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Australian Journal of Pharmacy : February 2005
diabetes How low can you go? T HE value of the glycemic index and its effect on blood sugar levels is gaining momentum. The first product launched in September by swimmer, Ian Thorpe, in his joint venture with ‘So Natural Foods’ was a low glycemic index energy water. In another venture, the Juvenile Diabetes Research Foundation, Diabetes Australia and the University of Sydney have set up a glycemic index (GI) symbol program. Mike Wilson, chief executive officer for the Juvenile Diabetes Research Foundation, told the AJPthe rating system for food glycemic content is similar to the Heart Foundation tick-test. The group is promoting the use of the symbol and licensing it to food companies for placing on their products. The first group of foods to carry the symbol would begin appearing on supermarket shelves in April, said the business manager for Glycemic Index Ltd, Gareth Hughes. Set up three years ago, he said the concept, which recommends that a low GI diet has benefits for everyone, was leading the world and the group was looking at developing the system internationally. Rachel Harris, public relations manager for the Foundation, said the role of pharmacy using the concept of the glycemic index as a way of managing type 1 and type 2 diabetes can be extremely helpful. This could include stocking pocket guides for customers to help them learn the GI way of eating and what foods they should avoid and explaining how this can have a major impact on blood glucose levels. ‘Basically not all carbohydrates are created equal and some carbohydrates raise blood glucose levels while others keep the levels stable, so it is advisable to put as many of the low GI foods into the diet as possible.’ Ms Harris said this can be as simple as swapping white bread for wholegrain bread, switching from corn-based to high-bran or muesli cereals, or eating an apple instead of a banana. Potatoes can also lift blood glucose levels so eating tinned or baked potatoes more often than boiled, or swapping brown rice in favour of basmati white rice, can help with the GI profile of a diet. ‘The whole focus of managing diabetes, whether it is type 1 or type 2, revolves around keeping blood-glucose as close to normal range as possible. Combined with exercise and other lifestyle modifications, it can have a big impact. ‘Type 2 diabetes in children is almost totally related to lifestyle, so diet and exercise is the message here.’ According to Brendan O’Loughlin pharmacy could benefit from a small booklet to give to patients referring them to information about GI foods. Pocket guides and generic fact sheets are available by contacting Diabetes Australia offices in each state. These are available at a special price for pharmacy sub-agents. ‘Diabetes is an extremely complicated area but there are many courses available to assist pharmacists in upgrading their skills.’ He said pharmacy is in the fore- front of training with the courses offered by the Pharmaceutical society of Aus- tralia and Diabetes Australia. ‘Community pharmacy is extremely well placed to be able to recognise people with diabetes and offer information, how to use the devices, counseling and refer to specialists.’ Experiences of a Diabetes Australia sub-agent Albert Regoli’s pharmacy at Marayong in western Sydney has been acting as a dia- betes sub-agent for a decade. ‘Our service for diabetes patients is not structured for performing diabetes and cholesterol testing, although we are in the process of developing such a service in the future,’ he told the AJP. Mr Regoli believes some pharmacies have reservations about providing these types of services because even simply checking a blood glucose meter requires private areas within the pharmacy. ‘The pharmacy would need to for- malise this if we move to an accredited service, although we see it as a natural extension to other health monitoring sys- tems where pharmacy is already involved. ‘It is an area pharmacy can develop, although patients have to be comfortable and the pharmacy has to accommodate the structures that need to be put in place.’ His pharmacy participated in the recent Pharmacy Diabetes Care Program 98 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 FEBRUARY 2005 run by the University of Sydney. Although initially reticent about becoming involved, Mr Regoli found it ultimately very rewarding. ‘Given the huge impact diabetes has on the community, we were able to help a number of patients with their medications and refer those we suspected might have the disease to their GP. I estimate we refer a least one patient a fortnight to a doctor to be checked.’ However, in order to encourage more participation from pharmacy, the service needs to be supported by some form of remuneration, he said. ‘There is a significant cost in providing this service which you only pick up in goodwill, although that is not to diminish the value of goodwill.’ s