1. has intensified to clinical depression.
2. requires urgent referral to a mental health professional.
3. could be responsive to self-management coaching.
4. may be a sign of disordered eating.

Click Here to Test your Knowledge

---

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.

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.
• A comprehensive set of assessment tools, educational materials, log sheets, and resources.

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.

For last week’s practice question, we quizzed participants on being at risk for NASH. 63% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question

Question: JR is 46 years old with type 2 diabetes and a BMI of 33. In addition, JR has hypertension and hyperlipidemia, with elevated liver enzymes (ALT and AST).

According to the latest ADA Standards, which of the following would best help determine if JR is at risk for liver fibrosis and cirrhosis?

Answer Choices:

1. UACR
2. FIB-4
3. GAD or ICA
4. Weight in (kg) divided by the square of height in meters (m2)

---

Getting to the Best Answer

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

Answer 1 is incorrect. 14.51% chose this answer. “UACR.” This is a juicy answer, however the Urinary Albumin Creatinine Ratio (UACR) evaluates kidney function and doesn’t provide any hepatic insights. Instead we would recommend the Fibrosis-4 Index for Liver Fibrosis helps determine risk of hepatic cirrhosis and inflammation (see answer 2).

Answer 2 is correct. 62.53% of you chose this answer. “FIB-4.” GREAT JOB. The Fibrosis-4 Index for Liver Fibrosis helps determine risk of hepatic cirrhosis and inflammation. By entering the person’s age, AST, ALT and Platelet count using the FIB-4 calculator, a risk level is calculated (see slide below). The hope is that by screening for hepatic issues early, we can take action to protect the liver and improve outcomes.

Answer 3 is incorrect. About 11.69% of respondents chose this. “GAD or ICA.” Although this answer is familiar, it does not match the intent of the question. GAD and ICA are blood tests to determine if someone has autoimmune mediated type 1 diabetes. Instead we would recommend the Fibrosis-4 Index for Liver Fibrosis helps determine risk of hepatic cirrhosis and inflammation (see answer 2).

Finally, Answer 4 is incorrect. 11.27% chose this answer. “Weight in (kg) divided by the square of height in meters (m2).” This answer is also familiar since it is the formula to determine a person’s body mass index (BMI). Instead we would recommend the Fibrosis-4 Index for Liver Fibrosis helps determine risk of hepatic cirrhosis and inflammation (see answer 2).

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! Learn more by attending our Virtual Conference plus save $100 through April 18, 2023.

---

Register now for our Virtual DiabetesEd Training Conference

Your team is invited to our Virtual DiabetesEd™ Training Conference! Set your team apart and prepare for diabetes certification!

Join this state-of-the-art conference taught by content experts, Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES, Beverly Thomassian RN, MPH, CDCES, BC-ADM, and Ashley LaBrier who are passionate about improving diabetes care.

Group discounts are available!*

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.

1. 2 vials
2. 4 pens
3. 6 pens
4. 3 pens

Click Here to Test your Knowledge

---

Register now for our Virtual DiabetesEd Training Conference

Your team is invited to our Virtual DiabetesEd™ Training Conference! Set your team apart and prepare for diabetes certification!

Join this state-of-the-art conference taught by content experts, Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES, Beverly Thomassian RN, MPH, CDCES, BC-ADM, and Ashley LaBrier who are passionate about improving diabetes care.

Group discounts are available!*

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.

You’re invited! Join us on April 11th & April 13th for our upcoming Standards of Care Intensive Updates!

---

Our Microvascular Complications, Prevention & Treatment | Eye, Kidney, Nerve Disease | Level 2 Webinar airs live on April 11th at 11:30 am PST

This course provides the need-to-know information regarding the microvascular complications of diabetes. It includes a brief overview of the pathophysiology & clinical manifestations along with prevention strategies & screening guidelines. This straightforward program will provide participants with the information they can use in a clinical setting & also provides critical content for certification exams.

Objectives:

1. List the main factors contributing to eye, kidney, & nerve disease.
2. Describe modifiable & non-modifiable risk factors for diabetes complications.
3. State screening guidelines & prevention strategies.

