Question of the Week | Sleep and ADA Recommendations
A 62-year-old with type 1 diabetes presents for their follow-up visit. They report struggling with fatigue, poor sleep quality, and difficulty with glucose management despite taking medications as prescribed. Upon review, you find their A1C is 7.6%, and their average nightly sleep duration is 4.5-6 hours per night.
Based on the 2025 ADA Standards of Care, which of the following interventions would be the most appropriate next step to address sleep and glucose management?
- Refer to a sleep study to evaluate for obstructive sleep apnea and adjust the medication regimen.
- Encourage engagement in vigorous evening exercise to promote better sleep.
- Screen sleep health and develop a plan to create consistent sleep routines and habits.
- Advise taking over-the-counter melatonin supplements to improve sleep quality.
Want to learn more about this question?
Ignite your passion & prepare for Diabetes Certification!
Join our Expert Team at our dynamic Virtual DiabetesEd Training Conference April 16-18th, 2025
Gain fresh insights, practical tools, and a deeper understanding of the latest in person-centered diabetes care. Our expert team brings the ADA Standards of Care to life—covering medications, behavior change, technology, and more! If you’re preparing for the CDCES or BC-ADM exam, this conference—paired with free bonus courses—serves as the ideal study companion!
With interactive co-teaching, we keep sessions engaging, relevant, and fun. Let’s learn and grow together!
Our expert team transforms complex diabetes science into clear, practical insights—keeping it real, engaging, and fun! The faculty includes:
- Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES
- Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
- Christine Craig, MS, RD, CDCES
- 3 Days: of critical information delivered by passionate speakers in an engaging and fun format!
- 11 Bonus Online Courses: As a course attendee, you automatically receive a bonus online course bundle of 11 online courses valued at over
Rediscovering Walking – From Rucking to Kicking Up Intensity
Walking is often recognized as the most accessible and underrated form of exercise. While some may argue in favor of high-intensity cardio or resistance training, a growing body of evidence suggests that walking offers significant benefits—especially when approached with intention and consistency.
According to Dr. Elroy Aguiar, an assistant professor of exercise science at The University of Alabama, walking remains one of the most beneficial forms of movement due to its low barriers to entry—minimal cost, equipment, or skill required. “That’s why we say it’s the best,” Dr. Aguiar notes. And yet, despite this accessibility, many individuals struggle to find time to incorporate walking into their busy, sedentary lives.
🚶♂️ Cadence Matters: Walking with Intensity
Not all walking provides the same health return. The intensity, particularly cadence (steps per minute), plays a crucial role in determining health outcomes.
🕒 100 steps per minute is considered moderate intensity
⚡ 130 steps per minute qualifies as vigorous intensity
Dr. Aguiar’s research, published in the British Journal of Sports Medicine, indicates that health benefits from walking begin to accumulate at moderate or higher intensities. Most people naturally walk at a pace of 110–115 steps per minute when moving briskly. Increasing cadence just slightly can shift the effort from moderate to vigorous, maximizing the health payoff in a shorter time span.
🎒 Add Intensity with Rucking
For those looking to increase the challenge of walking, rucking—walking with a weighted backpack—offers a practical solution.
Adding resistance increases oxygen demand, raises heart rate, and enhances caloric burn without requiring a change in pace or duration. According to Dr. Aguiar, this method can also improve lower body strength and bone density, particularly with consistent practice over time.
While it won’t replace traditional strength training, rucking offers an accessible way to gain some muscular benefits while walking. A light weight to start, gradually increased, can help prevent injury and support adaptation.
⏱️ One Minute Can Make a Difference
A 2024 study published in the Scandinavian Journal of Medicine and Science in Sports found that both the quantity and intensity of physical activity are associated with better health outcomes. Remarkably, even one minute of higher-intensity activity per day was linked to a lower likelihood of having metabolic syndrome—a cluster of risk factors including visceral adiposity, high blood pressure, high blood sugar, low HDL cholesterol, and elevated triglycerides.
Dr. Aguiar explains that an individual’s most intense one-minute activity across the day can serve as a strong indicator of metabolic health. Even brief, high-intensity bursts of activity may help reduce risk for diabetes, hypertension, and cardiovascular disease.
🍽️ Walking After Meals: A Simple Strategy for Blood Glucose Improvement
Another practical strategy supported by research is post-meal walking. A 15-minute walk after meals can help blunt spikes in blood glucose, particularly in older adults at risk for glucose intolerance.
