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Question of the Week | CS’s A1C Climbs After Experiencing Distress
CS is a 42-year-old with type 1 diabetes for just over 18 years. In the past year, their A1C changed from 7.4% to 9.1%, and weight increased by 20 pounds. Review of CGM data suggests missed insulin boluses more than 7 times per week, and discussion with CS reveals missed clinic visits due to feeling “burned out”. They score in the moderate range on the Diabetes Distress Scale.
Based on the ADA 2026 Standards of Care, which of the following is the most appropriate next step?
- Partner with CS to reduce missed boluses and reassess in 3 months.
- Simplify regimen to support current state of diabetes distress.
- Refer to a qualified behavioral health professional for evaluation and treatment.
- Recommend referral to MNT for a structured weight-loss program.
Level 2 | ADA Standards of Care Complete Review
2026 Recording Available On-Demand
Level 2 | Improving Care and Promoting Health
Join us live on February 10th, 2026 at 11:30 AM PST!
The Case for Professional Practice Groups in the Digital Age
If you’ve considered not renewing your professional practice group membership this year, you’re not alone. Membership in professional organizations has declined as many turn to social media and AI-driven platforms for information and connection. Still, I encourage you not to abandon professional membership in favor of options that may seem cheaper or more convenient.
In a noisy, chaotic landscape of information overload, professional practice groups remain a refuge from the storm. They offer a trusted alternative to clickbait, providing vetted expertise, meaningful connection, and true professional community.
No amount of viral TikTok videos or LinkedIn commentary can replace the depth of connection and sense of purpose that come from active engagement in a professional practice organization. And, here’s why.
What is a Professional Practice Group?
Professional practice groups, also known as professional practice organizations, are designed to advance a specific field by providing members with networking opportunities, professional development, and practice resources. In healthcare, these organizations may be tailored to the needs of a single discipline, such as the American Nurses Association, or span interdisciplinary areas of practice, like the Association of Diabetes Care and Education Specialists or the American Diabetes Association.
Some organizations focus primarily on education and credentialing, while others emphasize leadership development and community building. Still others center their work on advocacy related to patient care, access, and insurance coverage.
Who Actually Runs a Professional Practice Group?
At its core, most professional practice groups are founded and driven by their members, with membership dues supporting the administrative needs required to operate. As groups grow, they often engage professional management or organizational leadership teams to oversee day-to-day operations such as membership services, programming, finances, legal compliance, and other administrative functions.
Strategic direction and oversight typically remain the responsibility of an elected or appointed governing body. In some cases, professional organizations may choose to hire members, transitioning them from volunteer roles into paid staff positions.
As operating costs rise, often without corresponding increases in salaries or reimbursement, many professional practice groups partner with industry or government organizations for additional financial support. These partnerships can help keep membership dues, educational programming, and events accessible and affordable for members.
Why is Membership on the Decline?
It would be easy to blame declining professional membership on COVID, but the reality is this trend started long before the pandemic. Across healthcare, fewer clinicians are joining or renewing professional organizations. Cost is often the biggest factor. When budgets are tight, many people feel forced to choose one membership instead of several. Others question whether the return on investment is still there, especially when education, networking, and professional content are now easy to find online for free.
In my own field of dietetics, I also hear concerns about transparency and alignment with the future of the profession. The move to a master’s degree requirement without a meaningful increase in entry-level pay has created real frustration, particularly for early-career professionals and those from underrepresented backgrounds. Many feel their needs were not fully considered or advocated for during that transition.
These frustrations are valid. But they are also exactly why walking away may not be the answer. Professional practice groups are shaped by the people who show up. If something isn’t working, the most effective way to change it is to get involved.
The Case for Professional Membership
Despite the challenges, the benefits of professional membership far outweigh the drawbacks, and the opportunity to influence the future of your profession is worth staying engaged.
Mentorship That Isn’t Transactional
Social media platforms like LinkedIn, Substack, and X (formerly Twitter) are great for ideas and inspiration, but they rarely offer sustained, reciprocal mentorship. Most interactions are brief, one-sided, or tied to someone selling something.
