How to Succeed with Person-Centered Coaching
A diagnosis of diabetes often carries a significant emotional response. A person with diabetes might report shame, fear, and guilt as they come to terms with their diagnosis and anticipate their future. As diabetes healthcare providers, we can learn to address these feelings while helping people move forward!
This cheat sheet provides a dozen simple coaching strategies for providers to help people believe in their ability to self-manage their diabetes successfully.
Using a person-centered approach, we can identify the individual’s strengths and expertise and then leverage this information to open a door of possibilities. Our choice of communication techniques can spark behavior change in people living with diabetes.
Adopting this style of communication can be a dramatic shift for some providers. Think of it this way: In usual care, the diabetes healthcare provider steers the boat, brings the fuel, and charts the course. Using the person-centered approach, the provider is simply the rudder, serving as a guide, and the individual steers.
Strategies that Work
DO: Mindfully Listen to the individuals’ problems and fears.
The first strategy is carefully listening to the person’s fears and concerns. If someone struggles with nutrition, meds, or behavioral changes, listen to the struggle, and try not to push, advise, or fix it. Listen and reflect on what you think is happening for the first few minutes.
For example, reflecting back could go something like this: “Taking medications is hard for you because you are not sure if they are really working.” Or, “It’s hard to eat more vegetables because you are a long-haul truck driver.” Or, “It sounds like you blame yourself for having diabetes.”
Listening and then reflecting back on the struggles of the individual is the first phase of energizing the visit.
DO: Focus on curiosity before exploring possible changes in behavior.
With a person-centered approach, spend more time in the “curiosity” phase before moving to the “action” phase.”
We might ask, “As a truck driver, I am curious to learn more about your food choices when driving.” As care providers, we may be slightly overanxious to get to the “action” phase, which involves aspects such as action, planning, goal setting, and looking at specific foods and exercise prescriptions. It can be disorienting for providers to delay the “action” phase and spend most of the time exploring the “curiosity” phase, and there’s a perception that it takes longer. In fact, it’s probably more efficient with time. It’s a redistribution of the provider’s time in that more time is spent listening to the individual’s barriers and fears and responding to them.
Curiosity can provide comfort and open the door to insights.
DO: Listen for individual insights and ideas.
After reflecting on the person’s struggles and feelings, the next phase is the “building change” talk. It combines having the person express how a behavior change would benefit them and realistic ways to move to the action phase.
As genuinely curious providers we ask, “what are your ideas about how you can improve this situation?” Then the provider would listen carefully to what the person shares. Along with the struggles and barriers, the individual might say, “I could buy a veggie tray before heading out in my truck,” or “I could try taking my medication every day for a week to see how they affect my blood sugars.”
We want to fine-tune our listening skills so that we can pick up the scent of the trail. People often allude to what they’re willing to do and drop crumbs when they feel safe and heard during the conversation. All we need to do is pick up on the hints and encourage them down the path.
DO: Ask Questions and Collaborate.
Once the individual has identified their motivation and begins brainstorming on ways to make behavior changes, the door is open for respectful collaboration. You’ll want to explore how much change the individual is willing and able to make at that time.
To keep it real and achievable, we start with a very small step by saying, “So, you think you could buy a vegetable tray before heading out?” or “You think you could take your diabetes meds for a week to see if they work?” and let that sit; let the person describe their thoughts and feelings.
Then we might say, “How, if at all, do you see this plan fitting into your life?” We are careful to avoid any form of prescription or declaration and stick with asking questions. If the person volunteers—”I will monitor my blood sugars for a week to see if these diabetes meds work.” Or “I think I could pick up veggie trays on driving days.” We would absolutely reinforce and support these choices.
Strategies To Avoid
AVOID: Pressure, fix, or control.
A person-centered approach energizes individuals to take the lead in managing their condition, in step with their providers and supporters. We are careful to avoid forced solutions or controlling language. As providers, we feel like we have these great ideas that we are sure will fix the person, if only…. However, the truth is, our job is to help the person with diabetes find their own answers and solutions.
Let’s stop “Shoulding” on people.
It’s time to let go of terms like “You must, you should, you have to, it’s better, it’s important, do it for me” since they fall under the category of “controlling motivation”—which can be hurtful and lead to the individual becoming defensive or shutting down. We avoid controlling language because it elicits resistance and defiance. The literature is quite clear about people doing something because someone made them feel guilty, ashamed, or pressured them. The long-term prognosis for behavior change using this approach is underwhelming.
DON’T employ Scare Tactics.
As providers, we genuinely care about people’s health and may try to energize behavior change using fear. Such as, “If you don’t get your A1C down, you are heading for dialysis or amputation.” or “Don’t you want to see your kids grow up?” We don’t generally motivate people by scaring them since research shows it is ineffective, and they may never return for that follow-up appointment.
Short-term, people are usually willing to make changes when they’re terrified—when they first get diagnosed–but that wanes in a relatively short period of time. The question is how to keep the person energized when the initial fear has worn off.
In Conclusion: Celebrate and Recognize Each Person’s Effort
Making behavior changes, like losing weight or adjusting lifelong eating habits, can be extremely difficult.
Find a way to recognize and affirm their efforts even if there is no or little change in clinical measures.
If someone’s A1C has not moved, but they took their medications daily or ate their vegetables, we say, “Wow, I want to recognize the effort you put into this.”
