Diabetes Intensive with Dana Armstrong, RD, CDCES | Medical Nutrition Therapy + Meal Planning

Join Dana Armstrong, RD, CDCES, a trailblazer and thought leader, for a lively and intensive review of the latest in Medical Nutrition Therapy with immediate application to your clinical practice.

Dana combines the newest findings, her clinical experiences, plus the ADA Standards of Care into an action-packed presentation that will inform your practice while preparing for the certification exam.

Virtual MNT Course Dates:

Session 1 May 27 | Medical Nutrition Therapy Overview | Ready for Viewing!

Session 2 May 27| Meal Planning – How to Eat by the Numbers | Ready for Viewing!

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$69 | Earn 4.0 CEs

Course Description:  These two 2-hour courses review the latest national nutrition guidelines and provide strategies to translate this information to an individual living with diabetes.

Included is a discussion on different approaches to meal planning and the benefits and limitations of each. Dana will also review metabolic surgery, gastroparesis, and disordered eating.

She reviews nutrition approaches during pregnancy and for those living with chronic co-conditions. Dana also provides insights on how to support the transition to healthier eating using a “tasteful” approach.

Objectives:

1. Prioritize person-centered nutrition issues based on assessment and clinic data.
2. Explore national guidelines for medical nutrition therapy and how to individualize interventions from a person-centered perspective.
3. Describe the impact of micro and macronutrients on health.
4. List different meal planning approaches and the pros and cons of each.
5. Describe how to help people with diabetes to read labels and be thoughtful consumers.
6. State how to customize nutritional approaches in people living with complications of diabetes.

Speaker Bio for Dana Armstrong, RD, CDCES

We are thrilled to welcome our guest speaker, Dana Armstrong, who will be joining our Virtual and Live Courses!

Dana received her degree in nutrition and dietetics from the University of California, Davis, and completed her internship in dietetics at the University of Nebraska Medical Center in Omaha. Dana is the Medical Clinic Director of The Diabetes Center/Salinas Valley Medical Clinic. She provides leadership for the Department of Diabetes Services and ensures coordination and integration of an effective system-wide Diabetes Center of Excellence across the organization for optimum patient care and collaboration of services.  Having a child with diabetes, she combines her professional knowledge with personal experience and understanding.

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These sessions are also included in our Virtual Conference.
Click here to enroll in the entire program.

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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.

To be honest. the vaccination recommendations for diabetes have been shrouded in a veil of mystery for me, until this year.

Thankfully, the 2022 ADA Standards are wonderfully clear in describing the vaccination schedule and types for people living with diabetes. We created this simple chart that you are free to download and share with your colleagues and in your work setting.

What percent of People with Diabetes Get Vaccinated?

Even though these vaccine recommendations are well established, I thought it would be interesting to find out what percentage of people actually get the complete compliment of recommended vaccinations.

According to the CDC data, among those with diagnosed diabetes, the vaccination coverage for influenza, pneumococcal, and shingles was lowest among lower income adults and varied by race and ethnicity. Hepatitis B vaccination coverage was lowest among poor adults, and it decreased with age.

As diabetes specialists, we can have a significant impact on encouraging people with diabetes to receive these important vaccinations. We can work within our health care systems to establish systems and surveillance to monitor vaccine participation. Partnering with community health workers and liaisons can create bridges to increase vaccination rates.

Vaccination Rates for People with Diabetes:

• Influenza vaccine, about 60% of people with diabetes get their annual shot.
• Pneumonia vaccine only 53% of people with diabetes have recieved this vaccine.
• Hepatitis Vaccine Series: Only 33.2% of people with diabetes have received their Hepatitis Vaccines as of 2018.
• Herpes Zoster Series: Only 27.2% adults 60 and older with diabetes had ever received their Herpes Zoster vaccine.
• HPV Vaccine: About 59% of people in the U.S. have completed their HPV vaccine series.

Given that most experts predict that severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) and influenza viruses will both be active in the U.S. during the 2021–2022 season, getting the influenza vaccine is especially important.

Most people don’t know that getting the Influenza vaccine decreases risk of death.

New data is revealing that the influenza vaccine doesn’t just lower the risk of getting the flu, it also lowers risk of all cause mortality and cardiovascular events and death. This simple annual intervention is recommended for all individuals with diabetes 6 months and older.

See Table 4.5 in ADA Standard 4, 2022 for complete info

• Read more CDC 2015 Report

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DiabetesEd Boot Camp | Level 3

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 BC-ADM or the CDCES certification Exam.

