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the pharmacist’s essential role in diabetes management
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the role of the pharmacist is also to counsel patients on their diabetes, helping to support their management of medications.
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this article was produced by the healthing editorial team with the support of a grant from diabetes canada. while diabetes canada made the production of this article possible, they did not have any editorial influence or control over the content, including review prior to publication.
shailesh desai, a retired pharmacist and diabetes advocate, was diagnosed with type 2 diabetes after a routine blood test in 2014. he managed to keep his blood sugar in range without medication for about five years, watching his diet and keeping physically active.
but then he experienced a mild myocardial infarction, a “mini heart attack” that required bypass surgery to open new pathways for blood flow to his heart. following his recovery, he started medication for his type 2 diabetes, which he continues today.
before retiring, the people who would come to his pharmacy with a recent diagnosis of type 2 diabetes were often uncertain about their symptoms and medications. there is still stigma surrounding the condition, where people might blame themselves because of their eating habits, being overweight or inactive. but the reality is that diabetes is highly complex, rooted in genetic predisposition, environmental and lifestyle factors.
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that’s where pharmacists can help. with family doctor shortages and busy specialists, pharmacists are the most accessible health-care provider for people with diabetes. medication is an important tool to manage the condition, and understanding the dosing, technological devices and troubleshooting low or high blood sugar is an ongoing challenge. the more support people have with education and management, the better.
“people are reluctant, they’re not too sure what’s happening and so on. or ‘oh, it’s ok, i got medication for three months. i don’t need it anymore,’” desai, 65, recalls. he would take the time to gently explain that one of the reasons the person’s blood glucose levels were normal was because of the medication. and if their diabetes goes untreated, there can be consequences in the long-term to kidneys, eyes, nerves and memory function.
“now it’s under control, so go slow. continue your medication. and if we don’t do that, these are the challenges,” he says. “that’s the way i would approach my patients. it was very easy for them to come and talk rather than me pushing.”
most people have some type of health concern, desai says, and he brought his own health journey to his pharmacy practice, helping support his customers with his professional knowledge and personal experience. he says his career strength is operational management, which he learned early on as a kid growing up in mumbai, india where he helped with medication inventory for his physician father’s dispensary. but he’s also compassionate and personable, the softer skills that pharmacists can bring to people in the community.
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“i was diagnosed with rheumatoid arthritis 25 years ago,” says desai, who lives in mississauga, ont. “i was going through my regular blood work and all that, so blood glucose was being checked on a yearly basis. because of my rheumatoid arthritis medications, i had to go for a liver function test every three months. so that routine and yearly blood work and everything else was being looked after. so it’s not that i was not taking care of myself, i was totally on top of it.”
pharmacists are a support system for diabetes care
according to a national survey by diabetes canada, 40 per cent of people with type 1 diabetes and 56 per cent of people with type 2 diabetes never or rarely ask for support to help manage their diabetes when they need it.
“when you initially go into pharmacy, you’re thinking, i’m the medication expert, but really it’s about building trust. people come in, they see you and over time you get to know different things about them,” says janet chong-lee, a scarborough, ont. pharmacist for 18 years, health-care leader and certified diabetes educator (cde). she has over a decade of experience advancing integrated, community-based models of care for older adults and underserved populations in ontario.
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“you’re supporting them with compassion, because yes, it’s about medications, but there’s other aspects of their health (that you know and support).”
she says that pharmacists aren’t always top of mind for people when they think about diabetes, but they should be. for those pharmacists in community settings, the challenge is the competing services. they offer vaccinations, diagnose and treat minor ailments, help with billing issues, fielding questions and offering patient consultations. “so public education about the pharmacist’s role in diabetes care can fall behind the other priorities.”
instead of a poster about vaccinations, she’d like to see a poster or flyers of someone with a glucometer that reads ‘confused about blood sugar readings? ask your pharmacist.’ or, ‘questions about insulin? ask your pharmacist” to remind people that pharmacists are accessible experts. or discuss with the pharmacy team to ask if they have any questions about their diabetes when they fill their diabetes medication or test strips for blood sugar testing . “so it’s a whole new team approach as well,” she says, advising collaboration to help inform the public about the pharmacist role in diabetes care.
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“i definitely think that we need to work harder to let the public know diabetes is a population health issue that we need to catch sooner,” chong-lee says, noting the need for building capacity for blood sugar screening to detect diabetes. “one in three canadians will be diagnosed with prediabetes or diabetes, but there are people who may otherwise not access the traditional health-care system. so how do we catch these individuals?”
easing the burden of self-management
the stigma of diabetes also compounds the challenges of access, not only around getting blood sugar screening but affordability, where people can’t afford their insulin needles or the medications, but don’t want to admit this to their pharmacist (or anyone else). pharmacists as accessible health-care providers for diabetes care need to ask people questions and normalize the fact that everything is expensive, she says, adding that diabetes management doesn’t exist in isolation. people often have multiple chronic conditions and each comes with its own appointments, monitoring and medications.
“the burden of self-management actually accumulates and increases, and the treatment burden can be very overwhelming. because you only have so much time and energy to do your work and manage your home, managing your own health can fall by the wayside.”
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the role of the pharmacist is also to counsel patients on their diabetes, helping to support their management of medications. another population in need of this support is people with cognitive impairment or undiagnosed cognitive impairment who are on insulin for their diabetes but may be struggling with the responsibilities.
“that’s one thing that stuck out to me a lot was i would assume that people can manage the medications. all i had to do was just put it in the bottle or put it in the blister pack,” she says of her early days as a pharmacist.
“one thing we need to be mindful of as pharmacists is to make sure we’re assessing that people can manage their care. and more broadly i would say this is about equity and access. people can’t afford healthy meals and we know that food is what’s driving whether or not your blood sugar goes up or they’re relying on food banks or inconsistent meals. people are reusing lancets or insulin needles to save money. and if they have an impairment, maybe they’re not even remembering to change their needles and they’re using the same needles over and over again,” she explains of mounting concerns.
“these realities significantly affect the management of diabetes, and it’s important for all health-care providers to recognize.”
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