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:

• Elevated glucose
• Elevated anion gap
• pH of 7.4 or greater
• Bicarbonate of 15 mmol/L or greater

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.

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Level 2 | Hyperglycemic Crises, DKA & HHS Standards | 1.0 CE

Annual Webinar Recorded on December 15th

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:

1. Common causes of hyperglycemic crises.
2. The difference and similarities between DKA and HHS and treatment strategies
3. Causes and treatment of hyperglycemic crises.

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.

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Enroll in our entire Level 2 – Standards of Care to join us for the below Annual Live Webinar Updates. All courses air at 11:30 a.m. (PST)

• December 15, 2021 – Hyperglycemic Crises, DKA & HHS Standards | 1.0 CE
• December 21, 2021 – Assessing and Promoting Well-Being: From Population Health to a Person-Centered Approach Standards | 1.5 CEs
• February 3, 2022 – ADA Standards of Care | 2.0 CEs
• March 24, 2022 – Meds Management for Type 2 – 1.5 CEs
• March 29, 2022 – Lower Extremity Assessment 1.5 CEs
• April 26, 2022 – Microvascular Complications, Eye, Kidney Nerve Disease 1.5 CEs
• April 28, 2022 – Critical Assessment of Diabetes Patient 2.0 CEs
• May 10, 2022 – Cardiovascular Disease and Diabetes Standards 1.5 CEs
• May 12, 2022 – Older Adults and DIabetes 1.5 CEs
• May 17, 2022 – Tots to Teens – Diabetes Standards 1.5 CEs
• May 19, 2022 – Pregnancy and Diabetes 1.5 CEs
• May 26, 2022 – Hospital and Hyperglycemia 1.5 CEs
• July 21, 2022 – Setting up a Successful Diabetes Program 1.5 CEs

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.

• Monitor kidney function twice yearly if urinary albumin is 300 or greater and/or if GFR is 30-60.
• For people with GFR less than 60, relax glucose target to prevent hypoglycemia.
• If GFR is less than 30 in an individual with diabetes, avoid use of SGLT-2 Inhibitors.
• For individuals with GFR less than 60, refer to RD to encourage low protein diet.

Click Here to Test your Knowledge

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Enroll in Our Standards of Care Intensive | Level 2

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.

2022 Live Webinar Updates

• Recorded December 15, 2021 – Hyperglycemic Crises, DKA & HHS Standards | 1.0 CE
• Recorded December 21, 2021 – Assessing and Promoting Well-Being: From Population Health to a Person-Centered Approach Standards | 1.5 CEs
• February 3, 2022 – ADA Standards of Care | 2.0 CEs
• March 24, 2022 – Meds Management for Type 2 – 1.5 CEs
• March 29, 2022 – Lower Extremity Assessment 1.5 CEs
• April 26, 2022 – Microvascular Complications, Eye, Kidney Nerve Disease 1.5 CEs
• April 28, 2022 – Critical Assessment of Diabetes Patient 2.0 CEs
• May 10, 2022 – Cardiovascular Disease and Diabetes Standards 1.5 CEs
• May 12, 2022 – Older Adults and DIabetes 1.5 CEs
• May 17, 2022 – Tots to Teens – Diabetes Standards 1.5 CEs
• May 19, 2022 – Pregnancy and Diabetes 1.5 CEs
• May 26, 2022 – Hospital and Hyperglycemia 1.5 CEs
• July 21, 2022 – Setting up a Successful Diabetes Program 1.5 CEs

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

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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.

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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.

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.

Screen for diabetes at 35 years

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:

• A1c
• Fasting Plasma Glucose (FPG) or
• Oral Glucose Tolerance Test (OGTT)

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.

Screen if receiving treatment for HIV also added

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.

Screen for anyone with elevated BMI regardless of age

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.

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Enroll in our Diabetes Fundamentals | Level 1

Airs Live Jan 11th – Jan 27th, 2022 at 11:30 am PST

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.

2022 Live Webinar Updates

• January 11, 2022 – Class 1 – Getting to the Nitty Gritty 1.5 CEs
• January 13, 2022 – Class 2 – Nutrition and Exercise 1.5 CEs
• January 18, 2022 – Class 3 – Insulin Therapy & Pattern Management 1.5 CEs
• January 20, 2022 – Class 4 – Meds Overview for Type 2 – 1.5 CEs
• January 25, 2022 – Class 5 – Goals of Care – 1.5 CEs
• January 27, 2022 – Class 6 – Hypoglycemia, Sick Days, Monitoring, Foot Care 1.5 CEs

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

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CDCES Deluxe Prep Bundle Levels 1, 2, & 3 + Toolkits | 47 CEs

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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.

