Inclusive Diabetes Care for LGBTQ Community

Expert Interview with Theresa Garnero, APRN, BC-ADM, MSN, CDE President of Sweet People Club

1. What inspired you to write the ground-breaking article for on “Providing Culturally Sensitive Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) community” in Diabetes Spectrum, gosh – already 10 years ago now?

I heard a researcher at a national conference go on and on about needing to screen the daughters of women with polycystic ovarian syndrome (PCOS) for diabetes since there is a strong link between PCOS and type 2. She never discussed the population of women that have the highest rates of PCOS – lesbians (38% of lesbians have PCOS vs. 14% of heterosexual women1). So I went up to the mic and asked her if she was aware of Agrawal’s work showing lesbians have the highest rate of PCOS. I was flabbergasted when she said yes. I responded she might want to include that most vulnerable population in her talk as we need to screen all women at risk.

It got me thinking about how could a well-known professor at a national diabetes conference willingly withhold data about an under-served population? So, I began to comb through the existing research that impacts the LGBTQ community with regards to diabetes care and prevention. And I was astonished what I found. So, I wrote the article and was so glad the ADA published it. But why wasn’t this part of the conversation back then? Even now? And I still ask, why won’t ADA reply to my inquiries to include this special population within their Standards of Care?

2. What’s the first step our readers could do to provide inclusive care to the sexual and gender minority population of people with prediabetes and diabetes who seek care?

Actually take steps to include this special population. I think there are several opportunities to do this, starting with making sure their environment gives clues that it is a safe place for the LGBTQ community to seek care. Remember, this community is used to outright hostility from within the healthcare system and are often reluctant to self-disclose out of fear for getting substandard care.  I once worked with a man with type 1 diabetes who was gay tell me that his endocrinologist told him he deserved every low he got, and that when he’d go to the emergency department, they refused for his husband to be by his side And that happened in the gay mecca of San Francisco! Imagine other “less tolerant” places.

If they see you don’t have a clue because you have old forms with old terms, they most likely won’t come out. And if they don’t come out, then you don’t have all the data to make an individualized plan. So, you can check your assessment forms to see if you use inclusive terms. Do you actually ask for LGBTQ status by asking for sexual orientation, gender identification and relationship status (not marital status)? And collect the aggregate data! Just because it’s not measured doesn’t mean it doesn’t exist. Do you have clues in your waiting room that it’s safe and friendly for this group (like post a little rainbow flag)? Do you include LGBTQ risk factors for health outcomes in your materials? Do you tell people you are here to help everyone, no matter their situation or who they’re with? I realize change is slow, but collectively as individuals, and nationally, we can make it a better place for this underserved population.

3. “Inclusive Care” seems to be the new buzz phrase, but I bet most diabetes care and education specialist think they are being inclusive. I mean, how could you not be?

Because if you don’t even know a certain segment of those you care for have unique risk factors, and arguably worse – you have no clue who that vulnerable population is in your practice – you aren’t doing all you can to provide quality care to all you serve. It’s estimated that the number of LGBTQ individuals with diabetes equals that of the amount of people with type 1, so it’s not a small number we’re talking about. As an example, let’s apply this to Social Determinants of Health. We talk about the research showing how your zip code has more to do with your health than your DNA, particularly as it relates to food insecurity. But did you know LGBTQ individuals and families have the highest rates of food insecurity? Why isn’t that research included in diabetes mainstream publications and conferences?

According to research presented by the Williams Institute2, more than 1 in 4 LGBTQ adults (27%), approximately 2.2 million people, experienced a time in the last year when they did not have enough money to feed themselves or their families, compared to 17% of non-LGBTQ adults.

And when you add racial/ethnic sub-populations within the LGBTQ community, the stats are staggering:

  • Among LGBTQ people, 42% of African-Americans, 33% of Hispanics, 32% of American Indians and Alaskan Natives, and 21% of Whites reported not having enough money for food in the past year.

4. I was thrilled to see the handout that you wrote about inclusive care for the AADE. That’s a start for sure. How do you think this came about?

Thank you! I am so excited to see our national organization pay attention to the LGBTQ population and help get the word out about what we can do. I think because they are interested in us being the best diabetes care and education specialist that we can and including everyone is part of that. I had also just spoken at the AADE conference in Houston. We had a panel of professionals and researchers that represented the LGBTQ community. (I had spoken previously at AADE, but that was just by myself and this last time was so special.) I’m truly impressed with how much research that has transpired in these 10 years.

