LS tells you that they frequently attend company mixers where they feel compelled to have at “least a few drinks”, to fit in and network. The tricky part of this scenario is that LS lives with type 1 diabetes. Since they don’t have a working pancreas, their circulating levels of insulin and glucagon are often mismatched to their body’s needs.

When discussing the situation, LS says they feel confident they can handle alcohol and prevent lows since they have lived with type 1 diabetes for over ten years. LS shares, “I feel comfortable recognizing when both arrows are pointing down and I am heading for a glucose crash”.

As educators, we are committed to taking person-centered approach while encouraging safe practices.

In regards to LS, we realize alcohol’s impact on the thought process and blood glucose levels. We know that alcohol can affect critical thinking and possibly impair recognition of an impending hypoglycemic event. Inebriation also has many symptoms in common with hypoglycemia. Plus, alcohol consumption slows glycogen breakdown in the liver, which increases the risk of hypoglycemia. Lastly, based on a study published in Endocrinology Advisor, higher levels of alcohol in the blood can delay and blunt the effectiveness of glucagon rescue medications.

In the worst-case scenario, if LS experiences severe low blood sugar and passes out, alcohol ingestion can blunt the effectiveness of the glucagon rescue medications.

Alcohol and Glucagon Pathophysiology Review

The body considers alcohol a toxin and as soon as it reaches the bloodstream, the liver prioritizes metabolizing the alcohol and breaking it down. During this clean-up process, the liver is distracted from responding to endogenous glucagon, the hormone that signals the liver to break down glycogen for energy and liberate glucose into the bloodstream. This clean-up can last for up to 8 hours, making delayed hypoglycemia a real possibility.

When a person with type 1 diabetes drink alcohol, they at increased risk of hypoglycemia because the liver isn’t breaking down stored glycogen to increase blood glucose levels.

Let’s get back to LS. What if LS is drinking gin and diet tonics and only munching on low-carb vegetables and cheeses during the mixer? LS is not ingesting many carbohydrates, so glycogen stores may be low and the liver is busy cleaning up the alcohol and blood sugars start dropping. By the 4th drink, LS isn’t thinking very clearly, says they “feel funny” and passes out.

A colleague of LS carries a glucagon emergency kit and provides LS with a dose and calls 911. After 15 minutes, LS still hasn’t regained consciousness, so a second dose is administered. The paramedics arrive and check the glucose, it is 53.

Simply put, glucagon rescue medications may not work if the person drinks too much alcohol.

After reviewing the package inserts of all available US manufactured Glucagon Rescue Meds, there are no warnings for alcohol intake decreasing the effectiveness of glucagon rescue meds. So, I dug a little deeper and found a decent study on the topic which describes the impact of alcohol ingestion on glucose-regulating hormones.

I also found a very helpful monograph published by Lilly Baqsimi in Canada. Baqsimi is a powdered glucagon rescue medication that is delivered nasally. The Baqsimi monograph clearly states several warnings, “Alcohol can suppress hepatic gluconeogenesis and chronic alcoholism can deplete liver glycogen stores. Therefore BAQSIMI may be less effective in presence of acute or chronic alcohol ingestion. Alcohol-induced hypoglycemia is associated with a failure of blood glucose levels to rise normally after glucagon administration. BAQSIMI may not work if the person drinks too much alcohol.“.

Keeping it Real and Safe

In conclusion, having a conversation with people with type 1 about the suppressive nature of alcohol on glycogen release for many hours after consuming alcohol is very important. Another important teaching point is that glucagon rescue meds may not be as effective and timely in raising glucose to safe levels.

As a general rule of thumb, encouraging people with type 1 to eat 15gms of carbs with each drink and have a glass of water in between, may help make sure they have enough circulating carbs and slow the pace of alcohol consumption to help the liver with processing. They may also consider decreasing their insulin dose in association with alcohol intake to prevent this serious side effect.

