Linked with Diabetes- Reflection Account

Question: Explain and Discuss How Obesity is Linked with Diabetes- Reflection Account? Answer: What? It was one of Ms. Holmes' infrequent visits to the pharmacy. She was panting from the sheer effort of walking to the counter. She was a 62 year old, who had to stop and catch her breath before she asked for pain medication. Her knee pain was troubling her again. Her high BMI made the pain worse. While taking her seat she almost fell and I rushed to support her, but she collapsed further and slumped on the chair. She was suffering from excruciating pain. My colleague and I helped her recline on the nearby bench. Quickly I checked her blood glucose with a monitor that I had, her random BGL was 170 mg/dl. I decided to find a more opportune moment to persuade her to seek an appointment with the GP. She complained of a boil on the waist that had not healed for 15 days. My colleague and I tried to suggest that she should get herself checked for diabetes mellitus Type II. Just then my colleague said that her obesity had put her in the high risk group and since her father had died of diabete s complications, she needed to be cautious. The very moment that mention of diabetes was made and she quickly left the pharmacy with the pain medication. Fortunately I had her contact details and I made a mental note about contacting her soon. Even as I was dispensing medicines to other patients who came thereafter, Mrs. Holmes' condition did not leave me. My professor's words echoed in my mind. He had always emphasized the importance of empathy to be a pharmacist, and that a pharmacist does not just dispense medicines, but the regular contact with patients made the pharmacist an important dispenser of information Satisfying patient queries that they could not directly ask the doctor. In Ms. Holmes' case it was important that she seek appointment of a GP, get tests done to find out whether she had diabetes. Her obesity and genetics had predisposed her to diabetes. The difficulty was that a mere mention of the possibility had scared her away. So What When I look back I felt rather concerned that a regular patient had shown two symptoms of diabetes. My colleague also felt the same and we spoke about it once Ms. Holmes had left. I continue to feel worried that I could not convince her to seek an appointment with the GP right away. But I know that I shall be able to educate her about the importance of seeking treatment and I start thinking about to contact her and approach the subject of introducing her to complications that could impact her health. Except that I will have to deal with caution while trying to convince Ms Holmes about starting a weight loss regime. From my brief encounters with her earlier I have noticed that she does not include any physical activity in her routine. As a first step I plan to introduce her to a dietician. Because it is important for her to understand that if her obesity is treated it will help her to reduce risks associated with diabetes. She needs to be educated about tests such as Hb1Ac, lipid prof ile, regular medication, diet and lifestyle changes. These could keep her safe from possible complications. I should have able to take steps when she was at the hospital. But I feel somewhat reassured that I was able to measure her BGL before she left. I wish I had been successful at persuading her to seek an urgent appointment with the GP then. I also wish I had warned her on earlier occasions about her risk of developing diabetes so that she could have taken preventive steps to work on reducing her weight and the risk of cardiovascular disease (Andrew Willis, 2014). I could have explained to her that when cells have to handle high density of nutrients the endoplasmic reticulum has to transport more nutrients across the cell. It sends a message to the plasma membrane to shut down the insulin receptors. Glucose cannot enter the cell anymore and BGL increase beyond the normal range. Forewarned, she could have reduced the nutrient density by eating healthier foods I realize that I need to improve my persuasive skills. I asked my colleague and he too felt that we could have persuaded Ms Holmes to start treatment right away. 90% of the population has some contact with the pharmacist annually.(C, 2000). We looked for her phone and address in the hospital records and set about trying to contact her. Now What? The impact of counselling by pharmacists on reducing Hb1Ac has been evidenced. (Ali M, 2012) (Mehuys E1, 2012). There are benefits to be derived from monitoring and counselling by community pharmacists on the treatment of diabetics. Implications of the above scenario where a patient could not be taken to a GP in order to begin diabetes treatment are serious but intervention is possible since Ms Holmes will return to the pharmacy to get her usual medicines. Pharmacists like me can take training programs and certification in order to act as effective community pharmacists and help in modifying behaviour of high-risk patients (Gloria J. Nichols-English, 2002). I could continue to be the pharmacist that I was without seeking training. But many patients would still remain without medication and would exposed to life threatening complications. The School of Pharmacy at the University of Hertfordshire and some other departments of Pharmacy run training programs for pharmacists where training in imparted for counselling and monitoring patients who are new to a diabetes treatment regimen. According to the Public Health: a handbook for community pharmacists, there are several ways in which a pharmacist can contribute to disbursement of information and awareness among patients. Pharmacist can promote healthy eating practices and emphasize the importance of exercise among obese/diabetic patients. Educate colleagues and customers about how to identify signs of diabetes. Help in identifying a case of diabetes. Counsel diabetic patients to take medicines regularly and regularly visit the GP. Pharmacists have also proven to be useful in several other ways. They have reported the difficulties patients face when using blood glucose monitors at home. They have helped patients manage the disease better through regular intake of medicine s and suggested referrals to physicians when a particular drug did not help a patient control diabetes (Anon., n.d.). Training shall help me tackle a similar situation should it happen again. As a result of the training I aim to be able to contribute more not just to patients dealing with obesity and diabetes but several other situations depending on the patient that visit my pharmacy. The main learning that I take from reflecting in the above case upon my practice is that reflection helps one to strive towards making a better contribution. The thinking that follows the reflection can help to change the way I run my practice and am able to impact public health in a better way and work towards the better health of patients who frequent my pharmacy. The intensity and effectiveness of counselling that can be provided to patients by pharmacists will depend on the extent of training available to them and result in better patient outcomes (Nkansah N1, 2010). References: Ali, M., Schifano, F., Robinson, P., Phillips, G., Doherty, L., Melnick, P., Laming, L., Sinclair, A. and Dhillon, S. (2012). Impact of community pharmacy diabetes monitoring and education programme on diabetes management: a randomized controlled study. Diabetic Medicine, 29(9), pp.e326-e333. Willis, A., Rivers, P., Gray, L., Davies, M. and Khunti, K. (2014). The Effectiveness of Screening for Diabetes and Cardiovascular Disease Risk Factors in a Community Pharmacy Setting. PLoS ONE, 9(4), p.e91157. Psnc.org.uk, (2016). [online] Available at: https://psnc.org.uk/wp-content/uploads/2013/07/public_health_book_all.pdf. [Accessed 15 Feb. 2016]. Anderson, C. (2000). Health promotion in community pharmacy: the UK situation. Patient education and counselling, 39(2-3):285-91. Nichols-English, G. J., Provost, M., Koompalum, D., Chen, H. and Athar, M. (2002). Strategies for Pharmacists in the Implementation of Diabetes Mellitus Management Programs. Disease management and health outcomes, 10(12), pp. 783-803. Mehuys, E., Van Bortel, L., Van Tongelen, I., Annemans, L., Remon, J.P. and Giri, M., (2012). Effectiveness of a community pharmacist intervention in diabetes care: a randomized controlled trial.. Journal of Clinical pharmacy and therapeutics, 36(5), pp. 602-13. Nkansah, N., Mostovetsky, O., Yu, C., Chheng, T., Beney, J., Bond, C. M. and Bero, L., (2010). Effect of outpatient pharmacists' non-dispensing roles on patient outcomes and prescribing patterns.. Cochrane database of systematic reviews, 7(7), p. CD000336.