Rationale of the Week | DKA Prevention After T1D Diagnosis
For last week’s practice question, we quizzed participants on DKA Prevention After T1D Diagnosis. 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: A 10-year-old child with newly diagnosed type 1 diabetes is being discharged from the hospital. Which of the following components is most critical to include in the initial outpatient diabetes management plan to reduce the risk of diabetic ketoacidosis (DKA) and hospital readmission?
Answer Choices:
- Initiate basal insulin therapy and MNT instruction, with follow-up in two weeks.
- Provide basic carbohydrate counting and bolus insulin instruction with a follow-up appointment within 30 days.
- Establish follow up with a specialist within a week and provide actions to take in case of glucose emergencies.
- Prescribe continuous glucose monitoring (CGM) and glucagon rescue medication and ask family to schedule a follow-up appointment after the sensor is delivered and set up.
Getting to the Best Answer
Answer 1 is incorrect. 21% chose this answer, “Initiate basal insulin therapy and MNT instruction, with follow-up in two weeks.” Basal insulin alone is insufficient; children require both basal and bolus insulin to mimic physiologic insulin needs and prevent DKA.
Answer 2 is incorrect. 13% of you chose this answer, “Provide basic carbohydrate counting and bolus insulin instruction with a follow-up appointment within 30 days.” Delayed follow-up increases the risk of complications. Carbohydrate counting and bolus insulin are important, but must be paired with timely, ongoing support.
Answer 3 is correct. About 52% of respondents chose this, “Establish follow up with a specialist within a week and provide actions to take in case of glucose emergencies.” Early involvement of a diabetes specialist and problem solving in case of glucose crises, significantly reduce the risk of DKA and readmission. Frequent follow-up in the first week is associated with better outcomes.
Finally, Answer 4 is incorrect. 13% chose this answer, “Prescribe continuous glucose monitoring (CGM) and glucagon rescue medication and ask family to schedule a follow-up appointment after the sensor is delivered and set up.” While CGM is valuable, delaying education and clinical engagement is risky; immediate education and care planning are essential.
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!
Join us live on June 11th @ 11:30am PST!
Level 5 | Mindful Eating for Successful Diabetes Management
Join us live on June 11, 2025, at 11:30 am PST to watch our brand new webinar, Mindful Eating for Successful Diabetes Management by Evgeniya Evans, MS, RDN, CDCES
This engaging and practical webinar, developed by Evgeniya Evans, MS, RDN, CDCES, a positive psychology practitioner, is tailored explicitly for healthcare professionals including dietitians, diabetes care specialists, and providers.
Using evidence-based strategies, participants will gain a deeper understanding of the benefits of incorporating mindfulness into the eating experience, including enhanced glycemic management, improved emotional well-being, and healthier eating behaviors. The webinar includes an overview of mindfulness and mindful eating strategies, such as engaging all five senses, recognizing hunger cues, addressing cravings, and using practical tools to create supportive eating environments.
Participants will also learn how to adapt these approaches to diverse populations and the unique needs of individuals. Join us to deepen your expertise, participate in insightful discussions, and empower individuals to cultivate sustainable, positive relationships with food while achieving long-term health goals.
All hours earned count toward your CDCES Accreditation Information
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
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.
Next Level Libre: The Latest CGM Updates You Need to Know
Abbott has recently announced that as of September 30, 2025, the Libre 2 and Libre 3 CGM systems will be discontinued and replaced with the Libre 2+ and Libre 3+ CGM systems. As a diabetes education specialist, you wear many hats, including diabetes technology expert. Education, communication, and collaboration with those living with diabetes are the keys to a smooth and successful transition into updated technology.
Over 7 million people living with diabetes worldwide use a Libre Continuous Glucose Monitoring (CGM) system (1). The American Diabetes Association (ADA) 2025 Standards of Care recommends CGM as the standard of care for glucose monitoring for those on insulin therapy. The ADA also notes that CGM can be considered for those with diabetes who do not use insulin. (2)
Make Room for the Libre 2+ and Libre 3+ Systems
Since the early days of CGM technology, the Libre CGM systems have undergone several changes, and they recently announced the latest round of system improvements. They will be replaced with the Libre 2+ and Libre 3+ CGM systems.
What changes with New Libre 2+ and 3+:
- Selected insulin pump compatibility
- 15-day wear time (previously 14-day wear time)
- Approved for ages 2 years and older (previously approved for ages 4 years and older)
- More than 1000 mg of Vitamin C per day may affect glucose data (previous Vitamin C limit was 500 mg/day)
What stays the same:
- A handheld receiver (if needed for those without smartphone compatibility)
- High and low blood glucose alarms
- Sharing capability
- Size of sensors and application process
- 60-minute warm-up time
Action Needed – New Prescription
Individuals using these devices are advised to contact their healthcare provider to request a new prescription for the updated sensors. After September 30, 2025, any leftover 2 or 3 systems can still be used until their expiration date. The diabetes education specialist plays a crucial role in creating a plan to help navigate this technology transition.
New Universal Libre App
A new, universal updated phone app was released in April 2025. This changes the need for separate Libre 2 and Libre 3 apps to a universal Libre app compatible with the Libre 2, Libre 3, Libre 2+, and Libre 3+ sensors. The universal Libre app will remove the need for separate app downloads for those switching between the currently available Libre sensors. Additional features of the updated app include an easier-to-navigate platform, and users can silence alarms for a customized timeframe of up to six hours (3,4).