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:

• In most states, it can be purchased over the counter without a prescription
• Instructions include to gently shake before injection to adequately mix the particles
• NPH stands for Natural Proinsulin Hagedorn
• Due to its high rates of hypoglycemia, NPH is no longer recommended.

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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.

Getting to the Best Answer

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!

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Enroll in our Diabetes Fundamentals | Level 1

Airs Live Jan 11th – Jan 27th, 2022 at 11:30 am PST

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.

2022 Live Webinar Updates

• January 11, 2022 – Class 1 – Getting to the Nitty Gritty 1.5 CEs
• January 13, 2022 – Class 2 – Nutrition and Exercise 1.5 CEs
• January 18, 2022 – Class 3 – Insulin Therapy & Pattern Management 1.5 CEs
• January 20, 2022 – Class 4 – Meds Overview for Type 2 – 1.5 CEs
• January 25, 2022 – Class 5 – Goals of Care – 1.5 CEs
• January 27, 2022 – Class 6 – Hypoglycemia, Sick Days, Monitoring, Foot Care 1.5 CEs

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

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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.

Stay up-to-date with the new ADA Standards of Care by joining us for our 2022 Live Webinar Updates

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

• Level 1 | Diabetes Fundamentals | Jan 11 – Jan 27, 2022 – Earn 9.25 CEs
• Level 2 | ADA Standards of Care Intensive | Began Dec 15, 2021 – July 21, 2022 – Earn 20 CEs
• Level 3 | DiabetesEd Specialist Boot Camp | Feb 8th – March 8, 2022- | 12+ CEs

FREE Webinars

• ?January 26, 2022 – Preparing for the CDCES Exam | FREE Webinar
• Feb 9, 2022 – Preparing for BC-ADM | FREE Webinar

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Diabetes Fundamentals | Level 1

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.

2022 Live Webinar Updates

• January 11, 2022 – Class 1 – Getting to the Nitty Gritty 1.5 CEs
• January 13, 2022 – Class 2 – Nutrition and Exercise 1.5 CEs
• January 18, 2022 – Class 3 – Insulin Therapy & Pattern Management 1.5 CEs
• January 20, 2022 – Class 4 – Meds Overview for Type 2 – 1.5 CEs
• January 25, 2022 – Class 5 – Goals of Care – 1.5 CEs
• January 27, 2022 – Class 6 – Hypoglycemia, Sick Days, Monitoring, Foot Care 1.5 CEs

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

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Standards of Care Intensive | Level 2

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.

2022 Live Webinar Updates

• Recorded December 15, 2021 – Hyperglycemic Crises, DKA & HHS Standards | 1.0 CE
• Recorded December 21, 2021 – Assessing and Promoting Well-Being: From Population Health to a Person-Centered Approach Standards | 1.5 CEs
• February 3, 2022 – ADA Standards of Care | 2.0 CEs
• March 24, 2022 – Meds Management for Type 2 – 1.5 CEs
• March 29, 2022 – Lower Extremity Assessment 1.5 CEs
• April 26, 2022 – Microvascular Complications, Eye, Kidney Nerve Disease 1.5 CEs
• April 28, 2022 – Critical Assessment of Diabetes Patient 2.0 CEs
• May 10, 2022 – Cardiovascular Disease and Diabetes Standards 1.5 CEs
• May 12, 2022 – Older Adults and DIabetes 1.5 CEs
• May 17, 2022 – Tots to Teens – Diabetes Standards 1.5 CEs
• May 19, 2022 – Pregnancy and Diabetes 1.5 CEs
• May 26, 2022 – Hospital and Hyperglycemia 1.5 CEs
• July 21, 2022 – Setting up a Successful Diabetes Program 1.5 CEs

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

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DiabetesEd Boot Camp | Level 3

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.

