Home' Australian Pharmacist : November 2011 Contents Vol. 30 -- November #11, 2011
Continuing Professional Development
The articles in this series are independently researched and compiled by PSA commissioned authors and peer reviewed.
The following recommendations were
made to the GP about SB:
3. Implement a treatment plan
for SB for managing sick days,
advising continued use of insulin
when ill, consumption of 15--20 g
carbohydrates every two hours and
monitoring BSL levels and ketone
levels every two to four hours.
4. Advise household members on
signs and symptoms of acute
diabetes complications, and
what to do in case of emergency.
A list of the signs, symptoms
and treatment of hypoglycemia
should be placed in a place which
is visible and easily referred to.
Counselling and demonstration on
use of glycogen hypo kit in case
of emergency for all household
members to be provided at review.
5. A referral to a dietitian for a healthy
weight loss plan is advised. It was
also recommended to SB that
she must not skip her meals and
limit carbohydrate consumption,
but implement a balanced
6. The associated risk of alcohol and
binge drinking was highlighted to
the patient and the importance
of avoiding excessive alcohol
consumption and associated risks
7. While a CSII pump improves
socialisation, decreases rate of
hypoglycaemia and improves
HbA1c levels, they also require
a great deal of adherence and
perseverance, and due to the
patient's current lack of discipline,
the pharmacist may suggest to
the GP that SB is not deemed
a suitable candidate for CSII
pump therapy until she improves
adherence with the current
8. Referral to a diabetes educator
to understand more about how
diabetes affects the body, to learn
how to balance eating and physical
activity with BSL readings and
managing sick days is suggested.
SB's doctor referred her to a
dietitian for supervised weight loss
and a diabetes educator to help
her understand the importance
of diabetes management. It was
agreed that if SB displays discipline
and adheres strictly to her current
regimen for six months that CSII
therapy would be considered.
Diabetes is a chronic disease
with serious short and long term
complications. A disciplined
multifactorial approach to the
management of diabetes is
required for all patients to minimise
co-morbidities associated with
uncontrolled elevated blood sugar
levels. Education of associated risk
factors is an important aspect of
diabetes control and patients would
benefit from the team approach for
1. Pharmacist disease management. Washington, D.C.
Third edition 2005.
2. Continuous Subcutaneous Insulin Infusion for the
treatment of diabetes mellitus. United Kingdom:
3. Therapeutic Guidelines. Endocrinology [2009
Version 4] in: eTG Complete at: www.tg.org.au
4. Neal M. Endocrinology, diabetes and metabolism.
A problem-oriented approach. 1996.
5. Richard Laliberte. Taking charge of diabetes.
Sydney: Consultant of Australia and New Zealand;
6. Misso M, Egberts K, Page M, Shaw J, O'Connor
D. Continuous Subcutaneous Insulin Infusion (CSII)
versus multiple insulin injections for type I diabetes
mellitus. The Cochran library. Jan 2010 At: http://
7. Chew S, Leslie D. Clinical endocrinology and
diabetes. London. Elsevier press. 2006.
8. Hillson R. Diabetes A beyond basics guide.
Australia: Reed Methuen publishers. 1987.
9. Diabetes: Pharmacist disease management.
Washington: American Pharmacist association.
10. Hirsch B, Bode B, Garg S, Lane W, Suosman A, Hu P,
Santiago O, Kolaczynski J. CSII versus MDI in type
I diabetes. Diabetes Care. Volume 26. Number 3.
March 2005 At: http://care.diabetesjournals.org/
11. Juvenile diabetes research foundation Australia at:
1. Which of the following
combination of hypoglycemic
symptoms require the use of
a) Nervousness, anxiety and
b) Pallor, sudden fatigue and amnesia.
c) Excessive sweating, loss of
coordination and headache.
d) Confusion, amnesia and
2. Which of the following
statements is MOST accurate?
a) Macrovascular complications
manifest 10--20 years after
diagnosis of diabetes.
b) Nerve damage manifests itself in
affected limbs and foot ulcerations
c) Inadequate management of
diabetes may increase risk of
cardiovascular disease, including
coronary artery disease, heart
attack and stroke.
d) Retinopathy is an ocular
manifestation which affects 80%
of diabetics after ten years or more
3. Which of the following
statements is FALSE?
a) A major disadvantage of CSII
pump is that it is not currently
b) CSII pumps aims to improve
metabolic control and the quality
of life of type I diabetes.
c) CSII pump allows a more accurate
delivery of insulin and flexibility
in dosing insulin according to
A score of 3 out of 4 attracts 0.75 CPD credits.
d) CSII pumps decreases rate of
hypoglycemia and hypoglycaemic
4. Select the CORRECT statement
regarding management of sick
days for people with diabetes.
a) Omission of insulin is
recommended when a diabetic
patient have not eaten due to
b) It is important for a diabetic to
consume 20 g of carbohydrates
every four hours when unwell.
c) A reduced insulin dose is required
after recovery of illness, and
patients must seek medical advice
for insulin dosage adjustment.
d) Blood sugar levels and urinary
ketones should be monitored every
one to four hours during illness.
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