diabetes management Archives - London Drugs Blog

Planning to travel with diabetes? Keep these tips in mind

General Travel Tips:

• Keep your medication, meal, and snack times as regular as possible.
• If travelling by air or car, try to do some form of activity during your journey: do simple stretches in your seat, circle your ankles, raise your legs, or move around periodically in the aisles.
• If you will be extremely active while travelling, you may need to decrease your diabetes medication, so be sure to discuss this with your diabetes educator or physician.
• If you are crossing time zones, you should discuss your meal and insulin schedule with your doctor or diabetes educator.

Carrying & Storing Insulin Tips:

• Insulin keeps its strength at room temperature for 30 days. If travelling in hot temperatures, store your insulin in an insulated bag. If travelling in cold temperatures, keep your insulin close to your body to stop it from freezing.
• You can carry a small sharps container to store used needles and syringes while travelling.
• When travelling by air, you may carry liquids such as insulin, juice or gels to treat hypoglycemia, etc., even in amounts greater than 100 ml. Just make sure they’re accessible and declare them to security when being screened.

Use this travel checklist to get ready for your trip:

Have a list of your medications. Include the generic names and their dosages from your pharmacist. Bring a letter from your doctor stating:

• Your diabetes treatment plan so doctors in the places you travel can understand your needs.
• That you need to carry syringes or needles for insulin pens and lancets as part of your insulin treatment. Having this will be helpful if your luggage is examined at airport security checkpoints.
• The supplies you need for your diabetes care. Be sure to keep your syringes, needles, pens, and lancets in the same boxes that they came in with the original prescription label on them.

Ask your doctor, diabetes educator or healthcare team about:

• Illness management
• Low blood sugar management (and Glucagon for insulin users)
• Adjustments for meals, insulin and medications in different time zones
• Avoiding illness caused by contaminated food and water
• Tips for adjusting your medication if required

Other tips to remember:

Pack extra supplies
Keep them in your carry-on bag in case your luggage goes astray. This includes your meter, test strips, glucose tabs, alcohol swabs and insulin pens or syringes (and insulin vials).

Bring plenty of travel snacks
Some good ones include low-fat granola bars, whole-wheat crackers or nuts. Be on the safe side and bring enough in case you get delayed. As well, bring some fast-acting sugar to treat low blood sugar. If you’re going to the U.S., you may not be able to bring certain types of food, like fruit.

Consider getting travel insurance
Before you leave for your trip, consider getting travel insurance. And remember, some countries require proof of health insurance on arrival.

Some other things to have:

• Telephone numbers of your doctor and diabetes educator
• Meter, test strips, and logbook
• Urine ketone-testing strips
• A print-out of your medical history summary from your healthcare professional

London Drugs also has Diabetes Management Clinics and Certified Diabetes Educators (CDEs) who offer one-on-one consultations specific to your needs. Learn more about this service here.

Lifestyle choices & blood glucose

The most important aspect of diabetes management is controlling blood glucose (blood sugar) levels, and making healthy lifestyle choices plays a major role in achieving that goal. These healthy lifestyle choices fall into six main categories:

Healthy eating

While there is no single diet that is right for everyone with diabetes, there are a number of different eating plans that can help you manage your blood glucose levels, your blood pressure, your cholesterol, and your weight—all of which will help reduce your risk of developing diabetes-related complications such as heart attack and stroke. A registered dietitian can help you develop a meal plan that is best suited to meeting your personal needs, but here are some general guidelines to get you started:

• Diabetes Canada recommends choosing foods lower in fat, sodium (salt), and sugar. Fat adds extra calories, and saturated fats and trans fats increase the risk of heart disease. Salt and salty foods can lead to high blood pressure. Sugar adds extra calories and can make it more difficult to control cholesterol and manage blood glucose.

• How much you eat is just as important as what you eat, and your diabetes care team can guide you regarding portion sizes that are right for you. Canada’s Food Guide recommends filling half of your plate with vegetables and fruits. (People with diabetes should choose more vegetables than fruits because vegetables generally contain less sugar than fruits.) Separate the remaining half of your plate into two equal parts and fill one with protein food and the other with whole grain food.

• Making water your primary beverage choice will also help, because it is a sugar-free and calorie-free way of quenching your thirst.

• If you use alcohol at all—and you should check with your doctor to make sure it is safe for you before consuming alcohol—do so in moderation.

