Question of the Week | Low carb diets and SGLT-2’s a good mix?
ST is a 56-year-old presenting for MNT and diabetes education. Their last A1c was 7.4%, and they are currently taking 1000 mg of Metformin and 10 mg of empagliflozin daily for glucose management. They recently read that a very low-carbohydrate eating pattern can help individuals with type 2 diabetes reduce A1C and the need for additional medications and are motivated to implement diet changes.
What would be your primary considerations and guidance in response to ST?
- ST is motivated for change, encourage their desire to implement a very low-carbohydrate diet as it is safe for all individuals with diabetes.
- ST should avoid a very low-carbohydrate diet.
- A very low-carbohydrate diet may be appropriate if ST transitions off the SGLT2 inhibitor.
- ST should follow a fixed carbohydrate intake at each meal to align with their medication regimen.
Want to learn more about this question?
Check out these upcoming class offerings!
All hours earned count toward your CDCES Accreditation Information
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
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 | A1C 13.6% – Next Important Step?
KT is a 17-year-old with newly diagnosed diabetes and an A1C of 13.6%. The provider starts KT on 30 units of basal insulin and 10mg empagliflozin (Jardiance). KT is asked to get C-peptide levels checked and their C-peptide level is 0.9 ng/mL.
Based on this information, what is the next most important step?
- Add bolus insulin and stop empagliflozin
- Discuss the importance of starting CGM
- Evaluate auto immune markers
- Decrease basal insulin and start metformin
Interested in becoming a CDCES but not sure where to start?
Our 2-Step FREE Webinars Series Will Guide You
Our FREE webinars will help you discover the steps required to become a CDCES and will transform your test anxiety into calm self-confidence and test-taking readiness.
- Want to learn more about the qualifications to take the CDCES exam? Register for our Free “Becoming A Diabetes Specialist” Step 1 Webinar.
- Taking the CDCES Exam in the next 6 months? Register for our Step 2, “Prep to Take the CDCES Exam” Free Webinar.
Step 1: Becoming a Diabetes Specialist (CDCES)
If you are a health care professional considering becoming a CDCES and want to learn more about eligibility and benefits of joining the Diabetes Education Community, this FREE webinar is for YOU. Coach Beverly will provide clarification on requirements, exam content, and study strategies to prepare for success.
Step 1: Webinar Topics
- Benefits of becoming a CDCES
- CDCES eligibility requirements for 2025
- Exam outline and study strategies to succeed
2025 Step 1 Webinar
Handouts
Step 2: Preapring to Take the CDCES Exam
We will review examination process, sample test questions, and the reasoning behind choosing the BEST answers.We will review examination process, sample test questions, and the reasoning behind choosing the BEST answers.
Step 2: Webinar Topics
- Test content updates for 2025
- Strategies to experience exam success
- Review of study tips and test taking practice questions
2025 Step 2 Webinar
Handouts
Can’t join us live?
Don’t worry, if you register, we will send you a link to the recorded version.
Instructor
Coach Beverly Thomassian, RN, MPH, BC-ADM, CDCES
Author, Nurse, Educator, Clinician, and Innovator, Beverly has specialized in diabetes management for over twenty years and has successfully passed the CDCES exam six times. As president and founder of Diabetes Education Services, Beverly is dedicated to optimizing diabetes care and improving the lives of those with diabetes.
“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
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Question of the Week | Best Action to Avoid Thanksgiving Post Meal Elevation?
JR is excited about enjoying Thanksgiving with family but is a little worried about post-Thanksgiving meal blood sugar elevations. JR takes 1 unit bolus insulin for every 10 gms of carb, with a correction factor of 1 unit for every 50 points above 120, plus 23 units of basal insulin at night. For Thanksgiving JR plans to eat:
- 1 cup of mashed potatoes
- Spoonful of green beans
- Gravy
- 1 Roll with lots of butter
- ½ cup of sweet potatoes
- Turkey leg
- A glass of white wine
If JR’s blood Sugar is 173 before the meal, what is the best approach?
- Decrease carbs by half and increase intake of high fiber vegetables.
- Take about 7-8 units bolus insulin before the meal.
- Increase basal the night before to prevent post meal elevation.
