Ramadan & Fasting Considerations for People Living with Diabetes

Ramadan Mubarak…. Happy Ramadan.

This evening, Ramadan begins. It is the most important spiritual time for the 1.8 billion Muslims around the world.

‘Have a generous Ramadan”

In Islam, Ramadan is the month in which the first verses of the Quran, were revealed to Prophet Muhammad. In observance, many Muslims fast by abstaining from food, drink, smoking, and sex, from pre-sunrise to sunset. This fasting achieves greater “taqwa” or “consciousness to God.”

As Diabetes Care and Education specialists, we have the chance to provide tools for those who fast while keeping diabetes in mind.

The Association for Diabetes Care and Education Specialists (ADCES) put together some helpful handouts to better support people who are fasting and living with diabetes.

Below is the list of resources shared by ADCES

To read more about Ramadan, click here.

To take our Question of the Week that considers Type 1 and fasting during Ramadan.

On Sale | Now just $24.95
ADA 2021 Standards of Medical Care in Diabetes Book

The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.

One of the most important pieces of literature to read prior to becoming a Diabetes Care and Education Specialist and for clinical practice, the Standards of Care book is a study must!

The book includes:

  • ADA’s standards for diagnosing and treating diabetes
  • Nutrition recommendations and principles
  • Position statements on managing diabetes and its complications in various settings

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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.

Finding Gratitude During a Pandemic

As we all prepare for the holidays this year we may be having a difficult time feeling thankful.

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.

Dr. Sexton suggests these three ways to increase resilience.

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. 

Today as I was practicing my joyful thanksgiving I paid special attention to my breakfast of oatmeal, blueberries, banana, walnuts and cinnamon. I love oatmeal in the fall and winter months.

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.

Blueberry-Banana Overnight Oats

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

  1. Understanding the links between resilience and type-2 diabetes self-management: a qualitative study in South Australia . Arch Public Health. 2017; 75: 56.
  2. Seligman, Steen, Park & Petersen (July-August 2005). Positive Psychology Progress: Empirical Validation of Intervention. American Psychologist
  3. The Metabolic Effects of Oats Intake in Patients with Type 2 Diabetes: A Systematic Review and

 Meta-Analysis. Nutrients. 2015 Dec; 7(12): 10369-10387p. 1392:8

  • Chandalia, M., et al., Beneficial effects of high dietary fiber intake in patients with type 2     diabetes mellitus. N Engl J Med, 2000. 342(19):

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Forest Bathing | Oxygen Cocktails can Boost Your Killer T Cells

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.

Phytoncides are Natures Immune Boosters

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.

When people breathe in these phytoncides, our bodies respond by increasing the number and activity of a type of white blood cell called natural killer cells or NK.

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.

Boost your immune system and state of mind.

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:

  • Let nature enter through your ears, eyes, nose, mouth, hands, and feet.
  • Listen to the birds singing and the breeze rustling in the leaves of the trees.
  • Look at the different greens of the trees and the sunlight filtering through the branches.
  • Smell the fragrance of the forest and breathe in the natural aromatherapy of phytoncides.
  • Taste the freshness of the air as you take deep breaths. Place your hands on the trunk of a tree.
  • Dip your fingers or toes in a stream. Lie on the ground. Drink in the flavor of the forest and release your sense of joy and calm.
  • This is your sixth sense, a state of mind. Now you have connected with nature. You have crossed the bridge to happiness.

To read more, click here.

Surviving the Holidays – 10 Steps to Success

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!

COVID & Diabetes Update – Navigating a Crisis

COVID & Diabetes Update
Navigating a Crisis

Recorded & Ready for Viewing

Purchase Now | 1.5 CEs
Includes Handouts, Video & Podcast

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:

  1. Discuss the current state of diabetes in the United States.
  2. Describe the relationship between COVID and health care disparities 
  3. Explore the impact of COVID infection on those with pre-existing diabetes.
  4. Discuss treatment strategies for COVID and diabetes, including new vaccines.
  5. List critical teaching points for people with diabetes and COVID.

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.

FREE Resource Catalog

See Full Free Resource Catalog

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AccreditationDiabetes 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.

Happy World Diabetes Day

Today, November 14, is Dr. Banting’s Birthday

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. 

Historical Insulin Powerpoint Slides – here is a collection of some of my favorite powerpoint slides, depicting 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

  • Sold insulin patent for $1
  • Was wounded during the First World War and received the Military Cross
  • Youngest Nobel Laureate in Medicine
  • First Canadian on the cover of Time Magazine
  • Among the last Canadians to receive a knighthood and have the title, Sir Frederick Banting
  • One of only two “non-Americans” to have a Second World War Liberty Ship named after him (USS Frederick Banting)
  • Has as a crater on the Moon named after him (between Apollo 15 & 17 landing sites).

