As a diabetes specialist in a rural clinic, many of my clients’ use marijuana to help them cope with chronic neuropathy.

Due to hyperemesis and other factors, people with type 1 diabetes who use cannabis on a regular basis, may present to the emergency room with diabetes ketoacidosis (DKA).

However, their unusual labs might cause some initial confusion in determining the correct diagnosis.

In a study that appeared in Diabetes Care, researchers followed people with type 1 admitted to the emergency department for DKA over a five-year period. On admission, they checked to see if they were cannabis positive. Of the 68 people with type 1 in DKA (out of 172 DKA events) who had cannabis in their system, the lab results were surprising.  Usually, people in diabetes ketoacidosis have a low pH (less than 7.3) and a low bicarbonate, due to the presence of excess ketone bodies.  However, for those with positive cannabis, their pH (mean 7.42 vs 7.09) and bicarbonate (mean 19.2 mmol/L vs 9.1 mmol/L) respectively, were both elevated compared to non users. But their glucose levels, anion gap and beta-hydroxybutyrate were similarly elevated in both groups.

The authors speculate that this paradoxical presentation may be due to vomiting syndromes associated with cannabis use. 

Frequent marijuana use can lead to cannabinoid hyperemesis syndrome (CHS).  CHS is defined as recurrent nausea, vomiting and cramping abdominal pain that is sometimes associated with at least weekly cannabis use. A common treatment for this syndrome is hot bath or shower. 

With heavier marijuana use, people are at risk for cyclic vomiting syndrome (CVS), in which they experience unrelenting nausea and vomiting. The most effective treatment for this is to abstain from cannabis for at least a few weeks. People with type 1 diabetes and gastroparesis are especially at risk for both CHS and CVS.  A person with type 1 and gastroparesis is also more at risk for other neuropathies and the associated chronic, often debilitating pain.

The authors are eager to share their findings and suggest screening for cannabis for those admitted with type 1 in hyperglycemic crisis, especially if the person presents with an elevated pH and bicarbonate. The researchers suggest a new term, “Hyperglycemic ketosis due to cannabis hyperemesis syndrome” or HK-CHS. 

The diagnostic criteria for hyperglycemic ketosis due to cannabis hyperemesis syndrome (HK-CHS) would include:

• Elevated glucose
• Elevated anion gap
• pH of 7.4 or greater
• Bicarbonate of 15 mmol/L or greater

in the presence of ketosis in those presenting with DKA.

Due to fears of opioid addiction and with the legalization of marijuana in many states, people with diabetes are turning to cannabis to manage their chronic neuropathic pain.

As diabetes specialists, we can encourage having open and honest conversations about marijuana use. If people are experiencing excess vomiting associated with cannabis use, we can help explore other options to manage chronic pain including referral to a pain management clinic and mental health support as needed.

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Want to learn more about this topic?

Level 2 | Hyperglycemic Crises, DKA & HHS Standards | 1.0 CE

Annual Webinar Recorded on December 15th

This course discusses common causes of hyperglycemia crises. Topics include hyperglycemia secondary to medications and insulin deprivation. The difference and similarities between Diabetes Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome are also covered. Treatment strategies for all situations are included.

Objectives:

1. Common causes of hyperglycemic crises.
2. The difference and similarities between DKA and HHS and treatment strategies
3. Causes and treatment of hyperglycemic crises.

Intended Audience:  A great course for healthcare professionals in the field of diabetes education looking for a straightforward explanation of identification and treatment of hyperglycemic crises.

Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator and a nationally recognized diabetes expert.

