Rationale of the Week | Assessment of Hypoglycemia
For last week’s practice question, we quizzed participants on assessing risk factors for hypoglycemia. 69% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question
Question: LM has had type 2 diabetes for over 30 years and takes 1000 mg metformin BID, 30 units of glargine at bedtime, 25 mg empagliflozin, as well as daily lisinopril and lovastatin. A1c was 7.2%, LDL: 56, and eGFR was 38 mL/min/1.73m2 last visit. CGM ambulatory glucose profile report indicates a time in range of 71%, time below range of 4%, and time above range of 25%. LM reports living on a fixed income, relying on social security, and an increase in recent financial stress. They are concerned they may not have enough money to purchase foods by the end of the month.
Select the best answer considering LM’s potential risk factors for hypoglycemia?
Answer Choices:
- LM has chronic kidney disease, and we note he is taking an ACE and SGLT-2
- Basal insulin therapy alone.
- Income status.
- All the above.
Getting to the Best Answer
Answer 1 is incorrect. 7.42% chose this answer. “LM has chronic kidney disease, and we note he is taking an ACE and SGLT-2.” Answer 1 is somewhat true but is not the best answer. We may consider this question incorrect due to the statement that LM is taking ACE and SGLT-2 medications, and we know these have a low risk of hypoglycemia. However, a diagnosis of CKD, especially along with basal insulin therapy, can be a factor that increases hypoglycemia risk. If LM’s GFR was below 15 with a diagnosis of end-stage renal disease, then we would consider this a major risk factor. Let’s keep reading for the best answer.
Answer 2 is incorrect. 8.36% of you chose this answer. “Basal insulin therapy alone.” Answer 2 is also true but is not the best answer. Hypoglycemia risk is highest in individuals treated with intensive insulin therapy followed by basal insulin and then sulfonylureas.1 Basal insulin therapy is a risk factor for hypoglycemia, and we may be tempted to select this answer alone. However, other considerations also impact LM’s risk for hypoglycemic events while on basal insulin therapy.
Answer 3 is incorrect. About 15.26% of respondents chose this. “Income status.” Answer 3 is also true but is not the best answer. Income status and food insecurity are considered risk factors for hypoglycemia and are associated with increased hospital admissions and ER visits. However, we must also consider this along with medication treatment. Food insecurity along with LM’s basal insulin therapy is a major risk factor for hypoglycemia.
Finally, Answer 4 is correct. 68.97% chose this answer. “All the above.” Answer D is the correct Answer. The 2024 Standards of Care recommends hypoglycemia assessment at every clinical visit. We can use validated tools to determine risk for hospital admission or an ER visit, but these do not consider every risk factor. It is important to consider not only clinical factors but also social, economic, and cultural factors. Risk stratification is for all individuals treated with insulin, sulfonylureas, or meglitinides. ° American Diabetes Association Professional Practice Committee; 6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2024. Diabetes Care 1 January 2024; 47 (Supplement_1): S111–S125. https://doi.org/10.2337/dc24-S006
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 recognizing and addressing Diabetes Distress?
Join us live on June 17th & June 24th, 2024 for our
ReViVE 5 Diabetes Training Program:
Unlocking Hidden Barriers to Diabetes Management
“ReVive 5” breathes new life into our relationship with diabetes, bringing a fresh perspective to both the person with diabetes and the provider.
The ReVive 5 program is built on sound research from the Embark Trial and will revolutionize your approach to diabetes self-management education.
We have reassembled the Embark training team and created a resource binder of fantastic tools that we are excited to share with you in our ReVive 5 Diabetes Training Program. You are invited to join us to learn a step-wise, proven approach to addressing hidden barriers to diabetes self-management and glucose management.
You don’t need to be mental health expert or diabetes technology wiz to join this training or to integrate these new strategies into your daily practice.
ReVive 5 uses an integrated, evidence-based approach that provides health care professionals with a realistic 5-step approach to addressing the whole person, starting with emotional distress and incorporating a unique, but integrated approach to problem-solving glucose management difficulties.
Intended Audience: 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 CDCES or BC-ADM Certification Exams.
Can’t join live? That’s okay. Your registration guarantees you access to the recorded version of the series, along with podcasts and resources for one full year.
