Question of the Week | Best technique to assess Protective Sensation in feet?
Which of the following best describes the proper technique for using a 10-gram monofilament to assess protective sensation in a person with diabetes?
- Press the monofilament firmly against the skin until it bows for at least 2 seconds, then ask if the person if they feel pressure.
- Stroke the monofilament across the skin surface to assess for light touch sensation.
- Apply the monofilament to the dorsal surface on random sites without informing the individual when contact is made.
- Press the monofilament until it bends into a “C” shape at selected sites, holding for about 1 second before lifting.
Want to learn more about this question and get ready for certification exam success?
Join us live on April 29th for our
Lower Extremity Assessment
Level 2
Can’t make it live? Don’t worry – you have access to the recorded version for a year after purchase!
People with diabetes are at increased risk of Lower Extremity Complications. This course reviews the steps involved in performing a detailed assessment of the lower extremities, including how to use a monofilament and tuning fork to detect neuropathy. We also discuss the significance of the Ankle Brachial Index and strategies to prevent lower extremity complications.
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!
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 | What Stage of Change?
For last week’s practice question, we quizzed participants on What Stage of Change? 58% 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
BT was started on a GLP-1 and is losing weight. BT has read articles about the importance of strength training to maintain muscle. They ask you questions about whether using weights or resistance bands is better.
According to the transtheoretical model, what stage of change is BT in?
Answer Choices:
- Contemplation
- Acceptance
- Precontemplation
- Action
Getting to the Best Answer
Answer 1 is correct. 58% chose this answer, “Contemplation.” GREAT JOB! When people are in contemplation stage, they are aware of the need for change and are actively considering making a change within the next six months. They are weighing the pros and cons of changing their behavior. In this situation BT is contemplating two different approaches to strengthening exercises,
Answer 2 is incorrect. 11% of you chose this answer, “Acceptance.” Even though BT may be accepting the need to get active, acceptance is not one of the stages in the transtheoretical model. This was one of those juicy answers.: -)
Answer 3 is incorrect. About 10% of respondents chose this, “Precontemplation.” This answer is tempting, but in precontemplation, individuals are not yet considering changing behavior. They may be unaware of the need for change or may have a resistant attitude toward it. BT wants to increase activity, but is choosing between two strength training options.
Finally, Answer 4 is incorrect. 20% chose this answer, “Action.” This person is not quite at the action stage. Action is when Individuals are actively modifying behavior, implementing plans, and making observable changes in their behavior, environment, or lifestyle.
Watch our FREE webinar, Behavior Change Made Easy. Register Here >>
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 our upcoming Tech Data Toolkit Webinar!
Join us live on May 8th & May 15th!
Session 1 – May 8th
with Beverly Thomassian at 11:30am to 12:30pm PST
Session 2 – May 15th
with Dr. Diana Isaacs at 11:30am to 2:30pm PST
Gain confidence in interpreting Glucose Profile Report (AGP) & CGM data using a person-centered approach!
If you are preparing for certification exams or want to up your game using CGM data to improve outcomes, this course is for you.
We still have room available for the May 8th kick off date.
With diabetes technology entering all aspects of diabetes care, figuring out how to make sense of all the data can seem overwhelming. Join Diana Issacs and Coach Beverly for a truly unique learning experience. Dr. Isaacs has a special knack for breaking down the essential elements of the Ambulatory Glucose Profile (AGP) report to provide participants with a clear road map for data interpretation. She includes many sample practice cases utilizing CGM data for various types of people with diabetes including type 2 and people with type 1 not on pumps.
Coach Beverly will build on Dr. Isaacss’ presentation. She will expand the focus to include steps to collaborate with the person with diabetes. Using a case study approach, she will provide strategies to integrate the AGP with person-centered care that empowers individuals to experience increased confidence in their diabetes self-management.
