Rationale of the Week | To Prevent Hypo’s, JR Stopped Taking Bolus Insulin
For last week’s practice question, we quizzed test takers on JR’s fear of hypoglycemia. 85% of respondents chose the best answer. GREAT JOB. We want to 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 26 years old with type 1 diabetes for over a decade. JR keeps missing appointments and when you finally get a hold of them on the phone, they start crying and say “I am afraid my blood sugars will go too low, so I stopped using my bolus insulin”. They explain that they were too embarrassed to come in and have their data downloaded.
Based on this information, what would be the most helpful approach?
Answer Choices:
- Provide reassurance and recognize that JR is dealing with childhood trauma.
- Encourage JR to start using half their usual dose of bolus insulin to get started.
- Recognize JR’s effort to prevent low blood sugars and explore their feelings.
- Remind JR that all of the downloaded data and reports are confidential.
Getting to the Best Answer
Answer 1 is incorrect. 5.15% chose this answer, “Provide reassurance and recognize that JR is dealing with childhood trauma.” While there is a real possibility that JR experienced childhood trauma, there is no information to support that assumption in the question. However, providing JR with reassurance and helping with problem solving would be very helpful.
Answer 2 is incorrect. 5.36% of you chose this answer, “Encourage JR to start using half their usual dose of bolus insulin to get started.” Although taking half of the usual dose of bolus insulin is certainly better than taking no insulin, it is not a person centered approach. We need to engage JR in determining the best approach.
Answer 3 is correct. 85.84.% of respondents chose this answer, “Recognize JR’s effort to prevent low blood sugars and explore their feelings.” YES, great job, this is the best answer. We want to use a strength based approach and acknowledge that JR is making a big effort to prevent hypoglycemia and stay safe. We also want to recognize JR’s big emotions around hypoglycemia and explore them more closely. Finally, we will encourage JR to identify next steps.
Finally, Answer 4 is incorrect. 3.65% chose this answer, “Remind JR that all of the downloaded data and reports are confidential.” Not the best answer, but it is true that many people may have access to JR’s reports, which can add even more pressure to make sure everything looks good. When we look at JR’s report, we want to make sure we acknowledge the periods where things are going well before we dive into the troubled spots.
Thank you so much for reading this “Rationale of the Week”.
Want to learn more about this question? Join our NEW
ReVive 5 Diabetes Training Program
Save $100! Live Virtual Sessions Air July 19 & July 26th
Whether you are a novice or an expert in providing diabetes care, we invite you to attend this exciting training program that provides the essential steps to address diabetes distress combined with an innovative approach to glucose management that will revolutionize your practice.
“ReVive 5” breathes new life into our relationship with diabetes, bringing a fresh perspective to both the person with diabetes and the provider.
Join A Team of Experts – Save $100
Team of Experts: ReVive 5 is taught by a team of 3 Interdisciplinary Experts:
- Lawrence Fisher, Ph.D., ABPP, Professor Emeritus, UCSF
- Susan Guzman, PhD
- Beverly Thomassian, RN, MPH, CDCES, BC-ADM
Accredited Training Program:
- 14.0 CEs – Includes the 7-hour Session ReVive 5 Training Program, Certificate, and 5 FREE bonus courses to supplement content.
- Free Quarterly ReVive 5 Connect – connect with the instructors to help with problem solving for an hour four times a year.
- A comprehensive set of assessment tools, educational materials, log sheets, and resources.
Dates and Times for ReVive Virtual Training
- For your convenience, we have combined the 4 sessions into 2 half days. Same great content.
- July 19 and 26th from 9am to 12:30 pm PST. Space is limited, so save your space today!
Speakers Interviews – Learn more about the ReVive 5 Team
What is the Biggest Takeaway when Addressing Diabetes Distress? – Dr. Susan Guzman
Do you have to be a Mental Health Expert to Tackle Diabetes Distress? – Dr. Lawrence Fisher
Why I Transformed my Approach to Diabetes Self-Management Education- Coach Beverly
Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.
All hours earned count toward your CDCES Accreditation Information
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
Question of Week | Basal, Bolus and Blood Transfusions
JZ is excited about their A1c of 5.4%. They take bolus insulin 4 times a day, plus basal insulin at night. To treat their leukemia, JZ receives blood transfusions weekly.
What is your biggest concern?
- Is JZ experiencing lipohypertrophy?
- Why is JZ on multiple daily doses?
- Is JZ adjusting insulin for exercise?
- What is JZ’s fructosamine level?