Want to Learn More About Dr. Banting?

  Visit Banting House FaceBook Page

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November Newsletter | You’re Invited to Celebrate Diabetes Month | 2 FREE Webinars

November is an exciting month. We celebrate National Diabetes Month and World Diabetes Day. Plus, we get to exercise our right to vote.

I love this quote by Sharon Salzberg, “Voting is the expression of our commitment to ourselves, one another, this country and this world.”

Ms. Salzberg’s expression is the perfect segue to this year’s Diabetes Month Celebration theme; Taking care of Youth with Diabetes. When we take care of children with diabetes, we are making a long-term commitment to our families, communities, and the future. Diabetes Specialists are natural advocates for children and families living with diabetes.

We are excited to share helpful resources to support you with ongoing advocacy, education, and emotional support for young people living with diabetes.

November also kicks off our holiday season extravaganza. Celebrating during a pandemic is going to present many challenging situations and awkward conversations around safety. To help out, we are sharing our Stress Management Strategies for the Holidays handout. Plus, our dietitian expert, Dawn DeSoto, bravely explores her personal story of stress and sugar overconsumption. She provides some delicious low sugar recipes to help ease us through the holidays.

Lastly, as part of our annual celebration, we are excited to invite you to two FREE Webinars. Diabetes Management in Tots to Teens and our Gut & Skin Microbiome Webinar. We will look into COVID and gut health plus explore some new science that might change our showering habits.

We are grateful for family and friends. We are thankful for each one of you and the message of hope you share with our diabetes community.

In health and gratitude,

Coach Beverly, Bryanna, and Jackson

Click here to read our full November newsletter.
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FREE Webinar – Getting to the Gut, Meet Your Microbiome airs November 9th at 11:15 am PST

Join the wonderment as we explore the role of our Microbiome.

“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

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.

Webinar topics:

  • Discuss the latest research on our microbiome
  • State the relationship between gut health and diabetes risk
  • Describe 3 strategies to get our microbiome back to better health.

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!

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.

National Diabetes Month Resources | Focus on Youth

Youth with Diabetes Campaign

Taking Care of Youth Resources

Almost 200,000 people under the age of 20 are living with type 1 or type 2 diabetes. This makes diabetes the most common chronic condition in school-age youth in the United States.

Living with diabetes is challenging, no matter their age. Being a young person with diabetes presents the additional challenge of managing glucose during a period of intense hormonal fluctuations and the complexity of managing a social life, extra-curricular activities, and risk-taking behaviors. For caregivers, advocating for the rights of school-age children with diabetes can be time-consuming and full of challenges.

The National Institute of Health (NIH) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), has put together a Toolkit for health care professionals and caregivers alike to help navigate this challenging time.

Health Professional Toolkit – To help raise awareness about the best care for youth with diabetes, this toolkit by the NIDDK, includes social media posts that you can easily copy and share.

Juvenile Diabetes Research Foundation – Type 1 Diabetes Resources and Support

Articles on NIDDK Website

Diabetes care and the Adolescent Population: Navigating the Transition of Roles and Responsibilities. In this Q & A session, David Schwartz, Ph.D., shares insights on how providers can facilitate shared responsibility for diabetes care while minimizing conflict between adolescents and their parents/guardians.

Managing Diabetes at School – In a perfect world, all teachers and other school staff would understand how to manage diabetes. In the reality, parents and caregivers need to provide information to the school and work with staff to keep children safe and healthy, no matter what the school day brings. This link includes information and a downloadable Diabetes Medical Management Plan.

The Role of the Community Environment in Managing Diabetes Risk – this diabetes discoveries and practice blog are full of interesting, short articles and presentations on a range of critical and timely topics. You can sign up to receive blog notifications too.

Guiding Principles for the Care of People with Diabetes – These Guiding Principles aim to identify and synthesize areas of general agreement among existing guidelines to help guide primary care providers and health care teams to deliver quality care to adults with or at risk for diabetes.

National Diabetes Month Helpful Resources

  1. ADA’s Risk Quiz: 60-second online risk assessment for type 2 diabetes. ADA created a self-assessment and aversion to fill out the assessment for others. There’s also a printable version in English & Spanish that can be distributed to help ascertain risk. This is a great first step in helping individuals consider coming in for an appointment
  2. Sweet People Club: Theresa Garnero founded the Sweet People Club which provides education, support, and community for individuals with prediabetes or type 2 and their families. She has excellent resources on meal planning and active living, plus she provides a free guide on flexible meal planning.
  3. Spanish Language Resources: language can be a barrier to adequate and quality care. ADCES has created a number of free downloads for people with diabetes and prediabetes, which have been translated into Spanish.
  4. Free Monofilaments: Lower Extremity Amputation Prevention (LEAP) provides monofilaments for free (just send them an envelope with postage!). Use these monofilaments, which delivers 10 grams of pressure, to identify those at risk of developing foot problems. (The ADA Foot Examination Pocket Chart fully explains how to conduct a foot exam, including a picture explanation of how to use a monofilament).

