Question of the Week | JR and Donut Fridays – What is the wise approach?
You are reviewing JR’s ambulatory glucose profile and it is over 70% time in range. JR usually takes bolus insulin before each meal and basal insulin at night. However, you notice that once a week on Fridays, JR’s blood glucose levels are above target between 2-5pm. When you bring this Friday glucose elevation to JR’s attention, they tell you it’s because the boss always brings in donuts after lunch on Fridays to celebrate everyone’s hard work. JR asks you about strategies to address this time above target.
What is the wise approach?
- Have you considered eating a piece of fruit instead?
- Can you let your boss know that you appreciate the gesture, but your diabetes doesn’t allow for this treat.
- Would you consider giving a little extra bolus insulin and enjoying the donut?
- Would you be willing to bring in a special low carb treat for everyone to enjoy?
Want to learn more about this question?
Invite Coach Beverly Thomassian to Speak – In Person or Virtually!
An Innovative Approach to Diabetes Education
With over two decades as a thought leader in diabetes care and education, Beverly is an inspiring and informational presenter. She can delve deep into the science of diabetes while incorporating real-life applications coupled with a compassionate approach that resonates with healthcare professionals.
Beverly is a relentless advocate for non-judgmental and inclusive diabetes care and believes that we are at our best when we are curious, kind, and engaging.
As a nurse entrepreneur and professional speaker, Beverly champions person-centered and evidence-based diabetes care through her live courses, keynote speeches, and webinar presentations.
Coach Beverly makes it a priority to make time to teach at conferences and organizations across the country. In addition to providing the latest research-based information, she incorporates story telling, games, movement breaks and small group activities.
She believes people learn best when the content is meaningful and fun!
Participants leave feeling energized, inspired, and excited about providing best diabetes care.
See more info here >>
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The use of DES products does not guarantee the successful passage of the diabetes certification exams. CBDCE & ADCES does not endorse any preparatory or review materials for the certification exams, except for those published by CBDCE & ADCES.
**To satisfy the requirement for renewal of certification by continuing education for the Certification Board for Diabetes Care & Education (CBDCE), continuing education activities must be applicable to diabetes and approved by a provider on the CBDCE List of Recognized Providers (www.ncbde.org). CBDCE does not approve of continuing education. Diabetes Education Services is accredited/approved by the Commission of Dietetic Registration which is on the list of CBDCE Recognized Providers.
October 2024 eNews | Combating Cognitive Decline & Healing Through Art
Happy October
Lately, there has been increased attention on the relationship between hyperglycemia and vascular dementia, sometimes referred to as Type 3 Diabetes. Our first article, contributed by Christine Craig, MS, RD, CDCES, explores the multifaceted link between diabetes and cognitive impairment, highlighting strategies to protect against this progressive condition.
Next is a celebration of National Pharmacists Month. Our article features two of my favorite pharmacists and recognizes their invaluable contributions to improving care in the inpatient and outpatient settings. We also appreciate their expansive knowledge of pharmacology and its application to promoting the best diabetes care. Thank you, pharmacists, for all that you do!
Our guest contributor, Jane Giambrone, RN, CDCES, CPCC, shares her insights on providing person-centered coaching that starts where people are at in their journey while recognizing the importance of creating a judgment-free space.
We are thrilled to introduce our new Artists Corner, and you are invited to participate! At DiabetesEd, we celebrate the expression of art and creativity to bring beauty and healing to individuals and communities. Each month, we will highlight a different artistic contribution. This month, we highlight our very own Tiffany Bergeron, who picked up painting during the pandemic and hasn’t put down her brushes since. It’s an honor to share her art with you.
As always, we encourage you to test your knowledge with the question and rationale of the week.
Lastly, I want to give a big shout-out to my incredible team, who have been working non-stop to prepare for our upcoming San Diego Conference. We look forward to sharing time with over 100 diabetes educators and advocates in a beautiful setting.
We hope your fall is off to a good start. We can’t wait to announce our list of activities for National Diabetes Month in November.
