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Diabetes Toolkit for Pharmacist to Build Better Relationships with

Clients Seeking Blood Sugar Management

MARILYN MILLS, MS,LD,RD,CDE

CLINICAL DIETITIAN AND DIABETES EDUCATOR

Statement of disclosure

The purpose of this activity is to provide learners with knowledge and practical application of diabetes education and nutrition therapy in the treatment of diabetes and pre-diabetes.

There is no conflict of interest for the presenter, planning committee members, or content reviewers.

There is no commercial support for this program.

The requirement for successful completion of this program includes attending the entire program and return of the post quiz.

Objectives

Differentiate criteria in the diagnosis of Type 1 and Type 2 and Pre-Diabetes.

Describe 2 roles of Pharmacist in offering diabetes education to assist their clients/patients with diabetes.

Describe 3 Nutrition Fact changes to the New Food Label of 2020.

Describe recommendations of when to test and interpreting glucose results for fasting and random blood glucose monitoring during a glucometer instruction to the diabetes client/patient.

Identify when to use glucose tablets.

Recognize at least two resources for education and ongoing support for their clients/patients.

Diabetes Fast Facts

Total: 30.3 million people have

diabetes (9.4% of the US population)

Diagnosed: 23.1 million people

Undiagnosed: 7.2 million people

(23.8% of people with diabetes are

undiagnosed)

Diabetes is the 7th leading cause of death in New Hampshire.

In 2013, 9.2% of New Hampshire adults reported having been

diagnosed with diabetes.

Approximately, 6.8% of New Hampshire adults reported having

been diagnosed with prediabetes, a risk factor for type 2 diabetes.

New Hampshire Department of Health and Human

Services Division of Public Health Services

What is Diabetes?A problem with glucose transportation

Type 1

The Pancreas has stopped making

insulin suddenly.

Fasting blood sugar usually over

200

HbgA1C : >6.5% likely higher

Changes in vision, increased thirst and urination, weight loss

Since Insulin is necessary to sustain life, the person must take daily

insulin (several times daily)

Type 2

Your body is making insulin, even

likely making too much, but it’s not doing the job it should

Insulin resistance

HbA1C >6.5% (even one time)

No dramatic symptoms: maybe tired or feels loss of interest, needs

new glasses, tingling in feet, sugar “coma” (feels very fatigue after high carb meal)

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World J Gast roenterol 2018 August 14; 24(30):3361-3373

Plate method

Food Breakdown

Carbohydrate

Protein

FatFiber WATER

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What is Carbohydrate Anyway?

Sugar from “Mother Nature” or the “Keebler Elves”

Sweets: candy, desserts, added sugar, honey, maple

syrup even coconut sugar, fruit, fruit juice and milk

Starchy vegetables: potatoes, corn and peas and

winter squash, beans and legumes

Grains: wheat, oat, rice, corn, barley, quinoa and

foods made from these items (CEREAL, BREAD, etc)

Let’s Read a Food Label

Reading Food

Labels

“NOT JUST

SUGAR”

IT’S ABOUT

SERVING SIZE

TOTAL CARB

GRAMS

DIETARY FIBER

How Much

Sugar is in it ?

Daily added sugar

intake for Women and

Children: 6 teaspoons

Daily added sugar

intake for Men: 9

teaspoons

How Much Carbohydrate Should I

Eat?

Meals

Gals: 30-45 g per meal

Guys: 45- 60g per meal

Overall for Day:

Not less than 100g

Spread out the Carb throughout

the day

Snack

Gals: 6-15g per snack

Guys: 10-20 g per snack

Limit to 2-3 daily

Less than 5g are FREE Carbs

Should I follow a Diet?

Atkins Very Low Carbohydrate (50g daily)

Paleo?

Weight Watchers Points?

Whole 30?

Keto?

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Should I Rx: Keto Diet?

Ketogenic diets data if followed 1-2 years

↓ Wt ↓ BS ↓ BP, ↓Triglycerides, ↑HDL Chol ↓LDL ↔ total Chol

KETO diets are strict!

20 g Carbohydrate/day 5% calories

High Fat

Moderate Protein

Quality foods (nuts, healthy oils, fish, eggs, veggies)

Highly processed (commercial engineered bars, fast food

cheeseburger, no bun, artificial sweeteners

Diane Vizthum, MS, RD, CSSD, LDN

Johns Hopkins Institute for Clinical and Translational Research

CUTTING OUT CARBS CAN ↓ YOUR ENERGY LEVEL

EATING MORE FAT, ESPECIALLY SATURATED FAT → ♥ DISEASE

EATING MORE PROTEIN, ANIMAL (RED MEAT) PROTEIN → KIDNEY FUNCTION OR CERTAIN CANCERS

Nutrition Therapy: What should you

recommend for your patient ?

