There are some specific questions that pharmacist should ask when counseling type 2 diabetics.
As the last lines of defense in health care, pharmacists can help to improve patient outcomes.
During a counseling opportunity or medication therapy management (MTM) session with a type 2 diabetic, there are some specific questions that the pharmacist should ask the patient.
Question 1: What is your diet?
Overeating is a common reason why patients become and remain diabetic, but diet programs can be challenging because of easy access to cheap, non-nutritional foods. The general diet recommendations for a diabetic without comorbidities aren’t much different than those for the general population.
It is important for pharmacists to stress avoidance of “sugar bursts” like candy, sugary soda, and white bread. It’s also worth noting that fiber is an important part of a diet plan, which can be achieved through the addition of vegetables and certain fiber-rich fruits.
As a supplement resource, pharmacists can direct patients with diabetes to the newly released Dietary Guidelines.1
Question 2: How often do you exercise?
Exercise programs may seem daunting, but diabetics don’t need to train like professional athletes. American Diabetes Association (ADA) guidelines only recommend 150 minutes of exercise per week, which can be simplified to 30 minutes of exercise per day Monday through Friday.
The ADA recommends moderate-intensity physical activity, but it doesn’t offer specific routines. Nevertheless, pharmacists may suggest a brisk walk around the neighborhood, body-weight exercises like air squats or leg kicks, or high-repetition weight training with light weights.2
Question 3: Which medications do you take for diabetes?
This question can be applied to any disease state, but it has even more relevance in diabetes because the patient may be taking multiple drugs. Asking this question will also help the patient differentiate between their comorbid conditions.
For example, lisinopril and other angiotensin-converting enzyme inhibitors are commonly used as first-line therapy for diabetics with high blood pressure. If the patient’s endocrinologist prescribed lisinopril, then the patient may believe that the drug is used for diabetes, but it isn’t
Question 4: When do you take your diabetes medications?
This question will assess a patient’s adherence to their drug therapy. Timing of administration is an important concept for patients to grasp, as well.
Diabetes medications have a wide array of dosing frequencies and timings that can become quite confusing.
Some medications should be taken before meals, some should be taken with meals, and some can be taken without regards to meals. There are also medications that patients may want to skip when they’re not eating a meal.
Providing proper administration times and the reasoning behind them to patients may curb the possibility of adverse drug reactions.
Question 5: What problems are you having with your medications?
The safety concerns with the newer diabetes medication classes are especially important to know. Most if not all of the dipeptidyl peptidase 4 inhibitors and sodium-glucose co-transporter 2 inhibitors are still under some sort of post-marketing surveillance by either the FDA or the drug manufacturer.
When a patient reports any adverse events or medication errors to you, it is your duty as a pharmacist to elevate the issue to the FDA, Institute for Safe Medication Practices, or the manufacturer.
Question 6: How often do you measure blood glucose?
Blood glucose and A1C tests are key measures that help show either progression or regression in patients with diabetes. Not all diabetics will be measuring their blood glucose daily, but it is still important for them to know their normal range for before or after meals.
Diabetics who don’t measure their blood glucose daily present good opportunities for pharmacist counseling on the symptoms of hyper- and hypoglycemia, while patients who do test their blood glucose daily present great opportunities to review proper technique and inquire further about any issues that they may have with testing.
Whether it’s blood testing, diet patterns, or exercise, pharmacists should attempt to highlight a daily routine for diabetics. Building such a routine helps ensure more overall benefits.
Question 7: What was your most recent hemoglobin A1C reading?
Hemoglobin A1C should be monitored in almost every diabetic. This question gives you the opportunity to explain goals and usefulness of A1C and how it provides a better picture of long-term improvement in diabetes.
Patients may give you a puzzled look when you ask them about their A1C. This may be because they are unfamiliar with it, especially if it is only tested once or twice a year and the physician does not report the results.
1. US Department of Health and Human Services and US Department of Agriculture. 2015 — 2020 Dietary Guidelines for Americans. 8th ed. December 2015. http://health.gov/dietaryguidelines/2015/guidelines.
2. American Diabetes Association. Standards of medical care in diabetes—2015. Diabetes Care. 2015;38:S1-S93.