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Enroll in our entire Level 2 – Standards of Care to join us for the below Annual Live Webinar Updates. All courses air at 11:30 a.m. (PST)

• December 15, 2021 – Hyperglycemic Crises, DKA & HHS Standards | 1.0 CE
• December 21, 2021 – Assessing and Promoting Well-Being: From Population Health to a Person-Centered Approach Standards | 1.5 CEs
• February 3, 2022 – ADA Standards of Care | 2.0 CEs
• March 24, 2022 – Meds Management for Type 2 – 1.5 CEs
• March 29, 2022 – Lower Extremity Assessment 1.5 CEs
• April 26, 2022 – Microvascular Complications, Eye, Kidney Nerve Disease 1.5 CEs
• April 28, 2022 – Critical Assessment of Diabetes Patient 2.0 CEs
• May 10, 2022 – Cardiovascular Disease and Diabetes Standards 1.5 CEs
• May 12, 2022 – Older Adults and DIabetes 1.5 CEs
• May 17, 2022 – Tots to Teens – Diabetes Standards 1.5 CEs
• May 19, 2022 – Pregnancy and Diabetes 1.5 CEs
• May 26, 2022 – Hospital and Hyperglycemia 1.5 CEs
• July 21, 2022 – Setting up a Successful Diabetes Program 1.5 CEs

All hours earned count toward your CDCES Accreditation Information

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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.

Let’s be honest. There is a lot of work associated with diabetes self-management. And despite best efforts, sometimes blood sugars just land in the above target or below target zone. That’s why we are trying to move away from using the term “control”, because it suggests that a person can take certain actions to get blood sugars on target all the time, and that’s just not true. At any given time, there are dozens of factors affecting blood sugar including; body temperature, stress levels, glucagon release, activity level, undigested food, metabolic rate, time since eating and many more.

Plus, diabetes self-management can be very burdensome, especially when you add on the emotional responses and expectations. Here is how a diabetes specialist, Heather Beiden Jacobs, described the burden of daily self-management.

Let’s imagine that each self-care activity is a different size rock that a person carries around in their diabetes backpack.  They check their blood sugar before breakfast and it’s above target.  The first rock in the backpack is pretty heavy because it holds the action of evaluating their blood sugar PLUS the emotions around the number being above their target.  They take some insulin (next rock) and skip breakfast and head to work.  They get low blood sugar while at a meeting and need to leave to get a snack from the vending machine (soda).  This is another heavy rock, because not only did they have to manage a low, but there can also be a lot of big feelings around letting blood sugars go too low. Throughout the rest of the day, they add several more rocks to their backpack which can make things can start getting really heavy and burdensome.

If this kind of day only happens occasionally then their backpack is usually pretty light and manageable. But, if day after day the blood sugars are fluctuating a lot and the person can’t seem to get them on target, the backpack becomes very heavy and unwieldy.

That’s when the negative and judgmental emotions can creep in, these are the ones that are usually associated with feeling like they are not doing enough to manage their diabetes. That no matter what, blood sugars are “out of control”.

This can dramatically impact the daily quality of life and their ability to self-manage.  A person might feel like, why bother? They might even take a diabetes vacation. We want to support people on their diabetes self-management journey and help them minimize distress and burnout. Coach Beverly listened to a bunch of great podcasts by the experts in the field and compiled a summary of the suggestions plus added in a few of her own garnered from decades of supporting people through “diabetes vacations”.

12 Reframes to Help with Diabetes Burnout or Distress

• It’s not your fault you have diabetes. It’s not your fault your pancreas doesn’t work right.
• You can’t control your blood sugars all the time, but you can take actions to manage your diabetes to the best of your ability.
• Blood sugars are not good or bad, they are just numbers that inform us of what action is needed next.
• Listen to your self-talk.  It is tempting to be overly self-critical and blame ourselves.  Try to imagine you are coaching a friend with diabetes. What advice or coaching would you provide?
• Diabetes isn’t about perfect or getting it right all the time. Its about taking baby steps to make small improvements and keep safe.  
• Take short mental breaks from your diabetes – walk outside, enjoy a hobby, listen to music, volunteer, join a group.
• Talk about your feelings to friends and family.  Let them know how to help you succeed and things that don’t help.
• Keep active, nourish your body, try meditation, enjoy oxygen cocktails, get out in nature.
• Remind yourself of all the work you ARE doing to manage your diabetes
• Join diabetes camps, social media groups, find your people, your community.
• Consider connecting with a mental health professional.
• Remember, you are not alone. You are resilient. You are not your blood sugars. You got this.  Baby Steps.

