Warning – Alcohol can Blunt Impact of Glucagon Rescue Meds

LS tells you that they frequently attend company mixers where they feel compelled to have at “least a few drinks”, to fit in and network. The tricky part of this scenario is that LS lives with type 1 diabetes. Since they don’t have a working pancreas, their circulating levels of insulin and glucagon are often mismatched to their body’s needs.

When discussing the situation, LS says they feel confident they can handle alcohol and prevent lows since they have lived with type 1 diabetes for over ten years. LS shares, “I feel comfortable recognizing when both arrows are pointing down and I am heading for a glucose crash”.

As educators, we are committed to taking person-centered approach while encouraging safe practices.

In regards to LS, we realize alcohol’s impact on the thought process and blood glucose levels. We know that alcohol can affect critical thinking and possibly impair recognition of an impending hypoglycemic event. Inebriation also has many symptoms in common with hypoglycemia. Plus, alcohol consumption slows glycogen breakdown in the liver, which increases the risk of hypoglycemia. Lastly, based on a study published in Endocrinology Advisor, higher levels of alcohol in the blood can delay and blunt the effectiveness of glucagon rescue medications.

In the worst-case scenario, if LS experiences severe low blood sugar and passes out, alcohol ingestion can blunt the effectiveness of the glucagon rescue medications.

Alcohol and Glucagon Pathophysiology Review

The body considers alcohol a toxin and as soon as it reaches the bloodstream, the liver prioritizes metabolizing the alcohol and breaking it down. During this clean-up process, the liver is distracted from responding to endogenous glucagon, the hormone that signals the liver to break down glycogen for energy and liberate glucose into the bloodstream. This clean-up can last for up to 8 hours, making delayed hypoglycemia a real possibility.

When a person with type 1 diabetes drink alcohol, they at increased risk of hypoglycemia because the liver isn’t breaking down stored glycogen to increase blood glucose levels.

Let’s get back to LS. What if LS is drinking gin and diet tonics and only munching on low-carb vegetables and cheeses during the mixer? LS is not ingesting many carbohydrates, so glycogen stores may be low and the liver is busy cleaning up the alcohol and blood sugars start dropping. By the 4th drink, LS isn’t thinking very clearly, says they “feel funny” and passes out.

A colleague of LS carries a glucagon emergency kit and provides LS with a dose and calls 911. After 15 minutes, LS still hasn’t regained consciousness, so a second dose is administered. The paramedics arrive and check the glucose, it is 53.

Simply put, glucagon rescue medications may not work if the person drinks too much alcohol.

After reviewing the package inserts of all available US manufactured Glucagon Rescue Meds, there are no warnings for alcohol intake decreasing the effectiveness of glucagon rescue meds. So, I dug a little deeper and found a decent study on the topic which describes the impact of alcohol ingestion on glucose-regulating hormones.

I also found a very helpful monograph published by Lilly Baqsimi in Canada. Baqsimi is a powdered glucagon rescue medication that is delivered nasally. The Baqsimi monograph clearly states several warnings, “Alcohol can suppress hepatic gluconeogenesis and chronic alcoholism can deplete liver glycogen stores. Therefore BAQSIMI may be less effective in presence of acute or chronic alcohol ingestion. Alcohol-induced hypoglycemia is associated with a failure of blood glucose levels to rise normally after glucagon administration. BAQSIMI may not work if the person drinks too much alcohol.“.

Keeping it Real and Safe

In conclusion, having a conversation with people with type 1 about the suppressive nature of alcohol on glycogen release for many hours after consuming alcohol is very important. Another important teaching point is that glucagon rescue meds may not be as effective and timely in raising glucose to safe levels.

As a general rule of thumb, encouraging people with type 1 to eat 15gms of carbs with each drink and have a glass of water in between, may help make sure they have enough circulating carbs and slow the pace of alcohol consumption to help the liver with processing. They may also consider decreasing their insulin dose in association with alcohol intake to prevent this serious side effect.

Download our Glucagon Rescue Med PocketCard for more information here.


Want to learn more about Diabetes Care?  Join us for our

Virtual DiabetesEd Specialist Conference
30+ CEs

Airs October 12-14th, 2022

Join us LIVE for this Virtual Course and enjoy a sense of community!

Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.

Download Course Flyer | Download Schedule

If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.

Team of expert faculty includes:

  • Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
  • Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
  • Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator

Two Registration Options

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!

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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.

New Injectable – “TwinCretin” on Printed PocketCards

We have just added this novel, first in class, dual incretin hormone therapy, Tirzepatide (Mounjaro), to our printed version of our Diabetes Medication PocketCard.

This new twin therapy includes not only a GLP-1 Receptor Agonist, but also a Glucose-dependent insulinotropic polypeptide (GIP), which magnifies the therapeutic effectiveness. The SURPASS studies indicate that study participants experienced an A1C drop of up to 2.5% and weight loss of up to 10kg or more.

How does it work?

Tirzepatide (Mounjaro) 15mg Eli Lilly

Incretins (GLP-1 and GIPs) play a major role in glucose regulation post prandially.  Incretins are gut hormones that stimulate insulin release from the pancreas when glucose rises in response to food ingestion. They keep blood sugars in check as well as activating the satiety center, to increase the sense of fullness. Incretins slow gastric emptying and also curb post-meal glucagon release, decreasing post prandial glucose spikes. Unfortunately, people with type 2 diabetes, make less than half of the usual amount of the GLP-1 and GIP hormones, which contributes to chronically elevated glucose levels.

To date, therapies that have only included the Glucagon-Like Peptide-1 (GLP-1) have demonstrated major success in managing Type 2 DM.

By creating a formulation with BOTH the GIP and GLP incretin hormones, the A1C lowering and weight loss effectiveness has been significantly amplified.

First in Class – Dual Incretin Injectable Therapy

Tirzepatide is a novel synthetic peptide, engineered to provide a once-weekly injectable medication that acts on glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors.

Tirzepatide has been granted FDA approval for treatment of type 2 diabetes based primarily on a series of trials known as SURPASS. The SURPASS 1 trial compared increasing doses to evaluate dose response. The SURPASS 2-5 Trials compared tirzepatide to the GLP-1 semaglutide and to the basal insulins degludec and glargine. In all of the trials, the findings were impressive.

Summary of SURPASS Trials and Results based on Tirzepatide Package Insert.

  • SURPASS -1 Dose efficacy study ranging rom 5 to 15 mg, evaluating A1C and weight loss. Up to 85% of participants on tirzepatide achieved an A1C of less than 7%. A1C drop of 1.7% with 15mg dose. Weight loss of up to 7.8kgs.
  • SURPASS-2 Compared tirzepatide with patients on metformin to semaglutide. Up to 86% of participants on tirzepatide achieved an A1C of less than 7%. A1C drop of 2.3% with 15mg dose. Weight loss of up to 11.2 kgs.
  • SURPASS-3 Compared tirzepatide with patients on metformin, with our without an SGLT-2 Inhibitor to Insulin degludec. Up to 83% of participants on tirzepatide achieved an A1C of less than 7%. A1C drop of 2.1% with 15mg dose and weight loss of up to 11.3kgs.
  • SURPASS-4 Compared tirzepatide with people on metformin, and/or sulfonylureas and/or SGLT-2s with Insulin Glargine in people with increased cardiovascular risk. Up to 85% of participants on tirzepatide achieved an A1C of less than 7%. A1C drop of 2.4% with 15mg dose and weight loss of up to 10.6 kgs.
  • SURPASS-5 Compared tirzepatide vs placebo in people taking Insulin glargine with or without metformin. Up to 90% of participants on tirzepatide achieved an A1C of less than 7%. A1C drop of 2.4% with 10mg dose and weight loss of up to 10.5kgs.

Tirzepatide (Mounjaro) Indications and Dosing

This once a week injectable is for adults with type 2 diabetes as an adjunct to diet and exercise to improve glycemic control and support weight loss. Tirzepatide is delivered with a single dose prefilled pen.

Starting Dose: 2.5 mg SC every week for 4 weeks initially; THEN increase to 5 mg SC every week. If additional glycemic improvement is needed, increase by 2.5-mg increments after at least 4 weeks at current dose.

