Great News. Our updated PocketCards just arrived in time for this newsletter!  We are excited to share this latest printed version of our world-famous Medication and Insulin Pocketcards and let you know they are ready for ordering. You can purchase them one at at time or we offer quantity discounts too. We also have a PocketCard Bundle that includes the Meds PocketCard, ADA Standards & Foot PocketChart, plus a FREE sticker. 

Our eight-sided medication accordion Pocketcards were designed by Coach Beverly Thomassian as a tool for clinical practice and exam preparation. One of our best sellers, the Diabetes Medication PocketCard is perfect for any health care professional providing diabetes care.  Also a great gift for colleagues and staff.

Updates in these PocketCards Include:

• Indicated new Pediatric approval for empagliflozin (Jardiance) and dulaglutide (Ozempic) for ages 10 and older.
• Deleted the DPP-IVi Saxagliptin (Onglyza) & Kombiglyze XR (saxagliptin/metformin XR) since permanently discontinued.

Download for FREE or Order Laminated Pocketcards Here

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Get all of our Best-Selling Pocketcards in One Bundle!

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Now available!

ADCES released a new edition of the Certification Review Guide

This 6th edition contains over 475 practice questions

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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!

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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.

For last week’s practice question, we quizzed participants on gestational diabetes & medication. A whopping 70% of respondents chose the best answer – great job. 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: AR has PCOS and type 2 diabetes and is in shock because they just discovered they are 6 weeks pregnant.  AR takes metformin 1000mg BID plus empagliflozin (Jardiance) 25 mg and their most recent A1C is 8.6%.

Which of the following actions do you recommend?

Answer Choices:

1. Stop empagliflozin
2. Stop metformin, keep empagliflozin
3. Stop metformin and empagliflozin, start insulin.
4. Stop empagliflozin, start a GLP-1 inhibitor

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Getting to the Best Answer

If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.

Answer 1 is incorrect. 20.16% chose this answer. “Stop empagliflozin.” It is true that empagliflozin and all SGLT-2’s are not indicated during pregnancy. However, there is a better answer given that her A1C of 8.6% is above the pregnancy target of less than 6.5%.

Answer 2 is incorrect. 2.58% of you chose this answer. “Stop metformin, keep empagliflozin.” Empagliflozin and all SGLT-2’s are contraindicated during pregnancy, so this answer is not the best choice.

Answer 3 is correct. About 70% of respondents chose this. “Stop metformin and empagliflozin, start insulin.” GREAT JOB. Given that her A1C of 8.6% is above the pregnancy target of less than 6.5%, insulin absolutely needs to be started to get glucose to goal. According to the ADA Standards, the provider may opt to continue the metformin treatment for PCOS for the first trimester But given the urgent need to get blood glucose to target, this individual will be most effectively managed with a combination of nutrition therapy and insulin.

Finally, Answer 4 is incorrect. 7.26% chose this answer. “Stop empagliflozin, start a GLP-1 inhibitor.” Yes, we need to stop empagliflozin since all SGLT-2’s are contraindicated during pregnancy. However, GLP-1 Inhibitors are also contraindicated during pregnancy, so this answer is incorrect.

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!

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Want to learn more about this question? Enroll in our

Level 2 | Pregnancy & Diabetes | 1.5 CEs

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:

1. List three issues that affect pregnancy with diabetes.
2. Describe the unique attributes of pre-existing diabetes in pregnancy & gestational diabetes.
3. State the diagnostic criteria & management goals for gestational diabetes.
4. Potential short-term & long-term complications of fetal exposure to hypoglycemia.
5. Prevention measures to keep mother & baby healthy.

Intended Audience: A great course for healthcare professionals seeking to enhance their knowledge of the issues surrounding pregnancy and diabetes and appropriate care to improve outcomes.

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Level 2 | Hospitals & Hyperglycemia | 1.5 CEs

Research clearly 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:

1. Describe the impact of hyperglycemia in the hospital setting.
2. Discuss the importance of inpatient glucose control.
3. List three strategies to get glucose to goal in the hospital setting.

Intended Audience: A great course for healthcare professionals seeking strategies to manage and improve inpatient diabetes care.

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

All hours earned count toward your CDCES Accreditation Information

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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!

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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.

1. Increase basal insulin by 10- 20%.
2. Intensify correction scale.
3. Continue with same basal dose.
4. Ask MS if they are snacking during the night before making adjustments.

Click Here to Test your Knowledge

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Want to learn more about this question? Enroll in our

Level 2 | Hospitals & Hyperglycemia | 1.5 CEs

Research clearly 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:

1. Describe the impact of hyperglycemia in the hospital setting.
2. Discuss the importance of inpatient glucose control.
3. List three strategies to get glucose to goal in the hospital setting.

Intended Audience: A great course for healthcare professionals seeking strategies to manage and improve inpatient diabetes care.

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

All hours earned count toward your CDCES Accreditation Information

---

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.

For last week’s practice question, we quizzed participants on gestational diabetes & pregnancy complications. 68% 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: AR has PCOS type 2 diabetes and worried because they just discovered they are 6 weeks pregnant. AR takes metformin 1000mg BID plus empagliflozin (Jardiance) 25 mg and their most recent A1C is 8.6%.

Which of the following is a potential complication associated with hyperglycemia during the first 10 weeks of pregnancy?

Answer Choices:

1. Intrauterine hypoglycemia
2. Macrosomia and post-natal jaundice
3. Neonatal respiratory distress
4. Diabetic embryopathy

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Getting to the Best Answer

If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.

Answer 1 is incorrect. 10.53% chose this answer. “Intrauterine hypoglycemia.” Although this answer is tempting, it is not accurate. If the fetus experienced elevated blood sugars (from mom) during gestation, this stimulates increased fetal production of insulin. After delivery, baby’s who were exposed to intrauterine hyperglycemia are at higher risk of post-delivery hypoglycemia (not intrauterine hypoglycemia).

Answer 2 is incorrect. 14.56% of you chose this answer. “Macrosomia and post-natal jaundice.” Although this answer is tempting, it is not accurate. If the fetus experienced elevated blood sugars (from mom) during their first 10 weeks of gestation, this stimulates increased fetal production of insulin and can stimulate extra fat stores later in pregnancy leading to larger babies and higher risk for post delivery jaundice. However, the question is asking, what complications can elevated blood sugars cause during their first 10 weeks of pregnancy when the organs are developing?

Answer 3 is kind of incorrect. About 7.37% of respondents chose this. “Neonatal respiratory distress.” The question is asking, if the fetus experienced elevated blood sugars (from mom) during the first 10 weeks of gestation, what complications can elevated blood sugars cause during the first trimester pregnancy when the organs are developing? The lungs can be affected by first trimester hyperglycemia, causing the newborn to struggle with respiratory distress.

Finally, Answer 4 is correct. 67.54% chose this answer. “Diabetic embryopathy.” GREAT JOB. This is the best answer. If the fetus experienced elevated blood sugars (from mom) during the first 10 weeks of gestation, embryonic complications result from elevated blood sugars during the first trimester pregnancy when the organs are developing. These can include, congenital heart disease, renal anomalies and caudal regression.

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!

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Want to learn more about this question? Enroll in our

Level 2 | Pregnancy & Diabetes | 1.5 CEs

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:

1. List three issues that affect pregnancy with diabetes.
2. Describe the unique attributes of pre-existing diabetes in pregnancy & gestational diabetes.
3. State the diagnostic criteria & management goals for gestational diabetes.
4. Potential short-term & long-term complications of fetal exposure to hypoglycemia.
5. Prevention measures to keep mother & baby healthy.

Intended Audience: A great course for healthcare professionals seeking to enhance their knowledge of the issues surrounding pregnancy and diabetes and appropriate care to improve outcomes.

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Level 2 | Hospitals & Hyperglycemia | 1.5 CEs

Research clearly 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:

1. Describe the impact of hyperglycemia in the hospital setting.
2. Discuss the importance of inpatient glucose control.
3. List three strategies to get glucose to goal in the hospital setting.

Intended Audience: A great course for healthcare professionals seeking strategies to manage and improve inpatient diabetes care.

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

All hours earned count toward your CDCES Accreditation Information

---

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.

1. Stop empagliflozin
2. Stop metformin, keep empagliflozin
3. Stop metformin and empagliflozin, start insulin.
4. Stop empagliflozin, start a GLP-1 inhibitor.

Click Here to Test your Knowledge

---

Want to learn more about this question? Enroll in our

Level 2 | Pregnancy & Diabetes | 1.5 CEs

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:

1. List three issues that affect pregnancy with diabetes.
2. Describe the unique attributes of pre-existing diabetes in pregnancy & gestational diabetes.
3. State the diagnostic criteria & management goals for gestational diabetes.
4. Potential short-term & long-term complications of fetal exposure to hypoglycemia.
5. Prevention measures to keep mother & baby healthy.

Intended Audience: A great course for healthcare professionals seeking to enhance their knowledge of the issues surrounding pregnancy and diabetes and appropriate care to improve outcomes.

---

Level 2 | Hospitals & Hyperglycemia | 1.5 CEs

Research clearly 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:

1. Describe the impact of hyperglycemia in the hospital setting.
2. Discuss the importance of inpatient glucose control.
3. List three strategies to get glucose to goal in the hospital setting.

Intended Audience: A great course for healthcare professionals seeking strategies to manage and improve inpatient diabetes care.