Accredited Training Program:
- 15+ CEs – Includes the 7-hour ReVive 5 Training Program, Certificate, and 5 FREE bonus courses to supplement content.
- A comprehensive set of assessment tools, educational materials, log sheets, and resources.
Join us to gain the confidence and learn the skills needed to support people with diabetes to move forward in their self-management and discover the expert within.
Team of Experts:
ReVive 5 is taught by a team of 3 Interdisciplinary Experts:
- Lawrence Fisher, Ph.D., ABPP, Professor Emeritus, UCSF
- Susan Guzman, PhD
- Beverly Thomassian, RN, MPH, CDCES, BC-ADM
Speakers Interviews – Learn more about the ReVive 5 Team
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!
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
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 treatment for hypoglycemia with gastroparesis?
JR has type 1 diabetes and was recently diagnosed with gastroparesis. JR is a runner and has not been able to exercise recently due to nausea, vomiting, bloating, and intestinal pain. They experience hypoglycemia about 3 times a week.
Based on this information, what is the best treatment for hypoglycemia?
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- Glucose tabs or gels
- Skittles or gummies
- High carb, low fiber snack bar
- Peanut butter crackers
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Want to Learn More About this Topic?
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Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, and “aha” moments for our Virtual DiabetesEd Training Conference.
Attendees will leave this conference with new tools and a refreshed understanding of the latest advances in person-centered diabetes care. Our team highlights the ADA Standards of Care, medications, behavior change, technology, medical nutrition therapy, and more!
Our instructors co-teach the content to keep things fresh and lively.
Program Details
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- Speakers: View Conference Faculty
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!
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
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.
May 2024 eNews | Why don’t CGM readings match meter glucose results? Person-Centered Coaching & Technology; Step-By-Step Approach, Biggest Takeaway when Addressing Diabetes Distress?
Happy May
In our rural clinic, we are starting more and more individuals on glucose sensors. People’s response to using a CGM device has garnered mixed reactions. Most individuals are thrilled that they can see their blood sugars are at a glance with fewer finger pricks. They feel empowered with this play-by-play blood sugar report.
However, others experience a sense of overwhelm in response to the sudden onslaught of glucose data on their screen. This stress becomes more acute as they hone in on sugar spikes or sudden lows that don’t seem to have a rhyme or reason. In addition, many people are confused by the discrepancy between the meter and sensor glucose, causing even more upset.
These individuals may experience an understandable amount of confusion, frustration, and distress.
This newsletter provides a range of tools and resources to assist you in addressing these distress points, detailed in the following featured articles.
Our first article explores the reasons behind the gap between CGM and meter readings. We also provide a CGM Troubleshooting Cheat Sheet that you can share with your colleagues and clients.
Next, we outline a step-by-step communication approach designed to help individuals adjust to sensor data overwhelm using a person-centered approach.
Finally, we address diabetes distress by interviewing expert Susan Guzman, PhD. You are invited to join Dr. Guzman and Larry Fisher, PhD, who will share their expertise on this topic in June, during our highly popular ReVive 5 training program.
Our last article recognizes the healing relationship we have with our pets. Challenge yourself with our Question and Rationale of the Week and please keep in touch.
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Sending notes of joy and health, Coach Beverly, Bryanna, Brent, Christine, Andrew, and Ginger |
Featured Articles
- Why Don’t My CGM Numbers Match My Meter?
- NEW CGM Trouble Shooting Cheat Sheet
- Step-By-Step Person-Centered Coaching w/Tech
- Biggest Takeaway when Address Diabetes Distress
- 3 Ways Pets Can Support People with Diabetes
- Question of the Week
- Rationale of the Week
Upcoming Webinars
- Older Adults and Diabetes Disease – May 2nd
- Prep for CDCES – May 28
- ReVive 5 – June 17th & 24th
- Upcoming Events – See the complete calendar listing
Want to learn more about this question?
Unlock insights for managing diabetes distress with the experts!
Join us live on June 17 & 24, 2024 for our
ReVive 5 Diabetes Training Program:
The 2024 ADA Standards of Care now recommends annual screening for diabetes distress. If you are wondering how to screen for distress and tailor education based on the results, we encourage you to join this unique training program.
