What we say matters.

As educators, advocates, spouses, friends, and providers, our use of language can deeply affect the self-view of people living with diabetes every day.

Intentional communication is a powerful tool that can uncover trauma, identify barriers, and move both the provider and person with diabetes toward a greater understanding of the issues involved.

The language used in the health care setting is immensely important in determining trust, mutual respect, and meaningful long term relationships.

Many people with diabetes have experienced injustice, trauma, marginalization, and are often struggling with feelings of shame and blame.

• Let’s lift people through our commitment to careful listening.
• Let’s choose the language that is person-centered and free from judgment.
• Let’s empower our interactions by identifying and addressing trauma and the impact of social determinants.

FREE Mini Webinar – Lifting People Up with Language

Watch 2020 Lifting People Up with Language 33 minute Webinar Now

 Language and Diabetes Powerpoint Handout

FREE Diabetes & Language | Quiz

Topics covered include:

• Learn phrases, words, and approaches that can be left behind.
• Describe diabetes language that is respectful, inclusive, person-centered, and imparts hope.
• Discuss how to evaluate for ACE and provide trauma-informed care.
• Practice communicating about diabetes using phrases free from judgment with a focus on a strength-based approach.

This mini-webinar is free, and no CEs are provided, but there is lots of great info!

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Articles and Resources

Use of Language in Diabetes Care and Education – 2017 ADA & AADE  
Language is powerful and can have a strong impact on perceptions as well as behavior. This article provides recommendations for the language used by health care professionals and others when discussing diabetes through spoken or written words whether directed to people with diabetes, colleagues, or the general public, as well as research questions related to language and diabetes. 

Quick Guide on Diabetes and Language for Health Care Professionals – AADE

Empowerment vs. Compliance Model

Action for Happiness – Excellent website filled with actions we can all take to feel better every day.

Trauma-Informed Care Resources

Adverse Childhood Experiences (ACE) Resources

ACE Screening Tool and Resilience Inventory

Becoming ACE-Aware Training Program

Nadine Burke Harris, MD TED Talk on How Childhood Trauma affects health

NPR Article – Take the ACE Score and Learn what it does and doesn’t mean

Trauma-Informed Care Fact Sheet

Meds Management for Type 2 |
Standards of Care Intensive 2020
Join us on June 25, 2020, at 11:30 am (PST) 
1.5 CE | $29.00 or No CEs | Free

This advanced-level course is designed to help participants determine the best medication choice based on the patient’s unique characteristics. The content incorporates the management guidelines published by the American Association of Clinical Endocrinologists (AACE) and the American Diabetes Association (ADA) Algorithms. We will discuss the role of lifestyle changes and review the pros and cons of available diabetes medications using a patient-centered approach. In addition, we discuss medication algorithms in detail. Participants not familiar with the basics of diabetes medication may benefit from first enrolling in our “Meds for Type 2” and “Insulin 101 Course.”

Register for FREE live stream webinar (no CEs).

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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.

June is Pride Month and in honor of our LGBTQ+ community, we want to share some helpful resources for Diabetes Specialists to create more inclusive practices.

Whether we provide services in the hospital, clinic, or other outpatient settings, we can take steps to help the people we work with feel welcome.

By paying careful attention to each person’s experience from the moment they walk in the door until we say goodbye, we can find ways to create a more inclusive environment. This awareness of the details, such as inclusive gender questions on intake forms or gender-neutral signage on the bathrooms, are great first steps to show your care and respect for those you work with.

“Members of the lesbian, gay, bisexual, transgender and queer (LGBTQ) community have unique health disparities and worse health outcomes than their heterosexual counterparts, which has clinical relevance in the delivery of diabetes care and education. Diabetes care and education specialists are in a pivotal position to help this medically-underserved and vulnerable population get the best possible care.” – ADCES

List of Resources

ADCES Inclusive Care for LGBTQ+ People with Diabetes Handout – this handout provides definitions, terms to avoid, and a cultural competency checklist to help you move towards improving inclusivity within your practice.

All Gender Restroom Sign PDF

Diabetes Prevention and Management for LGBTQ+ People Handout – this handout includes research of diabetes within the LGBTQ community, along with clinical considerations, programs, and resources for diabetes educators to use within their practice.

Policies on Lesbian, Gay, Bisexual, Transgender & Queer (LGBTQ+) issues – this resource by the American Medical Association lists all the current healthcare policies in place for the LGBTQ community.