Respond kindly and compassionately to their disappointment, frustration, and fear. It won’t fix the immediate problem, but it helps the person feel that their effort was well-spent. It helps them feel heard instead of just “fixing it” and saying, “Okay, we’ll try a new medication.” Over time, your empathy builds bridges and trust, leading to long term collaboration and better health.
About the author – Coach Beverly has been fine-tuning her guilt-free approach to diabetes education for over 30 years and has witnessed its impact on improving well-being and building connections.
Learn more about effective communication approaches in our ReVive 5 Diabetes Training Program.
Inspired by https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/motivational-interviewing-dos-dont
You are welcome to Download Effective Person-Centered Communication Approaches Cheat Sheet to share with your colleagues.
Inspired by https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/motivational-interviewing-dos-donts
ReVive 5 Training Program
Unlocking Hidden Barriers to Diabetes Management
Addressing diabetes distress can be tricky, even for seasoned healthcare professionals.
We invite you to attend this hands-on training program that provides the essential steps to address diabetes distress combined with an innovative approach to glucose management. Our experts offer realistic strategies to address diabetes distress that you can immediately apply to your practice setting. Plus, the ReVive 5 Program provides a breadth of tools and resources to create more meaningful connections with people with diabetes.
“ReVive 5” breathes new life into our relationship with diabetes, bringing a fresh perspective to both the person with diabetes and the provider.
Join A 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
Accredited Training Program:
-
- 7.0 CEs – Includes the 7-hour Session ReVive 5 Training Program
- A comprehensive set of assessment tools, educational materials, log sheets, and resource
- Speakers Interviews – Learn more about the ReVive 5 Team
- What is the Biggest Takeaway when Addressing Diabetes Distress? – Dr. Susan Guzman
- Do you have to be a Mental Health Expert to Tackle Diabetes Distress? – Dr. Lawrence Fisher
- Why I Transformed my Approach to Diabetes Self-Management Education- Coach Beverly
Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.
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.
What is the Biggest Takeaway when Addressing Diabetes Distress?
We asked Dr. Susan Guzman (see bio below), lead trainer and clinician in the Embark Trial to share insights on providing the best care to people with diabetes. Learn more by joining our ReVive 5 Diabetes Training Program where the team shares evidence-based tools and the step-by step approach utilized in the Embark Study.
From all of your research and clinical experience, what are the biggest takeaways you would like to share?
Over time, our research has shown that the best way of helping a person with diabetes is to have them define their challenges and come up with their own goals and strategies. They can learn how to become their own ‘fixers”.
Dr. Guzman
In hindsight, this sounds like the opposite of what we might have expected. With much of our focus on diabetes technology and the use of new and varied medications, all of which are important, it seems we may not be listening to what people are asking for; what their goals and targets are, how they define their problems, what the impact of diabetes on their life has been, and how they want to address these difficulties.
We clinicians are trained as “fixers” and “doers.” We see a problem and we jump to fix it – and in most cases we have the skills and knowledge to do just that. But an exclusive focus on being a “fixer” means an exclusive focus on numbers, targets and mechanisms – we often forget to acknowledge the expertise the person with diabetes brings to the table.
“Over the years of being a diabetes clinician and researcher we have learned to spend more time listening and less time “doing.”
We can get started by encouraging them to identify problems and goals on their terms that are defined by their language. We can help by adding to or modifying the direction they suggest and by providing helpful tools, techniques, and information to reach the goals that they set.
Ultimately, it is the person with diabetes who must make it all work. The key take-away is to move away from being a “fixer” and shift to becoming a “curious coach” by asking the right open-ended questions and really listening to the response.
Reinvisioning our role as a “coach” instead of a “fixer” also enables the clinician to identify the often-hidden underpinnings of barriers and the problematic emotional narratives that drive management difficulties – like feeling like a failure, pounding oneself with self-blame, believing that their glucose levels are unmanageable, feeling like a burden on their family, and feeling hopeless.
How can we expect people to make goals and effectively engage in the complex daily management of diabetes when they are experiencing these burdensome feelings and thoughts?
By addressing concerns and helping with the specifics of diabetes management problems while seeing the whole person in their life context (person-centered care), we can help people with diabetes discover that they are truly their own best fixer.
Listen to Susan address a new innovative approach to diabetes distress by joining our ReVive 5 Program.
ReVive 5 Diabetes Training Program Expert Faculty
Susan Guzman, PhD is passionate about helping to change the conversations in diabetes away from shame, blame and judgment to those based on facts, empathy, and engagement. She has been part of a joint ADA/ADCES effort to address problematic language and messages in diabetes.
Dr. Guzman is a clinical psychologist specializing in diabetes. In 2003, Dr. Guzman co-founded the Behavioral Diabetes Institute (BDI), the first non-profit organization devoted to the emotional and behavioral aspects of living with diabetes.
At BDI, she serves as the Director of Clinical Education, developing and leading programs for people with diabetes and healthcare professionals. She has helped develop and facilitates diabetes distress group interventions for two NIH-funded research studies for adults with type 1 diabetes.
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.
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!
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 to Succeed with Person-Centered Coaching
A diagnosis of diabetes often carries a significant emotional response. People with diabetes experience a myriad of feelings as they come to terms with their diagnosis and anticipate their future. As diabetes healthcare providers, we can learn to address these feelings through person centered coaching and help individuals take steps to get to their best health.
This Coaching Cheat Sheet provides a dozen simple coaching strategies for providers to help people believe in their ability to self-manage their diabetes successfully.
