Rationale of the Week | Giving Up Tortillas?
For our March 16th Question of the Week, over 86% of respondents chose the best answer!
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: PZ arrives for their diabetes appointment with their food diary and glucose log book. PZ’s blood glucose levels have improved since last visit by about 20 points, with morning glucose levels in the 130 range and bedtime glucose in the 180 range. When you ask PZ about what changes they have made, PZ shrugs their shoulders and says, “I quit eating tortillas because my children said they are bad for me.”
What is the best response?
Answer Choices:
- Good for you, giving up tortillas is really hard.
- Your children sound like they are worried about your health?
- Yes, we don’t recommend tortillas since they are high in starch.
- How are you feeling about giving up tortillas?
As shown above, the most common choice was option 4, the second most common answer was option 2, then option 1, and finally option 3.
Getting to the Best Answer
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 apply a blend of science coupled with psychosocial awareness to determine the best answer.
Answers & Rationale
Answer 1 is incorrect, 2.31% chose this answer. “Good for you, giving up tortillas is really hard”. We notice that PZ shrugs their shoulders when they tell us they have given up tortillas. In addition, PZ states that they have stopped eating tortillas, not because they think it is best for them to stop, but because their children advised them that tortillas are bad. The word “bad” is loaded with judgment and perhaps PZ is feeling ashamed for eating this traditional food that has been part of their everyday life for decades. For this response, instead of affirming giving up tortillas, a better choice would be to explore this choice further.
Answer 2 is incorrect, 9.49% of you chose this answer. “Your children sound like they are worried about your health?” This seems like an accurate response, but is it the BEST response? The goal of DSME is to provide a person-centered approach. This question puts the emphasis on the children’s belief that tortillas are bad instead of exploring how the person with diabetes is responding to this drastic behavior change.
Answer 3 is incorrect, 1.28% of you chose this answer “Yes, we don’t recommend tortillas since they are high in starch.” One corn tortilla has 15gms of carbohydrate, plus fiber and other micronutrients. Tortillas can absolutely be included as part of a healthy meal plan. In addition, tortillas are more than a serving of starch, they are a central and traditional part of the meal for many cultures.
Answer 4 is correct, 86.92% of you chose this answer. ” How are you feeling about giving up tortillas?” GREAT JOB. Most of you chose this person-centered response which gives us an opportunity to see how giving up tortillas is impacting PZ from an emotional standpoint. As diabetes specialists, we know that eliminating tortillas completely may not be the best choice from an evidence-based and emotional perspective.
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!
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!
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.
Rationale of the Week | Get Your Calculator Ready!
For our March 9th Question of the Week, over 67% of respondents chose the best answer!
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 wants to lose weight in the next 30 days by drinking less juice. There are 100 calories per glass of juice and JR usually drinks 3 glasses a day.
How much weight would JR lose by only drinking 1 glass a day?
Answer Choices:
- 0.85 pounds
- It depends on the type of juice
- 1.7 pounds
- 3000 calories
As shown above, the most common choice was option 3, the second most common answer was option 1, then option 2, and finally option 4.
Getting to the Best Answer
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 apply their math skills to a word problem and choose the BEST answer. If you see a question that requires math, just take a deep breath, read the question carefully and call upon your abundant common sense. For this particular question, we also need to know that 1 pound equals 3,500 kcals.
Answers & Rationale
Answer 1 is incorrect, 19.89% chose this answer. “0.85 pounds”. This was the juicy answer designed to distract test takers from the best answer. JR was drinking 3 glasses of juice and is reducing their intake by 2 glasses of juice. Their net calorie reduction, therefore, is not one glass a day, but 2 glasses a day. Each glass contains 100 calories, leading to a 30-day calorie deficit of 6,000 calories a month (not 3,000 calories).
Answer 2 is incorrect, 7.73% of you chose this answer. “It depends on the type of juice”. Since we are given the caloric content of the juice, we don’t need to know what kind of juice to get the best answer.
Answer 3 is correct, 67.96% of you chose this answer “1.7 pounds”. Good job. JR was drinking 3 glasses of juice and is reducing their intake by 2 glasses of juice. Each glass contains 100 calories. This leads to a 200 calorie a day deficit, and a 30-day calorie deficit of 6,000 calories. 6,000 calories divided by 3,500 calories (1 pound) equals 1.7 pounds.