Helio’s LGBTQ+ Health Updates Resource Center – this is a “collection of news articles and features that provide the latest information on the unique health needs of individuals in the LGBTQ+ community.”

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Are we missing important information and resources? Send us your favorites to info@diabetesed.net.

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Inclusive Diabetes Care for LGBTQ Community

For more information, read our Expert Interview with Theresa Garnero, APRN, BC-ADM, MSN, CDE President of Sweet People Club, and writer of the article for on “Providing Culturally Sensitive Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) community” in Diabetes Spectrum.

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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.

We at Diabetes Education Services want to call attention to the importance of standing against racism, now and always.

As a business serving all people with a shared goal of trying to improve health, we have an obligation to advocate on behalf of those who are often undertreated and undeserved. 

Diabetes disproportionally affects people of color and we encourage our community to take this Mindful Monday to reflect on the intersections of race and healthcare accessibility.

Make Your Voice Heard

For strategies to increase health access and promote equity, the World Health Organization, has established goals and advocates for system-wide changes to address barriers associated with racism.

Additionally, Harvard Health Publishing, recommends, as health care professionals, we can start by having honest conversations about race with our peers, policymakers, and communities.

“One of the first steps in addressing these issues is to make the general public, health care providers, insurance companies, and policymakers aware of these disparities and the public health consequences of them.

It is especially important for health care providers across the nation to be aware of the multiple biological, social, psychological, financial, and cultural factors that influence diabetes and other diseases, and to routinely take these into consideration when developing prevention and treatment programs for all groups” – Harvard Health Publishing.

For more resources, UCLA’s Equity, Diversity, and Inclusion department have created a list of Racial Trauma Resources, which they plan to continue updating over time.

Watch TED TALK How to Build an Antiracist World by Ibram X. Kendi

There is no such thing as being “not racist,” says author and historian Ibram X. Kendi. In this vital conversation, he defines the transformative concept of antiracism to help us more clearly recognize, take responsibility for and reject prejudices in our public policies, workplaces and personal beliefs. Learn how you can actively use this awareness to uproot injustice and inequality in the world — and replace it with love.

Become an ADA Advocate

Elevate your voice and expertise in the field by Becoming an Advocate with the ADA. You can sign up by clicking here and to read more about ADA recommendations for becoming a Diabetes Advocate, click here.

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National Nurses Week is celebrated annually, starting with National Nurses Day on May 6th (this Wednesday), through Florence Nightingale’s, the founder of modern nursing, birthday, on May 12th!

I am so proud to call myself a nurse and be a part of this dedicated, hard-working, self-sacrificing and healing profession for over 25 years. During the COVID-19 pandemic, we have witnessed and cried along with our nursing colleagues as they have risked their lives to provide care to those impacted by the virus.

Thank you nurses for your careful listening, compassionate care and for providing reassurance and love to those who need it most.

Coach Beverly, RN for 25+ years

Though this year Pope Francis, the ANA, and others are recognizing 2020 as the year of nurses.

We want to highlight all of their hard work and bravery during this time. We simply couldn’t do this without them.

“Let us pray for them all that they may do their precious work in the best possible way,” said Pope Francis earlier this year of nurses and midwives.

The American Nurses Association has put together a page dedicated to the Year of the Nurse.

This page has a place to support nurses on the front-lines of COVID-19, space for nurses to share their stories, inspiring videos and podcasts, and more.

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Mary Jane Oliver was an American poet who won the National Book Award and the Pulitzer Prize.

Her wisdom and candor offers readers the opportunity to see the world as it is and then slightly adjust their gaze to see the potential for hope and healing.

In this time of uncertainty, we can look to poetry, art and music to provide comfort, wisdom and a little beauty. We hope you enjoy this poem that Coach Beverly has chosen to share.

I WORRIED

I worried a lot. Will the garden grow, will the rivers

flow in the right direction, will the earth turn

as it was taught, and if not, how shall I correct it?

Was I right, was I wrong, will I be forgiven,

can I do better?

Will I ever be able to sing, even the sparrows

can do it and I am, well,

hopeless.

Is my eyesight fading or am I just imagining it,

am I going to get rheumatism,

lockjaw, dementia?

Finally I saw that worrying had come to nothing.

And gave it up. And took my old body

and went out into the morning,

and sang.