---

Want to learn more about Diabetes Care?  Join us for our

Virtual DiabetesEd Specialist Conference
30+ CEs

Airs October 12-14th, 2022

Join us LIVE for this Virtual Course and enjoy a sense of community!

Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.

Download Course Flyer | Download Schedule

If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.

Team of expert faculty includes:

• Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
• Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
• Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator

---

Two Registration Options

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

All hours earned count toward your CDCES Accreditation Information

---

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!

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.

July 2022 eNews | 3 Steps to”DeFeet” Amputations in People with Diabetes

Happy July

It’s officially summer. What better season to celebrate feet and lower extremities!

My passion for lower extremity advocacy began with my work at Stanford Hospital over 25 years ago. A kind-hearted man was admitted to the vascular unit with an infected foot ulcer and osteomyelitis. Despite days of antibiotic therapy and wound care, a partial foot amputation was required. He was devastated by this loss and so was I.

Here is the real tragedy. I am sure this amputation could have been prevented with some simple foot care education.

For this newsletter issue, we have put together a toolkit full of foot care resources that we are excited to share with you, including a FREE Webinar on 3 Steps to Save Feet.

Amputation rates are on the rise. We hope by sharing these tools and information, we reverse this trend and save limbs.

The great thing about foot care education is that all health care professionals can engage in sharing the prevention strategies outlined in our free handouts. Just think of all the unnecessary suffering we can prevent by looking at feet, providing education, and taking action on any unusual foot findings.

I think our foot care motto from Stanford Hospital says it best, “Lift the Sheets and Look at the Feets”. Let’s just start with this first step.

We are also overjoyed to announce that we are providing two Flower Scholarships that cover the cost of our Fall Virtual DiabetesEd Course. Applications are now being accepted.

Thank you in advance for your actions and advocacy on behalf of people living with diabetes.

Beverly, Bryanna, Robert, and Amanda

---

Featured Articles

• FREE Feet Toolkit
• Diabetes Wellness Visits Reduce Amputations
• 3 Steps to Save Feet FREE Webinar| July 19th
• Virtual Conference Scholarships
• Question of the Week
• Rationale of Week

Upcoming FREE Webinars

• Virtual DiabetesEd Specialist Conference|Oct. 12-14th
• CDCES Exam Prep | July 12th
• BC-ADM Exam Prep | July 14
• 3 Steps to Save Feet FREE Webinar| July 19th

Free Resources

---

Want to learn more about this question?
Join us for our new FREE Webinar
3 Steps to Save Feet; Assess, Screen, and Report

Airs live July 19th at 11:30 am PST (45 to 60 minutes)

All health care professionals are invited to join us to learn strategies to protect lower extremities during this FREE Webinar.

Coach Beverly will walk participants through the 3 Step Process to Save Feet; Assess, Screen and Report.   She will provide simple and clear instructions on how to assess and inspect feet, along with risk assessment and action steps. We will share free teaching tools, strategies, and documentation forms adapted from the Lower Extremity Prevention Program (LEAP) that you can immediately implement in your practice setting.

CEs: 1.0 CEs for $19 or No CEs for FREE

Topics include:

• Effective foot assessment made easy
• How to use a monofilament to assess sensation
• Using screening form to report findings

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

FREE Handouts and Resources

3 Steps to Save Feet – Assess, Screen, Report Handout.  This handout walks health care professionals through the steps involved in a 10-minute foot assessment and monofilament screening. Also includes a Screening Form to document and report findings.

Foot Care Teaching Sheet: This handout covers the important elements of foot care for people living with diabetes with simple and straightforward language.

---

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

Author, Nurse, Educator, Clinician and Innovator, Beverly has specialized in diabetes management for over twenty years. As president and founder of Diabetes Educational Services, Beverly is dedicated to optimizing diabetes care and improving the lives of those with diabetes.

---

NEW! Order Monofilament (5.07) for Diabetes Foot Screening 20-Pack

---

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!

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.

