Based on the 2022 ADA Standards and Screening Guidelines, which one of the following people would need to be tested for hyperglycemia?
Click Here to Test your Knowledge
This course, updated annually, is an essential review for anyone in the field of diabetes. Join Coach Beverly as she summarizes the 2022 updates to the American Diabetes Association’s Standards of Medical Care in Diabetes and provides critical teaching points and content for health care professionals involved in diabetes care and education.
Objectives:
Intended Audience: This course is a knowledge-based activity designed for individuals or groups of diabetes educators, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other health care providers interested in staying up to date on current practices of care for their patients with diabetes and other related conditions.
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
This bundle includes our CDCES Online Prep Bundle plus the ADCES Review Guide.
The online bundle includes Level 1, Level 2, and Level 3 (Boot Camp), plus two bonus courses. The ADCES Review Guide offers over 480+ practice questions and is a fantastic independent study tool and comprehensive resource for the Diabetes Care and Education Specialist Exam.
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″]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.
January eNews | New 2022 Diabetes Standards – Screening Updates and Cheat Sheets
January kicks off our ADA Standards of Care (SOC) celebration and exploration. Coach Beverly has discovered some real gems that she is excited to share with all of you.
“By implementing and championing these evidence-based guidelines, we can make a significant impact in improving care.”
Our goal is to highlight key areas and changes to the standards that will benefit people with diabetes the most.
In this first newsletter of 2022, we feature the new screening guidelines for prediabetes and diabetes. Plus, we explore other important additions and changes to the standards, including a new standard on the prevention and management of chronic kidney disease and vaccination updates.
We look at the relationship between cannabis, hyperemesis, and ketoacidosis for those living with type 1 diabetes. Plus, we invite you to test your knowledge with our Question of the week based on the 2022 SOC.
Coach Beverly updated our Cheat Sheets to reflect the SOC updates so you can download these helpful references and study tools. Lastly, our 2022 medications and glucagon PocketCards are back from the printer and ready for mailing.
With the New Year, you might have set a goal or two for yourself. I hope you have success, but if not, that is okay too.
Coach Beverly, Bryanna, and Jackson
Click here to read our full December 2022 newsletter.
Featured Articles
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This bundle is specifically designed for healthcare professionals who want to learn more about diabetes fundamentals for their clinical practice or for those who are studying for the Certified Diabetes Care and Education Specialist (CDCES) exam.
Intended Audience: A great course for healthcare professionals in the field of diabetes education looking for a straightforward explanation of identification and treatment of hyperglycemic crises.
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
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″]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.
We quizzed test takers on the difference between Type 1 & Type 2 Diabetes. 87% of respondents chose the best answer. We want to share this important info 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 below: Answer Question
Question: JS has newly diagnosed type 1, yet their parent has type 2 diabetes. They ask you the difference between the two types of diabetes.
What is your best response?
Answer Choices:
As shown above, the most common choice was option 4, the second most common answer was option 1, then option 2, and then finally option 3.
Answer 1 is incorrect. 6.67% chose this answer, “Type 1 and Type 2 are both autoimmune conditions, but people with type 2 don’t need insulin at first.” Only type 1 diabetes is considered an immune mediated condition where there is autoimmune destruction of the beta cells. About 30% of people with type 2 will eventually require insulin due to gradual loss of beta cells.
Answer 2 is incorrect. 5.33% of you chose this answer, “Type 1 is due to a progressive destruction of the alpha cells of the pancreas.” In type 1 diabetes, there is destruction of the beta cells that produce insulin, not the alpha cells. Alpha cells produce glucagon, an important hormone that increases glucose levels.
Answer 3 is incorrect. 1.33% of respondents chose this answer, “People with type 2 are less likely to experience diabetes complications than those with type 1 diabetes.” Complications are a result of a complex interplay of genetics, lifestyle and duration plus severity of hyperglycemia. Many people with type 2 diabetes already have complications at diagnosis due to unknowingly having diabetes for an average of six years.
Finally, Answer 4 is correct. 86.67% chose this answer, “Type 1 diabetes is an immune mediated condition that requires insulin from the start.” YES, This is best answer. All people diagnosed with type 1 diabetes immediately need exogenous insulin since their beta cells have been destroyed and they are at risk for hyperglycemic crisis due to insulinopenia.
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 important learning activity!
This bundle is specifically designed for healthcare professionals who want to learn more about diabetes fundamentals for their clinical practice or for those who are studying for the Certified Diabetes Care and Education Specialist (CDCES) exam.
Intended Audience: A great course for healthcare professionals in the field of diabetes education looking for a straightforward explanation of identification and treatment of hyperglycemic crises.
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
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″]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.
As a diabetes specialist in a rural clinic, many of my clients’ use marijuana to help them cope with chronic neuropathy.
Due to hyperemesis and other factors, people with type 1 diabetes who use cannabis on a regular basis, may present to the emergency room with diabetes ketoacidosis (DKA).
