Food Insecurity and Food Programs
by Christine Craig, MS, RD, CDCES
LT shared during a recent visit that over the past year, money to purchase food has become tight, and there are times when, by the end of the month, they do not have the resources to purchase more food.
In the US, 12.8% of individuals, 17 million households, and 16% of individuals with diabetes report experiencing food insecurity.1
From 2021 to 2022, the prevalence significantly increased by 2.6% within the US population. Food insecurity has racial inequities and has a higher incidence in American or Alaska Native, Black, Hispanic, or multiracial households.1 Children, older adults, individuals with increased diabetes complications, and individuals living in rural and urban areas are among the highest sub-populations at risk.
Food Insecurity Linked to Diabetes
Food insecurity is defined as “the limited or uncertain availability of nutritionally adequate and safe foods or the inability to acquire foods in socially accepted ways.”2 Food insecurity and diabetes have a bi-directional relationship. Insecurity can lead to poor health, and poor health can reduce food access through loss of work/time at work, increased cost of medical care, and increased burden of disease.
Dietary intake and food access is strongly linked to health outcomes, and adults who experience food insecurity are two to three times more likely to develop type 2 diabetes.3 Reduced consumption of fruits, vegetables, and nutrient-dense foods increases the risk of insulin resistance and type 2 diabetes. For low-income individuals, studies3 have shown increased hospital ER visits and admissions for hypoglycemia during the last week of the month compared to earlier weeks. Financial constraints often force individuals to choose between purchasing medications and buying food.
The co-occurrence of diabetes and food insecurity is influenced by nutritional, mental health, and behavioral factors, according to the Weiser et al.2 conceptual framework. At the individual level, interventions targeting food security and diabetes should focus on these interconnected pathways, especially considering the impact of competing demands on self-care prioritization. People living with diabetes and food insecurity often experience increased diabetes distress, depression, and higher A1c levels. Additional challenges such as cost-of-living, transportation, and medication costs further exacerbate these outcomes. Addressing behavioral barriers may involve providing transportation assistance, social work case management, and comprehensive medical care, and ensuring a review of medication costs. Mental health interventions could involve integrating food access programs with mental health screening and referral services in addition to problem-solving and coping strategies to reduce diabetes distress. The most helpful nutrition interventions aim to improve food accessibility, offer person-centered and budget-friendly nutrition counseling, and address policies and programs that reduce diabetes risk and complications.
Food Is Medicine Programs – Medically Tailored Meals
In 2023, the Department of Health and Human Services (HHS) developed the Food Is Medicine initiative, understanding that “access to nutritious food is critical to health and resilience.”3 The initiative focuses on developing strategies to reduce nutrition-related chronic disease and food insecurity while improving health and racial equity in the US.3 Food is Medicine can encompass many different programs, such as medically tailored meals, groceries, or produce prescription programs. Although A1C reduction results are mixed, each of these programs has shown an increase in fruit and vegetable consumption, food security, and quality of life measures.4
For individuals with diabetes, medically tailored meals result in the most evidence for improved diet quality, increased food security, improved diabetes self-management, and reduced hypoglycemic events.4 The programs are associated with lower health care utilization and cost for individuals with complex care needs. Medically tailored meals are designed by an RDN to meet the needs of the individual, are delivered directly to the home, and maybe a covered benefit if medical criteria are met. Seniors may access medically tailored and delivered programs through Medicare Advantage, Medicaid, or Area on Aging programs. Individuals who have chronic conditions and are post-hospital discharge have the highest likelihood of coverage. In California, Medi-Cal may provide up to three meals per day for twelve weeks for individuals with chronic health conditions (such as diabetes) who were recently discharged from a hospital or nursing home or require extensive care coordination. The Food is Medicine Coalition is a resource for additional information regarding Food is Medicine programs and can link individuals and providers to local participating agencies.
Food Insecurity on the Rise
Interventions begin with screening and knowing that more individuals with diabetes will experience food insecurity compared to just one year ago. We can utilize risk assessment tools, including the hunger vital signs, at least annually during our visits and, with patient collaboration, provide referrals to assistance programs. The most extensive federal food assistance programs include the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). These programs are effective in increasing food security while also improving health outcomes. Reviewing eligibility and assisting in the coordination of services for Food Is Medicine programs, Nutrition Assistance Programs, and resources such as local food pantries, Meals on Wheels, or Area on Aging Agencies programs. www.Findhelp.org is a tool that can help individuals and providers find free or reduced- resources, from food to housing and more. Through assessment, understanding patient priority needs, and linking to resources, we can create a more supportive and therapeutic environment for individuals managing diabetes while experiencing food insecurity.
