Rationale of the Week | Current Hormone Therapy Guidance in T2D
For last week’s practice question, our special guest expert Jill Schramm, DNP, FNP-C, BC-ADM, CDCES quizzed us on Current Hormone Therapy Guidance for people with T2D. 57% 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: Which statement accurately reflects current guidelines on hormone therapy (HT) in postmenopausal women with type 2 diabetes?
Answer Choices:
- Oral estrogen is preferred over transdermal forms due to better metabolic outcomes.
- Progesterone levels increase post-menopause, exacerbating insulin resistance.
- Transdermal estrogen may improve insulin sensitivity and carries a lower thrombotic risk compared to oral
estrogen. - Testosterone levels rise during menopause, leading to increased central adiposity.
Getting to the Best Answer
Answer 1 is incorrect. 10% chose this answer, “Oral estrogen is preferred over transdermal forms due to better metabolic outcomes.” Oral estrogen undergoes first-pass hepatic metabolism, which can negatively influence clotting factors. Transdermal estrogen bypasses the liver and is generally favored in women with cardiometabolic risk, such as those with type 2 diabetes.
Reference: The Menopause Society, 2022; American Diabetes Association (ADA) Standards of Care in Diabetes; 2025.
Answer 2 is incorrect. 16% of you chose this answer, “Progesterone levels increase post-menopause, exacerbating insulin resistance.” Progesterone levels actually decrease after menopause due to ovarian senescence. There is no physiological increase in progesterone levels that would worsen insulin resistance during the postmenopausal years.
Reference: The Menopause Society, 2022.
Answer 3 is correct. About 57% of respondents chose this, “Transdermal estrogen may improve insulin sensitivity and carries a lower thrombotic risk compared to oral estrogen.” GREAT JOB. This is the best answer and aligns with current guidelines. Transdermal estrogen has been shown to improve insulin sensitivity and does not increase hepatic production of clotting factors the way oral estrogen does. As a result, it is associated with a lower risk of venous thromboembolism, making it a safer option for postmenopausal women with metabolic concerns such as type 2 diabetes.
Reference: The Menopause Society (formerly NAMS), 2022 Position Statement
Finally, Answer 4 is incorrect. 14% chose this answer, “Testosterone levels rise during menopause, leading to increased central adiposity.“Testosterone levels generally decline with age and menopause, although the ratio of testosterone to estrogen may shift due to declining estrogen. While visceral adiposity does tend to increase in menopause, it is more directly related to estrogen deficiency rather than a surge in testosterone.
Reference: The Menopause Society, 2022.
Thanks to Jill Schramm, DNP, FNP-C, BC-ADM, CDCES for her providing us with these terrific insights into menopause. Join her presentation on August 27th to learn more! See info below. 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 this question?
Join us live on August 27th for our
Level 5: Hot Flashes & Hyperglycemia: What Clinicians Need to Know
Join us live on August 27th, 2025, at 11:30 am PST to watch our brand new webinar, Hot Flashes & Hyperglycemia: What Clinicians Need to Know by Dr. Jill Schramm, DNP, FNP-C, BC-ADM, CDCES
The intersection of menopause and diabetes is often underrecognized in clinical care, yet people with diabetes in menopausal transition face unique metabolic, hormonal, and lifestyle changes that can significantly impact glycemic control. This session explores the physiological shifts of menopause, the implications for insulin resistance, and evidence-based strategies for individualized care. Attendees will leave with practical guidance on hormone therapy, lifestyle management, and education tools to improve outcomes for people with diabetes navigating both diabetes and the menopausal transition.
All hours earned count toward your CDCES Accreditation Information
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Rationale of the Week | Current Hormone Therapy Guidance in T2D
- Beyond Blood Glucose: Empowering Health Through a Holistic Lens
- Question of the Week | Diabetes Burnout Despite BG in Target?
- Gut to the Butt Webinar – Join for FREE & Earn CE | June 25th
- Rationale of the Week | T1D and Artificial Sweeteners: Safe Limits
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Beyond Blood Glucose: Empowering Health Through a Holistic Lens
In today’s fast-paced, tech-forward medical world, we’ve made incredible strides in diabetes management—continuous glucose monitors, automated insulin delivery systems, and smart dosing algorithms. But amidst this progress, something vital is often overlooked: the person behind the diagnosis.