When muscles are active, they draw glucose from the bloodstream to use for energy, thereby reducing blood sugar levels and easing the demand on insulin. Over time, this can help prevent insulin resistance, a precursor to Type 2 diabetes.
Dr. Aguiar notes that consistent post-meal movement can reduce the workload on the pancreas and enhance the muscles’ ability to absorb and use glucose. This daily practice may offer long-term protection against metabolic syndrome, hypertension, and diabetes.
📉 Step Count and Longevity
Large-scale studies have shown clear associations between step count and mortality risk. A 2023 meta-analysis published in the European Journal of Preventive Cardiology found:
- 2,337 steps/day: lower cardiovascular mortality
- 3,867 steps/day: lower all-cause mortality
- Each additional 1,000 steps: 15% reduction in all-cause mortality
- Each additional 500 steps: 7% reduction in cardiovascular mortality
Additionally, a study by the University of Granada concluded that while more steps bring more benefits, the majority of cardiovascular protection appears to occur around 7,000 steps/day. The popular goal of 10,000 steps per day, while not evidence-based, remains a useful motivational benchmark.
💡 Who Benefits the Most?
For elite athletes, walking may offer limited fitness returns. However, for individuals who are sedentary or new to exercise, walking provides a low-impact, effective entry point to better health.
Some key benefits of walking for the general population include:
- Improved cardiovascular health
- Strengthened muscles and joints
- Support for bone density
- Increased daily caloric expenditure
- Reduced risk of chronic diseases
Walking is especially valuable for individuals managing or at risk for Type 2 diabetes, obesity, hypertension, and metabolic syndrome.
🔟 Key Takeaways
- Cadence matters – 100 steps per minute = moderate; 130+ = vigorous
- Even one minute of high-intensity movement can improve metabolic markers
- 15-minute walks after meals can significantly lower blood glucose
- Rucking adds intensity, strength, and calorie burn to walking
- Walking is linked to lower mortality from all causes and cardiovascular disease
- Most benefits occur by 7,000 steps/day, but more is better
- Walking is an entry point to fitness, particularly for the sedentary
- The practice supports muscle and bone health
- It requires no equipment and is nearly universally accessible
Walking delivers significant, sustainable health benefits with minimal risk
📝 Final Thoughts
Walking is a powerful yet underappreciated form of movement. Whether used to regulate blood sugar, reduce cardiovascular risk, or improve mental clarity, walking remains one of the most effective and inclusive health strategies available.
For anyone looking to improve overall health without the barriers of cost, complexity, or time—walking offers a proven path forward.
📚 References
- Aguiar, E. J., et al. (2021). Walking cadence (steps/min) and intensity in 21–40-year-olds: CADENCE-adults. British Journal of Sports Medicine.
- DiPietro, L., et al. (2013). Benefits of Postmeal Walking on Glycemic Control in Older Adults at Risk for Impaired Glucose Tolerance. Diabetes Care, 36(10), 3262–3268.
- European Journal of Preventive Cardiology (2023). Daily step count and all-cause and cardiovascular mortality: a dose–response meta-analysis.
- University of Granada Study (2023). Step count thresholds for cardiovascular benefit: optimal versus traditional targets. European Journal of Preventive Cardiology.
Ignite your passion & prepare for Diabetes Certification!
Join our Expert Team at our dynamic Virtual DiabetesEd Training Conference April 16-18th, 2025
Gain fresh insights, practical tools, and a deeper understanding of the latest in person-centered diabetes care. Our expert team brings the ADA Standards of Care to life—covering medications, behavior change, technology, and more! If you’re preparing for the CDCES or BC-ADM exam, this conference—paired with free bonus courses—serves as the ideal study companion!
With interactive co-teaching, we keep sessions engaging, relevant, and fun. Let’s learn and grow together!
Our expert team transforms complex diabetes science into clear, practical insights—keeping it real, engaging, and fun! The faculty includes:
- Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES
- Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
- Christine Craig, MS, RD, CDCES
- 3 Days: of critical information delivered by passionate speakers in an engaging and fun format!
- 11 Bonus Online Courses: As a course attendee, you automatically receive a bonus online course bundle of 11 online courses valued at over
Celebrating Earth Day: How Native Plants Support Wildlife and Our Well-Being
In honor of Earth Day, April 22, 2025, we’re shining a light on the power of native plants in creating vibrant, resilient ecosystems—for wildlife and for people.
