Finding Gratitude During a Pandemic

As we all prepare for Thanksgiving this year we may be having a difficult time feeling thankful.

As we continue to navigate this long-lasting pandemic there has been so much loss and heartache.  

Years ago I went to a conference on preventing burnout in healthcare providers with Dr. J. Bryan Sexton, associate professor in psychiatry and behavioral sciences at Duke’s School of Medicine and an expert in the idea of resilience.  He impressed me and I have talked about his conference to many colleagues over the years.

I loved sharing his wisdom with my clients, because of studies that link resilience to better diabetes self management. (1)

Lately, as I have been struggling with overwhelming feelings of sadness, I have remembered to practice some of his tools to cultivate resilience. Cultivating resiliency is something that takes daily focus. To cultivate means to nurture, grow, and encourage resilient behaviors.

Dr. Sexton suggests these three ways to increase resilience.

Three Good Things

Humans are hard-wired to remember the negative aspects of our day, but flipping around the natural inclination is simple.

Building resilience is possible by focusing on positive emotions – joy, serenity, hope gratitude, inspiration, pride, love, awe, and amusement.

Promoting positive thoughts and building resilience can be as easy as taking notes each night before bed. Think of three things that happened during the day that went well and your role in the positive outcome, then jot down those three things. Best results for this exercise come after 14 consecutive days. Empirical evidence shows that this elevates brain serotonin with positive effects on our mood that last for months. (2)

Show Gratitude

Grab a pen and paper and write a letter of appreciation to someone- anyone. Take five minutes to explain something they did, how it impacted you and the benefits you received. Whether you share the letter or not, Dr. Sexton said it can have lasting impacts, increasing happiness while lowering depressing thoughts because focusing on benefits forces us to linger on positive thoughts.

Rediscover Awe

Through an “awe intervention,” you can create a sense of slowed down time, which offers a calming sensation and a feeling of having more time available.

Awe also helps us to feel inspired. I call awe intervention, “joyful thanksgiving”. It is a practice that I am doing in which I acknowledge and give a little extra gratitude for the many amazing sights, sounds, tastes, relationships, information, and emotions that excite me and create awe right from the moment when I wake up. 

Today as I was practicing my joyful thanksgiving I paid special attention to my breakfast of oatmeal, blueberries, banana, walnuts and cinnamon. I love oatmeal in the fall and winter months.

I began to feel grateful for this medicinal food.  Oats, blueberries, banana, and nuts contain water soluble fiber which slow the absorption of sugar and fat from food, and therefore help prevent spikes in blood sugar and blood fat, possibly reducing the inflammatory response to food. (3)(4)

Fiber is a super food which provides important nutrition for our intestinal bacteria to live and prosper, that’s why fiber is called a pre-biotic. Vegetables, fruit, whole grains, nuts and legumes remain the single best sources of fiber in the diet.  High-fiber vegetables include many of the green leafy vegetables like kale, collard greens, chard, arugula, and even lettuces. Whole-grain sources of fiber include oats, quinoa, barley and rye. Legumes include beans like peas, soy, black, pinto and lentils.

Encouraging our clients to consider adding more fiber rich dishes to the holiday meals this season and perhaps telling them about Dr. Sexton’s tools for cultivating resilience may help them to feel happier and more hopeful and contribute to better blood sugar control.

Blueberry-Banana Overnight Oats

½ cup unsweetened coconut milk beverage

½ cup old-fashioned oats

½ TB chia seeds

½ banana

1 tsp maple syrup

½ cup blueberries

2 TB chopped walnuts

1/8 tsp cinnamon

Combine coconut milk, oats, chia, banana, maple syrup in a pint-sized jar and stir. Top with blueberries and coconut. Cover and refrigerate overnight. Heat up and sprinkle with walnuts and cinnamon in the morning.

285 calories, 6 gm protein,  57 gms carbohydrate, 7 gms fiber 6 gm fat

  1. Understanding the links between resilience and type-2 diabetes self-management: a qualitative study in South Australia . Arch Public Health. 2017; 75: 56.
  2. Seligman, Steen, Park & Petersen (July-August 2005). Positive Psychology Progress: Empirical Validation of Intervention. American Psychologist
  3. The Metabolic Effects of Oats Intake in Patients with Type 2 Diabetes: A Systematic Review and

 Meta-Analysis. Nutrients. 2015 Dec; 7(12): 10369-10387p. 1392:8

  • Chandalia, M., et al., Beneficial effects of high dietary fiber intake in patients with type 2     diabetes mellitus. N Engl J Med, 2000. 342(19):

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!