Physical activity

Adding physical activity to your day is an important part of managing your diabetes as well as your overall health. You can start becoming more active by limiting the length of time you sit. Get up every 20 or 30 minutes and stand or move around. There are two types of exercise that are particularly important for people with diabetes:
aerobic exercise and resistance exercise.

• Aerobic exercise involves continuous movement that increases heart rate and breathing. Examples of aerobic exercise include walking, jogging, and riding a bicycle. In addition to helping you become more fit, the benefits of aerobic exercise include helping you achieve healthier levels of blood glucose, blood fat, and blood pressure.

• Resistance exercise involves brief, repetitive exercises with weights, weight machines, resistance bands, or your own body weight. The benefits of resistance exercise include maintaining or increasing lean muscle mass, burning calories even while at rest, and weight control.

Getting started on your physical activity program will require some preparation, especially if you have been inactive for a while. Speak with your doctor before beginning any new exercise program to make sure that the activities you are planning to engage in are appropriate for you. Wear comfortable clothing and proper-fitting shoes that are right for the activity. Monitor your blood glucose level before starting to exercise and carry a fast-acting carbohydrate with you in case your blood glucose drops too low.

A healthy weight

Maintaining a healthy weight should be part of your diabetes management plan. Eating healthy and being physically active will help you control your weight, but even if your weight is in a healthy range, excess fat carried around the waist can raise your risk of high blood pressure, high cholesterol, and heart disease. The best way to determine if your waist is causing a problem for your health is to measure it. To get an accurate measurement, stand upright and place the measuring tape around your waist. Exhale normally and read the tape. Unless your healthcare provider advises differently, women should aim for a waist circumference of no more than 88 cm (36 inches), and men should aim for a measurement no greater than 102 cm (40 inches).

Your treatment plan

Along with following your meal and activity plans, if your doctor has prescribed medication or insulin for you, it is critical to take it exactly according to the directions—every dose, every time.

Don’t smoke

Smoking and exposure to second-hand smoke increase a person’s risk of developing heart disease and stroke. Because the risk of heart disease is already higher in people with diabetes, it is especially important for them
to avoid smoking. If you smoke and want to stop, your London Drugs pharmacists can advise you on products and strategies that can increase your chances of quitting successfully.

Blood glucose monitoring

Your diabetes care plan is focused on managing your blood glucose levels to keep you as healthy as possible and prevent complications. Monitoring your blood glucose will provide the information your healthcare team needs to guide you in making lifestyle and medication changes to improve your diabetes management. If you are newly diagnosed, it is important to receive training on how to use your meter properly. You will have to learn:

• how to get a blood sample

• where to take the sample from

• how to use and dispose of the lancets you use to pierce your skin to get the sample

• the size of the blood sample you will need

• the type of blood glucose strips to use

• how to check your meter to ensure that it is accurate

• how to clean and maintain your meter

There are newer types of glucose meters that don’t require you to draw a blood sample. A flash glucose meter uses a sensor that is inserted under the skin, usually in the upper arm, that measures blood glucose. A hand-held scanner swiped over the sensor enables the user to read the blood glucose level. A continuous glucose monitor (CGM) is a device that also uses a sensor inserted under the skin to check blood glucose. A CGM monitors blood glucose continuously throughout the day and displays the readings. These monitors also provide alarms that alert users to high and low blood glucose levels, and they can be integrated with insulin pumps. Your diabetes care team can help you find the glucose monitoring system that best matches your personal needs.

Target blood glucose levels vary depending on a number of factors including age, medical condition, and other risk factors a person has. For example, targets can be different for pregnant women, seniors, and children 12 years of age and younger. Your healthcare provider will be able to tell you what your personal target range should be.

Read other health-related articles in our Living With Diabetes Magazine here.

Diabetes and Heart Health

People with diabetes are more likely to develop heart disease or have a stroke than people without diabetes, and they are more likely to develop these problems at a younger age.

This is due, at least in part, to the fact that high blood glucose (blood sugar) levels can damage blood vessels as well as the nerves that control the heart and blood vessels. Additionally, people with diabetes often have a number of other risk factors that increase the chances of developing heart disease. These risk factors include being overweight (especially if the excess fat is found around the waist), high blood pressure, high cholesterol, being inactive, and smoking or using other tobacco products. Having a family history of heart disease or stroke also increases the risk. Because there is nothing we can do about our family history, it is even more important to take actions to minimize those risk factors that we can control.

