Diabetes | June 17, 2015 | Author: The Super Pharmacist
Diabetes type 2 is a condition in which the metabolism of glucose (a simple sugar that is also a 'building block' for many forms of carbohydrate) is dysfunctional. This is often related to the increased resistance of cells to the normal control of glucose breakdown in cells, which is mediated by the hormone insulin. In contrast, diabetes type 1 is the chronic deficiency of insulin. Some estimates suggest that diabetes type 2 accounts for approximately 90% of all diabetes cases.
The concentration of unmetabolised free glucose in the blood is a major factor associated with diabetes. This can be measured by the numbers of a prominent blood protein, haemoglobin, which becomes bound to free glucose when this sugar is not broken down or used by the body. This is known as glycated haemoglobin or Hb1c. Other factors that may affect both type 2 diabetes and blood glucose may include thyroid function and magnesium deficiency3,4. Blood sugar levels can be tested for by using finger-prick blood tests, which are commercially available and may be performed by patients themselves at home.
Current guidelines suggest that patients with type 2 diabetes should check their BSL as a part of their normal daily or weekly routine. The benefits of doing so are diverse, as the result can provide an almost instant understanding of the current BSL and allow the person to act accordingly, with regard to diet and exercise. Regular monitoring is intended to reduce the risks of diabetic complications, and may be particularly important in those who are not currently using insulin to control their diabetes. Home blood glucose testing may help a patient to plan their dietary intake of any sugars in the immediate future, assess the advisability of exercise routines and correct any sudden drops in blood glucose with a small intake of sugar. Pathology blood tests can provide a glycated haemoglobin level, which can indicate the long-term control achieved by the patient. Increased blood sugar is typically regarded as blood concentrations of glycated haemoglobin equal to or above approximately 9%5. This is often termed 'poor glycaemic control' or 'increased blood sugar'. Glycaemic control affects the risk of the complications associated with diabetes type 1 and 26. It is regulated by treatments such as oral medications and exogenous (or supplementary) insulin. These are standard treatments in the control of diabetes type 2. Diabetic patients may exhibit increased blood glucose even when prescribed medications or insulin to control this. Some demographics or other variables are associated with poor glycaemic control in type 2 diabetes patients eligible for insulin therapy. These may include5:
Many patients with type 2 diabetes do not adhere to (or even start) treatment with insulin and/or other lifestyle modifications associated with glycaemic control. This is also associated with a number of factors, many of which are psychological in nature. These factors include:
Fears concerning the side effects of insulin therapy: Popular preconceptions about the consequences of adhering to a course of this treatment include weight gain, hypoglycaemia and interactions with other drugs taken.
Fears concerning hypoglycaemia: Concerns about reduced blood sugar are also common among patients diagnosed with type 2 diabetes. They may be educated in the effects of this complication, as well as those of hyperglycaemia, by a consulting physician or other health professional. This may result in increased concerns of developing this condition as a result of insulin treatment. The symptoms of hypoglycaemia may include increased feelings of lethargy, reduced energy, loss of consciousness and the inability to exercise without the increased risks of the same. Some patients may report that they are inclined to over-eat to countermand the possible risk of reduced blood sugar perceived to result from a dose of insulin. However, this behaviour is associated with possible risks of hyperglycaemia. In addition, some patients may choose to prioritise other conditions requiring increased exercise (e.g. cardiovascular disease) over glycaemic control.
Interruptions to daily routines: Some patients may report difficulties with issues such as finding time to inject insulin or monitor blood sugar levels. Physicians may also recommend changes in the structure of eating patterns, such as more regular meals or adaptations in the timing or frequency of meals. Patients may also find this a difficult or unwelcome change in their lives.
Food cravings and eating patterns: Some patients may find the calorific and/or macronutrient (e.g. fat) balancing often necessary for glycaemic control, exceptionally difficult or frustrating to adhere to.
Negative psychological effects or thought patterns: Patients may have many negative reactions, including feelings of shame, self-blaming and guilt in response to learning that they have developed type 2 diabetes. Further psychological effects of diagnosis include cultural or personal belief factors, anxiety, stress and possible depressive symptoms.
Fear of needles and pain: Insulin (including at-home treatment) is typically administered by injection. Therefore, the fear of needles among patients may be a factor in non-adherence.
Dissatisfaction with dietary guidelines provided by healthcare professionals: Physicians and other professionals may advise eating patterns and/or calorie restrictions based on a patient's fasting blood glucose, body mass and other factors. However, some patients may believe these practices do not allow them to eat enough to avoid hypoglycaemia.
Patient education: The control of diabetes may require awareness about hyperglycaemia, ideal blood sugar levels (often referred to as 'glycaemic targets') and how to monitor and regulate these. However, some patients may not have this information, or access to blood sugar monitoring. It is also possible for patients to adjust their own dose of insulin in response to changes in blood sugar, in conjunction with professional health advice, but some may not have the necessary education or confidence to do so without their doctor present. Improvements in these factors may reduce the risk of hyperglycaemia and related complications. This may indicate the importance of blood sugar monitoring.
Pharmacist-led or -provided interventions: This may take the form of advice, recommended treatment or other interventional measures offered by pharmacists in response to changes in counts of glycated haemoglobin. A review of 27 studies of this strategy indicated that a pharmacist's intervention resulted in the reduction of blood glucose levels in all of these trials, as well as other relevant factors such as lipid profiles, body mass and complications. This review also indicated that pharmacist-based diabetes management had some economic benefits.
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