Happy Earth Day | Promoting Planetary and People Health

Like me, you might feel overwhelmed and powerless with all the news about global warming, habitat loss and planetary suffering.

There is HOPE. After listening to many experts, I have come to the conclusion that our actions CAN MAKE A DIFFERENCE, no matter how small. As a diabetes specialist, I also know that rates of diabetes have increased dramatically over the past 20 years as the microbial diversity of humans (and the planet) is in sharp decline.

I am acutely aware that the health of our people is inextricably linked to the health of our planet.

As a diabetes leader and CEO, I have a tremendous opportunity and obligation to speak up and support my community in making positive changes to promote the well-being of humans and our planet.

We came up with a list of 10 Simple Steps we can take to improve planetary health. I am committing to making all 10 of these changes in my personal and professional life, starting today.

I am going to share my planet pledge journey and resources with you in our weekly blog posts.

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!

10 Earth Actions We Pledge to Take

1. Grow plants native to you area.

In celebration of Earth Day, we are excited to highlight the importance of plants and their role in supporting wildlife. The biggest secret to success is choosing Native Plants for your outdoor pots, balcony, yard or garden this year.
By choosing plants that originated from your geographic area, you help support your regional ecosystem and offer pollinators, birds, butterflies and other healthy critters needed food, pollen and building materials for their survival.

Read more on our blog, Earth Day Secrets to Improving Planet Health

2. Compost kitchen scraps and cut down on waste

3. Eat more sustainable veggies, fruits, grains and less meat, processed foods.

4. Drive less and walk more, especially in nature

5. Think of 3 ways to use less water

6. Use cold water to wash, hang clothes to dry.

7. Turn appliances, lights and computers off when not in use.

8. Purchase used items and re-use everything you can. Swap and trade instead of buying new.

9. Try to use less plastics

10. Trade out filament light bulbs for new LED bulbs.

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!

Take the Planetary Pledge for a PocketCard

Coach Bev with “plantable” Wildflower Action Postcard

We came up with a list of 10 simple steps you can take to improve planetary health. Just pick your action(s) on this survey or come up with your own, and we will send you two gifts of appreciation, for free.

To thank you for taking action, we will mail you (while supplies last) our world-famous Medication PocketCard and a Wildflower Seed Post Card, complete with 10 simple action steps printed on it, that you can read, review and then plant.

Like you, I have a deep appreciation for all the earth has given me and I want to give back to this beautiful blue planet. Each intention and action matters.

We are excited to celebrate Earth Day on April 22 and everyday. We will be posting blogs and resources to expand on actions we can all take to protect this precious earth we have the privilege to live on.

Each action, no matter how small, matters. We can do this!

With wishes for improved planetary health,

Beverly, Bryanna, Jackson, and Amanda

How to Protect the Planet Resources Page

Click here for the How to Protect the Planet Resources Page

Free Diabetes PocketCard for Planet Pledge

We have a favor to ask.

In celebration of Earth Day, could you commit to taking just one action to protect the planet? We made it super easy and came up with a list of 10 simple steps you can take to improve planetary health. Just pick your action(s) on this survey or come up with your own, and we will send you two gifts of appreciation, for free.

To thank you for taking action, we will mail you our world-famous Medication PocketCard and a Wildflower Seed Post Card, complete with 10 simple action steps printed on it, that you can read, review and then plant.

The health of our people is inextricably linked to the health of our planet.

Like you, I have a deep appreciation for all the earth has given me and I want to give back to this beautiful blue planet. Each intention and action matters.

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 Medication PocketCard and Wildflower Seed PostCard.

It’s easy! Just pick your action(s) on this Earth Action survey and provide a mailing address where to send these gifts of appreciation. Each action, no matter how small, matters. We can do this!

With wishes for improved planetary health,

Beverly, Bryanna, Jackson, and Amanda

How to Protect the Planet Resources Page

Click here for the How to Protect the Planet Resources Page

Free Diabetes PocketCard for Planet Action Pledge

We have a favor to ask.

The health of our people is inextricably linked to the health of our planet.

Like you, I have a deep appreciation for all the earth has given me and I want to give back to this beautiful blue planet. Each intention and action matters.

Free PocketCard and Wildflower Seed Postcard

With wishes for improved planetary health,

Beverly, Bryanna, Jackson, and Amanda

How to Protect the Planet Resources Page

Click here for the How to Protect the Planet Resources Page

Rationale of the Week | The “tooth” about diabetes & oral health

For last week’s practice question, we quizzed test takers on the link between oral health & hyperglycemia. 73% 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 below: Answer Question

Question: Diabetes is associated with an increased risk of oral disease. Which of the following statements is true regarding people living with diabetes and hyperglycemia?

