LS tells you that they frequently attend company mixers where they feel compelled to have at “least a few drinks”, to fit in and network. The tricky part of this scenario is that LS lives with type 1 diabetes. Since they don’t have a working pancreas, their circulating levels of insulin and glucagon are often mismatched to their body’s needs.
When discussing the situation, LS says they feel confident they can handle alcohol and prevent lows since they have lived with type 1 diabetes for over ten years. LS shares, “I feel comfortable recognizing when both arrows are pointing down and I am heading for a glucose crash”.
As educators, we are committed to taking person-centered approach while encouraging safe practices.
In regards to LS, we realize alcohol’s impact on the thought process and blood glucose levels. We know that alcohol can affect critical thinking and possibly impair recognition of an impending hypoglycemic event. Inebriation also has many symptoms in common with hypoglycemia. Plus, alcohol consumption slows glycogen breakdown in the liver, which increases the risk of hypoglycemia. Lastly, based on a study published in Endocrinology Advisor, higher levels of alcohol in the blood can delay and blunt the effectiveness of glucagon rescue medications.
In the worst-case scenario, if LS experiences severe low blood sugar and passes out, alcohol ingestion can blunt the effectiveness of the glucagon rescue medications.
Alcohol and Glucagon Pathophysiology Review
The body considers alcohol a toxin and as soon as it reaches the bloodstream, the liver prioritizes metabolizing the alcohol and breaking it down. During this clean-up process, the liver is distracted from responding to endogenous glucagon, the hormone that signals the liver to break down glycogen for energy and liberate glucose into the bloodstream. This clean-up can last for up to 8 hours, making delayed hypoglycemia a real possibility.
When a person with type 1 diabetes drink alcohol, they at increased risk of hypoglycemia because the liver isn’t breaking down stored glycogen to increase blood glucose levels.
Let’s get back to LS. What if LS is drinking gin and diet tonics and only munching on low-carb vegetables and cheeses during the mixer? LS is not ingesting many carbohydrates, so glycogen stores may be low and the liver is busy cleaning up the alcohol and blood sugars start dropping. By the 4th drink, LS isn’t thinking very clearly, says they “feel funny” and passes out.
A colleague of LS carries a glucagon emergency kit and provides LS with a dose and calls 911. After 15 minutes, LS still hasn’t regained consciousness, so a second dose is administered. The paramedics arrive and check the glucose, it is 53.
Simply put, glucagon rescue medications may not work if the person drinks too much alcohol.
After reviewing the package inserts of all available US manufactured Glucagon Rescue Meds, there are no warnings for alcohol intake decreasing the effectiveness of glucagon rescue meds. So, I dug a little deeper and found a decent study on the topic which describes the impact of alcohol ingestion on glucose-regulating hormones.
I also found a very helpful monograph published by Lilly Baqsimi in Canada. Baqsimi is a powdered glucagon rescue medication that is delivered nasally. The Baqsimi monograph clearly states several warnings, “Alcohol can suppress hepatic gluconeogenesis and chronic alcoholism can deplete liver glycogen stores. Therefore BAQSIMI may be less effective in presence of acute or chronic alcohol ingestion. Alcohol-induced hypoglycemia is associated with a failure of blood glucose levels to rise normally after glucagon administration. BAQSIMI may not work if the person drinks too much alcohol.“.
Keeping it Real and Safe
In conclusion, having a conversation with people with type 1 about the suppressive nature of alcohol on glycogen release for many hours after consuming alcohol is very important. Another important teaching point is that glucagon rescue meds may not be as effective and timely in raising glucose to safe levels.
As a general rule of thumb, encouraging people with type 1 to eat 15gms of carbs with each drink and have a glass of water in between, may help make sure they have enough circulating carbs and slow the pace of alcohol consumption to help the liver with processing. They may also consider decreasing their insulin dose in association with alcohol intake to prevent this serious side effect.
