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JL has diabetes and injects insulin 2-3 times a day. JL is at a holiday party and is struggling with wanting a holiday spirit. Which of the following is the best approach for JL?
A. JL is on insulin and needs to avoid alcohol.
B. JL needs to take extra insulin to cover alcohol.
C. Wine is a better choice than a margarita.
D. For every alcohol drink, JL needs to eat 15 gms of carb.
E. Both C & D.
Click here to test your knowledge!
Join our Live Webinar on December 2 at 11:30 am PST | Earn 1.5 CE | $19
With the surge in new COVID cases, what is the essential information health care professionals and Diabetes Specialists need to navigate this overwhelming crisis?
What are the best practices to care for people with diabetes and COVID-19 in the outpatient and hospital setting?
Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM, has completely updated this critical presentation, to bring health care professionals up-to-date on the current state of COVID and its impact on diabetes care. She summarizes key information including critical teaching points and management strategies for people with diabetes who develop a COVID-19 infection.
Topics Include:
If you miss the live version, your registration guarantees access to the recorded version.
Join us to learn critical information about Diabetes and COVID Management
Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF and Touro University and a nationally recognized diabetes expert.
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
As we continue to navigate this long-lasting pandemic there has been so much loss and heartache.
Years ago I went to a conference on preventing burnout in healthcare providers with Dr. J. Bryan Sexton, associate professor in psychiatry and behavioral sciences at Duke’s School of Medicine and an expert in the idea of resilience. He impressed me and I have talked about his conference to many colleagues over the years.
I loved sharing his wisdom with my clients, because of studies that link resilience to better diabetes self management. (1)
Lately, as I have been struggling with overwhelming feelings of sadness, I have remembered to practice some of his tools to cultivate resilience. Cultivating resiliency is something that takes daily focus. To cultivate means to nurture, grow, and encourage resilient behaviors.
Three Good Things
Humans are hard-wired to remember the negative aspects of our day, but flipping around the natural inclination is simple.
Building resilience is possible by focusing on positive emotions – joy, serenity, hope gratitude, inspiration, pride, love, awe, and amusement.
Promoting positive thoughts and building resilience can be as easy as taking notes each night before bed. Think of three things that happened during the day that went well and your role in the positive outcome, then jot down those three things. Best results for this exercise come after 14 consecutive days. Empirical evidence shows that this elevates brain serotonin with positive effects on our mood that last for months. (2)
Show Gratitude
Grab a pen and paper and write a letter of appreciation to someone- anyone. Take five minutes to explain something they did, how it impacted you and the benefits you received. Whether you share the letter or not, Dr. Sexton said it can have lasting impacts, increasing happiness while lowering depressing thoughts because focusing on benefits forces us to linger on positive thoughts.
Rediscover Awe
Through an “awe intervention,” you can create a sense of slowed down time, which offers a calming sensation and a feeling of having more time available.
Awe also helps us to feel inspired. I call awe intervention, “joyful thanksgiving”. It is a practice that I am doing in which I acknowledge and give a little extra gratitude for the many amazing sights, sounds, tastes, relationships, information, and emotions that excite me and create awe right from the moment when I wake up.
I began to feel grateful for this medicinal food. Oats, blueberries, banana, and nuts contain water soluble fiber which slow the absorption of sugar and fat from food, and therefore help prevent spikes in blood sugar and blood fat, possibly reducing the inflammatory response to food. (3)(4)
Fiber is a super food which provides important nutrition for our intestinal bacteria to live and prosper, that’s why fiber is called a pre-biotic. Vegetables, fruit, whole grains, nuts and legumes remain the single best sources of fiber in the diet. High-fiber vegetables include many of the green leafy vegetables like kale, collard greens, chard, arugula, and even lettuces. Whole-grain sources of fiber include oats, quinoa, barley and rye. Legumes include beans like peas, soy, black, pinto and lentils.
Encouraging our clients to consider adding more fiber rich dishes to the holiday meals this season and perhaps telling them about Dr. Sexton’s tools for cultivating resilience may help them to feel happier and more hopeful and contribute to better blood sugar control.