Using a person-centered approach, we can identify the individual’s strengths and expertise and then leverage this information to open a door of possibilities. Our choice of communication techniques can spark behavior change in people living with diabetes.
Adopting this style of communication can be a dramatic shift for some providers. Think of it this way: In usual care, the diabetes healthcare provider steers the boat, brings the fuel, and charts the course. Using the person-centered approach, the provider is simply the rudder, serving as a guide, and the individual steers.
Strategies that Work
DO: Mindfully Listen to the individuals’ problems and fears.
The first strategy is carefully listening to the person’s fears and concerns. If someone struggles with nutrition, meds, or behavioral changes, listen to the struggle, and try not to push, advise, or fix it. Listen and reflect on what you think is happening for the first few minutes.
For example, reflecting back could go something like this: “Taking medications is hard for you because you are not sure if they are really working.” Or, “It’s hard to eat more vegetables because you are a long-haul truck driver.” Or, “It sounds like you blame yourself for having diabetes.”
Listening and then reflecting back on the struggles of the individual is the first phase of energizing the visit.
DO: Focus on curiosity before exploring possible changes in behavior.
With a person-centered approach, spend more time in the “curiosity” phase before moving to the “action” phase.”
We might ask, “As a truck driver, I am curious to learn more about your food choices when driving.” As care providers, we may be slightly overanxious to get to the “action” phase, which involves aspects such as action, planning, goal setting, and looking at specific foods and exercise prescriptions. It can be disorienting for providers to delay the “action” phase and spend most of the time exploring the “curiosity” phase, and there’s a perception that it takes longer. In fact, it’s probably more efficient with time. It’s a redistribution of the provider’s time in that more time is spent listening to the individual’s barriers and fears and responding to them.
Curiosity can provide comfort and open the door to insights.
DO: Listen for individual insights and ideas.
After reflecting on the person’s struggles and feelings, the next phase is the “building change” talk. It combines having the person express how a behavior change would benefit them and realistic ways to move to the action phase.
As genuinely curious providers we ask, “what are your ideas about how you can improve this situation?” Then the provider would listen carefully to what the person shares. Along with the struggles and barriers, the individual might say, “I could buy a veggie tray before heading out in my truck,” or “I could try taking my medication every day for a week to see how they affect my blood sugars.”
We want to fine-tune our listening skills so that we can pick up the scent of the trail. People often allude to what they’re willing to do and drop crumbs when they feel safe and heard during the conversation. All we need to do is pick up on the hints and encourage them down the path.
DO: Ask Questions and Collaborate.
Once the individual has identified their motivation and begins brainstorming on ways to make behavior changes, the door is open for respectful collaboration. You’ll want to explore how much change the individual is willing and able to make at that time.
To keep it real and achievable, we start with a very small step by saying, “So, you think you could buy a vegetable tray before heading out?” or “You think you could take your diabetes meds for a week to see if they work?” and let that sit; let the person describe their thoughts and feelings.
Then we might say, “How, if at all, do you see this plan fitting into your life?” We are careful to avoid any form of prescription or declaration and stick with asking questions. If the person volunteers—”I will monitor my blood sugars for a week to see if these diabetes meds work.” Or “I think I could pick up veggie trays on driving days.” We would absolutely reinforce and support these choices.
Strategies To Avoid
AVOID: Pressure, fix, or control.
A person-centered approach energizes individuals to take the lead in managing their condition, in step with their providers and supporters. We are careful to avoid forced solutions or controlling language. As providers, we feel like we have these great ideas that we are sure will fix the person, if only…. However, the truth is, our job is to help the person with diabetes find their own answers and solutions.
Let’s stop “Shoulding” on people.
It’s time to let go of terms like “You must, you should, you have to, it’s better, it’s important, do it for me” since they fall under the category of “controlling motivation”—which can be hurtful and lead to the individual becoming defensive or shutting down. We avoid controlling language because it elicits resistance and defiance. The literature is quite clear about people doing something because someone made them feel guilty, ashamed, or pressured them. The long-term prognosis for behavior change using this approach is underwhelming.
DON’T employ Scare Tactics.
As providers, we genuinely care about people’s health and may try to energize behavior change using fear. Such as, “If you don’t get your A1C down, you are heading for dialysis or amputation.” or “Don’t you want to see your kids grow up?” We don’t generally motivate people by scaring them since research shows it is ineffective, and they may never return for that follow-up appointment.
Short-term, people are usually willing to make changes when they’re terrified—when they first get diagnosed–but that wanes in a relatively short period of time. The question is how to keep the person energized when the initial fear has worn off.
In Conclusion: Celebrate and Recognize Each Person’s Effort
Making behavior changes, like losing weight or adjusting lifelong eating habits, can be extremely difficult.
Find a way to recognize and affirm their efforts even if there is no or little change in clinical measures.
If someone’s A1C has not moved, but they took their medications daily or ate their vegetables, we say, “Wow, I want to recognize the effort you put into this.”
Respond kindly and compassionately to their disappointment, frustration, and fear. It won’t fix the immediate problem, but it helps the person feel that their effort was well-spent. It helps them feel heard instead of just “fixing it” and saying, “Okay, we’ll try a new medication.” Over time, your empathy builds bridges and trust, leading to long term collaboration and better health.
About the author – Coach Beverly has been fine-tuning her guilt-free approach to diabetes education for over 30 years and has witnessed its impact on improving well-being and building connections.
Learn more about effective communication approaches in our ReVive 5 Diabetes Training Program.