Confessions of an RD Sugar Addict & Low-Sugar Recipes

The holidays are upon us in the midst of a pandemic.

In past holiday seasons, I would check in with my clients to see how the holiday season was affecting their health.  We would talk about getting enough sleep and adapting exercise routines to adjust for cold weather and shorter days.

We would talk about stress management tools to help cope with the pressures to overeat and the pressures to eat foods that we have been attempting to avoid. 

This year is challenging because we are already taxed by the unbelievable stress of living in a pandemic.

I have found that I am already struggling with insomnia and less exercise. I have been overeating and craving sweets. In fact, I think that I have developed a sugar addiction during these last 7 months. I have been substituting ice cream, donuts, and chocolate for the hugs that I used to take for granted. I am missing gatherings,  parties, and shared dinners with friends. 


I started to look at the total amount of free sugar that I was consuming.  On some days it added up to over 12 teaspoons per day! And I am a dietitian.


Sugar is a powerful stimulant of serotonin that is lacking in my brain these days. I thought that I was developing a cavity and this woke me up.

I had to make a commitment to cut back on sugar. 

I thought about the World Health Organization’s sugar recommendation of lowering our free sugar intake to less than 5% of our total daily calories. This works out to about 6 teaspoons a day, depending on the person.

Free sugar applies to 

  • Added sugars such as:
    • glucose
    • fructose
    • sucrose
  • Naturally occurring sugars such as in:
    • fruit juice
    • honey
    • syrups

Whole fruit and milk sugar are not included in free sugar. 

I started to look at the total amount of free sugar that I was consuming.  On some days it added up to over 12 teaspoons per day! And I am a dietitian.

The average American consumes 17 teaspoons of sugar daily. This translates to 57 pounds of sugar consumed each year.

Hidden Sugars are Tricky to Find

Many people don’t realize that a lot of the sugar they take in are “hidden” in processed foods, according to the World Health Organization.

  • 12 oz of soda may contain up to 10 teaspoons of sugar.
  • Starbuck’s 12 oz Vanilla Latte contains about 7 teaspoons of sugar.
  • 1 Tablespoon of ketchup contains 1 teaspoon of sugar.
  • Fun size trick or treat plain M & M’s contain 3 teaspoons of sugar.
  • 1 piece of apple pie contains up to 8 teaspoons of sugar.
  • 6 oz of fruit-flavored yogurt has 6 teaspoons of sugar.

Research does show that for some people eating sugar produces characteristics of craving and withdrawal, along with chemical changes in the brain’s reward center, the limbic region. These changes are linked to a heightened craving for more sugar. 

I am grateful to be able to consciously choose to lower my sugar intake to improve my health.

I am grateful that the whole fruit can be used as a sweet substitute for my sugar cravings.

I love the new fall crop of apples, pears, kiwi, and persimmons.

Delicious Naturally Sweet Recipes

Below are my recipes for baked apples and poached pears that are a delicious holiday dessert.

Simple Baked Apples

  • 5 – 6 medium apples, peeled and cut into chunks
  • 2 Tablespoons butter or coconut oil, melted
  • 1 teaspoon cinnamon
  • ½ cup chopped walnuts
  • Preheat the oven to 350 degrees
  • Place the apples in a medium baking dish

Mix the melted butter or coconut oil, walnuts, and cinnamon together and pour over the apples. Bake in the preheated oven until the apples are soft, about 20 – 30 minutes. Stir once during the baking.

Enjoy!

Poached Pears (Naturally Sugar-Free)

  • 1 cup red wine
  • 1 orange zest and juice
  • 1 cinnamon stick
  • 1-inch ginger root peeled
  • 3 cloves whole
  • 2 Conference pears, peeled, sliced in half, and core
  • 1 Tablespoon sliced toasted almonds
  • 2 Tablespoons thick plain Greek yogurt

Pour the wine into a small saucepan along with the orange zest and juice and all of the spices

Bring almost to a boil and add the pear halves. Turn down the heat and let the pears simmer gently for 20 – 30 minutes, or until they have slightly softened.  Carefully turn the pears over a few times throughout the cooking time to ensure they color evenly. When the pears are cooked remove them from the wine and place them on plates. Add a tablespoon of yogurt to each plate and sprinkle with toasted almonds.

Visit our Joy of 6 Page for sugar info and resources to share with your clients!