Download our Glucagon Rescue Med PocketCard for more information here.
Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.
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If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.
Team of expert faculty includes:
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RT is a 17-year-old with type 1 diabetes who uses an insulin pump and glucose meter to manage blood glucose levels. RT is out with friends, drinking beers and suddenly passes out. One of RT’s friends carries a glucagon rescue medication and administers it to RT in a panic.
Which of the following statements is most accurate?
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This bundle is specifically designed for healthcare professionals who want to learn more about Specialty Topics for their clinical practice or for those who are studying for the Board Certified in Advanced Diabetes Management (BC-ADM) certification exam.
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Coach Beverly Thomassian, RN, MPH, BC-ADM, CDCES
Author, Nurse, Educator, Clinician and Innovator, Beverly has specialized in diabetes management for over twenty years. As president and founder of Diabetes Educational Services, Beverly is dedicated to optimizing diabetes care and improving the lives of those with diabetes.
LS tells you that they frequently attend company mixers where they feel compelled to have at “least a few drinks”, to fit in and network.
The tricky part is that LS lives with type 1 diabetes. Since they don’t have a working pancreas, their circulating levels of insulin and glucagon are often mismatched to their body’s needs.
If LS has several drinks, then loses consciousness from hypoglycemia, will emergency treatment be effective?
There is emerging evidence that glucagon rescue medications may have a blunted response when ingesting alcohol.
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.
This course will transform your test anxiety into calm self-confidence and test taking readiness.
Read More: Preparing for CDCES Exam Webinar TopicsPreparing for the CDCES Exam |
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Read More: What is a CDCES? First awarded in 1986, as Certified Diabetes Educator (CDE) credential and in 2020 with a new name: Certified Diabetes Care and Education Specialist (CDCES) to more accurately reflect the specialty. CDCES has become a standard of excellence for the delivery of quality diabetes education. Those who hold this certification are known to possess comprehensive knowledge of and experience in diabetes prevention, management, and prediabetes. “Becoming a Certified Diabetes Care and Education Specialist (CDCES) is one of the best professional and personal decisions I have ever made.” – Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
Read More: 3 Reasons to Become a CDCES “The best part of becoming a CDCES is working with my colleagues and people living with diabetes. As diabetes educators, we hear compelling and beautiful life stories. I am astounded by the barriers they face and inspired by their adaptability, problem-solving skills, and resilience.” Reason 1: CDCES is a widely recognized certification by employers and health care professionals throughout the U.S. This credential demonstrates a specialized and in-depth knowledge in the prevention and treatment of individuals living with pre-diabetes and diabetes. Reason 2: Currently, 10% of people in the U.S. have diabetes and another 35% have pre-diabetes which means 45% of Americans are running around with elevated blood glucose levels. Given this epidemic, there will be plenty of future job opportunities. Reason 3: Having my CDCES along with my nursing degree, has opened many doors of opportunity; from working as an inpatient Diabetes Nurse Specialist in a hospital to working as a Manager of Diabetes Education in the outpatient setting to starting my own consulting company.
This bundle includes our CDCES Online Prep Bundle (featured above) plus the ADCES Review Guide.
The online bundle includes Level 1, Level 2, and Level 3 (Boot Camp), plus two bonus courses. The ADCES Review Guide offers over 480+ practice questions and is a fantastic independent study tool and comprehensive resource for the Diabetes Care and Education Specialist Exam.
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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.
August 2022 eNews | Diabetes Safety Update | Does Alcohol Blunt Glucagon Effectiveness?
Happy August
There is still time to celebrate warm summer nights before the days lengthen and get cooler. For people living with diabetes, summer parties, with their special treats and yummy drinks, can be complicated to navigate.
In our first article, we take a close look at the impact of alcohol on the effectiveness of glucagon rescue medications. As an educator for many years, I was not aware of alcohol’s impact on glucagon efficacy. Through increased knowledge, I am hopeful we can enhance the safety of people living with type 1 diabetes.