Inspired by https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/motivational-interviewing-dos-dont
You are welcome to Download Effective Person-Centered Communication Approaches Cheat Sheet to share with your colleagues.
Inspired by https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/motivational-interviewing-dos-donts
ReViVE 5 Diabetes Training Program:
Unlocking Hidden Barriers to Diabetes Management
June 17th & 24th, 2024
“ReVive 5” breathes new life into our relationship with diabetes, bringing a fresh perspective to both the person with diabetes and the provider.
The ReVive 5 program is built on sound research from the Embark Trial and will revolutionize your approach to diabetes self-management education.
We have reassembled the Embark training team and created a resource binder of fantastic tools that we are excited to share with you in our ReVive 5 Diabetes Training Program. You are invited to join us to learn a step-wise, proven approach to addressing hidden barriers to diabetes self-management and glucose management.
You don’t need to be mental health expert or diabetes technology wiz to join this training or to integrate these new strategies into your daily practice.
ReVive 5 uses an integrated, evidence-based approach that provides health care professionals with a realistic 5-step approach to addressing the whole person, starting with emotional distress and incorporating a unique, but integrated approach to problem-solving glucose management difficulties.
Intended Audience: This library of critical information is designed for individuals or groups of diabetes specialists, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other health care providers interested in staying up to date on current practices of care for people with diabetes and preparing for the CDCES or BC-ADM Certification Exams.
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:
- 7 CEs – Includes the 7-hour ReVive 5 Training Program
- 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!
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.
Troubleshooting CGM Accuracy
By Christine Craig, MS, RD, CDCES
As more and more people are using glucose sensors as a tool to improve their blood sugars, they may feel frustrated or confused about the mismatch between their sensor and glucose meter readings. Some many even ditch this new fangled sensor, thinking that their old friend, the meter, provides more reliable information.
AW called the clinic to report an issue with the accuracy of their continuous glucose monitor (CGM). They stated that their blood glucose (BG) and sensor glucose (SG) have been 60-100 points different for the past 24 hours. They are concerned about this difference and want help troubleshooting what could have gone wrong.
In this article, Christine Craig, MS, RD, CDCES outlines strategies to explore this glucose mismatch and provides practical problem solving actions to clear up the confusion. In addition, we invite you to download a CGM Troubleshooting Cheat Sheet that provides specific information on different interfering substances and other factors that can affect the accuracy of continuous glucose monitor (CGM).
Assessing CGM Accuracy
Assessment of accuracy within CGM or flash glucose monitors in studies uses mean average relative difference or MARD. (For simplification, we will refer to both as CGM or sensor for the remainder of this article). CGM values, also called sensor glucose values, are compared with a standard reference, often the lab-measured Yellow Springs Instrument (YSI) analyzer, and are reported as a percent of the mean or median absolute error between CGM and reference values.
Almost 20 years ago, the MARD values for CGM were about 20%, and now most CGMs have MARD values near or under 10%.1
As CGM accuracy improves, we now see non-adjunctive indications for many CGMs on the market. This term means the FDA has approved the use of CGM for treatment decisions without BG confirmation. In studies, we can see MARD differences within specific populations, in different CGM site placements, or between different sensor glucose values. For example, a sensor glucose range between 70 and 180 may have a different MARD than a sensor glucose range of less than 54 mg/dl.
How do we share about sensor accuracy and highlight when differences are most likely to occur?
As an individual living with diabetes in the real world, MARD can be impacted by factors specific to the sensor or factors of daily living. Day of sensor wear, sensor-to-sensor variation, or insertion factors such as body site selection, skin integrity (thin or loose skin), scar tissue, or body movements can impact sensor glucose accuracy. 2
If the sensor is compressed due to positioning, lack of perfusion to the sensor site can cause the sensor glucose to be temporally lower than actual glucose values.3 In this case, during CGM data interpretation, you may see a fall and then a return of trend within the sensor glucose readings. Often, compression lows occur overnight due to sleeping directly on the sensor, but during the day, compression can occur with other situations such as placement around a beltline, other very tight clothing restrictions, or if positioned within the interior of the upper arm.
In studies, body site selection between arm, abdomen, and buttocks has shown differences in accuracy, and in the real world, for each individual, this actual difference can be more significant than for others. Using recommended site selection can improve sensor accuracy, but it is essential to consider each individual living with diabetes to determine the best placement for optimal sensor accuracy.
We often hear that BG does not equal SG, but what does this mean?
A blood glucose meter measures capillary blood glucose, and CGM sensors measure interstitial fluid, a thin layer of fluid surrounding the cells just below the skin. These values correlate well, but they measure two different types of fluids.
This difference in BG vs. SG at one point in time can be alarming at first and is a commonly reported concern related to sensor accuracy. Education about the difference in measure and understanding that this difference is most significant during rates of change (a rise or fall in glucose values) can help address this concern. Blood glucose values change first, followed by sensor glucose.
The lag time between BG and interstitial glucose (what the sensor measures) can be from 2 to 20 minutes.
We may notice this difference most during increased rates of change (such as >2 mg/dl per min) and during circumstances such as after a meal, after treating a low glucose event, during and immediately after exercise, or after taking diabetes medications that have a more rapid effect on glucose such as meal/correction insulin or sulphonylurea.1
Educating about the difference between BG and SG and how to interpret glucose trends, sensor glucose trend arrows, and monitoring change over time can improve understanding.