Websites that offer FREE handouts for diabetes education

ADA’s FREE Living with Type 2 Diabetes Program: ADA’s program includes six digital, printable journeys to teach how to live well with diabetes; a monthly e-newsletter with tips, stories, and more resources; six free issues of the Diabetes Forecast® magazine; access to an online community and local events. (The program is available in both English and Spanish).

ADA Diabetes Education Library Offers over 170 topics on diabetes that are searchable by topic and language. A treasure trove of educational info.

CDC Diabetes Prevention Program Curricula and Handouts  This site offers excellent resources for those interested in offering Diabetes Prevention Education.

National Diabetes Education Program is an online library of resources compiled by the 

Indigenous Peoples’ Day – 5 Ways to Acknowledge This Day

Last year, during our campus tour at Santa Clara University, the docent took a moment to recognize and thank the Indigenous Peoples’ for the use of the land that we were gathered on.

“We pause to acknowledge that Santa Clara University sits on the land of the Ohlone and Muwekma Ohlone people. We remember their continued connection to this region and give thanks to them for allowing us to live, work, learn, and pray on their traditional homeland. We offer our respect to their Elders and to all Ohlone people of the past and present.

Santa Clara University

I found this statement and acknowledgment to be very moving. It was the first time I had experienced a “Land Acknowledgment”. Since that time, I have heard it more frequently at events and gatherings.

What is Land Acknowledgment?

Land Acknowledgement is defined as a formal statement that recognizes and respects Indigenous Peoples as traditional stewards of this land and the enduring relationship that exists between Indigenous Peoples and their traditional territories.

To perform a Land Acknowledgment, first, find out the history of the land you’re on.

  • What are the name and correct pronunciation of their tribe and their language for whose land you are occupying?
  • Who are historical figures within the tribe that you can learn more about?

In our town, Chico, CA, we acknowledge the land of the Mechoopda tribe.

A land acknowledgment is just one way we can celebrate Indigenous Peoples’ Day.

As of today, 14 States and 130 cities celebrate Indigenous Peoples’ Day. Keep reading to find out other ways to recognize this important day.

The Smithsonian National Museum of the American Indian has compiled wonderful ideas on taking a moment to celebrate the lives and traditions of our lands’ first inhabitants.

Ideas for Indigenous Peoples’ Day Recognition

  1. Plant something that is native to your area. Native plants provide habitat and food for animals and are the cornerstone of a healthy environment. For example, the pawpaw tree (a native tree widely distributed in most of the United States and common east of the Mississippi) is the only host species for the caterpillars of the zebra swallowtail butterfly.

    What plants are native to your area? Find out about native plants and species in your area by visiting the U.S. Forest Service website Celebrating Wildflowers.

  2. Attend a virtual Indigenous Peoples’ Day celebration by streaming the Indigenous Peoples’ Day program today, Oct 12. You can also participate in the Indigenous Peoples’ Day Convergence, on October 12, which spotlights Indigenous leaders, change-makers, and artists working on important contemporary issues.

  3. Learn more by visiting Native Knowledge 360°, and advocate for Indigenous Peoples’ Day. Native Knowledge 360° is Smithsonian’s National Education Initiative, working to transform teaching and learning about American Indians. One practice we recommend is to acknowledge the lands you live on and name the Indigenous people originally from there. The museum can help with things to consider when thinking about Land Acknowledgements.

  4. Find out what political and social efforts are being led by Indigenous people in your area. Ask how can you support and elevate visibility for those efforts?

  5. Support local Indigenous artists in your area.

Read more about this exciting and important topic on the Smithsonian Website.

Thank you for being a part of the diabetes community.

Coach Beverly and Bryanna

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Bev is on her way to Texas

We are off to College!

Good morning everyone, Beverly won’t be at work today. She will be taking the next step in moving her son toward independence.

In 2002, Beverly brought her firstborn into the world.

Now she is bringing him to college.

After surviving the first 18 years of motherhood (barely), Coach Beverly is ready to kick (gently) her oldest little fledgling, Robert, out of her nest and into the much bigger nest of the collegiate world.

Robert shows all the signs of readiness to leave his home of origin behind and move to the dorms to start college at SMU (Go Mustangs) in Texas.

Robert’s signs of readiness to move out and move on include:

  • Eye rolling when parents speak
  • Short grunts when answering questions
  • Putting in his earbuds when we are reminding him of his chore list
  • Frequently says, “I can’t wait to move out”.

These are all signs that we have succeeded at our job as parents. Now with a mixture of joy and a twinge of longing, I will deliver him to the next stage of his journey.

Our prayers are with him. We will keep you posted!

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