That’s where holistic care comes in.
What Is Holistic Care?
“Holistic” has become a bit of a buzzword lately—often evoking images of spa treatments, essential oils, or acupuncture needles. But at its core, holistic care is much simpler and more profound. It means supporting the whole person—not just a diagnosis or set of symptoms. It’s about understanding the interconnectedness of body, mind, environment, and lifestyle, and recognizing that true healing requires addressing all of these layers.
In holistic care, we recognize the body’s innate ability to heal itself when given the right conditions—adequate rest, nourishment, connection, and movement. Rather than just reacting to symptoms, holistic practitioners aim to restore balance and strengthen the body’s foundation, from the ground up.
In many cases, the healthcare system we work in tends to focus on disease management rather than actual health and healing. Managing symptoms, prescribing medications, and performing procedures are often necessary—and can be life-saving—but they’re just one part of the picture. Holistic care does not replace conventional medicine, it complements it by focusing on the why behind the symptoms and empowering people living with diabetes to take an active role in their well-being.
Why Approach Diabetes Holistically?
The simple truth? It doesn’t work any other way. Real health care has to be holistic—because human beings are holistic. We’re not just blood glucose readings or lab values; we’re a complex blend of body, mind, emotions, thoughts, and even spirit. When we focus only on the numbers, we risk overlooking 99% of the person sitting in front of us.
Diabetes care, in particular, is uniquely suited to a holistic approach. It’s a condition shaped not just by biology, but by lifestyle, environment, sleep, stress, and social factors—many of which can’t be solved with medication alone. And while innovations in technology and therapeutics are incredible tools, they often become expensive “Band-Aids” unless they’re paired with strategies that build health from the inside out.
What Does Taking a Holistic Approach Look Like?
Holistic care doesn’t mean ditching science or abandoning evidence-based practice. It simply means zooming out—expanding our perspective and staying open to the full context of a person’s life. For practitioners, it’s often more of a mindset shift than a change in tools. Thinking holistically invites us to pause and ask deeper questions like:
🩺 What does this person’s body need to heal, not just manage blood glucose?
🌿 What’s happening in their lifestyle, stress levels, relationships, or environment that might be influencing their blood glucose?
🧠 Are we supporting the health of the whole person, not just treating the symptom?
🍎 Does this person have access to nutritious food or safe spaces to exercise?
🧳 Are they carrying the weight of adverse childhood experiences (ACEs)?
🪞 Is this person’s mindset or beliefs about their health holding them back from improving?
The goal isn’t to replace conventional tools—but to strengthen the foundation beneath them. As practitioners, these questions help us connect the dots between physiology, psychology, and lived experience—especially when working with marginalized populations disproportionately affected by diabetes and its complications.
It’s Not All or Nothing
Some healthcare professionals hesitate to embrace holistic care because it feels like a totally different world—outside the bounds of what we were taught in school or what we have time to address in a 20-minute visit. But this doesn’t have to be an all-or-nothing shift.
You don’t need fancy certifications or to leave your clinic to practice holistically. You can integrate holistic thinking into your everyday work with individuals by listening more deeply, validating lived experiences, and supporting foundational lifestyle changes—even in small ways.
And if that still feels out of reach? Let me remind you: there is a holistic practitioner inside of you. Whether you’re just beginning to explore this space or have been weaving in integrative tools for years, simply being curious about the whole person already puts you on the path.
A Call to Expand Our Perspective
As diabetes professionals, we have an opportunity—and a responsibility—to widen our scope. Learning the tenets of holistic care doesn’t just help us become more well-rounded clinicians; it helps us better understand the people we serve. Exploring other modalities, understanding root-cause approaches, and appreciating the interconnectedness of body and mind allows us to offer more personalized, compassionate, and effective care.
As a CDCES who splits time between a busy endocrinology clinic and holistic practice myself, I’ve seen firsthand the difference this integrated lens makes. When we treat the person, not just the pancreas, outcomes improve—and so does quality of life.
Holistic care isn’t about abandoning what works—it’s about expanding what’s possible.
