JR is 78, lives alone and manages their diabetes with bolus insulin at breakfast and dinner and basal insulin at night. For the past few months, JR has had trouble remembering to take insulin with meals and JR’s most recent A1c is above 9%.
Which of the following is most likely contributing to this change of behavior for JR?
Click here to test your knowledge!
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We have updated this content based on the ADA 2021 Standards of Care.
We are living longer and more people are getting diabetes. The American Diabetes Association has updated the Older Adults Standards, with special attention to considering reduction of medication and insulin therapy intensity. The older population has unique issues and special needs that require consideration as we provide diabetes self-management education. This online course highlights key areas of assessment, intervention, and advocacy for older clients living with diabetes.
Objectives:
Can’t make it live? All paid registrants are guaranteed access to the video presentation, handouts and podcasts.
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.
Happy July!
Did you know that only about 50% of people in the U.S. are reaching the A1C target of less than 7%?
And only 22% of Americans reached all 3 targets for A1C, blood pressure, and lipids.
Unfortunately, the percentage of people reaching these goals has declined or stalled over the past ten years. These disappointing results are based on an analysis of the most recent data from the National Health and Nutrition Examination Survey (NHANES) published in NEJM this June.
But I have hope for several reasons!
First, Diabetes Care and Education Specialists can continue to raise awareness of the ADA Standards of Care for Diabetes and advocate for initiating first-line and add-on therapies in their work settings. Plus, we can encourage streamlining of the referral process to facilitate participant access to DSMES and to RD/RDN for initial and ongoing lifestyle and nutrition counseling. Plus, we discuss lots more ideas to improve care in the article below.
Second, I am excited to highlight our interview with a health care visionary and leader, Dr. Avni Shah, who is moving forward with a radical approach to providing diabetes care to our most vulnerable populations designed to improve outcomes.
Third, to improve care, we need more CDCES’s and taking the exam just got a little bit easier. By the end of the year, we will be able to take the CDCES exam from our home or other remote locations.
In this newsletter, we also dive into a Pediatric Question of the Week and explore Preparation for Surgery with our Rationale of the Week. We are thrilled by the interest & response to our Live San Diego Course in October and look forward to gathering together again in person.
Keep cool everyone,
Coach Beverly, Bryanna, Jackson, and Robert
Click here to read our full July 2021 newsletter.
Featured Blogs
Upcoming Events & Resources
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 our June 29th Question of the Week, 56% of respondents chose the best answer. Since people with diabetes will often need to undergo a procedure or surgery that requires they be NPO, we wanted to “take a closer look” at this question and determine strategies to choose the best response.
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 1: AR is living with type 2 diabetes, has an A1c of 7.4%, and takes metformin 1000 BID and 60 units of glargine at bedtime. AR is admitted to the hospital overnight for early morning surgery.
According to ADA Guidelines, what adjustment in his diabetes medications are needed to prepare for a safe surgery?
Answer Choices:
As shown above, the most common choice was option 2, the second most common answer was option 3, then option 1, and finally option 4.
If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. The exam will present questions that require test takers to be familiar with knowledge of preparation for surgery or other procedures that require the person with diabetes to be in a fasting state.
Answer 1 is incorrect, 14.85% chose this answer, “Hold the evening metformin and glargine the night before surgery to prevent perioperative hypoglycemia.” Since AR has type 2 diabetes, even though AR is going to be NPO in preparation for surgery, AR can still take the evening metformin and most of the glargine. If AR holds both of these treatments, there is a high chance that AR will wake up with elevated morning blood sugars, which could delay surgery or lead to a hyperglycemic crisis.
Answer 2 is correct, 55.98% of you chose this answer, “Hold morning metformin the day of surgery and give about 40 units of bedtime glargine the night before surgery.” GREAT JOB. This is the BEST answer. According to the ADA, since AR has type 2 diabetes, even though AR is going to be NPO in preparation for surgery, AR can still take the evening metformin and 60-80% of the evening glargine. Since AR’s A1c is 7.4%, we give 60% of the usual 60 units of glargine (~40 units), so that AR wakes up with glucose close to the target, but not too low to cause hypoglycemia.
Answer 3 is incorrect, 16.56% of you chose this answer, “Hold metformin 3 days before surgery and give 60 units of bedtime glargine the night before surgery.” Since AR has type 2 diabetes, even though AR is going to be NPO in preparation for surgery, there is no reason for AR to hold the metformin for 3 days. AR can take metformin the day before surgery and resume metformin the evening after surgery if kidney function is stable. Since AR’s A1c is 7.4%, we give only 60% of the usual 60 units of glargine (~40 units), so that AR wakes up with glucose close to the target, but not too low to cause hypoglycemia.