Links to Listed Resources:
- Food is Medicine Coalition: https://fimcoalition.org
- Hunger Vital Sign: https://fimcoalition.org
- Supplemental Nutrition Assistance Program (SNAP): https://www.fns.usda.gov/snap/supplemental-nutrition-assistance-program
- WIC: https://www.fns.usda.gov/wic
- Local Food Pantries: https://www.feedingamerica.org/our-work/nutrition-health
- Meals on Wheels: https://www.mealsonwheelsamerica.org/find-meals
- Area on Aging Agencies: https://eldercare.acl.gov/Public/About/Aging_Network/AAA.aspx
- Find Help: www.findhelp.org
References:
- Food Security and Nutrition Assistance downloaded on June 19th, 2024 from: https://www.ers.usda.gov/data-products/ag-and-food-statistics-charting-the-essentials/food-security-and-nutrition-assistance/#:~:text=In%202022%2C%2012.8%20percent%20of,of%20a%20lack%20of%20resources
- Weiser, Sheri & Palar, Kartika & Hatcher, Abigail & Young, Sera & Frongillo, Edward & Laraia, Barbara. (2015). Food Insecurity and Health: A Conceptual Framework. 10.1201/b18451-3.
- Food is Medicine: A Project to Unify and Advance Collective Action. Downloaded on June 19th, 2024 from https://health.gov/our-work/nutrition-physical-activity/food-medicine.
- Levi R, Bleich SN, Seligman HK. Food Insecurity and Diabetes: Overview of Intersections and Potential Dual Solutions. Diabetes Care. 2023 Sep 1;46(9):1599-1608. doi: 10.2337/dci23-0002. PMID: 37354336; PMCID: PMC10465985.
- Wylie-Rosett J, DiMeglio LA. Strategies to Reduce Food Insecurity for People With Diabetes: A Call to Action. Diabetes Care. 2023 Feb 1;46(2):245-248. doi: 10.2337/dci22-0058. PMID: 36701599; PMCID: PMC9887607.
Join us Live in Sunny San Diego for our
Annual DiabetesEd Training Conference
October 9th-11th, 2024
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, networking, games with prizes, and “aha” moments in beautiful San Diego on October 9-11, 2024.
You don’t want to miss this one-of-a-kind learning opportunity. Get away from all those daily responsibilities and immerse yourself in a fun and intensive conference with plenty of networking opportunities.
Attendees will leave this conference with new tools and a more complete understanding of the latest advances in diabetes care, from medications to technology to Medical Nutrition Therapy!
Each day, we provide a healthy breakfast, including fresh coffee, to kick off your morning. Our instructors co-teach the content to keep things fresh and lively. Plus, we play DiaBingo to reinforce key content and give away prizes. In addition, we provide plenty of movement breaks led by volunteers from the audience. Did we mention delicious lunches and a conference meeting space just minutes from San Diego Bay?
Friend Discount: 3 or more only $559-$799 (based on registration package) per person. Email us at [email protected] with the name and email of each registrant to get the discount!
Time: The course is Wednesday through Friday. Join us for breakfast at 7:00 a.m. each day. The class begins at 8:00 a.m. and ends at 5:00 p.m. on Wednesday and Thursday and at 3:00 p.m. on Friday.
- 3 Days: of critical information delivered by passionate speakers in an engaging and fun format!
- 18+ CEs: earned at the Live Seminar (RDs earn 18.75 CEs while Nurses & CA Pharmacists earn 22.75 CEs)
- 10 Bonus Online Courses, Earn 10+ CEs: As a course attendee, you automatically receive a bonus online course bundle of 13 online courses valued at over $179. Coach Beverly carefully chose each of these courses based on student feedback on which content best helped them succeed at the certification exams and in their clinical practice. You will be given instructions after you purchase the course on how to enroll in our Online University and get started!
- Healthy breakfast all days, gourmet lunch both days and refreshments.
- E-version of the syllabus
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Strategies to Stick With Incretin Therapy: Managing GI Symptoms
- Letting Go of Judgment – Embracing Curiosity
- Question of the Week | Remote Eye Screening Precautions
- Rationale of the Week | Weight-Inclusive Diabetes Care
- Honoring Excellence: Celebrating This Year’s Diabetes Education Scholarship Recipients
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
3 Ways Companion Pets Can Support People with Diabetes
For people living with diabetes, a companion pet may support their diabetes self-management and improve their quality of life.