Interfering Substances
The 2024 ADA Standards of Care recommends that for ALL people who wear CGM devices, education and assessment of potential interfering substances occur. Many of these interfering substances can be a common over-the-counter supplement or pain reliever. The effect for all reported interfering substances is a false elevation in sensor glucose versus actual blood glucose values. 4 It is cautioned that this could cause missing a severe glucose event.
Each manufacturer has different identified interfering substances.
- For the Libre 2 and 3 systems, more than 500 mg/day of supplemental Vitamin C can interfere. More than 1000 mg/day can interfere with the Libre 2 Plus. 5
- Dexcom G4, G5, G6 6, and G7 7 are all affected by hydroxyurea and acetaminophen,
- However for Dexcom G6 and G7 devices acetaminophen dose is specified as greater than 4 grams per day or 1 gram every 6 hours.
- Medtronic Guardian 3 and Guardian 4 devices are affected by hydroxyurea and any acetaminophen dose8
- For more information, refer to our cheat sheet: CGM Interfering Substances.
Studies and reports of interfering substances are not comprehensive, so it is recommended that if suspicion occurs that a medication or supplement is contributing to erroneous CGM values, they should contact the manufacturer’s technical support team.9
Calibration
For sensors requiring calibration, poor quality of the blood glucose test can also create inaccuracies with the glucose sensor readings. Most manufacturers with CGM calibration requirements recommend ensuring a “clean calibration,” having individuals wash their hands, taking the second drop of blood when hand washing is unavailable, and calibrating when glucose values are more stable, such as before a meal, insulin, or exercise. Luckily, most devices no longer require calibration, but it is important to review technique when applicable.
Getting Back to AW
AW reported no recent changes with medications, supplement intake, or fortified food sources, and no changes were noted at the sensor site. However, they did report that the CGM was on the last day of manufacturer recommended sensor wear. Sensor integrity variation based on day of sensor was determined to be the main consideration of cause. After changing to a new sensor, AW’s general range of BG to SB differences were observed. This event served as an important reminder to AW to check BG when SG values were not reading as expected and different than any symptoms.
Education When Starting Sensor Important
As educators, we can support individuals concerned with CGM accuracy by providing education about the differences between SG and BG values. Assessing individual factors such as medical conditions, movement and activity, site integrity and placement, issues of compression, and medication and supplement use (assessing for potential inferring substances). We can educate individuals to check BG anytime symptoms do not match SG readings and report any concern of a faulty sensor to the manufacturer. Reporting can often lead to the replacement of faulty sensor.
Since the arrival of CGM, benefits including improved quality of life factors, A1c reduction, increased Time in Range, and prevention of hypoglycemia have been found.4 We know from working in diabetes care and through real-world studies the overall value of CGMs. Unlike BG, CGMs provide a complete picture showing trends for direction, personalized alerts, and supporting pattern recognition.
Although not ideal for all, growth of users will continue to rise with approval of over-the-counter product options and understanding accuracy issues is essential to ensure safety and support user experience.
For more information, refer to our cheat sheet: CGM Interfering Substances.
References:
- Bailey, Timothy & Alva, Shridhara. (2021). Landscape of Continuous Glucose Monitoring (CGM) and Integrated CGM: Accuracy Considerations. Diabetes Technology & Therapeutics. 23. S-5. 10.1089/dia.2021.0236.
- Heinemann L, Schoemaker M, Schmelzeisen-Redecker G, Hinzmann R, Kassab A, Freckmann G, Reiterer F, Del Re L. Benefits and Limitations of MARD as a Performance Parameter for Continuous Glucose Monitoring in the Interstitial Space. J Diabetes Sci Technol. 2020 Jan;14(1):135-150.
- Mensh BD, Wisniewski NA, Neil BM, Burnett DR. Susceptibility of interstitial continuous glucose monitor performance to sleeping position. J Diabetes Sci Technol. 2013 Jul 1;7(4):863-70
- American Diabetes Association Professional Practice Committee. 7. Diabetes technology:Standards of Care in Diabetes—2024. Diabetes Care 2024;47(Suppl. 1):S126–S144
- Full Indications and Important Safety Information. Download On April 17th 2024 From: https://www.freestyle.abbott/us-en/safety-information.html
- Interfering Substances and Risks. Downloaded on April 17th 2024 from: https://www.dexcom.com/en-us/interference.
- Dexcom G7 Safety Information. Downloaded on April 17th 2024 from: https://dexcompdf.s3.us-west-2.amazonaws.com/en-us/G7-CGM-Users-Guide.pdf#page=12
- Medtronic Device Safety Information. Downloaded on April 17th, 2024 from: https://www.medtronicdiabetes.com/important-safety-information
- Heinemann L. Interferences With CGM Systems: Practical Relevance? J Diabetes Sci Technol. 2022 Mar;16(2):271-274.
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.
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!
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.
A Recipe from Mohammed Ali
Mohammed Ali was a fierce competitor and fought for what he believed in.
Yes, the towering figure had a poetic side, that leaned toward justice.
In 1972 Ali was being interviewed by journalist David Frost and was asked how he would like people to remember him when he was gone. Here is his response.
Recipe for Life - Mohammed Ali
“I’d like for them to say he took a few cups of love.
He took one tablespoon of patience,
One teaspoon of generosity,
One pint of kindness;
He took one quart of laughter,
One pinch of concern.
And then, he mixed willingness with happiness,
He added lots of faith and he stirred it up well.
