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To celebrate Registered Dietitians, we are interviewing an emerging leader in the field and our Virtual Conference Speaker, Ashley LaBrier.
Ashley LaBrier, MS, RD, CDES, is an innovator in the field of diabetes, nutrition, and technology. Ashley is a consultant, and the Diabetes Education Program Coordinator at the Salinas Valley Medical Clinic’s Diabetes & Endocrine Center.
Ms. LaBrier is passionate about providing person-centered education to empower those who live with diabetes. Having been diagnosed with type 1 diabetes herself nearly 20 years ago, she combines her professional knowledge with personal experience and understanding.
Meet Ashley in person at our Virtual Diabetes Specialist Course on April 17, 2021
1. Question – What do you love about being a RD and Diabetes Specialist?
Ms. Labrier – There are a few things I REALLY love about being a dietitian and working with those living with diabetes:
At our clinic, education visits are purposely scheduled to allow adequate time to really understand the needs of each individual and make personalized suggestions. I LOVE that our work allows us to get to know the people we work with so intimately. This knowledge ultimately translates into providing meaningful support based on individual needs.
I also love teaching group education classes. There are few things more energizing than a room full of people who have come together to learn more about their diabetes. These classes always lead to great questions, dialogue, and connection. Hearing people leave an education class feeling empowered to conquer their diabetes and live a more healthful life is so satisfying for me personally and professionally.
Lastly, translating nutrition and diabetes so it “makes sense” – I find it satisfying to see that “light bulb moment” after explaining a new concept.
Question – How do you anticipate nutrition recommendations changing for people with diabetes lives over the next few years?
Ms. LaBrier – I’m not sure how nutritional guidelines will change in the next few years, but I’d like to see more research exploring the long-term health impact of the popular diets, particularly the ketogenic diet and other higher fat and protein diets. I also hope that dietary guidelines begin to factor in the social and environmental consequences of what we eat, not just nutrition alone. What we eat impacts our health and the planet – sustainability is key.
Question – Over the past year, what has been most challenging about providing diabetes care during the pandemic?
Ms. LaBrier – The pandemic has brought so much uncertainty to our lives. In working with our participants at the clinic, many have lost their jobs and are experiencing financial hardship. Some are busy caring for children or elderly or have lost a loved one. Others are more isolated from their social circles and support systems. Many have found it difficult to manage stress because certain activities that bring joy have been suspended. All of these factors, and many more, have complicated the picture for our community. Although every person has individual concerns, it seems like many individuals and families are stretched thin. They may have competing priorities and concerns that make managing a chronic condition more difficult than ever before.
Question – What actions can Diabetes Specialists take to counsel people with diabetes who are facing food insecurity?
Ms. LaBrier – a key in working with individuals who face food insecurity is approaching the situation with compassion and a desire to understand.
Ask questions and make an honest effort to understand the struggles that they are facing around obtaining food. Not only does this help to build trust between the specialist and person with diabetes, but providing effective assistance is more realistic when you know what struggles they are facing. Being aware of the resources in your local community is especially important. Social workers can assist in applying for financial and food assistance programs. Plus local and affordable farmers markets and food banks can help sustain people through rough times. f
Question: Would you share your hobby (ies) and how you maintain work life balance?
Ms. LaBrier – My fiancé and I make an effort to get outside for fresh air cocktails regularly. We live in a beautiful area and enjoy paddle boarding, runs on the beach, hiking, camping trips, or walks in the neighborhood. Even on the busy days we maintain our work life balance by prioritizing time together doing these activities.
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.
This month we are celebrating our amazing sister organization, Just One Person.
Just One Person is a sustainable model program that prepares girls in rural Kenya for post-secondary opportunities, supporting their development towards economic independence. Diabetes Education Services donates the profit from the sale of the Pancreas Pillow to help fund school scholarships and seminars for other girls in rural Kenya.
Mwanaidi’s story:
Mwanaidi, of Just One Person, has hand-sewn hundreds of beautiful Pancreas Partners in her hometown in Kenya and shipped them to the Diabetes Education Services office in California, so we can share them with you.
While Mwanaidi was waiting for admission to college she began sewing the “pancreas pillows” that Diabetes Education Services sells in the US. She used a donated treadle sewing machine, a pattern designed by Just One Person (JOP) Executive Director, Emma Sisia, and traditional leso cloth.
Mwanaidi joined the Just One Person (JOP) project in rural Kenya after her high school recognized her potential. Mwanaidi graduated from high school in 2010 and subsequently, became a certified chef. She uses the income from her job to help support her family of 7 siblings along with her mother and father.
After paying Mwanaidi for her beautiful work, Diabetes Education Services donates the profit from the sale of the Pancreas Pillow to help fund school scholarships and seminars for other girls in rural Kenya. Other alumnae of JOP have followed suit and are continuing to produce these wonderful pillows to help ensure the sustainability of our program.