This two-session training provides the essential steps to address diabetes distress combined with an innovative approach to helping people make sense of their glucose data.
The first session is team-taught by experts in the field of diabetes distress and effective communication approaches. Dr. Larry Fisher kicks off the program by describing the difference between depression and distress and interpreting Diabetes Distress screening results. Dr. Susan Guzman uses a case study approach and step-by-step communication strategies to address responses from the Diabetes Distress screening tool. This session includes an abundance of evidence-based approaches that you can apply in your clinical setting.
Coach Beverly leads the second session. During this three-hour program, Beverly describes insulin dosing strategies, meter and sensor data interpretation, and common issues encountered by people using diabetes technology. Case studies include tools to help individuals discover what changes are needed to get glucose to target, coupled with the communication skills discussed in the first session. In conclusion, the team of instructors review a case study that pulls together all the ReVive 5 elements.
“ReVive 5” breathes new life into our relationship with diabetes, bringing a fresh perspective to both the person with diabetes and the provider.
Can’t join live? That’s okay. Your registration guarantees you access to the recorded version of the series, along with podcasts and resources for one full year.
Accredited Training Program:
- 15+ CEs – Includes the 7-hour ReVive 5 Training Program, Certificate, and 5 FREE bonus courses to supplement content.
- A comprehensive set of assessment tools, educational materials, log sheets, and resources.
Join us to gain the confidence and learn the skills needed to support people with diabetes to move forward in their self-management and discover the expert within.
Team of Experts:
ReVive 5 is taught by a team of 3 Interdisciplinary Experts:
- Lawrence Fisher, Ph.D., ABPP, Professor Emeritus, UCSF
- Susan Guzman, PhD
- Beverly Thomassian, RN, MPH, CDCES, BC-ADM
Speakers Interviews – Learn more about the ReVive 5 Team
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!
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
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.
Rationale of the Week | RD feels overwhelmed by all this sensor data. Best action?
For last week’s practice question, we quizzed participants on actions to help address stress during data monitoring. 87% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question
Question: RD is 82 years old, on basal insulin with bolus insulin at breakfast and dinner if need. RD just started using a sensor to track their daily blood sugars. After using the sensor for a few weeks, they share that they are feeling anxious and don’t know what to do with all this information. They even took extra bolus insulin yesterday to try and get blood sugars down. RD’s time in range is over 70%.
Which of the following is the most appropriate intervention?
Answer Choices:
- Refer RD to a mental health provider who specializes in diabetes.
- Reassure RD that their time is range is on target and they are not at risk of complications.
- Suggest that RD stops using a sensor and resumes using a glucose meter.
- Explore feelings of anxiety associated with the data and glucose levels.
Getting to the Best Answer
Answer 1 is incorrect. 1.83% chose this answer. “Refer RD to a mental health provider who specializes in diabetes.” RD is having an understandable response to the abundance of info provided by their new CGM and is experiencing diabetes distress. Based on the information provided, their anxiety doesn’t warrant a referral to a mental health specialist.
Answer 2 is incorrect. 6.26% of you chose this answer. “Reassure RD that their time is range is on target and they are not at risk of complications.” Although it is important to reassure RD that they have a time in range greater than 70%, it is important to acknowledge their feelings and explore strategies to address to diabetes distress.
Answer 3 is incorrect. About 4.43% of respondents chose this. “Suggest that RD stops using a sensor and resumes using a glucose meter.” Since RD has only been using the sensor for a few weeks, we wouldn’t want to suggest giving it up just yet. In addition, we want to learn more about what RD is experiencing and the issues that are increasing their anxiety and help with problem solving.
Finally, Answer 4 is correct. 87.48% chose this answer. “Explore feelings of anxiety associated with the data and glucose levels.” YES. GREAT JOB! This is the best person-centered answer that encourages RD to share their feelings so we can help with problem solving and evaluate the best approach for this individual.
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 question?
Unlock insights for managing diabetes distress with the experts!
Join us live on June 17 & 24, 2024 for our
ReVive 5 Diabetes Training Program:
The 2024 ADA Standards of Care now recommends annual screening for diabetes distress. If you are wondering how to screen for distress and tailor education based on the results, we encourage you to join this unique training program.