- Take bolus insulin after meal based on blood sugar response.
Want to learn more about this question?
Register for these FREE courses today!
Why Attend These Webinars?
All hours earned count toward your CDCES Accreditation Information
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
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 | Reluctant to Start Metformin due to Side Effects
LS is reluctant to start on metformin because they heard it can cause diarrhea and kidney problems. You reassure LS that metformin doesn’t harm the kidneys and can actually improve gut health.
Based on the most recent evidence, which of the following is true?
- Hold metformin if the GFR is less than 45 and the person has an occasional alcoholic beverage.
- Metformin increases the growth of bacteria like Akkermansia muciniphila.
- Most people with metformin experience diarrhea, so make sure to increase fiber intake when starting.
- Start vitamin B12 therapy and iron supplements with initiation of metformin.
Want to learn more?
Check out our Free Webinars for the month of November.
All hours earned count toward your CDCES Accreditation Information
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
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 | Diabetes Risk with Statin Use
Question of Week
LC is a 49-year-old living with type 2 diabetes and reports during their appointment they have stopped their statin because of concern over risk of type 2 diabetes incidence with statin use.
Using the ADA Standards of Care as a guide, what would be the best response to LC concerns?
- Your concern is valid, but restarting the statin is mandatory. Everyone with type 2 diabetes should be on one without exception.
- While statins may slightly increase the risk of type 2 diabetes, their benefits in preventing cardiovascular events outweigh the risks for most people. Let’s talk about your personal risks and explore if continuing a statin is right for you.
- Stopping your statin was a good idea. There are other medications that don’t carry any risk of increasing diabetes incidence.
- We can focus solely on lifestyle changes to manage both your cholesterol and diabetes.
Want to learn more about this question?
Join us live on November 13, 11:30 am PST for our
FREE Prep for CDCES Exam Webinar
Join us to get ready to succeed a the CDCES Exam. This course will transform your test anxiety into calm self-confidence and test taking readiness. Topics covered include:
- Changes in requirements for 2024
- Exam eligibility and the updated test format
- Strategies to succeed
- Review of study tips and test taking tactics.
We will review sample test questions, and the reasoning behind choosing the right answers.
After registering, you will receive a confirmation email containing information about joining the webinar.
Intended Audience: This FREE webinar is 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 achieving excellence in diabetes care and becoming Certified Diabetes Care and Education Specialists®.
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator who has passed her CDCES Exam 7 times. She is a nationally recognized diabetes expert for over 25 years.
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
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 Approach Considers Cultural Humility
You are caring for ML, a Latinx person with newly diagnosed diabetes about lifestyle modifications. ML mentions that traditional family dinners are a central part of their daily routine.
How can the educator apply cultural humility in their approach to diabetes education to support ML’s dietary needs and preferences?
- Advise the ML to avoid traditional foods that are higher in carbohydrates.
- Ask ML about the traditional types of foods they typically eat and enjoy.
- Provide a standardized meal plan considering cultural food preferences.
- Emphasize the importance of monitoring carb intake regardless of cultural traditions.
Want to learn more about this question?
Join us live on November 13, 11:30 am PST for our
FREE Prep for CDCES Exam Webinar
Join us to get ready to succeed a the CDCES Exam. This course will transform your test anxiety into calm self-confidence and test taking readiness. Topics covered include:
- Changes in requirements for 2024
- Exam eligibility and the updated test format
- Strategies to succeed
- Review of study tips and test taking tactics.
We will review sample test questions, and the reasoning behind choosing the right answers.
After registering, you will receive a confirmation email containing information about joining the webinar.
Intended Audience: This FREE webinar is 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 achieving excellence in diabetes care and becoming Certified Diabetes Care and Education Specialists®.
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator who has passed her CDCES Exam 7 times. She is a nationally recognized diabetes expert for over 25 years.
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
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 | Type 1 and Food Insecurity
AR is an 8 year old with type 1 diabetes who has a CGM but still uses insulin injections due to lack of insurance coverage. AR’s parents struggle with food insecurity and some days AR only has school provided breakfast and lunch. You notice he is experiencing level 1 hypoglycemia frequently around 6pm.
What is the best first intervention?
- Reassess the insulin dosing strategy.