Click Here to Test your Knowledge
Want to learn more about this question? Join us for our
Level 4 | Cancer and Diabetes | 1.25 CEs
Airs live on Wednesday, October 26th at 11:30 am PST
Diabetes Education Services Online University Courses are an excellent way to study for your exam anytime and anywhere that is convenient for you. You will have immediate access to your courses for 1 year after your purchase date. Each individual online course includes a: video presentation, podcast, practice test and additional resources.
Patients with cancer often experience hyperglycemia secondary to treatment, which can increase risk of infection and compromise their nutritional status. In addition, recent research has identified the link between diabetes and cancer. Join us to learn more about this unexpected link and treatment strategies for steroid induced hyperglycemia using a case study approach.
Objectives:
- Discuss the relationship between cancer, hyperglycemia and insulin resistance.
- State 3 benefits of normalizing glucose levels during chemotherapy.
- Using a case study approach, discuss strategies to improve glucose levels and quality of life.
Intended Audience: These courses are knowledge-based activities designed for individual or groups of diabetes educators, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants and other health care providers interested in enhancing their knowledge of diabetes management for people with cancer.
Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.
All hours earned count toward your CDCES Accreditation Information
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
October 2022 eNews | Why I Transformed my Approach to Diabetes Care
October Greetings
A few years ago, I drastically changed my approach to diabetes self-management education as a result of participating in the Embark Trial Research Team.
To my surprise, the innovative coaching techniques I learned and applied in the Embark study upped my game and improved my skills. With this new approach, I feel a deeper sense of connection and experience more success when providing care to people with diabetes.
The good news is that we are ready to share these techniques with you. We have reassembled the Embark Instructional team to provide the evidence-based tools and the step-by-step approach in our ReVive 5 Diabetes Training Program.
We distilled the most important skills and content from the Embark study and packaged it into our four-session ReVive 5 Program.
ReVive 5 Training Program – First session FREE
Our first ReVive 5 class of the four-session series starts November 1st. Good news! As part of our opening launch celebration, we are inviting you to join the first training session for FREE.
For this newsletter, we feature interviews from the Embark Training and Research Team. Enjoy the wisdom of these two amazing pioneers in the field of Diabetes Distress. Plus, Coach Beverly shares the impact of the trial on her approach.
If you feel like a challenge, take a moment to check out our Question and Rationale of the Week. We are excited to announce our New and Improved Online University is up and running. You are invited to stop by, kick off your shoes and get comfy.
In recognition of Indigenous Peoples’ Day, we are honored to share the poem, “Remember” by Poet Laureate, Joy Harjo.
Thank you for caring and advocating on behalf of people living with diabetes. With gratitude,
Beverly, Bryanna, and Amanda
Featured Articles
- Why Coach Bev Transformed Her Approach to DSME
- Do you Have to be a Mental Health Expert to Provide Diabetes Care?
- Biggest Lessons from Addressing Diabetes Distress
- Question of the Week
- Rationale of the Week
Upcoming Webinars
- ReVive 5 Diabetes Training
- FREE ReVive Session 1
- New, Improved DiabetesEd Online University
- Free Resources
- “Remember” by Poet Laureate, Joy Harjo
- Free Resources
Want to learn more about this question? Join our NEW
ReVive 5 Diabetes Training Program
Whether you are a novice or an expert in providing diabetes care, we invite you to attend this exciting training program that provides the essential steps to address diabetes distress combined with an innovative approach to glucose management that will revolutionize your practice.
“ReVive 5” breathes new life into our relationship with diabetes, bringing a fresh perspective to both the person with diabetes and the provider.
By releasing old habits that no longer serve us, we have the opportunity to create a new life tool kit toolkit in partnership with the person living with diabetes.
The ReVive 5 program is built on international research study results and will revolutionize your approach to diabetes self-management education.
Join our Team of Experts
Team of Experts:
ReVive 5 is taught by a team of 3 Interdisciplinary Experts:
- Lawrence Fisher, Ph.D., ABPP, Professor Emeritus, UCSF
- Susan Guzman, PhD
- Beverly Thomassian, RN, MPH, CDCES, BC-ADM
Training Program Includes:
- 14.0 CEs – Includes the 4 Session ReVive Training Program, Certificate and 5 FREE bonus courses to supplement content
(Four 1.5 hour training sessions (6.0 CEs) plus Five bonus courses worth 9.0 CEs) - Quarterly 1 hour follow-up sessions with an expert -dates to be announced
- A comprehensive set of assessment tools, educational materials, log sheets and resources.
Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.
All hours earned count toward your CDCES Accreditation Information
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
Do you have to be a Mental Health Expert to Tackle Diabetes Distress?