If you’re interested in gaining a deeper understanding of holistic care—its core principles, supporting modalities, and how it can complement your clinical work—I’d love to see you at my upcoming webinar Beyond Blood Glucose: Empowering Health Through a Holistic Lens on July 24th. Whether you’re curious about this approach or ready to begin integrating it into your practice, this session will offer valuable insight and practical tools. Hope to see you there!
Advance With Purpose & Deepen Your Impact
Join us live on July 24th, 2025, at 11:30 am PST to watch our brand new webinar, Beyond Blood Glucose: Empowering Health Through a Holistic Lens by Nick Kundrat, BS, CEP, CDCES, LMT
Despite the rise of cutting-edge diabetes technologies and therapeutics, many people with diabetes still struggle with fatigue, blood glucose swings, and burnout. Why? Because we’re often so focused on managing diabetes itself that we often forget to take care of the human being who lives with it.
Join Nick Kundrat, CDCES and Integrative Health Practitioner, for an engaging webinar where he simplifies the often-misunderstood world of holistic health. You’ll learn practical, accessible strategies to begin thinking more holistically and discover simple, effective tools that enhance conventional care and empower people with diabetes to thrive—physically, emotionally, and spiritually.
Drawing from over two decades of lived experience with type 1 diabetes and years of supporting clients in both clinical and holistic settings, Nick offers a unique perspective on diabetes care focused on the whole person. Through reconnecting with the foundational elements of health, which are often overlooked in conventional diabetes care, Nick aims to equip you with actionable strategies to help people with diabetes restore their energy, support their bodies, and thrive beyond diabetes.
Course topics:
-
Understanding the Holistic Mindset:
Explore what it means to think holistically in diabetes care and how adopting this mindset can transform your approach to supporting people with diabetes beyond blood glucose and lab values. -
Foundations of Health: Back to Basics:
Discover simple, low-cost, high-impact strategies rooted in foundational health principles that are vital to improving people with diabetes’ energy, resilience, and overall well-being. -
Evaluating Popular Holistic Approaches:
Gain insight into common holistic methods and modalities—what’s effective, what’s overhyped, and how to integrate complementary therapies safely alongside conventional care.
Question of the Week | Diabetes Burnout Despite BG in Target?
Jada, a 29-year-old with type 1 diabetes, tells you she’s feeling burned out and emotionally drained, despite maintaining a time in range above 70% for the past several months. She says, “I’m doing everything right, but I’m exhausted and don’t feel like myself lately.” You review her CGM data and see no major red flags. She denies any recent illnesses or major changes in insulin needs. What is the most appropriate next step?
- Celebrate her strong glucose metrics and encourage her to stick with the same plan, reassuring her that she’s doing well.
- Recommend scheduling an appointment with her endocrinologist to reevaluate her insulin doses and technology settings.
- Acknowledge her experience and assess for emotional burnout, stressors, or imbalances in her lifestyle that could be contributing to her fatigue.
- Increase the frequency of data sharing and remote monitoring to help identify subtle trends and reduce her self-management burden.
Want to learn more about this question?
Join us live on July 24th for
Level 5: Beyond Blood Glucose: Empowering Health Through a Holistic Lens
Join us live on July 24th, 2025, at 11:30 am PST to watch our brand new webinar, Beyond Blood Glucose: Empowering Health Through a Holistic Lens by Nick Kundrat, BS, CEP, CDCES, LMT
Despite the rise of cutting-edge diabetes technologies and therapeutics, many people with diabetes still struggle with fatigue, blood glucose swings, and burnout. Why? Because we’re often so focused on managing diabetes itself that we often forget to take care of the human being who lives with it.
Join Nick Kundrat, BS, CEP, CDCES, LMT and Integrative Health Practitioner, for an engaging webinar where he simplifies the often-misunderstood world of holistic health. You’ll learn practical, accessible strategies to begin thinking more holistically and discover simple, effective tools that enhance conventional care and empower people with diabetes to thrive—physically, emotionally, and spiritually.