½ cup unsweetened coconut milk beverage
½ cup old-fashioned oats
½ TB chia seeds
½ banana
1 tsp maple syrup
½ cup blueberries
2 TB chopped walnuts
1/8 tsp cinnamon
Combine coconut milk, oats, chia, banana, maple syrup in a pint-sized jar and stir. Top with blueberries and coconut. Cover and refrigerate overnight. Heat up and sprinkle with walnuts and cinnamon in the morning.
285 calories, 6 gm protein, 57 gms carbohydrate, 7 gms fiber 6 gm fat
Meta-Analysis. Nutrients. 2015 Dec; 7(12): 10369-10387p. 1392:8
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JR is going to stay home for Thanksgiving and decided to prepare a fantastic dinner. JR has type 1 diabetes and injects bolus insulin before each meal. JR takes 1 unit of insulin for each 10 gms of carbohydrates.
Using myfitnesspal to calculate JRs carb intake for the following festive meal, how much insulin would JR need to take?
Click here to test your knowledge!
The winter and holiday seasons can be stressful and wear us down, especially during the pandemic. We tend to spend more time indoors. To help out, we have some suggestions that will not only help with stress management but can also boost your immunity.
Walking outside in nature and drinking in an “oxygen cocktail” feels good, but does it benefit our immunity?
You might be familiar with the term “Forest bathing” or shinrin-yoku. In Japanese, Shinrin means “forest,” and yoku means “bath.” Shinrin-yoku means bathing in a forest atmosphere or taking in the forest through our senses.
Research has demonstrated that trips to the forest can not only make us feel better by lowering muscle tension, boosting sleep, and reducing blood pressure. It turns out being in nature also enhances our immune systems by increasing the number and activity of our lympocytes and killer T cells.
When we walk among trees and plants, we breathe in airborne chemicals from plants called phytoncides.
Plants produce these chemicals to protect themselves from insects, bacterial and fungal infections. Phytoncides help plants fight disease.
These cells kill tumor and virus-infected cells in our bodies. In one study, increased NK activity from a 3-day, 2-night forest bathing trip lasted for more than 30 days.
According to Dr. Qing Li, author of the book, Forest Bathing, the key to unlocking the power of the forest is in the five senses:
To read more, click here.
The holiday season can also be stressful and throw us off our normal routine. This can compromise our sleep and our overall eating habits.
To help everyone feel their best during this holiday season, we have ten strategies for you and your patients. And even if you can’t do all ten, just pick one or a few that you feel you can commit to and succeed with most of the time.
We have created a 10 Steps to Survive the Holidays PDF – a handout that includes the info below to print and share with your friends, patients, and colleagues!
Recorded & Ready for Viewing
Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM, has completely updated this critical presentation, to bring health care professionals up-to-date on the current state of COVID and its impact on diabetes care. She summarizes key information including critical teaching points and management strategies for people with diabetes who develop a COVID-19 infection.
Topics Include:
Join us to learn critical information about Diabetes and COVID Management
Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF and Touro University and a nationally recognized diabetes expert.
See Full Free Resource Catalog
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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
Our November 10th Question of the week quizzed test takers on intestinal bacterial health and diabetes. 40% of respondents chose the correct answer, while 60% did not. We thought that this was an important topic to discuss further, so we can pass on correct info to people living with diabetes.
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question
Question: Intestinal health and diabetes are co-related. Which of the following statements is true?
Answer Choices:
As shown above, the most common choice was option 2, the second most common answer was option 1, then option 3, and finally option 4.
If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.
Answer 1 is incorrect. 26.30% chose this answer. “High levels of intestinal butyrate indicate excess inflammation and increased glucose levels.”
Butyrate is one of the main metabolites produced in the colon by bacterial fermentation of dietary fiber. When it comes to gut health, higher levels of butyrate, a short-chained fatty acid, indicate higher fiber consumption and overall gut health and happiness.
