Question of the Week | Why did 16 year old stop taking meds?
A 16 year old tells you they stopped taking their diabetes medications. “It doesn’t seem to matter whether or not I take them”.
What is the best response?
- Acknowledge their honesty and ask them to discuss with their provider.
- Gently remind them that stopping their meds is dangerous.
- Ask them if they are experiencing trauma at home.
- Explore possible reasons for this action.
Want to learn more about this question?
Join us live on July 11th at 11:30 am PST for our
Language and Diabetes FREE Webinar
What we say matters.
As educators, advocates, spouses, friends, and providers, our use of language can deeply affect the self-view of people living with diabetes every day.
Intentional communication is a powerful tool that can uncover trauma, identify barriers, and move both the provider and person with diabetes toward a greater understanding of the issues involved.
The language used in the health care setting is immensely important in determining trust, mutual respect, and meaningful long-term relationships.
Topics covered include:
- Learn phrases, words, and approaches that can be left behind.
- Describe diabetes language that is respectful, inclusive, person-centered, and imparts hope.
- Discuss how to evaluate for ACE and provide trauma-informed care
- Practice communicating about diabetes using phrases free from judgment with a focus on a strength-based approach
This webinar is free and you can view it at any time, on any device. To earn CEs, you can purchase this course at our online university store.
Coach Beverly Thomassian, RN, MPH, BC-ADM, CDCES
Author, Nurse, Educator, Clinician, and Innovator, Beverly has specialized in diabetes management for over twenty years. As president and founder of Diabetes Educational Services, Beverly is dedicated to optimizing diabetes care and improving the lives of those 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!
Recent Blog Bytes
- Question of the Week | Managing Overnight Hypoglycemia: Best Plan?
- 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
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*
The use of DES products does not guarantee the successful passage of the diabetes certification exams. CBDCE & ADCES does not endorse any preparatory or review materials for the certification exams, except for those published by CBDCE & ADCES.
**To satisfy the requirement for renewal of certification by continuing education for the Certification Board for Diabetes Care & Education (CBDCE), continuing education activities must be applicable to diabetes and approved by a provider on the CBDCE List of Recognized Providers (www.ncbde.org). CBDCE does not approve continuing education. Diabetes Education Services is accredited/approved by the Commission of Dietetic Registration which is on the list of CBDCE Recognized Providers.
Rationale of the Week | Inpatient didn’t get bolus insulin before lunch. What is best action?
For last week’s practice question, we quizzed participants on missing bolus insulin before lunch, how should you follow up? 66% 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: RT is in the hospital with pneumonia. Based on pre lunch glucose check, RT needs 3 units bolus insulin for lunch. RT’s blood glucose before lunch (20 minutes ago) was 173. You walk in room and RT is almost done with lunch.
What is best action?
Answer Choices:
- Give the 3 units of bolus insulin now.
- Hold the bolus insulin since RT is almost done.
- Recheck the glucose now and adjust insulin dose accordingly.
- Call MD for further instructions.
Getting to the Best Answer
Answer 1 is correct. 66.15% chose this answer. “Give the 3 units of bolus insulin now.” YES, this is the BEST answer. Since RT just checked their blood glucose 20 minutes ago, even though they have consumed most of their meal, it is best to give the bolus insulin now so the insulin can help blunt the post prandial increase. It also provides a great teaching moment to encourage individuals to give insulin before eating, to allow the insulin to start working to match the post meal increase from food.
Answer 2 is incorrect. 5.59% of you chose this answer. “Hold the bolus insulin since RT is almost done.” If we hold the bolus insulin, RT’s blood glucose level will go above target since there would be no insulin available to store the incoming carbohydrates in muscle and liver cells as glycogen.
Answer 3 is incorrect. About 18.94% of respondents chose this. “Recheck the glucose now and adjust insulin dose accordingly.” Unfortunately, this is not a good time to determine insulin needs based on glucose. Since RT is eating, the blood sugars are rising and we might end up giving too much insulin based on this temporary increase. It is best to determine insulin dose on premeal glucose and anticipated carb consumption.
Finally, Answer 4 is incorrect. 9.32% chose this answer. “Call MD for further instructions.” No need to call for instructions in this situation. If a person with diabetes experienced this situation at home, they would simply give their insulin mid-meal. In this situation, it won’t cause any harm to give the recommended dose now. It also provides a great teaching moment to encourage individuals to give insulin before eating, to allow the insulin to start working to match the post meal increase from food.
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 this question?