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Warmly, Coach Beverly, Bryanna, Tiffany, Christine, Andrew, and Ginger |
Featured Articles
- Actions to Prevent Cognitive Decline
- Celebrating Pharmacists Month
- Take Charge of Type 2 Diabetes
- New Artists Corner – You’re Invited!
Upcoming Programs
- Aloha! Join us in Hawaii Conference on Oct 18th
- Coach Bev keynotes in Redding Conf. Oct 25, 2024!
- Trauma, Diabetes and Hope Oct 29th
- From the Gut to the Butt- Exploring the GI System, November 12th
- Prep for CDCES – Nov 13th
Join us Live in Beautiful San Diego for our
Annual DiabetesEd Training Conference
October 9th-11th, 2024
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, networking, games with prizes, and “aha” moments in beautiful San Diego on October 9-11, 2024.
You don’t want to miss this one-of-a-kind learning opportunity. Get away from all those daily responsibilities and immerse yourself in a fun and intensive conference with plenty of networking opportunities.
Attendees will leave this conference with new tools and a more complete understanding of the latest advances in diabetes care, from medications to technology to Medical Nutrition Therapy!
Each day, we provide a healthy breakfast, including fresh coffee, to kick off your morning. Our instructors co-teach the content to keep things fresh and lively. Plus, we play DiaBingo to reinforce key content. In addition, we provide plenty of movement breaks led by volunteers from the audience. Did we mention delicious lunches and a conference meeting space just minutes from San Diego Bay?
Friend Discount: 3 or more only $559-$799 (based on registration package) per person. Email us at info@diabetesed.net with the name and email of each registrant to get the discount!
Time: The course is Wednesday through Friday. Join us for breakfast at 7:00 a.m. each day. The class begins at 8:00 a.m. and ends at 5:00 p.m. on Wednesday and Thursday and at 3:00 p.m. on Friday.
- 3 Days: of critical information delivered by passionate speakers in an engaging and fun format!
- 18+ CEs: earned at the Live Seminar (RDs earn 18.75 CEs while Nurses & CA Pharmacists earn 22.75 CEs)
- 10 Bonus Online Courses, Earn 10+ CEs: As a course attendee, you automatically receive a bonus online course bundle of 13 online courses valued at over $179. Coach Beverly carefully chose each of these courses based on student feedback on which content best helped them succeed at the certification exams and in their clinical practice. You will be given instructions after you purchase the course on how to enroll in our Online University and get started!
- Healthy breakfast all days, gourmet lunch both days and refreshments.
- E-version of the syllabus
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!
Sign up for DiabetesEd Blog Bytes
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Rationale of the Week | KR is Overwhelmed with Insulin Regimen
For last week’s practice question, we quizzed participants on feeling overwhelmed with insulin regimen. 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: KR is a 49-year-old with a learning disability and diabetes for over 20 years and is taking the following classes of diabetes medications at maximum doses; SGLT-2, Sulfonylurea, GLP-1 RA, biguanide and a TZD. Over the past month, KR’s blood glucose levels have increased to over 300 despite a 20-pound weight loss. The endocrinologist starts KR on basal insulin plus bolus insulin at each meal based on blood glucose and carbohydrates consumed. KR arrives for their education appointment in tears, saying “I feel completely overwhelmed and confused about all this insulin stuff.”
What is the best response?
Answer Choices:
- This must seem overwhelming, but I believe that you can do this.
- Let’s review carb counting again, so you feel more confident about calculating your dose.
- Many people starting on insulin feel overwhelmed, but with time it gets easier.
- Let’s start the basal insulin first, then we can tackle the meal bolus when you are ready.
Getting to the Best Answer
Answer 1 is incorrect. 21.01% chose this answer. “This must seem overwhelming, but I believe that you can do this.” Even though this response affirms KR’s ability to count carbs and adjust insulin coverage, it is not a realistic expectation. Given KR’s learning disability and his feelings of being overwhelmed, this complicated insulin management strategy is not the best approach for KR. We need to keep the insulin plan simple, until KR is ready to move forward.
Answer 2 is incorrect. 12.67% of you chose this answer. “Let’s review carb counting again, so you feel more confident about calculating your dose.” While this is a compassionate response, it does not take into account the complexity of the overall insulin management strategy and KR’s feelings of being overwhelmed. We need to keep the insulin plan simple, until KR is ready to move forward.