Note: The initial 2.5-mg dose is intended for treatment initiation and is not effective for glycemic control

Maximum dose: 15 mg SC qWeek

Common Adverse Side effects: Nausea, diarrhea, abdominal discomfort and injection site hypersensitivity reactions. There is also a black box warning to avoid if family history of medullary thyroid tumor and to report any signs of pancreatitis immediately.

Cost: Tirzepatide is comparably priced to other GLP-1 RAs on the market at $974.33 for four weekly doses, regardless of dose size. Hopefully, insurance companies will recognize the long term benefits of these newer classes of agents, and increase coverage of these beneficial treatment options.

In conclusion: This new medication class substantially lowers blood sugars and body weight, with a once a week injection. Coupled with healthy eating and keeping active, people with diabetes have the opportunity to improve their health and quality of life with this novel medication class.

Author’s note: Beverly Thomassian has no conflict of interest to report and distilled the content of this article from the SURPASS study results and the tirzepatide package insert.

*PocketCardsTM are for individual use only. 


Learn all about this new medication and other updates at our:

Virtual DiabetesEd Specialist Conference
30+ CEs | October 12-14, 2022

Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.

 Download Course Schedule |  Download Course Flyer

If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.

Join us LIVE for this Virtual Course and enjoy a sense of community!

Team of expert faculty includes:

  • Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
  • Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
  • Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator

Two Registration Options


Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

  • Q & A Session with the instructor after each webinar.
  • LIVE Presentations by our team of experts.
  • State of the art review of current diabetes care and technology.
  • Resources for each session.
  • Access to free podcasts and video recordings within a week of each live session for one year.

Deluxe Version includes Syllabus, Standards and Swag*:

  • Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
  • ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
  • DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

  • Q & A Session with the instructor after each webinar.
  • LIVE Presentations by our team of experts.
  • State of the art review of current diabetes care and technology.
  • Resources for each session.
  • Access to free podcasts and video recordings within a week of each live session for one year.

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!

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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.

High Dose Ozempic Superior at Dropping A1c & Body Weight

The injectable GLP-1 semaglutide (Ozempic) can now be dosed up to 2.0mg a week. This higher maximum dose provides greater reductions in body weight (6.9kgs vs 6.0kgs) and A1c (2.2 vs 1.9% ) when compared to 1.0 semaglutide dose. There was a comparable safety profile with both doses. However, more people experienced negative gastrointestinal side effects when receiving the higher dose (34% compared to 30.8%).

This is good news for people with type 2 diabetes who would like to benefit from both A1C and weight reduction. Plus, semaglutide lowers the risk of cardiovascular events.

Without insurance coverage, this medication costs about $1000 for a month’s supply. However, since semaglutide (Ozempic) is an established diabetes medication covered by many insurance plans, we are hopeful that people who would benefit from this therapy will have access to this higher dose.

The SUSTAIN FORTE trial lasted for 40-weeks and enrolled 961 patients with type 2 diabetes with an A1C of 8.0-10.0%. All patients in the trial initiated treatment with a 0.25 mg dose of semaglutide that was doubled every 4 weeks until the target dose was achieved.

In addition to reduction in A1C and body weight, the semaglutide 2.0 mg arm of the trial saw a greater proportion of patients achieve an A1C less than 7% (67.6% vs 57.5% [OR, 1.60; 95% CI, 1.21-2.13; P=.001]) or a body weight reduction greater than 5% (59.2% vs 51.3% [OR, 1.41; 95% CI, 1.08-1.84]) than the semaglutide 1.0 mg arm.

We have updated our Diabetes Medication PocketCard with this higher maximum dose or our website, CDCES Coach App, and printed PocketCards.


Studying for the CDCES Exam?

Enroll in CDCES Online Prep Bundle + 5th Ed ADCES Review Guide Book | 47 CEs

This bundle includes our CDCES Online Prep Bundle plus the ADCES Review Guide.

The online bundle includes Level 1, Level 2, and Level 3 (Boot Camp), plus two bonus courses. The ADCES Review Guide offers over 480+ practice questions and is a fantastic independent study tool and comprehensive resource for the Diabetes Care and Education Specialist Exam.


What is a Certified Diabetes Care and Education Specialist?

Read More: What is a CDCES?