Professional practice groups offer something different. They foster trusted relationships with people who have walked the same path and understand the realities of the work. Advice is shared openly, support develops over time, and there is no sales funnel attached. It is not a transaction. It is a co-op.
Space to Grow, Not Perform
Professional practice groups offer a space to ask questions without worrying about who is watching or how you are being perceived. There is room to be unsure, curious, or quietly ambitious, especially early in your career or during periods of transition.
Unlike social media, which often rewards confidence and visibility, professional groups tend to reward competence, growth, and thoughtful engagement. The focus is less on performance and more on learning and supporting one another as professionals.
Depth Over Virality
Most online content is designed for reach, not rigor. Professional practice groups focus on depth, offering evidence-based, peer-reviewed insights shared by professionals, for professionals. It is not about trends. It is about trust. As these professional practice groups evolve, many are also opening the door to honest conversations about topics once considered off-limits, such as workplace culture, compensation, and career options.
More Than a Membership
I’ve made meaningful connections on social media and learn something new every day from tools like ChatGPT. Those platforms have their place.
But when I want to understand where a profession is really headed, I look to professional practice groups. Who is presenting the research? What study resources are being recommended? Who is mentoring, volunteering, and helping shape the future of the field? These groups create space to contribute, learn, and grow alongside peers who care deeply about the work.
I’ve always respected my work colleagues, but I truly value my professional practice peers. I hope you will, too.
References:
- Southwest journal of pulmonary, critical care and sleep – editorials – the decline in professional organization growth has accompanied the decline of physician influence on healthcare. https://www.swjpcc.com/editorials/2024/5/16/the-decline-in-professional-organization-growth-has-accompan.html. Accessed December 13, 2025.
- Why professional associations aren’t engaging young professionals – highland. https://www.highlandsolutions.com/insights/why-professional-associations-arent-engaging-young-professionals. Accessed December 13, 2025.
- Markham MJ, Gentile D, Graham DL. Social Media for Networking, Professional Development, and Patient Engagement. Am Soc Clin Oncol Educ Book. 2017;37:782-787. doi:10.1200/EDBK_180077.
- Cline D, Curtin K, Johnston P. Professional organization membership: the benefits of increasing nursing participation. CJON. 2019;23(5):543-546. doi:10.1188/19.CJON.543-546
About Sarah
Sarah is the owner of Sarah Hormachea: Diabetes Care and Education, LLC. She is a long-time member of the Academy of Nutrition and Dietetics, the Association of Diabetes Care and Education Specialists (ADCES), and the American Diabetes Association (ADA). She currently serves as Webinar Chair for the Academy’s Diabetes Practice Group and is an incoming member of the ADCES Board of Directors. She is also enrolled in a women’s leadership development program through the ADA.
Learn More With Our Upcoming Courses
How Not Winning Motivated Me to Write A Book
Several years ago, I was nominated for Diabetes Educator of the Year. Being put forward by colleagues I deeply respected and admired was profoundly meaningful—and, honestly, a little overwhelming.
The nomination felt like recognition of decades of clinical work, teaching, mentoring, and advocacy for person-centered diabetes care. After submitting the detailed application, I allowed myself to feel hopeful. I imagined sharing my philosophy of judgment-free diabetes care with audiences across the country, offering a message of healing for both healthcare professionals and the people they serve. I even choreographed my walk-up dance in my head, ready to hit the ground running.
Then the email arrived from the board: I hadn’t been selected.
I won’t pretend it didn’t sting. I was devastated. Awards matter because they symbolize recognition; they affirm that your voice has value. When I wasn’t chosen, I found myself sitting with a familiar response that many healthcare professionals have experienced: a complicated mix of disappointment, sharp self-doubt, and the well-worn instinct to minimize the hurt and simply move on.
But once the initial ache softened, something important came into focus. I realized that while awards can amplify a message and provide a platform for it, they are not the source of the message itself. And my message was still burning—undiminished—inside me.