Then he spread it throughout a lifetime and he served it to every deserving person he met.”
When I heard this, I thought it a perfect description of how we approach people with diabetes, starting with a foundation of love. The practice of diabetes care is just a little bit of science and loads of kindness and concern with lots of faith and belief in the ability of each individual.
We spread this over a lifetime of care and share it with generosity to each person we meet.
Join us in Preparing for the 2024 BC-ADM Exam!
Airs April 10th @ 11:30 am
Topics of discussion include
- Exam eligibility and test format
- Strategies to succeed
- Study tips and test-taking tactics
Coach Bev will also review sample test questions and the reasoning behind choosing the right answers. We hope you can join us.
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.
Rationale of the Week | How to Increase Participation in DSMES?
For last week’s practice question, we quizzed participants on how to Increase participation in DSMES. 75% 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: Studies indicate that only 53% of individuals eligible for Diabetes Self-Management Education and Support (DSMES) through their health insurance receive it.
Answer Choices:
- Adjust DSMES charges for Medicare enrollees based on ability to pay.
- Increase access to telehealth delivery of care and other digital health solutions.
- Provide DSMES in non-hospital workplace settings to increase access for employees.
- Incentivize participation through use of giveaways and positive reinforcement.
Getting to the Best Answer
Answer 1 is incorrect. 4.79% chose this answer. “Adjust DSMES charges for Medicare enrollees based on ability to pay.” To ensure parity, Medicare guidelines specifically state that all DSME participants must be billed at the same rate. Billing at a lower rate or offering DSME for reduced rates or free for some, but not for all, is prohibited.
Answer 2 is correct. 74.77% of you chose this answer. “Increase access to telehealth delivery of care and other digital health solutions.” YES, GREAT JOB! To promote equity and outreach to rural and under resourced communities, the ADA encourages leveraging technology platforms and telehealth to deliver DSMES.
Answer 3 is incorrect. About 10.5% of respondents chose this. “Provide DSMES in non-hospital workplace settings to increase access for employees.” This is a tempting answer, but unfortunately it is not accurate. The location where DSMES is delivered must have prior approval as a Medicare recognized site in order to be able to bill for services. Of course, providing onsite worksite wellness and lifestyle coaching is beneficial, but it would not be a billable service unless the facility has a recognized DSMES program and an approved site.
Finally, Answer 4 is incorrect. 9.94% chose this answer. “Incentivize participation through use of giveaways and positive reinforcement.” Although this is another tempting answer and could help improve DSMES participation in real-life, the ADA Standards don’t include this strategy as a means to boost enrollment.
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?
Virtual DiabetesEd Training Conference – Join us Live on April 17th – 19th 2024 at 11:30 AM PST
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, and “aha” moments for our Virtual DiabetesEd Training Conference April 17th – 19th, 2024.
Attendees will leave this conference with new tools and a refreshed understanding of the latest advances in person-centered diabetes care. Our team highlights the ADA Standards of Care, medications, behavior change, technology, medical nutrition therapy, and more!
Our instructors co-teach the content to keep things fresh and lively.
Friend Discount: 3 or more only $449 per person. Email us at [email protected] with the name and email of each registrant to get the discount!
Program Details
- Dates: April 17-19th, 2024
- Registration Fee: $399-$569 (see more about reg. options below)
- Friend Discount: For 3 or more people, each person saves $50 off their registration. Email us at [email protected] with the name and email of each registrant to get the discount!
- CEs: 30+ CEs | 18 units for Virtual Conference plus 10+ Bonus CEs. CEs can be applied toward CDCES’s initial application or renewal.
- Speakers: View Conference Faculty
Registration Options
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.
Positively Type 1: A Holistic Perspective for Diabetes Educators
Holistic Diabetes Educator & Author of “Positively Type 1”
An interview with Nick Kundrat, BS, CEP, CDCES, LMT
Nick Kundrat first caught our attention when he shared his incredibly detailed study sheets on our CDCES Exam Prep Facebook Group. He had just passed his CDCES exam and posted his lecture notes on the FB group to support his colleague’s success at the exam, too. This act of generosity made Nick a standout educator, and our team contacted him to help with our national CDR accreditation application. Through this connection, we learned that Nick not only provides diabetes care and education but also lives with type 1 diabetes. He recently published a book, “Positively Type 1” that emphasizes the transformative power of a positive mindset and a holistic approach. Whether you’re a seasoned educator or someone living with Type 1 diabetes, Nick’s message is clear: positivity, understanding, and resilience pave the way for a brighter future.
Let Nick’s words be a call to action. By fostering positivity and empathy, we contribute to a more hopeful journey for everyone touched by Type 1 diabetes.
We hope you enjoy this interview with Nick as he describes his path as a role model of holistic diabetes care and a beacon of hope for the 1.5 million people and their families living with type 1 diabetes. Thank you, Nick, for sharing the knowledge and insights you gained through personal experience and your commitment to lifelong learning. May “Positively Type 1” continue to inspire positive change in the diabetes community.
Interview with Nick Kundrat , BS, CEP, CDCES, LMT
In the realm of diabetes education, where deep struggles often cast shadows on hope, one holistic diabetes educator has embarked on a mission to illuminate a different path—a path that embraces positivity, resilience, and a profound understanding of living with Type 1 diabetes. Join us in this exclusive interview with Nick Kundrat – Holistic diabetes educator and author behind “Positively Type 1,” as we delve into a refreshingly simple and optimistic approach to diabetes care.
