Page 73 - Retail Pharmacy November/Decemeber 2020

72 CPD ACTIVITY FROM PAGE 71 when they drive, so they can adequately treat for hypoglycaemia if needed.42 Patients with diabetes should check their state or territory transport department regarding specific requirements for driving, as there may be conditions placed on licences due to diabetes.42 The role of a pharmacist Pharmacists have an important role in counselling on the benefits and risks of antihyperglycaemic medicines. Hypoglycaemia and its management are vital to discuss. Pharmacists also have a role in supply of glucose monitoring equipment. In a study in which pharmacists provided ongoing counselling and education to patients with type 2 diabetes, the arm with the pharmacist intervention had lower reports of symptomatic hypoglycaemia.43 When counselling patients on antihyperglycaemic medications, it’s important to discuss information on the risk of hypoglycaemia, symptoms recognition, monitoring and the acute treatment of hypoglycaemia. A pharmacist can supply glucagon without prescription and should be familiar with education on its administration and when it’s indicated in an acute setting. Medications and their timing to food intake is also very important – for example, sulfonylureas are recommended to be dosed with food to minimise hypoglycaemia risk.20 A number of insulin preparations are also to be dosed at the same time food is ingested.20 Counselling on the correct administration of insulin is vital as injecting insulin into areas of lipohypertrophy or intramuscularly may cause inadvertent hypoglycaemia.19 These injection risks can be minimised by appropriate site selection, effective site rotation of injections, using appropriate length needles and correct administration angles.20 It can be beneficial for pharmacists to educate patients on how to use their blood glucose machines and supply all the correct equipment (ie, blood glucose meter, blood glucose strips, lancing device and lancets) so that effective monitoring of hypoglycaemia can occur. Pharmacists play an important role in understanding hypoglycaemia and assisting patients in the community to understand, recognise and reduce their incidence of hypoglycaemia. References: Available on request. Accreditation number: A2011RP1 (Exp. 31/10/2022). This activity has been accredited for 1.5 hours of Group One CPD (or 1.5 CPD credits) suitable for inclusion in an individual pharmacist’s CPD plan which can be converted to 1.5 hours of Group Two CPD (or 3 CPD credits) upon successful completion of relevant assessment activities. 1. Which of the following is NOT a risk factor for hypoglycaemia? A) Renal impairment. B) Ulfonylurea use. C) Shorter duration of diabetes. D) Older age. 2. What is NOT likely to be a precipitant of hypoglycaemia? A) Error in administration of insulin. B) Carbohydrate intake variation. C) Alcohol intake. D) Corticosteroid commencement. 3. Which of the following statements is MOST correct? A) Neuroglycopenic symptoms arise from glucose deficiency in the CNS, and neurogenic symptoms arise from counterregulatory activation of the autonomic nervous system. B) Neurogenic symptoms arise from glucose deficiency in the CNS, and neuroglycopenic symptoms arise from counterregulatory activation of the autonomic nervous system. C) Neuroglycopenic symptoms arise from glucose deficiency in the CNS, and neurogenic symptoms arise from counterregulatory activation of the somatic nervous system. D) Neurogenic symptoms arise from glucose deficiency in the CNS, and neuroglycopenic symptoms arise from counterregulatory activation of the somatic nervous system. 4. Which of the following is NOT generally a symptom of hypoglycaemia? A) Anxiety. B) Hunger. C) Pupil constriction. D) Paraesthesia. 5. John Smith (a 45-year-old male patient) has had type 1 diabetes for 25 years. He comes into the pharmacy and while waiting for his prescription he checks his blood glucose and discovers it is 3.6mmol/lt. He advises you he is experiencing no symptoms of hypoglycaemia. John has a history of impaired awareness of hypoglycaemia. Which of the following best describes the MOST appropriate action? A) Advise John to consume 15g of long acting carbohydrate and retest blood glucose in 10 to 15 minutes. B) Advise John to consume 15g of short acting carbohydrate and retest blood glucose in 10 to 15 minutes. C) Wait 10 to 15 minutes while calibrating the meter, retest blood glucose to confirm hypoglycaemia and then advise John to consume 15g of long acting carbohydrate. D) Wait 10 to 15 minutes while calibrating the meter, retest blood glucose to confirm hypoglycaemia and then advise John to consume 15g of short acting carbohydrate. 6. Non-severe hypoglycaemia requires assistance from a third party to recover. A) TRUE. B) FALSE. 7. Which of the following best describes a cycle of recurrent hypoglycaemia, defective glucose counter-regulation and impaired hypoglycaemia awareness? A) Hypoglycaemia syndrome. B) Nocturnal hypoglycaemia. C) Hypoglycaemia associated autonomic failure. D) Neuropathy associated with diabetes. 8. What is a key message from the National Diabetes Services Scheme regarding blood glucose levels (mmol/lt) in people with diabetes and driving? A) Don’t drive under five. B) Over four is your score. C) Seven before driving. D) Six and you’re swell. The low-down on hypoglycaemia 3 CPD CREDITS RETAIL PHARMACY • NOV/DEC 2020