First awarded in 1986, as Certified Diabetes Educator (CDE) credential and in 2020 with a new name: Certified Diabetes Care and Education Specialist (CDCES) to more accurately reflect the specialty. CDCES has become a standard of excellence for the delivery of quality diabetes education. Those who hold this certification are known to possess comprehensive knowledge of and experience in diabetes prevention, management, and prediabetes.

Becoming a Certified Diabetes Care and Education Specialist (CDCES) is one of the best professional and personal decisions I have ever made.” – Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM


Why become a CDCES?
Three Reasons from Coach Beverly

Read More: 3 Reasons to Become a CDCES

The best part of becoming a CDCES is working with my colleagues and people living with diabetes. As diabetes educators, we hear compelling and beautiful life stories. I am astounded by the barriers they face and inspired by their adaptability, problem-solving skills, and resilience.

– Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM

Reason 1: CDCES is a widely recognized certification by employers and health care professionals throughout the U.S.  This credential demonstrates a specialized and in-depth knowledge in the prevention and treatment of individuals living with pre-diabetes and diabetes.

Reason 2: Currently, 10% of people in the U.S. have diabetes and another 35% have pre-diabetes which means 45% of Americans are running around with elevated blood glucose levels.  Given this epidemic, there will be plenty of future job opportunities.

Reason 3: Having my CDCES along with my nursing degree, has opened many doors of opportunity; from working as an inpatient Diabetes Nurse Specialist in a hospital to working as a Manager of Diabetes Education in the outpatient setting to starting my own consulting company.


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.

Diabetes Meds do more than Lower Glucose & PocketCard Updates

Diabetes medications are not just about glucose management anymore

In the past, to determine the right medication for an individual, the primary focus was placed on the glucose-lowering impact. However, with the introduction of the SGLT-2 Inhibitors and GLP-1 RA’s, there has been a tremendous leap forward and expansion of expectations for the co-benefits of diabetes medications.

The SGLT2s and GLP1’s, are both associated with weight loss without the fear of hypoglycemia. They decrease the risk of cardiovascular events and also offer renal protection. In addition, the SGLT-2s are so effective at treating heart failure (HF), that they are now being used for people with HF without diabetes.

Keeping close tabs on UACR and GFR

A big shift in determining the optimal diabetes treatment now includes thoughtful evaluation of Urinary Albumin Creatine Ratio (UACR) and GFR.

In the past, we collected UACR and GFR yearly to monitor kidney function. Now we use the results of these tests to determine not only kidney function but the risk of heart disease and the best therapy for diabetes, kidney health, and hypertension.

Now, more than ever, we are compelled to evaluate urinary labs to determine the albumin to creatinine ratio and keep a close eye on GFR to determine best practices to not only extend lifespan but improve healthspan.

For more info on UACR and GFR, see our blog post, From Dipsticks to GFR – How to evaluate kidney function“.

PocketCards Update

Our updated Medication PocketCards reflect these shifts

In this latest version available for download and purchase, we have expanded and clarified the SGLT-2 considerations to reflect the changes in the 2022 ADA Standards of Care. We recognize that SGLT2 Inhibitors may be used as first-line therapy due to their additional benefits, “Along with metformin, SGLT-2s may be considered at first line diabetes therapy, especially for those with heart and kidney failure.” Since this class also slows the progression of chronic kidney disease, we also added, “for renal protection, use SGLT-2 Therapy if eGFR greater than or equal to 25 and UACR greater than or equal to 300.”

Download Updated PocketCards Here

Since the GFR cut-offs for this med class are changing frequently, we removed the GFR guidelines for individual SGLT2’s and encourage users to review the package insert for the most recent recommendations.

Over the past twenty years, there has been tremendous expansion in the availability of diabetes medications that not only lower glucose but help decrease the progression of common diabetes co-comorbidities.  In this evolving medication landscape, our Medication PocketCards capture the critical and current information you need for your clinical practice and certification exams.


Want to learn more about this topic?  Enroll in our

Meds Management for Type 2 Standards | 1.5 CEs

Recorded & Ready to Watch!

Coach Beverly will highlight the key elements of the latest Medication Guidelines by AACE and ADA. We will explore clinical factors to consider when determining the best strategy to improve glucose management in people with type 2 diabetes and other co-conditions. There will be a special focus on cardiovascular risk reduction and renal protection.