5. Any closing thoughts?

I’d say that a willingness to learn is so important. As is recognizing one’s personal biases. We certainly don’t agree with the lifestyles of all we serve, but it is not our role to judge or let those biases interfere with helping someone find a path to thriving with diabetes. And just know, it takes time to get up to speed. I’d encourage readers to check out the AADE handout and watch this funny video clip that a colleague sent me. Honestly, it is hard to keep up with the terms, even for someone like me who helped to get this topic on the diabetes radar. This video made me crack up and appreciate the nuance of all the terms. I bet your audience would like it too. You can check out the “What “The Sex Talk” Looks Like Now, by Alternatino. Thanks so much, Beverly, for your willingness to discuss the topic. I truly hope it helps your readers improve their care delivery.


Ms. Theresa Garnero, APRN, BC-ADM, MSN, CDE  trail-blazed several innovations in the field of diabetes in the years that followed being awarded the national Diabetes Educator of the Year by the American Association of Diabetes Educators (2004).

Her latest efforts involve trying to reach people with prediabetes and type 2 who are currently not being reached with our face-to-face programs. How? She created the Sweet People Club  an all online program which uses a flipped classroom concept so people can follow the Diabetes Prevention Program and also manage type 2 through a series of professionally-made videos (ahem, nearly 150 of them!) that they can watch at a time that is convenient for them, then ask questions through the portal, as well as meet virtually face-to-face real time with a Registered Dietitian twice a month.

If you’d like access to experience what the program is like, she is sharing her work and invites your feedback. Visit https://www.sweetpeopleclub.com/pro/ or email her for questions at Theresa.Garnero@sweetpeopleclub.com 

  1. Agrawal et al: Prev. of polycystic ovaries and polycystic ovary syndrome in lesbian women compared w heterosexual women. Fert Steril 82:1352-57, 2004.
  2. FOOD INSECURITY AND SNAP PARTICIPATION IN THE LGBT COMMUNITY. (n.d.).
  3. Sweet People Club

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I was more than ready for the announcement to board my late-night plane for the long journey home. I had taught my Diabetes Seminar from 8am to 4pm, packed up my stuff, then plodded through two hours of traffic to Dulles Airport and was anxious to get back home to northern California.

Just as I was getting comfy in my airport seat, my feet propped up on my suitcase, cradling a cup of hot tea, a gentleman who could have doubled for Santa Claus, plopped down next to me and asked, “Were you here for business or pleasure?” 

I explained that I had taught a seminar on diabetes for the health care professionals at a local hospital.

“I have diabetes, he said as he looked away, but I just got tired of taking my medications, so I stopped taking them.” 

I took a sip of my tea and nodded.

He continued, “actually, since I stopped my medications, I have lost over ten pounds. I don’t think those medications work.”

I asked more questions about his self-care and barriers. He wondered if taking care of his diabetes really mattered.

I provided a passionate description of how important it was to keep working on his diabetes and at least continue taking his metformin. I encouraged him to try to monitor blood sugars a few times a week.

I described how elevated blood sugars can cause weight loss as the kidneys try to clear out extra sugar in the urine (he was experiencing polyuria) and that his blood might be looking thick and gooey like honey, slowing down his circulation.

I reassured him that metformin, in addition to helping to lower his blood sugars won’t harm his kidneys, can help lower cholesterol levels and may even have a cancer protective effect.

He got quiet for a few minutes and said,

“Well, maybe I could restart taking the metformin, I just hate taking all those pills.”

 “Yeah, it is a lot, I replied. But it’s worth it, and you are worth it. You deserve to live the best life possible with your diabetes.”

When they called our group to board the plane, he patted my shoulder and nodded a thank you.

As a frequent traveler, dozens of complete strangers have opened up their hearts to me and told me stories about their struggles managing diabetes.

Each story touches me in a different way and reminds me of the complexity and permanence of living with a chronic condition.

I consider these stories sweet and fragile gifts. Gifts that make me a better and more compassionate educator.

As educators, people tell us their diabetes stories all the time, in clinics, hospitals and airports. A special thanks to all of you for your careful listening. You are providing a gift of invaluable hope for people living with diabetes.