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Want to learn more about this topic?

Enroll in our Level 2 | Assessing and Promoting Well-Being: From Population Health to a Person-Centered Approach Standards | 1.5 CEs

Annual Update Recorded on December 21st

This presentation will include the latest information on Social Determinants of health, assessment strategies, and approaches. We will explore the psychosocial issues that can discourage individuals from adopting healthier behaviors and provides strategies to identify and overcome these barriers. Life studies are used to apply theory to real-life situations. A great course for anyone in the field of diabetes education or for those looking for a new perspective on assessment and coping strategies.

Objectives:

1. State strategies to assess and address social determinants of health
2. Discuss health care delivery systems using a person-centered approach
3. List screening tools that can help detect depression, trauma, and cognitive decline
4. Describe psycho-social and emotional barriers to diabetes self-management
5. Provide strategies for healthcare professionals to identify and overcome barriers to self-care

Intended Audience:  A great course for healthcare professionals in the field of diabetes education looking for a straightforward explanation of identification and treatment of hyperglycemic crises.

Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator and a nationally recognized diabetes expert.

Enroll in our entire Level 2 – Standards of Care to join us for the below 2022 Live Webinar Updates. All courses air at 11:30 a.m. (PST)

• December 15, 2021 – Hyperglycemic Crises, DKA & HHS Standards | 1.0 CE
• December 21, 2021 – Assessing and Promoting Well-Being: From Population Health to a Person-Centered Approach Standards | 1.5 CEs
• February 3, 2022 – ADA Standards of Care | 2.0 CEs
• March 24, 2022 – Meds Management for Type 2 – 1.5 CEs
• March 29, 2022 – Lower Extremity Assessment 1.5 CEs
• April 26, 2022 – Microvascular Complications, Eye, Kidney Nerve Disease 1.5 CEs
• April 28, 2022 – Critical Assessment of Diabetes Patient 2.0 CEs
• May 10, 2022 – Cardiovascular Disease and Diabetes Standards 1.5 CEs
• May 12, 2022 – Older Adults and DIabetes 1.5 CEs
• May 17, 2022 – Tots to Teens – Diabetes Standards 1.5 CEs
• May 19, 2022 – Pregnancy and Diabetes 1.5 CEs
• May 26, 2022 – Hospital and Hyperglycemia 1.5 CEs
• July 21, 2022 – Setting up a Successful Diabetes Program 1.5 CEs

All hours earned count toward your CDCES Accreditation Information

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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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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.

December eNews | Diabetes Distress & Holidays? New Handout with 12 Reframes to Help

Happy December

Greetings to my wonderful health care colleagues. Thank you for all the love and care you have provided this year. I know you touch the lives and hearts of many people who boldly try their best to self-manage their diabetes and I am grateful for you!

As I am sure you have witnessed over time, holidays can amplify stress levels for people living with diabetes. With that in mind, we think this is a perfect time to provide you with some tools to address diabetes distress and burnout during the holidays and in preparation for those New Year resolutions.

Approximately 30% of people with diabetes experience distress at any given time. In addition, many people may be struggling with diabetes burnout.

As health care providers, how do we know if someone is in diabetes distress or is burning out on their self-care?

We might connect with these individuals in a hyperglycemic or hypoglycemic crisis. Maybe they are not showing up for their appointments. These individuals might be mistakenly labeled as “non-adherent” or it may be wrongly assumed that they just don’t care. However, we are compelled to reach out to them and provide a compassionate check-in of their emotional health and state of well-being.

Diabetes specialists help identify and address diabetes distress to improve quality of life and outcomes.

