DIABETES
WITH AROUND TEN PER CENT OF PEOPLE WITH DIABETES IN THE UK AFFECTED BY TYPE 1 DIABETES, THE PHARMACIST IS FREQUENTLY CALLED ON TO ENSURE ADHERENCE TO TREATMENT TO AVOID COMPLICATIONS.
DEALING WITH DIABETES T
ype 1 diabetes is a serious, life-long condition where a patient’s blood glucose level is too high. This is caused by the fact that the patient’s body cannot make a hormone called insulin. As a result, the body still breaks down the carbohydrate from food and drink and turns it into glucose (sugar). This leads to an increasing amount of glucose building up in the bloodstream.
SYMPTOMS
Prior to diagnosis of Type 1 diabetes, the patient’s body will try to get rid of the glucose through the kidneys and will therefore pass urine a lot – one of the first significant symptoms of the condition. The over-frequent passing of urine leads to another main symptom: excessive thirst.
The fact that the glucose cannot enter the body’s cells to create energy means that the patient will experience extreme tiredness and may also lose weight due to the fact that the body will break down fat stores in order to provide fuel.
DIAGNOSIS
A critical factor for both the diagnosis and monitoring of Type 1 diabetes is, unsurprisingly, the blood glucose level. However, according to the recommendations of the World Health Organization (WHO), the analysis of immediate blood glucose levels differs, depending on the patient symptom stage.
The WHO states, for example, that under no circumstances should a diagnosis of diabetes be given after a single blood glucose determination. Instead, at least one other blood glucose test, taken on another day, which is in the diabetic range, is essential for diagnosis.
10 - SCOTTISH PHARMACIST TREATMENT
In the treatment of Type 1 diabetes, it is important that the patient aims to maintain blood glucose at a level which is as normal as possible (ie, the equivalent of a person, who does not have diabetes). Pharmacists should therefore be aware of the correct levels so that they are in a position to counsel patients – particularly those, who are newly diagnosed.
According to Diabetes UK, the current guide target levels are:
• Children with T1 diabetes: 4-8 mmol/L before meals
• Less than 10 mmol/L two hours after a meal
• Adults with T1 diabetes: 4-7 mmol/L before meals
• Less than 9 mmol/L two hours after a meal
Due to the complex nature of the condition, target levels may vary somewhat on a patient-to-patient basis, with these being agreed between the patient and their diabetes care team.
The standard treatment for Type 1 diabetes is the use of insulin.
TYPES OF INSULIN
There are five different types of insulin and they all work slightly differently to manage diabetes.
RAPID-ACTING INSULIN
Rapid-acting insulin (sometimes known as fast-acting insulin) is taken shortly before or after meals and is usually taken alongside an intermediate-acting insulin or long- acting insulin. The dose will depend on how many carbohydrates the patient is eating.
SHORT-ACTING INSULIN
Short-acting insulin is similar to rapid- acting insulin, but is slightly slower. It’s also called a bolus insulin, which means it is taken around meal times (usually about 25 minutes before eating).
MIXED INSULIN
This is a mixture of short-acting and long-acting insulins. Also taken before meals, but does not require a background insulin as well.
INTERMEDIATE-ACTING INSULIN
Intermediate-acting insulin is also known as background insulin or basal insulin. This means it works throughout the day and is taken once or twice a day.
LONG-ACTING INSULIN
Long-acting insulin is slower than intermediate insulin, but very similar in how the body processes it. Usually taken once a day, at the same time each day. Long-acting insulin has been shown to reduce the risk of hypos compared to intermediate-acting insulin.
TAKING INSULIN
Insulin is taken by injecting it or by using an insulin pump. The patient’s healthcare team will direct them with regard to the type of insulin that is best suited for them and the amount required.
INSULIN PUMP
An insulin pump is a small electronic device that gives the body the regular insulin it needs throughout the day and night. There are two types of insulin pump – a tethered pump and a patch pump. Both are attached to the body by a tiny tube called a cannula, which sits just under the skin.
The patient has to learn how to change the cannula themselves every two or three days and has to ensure that they move it to a different place every time they change it. This is because they can develop lipohypertrophy, which is where the body forms hard lumps that stop insulin working properly.
INSULIN SIDE EFFECTS HYPOS
Hypos are the most common side effect of taking insulin. Hypos occur when the blood sugar is low, but they can also be caused by taking too much insulin. If a patient is having a lot of hypos, then they may be on the wrong dose of insulin and should be signposted back to their healthcare professional.
WEIGHT GAIN
Weight gain is a common side effect of taking insulin. Insulin is a growth hormone, and any growth hormone a patient takes will mean putting on more weight. Also, when a patient is diagnosed with diabetes, it’s likely that they have previously lost a lot of weight in a short space of time, as this is one of the symptoms, and the weight gain is part of the recovery.
INSULIN OVERDOSE
Insulin overdose can happen if a patient takes more insulin then they need. This can be very serious, and may lead to severe hypos. In worse case scenarios patients can feel disorientated, experience seizures and could even die. Patients who think they have taken too much insulin accidentally, should be advised to eat a lot of fast-acting carbohydrate, such as sweets or glucose tablets. In severe cases they should go to A & E. •
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