According to the recently published ADA report on the 2022 Economic Costs of Diabetes in the U.S., which of the following statements is most accurate?

1. 25% of health care dollars are spent on caring for people with diabetes.
2. Although diabetes prevalence remains stable, the direct medical costs attributed to diabetes increased by 7% between 2017 and 2022.
3. The cost burden of diabetes is disproportionately borne by vulnerable and underserved communities.
4. After adjusting for inflation, the total cost of insulin and other diabetes medications increased by 26% from 2017 to 2022.
5. All of the above

Click Here to Test your Knowledge

National Diabetes Month

November kicks off National Diabetes Month, a time to recognize that over 11% of Americans are living with diabetes and over 35% have prediabetes. Since diabetes results from a combination of genetics plus environment, there is a recognition that social determinants of health play a pivotal role in the development of diabetes and its complications. Through advocacy and education, we can inform individuals on best care for diabetes and support them in taking action to improve the health of their communities to prevent future diabetes. We have put together a list of FREE diabetes resources in English and Spanish to share with people living with prediabetes and diabetes. Thank you for your advocacy and belief that we can make a difference. Coach Beverly

All hours earned count toward your CDCES Accreditation Information

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.

To recognize Native American Heritage Month, we are honored to share a treasured poem by one of my favorite poets and writers, Joy Harjo. Plus, we also share an interactive map of Indigenous Lands (credit to NPR).

In 2019, Joy Harjo was recognized as the United States poet laureate and served three terms. Harjo is an internationally renowned performer and writer of the Muscogee (Creek) Nation.

She lives in Tulsa, Oklahoma and is the author of nine books of poetry, including the highly acclaimed An American Sunrise, several plays and children’s books, and two memoirs, Crazy Brave and Poet Warrior. Her many honors include the Ruth Lily Prize for Lifetime Achievement from the Poetry Foundation, the Academy of American Poets Wallace Stevens Award, two NEA fellowships, and a Guggenheim Fellowship. 

You can learn more about Joy Harjo on her webpage, www.joyharjo.com.

Remember

Joy Harjo

Remember the sky that you were born under,
know each of the star’s stories.
Remember the moon, know who she is.
Remember the sun’s birth at dawn, that is the
strongest point of time. Remember sundown
and the giving away to night.
Remember your birth, how your mother struggled
to give you form and breath. You are evidence of
her life, and her mother’s, and hers.
Remember your father. He is your life, also.
Remember the earth whose skin you are:
red earth, black earth, yellow earth, white earth
brown earth, we are earth.
Remember the plants, trees, animal life who all have their
tribes, their families, their histories, too. Talk to them,
listen to them. They are alive poems.
Remember the wind. Remember her voice. She knows the
origin of this universe.
Remember you are all people and all people
are you.
Remember you are this universe and this
universe is you.
Remember all is in motion, is growing, is you.
Remember language comes from this.
Remember the dance language is, that life is.
Remember.

Which Indigenous lands are you on? This map will show you.

From NPR

Indigenous Peoples’ Day is a time of reflection, recognition and celebration of the role Native people have played in U.S. history. One way to mark the day — and to learn about Indigenous history year-round — is to learn which Native lands you live on.

November is Transgender Awareness Month and in honor of our Trans and Gender Non-conforming community, we want to share some helpful resources for Diabetes Specialists to create more inclusive practices.

Whether we provide services in the hospital, clinic, or other outpatient settings, we can take steps to help the people we work with feel welcome.

“Members of the lesbian, gay, bisexual, transgender and queer (LGBTQ) community have unique health disparities and worse health outcomes than their heterosexual counterparts, which has clinical relevance in the delivery of diabetes care and education. Diabetes care and education specialists are in a pivotal position to help this medically-underserved and vulnerable population get the best possible care.”

Association of Diabetes Care & Education Specialists (ADCES)

Actions diabetes professionals can take to provide more inclusive care

Create healthcare settings that send a message of welcomeness to the Trans and greater LGBQIA+ community. There are many small and big ways to send a message of inclusion.

• Update intake forms to list more than just “Male” and “Female,” along with a spot for pronouns and/or a body map to list preferred terms of various body parts.
• Add bathroom door signs that welcome all genders.
• Placing pride symbols in clinic windows, waiting rooms, and exam rooms, especially during Pride month.
• Practicing cultural humility when providing care.
• Shift to using more inclusive language both in writing and when speaking with people living with diabetes. Inclusive language creates a bridge and the foundation of trust between healthcare providers and participants.

Practicing cultural humility

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

Shifting Our Language

As Diabetes Educators, we recognize the importance of language in providing person-centered care to best support people living with diabetes.