FreeStyle Libre 2 and FreeStyle Libre 2 Plus Sensor users will receive real-time glucose readings sent automatically to their smartphone when used with the Libre app. The Libre 2 and 2+ users will only need to scan the sensor to backfill and recover glucose data to fill in gaps on the home screen graph during periods of signal loss.
Keeping You Connected
Managing a chronic illness such as diabetes takes a team effort between those living with diabetes, the healthcare team, and family or caregivers. The LibreLinkUp app invites family members or caregivers who are helping with diabetes management to have access to glucose readings and alarms. Libre View is a cloud-based connected system between the person living with diabetes and the healthcare team. Using the Libre phone app, clients can permit healthcare providers to access their Libre CGM data to assist with creating an individualized plan of care. Abbot has also announced a collaboration with the Epic electronic medical records (EMR) system for data integration from LibreView into the EMR (1).
Libre 2+ and Libre 3+ Pump Integration
Libre 2+ and Libre 3+ can now integrate with selected automated insulin delivery (AID) systems. This will allow those using a Libre CGM to use an AID insulin pump as part of their glucose management plan. (5)
Here is a list of the current insulin pump compatibility:
- Libre 2+
-
- Omnipod 5 ® (Omnipod 5 app)
- Tandem t: slim X2 ™ (t:connect mobile app)
- Libre 3+
-
- Beta Bionics iLet Bionic Pancreas (iLet mobile app)
Over-the-Counter Libre Options
Over-the-counter (OTC) CGM is now an option for diabetes management. It is also available for those without diabetes who want to know more about glucose fluctuations. Libre now offers two OTC options, gaining approval in the US for use in 2024.
Libre Rio is an OTC CGM FDA approved for glycemic monitoring in adults 18 years and older who are not on insulin. This device can provide insightful data for those living with diabetes or prediabetes.
Libre Lingo is an OTC CGM in the health and wellness space, which is FDA approved for monitoring glucose variations to gain insight into the metabolic response to food and activity in those 18 years and older. (6)
The Bottom Line for Clinical Practice
Helping those living with diabetes navigate the changes to the Libre systems and apps can reduce frustration and data gaps. As diabetes education specialists and technology experts, you play a key role in preparing clients for upcoming changes to their diabetes technology. Understanding the differences between the Libre devices and what features are available will help create an individualized approach to diabetes care and education. If you want more information on improving your CGM data interpretation skills, check out the latest Tech Data Toolkit webinar.
Addendum published on 6/15/25:
It has come to our attention that Libre 2 and Libre 2+ no longer require scanning when using the Libre app to receive glucose data. Scanning is required to backfill glucose data when there is a signal loss. Intermittent scanning is still required to obtain glucose data when using the Libre 2 or 2+ with the receiver. The article has been corrected with this updated information, and we greatly apologize for any confusion.
Welcome Sarah Beattie, Expert Contributor
We are thrilled to welcome Sarah Beattie, DNP, APRN-CNP, CDCES, diabetes content expert to our team. As a Nurse Practitioner in a busy Endocrinology Clinic, Dr. Beattie is passionate about improving diabetes care. In addition, she creates engaging and educational content for healthcare providers as the owner of DNP Health Writer, LLC.
References
- Abbot integrates Libre’s data with Epic’s electronic health record system, providing healthcare professionals seamless glucose monitoring information. (2025, April 9). Abbot. Retrieved May 8, 2025, from https://abbott.mediaroom.com/2025-04-29-Abbott-Integrates-Libres-Data-with-Epics-Electronic-Health-Record-System,-Providing-Healthcare-Professionals-Seamless-Glucose-Monitoring-Information#:~:text=About%20FreeStyle%20Libre:,more%20than%2040%20countries7
- American Diabetes Association Professional Practice Committee. (2025). Diabetes technology: Standards of care in diabetes – 2025. Diabetes Care, 48 (supplement 1), S146-S166. https://doi.org/10.2337/dc25-S007
- Abbot. (n. d.). Freestyle Libre apps. Abbot. https://www.freestyle.abbott/us-en/products/freestyle-libre-app.html
- HME News Staff. (2025, April 21). Abbot launches Libre app. HME News. https://www.hmenews.com/article/abbott-launches-libre-app
- Abbot. (n. d.). Compatible insulin pumps. Abbot. https://www.freestyle.abbott/us-en/products/insulin-pump-compatibility.html
- Bender, C., Vestergaard, P., & Cichosz, S. L. (2025). The history, evolution and future of continuous glucose monitoring (CGM). Diabetology, 6(3), 17. https://doi.org/10.3390/diabetology6030017
Tech Data Toolkit is ready for OnDemand Viewing!
Gain confidence in interpreting the Glucose Profile Report (AGP) & CGM data using a
person-centered approach
As diabetes technology is becoming commonplace in our practice, figuring out how to make sense of all the data can seem overwhelming. Join Diana Issacs and Coach Beverly for a truly unique learning experience.
Topics include:
- Review CGM key metrics and individualize time in-range goals
- Learn how to recognize patterns with the AGP report efficiently
- Utilize the AGP report as a discussion guide when meeting with a person with diabetes
- Recommend lifestyle and medication adjustments based on CGM data
- Strategies to recognize the expertise of the individual and collaborate on person-centered problem solving.
Question of the Week | CGM Timing After Type 1 Diagnosis
JT, a 17-year-old recently hospitalized with a new diagnosis of type 1 diabetes, is using Multiple Daily Injections (MDI) therapy. JT uses fingerstick blood glucose monitoring but wants to move to a CGM. JT’s mother wants to know how long fingerstick monitoring must be used before a CGM can be started. According to the ADA 2025 Standards of Care, when can a CGM be initiated after a type 1 diabetes diagnosis?