Answer Choices:

Experience decreased salivary production.
Benefit from vinegar gargles to decrease the bacterial load.
At greater risk for oral cancers.
More likely to experience tonsillitis.

As shown above, the most common choice was option 1, the second most common answer was option 4, then option 3, and finally 2.

Getting to the Best Answer

Answer 1 is correct. 73.61% chose this answer, “Experience decreased salivary production.” YES, GREAT JOB, this is the best answer. When a person is experiencing hyperglycemia, this leads to dehydration due to the chronic diuresis. When dehydrated, people with hyperglycemia produce less saliva and they saliva they do produce is laden with glucose. These 2 factors contribute to a higher risk of dental caries and can make mastication more difficult. There are products to increase salivary production, but the best treatment is to improve blood glucose levels.

Answer 2 is incorrect. 7.01% of you chose this answer, “Benefit from vinegar gargles to decrease the bacterial load.” Actually, gargling with vinegar can be harmful to your mouth if it is dry. Without the proper amount of saliva, the acid can break down enamel and decrease ability to fight off infection. There are products to increase salivary production, but the best treatment is to improve blood glucose levels.

Answer 3 is incorrect. 7.63% of respondents chose this answer, “At greater risk for oral cancers.” People with diabetes and chronic hyperglycemia have a higher risk for oral carries, gingivitis and periodontitis due to increased levels of sugar in the saliva that supports bacterial growth. However, do not have an increased risk of oral cancers.

Finally, Answer 4 is incorrect. 11.75% chose this answer, “More likely to experience tonsillitis.” People with diabetes and chronic hyperglycemia have a higher risk for oral carries, gingivitis and periodontitis due to increased levels of sugar in the saliva that supports bacterial growth. However, do not have an increased risk of tonsillitis.

More information from the American Dental Association.

We hope you appreciate this week’s rationale!

Want to learn more about this question? View our

Virtual DiabetesEd Specialist Conference
30+ CEs

Recorded & Ready to Watch!

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.

Download Course Flyer

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:

Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator

Two Registration Options

Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

Q & A Session with the instructor after each webinar.
LIVE Presentations by our team of experts.
State of the art review of current diabetes care and technology.
Resources for each session.
Access to free podcasts and video recordings within a week of each live session for one year.

Deluxe Version includes Syllabus, Standards and Swag*:

Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

Q & A Session with the instructor after each webinar.
LIVE Presentations by our team of experts.
State of the art review of current diabetes care and technology.
Resources for each session.
Access to free podcasts and video recordings within a week of each live session for one year.

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.

Question of the Week | Which Produce listed in the”Dirty Dozen”?

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)?

A. Strawberries, tomatoes, pears
B. Kale, asparagus, mangoes
C. Avocados, onions, sweet corn
D. Sweet potatoes, watermelon, cherries

Click Here to Test your Knowledge

How to Protect the Planet Resources Page

Click here for the How to Protect the Planet Resources Page

Want to learn more about this question? View our

Virtual DiabetesEd Specialist Conference
30+ CEs

Recorded & Ready to Watch!

Download Course Flyer

Join us LIVE for this Virtual Course and enjoy a sense of community!

Team of expert faculty includes:

Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator

Two Registration Options

Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

Q & A Session with the instructor after each webinar.
LIVE Presentations by our team of experts.
State of the art review of current diabetes care and technology.
Resources for each session.
Access to free podcasts and video recordings within a week of each live session for one year.

Deluxe Version includes Syllabus, Standards and Swag*:

Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

Q & A Session with the instructor after each webinar.
LIVE Presentations by our team of experts.
State of the art review of current diabetes care and technology.
Resources for each session.
Access to free podcasts and video recordings within a week of each live session for one year.

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!

Upcoming Standards of Care Webinar Updates | Airs April 26th & 28th

Join us live next Tuesday and Thursday as we continue our Level 2 – Standards of Care Intensive live updates! Read more and enroll below.

Level 2 | Microvascular Complications, Eye, Kidney & Nerve Disease Standards | 1.5 CEs | $29

Join us live on April 26, 2022, at 11:30 am PST

This course provides you with the need-to-know information regarding the microvascular complications of diabetes. We start with a brief overview of the pathophysiology and clinical manifestations then sum up with prevention strategies and screening guidelines. This straight-forward program will provide you with information you can use in your clinical setting and also provides critical content for the diabetes educator exam.