Last week, I attended my 17-year-old son’s band and theater high school award ceremony. In addition to the cultural diversity of these gifted teenagers, there were a number of award recipients from the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community. Each individual was celebrated and cheered on by their peers and recognized for their unique talents. As I left the auditorium, my heart was filled with joy knowing that there is room for everyone to share their gifts. This event was so much more enlightened compared to my high school experience over 30 years ago.

I am thrilled that the public high school in our community is taking steps to increase inclusivity for the LGBTQ+ community, but we have a long way to go in making other public spaces and health care settings welcoming for all.

According to an article recently published in ADCES in Practice, “Know Thyself, A Cultural Humility Framework for Diabetes Education for LGBTQ+ Individuals”, authored by Katie Savin and Theresa Garnero, the LGBTQ+ population continues to experience worse health outcomes than their heterosexual and cis counterparts. This discrimination is amplified in communities of color.

Health and Diabetes Disparities

In their article, Garnero and Savin highlight that members of the LGBTQ+ community are less likely to have health insurance and experience higher rates of food insecurity. LGBTQ+ adults are also vulnerable to poor physical and mental health. Membership in a stigmatized community puts LGBTQ+ adults of all ages at greater risk for engaging in behaviors such as smoking, substance misuse and binge eating. Experts suggest that the Minority Stress Model, which includes the LGBTQ+ community, increases sexual and gender minorities risk for mental illness, anxiety, depression and risky health behaviors.

Actions diabetes professionals can take to provide more inclusive care

Create health care settings that send a message of welcomeness to the LGBTQ+ community. There are many small and big ways to send a message of inclusion.

• Making sure the health intake forms include more than just Male and Female when asking people to check their gender.
• Bathroom door signs that welcome all genders.
• Placing pride symbols in the waiting and exam rooms, especially during Pride month.
• Practicing cultural humility when providing care
• Get comfortable with the language of LGBTQ+

Cultural humility asks health care providers to develop critical self-awareness of personal implicit or explicit values that and behaviors that may contribute to health care disparities.  Cultural humility acknowledges the role of power and privilege within the patient-provider dynamic and within the health care system itself.  Cultural values and behaviors emanating from the provider actually have the power to shape the encounter and may minimize the values of the person seeking care. By taking a closer look at our own biases during interactions, we can start becoming more intentional and align with the individual’s needs and values when providing care.

Get comfortable with the language of LGBTQ+

Inclusive language creates a bridge and the foundation of trust between health care provider and participant.  Challenge yourself to adopt inclusive language practices by taking time to learn the terminology. Make sure intake forms include same-gender parenting, same-gender partnerships and non-binary gender options.

To get more comfortable with the language culture of LGBTQ+ community members, consider challenging your healthcare setting to integrate LGBTQ+ cultural events and practices in the work setting.

As individuals, we can visit a local LGBTQ+ Center, attend a pride march, drag show or other event that provides acculturation to the community’s customs. Plus, you’re likely to have fun in the process.

Increasing exposure to the LGBTQ+ community helps decrease discomfort and improves the quality of your interactions when providing care. In addition, since members of the LGBTQ+ are at higher risk for mental health distress, make sure to assess for anxiety, depression and drug misuse.

We enrich our practice when we welcome people from diverse communities and backgrounds. Let’s make sure to let our LGBTQ+ community know they are safe with us.

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.”

---

Studying for the CDCES Exam?

Enroll in CDCES Online Prep Bundle + 5th Ed ADCES Review Guide Book | 47 CEs

---

What is a Certified Diabetes Care and Education Specialist?

Read More: What is a CDCES?

---

Why become a CDCES?
Three Reasons from Coach Beverly

Read More: 3 Reasons to Become a CDCES

---

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!

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.

Like many of you, I have a personal relationship with climate change.

On a blustery day in November 2018, the Camp Fire burned down the hospital and the entire town where I provided diabetes care for over 20 years. In a matter of a short six hours, over 30,000 people who lived in Paradise lost their community and sense of place.

