The challenges of managing diabetes at mealtimes
Mealtimes pose many challenges for people living with diabetes, especially those who require a fast-acting insulin treatment to cover the post-meal glucose surge.
Deciding when to eat, what to eat and how much to eat in advance is something that we expect patients to do three times a day, seven days a week. Yet recent data show that we could be doing more to educate patients on the consequences of poor management of post-meal glucose levels and the importance of taking their treatment as prescribed.
To gain further insight into this issue, we recently undertook a survey of 200 adults living with type 1 or type 2 diabetes, all of whom manage their disease through a basal-bolus insulin regimen. The survey showed that one-third of respondents did not take their mealtime insulin treatment as recommended before their meals to control a ‘spike’ in their post-prandial glucose (PPG) levels. As well as causing unpleasant short-term symptoms, regular hyperglycaemia after meals can lead to higher overall glycaemic load and increases the risk of serious longer-term complications, such as amputation and blindness.
More worryingly only one in three of respondents discussed symptoms of hyperglycaemia with their healthcare professional. Reasons cited included fear of being chastised for not taking their insulin properly and belief that they should be experienced enough to handle this chronic condition themselves. The reality is that, on average, people living with diabetes only spend three hours a year with a healthcare professional.
This means that, for the remaining 8,757 hours, they need to have the knowledge and confidence to control their diabetes by themselves. It is therefore important that we equip people living with diabetes with the skills to effectively self manage.
The social impact of trying to manage hyperglycaemia was brought to light by the survey respondents. One-quarter of respondents reported that worries about mealtime management had a negative impact on their relationships. Over 40% found doing things ‘on the spur-of-the-moment’ difficult, as well as planning holidays. For lifelong diseases like diabetes, improving quality of life for patients should be paramount.
We can go some way to achieving this objective by improving the clinical effectiveness of treatments and optimising prescriptions. Such optimisation will ultimately improve the cost-effectiveness of care, which is especially important in view of pressures on the NHS budget.
Pharmacists have an important role to play in up-skilling people living with diabetes to self-manage their disease. Medicines use reviews, the advanced service offered by pharmacies England, helps improve patients’ understanding of their treatment. It also provides an opportunity to identify and address any potential side effects. Unlike quarterly appointments with a GP or practice nurse, pharmacists have more regular touch points to ask patients about whether they are experiencing symptoms of hyperglycaemia after meals, such as fatigue, extreme thirst or the frequent need to urinate and can reinforce advice on when to take their insulin and how to plan their meals.
Manufacturers, like Novo Nordisk, can help ensure that pharmacists have the information and skills required to optimise treatments for people living with diabetes. A recent example is the development of the ‘Mealtime management’ resource on NovoNordisk.co.uk, which provides educational resources on PPG management and the symptoms of hyperglycaemia, for pharmacists based in hospitals and the community to share with their patients.
Clinical, medical and regulatory (UK/IRE)
Citation: Clinical Pharmacist DOI: 10.1211/CP.2017.20202092
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