Reducing your risk

Fortunately, you can reduce your risk of developing heart disease or having a stroke by taking steps to manage your blood glucose, monitoring your health, and making wise lifestyle choices. Here are some guidelines that will help.

• Alcohol intake: If you consume alcohol, check with your doctor to make sure it is all right for you to do so. Alcohol raises blood pressure by interfering with blood flow to and from the heart, and it can affect blood glucose levels. If your doctor says it is okay for you to drink alcohol, do so in moderation.

• Blood glucose: Aim for an A1C level of 7% or less by following your diabetes management plan.

• Blood pressure: Test your blood pressure regularly to make sure it is within the range your healthcare team has established for you, and have it professionally checked every time you visit your healthcare provider.

• Cholesterol: LDL cholesterol (sometimes called “bad” cholesterol) increases the risk of heart problems. Aim to keep yours below 2.0 mmol/L. To limit your LDL cholesterol and raise your HDL (“good”) cholesterol, limit the amount of animal fats you consume and eat more plant-based foods. Triglycerides, another type of blood fat related to cholesterol, can also raise heart disease risk. Check with your healthcare team to find out what range your triglycerides should be in and have your triglyceride levels checked periodically to make sure they are in that range.

• Smoking: The nicotine in tobacco causes blood vessels to narrow, which raises blood pressure. Smoking also makes blood pressure medications less effective. If you are a smoker and need help quitting, your London Drugs pharmacists can help with tips and smoking cessation products that can help you quit successfully.

• Stress: Stress can affect both blood pressure and blood glucose. Learn to manage stress in a healthy manner. Some options include socializing, being physically active, listening to soothing music, and engaging in a hobby you enjoy. Practicing relaxation techniques for just a few minutes each day can also help you manage your stress in a healthy manner.

Helpful relaxation techniques include:

• Yoga and tai chi are ancient arts that combine rhythmic breathing with postures or flowing movements. They provide a mental focus that is calming and can distract you from distressing thoughts.

• Mindful meditation involves sitting comfortably and focusing your attention on your breathing and on the present moment. Don’t let your mind drift to another time or place or to things you are concerned about. Research shows that mindful meditation may be helpful in relieving anxiety, depression, and pain.

• Guided imagery involves calling to mind images of places or experiences that you find soothing to help you relax.

• Breath focus is a simple technique in which you focus on taking long, slow, deep breaths and try to distance your mind from distracting thoughts.

• Body scan combines progressive muscle relaxation with breath focus. After a few minutes of deep breathing, focus your mind on one part of your body or one muscle group at a time and mentally release any physical tension you feel there. When the tension in that spot eases, shift your focus to another part of your body, moving your attention methodically until you have relaxed your entire body.

• Weight: Being overweight can make it more difficult to manage diabetes and can raise the risk for many health problems including high blood pressure and heart disease. A healthy eating plan and more physical activity often help. Excess fat carried around the waist can raise the risk of heart disease even in people who are not overweight. Ask your healthcare team to assess your waist circumference to see if your belly fat is in the healthy range.

When lifestyle changes aren’t enough to reduce your risk, your doctor may prescribe medication. It is important to take the medicine exactly as prescribed in order to get the most benefit from it. If you have any questions about your medicines or how to take them, your London Drugs pharmacists will be happy to answer them. Learn more about the Diabetes Management Clinics offered at London Drugs.

Managing your heart health

Coronary artery disease is the most common form of heart disease for people living with diabetes. This is caused by a buildup of plaque, or cholesterol deposits in the coronary artery walls. These arteries serve to supply oxygen and blood to the heart. When the plaque narrows or blocks the arteries, it decreases the blood flow to the heart, which can then cause a heart attack. If the blood flow to the brain is decreased, a stroke can occur. 1

Adults with diabetes are nearly twice as likely to have heart disease or stroke as adults without diabetes. 2 Gradually, high blood sugar can cause damage to your blood vessels and nerves. When your blood vessels are weak, they can become leaky and susceptible to cholesterol buildup. 3 However, you can make changes today to lower your risk of a heart attack or stroke by knowing you ABCDEsss 4*.