Native plants—those that have evolved naturally in a specific region—play a crucial role in supporting local pollinators, birds, butterflies, and other wildlife. These plants provide essential food, pollen, and shelter that many species rely on for survival. And while the benefits to the environment are clear, cultivating native plants also boosts human well-being. Thriving ecosystems support cleaner air and water, increased biodiversity, and create opportunities for people to reconnect with nature.
🌻 A Journey Toward Native Planting
When Coach Beverly moved into her home 26 years ago, she planted what many of us do—flowers and grasses that looked appealing and could withstand local heat. With an acre of land surrounding her home and office, she had space to experiment, adding a wide variety of foliage and trees for beauty and shade.
But like many at that time, she wasn’t yet aware of the importance of native plants—or how their presence (or absence) affects the animals, insects, and birds that share our space.
Over time, as she learned more about habitat loss and the plight of pollinators, she began to rethink her approach. Through research, visits to a nearby native nursery, and the help of trusted websites, she and her husband began the transformation: reshaping their land into a space that supports bees, butterflies, frogs, birds, lizards, and more. Today, their yard is not only beautiful but also an oasis for wildlife—and a model of sustainable gardening.
💧 Water: A Simple Yet Powerful Addition
In addition to plants, providing a water source can be a game-changer for thirsty pollinators and wildlife. Whether it’s a birdbath, a shallow dish, or a small pond, water invites life into any garden.
Last year, Coach Beverly dug a small frog pond. Within weeks, frogs, toads, and birds made themselves at home. A year later, the pond teems with tadpoles, mosquito fish, dragonflies, water beetles, and countless other tiny creatures.
The pond has become a source of daily joy and fascination for family and visitors alike—a reminder of how deeply nature nurtures our spirits. It has also been a powerful tool for stress relief and mental well-being.
🌿 Nature as Therapy
For those managing diabetes, chronic conditions, or everyday stress, spending time in nature and caring for living things can be deeply therapeutic. And it doesn’t have to be complicated.
Start small:
- Plant a few herbs or flowers in containers
- Scatter wildflower seeds on a patch of earth
- Nurture a potted tomato plant on a sunny windowsill
For the more adventurous, creating a native plant garden is a wonderful excuse to get outdoors, move your body, and take pride in a growing, living space. There’s something special about tasting a sun-warmed tomato that’s been nurtured from seed to fruit.
🌸 Not Sure What’s Native in Your Area?
A great place to start is the article Audubon – 20 Common Types of Native Plants, which outlines beneficial plants found across the U.S. To make it local, cross-reference with your zip code using tools like the Native Plant Finder – NWF by the National Wildlife Federation.
For example, in Chico, California, the California Christmas-Berry is drought-tolerant and a favorite food source for local birds.
🌳 Here are a few native plant ideas to consider:
- Trees: Oak, Pine, Dogwood, Willow
- Colorful blooms: Coneflower, Sunflower
- Edible treats for people and birds: Blueberries, Elderberries, Serviceberries
Need help sourcing plants? The Plant Native website offers a helpful directory of native nurseries throughout the U.S.
🌱 Every Action Counts
Many people feel overwhelmed or discouraged by the state of the planet. But there is also a growing awareness of our power to make change—and hope rooted in action.
Whether it’s planting a single native shrub, providing a bowl of water, or simply observing and appreciating the life around us, every effort makes a difference.
Visit www.earthday.org and Project Regeneration for more ideas and inspiration on how to help the Earth thrive.
💚 Final Thoughts
Each person has the ability to nurture the planet and themselves, starting right at home. Native plants are a simple, beautiful way to support both biodiversity and human well-being.
So this Earth Day, consider taking that first step. Plant something. Provide water. Let nature in. And know that even the smallest actions ripple outward in meaningful ways.
🌎 Happy Earth Day from Coach Beverly and the Diabetes Education Services team.
Rationale of the Week | Who Benefits Most from Mindful Eating as a Primary Strategy?
For last week’s practice question, we quizzed participants on Who Benefits Most from Mindful Eating as a Primary Strategy? 67% 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: Mindful eating can support diabetes management in various ways.
For which of the following individuals would mindful eating be most effective as a primary strategy rather than a complementary approach?
Answer Choices:
- A 46-year-old male with type 1 diabetes on a fixed carbohydrate meal plan.
- A 30-year-old pregnant female recently diagnosed with gestational diabetes.
- A clinically underweight 77-year-old female with prediabetes and osteoporosis on a high-protein, high-calcium diet.