---

Our Cardiovascular Disease & Diabetes | Level 2 Webinar airs live on April 13th at 11:30 am PST

This course takes a close look at insulin resistance syndrome & vascular complications. We discuss the impact of vessel disease from the heart to the toes. Included is a discussion of identifying & preventing vascular disease & a comprehensive review of the latest American Diabetes Association’s (ADA) Standards of Medical Care in Diabetes for heart disease.

Objectives:

1. The impact of insulin resistance & hyperglycemia on vessel disease.
2. State the complications & factors associated with vascular disease.
3. List management goals to reduce the risk of vascular disease.
4. Discuss strategies to promote health.

---

Virtual DiabetesEd Training Conference

Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.

If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.

Group discounts are available!*

Download Course Flyer | Download Schedule

All hours earned count toward your CDCES Accreditation Information

---

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

---

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

For last week’s practice question, we quizzed participants on having their cake and eating it too. A whopping 94% of respondents chose the best answer. We want to celebrate your success and give you all a shout out for a job well done.

Before we start though if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question

Question: AJ is a 9-year-old with type 1 diabetes, A1c of 7.2%, and uses an insulin pump and CGM. They ask you how to include a piece of birthday cake for an upcoming birthday celebration.

What is the best advice?

Answer Choices:

1. Accept the cake but don’t actually eat it.
2. Increase their daytime basal insulin to prevent hyperglycemia.
3. Take additional bolus insulin to cover the extra carbs.
4. Encourage AJ to have a piece of fruit instead.

---

Getting to the Best Answer

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

Answer 1 is incorrect. 1.53% chose this answer. “Accept the cake but don’t actually eat it.” Since this doesn’t honor AJ’s choice to accept and enjoy the cake, it is not the best answer. People with diabetes can absolutely enjoy special treats by adjusting their bolus insulin dose to account for the extra carbs to prevent post cake hyperglycemia.

Answer 2 is incorrect. 2.3% of you chose this answer. “Increase their daytime basal insulin to prevent hyperglycemia.” People with diabetes can absolutely enjoy special treats by adjusting their bolus insulin dose to account for the extra carbs to prevent post cake hyperglycemia.

Answer 3 is correct. About 94.12% of respondents chose this. “Take additional bolus insulin to cover the extra carbs.” YAY! This person centered approach is the BEST guilt free answer since it recognizes and respects AJ’s choice to enjoy a piece of birthday cake while still managing blood sugars with extra bolus insulin.

Finally, Answer 4 is incorrect. 2.05% chose this answer. “Encourage AJ to have a piece of fruit instead.” Since this doesn’t honor AJ’s choice to accept and enjoy the cake, it is not the best answer. People with diabetes can absolutely enjoy special treats by adjusting their bolus insulin dose to account for the extra carbs to prevent post cake hyperglycemia.

We hope you appreciate this week’s person-centered 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 Medical Nutrition Therapy?

You are invited to join our Virtual Conference  with our Nutrition expert speaker, Ashley LaBrier, MS, RD, CDCES, who will be providing a half-day presentation on this important topic!

Ashley LaBrier, MS, RD, CDES, is an innovator in the field of diabetes, nutrition, and technology. Ashley is a consultant and the Diabetes Education Program Coordinator at the Salinas Valley Medical Clinic’s Diabetes & Endocrine Center. 

Ms. LaBrier is passionate about providing person-centered education to empower those who live with diabetes. Having been diagnosed with type 1 diabetes herself nearly 20 years ago, she combines her professional knowledge with personal experience and understanding. 

---

Virtual DiabetesEd Training Conference

Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.

If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.

Group discounts are available!*

Download Course Flyer | Download Schedule

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.

“Why do you say “pregnant people” in your webinars?”

A few years ago, we recognized that we were not including everyone in the conversation when discussing prenatal care in our standards course so we made the shift of changing the language from “Women & Diabetes” to “Pregnancy & Diabetes.”

While the majority of people who become pregnant are women, we know that gender-diverse people and transmen can also become pregnant and including them in discussions around prenatal care is important. We also recognize that the experience of being a parent and/or giving birth varies widely for both cis and trans people; some women who are mothers adopted their children, used a surrogate, or their partner gave birth to their children, while others who give birth are gender-diverse, trans, two-spirit, or intersex and don’t identify as a woman.

