Counselling diabetic patients

1. Diabetic Counseling
Rph/ Sara Saber
Clinical ph diploma Ain Shams university
Counseling Diabetic
Patient
Rph/ Sara Saber
Clinical ph diploma Ain Shams university

3. • 1 in 11 adults has diabetes (425 million).
• 1 in 2 adults with diabetes is undiagnosed (212 million).
• 1 in 6 births is affected by hyperglycemia in pregnancy.

4. • Over 1 million children and adolescents have type 1 diabetes.
• Three-quarters of people with diabetes are of working age
(327 million)
• Two-thirds of people with diabetes live in urban areas (279
million

7. MIDDLE EAST AND NORTH AFRICA
Prevalence
 Countries with highest age adjusted comparative diabetes are Saudi
Arabia (17.7%).
 Saudi Arabia is the highest number of people with type 1 diabetes
in children and adolescents(0-19 years) in 2017.
 The countries which allocated the largest share to diabetes were
Saudi Arabia(24%).

8. Role of pharmacists in diabetes management
Due the significant gaps between reaching the goal of “optimal
medication therapy” and the current state of medication use.
The pharmacist's role in caring for diabetic patients has expanded.
Pharmacists utilize their clinical expertise in monitoring and
managing diabetes medication plans to positively impact health
outcomes and empower patients to actively manage their health.
The pharmacist can educate the patients about the proper use of
medication to assure safe, appropriate, cost-effective diabetes
medication use.

10. Essential components of diabetic counseling
I. Counseling regarding the disease:
The diabetic patients should be explained that the disease is
lifelong, progressive and needs necessary modifications in
the lifestyle pattern. strict compliance with the prescribed
medication.

11. Type 1 Diabetes
• Body does not make insulin.
• Usually develops in children or young adults.
• Normal Weight.
• Must take insulin daily to live.

12. Why is Insulin so
Important
•If the sugar stays in your blood – it doesn’t do
your cells (body) any good.
•The sugar has to get inside the cells for the body
to use it.
•Insulin is like a key that opens up the door and
allows the sugar to get out of the blood and
inside the cell where the cell can “burn” the fuel
for energy!

13. .
Without insulin. With treatment of insulin.

14. Type 2 Diabetes
• Cells do not use insulin properly.
• Not enough insulin being produced.
•Becoming more common in children due to obesity.
•Many people with type 2 diabetes may remain unaware of their
condition for years as the symptoms become over a period of time.

15. Gestational Diabetes
Mellitus (GDM)
• High blood sugar during pregnancy in non-diabetic
person
•Studies suggest the disease affects between 1 and 14
% of pregnancies in the United States each year
•Risk factors for gestational diabetes include
Prediabetes (blood sugar that's elevated, but not
high enough to be called diabetes)
High blood pressure
A family history of type 2 diabetes
Hormone disorders
 obesity.

16. •Can cause large birth weight babies
• Must tightly control sugar during pregnancy
• Goes away after pregnancy, but many women go on to develop
type 2 diabetes
•All pregnant women should be screened for GDM between 24
and 28 weeks of pregnancy.

18. Know why it is important to take your medicines as
prescribed.
Know the medications you are on for diabetes .
Know the possible side effects of your meds.

19. All about Insulin
• Used in patients with type 1 and type 2 diabetes
• Used to replace the insulin your body is no longer able to
make
Available in different formulations
• Short-acting insulin to take with meals
• Long-acting insulin to provide baseline insulin
• Insulin mixes
• Come in vials or pens

23. Prandial (Meal)
Insulin's
Humulin R®, Novolin R®
Actrapid®
PID®
Novorapid® , humalog®
apidra®
APIDRA®
Clear
Rapid-Acting
Inject these 15 minutes before
meals
Can inject right before meal or
immediately after finishing meal
Regular” insulin
Clear
Short-acting
Inject these 30 minutes before
meals

24. Basal
Cloudy
Lasts about 12-18 hours
Inject these at consistent times, as
prescribed
Usually taken twice a day
Intermediate long-acting analogue
Clear
Longer acting, usually taken once
or twice a day

25. Premixed insulin
• Cloudy
• Usually taken twice a day with meals.
• Longer-acting part tends to work better when taken
later at night (8-10pm) than when taken with supper

26. Insulin Delivery
• Syringe
•Pen Device
•Pump
•Inhaler

27. https://www.youtube.com/watch?v=WWS4rw
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32. Insulin Pumps/Pods
https://www.youtube.com/watch?v=t7ajHnpa
Lpk
• External insulin pumps connect to narrow,
flexible plastic tubing that ends with a
needle inserted just under the skin
• The insulin pump delivers both basal and
bolus doses of insulin .
• Three programmable ways to deliver insulin
 Basal rates
 Bolus doses
 Correctional doses

33. Injection sites

34. .

35. Insulin Care
• Refrigerate all insulin vials while not in-use
• May keep individual insulin vial at room temperature once in-use
• Just avoid exposing vials to high temperatures (over 30 degrees C) for
extended periods
• Never freeze insulin – do not use after it has been frozen.
• Whether kept in refrigerator or at room temperature, most insulin
vials should be discarded 4 weeks after first dose was drawn from it
Exception: Levemir is good until 42 days after first use

37. Insulin - Side Effects
• Hypoglycemia = low blood sugar
If you experience these symptoms, you
need a quick source of sugar: juice,
hard candy or glucose tablets
• Soreness or redness at injection site
You can minimize this by rotating the
injection site each time you administer
insulin

39. Diabetes Pills

40. Metformin
• Tells the liver to stop sending out sugar
• Can help people lose some weight
• Main side effects are upset stomach and diarrhea ,vit B-12
deficiency.
• These usually get better after about 1 week
•Taking with food can help.
• Stop if undergoing procedures using iodinated contrast dye
because risk of nephrotoxicity then initiate after 48hrs.

41. Sulfonylureas
• Main thing to watch out for is having too many low blood
sugars, If this happens, your doctor will give you a lower
dose.
• Take the same way everyday
• Glucotrol XL cannot be crushed or cut in half; might see its
empty shell in toilet

42. Meglitinides
• These tell the pancreas to make more insulin
• These are taken with meals, so you skip a dose if you
skip a meal.
• Main side effect to watch out for is low sugars

43. (Gliptins)
•Usually given once a day and can be taken with or without
food
•You may need a lower dose if you have kidney disease

45. A. Diet: Dietary control is the mainstay of treatment in type 2 diabetes and
an integral part in type 1 diabetes
Carbohydrates
Fat:
Fiber
B. Exercise and physical activity: Exercise can help to promote weight
loss and maintain ideal body weight when combined with restricted
caloric intake
C. Smoking: