
JR is taking Metformin 1000mg BID but is worried about getting cancer and is thinking about stopping the metformin.
Which of the following is an accurate statement regarding diabetes and cancer?
Click here to test your knowledge!
Want to learn more about this topic? Enroll in our
Level 4 | Cancer & Diabetes | 1.25 CEs

Patients with cancer often experience hyperglycemia secondary to treatment, which can increase risk of infection and compromise their nutritional status. In addition, recent research has identified the link between diabetes and cancer. Join us to learn more about this unexpected link and treatment strategies for steroid induced hyperglycemia using a case study approach.
Topics Include:
Can’t make it live? All paid registrants are guaranteed access to the video presentation, handouts and podcasts.
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!
[yikes-mailchimp form=”1″]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.

Happy June!
Coach Beverly is feeling grateful
For this newsletter, I am practicing my gratitude out loud and sharing it with you all.
Here are 7 things I am grateful for:
In this newsletter, we address topics ranging from hemoglobinopathies to inclusion to new glucagon meds.
Bryanna and I had a lot of fun putting this newsletter together because it rings so true to the mission of our company; to be inclusive and welcoming, to celebrate each individual while leaving judgment behind. To lift each other up, especially during hard times. To offer hope, promote curiosity, and let you always know that we believe in you.
Happy June everyone,
Coach Beverly, Bryanna, and Jackson
Click here to read our full June 2021 newsletter.
Featured Blogs
Featured Items
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!
[yikes-mailchimp form=”1″]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.

For our May 25th Question of the Week, 71% of respondents chose the best answer, which is awesome! However, for safety and teaching purposes, we still want to “take a closer look” at this question at aim for 100% correct responses the next go around.
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question
Question: Mr. J is started on 100 units U-500 twice a day.
Which of the following administration techniques would ensure he gets the right dose?
Answer Choices:

As shown above, the most common choice was option 3, the second most common answer was option 2, then option 4, and finally option 1.
If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. The exam will present questions that require test takers to be familiar with accurate dispensing of diabetes medications, injectables and insulins, including the concentrated versions.
Answer 1 is incorrect, 7.11% chose this answer, “Using a U-100 syringe, withdraw 100 units.” This answer is wrong because when withdrawing U-500 insulin from a vial, a U-500 insulin syringe must be used (see image). Since U-500 insulin is 5x’s the concentration of U-100 insulin, drawing up 100 units of U-500 insulin in a U-100 syringe would deliver 500 units of insulin (or 5x’s too much and could be life threatening). See Concentrated insulin card below.
When using a U-500 syringe, no conversion is needed since the syringe automatically delivers the correct dose of U-500 insulin. No conversion, calculations or adjustments required.
Answer 2 is incorrect, 12.64% of you chose this answer, “Using a U-500 syringe, withdraw 20 units.” When using a U-500 syringe, no conversion is needed since the syringe automatically delivers the correct dose of U-500 insulin. No conversion, calculations or adjustments required. For example, if the order reads “100 units of U-500 concentrated insulin twice a day”, using a U-500 syringe, the person would withdraw 100 units of U-500 insulin.
Answer 3 is correct, 71.25% of you chose this answer, “Using a U-500 pen, dial to 100 units.” YES, GREAT JOB! If the order reads “100 units of U-500 concentrated insulin twice a day”, using a U-500 pen, the person would dial to 100 units of U-500 insulin. The pens automatically deliver the correct dose in less volume. No conversion, calculations or adjustments required.
Answer 4 is incorrect, 9.00% of you chose this answer, “Using a U-500 pen, covert to 20 units.” When using a U-500 pen, no conversion is needed since the U-500 pen is specifically created to deliver the correct dose of U-500 insulin. For example, if the order reads “100 units of U-500 concentrated insulin twice a day”, using a U-500 pen, the person would dial to 100 units of U-500 insulin.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
Want to learn more? Enroll in our
We are so excited to expand our Level 4 – Advanced Level & Specialty Topics Series!

Our Level 4 specialty courses are designed to address topics that not only enhance the clinical practice but also prepare participants to take the Board Certification in Advanced Diabetes Management (BC-ADM) exam. The fast-paced content is designed to fulfill curiosity, build on previous significant diabetes care experience and support your journey toward expanding your diabetes knowledge.
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!
[yikes-mailchimp form=”1″]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.
Wow! This is fantastic news. I sit for the CBCDE Exam for the 7th time next year, and I am definitely going to take advantage of this remote feature! ~ Coach Beverly
The Certification Board for Diabetes Care & Education (CBDCE) is now offering the opportunity to take your Certified Diabetes Educator (CDCES) exam remotely!
By the end of this year, you will have the option to take your certification exam using their new Live Remote Online Proctoring (LRP) platform.