The Message Wouldn’t Let Me Go
For years, I had been witnessing something under the surface of diabetes care and, more broadly, of healthcare. Earnest and compassionate clinicians were giving their all to provide the best care, but felt they weren’t breaking through or reaching people in ways that led to significant change. Many were questioning their worth, their effectiveness, and even their decision to enter healthcare at all.
I heard it in hallway conferences. In mentoring meetings. In calm moments after lectures when someone would come up to me and say, “I thought it was just me.”
I knew then that the story I was burning to share couldn’t be reduced to a title or an award category. The message I was holding wasn’t just about diabetes education and achieving an A1C of less than 7%. It was about the emotional gift of caring—and the healing strength of connection.
Choosing Impact Over Recognition
Not winning that award forced a reckoning moment: How could I share my message on a bigger stage?
The answer surprised me with its clarity. Write a book.
I wrote Healing through Connection for Healthcare Professionals because this story matters, award or no award.
The lived experiences and emotional well-being of healthcare professionals matter. You can make a bigger impact in the care you provide by taking inventory of your inner dialogue and beliefs.
Working with people living with diabetes can be filled with connection, joy, and revitalization. By leaving judgment at the door and accepting each other as we are – messy, complicated, and beautiful- you can deepen your connection. The unvoiced grief, the unresolved trauma, the silent resilience, can all have a voice at the table. As a healthcare professional, you deserve healing too.
From Disappointment to Direction
Not winning hasn’t stopped me from sharing my message; it motivated me to find a different way to share it.
It pushed me to write honestly about:
- How your personal history walks into the exam room with you.
- How to create a meaningful connection with the people in our care and provide healing that flows both ways.
- How to revitalize your creativity and give yourself permission for self-care.
This book is not a rebuttal to an award committee.
It’s a love letter to healthcare professionals who keep showing up even when recognition is scarce.
The Real Win
Today, when a nurse, pharmacist, dietitian, or physician tells me, “This book made me feel less alone,” I know I chose the right path.
I didn’t win an award, but I found my voice and shared my authentic life story in my book. This book is my commitment transparency with the hopes that it gives you permission to share your truth.
I wrote Healing through Connection so that other healthcare professionals can share their story and create a healing space for themselves and the people in their care.
Because in the end, the greatest legacy is knowing that your message touched the lives of your community and created space for more compassion, for us and those in our care.
Healing through Connection for Healthcare Professionals
Zoom Celebration Gathering
Join Coach Beverly for a Book Celebration on February 20th at 11:30am PST.
Coach Beverly is thrilled to invite you to join this celebration of completing her book and finally getting the Audible and Kindle version up on Amazon.
We will be discussing why this book matters now more than ever. She will share real stories from her clinical practice and ask you to share yours.
Coach Bev will discuss the process involved in writing this book and how she found her voice. We will wrap up with a question-and-answer session. We hope you can join us.
Invite your friends and colleagues too!
Keeping You in the Loop: twiist Insulin Pump
Have you heard about the twiist insulin pump? If not, don’t worry – we are here to keep you in the loop! The twiist is the latest automated insulin delivery (AID) system to join the diabetes treatment toolbox. This insulin pump features a unique algorithm powered by Tidepool Loop Technology, offering clients another option in insulin management.
Meet twiist
The twiist is an AID system that looks and acts a bit differently than current insulin pumps. FDA-approved for individuals 6 years old and older, it is a circular-shaped insulin pump. There is a bladder-type reservoir, called a cassette, that holds up to 300 units of insulin. The twiist AID system is currently compatible only with the Libre 3+ continuous glucose monitor (CGM) and iPhone. Meal and correction boluses are delivered via the phone app or Apple Watch for discreet diabetes management. Humalog (insulin lispro) U-100 and Novolog (insulin aspart) are the insulins approved for use with the twiist insulin pump.