Answer 4 is incorrect, 4.42% of you chose this answer. “3,000 calories”. If you go back to the root of the question, it asks the test taker, “How much weight” would JR lose. Weight is expressed in kg or pounds, not calories. By making sure the answers’ unit of measure matches the questions’ unit of measure, test takers can eliminate wrong answers.
Special note: I want to acknowledge that weight and weight loss are complicated. It is so much more than a function of calories consumed or deprived. There are hormones, genetics, set-points, co-conditions, and a whole range of other influencing factors that contribute to weight at any given time. This sample test question does not address these factors since its main focus was providing a word problem with math calculations.
I would encourage you to check out this blog on Diabetes and Diet Culture, which interviews Megrette Fletcher, M.Ed., RD, CDCES, co-founder of The Center for Mindful Eating, co-founder of WN4DC Symposium, and author of five mindful eating books. Megrette is a trailblazer in the field and offers a new approach that values the individual first and encourages us to address our own weight biases.
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!
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!
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.
Question of the Week | How Many Insulin Pens?
JR is 24 years old and uses an insulin pen for their basal insulin injections each evening. JR takes 30 units a night and each insulin pen holds 300 units of insulin.
How many insulin pens would JR need for one month?
- 3 pens
- 4 pens
- 10 pens
- 1 box
Click here to test your knowledge!
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!
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.
Plant-Based Eating Resources | Free Resource Friday
It’s National Nutrition Month!
We have compiled a list of plant-based therapy articles and resources to celebrate the importance of nutrition.
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!
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.
Steroids, Sugar Spikes and Management Strategies
JR is 64 years old, in hospital with type 2 diabetes and COVID. JR normally manages their diabetes with metformin, but during this inpatient stay, JR is on prednisone therapy which has spiked sugar levels into the 250 mg/dl to 350 range. JR is receiving bolus insulin sliding scale with meals and bedtime glargine, but blood sugars are persistently elevated. To improve outcomes for JR, it is important to keep blood glucose levels less than 180 mg/dl, but what should we recommend to get glucose to goal?
What are some strategies to get blood sugar to target while on steroids?
There is no consensus on the best approach to manage this situation. Up until this point in history, steroid-induced hyperglycemia was mostly found in people with diabetes in COPD, those undergoing chemotherapy or in post-transplant situations.
Oral Meds plus an Old Friend
With the COVID pandemic, many people with diabetes in hospitals and at home, are on steroids. Health care professionals are trying to figure out how to lower glucose levels.
For people with type 2 diabetes and COVID, the latest research indicates that sitagliptin (Januvia) not only helps maintain blood glucose but also decreases the inflammatory response associated with COVID infections. If not contraindicated, sitagliptin can be used in conjunction with insulin, to treat the extreme insulin resistance and hyperglycemia caused by steroid therapy.
To treat steroid induced hyperglycemia, we are going to call on our old insulin friend, NPH. Neutral Protamine Hagedorn (NPH) is an intermediate acting basal insulin. NPH insulin is made by mixing regular insulin and protamine in exact proportions with zinc and phenol such that a neutral-pH is maintained and crystals form.
NPH insulin’s peak action time matches steroid’s action time
NPH insulin is cloudy and has an onset of 1–4 hours. Its peak is 6–10 hours and its duration is about 10–16 hours.
Steroids have their highest potency at 4-12 hours, with the exception of the very potent dexamethasone, which has a half life of 1-2 days.
However, with all steroids, including dexamethasone, people will experience elevated glucose values after breakfast, lunch, dinner, and at bedtime but will have a significant drop toward normal glucose overnight.
Therefore, hyperglycemia is greatest 1–2 hours after a meal, with persistent elevation until the following meal, followed by a return to normal overnight.
NPH Insulin Dosing Strategies
There are several articles (see below) that recommend a variety of NPH dosing strategies. Generally, insulin dosing is based on a combination of steroid dose and body weight. For those on lower dose steroid (ie less than 40 mg prednisone daily) a starting NPH insulin dose of 0.1 – 0.2 units per kg is reasonable. If JR weighs 100 kg, that means 10 to 20 units of NPH daily.
