1. Elevated ALT and AST indicate a diagnosis of NAFLD.
2. Approved treatment for NAFLD includes low-dose aspirin and pioglitazone.
3. Fatty liver disease indicates that 5-10% of the liver weight is from fat.
4. Surgical intervention is indicated to resect the liver in the presence of NAFLD.  

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Test Taking Practice Exam Toolkit | FREE Webinar 

Are You Ready for Exam Success?

Join us live Thursday, June 30th at 11:30 am PST

Learn Test-Taking Secrets with Coach Bev – Option to add on 200+ Computerized Practice Test Questions for $49

During this webinar, Coach Beverly will help you transform your nervousness into focused energy that will help you succeed. She will provide test-taking tips based on her experience taking the certification exam six times.  

To provide plenty of practice, Coach Beverly will sample 20 test questions that have been plucked from our Test Taking Toolkit during this live webinar.

She will explain how to dissect the question, eliminate wrong answers and avoid getting lured in by juicy answers.

Two Ways to Join

Includes a review of 20 sample test questions with test taking strategies.

This includes access to the recorded version of this webinar on your Online University Student Portal.

Plus, the Test Taking Toolkit provides you with over 200+ sample online practice questions, simulating the exam experience.

A perfect way to assess your knowledge and create a focused study plan, while increasing your test-taking confidence.

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Want to learn more about Diabetes Care?  View our

Virtual DiabetesEd Specialist Conference
30+ CEs

Recorded & Ready to Watch!

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

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.

Join us LIVE for this Virtual Course and enjoy a sense of community!

Team of expert faculty includes:

• Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
• Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
• Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator

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Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

• Q & A Session with the instructor after each webinar.
• LIVE Presentations by our team of experts.
• State of the art review of current diabetes care and technology.
• Resources for each session.
• Access to free podcasts and video recordings within a week of each live session for one year.

Deluxe Version includes Syllabus, Standards and Swag*:

• Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
• ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
• DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

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All hours earned count toward your CDCES Accreditation Information

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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 glucose monitoring in the inpatient setting. 60% of respondents chose the best answer. 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: JL is a new nursing graduate and asks you questions about glucose monitoring in the inpatient setting. Which of the following statements is most accurate regarding providing diabetes care in the hospital setting?

Answer Choices:

1. If a patient is experiencing morning hypoglycemia, reduce basal insulin.
2. Nursing staff can use the patient’s CGM glucose results to determine insulin dose.
3. Any patient admitted with a glucose of 140 mg/dl or greater, confirmed on two different occasions, needs to be started on insulin.
4. Hospital point-of-care glucose meters are mostly as accurate as lab glucose results.

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As shown above, the most common choice was option 1, the second most common answer was option 4, then option 2, and finally 3.

Getting to the Best Answer

Answer 1 is correct. 59.86% chose this answer, “If a patient is experiencing morning hypoglycemia, reduce basal insulin.” YES, GREAT JOB! During hospitalization, keeping glucose levels on target improves outcomes and decreases the length of stay. This includes preventing hypoglycemia, which can be life-threatening. The most common cause of morning hypoglycemia is basal insulin. Treating hypoglycemia rapidly with carbs and rechecking to make blood sugar is increasing is critical. However, to prevent future hypoglycemic events, determining the cause of the low blood sugar and taking corrective action is just as important. Reducing basal insulin by 20% or more when morning blood sugars are less than 100 mg/dL in the hospital setting makes a big difference in protecting against hypoglycemia.

Answer 2 is incorrect. 12.93% of you chose this answer, “Nursing staff can use the patient’s CGM glucose results to determine insulin dose.” This is a juicy answer, however, the FDA has not approved the dosing of insulin based on CGM results in the hospital setting. Inpatients with adequate cognition are allowed to use their CGM to monitor their blood sugar and keep an eye on trends based on the hospital’s policy. However, insulin dosing is based on the hospital-approved point-of-care glucose meter results.