- A 28-year-old female with type 2 diabetes, a BMI of 35, and a history of disordered eating
Getting to the Best Answer
If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.
Mindful eating is a flexible, non-restrictive approach that promotes awareness, self-regulation, and a healthier relationship with food. While many people with diabetes can benefit from mindful eating, individuals with a history of disordered eating often find it to be the most transformative strategy (Kristeller & Hallett, 1999; Miller et al., 2012; Mercado et al., 2021).
Answer 1 is incorrect. 7% chose this answer, “A 46-year-old male with type 1 diabetes on a fixed carbohydrate meal plan:
- Fixed-carb meal plans are essential for stabilizing blood sugar and matching insulin dosages.
- While mindful eating can support self-awareness and reduce mealtime stress, structured meal timing, and portioning remain the primary strategy.”
Answer 2 is incorrect. 15% of you chose this answer, “30-year-old pregnant female recently diagnosed with gestational diabetes:
- Gestational diabetes requires careful carbohydrate distribution and nutrient timing for optimal maternal and fetal health.
- Mindful eating may help reduce stress and support portion awareness, but medical nutrition therapy (MNT) takes priority for managing blood sugar levels during pregnancy.”
Answer 3 is incorrect. About 9% of respondents chose this, “A clinically underweight 77-year-old female with prediabetes and osteoporosis on a high-protein, high-calcium diet:
- While mindful eating can help this individual enhance food enjoyment and reduce mealtime stress, her primary concern is nutritional adequacy and weight gain.
- A structured, high-protein, high-calcium diet supports bone health, prevents muscle loss, and maintains energy balance.
- Encouraging mindful eating without ensuring sufficient caloric intake may not address the underlying need for increased nutrition.”
Finally, Answer 4 is correct. 67% chose this answer, “A 28-year-old female with type 2 diabetes, BMI 35, and a history of disordered eating:
- Mindful eating is particularly effective as a primary strategy for individuals with a history of emotional eating, binge eating, or restrictive dieting.
- It reduces anxiety around food, promotes a nonjudgmental approach to eating, and fosters long-term self-regulation (Miller et al., 2012; Kristeller et al., 2014).
- Studies show mindful eating lowers binge-eating episodes, improves self-efficacy, and helps individuals develop a positive relationship with food (Harvard T.H. Chan School of Public Health, 2024; Mercado et al., 2021).”
Why is #4 the correct answer?
Mindful eating is most beneficial as a primary approach for individuals who have struggled with disordered eating patterns. Unlike restrictive diets, it provides a structured yet flexible way to reconnect with hunger cues, reduce emotional eating, and develop sustainable habits.
We hope this week’s rationale clarifies the diverse applications of mindful eating. Thank you for engaging with this question, and we look forward to more learning opportunities together!
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!
by Evgenia Evans, MS, RDN, CDCES
References
Aikens, J. E. (2012). Prospective associations between emotional distress and poor outcomes in type 2 diabetes. Diabetes Care, 35(12), 2472–2478. https://doi.org/10.2337/dc12-0181
Forman, E. M., Shaw, J. A., Goldstein, S. P., Butryn, M. L., Martin, L. M., Meiran, N., Crosby, R. D., & Manasse, S. M. (2016). Mindful decision making and inhibitory control training as complementary means to decrease snack consumption. Appetite, 103, 176-183. https://doi.org/10.1016/j.appet.2016.04.014
Framson, C., Kristal, A. R., Schenk, J. M., Littman, A. J., Zeliadt, S., & Benitez, D. (2009). Development and validation of the Mindful Eating Questionnaire. Journal of the American Dietetic Association, 109(8), 1439–1444. https://doi.org/10.1016/j.jada.2009.05.006
Fredrickson, B. L. (2004). The broaden-and-build theory of positive emotions. Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences, 359(1449), 1367–1377. https://doi.org/10.1098/rstb.2004.1512
Garland, E. L., Fredrickson, B. L., Kring, A. M., Johnson, D. P., Meyer, P. S., & Penn, D. L. (2010). Upward spirals of positive emotions counter downward spirals of negativity: Insights from the broaden-and-build theory and affective neuroscience on the treatment of emotion dysfunctions and deficits in psychopathology. Clinical Psychology Review, 30(7), 849–864. https://doi.org/10.1016/j.cpr.2010.03.002
Harvard T.H. Chan School of Public Health. (2024, November 7). Mindful Eating. The Nutrition Source. https://nutritionsource.hsph.harvard.edu/mindful-eating/
Kabat-Zinn, J. (2009). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Random House Publishing Group.