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

All hours earned count toward your CDCES Accreditation Information

---

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.

We want to fix our mistake and clarify this important information. For last month’s practice question, a participant reached out to us and kindly shared that one of the medications listed was actually recently approved by the FDA for kids ages 10-17. We want to make this right, so you can pass on updated info to people living with diabetes and your colleagues, plus prepare for exam success! Look for 2 correct answers and explanations for this Rationale of the Week.

Question: KS is 14 years old and recently diagnosed with type 2 diabetes. Their A1C is 8.6%, LDL cholesterol is 137 mg/dL and their GFR is greater than 90.

Based on this clinical information and the ADA Standards for Pediatric Care, in addition to lifestyle and behavior changes, what medication(s) would be recommended?

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

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Based on this clinical information and the ADA Standards for Pediatric Care, in addition to lifestyle and behavior changes, what medication(s) would be recommended?

Answer Choices:

1. Dulaglutide (Trulicity) and Metformin
2. Metformin and an ACE Inhibitor
3. Exenatide XR (Bydureon) and a statin
4. Empagliflozin (Jardiance) or Metformin

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Getting to the Best Answer

If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.

Answer 1 is CORRECT. 23.08% chose this answer. “Dulaglutide (Trulicity) and Metformin.” Both metformin and Dulaglutide (Trulicity) are FDA approved for children starting at age of ten. Dulaglutide was recently FDA approved for pediatrics up at doses up to 1.5 mg per week. We have updated our eMed PocketCards to include this GLP-1 RA as approved for kids ages 10-17.

Answer 2 is incorrect. 16.62% of you chose this answer. “Metformin and an ACE Inhibitor.” Although this answer if tempting, because metformin is FDA approved for children starting at age of ten, there is no mention of hypertension that would justify starting an ACE Inhibitor. See Med PocketCards. For this reason, this is not the best answer.

Answer 3 is CORRECT. About 39.36% of respondents chose this. “Exenatide XR (Bydureon) and a statin.” YES, this is the BEST answer. GREAT JOB. Two of the GLP-1 RA’s are approved for kids including exenatide XR and liraglutide. See Med PocketCards. In addition, statins are indicated for children age 10 or greater if they have diabetes and an LDL cholesterol of 130 mg/dL or greater.

Finally, Answer 4 is incorrect. 20.93% chose this answer. “Empagliflozin (Jardiance) or Metformin.” Although this answer if tempting, because metformin is FDA approved for children starting at age of ten, none of the SGLT-2’s are approved for pediatrics, including empagliflozin. See Med PocketCards. For this reason, this is not the best answer.

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! For more information, see ADA Standard 14 on Children and Adolescents or join our webinar (see below).

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Want to learn more about this question? Enroll in our

Level 2 | From Tots to Teens | Diabetes Standards | 1.5 CEs

This course includes updated goals & guidelines for children living with type 1 or type 2 diabetes. This course discusses the special issues diabetes educators need to be aware of when working with children with diabetes & their families. We discuss the clinical presentation of diabetes, goals of care, & normal growth & development through the early years through adolescence. Strategies to prevent acute & long-term complications are included with an emphasis on positive coping for families & children with diabetes.

Objectives:

1. Discuss the goals of care for Type 1 and Type 2 Kids with Diabetes.
2. State Strategies to prevent acute and chronic complications.
3. Discuss the importance of positive psychosocial adjustment & resources.

Intended Audience: A great course for healthcare professionals seeking information about providing care for children with diabetes and their families.

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

All hours earned count toward your CDCES Accreditation Information

---

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.

1. Intrauterine hypoglycemia
2. Macrosomia and post-natal jaundice
3. Neonatal respiratory distress
4. Diabetic embryopathy

Click Here to Test your Knowledge

---

Want to learn more about this question? Enroll in our

Level 2 | Pregnancy & Diabetes | 1.5 CEs

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:

1. List three issues that affect pregnancy with diabetes.
2. Describe the unique attributes of pre-existing diabetes in pregnancy & gestational diabetes.
3. State the diagnostic criteria & management goals for gestational diabetes.
4. Potential short-term & long-term complications of fetal exposure to hypoglycemia.
5. Prevention measures to keep mother & baby healthy.

Intended Audience: A great course for healthcare professionals seeking to enhance their knowledge of the issues surrounding pregnancy and diabetes and appropriate care to improve outcomes.

---

Level 2 | Hospitals & Hyperglycemia | 1.5 CEs

Research clearly 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:

1. Describe the impact of hyperglycemia in the hospital setting.
2. Discuss the importance of inpatient glucose control.
3. List three strategies to get glucose to goal in the hospital setting.

Intended Audience: A great course for healthcare professionals seeking strategies to manage and improve inpatient diabetes care.

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

All hours earned count toward your CDCES Accreditation Information

---

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.