Page 71 - Retail Pharmacy November/Decemeber 2020

70 CPD ACTIVITY FROM PAGE 69 Monitoring In the absence of a blood glucose test result, a patient symptomatic of hypoglycaemia should be treated, due to dangers in delay of treatment.3 Continuous glucose monitoring and flash glucose monitoring can be useful in the detection of hypoglycaemia, but it should be known that there is a five- to 10-minute delay in readings as these devices measure subcutaneous interstitial fluid.33,34 It’s recommended that confirmation of hypoglycaemia be determined with a finger- prick test on a blood glucose meter.35 Hypoglycaemia treatment It’s important that hypoglycaemia is treated appropriately and rapidly. In non-severe hypoglycaemia, if a patient is conscious, able to swallow and cooperative, orally consumed short acting carbohydrate is the treatment of choice to rapidly increase the blood glucose levels.3 In severe hypoglycaemia where a patient is unconscious, glucagon and/or intravenous glucose are the preferred treatments.3 Appropriate treatment of hypoglycaemia is important not only to treat the hypoglycaemia, but also to reduce post treatment hyperglycaemia.30 After an episode of hypoglycaemia, it’s essential to investigate what may have precipitated the event, as lifestyle alterations, changes in medication administration or dose, or alterations to dietary intake may be able to help prevent future episodes. Protocol for the management of non- severe hypoglycaemia in adults3,36 The first action is for patients to check their blood glucose levels. However, if this is not possible, assume hypoglycaemia based on symptoms and treat. If blood glucose is less than 4mmol/lt, 15g of short acting carbohydrate should be consumed. (See Table 3).3 In adults, a 20g portion of short acting carbohydrate may be considered in the case that blood glucose Table 3. Examples of 15g of short acting carbohydrate3,36 Table 4. Examples of long acting carbohydrate3,36,37 is less than 3mmol/lt.3 Blood glucose levels should be checked within 10 to 15 minutes and if still below 4mmol/lt, a patient must repeat the short acting carbohydrate. If more than three short acting carbohydrate portions are needed to restore blood glucose, the patient needs to seek medical advice. If blood glucose is more than 4mmol/ lt after 10 to 15 minutes, a long acting carbohydrate in a snack or meal is to be consumed.3 (See Table 4) Examples of short acting carbohydrate * Six to seven jellybeans * Glucose tablets, gel or liquid equivalent to 15g carbohydrate * 100 mL of oral glucose solution (eg, Lucozade) * Three teaspoons of honey * Three teaspoons of sugar * 150ml of regular soft drink (not ‘diet’) * 125ml of fruit juice (about half a cup or 1 x small popper) Examples of long acting carbohydrate *A slice of bread *A piece of fruit (e.g. apple, banana) *Two to three pieces of dried fruit (eg, apricots, figs) *Glass of milk (250 ml) *One tub of yoghurt *Two plain sweet biscuits *Rice *Pasta RETAIL PHARMACY • NOV/DEC 2020 *Note that patients on acarbose should have glucose as their short acting carbohydrate, as the absorption of sucrose (eg, fruit juice, cane sugar) is impaired.20