Answer 4 is incorrect, 12.61% of you chose this answer “Hold the metformin the day before surgery and give the glargine the morning of surgery to prevent perioperative hyperglycemia.” Since AR has type 2 diabetes, even though AR is going to be NPO in preparation for surgery, there is no reason for AR to hold the metformin the day before surgery. AR can take metformin the day before surgery and resume metformin the evening after surgery if kidney function is stable. As far as changing glargine administration time to the morning to lower surgical glucose, this would not be advised since it would be a departure from AR’s usual routine and could cause unwanted glucose fluctuations.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
Want to learn more about this topic? Enroll in our
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 outline practical strategies to achieve targets in the inpatient setting. We incorporate the latest ADA Standards and provide links to resources and inpatient management templates.
Topics include:
Can’t make it live? All paid registrants are guaranteed access to the video presentation, handouts and podcasts.
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.
Semglee (insulin glargine-yfgn) is a biosimilar basal insulin with the same chemical composition as insulin glargine. However, since it is a biosimilar, it is a less costly version of this widely popular basal insulin. Up until now, pharmacists could not make “pharmacy-level substitution”—much like how generic drugs are substituted for brand name drugs, without provider approval.
With this new FDA approval, an interchangeable biosimilar product may be substituted for the reference product without the intervention of the prescriber. Biosimilars marketed in the U.S. typically have launched with initial list prices 15% to 35% lower than comparative list prices of the reference products.
Bottom line, the pharmacist can now interchange or substituted semglee for its reference product Lantus (insulin glargine) without prescriber approval.
“This is a momentous day for people who rely daily on insulin for treatment of diabetes, as biosimilar and interchangeable biosimilar products have the potential to greatly reduce health care costs,” said Acting FDA Commissioner Janet Woodcock, M.D.
This also has implications for future, lower cost biosimilars says Dr. Woodcock. “Today’s approval of the first interchangeable biosimilar product furthers FDA’s longstanding commitment to support a competitive marketplace for biological products and ultimately empowers patients by helping to increase access to safe, effective and high-quality medications at potentially lower cost.”
Semglee (insulin glargine-yfgn), offered in 10 mL vials and 3 mL prefilled pens, is administered subcutaneously once daily.
Access to affordable insulin is critical and the approval of this first biosimilar heralds good news for future biosimilar interchangeability.
Want to learn more about this topic and more?
Did you miss the live conference? No worries! You can register now to watch on-demand
Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.
If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.
Team of expert faculty includes:
In addition to informative lectures, we also use group activities and case studies to highlight the essential knowledge, skills, and strategies needed to succeed in diabetes education today!
CEs: Includes over 30 CEs
Program Info: 2021 Diabetes Educator Course Flyer & Schedule (subject to change)
Speakers: View Conference Faculty.
Dates: Your registration fee includes access to FREE podcast and all recorded webinars for one year.
Two Registration Options
Virtual DiabetesEd Specialist Conference Deluxe | Oct. 6-8 | 30+ CEs
Deluxe Virtual Program for $459 includes:
+Plus Syllabus, Standards and Swag:
2021 Diabetes Educator Course Flyer & Schedule (subject to change)
Virtual DiabetesEd Specialist Conference Basic | Oct. 6-8 | 30+ CEs
Basic virtual program for $359 includes:
2021 Diabetes Educator Course Flyer & Schedule (subject to change)
Team of Experts: Our team of expert faculty has been fine-tuning this course for over fifteen years and we know what you need to succeed! In addition to informative lectures, we also use group activities and case studies to highlight the essential knowledge, skills, and strategies needed to succeed in diabetes education today!
When you register for our Virtual Course, you have immediate access to these Bonus DiabetesEd University Online Courses – for FREE!
2021 Diabetes Educator Course Flyer & Schedule (subject to change)
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 our June 22nd Question of the Week, 64% of respondents chose the best answer. Since many diabetes specialists aren’t exposed to the care of people with diabetes during pregnancy, we want to “take a closer look” at this question and determine strategies to choose the best response so test takers can be ready for these types of questions.
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: ML has type 1 diabetes, her A1c is on target and she and is hoping to get pregnant in the upcoming year.
Which of the following statement best reflects the physiologic changes associated with pregnancy?
Answer Choices:
As shown above, the most common choice was option 4, the second most common answer was option 1, then option 3, and finally option 2.
If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. The exam will present questions that require test takers to be familiar with knowledge of diabetes during pregnancy,
Answer 1 is incorrect, 24.57% chose this answer, “A sharp increase in glucose levels in the first trimester due to placental hormones.” This is not the best answer based on the pathophysiology of early pregnancy. According to ADA Standards of Care 14, “early pregnancy is a time of enhanced insulin sensitivity and lower glucose levels, many women with type 1 diabetes will have lower insulin requirements and increased risk for hypoglycemia.” Often, during the first trimester, insulin doses may need to be decreased to prevent hypoglycemia.