LRP is a secure and non-invasive platform that uses professional proctors and technology to monitor candidates live while they complete the Certification Examination for Diabetes Care and Education Specialists (Exam). This method of test delivery allows the candidate to take the exam from their home, office or a remote site, using their own computer. The process is secure, easily accessible, and monitors testing activity and records all aspects of the exam testing session.
During your exam appointment, you will be connected with a moderator who will guide you through the process and be there throughout your entire exam. You will need to share your screen and broadcast yourself during your entire exam. Your workspace should be quiet, tidy, and free of any study notes/materials.
No electronics, besides the computer you are taking the test on are allowed. However, since there may be math questions, a basic calculator is allowed after clearance by the moderator. A 10-minute break is an option, but no changes to completed test questions are allowed after the break. In addition, the moderator will need to rescan your workspace to make sure it is free of study notes and materials. After you take the exam, you will instantly get a report of your results.
To connect to the LRP platform, you will need a computer with a webcam and microphone. The CBDCE recommends that you run compatibility tests before your exam to ensure your equipment is compatible.
To learn more about LRP, watch the 4-minute video below and read the Guide to Live Remote Online Proctoring (LRP)

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:
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 individuals 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®.
Can’t make it live? All paid registrants are guaranteed access to the video presentation, handouts and podcasts.
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!
[yikes-mailchimp form=”1″]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.

JR is 43 years old with newly discovered type 2 diabetes.
According to the ADA Standards, which of the following actions needs to be taken with a new type 2 diabetes diagnosis?
Click here to test your knowledge!
Want to learn more about this topic? Enroll in our

This 2 hours course provides a detailed overview of the pathophysiology of type 2 diabetes, prevention strategies, and cardiovascular risk reduction. In addition, we highlight type 2 treatment approaches including nutrition, activity, oral and injectables medications plus screening and treatment guidelines for micro and macrovascular disease. Through case studies and discussion, we highlight strategies to focus on a person-centered approach along with attention to psychosocial care for people living with diabetes.
Objectives:
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!
[yikes-mailchimp form=”1″]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.

For our May 18th Question of the Week, 76% of respondents chose the best answer, which is awesome! We still want to “take a closer look” at this question.
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question
Question: CT was diagnosed with type 2 diabetes three years ago. The current medication regimen includes 1000 mg of metformin twice daily and 70 units of glargine at night. CT wears an intermittent sensor, and you look at the glucose trends together on CT’s phone app. You both agree that there are consistent postmeal spikes up to 250 almost every day after lunch and dinner. The lowest blood sugar readings are in the 100s. BMI is 33.8 and CT says, “I never feel full”. The most recent A1C is 8.2%, urinary albumin creatinine ratio less than 30.
Based on this information, what intervention would be most likely help CT get to recommended ADA targets?
Answer Choices:

As shown above, the most common choice was option 2, the second most common answer was option 4, then option 3, and finally option 1.
If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. The exam will present questions that require test takers to be familiar with the stepwise approach to type 2 diabetes management in a variety of settings and situations.
For a complete listing of diabetes medications, please Download our Medication PocketCards.
Answer 1 is incorrect, 2.51% chose this answer, “Add on low-dose sulfonylurea to prevent hypoglycemia.” Although we might consider this option, we can quickly identify a “tacked on” second half of the answer that makes it a wrong choice. One of the major side effects of sulfonylureas is hypoglycemia, so adding this class of medication wouldn’t prevent hypoglycemia, it would actually increase the risk of low blood sugars.
Answer 2 is correct, 76.57% of you chose this answer, “Suggest adding a GLP-1 Receptor Agonist.” GREAT JOB! Given the fact that CT is on 70 units of basal plus metformin and is experiencing postmeal spikes up to 250 almost every day after lunch and dinner and “never feels full”, adding a GLP-1 is the best choice. Adding a GLP-1 will decrease post meal hyperglycemia and postprandial glucose. In addition, GLP-1s can decrease appetite and increase feelings of satiation. Before suggesting addition of this medication class, it is important to consider insurance coverage and out of pocket cost, since cost could be a barrier.
Answer 3 is incorrect, 9.83% of you chose this answer, “Hold metformin, and switch to basal-bolus therapy.” According to the ADA, when initiating basal bolus insulin therapy for people with type 2 diabetes, they recommend continuing metformin to decrease insulin resistance. The ADA also suggests considering adding a GLP-1 RA or SGLT-2 Inhibitor before switching to basal bolus therapy.
Answer 4 is incorrect, 11.09% of you chose this answer, “Encourage CT to get more active, especially after meals.” While activity is important, this goal is very vague and not really actionable. In addition, “getting active after meals” will certainly improve health and is a great recommendation, but is not likely to drop the A1c to less than the goal of 7% or help with appetite.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
Want to learn more about this topic? Join us for our upcoming