Written by Dawn DeSoto RD, CDCES, our resident Nutrition Content Writer


Join us for our FREE Webinar – Getting to the Gut, Meet Your Microbiome | November 9th at 11:15 am PST

“This Webinar is filled with Bev’s energy, knowledge, and passion for diabetes that she replicates in all her teachings. She puts a demand on herself to be a mentor to all. Her information is well organized, full of current/relevant research, and helps CDCES’ view into the future as a changing world impacts diabetics. I find her to be the most exciting and engaging educator and … OUTSTANDING teacher!!” – recent participant

This one-hour complimentary journey will expand your view of how the trillions of bacterial hitchhikers profoundly influence our health. We will discuss how foods, the environment, and our medical practices have impacted our gut bacteria over time and strategies we can take to protect these old friends.

Webinar topics:

  • Discuss the latest research on our microbiome
  • State the relationship between gut health and diabetes risk
  • Describe 3 strategies to get our microbiome back to better health.

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!

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.

New Nutrition Facts Label Toolkit

Just one of the Label Education Videos

On Wednesday, we wrote about the FDA changes to the Nutrition Facts Label.

We wanted to share with you the Social Media Toolkit on this new label so you can spread the news.

Included in the Toolkit

This information is also available in Spanish by clicking here.


Interactive Virtual Nutrition Facts Label

An interactive tool was also created to learn how the new label applies to our daily food intake. This tool includes explanations and definitions for what is on each label.


Expert Team Toolkit | Technology, Insulin, & Medical Nutrition Therapies | 8.0 CEs

On sale! Now $89 from $109!

Join Dr. Diana Isaacs and Dana Armstrong for eight hours of intensive instruction on some of the most critical content needed to prepare for certification and to position yourself as a diabetes leader.

Both Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES, and Dana Armstrong, RD, CDCES are noted leaders in the field of diabetes.

Dr. Isaacs, named 2020 AADE Diabetes Educator of the Year for her educational platform promoting the use of CGM for people with diabetes and other innovations. She is the CGM Program Coordinator and clinical pharmacist specialist in the Cleveland Clinic Diabetes Center.

Dana Armstrong is the Medical Clinic Director of The Diabetes Center/Salinas Valley Medical Clinic. She provides leadership and ensures coordination and integration of effective system-wide excellence across the organization. Having a child with diabetes, she combines her professional knowledge with personal experience and understanding.

Each expert highlights the critical content of their topic area, so you can focus your study time most efficiently. They also launch multiple poll questions to help focus on key concepts and assess their knowledge.


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!

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.

New Nutrition Label Education Campaign, “What’s in it for You?”

The New Nutrition Facts Label: What’s in it for You?” education campaign developed by FDA, aims to raise awareness and increase use of the updated Nutrition Facts label.

Consumers, health care professionals, and educators will all benefit from this information and educational tools included in this campaign. Food labels can be confusing. This latest label, updated for the first time in 20 years, includes important changes worth exploring.

These changes by the FDA are based on advances in our understanding of nutrition and scientific research.

4 Major Updates

There are four major updates to the label around serving size, calories, % of the daily value, and the nutrients of the food.

Serving Size

Now in a larger, bolder font, the serving size is more noticeable. These adjustments mirror measurements we use when cooking. For example, a cup or tablespoon.

Serving sizes are based on the amount we typically consume in a day, rather than a recommendation of how much you should consume.

The new label may also contain multiple serving sizes if there are different foods packaged together.

Calories

The calories are also more obvious with a larger, eye-catching font.

Calorie intake should be based on the serving size food container. If the calories listed are 530, with two servings per container, eating the entire box would mean you are ingesting 1060 calories.

Each person’s daily recommended calorie intake is different, use My Plate to determine yours.

Nutrient % of Daily Value (% DV)

Daily Values are the recommended amounts of nutrients to consume or not to exceed each day.

https://www.fda.gov/food/new-nutrition-facts-label/daily-value-new-nutrition-and-supplement-facts-labels

These daily value percentages are anchored on new nutritional research and some of the daily %s have changed. For example, total fat values have increased from 65g to 75gs per day.

Certain nutrients do not have a daily value, such as protein, sugars, and trans fats. When looking at labels, check the grams for each of these so you aren’t consuming too much in a day.

Nutrient daily values are a balancing act. We don’t necessarily need to give up our favorite foods, but rather be mindful of how the foods we eat impact our overall daily % nutrient value.

Updated Nutrients Listed

A few nutrients have been omitted in the new labels.