Caring for our pets can bring a sense of joy, love, and companionship. It can also help us maintain a routine as we care for the well-being of our animals and thereby ourselves. Pets are an important part of the Diabetes Education Services work environment. You might hear Muffin and Biscuit wrestling in the background if you call Bryanna by phone. Those cute rescue felines are busy making mischief and keep Bryanna hopping. Or the barks of Freya and Sadie while talking with Brent. If you are watching a webinar with Coach Beverly, you will see her constant companion and Chiweenie, Choochi, napping on the comfy chair in the background. Choochi reminds Coach Beverly to take walks in the nearby field and to take a break from her treadmill desk.
Here are a few ways animals can support people living with diabetes.
Structure & Routine
Animals like a routine and need structure. Many know when their feeding time or play/exercise time is and will alert you to when those times are coming up. A pet’s routine can also be used by people living with diabetes to schedule their own meal times, medication schedules, and times for exercise. In fact, 47% of pet owners surveyed said that their pets keep them more active.
The American Hearth Association has this great handout for ways pets can motivate us to be more active.
Isolation & Loneliness
A study published by BMC Public Health that assessed the relationship between loneliness and blood glucose control in diabetes found that “systolic blood pressure was significantly correlated with loneliness in patients with diabetes.”
For people living with diabetes, pets can provide company, love, and nonhuman social support. Having animals can also connect us with others, such as going to the park with your dog, riding horses with others, or joining a pet group on social media.
Stress Reduction & Mood
Last year, the American Heart Association conducted a survey for their Healthy Bond for Life program which showed that “95% of pet parents rely on their pets for stress relief.” For those who experience diabetes distress, spending time petting an animal, watching them play, and snuggling up with them may help in times of stress.
Animal-assisted interventions have also been shown to have positive outcomes for those experiencing depression, PTSD, and anxiety.
How to Keep You and Your Pet Healthy
While there are many benefits to owning a pet, it is important to be aware of how to keep you and your pet safe. The CDC’s “Healthy Pets, Healthy People” hub has helpful information and resources on pet safety.
Unlock insights for managing diabetes distress with the experts!
Join us live on June 17 & 24, 2024 for our
ReVive 5 Diabetes Training Program:
The 2024 ADA Standards of Care now recommends annual screening for diabetes distress. If you are wondering how to screen for distress and tailor education based on the results, we encourage you to join this unique training program.
This two-session training provides the essential steps to address diabetes distress combined with an innovative approach to helping people make sense of their glucose data.
The first session is team-taught by experts in the field of diabetes distress and effective communication approaches. Dr. Larry Fisher kicks off the program by describing the difference between depression and distress and interpreting Diabetes Distress screening results. Dr. Susan Guzman uses a case study approach and step-by-step communication strategies to address responses from the Diabetes Distress screening tool. This session includes an abundance of evidence-based approaches that you can apply in your clinical setting.
Coach Beverly leads the second session. During this three-hour program, Beverly describes insulin dosing strategies, meter and sensor data interpretation, and common issues encountered by people using diabetes technology. Case studies include tools to help individuals discover what changes are needed to get glucose to target, coupled with the communication skills discussed in the first session. In conclusion, the team of instructors review a case study that pulls together all the ReVive 5 elements.
“ReVive 5” breathes new life into our relationship with diabetes, bringing a fresh perspective to both the person with diabetes and the provider.
Can’t join live? That’s okay. Your registration guarantees you access to the recorded version of the series, along with podcasts and resources for one full year.
Accredited Training Program:
- 15+ CEs – Includes the 7-hour ReVive 5 Training Program, Certificate, and 5 FREE bonus courses to supplement content.
- A comprehensive set of assessment tools, educational materials, log sheets, and resources.
Team of Experts:
ReVive 5 is taught by a team of 3 Interdisciplinary Experts:
- Lawrence Fisher, Ph.D., ABPP, Professor Emeritus, UCSF
- Susan Guzman, PhD
- Beverly Thomassian, RN, MPH, CDCES, BC-ADM
Speakers Interviews – Learn more about the ReVive 5 Team
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Strategies to Stick With Incretin Therapy: Managing GI Symptoms
- Letting Go of Judgment – Embracing Curiosity
- Question of the Week | Remote Eye Screening Precautions
- Rationale of the Week | Weight-Inclusive Diabetes Care
- Honoring Excellence: Celebrating This Year’s Diabetes Education Scholarship Recipients
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Question of the Week | What is the cause of this emergency room visit?
