Like many of you, I have a personal relationship with climate change.
On a blustery day in November 2018, the Camp Fire burned down the hospital and the entire town where I provided diabetes care for over 20 years. In a matter of a short six hours, over 30,000 people who lived in Paradise lost their community and sense of place.
I lost working with my incredible diabetes team and my extended diabetes family. Others lost everything. The Camp Fire has devastated us all in very personal ways. It is considered the deadliest and most destructive wildfire in California history.
Since the town of Paradise was a popular retirement destination, many of those who survived the fiery drive down the hill were frail and elderly. More than 3,000 of them had diabetes and many fled their homes without their meters, insulin, or other critical medications.
With the help of the Red Cross and hundreds of volunteers, we were able to connect most people with needed medications and supplies, but many went without. People with diabetes lost connections to their providers, pharmacies and support systems.
We lost 85 of our beautiful community members due to the fire and thousands of our neighbors dispersed to other states and towns to start their lives over. Over half of our providers moved away and a hospital that provided care to a rural community was suddenly gone. This extreme loss and upheaval reveals the painful truth that we need proactively take action to reduce the frequency and severity of climate disasters and be prepared for future events.
According to a 2020 article published in the Journal of Community Hospital Internal Medicine Perspectives, climate change, and in particular, increasing global temperatures, is expected to impact the health of people living with diabetes and lead to worse outcomes.
After completing a literature review, the authors concluded that diabetes and climate change are interconnected. Let’s explore how.
Hotter Temperatures Worsen Diabetes Outcomes
People with diabetes are at greater risk of experiencing dehydration and cardiovascular events during periods of extreme heat. With the increasing frequency of extreme heat episodes, there is an associated increased risk of heat-related death and cardiovascular events for people living with diabetes. Several studies reveal that people with diabetes have a higher risk of death on hot days, and are more likely to need emergency care and those with a history of heart disease are most vulnerable.
Shortage of Medical Supplies and Medications
Recent climate disasters, like the Camp Fire, Hurricane Katrina in 2005, and Hurricane Harvey in 2017, resulted in people not being able to access, afford or safely store their medications, including insulin. In addition, we are experiencing supply chain disruptions in D50 (25 grams of glucose in a 50 ml prefilled syringe (50% glucose)) to treat hypoglycemia and certain intravenous fluids are in short supply.
Food Supply Shortages
Extreme weather can result in agricultural production disruptions. In our community, many fields that were once green with trees and crops, now are brown and barren. There is not enough water to keep crops alive and growing. This also means job loss and less money flowing into communities. When the healthy food supply is limited, people living with diabetes may turn to lower-cost, processed foods which are environmentally unfriendly and low in nutrients.
Diabetes and climate change are clearly interconnected. Extreme weather events and rising temperatures will significantly impact people living with diabetes, especially those with cardiovascular disease. The disruption in the supply of life-saving medications (e.g. insulin) due to extreme weather combined with decreased access to healthy foods are difficult issues that require problem-solving by individuals, communities, and government leaders.
As Diabetes Specialists, I believe we can make a difference by leaning into our unique blend of behavior change skills, advocacy, and scientific knowledge
We can take a two-fold approach:
A note of hope. Three years after the Camp Fire, people are rebuilding in Paradise. There is a better understanding of the need for preventive forest management and exit routes. However, the longstanding California drought continues to contribute to future fire risk. Water conservation is more important now than ever. We can take action to reverse the heating planet. Read our blog on actions we can start taking today.
Change isn’t easy. We aren’t going for perfect, we are starting with intention and slowly moving to action, giving ourselves lots of grace along the way. I am excited to share my successes and wrong turns with you on this journey and we would love to hear from you too!
Read more on our blog, Earth Day Secrets to Improving Planet Health
Stay tuned and we share details and resources on each of these 10 Steps over the next few months. And, please send us your stories too at [email protected]. We want to hear from you!
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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 older adults with diabetes using insulin therapy, which of the following is the most accurate statement?
Click Here to Test your Knowledge
We are living longer and more people are getting diabetes. The American Diabetes Association has updated the Older Adults Standards, with special attention to considering the reduction of medication and insulin therapy intensity. The older population has unique issues and special needs that require consideration as we provide diabetes self-management education. This online course highlights key areas of assessment, intervention, and advocacy for older clients living with diabetes.
Objectives:
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.
We loved celebrating Earth Day with all of you. Your response to our “PocketCard for a Planet Pledge campaign” knocked our socks off. Over 900 people committed to taking action for the Earth. Plus, hundreds of you added our own ideas. We decided to continue the planetary PocketCard party for one more week because we love our community!
This month’s newsletter explores the link between climate change and diabetes from a personal and community level. We provide ideas for prevention, preparation, and actions to take in case of a climate-related disaster. People with diabetes are especially vulnerable during extreme climate events and helping ready them for disasters can save lives.