By attending this interactive workshop, participants will become more confident in interpreting the AGP and continuous glucose monitor (CGM) data and determining needed medication and lifestyle adjustments with a person-centered approach.
Topics include:
Review CGM key metrics and individualize time in-range goals.
Learn how to recognize patterns with the AGP report efficiently.
Recommend lifestyle and medication adjustments based on CGM data.
Utilize the AGP report coupled with a person centered approach when meeting with a person with diabetes.
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!
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.
Question of the Week | Best treatment for Diabetes + Heart Disease?
BT has a history of stroke and new diagnosis of diabetes with an A1C of 6.9%.
Which of following treatment strategies is most appropriate for a person with new type 2 diabetes and established cardiovascular disease (CVD)?
- Start metformin and limit other meds to determine glucose response.
- Initiate lifestyle changes plus a statin and re-evaluate A1C in 3 months.
- Make sure BT is taking both an ACE and an ARB to reduce CV risk.
- Start a GLP-1 RA or SGLT2 with proven cardiovascular benefit.
Want to learn more about this question?
Join us live on April 24th, 2025 for our
Cardiovascular Disease & Risk Management
Level 2: ADA Standards
This course is included in: Level 2 – Standards of Care. Purchase this course individually for $29 or enroll in the entire bundle and save 45% (discount already applied).
Diabetes Education Services Online University Courses are an excellent way to study for your exam anytime and anywhere that is convenient for you. You will have immediate access to your courses for 1 year after your purchase date. Each online course includes a: video presentation, podcast, practice test, and additional resources.
We discuss insulin resistance and the impact of hyperglycemia of vessel disease from the heart to the toes. Included is a discussion of identifying & preventing cardiovascular disease & a comprehensive review of the latest American Diabetes Association’s (ADA) Standard of Medical Care in Diabetes for heart disease.
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!
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.
Celebrating Earth Day: How Native Plants Support Wildlife and Our Well-Being
In honor of Earth Day, April 22, 2025, we’re shining a light on the power of native plants in creating vibrant, resilient ecosystems—for wildlife and for people.
Native plants—those that have evolved naturally in a specific region—play a crucial role in supporting local pollinators, birds, butterflies, and other wildlife. These plants provide essential food, pollen, and shelter that many species rely on for survival. And while the benefits to the environment are clear, cultivating native plants also boosts human well-being. Thriving ecosystems support cleaner air and water, increased biodiversity, and create opportunities for people to reconnect with nature.
🌻 A Journey Toward Native Planting
When Coach Beverly moved into her home 26 years ago, she planted what many of us do—flowers and grasses that looked appealing and could withstand local heat. With an acre of land surrounding her home and office, she had space to experiment, adding a wide variety of foliage and trees for beauty and shade.
But like many at that time, she wasn’t yet aware of the importance of native plants—or how their presence (or absence) affects the animals, insects, and birds that share our space.
Over time, as she learned more about habitat loss and the plight of pollinators, she began to rethink her approach. Through research, visits to a nearby native nursery, and the help of trusted websites, she and her husband began the transformation: reshaping their land into a space that supports bees, butterflies, frogs, birds, lizards, and more. Today, their yard is not only beautiful but also an oasis for wildlife—and a model of sustainable gardening.
💧 Water: A Simple Yet Powerful Addition
In addition to plants, providing a water source can be a game-changer for thirsty pollinators and wildlife. Whether it’s a birdbath, a shallow dish, or a small pond, water invites life into any garden.
Last year, Coach Beverly dug a small frog pond. Within weeks, frogs, toads, and birds made themselves at home. A year later, the pond teems with tadpoles, mosquito fish, dragonflies, water beetles, and countless other tiny creatures.
The pond has become a source of daily joy and fascination for family and visitors alike—a reminder of how deeply nature nurtures our spirits. It has also been a powerful tool for stress relief and mental well-being.
🌿 Nature as Therapy
For those managing diabetes, chronic conditions, or everyday stress, spending time in nature and caring for living things can be deeply therapeutic. And it doesn’t have to be complicated.