This two-session training provides the essential steps to address diabetes distress combined with an innovative approach to helping people make sense of their glucose data.
The first session is team-taught by experts in the field of diabetes distress and effective communication approaches. Dr. Larry Fisher kicks off the program by describing the difference between depression and distress and interpreting Diabetes Distress screening results. Dr. Susan Guzman uses a case study approach and step-by-step communication strategies to address responses from the Diabetes Distress screening tool. This session includes an abundance of evidence-based approaches that you can apply in your clinical setting.
Coach Beverly leads the second session. During this three-hour program, Beverly describes insulin dosing strategies, meter and sensor data interpretation, and common issues encountered by people using diabetes technology. Case studies include tools to help individuals discover what changes are needed to get glucose to target, coupled with the communication skills discussed in the first session. In conclusion, the team of instructors review a case study that pulls together all the ReVive 5 elements.
“ReVive 5” breathes new life into our relationship with diabetes, bringing a fresh perspective to both the person with diabetes and the provider.
Can’t join live? That’s okay. Your registration guarantees you access to the recorded version of the series, along with podcasts and resources for one full year.
Accredited Training Program:
- 15+ CEs – Includes the 7-hour ReVive 5 Training Program, Certificate, and 5 FREE bonus courses to supplement content.
- A comprehensive set of assessment tools, educational materials, log sheets, and resources.
Join us to gain the confidence and learn the skills needed to support people with diabetes to move forward in their self-management and discover the expert within.
Team of Experts:
ReVive 5 is taught by a team of 3 Interdisciplinary Experts:
- Lawrence Fisher, Ph.D., ABPP, Professor Emeritus, UCSF
- Susan Guzman, PhD
- Beverly Thomassian, RN, MPH, CDCES, BC-ADM
Speakers Interviews – Learn more about the ReVive 5 Team
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!
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
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.
2 Scholarships for DiabetesEd Conference in San Diego | Apply Today
2 Scholarships will be awarded for October 11-13th
– DiabetesEd Training Conference
– Making a Difference & Flower Scholarship
Two Scholarships for those Preparing to Take CDCES
We will award two diabetes educators who provide care and education to under-served communities that lack access to Diabetes Specialists and health care resources. Applicants will be taking their CDCES exam within a year. Each scholarship covers course registration for our Live in San Diego: DiabetesEd Training Conference Registration and 3 nights hotel stay.
We are offering two scholarships, both for the entire registration of the Live Training and 3 hotel nights:
- Flower Scholarship Recipient Seminar – Registration + Hotel (valued at $1500)
- Making a Difference Scholarship Recipient – Registration + Hotel (valued at $1500)
*These scholarships cover the course registration fee and 3 nights hotel stay. It does not cover any other expenses incurred by the winners (including travel expenses, food, transportation, etc.). Please consider travel and other costs prior to applying for the scholarship. Each applicant must currently reside within the United States. If you are interested, please click on the button below to complete the scholarship application.
Apply for Scholarships Today – Attend Live Seminar for FREE ($1,500 value)
Eligibility Requirements for Both Scholarships
The goal of these scholarships is three-fold:
- To support U.S. healthcare professionals who are going above and beyond to improve diabetes care in their community; and
- To support applicants’ efforts to become Certified Diabetes Care and Education Specialists (CDCES) and
- To provide financial assistance with the DiabetesEd Course registration fee.
Flower Scholarship: This scholarship is awarded to Diabetes Nurse Educators and is available because of the generous contribution of an anonymous colleague, friend, co-instructor, and mentor. Our donor worked as a Nurse Practitioner and Diabetes Specialist, serving her community, plus mentoring healthcare professionals about diabetes for over 30 years. With the Flower Diabetes Educator Scholarship, she wants to keep investing in the health of our future by supporting future diabetes educators.
- Applicants must be diabetes nurse educators who come from an under-served community and are providing care and education to communities that lack access to Diabetes Specialists and healthcare resources
- The nurse applicants will be taking their CDCES exam within a year.
- Preference is given to those facing financial hardships that are interfering with their ability to pursue this dream of achieving their CDCES.
- All applicants must be a U.S. residents.