LS is a 29-year-old who arrives in the emergency room with known history of type 2 diabetes. BMI is 23.9 and they are on basal insulin therapy and an oral medication to help “clear extra sugar”. On admission, their blood glucose is 189, pH is 7.2 and LS has 3+ betahydroxybyturate.
What is the most likely cause of these lab results?
- LS is omitting insulin to lose weight.
- There is a lab error in the glucose reading.
- LS is taking a SGLT-2 Inhibitor.
- New onset of cardiorenal syndrome.
Want to learn more about this question?
Join us live on June 13th at 11:30 am PST for our
Hospitals & Hyperglycemia
Level 2 Standards of Care Intensive
Research demonstrates the importance of glucose control during hospitalization to improve outcomes not only in the inpatient setting but after discharge. This course reviews the evidence that supports inpatient glucose control & outlines practical strategies to achieve targets in the inpatient setting. We incorporate the latest American Diabetes Association’s (ADA) Standards of Medical Care in Diabetes & provide links to resources & inpatient management templates.
Objectives:
- Describe the impact of hyperglycemia in the hospital setting.
- Discuss the importance of inpatient glucose control.
- List three strategies to get glucose to the goal in the hospital setting.
Learning Outcome:
The diabetes care team will gain insights and knowledge of special considerations, individualized goals, and standards for inpatients with diabetes that they can include in their practice.
Target Audience:
This course is a knowledge-based activity designed for individuals or groups of diabetes professionals, including RNs, RDs/RDNs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other healthcare providers interested in staying up to date on current practices of care for people with prediabetes, diabetes, and other related conditions. The practice areas for RDs/RDNs for CDR reporting are healthcare, preventative care, wellness, and, lifestyle along with, education and research.
CDR Performance Indicators:
- 9.6.7
- 9.6.8
- 10.3.1
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working diabetes specialist and a nationally recognized diabetes expert.
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Strategies to Stick With Incretin Therapy: Managing GI Symptoms
- Letting Go of Judgment – Embracing Curiosity
- Question of the Week | Remote Eye Screening Precautions
- Rationale of the Week | Weight-Inclusive Diabetes Care
- Honoring Excellence: Celebrating This Year’s Diabetes Education Scholarship Recipients
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Rationale of the Week | Are statins indicated for Peds with Diabetes?
For last week’s practice question, we quizzed participants on when to start statin therapy for pediatrics with diabetes. 50% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question
Question: Based on the ADA Standards, in addition to dietary intervention, lifestyle and glucose management, when is it indicated to consider starting statin therapy for pediatrics with diabetes?
Answer Choices:
- When LDL is greater than 100 with a BMI of 25 or more.
- After age 10, if LDL is still greater than 130 at 6 months.
- Only if LDL and triglycerides are greater than 90thpercentile.
- Statins are only indicated for individuals 18 years and older.
Getting to the Best Answer
Answer 1 is incorrect. 11.84% chose this answer. “When LDL is greater than 100 with a BMI of 25 or more.” This is a tempting answer. However, according to ADA Standards, if after 6 months of intensive lifestyle intervention, the LDL is still greater than 130mg/dL and the child is 10 years or older, statin therapy is indicated to prevent cardiovascular complications.
Answer 2 is correct. 50% of you chose this answer. “After the age of 10 if LDL is 130 or greater.” Great job, this is the BEST answer. According to ADA Standards, if after 6 months of intensive lifestyle intervention, the LDL is still greater than 130mg/dL and the child is 10 years or older, statin therapy is indicated to prevent cardiovascular complications.
Answer 3 is incorrect. About 15.13% of respondents chose this. “Only if LDL and triglycerides are greater than 90thpercentile.” According to ADA Standards, if after 6 months of intensive lifestyle intervention, the LDL is still greater than 130mg/dL and the child is 10 years or older, statin therapy is indicated to prevent cardiovascular complications.
Finally, Answer 4 is incorrect. 23.03% chose this answer. “Statins are only indicated for individuals 18 years and older.” According to ADA Standards, if after 6 months of intensive lifestyle intervention, the LDL is still greater than 130mg/dL and the child is 10 years or older, statin therapy is indicated to prevent cardiovascular complications.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
Want to learn more about this question?