Answer 3 is incorrect. About 16.84% of respondents chose this. “Many people starting on insulin feel overwhelmed, but with time it gets easier.” This is a compassionate response that doesn’t address the main issue. The insulin plan is not realistic for this individual with a learning disability. We need to keep the insulin plan simple, until KR is ready to move forward.
Finally, Answer 4 is correct. 49.48% chose this answer. “Let’s start the basal insulin first, then we can tackle the meal bolus when you are ready.” YES, this is the best answer and most of you chose this. GREAT JOB. We need to keep the insulin plan simple, until KR is ready to move forward. Start with basal insulin first, until KR seems ready to add on bolus insulin at meals.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
Want to learn more about this question?
There is still time to join us Live in Beautiful San Diego for our
Annual DiabetesEd Training Conference
October 9th-11th, 2024
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, networking, games with prizes, and “aha” moments in beautiful San Diego on October 9-11, 2024.
You don’t want to miss this one-of-a-kind learning opportunity. Get away from all those daily responsibilities and immerse yourself in a fun and intensive conference with plenty of networking opportunities.
Attendees will leave this conference with new tools and a more complete understanding of the latest advances in diabetes care, from medications to technology to Medical Nutrition Therapy!
Each day, we provide a healthy breakfast, including fresh coffee, to kick off your morning. Our instructors co-teach the content to keep things fresh and lively. Plus, we play DiaBingo to reinforce key content and give away prizes. In addition, we provide plenty of movement breaks led by volunteers from the audience. Did we mention delicious lunches and a conference meeting space just minutes from San Diego Bay?
Friend Discount: 3 or more only $559-$799 (based on registration package) per person. Email us at info@diabetesed.net with the name and email of each registrant to get the discount!
Time: The course is Wednesday through Friday. Join us for breakfast at 7:00 a.m. each day. The class begins at 8:00 a.m. and ends at 5:00 p.m. on Wednesday and Thursday and at 3:00 p.m. on Friday.
- 3 Days: of critical information delivered by passionate speakers in an engaging and fun format!
- 18+ CEs: earned at the Live Seminar (RDs earn 18.75 CEs while Nurses & CA Pharmacists earn 22.75 CEs)
- 10 Bonus Online Courses, Earn 10+ CEs: As a course attendee, you automatically receive a bonus online course bundle of 13 online courses valued at over $179. Coach Beverly carefully chose each of these courses based on student feedback on which content best helped them succeed at the certification exams and in their clinical practice. You will be given instructions after you purchase the course on how to enroll in our Online University and get started!
- Healthy breakfast all days, gourmet lunch both days and refreshments.
- E-version of the syllabus
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!
Sign up for DiabetesEd Blog Bytes
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Diabetic Retinopathy: The Role of Diet in Prevention and Progression
Nutrition Intervention Can Protect Vision
by Christine Craig, MS, RD, CDCES
Recent research highlights the role of diet in preventing and slowing the progression of diabetes retinopathy, which is the leading cause of vision impairment among individuals with diabetes.
While glucose management is essential in reducing the risk of retinopathy, nutritional strategies that target reduced glycemic variability, blood pressure, inflammation, and oxidative stress significantly impact retinal health and vision.
In 2021, it was estimated that 26.43% of individuals with diabetes in the US have diabetic retinopathy, and 5.06% of individuals have vision-threatening diabetic retinopathy.1
Non-Proliferative and Proliferative Retinopathy
Clinically, diabetic retinopathy presents as non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR).
- NPDR occurs in the early stages when blood vessels in the retina weaken, and microaneurysms occur, but there is no new blood vessel growth.
- PDR is when there is a “proliferation” of new blood vessel growth in the retina, and these unstable vessels break and bleed into the vitreous, causing severe vision loss. PDR requires urgent and ongoing medical treatment.
Chronic hyperglycemia, dyslipidemia, nephropathy, and hypertension are factors that increase the risk of diabetic retinopathy.3 In type 1 diabetes, the DCCT and EDIC studies identified that higher mean HgbA1c is the strongest predictor of retinopathy progression. A 1% reduction in HgbA1c was associated with a 35% reduction in the risk of developing diabetic retinopathy.