Just One Person’s philosophy is that girls are members of our organization for life. They are committed to sharing their knowledge and resources with their mothers, sisters, neighbors, and daughters for generations to come.
At Diabetes Education Services we are dedicated to supporting the growth and well-being of our future generations.
Save your spot for our
Virtual DiabetesEd Specialist Conference | April 15-17, 2021
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 interested in taking the CDCES or BC-ADM exam or are seeking a state-of-the-art review of current diabetes care, this course is for you.
Entire Program Fee: $399
Dates: April 15-17, 2021
3 Expert Speakers
CEs: 30+ CE hours
Live Webinar Schedule: All webinars start and end times are in Pacific Standard Time
Come join our Virtual DiabetesEd Specialist Program.
Team of expert faculty includes:
In addition to informative lectures, we also use group activities and case studies to highlight the essential knowledge, skills, and strategies needed to succeed in diabetes education today!
Prepare for CDCES or BC-ADM certification or earn hours for renewal.
Your registrations include access to all the Online Sessions plus Bonus Courses through December 31st, 2021.
This virtual program includes:
3 day live webinar courses from April 15th-17th (20 CEs) + enrollment in our Bonus Bundle (14.0+ CEs) from now through December 2021.
View full Conference Schedule and Faculty.
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!
[yikes-mailchimp form=”1″]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.
Type 1 Diabetes Resources
Below is a list of helpful online resources for Type 1 Diabetes. They include sites for national organizations like the American Diabetes Association (ADA), sites for diabetes interest groups, and other participant organizations that provide helpful diabetes tips and opportunities to join online groups.
Click the links below to visit the website:
I started walking while working 7 years ago after reading research on how “sitting was the new smoking”. I purchased my treadmill desk in 2013 and since that time, I have been walking 7 miles a day, through a combination of my treadmill desk and outdoor strolls.
Over the past 7 years, I have accumulated almost 18,000 miles in an attempt to prevent heart disease, cancer, and a myriad of other chronic health problems. But it seems there is more to the story.
The Terry Gross interview with Daniel Lieberman, a professor at Harvard in the department of human evolutionary biology, put my beliefs into question. Dr. Lieberman recently penned a book called “Exercised”, which details his research finding and dispels some commonly held myths.
Besides being a super-smart paleoanthropologist and professor, Lieberman has also spent a lot of time with indigenous hunter-gatherers in Africa and Latin America. He has observed and cataloged how much time they spend walking, running, lifting, carrying, and sitting.
Based on current hunter-gathering behaviors, Dr. Lieberman calculates our ancestors walked about 5 miles a day or 10,000 steps. The average adult in America walks about half of that distance or 5,000 steps a day which equals 2.5 miles. This number might be even lower over the past year, given the pandemic and people working from home.
Even though we walk less than our ancestors, Lieberman is encouraging. He says if 10,000 steps feel out of reach, it’s okay to aim for less, as long as the person focuses on movement and engaging muscles to prevent atrophy. Any movement is better than no movement!
“The more we study physical activity, the more we realize that it doesn’t really matter what you do,” Lieberman says. “You don’t have to do incredible strength training … to get some benefits of physical activity. There’s all different kinds of physical activity, and it’s all good in different ways.”
Daniel lieberman
2. Hunter-gatherers sit a lot less than modern humans.
Not true. Surprisingly, research on hunter-gatherers reveals that they sit for 10 hours a day on average, which is the same amount of times the average American sits.
Humans are designed to conserve energy in case of a lack of adequate nutrition. Most hunter-gatherers Lieberman studied don’t have chairs, but they spent a great deal of time sitting. This lack of chairs is actually associated with better spine and back health (see more below)
3. Sitting is really that bad for us.
Interrupted sitting is a far better approach than nestling your body in a comfy chair for hours at a time.
Time spent sitting at work isn’t the major problem. It’s leisure time sitting for hours at a time that is associated with poor health outcomes like heart disease, cancer, or diabetes.
But regardless of sitting at work or home, just getting up every once in a while, every 10 minutes or so makes a big difference in health outcomes.
Try to intentionally get up frequently to go to the bathroom or pet the dog or make yourself a cup of tea. Even though you’re not spending a lot of energy, you’re turning on your muscles. Since muscles are the largest organ in your body, using them decreases inflammation and burns fat and glucose.
4. You can prevent back pain by getting lumbar support or a fancy chair.
Another myth.
Up until recently, only the upper class had chairs with a seatback. Most human beings usually sat on the ground, stools, or benches. The problem with chairs with backs is that sitting becomes more of a passive activity since you use fewer muscles to stabilize your upper body.
Using chairs with seat backs result in weaker back muscles that begin to atrophy due to disuse.
Chairs with lumbar support and lots of cushioning may encourage sitting for longer periods of time, which may further contribute to muscle loss.