I lost working with my incredible diabetes team and my extended diabetes family. Others lost everything. The Camp Fire has devastated us all in very personal ways. It is considered the deadliest and most destructive wildfire in California history.

Since the town of Paradise was a popular retirement destination, many of those who survived the fiery drive down the hill were frail and elderly. More than 3,000 of them had diabetes and many fled their homes without their meters, insulin, or other critical medications.

With the help of the Red Cross and hundreds of volunteers, we were able to connect most people with needed medications and supplies, but many went without. People with diabetes lost connections to their providers, pharmacies and support systems.

We lost 85 of our beautiful community members due to the fire and thousands of our neighbors dispersed to other states and towns to start their lives over. Over half of our providers moved away and a hospital that provided care to a rural community was suddenly gone. This extreme loss and upheaval reveals the painful truth that we need proactively take action to reduce the frequency and severity of climate disasters and be prepared for future events.

How is climate change impacting diabetes risk?

According to a 2020 article published in the Journal of Community Hospital Internal Medicine Perspectives, climate change, and in particular, increasing global temperatures, is expected to impact the health of people living with diabetes and lead to worse outcomes.

After completing a literature review, the authors concluded that diabetes and climate change are interconnected. Let’s explore how.

Hotter Temperatures Worsen Diabetes Outcomes

People with diabetes are at greater risk of experiencing dehydration and cardiovascular events during periods of extreme heat. With the increasing frequency of extreme heat episodes, there is an associated increased risk of heat-related death and cardiovascular events for people living with diabetes. Several studies reveal that people with diabetes have a higher risk of death on hot days, and are more likely to need emergency care and those with a history of heart disease are most vulnerable.

Shortage of Medical Supplies and Medications

Recent climate disasters, like the Camp Fire, Hurricane Katrina in 2005, and Hurricane Harvey in 2017, resulted in people not being able to access, afford or safely store their medications, including insulin. In addition, we are experiencing supply chain disruptions in D50 (25 grams of glucose in a 50 ml prefilled syringe (50% glucose)) to treat hypoglycemia and certain intravenous fluids are in short supply.

Food Supply Shortages

Extreme weather can result in agricultural production disruptions. In our community, many fields that were once green with trees and crops, now are brown and barren. There is not enough water to keep crops alive and growing. This also means job loss and less money flowing into communities. When the healthy food supply is limited, people living with diabetes may turn to lower-cost, processed foods which are environmentally unfriendly and low in nutrients.

Diabetes and climate change are clearly interconnected. Extreme weather events and rising temperatures will significantly impact people living with diabetes, especially those with cardiovascular disease. The disruption in the supply of life-saving medications (e.g. insulin) due to extreme weather combined with decreased access to healthy foods are difficult issues that require problem-solving by individuals, communities, and government leaders.

We are expecting more intense weather-related events in the future and the question is what can WE do?

As Diabetes Specialists, I believe we can make a difference by leaning into our unique blend of behavior change skills, advocacy, and scientific knowledge

We can take a two-fold approach:

1. Take action to help slow and reverse climate change – Read our blog on actions we can start taking today.
2. Help people with diabetes to be prepared for natural disasters. Read our blog on How to Get Ready

A note of hope. Three years after the Camp Fire, people are rebuilding in Paradise. There is a better understanding of the need for preventive forest management and exit routes. However, the longstanding California drought continues to contribute to future fire risk. Water conservation is more important now than ever. We can take action to reverse the heating planet. Read our blog on actions we can start taking today.

---

10 Ways to Help the Planet

Change isn’t easy. We aren’t going for perfect, we are starting with intention and slowly moving to action, giving ourselves lots of grace along the way. I am excited to share my successes and wrong turns with you on this journey and we would love to hear from you too!