iiSure Technology and Tidepool Loop
The twiist AID system uses iiSure technology within the pump and the cassette to dose insulin. Sound waves are used for direct volume measurement to ensure accurate insulin dosing. This feature also identifies occlusions faster than other currently available AID
systems.¹ Insulin moves through the pump chamber into the iiSure chamber, where sound waves use four checkpoints to verify insulin flow and correct dosing:
1. A baseline measurement is taken of the empty iiSure chamber before the insulin reaches this part of the cartridge.
2. The iiSure chamber fills with the determined dose of insulin and is measured for accuracy.
3. A second check of the iiSure chamber is verified for accuracy.
4. After insulin delivery, the pump measures the iiSure chamber to calculate the amount of insulin delivered. ¹ Tidepool Loop is the algorithm that powers the twiist AID system. Tidepool Loop creates a 6-hour glucose prediction forecast based on pump settings, insulin on board, recent carbohydrate entries, and CGM history. This information is collected every 5 minutes to create a 6-hour glucose forecast. Clients using twiist can view this glucose forecast to help make treatment decisions.
How Is twiist Different?
As we have discussed, twiist not only looks different but also functions slightly differently from other AID systems.
Here are a few more unique features:
Target Range: One of the most interesting twiist differences is that the lowest target range setting is 87 mg/dL, with the highest being 180 mg/dL for insulin delivery recommendations.
Retroactive Meal Adjustment: Users can adjust the CHO amount for a meal or snack bolus if they consume fewer carbs than planned.
Emojis: Using meal emojis helps the algorithm set a personalized prediction of food absorption based on carb, fiber, and fat content. If emojis aren’t used, the system defaults to a 3-hour food absorption.
No contracts: The twiist is a pharmacy benefit (rather than a Durable Medical Equipment benefit) and does not require a long-term contract commitment.
Premeal Preset: This option allows the user to temporarily lower the correction range before a meal to help prevent a post-meal glucose spike.
Workout Preset: This optional setting allows for glucose ranges from 87 mg/dL to 250 mg/dL to be set before, during, or after a workout.
Clinical Pearls — With a twiist
Diabetes healthcare professionals are considered experts in insulin pumps. Whether you are discussing insulin pump options, training, or troubleshooting the twiist insulin pump with clients, here are some helpful clinical pearls:
- Assess for physical and cognitive ability to use, manage, and troubleshoot the twiist insulin pump. Also, evaluate clients’ current cell phones or their willingness to change, as twiist can only be used with the iPhone at this time.
- If a user needs to be away from their iPhone, a small button on the pump itself can deliver an insulin bolus.
- The Libre 3+ CGM cannot connect to the Libre family of apps or the reader when using twiist. All CGM alerts will be through the twiist app.
- There are multiple alarms for various conditions. Education is vital to clients about these different alarms for identification and prompt intervention of potential issues.
- The twiist AID system is not safe for MRI, CT scans, x-ray, or any other procedures involving radiation and will need to be removed for these procedures.²
References:
- twiist. (n.d.). iiSure technology: Introducing the next generation of insulin delivery. https://www.twiist.com/iisure-technology#:~:text=Introducing%20iiSure%20Technology,Join%20the%20Insider%20Listhttps://doi.org/10.2337/dc25-S015
- twiist. (n.d.). Support & resources. https://www.twiist.com/twiist-on-support
Learn More From Our Technology Expert:
Dr. Diana Isaacs
During Our Virtual DiabetesEd Training Conference
April 15th-17th, 2026
Gain fresh insights, practical tools, and a deeper understanding of the latest in person-centered diabetes care. Our expert team brings the ADA Standards of Care to life—covering medications, behavior change, technology, and more!
If you’re preparing for the CDCES or BC-ADM exam, this conference, paired with a handful of free bonus courses, serves as the ideal study companion! Plus, this content counts toward the ADA Standards requirements for CDCES Renewal.
With interactive co-teaching, we keep sessions engaging, relevant, and fun.
Let’s learn and grow together!
Course credits through AMA PRA Category 1 Credits™, ACPE, ANCC, and CDR!
