appear intoxicated. at this point a rapid response and emergency treatment is essential since, if the patient is left untreated, they may fall into a coma, which could eventually lead to death.
‘It is important that patients take steps to avoid frequent repetition of hypos where possible. hypoglycaemia at the time is very unpleasant and, even after blood sugars are once again normal, a person can feel below par for many hours afterwards.
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