1. Grow plants native to your area.
2. Compost kitchen scraps and cut down on waste
3. Eat more sustainable veggies, fruits, grains and less meat, processed foods.
4. Drive less and walk more, especially in nature
5. Think of 3 ways to use less water
6. Use cold water to wash, hang clothes to dry.
7. Turn appliances, lights and computers off when not in use.
8. Purchase used items and re-use everything you can. Swap and trade instead of buying new.
9. Try to use less plastics
10. Trade out filament light bulbs for new LED bulbs.

Read more on our blog, Earth Day Secrets to Improving Planet Health

Stay tuned and we share details and resources on each of these 10 Steps over the next few months. And, please send us your stories too at [email protected]. We want to hear from you!

How to Protect the Planet Resources Page

---

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!

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

Happy May

We loved celebrating Earth Day with all of you. Your response to our “PocketCard for a Planet Pledge campaign” knocked our socks off. Over 900 people committed to taking action for the Earth. Plus, hundreds of you added our own ideas. We decided to continue the planetary PocketCard party for one more week because we love our community!

This month’s newsletter explores the link between climate change and diabetes from a personal and community level. We provide ideas for prevention, preparation, and actions to take in case of a climate-related disaster. People with diabetes are especially vulnerable during extreme climate events and helping ready them for disasters can save lives.

In addition, we highlight a recent study that demonstrates reducing four risk factors improves outcomes, which is great news to share.

Living with diabetes can be overwhelming. Messages of hope for people with diabetes can provide motivation to continue with self-care during those hard times.

Lastly, I would like to dedicate this newsletter to a very special person. Ruth always showed up to our diabetes support group with the energy of two people and the mental clarity of someone half her age. Around this time of year, she would distribute Emergency Preparedness materials and would carefully review the exit routes out of Paradise in case of fire. She would go around the room and ask each person if they had their emergency bag ready. For each of the seventeen years that I ran that support group before the hospital and town burned down, Ruth gave the same impassioned spiel. I can only imagine how many lives she saved.

May we all embody the spirit of Ruth as we move forward on this journey. With wishes for health and wonderment,

Beverly, Bryanna, Jackson, and Amanda

---

Featured Articles

• How a Changing Climate Impact Diabetes Risk.
• Earth Day Pledge Success
• Semaglutide Max Dose Increased to 2mg
• Reducing 4 Risk Factors to Increase Life Expectancy
• How to Prepare for Natural Disasters
• Question of the Week
• Rationale of Week

Upcoming Webinars

• DiabetesEd Virtual Conference | Recorded & Ready to Watch!
• Cardiovascular Disease & Diabetes | May 10th
• Older Adults | May 12th

Featured Items

• ADCES Book Bundle

---

Studying for the CDCES Exam?

Enroll in CDCES Online Prep Bundle + 5th Ed ADCES Review Guide Book | 47 CEs

---

What is a Certified Diabetes Care and Education Specialist?

Read More: What is a CDCES?

---

Why become a CDCES?
Three Reasons from Coach Beverly

Read More: 3 Reasons to Become a CDCES

---

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!

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.

Research published in The Lancet Diabetes & Endocrinology this month confirmed the same findings as a growing number of studies.  COVID-19 increases a person’s risk of diabetes, even months after being infected.

In this latest robust study, researchers reviewed the medical records of over 180,000 US Veterans who survived the first 30 days of COVID-19 infection between March 2020 and September 2021 and compared them with 2 large control groups—a contemporary cohort of more than 4.1 million non-infected participants who used VA services during the same time period and a historical cohort of another 4.28 million non-infected participants who used VA services during 2017.

What researchers discovered is very concerning

Over 40% of study participants infected with COVID-19 were more likely to develop diabetes or be prescribed diabetes medication within a year compared to the control group.  Simply translated, 2 in 100 COVID-19 patients were more likely to develop diabetes than those who did not get infected.