A – A1C of 7.0% or less
This lab test is done every 3 to 6 months measures your blood sugar control.

B – Blood pressure (BP) of less than 130/80 mmHg
Systolic is your top number. Diastolic is your bottom number.

C – Cholesterol (LDL cholesterol) less than 2.0 mmol/L
Buildup of LDL (low-density lipoprotein) and low HDL (high-density lipoprotein) increases the risk of heart attack and stroke.

Drugs
Speak to your health care team about medication to lower your risk of a heart attack or stroke.

Exercise and healthy eating.
See below for some tips.

Self-management support
People with diabetes should set personalized goals to manage their diabetes.

Screening for diabetes complications
Most people with diabetes will need a yearly foot exam, kidney evaluation and an eye exam.

Smoking increases your risk of heart attack and stroke
If you smoke, you should quit.

How to reduce your risk of a heart attack and stroke*

Maintain a healthy plate. 6

• Cook at home. Try to limit highly processed food and restaurant food that are high in salt, fat, and sugar. 7

• Read food labels. Look for foods with a % daily value (%DV) of less than 5% for fat, sodium, sugars. 8

• Make a grocery list. This helps to prevent impulse buys, helps you stay on budget and reduces food waste. 9

Exercise: Keeping active helps your diabetes and your heart

Experts recommend that keeping active can have major benefits for your diabetes, heart, and your weight. It is recommended that you should try to get 5*:

• 150 minutes of aerobic exercise per week. Aerobic is exercise that makes you breathe faster and raises your heart rate. e.g. brisk walking, swimming, dancing, and riding a bike.

• Lifting weights 2 to 3 times per week.

Symptoms of heart disease. 10

The symptoms of heart disease may differ between men and women. Signs may include:

• Chest pain, including a burning sensation, heaviness or pressure/discomfort in the chest

• Upper body discomfort in your arms, neck, shoulders, back or jaw

• Shortness of breath

• Lightheadedness/fainting

• Sweating

• Nausea

If you experience any of these symptoms, immediately call 911 or your local emergency number.

TM see www.ascensiadiabetes.ca/tm-mc. All other trademarks are the property of their respective owners © 2021 Ascensia Diabetes Care Canada Inc.
* Patient should consult with their health care provider about taking medications and prior to making any changes to treatment regimen. 1. Centers for Disease Control and Prevention (2021). Diabetes and Your Heart. https://www.cdc.gov/diabetges/library/features/diabetes-and-heart.html. 2. National Institute of Diabetes and Digestive and Kidney Diseases (2020 NIDDK). Diabetes, Heart Disease, and Stroke. https://www.niddk.nih.gov/health-information/diabetes/overview/preventingproblems/heart-disease-stroke. 3. Heart and Stroke Foundation. Diabetes and heart disease: your top 3 questions answered. https://www.heartandstroke.ca/articles/diabetes-and-heart-disease-your-top-3-questions-answered. 4. Diabetes Canada (2020 Canadian Diabetes Association). Staying healthy with diabetes. https://www.diabetes.ca/DiabetesCanadaWebsite/media/Managing-My-Diabetes/Tools%20and%20Resources/staying-healthy-with-diabetes.pdf?ext=.pdf. 5. Diabetes Canada (2020 Canadian Diabetes Association). Physical activity and diabetes. http://guidelines.diabetes.ca/docs/patient-resources/physical-activityand-diabetes.pdf. 6. Canada’s Food Guide (2019 Government of Canada). Food guide snapshot. https://food-guide.canada.ca/en/food-guide-snapshot. 7. Canada’s Food Guide (2019 Government of Canada). Cook more often. https://food-guide.canada.ca/en/healthy-eating-recommendations/cook-more-often. 8. Canada’s Food Guide (2019 Government of Canada). Use food labels. https://food-guide.canada.ca/en/healthy-eatingrecommendations/using-food-labels. 9. Canada’s Food Guide (2019 Government of Canada). Meal planning. https://food-guide.canada.ca/en/tips-for-healthy-eating/meal-planning. 10. Heart and Stroke Foundation. Emergency Signs. https://www.heartandstroke.ca/heart-disease/emergency-signs.

