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Preparing for the CDCES Exam? Join us for our FREE Webinar

Airs live on November 14th, 2023, at 11:30 am PT

Topics covered include:

• Changes in requirements for 2023
• Exam eligibility and test format
• Strategies to succeed
• Review of study tips and test taking tactics.

Can’t make it live? No worries. We will send post the recorded version to the Online University within 24 hours of the broadcast

Intended Audience: All healthcare professionals & paraprofessionals looking to become CDCES-certified

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.

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Join the wonderment as we explore the role of our GI System

Now Recorded & Ready to Watch

Coach Bev invites you to join this 60-minute webinar that covers gastrointestinal health from top to bottom. Topics include; fatty liver disease diagnosis and treatment, intestinal complications associated with diabetes, keeping the microbiome healthy, and more. Join us to explore the magnificent wonders of diabetes and the gut.

New content and exciting research findings! Join the wonderment as we explore the impact of our GI System on our health.

Topics covered include:

• From the Mouth to Intestines: Periodontal disease, Gastroparesis, Fatty liver disease, pancreas disorders
• The intestine as an Endocrine Organ & Bacterial Host
• NASH Treatment Options including lifestyle and pharmacotherapy
• State the relationship between gut health, microbiome and diabetes and inflammation
• Describe 3 strategies to get our microbiome back to better health.

Intended Audience: These courses are knowledge-based activities 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 enhancing their diabetes and microbiome knowledge

Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working diabetes specialist and a nationally recognized diabetes expert.

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Two registration options

Enroll in our entire Level 4 | Advanced & Specialty Topic Courses  All courses air at 11:30 a.m. (PST)

All hours earned count toward your CDCES Accreditation Information

Can’t make it live? No worries. We will send post the recorded version to the Online University within 24 hours of the broadcast

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Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

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The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

For last week’s practice question, we quizzed participants on the 5 different tongue tastes. 67% 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: JR thinks that their ability to taste food has diminished recently. They ask you, what are the five confirmed basic tastes of the tongue?

Which of the following lists describes the best answer?

Answer Choices:

1. Sweet, salty, bitter, pepper, sour.
2. Umami, sweet, sour, salty, ammonia.
3. Bitter, sour, sweet, salty, umami.
4. Sour, sweet, ammonia, salty, bitter

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Getting to the Best Answer

If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.

Answer 1 is incorrect. 15.92% chose this answer. “Sweet, salty, bitter, pepper, sour.” This answer is really close, however there are no specific receptors on the tongue to detect the flavor pepper.

Answer 2 is incorrect. 5.22% of you chose this answer. “Umami, sweet, sour, salty, ammonia.” This answer is really close, however, ammonia is not a confirmed flavor and this list is missing the flavor, bitter.

Answer 3 is correct. About 67.41% of respondents chose this. “Bitter, sour, sweet, salty, umami.” YES, these are the 5 confirmed tastes and one more taste might be added to list, ammonium chloride. According to an article in Neuroscience News, “The tongue’s response to ammonium chloride, a component in some candies, may indicate a sixth basic taste. The study illuminated that OTOP1, a protein receptor that signals sour taste, also responds notably to ammonium chloride.”

Finally, Answer 4 is incorrect. 11.44% chose this answer. “Sour, sweet, ammonia, salty, bitter” This answer is really close, however, ammonia is not a confirmed flavor and this list is missing the flavor, umami.

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!

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Want to learn more about the GI System and Diabetes?

Exploring the GI System – From the Gut to the Butt | FREE Webinar

Now Recorded & Ready to Watch

Coach Bev invites you to join this 60 minute webinar that covers gastrointestinal health from top to bottom. Topics include; fatty liver disease diagnosis and treatment, intestinal complications associated with diabetes, keeping the microbiome healthy, and more. Join us to explore the magnificent wonders of diabetes and the gut.

Getting to the Gut Topics:

• From the Mouth to Intestines: Periodontal disease, Gastroparesis, Fatty liver disease, pancreas disorders
• Intestine as an Endocrine Organ & Bacterial Host
• NASH Treatment Options including lifestyle and pharmacotherapy
• State the relationship between gut health, microbiome and diabetes and inflammation
• Describe 3 strategies to get our microbiome back to better health.