Program Objectives:
Upon completion of this activity, participants should be able to:
- Describe the current ADA Standards for diagnosis, goals, and person-centered diabetes management across the lifespan.
- Demonstrate insulin pattern management and dosing strategies in clinical scenarios.
- Implement timely screening and risk reduction strategies for microvascular and cardiovascular complications.
- Incorporate behavior change techniques and medical nutrition therapy to support people with diabetes self-management and lifestyle adjustment.
Question of the Week | What Do New ADA Standards Say About Development of Type 2?
According to the new 2026 ADA Standards, “type 2 diabetes is associated with insulin secretory defects related to” which of the following?
- BMI and activity level.
- Lifestyle and inflammation.
- Genetics and visceral adipose distribution.
- Epigenetics and metabolic stress.
Learn More About the 2026 ADA Standards
During Our Live Webinar on:
January 29th, 2026 at 11:30 AM PST!
Rationale of the Week | What Year ADA Standards Should JR Study?
For last week’s practice question, we quizzed participants on JR studying to take their CDCES exam, and they have questions studying for the 2025 or 2026 ADA Standards of Care. 55.56% 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
JR has been diligently studying to take their CDCES exam at the end of January 2026. They are wondering if they should study the 2025 or 2026 ADA Standards of Care.
As a mentor to healthcare professionals entering the field of diabetes, what do you recommend?
- Know the 2025 Standards, since it takes about a year for the new standards to be incorporated unless there is a significant clinical guideline update.
- Thoroughly review the 2026 Standards since the most recent ADC Standards content will be included in the exam.
- Be familiar with the goals of care from both years, so you can compare and contrast to get to the best answers.
- In addition to knowing the 2026 ADA Standards, you will need to be familiar with the latest American Association of Clinical Endocrinology (AACE) Standards.
Getting to the Best Answer
Answer A is correct: 55.56% chose this answer, “Know the 2025 Standards, since it takes about a year for the new standards to be incorporated unless there is a significant clinical guideline update.” Answer A is the BEST answer. It takes at least a year for the CBDCE to update the exam based on the ADA Standards. Knowing the 2025 Standards along with any urgent clinical updates announced in 2026 will help prepare JR for success.
Answer B is incorrect: 11.45% chose this answer, “Thoroughly review the 2026 Standards since the most recent ADC Standards content will be included in the exam.” Answer B is not the best answer. Since it takes at least a year for the CBDCE to update the exam based on the ADA Standards, JR can feel comfortable knowing the 2025 Standards along with any urgent clinical updates announced in 2026.
Answer C is incorrect: 19.53% chose this answer, “Be familiar with the goals of care from both years, so you can compare and contrast to get to the best answers.” Answer C is not the best answer. Thinking about comparing and contrasting two consecutive years standards and lead to testing confusion. JR can feel comfortable knowing the 2025 Standards along with any urgent clinical updates announced in 2026.
Answer D is incorrect: 13.47% chose this answer, “In addition to knowing the 2026 ADA Standards, you will need to be familiar with the latest American Association of Clinical Endocrinology (AACE) Standards.” Answer D is not the best answer. Since it takes at least a year for the CBDCE to update the exam based on the ADA Standards, JR can feel comfortable knowing the 2025 Standards along with any urgent clinical updates announced in 2026.
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!
Get Ready For Your CDCES Exam With Our Upcoming Webinars!
Question of the Week | Teens’ A1C climbs after starting CGM
Katie is a 14-year-old living with type 1 diabetes since age 10. She uses multiple daily insulin injections (MDI) therapy to manage her diabetes and started using a continuous glucose monitor (CGM) 3 months ago at the recommendation of her endocrinology team. Her A1c has increased to 9.2% since starting CCM technology.
Her mother reports that Katie has episodes of prolonged hyperglycemia when she is away from home. When at home, her mother will remind Katie to bolus based on the alerts she gets on the CGM share app. Katie reports she mutes alarms and alerts because she doesn’t want her classmates to hear them, afraid they will judge her. When you ask if she has uploaded her data to the school nurse or her endocrinology team she says, “The app is really confusing.” Her mother is frustrated with Katie for not paying attention to the CGM, saying, “She can text her friends without any problem; I don’t know why she struggles with the CGM”.