“Making a Difference” Scholarship: Diabetes Education Services is committed to improving equity and access to diabetes training and education for a diverse group of healthcare professionals. We don’t want financial barriers to stop anyone from attending this conference. In appreciation of those who are role models and advocates for practicing the best diabetes care in their communities
- Available to all diabetes educators who are eligible to apply for the CDCES exam who come from an under-served community and are providing care and education to communities that lack access to Diabetes Specialists and healthcare resources
- The applicants will be taking their CDCES exam within a year.
- Preference is given to those facing financial hardships that are interfering with their ability to pursue this dream of achieving their CDCES.
- All applicants must be a U.S. residents.
Special Thanks to the “Making a Difference” and “Flower” Scholarships Donors
These scholarships are available due to the generous contribution of diabetes colleagues, friends, co-instructor, and mentors.
“Making a Difference” Scholarship Donor – Lonnie Vaughn, RNC, BSN, CDCES
Our esteemed donor for the Making a Difference Scholarship, Lonnie, possesses a profound understanding of the challenges that diabetes care and education specialists face in the healthcare setting. As a leader in the field of diabetes management, Lonnie has been championing best care practices at Doctors Medical Center in Modesto for over 30 years. Her role as a certified diabetes educator, trainer, mentor, and advocate is recognized and celebrated by patients and professionals, underscoring the unique value she brings to the cause.
Lonnie’s Vision: Lonnie wants to lift the next generation of diabetes care and education specialists to advocate for under-resourced individuals and fight for evidence-based, compassionate care for ALL people living with diabetes.
A note from Coach Beverly: I met Lonnie over 25 years ago at a conference where I was presenting on diabetes care. Her curiosity and passion for the topic were reflected in her attention, thoughtful questions, and dedication to her community. I invited her to join our live conference team to teach, coordinate, and share her passion and energy for the best diabetes care. She not only rose to the challenge, she surpassed all expectations and became an integral part of our Diabetes Education Services family. Lonnie’s impact on the community is immeasurable. She has mentored and trained over a dozen CDCESs (and hundreds of interns) at Doctors Medical Center, investing in the future of this honorable and essential profession. I am deeply grateful for Lonnie’s years of generous contributions and dedication to ushering in the next generation of diabetes care and education specialists. Thank you, Ms. Lonnie Vaughn, for being such a bright and present light in the world of diabetes care and education.
“Flower” Scholarship Donor Gratitude
Our donor for the Flower Scholarship worked as a Nurse Practitioner and Diabetes Specialist, serving her community, plus mentoring healthcare professionals about diabetes for over 30 years.
With the Flower Diabetes Educator Scholarship, she wants to keep investing in the health of our future by supporting future diabetes educators.
Her vision is to increase diversity in the diabetes education workforce by supporting diabetes nurse educators who come from underserved communities. By increasing the number of diabetes educators who represent the population demographics of those living with diabetes, we can make more meaningful connections on an individual and community level while promoting the best care.
The Flower Scholarship is a tribute to our donor’s last name, which translates to flower. The flower is a perfect symbol for this scholarship that aims to support the growth of novice diabetes educators into Certified Diabetes Care and Education Specialists.
Flowers are a symbol of hope and can be found growing in the most unexpected places, including harsh cities and forgotten spaces. With just a little sunlight and water, they have the ability to thrive in even the most difficult situations and shine their fierce beauty. Given a chance, as these flowers are tended to and nurtured, they grow stronger and brighter, spreading their beauty to new places to give people hope. These resilient flowering seeds perpetuate the opportunity for a future generation of diabetes specialists.
Past Scholarship Recipients
Not Ready to Apply for a Scholarship? You can still join our Conference! 
Join us Live in San Diego and Celebrate Success!
More Info Here >>
The use of DES products does not guarantee the successful passage of the diabetes certification exams. CBDCE & ADCES does not endorse any preparatory or review materials for the certification exams, except for those published by CBDCE & ADCES.
**To satisfy the requirement for renewal of certification by continuing education for the Certification Board for Diabetes Care & Education (CBDCE), continuing education activities must be applicable to diabetes and approved by a provider on the CBDCE List of Recognized Providers (www.ncbde.org). CBDCE does not approve continuing education. Diabetes Education Services is accredited/approved by the Commission of Dietetic Registration which is on the list of CBDCE Recognized Providers.