- CGM is to be initiated when an individual with type 1 diabetes does not meet glycemic targets.
- CGM is to be initiated only when an individual with type 1 diabetes is started on continuous subcutaneous insulin infusion (CSII) therapy.
- CGM can be initiated when an individual with type 1 diabetes is ready and able, and the individual or caregiver has been educated on its use, even at diagnosis.
- CGM is to be initiated when an individual with type 1 diabetes is over the age of 18.
Tech Data Toolkit – Recorded and Ready to Watch!
Gain confidence in interpreting the Glucose Profile Report (AGP) & CGM data using a
person-centered approach
As diabetes technology is becoming commonplace in our practice, figuring out how to make sense of all the data can seem overwhelming. Join Diana Issacs and Coach Beverly for a truly unique learning experience.
Topics include:
- Review CGM key metrics and individualize time in-range goals
- Learn how to recognize patterns with the AGP report efficiently
- Utilize the AGP report as a discussion guide when meeting with a person with diabetes
- Recommend lifestyle and medication adjustments based on CGM data
- Strategies to recognize the expertise of the individual and collaborate on person-centered problem solving.
All hours earned count toward your CDCES Accreditation Information
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
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.
Strategies to Bridge Gaps in Diabetes Nutrition
Summer offers an excellent opportunity to engage with fresh, seasonal eating and a local farmer’s market offers an ideal starting point for both inspiration and nutrition. In diabetes care, fruit and vegetable consumption are cornerstone nutrition recommendations, yet most Americans don’t get enough.
Fresh Fruit and Veggies Improve Health – Yet gaps exist
Increased consumption is associated with diabetes prevention, diabetes management, and reduced risk of cardiovascular and kidney disease. A recent meta-analysis found for individuals with Type 2 Diabetes, an additional 200 grams per day (about 2.5 servings) was associated with a 26% lower risk of all-cause mortality.¹
Despite these benefits, 2019 national data showed adults met only 12.3% of daily fruit recommendations (1.5-2 cups) and 10.0% of daily vegetables recommendations (2-3 cups).² The lowest intakes were found among males for fruit consumption and in individuals living at or below the poverty line for vegetable consumption. Barriers such as cost, limited access, lack of preparation skills, and previous food experiences all contribute to these gaps; however, by supporting access and confidence in use, we can help bridge this gap.
Taking Action to Address Food Quality and Access
In 2019, I experienced these challenges firsthand while working at a rural health clinic in Northern California serving individuals living with type 1 and type 2 diabetes. While we were making progress using population health strategies to support outreach and engagement, as a dietitian, I recognized we could do more to address food quality and access for our rural community.
A chance conversation at a community health event led to a grant opportunity and the creation of a Fruit and Vegetable Prescription program. Individuals attending diabetes care visits could be eligible to receive farmer’s market vouchers, aligning with the recent launch of a local downtown market. Although the market was not year-round, we saw this as an opportunity to help connect individuals at risk of low intakes with seasonal produce found at farmers’ markets.
Each week, we partnered with farmers to provide recipe cards, seasonal produce challenges, and activities that encouraged trying new foods into traditional meals. Although early outcomes were limited by the onset of COVID the following year, similar programs continue across the U.S.³, with studies suggesting potential long-term benefits for fruit and vegetable intake, food security, and clinical markers linked to diabetes and cardiovascular disease.⁴
Nutrition Assistance Programs Make a Difference
In addition to Prescription Programs, several other, currently funded⁵, nutrition assistance programs can help increase food dollars for farmers’ market spending. Many farmers’ markets across the U.S. now accept SNAP/EBT and programs like Market Match, WIC, and the Senior Farmers’ Market Nutrition Program, offering incentives by matching the value of EBT dollars spent on fruits and vegetables. Identifying participating markets in our communities and sharing how individuals can access these benefits may help reduce financial barriers and support more equitable access to fresh, healthy foods.
A helpful resource is the USDA Farmers Market Directory, which allows users to search by zip code for local markets and filter results to show those that accept SNAP or other benefits.
Getting Familiar with New Foods
Familiarity, exploring new foods, and obtaining skills for preparation can be another challenge. Tools such as the Seasonal Food Guide offers information by state and month on what produce is in season. Within this guide, you will find links to information on each type of food, including purchasing, storing, and cooking. Fruitsandveggies.org offers resources for health professionals, consumer handouts, information about each fruit or vegetable, seasonal guides, and recipes.
Clients have shared wonderful resources from Tiktok, Instagram, or YouTube for how to cook videos for new foods. Many farmers’ markets have their own pages, which can tell you what is in season at your local market that week. Planning meals and determining what to eat can be one of the most challenging aspects of nutrition management in diabetes. Knowing what is available, exploring meal planning ideas, helping shop with a plan, sharing tips, and engaging with farmers for preparation and storage advice can help build confidence in food selection.
Enjoying the Rainbow of Fruits and Veggies
At our local market in Northern California, produce such as berries, cucumbers, zucchini, cherry tomatoes, bell peppers, and leafy greens are plentiful and align well with diabetes nutrition therapy. Berries are high in antioxidants and fiber. Zucchini and cucumbers are hydrating non-starchy vegetables, perfect for raw salads or simple sautéed side dishes. Leafy greens, such as arugula, spinach, and Swiss chard, are rich in vitamins and minerals and pair well with many summer meals.