Mediterranean Diet

Skip sugar, ↓ red meat;

Eat more lean animal protein; plant protein

Eat oily fish, nuts (Omega 3); ♥ olives and oils (MUFA)

Eat whole foods: whole grains, high fiber, lower carb

vegetables, whole fruits

Eat ↓ processed foods

Intermittent Fasting

Increased interest in this eating pattern

Limited studies available for Type 2 Diabetes

3 Studies showed intermittent fasting in

consecutive days of restriction or by fasting 16

hours per day

Resulted in weight loss

Did not improve HbgA1C compared to

non- fasting eating plan

Calls for more research

Diabetes Management & Nutrition Guide

The ADA (American Diabetes Association) released recent Overview of what’s New in Nutrition Guidance for persons with Diabetes and Prediabetes

Healthful Eating Pattern

No Single Nutrition Plan

No Ideal % of Calories from Calories, Protein and Fat for Everyone

Eat more non-starchy vegetables

Minimize consumption of added sugars and refined grains

Choose whole foods over highly processed foods

Replace Sugar-sweetened beverages with water as often as possible

Less

High Calorie

High Carb

Low Fiber

More

Lower Calorie

Lower Carb

High Fiber

Diabetes Educator Diet Recommendations

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Where are

patients with

Diabetes

Getting their

Education?

Doctor’s Office

Hospital Outpatient Diabetes Programs

Community Health Center

Minute Clinics

Pharmacies (Hospital and Retail based)

Online

Pharmacists Role in Diabetes Management

Medication info: action, dosage timing,

interactions and side effects

Teaching How to use Glucometer (meter,

testing strips and supplies)

Frequency of testing

Supporting goal blood sugar range (80-130 mg/dl); less than 180

mg/dl 2 hours postprandial (after start

of meal)

Treatment of low blood sugar with emergency

glucose (glucose tablets)

Diet info: Carbohydrate Counting info

Identify education needs

Making referral for formalized diabetes

education

Prediabetes Fast Facts

Total: 84.1 million adults aged 18 years or older have prediabetes (33.9% of the adult US population)

65 years or older: 23.1 million adults aged 65 years or older have

prediabetes

1 in 3 persons have Pre-Diabetes

9 in 10 Don’t know they have Pre- diabetes

doihaveprediabetes.org.

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Pre-DiabetesNot a “touch of sugar”

People have prediabetes if their blood sugar is higher than normal,

but not high enough to be diagnosed with type 2 diabetes

Prediabetes puts you on the road to developing type 2 diabetes as

well as heart disease and other health problems

How is Pre-Diabetes Diagnosed?

American Diabetes Assn: your A1C is 5.9-6.4

Best Way to Manage Pre- Diabetes

GET HEALTH EDUCATION GUIDANCE AND SUPPORT DPP (DIABETES PREVENTION PROGRAM) PARTICIPANTS OF THE LIFESTYLE GROUP HAVE A LOWERED RISK OF DEVELOPING TYPE 2 DIABETES

MOVE MORE (150 MINUTES PER WEEK)

LOSE 7-10% CURRENT BODY WEIGHT

MAKE SOME LIFESTYLE CHANGES

Getting Help with Your Diabetes and Pre-Diabetes

Elliot Center for Diabetes Education and Management

Certified Diabetes Nurses

Registered Licensed Dietitians

Endocrinologist

Nurse Practitioners

Triage Nurses

Pharmacists

Medical Assistants

Pharmacy Technicians

References

American Diabetes Association. “Economic Costs of Diabetes in the U.S. in 2012.” Diabetes Care. . http://care.diabetesjournals.org/content/36/4/1033

Introduction: Standards of Medical Care in Diabetes 2018 Diabetes Care 2018 Jan; 41 (Supplement 1): S1-S2. https://doi.org/10.2337/dc18-Sint01

Warshaw,H ADA’s 2019 Nutrition Therapy Consensus Report Today’s Dietitian 2019;21(7) :36-39.

Evert, A.. M. et al. Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report Diabetes Care 2019Apr; dci190014. https://doi.org/10.2337/dci19-0014

Newby O, Gray D. Culturally tailored group medical appointments for diabetic Black Americans Journal for Nurse Practitioners 2016; 12(5); 317-323.

Cline JC. Nutritional aspects of detoxification in clinical practice. Alternative Therapies 2015;21(3):54-62

Vizthum D. Keto: fad diet or health benefit? [published online March 13, 2019]. Cardiology Consultant.