Join us live on May 30th at 11:30 PST for our
From Tots to Teens
Level 2 Standards of Care Intensive
This course includes updated goals & guidelines for children living with type 1 or type 2 diabetes. This course discusses the special issues diabetes educators need to be aware of when working with children with diabetes & their families. We discuss the clinical presentation of diabetes, goals of care, & normal growth & development through the early years through adolescence. Strategies to prevent acute & long-term complications are included with an emphasis on positive coping for families & children with diabetes.
Objectives:
- Discuss the goals of care for Type 1 and Type 2 Kids with Diabetes.
- State Strategies to prevent acute and chronic complications.
- Discuss the importance of positive psychosocial adjustment & resources.
Learning Outcome:
Attendees will have comprehensive knowledge of special considerations, individualized goals and standards for children with diabetes to include in their practice.
Target Audience:
This course is a knowledge-based activity designed for individuals or groups of diabetes professionals, including RNs, RDs/RDNs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other healthcare providers interested in staying up to date on current practices of care for people with prediabetes, diabetes, and other related conditions. The practice areas for RDs/RDNs for CDR reporting are healthcare, preventative care, wellness, and, lifestyle along with, education and research.
CDR Performance Indicators:
- 9.6.7
- 9.6.8
- 10.3.1
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working diabetes specialist and a nationally recognized diabetes expert.
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Strategies to Stick With Incretin Therapy: Managing GI Symptoms
- Letting Go of Judgment – Embracing Curiosity
- Question of the Week | Remote Eye Screening Precautions
- Rationale of the Week | Weight-Inclusive Diabetes Care
- Honoring Excellence: Celebrating This Year’s Diabetes Education Scholarship Recipients
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Question of the Week | KR is on Metformin & 4 Weeks Pregnant. Best action?
KR has polycystic ovary syndrome and takes metformin 850mg twice daily. KR just discovered they are 4 weeks pregnant. Fasting glucose is 103 mg/dl.
According to ADA Guidelines, if prediabetes diagnosis is confirmed, what is the next step?
- Continue metformin through first trimester.
- Start basal insulin, stop metformin.
- Add human basal bolus insulin.
- Stop metformin, start sulfonylurea.
Want to learn more about this question?
Join us live on June 11th at 11:30 am PST for our
Pregnancy & Diabetes
Level 2 Standards of Care Intensive
Pregnancy with diabetes is confronted with a variety of issues that require special attention, education, & understanding. This course reviews those special needs while focusing on Gestational Diabetes & Pre-Existing Diabetes. Included are the most recent diagnostic criteria, management goals, & prevention of complications during pregnancy. This is a helpful review for Certification Exams & those who want more information on people who are pregnant & live with diabetes.
Objectives:
- List three issues that affect pregnancy with diabetes.
- Describe the unique attributes of pre-existing diabetes in pregnancy & gestational diabetes.
- State the diagnostic criteria & management goals for gestational diabetes.
- Potential short-term & long-term complications of fetal exposure to hypoglycemia.
- Prevention measures to keep mother & baby healthy.
Learning Outcome:
Participants will gain knowledge of special considerations, individualized goals, and standards for people experiencing diabetes during pregnancy to improve outcomes.
Target Audience:
This course is a knowledge-based activity designed for individuals or groups of diabetes professionals, including RNs, RDs/RDNs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other healthcare providers interested in staying up to date on current practices of care for people with prediabetes, diabetes, and other related conditions. The practice areas for RDs/RDNs for CDR reporting are healthcare, preventative care, wellness, and, lifestyle along with, education and research.
CDR Performance Indicators:
- 9.6.7
- 9.6.8
- 10.3.1
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working diabetes specialist and a nationally recognized diabetes expert.
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Strategies to Stick With Incretin Therapy: Managing GI Symptoms
- Letting Go of Judgment – Embracing Curiosity
- Question of the Week | Remote Eye Screening Precautions
- Rationale of the Week | Weight-Inclusive Diabetes Care
- Honoring Excellence: Celebrating This Year’s Diabetes Education Scholarship Recipients
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Rationale of the Week | Best treatment for Hypoglycemia with Gastroparesis
For last week’s practice question, we quizzed participants on how to treat hypoglycemia while dealing with gastroparesis. 73% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question
Question: JR has type 1 diabetes and was recently diagnosed with gastroparesis. JR is a runner and has not been able to exercise recently due to nausea, vomiting, bloating, and intestinal pain. They experience hypoglycemia about 3 times a week.
Based on this information, what is the best treatment for hypoglycemia?
Answer Choices:
- Glucose tabs or gels.