Ideas for incorporating these foods could include zucchini noodles tossed in pesto or a basic marinara sauce, a cucumber and tomato salad with vinaigrette, a berry and Greek yogurt bowl, or sautéed peppers and greens served with grilled chicken or a bean of choice. When healthcare providers connect individuals to accessible nutrition strategies, they support sustainable, community-based diabetes care that can promote health beyond the clinic walls.
Easy Plant-Based Recipe:
3- Minute Skillet Beans & Greens⁶
Time: 5 minutes, Cook Time: 3 minutes
Servings: 4 (¾ cup each)
Ingredients:
-
🫒 1 tbsp olive oil
-
🫘 1 (15-oz) can no-salt-added garbanzo beans (or rinse regular beans), drained
-
🌶️ 1 tsp curry powder
-
🌿 ½ tsp ground ginger
-
🧂 ¼ tsp black pepper
-
🥬 5 oz fresh baby spinach
-
🧂 ¼ tsp salt
💡 No spinach? Swap with kale, collard greens, or other leafy greens! (Note: heartier greens will need 2–3 more minutes to cook!)
🔥 Just heat, stir, and enjoy your speedy, healthy, and super tasty dish! 😋✨
Instructions:
-Heat the olive oil in a large skillet over medium heat.
-Add garbanzo beans, curry powder, ground ginger, and black pepper. Stir to coat the beans evenly in the spices.
-Add spinach and salt. Stir gently and cook for about 2½ minutes, or until the spinach is wilted and the beans are heated through.
-Serve warm.
Optional Add-Ins:
-For a saucier dish, add a few spoonfuls of the reserved bean liquid to the pan.
-Add a splash of coconut milk for a creamy, richer version.
Nutrition Facts (Per ¾ Cup Serving):
-Calories: 155, Total Fat: 6g (Saturated Fat: 0.7g), Carbohydrates: 21g (Dietary Fiber: 7g, Sugars: 4g), Protein: 8g, Sodium: 170mg, Potassium: 415mg
For More Information:
-Farmer’s Market Programs: https://www.fns.usda.gov/farmersmarket
-Find a local Farmer’s Market: Local Food Directory https://www.usdalocalfoodportal.com/fe/fdirectory_farmersmarket/
-Seasonal Food Guide: www.seasonalfoodguide.org
-Have a Plant: Fruit and Veggies.org: www.fruitsandveggies.org
References:
- Faezeh Geravand, Mohsen Montazer, Seyed Mohammad Mousavi, Leila Azadbakht, Fruit and Vegetable Consumption and Risk of All-Cause and Cause-Specific Mortality in Individuals With Type 2 Diabetes: A Systematic Review and Dose–Response Meta-analysis of Prospective Cohort Studies, Nutrition Reviews, 2025;, nuaf013, https://doi.org/10.1093/nutrit/nuaf013
- Lee SH, Moore LV, Park S, Harris DM, Blanck HM. Adults Meeting Fruit and Vegetable Intake Recommendations- United States, 2019. MMWR Morb Mortal Wkly Rep 2022;71:1-9 downloaded on June 18th 2025 from https://www.cdc.gov/mmwr/volumes/71/wr/mm7101a1.htm?s_cid=mm7101a1_w
- Voucher Incentives and Produce Prescriptions downloaded on June 18th, 2025 from https://www.cdc.gov/nutrition/php/incentives-prescriptions/index.html
- Hager K, Du M, Li Z, et al. Impact of produce prescriptions on diet, food security, and cardiometabolic health outcomes: A multisite evaluation of 9 produce prescription programs in the United States. Circ Cardiovasc Qual Outcomes. 2023;16(9). doi:10.1161/CIRCOUTCOMES.122.009520
- Learn about how to take Action to Support Nutrition Programs by visiting Academy of Nutrition and Dietetics Leads Trusted Health Organizations in Urging Congress to Protect Investments in Nutrition Security downloaded on June 19th 2025 from
https://www.eatrightpro.org/about-us/for-media/press-releases/academy-leads-organizations-in-urging-congress-to-protect-investments-in-nutrition-security - Recipe from Diabetes Food Hub downloaded on June 18th, 2025.
🎉 Register Today: DiabetesEd Live Conference – San Diego!
October 22–23, 2025 | 🌴 San Diego, CA
Get ready for two days of expert-led, info-packed learning at our in-person DiabetesEd Live Seminar! Whether you’re preparing for your certification exam or looking to sharpen your clinical skills, this intensive event is designed to give you the tools, confidence, and knowledge you need.
💡Ideal for exam prep and clinical refresh
💡 Interactive sessions with real-world applications
💡Network with peers and diabetes care experts
📅 Mark your calendar — October 22–23
📍 San Diego – beautiful location, powerful learning!
Exciting News! Newly Expanded Accreditation
Diabetes Education Services has teamed up with Partners for Advancing Clinical Education (Partners) to expand our accreditation offerings.
You can now earn CE credit for the Live San Diego Conference through the following accrediting bodies:
- AMA PRA Category 1 Credits™
- ACPE
- ANCC
- CDR
“Have You Been Drinking?’ – Coach Bev’s Book Excerpt
The paramedics rushed me into the emergency room. They gave report as the nurse busied herself with wrapping a blood pressure cuff around my arm and clipping a pulse oximeter to my index finger. With the sloppy arrangement of bandages around my head, I looked like a pale mummy dressed up for Halloween. The oral surgery from earlier that day caused my lips and mouth to swell, making me look like I had recently survived a brawl.
