If you are considering taking the CDCES or BC-ADM Exam, we have great news. We are offering 2 different webinars that provide you with the study prep information and tools you need to propel across the finish line.
As health care professionals, we value your limited study time by offering evidence-based content carefully crafted for exam success with direct application to your clinical practice. Please let us know if we can be of any help on your journey!
Warmly, Coach Beverly and Bryanna
Register for BC-ADM Webinar | September 20, 2022
BC-ADM 2022 Note Taking Handout
We hope you can join us live. But, if not, no worries.
We will send you a link to the recorded version within 24 hours of airing.
This course will transform your test anxiety into calm self-confidence and test-taking readiness.
Join Coach Bev Live – September 22, 2022 at 11:30am
2022 PowerPoint Note-Taking Handouts
We hope you can join us live. But, if not, no worries.
We will send you a link to the recorded version within 24 hours of airing.
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator who has passed her CDCES Exam 6 times and first earned her BC-ADM credential 20 years ago. She is a nationally recognized diabetes expert for over 25 years.
3 Day Intensive: Virtual DiabetesEd Specialist Conference |Oct. 12-14th
This Virtual Training Conference streams LIVE in October. Invite your friends to enjoy a group discount. Plus, save on travel costs and enjoy conference interactivity through demonstrations, games and Q&A sessions. Our Deluxe Conference Package includes a 100+ page printed syllabus, Med PocketCards, ADA Standards and swag. This advanced level course features 3 expert speakers who translate the ADA Standards, Meds, Technology, Complications, Nutrition Therapy and more. Join us to get recharged or to prepare for certification.
Self-Study Online Certification Bundles:
These courses are designed to walk participants through the knowledge needed to succeed at either the CDCES or BC-ADM certification exams. Viewed at your convenience and pace, each module contains poll questions, case studies and real life situations that prepare participants for clinical situations as well as the exams. Students consistently state that our online courses not only helped them achieve certification, they also provided valuable insights into providing effective diabetes care. See more info below.
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 test takers on ambulatory glucose profile confusion. Only 62% of respondents chose the best answer, which indicates that there was some uncertainty. 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:
LS is 72 years old with type 2 diabetes and injects insulin 4 times a day. They were started on a CGM device last month and you are looking at the Ambulatory Glucose Profile (AGP) together. You notice their time in range is 60%, their time above range is 38%, in low range is 2% and their coefficient of variation is less than 36%.
What is the best response?
Answer Choices:
Answer 1 is incorrect. 11.89% chose this answer, “We still need to improve your coefficient of variation.” This is a juicy answer, but not the best one. If you refer to the Ambulatory Glucose Profile (AGP) below, you will see that the goal for Coefficient of Variation is less than 36%. In this question, LS has coefficient of variation is less than 36%, so they are meeting the target. This measure of glucose variability is important since it informs us of the intensity and duration of glucose levels fluctuations.
Answer 2 is incorrect. 5.26% of you chose this answer, “Based on these results, let’s decrease your insulin by 20%.” This is not the best answer either. Since their time in range of 60% is a little below target and 38% of the time they are above target, LS might actually need some more insulin. Of course, safety is always first, but their low blood sugar range is only 2%, well below the 5% target.
Answer 3 is incorrect. 20.91% of respondents chose this answer, “Time in range should be 70% or greater for your age group.” Another juicy answer, but just like A1C goals, time in range targets are based on the individual and other factors. For a 72 year old on multiple daily injections, 70% time in range may be too aggressive and put them at risk for hypoglycemia. The target time in range is not a “one size fits all” and needs to be customized to the individual. In addition, this statement uses the “should” word, which can evoke feelings of embarrassment or shame. Instead we might say, “Great job tracking your blood sugars. How are you feeling about your progress?
Finally, Answer 4 is correct. 61.94% chose this answer, “This information is going to help with problem solving.” YES, GREAT JOB, this is the best answer. It is person centered, acknowledges their effort and engages LS in participating in problem solving. This comment will definitely increase their feelings of mastery and empowerment.
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.
Download Course Flyer | Download Schedule
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.
Team of expert faculty includes:
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.
JR, a 67-year-old with type 2 diabetes for seven years and an A1C of 9.7% was started on empagliflozin 10mg two weeks ago. Other labs include a GFR of 49 and a UACR of 34 mg/g. Other diabetes medications include glucotrol 10mg twice daily and sitagliptin 100mg daily. JR sometimes has a few shot’s of whiskey before bed, especially if they had a stressful day. JR’s partner calls you in a panic and says JR is admitted to the hospital in DKA.
What is the most likely explanation?