Blood Glucose Monitoring

Self-monitoring of blood glucose (blood sugar) levels is a critical part of managing
diabetes, because it provides a picture of how well blood glucose is being controlled. In addition to providing an indication of long-term control, it helps identify impending problems, and this allows people to make necessary adjustments to prevent highs and lows. For example, if blood glucose drops, the person can eat something; if it rises, a medication adjustment may be necessary.

Traditionally, blood glucose self-monitoring has been done using a blood sample obtained by pricking part of the body—usually a finger—with a lancet and applying the sample to a special strip that is read by a glucose testing device.

Continuous glucose monitoring

Another testing option is also available. Called continuous glucose monitoring (CGM), it involves a small, disposable sensor that is worn under the skin (commonly on the arm or stomach) and tests blood glucose every few minutes all day and night. The readings are sent to a transmitter and usually to a separate device as well, allowing the data to be read by the patient, caregiver, or healthcare provider. The CGM can also be paired with an insulin pump, which is called integrated CGM.

CGM is a good option for some patients, because:

• It allows people to see their blood glucose reading 24 hours a day with few—or
sometimes even no—finger prick tests.

• It improves the ability to identify glucose patterns, so daily management decisions can be made in a timely manner.

• Because CGM monitors blood glucose continually, it can be particularly helpful overnight when regular testing is not likely to be done. Alarms and alerts can warn users when blood glucose drops too low.

• It provides more information than sporadic finger prick tests. The device shows the current glucose reading, a graph of glucose readings over the previous hours, and
the rate of change in the levels.

• The ease of use and greater information provided can lead to improved glycemic control.

According to Diabetes Canada, there is evidence to suggest that CGM may be beneficial for both adults and children with type 1 diabetes who have not achieved their blood glucose targets or who have difficulty with hypoglycemia.

Diabetes apps

Apps that help manage blood glucose have been shown to be beneficial in improving the health of people with diabetes. Many diabetes devices—including glucose meters, continuous monitors, and insulin pumps—come with integrated apps that sync the device to a mobile phone. A diabetes educator can help you learn how they work.

The bottom line

Diabetes management must be individualized. People living with diabetes should work with their healthcare team to determine the meal plan, activity program, blood glucose monitoring device and schedule, and the diabetes supplies that will best meet their personal needs.

Your London Drugs pharmacists are always happy to answer your questions and counsel you on products to help you manage your diabetes and lead a healthy life.

Could you have diabetes?

On average, every day 480 Canadians are diagnosed with diabetes, more than 20 Canadians die of diabetes-related complications, and 14 Canadians have a lower limb amputated due to diabetes. Could you have diabetes and not know it? It is important to know whether you have diabetes, because if you are aware of it, you can take steps to manage your condition and lead a healthier life. However, if left untreated, diabetes can cause very serious complications.

Different types of diabetes

There are several different types of diabetes:

• Type 1 diabetes is a condition in which the body’s immune system destroys the insulin-producing cells of the pancreas, making the affected people dependent on injecting insulin into their bodies. Type 1 diabetes usually develops in children and youths, but it can occur in adults as well.

• Type 2 diabetes occurs when the pancreas does not produce enough insulin or the body cannot properly use the insulin it produces. In some cases, type 2 diabetes can be managed with oral medication, but some people with type 2 will need to inject insulin.

• Gestational diabetes may develop during pregnancy if a woman’s blood sugar reaches too high a level. It usually disappears following delivery of the baby, but it increases the woman’s chances of developing type 2 diabetes.

What causes diabetes?

There is a lot of misinformation about diabetes floating around. For example, diabetes is not caused by eating too much sugar, and people do not give themselves diabetes. The causes of diabetes depend on the type of diabetes the person has—type 1 diabetes, type 2 diabetes, or gestational diabetes. Among the possible causes are your genes, family medical history, ethnic background, and your general health.

Symptoms

Some people with diabetes don’t experience any obvious warning signs, but those who do may have some of the following symptoms:

• cuts and bruises that are slow to heal
• lack of energy or extreme fatigue
• frequent or recurring infections
• unusual thirst
• frequent urination
• tingling or numbness in the hands or feet
• trouble achieving or maintaining an erection
• blurred vision
• weight loss or weight gain

Prediabetes

Prediabetes is a condition in which blood glucose (blood sugar) levels are higher than normal, but not high enough to be diagnosed as diabetes. Nearly six million Canadians have prediabetes. If left untreated, prediabetes can develop into type 2 diabetes. If you have prediabetes, taking steps to manage your blood glucose levels can help prevent you from developing diabetes.