Kristeller, J. L., & Hallett, C. B. (1999). An exploratory study of a meditation-based intervention for binge eating disorder. Journal of Health Psychology, 4(3), 357–363. https://doi.org/10.1177/135910539900400305
Kristeller, J. L., Wolever, R. Q., & Sheets, V. (2014). Mindfulness-based eating awareness training (MB-EAT) for binge eating: A randomized clinical trial. Mindfulness, 5(3), 282–297. https://doi.org/10.1007/s12671-012-0179-1
Mercado, C., Marasigan, K., Cardona, J., & Ko, E. (2021). Mindfulness-based interventions for emotional eating and binge eating in adults: A meta-analysis. Appetite, 164, 105265. https://doi.org/10.1016/j.appet.2021.105265
Miller, C. K. (2017). Mindful eating with diabetes. Diabetes Spectrum, 30(2), 89–94. https://doi.org/10.2337/ds16-0040
Miller, C. K., Kristeller, J. L., Headings, A., Nagaraja, H., & Miser, W. F. (2012). Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: A pilot study. Journal of the Academy of Nutrition and Dietetics, 112(11), 1835–1842. https://doi.org/10.1016/j.jand.2012.07.036
Miller, C. K., Kristeller, J. L., Headings, A., & Nagaraja, H. (2014). Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: A randomized controlled trial. Health Education & Behavior, 41(2), 145–154. https://doi.org/10.1177/1090198113493092
Nicolucci, A., Kovacs Burns, K., Holt, R. I. G., Comaschi, M., Hermanns, N., Ishii, H., Kokoszka, A., Pouwer, F., Skovlund, S. E., Stuckey, H., Tarkun, I., Vallis, M., Wens, J., & Peyrot, M. (2013). Diabetes Attitudes, Wishes and Needs second study (DAWN2™): Cross-national benchmarking of diabetes-related psychosocial outcomes for people with diabetes. Diabetic Medicine, 30(7), 767–777. https://doi.org/10.1111/dme.12245
Nelson, J. B. (2017). Mindful eating: The art of presence while you eat. Diabetes Spectrum, 30(3), 171–174. https://doi.org/10.2337/ds17-0015
Want to learn more about this question?
Enroll in our upcoming webinar led by Evgenia Evans, MS, RDN, CDCES
Mindful Eating for Successful Diabetes Management
Join us live on June 11, 2025, at 11:30 am PST
This engaging and practical webinar, developed by Evgenia Evans, MS, RDN, CDCES, a positive psychology practitioner, is tailored explicitly for healthcare professionals including dietitians, diabetes care specialists, and providers.
Using evidence-based strategies, participants will gain a deeper understanding of the benefits of incorporating mindfulness into the eating experience, including enhanced glycemic management, improved emotional well-being, and healthier eating behaviors. The webinar includes an overview of mindfulness and mindful eating strategies, such as engaging all five senses, recognizing hunger cues, addressing cravings, and using practical tools to create supportive eating environments.
Participants will also learn how to adapt these approaches to diverse populations and the unique needs of individuals. Join us to deepen your expertise, participate in insightful discussions, and empower individuals to cultivate sustainable, positive relationships with food while achieving long-term health goals.
Course topics:
- Introduction to the concept and benefits of mindful eating for individuals with diabetes
- Overview of key strategies for mindful eating
- Practical tools for incorporating mindful eating into professional practice (of Diabetes Educators)
- Cultural and individual adaptations of the mindful eating approach
Instructor: Evgenia Evans, MS, RDN, CDCES
Evgeniya Evans, MAPP, RDN, LDN, CDCES, specializes in chronic disease prevention, diabetes management, and women’s health. Her unique approach integrates mindfulness-based nutrition and positive psychology, creating transformative impacts on her patients’ health and well-being.
Evgeniya’s academic journey reflects her dedication to lifelong learning and her holistic understanding of nutrition and health. She began with four years of Sociology studies at Omsk State University in Russia, followed by earning a Bachelor of Science in Nutrition and Dietetics from the University of Illinois Chicago. She furthered her expertise with a master’s degree in Applied Positive Psychology from the University of Pennsylvania. This diverse educational foundation allows her to address the socio-psychological factors that influence dietary behaviors and deliver a well-rounded approach to patient care.
