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56 HEALTH DIABETES FROM PAGE 54 Mr Quigley says some medications (such as prednisolone, a steroid) may also predispose someone to the development of type 2 diabetes. “Steroids tend to raise blood glucose levels and sometimes the levels don’t go back down to normal once the steroids are finished,” he said. “That’s why anybody on steroid medication needs careful management depending on those other risk factors. So, if you have a pool of risk factors then they have to be managed and blood glucose readings ... should be routinely done.” He adds that it’s particularly important for anyone aged over 35 years to have their blood glucose level checked regularly as part of the “basket of blood tests that person has”. Symptom check: who’s at risk? According to Ms Itzstein and Ms Crow, symptoms to look out for that may indicate the presence of diabetes include: • Tiredness or fatigue. • Excessive urination (especially at night). • Thirst. • Blurred vision. • Itchy, dry skin. • Poor healing. • Frequent infections. • Weight loss. However, it may not be as simple as this, as they add that “a person may have some or no symptoms upon diagnosis”. “Pathology for the diagnosis of type 2 diabetes is usually a result of an elevated fasting blood screen, an elevated random blood glucose level, suspicious symptoms, an optometrist noting retinal changes, or when a person is considered high risk of type 2 diabetes,” they said, adding that the process towards diagnosis also includes an “oral glucose tolerance test or a HbA1c \\\[blood test\\\]”. Management of diabetes Most experts agree that one of the keys to managing type 2 diabetes is a healthy lifestyle. “Addressing lifestyle factors such as maintaining healthy eating and daily regular activity is a lasting foundation for managing type 2 diabetes,” Ms Itzstein and Ms Crow said. “Achieving a healthy weight and waistline reduces insulin resistance.” According to Mr Quigley, losing 10kg will change your “blood glucose levels completely”. Ms Itzstein and Ms Crow add that along with regular monitoring and screening, the management of type 2 diabetes also includes smoking cessation and blood pressure and cholesterol level checks. They say the annual cycle of diabetes care also involves regular “screening of eyes, feet, kidneys and mood”, which “reduces the impact of complications”. “Medications to reduce hyperglycaemia may be employed strategically according to comorbidities and in a stepwise manner according to needs,” they said. “Medication should be reviewed at least annually with major health changes.” Mr Quigley says that when addressing a patient’s weight, referring to a dietitian and an exercise specialist for the prescription of appropriate exercise should be among considerations. “I think there’s an awful gap between education about living with diabetes and keeping your diabetes well under control, therefore minimising your reliance on medication,” he said. “The fact is, today we see people whose blood glucose levels aren’t being appropriately controlled because they actually haven’t been educated correctly.” Mr Quigley adds that education is a fundamental role of the pharmacist, an opportunity to assist in the management of the condition. “There’s a huge gap between the patient with diabetes and the educational aspects that should be fundamental to the management of the condition,” he said. “And pharmacists play a huge role because they’re seeing \\\[patients\\\] regularly for their medications.” The role of diet While much controversy surrounds the best dietary management plan for people with type 2 diabetes, Dr Barclay says it boils down to a “good healthy diet”. “It can be either high in carbohydrates or low in carbohydrates,” he said. “The evidence suggests it doesn’t really matter as long as the quality of the foods that you’re eating is high.” This includes “high quality protein” (animal or vegetable) and “good quality fats, preferably mono- and poly- “Addressing lifestyle factors such as maintaining healthy eating and daily regular activity is a lasting foundation for managing type 2 diabetes.” RETAIL PHARMACY • JUL 2020