- Double check that the family has a glucagon emergency kit.
- Reduce insulin dose and start a SGLT-2i to prevent hypoglycemia.
- Make sure AR is wearing identification that says they have type 1 diabetes.
Want to learn more about this question?
Join us live on October 29th 2024 11:30 am PST for our
The Impact of Adverse Childhood Experiences on Health
Level 4 Advanced Specialty Topics
Adverse childhood experiences (ACE) are associated with an increased risk of diabetes, heart disease, cancer & a variety of other health consequences for adults. This session reviews how diabetes care & education specialists can provide screening, assessment, & trauma-informed care to individuals who experienced ACEs & are living with toxic stress. We will explore strategies to address ACES & improve outcomes for individuals & communities. Throughout, we will focus on supporting self-care with a focus on recognizing & promoting resilience.
Topics include:
- Discuss the benefits of assessing Adverse Childhood Experiences (ACE) in individuals with diabetes.
- State the relationship between ACE Scores & the risk of future health complications.
- Describe a person-centered approach to fostering resilience & self-care for individuals with toxic stress.
- Identify two strategies to provide trauma-informed care in your work setting.
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 knowledge of management of inpatient hyperglycemia.
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator and a nationally recognized diabetes expert.
Two registration options:
- Enroll for FREE (No CEs): Click here to enroll.
- Earn 0.5 CEs – Fee: $19.00 – Click here to enroll in the course.
Enroll in our entire Level 4 | Advanced & Specialty Topic Courses
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our Level 4 | The Impact of Adverse Childhood Experiences on Health awards 1.0 CPEUs in accordance with the Commission on Dietetic Registration’s CPEU Prior Approval Program.
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 | Jr arrives late and out of sorts.
JR is a 22-year-old living with type 1 diabetes who arrives late for their appointment and seems out of sorts. When looking at the ambulatory glucose profile, you notice that time in range is less than 40% and coefficient of variation is also over 40%. You remember from a previous visit that JR had experienced almost half a dozen adverse childhood experiences and had elevated diabetes distress.
Based on this information, what is the next best step?
- Use the empowerment approach to help JR take charge of their life.
- Request that JR is referred to a mental health specialist.
- Utilize motivational interviewing techniques to help JR through this rough spot.
- Create a judgement free zone and explore with JR how they are feeling.
Want to learn more about this question?
Join us live on October 29, 2024 for our
The Impact of Adverse Childhood Experiences on Health
Level 4 | Advanced & Specialty Topic Courses
Adverse childhood experiences (ACE) are associated with an increased risk of diabetes, heart disease, cancer & a variety of other health consequences for adults. This session reviews how diabetes care & education specialists can provide screening, assessment, & trauma-informed care to individuals who experienced ACEs & are living with toxic stress. We will explore strategies to address ACES & improve outcomes for individuals & communities. Throughout, we will focus on supporting self-care with a focus on recognizing & promoting resilience.
Objectives:
- Discuss the benefits of assessing Adverse Childhood Experiences (ACE) in individuals with diabetes.
- State the relationship between ACE Scores & the risk of future health complications.
- Describe a person-centered approach to fostering resilience & self-care for individuals with toxic stress.
- Identify two strategies to provide trauma-informed care in your work setting.
Learning Outcome:
Participants will identify how trauma can impact diabetes and self-management along with strategies to support hope when working with people with diabetes.
Target Audience:
This course is a knowledge-based activity designed for individuals or groups of diabetes professionals, including RNs, RDs/RDNs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other healthcare providers interested in staying up to date on current practices of care for people with prediabetes, diabetes, and other related conditions. The practice areas for RDs/RDNs for CDR reporting are healthcare, preventative care, wellness, and, lifestyle along with, education and research.
CDR Performance Indicators:
- 9.2.1
- 9.2.3
- 9.4.3
Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 15 years. She is an Associate Clinical Professor at UCSF, a working educator, and a nationally recognized diabetes expert.
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our Level 4 | The Impact of Adverse Childhood Experiences on Health awards 1.0 CPEUs in accordance with the Commission on Dietetic Registration’s CPEU Prior Approval Program.
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.
![](/wp-content/uploads/2023/01/insta-png-v5.png")
