Diabetes Management Pragmatic Topics Flashcards
What is Certified Diabetes Educator -
A Certified Diabetes Educator (CDE)® is a health professional, committed to excellence in diabetes
education, who has a sound knowledge base in diabetes care/management and education processes, as well as good communication skills and who has passed the Canadian Diabetes Educator Certification
Board (CDECB) exam.
To become a CDE:
● Must be a HCP licensed by a Regulatory Body in Canada (ie. nurse, pharmacist, MD, dietician,
physiotherapist, psychologist)
● Have accumulated 800 hours of diabetes education experience over previous 3 years
● Write and successfully pass exam (held annually in May across locations within Canada)
Recertification: Rewrite exam every 5 years or choose to submit credit portfolio (250 Diabetes
related CE hours accumulated within 5 yr)
Why become a CDE?
With the increasing numbers of diabetes worldwide, it is a chronic disease state that we as pharmacists see on a daily basis. DM is a serious condition with
potentially devastating complications that affects all age groups worldwide.
In 2012 - 371 million people had diabetes
Currently:
● 11 million Canadians have pre-diabetes or diabetes
● Nearly 1 in 3 Canadians are living with prediabetes or diabetes (including Type 1 & 2)
In 2030 - 3.7 million people alone in Canada projected to have diabetes
Why become a CDE? - continued
CVD is the leading cause of death in diabetic patients (2-4 fold more than those without diabetes).
We can screen, refer, educate, monitor, adjust medications, prescribe, order lab
tests, and frequently follow up with patients given our ease of access, reducing strain on primary care physicians
If we can screen and provide access to diabetes experts
Immerse yourself in various aspects of diabetes
to enhance your undergraduate training
● Diet ● Exercise ● Footcare ● Natural Health Products ● Complications: Erectile dysfunction, CKD, Retinopathy, Neuropathy, CVD
special Populations: ● Children/Youth (Type 1 and Type 2) ● Gestational Diabetes ● Diabetes in Pregnancy (Type 1 and 2) ● Indigenous ● Elderly ● Diabetes in Driving
Using APA in practice - Prescribing
Why prescribe in Diabetes Care?
● Pharmacists are EXPERTS in pharmacotherapy management of diabetes and have excellent training in managing drug therapy
● We are very accessible HCP and reduce pressure on physicians/medical clinics.
● Given this accessibility, we also are able to generate and maintain long standing patient-pharmacist relationships.
● Pharmacists still work in collaboration with many
● primary care physicians and endocrinologists to help patients reach their management goals
Pharmacist assessments
We can assess the patient and tailor therapy based on various patient specific
characteristics through prescribing and involve other HCP when a further
collaborative approach is needed:
We can assess the patient and tailor therapy based on various patient specific characteristics through prescribing and involve other HCP when a further
collaborative approach is needed:
■ Established cardiovascular, renal disease, or heart failure
■ Renal Function
■ Targets
■ Reducing risk of hypoglycemia
■ Contraindications and avoid potentially dangerous drug-drug interactions and
drug-condition combination
■ Weight gain/loss neutral: DPP4, biguanide, acarbose
Loss: GLP1-RA, SGLT2i Gain - SU, meglitinides, TZD, insulin
● Sick Day Management - SADMANS
○ Sick Day Management
○ DC Pt resource
○ RxFiles
● Cost
● Insulin adjustment
○ Insulin Prescription Tool
● Compliance and Adherence
How we screen our patients?
We see countless patients daily and it is important to be screening risk factors for
diabetes to prevent the disease from progressing.
Retinopathy, neuropathy and nephropathy are often present at diagnosis so if we
screen regularly, we can initiate early treatment and slow disease progression and
complications.
Diabetes Canada Interactive Screening Tool
Obesity, hypertenson, bloodwork
Monitoring and follow up with your DM patients
● Regular review by pharmacist at each visit
● May need to focus on 1-2 items per visit
● Regular assessment of glycemic control CV/Renal status
● Screen for complications (eyes, feet, kidneys)
Review efficacy, side effects, safety and ability to take current medications
● Reinforce and support healthy behaviour interventions
● Get patient involvement in the decision making for better success
Calendar system on computer
SMBG: Review Diabetes Canada
Online Tools for HCP
Capillary Blood Glucose
One Touch, Ascensia/Bayer, Accu Chek, Freestyle,
Flash Glucose monitoring: Libre 2, Dexcom
You have an A1C - now what do you do with it?
As a pharmacist, you can assess blood glucose control using A1C, fasting
glucose, log books of SBGM and online SBGM results.
If patient is not at individualized target, then we as pharmacists can recommend,
adapt, or prescribe (with APA) drug therapy to ensure patients are able to reach
their targets. CPG suggest reaching target within 3-6 months.
Use this online tool to get recommendations on starting treatment and intensifying
when not at target
Engage your patients in decision making
Engaging your patients
How do we engage our patients?
What if there are multiple issues that you notice in your patients that you may want
to focus on/target? How do we approach the patient?
Ensure your practice is client centered rather than clinician centered
Goal setting
Assess their RICk - Readiness, Importance, Confidence and knowledge
You will be introduced to Health Change Methodology in Pharm 420
Exercise - What do we expect patients to do?
GPGs recommends a minimum 150 mins of moderate to vigorous intensity aerobic exercise each week, spread over at least 3 days of the week, with no
more than 2 consecutive days without exercise.
Things to think about:
● Who is safe to start?
● Need to perform stress test?
● What about Type 1 diabetics using insulin - how would they adjust insulin?
● Professional athlete? - hockey player, triathlon, long distance running
Other situations to consider
● Ramadan or periods of fasting
● Travelling overseas with Insulin - dosage adjustments/holding doses due to time zone changes?
● High intensity/long duration sporting events (Type 1 MDI, insulin pump etc)
● Going for a colonoscopy or surgery
● Long haul truck driver (managing lows)
● Young toddler with picky, erratic eating using insulin
● Teenage girl omitting insulin to avoid weight gain or has eating disorder
● An unmotivated patient who is not willing to intensify therapy, perform SBGM, believes an extremely elevated A1C is satisfactory
● Patient is needle phobic (afraid to perform SBGM or use injectable therapy)
● Encourage use of medical bracelets/identification for those at risk for hypoglycemia
● Glucagon - Treating hypoglycemia subcut, IM or intranasally (Baqsimi)