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, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF, a working educator, and a nationally recognized diabetes expert. She has a Master’s Degree in Public Health from UCLA, with a focus on behavioral health and education.

All hours earned count toward your CDCES Accreditation Information

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Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

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The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

Happy November

This newsletter also explores why a new sweetener may confuse those who dose insulin based on carb counting. This vital information can help prevent unintended hypoglycemia.

We include a quick primer on new terms that describe liver disease to better reflect the metabolic inflammation and remove the stigma associated with terms like “fatty” and “non-alcoholic.”

Lastly, we welcome Ginger to our team and invite you to test your knowledge with our Question and Rationale of the Week!

Thank you for your advocacy and belief that we can make a difference.

With thanks to all of you,

Coach Beverly, Bryanna, Andrew, and Ginger

Featured Articles

• Diabetes Month Resources
• New Sweetener Causing Confusion
• Ditch NASH for MASH
• Surviving the Holidays & Diabetes Distress
• Welcome Ginger
• Question of the Week
• Rationale of the Week
• Save the Date: Cyber Monday Sale, Nov. 27th

FREE Webinars & Resources

• CDCES Prep FREE Webinar – Nov. 14th
• From the Gut to the Butt – FREE Webinar – Nov. 16th
• Hyperglycemic Crises, DKA & HHS – Dec. 12th
• Level 1, 2024 Updates
• Level 3, 2024 Updates

Upcoming Events – See the complete calendar listing

Free Resource Catalog

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National Diabetes Month

November kicks off National Diabetes Month, a time to recognize that over 11% of Americans are living with diabetes and over 35% have prediabetes. Since diabetes results from a combination of genetics plus environment, there is a recognition that social determinants of health play a pivotal role in the development of diabetes and its complications. Through advocacy and education, we can inform individuals on best care for diabetes and support them in taking action to improve the health of their communities to prevent future diabetes. We have put together a list of FREE diabetes resources in English and Spanish to share with people living with prediabetes and diabetes. Thank you for your advocacy and belief that we can make a difference. Coach Beverly

All hours earned count toward your CDCES Accreditation Information

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Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

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The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

1. Rates of diabetes are highest amongst Native Americans & Alaska Natives.
2. Higher income levels are associated with an increased prevalence of diabetes.
3. More than 50% of people over the age of 65 have diabetes.
4. People who don’t complete high school, have lower rates of diabetes related complications.

Click Here to Test your Knowledge

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National Diabetes Month

November kicks off National Diabetes Month, a time to recognize that over 11% of Americans are living with diabetes and over 35% have prediabetes. Since diabetes results from a combination of genetics plus environment, there is a recognition that social determinants of health play a pivotal role in the development of diabetes and its complications. Through advocacy and education, we can inform individuals on best care for diabetes and support them in taking action to improve the health of their communities to prevent future diabetes. We have put together a list of FREE diabetes resources in English and Spanish to share with people living with prediabetes and diabetes. Thank you for your advocacy and belief that we can make a difference. Coach Beverly

All hours earned count toward your CDCES Accreditation Information

---

Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

---

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 last week’s practice question, we quizzed participants on checking for fibrosis & liver elastography. 52% 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: The provider is sending JR for a Liver Elastography or FibroScan test since JR has elevated ALT and AST levels along with an elevated Fib-4 score.

 Which of the following are measured during this liver ultrasound procedure?

Answer Choices:

1. Liver diameter and density.
2. Liver scarring and ductal health.
3. Hepatocyte density and distribution.
4. Liver stiffness and fat density.

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Getting to the Best Answer

If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.

Answer 1 is incorrect. 13.61% chose this answer. “Liver diameter and density.” This answer is tempting, but unfortunately, it is not accurate. Liver Elastography or FibroScan test measures for liver stiffness and fat density, two very important findings to quantify liver health.

Answer 2 is incorrect. 20.21% of you chose this answer. “Liver scarring and ductal health.” This answer is also tempting, but not accurate. Liver Elastography or FibroScan test measures for liver stiffness and fat density, two very important findings to quantify liver health.