- Skittles or gummies.
- High carb, low fiber snack bar.
- Peanut butter crackers.
Getting to the Best Answer
Answer 1 is correct. 73.02% chose this answer. “Glucose tabs or gels.” Great job! Since JR has gastroparesis with slowed gastric emptying and delayed absorption of nutrients, we need to provide a fast acting carb that can instantly raise blood sugar. Fast absorption of sugar from glucose tabs and gels begins in the mouth, to quickly raise blood sugar levels.
Answer 2 is incorrect. 3.72% of you chose this answer. “Skittles or gummies.” Since JR has gastroparesis with slowed gastric emptying and delayed absorption of nutrients, we need to provide a fast acting carb that can instantly raise blood sugar. Gummies and skittles are more challenging to chew and need to be broken down in the stomach, which would delay the blood sugar from increasing to a safe level. Another consideration is that the ability to chew can be impaired when someone is experiencing significant hypoglycemia. Glucose tabs and gel, are quickly absorbed and require minimal chewing and are the best choice.
Answer 3 is incorrect. About 14.70% of respondents chose this. “High carb, low fiber snack bar.” Since JR has gastroparesis with slowed gastric emptying and delayed absorption of nutrients, we need to provide a fast acting carb that can instantly raise blood sugar. A snack bar, even though it is low fiber, is more challenging to chew and needs to be broken down in the stomach, which would delay the blood sugar from increasing to a safe level. Another consideration is that the ability to chew can be impaired when someone is experiencing significant hypoglycemia. Glucose tabs and gel, are quickly absorbed and require minimal chewing and are the best choice.
Finally, Answer 4 is incorrect. 8.56% chose this answer. “Peanut butter crackers.” Since JR has gastroparesis with slowed gastric emptying and delayed absorption of nutrients, we need to provide a fast acting carb that can instantly raise blood sugar. Peanut butter crackers are more challenging to chew and need to be broken down in the stomach, which would delay the blood sugar from increasing to a safe level. Another consideration is that peanut butter is a protein and fat combination food that would delay the absorption of the carbs from the crackers. Glucose tabs and gel, are quickly absorbed and would be the best choice!
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity
Unlock insights for managing diabetes distress with the experts!
Join us live on June 17th & 24th, 2024 for our
ReVive 5 Diabetes Training Program:
The 2024 ADA Standards of Care now recommends annual screening for diabetes distress. If you are wondering how to screen for distress and tailor education based on the results, we encourage you to join this unique training program.
This two-session training provides the essential steps to address diabetes distress combined with an innovative approach to helping people make sense of their glucose data.
The first session is team-taught by experts in the field of diabetes distress and effective communication approaches. Dr. Larry Fisher kicks off the program by describing the difference between depression and distress and interpreting Diabetes Distress screening results. Dr. Susan Guzman uses a case study approach and step-by-step communication strategies to address responses from the Diabetes Distress screening tool. This session includes an abundance of evidence-based approaches that you can apply in your clinical setting.
Coach Beverly leads the second session. During this three-hour program, Beverly describes insulin dosing strategies, meter and sensor data interpretation, and common issues encountered by people using diabetes technology. Case studies include tools to help individuals discover what changes are needed to get glucose to target, coupled with the communication skills discussed in the first session. In conclusion, the team of instructors review a case study that pulls together all the ReVive 5 elements.
“ReVive 5” breathes new life into our relationship with diabetes, bringing a fresh perspective to both the person with diabetes and the provider.
Can’t join live? That’s okay. Your registration guarantees you access to the recorded version of the series, along with podcasts and resources for one full year.
Accredited Training Program:
- 15+ CEs – Includes the 7-hour ReVive 5 Training Program, Certificate, and 5 FREE bonus courses to supplement content.
- A comprehensive set of assessment tools, educational materials, log sheets, and resources.
Team of Experts:
ReVive 5 is taught by a team of 3 Interdisciplinary Experts:
- Lawrence Fisher, Ph.D., ABPP, Professor Emeritus, UCSF
- Susan Guzman, PhD
- Beverly Thomassian, RN, MPH, CDCES, BC-ADM
Speakers Interviews – Learn more about the ReVive 5 Team
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Strategies to Stick With Incretin Therapy: Managing GI Symptoms
- Letting Go of Judgment – Embracing Curiosity
- Question of the Week | Remote Eye Screening Precautions
- Rationale of the Week | Weight-Inclusive Diabetes Care
- Honoring Excellence: Celebrating This Year’s Diabetes Education Scholarship Recipients
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
CGM Interfering Substances Cheat Sheet
By Christine Craig, MS, RD, CDCES
As more and more people are using glucose sensors as a tool to improve their blood sugars, they may feel frustrated or confused about the mismatch between their sensor and glucose meter readings. Some many even ditch this new fangled sensor, thinking that their old friend, the meter, provides more reliable information.