However, their unusual labs might cause some initial confusion in determining the correct diagnosis.
In a study that appeared in Diabetes Care, researchers followed people with type 1 admitted to the emergency department for DKA over a five-year period. On admission, they checked to see if they were cannabis positive. Of the 68 people with type 1 in DKA (out of 172 DKA events) who had cannabis in their system, the lab results were surprising. Usually, people in diabetes ketoacidosis have a low pH (less than 7.3) and a low bicarbonate, due to the presence of excess ketone bodies. However, for those with positive cannabis, their pH (mean 7.42 vs 7.09) and bicarbonate (mean 19.2 mmol/L vs 9.1 mmol/L) respectively, were both elevated compared to non users. But their glucose levels, anion gap and beta-hydroxybutyrate were similarly elevated in both groups.
The authors speculate that this paradoxical presentation may be due to vomiting syndromes associated with cannabis use.
Frequent marijuana use can lead to cannabinoid hyperemesis syndrome (CHS). CHS is defined as recurrent nausea, vomiting and cramping abdominal pain that is sometimes associated with at least weekly cannabis use. A common treatment for this syndrome is hot bath or shower.
With heavier marijuana use, people are at risk for cyclic vomiting syndrome (CVS), in which they experience unrelenting nausea and vomiting. The most effective treatment for this is to abstain from cannabis for at least a few weeks. People with type 1 diabetes and gastroparesis are especially at risk for both CHS and CVS. A person with type 1 and gastroparesis is also more at risk for other neuropathies and the associated chronic, often debilitating pain.
The authors are eager to share their findings and suggest screening for cannabis for those admitted with type 1 in hyperglycemic crisis, especially if the person presents with an elevated pH and bicarbonate. The researchers suggest a new term, “Hyperglycemic ketosis due to cannabis hyperemesis syndrome” or HK-CHS.
The diagnostic criteria for hyperglycemic ketosis due to cannabis hyperemesis syndrome (HK-CHS) would include:
in the presence of ketosis in those presenting with DKA.
Due to fears of opioid addiction and with the legalization of marijuana in many states, people with diabetes are turning to cannabis to manage their chronic neuropathic pain.
As diabetes specialists, we can encourage having open and honest conversations about marijuana use. If people are experiencing excess vomiting associated with cannabis use, we can help explore other options to manage chronic pain including referral to a pain management clinic and mental health support as needed.
This course discusses common causes of hyperglycemia crises. Topics include hyperglycemia secondary to medications and insulin deprivation. The difference and similarities between Diabetes Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome are also covered. Treatment strategies for all situations are included.
Objectives:
Intended Audience: A great course for healthcare professionals in the field of diabetes education looking for a straightforward explanation of identification and treatment of hyperglycemic crises.
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
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″]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.
Based on the 2022 ADA Standards of Care, which of the following is the most accurate statement regarding chronic kidney disease and risk management?
Click Here to Test your Knowledge
This bundle is specifically designed for healthcare professionals who want to learn more about the ADA Standards of Diabetes Care for their clinical practice or for those who are studying for the BC-ADM or the CDCES certification exam.
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
Intended Audience: A great course for healthcare professionals in the field of diabetes education looking for a straightforward explanation of identification and treatment of hyperglycemic crises.
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator and a nationally recognized diabetes expert.
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″]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.
The 2022 ADA Standards of Care (SOC), have some exciting new updates that impact our clinical practice. We have updated our cheat sheets for your clinical practice and in preparation for certification exam success.
Given the increasing incidence of prediabetes and diabetes in younger populations, the ADA has adjusted their screening threshold. The old guidelines suggest screening everyone starting at age 45.
The new recommendations state that everyone aged 35 or older needs to have their blood glucose level evaluated to find undiagnosed prediabetes or diabetes.
Testing methods for prediabetes or diabetes can include:
By testing for elevated glucose levels at this younger age bracket, health care professionals can provide early intervention to slow progression from prediabetes to diabetes and provide immediate care to those with newly discovered diabetes.
In addition to lowering the screening age, the ADA suggests evaluating glucose levels for people with HIV who are started on antiretroviral therapy with ongoing glucose screening during therapy. Antiretroviral therapy can damage beta cells leading to hyperglycemia. To prevent complications, early detection and treatment is important for these higher risk individuals.
The guidelines still recommend testing adults of any age with BMI of 25 or more or BMI of 23 or more in Asian Americans with one or more additional risk factors. See cheat sheet below for more details.
In addition, all newly pregnant individuals at risk of diabetes (using the same risk criteria as listed below) need glucose testing. However, the ADA suggests universal screening for all individuals early in pregnancy to identify those with undiscovered hyperglycemia or diabetes, so treatment can be initiated to protect fetal and maternal health.
This is an exciting start to 2022. Finding people with elevated blood sugars at a younger age promises to help decrease risk of diabetes complications and improve outcomes along with quality of life.