Read more to learn the definition and signs of diabetes distress and burnout and what action to take. Download our FREE Handouts on Surviving the Holidays and Ideas to Deal with Diabetes Distress.

We hope you can join us for our Annual Webinar Updates starting in December. We have over 50 courses to update, so Coach Bev likes to get an early start (see schedule below).

Wishing you health and moments of awe as we move toward 2022.

Coach Beverly, Bryanna, and Jackson

Click here to read our full December 2021 newsletter.

Featured Topics

• How to Identify Diabetes Distress
• 12 Ways to Help Diabetes Distress
• Coach Bev Receives Statewide World
• Question of the Week
• Rationale of the Week

Upcoming Webinars

• CDCES vs. BC-ADM | Dec 9th
• Hyperglycemic Crisis | Dec 15th
• Test Taking Toolkit | Dec 16th
• Assessing & Promoting Well-Being | Dec 9th
• Diabetes Fundamentals | Begins Jan 11th
• ADA Standards of Care | Feb 3rd
• Bootcamp | Begins Feb 8th

Featured Items

• CDCES Prep Bundle + Review Guide
• Free Resources

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Test Taking Practice Exam Toolkit Webinar
20 Sample Practice Questions

Join us live June 30, 2022, for live webinar 2022 updates

You are invited to join Coach Beverly for this FREE Webinar. And, if you want to have access to an additional 220+ sample practice online questions, you can purchase the complete Test Taking Toolkit.

For many of us, taking the certification exam is a nerve-wracking process.

During this webinar, Coach Beverly will help you transform your nervousness into focused energy that will help you succeed. She will provide test-taking tips based on her experience taking the certification exam six times.

2 Ways to Join Test Taking Webinar

Watch Webinar for FREE

This includes a review of 20 sample test questions with test-taking strategies. This does not include access to the recorded webinar or the practice questions.

This includes access to the recorded version of this webinar on your Online University Student Portal. Plus, the Test Taking Toolkit provides you with over 220 sample online practice questions, simulating the exam experience. A perfect way to assess your knowledge and create a focused study plan, while increasing your test-taking confidence.

Don’t worry if you can’t make it live.
Your registration guarantees access to the recorded version.

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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.

What is Diabetes Distress?

At some point, almost everyone with diabetes will experience a degree of diabetes distress.  It’s expected and completely understandable, especially for those on intensive medication and insulin regimens. Having diabetes is not just about checking blood sugars, counting carbs, taking medications, and giving insulin. People also have an emotional relationship with their diabetes. These feelings around their diabetes can fluctuate throughout their lifetime.

Sometimes a person might have a great day, when their blood sugars on mostly on target, they don’t miss any of their medications and insulin, plus they made it to the gym. But the next day or week or month may feel like a complete mess, with blood sugars all over the place. These blood sugar swings are due to a variety of different reasons, many of which may be out of the person’s control.

Regardless of where a person is with their diabetes self-care, the emotions that bubble up, need to be acknowledged and recognized both by the person with diabetes and the health care provider.   

When diabetes self-care all starts feeling like it’s too much or like it’s out of control, that’s when we might say a person is experiencing diabetes distress.

You can determine if a person is experiencing diabetes distress by observing self-care behaviors and asking questions. Or you can use a standardized assessment tool to determine how much distress a person is experiencing in four different areas of diabetes self-care. Please see this link to download the Diabetes Distress Scale and other psychosocial screening tools.

The four areas of Diabetes Distress include:

Emotional Distress – Feeling like they are not doing enough; like they are failing and out of control.

Physician-related distress – Provider doesn’t understand diabetes.

Interpersonal Distress – Friends and family don’t really get it, or are critical, or don’t want to hear about diabetes.  Can often be co-associated with depression.

Regimen-related distress – all the daily stuff a person has to do to self-manage their diabetes. Regimen-related distress is the most common kind of diabetes distress, especially for those living with type 1 diabetes.