  • Calories from fat
  • Vitamin A
  • Vitamin C

Research indicates that calories from fat aren’t as important as the types of fat we consume. Additionally, we don’t see deficiencies of Vitamins A & C as often anymore.

New nutrients added are:

  • Added sugars
  • Vitamin D
  • Potassium

Since added sugars increase overall calories, but do not have an impact on % of DV, it is important to label these additives. Vitamin D and potassium as added because research shows many people in the United States are not getting the recommended daily value and may be deficient in each.

To explore the “The New Nutrition Facts Label: What’s in it for You?” education toolkit in English and Spanish, click here and click here.


Expert Team Toolkit | Technology, Insulin, & Medical Nutrition Therapies | 8.0 CEs

On sale! Now $89 from $109!

Join Dr. Diana Isaacs and Dana Armstrong for eight hours of intensive instruction on some of the most critical content needed to prepare for certification and to position yourself as a diabetes leader.

Both Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES, and Dana Armstrong, RD, CDCES are noted leaders in the field of diabetes.

Dr. Isaacs was named 2020 AADE Diabetes Educator of the Year for her educational platform promoting the use of CGM for people with diabetes and other innovations. She is the CGM Program Coordinator and clinical pharmacist specialist in the Cleveland Clinic Diabetes Center.

Dana Armstrong is the Medical Clinic Director of The Diabetes Center/Salinas Valley Medical Clinic. She provides leadership and ensures coordination and integration of effective system-wide excellence across the organization. Having a child with diabetes, she combines her professional knowledge with personal experience and understanding.

Each expert highlights the critical content of their topic area, so you can focus your study time most efficiently. They also launch multiple poll questions to help focus on key concepts and assess their k


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!

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.

Pumpkin Pie Recipe – Finding Joy in Food during the Pandemic

This time of year is my favorite. Seeing the beautiful colors of the fall harvest soothes and invigorates me.  Being outdoors with my community is especially healing during this unusual and stressful time of isolation due to the pandemic.

I especially adore shopping and gathering fresh produce and other goodies from our local Farmers’ Market!

The farmer’s market is also a special place for me because my daughter works there. Her booth is overflowing with all the pumpkins and winter squash they have harvested.  Last week, at the market, my daughter introduced me to her friend as they were talking about a pumpkin pie he had made from the pumpkin that he had purchased from her. 

“Unfortunately, I can’t eat the pumpkin pie anymore because I was just diagnosed with having Type-2 Diabetes,” he explained.

 I couldn’t help but tell him that I was a Dietitian and Diabetes Specialist.

We started talking about modifying the recipe using sugar substitutes or low carbohydrate crusts. We discussed portion control and going for a walk after eating a piece of the pie. He was intrigued. 


My philosophy is that, with thoughtfulness and creativity, all of our favorite foods can be included in our meal plans with knowledge and love. 


Pumpkin and other winter squash do contain carbohydrates but are nourishing food. Benefits include:

  • They are high in fiber, beta-carotene, magnesium, potassium, lutein, and zeaxanthin. 
  • 1 cup of pumpkin puree has 80 calories, 22 gms carbohydrate, 6 gms of fiber. 
  • A piece (1/8  of a 9-inch pie) of traditional pumpkin pie made with sweetened condensed milk contains 379 kcal and 31 gms of carbohydrate or
  • Compared to the included recipe (see below) of a piece of stevia-sweetened pumpkin pie (1/6 of a 9-inch pie) made with low fat evaporated milk and stevia containing 188 calories and 17 gms of carbohydrate. Both can be included in our meal plans if desired. 

It is important to take away the judgment around food choices, to encourage thoughtful choices, and find joy in our food.  At this difficult time, every effort to empower ourselves with choice and joy is highly recommended. 


Stevia Pumpkin Puree Recipe (Serves 6):

Choose a pie pumpkin and wash it’s exterior. Cut in half lengthwise and remove the seeds and pulp. Roast in your oven for about 45 minutes at 350 degrees F.

Simply peel away the skin from the flesh and toss the pumpkin pulp into your food processor or blender.

Ingredients:

  • 1 unbaked 9-inch pie crust
  • ½ teaspoon stevia powder
  • 1 teaspoon cinnamon
  • ½ teaspoon ginger
  • ½ teaspoon nutmeg
  • ¼ teaspoon salt
  • 2 eggs 
  • 1 ¾ cups pumpkin puree
  • 1 cup low-fat evaporated milk. 