Eye Screening Guidelines
Screening is essential; 2019 data indicates that 64.8% of individuals with diabetes had completed an eye exam in the past 12 months.2
The ADA Standards of Care recommends that adults with type 1 diabetes be screened within five years of diagnosis and individuals with type 2 diabetes be screened at the time of diagnosis. followed by an annual screening. If the eyes are healthy on exam and glucose is within the target range, eye specialists can consider extending screening to every 2 years.3
Diet and Retinopathy Risk
An individual’s diet plays in important role in retinal health.
Research has associated the consumption of fatty fish, fruits, vegetables, and antioxidant-rich foods with a reduced risk of diabetic retinopathy.4
In contrast, dietary patterns that contribute to glucose elevation and increase advanced glycation end-products (AGEs) contribute to retinal inflammation and microvascular damage.4 Focus on dietary interventions that support glycemic, lipid and blood pressure management help reduce risks or slow profession of this condition.3
Just as in general diabetes management, no one diet pattern is recommended; however, there is some evidence for specific nutrients. Research on nutrients such as omega-3 fatty acids, fiber, lutein and zeaxanthin, Vitamin C, Vitamin E, and Zinc have shown positive association with lowering diabetic retinopathy risk.4 To meet these nutrient needs, whole food-based diets rich in vegetables, whole grains, legumes, lean proteins, and healthy fats may be considered.
The Dietary Inflammatory Index (DII)
The Dietary Inflammatory Index (DII) is a scoring system that measures the inflammatory potential of individual diets based on 45 parameters, including various macronutrients, micronutrients, and phytochemicals. Liu and colleagues5 found that a one-point increase in the DII score was associated with 38% increased odds of having diabetic retinopathy. Their research also noted the relationship between higher HbgA1c, duration of diabetes, and increased retinopathy risk. While the research used NHANES data, the small sample size and retrospective cross-sectional analysis limit the ability to conclude causation.
We can consider the benefits of increasing anti-inflammatory foods and decreasing inflammatory foods, but additional information is needed to implement direct recommendations.
Role of Diabetes Educators in Prevention
As Diabetes Care and Education Specialists (DCES), we can support the prevention of diabetic retinopathy by helping individuals manage glucose through dietary patterns to reduce risk and slow progression. Although barriers exist to adopting anti-inflammatory diets rich in whole foods, antioxidants, and essential nutrients, understanding the potential connection beyond glycemic management can guide additional nutrition interventions.
Programs that support retinal photography with remote reading can increase access to screening in areas lacking accessible services. Additionally, ensuring blood pressure, lipid and renal screening and management, understanding the role of physical activity, and long-term glucose management can support vision health. DCES can empower patients to make sustainable lifestyle changes that support retinal health through individualized counseling and interdisciplinary collaboration with eye care providers.
References:
- Lundeen EA, Burke-Conte Z, Rein DB, et al. Prevalence of Diabetic Retinopathy in the US in 2021. JAMA Ophthalmol.2023;141(8):747–754. doi:10.1001/jamaophthalmol.2023.2289
- Healthy People 2030 Data Report. Downloaded on October 18th 2024 from https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/diabetes/increase-proportion-adults-diabetes-who-have-yearly-eye-exam-d-04
- American Diabetes Association Professional Practice Committee; 12. Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes—2024. Diabetes Care1 January 2024; 47 (Supplement_1): S231–S243. https://doi.org/10.2337/dc24-S012
- Bryl A, Mrugacz M, Falkowski M, Zorena K. The Effect of Diet and Lifestyle on the Course of Diabetic Retinopathy-A Review of the Literature. 2022 Mar 16;14(6):1252. doi: 10.3390/nu14061252. PMID: 35334909; PMCID: PMC8955064.