Drawing from over two decades of lived experience with type 1 diabetes and years of supporting clients in both clinical and holistic settings, Nick offers a unique perspective on diabetes care focused on the whole person. Through reconnecting with the foundational elements of health, which are often overlooked in conventional diabetes care, Nick aims to equip you with actionable strategies to help people with diabetes restore their energy, support their bodies, and thrive beyond diabetes.
All hours earned count toward your CDCES Accreditation Information
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Rationale of the Week | Current Hormone Therapy Guidance in T2D
- Beyond Blood Glucose: Empowering Health Through a Holistic Lens
- Question of the Week | Diabetes Burnout Despite BG in Target?
- Gut to the Butt Webinar – Join for FREE & Earn CE | June 25th
- Rationale of the Week | T1D and Artificial Sweeteners: Safe Limits
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Gut to the Butt Webinar – Join for FREE & Earn CE | June 25th
Save the Date for an Advancements in Diabetes Webinar
From the Gut to the Butt – Exploring the GI System
Wednesday, June 25, 2025 3 pm Eastern
(2 pm Central | 1 pm Mountain | 12 pm Pacific | 11 am Alaska)
This session offers 1 hour of CME/CE/CPEU/CPE
Presented by:
Beverly Thomassian, RN, MPH, CDCES, BC-ADM
President, Diabetes Education Services
Diabetes Nurse Specialist, Colusa Indian Health
Information about the webinar presentation:
This webinar is designed to encourage health care professionals to explore digestive co-conditions
associated with diabetes and take actions to prevent and address disorders of the GI system.
Participants will gain a more in-depth understanding of the interrelationship between glucose levels,
insulin resistance and the role of the liver, pancreas, and intestinal tract in overall health.
Join at:
Link: https://hhs-ihs.webex.com/hhs-ihs/j.php?MTID=m9eb2bbefe1c03867eefeb4634b5c3b7f
Webinar Number & Access Code: 2825 648 4919
Webinar Password: qPZt6bGCu77 (77986242 when dialing from a phone or video system)
Join by Phone: 1-415-527-5035
Download Information Flyer Here
Notes:
• Advancements in Diabetes webinars use the Webex platform; if you have difficulty joining, please visit Webex help.
• If joining from a browser, please use Microsoft Edge or Google Chrome.
• Be sure to join the session about 5 minutes before the start time.
• Registration is not required.
• There is no cost for participation in the webinar.
For additional information, please contact the Division of Diabetes at [email protected].
Rationale of the Week | T1D and Artificial Sweeteners: Safe Limits
For last week’s practice question, we quizzed participants on T1D and Artificial Sweeteners: Safe Limits. 95% 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: Sam is a 28-year-old with type 1 diabetes who reports drinking six diet sodas per day, believing they help manage blood sugar. Sam asks if this is safe or if they should reduce consumption. What would be an appropriate response based on the 2025 ADA Standards of Care?
Answer Choices:
- You should avoid diet soda and all non-nutritive sweeteners because they’re linked to cancer and heart disease.
- Diet sodas are completely safe, so there’s no reason to change your intake.
- While non-nutritive sweeteners are FDA-approved, let’s discuss your current intake, concerns, and whether unsweetened beverages may be a better option.
- Switch to natural sugars like honey or agave syrup since they are healthier than artificial sweeteners.
Getting to the Best Answer
Answer 1 is incorrect. 1% chose this answer, “You should avoid diet soda and all non-nutritive sweeteners because they’re linked to cancer and heart disease.” While concerns about non-nutritive sweeteners (NNS) exist, especially aspartame and erythritol, the ADA and FDA consider approved sweeteners safe and within acceptable daily intake levels. Blanket avoidance is not person-centered nor based on current evidence.
Answer 2 is incorrect. 1% of you chose this answer, “Diet sodas are completely safe, so there’s no reason to change your intake.” Although NNS are considered safe by the FDA, the ADA recommends moderation. It supports reducing the total intake of sweetened beverages and those with NNS, encouraging water and unsweetened options where possible.
Answer 3 is correct. About 95% of respondents chose this – GREAT JOB! “While non-nutritive sweeteners are FDA-approved, let’s discuss your current intake, concerns, and whether unsweetened beverages may be a better option.” The 2025 ADA Standards of Care support a person-centered approach and recognize that FDA-approved non-nutritive sweeteners (NNS) are safe when used in moderation. This answer allows for a discussion tailored to Sam’s health goals, type of sweetener consumed and specific concerns. While water is the preferred beverage, using NNS to replace sugar-sweetened drinks may be an option to reduce overall calorie and carbohydrate intake.