- Turn on her CGM alarms but increase the high alarm so she doesn’t get as many hyperglycemia related alerts.
- Show her step-by-step how to use the app and how to troubleshoot the alerts and alarms.
- Have the school nurse monitor her CGM trends when Katie is at school, since her mom monitors the CGM trends when she is at home.
- Email Katie’s mother once a week for updates to make sure she is monitoring CGM trends.
Learn more about this Question at our Virtual DiabetesEd Training Conference
April 15th-17th, 2026
Gain fresh insights, practical tools, and a deeper understanding of the latest in person-centered diabetes care. Our expert team brings the ADA Standards of Care to life—covering medications, behavior change, technology, and more!
If you’re preparing for the CDCES or BC-ADM exam, this conference, paired with a handful of free bonus courses, serves as the ideal study companion! Plus, this content counts toward the ADA Standards requirements for CDCES Renewal.
With interactive co-teaching, we keep sessions engaging, relevant, and fun.
Let’s learn and grow together!
Course credits through AMA PRA Category 1 Credits™, ACPE, ANCC, and CDR!
Program Objectives:
Upon completion of this activity, participants should be able to:
- Describe the current ADA Standards for diagnosis, goals, and person-centered diabetes management across the lifespan.
- Demonstrate insulin pattern management and dosing strategies in clinical scenarios.
- Implement timely screening and risk reduction strategies for microvascular and cardiovascular complications.
- Incorporate behavior change techniques and medical nutrition therapy to support people with diabetes self-management and lifestyle adjustment.
December 2025 eNews
Featured Articles ___________________________ |
Upcoming Programs ___________________________
Upcoming FREE Webinars ___________________________ Pre-Order ADA Standards Book for 2026
|
Happy December!💚
Hi friends, we have two pieces of exciting news!
First, the 2026 ADA Standards of Care are here! This updated content is full of evidence-based guidelines and clinical pearls that you can bring back to your practice, prepare for certification exams, and, of course, advocate on behalf of people living with pre-diabetes and diabetes.
As a busy healthcare professional, we understand that you may not have time to read all 350+ pages! We have a solution.
Join Coach Bev on January 29th for a 2.5 CE Live Webinar that summarizes the critical content you need to know. If you can’t join us live, once you register, you have access to the recorded version for a full year.
You can relax as your expert guide, Coach Bev, leads you through a two hour journey highlighting updates to the ADA Standards. You will walk away feeling confident and focused on what’s most important for certification exams and your practice.
Second exciting announcement!
The New CDCES Coach App is NOW available on Apple and Google Play. Best part? It’s still FREE!
After 6 months of renovation (thanks, Bryanna), you are going to love our new and improved CDCES Coach App. Our older version is sunsetting at the end of the month, so download the new version today! Enjoy quick access to the ADA Standards, new sample test questions with rationales, cheat sheets, Question of the Week and more!
Coach Beverly, Bryanna, Astraea & Katarina
Standards Webinar & New CDCES App
New CDCES Coach App - Download Today
Our new, revitalized CDCES Coach app, will equip you with certification exam study tools and clinical resources- right at your fingertips!
✨ Fresh new design with easier navigation.
- Forums to connect with your peers
- Instant access to blogs and news
- Quizzes with rationale
New Quizzes with Rationale for In-app Purchase Option
✨ 25 Practice Test Questions with Rationale – Only $9.99! ✨
📱 Register Today! To take advantage of all these enhanced features, you will need to sign up for the new CDCES Coach App! The old app sunsets on 12/31/2025.
You have been asking for these app improvements. We are happy to deliver new features while keeping your favorite resources at the ready!
- Medication PocketCards, Cheat Sheets
- ADA Standards of Care. Free Webinars
- Study materials
📱 Works on mobile, tablet, and desktop-friendly!