Our next article celebrates the abundance and deliciousness of summer fruit. Sadly, so often, people with diabetes are told not to eat fruit because it is “full of sugar.”
I reassure them that fruit is loaded with nutrients, fiber and decreases inflammation. In a new study, researchers highlight clear evidence that eating a portion of fruit is far better for our mental health than eating other sweet treats like cookies and snack foods. Plus, the study demonstrated that snacking on fruit not only boosts mood it can also improve cognition and decrease stress.
We also take a close look at the impact of those pesky dates on our food packaging. Almost 40% of food waste happens in our kitchen when consumers think food is too old to eat based on package dates. But, are we wasting food unnecessarily? Read more to gain clarity on what these dates signify. Let’s share this information with our communities to help decrease food waste and save money.
Lastly, we celebrate our special scholarship recipient, Judith, who recently earned her CDCES. Please join me in congratulating this dedicated, kind and enthusiastic individual.
We hope you enjoy our question and rationale of the week and we invite you to join our upcoming webinars and Virtual Conference.
Thank you in advance for your actions and advocacy on behalf of people living with diabetes.
Beverly, Bryanna, Robert, and Amanda
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Read More: What is a CDCES? First awarded in 1986, as Certified Diabetes Educator (CDE) credential and in 2020 with a new name: Certified Diabetes Care and Education Specialist (CDCES) to more accurately reflect the specialty. CDCES has become a standard of excellence for the delivery of quality diabetes education. Those who hold this certification are known to possess comprehensive knowledge of and experience in diabetes prevention, management, and prediabetes. “Becoming a Certified Diabetes Care and Education Specialist (CDCES) is one of the best professional and personal decisions I have ever made.” – Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
Read More: 3 Reasons to Become a CDCES “The best part of becoming a CDCES is working with my colleagues and people living with diabetes. As diabetes educators, we hear compelling and beautiful life stories. I am astounded by the barriers they face and inspired by their adaptability, problem-solving skills, and resilience.” Reason 1: CDCES is a widely recognized certification by employers and health care professionals throughout the U.S. This credential demonstrates a specialized and in-depth knowledge in the prevention and treatment of individuals living with pre-diabetes and diabetes. Reason 2: Currently, 10% of people in the U.S. have diabetes and another 35% have pre-diabetes which means 45% of Americans are running around with elevated blood glucose levels. Given this epidemic, there will be plenty of future job opportunities. Reason 3: Having my CDCES along with my nursing degree, has opened many doors of opportunity; from working as an inpatient Diabetes Nurse Specialist in a hospital to working as a Manager of Diabetes Education in the outpatient setting to starting my own consulting company.
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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 test takers on the best treatment for abrasions 65% of respondents chose the best answer. We want to 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 is 38 years old and takes insulin twice a day. They mention they went to the bathroom at night, lost their balance, and scraped their shin. They put a band-aid on it, but want you to take a look.
What is the best approach to treat the abrasion?
Answer Choices:
As shown above, the most common choice was option 2, the second most common answer was option 1, then option 4, and finally option 3.
Answer 1 is incorrect. 16.23% chose this answer, “Clean carefully with sanitizing gel, apply topical antibiotic and observe for signs of infection.” This is a juicy answer, but not the best answer for this situation for two main reasons. Applying topical antibiotic is a great idea, but generally, abrasions are cleansed with soap and water instead of sanitizing gel. In addition, this answer did not address the core issue, of improving safety when going to the bathroom at night.
Answer 2 is correct. 64.91% of you chose this answer, “Discuss creating a safe path to the bathroom at night and assess the abrasion for severity.” YES, GREAT JOB, this is the best answer. Many lower extremity falls, scrapes and injuries happen on the way to the bathroom when it is dark. It is important to make sure people have a safe path, including night lights and removal of any potential fall risks, especially for older people with balance issues.