At Cook County Health’s Diabetes Clinic within the Endocrinology Department, Evgeniya provides medically tailored nutrition therapy and culturally sensitive counseling. She works with individuals from various socio-economic backgrounds, guiding them through their unique health challenges with compassion and precision. Her dedication to creating personalized, sustainable dietary strategies highlights her commitment to promoting long-term health and vitality for her patients.
In addition to her clinical practice, Evgeniya is a passionate educator. She teaches several classes at her clinic, including Pillars of Diabetes Management with Lifestyle, Nutrition for Health and Vitality, and The Art of Mindful Eating. Her emphasis on education underscores her belief in the transformative power of fostering a healthy, enjoyable lifestyle supported by mindful eating and a positive mindset.
Evgeniya envisions a world where individuals are free from the struggles of dieting and food-related shame. She dreams of a future where no one feels deprecated by their appearance or food choices, and everyone enjoys the vitality and health to pursue their dreams. She is devoted to fostering vibrant, authentic lives where cooking, eating, and sharing meals with loved ones are sources of joy, love, and positive connection.
All hours earned count toward your CDCES Accreditation Information
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- Letting Go of Judgment – Embracing Curiosity
- Question of the Week | Remote Eye Screening Precautions
- Rationale of the Week | Weight-Inclusive Diabetes Care
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- Question of the Week | Who Benefits Most from Mindful Eating as a Primary Strategy? by Evgenia Evans, MS, RDN, CDCES
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Earth Day Resource Page
🔹 Educational & Advocacy Resources
- EarthDay.org
- The official Earth Day site with toolkits, event listings, campaigns, and actions for climate and environmental justice.
- Explore initiatives like The Great Global Cleanup, Climate Literacy, and Canopy Project.
- EPA: Environmental Protection Agency
- U.S. government resource for Earth Day activities, environmental data, and sustainability tips.
- Great for educators, students, and community organizers.
🔹 Native Plant and Wildlife Support
- National Wildlife Federation – Native Plant Finder
- Enter a zip code to find plants native to your region that support pollinators and birds.
- Audubon Society – Plants for Birds
- Offers native plant lists by zip code, along with guidance on how to create a bird-friendly yard or balcony.
- Plant Native
- Directory of native plant nurseries across the U.S., plus regional planting guides.
🔹 Local Action & Community Involvement
- VolunteerMatch – Environmental Opportunities
- Search for local Earth Day cleanups, planting projects, and sustainability initiatives.
- The Great Global Cleanup
- A global effort to remove billions of pieces of trash from neighborhoods, beaches, rivers, and parks.
🔹 Resources for Teachers & Families
- National Geographic Education – Earth Day Resources
- Lesson plans, activities, and videos for classrooms and curious learners.
- NASA Climate Kids
- Fun, educational site for children that explains climate science with games, activities, and stories.
🔹 Sustainable Living Guides
- Offers practical advice on reducing personal environmental impact across home energy, food, waste, and travel.
- Interactive platform that turns sustainability efforts into group challenges for schools, businesses, and individuals.
✅ Bonus Tip:
Host a Local Event!
Use EarthDay.org’s event map to find or promote cleanups, workshops, or plantings in your area.
Strategies to Stick With Incretin Therapy: Managing GI Symptoms
The use of GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists has expanded significantly in diabetes care. Their proven efficacy in lowering blood glucose levels, promoting weight loss, improving cardiovascular outcomes, and providing kidney protection has contributed to their popularity.
GLP-1 Therapy Often Stopped Within One Year
However, research shows that over one-third of individuals with diabetes discontinue these medications within one year.1 A 2024 JAMA study, which did not include the newest incretin tirzepatide, identified key factors contributing to this trend.
Discontinuation rates were significantly higher among individuals with increased out-of-pocket costs, those from Black or Hispanic populations, individuals with more significant social needs, and those experiencing gastrointestinal intolerances.1
Education and support, frequency of follow-up visits after therapy initiation, and proactive management of gastrointestinal symptoms are recommended to enhance therapy tolerance and increase the likelihood of continued use. Understanding effective strategies to manage gastrointestinal side effects is essential for symptom mitigation in individuals on incretin therapy.