In addition, we highlight a recent study that demonstrates reducing four risk factors improves outcomes, which is great news to share.
Living with diabetes can be overwhelming. Messages of hope for people with diabetes can provide motivation to continue with self-care during those hard times.
Lastly, I would like to dedicate this newsletter to a very special person. Ruth always showed up to our diabetes support group with the energy of two people and the mental clarity of someone half her age. Around this time of year, she would distribute Emergency Preparedness materials and would carefully review the exit routes out of Paradise in case of fire. She would go around the room and ask each person if they had their emergency bag ready. For each of the seventeen years that I ran that support group before the hospital and town burned down, Ruth gave the same impassioned spiel. I can only imagine how many lives she saved.
May we all embody the spirit of Ruth as we move forward on this journey. With wishes for health and wonderment,
Beverly, Bryanna, Jackson, and Amanda
Featured Articles
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This bundle includes our CDCES Online Prep Bundle 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.
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.
For last week’s practice question, we quizzed test takers on which labs to order for JR. 57% 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’s mom has type 1 diabetes and JR’s dad has type 2 diabetes. JR is 21 years old and in the emergency room with a glucose of 482 mg/dl. Besides checking glucose, ketones and A1C levels, which of the following lab test can be used to determine if someone has autoimmune diabetes?
Answer Choices:
As shown above, the most common choice was option 2, the second most common answer was option 3, then option 4, and finally 1.
Answer 1 is incorrect. 9.71% chose this answer, “Endogenous insulin titer.” This is a juicy answer. Evaluating endogenous insulin production is helpful since it reflects how much insulin the pancreas is secreting. However, it does not reveal if the beta cell loss is due to an immune-mediated response.
Answer 2 is correct. 57.56% of you chose this answer, “Glutamic acid decarboxylase (GAD)”, YES, this is the best answer. If the autoimmune blood test GAD comes back positive, it verifies that the pancreas is being destroyed through an immune-mediated attack of the beta cells. Autoantibodies against GAD are found in 80% of people with type 1 diabetes at clinical presentation.
Answer 3 is incorrect. 22.88% of respondents chose this answer, “Beta cells autoantibodies.” Another juicy answer that is very tempting. However, there is no blood test with this name. The three common antibodies tested are Islet Cell Autoantibodies (ICA), Insulin Autoantibodies (IAA), and Glutamic Acid Decarboxylase (GAD).
Finally, Answer 4 is incorrect. 9.85% chose this answer, “Langerhan’s antibody titer.” Another juicy answer that is very tempting. However, there is no blood test with this name. The three common antibodies tested are Islet Cell Autoantibodies (ICA), Insulin Autoantibodies (IAA), and Glutamic Acid Decarboxylase (GAD).
This bundle includes our CDCES Online Prep Bundle 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.
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.
According to a NIH systematic literature review, there is clear evidence that diabetes and climate change are interconnected. Which of the following situations are due to the impact of a changing climate?
Click Here to Test your Knowledge
Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.
If you are 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.
Join us LIVE for this Virtual Course and enjoy a sense of community!
Team of expert faculty includes:
Deluxe Option for $499: Virtual Program includes:
Deluxe Version includes Syllabus, Standards and Swag*:
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.
Research published in The Lancet Diabetes & Endocrinology this month confirmed the same findings as a growing number of studies. COVID-19 increases a person’s risk of diabetes, even months after being infected.
In this latest robust study, researchers reviewed the medical records of over 180,000 US Veterans who survived the first 30 days of COVID-19 infection between March 2020 and September 2021 and compared them with 2 large control groups—a contemporary cohort of more than 4.1 million non-infected participants who used VA services during the same time period and a historical cohort of another 4.28 million non-infected participants who used VA services during 2017.
Over 40% of study participants infected with COVID-19 were more likely to develop diabetes or be prescribed diabetes medication within a year compared to the control group. Simply translated, 2 in 100 COVID-19 patients were more likely to develop diabetes than those who did not get infected.
People older than 65 years and those with cardiovascular disease, high blood pressure, high cholesterol, or prediabetes had a higher risk of diabetes than younger individuals or those without underlying conditions. Additionally, Black participants had higher risks of developing diabetes than White participants.
Most of the post-COVID diabetes cases (over 99%) developed type 2 diabetes. In addition, the severity of the COVID-19 infection impacted the risk. People with COVID-19 admitted to intensive had the highest risk of developing develop diabetes, compared to those not infected.
Some limitations of the study include that the findings may not translate to other populations, since the US Veterans study group consisted of mostly older white men, many of whom had risk factors for diabetes, including hypertension and extra weight. The risk of getting diabetes post-COVID-19 seems to be much lower in younger people. Another limitation is that some people in the control group might have had an asymptomatic missed COVID-19 diagnosis.