Answer 3 is incorrect. 7.71% of respondents chose this answer, “Replace the band-aid with gauze and suggest they make an appointment with podiatry.” It is important to evaluate and treat the abrasion, but it does not warrant an automatic referral to the podiatrist, especially since it is on the shin. Also, this question does not provide enough details about the severity of the wound to determine if further treatment is required.
Finally, Answer 4 is incorrect. 11.16% chose this answer, “Take a photo of the abrasion, wash with soap and water, and apply iodine around the perimeter.” Of course it is a great idea to evaluate an abrasion, but iodine can cause skin irritation and not usually recommended as an antiseptic. In addition, this answer did not address the core issue, of improving safety when going to the bathroom at night.
People with diabetes are at increased risk of foot complications. Basic foot care education and intervention can reduce the risk of amputation by over 50 percent.
This bundle comes with our:
We have included instructions on assessing and inspecting feet, risk assessment, and action steps. We enhanced the teaching tools and forms from the Lower Extremity Prevention Program (LEAP) and are excited to share them with our community of diabetes advocates.
3 Steps to Save Feet – Assess, Screen, Report Handout. This handout walks health care professionals through the steps involved in a 10-minute foot assessment and monofilament screening. Also includes a Screening Form to document and report findings.
Foot Care Teaching Sheet – Steps to Healthy Feet. This handout covers the important elements of foot care for people living with diabetes with simple and straightforward language.
Foot Care Teaching Sheet in Spanish– Pasos Para Tener Pies Sanos. This handout covers the important elements of foot care for people living with diabetes with simple and straightforward language.
Read More: FREE Handouts and Resources 3 Steps to Save Feet – Assess, Screen, Report Handout. This handout walks health care professionals through the steps involved in a 10-minute foot assessment and monofilament screening. Also includes a Screening Form to document and report findings. Foot Care Teaching Sheet – Steps to Healthy Feet. This handout covers the important elements of foot care for people living with diabetes with simple and straightforward language. Foot Care Teaching Sheet in Spanish– Pasos Para Tener Pies Sanos. This handout covers the important elements of foot care for people living with diabetes with simple and straightforward language. 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. When Judith reached out to us for guidance to achieve her dream of becoming a CDCES, her sincerity and passion for improving diabetes care were immediately evident. Judith contacted us last winter as she was preparing to take the CDCES exam. Through our phone conversations, her passion for Diabetes Care stood out.; she is inquisitive, enthusiastic, and has a strong desire to provide the best diabetes care possible. Through our conversations, I got to know Judith very well. She had moved here several years ago from Haiti with a goal to become an RN, and eventually a Diabetes Educator. For Judith, diabetes is very dear to her heart as she has close family members who live with diabetes. She saw firsthand the devastating effects it can have when someone doesn’t receive adequate care. Judith Paul embodies what it means to be a Diabetes Advocate Becoming a CDCES is not an easy journey for anyone. A health care professional has to demonstrate 1000 hours of diabetes self-management work experience, earn CE’s, apply online and pay the testing fee of $350. Then there is the grueling four-hour exam, with complicated questions that use precise and nuanced language. Preparing for the exam requires months of dedicated study and preparation. Making a Difference Scholarship As I got to know Judith more, I felt should we be a great candidate for our “Making a Difference” Scholarship. We usually only offer this award once a year in the Spring to candidates who are making significant contributions to improving diabetes care in their community, but Judith’s desire and determination won our hearts. We awarded Judith free access to our CDCES Prep Bundle, to support her dream to become a Certified Diabetes Care and Education Specialist. Judith fully immersed herself in her studies. Over time, I could hear the changes in her language as she moved towards a more person-centered approach. After months of dedicated studying, she passed her CDCES Exam this June! We are so proud of you, Judith, and know that you are going to continue being a fantastic model for your colleagues to provide outstanding care for people living with diabetes! I am so excited to let Diabetes Education Services know that I recently passed the CDCES exam! I have dreamed of becoming a CDCES since 2017 and my thanks go to coach Beverly and Bryana for helping me