Health Care Professionals can take an active role in identifying Diabetes Distress

We can start by asking this question, “What is most driving you crazy about your diabetes right now?” or “How are you doing with your diabetes?” while listening carefully to their response and evaluating their degree of distress.

We can also look at self-care behaviors to identify distress:

• A person may not be giving bolus insulin before meals when they used to in the past
• They disconnect from their CGM for extended periods of time.
• A surprise elevation in their blood sugars 
• Expressing feelings of anger, discouragement, or frustration.
• They may think that they are the only ones going through this, that everyone else with diabetes has it figured out, so what is wrong with them?

Sometimes diabetes distress can lead to burnout or be co-associated with burnout.  Sometimes, it may be hard to tell the difference. Don’t worry about figuring out if it’s burnout or distress. What’s most important is to recognize that this person is having trouble coping and to provide active listening and help with problem-solving.

What is diabetes burnout?

Diabetes burnout is an emotional reaction that is usually more intense than diabetes distress. A person in the state of burnout is someone with diabetes who has grown tired of managing their condition, then simply ignores it for a period of time. 

Sometimes I refer to burnout as taking a diabetes vacation. 

This vacation might be a weekend trip, a week trip, or a long-term sabbatical. Diabetes burnout looks different for everyone.  Diabetes burnout is a normal reaction to living with diabetes.  I am not saying it is a good thing, or we want people to feel burned out.  We want to recognize that managing diabetes is a lot of work and sometimes people just take breaks from diabetes self-management. 

As health care providers, we can support people experiencing diabetes distress or burnout. According to Mark Heyman, PhD, CDCES, here is an approach he has found helpful.

1. Ask how they are doing and listen for emotions or actions that indicated diabetes distress.
2. Help them recognize there are 2 parts to it
   1. Emotional reaction – Feelings of being distressed or burned out. A person might be thinking, “If I ignore my diabetes for a while, it might go away or the distress might go away.”
   2. Behavioral reaction – when a person feels distressed or burned out, they might ignore the diabetes as a way to manage that stress. 
3. Recognize how they are feeling and reassure them that their reaction makes sense.
4. Then explore if they could consider separating the emotion from the behavior.
   1. Yes, you feel burned out but can you still check blood sugars and give yourself insulin?”
   2. We can help people recognize the feeling of being burned out and encourage them to make adjustments to their self-care response, ie  “I am going to manage my diabetes anyway, even though I am completely frustrated and burnt out.”

As health care professionals, we need to check in with people about their distress on a regular basis and provide support.

We need to reassure them that management of diabetes isn’t easy, but they are not alone. There are lots of other people with diabetes experiencing the same feelings.

We might say something like, “Managing diabetes is hard work, but we believe in your ability to make small changes to get to a safer place.  You don’t have to move mountains; you just need to take a baby step.“

Let’s remind them, that having diabetes is like getting a job you didn’t ask for. You have to do the work of a body organ, a pancreas. that requires 24 hours a day of attention, without any pay or vacations. Sincerely focus on their successes, no matter how small, and reinforce our belief in their ability to move forward. We got this.

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Special thanks for the Team from Quin for hosting this interview. To learn more about Quin, click here.

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Want to learn more about this topic?

Enroll in our Level 2 | Assessing and Promoting Well-Being: From Population Health to a Person-Centered Approach Standards | 1.5 CEs

Annual Update Airs Live on December 21st at 11:30 am PST

This presentation will include the latest information on Social Determinants of health, assessment strategies, and approaches. We will explore the psychosocial issues that can discourage individuals from adopting healthier behaviors and provides strategies to identify and overcome these barriers. Life studies are used to apply theory to real-life situations. A great course for anyone in the field of diabetes education or for those looking for a new perspective on assessment and coping strategies.

Objectives:

1. State strategies to assess and address social determinants of health
2. Discuss health care delivery systems using a person-centered approach
3. List screening tools that can help detect depression, trauma, and cognitive decline
4. Describe psycho-social and emotional barriers to diabetes self-management
5. Provide strategies for healthcare professionals to identify and overcome barriers to self-care

Intended Audience:  A great course for healthcare professionals in the field of diabetes education looking for a straightforward explanation of identification and treatment of hyperglycemic crises.

Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator and a nationally recognized diabetes expert.

Enroll in our entire Level 2 – Standards of Care to join us for the below 2022 Live Webinar Updates. All courses air at 11:30 a.m. (PST)

• December 15, 2021 – Hyperglycemic Crises, DKA & HHS Standards | 1.0 CE
• December 21, 2021 – Assessing and Promoting Well-Being: From Population Health to a Person-Centered Approach Standards | 1.5 CEs
• February 3, 2022 – ADA Standards of Care | 2.0 CEs
• March 24, 2022 – Meds Management for Type 2 – 1.5 CEs
• March 29, 2022 – Lower Extremity Assessment 1.5 CEs
• April 26, 2022 – Microvascular Complications, Eye, Kidney Nerve Disease 1.5 CEs
• April 28, 2022 – Critical Assessment of Diabetes Patient 2.0 CEs
• May 10, 2022 – Cardiovascular Disease and Diabetes Standards 1.5 CEs
• May 12, 2022 – Older Adults and DIabetes 1.5 CEs
• May 17, 2022 – Tots to Teens – Diabetes Standards 1.5 CEs
• May 19, 2022 – Pregnancy and Diabetes 1.5 CEs
• May 26, 2022 – Hospital and Hyperglycemia 1.5 CEs
• July 21, 2022 – Setting up a Successful Diabetes Program 1.5 CEs

All hours earned count toward your CDCES Accreditation Information

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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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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.

Vertex Pharmaceuticals just announced preliminary results from a trial that explores a new intervention to treat type 1 diabetes. The early results are very promising.

The first person with type 1 diabetes to receive this new stem-cell derived experimental therapy, had an 91% drop in their insulin needs. The person has lived with type 1 for over 40 years. After the intervention, they not only experienced a reduction in their insulin needs, their fasting C-peptide levels went from undetectable to 280. This dramatic C-peptide increase is a clinical indicator of stem-cell therapy success and endogenous insulin secretion.

These results are exciting and offer hope for a potential new treatment approach for type 1 diabetes.

VX-880 is a stem cell derived therapy that replaces damaged beta cells with healthy transplanted insulin producing cells in clinical trials. However, these new cells are at risk for attack by the body’s immune system, so immunosuppression therapy is currently required for stem-cell transplant success.

The future goal is to create a version of this treatment that doesn’t require immunosuppressive therapy. And Vertex, the makers of VX-880 are working on creating an encapsulated islet cell program that doesn’t initiate an autoimmune attack.

For more information and clinical trials, click this link.

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Resources for People Living with Type 1 Diabetes

Below is a list of helpful online resources for Type 1 Diabetes. They include sites for national organizations like the American Diabetes Association (ADA), sites for diabetes interest groups, and other participant organizations that provide helpful diabetes tips and opportunities to join online groups. Click here for a Type 1 Resource Handout to share with colleagues and people living with type 1 diabetes.

Click the links below to visit the website:

• Let’s fight Type 1 Together | American Diabetes Association (ADA)
• Mental Health Resources Directory | ADA
• Type 1 Diabetes Resources and Support | Juvenile Diabetes Research Foundation: Explore our informational guides or make a personal connection with someone experienced with type 1 diabetes (T1D). The JDRF community has you covered.
• Empowering Youth with Type 1 Diabetes |The Chris Dudley Foundation
• The National Institutes of Health Diabetes Resources | CDC
• The College Diabetes Network: Focuses Specifically on Young Adults with Diabetes | College Diabetes Network
• The Diabulimia Helpline: for Individuals Having Eating Problems
• Beyond Type 1 Diabetes
  • Type 1 Diabetes Online Community
  • Mental Health Resources website
• Connected in Motion: Peer-Based Sports & Outdoor Adventures for those with Type 1 (in U.S. and Canada) | Connected In Motion
• Diatribe: Library of Online Resources, Blog & Community Forums
• Diabetes Education: At times it might seem overwhelming, but you can thrive with diabetes, and a Diabetes Care and Education Specialist can help. Includes a link to find a diabetes program near you.