Join us live on [Air Date] for our
Hospitals & Hyperglycemia
Level 2 Standards of Care Intensive
Research demonstrates the importance of glucose control during hospitalization to improve outcomes not only in the inpatient setting but after discharge. This course reviews the evidence that supports inpatient glucose control & outlines practical strategies to achieve targets in the inpatient setting. We incorporate the latest American Diabetes Association’s (ADA) Standards of Medical Care in Diabetes & provide links to resources & inpatient management templates.
Objectives:
- Describe the impact of hyperglycemia in the hospital setting.
- Discuss the importance of inpatient glucose control.
- List three strategies to get glucose to the goal in the hospital setting.
Learning Outcome:
The diabetes care team will gain insights and knowledge of special considerations, individualized goals, and standards for inpatients with diabetes that they can include in their practice.
Target Audience:
This course is a knowledge-based activity designed for individuals or groups of diabetes professionals, including RNs, RDs/RDNs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other healthcare providers interested in staying up to date on current practices of care for people with prediabetes, diabetes, and other related conditions. The practice areas for RDs/RDNs for CDR reporting are healthcare, preventative care, wellness, and, lifestyle along with, education and research.
CDR Performance Indicators:
- 9.6.7
- 9.6.8
- 10.3.1
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working diabetes specialist and a nationally recognized diabetes expert.
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
- Question of the Week | Managing Overnight Hypoglycemia: Best Plan?
- 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
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
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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The Imperfections of BMI
Is BMI the Right Measure?
By Christine Craig, MS, RD, CDCES
For years, the Body Mass Index (BMI) has been the standard for determining body weight health, but are there other factors we should be considering?
In June of 2023, the American Medical Association (AMA) adopted a policy to clarify the use of BMI for medical care. And in 2024, the ADA Standards of Care1 followed, updating their recommendations for the use of BMI.
Both organizations reported BMI as an imperfect measure as it does not measure weight distribution or factor in weight-related health conditions. More accurate body measurement approaches are under consideration that may replace BMI in the future.
Question of the Week | What does Medicare Cover?
KT just turned 65 and asks you about Medicare Insurance Coverage for Diabetes.
Which of the following is accurate regarding Medicare Coverage for people living with diabetes?
- Medicare Part D covers Diabetes Self-Management Education
- Medicare Part A covers Diabetes Prevention Programs.
- Medicare Part B covers durable medical equipment and diabetes medications.
- Medicare Part A covers hospitalization.
Join us live on June 20th, 2024 for our
Setting up a Successful DSME Program
Level 2 Standards of Care Intensive
This course provides you with a succinct overview of the latest standards for Diabetes Self-Management Education (DSME) & 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 & simplified standards & provide strategies for program implementation. In addition, we discuss Medicare Reimbursement & covered benefits. This course provides insights into the exam philosophy & also highlights critical content areas.
Objectives:
- Describe DSME program examples from across the country.
- List the six standards for creating a successful DSME program.
- Discuss marketing strategies for success.
- Describe Medicare Reimbursement for diabetes care & education.
Learning Outcome:
Participants will articulate the steps involved in setting up and meeting the Standards while exploring psychosocial issues and considering social determinants of health.
Target Audience:
This course is a knowledge-based activity designed for individuals or groups of diabetes professionals, including RNs, RDs/RDNs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other healthcare providers interested in staying up to date on current practices of care for people with prediabetes, diabetes, and other related conditions. The practice areas for RDs/RDNs for CDR reporting are healthcare, preventative care, wellness, and, lifestyle along with, education and research.
CDR Performance Indicators:
- 9.6.7
- 9.6.8
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator and a nationally recognized diabetes expert.
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
- Question of the Week | Managing Overnight Hypoglycemia: Best Plan?
- 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
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our Level 2 | Setting up a Successful DSME Program awards 1.5 CPEUs in accordance with the Commission on Dietetic Registration’s CPEU Prior Approval Program.
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 | ADA Standards for Gestational Diabetes
For last week’s practice question, we quizzed participants on ADA standards for gestational diabetes. 43% 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: LS has type 1 diabetes and is here for the first visit after confirmation of pregnancy. LS has been using non-adjunctive continuous glucose monitoring (CGM) along with insulin pump therapy to manage diabetes. Previous visits have focused on preconception counseling and last A1c was 6.4%.
According to the 2024 ADA Standards of Care, what do we recommend regarding glucose monitoring during pregnancy?
Answer Choices:
Getting to the Best Answer
Answer 1 is incorrect. 21.84% chose this answer. “Recommend continued CGM use with the addition of post-prandial glucose monitoring.” The 2024 ADA Standards of Care do recommend CGM use for individuals with type 1 diabetes during pregnancy but simply monitoring post-prandial glucose is insufficient. Keep reading below.