- Liu, R., Zhang, J., Gu, W. et al.Dietary Inflammatory Index and diabetic retinopathy risk in US adults: findings from NHANES (2005–2008). BMC Ophthalmol 24, 46 (2024). https://doi.org/10.1186/s12886-024-03303-1
Join us live on November 20, 11:30 am PST for our
FREE Prep for BC-ADM Exam Webinar
Join us to get ready to succeed a the BC-ADM Exam. This webinar will transform your test anxiety into calm self-confidence and test-taking readiness.
Topics covered include:
- exam eligibility and test format
- strategies to succeed
- study tips and test-taking tactics
Preparing for the BC-ADM Exam – What you need to know
Becoming BC-ADM is a great achievement for diabetes health care professionals with an advanced degree in their field and a professional license as an advanced practice nurse, registered dietitian, or registered pharmacist. The scope of advanced diabetes practice includes management skills such as medication adjustment, medical nutrition therapy, exercise planning, counseling for behavior management, and psychosocial issues.
Attaining optimal metabolic control in the diabetic client may include treatment and monitoring of acute and chronic complications. This webinar will review changes in requirements for 2024, exam eligibility and test format, strategies to succeed along with a review of study tips and test-taking tactics.
Coach Beverly will review sample test questions and the reasoning behind choosing the right answers. We hope you can join us for this webinar.
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator who has passed her CDCES Exam 7 times. She is a nationally recognized diabetes expert for over 25 years.
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!
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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.
Holiday Survival Guide & Reframing Diabetes Distress – Steps to Success
The holiday season can be stressful and throw us off our normal routine. This can compromise sleep and disrupt usual eating habits. In addition, it can trigger feelings of distress and self-doubt for people with diabetes if blood sugars go outside of goal range.
To help everyone feel their best during this holiday season, we have created a handout that highlights ten strategies to survive the holiday commotion. And even if all ten aren’t possible, just pick one or a few to try out. In addition, we have compiled a list of strategies to help reframe and reset when individuals are experiencing feelings of diabetes distress.
These Cheat Sheets have lots of helpful tips that you can print and share with your friends, participants, and colleagues!
1. Be a sleep warrior – People living in the United States are chronically underslept. Not getting enough sleep is associated with increased hunger, higher blood sugars, poor concentration, frequent illness, and impaired problem-solving. Make sure to give yourself the gift of at least 7 hours of sleep a night. This sleep will help you make the best choices for your health and will protect against illness and fatigue. You got this.
Goal: Get at least 7 hours of sleep a night. You deserve it.
2. Keep active – Holidays can put our exercise plans to the test, but we have a few ideas for you. Take an after-meal stroll instead of plopping on the couch. After meal walks lower post-meal blood sugars and increases energy by getting muscles activated. Just 10 minutes of walking after meals can make a big difference. You can even put music on and have a small dance session, anything to get your body moving.
Goal: Work toward 30 minutes of activity a day.
3. Don’t forget the Fiber – With all the snacks and tempting foods, whole healthy foods may take a back seat. Enjoy the abundance of seasonal vegetables, fruits, nuts, and grains that are fiber-rich and that decrease inflammation. Examples include; yams, squash, mandarin oranges, almonds, pistachios, quinoa, kale, brown rice, warm oatmeal, salads, and broth-based soups.
Goal: Strive to eat at least 25gms of fiber a day.
4. Enjoy the ultimate beverage – H20. Water is the perfect way to keep hydrated, replenished, and keeps appetite in check. Add a splash of flavor with a jigger of fruit juice or fresh cucumbers, lime slices, or a sprig of rosemary. Be creative. Sparkling waters come in a vast variety of flavors, are calorie-free, and contain no artificial sweeteners.
Goal: Keep hydrated by enjoying plenty of water.
5. Keep an eye on alcohol – While it’s true that red wine offers a beneficial anti-inflammatory compound called resveratrol, drinking too much alcohol can lead to unintended outcomes. Studies show that we make poorer food choices if alcohol is on board. This can offer special challenges in party settings, where temptations are abundant. A drink of alcohol contains about 100 calories and mixed drinks have even more. In addition, alcohol can lead to low blood sugars, especially for those taking insulin or sulfonylureas.
Goal: Limit alcohol to one drink a day for women, two drinks a day for men.