make my dream a reality. My passion about diabetes education and those living with the disease drove me, along with my desire to share accurate and compelling information with patients and colleagues to help improve care. I heard about Diabetes Education Services from a co-worker in December 2021 when I spoke with Bryanna. She was very professional, intelligent, kind, and helpful. She explained the program in detail and answered all of my questions and she provided me with information about the classes, online courses, free resources, App access, and much more. I am beyond grateful for all the support I received from coach Beverly and Bryanna. Coach Beverly made learning so fun and easy to understand. She teaches exactly the way I learn. I always looked forward to attending classes, listening to the webinar, podcast, and taking the quizzes. Her passion, knowledge and love for people living with diabetes are exceptional and she has inspired me even more. I have become more passionate, caring, and knowledgeable and I found myself talking to patients more effectively thanks to her example. Where I used to say “diabetic”, “obesity”, or “blood glucose not in control”, now I use phrases like “people with diabetes”, “participant with excess weight”, “blood glucose above target”, etc. I found the CDCES exam so EASY because of the coaching program and your teaching style was exactly what I needed to be successful. You provided me with all the tools and resources that I needed. Coach Beverly’s program has the WHOLE package for people like me who need to learn about special situations such as pregnancy or pediatric, and also about diabetes technology. I learned test-taking strategies like choosing the best answers by using a process of elimination. I have attended other diabetes courses in the past, but I had never felt ready for the exam until I attended your program. During the exam I felt ready, confident, calm, and well prepared and I smiled as I heard Coach Beverly’s voice in my head. Coach Beverly not only teaches what you need to know to be successful in the CDCES exam, but also, she teaches how to be an excellent diabetes educator. Throughout the entire program, I felt like I had my own, personal coach and tutor. Beverly and Bryanna always responded to my emails and my last-minute questions in a timely manner. Again, THANK YOU Coach Beverly, Bryanna, and all of the Diabetes Education Services staff for helping me make my dream a reality. As a person with a strong family history of diabetes, passing the CDCES exam is a HUGE personal accomplishment for me, and I could NOT have earned this certification without the Diabetes Education Services program. I plan to use Diabetes Education Services to obtain my CEUs and to polish my skills. If someone is considering becoming a CDCES, they should absolutely consider this program. The designations CDCES after my name came from hard work and with help and support from Diabetes Education Services. Thank you, and I highly recommend you. Judith Paul, BSN, RN, CCM, CDCES This course will transform your test anxiety into calm self-confidence and test taking readiness. Read More: Preparing for CDCES Exam Webinar Topics Read More: What is a CDCES? First awarded in 1986, as Certified Diabetes Educator (CDE) credential and in 2020 with a new name: Certified Diabetes Care and Education Specialist (CDCES) to more accurately reflect the specialty. CDCES has become a standard of excellence for the delivery of quality diabetes education. Those who hold this certification are known to possess comprehensive knowledge of and experience in diabetes prevention, management, and prediabetes. “Becoming a Certified Diabetes Care and Education Specialist (CDCES) is one of the best professional and personal decisions I have ever made.” – Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM Read More: 3 Reasons to Become a CDCES “The best part of becoming a CDCES is working with my colleagues and people living with diabetes. As diabetes educators, we hear compelling and beautiful life stories. I am astounded by the barriers they face and inspired by their adaptability, problem-solving skills, and resilience.” Reason 1: CDCES is a widely recognized certification by employers and health care professionals throughout the U.S. This credential demonstrates a specialized and in-depth knowledge in the prevention and treatment of individuals living with pre-diabetes and diabetes. Reason 2: Currently, 10% of people in the U.S. have diabetes and another 35% have pre-diabetes which means 45% of Americans are running around with elevated blood glucose levels. Given this epidemic, there will be plenty of future job opportunities. Reason 3: Having my CDCES along with my nursing degree, has opened many doors of opportunity; from working as an inpatient Diabetes Nurse Specialist in a hospital to working as a Manager of Diabetes Education in the outpatient setting to starting my own consulting company.