Nick Kundrat, a beacon of inspiration in the diabetes education community, didn’t arrive at this revolutionary approach by chance. It was forged through personal experiences, a deep empathy for those navigating the complexities of Type 1 diabetes, and a relentless belief in the transformative power of a positive mindset.
As we navigate the pages of “Positively Type 1,” we discover a manifesto for individuals with Type 1 diabetes seeking a brighter, more empowering point of view on their diabetes diagnosis. In this interview, Nick takes us behind the scenes, sharing the insights, anecdotes, and strategies that have the potential to redefine how we approach diabetes education.
Get ready to challenge preconceptions, embrace a holistic perspective, and embark on a journey that goes beyond the textbooks. “Positively Type 1” isn’t just a book; it’s a paradigm shift—a beacon guiding educators and individuals alike toward a positive, resilient, and fulfilling approach to Type 1 diabetes.
You mentioned being a “Holistic diabetes educator” – what does that mean?
Diabetes education technically includes a myriad of different topics related specifically to diabetes treatment, as well as nutrition, exercise and other lifestyle interventions. Yet in my experience, most diabetes education stops at the first one…. diabetes education. Now arguably, diabetes educators focusing on diabetes education seems like a good thing, right? Well…
While diabetes treatment is an important piece of the puzzle., it’s really only the tip of the iceberg when it comes to a person’s health. Your blood sugar balance is NOT just reliant on your insulin dosing and carb counting. Every other area of your life and health can affect your diabetes treatment in big ways. How you sleep, how you eat, how you think, how you rest, how you move, even how you relate to others are really the foundations of proper blood sugar control.
In my opinion, it is a disservice when health professionals focus solely on the diabetes. Besides… They are working with people. They aren’t working with diabetics, they’re working with people who just happen to also have diabetes. Unfortunately, many doctors and educators are just seeing numbers on a page rather than a whole person.
The holistic approach to diabetes is exactly that. A people first approach to diabetes care. Addressing the foundations of health (sleep, stress, nutrition, hydration, exercise, emotions, detoxification) along with your traditional diabetes care is the only way to cultivate true wellness, rather than just staying stuck in the loop of disease treatment.
In my wellness practice, I utilize a variety of different modalities to help my patients heal at a deep level. We always begin with the health foundations (as mentioned above) as well as optimizing diabetes care. With some clients who want to go even more in depth with their health, we utilize nutritional testing and manual therapy approaches to help rebalance the body at a deep level. I’m blessed to be able to share my experiences in both clinical and holistic health to help my patients feel good and cultivate true wellness.
How does your book tie into the Holistic Diabetes Education model?
A holistic diabetes education means looking at the WHOLE PERSON. What many professionals believe that means is: Diabetes education + exercise + nutrition only. What it really means is taking into account EVERY PART OF YOU… This includes the parts you cannot see. Emotions, feelings, psychology, stress, behaviors, choices and spirituality are all important parts of you that cannot be “seen” but are nonetheless very real, and very important factors in your health journey.
Your beliefs are a very important part of the “unseen” parts of your health puzzle. What you believe about the world, about your body, about health in general, and about your diabetes set the stage for how you will act in the world (and how well you will do actually treating your diabetes!
Beliefs determine our thoughts, which determine our feelings, which determine our actions. In other words, what you believe, determines how you act. So if you believe:
“Well my body is broken, I cannot get any better, and nothing ever works in my favor,” you will continue to run yourself in self limiting circles, keep making poor decisions and keep struggling with your health and diabetes treatment.
But if you believe:
“My body is strong and resilient, I can always make positive change and get healthier, and my struggles are opportunities to grow and change,” you will be able to make choices that lead you in a positive direction with your health and your diabetes treatment.
If you can shift someone’s beliefs, you can shift their entire lives. This was the goal for Positively type 1 – to shift the negative beliefs (that most of us living with type 1 diabetes hold) in a more positive, optimistic direction.
What inspired you to write “Positively Type 1”?
My book writing journey actually began at a very young age when I was diagnosed with Type 1 Diabetes myself. At age 4, after becoming terribly sick, my parents and I were told to head to the emergency room. We expected to be checked in, seen by the doctor, then be checked out with some antibiotics. But instead, a terrible nightmare ensued…. Being diagnosed with an incurable, life-long chronic illness: Type 1 Diabetes.
Growing up with a fantastic support system, the daily struggles of diabetes were outweighed by a very happy, healthy childhood filled with sports, school, activities, family and friendships. Yet still I spent lots of time with doctors and educators who helped me navigate my complex chronic condition.
Naturally, as an adult, I was led into the healthcare field, where I soon became the educator (instead of the educated). After spending countless hours around diabetes educators and endocrinologists as a patient, and countless hours on the other side of the coin, educating patients myself in hospitals & clinics, I arrived at a startling conclusion….
There is lots of negativity in the diabetes space. A LOT.
When I (and nearly everyone else I know with diabetes) was diagnosed with type 1, I was never given a pep talk and was never given much hope. Instead I was told:
“Your body is broken”
Your pancreas doesn’t work”
“Your body turned against you”
“You wont get to be like other kids”
While there is some truth in these statements, telling a 4 year old child these things can (and will) drastically shift their beliefs about their bodies and about themselves.
As an educator, I noticed most practitioners are approaching Type 1 diabetes through a similar lens.