People older than 65 years and those with cardiovascular disease, high blood pressure, high cholesterol, or prediabetes had a higher risk of diabetes than younger individuals or those without underlying conditions. Additionally, Black participants had higher risks of developing diabetes than White participants.

Most of the post-COVID diabetes cases (over 99%) developed type 2 diabetes. In addition, the severity of the COVID-19 infection impacted the risk. People with COVID-19 admitted to intensive had the highest risk of developing develop diabetes, compared to those not infected.

Some limitations of the study include that the findings may not translate to other populations, since the US Veterans study group consisted of mostly older white men, many of whom had risk factors for diabetes, including hypertension and extra weight.  The risk of getting diabetes post-COVID-19 seems to be much lower in younger people. Another limitation is that some people in the control group might have had an asymptomatic missed COVID-19 diagnosis.

Implications for Diabetes Specialists

These startling findings have significant implications for the 80 million people in the U.S. known to be infected with COVID-19, especially for people living with long-haul covid.

People who have experienced a COVID-19 infection need to know the symptoms of hyperglycemia and be encouraged to report suspicions of diabetes symptoms to their providers right away.  In addition, regular glucose testing of people who were infected with COVID-19 may now be recommended to detect those who may not be aware of the signs of diabetes.

Now, more than ever, we need to increase access to Diabetes Prevention Programs and Diabetes Self-Management Education, to make sure this expanding population of people with new diabetes gets the information they need to successfully manage glucose levels and maintain optimal quality of life.

For more information:
Washington Post Article and The Lancet Diabetes & Endocrinology

---

Want to learn more about this topic? Join us for our

Setting up a Successful DSME Program Standards | Level 2 $29 | 1.5 CEs

Recorded & Ready to Watch!

This course provides you with a succinct overview of the latest standards for Diabetes Self-Management Education (DSME) and Support Programs. If you are taking certification exams or considering setting up a DSME program, this program is designed for you. We highlight the newly revised and simplified 2022 Standards and provide strategies on program implementation. In addition, we discuss Medicare Reimbursement and covered benefits. This course provides insights into the exam philosophy and also highlights critical content areas.

Objectives:

1. Describe DSME program examples from across the country.
2. List the six standards for creating a successful DSME program
3. Discuss marketing strategies for success
4. Describe Medicare Reimbursement for diabetes care and education

---

Join us for our Virtual DiabetesEd Specialist Conference
30+ CEs

Recorded & Ready to Watch!

Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.

If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.

 Download Course Schedule |  Download Course Flyer

Join us LIVE for this Virtual Course and enjoy a sense of community!

Team of expert faculty includes:

• Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
• Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
• Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator

 Download Course Schedule |  Download Course Flyer

---

Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs

Deluxe Option for $449: Virtual Program includes:

• Q & A Session with the instructor after each webinar.
• LIVE Presentations by our team of experts.
• State of the art review of current diabetes care and technology.
• Resources for each session.
• Access to free podcasts and video recordings within a week of each live session for one year.

Deluxe Version includes Syllabus, Standards and Swag*:

• Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
• ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
• DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

---

All hours earned count toward your CDCES Accreditation Information

---

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!

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

Happy April

If you want to get fired up about providing Diabetes Self-Management Education and Support (DSMES), I highly recommend reading the updated Standards for DSMES. If you don’t have time to read the complete document, we have provided our top 9 takeaways to get you started.

This new version of the DSMES Standards, authored by a collaboration of education specialists, offers a fresh outlook and a simplified six standards with the clear goal of increasing inclusivity and breaking down barriers.

In addition, we explore the expanding clinical applications of the SGLT-2 Inhibitor class.

Clearly, the newer diabetes medications are impacting more than glucose levels, they can also boast about co-benefits including cardiovascular and renal protection. We have updated our Med Pocket Cards to reflect this new perspective and considerations.

Our last two articles take a look at the concerning findings of increased risk of future diabetes post-COVID-19 infection. Large, controlled trials are saying the same thing, about 25-40% of people one year after experiencing COVID-19 are being diagnosed with new type 2 diabetes.

