Q&A: Pharmacist Highlights Small Lifestyle Changes That Lower A1c

For many patients, starting insulin or receiving a new diabetes diagnosis is overwhelming, but Jennifer Griffin, PharmD, clinical pharmacist at Harps Food Stores Inc, emphasizes that effective management goes far beyond prescriptions. She explains how she combines objective data—such as daily blood glucose trends, A1c levels, and hypoglycemia episodes—with an understanding of patients’ eating, sleep, and activity patterns to safely titrate insulin and individualize care. Additionally, Griffin highlights the power of small, realistic lifestyle changes, noting that even modest adjustments can significantly improve glycemic control, as seen in a patient who reduced her A1c from above 10% to the 7% to 8% range without initially starting medication. She also underscores the importance of hands-on education—providing meter training, insulin injection coaching, and continuous glucose monitoring guidance—so patients feel confident managing their condition at home. Throughout, her approach centers on patient safety, clear communication with prescribers, and ongoing encouragement to help patients succeed with insulin therapy and long-term diabetes management.

Drug Topics®: Beyond A1C, what are the essential objective and subjective data points a pharmacist must collect and analyze to effectively assess a patient's response to an insulin regimen?

Jennifer Griffin, PharmD: Of course, A1c but we also want to look at other objective data points, such as their blood glucose readings throughout the day to look at their trends and determine if we need to titrate their current insulin therapy Next, we need to know if they're experiencing any episodes of hypoglycemia. So if this is occurring, how often are they having episodes of hypoglycemia? How severe are they and is the patient aware that they're having these episodes of hypoglycemia? How do they feel during those moments? Hypoglycemia can be very dangerous, and it really needs to be monitored. Just like I mentioned in our older patients, we can also look at some subjective data points, such as a patient's eating patterns, their sleep patterns, [and] their physical activity during the day. I love to talk about lifestyle modifications because they're so important and can have such a huge impact on patients' blood glucose control. Additionally, we need to look at comorbidities. What else does the patient have going on health-wise that our patients may be dealing with that could potentially affect their diabetes management?

Drug Topics: What general strategies do you employ to address the common psychological or behavioral barriers patients face when starting or continuing insulin therapy, and what is the pharmacist's role in patient education?

Griffin: So I love to talk about this because getting a new diagnosis of diabetes or having to start insulin therapy, it's a huge lifestyle change for these patients, and I want to make sure that they understand their regimen and they can stick with it at home. If the patient is interested, I'll do technique coaching with them, where we pull out all of their supplies, and we walk through the entire process with patients who are newly diagnosed with diabetes. I frequently sit down with them, and we do blood glucose meter training. We go over the whole process, and they show me that they can do it, and that makes them so much more confident that they will be able to test their blood sugar on their own at home. You could do this with anything: blood glucose meter training, insulin injection technique, and even how to apply a continuous glucose monitor. My main goal with patients is to make sure that they don't get home and they're confused about what they actually need to do. Even though this is a learning process, I want them to know that they can do it and that their pharmacist is there if they need anything or have any questions, and I think that support and encouragement goes a long way in these situations, and it's a joy to get to be in a situation where we can support them in that way.

Drug Topics: What professional communication best practices should a pharmacist follow when recommending an insulin dose or regimen modification to a prescribing physician?

Griffin: So this goes for all conversations that I have with physicians. I approach this conversation with keeping patient safety and the patient's well-being at the center of the conversation because everyone's intention in this situation should be making the best decision for the patient. So before I call a patient about a patient's medication regimen, I like to have all my ducks in a row this way that I can be very succinct in my reasoning. First, I want to present the data that is prompting me to make this phone call, and then I'll move forward with evidence-based recommendations. So I always like to be prepared with recommendations to start a conversation about what possible solutions to move forward with.

Drug Topics: Is there anything else you would like to add?

Griffin: With lifestyle modifications, they don't have to go out and feel like, "Oh, I'm going to go run 10 miles today, and that's going to be my exercise," or they're cutting their diet back to some to just nothing, and so small changes can go a really long way, and I like to give patient examples. We had a patient that was newly diagnosed with diabetes. Her A1c was over 10, and she did not want to do medications at all. That's the situation with an A1C that high that we want to start; we want to move into some kind of insulin regimen. This patient was like, Just give me time. Let me make some changes. And she went home, and she made changes, and it was impressive. She came back with an A1c in the in between 7 and 8. That just goes to show that those lifestyle modifications and those changes go a long way, and so continuously encouraging our patients to make small changes. It doesn't have to be drastic. Anything is going to make a difference.