Objectives:

Eye, kidney and nerve disease
Modifiable and non-modifiable risk factors for diabetes complications
Screening guidelines and prevention strategies.

Enroll Now

Level 2 | Critical Assessment – Fine-Tuning your Diabetes Detective Skills Standards | 2.0 CEs | $29

Join us live on April 28, 2022, at 11:30 am PST

This course integrates the ADA Standard of Care on elements of a comprehensive medical assessment (Standard 4) of the individual living with prediabetes, diabetes, or hyperglycemia. Through case studies and real-life situations, we discover often hidden causes of hyperglycemia and other complications, such as liver disease, sleep apnea, pancreatitis, autoimmune diseases, fractures, and more. We delve into therapy for complicated situations and discuss management strategies for other conditions associated with hyperglycemia such as Cystic Fibrosis, and Transplants. Join us for this unique and interesting approach to assessing and evaluating the hidden complications of diabetes.

Objectives:

Identify common yet often underdiagnosed complications associated with type 1 and type 2 diabetes.
State strategies to identify previously undiscovered diabetes complications during assessments.
Discuss links between hyperglycemia and other conditions including, transplant, cystic fibrosis and liver disease.

Enroll Now

Level 2 | Standards of Care Intensive | 20 CEs | $199

2022 Update Airs April 26 – May 26, 2022

This bundle is specifically designed for healthcare professionals who want to learn more about the ADA Standards of Diabetes Care for their clinical practice or for those who are studying for the BC-ADM or the CDCES certification exam.

Previously recorded

Upcoming Updates

April 26, 2022 – Microvascular Complications, Eye, Kidney Nerve Disease 1.5 CEs
April 28, 2022 – Critical Assessment of Diabetes Patient 2.0 CEs
May 10, 2022 – Cardiovascular Disease and Diabetes Standards 1.5 CEs
May 12, 2022 – Older Adults and DIabetes 1.5 CEs
May 17, 2022 – Tots to Teens – Diabetes Standards 1.5 CEs
May 19, 2022 – Pregnancy and Diabetes 1.5 CEs
May 26, 2022 – Hospital and Hyperglycemia 1.5 CEs

Enroll Now

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!

Rationale of the Week | Can you calculate LR’s Sensitivity Factor?

For last week’s practice question, we quizzed test takers on calculating LR’s sensitivity factor. 76% 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 below: Answer Question

Question: LR is a 30-year-old with type 1 diabetes. LS uses 25 units of basal insulin and 20 units of bolus insulin (about 6-7 units per meal) per day. Using the rule of 1700, what is LR’s insulin sensitivity factor?

Answer Choices:

As shown above, the most common choice was option 4, the second most common answer was option 3, then a tie for options 1 and 2.

Getting to the Best Answer

Answer 1 is incorrect. 7.81% chose this answer, “23.” To figure out the sensitivity factor, we first have to determine the Total Daily Dose (TDD) that LR is taking. LR is taking 25 units of basal insulin and 20 units of bolus insulin, which equals a TDD of 45 units. If we are using 1700 as our insulin sensitivity factor (ISF), we divide the 1700 divided by 45 or 1700/45 or 37.7 which we round up to 38. In other words, 1 unit of insulin will drop LR’s blood sugar by 38 points.

Answer 2 is incorrect. 7.81% of you chose this answer, “85.” People who chose this answer, probably only included the bolus insulin dose in the calculation or 1700/20. To get to the accurate answer, add the basal plus bolus to get the total dose of 45, the divide as follows 1700/45 equals or 37.7 which we round up to 38. In other words, 1 unit of insulin will drop LR’s blood sugar by 38 points.

Answer 3 is incorrect. 8.27% of respondents chose this answer, “50.” To figure out the sensitivity factor, we first have to determine the Total Daily Dose (TDD) that LR is taking. LR is taking 25 units of basal insulin and 20 units of bolus insulin, which equals a TDD of 45 units. If we are using 1700 as our insulin sensitivity factor (ISF), we divide the 1700 divided by 45 or 1700/45 or 37.7 which we round up to 38. In other words, 1 unit of insulin will drop LR’s blood sugar by 38 points.