Lastly, to celebrate EARTH DAY, we pause, take a deep breath and notice the wonderment and gift of our beautiful planet. Research shows that planet health improves human health and decreases chronic diseases. Maybe we can each start with one action toward caring for our planet. We provide some great getting started resources on growing native plants in your backyard, patio, or veranda. All of our actions matter.

Beverly, Bryanna, Jackson, and Amanda

Featured Articles

• New DSMES Standard Changes. 9 Takeaways.
• Medication Pocketcard Updates for SGLT-2s
• COVID Increases Diabetes Risk? 
• Celebrating Earth Day
• Question of the Week
• Rationale of Week

Upcoming Webinars

• DiabetesEd Virtual Conference | April 13-15th
• Microvascular Complications| April 26th
• Critical Assess | April 28th
• Prep for BC-ADM | April 7th

Featured Items

• ADCES Book Bundle
• Free Resources

---

Want to learn more about this question?  Join us for our

Virtual DiabetesEd Specialist Conference
30+ CEs | April 13-15, 2022

Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.

 Download Course Schedule |  Download Course Flyer

If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.

Join us LIVE for this Virtual Course and enjoy a sense of community!

Team of expert faculty includes:

• Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
• Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
• Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator

---

Two Registration Options

---

Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

• Q & A Session with the instructor after each webinar.
• LIVE Presentations by our team of experts.
• State of the art review of current diabetes care and technology.
• Resources for each session.
• Access to free podcasts and video recordings within a week of each live session for one year.

Deluxe Version includes Syllabus, Standards and Swag*:

• Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
• ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
• DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

---

Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

• Q & A Session with the instructor after each webinar.
• LIVE Presentations by our team of experts.
• State of the art review of current diabetes care and technology.
• Resources for each session.
• Access to free podcasts and video recordings within a week of each live session for one year.

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

All hours earned count toward your CDCES Accreditation Information

---

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!

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.

If you want to get fired up about providing Diabetes Self Management and Education Support (DSMES), the newly updated Standards for DSMES is highly recommended reading. If you don’t have time to read the complete document, we have provided our top 9 takeaways to get you started.

Every 5 years, a committee of diabetes education specialists and advocates gets together to update this roadmap for the provision of DSMES. In the last version of this document, there were ten standards and lots of complicated rules and regulations required to set up a recognized DSMES Program.

In this new version, the collaborative of authors possesses a fresh outlook and clear vision that resulted in six simplified standards with the goal of inclusivity and breaking down barriers.

To address inequities, a candid discussion of racial disparities and social determinants of health is included. In addition, there is recognition that participation in DSMES has lost momentum during the pandemic with stagnant or decreasing enrollment. We need to innovate and make access and participation a top priority to make sure all people have the opportunity to benefit from this knowledge and life-saving information.

Coach Beverly’s 9 Takeaways from updated DSMES Standard.

1. I love the definition they included of a CDCES – “A compassionate teacher and expert who, as an integral member of the care team, provides collaborative, comprehensive, and person-centered care and education for people with diabetes”. This is the best description of our caring expertise and role in improving care.

2. DSMES makes a difference! – Lowers A1c by at least 0.6% with greater A1c reductions when engaging in DSMES of 10 hours or more.  In addition, DSMES has a positive effect on clinical, psychosocial, and behavioral aspects while improving quality of life and coping skills.  Individuals who participate are more likely to engage in self-care through behavior change, including eating healthier eating and regular exercise.

3. Breaking down barriers through recognition of Social Determinants of Health and addressing equity. The authors recognize the need for person-centered services that embrace cultural differences, social determinants of health, and ever-increasing technological engagement platforms and systems. The goal is to increase health equity through access to this critical service while focusing more on person-centered care and decreasing administrative complexities.

