By Nicole Bereolos, PhD, MPH, CPH, MSCP, CDCES, FADCES 

Substance use affects far more than mood or energy — it can directly impact blood glucose and diabetes management. And yet, many common substances like caffeine, nicotine and performance enhancing drugs often go unnoticed in routine diabetes care. For youth and adults alike, these habits can carry real health risks. 

Below are just a few ways that we as diabetes care and education specialists can play a vital role in identifying and addressing substance-related behaviors in our clients with diabetes.  

1. Start by broadening your definition of “substances.” Think beyond alcohol. Consider nicotine, energy drinks, supplements, performance-enhancing drugs (PEDs), cannabis, or even excessive caffeine use. 

2. Be curious, not clinical. Try asking: “What’s in your bottle today?” Sometimes being a little nosey opens the door to big insights. 

3. Pay attention to behavior and body language. Vague answers, hesitation, or defensiveness can be cues to dig deeper — gently and respectfully. 

4. When working with youth, build trust before intervention. Younger people may see medical appointments as punishment. Make space for honest conversation before bringing in a parent. 

5. Support harm reduction, not perfection. Don’t aim to “fix” everything. Helping someone reduce their intake — or understand what they’re consuming — is a meaningful win. 

6. Use your strengths as a DCES. Problem-solving, active listening and empathy are powerful tools that DCESs possess. Don’t underestimate the role you play. 

   As a DCES, you may be the only professional on your client’s care team who has the time to ask detailed questions about what they are actually consuming — and how it makes them feel. Opening a door for supportive, nonjudgmental conversations rooted in harm reduction can make a huge difference in the lives of those with diabetes that we care for.