Click Here to Test your Knowledge
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.
Download Course Flyer | Download Schedule
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.
Team of expert faculty includes:
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.
After the Uvalde shooting, a group of mothers who belonged to a monthly book club, decided not to talk about their book of the month. Instead they dedicated their gathering to sharing their deep grief and feelings of powerlessness about the senseless loss of 19 beautiful children in Uvalde, Texas. Children, just like their own, who were excited to learn, hang out with friends and wrap up school for the summer.
I am one of the book club mothers.
We committed to shine a light on this tragedy and connect to our common humanity through art. We are often afraid to talk about gun violence because it is such a fraught conversation. However, we know one thing we all have in common regardless of our political affiliation or upbringing.
We all want our school aged children to be safe and free of death from gun violence in their schools, homes and communities.
Let’s start our conversation with this belief in mind.
To express our grief and touch the hearts of others, we created an art installation featuring 21 orange t-shirts of different sizes, with the hand-painted names of the children and teachers who died that day in May. We call it the “Uvalde T-shirt Clothesline”.
The Uvalde T-Shirt Clothesline speaks of the empty shirts left behind: shirts that will never be played in, worn to school, or hugged at night.
We displayed this at our local Farmer’s Market where many people stopped, looked up and reflected on the loss. It now it hangs at the entrance of the museum of northern california, monca.
On May 24, 2022, in the small town of Uvalde, Texas, nineteen innocent children and two teachers were gunned down at school by an 18-year-old with an automatic weapon. Out of our grief and dismay over this tragic loss of life arose this installation of 21 orange t-shirts, hand-painted with the names of the children and teachers who died that day.
The Uvalde T-Shirt Clothesline speaks of the empty shirts left behind: shirts that will never be played in, worn to school, or hugged at night. Shirts whose young owners will never reach their full potential. We chose orange shirts since orange is the commemorative color of gun violence prevention.
Empty orange shirts on a clothesline serves as a metaphor for the ordinary act of hanging our family’s clothes to dry, a commonplace fixture of household routine. It connects to the tragic reminder that gun violence in our schools is also becoming routine.
Firearms are the leading cause of death for children in the United States. Every two and a half-hours, a child loses their life due to firearm violence, accidents, or suicide. We hope this display touches hearts and shines a light on the senseless loss of these beautiful souls. Through connection and conversation, we can make a difference.
Please share any questions or comments regarding this blog with [email protected]. Thank you.
Maybe other communities could create their own clothesline? Read Enterprise Record Article here.
Download a List of Gun Violence Prevention Organizations
Nurses Union Addresses Gun Violence
Art Displays
Uvalde mural honors Robb Elementary School shooting
September 2022 eNews | Boosting Nutrition Health & Jumping for Joy
We are experiencing a food crisis. Ten percent of Americans in every state, across rural and urban households, experienced food insecurity at least some time during 2020. With food prices on the rise, how do we help people with prediabetes and diabetes make healthy food choices within their means? There is good news! A national nutrition task force has unveiled its findings and ambitious strategies to improve nutrition access and reduce diet-related diseases. These thought leaders and food experts have outlined an innovative plan to address the food crisis by increasing nutrition education and access, including funding cooking classes and more.
Good news in diabetes tech. The first ever tubeless integrated insulin delivery system was just FDA approved for toddlers 2 years old and up. Parents and providers alike are celebrating this latest advance in insulin delivery technology for kids and adults alike.
We all know that exercise is good for you, but does it elicit feelings of joy? A researcher has identified a series of one-minute movements that not only improve coordination, balance, and strength but also bring a smile to your face. Give it a try and invite your friends and family to join you in Jumping for Joy.
In preparation for our 25th year anniversary, we are adopting a higher tech Online University Learning Platform. This means easier navigation and more bells and whistles for our subscribers. We plan to make the switch in early Fall, so keep your eyes open for more info as we get closer to the date.
Finally, we are thrilled to announce two Flower Scholars for our October Virtual DiabetesEd Course. They are making a big difference in their communities, and we are overjoyed to celebrate both of them.
You and your colleagues are invited to join our three FREE Webinars this month. If you feel like a challenge, take a moment to check out our Question and Rationale of the Week.
Thank you in advance for your actions and advocacy on behalf of people living with diabetes.
Beverly, Bryanna, Robert, and Amanda
Click here to read our full September 2022 newsletter.
Featured Articles
Upcoming Webinars
What we say matters.
As educators, advocates, spouses, friends, and providers, our use of language can deeply affect the self-view of people living with diabetes every day.
Intentional communication is a powerful tool that can uncover trauma, identify barriers, and move both the provider and person with diabetes toward a greater understanding of the issues involved.