We asked Dr. Lawrence Fisher (see bio below), lead researcher and clinician in the Embark Trial to share his insights on providing best care to people with diabetes. Learn more by joining our ReVive 5 Diabetes Training Program where the team shares evidence-based tools and the step-by step approach utilized in the Embark Study.
Do you have to be a mental health expert to address diabetes distress?
Dr. Lawrence Fisher
Definitely not.
We believe that addressing the emotional side of diabetes is part of comprehensive diabetes care. It is part of living with and managing diabetes over time. Ideally, emotional care is incorporated into regular diabetes check-ups and problem-solving encounters.
Diabetes health care professionals have unique insights into the daily struggles that people living with diabetes experience. They have tremendous awareness, understanding and knowledge about diabetes self-management, including the distress that many people with diabetes experience with varying degrees over a lifetime. Diabetes specialists realize that recognizing and addressing distress is an integral part of providing care and helping people manage their lives around diabetes.
Frankly, there is no other option – Diabetes care professionals are the front line clinicians when it comes to helping people manage their diabetes, and that includes the emotional side of diabetes as well.
However, addressing diabetes distress effectively can be challenging, even for the most experienced diabetes health care professional. After all, most clinicians don’t receive formal training to address the emotional part of diabetes self-management. It makes sense that some additional training and support would be of benefit. That is why we need training programs like ReVive 5, so health care professionals have a safe place to increase their comfort level, enhance their skills, and learn time-efficient strategies that can be applied in clinical practice.
In addition, very few mental health professionals have any experience with diabetes and we have learned that very few people with diabetes follow through on referrals to mental health professionals. Frankly, there is no other option – Diabetes care professionals are the front line clinicians when it comes to helping people manage their diabetes, and that includes the emotional side of diabetes as well.
We also asked, How does addressing diabetes distress impact glucose levels?
This straightforward question has a relatively complex answer – like most things in clinical care. Many studies have shown that there is a modest but significant correlation between distress and A1C – the higher the distress, the higher the A1C and vice versa. But this is an ‘association’ and it DOES NOT mean that one CAUSES the other. We believe that the only modest association between distress and A1C can be explained, at least in part, by examining two related issues.
First, there is a relatively high rate of distress among people with diabetes with A1C levels of 7% or less. The distress that some people in this A1C range feel are associated with fears of hypoglycemia and struggles with eating. In fact, in a recent study, we discovered that about a quarter of participants with an A1C of 7% or less reported significantly elevated levels of diabetes distress. So even people who are reaching target glucose levels can experience significant levels of distress.
The second reason is really interesting, and it has implications for intervention. As mentioned above, in two recent studies, we reported a significant but modest association between distress and A1C. But as we delved into the findings, we discovered that reductions in distress associated with a clinical intervention were only ‘indirectly’ linked with reductions in A1C.
Most importantly, we found that reductions in distress were highly related to improvements in diabetes self-management, which, in turn, were significantly related to reductions in A1C. To say it simply, the reductions in distress were due to improvements in self-management behaviors which led to reductions in A1C. This is a critical point – because it suggests that health care providers can have the biggest impact by combining distress reduction AND management interventions to improve glucose management as well as help people improve their quality of life.
ReVive 5 Diabetes Training Program Expert Faculty
Dr. Lawrence Fisher’s most recent work focuses on diabetes distress and depression, disease management, and how adults and families struggle over time to manage chronic health conditions.
He has served as a professor in the Department of Family & Community Medicine at the University of California, San Francisco for over 25 years, and he is the Director of The Behavioral Diabetes Research Group at UCSF. He has conducted multiple cross-sectional and longitudinal NIH- and ADA-supported clinical research with adults with diabetes and their families. He maintains an active clinical practice at UCSF, has published over 190 peer-reviewed articles on diabetes and related topics, and frequently speaks to both professional and lay groups at local, national, and international meetings and workshops
Join us to gain the confidence and learn the skills needed to support people with diabetes to move forward in their self management and discover the expert within.
Speakers Interviews – Learn more about the ReVive 5 Team
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
Sign up for DiabetesEd Blog Bytes
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.
Why I Transformed my Approach to Diabetes Self-Management Education
When I was hired to be a part of the Embark Trial Team at UCSF, I felt confident in my approach to self-management education for people living with type 1 diabetes. After all, I had been providing diabetes care and education for over 20 years.
Little did I know that participating in this Trial would change my practice approach.
The Embark Trial, simply explained, was designed to evaluate if addressing diabetes distress and supporting an increased level of self-management confidence for people living with type 1 diabetes improved outcomes.