Finally, Answer 4 is correct. 76.11% chose this answer, “38.” YES, most of you chose the BEST answer. To figure out the sensitivity factor, we first have to determine the Total Daily Dose (TDD) that LR is taking. LR is taking 25 units of basal insulin and 20 units of bolus insulin, which equals a TDD of 45 units. If we are using 1700 as our insulin sensitivity factor (ISF), we divide the 1700 divided by 45 or 1700/45 or 37.7 which we round up to 38. In other words, 1 unit of insulin will drop LR’s blood sugar by 38 points.

Extra Credit info. What sensitivity factor should we use?

We use 1700 or 1800 insulin sensitivity factor (ISF) for people on insulin analogs and the 1500 ISF for people on regular insulin. But also, as you can see with the math below, a higher ISF number means less insulin. So, if we are working with a leaner more frail individual, we might choose to be more conservative and start with and ISF of 1800.

Example- A person’s Total Daily Dose (TDD) is 30 units a day. To figure out how much correction insulin they need to correct their hyperglycemia, we would consider the following options depending on their presentation.

1800/30 = 1 unit for every 60 points above target

1700/30 = 1 unit for every 56

1500 / 30 = 1 unit for every 50

We hope you appreciate this week’s rationale!

Join us for our Virtual DiabetesEd Specialist Conference
30+ CEs | April 13-15, 2022

Download Course Schedule | Download Course Flyer

Join us LIVE for this Virtual Course and enjoy a sense of community!

Team of expert faculty includes:

Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator

Download Course Schedule | Download Course Flyer

Two Registration Options

Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

Q & A Session with the instructor after each webinar.
LIVE Presentations by our team of experts.
State of the art review of current diabetes care and technology.
Resources for each session.
Access to free podcasts and video recordings within a week of each live session for one year.

Deluxe Version includes Syllabus, Standards and Swag*:

Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

Q & A Session with the instructor after each webinar.
LIVE Presentations by our team of experts.
State of the art review of current diabetes care and technology.
Resources for each session.
Access to free podcasts and video recordings within a week of each live session for one year.

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!

Diabetes Meds do more than Lower Glucose & PocketCard Updates

Diabetes medications are not just about glucose management anymore

In the past, to determine the right medication for an individual, the primary focus was placed on the glucose-lowering impact. However, with the introduction of the SGLT-2 Inhibitors and GLP-1 RA’s, there has been a tremendous leap forward and expansion of expectations for the co-benefits of diabetes medications.

The SGLT2s and GLP1’s, are both associated with weight loss without the fear of hypoglycemia. They decrease the risk of cardiovascular events and also offer renal protection. In addition, the SGLT-2s are so effective at treating heart failure (HF), that they are now being used for people with HF without diabetes.

Keeping close tabs on UACR and GFR

A big shift in determining the optimal diabetes treatment now includes thoughtful evaluation of Urinary Albumin Creatine Ratio (UACR) and GFR.

In the past, we collected UACR and GFR yearly to monitor kidney function. Now we use the results of these tests to determine not only kidney function but the risk of heart disease and the best therapy for diabetes, kidney health, and hypertension.

Now, more than ever, we are compelled to evaluate urinary labs to determine the albumin to creatinine ratio and keep a close eye on GFR to determine best practices to not only extend lifespan but improve healthspan.

For more info on UACR and GFR, see our blog post, “From Dipsticks to GFR – How to evaluate kidney function“.

PocketCards Update

Our updated Medication PocketCards reflect these shifts

In this latest version available for download and purchase, we have expanded and clarified the SGLT-2 considerations to reflect the changes in the 2022 ADA Standards of Care. We recognize that SGLT2 Inhibitors may be used as first-line therapy due to their additional benefits, “Along with metformin, SGLT-2s may be considered at first line diabetes therapy, especially for those with heart and kidney failure.” Since this class also slows the progression of chronic kidney disease, we also added, “for renal protection, use SGLT-2 Therapy if eGFR greater than or equal to 25 and UACR greater than or equal to 300.”

Since the GFR cut-offs for this med class are changing frequently, we removed the GFR guidelines for individual SGLT2’s and encourage users to review the package insert for the most recent recommendations.

Over the past twenty years, there has been tremendous expansion in the availability of diabetes medications that not only lower glucose but help decrease the progression of common diabetes co-comorbidities. In this evolving medication landscape, our Medication PocketCards capture the critical and current information you need for your clinical practice and certification exams.

Want to learn more about this topic? Enroll in our

Meds Management for Type 2 Standards | 1.5 CEs