Objectives:

  1. Describe the role of Diabetes Care and Education Specialists in stopping clinical inertia
  2. Discuss using the latest ADA and AACE Guidelines to determine the best therapeutic approach.
  3. Using the ADA and AACE Guidelines, describe strategies to initiate and adjust injectable therapy.

Join us for our Virtual DiabetesEd Specialist Conference
30+ CEs | April 13-15, 2022

Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.

If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.

 Download Course Schedule |  Download Course Flyer

Join us LIVE for this Virtual Course and enjoy a sense of community!

Team of expert faculty includes:

  • Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
  • Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
  • Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator

 Download Course Schedule |  Download Course Flyer


Two Registration Options


Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

  • Q & A Session with the instructor after each webinar.
  • LIVE Presentations by our team of experts.
  • State of the art review of current diabetes care and technology.
  • Resources for each session.
  • Access to free podcasts and video recordings within a week of each live session for one year.

Deluxe Version includes Syllabus, Standards and Swag*:

  • Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
  • ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
  • DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

  • Q & A Session with the instructor after each webinar.
  • LIVE Presentations by our team of experts.
  • State of the art review of current diabetes care and technology.
  • Resources for each session.
  • Access to free podcasts and video recordings within a week of each live session for one year.
Enroll now in the Basic Virtual Conference | $399

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!

Sign up for DiabetesEd Blog Bytes

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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.

Is Metformin associated with Low B12 levels?

Metformin is one of the most widely dispensed oral diabetes medications for good reason. It works great, lowering A1c 1-2% points, with an added benefit of dropping LDL cholesterol levels. It doesn’t cause hypoglycemia or weight gain and it is incredibly cheap. Many pharmacies offer a 3 month supply of this highly effective glucose-lowering medication for $10 or less, and that’s without insurance. This medication also seems to boost the diversity of the gut microbiota, in particularly increased levels of the very beneficial Akkermansia muciniphila.

However, it does have a few drawbacks. A small group of people on metformin will experience a B12 deficiency. This B12 deficiency may manifest as neuropathic pain or anemia.

Plus, a percentage of people will experience upset stomach, bloating, and diarrhea. People with these complaints will often respond better to the extended-release version (metformin XR), which isn’t any more expensive and it can be taken once a day. See our Mediation PocketCards for more info.

How prevalent is B12 Deficiency with metformin?

Milk, eggs, yogurt, fortified cereals are good sources of vitamin B12.

Currently, the ADA Standards have no clear recommendation for checking B12 for those on metformin, but it does note that long-term metformin use is associated with B12 deficiencies and that “measuring B12 levels should be considered for those with type 1 diabetes, peripheral neuropathy or unexplained anemia”.

To add to this, a study published this month in Human Nutrition and Metabolism, found the prevalence of B12 deficiency appears to be about 17% in people on metformin therapy. The highest rates of B12 deficiency were seen in those taking metformin for 2 years. Moreover, vitamin B12 deficiency is influenced by the occurrence and duration of diabetes.

They also measured the intake of vitamin B12 in the daily diet of the study participants. Those with lower vitamin B12 blood levels were also consuming less foods rich in vitamin B12 in their daily meal plan.

Recommendations for Regular B12 Monitoring and Replacement

The authors of this article suggest that routine monitoring for vitamin B12 serum levels is needed in people with T2DM, particularly when metformin is used for more than 2 years with a dose of over 1000 mg per day. They also recommend further studies are needed to assess the correlation between metformin duration and dose and patients with T2DM and other metabolic syndromes.

B12 replacement therapy

This article, nor the ADA Standards recommend dosing for B12 replacement therapy. However, based on several articles, including this 2005 Cochrane review, high-dose oral replacement (1 mg to 2 mg per day) for B12 deficiency, seems to be as effective as parenteral B12 administration for correcting anemia and neurologic symptoms.

Conclusion – Vitamin B12 deficiency is associated with worsening nerve pain and anemia. Testing B12 levels for those on long-term metformin therapy, especially for those taking more than 1000 mg of metformin a day seems like a reasonable approach. Increasing the intake of foods high in vitamin B12 and providing oral B12 replacement therapy of 1 mg to 2 mg a day, are both helpful interventions to boost B12 levels.