2022 Live Webinar Updates

• February 8, 2022 – Class 1 – Diabetes – Not Just Hyperglycemia
• February 10, 2022 – Class 2 – Standards of Care & Cardiovascular Goals
• February 15, 2022 – Class 3 – Insulin Therapy – From Basal/Bolus to Pattern Management
• February 17, 2022 – Class 4 – Insulin Intensive – Monitoring, Sick Days, Lower Extremities
• February 22, 2022 – Class 5 – Meds for Type 2 – What you need to know
• February 24, 2022 – Class 6 – Exercise and Medical Nutrition Therapy
• March 1, 2022 –  Class 7 – Screening, Prevention, and Treatment of Microvascular Complications
• March 3, 2022 – Class 8 – Coping and Behavior Change 1.5 CEs
• March 8, 2022 – Class 9 – Test-Taking Coach Session (48 Questions) No CE

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

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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.

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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!

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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.

• Type 1 and Type 2 are both autoimmune conditions, but people with type 2 don’t need insulin at first.
• Type 1 is due to a progressive destruction of the alpha cells of the pancreas.
• People with type 2 are less likely to experience diabetes complications than those with type 1 diabetes.
• Type 1 diabetes is an immune mediated condition that requires insulin from the start.

Click Here to Test your Knowledge

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Enroll in our Diabetes Fundamentals | Level 1

Airs Live Jan 11th – Jan 27th, 2022 at 11:30 am PST

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.

2022 Live Webinar Updates

• January 11, 2022 – Class 1 – Getting to the Nitty Gritty 1.5 CEs
• January 13, 2022 – Class 2 – Nutrition and Exercise 1.5 CEs
• January 18, 2022 – Class 3 – Insulin Therapy & Pattern Management 1.5 CEs
• January 20, 2022 – Class 4 – Meds Overview for Type 2 – 1.5 CEs
• January 25, 2022 – Class 5 – Goals of Care – 1.5 CEs
• January 27, 2022 – Class 6 – Hypoglycemia, Sick Days, Monitoring, Foot Care 1.5 CEs

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

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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!

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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.

If you are like me, you can’t wait to read through updated ADA Standards of Care (SOC). The SOC booklet version doesn’t arrive for a few weeks. But don’t worry, we have a solution.

Start reviewing the Standards Today with our CDCES Coach App!

Click below to download our CDCES Coach App to read the Standards today.

• CDCES Coach App for iOS devices

• CDCES Coach App – Google

Want to be notified when the Standards of Care Book is available for pre-order?

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You are invited to join Coach Bev on February 3rd at 11:30 for an intensive 2-hour live webinar reviewing what Diabetes Specialists need to know about the updated standards.

Enroll in our Level 2 | ADA Standards of Care | 2.0 CEs

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:

1. A review of changes and updates to the 2022 ADA Standards of Medical Care
2. Identification of key elements of the position statement
3. Discussion of how diabetes educators can apply this information in their clinical setting

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.

Enroll in our entire Level 2 – Standards of Care to join us for the below 2022 Live Webinar Updates. All courses air at 11:30 a.m. (PST)

• Recorded on December 15, 2021 – Hyperglycemic Crises, DKA & HHS Standards | 1.0 CE
• Recorded on December 21, 2021 – Assessing and Promoting Well-Being: From Population Health to a Person-Centered Approach Standards | 1.5 CEs
• February 3, 2022 – ADA Standards of Care | 2.0 CEs
• March 24, 2022 – Meds Management for Type 2 – 1.5 CEs
• March 29, 2022 – Lower Extremity Assessment 1.5 CEs
• April 26, 2022 – Microvascular Complications, Eye, Kidney Nerve Disease 1.5 CEs
• April 28, 2022 – Critical Assessment of Diabetes Patient 2.0 CEs
• May 10, 2022 – Cardiovascular Disease and Diabetes Standards 1.5 CEs
• May 12, 2022 – Older Adults and DIabetes 1.5 CEs
• May 17, 2022 – Tots to Teens – Diabetes Standards 1.5 CEs
• May 19, 2022 – Pregnancy and Diabetes 1.5 CEs
• May 26, 2022 – Hospital and Hyperglycemia 1.5 CEs
• July 21, 2022 – Setting up a Successful Diabetes Program 1.5 CEs

All hours earned count toward your CDCES Accreditation Information

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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!

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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.