There are a few small changes we can make to provide inclusive care for all people. To make our practices more welcoming, we can establish All Gender Restrooms and update our materials to use gender-inclusive language. Here is a list of terms and tips for shifting this language and creating more inclusive practices.

Person-Centered Care includes Individualized Language

The easiest way to become more inclusive in our language which respects the autonomy of each individual to describe themselves and their bodies is to give them opportunities to share with us what those terms are and how they would like to be referred to.

A few ways you can do this are by expanding the ways we collect this information in our intake forms or discussing it with the individual in their initial appointment. You can incorporate sections to ask for someone’s pronouns or even a body map where someone can make notes about the preferred language that is used around their bodies. Giving space to outline triggering or preferred language for each person can empower not only gender-diverse people but can also support trauma survivors of all genders.

By paying careful attention to each person’s experience from the moment they walk in the door until we say goodbye, we can find ways to create a more inclusive environment. This awareness of the details is the great first step to showing your care and respect for those you work with.

List of Resources

ADCES Inclusive Care for LGBTQ+ People with Diabetes Handout – this handout provides definitions, terms to avoid, and a cultural competency checklist to help you move towards improving inclusivity within your practice.

All Gender Restroom Sign PDF

Inclusive Perinatal Care – Our blog on shifting language for more inclusive perinatal care.

Diabetes Prevention and Management for LGBTQ+ People Handout – this handout includes research of diabetes within the LGBTQ+ community, along with clinical considerations, programs, and resources for diabetes educators to use within their practice.

Policies on Lesbian, Gay, Bisexual, Transgender & Queer (LGBTQ+) issues – this resource by the American Medical Association lists all the current healthcare policies in place for the LGBTQ+ community.

Helio’s LGBTQ+ Health Updates Resource Center – this is a “collection of news articles and features that provide the latest information on the unique health needs of individuals in the LGBTQ+ community.

Online Therapy Guide for LGBTQ+ Youth – this resource uncovers common mental health problems and causes in LGBTQ+ youth and gives pointers on finding the right online therapist.

Are we missing important information and resources? Send us your favorites to [email protected].

Inclusive Diabetes Care for LGBTQ Community

For more information, read our Expert Interview with Theresa Garnero, APRN, BC-ADM, MSN, CDE President of Sweet People Club, and writer of the article “Providing Culturally Sensitive Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community” in Diabetes Spectrum.

National Diabetes Month

November kicks off National Diabetes Month, a time to recognize that over 11% of Americans are living with diabetes and over 35% have prediabetes. Since diabetes results from a combination of genetics plus environment, there is a recognition that social determinants of health play a pivotal role in the development of diabetes and its complications. Through advocacy and education, we can inform individuals on best care for diabetes and support them in taking action to improve the health of their communities to prevent future diabetes. We have put together a list of FREE diabetes resources in English and Spanish to share with people living with prediabetes and diabetes. Thank you for your advocacy and belief that we can make a difference. Coach Beverly

All hours earned count toward your CDCES Accreditation Information

For last week’s practice question, we quizzed participants on diabetes & the impact it has on communities. 82% 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: November is National Diabetes Month.  This month shines a spotlight on the 37 million people living with diabetes and the 96 million with prediabetes. Certain communities are hit harder with diabetes than others due to a combination of genetics and social determinants of health. 

Which of the following statements are most accurate?

Answer Choices:

1. Rates of diabetes are highest amongst Native Americans & Alaska Natives.
2. Higher income levels are associated with an increased prevalence of diabetes.
3. More than 50% of people over the age of 65 have diabetes.
4. People who don’t complete high school, have lower rates of diabetes related complications.

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.

Answer 1 is correct. 82.45% chose this answer. “Rates of diabetes are highest amongst Native Americans & Alaska Natives.” YES, sadly, this is the best answer. For both men and women, prevalence of diagnosed diabetes was highest among American Indian and Alaska Native adults (13.6%), followed by non-Hispanic Black adults (12.1%), adults of Hispanic origin (11.7%), non-Hispanic Asian adults (9.1%) and non-Hispanic White adults (6.9%) (See CDC Appendix Table 3). As diabetes advocates, we can campaign for improved access to health care and address social determinants of health for communities at highest risk of prediabetes and diabetes.

Answer 2 is incorrect. 1.19% of you chose this answer. “Higher income levels are associated with an increased prevalence of diabetes.” People who have the lowest earnings and who don’t graduate high school have the highest rates of diabetes. Socioeconomic status and rates of diabetes are inversely related.

Answer 3 is incorrect. About 15.5% of respondents chose this. “More than 50% of people over the age of 65 have diabetes.” This is a tempting answer, but a little exaggerated. According to CDC Stats, 30% of people age 65 or live with diabetes.