Resources from our Article Library

Plant Based Eating Resources and Recipes

Carbohydrate Counting Resource Page


Want to learn more about this topic?  Enroll in our


Meds Management for Type 2 Standards | 1.5 CEs

Recorded & Ready to Watch!

Coach Beverly will highlight the key elements of the latest Medication Guidelines by AACE and ADA. We will explore clinical factors to consider when determining the best strategy to improve glucose management in people with type 2 diabetes and other co-conditions. There will be a special focus on cardiovascular risk reduction and renal protection.

Objectives:

  1. Describe the role of Diabetes Care and Education Specialists in stopping clinical inertia
  2. Discuss using the latest ADA and AACE Guidelines to determine the best therapeutic approach.
  3. Using the ADA and AACE Guidelines, describe strategies to initiate and adjust injectable therapy.

Enroll in the entire
Level 2 | Standards of Care Intensive Series | 20 CEs | $199

2022 Updates Airs March 17 – May 26, 2022

This bundle is specifically designed for healthcare professionals who want to learn more about the ADA Standards of Diabetes Care for their clinical practice or for those who are studying for the BC-ADM or the CDCES certification exam.


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 CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.


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.

From Med Updates to Successful DSME Programs | Webinars Begin March 17th

Join us for 3 exciting Webinars this month or sign up for our entire Level 2 Standards Bundle. As part of our Standards of Care Intensive, we take a deep dive into the content of each of the ADA Standards.


Setting up a Successful DSME Program Standards | Level 2 $29 | 1.5 CEs

Join us live Thursday March 17th at 11:30 am PST

Join us live on March 17, 2022, at 11:30 am PST for our Level 2 | Setting up a Successful DSME Program Standards live webinar

This course provides you with a succinct overview of the latest standards for Diabetes Self-Management Education (DSME) and 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 and simplified 2022 Standards and provide strategies on program implementation. In addition, we discuss Medicare Reimbursement and covered benefits. This course provides insights into the exam philosophy and also highlights critical content areas.

Objectives:

  1. Describe DSME program examples from across the country.
  2. List the six standards for creating a successful DSME program
  3. Discuss marketing strategies for success
  4. Describe Medicare Reimbursement for diabetes care and education

Lower Extremity Assessment Standards | Level 2
$29 for 1.5 CEs

Join us live Tuesday March 22nd at 11:30 am PST

Join us live on March 22, 2022, at 11:30 am PST for our Level 2 | Lower Extremity Assessment Standards live webinar

People with diabetes are at increased risk of Lower Extremity Complications. This course reviews the steps involved in performing a detailed assessment of the lower extremities, including how to use a monofilament and tuning fork to detect neuropathy. We also discuss the significance of Ankle Brachial Index and strategies to prevent lower extremity complications.

Objectives:

  1. Describe the risk factors for lower extremity complications
  2. Discuss prevention strategies
  3. Demonstrate steps involved in a lower extremity assessment

Meds Management for Type 2 Standards | 1.5 CEs

Join us live Thursday March 24th at 11:30 am PST

Join us live on March 24, 2022, at 11:30 am PST for our Level 2 | Meds Management for Type 2 Standards live webinar

Coach Beverly will highlight the key elements of the latest Medication Guidelines by AACE and ADA. We will explore clinical factors to consider when determining the best strategy to improve glucose management in people with type 2 diabetes and other co-conditions. There will be a special focus on cardiovascular risk reduction and renal protection.

Objectives:

  1. Describe the role of Diabetes Care and Education Specialists in stopping clinical inertia
  2. Discuss using the latest ADA and AACE Guidelines to determine the best therapeutic approach.
  3. Using the ADA and AACE Guidelines, describe strategies to initiate and adjust injectable therapy.

Enroll in the entire
Level 2 | Standards of Care Intensive Series | 20 CEs | $199

2022 Updates Airs March 17 – May 26, 2022

This bundle is specifically designed for healthcare professionals who want to learn more about the ADA Standards of Diabetes Care for their clinical practice or for those who are studying for the BC-ADM or the CDCES certification exam.