In an instant, I felt like I might pass out, and fear grabbed at my chest. I managed to croak out to the nurse, who was running back and forth between two rooms, “How would you know if I went unconscious?”
She glared at me and said, “Your blood pressure is fine.” Then she sighed and peppered me with the first questions she had asked since I arrived. “Are you on drugs?”
“No.”
“Do you have a mental illness?”
“No.”
“Have you been drinking?” she asked.
“No, I had oral surgery…”
My attention waned as my brain drifted off to sleep. Suddenly, a loud beeping filled the room as the blood pressure alarms began to sound. The nurse shifted into fast motion, dropped the head of the gurney, and deftly jabbed me with a 16-gauge intravenous (IV) needle. She ran a liter of normal saline, full throttle, into my parched body. This nurse knew her way around trauma. She was an emergency room hotshot, adept at triage, and could probably have started that IV blindfolded and with a full bladder. But I couldn’t figure out why she was so annoyed with me. Why couldn’t she comfort this frightened person in her care?
As a veteran nurse and a person with a handful of chronic conditions, I have witnessed healthcare professionals with cutting-edge expertise neglect to make a connection with the very people they are working so hard to serve. I have also encountered healthcare professionals with minimal experience making an earnest effort to connect and comfort individuals in their care. As a patient who has experienced enough ER visits and hospital stays to last a lifetime, I feel a deep and persistent gratitude to those caregivers who grabbed my hand and reassured me that I would be okay.
After receiving a few bags of saline, my low blood pressure—caused by severe dehydration—stabilized, and I quickly recovered. Besides my swollen face from oral surgery and bruised ego, I felt like my old self and easily joked around with the next nurse who took over my care. But inside, I felt embarrassed and angry. I kept wondering why the first nurse had not comforted the frightened and vulnerable person in her care instead of assuming I was suffering from mental illness, using drugs, or drinking. My pride was battered. I felt as though she stood in judgment of me, with a laser-like focus on asserting her clinical skills and knowledge.
With time and reflection, I began to view this event from a more nuanced perspective. There could be other factors contributing to her seemingly indifferent approach. Perhaps her shift was ending and she was eager to return home to her family. She might be struggling with burnout, like many of our healthcare colleagues. Maybe I reminded her of a past patient who was especially needy. Alternatively, she could be living with unresolved trauma that was in search of healing.
As a caregiver, can you recognize a part of yourself in this nurse?
Have you ever responded to a patient in a way that didn’t match your values and intentions? Maybe you were struggling with pain in your life, and you had nothing left to give. Or it could have been that a person’s fear and neediness triggered an unexpected response from you that caught you off guard. Perhaps you assumed the person in your care was drug-seeking or somehow trying to manipulate the situation without having all the facts. You’re not alone if you’re saying “yes” to those questions.
After 40 years as a nurse and diabetes specialist, I have responded to patients in ways that contradicted my values and intentions. I still carry a sense of regret for the times I have judged or treated others unfairly. However, the silver lining is that my missteps helped me forge a new path by recognizing where that “judgy” side of me exists and actively working to heal it. This shift to accepting people as they are and opening my heart to make meaningful connections has unexpectedly served as a healing balm to my most profound areas of pain. In return, I can be more present with people’s suffering and receive them as they are at that moment.
Offering acceptance without judgment may be one of the greatest gifts you can extend as a healthcare professional —to those you care for and yourself. This action creates space for mutual healing, flowing in both directions—from healthcare professional to patient and back again.
As a healthcare professional, you bring your own life experiences, traumas, wounds, triggers, blind spots, beliefs, and inner narratives to each patient encounter.. We all do. Gabor Maté, a renowned physician and author, has shared his journey of recovering from trauma through his work and personal reflections. His recovery was deeply tied to understanding the roots of his trauma, developing self-awareness, and engaging in practices that foster healing. Dr. Maté emphasizes that “trauma is not the event itself, but the wound left by the event—how the experience disrupts one’s sense of self and connection to others.” He believes sharing one’s story and connecting with others’ experiences can be a powerful way to heal.
My life story begins with the hope of living the American dream but quickly unravels with life events I did not ask for or anticipate. With a determined focus on my future, I reclaimed my life and marched forward, holding my pain inside. I figured that if I worked hard enough and finally proved myself worthy, these feelings of failure would slip away into the darkness from whence they came.
By the time I reached 50, I thought I had accomplished my goal and wrestled the inner critic to the ground. But that’s when my body stopped me cold in my tracks and forced me to look deep inside to start the healing process.
This book is an emancipation from those stories not told while providing a path toward healing. I aim to share these hidden moments as a commitment to healing myself and giving YOU permission to share your story. I know I am not the only healthcare professional who has endured painful experiences and had to keep going. We all have stories of suffering and triumph, desperation and survival, grief and reconciliation.
These lived experiences may even be what led you to enter the healthcare field in the first place.
Your Healing Journey Starts Here
At the intersection of healer and caregiver, a meeting of human experiences takes place. It’s an opportunity to connect with genuine curiosity and compassion—to see the person before you without preconceived notions or judgment.
This book is both a reminder and a roadmap; an invitation to care for yourself with the same compassion you offer others. It provides a rare perspective on mutual healing: As we help others heal, we also heal ourselves. Within these pages, you’ll find a toolbox for exploring your truth, tapping into your emotions, and cultivating creativity. Together, we’ll explore the often-overlooked connection between your own lived experiences and those of the individuals in your care.