Managing blood glucose

There are several measures you can take to help manage your blood glucose levels:

• Eat a healthy diet
• Be physically active
• Achieve and maintain a healthy body weight
• Monitor your blood glucose levels regularly
• Take any medication your doctor prescribes exactly according to the directions

Diagnosing diabetes

If you think you or someone you know may have diabetes, seek medical attention as soon as possible, so you can begin managing the condition and prevent complications. There are several tests used to diagnose diabetes:

• Fasting blood glucose test
• Random blood glucose test
• A1C test
• Oral glucose tolerance test

While diabetes cannot be cured, it can be managed, and people with diabetes can lead happy, fulfilling lives. Diabetes Management Clinics are also available at London Drugs for one-on-one consultations.

Read other articles in our Fall-Winter 2021 volume of our Bettercare magazine here or learn more about the Diabetes services offered at London Drugs.

Diabetes & Covid-19

COVID-19 is a virus that affects the respiratory system (the system that enables us to breathe). People with diabetes are not more likely than others to catch the COVID-19 virus, but if they do catch it, they are more likely to have a severe form of the infection and to suffer more complications. This makes it particularly important for people with diabetes to do everything they can to protect themselves from this virus. Here are some things you can do to help protect yourself.

• Wash your hands thoroughly and often with soap and water. If soap and water are not available, use an alcohol-based hand sanitizer.
• Avoid touching your eyes, nose, and mouth.
• Regularly clean commonly used surfaces and devices you touch or handle.
• Don’t make unnecessary trips away from home.
• If you do have to leave your home, try to stay at least 2 metres away from anyone else.
• Avoid contact with people who appear to be sick with a respiratory illness.
• Watch carefully to see if you develop any symptoms.

Common symptoms of COVID-19 to watch for include fever, tiredness, dry cough, aches and pains, nasal congestion, runny nose, sore throat, and diarrhea. However, some people who become infected with the virus never develop symptoms. If you do develop any of the symptoms, continue following your diabetes management plan and call your doctor to see whether you should make an appointment to go in for a checkup and for advice on how to treat your symptoms. Research has shown that insulin and other treatments for blood sugar control do not increase the risk of severe COVID-19, and you should continue to take them. In fact, you should not make any changes to your diabetes management plan without checking first with your doctor. It is always better to be prepared than to be surprised by something unexpected. For people with diabetes, this includes having a sick day management plan in place before you get sick.

The article “Sick Day Management” below will help you prepare for COVID-19 or any other illness you may develop.

Sick Day Management

Even a minor illness can cause serious problems for people with diabetes. When we are sick, our body reacts by releasing hormones to fight infection, but this can raise blood glucose (blood sugar) levels and make it more difficult for insulin to lower blood glucose. A little planning can reduce the likelihood of developing dangerously high blood glucose levels if you get sick.

Plan ahead

While you are still healthy, you should talk to your doctor or diabetes care team to create a sick day management plan. Your plan should include your target blood glucose goal during an illness, how often to test your blood glucose and ketone levels, how your diabetes medication schedule or insulin might have to be adjusted, if you should stop taking any other medications, and what warning signs indicate it’s time to contact a doctor. Make sure you keep your sick day management plan where it will be handy when you need it. Prepare a sick day kit that includes:
• glucose tablets to treat hypoglycemia (low blood sugar)
• sugar-free beverages
• a thermometer
• enough blood glucose testing strips
• a ketone meter and strips

Managing your blood sugar

If you are on insulin, continue taking it even if you are vomiting or have trouble eating or drinking. If you are managing your diabetes with medications or if you are taking medicines for other conditions, you may need to stop taking them if you are at risk of becoming dehydrated as a result of vomiting or diarrhea.

Speak with your doctor if you take any of these types of medicines to make sure you know what to do if you get sick:
• blood pressure medications
• diuretics (“water pills”)
• nonsteroidal anti-inflammatory drugs (NSAIDs)
• pain medicines
• sulfonylureas

Be careful about taking over-the-counter medicines. For example, if you have a cough or cold and you are looking for relief from your symptoms, you should be aware that some products contain sugar. Ask your London Drugs pharmacist for assistance in choosing a product that will help you feel better without affecting your blood glucose control.