• February 8, 2022 – Class 1 – Diabetes – Not Just Hyperglycemia
• February 10, 2022 – Class 2 – Standards of Care & Cardiovascular Goals
• February 15, 2022 – Class 3 – Insulin Therapy – From Basal/Bolus to Pattern Management
• February 17, 2022 – Class 4 – Insulin Intensive – Monitoring, Sick Days, Lower Extremities
• February 22, 2022 – Class 5 – Meds for Type 2 – What you need to know
• February 24, 2022 – Class 6 – Exercise and Medical Nutrition Therapy
• March 1, 2022 –  Class 7 – Screening, Prevention, and Treatment of Microvascular Complications
• March 3, 2022 – Class 8 – Coping and Behavior Change 1.5 CEs
• March 8, 2022 – Class 9 – Test-Taking Coach Session (48 Questions) No CE

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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.

This time of year is always exciting as the new ADA Standards of Care are released.

The 2020 version incorporates these 2019 Living Standard Updates, along with a lot of additional information that impacts our practice.

Want more details on the 2020 Standards?

Those are just some of the highlights,but there is so much more to discover. Please join Coach Beverly on January 21st at 11:30 for her annual State of the Standards Live Webinar.

Save money buy purchasing the full Level 1 Bundle and join us for all of Level 1 as we update this month: see full schedule here.

For more information read our January News Updates – Now Available!

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Standards of Care Section 9 – Pharmacologic Approaches to Glycemic Treatment

Insulin Therapy for Type 1
This updated version of Meds Management includes more detailed information on insulin therapy for Type 1s. They note that the Diabetes Control and Complications Trial (DCCT) demonstrated that intensive therapy with multiple daily injections or insulin pump therapy reduced A1C and was associated with improved long-term outcomes. The study used short-acting and intermediate-acting human insulins. Since DCCT, rapid-acting and long-acting insulin analogs have been developed. These analogs are associated with less hypoglycemia, less weight gain, and lower A1C than human insulins in people with type 1 diabetes.

Type 2 Management Strategies – Pharmacologic Therapy of Type 2 Diabetes – 2019

Pharmacologic Approaches to Glycemic Treatment 2019.  This hyperglycemia road map details strategies to achieve glucose control for both Type 1 and Type 2 Diabetes. Section 9 of Standards of Care, January 2019.

Step 1 –

According to the ADA 2019 Standards, section 9, Metformin therapy should be started along with lifestyle management at diagnosis of type 2 Diabetes (unless contraindicated). Metformin is effective, safe, inexpensive and may reduce risk of CV events and death. If contraindicated, see figure 9.1 for alternatives.

Step 2

If A1c target is not achieved after 3 months, consider metformin and any one of the six preferred treatment options based on drug specific effects and patient factors. These factors include cardiovascular disease (ASCVD), congestive heart failure (CHF) or Chronic Kidney Disease (CKD). Plus, preventing hypoglycemia, weight gain and making sure medications are affordable.

If the patient has ASCVD, CHF or CKD, consider adding a second agent with evidence of cardiovascular risk reduction (based on drug specific effects and patient factors).

Medications indicated to improve CVD, CHF and CKD outcomes include:

• SGLT-2 Inhibitors – empagliflozin (Jardiance), canagliflozin (Invokana), dapagliflozin (Farxiga)
• GLP-1 Receptor Agonist – liraglutide (Victoza), semaglutide (Ozempic)

Step 3

If A1c target is still not achieved after 3 months, combine metformin plus two other agents for a three-drug combination. Drug choice should be based on avoidance of side effects such as hypoglycemia, weight gain, cost, and individual preference.

Step 4  

If A1c target is still not achieved after 3 months, add combination injectable therapy to the three-drug combination.

For all steps, consider including medications with evidence of CV risk reduction, based on drug specific effects and patient factors.

Medication Therapy Based on A1c

• Upon initial diagnosis of type 2, most can consider monotherapy
• If A1c is greater than or equal to 1.5% above target, consider dual therapy
• If A1c is greater or equal to 10%, or if BG 300 or more, or pt is markedly symptomatic (polyuria/polydipsia), consider insulin and injectable therapy.

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Want to learn more about this topic?

• Meds Management Update Ready for On Demand Viewing!
• Join our Standards of Care Webinar – Jan 21, 2020
• Download our FREE Medication PocketCards (Or order any quantity with FREE shipping!)
• Download CDE Coach App – FREE

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