Answer 3 is incorrect. 9.52% of respondents chose this answer, “Any patient admitted with a glucose of 140 mg/dl or greater, confirmed on two different occasions, needs to be started on insulin.” If a person is admitted with a glucose of 140 or greater, this would certainly catch our attention and require ongoing monitoring. They may have undiagnosed prediabetes or diabetes (depending on if the glucose was fasting or random). However, this glucose level of 140 does not meet the criteria to start insulin. According to the ADA Standards, insulin therapy is initiated when the admitting glucose is 180 or greater.

Finally, Answer 4 is incorrect. 17.69% chose this answer, “Hospital point-of-care glucose meters are mostly as accurate as lab glucose results.” This is another juicy answer. The lab glucose is the most accurate. Approved hospital glucose meters can read 15% higher or lower than the actual lab glucose. At home glucose meters, can be up read up to 20% higher or lower than lab glucose and still be within FDA approval parameters. For more info, see our blog, How Accurate are Glucose Meters?

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Hospitals & Hyperglycemia Standards | Level 2 | $29 for 1.5 CEs

Recorded & Ready to Watch!

Research clearly demonstrates the importance of glucose control during hospitalization to improve outcomes not only in the inpatient setting but after discharge.  This course reviews the evidence that supports inpatient glucose control and outlines practical strategies to achieve targets in the inpatient setting.  We incorporate the latest ADA Standards and provide links to resources and inpatient management templates.

Objectives:

1. The impact of hyperglycemia in the hospital setting
2. The importance of inpatient glucose control
3. Three strategies to get glucose to the goal in the hospital setting

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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 at a local Native Health Services Clinic, I assess a lot of feet every day.  I believe this simple act of looking, touching, questioning, caring, and referring has saved many lower extremities.

Last month, a client arrived who was excited to report that they were able to walk for over an hour without getting short of breath. We celebrated this accomplishment and then I asked them to take off his shoes, knowing this person had already lost all of the toes on their left foot due to diabetes. The client wasn’t wearing custom shoes to accommodate this foot, just regular tennis shoes.

When the socks came off, I discovered an angry-looking ulcer that the person wasn’t too concerned about, saying, “it’s not really bothering me.”  We sent this client to the emergency department, and they were immediately started on antibiotics to stop this very dangerous infection.

That’s just one example of how the simple act of assessing feet at during a wellness visit can make a big difference in outcomes.

Lowering Amputation Rates Through Annual Wellness Visit

A study conducted by researchers at the University of Virginia School of Medicine reviewed data on the impact of Wellness Visits on amputation rates in the “Diabetes Belt”.

The “Diabetes Belt,” refers to 644 counties in the southeastern and Appalachian regions of the U.S. with higher rates of diabetes including the state of Mississippi as well as portions of Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and West Virginia. 

People living in the Diabetes Belt had 27% greater odds of requiring a lower-extremity amputation compared to residents of counties surrounding the belt.

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A simple intervention with big rewards:

This ten-year study at the University of Virginia found that people with diabetes who participated in a free Annual Wellness Visit covered by Medicare were 36% less likely to need an amputation compared to those who did not attend an Annual Wellness Visit regardless of where they lived.

“Our results confirmed our hypothesis that Annual Wellness Visits are associated with a reduced risk of major lower-extremity amputations, highlighting the importance of connecting patients to preventive care services,” said Jennifer Lobo, PhD, a researcher in UVA’s Department of Public Health Sciences.

Racial Disparities associated with increased amputation risk

The research also revealed significantly higher rates of diabetes-related amputations among Black participants compared with non-Hispanic White participants, both inside and outside the Diabetes Belt.

Based on these research results, more resources and changes in our health care system are needed to decrease amputation rates in the Diabetes Belt. As health care providers, we can take an active role in reaching out to Black community members to determine systemic barriers. Then, through community collaboration, we can start building bridges to improve inclusivity and access to healthcare.

To learn more about addressing racial disparities to reduce amputation, click here and click here.