This compassionate listening is making such a difference in so many people’s lives and I am sincerely grateful for each one of you!

Love, Coach Beverly

This story is from our December Newsletter. Click here to read previous issues or sign up for future newsletters.

November Newsletter Now Available!

Our November Newsletter celebrates Diabetes Awareness month, so it is brimming with free resources! Find out how you can get free monofilaments and raise awareness for diabetes and diagnosis.

 

November News Topics Include:

  • Akkermansia Mucinphila
  • November Toolkit: Raising Awareness to Improve Care
  • Surviving the Holidays
  • Sleep & the Gut Microbiome

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September Newsletter Now Available!

In our September Newsletter we highlight a string of new technology developments! From pump recalls and treatment decisions, to technology events and solutions.

Read this month’s newsletter to find out more about our latest technology toolkit, and can’t-miss events like the Women Leader’s Conference coming to the East Coast!

September Newsletter Topics Include:

  • Time in Range Goals for CGMs
  • Medtronic Pump Recall
  • EverSense Approved for Treatment
  • Women Leader’s Conference to include Technology Session

Want to learn more about Diabetes Technologies? Coach Beverly’s New Technology Toolkit – Earn 3.0 CEs is ready for on-demand viewing. Next Live Show: September 11 & 13, 2019 @ 11:30 a.m.

When it comes to insulin pumps, sensors and calculation, many of us feel overwhelmed and unsure about diabetes technology management. Plus, with the vast amount of information, it may seem impossible to figure out what to focus on for our clinical practice and to prepare for the diabetes certification exam.

Coach Beverly invites you to enroll in our NEW Technology Toolkit Online Course Bundle, to keep you abreast of the rapidly changing world of Insulin Pump Therapy, Continuous Glucose Monitoring and calculations while preparing for exam success. 

If you want cutting edge information on diabetes technology, problem solving and using formulas to determine appropriate insulin dosing, we highly recommend this toolkit.


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August Newsletter Now Available!

In our August Newsletter, we highlight several exciting new releases! Nasal Glucagon has been approved, generic Dapagliflozin has been released, and Cleveland Clinic has synthesized a chart of supplements and their efficacy for people with diabetes!

Come to the San Diego Live Seminar for 39 CEs and NEW Networking Night!

Read this month’s newsletter before August 16 to see how you could get a $50 discount.

August Newsletter Topics Include:

  • Nasal Glucagon Approved
  • Nutritional Supplement Chart for People With Diabetes
  • 5 Steps to Stop Sitting & Increase Longevity
  • Diabetes Educator Conference “Making a Difference” Scholarship Awarded
  • Generic SGLT-2 Inhibitor Approved
  • New Technology Course & Networking Mixer at San Diego Live Seminar
  • Women Leaders Conference Save the Date – December 6
  • CDCES Coach App® Rated by DANA | $50 Discount for App Survey

Click here to read our newsletter


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The marketing application for a generic version of Farxiga, or dapagliflozin has received tentative approval from the US Food and Drug Administration (USFDA). Alembic Pharmaceuticals received a nod for its abbreviated new drug application for Dapagliflozin Tablets in 5 mg and 10 mg strength.

The approved product is therapeutically equivalent to the reference listed drug product Farxiga Tablets.

No information on pricing has been posted yet, but the hope is that as patents expire, more affordable generic diabetes medications will be made available.

Dapagliflozin belongs to the SGLT-2 Inhibitor class of diabetes medications. To read more, download our FREE Diabetes Medication Pocket Cards.


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New studies show that sitting for too long can impair health and even shorten life expectancy. It’s difficult to keep active in a world of screens, movie theaters, and desk jobs. However, studies are showing that body awareness and movement is necessary. The goal is to get up at least every hour of sedentary time, to improve posture and metabolic rate.

Medical News Today published an article on proper posture while sitting, showing just how difficult it is to maintain good postural health, with over ten variables to consider. Sitting and staying in one position for more than an hour increases the likelihood of poor posture, decreased metabolism, and inhibits blood flow, which can worsen circulation problems for people with diabetes.

Here are several strategies to lessen their sedentary time and get healthier:

1. Standing Desk/Treadmill Desk

Office Fitness Industry News encourages employers to spend their wellness funds on standing desks or treadmill desks, rather than spending money on a wellness program that offers employees under-utilized gym memberships.