Start small:
- Plant a few herbs or flowers in containers
- Scatter wildflower seeds on a patch of earth
- Nurture a potted tomato plant on a sunny windowsill
For the more adventurous, creating a native plant garden is a wonderful excuse to get outdoors, move your body, and take pride in a growing, living space. There’s something special about tasting a sun-warmed tomato that’s been nurtured from seed to fruit.
🌸 Not Sure What’s Native in Your Area?
A great place to start is the article Audubon – 20 Common Types of Native Plants, which outlines beneficial plants found across the U.S. To make it local, cross-reference with your zip code using tools like the Native Plant Finder – NWF by the National Wildlife Federation.
For example, in Chico, California, the California Christmas-Berry is drought-tolerant and a favorite food source for local birds.
🌳 Here are a few native plant ideas to consider:
- Trees: Oak, Pine, Dogwood, Willow
- Colorful blooms: Coneflower, Sunflower
- Edible treats for people and birds: Blueberries, Elderberries, Serviceberries
Need help sourcing plants? The Plant Native website offers a helpful directory of native nurseries throughout the U.S.
🌱 Every Action Counts
Many people feel overwhelmed or discouraged by the state of the planet. But there is also a growing awareness of our power to make change—and hope rooted in action.
Whether it’s planting a single native shrub, providing a bowl of water, or simply observing and appreciating the life around us, every effort makes a difference.
Visit www.earthday.org and Project Regeneration for more ideas and inspiration on how to help the Earth thrive.
💚 Final Thoughts
Each person has the ability to nurture the planet and themselves, starting right at home. Native plants are a simple, beautiful way to support both biodiversity and human well-being.
So this Earth Day, consider taking that first step. Plant something. Provide water. Let nature in. And know that even the smallest actions ripple outward in meaningful ways.
🌎 Happy Earth Day from Coach Beverly and the Diabetes Education Services team.
Upcoming Webinars!
Why Attend These Webinars?
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our Level 4 | The Impact of Adverse Childhood Experiences on Health awards 1.0 CPEUs in accordance with the Commission on Dietetic Registration’s CPEU Prior Approval Program.
All hours earned count toward your CDCES Accreditation Information
Introducing New Level 5 Classes!
Ready to elevate your diabetes care expertise? Our new expert-led Level 5 Series is designed for healthcare professionals who want to stay ahead of the curve in a rapidly evolving field. Led by a dynamic and diverse faculty of leading experts and educators, each session dives into cutting-edge topics—including emerging therapies, technology integration, and social determinants of health.
Whether you’re looking to deepen your clinical knowledge, expand your toolkit, or lead with innovation, this series will keep you at the forefront of diabetes care and education.
Join us and transform your practice—one course at a time.
All hours earned count toward your CDCES Accreditation Information
Rationale of the Week | Sleep and ADA Recommendations
For last week’s practice question, we quizzed participants on Sleep and ADA Recommendations. 71% 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:
A 62-year-old with type 1 diabetes presents for their follow-up visit. They report struggling with fatigue, poor sleep quality, and difficulty with glucose management despite taking medications as prescribed. Upon review, you find their A1C is 7.6%, and their average nightly sleep duration is 4.5-6 hours per night.
Based on the 2025 ADA Standards of Care, which of the following interventions would be the most appropriate next step to address sleep and glucose management?
Answer Choices:
- Refer to a sleep study to evaluate for obstructive sleep apnea and adjust the medication regimen.
- Encourage engagement in vigorous evening exercise to promote better sleep.
- Screen sleep health and develop a plan to create consistent sleep routines and habits.
- Advise taking over-the-counter melatonin supplements to improve sleep quality.