Question of the Week | Assessment of Hypoglycemia
LM has had type 2 diabetes for over 30 years and takes 1000 mg metformin BID, 30 units of glargine at bedtime, 25 mg empagliflozin, as well as daily lisinopril and lovastatin. A1c was 7.2%, LDL: 56, and eGFR was 38 mL/min/1.73m2 last visit. CGM ambulatory glucose profile report indicates a time in range of 71%, time below range of 4%, and time above range of 25%. LM reports living on a fixed income, relying on social security, and an increase in recent financial stress. They are concerned they may not have enough money to purchase foods by the end of the month.
Select the best answer considering LM’s potential risk factors for hypoglycemia?
- LM has chronic kidney disease, and we note he is taking an ACE and SGLT-2.
- Basal insulin therapy alone.
- Income status.
- All the above.
Unlock insights for managing diabetes distress with the experts!
Join us live on June 17 & 24, 2024 for our
ReVive 5 Diabetes Training Program:
The 2024 ADA Standards of Care now recommends annual screening for diabetes distress. If you are wondering how to screen for distress and tailor education based on the results, we encourage you to join this unique training program.
This two-session training provides the essential steps to address diabetes distress combined with an innovative approach to helping people make sense of their glucose data.
The first session is team-taught by experts in the field of diabetes distress and effective communication approaches. Dr. Larry Fisher kicks off the program by describing the difference between depression and distress and interpreting Diabetes Distress screening results. Dr. Susan Guzman uses a case study approach and step-by-step communication strategies to address responses from the Diabetes Distress screening tool. This session includes an abundance of evidence-based approaches that you can apply in your clinical setting.
Coach Beverly leads the second session. During this three-hour program, Beverly describes insulin dosing strategies, meter and sensor data interpretation, and common issues encountered by people using diabetes technology. Case studies include tools to help individuals discover what changes are needed to get glucose to target, coupled with the communication skills discussed in the first session. In conclusion, the team of instructors review a case study that pulls together all the ReVive 5 elements.
“ReVive 5” breathes new life into our relationship with diabetes, bringing a fresh perspective to both the person with diabetes and the provider.
Can’t join live? That’s okay. Your registration guarantees you access to the recorded version of the series, along with podcasts and resources for one full year.
Accredited Training Program:
- 15+ CEs – Includes the 7-hour ReVive 5 Training Program, Certificate, and 5 FREE bonus courses to supplement content.
- A comprehensive set of assessment tools, educational materials, log sheets, and resources.
Team of Experts:
ReVive 5 is taught by a team of 3 Interdisciplinary Experts:
- Lawrence Fisher, Ph.D., ABPP, Professor Emeritus, UCSF
- Susan Guzman, PhD
- Beverly Thomassian, RN, MPH, CDCES, BC-ADM
Speakers Interviews – Learn more about the ReVive 5 Team
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!
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
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.
Upcoming Webinars | Older Adults & Diabetes, FREE Prep for CDCES Exam Webinar
Be a part of our diabetes community while learning about the latest in diabetes care.
Plus, Coach Beverly provides an interactive question and answer session at the end of each live webinar.
Level 2 | Older Adults & Diabetes
Airs live on May 2, 2024, at 11:30 am PT
We are living longer & more people are getting diabetes. The American Diabetes Association has updated the Older Adults Standards, with special attention to considering the reduction of medication & insulin therapy intensity. The older population has unique issues & special needs that require consideration as we provide diabetes self-management education. This online course highlights key areas of assessment, intervention, and advocacy for older clients living with diabetes.
Topics:
- Self-management considerations for older individuals.
- Strategies to prevent complications & maintain optimal quality of life.
- The role of the Diabetes Care & Education Specialist as an advocate.
Intended Audience: An important course for healthcare professionals seeking to gain an understanding of the special issues and evidence-based standards for older adults or studying for certification exams.
Can’t make it live? No worries. We will send post the recorded version to the Online University within 24 hours of the broadcast
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working diabetes specialist and a nationally recognized diabetes expert.
