Pharmacy U speaker Mike Boivin: 5 diabetes tools to help your patients manage their diet

Patient education is a key component of pharmacy practice. Pharmacists are not only expected to provide information on medications, but increasingly asked more detailed information on the disease and its overall management.

Educating a patient not only helps to improve outcomes, but can create the strong patient relationships that build loyalty and grow the pharmacy business.

Pharmacists are expected to provide information on many conditions, but it can be very difficult to provide the real-time information patients require. Fortunately, there are excellent tools that can facilitate disease management and improve the care pharmacists offer.

This article will focus on diabetes management tools. The tools provided can be used by every pharmacist and not just those who are certified diabetes educators (CDE). These tools can help educate and improve the outcomes of this highly prevalent condition.

1.    FIT Forum for Injection Technique

(http://www.fit4diabetes.com/canada-english/)

This tool is a detailed reference on the administration of insulin and proper injection technique. It also includes recommendations on needle length selection, insulin storage, and site rotation. The FIT Technique Plus is a series of patient information to help counsel patients.

2.    Just the Basics and Beyond the Basics

Just the Basics – (http://guidelines.diabetes.ca/cdacpg/media/documents/patient-resources/just-the-basics-healthy-eating.pdf)
Beyond the Basics – (http://www.diabetes.ca/clinical-practice-education/professional-resources/diet-nutrition-beyond-the-basics)

Some of the most commonly asked questions regarding diabetes are related to food.

The Just the Basics tool has some basic dietary information that can be easily integrated into counselling patients with diabetes. The portion size tool is a great teaching aid to help patients better manage their diet.

The Beyond the Basics tool provides information regarding how to tailor diet choices for patients. This tool can help a patient select a wide variety of foods with a predictable effect on blood sugar levels. The ‘helpful hints for educator document’ provides pharmacists with some easy diet recommendations that can be integrated into counselling patients with diabetes.

3.    ABCDEs of Vascular Protection

ABCDEs – (http://guidelines.diabetes.ca/vascularprotection/abcdes)
Drugs for Vascular Protection - (http://guidelines.diabetes.ca/cdacpg_resources/Reference_Guide-Vascular_protective_medications.pdf)

Managing a patient with diabetes is not just about blood glucose control. Most patients with diabetes will die from cardiovascular disease. The Diabetes Canada guidelines provide clear recommendations on strategies that can reduce the patient’s cardiovascular risk. These include managing:

• A1C
• Blood Pressure
• Cholesterol
• Drugs for vascular protection
• Exercise/eating
• Smoking cessation

Pharmacists should consider integrating the ABCDEs into counselling patients with diabetes. Monitoring a patient’s ABCDEs and ensuring patients are taking the medication for vascular protection can also create opportunities for pharmacist services such as pharmaceutical opinions, care plans and adaptation.

4.    SMBG Testing Guidelines

Self-Monitoring of Blood Glucose (SMBG) Recommendation Tool for Healthcare Providers (http://guidelines.diabetes.ca/cdacpg_resources/SMBG_HCP_Tool_lc_final.pdf)

With limits being placed on the number of testing strips by many payers, pharmacists should ensure their patients are testing appropriately based on their current regimen.  Diabetes Canada has developed clear recommendations for SMBG testing. They also provide recommendations on when to increase SMBG testing frequency. This tool also provides pharmacists with guidance on how to adjust insulin therapy based on the different SMBG readings.

By integrating these recommendations into meter training, pharmacists can ensure patients are testing appropriately.

5.    Carbs & Cals

(http://www.carbsandcals.com/)

Carbs & Cals has a book and app that can help patients with diabetes select food. The extensive database provides pictures of different portion sizes of many types of food. For each food choice and portion, the app provides the calories, fat, carbohydrates, protein and fibre. This can help patients who are carbohydrate counting, but also help them make food choices that can lead to weight loss. The app costs under $10 at both the Apple App and Google Play stores.