Answer 3 is incorrect. About 14.23% of respondents chose this. “Hepatocyte density and distribution.” Unfortunately, this tempting answer is not accurate. Liver Elastography or FibroScan test measures for liver stiffness and fat density, two very important findings to quantify liver health.

Finally, Answer 4 is correct. 51.96% chose this answer. “Liver stiffness and fat density.” YES, this is the BEST Answer. This 5-10 minute, non-invasive test, measures liver stiffness or degree of fibrosis (reported as the kPa score) and the amount of fat in the liver (reported as the CAP score). Join our FREE Webinar on Exploring the GI System – From the Gut to the Butt on November 16th to learn more!

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!

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Want to learn more about the GI System and Diabetes?

Exploring the GI System – From the Gut to the Butt | FREE Webinar

Now Recorded & Ready to Watch

Coach Bev invites you to join this 60 minute webinar that covers gastrointestinal health from top to bottom. Topics include; fatty liver disease diagnosis and treatment, intestinal complications associated with diabetes, keeping the microbiome healthy, and more. Join us to explore the magnificent wonders of diabetes and the gut.

Getting to the Gut Topics:

• From the Mouth to Intestines: Periodontal disease, Gastroparesis, Fatty liver disease, pancreas disorders
• Intestine as an Endocrine Organ & Bacterial Host
• NASH Treatment Options including lifestyle and pharmacotherapy
• State the relationship between gut health, microbiome and diabetes and inflammation
• Describe 3 strategies to get our microbiome back to better health.

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, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF, a working educator, and a nationally recognized diabetes expert. She has a Master’s Degree in Public Health from UCLA, with a focus on behavioral health and education.

All hours earned count toward your CDCES Accreditation Information

---

Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

---

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.

There has not been a significant update on the management of Diabetes Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar Syndrome since 2009. To remedy this, eight international diabetes organizations met to determine a consensus statement reflecting best practices that can be applied worldwide and in various settings. Researchers unveiled an updated consensus statement on hyperglycemic crises at the 2023 EASD Conference in Hamburg, Germany, in October 2023. However, the actual consensus statement has yet to be available online, but the authors shared some highlights through interviews and statements.

Rates of DKA and HHS on the Rise

From 2014 to 2018, emergency department visits among adults with diabetes increased by 21%, according to the CDC’s National Diabetes Statistics report. However, many rural healthcare facilities and providers may not be familiar with best practices when it comes to treating hyperglycemic crises. Patients may be discharged on ineffective insulin regimens or may continue taking their SGLT-2 Inhibitors, which can contribute to increased mortality. With the distribution of these new guidelines, the goal is to standardize and improve diagnosis, treatment, and follow-up.

Changing the Glucose Cutoff for DKA diagnosis 

With the emergence of euglycemic ketoacidosis secondary to mainly SGLT-2 Inhibitor use and other factors, the new hyperglycemia cutoff is now lowered to 200 mg/dL from the previous 250 mg/dL. However, the glucose cutoff has been removed entirely for people with a history of diabetes.

Assessing for DKA

The new guideline strongly recommends using beta-hydroxybutyrate via point-of-care tests or laboratory measurements with a low cutoff equal to or greater than 3.0 mmol/L. Alternatively, a urine ketone strip value of 2+ or greater can be used. The urine ketone test is beneficial for rural settings who may not have access to beta-hydroxybutyrate testing,

Less focus on anion gap.

Metabolic acidosis is now defined as a pH < 7.3 and a bicarbonate concentration < 18 mmol/L. Also, the anion gap has been removed from the primary definition, but the document will say that it can still be used in settings where ketone testing is unavailable.

Assessing for HHS

The glucose cutoff of 600 mg/dL or greater for HHS will stay the same. But now, the effective serum osmolality has been lowered from more than 320 to more than 300 mOsml/L to account for the effect of dehydration, along with alternative criteria of total serum osmolality of more than 320 mOsm/L. The same two changes as with DKA for both ketones and acidosis have also been included for HHS.

Different treatment strategies

In the statement, DKA is still classified as mild, moderate, or severe. All levels can be treated with IV insulin, fluids, and electrolyte replacement therapy. However, mild DKA can be treated with subcutaneous insulin therapy replacement, which may decrease the need for extended hospitalization.