Standing desks help improve posture by allowing people to stand, stretch, and interrupt their sitting time. Simply standing more can help tone muscle, increase metabolism, and prevent diabetes complications. However, some may have difficulty standing for long periods of time. A treadmill desk may feel more natural and compounds the benefits of standing desk: burning extra calories, increasing creativity in the workplace, and potentially even increasing mental acuity for kinesthetic learners or those with ADD.

Even if an employer won’t provide a standing or treadmill desk, just standing up every hour helps counteract a lot of the issues associated with sitting too much.

2. HIIT It!

Taking brief exercise breaks during the day can help tremendously. It doesn’t require going to the gym, or even using your full 10 – 15 minutes in the morning or afternoon. HIIT, or High Intensity Interval Training, only needs to be done in 30 second bursts to be effective. This can include 30 seconds of sprinting in place or doing quick push-ups against a counter (such as in a break room or bathroom). You can find more HIIT exercises that can be done in just 30 seconds, here.

3. Take More Breaks

Many people may only get two 10-15 minute breaks per day plus lunch, but that doesn’t mean they have to be chained to a desk at all other times. Refilling water bottles or glasses every hour can help interrupt sitting and also offer a refreshing mental break from staring at a screen or papers. If the job requires reviewing or reading documents, try doing this while standing or pacing to interrupt the monotony of sitting.

4. Treat the Feet

Suddenly switching from sitting to standing can be tough on lower extremities, and for those already standing most of the day because of their job, proper foot care is important to lessen fatigue and prevent ending the day on the couch until bed.

Wearing thicker socks and cushioned sole inserts can help during the day. Ending the day with an Epsom salt foot bath and lotion can help ease soreness, increase circulation, and help you get back on feet the next day.

5. Stay NEAT

NEAT means non-exercise activity thermogenesis. All it requires is simple stretches, twists, and bends to break up your sitting every hour. Practicing NEAT helps increase circulation, ease back pain and muscle aches, and increase daily range of motion, which will eventually make getting nore active easier too.

Staying mindful about sitting duration and taking any of these steps to move more can help lead to a longer and better quality of life. To see more on how to counteract or avoid sitting disease, see Just Stand’s Office, School, and Home resources.

See our Exercise Resource Page for a bunch of wonderful handouts and movement ideas.

July Newsletter Now Available!

Most of us aren’t even aware that weight bias is embedded in our everyday medical language, in scientific papers, and in our client interactions.  But with awareness, we start hearing and seeing this bias all around us and realize that change is needed. 

In our July Newsletter, we explore weight bias language and provide some examples and fixes. Plus, we invite you to apply for our diabetes education scholarship and highlight the approval for a GLP-1 RA for pediatrics with type 2 diabetes.

July Newsletter Topics

  • What is weight bias and how do we fix it.
  • You are invited to apply for our Diabetes Educator Course Scholarship in San Diego, CA – Deadline July 22, 2019.
  • Approval for a GLP-1RA for pediatrics with type 2 diabetes.
  • Digital PocketCards Updated.
  • Bring a Friend – $80 discount on the Diabetes Educator Course.

Click here to read our newsletter

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June Newsletter now available!

by Coach Beverly Thomassian RN, MPH, CDCES, BC-ADM

This newsletter highlights hard earned wisdom shared by our keynote speakers at the Women Leaders in Diabetes Conference last month in San Francisco. We have summarized their concrete strategies to make meaningful connections and engage our audience, for the long run. Newsletter topic includes:

  • How to make an impression through storytelling
  • Infusing creativity into diabetes education
  • Scholarship application window now open for San Diego Diabetes Ed Course
  • A new and more effective way to introduce yourself

Click here to read our newsletter!

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May Newsletter now available!

by Coach Beverly Thomassian RN, MPH, CDCES, BC-ADM

For this newsletter, we highlight some key finding in the newly released consensus report, “Nutrition Therapy for Adults with Diabetes or PreDiabetes.” We also explore the rising incidence of fatty liver disease in youth and provide encouragement to keep active with the “Don’t Sit, Get Fit Campaign.” Nurse Appreciation Week kicks off May 6th. Let’s take a moment to shout out and recognize the contributions of our amazing nursing colleagues.

  • Nutrition recommendations in bite-size pieces
  • This mutation makes people feel full – All the time
  • Why are so many Latino children developing fatty liver disease?

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