Stay hydrated

If you are vomiting, have diarrhea, have a fever, or are exposed to excessive heat, you are at risk of dehydration. Be sure to drink plenty of fluids that contain minimal or no sugar. Try to drink at least one cup (250 mL/8 oz.) of sugar-free fluids periodically for a total of at least nine cups (2.2L/72 oz.) daily to prevent dehydration. Good choices of fluids include water, clear soup or broth, herbal tea, and caffeine-free diet pop (such as diet ginger ale). Limit the amount of caffeine-containing beverages you drink (e.g., coffee, some teas, and some types of carbonated soft drinks), because caffeine makes dehydration worse. You may want to consider electrolyte replacement solutions.

Eating while you are sick

If you can, try to stick with your meal plan. If you can’t eat the foods you usually eat, try to consume light foods or fluids that contain 15 grams of carbohydrates every hour. Options include:
• 1 slice of bread
• 7 soda crackers
• 1 medium-size piece of fruit
• 1 twin popsicle
• ¹/2 cup (125 mL) of unsweetened applesauce
• ¹/2 cup (125 mL) of 100% fruit juice
• 2/3 cup (165 mL) juice
• ¹/2 cup (125 mL) regular Jell-O®
• 2/3 cup (165 mL) regular soft drink that does not contain caffeine
• ¼ cup (60 mL) regular pudding or ½ cup (125 mL) sugar-free pudding

If you are not vomiting and don’t have diarrhea, you may also want to try:
• 1 cup (250 mL) of milk
• ¹/2 cup (125 mL) of flavoured yogurt
• ¹/2 cup (125 mL) of ice cream

If you are eating less than normal and the symptoms last for more than 24 hours, you may need to temporarily stop taking some medications, including certain diabetes pills, blood pressure and heart medications, and anti-inflammatory pain medicines, and you may need to stop taking all diuretics (water pills). Check with your healthcare professional before you get sick to find out if any of your medications should be stopped, and incorporate this into your sick day management plan.

Test, test, test

Your sick day management plan should include instructions for what tests you should perform and how often to do them, but the following are some general guidelines to consider:
• Check your blood glucose at least every two to four hours. If it is rising quickly, check it more often, even throughout the night.
• If you take insulin, test your blood or urine for ketones.
• If your blood glucose tests above 16 mmol/L twice in a row, test your blood or urine for ketones every four hours.
• Weigh yourself and check your temperature, breathing rate, and pulse frequently.

When to seek help

There are some warning signs that point to a more serious problem. You should contact your healthcare provider if:
• You are sick for more than 24 hours and aren’t getting better or if you start to feel worse
• You can’t drink enough liquids
• You take any medicines and aren’t sure if you should change your dosage or stop taking them when you are sick
• You take insulin and aren’t sure if or how you should change your dosage
• You have been told to check your ketones and they are moderate to high
• You are unable to keep your blood glucose level above 4 mmol/L

If you can’t reach your healthcare provider and are not getting better, consider going to the emergency
department of your local hospital.

7 Services You Might Not Know Your Pharmacist Offers

You might be used to visiting your local pharmacist to pick up prescriptions, but did you know there are many other ways your pharmacist can help maintain and improve your health? For many years, pharmacists have been taking on expanded roles in our health care system, working closely with patients, their families and collaborating with other frontline health care providers to deliver personalized, team-based patient care.

In celebration of World Pharmacist Day on September 25^th, we’ve rounded up a list of 7 services you might not know your pharmacist offers, from travel vaccinations to smoking cessation consultations. As the most accessible health care providers, it’s easy to take advantage of these services conveniently at your local London Drugs pharmacy!

1. Medication Reviews

The theme of this year’s World Pharmacist Day is “safe and effective medicines for all”. Pharmacists play a crucial role in maintaining patient safety, improving medication adherence and reducing medication errors. One of the many ways they do this is by providing medication reviews. Through medication reviews, pharmacists provide personalized consultations to patients to examine and discuss issues around medication use, side effects, interactions, and anything else related to medication therapy, with the goal of ensuring safe and effective treatments.

2. Vaccinations and Immunizations

Certified Injection Pharmacists are able to administer vaccinations right at the pharmacy. If you haven’t taken advantage of this convenient way of getting vaccinated yet, you aren’t alone. According to a recent survey conducted by Insights West on behalf of London Drugs, only four in ten say they have used this service before.