Gender-inclusive terms for pregnancy and birthing are not new. Lesbian parents have long distinguished between birth and non-birth mothers, a practice that appears in over a decade of academic literature. In uncoupling gender from a body’s ability to gestate and birth a child, we note that adoptive mothers, cisgender lesbian non-birth mothers and trans mothers who were assigned male at birth (AMAB) all engage in mothering activities and typically identify as mothers.

Recognizing and renaming in obstetrics: How do we take better care with language?

Whether we provide services in the hospital, clinic, or other outpatient settings, we can take steps to help the people we work with feel welcome.

---

Shifting Our Language

As Diabetes Educators, we recognize the importance of language in providing person-centered care to best support people living with diabetes and prenatal care is no different.

There are a few small changes we can make to provide inclusive care for all people. As we outlined above, “mother” may not fit each and every person who is giving birth and someone might identify as a mother who hasn’t given birth. Because of this, we can change “mother” in our language to “parent” or shift “woman” to “people” when speaking generally about pregnancy.

To make our practices more welcoming, we can establish All Gender Restrooms and update our materials to use gender-inclusive language. Here is a list of terms and tips for shifting this language and creating more inclusive practices.

Person-Centered Care includes Individualized Language

The easiest way to become more inclusive in our language which respects the autonomy of each individual to describe themselves and their bodies is to give them opportunities to share with us what those terms are and how they would like to be referred to.

A few ways you can do this are by expanding the ways we collect this information in our intake forms or discussing it with the individual in their initial appointment. You can incorporate sections to ask for someone’s pronouns or even a body map where someone can make notes about preferred language that is used around their bodies and pregnancy. Giving space to outline triggering or preferred language for each person can empower not only gender-diverse people but can also support trauma survivors of all genders.

By paying careful attention to each person’s experience from the moment they walk in the door until we say goodbye, we can find ways to create a more inclusive environment. This awareness of the details is the great first step to showing your care and respect for those you work with.

---

Resources

ADCES Inclusive Care for LGBTQ+ People with Diabetes Handout – this handout provides definitions, terms to avoid, and a cultural competency checklist to help you move towards improving inclusivity within your practice.

ADA’s Providing Culturally Sensitive Diabetes Care and Education for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community article

ADA’s Considerations for Transgender People With Diabetes 

Focus on Forms and Policy: Creating an Inclusive Environment for LGBT Patients by the National LGBT Health Education Center

All Gender Restroom Sign PDF

Diabetes Prevention and Management for LGBTQ+ People Handout – this handout includes research of diabetes within the LGBTQ+ community, along with clinical considerations, programs, and resources for diabetes educators to use within their practice.

Policies on Lesbian, Gay, Bisexual, Transgender & Queer (LGBTQ+) issues – this resource by the American Medical Association lists all the current healthcare policies in place for the LGBTQ+ community.

Helio’s LGBTQ+ Health Updates Resource Center – this is a “collection of news articles and features that provide the latest information on the unique health needs of individuals in the LGBTQ+ community.”

---

Want to learn more about this question? Enroll in our

Level 2 | Pregnancy & Diabetes | 1.5 CEs

Pregnancy with diabetes is confronted with a variety of issues that require special attention, education, & understanding. This course reviews those special needs while focusing on Gestational Diabetes & Pre-Existing Diabetes. Included are the most recent diagnostic criteria, management goals, & prevention of complications during pregnancy. This is a helpful review for Certification Exams & those who want more information on people who are pregnant & live with diabetes.

Objectives:

1. List three issues that affect pregnancy with diabetes.
2. Describe the unique attributes of pre-existing diabetes in pregnancy & gestational diabetes.
3. State the diagnostic criteria & management goals for gestational diabetes.
4. Potential short-term & long-term complications of fetal exposure to hypoglycemia.
5. Prevention measures to keep mother & baby healthy.

Intended Audience: A great course for healthcare professionals seeking to enhance their knowledge of the issues surrounding pregnancy and diabetes and appropriate care to improve outcomes.

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.