Finally, Answer 4 is incorrect. 1% chose this answer, “Switch to natural sugars like honey or agave syrup since they are healthier than artificial sweeteners.” Natural sugars like honey and agave, although considered natural, are a form of added sugar that can negatively affect blood glucose. There is no specific guidance for the amount of added sugar within the diet, but the ADA Standards of Care recommends minimizing all forms of added sugar while also considering an individual’s nutrition plan.
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 holistic care from our guest expert, Nick Kundrat?
Join us live on July 24th for Beyond Blood Glucose: Empowering Health Through a Holistic Lens
Join us live on July 24th, 2025, at 11:30 am PST to watch our brand new webinar, Beyond Blood Glucose: Empowering Health Through a Holistic Lens by Nick Kundrat, BS, CEP, CDCES, LMT
Despite the rise of cutting-edge diabetes technologies and therapeutics, many people with diabetes still struggle with fatigue, blood glucose swings, and burnout. Why? Because we’re often so focused on managing diabetes itself that we often forget to take care of the human being who lives with it.
Join Nick Kundrat, BS, CEP, CDCES, LMT and Integrative Health Practitioner, for an engaging webinar where he simplifies the often-misunderstood world of holistic health. You’ll learn practical, accessible strategies to begin thinking more holistically and discover simple, effective tools that enhance conventional care and empower people with diabetes to thrive—physically, emotionally, and spiritually.
Drawing from over two decades of lived experience with type 1 diabetes and years of supporting clients in both clinical and holistic settings, Nick offers a unique perspective on diabetes care focused on the whole person. Through reconnecting with the foundational elements of health, which are often overlooked in conventional diabetes care, Nick aims to equip you with actionable strategies to help people with diabetes restore their energy, support their bodies, and thrive beyond diabetes.
All hours earned count toward your CDCES Accreditation Information
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Rationale of the Week | Current Hormone Therapy Guidance in T2D
- Beyond Blood Glucose: Empowering Health Through a Holistic Lens
- Question of the Week | Diabetes Burnout Despite BG in Target?
- Gut to the Butt Webinar – Join for FREE & Earn CE | June 25th
- Rationale of the Week | T1D and Artificial Sweeteners: Safe Limits
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
How Landing in the Wrong Place Can Help You Find Your Way
There are moments in life when you realize that even the wrong place can point you in the right direction. Looking back, I see now how one of the most emotionally wrenching chapters of my early nursing career became the impetus that guided me toward the work I was meant to do.
By my mid-twenties, I traded the heat of the San Fernando Valley for the ocean breezes of Venice Beach, California, and landed a position at UCLA Medical Center. My personal life was still bumpy, scarred by childhood wounds, unhealthy relationships, and a brush with death, but I was holding it together professionally. I had graduated nursing school, said goodbye to my job at Ying’s Kitchen, and proudly put on my white uniform and nursing cap each day. On the outside, I looked like I had it figured out. But inside, I felt like I was splitting in two.
You might know the feeling, where the version of you who shows up to work, strong and composed, is different from the one who goes home at night, aching for something more stable, more real, more whole. That was me.
My first day at UCLA placed me on the head, neck, and urology floor, and nothing could have prepared me for the heartbreak I would witness. Patients recovering from disfiguring cancer surgeries. People breathing through tracheostomies. The physical and emotional pain in those rooms was hard to hold. I often cried in my car after work, feeling helpless, overwhelmed, and unsure if I had what it took to stay in this profession.
And then came Midori
She had a “shrinking trachea,” the specialists said—something inoperable that would slowly close off her airway. One evening, we walked the hospital halls together, her IV pole trailing beside us. We paused at the window on the sixth floor, looking out over the glittering city. I put my arm around her small frame.
“I hope to go home and spend a few weeks with my family and friends,” she said quietly. Then, turning to me: “These last two days have been the most important days of my life. I am grateful that you have helped me through them.”