This book speaks directly to the heart of caregiving. It shows how, when you balance the science of medicine with the humanity of connection, every interaction becomes an opportunity for transformation, growth, and healing.
PreOrder your signed copy of Coach Bev’s book, Healing Through Connection for Healthcare Professionals today.
Special sale price and Free Med PocketCard with every order.
For a limited time only!
Join our Virtual Book Release Party on July 23rd at 11:30 PST
Before I launch my book tour, I want to share the contents with all of YOU first – at our upcoming virtual party.
This book is a personal testament to the strength of the human spirit,
with the belief that when we show up with open hearts, we become part of each other’s healing.
There will be some fun surprises during the launch party ???– so I hope you can join us!
Stop by my booth #527 at ADCES in Phoenix, Aug 8-10th. I will be there to sign books, hear your stories and dole out hugs!
Rybelsus Dosing Update & Single Dose Vial Tirzepatide (Zepbound)
In the world of incretin therapy, there are two important updates for your clinical practice. Staying informed about dosing updates and FDA actions remains essential in this dynamic GLP-1/GIP landscape.
First, the oral version of semaglutide (Rybelsus) now offers two dosing options. In addition to the original R1 formulation of 3, 7 and 14mg, there is now a more conservative R2 dosing formulation of 1.5, 4 and 9mg. This lower dosing option was recently introduced to help reduce gastrointestinal side effects while maintaining efficacy and enabling smoother escalation than the original dosing strategy.
We have updated our FREE Medication PocketCards to reflect this latest information. You can also purchase your own laminated version!
Second, Eli Lilly has launched single dose vials of tirzepatide (Zepbound), to provide more accessibility and pricing options for self-pay individuals who need a safe, less expensive option. This “twincretin” is FDA approved to treat people living with obesity and sleep apnea. Eli Lilly also just announced they will stop production of single dose vials of tirzepatide (Mounjaro) for treatment of diabetes. The Mounjaro pens will continue to be available.
1. Rybelsus (oral semaglutide) dosing update
Novo Nordisk’s FDA-approved oral GLP-1 therapy, Rybelsus, now comes in two formulations:
💊 Formulation R1 tablets: 3 mg, 7 mg, and 14 mg
💊 Formulation R2 tablets: 1.5mg, 4mg, and 9?mg
Standard titration protocols:
▶️R1: Start at 3mg daily (days 1–30), increase to 7mg (days 31–60); thereafter, remain at 7mg or escalate to 14mg if needed.
🔹R2: Starting dose is 1.5mg daily for 30 days, then increase to 4 mg (days 31–60); after that, maintain 4mg or advance to 9mg based on glycemic control
See Rybelsus Package Insert for more detailed information.
Looking ahead—CV benefits expansion
A supplemental new drug application (sNDA) is under review to broaden Rybelsus’s indication to include major adverse cardiovascular events risk reduction in type 2 diabetes patients with cardiovascular or kidney disease. The FDA is expected to rule by October 2025.
2. Single vial tirzepatide (Zepbound) rollout
Eli Lilly has launched single dose vials of tirzepatide (Zepbound) —a dual GLP-1/GIP agonist approved for obesity and sleep apnea treatment—offering a more accessible and flexible self-pay option.
What Zepbound doses are available in vials?
- ✅ 2.5mg and 5mg vials have been available for a while; now 7.5mg, 10mg, and even 12.5mg and 15mg single-dose vials are being offered.
- ✅ Pricing is approximately $349/month for 2.5mg, $499 for 5mg, and newly introduced higher doses cap around $499–699/month depending on dose and timing.
Why vials matter:
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✅ Affordability: Prices are considerably lower than injector pens, which often cost around $1,000 monthly before insurance
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✅ Accessibility: Targets self-pay patients not eligible for insurance or savings programs.
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✅ Precision: Enables titration beyond currently approved pen doses; however, it requires self-administration via syringe, increasing complexity and risk of dosing errors.
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More info health.com.
Safety considerations:
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⚠️ The FDA continues to crack down on compounded (non-FDA-approved) semaglutide and tirzepatide products due to serious safety reports tied to misdosing and sterility issues.
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⚠️ Lilly, in turn, is using its vial rollout and legal action to provide safer, legitimate alternatives to compounding pharmacies.
3. Clinical & financial insights
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🫀 Rybelsus: Benefit from the new R2 protocol that eases GI side effects and may soon gain cardiovascular protection indications.
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💰 Tirzepatide (Zepbound): Vials offer cost savings and dosage flexibility, but require extra care in administration. Safe sourcing is key
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🚫 Market impact: The FDA’s crackdown on compounding and Lilly’s legal and pricing strategies reflect a shift toward ensuring access to approved, reliable options over risky alternatives.
4. Bottom Line
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💊 Rybelsus: The new R2 dosing regimen improves tolerability while maintaining efficacy and supports potential future cardiovascular indications.
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💸 Tirzepatide (Zepbound) vials: A welcome, lower-cost, flexible injection option—but users must handle dosing themselves and steer clear of unsafe compounded products.
Download our FREE Medication PocketCards to reflect this latest information.
You can also purchase your own laminated version.
🎉 Register Today: DiabetesEd Live Conference – San Diego!
October 22–23, 2025 | 🌴 San Diego, CA
Get ready for two days of expert-led, info-packed learning at our in-person DiabetesEd Live Seminar! Whether you’re preparing for your certification exam or looking to sharpen your clinical skills, this intensive event is designed to give you the tools, confidence, and knowledge you need.