Managing Side Effects
Gastrointestinal intolerance (GI) occurs in 10-30% of individuals taking incretin medications2 and symptoms are typically transient, most noted after an increase in dose. Dose modifications and extending dose titration timing are recommended for individuals with persistent GI symptoms. In addition, the ADA 2025 Standards of Care recommends counseling on dietary modifications to mitigate GI side effects3, and a referral to a dietitian is recommended for individuals needing advanced support.4
Nausea is the most reported GI side effect. Diabetes Care and Education Specialists (CDCES) can encourage the pacing of meals, eating smaller portions, awareness of fullness, and avoiding high-fat or spicy foods. In some cases, consuming easy-to-digest, bland foods such as crackers, apples, mint, or ginger-based products and avoiding strong smells may provide relief.2
Diabetes educators can also advise individuals to stay upright after meals, including adequate hydration but avoiding rapid fluid intake (avoid the use of straws) to prevent exacerbating symptoms. If symptoms persist, coordination with a prescriber to consider anti-nausea or prokinetic agents and assessment of medication dosing may support symptom reduction.2
Vomiting and diarrhea, while less common than nausea, can impact quality of life and if severe may pose health risks. For vomiting, it is important to ensure adequate hydration, and use strategies discussed above to support nausea reduction. Emphasizing broths, liquids, and lower-fiber foods can also help until symptoms resolve. For diarrhea, it is essential to identify and avoid trigger foods and beverages such as sugar alcohols, isotonic sports drinks, coffee, alcohol, carbonation, and high-lactose foods.3 Including soluble fiber food sources can help with diarrhea symptoms. Healthcare professionals can work with prescribers to consider anti-emetic medications, a slower titration schedule, or discontinue therapy if symptoms persist.
Unlike nausea and vomiting, constipation symptoms may occur as a more chronic condition. The reduction in thirst caused by incretins may exacerbate this symptom. Strategies to support increased fluid intake, a minimum of 64 oz per day, are recommended. Dietary intervention strategies such as increasing dietary fiber intake from fruits, vegetables, and whole grains and promoting regular physical activity are key interventions.3 For individuals experiencing persistent constipation, a fiber supplement, stool softener, or laxative may be considered.
Role of Diabetes Care and Education Specialists
Diabetes care and education specialists, play a crucial role in supporting people using GLP-1 or GIP/GLP-1 RA medications. Referring individuals to a Registered Dietitian Nutritionist can provide personalized recommendations based on each patient’s symptoms and dietary patterns.
Working together in a team approach for lifestyle and medication management can reduce symptoms effectively. We can offer support for communities at risk of therapy discontinuation. Through education about common side effects, and providing practical strategies to manage symptoms, we can improve medication continuity and enhance long-term treatment success.
References
- Do D, Lee T, Peasah SK, Good CB, Inneh A, Patel U. GLP-1 Receptor Agonist Discontinuation Among Patients With Obesity and/or Type 2 Diabetes. JAMA Netw Open.2024;7(5):e2413172. doi:10.1001/jamanetworkopen.2024.13172
- Gorgojo-Martínez JJ, Mezquita-Raya P, Carretero-Gómez J, Castro A, Cebrián-Cuenca A, de Torres-Sánchez A, García-de-Lucas MD, Núñez J, Obaya JC, Soler MJ, Górriz JL, Rubio-Herrera MÁ. Clinical Recommendations to Manage Gastrointestinal Adverse Events in Patients Treated with Glp-1 Receptor Agonists: A Multidisciplinary Expert Consensus. J Clin Med. 2022 Dec 24;12(1):145. doi: 10.3390/jcm12010145. PMID: 36614945; PMCID: PMC9821052.
- American Diabetes Association Professional Practice Committee; Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025. Diabetes Care1 January 2025; 48 (Supplement_1): S181–S206. https://doi.org/10.2337/dc25-S009
- Gigliotti, Linda et al. Incretin-Based Therapies and Lifestyle Interventions: The Evolving Role of Registered Dietitian Nutritionists in Obesity Care. Journal of the Academy of Nutrition and Dietetics, Volume 125, Issue 3, 408 – 421
Ignite your passion & prepare for Diabetes Certification!
Join our Expert Team at our dynamic Virtual DiabetesEd Training Conference April 16-18th, 2025
Gain fresh insights, practical tools, and a deeper understanding of the latest in person-centered diabetes care. Our expert team brings the ADA Standards of Care to life—covering medications, behavior change, technology, and more! If you’re preparing for the CDCES or BC-ADM exam, this conference—paired with free bonus courses—serves as the ideal study companion!
With interactive co-teaching, we keep sessions engaging, relevant, and fun. Let’s learn and grow together!
Our expert team transforms complex diabetes science into clear, practical insights—keeping it real, engaging, and fun! The faculty includes:
- Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES
- Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
- Christine Craig, MS, RD, CDCES
- 3 Days: of critical information delivered by passionate speakers in an engaging and fun format!