Value of Preventive Foot Care

The researchers concluded that people with diabetes who participated in their Annual Medicare Wellness Visit may have had their foot complications diagnosed sooner, helping prevent amputations. Also, given the effectiveness of wellness visits to prevent future problems, the authors suggest incentivizing people with Medicare to use their annual wellness visits to evaluate lower extremities and provide education and foot care training.

1. Macrosomia and post-natal jaundice
2. Intrauterine hypoglycemia
3. Neonatal respiratory distress
4. Diabetic embryopathy

Click Here to Test your Knowledge

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Pregnancy & Diabetes Standards | Level 2 | $29 for 1.5 CEs

Recorded & Ready to Watch!

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

Objectives:

1. Three issues that affect pregnancy with diabetes
2. The unique attributes of pre-existing diabetes in pregnancy and gestational diabetes
3. Diagnostic criteria and management goals for gestational diabetes
4. Potential short term and long term complications of fetal exposure to hypoglycemia
5. Prevention measures to keep parent and baby healthy

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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 pregnancy and diabetes. 63% of respondents chose the best answer. 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: AR says they just found out they are pregnant.  AR has type 2 diabetes and polycystic ovary syndrome and takes metformin 1000mg BID, semaglutide (Ozempic) 1.0mg weekly, and 30 units glargine insulin for diabetes management.  Her most recent A1C was 8.2%.  What is the most important action to take?

Answer Choices:

1. Add bolus insulin to get A1C less than 6.5%.
2. Increase the semaglutide (Ozempic) to 2.0mg weekly.
3. Add a SGLT-2 Inhibitor to get glucose to target.
4. Instruct AR to stop the semaglutide (Ozempic).

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As shown above, the most common choice was option 4, the second most common answer was option 1, then option 2, and finally 3.

Getting to the Best Answer

Answer 1 is incorrect. 19.53% chose this answer, “Add bolus insulin to get A1C less than 6.5%.” This answer is accurate, but it is not the best answer. The A1C goal during pregnancy is less than 6.5% and in this case, AR will need to manage their diabetes using basal bolus insulin therapy. However, since semaglutide is not approved for pregnancy, the most important action is to stop the administration of this GLP-1 RA.

Answer 2 is incorrect. 9.40% of you chose this answer, “Increase the semaglutide (Ozempic) to 2.0mg weekly.” AR’s blood glucose levels are above the A1C pregnancy target of 6.5%, which means insulin intensification is needed. Insulin is safe during pregnancy. However, since semaglutide is not approved for pregnancy, the most important action is to stop the administration of this GLP-1 RA.

Answer 3 is incorrect. 8.50% of respondents chose this answer, “Add a SGLT-2 Inhibitor to get glucose to target.” AR’s blood glucose levels are above the A1C pregnancy target of 6.5%, which means insulin intensification is needed. Insulin is safe during pregnancy. However, SGLT-2s are not approved for pregnancy and the GLP-1 RA, semaglutide would also need to be discontinued.

Finally, Answer 4 is correct. 62.57% chose this answer, “Instruct AR to stop the semaglutide (Ozempic).” YES, GREAT JOB! AR’s blood glucose levels are above the A1C pregnancy target of 6.5%, which means insulin intensification is needed. Basal bolus insulin therapy is safe during pregnancy. However, since semaglutide is not approved for pregnancy, the most important action is to stop the administration of this GLP-1 RA. Metformin can be continued through the first trimester and the insulin would need to be intensified to get A1C to target.

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Want to learn more about this question? Join us for our webinar

Pregnancy & Diabetes Standards | Level 2 | $29 for 1.5 CEs

Recorded & Ready to Watch!

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

Objectives:

1. Three issues that affect pregnancy with diabetes
2. The unique attributes of pre-existing diabetes in pregnancy and gestational diabetes
3. Diagnostic criteria and management goals for gestational diabetes
4. Potential short term and long term complications of fetal exposure to hypoglycemia
5. Prevention measures to keep parent and baby healthy

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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. If a patient is experiencing morning hypoglycemia, reduce basal insulin.
2. Nursing staff can use the patient’s CGM glucose results to determine insulin dose.
3. Any patient admitted with a glucose of 140 mg/dl or greater, confirmed on two different occasions, needs to be started on insulin.
4. Hospital point-of-care glucose meters are mostly as accurate as lab glucose results.