We quizzed test takers on identifying why a teenager with type 1 is only taking insulin “when they feel like it”. 73% of respondents, chose the best answer. We want to share this important info so you can pass it on to people living with diabetes, your colleagues and 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: JR is a 15-year-old admitted to the hospital with DKA for the second time this month.  JR says they are tired of their parents always telling them how to manage their diabetes. They just stopped wearing their continuous glucose monitor and tell you they “take insulin when they feel like it”. 

What best describes what this teenager is experiencing?

Answer Choices:

• Diabetes distress.
• Diabetes burnout.
• Severe anxiety.
• Fear of hypoglycemia.

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

Getting to the Best Answer

Answer 1 is incorrect. 24.39% chose this answer, “Diabetes distress.” JR certainly is dealing with aspects of diabetes distress, which is described as feeling like it’s too much or that things are out of control. However, the fact that “JR just stopped wearing their continuous glucose monitor and is only “taking insulin when they feel like it”, gives us a more complete understanding that JR is experiencing more than distress. Please see our blog on How to Identify Diabetes Distress and Burnout.

Answer 2 is correct. 73.17% of you chose this answer, “Diabetes burnout.” YES, this is the BEST ANSWER. Great job! Diabetes burnout is an emotional reaction that is usually more intense than diabetes distress. A person in the state of burnout is someone with diabetes who has grown tired of managing their condition, then simply ignores it for a period of time. The fact that JR stopped wearing their CGM and only takes insulin when they feel like it, are strong indicators that JR is on a diabetes vacation and is burned out. This might mistakenly be perceived as non-compliance, but these behaviors indicate that JR is really struggling and needs the support of the health care team. Visit our page on Diabetes Burnout or Distress? 12 Reframes that can HELP for ideas to support people struggling with their diabetes self care.

Answer 3 is incorrect. 1.33% of respondents chose this answer, “Severe anxiety.” Hardly any of you chose this because in this vignette, JR is not exhibiting any signs of anxiety. Good job.

Finally, Answer 4 is incorrect. 1.11% chose this answer, “Fear of hypoglycemia.” Since this vignette does not mention that JR has experienced lows or that JR lets blood sugars run high to prevent lows, this is not the best answer. Good job.

Learn more about Diabetes Distress in our December Newsletter.

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!

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Want to learn more about this topic?

Enroll in our Level 2 | Assessing and Promoting Well-Being: From Population Health to a Person-Centered Approach Standards | 1.5 CEs

Updated for the new 2022 ADA Standards of Care

This presentation will include the latest information on Social Determinants of health, assessment strategies, and approaches. We will explore the psychosocial issues that can discourage individuals from adopting healthier behaviors and provides strategies to identify and overcome these barriers. Life studies are used to apply theory to real-life situations. A great course for anyone in the field of diabetes education or for those looking for a new perspective on assessment and coping strategies.

Objectives:

1. State strategies to assess and address social determinants of health
2. Discuss health care delivery systems using a person-centered approach
3. List screening tools that can help detect distress, depression, trauma, and cognitive decline
4. Describe psycho-social and emotional barriers to diabetes self-management
5. Provide strategies for healthcare professionals to identify and overcome barriers to self-care

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.

Enroll in our entire Level 2 – Standards of Care to join us for the below 2022 Live Webinar Updates. All courses air at 11:30 a.m. (PST)

• Recorded December 15, 2021 – Hyperglycemic Crises, DKA & HHS Standards | 1.0 CE
• Recorded December 21, 2021 – Assessing and Promoting Well-Being: From Population Health to a Person-Centered Approach Standards | 1.5 CEs
• February 3, 2022 – ADA Standards of Care | 2.0 CEs
• March 24, 2022 – Meds Management for Type 2 – 1.5 CEs
• March 29, 2022 – Lower Extremity Assessment 1.5 CEs
• April 26, 2022 – Microvascular Complications, Eye, Kidney Nerve Disease 1.5 CEs
• April 28, 2022 – Critical Assessment of Diabetes Patient 2.0 CEs
• May 10, 2022 – Cardiovascular Disease and Diabetes Standards 1.5 CEs
• May 12, 2022 – Older Adults and DIabetes 1.5 CEs
• May 17, 2022 – Tots to Teens – Diabetes Standards 1.5 CEs
• May 19, 2022 – Pregnancy and Diabetes 1.5 CEs
• May 26, 2022 – Hospital and Hyperglycemia 1.5 CEs
• July 21, 2022 – Setting up a Successful Diabetes Program 1.5 CEs

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.