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. RL carb counts and takes 1 unit of insulin for every 10 gms of carbohydrate. RL also uses a correction ratio and takes 1 unit for every 40 points above their glucose target of 120. RL’s asks you what to do if their premeal glucose is less than 70 before their lunch meal at work. RL often has blood sugar drops right before lunch and usually eats a sandwich, chips, berries and some sparkling water for lunch. Given the situation, what is the best recommendation for JL to do if their pre-lunch glucose is less than 70 mg/g? Click Here to Test your Knowledge Why do the blood sugars keep dropping after meals? Is the basal insulin set correctly? What adjustments are needed for exercise? During this webinar, Coach Beverly addresses each of these glucose mysteries and more, using a person-centered approach. She describes a stepwise approach to evaluate glucose patterns and correct common issues encountered by people living with type 1 diabetes. Objectives: Coach Beverly Thomassian, RN, MPH, BC-ADM, CDCES Author, Nurse, Educator, Clinician and Innovator, Beverly has specialized in diabetes management for over twenty years. As president and founder of Diabetes Educational Services, Beverly is dedicated to optimizing diabetes care and improving the lives of those with diabetes. 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. CHICO, CA, Sept 19, 2022—**Dismayed over the horrific school shooting that occurred in Uvalde, Texas on May 24, a group of local mothers organized an art installation featuring 21 orange t-shirts, hand-painted with the names of the children and teachers who died. The Uvalde T-Shirt Clothesline was displayed at the Chico Farmer’s Market on July 2nd and now graces the front arches of the Museum of Northern California Art (monca). Orange is the commemorative color of gun violence prevention. Since 2020, firearms have become the leading cause of death for children in the United States, surpassing motor vehicle accidents.[1] Every 2 hours and 36 minutes, a child loses their life due to firearm violence, accidents, or suicide.[2] “The Uvalde T-Shirt Clothesline speaks of the empty shirts left behind: shirts that will never be played in, worn to school, or hugged at night. Shirts whose young owners will never reach their full potential.” – Beverly Thomassian “Hanging shirts to dry on a line is a common household activity. The fact that our kids are growing up in a culture of gun violence and school shootings, that they do drills in school to practice how to respond in case of an actual violent attack, that this has become so routine, so commonplace–as ordinary as doing laundry–is why this installation of empty shirts hung on a clothesline has such an immediate, powerful effect.” – Amy Antongiovanni Be SMART – Gun Safety Alliance of Northern California is a newly formed local chapter of the national Be SMART for Kids campaign. Our goals are: Contact – Beverly Thomassian, Be SMART Advocate, bev@diabetesed.net [1] Current Causes of Death in Children and Adolescents in the United States, N Engl J Med, May 19 2022; 386:1955-1956, DOI: 10.1056/NEJMc2201761 [2] https://www.childrensdefense.org/policy/policy-priorities/gun-violence-prevention/ Read Enterprise Record Article here. How to Make a Memorial T-Shirt Clothesline Download a List of Gun Violence Prevention Organizations Nurses Union Addresses Gun Violence Art Displays Uvalde mural honors Robb Elementary School shooting
Announcing our Special Scholarship Recipient – Judith Paul
Judith’s Story in Her Own Words
Starting your journey to becoming a CDCES?
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Question of the Week | Premeal Glucose is Too Low
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Solving Glucose Mysteries for Type 1
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Uvalde T-Shirt Clothesline on display
at Museum of Northern California Art (monca)Installation Connects Common Humanity Through Art
Press Release
T-Shirt Clothesline Tribute makes local paper front page.
Communities Invited to Construct Memorial T-Shirt Clothesline
Resources
More information here