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58 HEALTH DIABETES FROM PAGE 57 Mr Quigley says that due to its complexity, “there’s no magic solution” when it comes to managing DPN, adding that it seems prevention is a lot better than cure in this case. “The product I use the most is called lipoic acid and there are lots of studies to back up the improvements in diabetic neuropathy with lipoic acid,” he said. “I also ask for the levels of vitamin B12 to be checked, because that’s important. There are other things: vitamins D and C play a role, Quercetin plays a role ... For wound healing, zinc and the amino acid L-arginine drive healing internally.” However, Mr Quigley adds that if a patient comes in with serious ulceration resulting from DPN, “pharmacists shouldn’t be initiating care unless they’d had all the training ... because it’s a specialist area”. The pharmacist’s role When it comes to patients with type 2 diabetes and DPN, Ms Itzstein and Ms Crow suggest the role of a pharmacist is “firstly to recognise when to treat and when to refer”. They say pharmacists play an important role in recommending that “people check their feet daily – look at and feel the feet, check for temperature changes”. “If people with diabetes present with changing feet conditions that are not healing, always refer to a doctor or podiatrist,” they said. When it comes to diabetes, Mr Quigley says it’s all about teamwork. “Pharmacists should be leaders ... and very important partners within the team,” he said. “Managing diabetes doesn’t mean you take someone’s prescription, dispense their medication and give it back to them. It’s more than that. “Diabetes is another condition where the pharmacists should develop a prescribing personality. You should have a string of things that you can go to, and if one doesn’t work you can then move to another, and you have a pattern and you build your professional expertise by maintaining and assessing constantly.” Ms Itzstein and Ms Crow suggest these strategies “to prevent or further damage (especially to the feet)”: • Optimising blood glucose control to prevent or slow the progression of DPN. • Wearing appropriately fitting footwear. • Regular visits to the podiatrist. • Referral to a doctor or podiatrist for any signs of food problems, including broken skin, blisters and maceration. • Applying Zostrix HP, a topical analgesic cream used to help provide relief and manage DPN or neuralgia. • Recommending any good moisturiser to apply to the feet to keep the skin in good condition. • Applying an antiseptic such as Betadine to any injury or crack, covering with a sterile dressing and seeing a doctor if it doesn’t improve within 24 hours. • Using toenail clippers to trim toenails straight and nail files to remove any sharp edges. “If people with diabetes present with changing feet conditions that are not healing, always refer to a doctor or podiatrist.” RETAIL PHARMACY • JUL 2020