The language used in the health care setting is immensely important in determining trust, mutual respect, and meaningful long-term relationships.
Topics covered include:
This mini-webinar is free, and no CEs are provided, but there is lots of great info!
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!
[yikes-mailchimp form=”1″]Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*
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 test takers on abdominal lumps and insulin injections. Only 46% of respondents chose the best answer, which indicates that there was some confusion. 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:
JL is 67 years old, with a BMI of 23 and A1C of 7.6% and injects insulin 4 times a day to manage their type 1 diabetes. On visual inspection, you notice that there are many areas of lipohypertrophy on JL’s abdominal region.
Which of the following interventions would be the best recommendation?
Answer Choices:
Answer 1 is incorrect. 18.54% chose this answer, “Switch to 50/50 insulin twice daily.” This is not the best answer since it doesn’t address the core issue of injection site overuse and fat accumulation. Switching to 50/50 insulin may even lead to worsening blood sugars since it is a premixed basal bolus insulin that would be difficult to fine tune for people with type 1 diabetes. (See photo of lipohypertrophy below)
Answer 2 is incorrect. 7.85% of you chose this answer, “Stop bolus insulin and switch to a GLP-1 RA.” This is not the best answer since GLP-1 RA’s are not FDA approved to treat people with type 1 diabetes*. If a person with type 1 diabetes stopped their bolus insulin, they would become very insulin deprived and likely experience severe blood glucose elevations and hyperglycemic crisis. Plus, this answer doesn’t address the core issue of injection site overuse and fat accumulation. *Footnote: some people with type 1 are prescribed a GLP-1 RA (off label) in ADDITION to basal bolus insulin to lower glucose levels and help with weight management. (See photo of lipohypertrophy below)
Answer 3 is correct. 45.93% of respondents chose this answer, “Switch bolus injections to inhaled insulin.” YES, GREAT JOB. Lipohypertrophy, a lump of fat accumulation due to frequent injections, has been shown to affect ?50% of people injecting insulin and results from lack of injection site rotation and needle. Injecting into these “lumps” reduces insulin absorption and action, raises postprandial glucose, and greatly increases insulin uptake variability. Despite this, inspection of injection sites is not routinely performed by health care professionals or people with diabetes, which reveals the “unexplained” nature of many blood glucose fluctuations. (Excerpted from this Article on Insulin Injection Technique- Clinical Diabetes, 2019).
To avoid lipohypertrophy, we can transition people to boluses of inhaled insulin to cover for food and hyperglycemia and still provide one basal injection a day, using sites free of fatty lumps. This reduction of the injection frequency allows time for tissue healing and reduces creation of new lipohypertrophy sites. Download our FREE Insulin PocketCards here.
If a person decides to stay on injections, encourage them to systematically space them at least 1 cm (about the width of an adult finger) from each other; this helps to avoid repeat tissue trauma. One approach involves dividing sites into quadrants (or halves when using the buttocks or thighs), using one quadrant per week and moving from quadrant to quadrant in a consistent direction (e.g., clockwise). Encourage people to rotate injections between sites, as well as within a site. Use needles once and toss, since excessive reuse of needles can traumatize the skin and underlying structures. (See photo of lipohypertrophy below)
Finally, Answer 4 is incorrect. 27.67% chose this answer, “Use a higher gauge needles to enhance absorption.” This is not the best answer since it doesn’t address the core issue of injection site overuse and fat accumulation. Switching to a higher gauge needle just means the barrel of the needle is thinner and hurts less when passing through the skin. Improper injection site rotation and needle reuse are the most common factors associated with lipohypertrophy. (See photo of lipohypertrophy below)
Read more great info here, The Injection Technique Factor: What You Don’t Know or Teach Can Make a Difference – Article from Clinical Diabetes, 2019. You are also invited to join our Virtual Conference where we tackle this topic and many more factors that affect diabetes self-care.
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.
LS is 72 years old with type 2 diabetes and injects insulin 4 times a day. They were started on a CGM device last month and you are looking at the Ambulatory Glucose Profile (AGP) together. You notice their time in range is 60%, their time above range is 38%, in low range is 2% and their coefficient of variation is less than 36%.
What is the best response?
Click Here to Test your Knowledge
Join our Virtual Conference to gain valuable insights from
Technology Expert, Dr. Diana Isaacs
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Topics covered include:
Intended Audience: A great course for healthcare professionals who want to learn the steps involved in providing a thorough lower extremity assessment.
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator and a nationally recognized diabetes expert.
All hours earned count toward your CDCES Accreditation Information
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.