As part of the Embark Trial Team, I attended trainings which outlined the philosophy and novel approach of the intervention. The research team repeatedly emphasized that even though we were diabetes specialists, we were not to provide answers or solutions for the type 1 participants during the group classes or individual interventions. In addition, they taught us to use an innovative step-wise approach for glycemic management along with custom log sheets and strategies to address diabetes distress.
Putting this new approach to the test.
As part of the intervention team, I provided a group training and met individually with each participant for up to 30 minutes for about six sessions. During these sessions we would explore issues that they would like to address and guide them in problem solving.
For example, if a person with diabetes asked, “why are my blood sugars so high in the morning”, I couldn’t suggest to them that they probably needed to increase their basal insulin.
Instead, I encouraged them to draw on their own knowledge about their diabetes and ask, “Why do you think your blood sugars are elevated in the morning?”
Another example is I would ask participants to scroll through their insulin pumps to find their basal and bolus insulin settings. They would ask me, “how do I find those?”
Instead of providing step by step instructions, I encouraged participants to start looking through their pump settings to see if they could discover it themselves.
Guess what? Participants of all ages and backgrounds were able to figure it out without any hands-on instruction from the “fixer”.
Even though the coaching was provided over the phone and on zoom, with each accomplishment, I could feel them glowing with the pride of self-discovery.
The participants were gaining a sense of agency and mastery.
And I was transitioning from being a “Fixer” to becoming a “Coach”. It felt great.
To be honest, it took a lot of pressure off of me to be the “all knowing” diabetes professional. This approach freed me from feeling like a failure if I didn’t know all the ins and outs of insulin pumps, CGMs, carb counting ratios and more. It felt very collaborative and I felt more authentic.
More importantly, I was able to tap into the individuals expertise by REALLY listening, asking meaningful questions and helping them find solutions. It turns out that people with diabetes have a lot of expertise in themselves. Unfortunately too many times, during provider visits, even though they try to share their worries, concerns and emotions, they often aren’t really seen and heard.
The study also provided simple conversational tools that the diabetes specialists could use to help participants address their diabetes distress. We often feel stuck or not sure how to best help people struggling with the real life distress that comes with living with a chronic condition 24/7/365. The approach used in this study empowered me to try new approaches that really made a difference.
As diabetes health care professionals, we can’t know everything, but we can gain needed skills to help address distress and encourage individuals figure it out for themselves. Being a part of this study help me grow my “Coach” approach and let my “Fixer” know that it can relax, we will call upon it as needed.
Now, we are excited to share the tools and approaches used in this study with our community of diabetes health professionals.
We have reassembled the training team and created a resource binder of fantastic tools that we are excited to share this all with you in our ReVive 5 Diabetes Training Program. Join us to learn a step-wise, proven approach to address hidden barriers to diabetes self-management and glucose management.
Learn from the Experts that Constructed this Approach
Live Virtual Sessions Air June 17 & June 24th
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.
Question of Week | To Prevent Hypo’s, JR Stopped Taking Bolus Insulin
Click Here to Test your Knowledge
JR is 26 years old with type 1 diabetes for over a decade. JR keeps missing appointments and when you finally get a hold of them on the phone, they start crying and say “I am afraid my blood sugars will go too low, so I stopped using my bolus insulin”. They explain that they were too embarrassed to come in and have their data downloaded. Based on this information, what would be the most helpful approach?
- Provide reassurance and recognize that JR is dealing with childhood trauma.
- Encourage JR to start using half their usual dose of bolus insulin to get started.
- Recognize JR’s effort to prevent low blood sugars and explore their feelings.
- Remind JR that all of the downloaded data and reports are confidential.
Click Here to Test your Knowledge
Want to learn more about this question? Join our NEW
ReVive 5 Diabetes Training Program
Save $100! Live Virtual Sessions Air July 19 & July 26th
Whether you are a novice or an expert in providing diabetes care, we invite you to attend this exciting training program that provides the essential steps to address diabetes distress combined with an innovative approach to glucose management that will revolutionize your practice.
“ReVive 5” breathes new life into our relationship with diabetes, bringing a fresh perspective to both the person with diabetes and the provider.
Join A Team of Experts – Save $100
Team of Experts: ReVive 5 is taught by a team of 3 Interdisciplinary Experts:
- Lawrence Fisher, Ph.D., ABPP, Professor Emeritus, UCSF
- Susan Guzman, PhD
- Beverly Thomassian, RN, MPH, CDCES, BC-ADM
Accredited Training Program:
- 14.0 CEs – Includes the 7-hour Session ReVive 5 Training Program, Certificate, and 5 FREE bonus courses to supplement content.