These startling findings have significant implications for the 80 million people in the U.S. known to be infected with COVID-19, especially for people living with long-haul covid.
People who have experienced a COVID-19 infection need to know the symptoms of hyperglycemia and be encouraged to report suspicions of diabetes symptoms to their providers right away. In addition, regular glucose testing of people who were infected with COVID-19 may now be recommended to detect those who may not be aware of the signs of diabetes.
Now, more than ever, we need to increase access to Diabetes Prevention Programs and Diabetes Self-Management Education, to make sure this expanding population of people with new diabetes gets the information they need to successfully manage glucose levels and maintain optimal quality of life.
For more information:
Washington Post Article and The Lancet Diabetes & Endocrinology
This course provides you with a succinct overview of the latest standards for Diabetes Self-Management Education (DSME) and Support Programs. If you are taking certification exams or considering setting up a DSME program, this program is designed for you. We highlight the newly revised and simplified 2022 Standards and provide strategies on program implementation. In addition, we discuss Medicare Reimbursement and covered benefits. This course provides insights into the exam philosophy and also highlights critical content areas.
Objectives:
Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.
If you are 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.
Download Course Schedule | Download Course Flyer
Join us LIVE for this Virtual Course and enjoy a sense of community!
Team of expert faculty includes:
Download Course Schedule | Download Course Flyer
Deluxe Option for $449: Virtual Program includes:
Deluxe Version includes Syllabus, Standards and Swag*:
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.
For last week’s practice question, we quizzed test takers on which produce has the most pesticide residue. 82% of respondents chose the best answer, GREAT JOB. 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: Each year, the Environmental Working Group (EWG) publishes the Shopper’s Guide to Pesticides in Produce™, which ranks the pesticide contamination of 46 popular fruits and vegetables based on test results by the Department of Agriculture and the Food and Drug Administration of around 45,000 samples of produce. Based on their 2022 analysis, which three fruits and vegetables listed are included in the “dirty dozen” (produce that is highest in pesticide residue)?
Answer Choices:
A. Strawberries, tomatoes, pears
B. Kale, asparagus, mangoes
C. Avocados, onions, sweet corn
D. Sweet potatoes, watermelon, cherries
As shown above, the most common choice was option 1, the second most common answer was option 4, then option 3, and finally 2.
Answer 1 is correct. 81.57% chose this answer, “Strawberries, tomatoes, pears.” YES, this is the best answer. The complete list of fruits and vegetables with the highest pesticide levels include:
These fruits and veggies are still healthy choices since they are packed with fiber and phytonutrients. However, given their higher amount of pesticide, try to purchase from the Organic Section of your local store or farmer’s market.
Answer 2 is incorrect. 9.68% of you chose this answer, “Kale, asparagus, mangoes.” Kale is included on the dirty dozen list, while asparagus and mangoes are part of the Clean 15.
Answer 3 is incorrect. 4.84% of respondents chose this answer, “Avocados, onions, sweet corn.” All of these vegetables and fruits have the lowest amount of pesticide and a part of the Clean 15.
These Clean 15 healthy fruits and veggies are safe to purchase in the non-organic or organic section. It’s always a good idea to wash fruit and veggies before eating.
Finally, Answer 4 is incorrect. 3.92% chose this answer, “Sweet potatoes, watermelon, cherries.” Sweet potatoes and watermelon are part of the Clean 15 while cherries are included in the dirty dozen.
Please visit the Environmental Working Groups Web page here
Dirty Dozen List
Clean 15 List
Info on how this list is created each year
We hope you appreciate this week’s rationale!
Free PocketCard and Wildflower Seed Postcard
We have created a list of 10 Actions to Celebrate Earth Day and printed these actions on wildflower seed postcards, that are ready for planting. To thank you for your pledge to commit to one or more actions that invest in the well-being of our planet, we will mail you a Free PocketCard and Wildflower Seed PostCard.
It’s easy! Just pick your action(s) on this survey and provide a mailing address where to send these gifts of appreciation. Each action, no matter how small, matters.
Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.
If you are 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.
Join us LIVE for this Virtual Course and enjoy a sense of community!
Team of expert faculty includes:
Deluxe Option for $449: Virtual Program includes:
Deluxe Version includes Syllabus, Standards and Swag*:
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.
JR’s mom has type 1 diabetes and JR’s dad has type 2 diabetes. JR is 21 years old and in the emergency room with a glucose of 482 mg/dl. Besides checking glucose, ketones and A1C levels, which of the following lab test can be used to determine if someone has autoimmune diabetes?
Click Here to Test your Knowledge
Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.
If you are 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.
Join us LIVE for this Virtual Course and enjoy a sense of community!
Team of expert faculty includes:
Deluxe Option for $499: Virtual Program includes:
Deluxe Version includes Syllabus, Standards and Swag*:
Deluxe Option for $499: Virtual Program includes:
Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.
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.