We invite you to download CGM Interfering Substances Cheat Sheet. This CGM Troubleshooting Cheat Sheet that provides specific information on different interfering substances and other factors that can affect the accuracy of continuous glucose monitor (CGM).
We often hear that BG does not equal SG, but what does this mean?
A blood glucose meter measures capillary blood glucose, and CGM sensors measure interstitial fluid, a thin layer of fluid surrounding the cells just below the skin. These values correlate well, but they measure two different types of fluids.
This difference in BG vs. SG at one point in time can be alarming at first and is a commonly reported concern related to sensor accuracy. Education about the difference in measure and understanding that this difference is most significant during rates of change (a rise or fall in glucose values) can help address this concern. Blood glucose values change first, followed by sensor glucose.
The lag time between BG and interstitial glucose (what the sensor measures) can be from 2 to 20 minutes.
We may notice this difference most during increased rates of change (such as >2 mg/dl per min) and during circumstances such as after a meal, after treating a low glucose event, during and immediately after exercise, or after taking diabetes medications that have a more rapid effect on glucose such as meal/correction insulin or sulphonylurea.1
Educating about the difference between BG and SG and how to interpret glucose trends, sensor glucose trend arrows, and monitoring change over time can improve understanding.
Interfering Substances
The 2024 ADA Standards of Care recommends that for ALL people who wear CGM devices, education and assessment of potential interfering substances occur. Many of these interfering substances can be a common over-the-counter supplement or pain reliever. The effect for all reported interfering substances is a false elevation in sensor glucose versus actual blood glucose values. 4 It is cautioned that this could cause missing a severe glucose event.
Each manufacturer has different identified interfering substances.
- For the Libre 2 and 3 systems, more than 500 mg/day of supplemental Vitamin C can interfere. More than 1000 mg/day can interfere with the Libre 2 Plus. 5
- Dexcom G4, G5, G6 6, and G7 7 are all affected by hydroxyurea and acetaminophen,
- However for Dexcom G6 and G7 devices acetaminophen dose is specified as greater than 4 grams per day or 1 gram every 6 hours.
- Medtronic Guardian 3 and Guardian 4 devices are affected by hydroxyurea and any acetaminophen dose8
- For more information, refer to our cheat sheet: CGM Interfering Substances.
Studies and reports of interfering substances are not comprehensive, so it is recommended that if suspicion occurs that a medication or supplement is contributing to erroneous CGM values, they should contact the manufacturer’s technical support team.9
Calibration
For sensors requiring calibration, poor quality of the blood glucose test can also create inaccuracies with the glucose sensor readings. Most manufacturers with CGM calibration requirements recommend ensuring a “clean calibration,” having individuals wash their hands, taking the second drop of blood when hand washing is unavailable, and calibrating when glucose values are more stable, such as before a meal, insulin, or exercise. Luckily, most devices no longer require calibration, but it is important to review technique when applicable.
Getting Back to AW
AW reported no recent changes with medications, supplement intake, or fortified food sources, and no changes were noted at the sensor site. However, they did report that the CGM was on the last day of manufacturer recommended sensor wear. Sensor integrity variation based on day of sensor was determined to be the main consideration of cause. After changing to a new sensor, AW’s general range of BG to SB differences were observed. This event served as an important reminder to AW to check BG when SG values were not reading as expected and different than any symptoms.
Education When Starting Sensor Important
As educators, we can support individuals concerned with CGM accuracy by providing education about the differences between SG and BG values. Assessing individual factors such as medical conditions, movement and activity, site integrity and placement, issues of compression, and medication and supplement use (assessing for potential inferring substances). We can educate individuals to check BG anytime symptoms do not match SG readings and report any concern of a faulty sensor to the manufacturer. Reporting can often lead to the replacement of faulty sensor.
Since the arrival of CGM, benefits including improved quality of life factors, A1c reduction, increased Time in Range, and prevention of hypoglycemia have been found.4 We know from working in diabetes care and through real-world studies the overall value of CGMs. Unlike BG, CGMs provide a complete picture showing trends for direction, personalized alerts, and supporting pattern recognition.