💡Ideal for exam prep and clinical refresh
💡 Interactive sessions with real-world applications
💡Network with peers and diabetes care experts
📅 Save your space today for this unique conference on October 22 & 23rd.
📍 San Diego – beautiful location, powerful learning!
Exciting News! Newly Expanded Accreditation
Diabetes Education Services has teamed up with Partners for Advancing Clinical Education (Partners) to expand our accreditation offerings.
You can now earn CE credit for the Live San Diego Conference through the following accrediting bodies:
- AMA PRA Category 1 Credits™
- ACPE
- ANCC
- CDR
Rediscovering Walking – From Rucking to Kicking Up Intensity
Walking is often recognized as the most accessible and underrated form of exercise. While some may argue in favor of high-intensity cardio or resistance training, a growing body of evidence suggests that walking offers significant benefits—especially when approached with intention and consistency.
According to Dr. Elroy Aguiar, an assistant professor of exercise science at The University of Alabama, walking remains one of the most beneficial forms of movement due to its low barriers to entry—minimal cost, equipment, or skill required. “That’s why we say it’s the best,” Dr. Aguiar notes. And yet, despite this accessibility, many individuals struggle to find time to incorporate walking into their busy, sedentary lives.
🚶♂️ Cadence Matters: Walking with Intensity
Not all walking provides the same health return. The intensity, particularly cadence (steps per minute), plays a crucial role in determining health outcomes.
🕒 100 steps per minute is considered moderate intensity
⚡ 130 steps per minute qualifies as vigorous intensity
Dr. Aguiar’s research, published in the British Journal of Sports Medicine, indicates that health benefits from walking begin to accumulate at moderate or higher intensities. Most people naturally walk at a pace of 110–115 steps per minute when moving briskly. Increasing cadence just slightly can shift the effort from moderate to vigorous, maximizing the health payoff in a shorter time span.
🎒 Add Intensity with Rucking
For those looking to increase the challenge of walking, rucking—walking with a weighted backpack—offers a practical solution.
Adding resistance increases oxygen demand, raises heart rate, and enhances caloric burn without requiring a change in pace or duration. According to Dr. Aguiar, this method can also improve lower body strength and bone density, particularly with consistent practice over time.
While it won’t replace traditional strength training, rucking offers an accessible way to gain some muscular benefits while walking. A light weight to start, gradually increased, can help prevent injury and support adaptation.
⏱️ One Minute Can Make a Difference
A 2024 study published in the Scandinavian Journal of Medicine and Science in Sports found that both the quantity and intensity of physical activity are associated with better health outcomes. Remarkably, even one minute of higher-intensity activity per day was linked to a lower likelihood of having metabolic syndrome—a cluster of risk factors including visceral adiposity, high blood pressure, high blood sugar, low HDL cholesterol, and elevated triglycerides.
Dr. Aguiar explains that an individual’s most intense one-minute activity across the day can serve as a strong indicator of metabolic health. Even brief, high-intensity bursts of activity may help reduce risk for diabetes, hypertension, and cardiovascular disease.
🍽️ Walking After Meals: A Simple Strategy for Blood Glucose Improvement
Another practical strategy supported by research is post-meal walking. A 15-minute walk after meals can help blunt spikes in blood glucose, particularly in older adults at risk for glucose intolerance.
When muscles are active, they draw glucose from the bloodstream to use for energy, thereby reducing blood sugar levels and easing the demand on insulin. Over time, this can help prevent insulin resistance, a precursor to Type 2 diabetes.
Dr. Aguiar notes that consistent post-meal movement can reduce the workload on the pancreas and enhance the muscles’ ability to absorb and use glucose. This daily practice may offer long-term protection against metabolic syndrome, hypertension, and diabetes.
📉 Step Count and Longevity
Large-scale studies have shown clear associations between step count and mortality risk. A 2023 meta-analysis published in the European Journal of Preventive Cardiology found:
- 2,337 steps/day: lower cardiovascular mortality
- 3,867 steps/day: lower all-cause mortality
- Each additional 1,000 steps: 15% reduction in all-cause mortality
- Each additional 500 steps: 7% reduction in cardiovascular mortality
Additionally, a study by the University of Granada concluded that while more steps bring more benefits, the majority of cardiovascular protection appears to occur around 7,000 steps/day. The popular goal of 10,000 steps per day, while not evidence-based, remains a useful motivational benchmark.
💡 Who Benefits the Most?
For elite athletes, walking may offer limited fitness returns. However, for individuals who are sedentary or new to exercise, walking provides a low-impact, effective entry point to better health.
Some key benefits of walking for the general population include:
- Improved cardiovascular health
- Strengthened muscles and joints
- Support for bone density
- Increased daily caloric expenditure
- Reduced risk of chronic diseases
Walking is especially valuable for individuals managing or at risk for Type 2 diabetes, obesity, hypertension, and metabolic syndrome.
🔟 Key Takeaways
- Cadence matters – 100 steps per minute = moderate; 130+ = vigorous
- Even one minute of high-intensity movement can improve metabolic markers
- 15-minute walks after meals can significantly lower blood glucose
- Rucking adds intensity, strength, and calorie burn to walking
- Walking is linked to lower mortality from all causes and cardiovascular disease
- Most benefits occur by 7,000 steps/day, but more is better
- Walking is an entry point to fitness, particularly for the sedentary
- The practice supports muscle and bone health
- It requires no equipment and is nearly universally accessible
Walking delivers significant, sustainable health benefits with minimal risk
📝 Final Thoughts
Walking is a powerful yet underappreciated form of movement. Whether used to regulate blood sugar, reduce cardiovascular risk, or improve mental clarity, walking remains one of the most effective and inclusive health strategies available.