Finally, Answer 4 is incorrect. 0.85% chose this answer. “People who don’t complete high school, have lower rates of diabetes related complications.” People who don’t graduate high school have the highest rates of diabetes and less resources to engage in preventive care.

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!

National Diabetes Month

November kicks off National Diabetes Month, a time to recognize that over 11% of Americans are living with diabetes and over 35% have prediabetes. Since diabetes results from a combination of genetics plus environment, there is a recognition that social determinants of health play a pivotal role in the development of diabetes and its complications. Through advocacy and education, we can inform individuals on best care for diabetes and support them in taking action to improve the health of their communities to prevent future diabetes. We have put together a list of FREE diabetes resources in English and Spanish to share with people living with prediabetes and diabetes. Thank you for your advocacy and belief that we can make a difference. Coach Beverly

All hours earned count toward your CDCES Accreditation Information

Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

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

In 1923, the Nobel prize in physiology or medicine was awarded to Frederick Grant Banting and John James Richard MacLeod “for the discovery of insulin”.  100 years later, we celebrate this life saving discovery each year on November 14^th, a day designated as World Diabetes Day.

Why do we celebrate World Diabetes Day on November 14^th? Please choose the best answer.

1. It was the date the Nobel prize was awarded to Dr. Banting and Dr. MacLeod.
2. It signifies the production date of the first vial of insulin.
3. It commemorates the opening date of the Banting Museum in Canada.
4. It is the birthday of Sir Frederick Banting.

Click Here to Test your Knowledge

FREE Preparing for the CDCES Exam Webinar

This course will transform your test anxiety into calm self-confidence and test-taking readiness.

Preparing for the CDCES Exam Webinar Topics

• Exam requirement updates for 2023.
• Exam eligibility and test format
• Strategies to succeed along with a review of study tips and test-taking tactics.
• We will review sample test questions and the reasoning behind choosing the right answers.
• Learn how to focus your time and prepare to take the CDCES Exam. We provide plenty of sample test questions

Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF, a working educator, and a nationally recognized diabetes expert. She has a Master’s Degree in Public Health from UCLA, with a focus on behavioral health and education.

All hours earned count toward your CDCES Accreditation Information

Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

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

On October 25th, 1923 the Nobel prize in physiology or medicine was awarded to Frederick Grant Banting and John James Richard MacLeod “for the discovery of insulin”. The discovery was made in 1921 i.e., only two years before, which makes the time period between the detection and this prize one of the shortest in the history of the Nobel Prize.

World Diabetes Day Celebrates Dr. Banting’s Birthday and the Discovery of Insulin

Dr. Banting was born on November 14, 1891.  That is why we celebrate World Diabetes Day on November 14th.

During a hot summer in 1921, Dr. Banting secured space to test out his theory in 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 a 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.

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 and 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 US, namely through Dr. Elliot Joslin in the late summer 1922.

Dr. Banting – Fun and Interesting Facts

• Sold insulin patent for $1
  
• Was wounded during the First World War and received the Military Cross
• Youngest Nobel Laureate in Medicine
• First Canadian on the cover of Time Magazine
• Among the last Canadians to receive a knighthood and have the title Sir Frederick Banting
• One of only two “non-Americans” to have a Second World War Liberty Ship named after him (USS Frederick Banting)
• Has as a crater on the Moon named after him (between Apollo 15 & 17 landing sites).

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 a saline to alcohol to purify the ‘extract’.  Dr. Macleod also secured the support of JB Collip, the 4th man on the team and the fist person to purify insulin for human use. Best is also known for pushing Banting to return to the research during a particular dark period of failure.

Want to Learn More About the Dr. Banting?

Historical Insulin Powerpoint Slides – here is a collection of some of my favorite powerpoint slides, depicting the discovery of insulin.

 Visit Banting House FaceBook Page

National Diabetes Month

November kicks off National Diabetes Month, a time to recognize that over 11% of Americans are living with diabetes and over 35% have prediabetes. Since diabetes results from a combination of genetics plus environment, there is a recognition that social determinants of health play a pivotal role in the development of diabetes and its complications. Through advocacy and education, we can inform individuals on best care for diabetes and support them in taking action to improve the health of their communities to prevent future diabetes. We have put together a list of FREE diabetes resources in English and Spanish to share with people living with prediabetes and diabetes. Thank you for your advocacy and belief that we can make a difference. Coach Beverly

All hours earned count toward your CDCES Accreditation Information

Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

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

Be a part of our diabetes community while learning about the latest in diabetes care. Plus, Coach Beverly provides an interactive question and answer session at the end of each live webinar.