Answer 2 is correct. 39.86% of you chose this answer. “Thicker intestinal mucous lining is correlated with a lower risk of diabetes”.
The image to the right is a great illustration. You can see that the thicker the mucus lining in the intestinal lumen, the less overall inflammation and leaky gut. A diet high in fiber feeds the microbiota in charge of maintaining a thick and healthy mucous lining.
Answer 3 is incorrect. About 19.58% of respondents chose this. “In diabetes, there is an inverse correlation between food diversity and gut bacteria diversity”
There is actually a direct correlation between food diversity and gut bacterial diversity. Enjoy a rainbow of foods, with lots of veggies, seeds, legumes, nuts, fruit, and whole grains.
Finally, Answer 4 is incorrect. 14.25% chose this answer. “Decreasing the prevalence of mucin-producing bacteria decreases diabetes risk.”
Mucin producing bacteria, like Akkermansia Muciniphila, help maintain a healthy mucus lining in the intestinal lumen. This is associated with less overall inflammation and leaky gut. A diet high in fiber feeds the microbiota in charge of maintaining a thick and healthy mucous lining.
We hope you appreciate this week’s rationale!
To learn more about this exciting topic, please join our
“This Webinar is filled with Bev’s energy, knowledge, and passion for diabetes that she replicates in all her teachings. She puts a demand on herself to be a mentor to all. Her information is well organized, full of current/relevant research, and helps CDCES’ view into the future as a changing world impacts diabetics. I find her to be the most exciting and engaging educator and … OUTSTANDING teacher!!” – recent participant
New Webinar topics:
This one-hour complimentary journey will expand your view of how the trillions of bacterial hitchhikers profoundly influence our health. We will discuss how foods, the environment, and our medical practices have impacted our gut bacteria over time and strategies we can take to protect these old friends.
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
Rationale of the Week | Hyperglycemia and Cystic Fibrosis [yikes-mailchimp form=”1″]
The COVID-19 Pandemic is taking a toll on people with diabetes.
Although people with diabetes are not more likely than the general population to be infected by COVID-19, they have much higher mortality rates than people without diabetes once infected with the virus.
The Corona Virus appears to have two portals of entry in humans.
In a recent study released in September in Diabetes Care, “Type 2 Diabetes and COVID-19: A Multicenter, Case-Control, Retrospective, Observational Study by Solerte et al”, the researchers demonstrated reduced mortality, improved clinical outcomes, and a greater number of hospital discharges for those started on sitagliptin on admission.
The COVID-19 virus seems to bind to the DPP-IV enzyme and the enzymatic activity of DPP4 causes overexpression of inflammatory cytokines, exaggerating the inflammatory response.
Since sitagliptin is a DPP-IV inhibitor, the researchers believe that the medication inhibited the virus’s ability to bind to DPP-IV. This had a net effect of decreasing the intense inflammatory response, often termed the “cytokine storm” associated with COVID-19 infections.
This Multicenter, Case-Control, Retrospective, Observational Study followed 338 consecutive patients with type 2 diabetes and COVID-19 admitted to Northern Italy hospitals.
Included in this study were 169 patients on sitagliptin and 169 on the standards of care. All patients had pneumonia and exhibited oxygen saturation <95% when breathing ambient air or when receiving oxygen support.
RESULTS: Treatment with sitagliptin at the time of hospitalization was associated with:
Sitagliptin contributed to a lowered risk and progression of acute respiratory complications for people with type 2 diabetes and COVID-19.
This research suggests that DPP-4 inhibitors can help decrease COVID-19-related immune overreaction in people with diabetes and dramatically improve outcomes.
Read article here >> Sitagliptin Treatment at the Time of Hospitalization was Associated with Reduced Mortality in Patients with Type 2 Diabetes and COVID-19: A Multicenter, Case-Control, Retrospective, Observational Study, Solerte et al. Diabetes Care 2020, Sept
Recorded & Ready for Viewing
Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM, has completely updated this critical presentation, to bring health care professionals up-to-date on the current state of COVID and its impact on diabetes care. She summarizes key information including critical teaching points and management strategies for people with diabetes who develop a COVID-19 infection.