By Mary Jane Oliver, (September 10, 1935 – January 17, 2019) From Swan, 2010

Also read our blog 10 Mental Health Strategies while we Shelter-in-Place

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Recently, metformin was in the news regarding a potential risk of N-Nitrosodimethylamine (NDMA) contamination during medication production. The Food and Drug Administration (FDA) tested Metformin products to evaluate NDMA levels.

In Metformin’s products, NDMA is not listed under the active pharmaceutical ingredients. However, after some testing, the FDA did find “low levels” of NDMA in a few Metformin products (see chart below).

“Most metformin drug products tested showed no detectable levels of NDMA, while others showed low levels of NDMA,” FDA said, noting that the low levels are similar to what one would be exposed to from grilled or smoked meats.

The FDA advises that “patients should continue taking Metformin to keep their diabetes under control. ”

Of the products tested, both Actavis’ Rx Metformin 1000mg ER and Rx Metformin 500mg ER contained trace amounts of NDMA. The FDA explained that these low levels found (at 0.01-0.02 micrograms-mcg/tablet) are akin to exposure to NDMA through grilled or smoked meats. The daily intake limit for NDMA is 0.096 micrograms, which the FDA regards as “reasonably safe for human ingestion based on lifetime exposure.” 

So far, the FDA has not recommended Metformin recalls in the US. Though other countries, like Singapore, have recalled a few Metformin products containing NDMA “above the internationally acceptable level.” 

Click here to read more. Download Diabetes Medication PocketCards here.

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Weight stigma is pervasive in most health care settings. As Diabetes Specialists, we have an opportunity to recognize our own biases and take a leadership role in decreasing weight stigma in our work settings.

Last month, Healio Endocrine Today interviewed clinical nutrition manager, Lisa Hodgson, RD, CDN, CDCES, to get her perspective on how health care professionals can address weight stigma within their practice and support long-term healthy behavioral modifications for people living with diabetes. For many, staying motivated to maintain long-term changes can be difficult.

As Hodgson explains, “Weight stigma projected onto people with diabetes by clinicians may lead them to avoid seeking medical care. It may also perpetuate binge eating and overeating, limit physical activity, encourage disordered eating and foster physiological stress.”

These stigmatizing attitudes among providers are often reflected in their interactions with the individuals they treat, which can have negative impacts. That is why it is so important for each of us to address and unlearn our own biases around weight.

7 Steps to Reduce Weight Stigma Within Your Practice

• Use person-centered, encouraging, and respectful language free of judgment
• Create a safe space by asking about and addressing situations where the person experienced weight stigma
• Address emotional eating and offer healthier coping strategies such as meditation, yoga or mindful eating techniques
• Identify what is important to an individual and develop action plans around these areas
• Use past successes to inform a plan for ongoing behavioral changes 
• Customize interventions based on a person’s access to resources and their preferences
• Measure individualized goals at each visit and adjust plan over time

Helpful Resources

• Joint international consensus statement for ending stigma – The ADA announced that they and over 100 professional societies and medical journals are taking the “pledge to eliminate weight bias and stigma.
• Evaluate your Weight Bias –Harvard’s Project Implicit – Project Implicit is a non-profit organization that provides international collaboration between researchers interested in implicit social cognition – the thoughts and feelings outside of conscious awareness and control. The goal of the organization is to educate the public about hidden biases and to provide a “virtual laboratory” for collecting data on the Internet.
• Language & Diabetes Free Webinar – Learn how to uplift your people by choosing language that is non-judgmental and person-centered.

To read the full interview and to get more tips from Lisa Hodgson, click here.

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A recent study published by BMJ Journals – Gut indicates that enjoying a Mediterranean diet (MedDiet) can promote healthier aging.

The study was conducted over a 12 month period across a large cohort of more than 600 individuals aged 65–79 years, within 5 different European countries (UK, France, Netherlands, Italy, and Poland). The researchers evaluated the differences in the gut microbiota in each individual before and after the year of consuming a MedDiet.

The results indicate that consuming a MedDiet improved cognitive function and the gut microbiome of those in the study. 

The positive effects of these alterations showed that there was an increase in fatty acid production and a decrease in “secondary bile acids, p-cresols, ethanol, and carbon dioxide.” These changes were associated with lower frailty and improved cognitive function and an overall decrease in inflammatory markers, such as C-reactive protein and interleukin-17.

This study shows that changing to a MedDiet can have a positive impact on people as they age.

Read more by clicking here.

Want to learn more about the Mediterranean diet? Click here.

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