Although not ideal for all, growth of users will continue to rise with approval of over-the-counter product options and understanding accuracy issues is essential to ensure safety and support user experience.
For more information, refer to our cheat sheet: CGM Interfering Substances.
Unlock insights for managing diabetes distress with the experts!
Join us live on June 17 & 24, 2024 for our
ReVive 5 Diabetes Training Program:
The 2024 ADA Standards of Care now recommends annual screening for diabetes distress. If you are wondering how to screen for distress and tailor education based on the results, we encourage you to join this unique training program.
This two-session training provides the essential steps to address diabetes distress combined with an innovative approach to helping people make sense of their glucose data.
The first session is team-taught by experts in the field of diabetes distress and effective communication approaches. Dr. Larry Fisher kicks off the program by describing the difference between depression and distress and interpreting Diabetes Distress screening results. Dr. Susan Guzman uses a case study approach and step-by-step communication strategies to address responses from the Diabetes Distress screening tool. This session includes an abundance of evidence-based approaches that you can apply in your clinical setting.
Coach Beverly leads the second session. During this three-hour program, Beverly describes insulin dosing strategies, meter and sensor data interpretation, and common issues encountered by people using diabetes technology. Case studies include tools to help individuals discover what changes are needed to get glucose to target, coupled with the communication skills discussed in the first session. In conclusion, the team of instructors review a case study that pulls together all the ReVive 5 elements.
“ReVive 5” breathes new life into our relationship with diabetes, bringing a fresh perspective to both the person with diabetes and the provider.
Can’t join live? That’s okay. Your registration guarantees you access to the recorded version of the series, along with podcasts and resources for one full year.
Accredited Training Program:
- 15+ CEs – Includes the 7-hour ReVive 5 Training Program, Certificate, and 5 FREE bonus courses to supplement content.
- A comprehensive set of assessment tools, educational materials, log sheets, and resources.
Team of Experts:
ReVive 5 is taught by a team of 3 Interdisciplinary Experts:
- Lawrence Fisher, Ph.D., ABPP, Professor Emeritus, UCSF
- Susan Guzman, PhD
- Beverly Thomassian, RN, MPH, CDCES, BC-ADM
Speakers Interviews – Learn more about the ReVive 5 Team
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Question of the Week | Are statins indicated for Peds with Diabetes?
Based on the ADA Standards, in addition to dietary intervention, lifestyle and glucose management, when is it indicated to consider starting statin therapy for pediatrics with diabetes?
- When LDL is still greater than 100 with a BMI of 25 or more.
- After age 10, if LDL is still greater than 130 at 6 months.
- Only if LDL and triglycerides are greater than 90thpercentile.
- Statins are only indicated for individuals 18 years and older.
Want to learn more about this question?
Join us live on May 30th at 11:30 PST for our
From Tots to Teens
Level 2 Standards of Care Intensive
This course includes updated goals & guidelines for children living with type 1 or type 2 diabetes. This course discusses the special issues diabetes educators need to be aware of when working with children with diabetes & their families. We discuss the clinical presentation of diabetes, goals of care, & normal growth & development through the early years through adolescence. Strategies to prevent acute & long-term complications are included with an emphasis on positive coping for families & children with diabetes.
Objectives:
- Discuss the goals of care for Type 1 and Type 2 Kids with Diabetes.
- State Strategies to prevent acute and chronic complications.
- Discuss the importance of positive psychosocial adjustment & resources.
Learning Outcome:
Attendees will have comprehensive knowledge of special considerations, individualized goals and standards for children with diabetes to include in their practice.
Target Audience:
This course is a knowledge-based activity designed for individuals or groups of diabetes professionals, including RNs, RDs/RDNs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other healthcare providers interested in staying up to date on current practices of care for people with prediabetes, diabetes, and other related conditions. The practice areas for RDs/RDNs for CDR reporting are healthcare, preventative care, wellness, and, lifestyle along with, education and research.
CDR Performance Indicators:
- 9.6.7
- 9.6.8
- 10.3.1
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working diabetes specialist and a nationally recognized diabetes expert.
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Recent Blog Bytes
- Strategies to Stick With Incretin Therapy: Managing GI Symptoms
- Letting Go of Judgment – Embracing Curiosity
- Question of the Week | Remote Eye Screening Precautions
- Rationale of the Week | Weight-Inclusive Diabetes Care
- Honoring Excellence: Celebrating This Year’s Diabetes Education Scholarship Recipients
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
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