We stood in silence, tears spilling freely. In the reflection of that hospital window, I saw two women: one nearing the end of her life, and one just beginning to understand hers. I will never forget Midori—or the string of 100 colorful paper cranes her family had hung from the ceiling, symbols of courage, strength, and hope. That moment moved me so deeply, I wrote a short story called “The Paper Crane,” which was later published in the American Journal of Nursing.
Not every story was as heartbreaking. Some were filled with hope. I saw patients with diabetes transform after kidney transplants—skin glowing, energy restored, lives renewed. That sixth floor gave me a front-row seat to human resilience. And it sparked a realization: I didn’t just want to help people recover. I wanted to help them avoid suffering in the first place.
That’s when everything began to shift.
Sometimes, the “Wrong Place” Is Really a Doorway
The emotional toll of working on that unit was heavy—but it was also clarifying. It showed me what I could handle, what I needed to heal, and most importantly, what I felt called to do next. I wasn’t meant to stay in acute care. I was meant to move toward prevention, education, and empowering people to take charge of their health.
I applied to the Master’s in Public Health program at UCLA and was accepted in 1987. But before diving into graduate school, I knew I needed a break—and something inside me longed for an adventure, something that would shake me free from old patterns and reconnect me with purpose.
I reached out to David Werner, author of Where There Is No Doctor, who had started a clinic in rural Mexico. He told me, “Fly into Mazatlán, catch a bus to the town of Ajoya, and ask for Lupe. She’ll rent you a room for $6 a night, breakfast included.”
So I packed a suitcase full of medical supplies and hope—and boarded the plane.
An Invitation to You
Maybe you’ve landed in the “wrong place” too. A job that drains you. A relationship that confuses you. A season of life where you feel off-course, uncertain, or lost. I want to tell you: those moments aren’t wasted. They might just be redirecting you toward something more aligned, more meaningful, more you.
We don’t always recognize turning points when we’re living them. But trust that every tear, every doubt, every step forward—no matter how shaky—is shaping something vital.
Wherever you are on your path, keep going. And don’t be afraid to listen when your heart asks for something different.
Because sometimes, it’s the wrong place that helps you find your way home.
Coach Beverly is kicking off the launch of her first book, “Healing Through Connection for Health Care Professionals.”
This deeply personal book invites you into the pivotal moments that shaped her career and calling. She will post a new story each month so you can access the behind-the-scenes stories of struggle, growth, and hope that fueled her passion for transforming diabetes care.
Coach Beverly’s book is scheduled for release in August, 2025. You can sign up for priority notification here .
You’ll get an exclusive update straight to your inbox, so you won’t miss out. Initial purchasers will receive a signed copy of the book and our Medication PocketCards mailed directly from Coach Bev.
Question of the Week | Best Hormone Therapy Approach for T2D?
Which statement accurately reflects current guidelines on hormone therapy (HT) in postmenopausal individuals with type 2 diabetes?
- Oral estrogen is preferred over transdermal forms due to better metabolic outcomes.
- Progesterone levels increase post-menopause, exacerbating insulin resistance.
- Transdermal estrogen may improve insulin sensitivity and carries a lower thrombotic risk compared to oral estrogen.
- Testosterone levels rise during menopause, leading to increased central adiposity.
Want to learn more about this question?
Join us live on August 27th for our
Level 5: Hot Flashes & Hyperglycemia: What Clinicians Need to Know
Join us live on August 27th, 2025, at 11:30 am PST to watch our brand new webinar, Hot Flashes & Hyperglycemia: What Clinicians Need to Know by Dr. Jill Schramm, DNP, FNP-C, BC-ADM, CDCES
The intersection of menopause and diabetes is often underrecognized in clinical care, yet people with diabetes in menopausal transition face unique metabolic, hormonal, and lifestyle changes that can significantly impact glycemic control. This session explores the physiological shifts of menopause, the implications for insulin resistance, and evidence-based strategies for individualized care. Attendees will leave with practical guidance on hormone therapy, lifestyle management, and education tools to improve outcomes for people with diabetes navigating both diabetes and the menopausal transition.