Virtual DiabetesEd Specialist Conference
30+ CEs | April 13-15, 2022

Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.

If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.

Join us LIVE for this Virtual Course and enjoy a sense of community!

Team of expert faculty includes:

  • Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
  • Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
  • Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator

Two Registration Options


Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

  • Q & A Session with the instructor after each webinar.
  • LIVE Presentations by our team of experts.
  • State of the art review of current diabetes care and technology.
  • Resources for each session.
  • Access to free podcasts and video recordings within a week of each live session for one year.

Deluxe Version includes Syllabus, Standards and Swag*:

  • Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
  • ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
  • DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

  • Q & A Session with the instructor after each webinar.
  • LIVE Presentations by our team of experts.
  • State of the art review of current diabetes care and technology.
  • Resources for each session.
  • Access to free podcasts and video recordings within a week of each live session for one year.
Enroll now in the Basic Virtual Conference | $399

2022 Live Webinar Events

See Full Calendar for upcoming webinars and Virtual Courses.

Can’t make it live? All paid registrants are guaranteed access to the video presentation, handouts and podcasts.


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 CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

Celebrating Martin Luther King Jr. – A Day of Service and Reflection

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

This quote, by Martin Luther King Jr., reflects his conviction that justice for all includes access to health care.

People with diabetes are more likely to struggle with food insecurity and lack adequate resources to pay for medications and diabetes supplies.

As Diabetes Specialists, we honor Dr. King’s words by advocating for affordable diabetes care, medications, and access to nutritious foods.

During these challenging times, I am comforted by his resonant statement  “The arc of the moral universe is long, but it bends toward justice.”

On this day of national celebration and service, we thank Dr. King for being a beacon of light and clarity. 

With Gratitude,
Coach Beverly


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PocketCard Updates – Concentrated Insulin and GFR Guidelines for SGLT2s

Did you know that Toujeo U-300 insulin pens are good for 56 days once opened? And that the max dose for Tresiba U-200 FlexTouch Pen is 160 units?

For our latest version of our printed PocketCards, we now include the number of pens in a box, max injection dose, total insulin amount per pen, and shelf life on the Concentrated Insulin Card. We also added Lyumjev KwikPen u200 insulin.

When determining the best insulin for people taking concentrated insulins, shelf life, max dosing, and total units of insulin in each device are important considerations.

We have also updated the GFR parameters for SGLT2 Inhibitors. This class of medication not only substantially lowers blood glucose but also has a profound impact on renal protection.

As more trial data become available, the GFR cutoff levels may change, so periodically refer to the package insert (PI) or our DES electronic pocket care version, for the most up-to-date information.

We update the printed version of our PocketCard once or twice a year.

We update our electronic PocketCard on an ongoing basis.
Fortunately, we can immediately update our electronic version of the PocketCard on our website and CDCES Coach App to reflect the latest medication recommendations and guidelines. In the electronic version, we also include that the GLP-1 Exenatide (Bydureon) is now approved for peds, age 10 and older and the GFR cut-off for empagliflozin is now approved for a GFR 30 or greater (please see package insert for details).


Preparing for the BC-ADM Exam Free Webinar – What you need to know

Becoming Board Certified in Advanced Diabetes Management (BC-ADM) provides an opportunity for diabetes specialists with an advanced degree in their field (plus a professional license as an advanced practice nurse, registered dietitian, registered pharmacist, or provider) to increase the breadth and depth of their diabetes knowledge. The scope of advanced diabetes practice includes management skills such as medication adjustment, medical nutrition therapy, exercise planning, counseling for behavior management, and psychosocial issues.

Attaining optimal diabetes management includes using a person-centered approach coupled with assessment, screening, management, and monitoring of acute and chronic diabetes co conditions. This webinar will review changes in requirements for 2021, exam eligibility and test format, strategies to succeed along with a review of study tips and test-taking tactics. We will review sample test questions and the reasoning behind choosing the right answers. We hope you can join us for this webinar.  


2021 Live Webinar Events

See Full Calendar for upcoming webinars and Virtual Courses.

Can’t make it live? All paid registrants are guaranteed access to the video presentation, handouts and podcasts.


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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 CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

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