This bundle is specifically designed for healthcare professionals who want to learn more about diabetes fundamentals for their clinical practice or for those who are studying for the Certified Diabetes Care and Education Specialist (CDCES) exam.
Intended Audience: A great course for healthcare professionals in the field of diabetes education looking for a straightforward explanation of identification and treatment of hyperglycemic crises.
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
Beverly has custom designed this deluxe course bundle to prepare you for your CDCES (formerly known as CDE) or BC-ADM Exam.
This Deluxe Prep Bundle includes:
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″]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.
We quizzed test takers on NPH insulin. 57% of respondents, chose the best answer. We want to share this important info 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 below: Answer Question
Question: NPH insulin, introduced in 1946 was one of the first basal insulins. It is considered intermediate-acting basal insulin since the duration of action is about a half-day. Given its effectiveness and affordability, it is on the World Health Organization’s List of Essential Medicines.
Which of the following is a true statement regarding NPH insulin?
Answer Choices:
As shown above, the most common choice was option 1, the second most common answer was option 2, then option 3, and then finally option 4.
Answer 1 is correct. 56.89% chose this answer, “In most states, it can be purchased over the counter without a prescription.” YES, GREAT JOB. Actually, there are three over-the-counter insulins that are available for purchase without a prescription. They include regular insulin, NPH (intermediate-acting), and 70/30 insulin, a premixed combination of NPH and regular.
People might be interested in purchasing these older insulins because of their lower cost. Walmart sells all three types under the ReliOn brand umbrella for roughly $25 a vial. Chain pharmacies can also sell regular, NPH, and 70-30 insulin. However, OTC insulin is more frequently sold at Walmart than other chain pharmacies, likely due to the considerably lower price point.
– For more info on the different types of insulins, download our FREE PocketCards.
– For Info on affordable insulin, please visit our Insulin Cost Savings Resource page.
Answer 2 is incorrect. 20.09% of you chose this answer, “Instructions include to gently shake before injection to adequately mix the particles.” Shaking NPH insulin can cause clumping and is not recommended. According to the package insert, the most accurate instruction is to gently roll NPH insulin or invert it repeatedly until the particles are evenly distributed. NPH looks milky and homogeneous when properly mixed.
Answer 3 is incorrect. 12.90% of respondents chose this answer, “NPH stands for Natural Proinsulin Hagedorn.” So close. The name refers to N for neutral, P for protamine (a protein), and H for its creator scientist name Hans Christian Hagedorn. NPH insulin is FDA-approved in the adult and pediatric population to manage type 1 and type 2 diabetes. It is also useful in gestational diabetes. More info.
Finally, Answer 4 is incorrect. 10.12% chose this answer, “Due to its high rates of hypoglycemia, NPH is no longer recommended.” NPH insulin does have a somewhat higher risk of hypoglycemia. One way to decrease the risk of hypoglycemia and high day-to-day variability is to thoroughly re-suspend NPH until it is uniformly cloudy before injecting. This will improve the pharmacodynamic and pharmacokinetic profile of NPH insulin, leading to less hypoglycemia. NPH insulin onset of action is 2 to 4 hours, time to peak effect is 4 to 10 hours, and total duration 10-16 hours. The newer basal insulins don’t have a peak, so there is slightly less hypoglycemia. However, with careful dosing and education, NPH insulin can provide a lower cost and effective alternative to the newer analog insulins, especially for those living with type 2 diabetes.
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 important learning activity!
Want to learn more? Join our Webinar on Hyperglycemic Crisis, which is ready for viewing!
This bundle is specifically designed for healthcare professionals who want to learn more about diabetes fundamentals for their clinical practice or for those who are studying for the Certified Diabetes Care and Education Specialist (CDCES) exam.
Intended Audience: A great course for healthcare professionals in the field of diabetes education looking for a straightforward explanation of identification and treatment of hyperglycemic crises.
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
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″]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 your convenience, we have listed the schedule for our most popular upcoming courses below. You can purchase levels individually, or also bundle levels for cost savings and convenience. Your registration guarantees access to live and recorded courses, plus free podcasts, for one full year. For more information on the content of the different course levels, see the description and dates below.
2022 Live Webinar Schedule
FREE Webinars
This bundle is specifically designed for healthcare professionals who want to learn more about diabetes fundamentals for their clinical practice or for those who are studying for the Certified Diabetes Care and Education Specialist (CDCES) exam.
Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.
This bundle is specifically designed for healthcare professionals who want to learn more about the ADA Standards of Diabetes Care for their clinical practice or for those who are studying for the BC-ADM or the CDCES certification exam.
Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.
This library of critical information is designed for individuals or groups of diabetes specialists, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other health care providers interested in staying up to date on current practices of care for people with diabetes and preparing for the BC-ADM or the CDCES certification Exam.
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
Intended Audience: A great course for healthcare professionals in the field of diabetes education looking for a straightforward explanation of identification and treatment of hyperglycemic crises.
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator and a nationally recognized diabetes expert.
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″]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.