Why are glucose levels elevated in the morning? When should insulin be started? What is the next step to get A1c to target?
During this course Coach Beverly addresses each of these glucose mysteries and more, using a person-centered approach. She describes a stepwise approach to evaluate glucose patterns and correct common issues encountered by people living with type 2 diabetes.
By attending this webinar, you will gain confidence in evaluating glucose patterns and making recommendations for improvement.
Objectives
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!
[yikes-mailchimp form=”1″]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.
For the past year, as the only diabetes nurse educator at a local FQHC clinic, I have had to fine-tune my nutrition coaching skills. We are hoping to hire a dietitian soon, but in the meantime, I am trying to find my nutrition groove as I work with Spanish-speaking clients, kids to elders, and everyone in between.
For many years, I shied away from using the plate method and mostly relied on dietary recalls and figuring out changes needed to improve the health quotient of their current meal plan.
However, as people walk into my clinic room, I am surprised by how many are drawn to the oversized healthy plate place-mats sitting on my display table. They ask, “Can I eat these foods?” This sparks a lively and constructive conversation on new approaches to eating.
Based on this enthusiastic response, after I complete the dietary recall, I jump into our food conversation using the plate method. Whether am I coaching kids to elders on healthy eating, this approach seems to get the best response. If needed, I will dive into more detail around carb serving sizes and matching carbs to insulin.
Using the plate method allows me to keep it person-centered and help them include their favorite foods to maintain the pleasure of eating.
This teaching tool is ideal because it has appealing pictures of the different foods that make it easy to provide a quick review of the food groups and their impact on blood sugars and overall health.
In addition, these plates represent a variety of cultures and eating styles, and come in several languages. Here is the one in Spanish I use all the time.

Take a vegetable tour: I start on the left side of this place mat, which has pictures of a variety of healthy high fiber vegetables, which I emphasize are low in calories and packed with nutrients. Then I ask which vegetables are they currently eating and provide encouragement to continue and expand their veggie choices, if possible. “Enjoy an abundance of these super foods, that fill you up, feed your good bacteria, decrease inflammation, help manage blood sugars and support a healthy weight.”
Next stop – CARBS and Beans – There is a lot of misinformation around the carbohydrate group and many people tend to lump them in the “bad food” category. We discuss the carbs they are consuming and discuss some they might be missing out on, like fruits or tortillas, thinking they were off-limits. I encourage 3 servings of fruit daily, (the size of a closed fist) spread throughout the day.
Beans, the magical fruit! I make an intentional effort to sing the praises of beans. They are the inexpensive, fiber-packed nutrition superstars and they are so versatile.
A big focus with carbs is portion sizes. The actual amount of carbs someone is consuming is really easy to underestimate. For this part, I DO pull out my rubber food models, which are as popular as ever.
Canned and Frozen veggies are good for you. Many people may not have access to fresh vegetables or refrigeration. Canned vegetables and soups are often a cheaper, more realistic option. They can choose low sodium if they have hypertension or they can rinse off salty, often less expensive canned vegetables. If they have access to a freezer, frozen veggies offer as many nutrients (and sometimes more) than fresh vegetables, especially if they have been on the shelf for a while.
I encourage starting meals with soups, salads, or water if they are trying to lose weight.
Protein and meats – Our discussion focuses on serving sizes and healthy ways to prepare low fat or skinless meats. If their LDL cholesterol is above target, we will include a discussion on meat alternatives and review cheese consumption.
Sugary Beverages, Sweet Treats, and Snacks – Coffee with a little cream and sugar is fine, but those coffee drinks topped with whip cream can pack lots of carbs and unwanted calories. Replacing sports drinks and sodas with water or unsweetened tea can make a huge difference in glucose levels and body weight.
Mindless muching. I find many people munching on snacks and sweet treats (especially in the evenings) out of boredom or in response to stress. Helping people ask themselves, “Am I really hungry?” before that first bite can make a big difference. Also keeping track of the emotion associated with “mindless snacking” can help people discover other strategies to deal with uncomfortable feelings.
The plate method is simple, engaging of fun. We can customize the plate based on their food favorites and help individuals and families improve their health and feel better!
Get Started on the ADA Diabetes Food Hub – Sign up to save recipes, create a personalized grocery list, and more.
Please visit the ADA’s Diabetes Food Hub recipe page.
They have an abundance of recipes based on budget, preferred foods, time of day, etc… Plus, they also provide the nutrition facts, and it’s FREE!
ADA website: https://www.diabetesfoodhub.org/

Check out Awesome photos and ideas modeling the “Diabetes Plate Method”
USDA Plate Method Website has lots of great info
THE EXCHANGE LIST for Diabetes
Join us for our live streaming of our brand new course

Determining basal and bolus rates for multiple daily injections or insulin pumps can seem overwhelming. This 90-minute course provides participants with a step-by-step approach to determine basal rates, bolus ratios and how to problem solve when blood glucose levels aren’t on target. During this 90-minute course, Coach Beverly will provide abundant case studies to give participants hands-on practice and build confidence when calculating insulin doses for a variety of situations.
Objectives:
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!
[yikes-mailchimp form=”1″]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.