In a large bowl, whisk eggs and pumpkin puree together. Add the rest of the ingredients and whisk together while slowly pouring in the evaporated milk.

Pour mixture into pie crust.Bake in the oven for 20 minutes at 390 degrees, reduce oven to 350 degrees and bake for another  45 – 60 minutes until inserted toothpick comes out clean. Store in the refrigerator overnight.

Written by Dawn DeSoto RD, CDCES, our resident Nutrition Content Writer


Dawn Desoto, Nutrition Content Writer

Meet Dawn Desoto, our resident Nutrition content expert. Dawn has specialized in diabetes care for over twenty years.

As a diabetes specialist, Dawn provides individual and group coaching. Dawn launched a Diabetes Prevention Program in her community and provided plant-based cooking classes coupled with take-home recipes. The participants loved the helpful, delicious, easy-to-understand food demonstrations and recipes. But, a big motivation to keep coming to classes, was the fact that they felt celebrated and supported by the kind wisdom of Dawn’s approach.

In addition to her diabetes and nutrition expertise, Dawn loves to garden, cook, swim, bike and hike with her son and daughter. She also enjoys reading, traveling, and star gazing!

Please join me in welcoming my friend and colleague, Dawn Desoto, RD, CDCES 

Use Coupon Code ‘Success10″.
Sale ends Oct 31st.

Subway’s “Bread” isn’t Bread in Ireland

Ireland’s Supreme Court announced that Subway’s sandwich “bread” cannot be legally labeled as bread.

After a Subway franchise in Ireland attempted to claim tax breaks for some of their items on the menu, a ruling was made that the bread Subway uses isn’t bread but more of a confectionary baked good.

“Subway’s bread is, of course, bread. We have been baking fresh bread in our restaurants for more than three decades and our guests return each day for sandwiches made on bread that smells as good as it tastes,” a Subway spokesperson said in a statement. The company says it’s reviewing the ruling.

Subway’s bread recipe has 10% of sugar to the weight of flour, which means their bread cannot be considered a staple food of bread and therefore ineligible for tax breaks.

This decision is in accordance with the Value-Added Tax Act of 1972 which states that “tax-exempt bread can’t have sugar, fat and bread improver exceed 2% of the weight of flour.”

This isn’t the first time Subway’s bread recipe has been questioned. In 2014 a petition went viral to remove azodicarbonamide, a chemical found in shoe rubber and items like yoga mats.

Overall, Subway, often revered as one of the healthier fast food options, may need to reevaluate its bread recipe and consider decreasing added sugar content.

To read more, click here.


Expert Team Toolkit | Technology, Insulin & Medical Nutrition Therapies | 8.0 CEs

Join Dr. Diana Isaacs and Dana Armstrong for eight hours of intensive instruction on some of the most critical content needed to prepare for certification and to position yourself as a diabetes leader.

Learn from the Experts! Both Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES, and Dana Armstrong, RD, CDCES are noted leaders in the field of diabetes.

Dr. Isaacs was named 2020 AADE Diabetes Educator of the Year for her educational platform promoting the use of CGM for people with diabetes and other innovations. She is the CGM Program Coordinator and clinical pharmacist specialist in the Cleveland Clinic Diabetes Center.

Dana Armstrong is the Medical Clinic Director of The Diabetes Center/Salinas Valley Medical Clinic. She provides leadership and ensures coordination and integration of effective system-wide excellence across the organization. Having a child with diabetes, she combines her professional knowledge with personal experience and understanding.

Each expert highlights the critical content of their topic area, so you can focus your study time most efficiently. They also launch multiple poll questions to help focus on key concepts and assess their knowledge while learning the best test-taking strategies. 


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!


AccreditationDiabetes 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.

Liver Disease and Diabetes – Should We be Screening?

Over 50% of people living with diabetes have fatty liver disease.

Over the next 20 years, non-alcoholic steatohepatitis (NASH) and type 2 diabetes will account for 65,000 transplants, 1.37 million cardiovascular-related deaths, and 812,000 liver-related deaths.
These statistics are from a 2020 article in Diabetes Care, Economic and Clinical Burden of Non-alcoholic Steatohepatitis in Patients With Type 2 Diabetes in the U.S.

Relationship between Type 2 and Fatty Liver Disease

Fatty liver disease is increasingly recognized as the hepatic manifestation of metabolic syndrome. Currently, there is no effective approved medical therapy to fix the fatty liver disease, management depends on lifestyle changes, such as weight loss and increased exercise.