Click Here to Test your Knowledge

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Want to learn more about this question? Join us for our webinar

Hospitals & Hyperglycemia Standards | Level 2 | $29 for 1.5 CEs

Recorded & Ready to Watch!

Research clearly demonstrates the importance of glucose control during hospitalization to improve outcomes not only in the inpatient setting but after discharge.  This course reviews the evidence that supports inpatient glucose control and outlines practical strategies to achieve targets in the inpatient setting.  We incorporate the latest ADA Standards and provide links to resources and inpatient management templates.

Objectives:

1. The impact of hyperglycemia in the hospital setting
2. The importance of inpatient glucose control
3. Three strategies to get glucose to the goal in the hospital setting

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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.

Join us for our final 2022 Standards of Care Intensive Update!

 Hospitals & Hyperglycemia | Level 2 | $29 for 1.5 CEs

Join us live Thursday, May 26 at 11:30 am PST

Research clearly demonstrates the importance of glucose control during hospitalization to improve outcomes not only in the inpatient setting but after discharge.  This course reviews the evidence that supports inpatient glucose control and outlines practical strategies to achieve targets in the inpatient setting.  We incorporate the latest ADA Standards and provide links to resources and inpatient management templates.

Objectives:

1. The impact of hyperglycemia in the hospital setting
2. The importance of inpatient glucose control
3. Three strategies to get glucose to goal in the hospital setting

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Studying for the CDCES Exam?

Enroll in CDCES Online Prep Bundle + 5th Ed ADCES Review Guide Book | 47 CEs

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What is a Certified Diabetes Care and Education Specialist?

Read More: What is a CDCES?

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Why become a CDCES?
Three Reasons from Coach Beverly

Read More: 3 Reasons to Become a CDCES

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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.

The injectable GLP-1 semaglutide (Ozempic) can now be dosed up to 2.0mg a week. This higher maximum dose provides greater reductions in body weight (6.9kgs vs 6.0kgs) and A1c (2.2 vs 1.9% ) when compared to 1.0 semaglutide dose. There was a comparable safety profile with both doses. However, more people experienced negative gastrointestinal side effects when receiving the higher dose (34% compared to 30.8%).

This is good news for people with type 2 diabetes who would like to benefit from both A1C and weight reduction. Plus, semaglutide lowers the risk of cardiovascular events.

Without insurance coverage, this medication costs about $1000 for a month’s supply. However, since semaglutide (Ozempic) is an established diabetes medication covered by many insurance plans, we are hopeful that people who would benefit from this therapy will have access to this higher dose.

The SUSTAIN FORTE trial lasted for 40-weeks and enrolled 961 patients with type 2 diabetes with an A1C of 8.0-10.0%. All patients in the trial initiated treatment with a 0.25 mg dose of semaglutide that was doubled every 4 weeks until the target dose was achieved.

In addition to reduction in A1C and body weight, the semaglutide 2.0 mg arm of the trial saw a greater proportion of patients achieve an A1C less than 7% (67.6% vs 57.5% [OR, 1.60; 95% CI, 1.21-2.13; P=.001]) or a body weight reduction greater than 5% (59.2% vs 51.3% [OR, 1.41; 95% CI, 1.08-1.84]) than the semaglutide 1.0 mg arm.

We have updated our Diabetes Medication PocketCard with this higher maximum dose or our website, CDCES Coach App, and printed PocketCards.

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Studying for the CDCES Exam?

Enroll in CDCES Online Prep Bundle + 5th Ed ADCES Review Guide Book | 47 CEs

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What is a Certified Diabetes Care and Education Specialist?

Read More: What is a CDCES?

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Why become a CDCES?
Three Reasons from Coach Beverly

Read More: 3 Reasons to Become a CDCES

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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.