“Well, it’s just something you have to manage”
“You’ll be stuck with this forever”
Which again there is some truth to, but statements like these lack a vital ingredient in the recipe of health and healing… HOPE!
If I’ve learned one thing as a diabetes patient and educator… Sometimes all it takes to drastically change someone’s life is a little dose of hope.
This was the inspiration behind writing Positively Type 1.
Tell us a little about the book itself. What can readers expect to learn?
In each chapter, I explain a different skill or character trait you learn living with Type 1. Allow me to share a few examples:
A person with type 1 diabetes makes on average over 180 more decisions per day (between insulin dosing and carb counting) compared to someone without diabetes. Through this, we become INCREDIBLE problem solvers.
With type 1, you learn to be extremely tuned in to every little shift and change in your blood sugar levels. This helps us build incredible levels of self awareness.
Having to endure countless needle-sticks and finger-pricks helps you cultivate a mental and physical toughness unlike any other group of people I’ve ever met.
And many more!
Plus, so that you aren’t just hearing from me, I sat down and interviewed amazing young type 1 warriors whom I’ve worked with as patients. So you get to hear from inspiring young voices who are doing a kick A** job with their diabetes mindset and treatment.
Overall, it’s an easy, lighthearted, humor filled read that will hopefully leave you smiling and filled with hope.
Who is your book for?
Positively Type 1 is for anyone with type 1 diabetes, or those who love someone with type 1 diabetes. It’s written for all ages, but many of the “Type 1 Interviews” at the end of the chapters are with young adults, so it may particularly resonate with the preteen/teen age group.
In Conclusion…
As we conclude our exploration of “Positively Type 1” with Nick, it’s evident that the book is more than words on paper—it’s a source of inspiration for both educators and individuals with Type 1 diabetes.
The insights shared today emphasize the transformative power of a positive mindset and a holistic approach. Whether you’re a seasoned educator or someone living with Type 1 diabetes, the message is clear: positivity, understanding, and resilience pave the way for a brighter future.
Thank you, Nick, for guiding us on this empowering path. May “Positively Type 1” continue to inspire positive change in the diabetes community.
Learn More:
To learn more about Nick’s holistic wellness practice, please visit his website:
To purchase a copy of Nick’s book from amazon, please visit:
Nick Kundrat Educational Background and Bio
- Bachelors in Exercise Science and Sports Medicine (BS)
- Clinical Exercise Physiologist (CEP)
- Certified Diabetes Care and Education Specialist (CDCES)
- Licensed Massage Therapist (LMT)
My name Nick and I’m a passionate educator, coach and the founder of Blueprint Wellness. My story began with years of struggle with multiple chronic illnesses. At my worst, I had over 12 chronic diagnoses including; POTS, Type 1 Diabetes, Hashimotos, EDS, parasite/fungal infections, lymes disease, mast cell activation syndrome, mold toxicity and depression/anxiety. After years of being severely debilitated with tons of “mystery symptoms,” and working with some of the best holistic doctors and practitioners who weren’t able to help me, I was truly sick of being sick.
Funny enough, being severely sick was the best gift I could’ve ever received. If I hadn’t been knocked out with illness, I never would’ve been forced to change my habits, and make an important shift in the way I thought about health.
Everything changed when I began focusing on cultivating wellness, rather than treating my diseases. I decided to completely disregard any diagnoses or labels, and embark on a mission of learning what a healthy human eats like, moves like, looks like, acts like, thinks like and functions like…. and cultivating habits and practices that would get me there.
And now after going on that journey myself, I have devoted my life to becoming the holistic practitioner I needed during my toughest health trials & tribulations.
I’m now blessed to be able to guide others on their journey to health, utilizing a unique blend of holistic and clinical approaches to facilitate real, deep healing for those who are also sick of being sick. I’m not simply after helping you “relieve your symptoms” My goal is to help you cultivate real health, evolve out of disease and grow into the person you were made to be.
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.
Question of the Week | Which statement is accurate regarding treatment of steatosis?
Up to 70% of people with diabetes have steatosis. Those at higher risk of moving to steatohepatitis include individuals with prediabetes and diabetes who also have cardiometabolic risk factors.
According to ADA Standards, which of the following is an accurate statement regarding treatment of liver disease in diabetes?
- GLP-1 Receptor agonists help with weight loss but do not improve steatosis.
- Pioglitazone therapy is indicated for individuals with steatohepatitis.
- Avoid insulin therapy in individuals with steatosis and advanced cirrhosis.
- Statin therapy is not effective at LDL lowering for individuals with steatosis.
Want to learn more about this question?
Critical Assessment in Diabetes Care | Fine-Tuning Diabetes Detective Skills
Level 2 | Standards of Care Intensive
This course integrates the American Diabetes Association’s (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 & real-life situations, we discover often hidden causes of hyperglycemia & other complications, such as liver disease, sleep apnea, pancreatitis, autoimmune diseases, fractures, & more. We delve into therapy for complicated situations & discuss management strategies for other conditions associated with hyperglycemia such as Cystic Fibrosis, & Transplants.
Objectives:
- Identify common yet often underdiagnosed complications associated with type 1 & type 2 diabetes.
- State strategies to identify previously undiscovered diabetes complications during assessments.
- Discuss links between hyperglycemia & other conditions including transplant, cystic fibrosis, & liver disease.
Intended Audience: These courses are knowledge-based activities designed for individual or groups of diabetes educators, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other health care providers interested in enhancing their diabetes assessment skills and preparing for certification.
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!
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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