Type 2 and Liver Disease Stats

About 34 million people in the U.S. have type 2 diabetes. Of those, over half are also living with liver disease.

In the U.S. in 2019:

  • About 50% (18.2 million people) are living with Type 2 diabetes plus Non-alcoholic fatty liver disease (NAFLD).
  • Of those, 37% (6.4 million) have a more severe form of liver disease known as non-alcoholic steatohepatitis (NASH).
  • Advanced fibrosis among biopsied people with NAFLD and T2DM was 17.02%
  • Twenty-year costs for NAFLD in these patients were $55.8 billion.

Should We Screen People with Diabetes for Liver Disease?

Given the high rate of liver disease in people with diabetes, I have been paying more attention to our client’s liver enzymes levels, including alanine aminotransferase (ALT) or aspartate aminotransferase (AST). Elevated levels of these liver enzymes indicate inflammation and a potential pathway to liver disease progression.

After discovering elevated enzymes, we send them for further diagnostic testing to evaluate the extent of liver disease. The question is, should we make liver health screening a part of our usual diabetes practice?

Is screening cost-effective and what are the next steps?

According to a recent article in Gastroenterology, screening for non-alcoholic fatty liver disease (NAFLD) followed by lifestyle modification among people with type 2 diabetes can be cost effective.

In a recent study, a team of researchers used a hypothetical cohort of people age 55 years with type 2 diabetes and developed a model that compared screening and treatment with no such protocol.

For the virtual intervention group, they measured ALT or AST and provided an ultrasound scan. If these tests came back positive for NAFLD, the participants underwent further screening with liver biopsies and transient elastography.

People found to have NASH with Stage 2 entered a year-long behavior program to help them with weight loss and lifestyle changes. They found the for participants with stage 2 fibrosis or higher, the screening and lifestyle intervention was just as cost-effective compared to the group with no screening.

“Our results indicate the potential value and cost-effectiveness of NAFLD screening” in people with type 2 diabetes, wrote the study authors. “Given the increasing burden of NAFLD/NASH and the expected rapid increase in approved medications, we recommend screening patients with type 2 diabetes for NAFLD.”

Click this link to read more about Screening People with Type 2 for Liver Disease.


Upcoming Cancer & Diabetes Webinar | Level 4 – Advanced Level | 1.5 CEs
Join us live on September 9th at 11:30 AM (PST)

People with cancer often experience hyperglycemia secondary to treatment, which can increase risk of infection and compromise their nutritional status. In addition, recent research has identified the link between diabetes and cancer. Join us to learn more about this unexpected link and treatment strategies for steroid-induced hyperglycemia using a case study approach. 

Topics Include:

  • Discuss the relationship between cancer, hyperglycemia and insulin resistance.
  • State 3 benefits of normalizing glucose levels during chemotherapy.
  • Using a case study approach, discuss strategies to improve glucose levels and quality of life.

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!


AccreditationDiabetes 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.

Food Insecurity Risk Rising for people with Diabetes

Food insecurity in the United States has doubled over the past 20 years.

Food insecurity “exists whenever the availability of nutritionally adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways is limited or uncertain” as defined by S. A. Anderson.

According to a recent study published by JAMA Network:

  • In 2015-16: 18% of adults surveyed reported food insecurity
  • In 1999-200 only 9% of adults reported food insecurity.

Food deserts, socioeconomic status, ability, and other factors impact one’s access to nutritionally healthy foods.

Food Insecurity & Diabetes

“Food insecurity in North America is consistently more prevalent among households with a person living with diabetes, and similarly, diabetes is also more prevalent in food-insecure households,” states Enza Gucciardi in “The Intersection between Food Insecurity and Diabetes.”

For people living with diabetes who experience food insecurity, adhering to diabetes self-management (DSM) regimens can be more challenging.

Often this can put a person living with diabetes in a situation in which they have to decide between healthy foods, prescriptions, or other expenses.

As Diabetes Specialists, we can create person-centered, realistic plans that are coupled with accessible resources to better support those living with diabetes.

The USDA has created a list of Food Assistance programs that may be able to help those experiencing food insecurity.

Written by Bryanna Sabourin, our Director of Operations & Customer Happiness


For more information on the JAMA published study click here. Additionally, read more from “The Intersection between Food Insecurity and Diabetes” by clicking here.


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!


AccreditationDiabetes 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.

Diabetes Blog Bytes

Sign up now to receive the latest Blog Bytes in your inbox.

Upcoming Courses & Events

    Live Seminars

  • N/A

View Full Calendar