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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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“I just want to get rid of my diabetes”, is something I frequently hear when people are newly diagnosed with diabetes.

Can people with type 2 get rid of their diabetes? Well, not exactly, but a small percentage of people with type 2 can achieve normoglycemia, especially after metabolic surgery or significant weight loss. However, over time, blood sugars often rise again. That is why diabetes isn’t “cured” or fixed. Keep reading to learn the new standardized term and ongoing screening guidelines.

What is the right term to use when blood sugars normalize, even with type 2 diabetes?

A new consensus statement designed to answer this question was issued by the American Diabetes Association, the Endocrine Society, the European Association for the Study of Diabetes, and Diabetes UK last month.

The 12-member panel recognized that we have no standard term to describe the phenomenon of prolonged normoglycemia in people previously diagnosed with type 2 diabetes, who are not using glucose-lowering medications.

Terms like “reversal”, “resolution”, or “cure”, are frequently used to describe this phenomenon and are sometimes are associated with unsubstantiated claims.

The new standardized term is “remission”.

Diabetes remission defined – A1c< 6.5% for at least 3 months after stopping glucose-lowering pharmacotherapy. This definition holds true whether attained by lifestyle changes, metabolic surgery, or other means,

When A1c is not a reliable marker of glycemic control (due to anemia, hemoglobinopathies, or others), fasting plasma glucose <126 mg/dL or estimated A1C <6.5% calculated from CGM values can be used.

With this standardized definition, researchers will be able to conduct studies and analyze medical records using standard terminology so they can accurately compare factors that help people with type 2 achieve remission and factors that influence remission duration.

A1c Testing still needed if in Remission?

Even if people are experiencing remission, they require continued glucose evaluation because hyperglycemia frequently recurs. People in remission who experience weight gain, are started on steroids or other medications like atypical antipsychotics or meds to treat HIV, may exhibit elevated blood glucose levels. In addition, stress from other forms of illness and the natural decline of beta-cell function over time can all lead to the recurrence of Type 2 diabetes. Testing of A1c or another measure of glycemic levels needs to be performed at least yearly.

Metabolic Memory – people in diabetes remission still experience complications.

Even after a remission, the classic complications of diabetes including retinopathy, nephropathy, neuropathy, and enhanced risk of cardiovascular disease can still occur due to metabolic memory.

Diabetes Care Consensus Report 2021

The metabolic memory or legacy effect is relevant in this setting. If a person with diabetes has a history of hyperglycemia, this metabolic memory can cause persisting harmful effects in various tissues. Even after remission, the classic complications of diabetes including retinopathy, nephropathy, neuropathy, and enhanced risk of cardiovascular disease can still occur. This is why it is important for people in diabetes remission to have regular retinal screening, tests of renal function, foot evaluation, and measurement of blood pressure and weight in addition to ongoing monitoring of A1c.

To read the complete article from Diabetes Care, Aug 2021, Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes.

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Are you preparing for the CDCES Exam?

Join us live on November 4th, for our FREE Webinar

Starting your journey to becoming a CDCES? We recommend watching our FREE Preparing for CDCES Exam Webinar!

This course will transform your test anxiety into calm self-confidence and test-taking readiness.

Webinar Topics

• Exam requirement updates for 2021.
• Exam eligibility and test format
• Strategies to succeed along with a review of study tips and test-taking tactics.
• We will review sample test questions and the reasoning behind choosing the right answers.
• Learn how to focus your time and prepare to take the CDCES Exam. We provide plenty of sample test questions and test-taking tips!

Can’t join us live?
Don’t worry, we will send you a link to the recorded version.