4. Recognition of the need for a thoughtful community needs assessment that looks at more than demographics. We still need to gain data from local and national resources to identify race, ethnicity, cultural background, sex, age, geographic location, tech access, and literacy. But just as important are the perceptions of risk associated with diabetes and barriers including socioeconomics, cultural factors, misaligned schedules, and health insurance shortfalls.

5. An important and often underappreciated barrier to DSMES includes perceived lack of need and limited encouragement from health care professionals to engage in DSMES. Plus, special attention needs to be payed to those who do not usually attend clinic appointments to discover their perceived and real barriers.

6. Diabetes Care Community Coordinators are needed to help build bridges between the medical community and the community we serve. These individuals include community health workers and health promoters who live in the community and have familiarity and understanding of the needs and cultural factors of the individuals we are seeking to serve. Diabetes care coordinators also include; dietetic technicians, medical assistants, peer educators, and leaders. They can instruct, reinforce self-management skills, support behavior change, facilitate group discussion and provide social support.

7. Keep the curriculum dynamic and practical. Research endorses the inclusion of practical, problem-solving approaches, collaborative care, consideration of psychosocial issues, and support of behavior change strategies to sustain self-management efforts. In addition, supplementing with resources and support materials can help individuals navigate the health care system and promote self-advocacy.

8. Strategies to increase DSMES participation through provider referrals. Keeping programs vibrant and active is no easy task and requires constant attention. I put together a list of strategies I have used to boost referrals by providers. Direct mail of DSMES flyers to providers, networking during community gatherings, lunch and learn CE activities, hallway conversations, welcome packet for new providers, delivery of referral forms and holiday gifts to offices, and shared participant testimonials.

9. Strategies to increase DSMES participation through self-referrals. We can directly appeal to our community members and then reach out to their providers to approve the referral f. Ideas to touch your community include; publishing articles on hot diabetes topics, sending out press releases, advertising in local papers and on social media, hosting events during National Diabetes Month, joining health fairs, providing community presentations to service organizations, and promoting word of mouth marketing with your graduates.

Diabetes Self-Management Education and Support is a critical components of comprehensive diabetes care. By addressing barriers and including community members in our outreach, we can break down the walls and increase participation and improve the quality of life for all people.

---

Want to learn more about this topic? Enroll in our

Setting up a Successful DSME Program Standards Webinar | Level 2 $29 | 1.5 CEs

Recorded & Ready to Watch!

This course provides you with a succinct overview of the latest standards for Diabetes Self-Management Education (DSME) and Support Programs. If you are taking certification exams or considering setting up a DSME program, this program is designed for you. We highlight the newly revised and simplified 2022 Standards and provide strategies on program implementation. In addition, we discuss Medicare Reimbursement and covered benefits. This course provides insights into the exam philosophy and also highlights critical content areas.

Objectives:

1. Describe DSME program examples from across the country.
2. List the six standards for creating a successful DSME program
3. Discuss marketing strategies for success
4. Describe Medicare Reimbursement for diabetes care and education

---

Join us for our Virtual DiabetesEd Specialist Conference
30+ CEs | April 13-15, 2022

Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.

If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.

 Download Course Schedule |  Download Course Flyer

Join us LIVE for this Virtual Course and enjoy a sense of community!

Team of expert faculty includes:

• Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
• Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
• Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator

 Download Course Schedule |  Download Course Flyer

---

Two Registration Options

---

Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

• Q & A Session with the instructor after each webinar.
• LIVE Presentations by our team of experts.
• State of the art review of current diabetes care and technology.
• Resources for each session.
• Access to free podcasts and video recordings within a week of each live session for one year.

Deluxe Version includes Syllabus, Standards and Swag*:

• Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
• ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
• DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

---

Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

• Q & A Session with the instructor after each webinar.
• LIVE Presentations by our team of experts.
• State of the art review of current diabetes care and technology.
• Resources for each session.
• Access to free podcasts and video recordings within a week of each live session for one year.

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

---

All hours earned count toward your CDCES Accreditation Information

---

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!

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.