- Free Quarterly ReVive 5 Connect – connect with the instructors to help with problem solving for an hour four times a year.
- A comprehensive set of assessment tools, educational materials, log sheets, and resources.
Dates and Times for ReVive Virtual Training
- For your convenience, we have combined the 4 sessions into 2 half days. Same great content.
- July 19 and 26th from 9am to 12:30 pm PST. Space is limited, so save your space today!
Speakers Interviews – Learn more about the ReVive 5 Team
What is the Biggest Takeaway when Addressing Diabetes Distress? – Dr. Susan Guzman
Do you have to be a Mental Health Expert to Tackle Diabetes Distress? – Dr. Lawrence Fisher
Why I Transformed my Approach to Diabetes Self-Management Education- Coach Beverly
Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.
All hours earned count toward your CDCES Accreditation Information
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
Indigenous Peoples’ Day | Remember – A Poem by Joy Harjo
To recognize Indigenous Peoples’ Day, we are honored to share a treasured poem by one of my favorite poets and writers, Joy Harjo. Plus, we also share an interactive map of Indigenous Lands (credit to NPR).
In 2019, Joy Harjo was recognized as the United States poet laureate and served three terms. Harjo is an internationally renowned performer and writer of the Muscogee (Creek) Nation.
She lives in Tulsa, Oklahoma and is the author of nine books of poetry, including the highly acclaimed An American Sunrise, several plays and children’s books, and two memoirs, Crazy Brave and Poet Warrior. Her many honors include the Ruth Lily Prize for Lifetime Achievement from the Poetry Foundation, the Academy of American Poets Wallace Stevens Award, two NEA fellowships, and a Guggenheim Fellowship.
You can learn more about Joy Harjo on her webpage, www.joyharjo.com.
Remember
Joy Harjo
Remember the sky that you were born under,
know each of the star’s stories.
Remember the moon, know who she is.
Remember the sun’s birth at dawn, that is the
strongest point of time. Remember sundown
and the giving away to night.
Remember your birth, how your mother struggled
to give you form and breath. You are evidence of
her life, and her mother’s, and hers.
Remember your father. He is your life, also.
Remember the earth whose skin you are:
red earth, black earth, yellow earth, white earth
brown earth, we are earth.
Remember the plants, trees, animal life who all have their
tribes, their families, their histories, too. Talk to them,
listen to them. They are alive poems.
Remember the wind. Remember her voice. She knows the
origin of this universe.
Remember you are all people and all people
are you.
Remember you are this universe and this
universe is you.
Remember all is in motion, is growing, is you.
Remember language comes from this.
Remember the dance language is, that life is.
Remember.
Which Indigenous lands are you on? This map will show you.
Indigenous Peoples’ Day is a time of reflection, recognition and celebration of the role Native people have played in U.S. history. One way to mark the day — and to learn about Indigenous history year-round — is to learn which Native lands you live on.
DiabetesEd Online University | Closed for Renovations Today, October 5th
DiabetesEd Online University is closed today to make the switch to our new platform.
We can’t wait to share our new look with you on Thursday, October 6th.
Students will be able to experience our New and Modernized learning platform starting Thursday! Since we will be busy setting up our new site, Bryanna and I may be delayed in answering emails and phone calls today. We appreciate your patience during this exciting renovation process.
Our main website and shopping cart will remain open.
We know for many of you, losing a day of progress can feel overwhelming and we appreciate your patience during this transition.
We invite you to use the following tools as part of your study plan while we make this transition.
• Free Webinars – This page offers some helpful info on test taking and other topics.
• CDCES Coach App – this app has a lot of great tools such as free quizzes that you can use to test your knowledge while the website is down.
• Cheat Sheets – We know that a great resource page full of accurate and helpful cheat sheets can save busy diabetes specialists time.
• Medication PocketCards – Download here to use as a study tool and resource.
However, with any move, there are some details that need to be wrapped up.
Other Important Info for University Students
If you are currently enrolled and active in DiabetesEd Online University for the past 1 year, you will be able to experience the new platform as soon as we make the switch in October. You will be prompted to create a new username and password as part of the process.
When we flip the switch over, you will notice a new fresh home page, more intuitive navigations, and some additional bells and whistles.
Still have questions? Please email us at info@diabetesed.net or chat with us at www.DiabtesEd.net.
More to come! We will be sending you ongoing communications to keep you posted on our progress and enhancements.
Thank you, Beverly and Bryanna
![](/wp-content/uploads/2023/01/insta-png-v5.png")