London Drugs’ Certified Injection Pharmacists can ensure you’re up-to-date with many vaccinations you require, and can administer vaccinations for pneumonia, tetanus, pertussis, shingles, and influenza.

Flu Shots

To make getting your annual flu shot as quick and easy as possible during flu season, you can see one of our London Drugs Certified Injection Pharmacists, who are able to administer flu shots to patients. Patients are encouraged to call the pharmacy to confirm availability of the flu vaccine and that an injection pharmacist is on staff. This is a convenient alternative to public flu clinics, where you may have experienced long lines and wait times in the past.

Travel and Vaccination Clinics

When you’re planning a trip abroad, ensuring you are up-to-date on the appropriate travel vaccines is important. Do you know where to get your travel vaccinations? Only one in three (35%) Canadians are aware that travel vaccinations can be administered by a pharmacist.

Travel and Immunization Clinics are hosted at many of our pharmacies to help prepare you for international travel. Pharmacists will review your immunization history and make sure vaccinations are up-to-date according to provincial, national and even international immunization programs. They can also suggest and administer additional vaccines depending on your planned travel activities, previous immunization history and the local conditions at many common destinations.

3. Emergency Prescription Refills, Prescription Renewals & Drug Modifications

Pharmacists make significant contributions to the quality of drug therapy and patient outcomes by initiating, monitoring and adjusting drug therapy. Traditionally in Canada, the authority to prescribe medications has rested with doctors but as part of Pharmacists’ expanded scope of practice in Canada, pharmacists in many provinces now have the ability to provide emergency prescription refills, renew or extend prescriptions, modify or adapt drug therapy, change drug dosage and even have independent prescriptive authority (in Alberta).

4. Diabetes Management Consults

The most important thing you can do to manage your diabetes is to form a partnership with your healthcare professionals. Our London Drugs Certified Diabetes Educators can assist patients through individualized Diabetes Management Consults. These customized one-on-one consultations focus on blood sugar testing, medication management, preventing low blood sugar, foot care, eating well and getting enough physical activity.

5. Healthy Heart Clinics

Pharmacists are playing a key role in the prevention of heart attacks and other cardiovascular problems, by helping patients understand their risk factors, emphasizing the importance of medication adherence and offering counselling to make important lifestyle changes.

During our one-on-one 45-minute Healthy Heart Clinics, patients have the opportunity to sit down with a London Drugs Patient Care Pharmacist for a customized screening and evaluation. The pharmacist screens for total cholesterol, HDL cholesterol, random glucose and blood pressure, and can determine a 10-year cardiovascular risk factor based on those measurements. They also discuss with the patient how to lower their risk and improve heart health, which include recommendations for changes to their diet, fitness routines or lifestyle. As a collaborative health care provider, the pharmacist may also contact a physician, in order to recommend changes to the patient’s medications, or further medical intervention.

6. Smoking Cessation Consultations

Trying to quit smoking? Your local pharmacist can be a convenient support resource. During a one-on-one smoking cessation consultation, a London Drugs Certified Tobacco Educator will:

Discuss practical tips and advice to help you reduce/quit tobacco
Develop a personalized quit plan to help you stop smoking

In BC, pharmacists can also offer the BC smoking cessation program for nicotine replacement.

7. Hepatitis C Screening Clinics

Hepatitis C Screening is just one example in which our pharmacists provide Point of Care Testing to patients. Point of care testing refers to any medical test or screening that is performed outside of a lab or clinic. The testing happens at a place where the patient is receiving care (such as a pharmacy), making it a convenient option for the patient.

This innovative and potentially life-saving hepatitis C screening is available at select London Drugs locations. Patients can undertake a simple finger prick test at the pharmacy to check if they have been exposed to hepatitis C virus (HCV) at some point in the past. The test, called the OraQuick HCV rapid antibody test, is more than 99% accurate at detecting HCV antibodies and provides results in 20 minutes.

In cases of a positive result, pharmacists refer patients to their family doctor for a diagnostic lab test. Pharmacists provide initial counselling regarding the potential diagnosis and education about the ability to cure HCV.

You can find out which locations offer hepatitis C screening here.

There are even more ways that your pharmacist can help you maintain and improve your health! Just visit them at your local London Drugs pharmacy to learn how.