6. You are already sweet enough – Holidays and sugar go hand in hand. If possible, try and eat less than 6 teaspoons of added sugar (does not include natural sugars found in fruit and milk). This goal may not be realistic on all days, but aim for success most of the time. Excess sugar intake can cause inflammation and buildup of fat in the liver. One strategy is to limit sugar intake during the day and save your 6 teaspoons for that special dessert or parties. When looking at labels, it is helpful to know that 1 teaspoon equals 4 gms of sugar.
Goal: Limit sugar to 6 teaspoons a day.
7. Your teeth need extra special attention – Taking care of our teeth and gums improves health. Gum inflammation is associated with blood vessel inflammation. Swollen gums can also lead to an increase in blood sugars. During the holidays, find time for regular oral hygiene. Your mouth (and dental team) will thank you.
Goal: Brush teeth at twice daily and floss at least once daily.
8. Keep connected to friends and family who love you just the way you are! – As enjoyable as holidays can be, reuniting with family can also cause stress and stir-up emotions. Feeling out of sorts can lead to stress eating and decrease self-care. If possible, reach out to a trusted friend to share your feelings or keep a holiday journal. Consider bringing a favorite book along during your travels that you find inspiring and comforting. Give yourself permission to steal away for some quiet time.
Goal: Self-care is important during the holidays.
9. Enjoy an Oxygen Cocktail – Studies show that when humans venture into natural outdoor settings, heart rate and blood pressure improve. Take a moment to appreciate the feeling of the air on your skin, take a deep breath of fresh air, try to find nests in leafless trees, listen to the animal sounds and bird songs and just enjoy that moment.
Goal: Step into nature daily.
10. Take inventory of things that you are grateful for – Find a moment each day to reflect on a few things that brought you joy or good feelings. Maybe it was your cousin who lent you her favorite sweater. Or an Aunt who gave you the best hug. Special moments with a best friend or an after-dinner walk enjoying the fall leaves. These small moments of connection and beauty are one of the most treasured gifts of the holiday season that linger in our hearts and memory long after we say our goodbyes.
Goal: Take note of special moments.
Click here to download 10 Steps to Survive the Holidays PDF – a great handout that includes the info above to print and share with your friends, patients, and colleagues!
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.”**To satisfy the requirement for renewal of certification by continuing education for the Certification Board for Diabetes Care & Education (CBDCE), continuing education activities must be applicable to diabetes and approved by a provider on the CBDCE List of Recognized Providers (www.ncbde.org). CBDCE does not approve of continuing education. Diabetes Education Services is accredited/approved by the Commission of Dietetic Registration which is on the list of CBDCE Recognized Providers.”
Question of the Week | Screening for Celiac Disease
TC is a 15-year-old who was diagnosed with type 1 diabetes just over a year ago. Following their diagnosis, they quickly transitioned to sensor-augmented pump therapy and are not currently taking any other medications. Recent lab results show that lipid and renal profiles are on target, A1C of 7.5%, and a fasting glucose level of 148 mg/dL. Despite following a nutrient-rich diet, TC reports experiencing fatigue, difficulty gaining weight, frequent nausea, and diarrhea.
What Standard of Care recommendation may help explain TC’s reported symptoms?
- TC’s Hemoglobin A1c is above target. Elevated glucose values could be contributing to fatigue and difficulty with weight gain.
- Ensure IgA tissue transglutaminase (tTG) antibodies, with documentation of total serum IgA levels, have been measured and noted.
- Recommend a gluten-free diet since individuals with type 1 diabetes can be at higher risk of celiac disease.
- Consider referral for a gastric emptying study given complaint of frequent nausea and diarrhea.
Want to learn more about this question?
Join us Live in Beautiful San Diego for our
Annual DiabetesEd Training Conference
October 9th-11th, 2024
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, networking, games with prizes, and “aha” moments in beautiful San Diego on October 9-11, 2024.
You don’t want to miss this one-of-a-kind learning opportunity. Get away from all those daily responsibilities and immerse yourself in a fun and intensive conference with plenty of networking opportunities.
Attendees will leave this conference with new tools and a more complete understanding of the latest advances in diabetes care, from medications to technology to Medical Nutrition Therapy!