Answer 2 is incorrect, 10.51% of you chose this answer, “A decrease in insulin needs during the second and third trimester.” This is not the best answer based on the pathophysiology of mid and later pregnancy. According to ADA Standards of Care 14, “Around 16 weeks, insulin resistance begins to increase, and total daily insulin doses increase linearly ?5% per week through week 36. This usually results in a doubling of daily insulin dose compared with the prepregnancy requirement.”
Answer 3 is incorrect, 15.09% of you chose this answer, “A minimal fluctuation in insulin needs until about 36 weeks.” This is not the best answer based on the pathophysiology of pregnancy. Based on answers 1 and 2, blood sugars can plummet during early pregnancy and then glucose levels dramatically increase starting at 16 weeks, resulting in increasing insulin requirement of about 5% a week through week 36 of pregnancy.
Answer 4 is correct, 49.83% of you chose this answer “A decrease in insulin needs during the first 16 weeks.” GREAT JOB – Since there is increased glucose uptake by the fetus and placenta combined with enhanced insulin sensitivity in early pregnancy, blood sugars generally run lower and are associated with lower insulin requirements during the first 16 weeks.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
Want to learn more about this topic? Enroll in our
People living with diabetes who are pregnant are 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.
Topics include:
Can’t make it live? All paid registrants are guaranteed access to the video presentation, handouts and podcasts.
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.
AR is living with type 2 diabetes, has an A1c of 7.4%, and takes metformin 1000 BID and 60 units of glargine at bedtime. AR is admitted to the hospital overnight for early morning surgery.
According to ADA Guidelines, what adjustment in his diabetes medications are needed to prepare for a safe surgery?
Click here to test your knowledge!
Want to learn more about this topic? Enroll in our
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 outline practical strategies to achieve targets in the inpatient setting. We incorporate the latest ADA Standards and provide links to resources and inpatient management templates.
Topics include:
Can’t make it live? All paid registrants are guaranteed access to the video presentation, handouts and podcasts.
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.
ML has type 1 diabetes, her A1c is on target and she and is hoping to get pregnant in the upcoming year.
Which of the following statement best reflects the physiologic changes associated with pregnancy?
Click here to test your knowledge!
Want to learn more about this topic? Enroll in our
People living with diabetes who are pregnant are 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.
Topics include:
Can’t make it live? All paid registrants are guaranteed access to the video presentation, handouts and podcasts.
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 our June 8th Question of the Week, only 64% of respondents chose the best answer. We want to “take a closer look” at this question and determine strategies to choose the best response.
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 taking Metformin 1000mg BID but is worried about getting cancer and is thinking about stopping the metformin.
Which of the following is an accurate statement regarding diabetes and cancer?
Answer Choices:
As shown above, the most common choice was option 3, the second most common answer was option 4, then option 2, and finally option 1.
If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. The exam will present questions that require test takers to be familiar with knowledge of diabetes co-conditions plus prevention and screening guidelines.
Answer 1 is incorrect, 3.69% chose this answer, “People with diabetes have a slightly lower risk of liver and uterine cancers.” People with type 2 diabetes have a higher risk of getting liver and endometrial cancers. There is an increased risk of diabetes and cancer in the same person due to an overlap of risk factors (age and weight) plus lifestyle factors (smoking, activity level, income and environmental factors).
Answer 2 is incorrect, 6.77% of you chose this answer, “Some brands of metformin were recalled because of an NDMA impurity, so it is best to hold metformin for now.” In 2020, some brands of Metformin were recalled because of above acceptable levels of NDMA due to the manufacturing process. The FDA recalled those brands and they were pulled from pharmacy shelves. Any dispensed metformin post recall should be safe.
Answer 3 is Correct, 64.46% of you chose this answer, “There is research suggesting that metformin may be associated with a decreased risk of certain cancers.” YES, you chose the BEST answer. Congratulations. Multiple studies have examined metformin for its potential tumor and cancer fighting ability and it looks very promising. Read more here >>
Answer 4 is incorrect, 25.08% of you chose this answer, “Metformin does not increase the risk of cancer, but it can negatively impact renal function.” This answer is NOT correct. Metformin appears to reduce the risk of some cancers but does NOT harm kidney function. There has been a increase of misinformation about metformin over the past year. Metformin is not recommended for anyone with a GFR less than 30 due to increase risk of lactic acidosis. But, metformin WON’T harm the kidneys and one could even argue that it protects them by lowering A1C by 1-2% points. You can download our Medication PocketCards for more information.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
Level 4 | Cancer & Diabetes | 1.25 CEs
Patients with cancer often experience hyperglycemia secondary to treatment, which can increase risk of infection and compromise their nutritional status. In addition, recent research has identified the link between diabetes and cancer. Join us to learn more about this unexpected link and treatment strategies for steroid induced hyperglycemia using a case study approach.
Topics Include:
Can’t make it live? All paid registrants are guaranteed access to the video presentation, handouts and podcasts.
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.