All hours earned count toward your CDCES Accreditation Information
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Rationale of the Week | Current Hormone Therapy Guidance in T2D
- Beyond Blood Glucose: Empowering Health Through a Holistic Lens
- Question of the Week | Diabetes Burnout Despite BG in Target?
- Gut to the Butt Webinar – Join for FREE & Earn CE | June 25th
- Rationale of the Week | T1D and Artificial Sweeteners: Safe Limits
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Rationale of the Week | CGM Timing Post-T1D Diagnosis: ADA 2025
For last week’s practice question, we quizzed participants on CGM Timing Post-T1D Diagnosis: ADA 2025. 95% 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: JT, a 17-year-old recently hospitalized with a new diagnosis of type 1 diabetes, is using
Multiple Daily Injections (MDI) therapy. JT uses fingerstick blood glucose monitoring but
wants to move to a CGM. JT’s mother wants to know how long fingerstick monitoring must
be used before a CGM can be started. According to the ADA 2025 Standards of Care, when
can a CGM be initiated after a type 1 diabetes diagnosis?
Answer Choices:
- CGM is to be initiated when an individual with type 1 diabetes does not meet glycemic
targets. - CGM is to be initiated only when an individual with type 1 diabetes is started on
continuous subcutaneous insulin infusion (CSII) therapy. - CGM can be initiated when an individual with type 1 diabetes is ready and able, and the individual or caregiver has been educated on its use, even at diagnosis.
- CGM is to be initiated when an individual with type 1 diabetes is over the age of 18.
Getting to the Best Answer
Answer 1 is incorrect. 1% chose this answer, “CGM is to be initiated when an individual with type 1 diabetes does not meet glycemic targets”. Since CGM is not used only for those with elevated glucose levels, this is not the best answer.
Answer 2 is incorrect. 1% of you chose this answer, “CGM is to be initiated only when an individual with type 1 diabetes is started on continuous subcutaneous insulin infusion (CSII) therapy”. Actually, CGM technology can be used with or without CSII (either standard pump or AID systems).
Answer 3 is correct. About 95% of respondents chose this, “CGM can be initiated when an individual with type 1 diabetes is ready and able, and the individual or caregiver has been educated on its use, even at diagnosis.” GREAT JOB! According to the American Diabetes Association 2025 Standards of Care, CGM technology can be initiated in any person living with diabetes on insulin therapy as early as diagnosis. The diabetes education specialist will use an individualized approach in choosing the most appropriate CGM technology and educating the individual and caregiver on how to use it. “
Finally, Answer 4 is incorrect. 1% chose this answer, “CGM is to be initiated when an individual with type 1 diabetes is over the age of 18.” According to the ADA 2025 Standards of Care, CGM technology should be offered to any adult or youth using insulin therapy. Some CGM devices are approved for use in the pediatric population (refer to each specific CGM for approval for use in children).
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!
Join us for this upcoming ADA Standards Webinar!
Level 2: From Tots to Teens with Diabetes
Join us live today June 12, 2025, at 11:30 am PST
This course is part of Level 2 – Standards of Care.
Course Overview:
This course covers updated care goals and guidelines for children with type 1 or type 2 diabetes. Topics include clinical presentation, developmentally appropriate care, complication prevention, and family support.
Learn anytime, anywhere with 1-year access. Each course includes a video, podcast, practice test, and resources.
Objectives:
-
Identify care goals for kids with Type 1 and Type 2 diabetes
-
Outline strategies to prevent complications
-
Emphasize positive psychosocial support
Learning Outcome:
Gain a thorough understanding of individualized care and standards for pediatric diabetes management.
Buy individually for $29 or get the full Level 2 Bundle and save 45% (discount applied). Don’t worry if you cannot attend, the course includes access to the recording for one year!
All hours earned count toward your CDCES Accreditation Information
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Recent Blog Bytes
- Rationale of the Week | Current Hormone Therapy Guidance in T2D
- Beyond Blood Glucose: Empowering Health Through a Holistic Lens
- Question of the Week | Diabetes Burnout Despite BG in Target?
- Gut to the Butt Webinar – Join for FREE & Earn CE | June 25th
- Rationale of the Week | T1D and Artificial Sweeteners: Safe Limits
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
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