Each day, we provide a healthy breakfast, including fresh coffee, to kick off your morning. Our instructors co-teach the content to keep things fresh and lively. Plus, we play DiaBingo to reinforce key content and give away prizes. In addition, we provide plenty of movement breaks led by volunteers from the audience. Did we mention delicious lunches and a conference meeting space just minutes from San Diego Bay?
Friend Discount: 3 or more only $559-$799 (based on registration package) per person. Email us at info@diabetesed.net with the name and email of each registrant to get the discount!
Time: The course is Wednesday through Friday. Join us for breakfast at 7:00 a.m. each day. The class begins at 8:00 a.m. and ends at 5:00 p.m. on Wednesday and Thursday and at 3:00 p.m. on Friday.
- 3 Days: of critical information delivered by passionate speakers in an engaging and fun format!
- 18+ CEs: earned at the Live Seminar (RDs earn 18.75 CEs while Nurses & CA Pharmacists earn 22.75 CEs)
- 10 Bonus Online Courses, Earn 10+ CEs: As a course attendee, you automatically receive a bonus online course bundle of 13 online courses valued at over $179. Coach Beverly carefully chose each of these courses based on student feedback on which content best helped them succeed at the certification exams and in their clinical practice. You will be given instructions after you purchase the course on how to enroll in our Online University and get started!
- Healthy breakfast all days, gourmet lunch both days and refreshments.
- E-version of the syllabus
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!
Sign up for DiabetesEd Blog Bytes
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Question of the Week | KR is Overwhelmed with Insulin Regimen
KR is a 49-year-old with a learning disability and diabetes for over 20 years and is taking the following classes of diabetes medications at maximum doses; SGLT-2, Sulfonylurea, GLP-1 RA, biguanide and a TZD. Over the past month, KR’s blood glucose levels have increased to over 300 despite a 20-pound weight loss. The endocrinologist starts KR on basal insulin plus bolus insulin at each meal based on blood glucose and carbohydrates consumed. KR arrives for their education appointment in tears, saying “I feel completely overwhelmed and confused about all this insulin stuff.”
What is the best response?
- This must seem overwhelming, but I believe that you can do this.
- Let’s review carb counting again, so you feel more confident about calculating your dose.
- Many people starting on insulin feel overwhelmed, but with time it gets easier.
- Let’s start the basal insulin first, then we can tackle the meal bolus when you are ready.
Want to learn more about this question?
Join us Live in Beautiful San Diego for our
Annual DiabetesEd Training Conference
October 9th-11th, 2024
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, networking, games with prizes, and “aha” moments in beautiful San Diego on October 9-11, 2024.
You don’t want to miss this one-of-a-kind learning opportunity. Get away from all those daily responsibilities and immerse yourself in a fun and intensive conference with plenty of networking opportunities.
Attendees will leave this conference with new tools and a more complete understanding of the latest advances in diabetes care, from medications to technology to Medical Nutrition Therapy!
Each day, we provide a healthy breakfast, including fresh coffee, to kick off your morning. Our instructors co-teach the content to keep things fresh and lively. Plus, we play DiaBingo to reinforce key content and give away prizes. In addition, we provide plenty of movement breaks led by volunteers from the audience. Did we mention delicious lunches and a conference meeting space just minutes from San Diego Bay?
Friend Discount: 3 or more only $559-$799 (based on registration package) per person. Email us at info@diabetesed.net with the name and email of each registrant to get the discount!
Time: The course is Wednesday through Friday. Join us for breakfast at 7:00 a.m. each day. The class begins at 8:00 a.m. and ends at 5:00 p.m. on Wednesday and Thursday and at 3:00 p.m. on Friday.
- 3 Days: of critical information delivered by passionate speakers in an engaging and fun format!
- 18+ CEs: earned at the Live Seminar (RDs earn 18.75 CEs while Nurses & CA Pharmacists earn 22.75 CEs)
- 10 Bonus Online Courses, Earn 10+ CEs: As a course attendee, you automatically receive a bonus online course bundle of 13 online courses valued at over $179. Coach Beverly carefully chose each of these courses based on student feedback on which content best helped them succeed at the certification exams and in their clinical practice. You will be given instructions after you purchase the course on how to enroll in our Online University and get started!