Answer 2 is incorrect. 24.01% of you chose this answer. “LS can continue use of non-adjunctive CGM device approved for use during pregnancy.” We can continue use of CGM devices during pregnancy, but blood glucose monitoring is recommended in addition to CGM.
Answer 3 is correct. About 43.17% of respondents chose this. GREAT JOB! “Recommend continued CGM with the addition of scheduled blood glucose monitoring.” The 2024 Standards of Care recommends CGM for individuals with type 1 diabetes during pregnancy but also recommends that it not replace pre-prandial and post-prandial blood glucose monitoring. Fasting, pre-prandial and post-prandial blood glucose monitoring is recommended for individuals with diabetes in pregnancy.
Finally, Answer 4 is incorrect. 10.99% chose this answer. “Recommend LS move to blood glucose monitoring and check fasting, pre-prandial and post-prandial glucose values.” We will recommend LS add blood glucose monitoring, but LS does not need to transition off CGM therapy.
Reference:
American Diabetes Association Professional Practice Committee; 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes—2024. Diabetes Care 1 January 2024; 47 (Supplement_1): S282–S294. https://doi.org/10.2337/dc24-S015
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 this question?
Now Recorded & Ready to Watch
Pregnancy & Diabetes
Level 2 Standards of Care Intensive
Pregnancy with diabetes is confronted with a variety of issues that require special attention, education, & understanding. This course reviews those special needs while focusing on Gestational Diabetes & Pre-Existing Diabetes. Included are the most recent diagnostic criteria, management goals, & prevention of complications during pregnancy. This is a helpful review for Certification Exams & those who want more information on people who are pregnant & live with diabetes.
Objectives:
- List three issues that affect pregnancy with diabetes.
- Describe the unique attributes of pre-existing diabetes in pregnancy & gestational diabetes.
- State the diagnostic criteria & management goals for gestational diabetes.
- Potential short-term & long-term complications of fetal exposure to hypoglycemia.
- Prevention measures to keep mother & baby healthy.
Learning Outcome:
Participants will gain knowledge of special considerations, individualized goals, and standards for people experiencing diabetes during pregnancy to improve outcomes.
Target Audience:
This course is a knowledge-based activity designed for individuals or groups of diabetes professionals, including RNs, RDs/RDNs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other healthcare providers interested in staying up to date on current practices of care for people with prediabetes, diabetes, and other related conditions. The practice areas for RDs/RDNs for CDR reporting are healthcare, preventative care, wellness, and, lifestyle along with, education and research.
CDR Performance Indicators:
- 9.6.7
- 9.6.8
- 10.3.1
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working diabetes specialist and a nationally recognized diabetes expert.
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
- Question of the Week | Managing Overnight Hypoglycemia: Best Plan?
- 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
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
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 | Inpatient didn’t get bolus insulin before lunch. What is best action?
RT is in the hospital with pneumonia. Based on pre lunch glucose check, RT needs 3 units bolus insulin for lunch. RT’s blood glucose before lunch (20 minutes ago) was 173. You walk in room and RT is almost done with lunch.
What is best action?
- Give the 3 units of bolus insulin now.
- Hold the bolus insulin since RT is almost done.
- Recheck the glucose now and adjust insulin dose accordingly.
- Call MD for further instructions.
Want to learn more about this question?
Join us live on June 13th at 11:30AM PST for our
Hospitals & Hyperglycemia
Level 2 Standards of Care Intensive
Research demonstrates the importance of glucose control during hospitalization to improve outcomes not only in the inpatient setting but after discharge. This course reviews the evidence that supports inpatient glucose control & outlines practical strategies to achieve targets in the inpatient setting. We incorporate the latest American Diabetes Association’s (ADA) Standards of Medical Care in Diabetes & provide links to resources & inpatient management templates.
Objectives:
- Describe the impact of hyperglycemia in the hospital setting.
- Discuss the importance of inpatient glucose control.
- List three strategies to get glucose to the goal in the hospital setting.
Learning Outcome:
The diabetes care team will gain insights and knowledge of special considerations, individualized goals, and standards for inpatients with diabetes that they can include in their practice.
Target Audience:
This course is a knowledge-based activity designed for individuals or groups of diabetes professionals, including RNs, RDs/RDNs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other healthcare providers interested in staying up to date on current practices of care for people with prediabetes, diabetes, and other related conditions. The practice areas for RDs/RDNs for CDR reporting are healthcare, preventative care, wellness, and, lifestyle along with, education and research.
