Page 65 - Retail Pharmacy November/Decemeber 2020

64 HEALTH HYPERGLYCAEMIA RAISED BLOOD GLUCOSE not the high you want As the silly season approaches, frequently reaching for the lolly jar while forgoing regular exercise routines is a common habit. However, extra treats and reduced exercise, among other factors, can lead to a high that you don’t need: high blood glucose levels. This month, Retail Pharmacy magazine delves into the topic of hyperglycaemia: what it is, how it’s caused and how to manage things when blood glucose levels rise. HBy Margaret Mielczarek. yperglycaemia occurs when a person’s blood glucose level (BGL) is above 15mmol/lt, according to Diabetes Queensland pharmacist and credentialled diabetes educator Alison Crow. “It can occur in people with type 1 diabetes, type 2 diabetes and gestational diabetes,” she said. She adds that the triggers for hyperglycaemia include “not having enough insulin or medication to treat diabetes; eating more carbohydrate than your medication or your body can cope with; being sick, stressed or having an infection; being less active; other medications such as corticosteroids; and overtreatment of a hypoglycaemia event”. Accredited practising dietitian Dr Alan Barclay, spokesman for Dietitians Australia, says “steroids are a good example” of medications that can cause or contribute to hyperglycaemia. “It gets back to stress hormones,” he said. “There are other medicines as well. So, people with HIV on certain medications, I believe, are at an increased risk. “There are many things that can cause high blood glucose levels, such as infection, so it’s not just food. Stress hormones can raise blood glucose levels, \[so\] any severe moment of stress or anxiety can make the blood glucose levels go up. \[As can\] excessive exercise ... if you really get your adrenal levels pumping, then it can raise blood glucose levels. Moderate exercise is wonderful for healthy people to lower blood glucose levels, but sometimes, if you’re doing really strenuous exercise, that can put your blood glucose levels up. So, people need to be aware of that.” According to community pharmacist and master herbalist Gerald Quigley, statins are another class of medications that can contribute to high BGLs. “It doesn’t happen to everybody,” he said of this statin effect, “but it certainly can happen, and it really means that we’ve got to be really careful about anybody with blood sugar levels that aren’t making sense – that we absolutely ensure their medications are appropriate.” Ms Crow warns that it’s important not to ignore high BGLs as, “if left untreated ... this can be life threatening”. “If a person has high blood glucose, it should be treated,” she said. “If they have ketones present in their blood over 0.6mmol/lt, they should begin to follow their sick-day management plan or contact their doctor, credentialled diabetes educator or go to the hospital for treatment.” While BGLs may fluctuate, Ms Crow advises that if they “remain high for a few days”, medical management is important. “In type 2 diabetes, blood glucose levels can fluctuate throughout the day,” she said. “If a person notices their blood glucose remains high for a few days, or if they feel sick, they should contact their doctor or diabetes educator for guidance.” In terms of hyperglycaemia symptoms, Dr Barclay says “it depends on how high” someone’s BGLs are. “So, frank diabetes, of course, is the standard – excessive thirst and urination, but ... that’s more of a classical type 1 diabetes diagnosis,” he said. “Some of the more common things may be that your vision is affected, you’re getting more infections – all the things that are signs of developing type 2 diabetes, including feeling tired, lethargic.” When it comes to unintentional weight loss, he says BGLs would have to be Hyperglycaemia symptoms Ms Crow says symptoms for hyperglycaemia include: • Feeling excessively thirsty. • Dry mouth. • Frequently passing large volumes of urine. • Feeling tired. • Blurred vision. • Infections (eg, thrush, cystitis, wound infections). • Weight loss. • Headache. • Confusion. “If patients have high blood glucose or ketones, they shouldn’t exercise,” Ms Crow said. Preventing hyperglycaemia Ms Crow suggests the following measures to help prevent hyperglycaemia: • • • • • • • Taking insulin or diabetes medications as prescribed. Checking BGLs frequently, especially if feeling sick. Consuming low-GI carbohydrates. Maintaining a high-fibre diet with two serves of fruit and five of vegetables daily. Reducing sugary beverages and highly processed foods. Being physically active. Reducing or controlling stress. Mr Quigley says preventing hyperglycaemia goes back to “lifestyle choices”. “If we could get people to understand the role of lifestyle choices on their overall health ... it’s incredibly important – it’s fundamentally important for blood glucose control,” he said. RETAIL PHARMACY • NOV/DEC 2020