Pharmacists as nutrition counselors.
Premier among health conditions requiring considerable nutritional discipline is diabetes.
Whether type 1 or type 2, there is a memorable moment when a physician announces to a patient that he or she has diabetes. A pleasant moment it is not. It is also the beginning of a learning journey sure to include some lifestyle changes.
Along with understanding medications, possible insulin therapy and exercise, there is the issue of understanding and gaining competence with daily blood glucose testing. Both require potential lifestyle adjustments and personal discipline.
That said, for most newly diagnosed patients with diabetes, advisable daily nutritional intake adjustments are likely to be challenging and represent the most likely points of potential failure.
Consider the following example. A slice of cold watermelon in the hot summer can be a tasty, refreshing treat. Its sugar content is a factor in making it so delicious. So should a patient with diabetes be counseled to avoid consuming watermelon?
The answer is, not necessarily. But to understand why requires knowledge of two things, the glycemic index and glycemic load of a particular food.
The glycemic index rates one's blood sugar response to a food in relation to glucose, a simple sugar and ranked at a base standard of 100. A three-fourths cup serving of watermelon has a glycemic index of 72, ranking high on the scale. Even such a minor serving is sure to spike blood sugar levels, thus triggering the pancreas to produce more insulin. Not a good thing for controlling blood sugar. Eating foods lower on the glycemic index scale creates lower and more extended elevation of blood glucose levels, thus requiring the pancreas to more moderately produce insulin over time. That's a better thing for controlling blood sugar.
While this is a good guide for proper nutritional intake, it is not the whole story. There exists a factor called the glycemic load. The glycemic load takes into account the carbohydrates in a particular food. The glycemic load of food is determined by multiplying the glycemic index by the total carbohydrates in a food serving and dividing that number by 100. Because watermelon is low in carbohydrates it has a glycemic load of 5. Thus, in moderate amounts, watermelon has a small impact on blood sugar levels. That's a good thing.
To compare, a same-size serving of raw apple has approximately twice the amount of sugars and carbohydrates as watermelon. A same-size serving of raw carrots has approximately the same amount of sugar and nearly twice the carbohydrates as watermelon.
The critical point for a patient with diabetes consuming watermelon is "in moderate amounts." Among watermelon lovers, what percentage would be satisfied with eating three-fourths cup or less at a serving? That's the hard part.
Pharmacists are active diabetes patient counselors on proper medication use and blood glucose monitoring. But when it comes to nutrition, most are likely less so beyond a less-than-detailed level. Which is not to infer that pharmacists so inclined cannot be helpful. Quite the opposite.
As in the foregoing watermelon example, portion control is a critical factor in a successful nutrition routine. Measuring cups, a simple weight scale and a tape measure are simple tools for success. Using this as an example, pharmacists engaged with their patients should be expected to provide some basic nutrition guidance.
Self-taught pharmacists using websites like the Joslin Diabetes Center and other credible sources can make a difference. Becoming a certified nutritionist or dietitian is another matter.
Robert Coopman is president of Robert Coopman Consultants, based in San Antonio. He can be contacted at email@example.com.
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|Title Annotation:||RX/Diabetes Care|
|Publication:||Chain Drug Review|
|Date:||Mar 13, 2017|
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