Preparing for the CDCES Exam? Join us for our FREE Webinar

Airs live on November 14th, 2023, at 11:30 am PT

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.

Topics covered include:

• Changes in requirements for 2023
• Exam eligibility and test format
• Strategies to succeed
• Review of study tips and test taking tactics.

Can’t make it live? No worries. We will send post the recorded version to the Online University within 24 hours of the broadcast

Intended Audience: All healthcare professionals & paraprofessionals looking to become CDCES-certified

Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 15 years. She is an Associate Clinical Professor at UCSF, a working educator, and a nationally recognized diabetes expert.

Join the wonderment as we explore the role of our GI System

Now Recorded & Ready to Watch

Coach Bev invites you to join this 60-minute webinar that covers gastrointestinal health from top to bottom. Topics include; fatty liver disease diagnosis and treatment, intestinal complications associated with diabetes, keeping the microbiome healthy, and more. Join us to explore the magnificent wonders of diabetes and the gut.

New content and exciting research findings! Join the wonderment as we explore the impact of our GI System on our health.

Topics covered include:

• From the Mouth to Intestines: Periodontal disease, Gastroparesis, Fatty liver disease, pancreas disorders
• The intestine as an Endocrine Organ & Bacterial Host
• NASH Treatment Options including lifestyle and pharmacotherapy
• State the relationship between gut health, microbiome and diabetes and inflammation
• Describe 3 strategies to get our microbiome back to better health.

Intended Audience: These courses are knowledge-based activities designed for individuals or groups of diabetes educators, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other health care providers interested in enhancing their diabetes and microbiome knowledge

Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working diabetes specialist and a nationally recognized diabetes expert.

Two registration options

Enroll in our entire Level 4 | Advanced & Specialty Topic Courses  All courses air at 11:30 a.m. (PST)

All hours earned count toward your CDCES Accreditation Information

Can’t make it live? No worries. We will send post the recorded version to the Online University within 24 hours of the broadcast

Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

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

For last week’s practice question, we quizzed participants on the 5 different tongue tastes. 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: JR thinks that their ability to taste food has diminished recently. They ask you, what are the five confirmed basic tastes of the tongue?

Which of the following lists describes the best answer?

Answer Choices:

1. Sweet, salty, bitter, pepper, sour.
2. Umami, sweet, sour, salty, ammonia.
3. Bitter, sour, sweet, salty, umami.
4. Sour, sweet, ammonia, salty, bitter

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.

Answer 1 is incorrect. 15.92% chose this answer. “Sweet, salty, bitter, pepper, sour.” This answer is really close, however there are no specific receptors on the tongue to detect the flavor pepper.

Answer 2 is incorrect. 5.22% of you chose this answer. “Umami, sweet, sour, salty, ammonia.” This answer is really close, however, ammonia is not a confirmed flavor and this list is missing the flavor, bitter.

Answer 3 is correct. About 67.41% of respondents chose this. “Bitter, sour, sweet, salty, umami.” YES, these are the 5 confirmed tastes and one more taste might be added to list, ammonium chloride. According to an article in Neuroscience News, “The tongue’s response to ammonium chloride, a component in some candies, may indicate a sixth basic taste. The study illuminated that OTOP1, a protein receptor that signals sour taste, also responds notably to ammonium chloride.”

Finally, Answer 4 is incorrect. 11.44% chose this answer. “Sour, sweet, ammonia, salty, bitter” This answer is really close, however, ammonia is not a confirmed flavor and this list is missing the flavor, umami.

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 the GI System and Diabetes?

Exploring the GI System – From the Gut to the Butt | FREE Webinar

Now Recorded & Ready to Watch

Coach Bev invites you to join this 60 minute webinar that covers gastrointestinal health from top to bottom. Topics include; fatty liver disease diagnosis and treatment, intestinal complications associated with diabetes, keeping the microbiome healthy, and more. Join us to explore the magnificent wonders of diabetes and the gut.

Getting to the Gut Topics:

• From the Mouth to Intestines: Periodontal disease, Gastroparesis, Fatty liver disease, pancreas disorders
• Intestine as an Endocrine Organ & Bacterial Host
• NASH Treatment Options including lifestyle and pharmacotherapy
• State the relationship between gut health, microbiome and diabetes and inflammation
• Describe 3 strategies to get our microbiome back to better health.

Can’t make it live? No worries. We will send post the recorded version to the Online University within 24 hours of the broadcast

Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF, a working educator, and a nationally recognized diabetes expert. She has a Master’s Degree in Public Health from UCLA, with a focus on behavioral health and education.

All hours earned count toward your CDCES Accreditation Information

Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

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