- 11 Bonus Online Courses: As a course attendee, you automatically receive a bonus online course bundle of 11 online courses valued at over
Rationale of the Week | What happens when people stop taking GLP /GIPs?
For last week’s practice question, we quizzed participants on what happens when people stop taking GLP /GIPs. 81% 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:
About 30% of people with diabetes started on GLP-1’s stop taking this medication before completing a year of therapy.
According to ADA Standards, what results from sudden discontinuation of GLP-1s /GIP like semaglutide and tirzepatide?
Answer Choices:
- People maintain their weight loss for at least a year.
- People regain at least one-half of their weight loss within a year.
- People experience decreased nausea and less than 10% weight regain.
- People continue behaviors learned on medication with ongoing weight loss success.
Getting to the Best Answer
Answer 1 is incorrect. 4.71% chose this answer. “People maintain their weight loss for at least a year.” According to the ADA Standards, people regain 50 to 70% of the weight lost after this gut hormone replacement therapy is stopped.
Answer 2 is correct. 81.44% of you chose this answer. “People regain at least one-half of their weight loss within a year.” YES, this is the best answer! Great JOB. According to ADA Standards, “sudden discontinuation of semaglutide and tirzepatide results in regain of one-half to two-thirds of the weight loss within 1 year. Consider trying lowest effective dose, using intermittent therapy, or stopping medication followed by close weight monitoring. This information is helpful for our clinical practice as we navigate the best approach to utilizing GLP-1 /GIP Therapy.
Answer 3 is incorrect. About 9.28% of respondents chose this. “People experience decreased nausea and less than 10% weight regain.” According to the ADA Standards, people regain 50 to 70% of the weight lost after this gut hormone replacement therapy is stopped.
Finally, Answer 4 is incorrect. 4.57% chose this answer. “People continue behaviors learned on medication with ongoing weight loss success.” According to the ADA Standards, people regain 50 to 70% of the weight lost after this gut hormone replacement therapy is stopped.
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!
Ignite your passion & prepare for Diabetes Certification!
Join our Expert Team at our dynamic Virtual DiabetesEd Training Conference April 16-18th, 2025
Gain fresh insights, practical tools, and a deeper understanding of the latest in person-centered diabetes care. Our expert team brings the ADA Standards of Care to life—covering medications, behavior change, technology, and more! If you’re preparing for the CDCES or BC-ADM exam, this conference—paired with free bonus courses—serves as the ideal study companion!
With interactive co-teaching, we keep sessions engaging, relevant, and fun. Let’s learn and grow together!
Our expert team transforms complex diabetes science into clear, practical insights—keeping it real, engaging, and fun! The faculty includes:
- Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES
- Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
- Christine Craig, MS, RD, CDCES
- 3 Days: of critical information delivered by passionate speakers in an engaging and fun format!
- 11 Bonus Online Courses: As a course attendee, you automatically receive a bonus online course bundle of 11 online courses valued at over
Question of the Week | Based on ADA Standards, what is next med addition?
JR has type 2 diabetes and takes Metformin 1000mg BID and sitagliptin (Januvia), A1C 8.1%. GFR 47, UACR 158mg/g. Recent diagnosis of congestive heart failure. These are the medications their insurance covers.
Of the following medications, which addition would most benefit JR?
- glipizide (Glucotrol)
- pioglitazone (Actos)
- semaglutide (Ozempic)
- dapagliflozin (Farxiga)
Ignite your passion & prepare for Diabetes Certification!
Join our Expert Team at our dynamic Virtual DiabetesEd Training Conference April 16-18th, 2025
Gain fresh insights, practical tools, and a deeper understanding of the latest in person-centered diabetes care. Our expert team brings the ADA Standards of Care to life—covering medications, behavior change, technology, and more! If you’re preparing for the CDCES or BC-ADM exam, this conference—paired with free bonus courses—serves as the ideal study companion!
With interactive co-teaching, we keep sessions engaging, relevant, and fun. Let’s learn and grow together!
Our expert team transforms complex diabetes science into clear, practical insights—keeping it real, engaging, and fun! The faculty includes:
- Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES
- Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
- Christine Craig, MS, RD, CDCES
- 3 Days: of critical information delivered by passionate speakers in an engaging and fun format!
- 11 Bonus Online Courses: As a course attendee, you automatically receive a bonus online course bundle of 11 online courses valued at over
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