Topics Include:
Join us to learn critical information about Diabetes and COVID Management
Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF and Touro University and a nationally recognized diabetes expert.
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
[yikes-mailchimp form=”1″]
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
COVID cases are surging throughout the United States. Providing the best care for people with diabetes is especially important during this crisis. Which of the following statements regarding diabetes and COVID is most accurate?
Click here to test your knowledge!
Join our Live Webinar on December 2 at 11:30 am PST | Earn 1.5 CE | $19
With the surge in new COVID cases, what is the essential information health care professionals and Diabetes Specialists need to navigate this overwhelming crisis?
What are the best practices to care for people with diabetes and COVID-19 in the outpatient and hospital setting?
Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM, has completely updated this critical presentation, to bring health care professionals up-to-date on the current state of COVID and its impact on diabetes care. She summarizes key information including critical teaching points and management strategies for people with diabetes who develop a COVID-19 infection.
Topics Include:
If you miss the live version, your registration guarantees access to the recorded version.
Join us to learn critical information about Diabetes and COVID Management
Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF and Touro University and a nationally recognized diabetes expert.
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
[yikes-mailchimp form=”1″]
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
World Diabetes Day is celebrated in honor of Dr. Fredrick Banting, whose leadership, tenacity and belief led to the discovery of insulin.
The discovery of insulin has saved the lives of countless millions of people over the past hundred years and will continue to save millions of lives in the near future and beyond.
During a hot summer in 1921, Dr.Banting secured space to test out his theory at the University of Toronto. Along with his colleague, Charles Best, and a bare-bones lab, they conducted dozens of experiments on dogs, which ultimately led to the discovery of insulin.
Dr. Banting and Charles Best began their experiments ligating the pancreases of dogs, thinking this would prevent destruction by the digestive pancreatic juices, and then isolating the extract from the islet cells. They then processed the extract from the islet cells and injected this extract they called “insulin” into diabetic dogs. According to an audio interview with Dr. Best, by July 1921, they had 75 positive examples of insulin lowering blood glucose levels in dogs.
In February 1922, doctor Frederick Banting and biochemist John Macleod published their paper on the successful use of an alcohol-based pancreatic extract for normalizing blood glucose levels in a human patient.
Here are some photos of the first insulin bottles produced by the University of Toronto and Eli Lilly.
Soon, word of their discovery got out and the race was on to produce enough insulin to treat the flood of type 1 patients arriving in Toronto to receive this miracle injection.
But, as with any amazing discovery, there is always more to the story.
One of the biggest barriers to Banting was the simple fact that he was not involved in the field of diabetes research. The idea leading to the discovery of insulin came to him after preparing a lecture on the pancreas and diabetes, a subject he knew little about. He wasn’t a trained researcher and thus securing support for the project was initially difficult.
First Children to Receive Insulin
The first patient to receive insulin was a ‘welfare’ case at Toronto General Hospital – no clinical trial structure to say the least. People from Canada/US flooded into Toronto to receive treatment. Banting struggled with the lack of accessibility of insulin – volume needed issues of purification.
The earliest patients were “selected”, some youths from Canada/US, some soldiers with diabetes (probably because of Banting’s service in the First World War), and then later some select private patients. During this time they were working hard to increase the volume and continue to improve the purification process. Insulin was available for testing in the US, namely through Dr. Elliot Joslin in the late summer of 1922.
Takes a Team
While Best played a critical and important role, credit must also go to Professor Macleod, from the University of Toronto, who provided the lab space, showed Dr. Banting how to operate on dogs, provided his student Best and suggested they switch from saline to alcohol to purify the ‘extract’. Dr. Macleod also secured the support of JB Collip, the 4th man on the team, and the first person to purify insulin for human use. Best is also known for pushing Banting to return to the research during a particularly dark period of failure.
Dr. Banting – Fun and Interesting Facts
Want to Learn More About Dr. Banting?
Visit Banting House FaceBook Page
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