5. Getting 8 hours of sleep a night is essential for well being
Based on Lieberman’s research of people who live in places where there is no electricity and computer screens, they don’t sleep more hours than the average American.
People in regions without electricity sleep on average 6.7 to 7.1 hours a night.
Lieberman says we need to stop sleep shaming.
It is true, that not getting enough sleep (4-5 hours a night) can be detrimental to health. But, if a person is getting 6 or 7 hours of sleep a night and they feel fine, that is what is most important.
Read the complete article here: Just Move: Scientist Author Debunks Myths About Exercise and Sleep
Please see our Exercise Resource Page for handouts to share
Save your spot for our
Virtual DiabetesEd Specialist Conference | April 15-17, 2021
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 interested in taking the CDCES or BC-ADM exam or are seeking a state-of-the-art review of current diabetes care, this course is for you.
Entire Program Fee: $399
Dates: April 15-17, 2021
3 Expert Speakers
CEs: 30+ CE hours
Live Webinar Schedule: All webinars start and end times are in Pacific Standard Time
Come join our Virtual DiabetesEd Specialist Program.
Team of expert faculty includes:
In addition to informative lectures, we also use group activities and case studies to highlight the essential knowledge, skills, and strategies needed to succeed in diabetes education today!
Prepare for CDCES or BC-ADM certification or earn hours for renewal.
Your registrations include access to all the Online Sessions plus Bonus Courses through December 31st, 2021.
This virtual program includes:
3 day live webinar courses from April 15th-17th (20 CEs) + enrollment in our Bonus Bundle (14.0+ CEs) from now through December 2021.
View full Conference Schedule and Faculty.
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!
[yikes-mailchimp form=”1″]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.
World Diabetes Day is celebrated in honor of Dr. Fredrick Banting, whose leadership, tenacity, and belief led to the discovery of insulin.
The discovery of insulin has saved the lives of countless millions of people over the past hundred years and will continue to save millions of lives in the near future and beyond.
During a hot summer in 1921, Dr.Banting secured space to test out his theory at the University of Toronto. Along with his colleague, Charles Best, and a bare-bones lab, they conducted dozens of experiments on dogs, which ultimately led to the discovery of insulin.
Dr. Banting and Charles Best began their experiments ligating the pancreases of dogs, thinking this would prevent destruction by the digestive pancreatic juices, and then isolating the extract from the islet cells. They then processed the extract from the islet cells and injected this extract they called “insulin” into diabetic dogs. According to an audio interview with Dr. Best, by July 1921, they had 75 positive examples of insulin lowering blood glucose levels in dogs.
In February 1922, doctor Frederick Banting and biochemist John Macleod published their paper on the successful use of an alcohol-based pancreatic extract for normalizing blood glucose levels in a human patient.
Here are some photos of the first insulin bottles produced by the University of Toronto and Eli Lilly.
Soon, word of their discovery got out and the race was on to produce enough insulin to treat the flood of type 1 patients arriving in Toronto to receive this miracle injection.
But, as with any amazing discovery, there is always more to the story.
One of the biggest barriers to Banting was the simple fact that he was not involved in the field of diabetes research. The idea leading to the discovery of insulin came to him after preparing a lecture on the pancreas and diabetes, a subject he knew little about. He wasn’t a trained researcher and thus securing support for the project was initially difficult.
First Children to Receive Insulin
The first patient to receive insulin was a ‘welfare’ case at Toronto General Hospital – no clinical trial structure to say the least. People from Canada/US flooded into Toronto to receive treatment. Banting struggled with the lack of accessibility of insulin – volume needed issues of purification.
The earliest patients were “selected”, some youths from Canada/US, some soldiers with diabetes (probably because of Banting’s service in the First World War), and then later some select private patients. During this time they were working hard to increase the volume and continue to improve the purification process. Insulin was available for testing in the US, namely through Dr. Elliot Joslin in the late summer of 1922.
Takes a Team
While Best played a critical and important role, credit must also go to Professor Macleod, from the University of Toronto, who provided the lab space, showed Dr. Banting how to operate on dogs, provided his student Best and suggested they switch from saline to alcohol to purify the ‘extract’. Dr. Macleod also secured the support of JB Collip, the 4th man on the team, and the first person to purify insulin for human use. Best is also known for pushing Banting to return to the research during a particularly dark period of failure.
Dr. Banting – Fun and Interesting Facts
Want to Learn More About Dr. Banting?
Visit Banting House FaceBook 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!
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RJ is 52 with type 1 diabetes and a minor stroke last year. RJ takes an ACE Inhibitor, insulin, and a statin.
According to ADA Standards of Care 2021, what is the blood pressure target for RJ?
Click here to test your knowledge!