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What is a Certified Diabetes Care and Education Specialist?

Read More: What is a CDCES?

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Why become a CDCES?
Three Reasons from Coach Beverly

Read More: 3 Reasons to Become a CDCES

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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.

Eli Lilly and Company issues a voluntary nationwide recall of one lot of GLUCAGON® Emergency Kit due to Loss of Potency. Warning – A person with severe hypoglycemia who injects this faulty formulation will experience worsening hypoglycemia.

Eli Lilly and Company is voluntarily recalling lot D239382D, Expiration April 2022, of Glucagon Emergency Kit for Low Blood Sugar (Glucagon for Injection, 1 mg per vial; Diluent for Glucagon, 1 mL syringe).

Loss of Potency due to manufacturing process issue

The Eli Lilly injectable glucagon kit (pictured here), usually contains a syringe with diluent and a vial with powdered glucagon. The user needs to put the diluent into the vial with the powdered glucagon and reconstitute it before injecting it.

However, a product complaint from a user found that the vial of Glucagon was in liquid form instead of powder form. Associated with this useful product complaint, the patient who was given this glucagon vial content, experienced worsening hypoglycemia and also reported subsequent seizures.

The use of the liquid form of this product may fail to treat severe low blood sugar due to loss of potency.

It is well known that severe hypoglycemia in people with diabetes, if not promptly treated and reversed, can potentially cause adverse health consequences ranging from transient, minor complaints to neurological damage, seizures, and even death. Eli Lilly’s investigation indicates that the liquid in this Glucagon vial could be related to a problem with the manufacturing process.

Please help get the word out

The Eli Lilly Glucagon product is packaged in a kit containing 1mg of freeze-dried (lyophilized) product in a 3 mL vial and a pre-filled diluent syringe. The affected Glucagon Emergency Kit lot is D239382D and the expiration date is April 2022 (label expiry date: 04 2022). The lot number can be found on the label of the kit as well as the vial (refer to the complete FDA warning below). The lot was distributed nationwide to wholesalers and retailers.

Contact Info for Consumers

Consumers in possession of Glucagon Emergency Kit lot D239382D should contact The Lilly Answers Center at 1-800-LILLYRX (1-800-545-5979) for return and replacement instructions for the product (hours of operation are Monday- Friday, 9AM – 7PM EST) and should contact their health care provider for guidance. Consumers should contact their physician or healthcare provider if they have experienced any problems that may be related to taking or using this product.

Lilly is notifying its distributors and customers by written communication and is arranging for the return and replacement of all recalled products. Wholesalers and Distributors with an existing inventory of Glucagon Emergency Kit lot D239382D should cease distribution and quarantine the product immediately.

Read complete FDA Announcement Here

FREE Glucagon PocketCards

There are now 4 different glucagon formulations to choose from.

This free card details the different formulations available, from the injectables to the nasal powder formulation.

The backside includes teaching and hypoglycemia prevention strategies, along with the different official levels of hypoglycemia (for your certification study preparation).

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Meritus Health’s Virtual Diabetes Conference

Diabetes in the 21st Century with Coach Beverly

Join us live on November 11th from 8:00 am to 4:00 pm for our Virtual Conference: Diabetes in the 21st Century | 6.5 CEs

This conference offers comprehensive presentations on care of a person with diabetes examining a variety of evidence-based topics to aid in the care of a person with diabetes.

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Location: Virtual

Fees: No charge for Meritus Health Employees. $50.00 for Non-Meritus Health Participants Meritus Health Employees: Please register via Healthstream, using keyword search “21st Century” or by clicking here.

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Check-in: Check-in starts at 8:00 a.m., please log in 15 minutes prior to the first presentation

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•  Registered Nurses: Nursing Education Department of Meritus Health is accredited with distinction as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.
  6.5 ANCC Contact Hours will be awarded; No partial credit will be given.
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Click here to download the program flyer.

Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator and a nationally recognized diabetes expert.

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