For anyone looking to improve overall health without the barriers of cost, complexity, or time—walking offers a proven path forward.
📚 References
- Aguiar, E. J., et al. (2021). Walking cadence (steps/min) and intensity in 21–40-year-olds: CADENCE-adults. British Journal of Sports Medicine.
- DiPietro, L., et al. (2013). Benefits of Postmeal Walking on Glycemic Control in Older Adults at Risk for Impaired Glucose Tolerance. Diabetes Care, 36(10), 3262–3268.
- European Journal of Preventive Cardiology (2023). Daily step count and all-cause and cardiovascular mortality: a dose–response meta-analysis.
- University of Granada Study (2023). Step count thresholds for cardiovascular benefit: optimal versus traditional targets. European Journal of Preventive Cardiology.
Recorded & Ready for OnDemand Viewing!
Tech Data Toolkit!
Gain confidence in interpreting Glucose Profile Report (AGP) & CGM data using a person-centered approach! Earn 4.0 CEs
If you are preparing for certification exams or want to up your game using CGM data to improve outcomes, this course is for you.
1:30am to 2:30pm PST
Gain confidence in interpreting Glucose Profile Report (AGP) & CGM data using a person-centered approach.
As diabetes technology is becoming commonplace in our practice, figuring out how to make sense of all the data can seem overwhelming. Join Diana Issacs and Coach Beverly for a truly unique learning experience.
Dr. Isaacs has a special knack for breaking down the essential elements of the Ambulatory Glucose Profile (AGP) report to provide participants with a clear road map for data interpretation. She includes many sample practice cases utilizing CGM data for various types of people with diabetes including type 2 and people with type 1 not on pumps.
Coach Beverly will build on Dr. Isaacs’ presentation and switch the focus to the person living with diabetes. Using a case study approach, she will provide strategies to integrate the AGP with person-centered care that empowers individuals to experience increased confidence in their diabetes self-management.
By attending this interactive workshop, participants will become more confident in interpreting the AGP and continuous glucose monitor (CGM) data and determining needed medication and lifestyle adjustments with a person-centered approach.
Topics include:
Review CGM key metrics and individualize time in-range goals
Learn how to recognize patterns with the AGP report efficiently
Utilize the AGP report as a discussion guide when meeting with a person with diabetes
Recommend lifestyle and medication adjustments based on CGM data
Strategies to recognize the expertise of the individual and collaborate on person-centered problem solving.
Rationale of the Week | Decoding AGP Report – Test Your Knowledge!
For last week’s practice question, we quizzed participants on Decoding AGP Report-Test Your Knowledge. 49% 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: AJ asks you why their blood glucose levels are “all over the place”. When you look at the AGP, you notice the coefficient of variation is 26%. What is the best response?
Answer Choices:
- Even though your coefficient of variation is above target, we can work to bring that down.
- It seems like you are making a big effort keep your glucose in target range.
- Given your glucose fluctuations, we may need to intensify your medication regimen.
- With some small changes in lifestyle activities, I am sure you can make improvements.
Getting to the Best Answer
Answer 1 is incorrect. 19% chose this answer, “Even though your coefficient of variation is above target, we can work to bring that down.” According to ADA Standards, the goal for glucose variability (or coefficient of variation) is less than 36%. AJ has a coefficient of variation of 26%, which is significantly below the target. This is a wonderful opportunity to recognize AJ’s self-management efforts.
Answer 2 is correct. 49% of you chose this answer, “It seems like you are making a big effort keep your glucose in target range.” YES, this is the BEST Answer. AJ has a coefficient of variation of 26%. That is 10% below the target of 36%. This is a wonderful opportunity to recognize AJ’s self-management efforts.
Answer 3 is incorrect. About 13% of respondents chose this, “Given your glucose fluctuations, we may need to intensify your medication regimen.” According to ADA Standards, the goal for glucose variability (or coefficient of variation) is less than 36%. AJ has a coefficient of variation of 26%, which is significantly below the target. This is a wonderful opportunity to recognize AJ’s self-management efforts.
Finally, Answer 4 is incorrect. 17% chose this answer, “With some small changes in lifestyle activities, I am sure you can make improvements.” According to ADA Standards, the goal for glucose variability (or coefficient of variation) is less than 36%. AJ has a coefficient of variation of 26%, which is significantly below the target. This is a wonderful opportunity to recognize AJ’s self-management efforts.
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!
There’s Still Time! 🕒
Join us today for Part 2 of Tech Data Toolkit!
*Don’t worry if you missed the first session. All of our webinars are recorded and ready for OnDemand Viewing!
Dr. Diana Isaacs speaks live today @ 11:30am PST today!
Dr. Isaacs has a special knack for breaking down the essential elements of the Ambulatory Glucose Profile (AGP) report to provide participants with a clear road map for data interpretation. She includes many sample practice cases utilizing CGM data for various types of people with diabetes including type 2 and people with type 1 not on pumps.
Topics include:
- Review CGM key metrics and individualize time in-range goals
- Learn how to recognize patterns with the AGP report efficiently
- Utilize the AGP report as a discussion guide when meeting with a person with diabetes
- Fresh approach to lifestyle and medication adjustments based on CGM data.
All hours earned count toward your CDCES Accreditation Information
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
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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