CDR Performance Indicators:
- 9.6.7
- 9.6.8
- 10.3.1
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working diabetes specialist and a nationally recognized diabetes expert.
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
- Question of the Week | Managing Overnight Hypoglycemia: Best Plan?
- 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
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
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.
June 2024 eNews | Weekly Insulin, BMI, Updated CDCES Exam, 5 Activity Activators
Happy June
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When I started in diabetes, we had two injectables, NPH and regular insulin. Fast forward to last month, the FDA evaluated the safety and efficacy of a once-a-week basal insulin called icodec. Citing safety reasons, the FDA denied the approval of icodec for people living with type 1 diabetes based on the data results. While researching this article, I discovered a concerning statistic: about 30% of people with type 1 still use multiple daily injections, especially in under-resourced communities. This statistic highlights the significant gap in access to diabetes technology and access in the U.S., and I consider it a call to action. In addition to detailing icodec insulin in this newsletter, we explore BMI as a health indicator and contemplate if communities would benefit from a more predictive and less stigmatized weight assessment. We prepare for the updated CDCES exam and highlight the significant changes starting July 1st. These changes reflect crucial knowledge needed to promote the best diabetes care. You are invited to check out our targeted resources to support CDCES success and promote excellence in diabetes care. With summer around the corner, we provide strategies to help people move forward with their activity goals and PLAN for setbacks. Plus, we have created a handy activity cheat sheet. Lastly, we are excited to announce that we are opening up the first session of ReVive 5 for FREE. This is a unique opportunity for you to join two experts in the field as they provide concrete strategies to evaluate and address diabetes distress. The session is designed to provide valuable support and care, and we believe it’s an opportunity you won’t want to miss. Our San Diego Scholarships are still open, and we would love to see you at this fun and intensive conference. This is a valuable experience to enhance your knowledge and skills in diabetes care, and we encourage you to consider applying. |
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Sending notes of joy and health, Coach Beverly, Bryanna, and Christine |
Featured Articles
- Once a Week Insulin Denied by FDA
- Is BMI the Right Measurement?
- CDCES Exam Updates – Begins July 1st
- 5 Activity Boosters
- Question of the Week
- Rationale of the Week
Upcoming Webinars
- Pregnancy & Diabetes – June 11th
- Hospitals & Hyper- June 13th
- ReVive 5 – June 17th & 24th
- Setting up a DSME Program- June 20th
- Prep for NEW CDCES Exam – June 25th
Unlock insights for managing diabetes distress with the experts!
Join us live on June 17 & 24, 2024 for our
ReVive 5 Diabetes Training Program:
The 2024 ADA Standards of Care now recommends annual screening for diabetes distress. If you are wondering how to screen for distress and tailor education based on the results, we encourage you to join this unique training program.
This two-session training provides the essential steps to address diabetes distress combined with an innovative approach to helping people make sense of their glucose data.
The first session is team-taught by experts in the field of diabetes distress and effective communication approaches. Dr. Larry Fisher kicks off the program by describing the difference between depression and distress and interpreting Diabetes Distress screening results. Dr. Susan Guzman uses a case study approach and step-by-step communication strategies to address responses from the Diabetes Distress screening tool. This session includes an abundance of evidence-based approaches that you can apply in your clinical setting.
Coach Beverly leads the second session. During this three-hour program, Beverly describes insulin dosing strategies, meter and sensor data interpretation, and common issues encountered by people using diabetes technology. Case studies include tools to help individuals discover what changes are needed to get glucose to target, coupled with the communication skills discussed in the first session. In conclusion, the team of instructors review a case study that pulls together all the ReVive 5 elements.
“ReVive 5” breathes new life into our relationship with diabetes, bringing a fresh perspective to both the person with diabetes and the provider.
Can’t join live? That’s okay. Your registration guarantees you access to the recorded version of the series, along with podcasts and resources for one full year.
Accredited Training Program:
- 15+ CEs – Includes the 7-hour ReVive 5 Training Program, Certificate, and 5 FREE bonus courses to supplement content.
- A comprehensive set of assessment tools, educational materials, log sheets, and resources.
Join us to gain the confidence and learn the skills needed to support people with diabetes to move forward in their self-management and discover the expert within.
Team of Experts:
ReVive 5 is taught by a team of 3 Interdisciplinary Experts:
- Lawrence Fisher, Ph.D., ABPP, Professor Emeritus, UCSF
- Susan Guzman, PhD
- Beverly Thomassian, RN, MPH, CDCES, BC-ADM
Speakers Interviews – Learn more about the ReVive 5 Team
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!
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
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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