Making the right diagnosis

Half of new-onset type 1 diabetes occurs in adults who are often misdiagnosed as type 2 diabetes, putting them at risk for DKA.

Transition to discharge. 
Mortality increases for those with multiple episodes of DKA and HHS. There is a need for careful follow-up and post-discharge monitoring and assistance.

Many times, social determinants of health are a driver of recurrent hyperglycemic crises. 

Addressing risk factors and providing resources for ongoing care must be included in the treatment plan.

We will discuss other updates in more detail in our upcoming webinar on Hyperglycemic Crisis – DKA and HHS New Guidelines.

More research needed

There are still gaps in the best treatment approaches, and more research is needed. This new unified international definition and treatment plan allows more effective comparisons and further research on best practices for diabetes hyperglycemic crisis.

The aim is to get the word out to community hospitals, primary care providers, and ED providers to increase familiarity with identifying and effectively treating DKA and HHS.

From EASD Interview posted on October 27, 2023 and Medscape article

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Join us for our upcoming Hyperglycemic Crises, DKA & HHS Standards webinar

Airs live on December 12th, 2023, at 11:30 am PT

Topics:

• Discuss the common causes of hyperglycemic crises.
• List the differences & similarities between DKA and HHS and treatment strategies.
• Describe the causes & treatment of hyperglycemic crises.

This course discusses common causes of hyperglycemia crises. Topics include hyperglycemia secondary to medications & insulin deprivation. The differences & similarities between Diabetes Ketoacidosis and hyperosmolar Hyperglycemic Syndrome are also covered. Treatment strategies for all situations are included.

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, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF, a working educator, and a nationally recognized diabetes expert. She has a Master’s Degree in Public Health from UCLA, with a focus on behavioral health and education.

All hours earned count toward your CDCES Accreditation Information

---

Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

---

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.

For last week’s practice question, we quizzed participants on how to address post holiday guilt. 94% 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: AR is 15 years old and uses an automated insulin delivery (AID) system to manage their diabetes.

They tell you they feel so guilty about all the food and sweets they ate during the holidays and have been trying to get back on track.  What is the best response?

Answer Choices:

1. Don’t worry about it, the insulin pump will keep your blood sugars on goal.
2. Shall I make an appointment with our mental health specialist so you can explore your feelings?
3. Sounds like you could benefit from a healthy eating coaching session?
4. Lots of people have a tough time eating healthy during the holidays. What was hardest for you?

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Getting to the Best Answer

If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.

Answer 1 is incorrect. 1.73% chose this answer. “Don’t worry about it, the insulin pump will keep your blood sugars on goal.”

Answer 2 is incorrect. 1.73% of you chose this answer. “Shall I make an appointment with our mental health specialist so you can explore your feelings?”

Answer 3 is incorrect. About 2.60% of respondents chose this. “Sounds like you could benefit from a healthy eating coaching session?”

Finally, Answer 4 is correct. 93.94% chose this answer. “Lots of people have a tough time eating healthy during the holidays. What was hardest for you?”

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!

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Want to learn more about this question?

Level 1 | Diabetes Fundamentals

Airs live on January 11th-30th, 2024, at 11:30 am PT

Class Topics & Webinar Dates:

• January 11, 2024 – Class 1: Getting to the Nitty Gritty | 1.5 CEs
• January 16, 2024 – Class 2: Nutrition & Exercise 1.5 | CEs
• January 18, 2024 – Class 3: Meds Overview for Type 2 | 1.5 CEs
• January 23, 2024 – Class 4: Insulin Therapy & Pattern Management | 1.75 CEs
• January 25, 2024 –Class 5: Goals of Care & Lower Extremity Assessment | 1.5 CEs
• January 30, 2024 – Class 6: Hypoglycemia, Sick Days, & Monitoring | 1.5 CEs

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 healthcare providers interested in staying up to date on current practices of care for people with diabetes and preparing for the CDCES Certification Exam.

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, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF, a working educator, and a nationally recognized diabetes expert. She has a Master’s Degree in Public Health from UCLA, with a focus on behavioral health and education.

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Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

---

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.