This course is an essential review for anyone in the field of diabetes. This course summarizes the 2021 updates to the American Diabetes Association’s Standards of Medical Care in Diabetes and provides critical teaching points and content for health care professionals involved in diabetes care and education.
Earn 2.0 CEs and get ready to lead the charge to implement best care practices for the New Year.
Topics Include:
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
What are the treatment options for people with type 1 diabetes with a COVID infection hospitalized for Diabetes KetoAcidosis (DKA)?
The typical treatment for DKA is fluids coupled with an IV insulin drip. Given the frequent monitoring and ICU bed required for treatment of DKA with an insulin drip, there has been a renewed interest in treating DKA with subcutaneous or sub-q insulin.
But after doing some research, I discovered an excellent 2004 paper co-authored by Dr. Guillermo Umpierrez et al. on using Sub-Q Insulin to Treat DKA. After completing a study comparing treatment of DKA using sub-q insulin vs. insulin drip, the author’s conclude that sub-Q insulin treatment is a safe and effective alternative treatment to IV insulin in the management of people with mild or moderate DKA.
With a little more digging, I found 2 more recent papers that suggest considering Sub-Q insulin treatment as an option for mild or moderate DKA.
It is important to note that sub-Q insulin treatment for DKA is NOT recommended for patients with arterial hypotension, severe and complicated DKA, or with HHS.
Insulins: Use either rapid acting lispro or aspart insulin.
1st Bolus: Starting dose is 0.1 or 0.2 or 0.3 units/kg of insulin (depending on initial blood glucose and clinical presentation)
Example: Pt weighs 100 kg, give 100kg x 0.1 – 0.2 – 0.3 units/kg of insulin = 10 or 20 or 30 units insulin sub-q bolus respectively.
Next Step – Sub-q insulin every 2 hours | Give 0.1 – 0.2 units of insulin /kg every 2 hours until blood glucose is less than 250.
Example: Pt weighs 100 kg, give 100kg x 0.1 – 0.2 units/kg of insulin = 10 or 20 units insulin sub-q bolus respectively every 2 hours.
Blood glucose less than 250 | Now give 1/2 the sub-q insulin dose every 2 hours. Calculate 0.05 to 0.1 units/kg every 2 hours until glucose at target and ketosis is resolved.
Example: Pt weighs 100 kg, give 100kg x 0.05 – 0.1 units/kg of insulin = 5 or 10 units insulin sub-q bolus respectively every 2 hours.
Using scheduled subcutaneous insulin allows for safe and effective treatment in the emergency room and step-down units without the need for ICU care. Umpierrez et al
Please see reference chart and articles below for more detailed information.
Of course, fluid and electrolyte status needs to be assessed before starting insulin.
If the K+ is less than 3.3, hold insulin and start with IV fluids (NS or LR) first with potassium replacement. Once the K is stable, start the insulin injection every 2 hours (see article and flow chart below).
Thank you for reading this article. Please share any feedback or your experiences using sub-q insulin for DKA. We always love to hear from you. You can email us at [email protected]
Eledrisi MS, Elzouki AN. Management of Diabetic Ketoacidosis in Adults: A Narrative Review. Saudi J Med Med Sci. 2020;8(3):165-173. doi:10.4103/sjmms.sjmms_478_19
Fayfman M, Pasquel FJ, Umpierrez GE. Management of Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State. Med Clin North Am. 2017;101(3):587-606. doi:10.1016/j.mcna.2016.12.011
Join Coach Beverly to learn more about causes and treatment of hyperglycemic crisis. (opens in a new tab)”>Find out more here>>
This course is included in: Level 2 – Standards of Care. Purchase this course individually for $19 or the entire bundle and save 70%.
This 60-minute course discusses common causes of hyperglycemia crises. Topics include hyperglycemia secondary to medications and insulin deprivation. The difference and similarities between Diabetes Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome are also covered. Treatment strategies for all situations are included.
Topics include:
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
Unsure about updates for this mastery level 2021 exam?
Join us to get ready to succeed a the CDCES Exam. This course will transform your test anxiety into calm self-confidence and test-taking readiness.
We will review sample test questions and the reasoning behind choosing the right answers. After registering, you will receive a confirmation email containing information about joining the webinar.
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator who has passed her CDCES Exam 6 times. She is a nationally recognized diabetes expert for over 25 years.
The 5th Edition ADCES Desk Reference & 5th Edition Review Guide Bundle –our most popular AADE Book Bundle for exam preparation!
What is included in the ADCES Book Bundle?
The Art & Science of Diabetes Self-Management Education Desk Reference – 5th Edition
Major Features:
ADECES Review Guide for the Diabetes Care and Education Specialist Exam – 5th Edition
Includes an answer key with rationales for all questions included in the guide!
Major Features:
3 self-assessment tests that cover three main content sections on the CDCES Exam:
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!
[yikes-mailchimp form=”1″]
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.