Airs live on May 28, 2024, at 11:30 am PT
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 test format updates for 2024
- 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®.
Can’t make it live? No worries. We will send post the recorded version to the Online University within 24 hours of the broadcast
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working diabetes specialist and a nationally recognized diabetes expert.
More info on our Prep for CDCES Page >>
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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
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.
Rationale of the Week | Euglycemic DKA – What is Best Intervention?
For last week’s practice question, we quizzed participants on what is the best intervention for euglycemic DKA. 55% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question
Question: KT is a 54-year-old, who presents to the emergency room with nausea and vomiting. KT weighs 58kg, has been feeling very tired and has diabetes and hypertension.
Meds include: losartan, metformin, and empagliflozin.
Labs: Na 140, K 4.0, Chloride 99, Bicarb 15, Glucose 189, Anion Gap 26, pH 7.1 and positive urine ketones
After infusing 2 liters of normal saline, what would be the best intervention for KT?
Answer Choices:
- Give another 2 liters of NS with 20 meq/L of KCL
- Continue current therapy.
- Start insulin infusion with a dextrose-based solution.
- Give an amp of sodium bicarbonate.
Getting to the Best Answer
Answer 1 is incorrect. 13% chose this answer. “Give another 2 liters of NS with 20 meq/L of KCL.” Since KT has already received 2 liters of normal saline for fluid resuscitation, the next step is to provide a solution with glucose, and possibly potassium depending on KT’s electrolyte levels. Even with euglycemic DKA, KT has depleted their glycogen stores and the cells are in desperate need of glucose for two reasons; to stop burning fat for fuel and to replete glycogen stores.
Answer 2 is incorrect. 13.42% of you chose this answer. “Continue current therapy.” While this answer is tempting, it does not provide a clear plan of action for KT. The only therapy this is currently being provided is an IV of normal saline. Even though KT’s blood glucose is less than 200mg/dL, in order to stop ketosis, we need to start IV insulin along with 5-10% dextrose to preserve blood glucose and replace glycogen stores.
Answer 3 is correct. About 55.20% of respondents chose this. “Start insulin infusion with a dextrose-based solution.” YES! This is the best answer. The next step is to provide an IV solution with 5-10% glucose, and possibly potassium depending on KT’s electrolyte levels. Even with euglycemic DKA, KT has depleted their glycogen stores and the cells are in desperate need of glucose for two reasons; to stop burning fat for fuel and to replete glycogen stores. In addition, in order to stop ketosis, we need to start IV insulin at a few units an hour!
Finally, Answer 4 is incorrect. 18.29% chose this answer. “Give an amp of sodium bicarbonate.” Since KT is in acidosis, this is a tempting answer. However, the acidosis will usually be corrected with administration of IV fluids and insulin. If not, and the pH is still below 7.0, bicarb administration may be considered.
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 question?
Keynote Presentation on DKA & Euglycemic DKA at
16th Annual Conference
Expanding the Universe of Diabetes Care hosted by CA ADCES
May 3-4th at Universal City, CA
Beverly will be speaking on DKA and EDKA on Saturday – May 4, 2024 at 11:30 am
Below is Saturday’s schedule of topics and flyer for more information. We hope to see you there!
>>Register for the Conference
>>Flyer for Event
- Discover the secrets to a successful and sustainable Diabetes Education Program – Tony Song, MBA
- Exercise Success Part 3 & 4 – Jacqueline Thompson, MS, RD, CDCES, MES
- Dynamic Duo: Registered Dietitian & Pharmacist Co-Appointments in Diabetes Care – Christal Pham, PharmD, APh, CDCES, Melanie Barbee, MS, RDN, CDCES, DipACLM
- Advocacy Update: Breakdown the Barriers to Evidence-Based Diabetes Care – Teresa Martin MS RDN CDCES LD
- New criteria and treatment guidelines for DKA, Euglycemic DKA, and HHS – Beverly Thomassian, RN, MPH, CDCES, BC-ADM
- Exercise Success Part 4 – Jacqueline Thompson, MS, RD, CDCES, MES
- Diabetes Technology: Understanding the Differences in the Latest CGMs and Pumps – David Ahn, MD
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!
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
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.
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