- Healthy breakfast all days, gourmet lunch both days and refreshments.
- E-version of the syllabus
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!
Sign up for DiabetesEd Blog Bytes
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Rationale of the Week | Hypoglycemia and Hospitalization: Is there a Connection?
For last week’s practice question, we quizzed participants on the connection with hypoglycemia and hospitalizations. Almost all of the 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 is 79 years old and takes insulin 3 times daily. Lately, they have been experiencing increased episodes of hypoglycemia.
Which of the following statements is true regarding hypoglycemia and the risk of hospitalization?
Answer Choices:
- Hypoglycemia is a minor concern and rarely leads to hospitalization.
- Only severe hypoglycemia results in hospitalization.
- Hypoglycemia, whether mild or severe, significantly increases the risk of hospitalization.
- Hospitalization from hypoglycemia is mainly a concern for people with type 1 diabetes.
Getting to the Best Answer
Answer 1 is incorrect. 1.4% chose this answer. “Hypoglycemia is a minor concern and rarely leads to hospitalization.” Hypoglycemia can lead to falls, confusion and loss of consciousness, all of which can precipitate hospitalization.
Answer 2 is incorrect. 1.4% of you chose this answer. “Only severe hypoglycemia results in hospitalization.” Even mild hypoglycemia can lead to falls and confusion, and if not treated, can worsen and result in loss of consciousness and hospitalization.
Answer 3 is correct. About 93.95% of respondents chose this. “Hypoglycemia, whether mild or severe, significantly increases the risk of hospitalization.” GREAT JOB! This is the best answer. Creating a collaborative plan to PREVENT hypoglycemia is especially important for people taking secretagogues or using insulin therapy.
Finally, Answer 4 is incorrect. 3.26% chose this answer. “Hospitalization from hypoglycemia is mainly a concern for people with type 1 diabetes.” Older people with type 2 diabetes and diminished renal function, who use insulin or secretagogues to lower glucose levels, are at risk of severe hypoglycemia and require close glucose monitoring.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
Want to learn more about this question?
Join us Live in Beautiful San Diego for our
Annual DiabetesEd Training Conference
October 9th-11th, 2024
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, networking, games with prizes, and “aha” moments in beautiful San Diego on October 9-11, 2024.
You don’t want to miss this one-of-a-kind learning opportunity. Get away from all those daily responsibilities and immerse yourself in a fun and intensive conference with plenty of networking opportunities.
Attendees will leave this conference with new tools and a more complete understanding of the latest advances in diabetes care, from medications to technology to Medical Nutrition Therapy!
Each day, we provide a healthy breakfast, including fresh coffee, to kick off your morning. Our instructors co-teach the content to keep things fresh and lively. Plus, we play DiaBingo to reinforce key content and give away prizes. In addition, we provide plenty of movement breaks led by volunteers from the audience. Did we mention delicious lunches and a conference meeting space just minutes from San Diego Bay?
Friend Discount: 3 or more only $559-$799 (based on registration package) per person. Email us at info@diabetesed.net with the name and email of each registrant to get the discount!
Time: The course is Wednesday through Friday. Join us for breakfast at 7:00 a.m. each day. The class begins at 8:00 a.m. and ends at 5:00 p.m. on Wednesday and Thursday and at 3:00 p.m. on Friday.
- 3 Days: of critical information delivered by passionate speakers in an engaging and fun format!
- 18+ CEs: earned at the Live Seminar (RDs earn 18.75 CEs while Nurses & CA Pharmacists earn 22.75 CEs)
- 10 Bonus Online Courses, Earn 10+ CEs: As a course attendee, you automatically receive a bonus online course bundle of 13 online courses valued at over $179. Coach Beverly carefully chose each of these courses based on student feedback on which content best helped them succeed at the certification exams and in their clinical practice. You will be given instructions after you purchase the course on how to enroll in our Online University and get started!
- Healthy breakfast all days, gourmet lunch both days and refreshments.
- E-version of the syllabus
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!
Sign up for DiabetesEd Blog Bytes
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
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