Click here to read our entire April Newsletter

At a local hospital, a person in their mid-40s, with type 2 diabetes was admitted for treatment of COVID-19 and Diabetes Ketoacidosis (DKA). An insulin drip was started and their SGLT-2 Inhibitor was stopped. Why are people with type 2 and COVID-19 going into DKA and how is this impacting outcomes?

A person with type 1 diabetes calls into a rural health clinic and says they are running a temperature, having difficulty breathing and can’t get their blood sugars below 300. The diabetes specialist instructs them to go to the hospital. What supplies should they take in case they are admitted to the hospital?

How do we help prepare people with diabetes for the possibility of hospitalization and what are best practices to care for people with diabetes and COVID-19 in the hospital setting?

What instruction do we provide for people with diabetes if they get sick and are wondering if they need to go to the hospital?

In this newsletter, our goal is to answer these questions based on the opinions of experts in the field and the best information to date.

In addition, we are excited to share information on drone delivery of insulin, mask making and the opportunity to celebrate the AADE (ADCES) Educator of the Year, Dr. Diana Isaacs.

Lastly, please let CMS (Medicare) know that RNs and Pharmacists need to be considered as providers of DSME telehealth services. Now, more than ever, we need all hands on deck.

Thank you everyone. Take extra good care of yourselves.

Beverly

Click here to read our entire April Newsletter

 

February Newsletter Now Available!

Our February Newsletter celebrates the future of diabetes care and education. As we settle into the year with a new title, amazing advances in health tech, and a person-centered approach, we are excited about what’s ahead! Our newsletter and Blog Bites are focused on filling the knowledge gaps while honoring these changes, as we move into a new era of diabetes care and education.

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Featured Blog Byte

Every weekday our Diabetes Detective Team scans the news to discover and report on the most relevant info that Diabetes Ed Specialists need for their daily practice.

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New Triple Combo Pill for Type 2 Diabetes

As the director of the diabetes research unit at the University of Texas Health Science Center at San Antonio, Ralph A. DeFronzo, MD, said, “Type 2 diabetes is a complex disease that often requires the use of multiple antidiabetic medications to improve glycemic control. Having three different diabetes medications in a single tablet is an important advance in diabetes treatment.”

Known as Trijardy XR, this medication combines the SGLT2 inhibitor empagliflozin, the DPP-IV inhibitor linagliptin, and metformin extended-release. Both empagliflozin and linagliptin lower blood glucose and empagliflozin has the added benefit of reducing the risk of cardiovascular death and chronic heart failure for those living with cardiovascular disease or chronic heart failure.

Additionally, a trial that was presented at the American Diabetes Association (ADA) Scientific Sessions by Healio found that linagliptin will not increase the risk for a cardiovascular event, nor will it contribute to the progression of renal disease among people with type 2 diabetes. This trial, known as the CARMELINA trial, was conducted over six years, across a group of 6,000 people. The trial demonstrated that no “between-group differences for the incidence of nonfatal myocardial infarction, nonfatal stroke and CV death during a median of 6 years.”

• Trijardy XR will be available in four dosages:
• 5 mg empagliflozin/2.5 mg linagliptin/1,000 mg metformin ER
• 10 mg empagliflozin/5 mg linagliptin/1,000 mg metformin ER
• 12.5 mg empagliflozin/2.5 mg linagliptin/1,000 mg metformin ER
• 25 mg empagliflozin/5 mg linagliptin/1,000 mg metformin ER.

There is no information on pricing as of yet. Read more about Trijardy here.

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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.

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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 [email protected] 

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

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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.

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!

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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