Getting to the Best Answer
Answer 1 is incorrect. 25% chose this answer, “Refer to a sleep study to evaluate for obstructive sleep apnea and adjust the medication regimen.” While a sleep study may be recommended for suspected sleep disorders, such as sleep apnea (for example: loud snoring, daytime sleepiness), the first step should be a comprehensive sleep health screening. This screening helps identify potential causes of poor sleep, including symptoms of sleep disorders, disruptions from diabetes management (for example: nocturnal hypoglycemia, frequent urination), or anxiety about sleep. Based on the findings, appropriate treatment modifications and referrals can then be made.
Answer 2 is incorrect. 1% of you chose this answer, “Encourage engagement in vigorous evening exercise to promote better sleep.” Although exercise can improve sleep quality, vigorous evening exercise may increase alertness, making it harder to fall asleep. In individuals with type 1 diabetes, this timing of exercise can also increase the risk of nighttime hypoglycemia, further disrupting sleep. Before recommending vigorous exercise, it’s important to first assess sleep habits to better understand the underlying causes of poor sleep quality.
Answer 3 is correct. About 71% of respondents chose the BEST ANSWER – GREAT JOB! “Screen sleep health and develop a plan to create consistent sleep routines and habits.” The 2025 ADA Standards emphasize the importance of screening for sleep health and providing guidance on sleep-promoting routines and habits. Based on screening results, referrals to sleep medicine programs, adjustment in medications or behavioral therapy programs are a few that may be appropriate. Prioritizing improved sleep duration and consistency can support better glucose management, reduce fatigue, and enhance overall well-being.
Finally, Answer 4 is incorrect. 1% chose this answer, “Advise taking over-the-counter melatonin supplements to improve sleep quality.” While melatonin may be helpful for certain sleep disorders, its use should be evaluated on a case-by-case basis and is not recommended within the ADA 2025 Standards of Care. The first-line recommendation should focus on screening to better determine appropriate actions.
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 Prepare for Exam Certification?
Join our Behavior Change Theories Made Easy FREE Webinar on April 22nd at 11:30am PST.
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!
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.
April Midmonth Newsletter
Announcements
Happy April!
Spring into New Course Offerings!
You are gonna love this new course bundle we are officially launching – today. This new Level 5 Expert-led Series, designed for HCPs committed to staying at the leading edge of this fast-evolving field, is ready. Featuring a dynamic and diverse faculty of top experts and educators, each session explores timely, advanced topics—such as emerging therapies, nutrition, integrating new technologies, and addressing social determinants of health. Join us to sharpen your clinical skills, broaden your care strategies, or drive innovation.
Also, if you are taking the CDCES or BC-ADM exam this year, you won’t want to miss our FREE Behavior Change Theories Made Easy webinar. Coach Bev will save you hours of studying tedious theories and provide you with a summary of the information you need to know for exam success.
There is still time to sign up for our ADA Standards Webinars. Don’t worry if you can’t make it live. Once you register, you can access the recorded version for a year. Save 10% on our online courses, by entering coupon code Success10 at checkout.
With love,
Coach Beverly, Bryanna, Tiffany, Christine, & Katarina
Preparing for the CDCES or BC-ADM Exam?
Join us April 22, 2025 @ 11:30am PST for Behavior Change Theories Made Easy
Question of the Week | What Stage of Change?
BT was started on a GLP-1 and is losing weight. BT has read articles about the importance of strength training to maintain muscle. They ask you questions about whether using weights or resistance bands is better.
According to the transtheoretical model, what stage of change is BT in?
- Contemplation
- Acceptance
- Precontemplation
- Action
Want to learn more about this question?
Join us live on April 22nd, 2025 for our
Behavior Change Theories Made Easy
Keeping all the behavior change and learning theories straight can be daunting, especially if you are trying to get to the “best” answer for certification exams. Coach Beverly feels your pain and wants to help out. To say thanks for 25 years, she’s hosting a FREE Behavior Change Webinar to sort out and dissect the theories most relevant in clinical practice and for exam preparation.
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!
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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