If JR is on a higher steroid dose, or blood sugars are extremely elevated, JR may need 0.3 units/kg or 30 units of NPH daily. Of course, we also need to keep nutritional status in mind as we determine best dose. People who are not eating or NPO, will require less insulin, even in the presence of steroids.
The timing of NPH administration matches the timing of the steroid therapy.
In addition, coverage for carbohydrates at meals and correction insulin bolus for hyperglycemia can help prevent post-prandial hyperglycemia.
A simple getting started strategy – 70/30 Insulin
A simple strategy I have used over many years, that I find safe and effective, is giving the basal-bolus premixed 70/30 insulin with the morning dose of steroid. A safe starting range is around 10 units in the morning and gradually increases 10-20% daily to get glucose to target. In addition, bolus coverage for carbs and hyperglycemia can be given at lunch and dinner.
Since blood sugars trend down overnight, nighttime NPH insulin is not usually needed.
Keeping it flexible
As the person starts recovering and steroid doses are gradually tapered down, it is important to also decrease the NPH insulin dose and bolus insulins to prevent hypoglycemia.
In conclusion:
Keeping blood sugars on target improves outcomes. For people with diabetes, steroids can cause a hyperglycemic crisis. Thoughtful and progressive management using NPH and bolus insulins can turn the tide and help get blood glucose levels to goal.
Join Coach Beverly at our Virtual Conference for more information on COVID and Diabetes Management Strategies.
Reference Articles
Glycemic Control in Hospitalized Patients with Diabetes Receiving Corticosteroids Using a Neutral Protamine Hagedorn Insulin Protocol: A Randomized Clinical Trial. Khowaja A, Alkhaddo JB, Rana Z, Fish L. Diabetes Ther. 2018 Aug;9(4):1647-1655.
How to Manage Steroid Diabetes in the Patient With Cancer
David S. Oyer, MD, FACE, Ajul Shah, BS, and Susan Bettenhausen, APRN, CDE, 2006
Virtual DiabetesEd Specialist Course
Earn 30+ CEs | April 15-17, 2021
Virtual DiabetesEd Specialist Program
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.
DiabetesEd Virtual Conference Flyer 2021
Diabetes Ed Virtual 3-Day Schedule 2021
Prepare for CDCES or BC-ADM certification or earn hours for renewal.
If you are interested in taking the CDCES or BC-ADM exam or 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.
Can’t join live? No worries, your registration guarantees access to the recorded content through Dec 31, 2021!
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
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!
Your registrations include access to all the Online Sessions plus Bonus Courses through December 31st, 2021.
Question of the Week | What About Tortillas?
PZ arrives for their diabetes appointment with their food diary and glucose log book. PZ’s blood glucose levels have improved since last visit by about 20 points, with morning glucose levels in the 130 range and bedtime glucose in the 180 range. When you ask PZ about what changes they have made, PZ shrugs their shoulders and says, “I quit eating tortillas because my children said they are bad for me.”
What is the best response?
- Good for you, giving up tortillas is really hard.
- Your children sound like they are worried about your health?
- Yes, we don’t recommend tortillas since they are high in starch.
- How are you feeling about giving up tortillas?
Click here to test your knowledge!
Virtual DiabetesEd Specialist Course
Earn 30+ CEs | April 15-17, 2021
Virtual DiabetesEd Specialist Program
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.
DiabetesEd Virtual Conference Flyer 2021
Diabetes Ed Virtual 3-Day Schedule 2021
Prepare for CDCES or BC-ADM certification or earn hours for renewal.
If you are interested in taking the CDCES or BC-ADM exam or 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.
Can’t join live? No worries, your registration guarantees access to the recorded content through Dec 31, 2021!
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
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!
Your registrations include access to all the Online Sessions plus Bonus Courses through December 31st, 2021.
Bonus Courses worth 14 + CEs FREE – When you register for our Virtual Course, you have immediate access to these Bonus DiabetesEd University Online Courses – for FREE!
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!
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.
Interview with Dr. Diana Isaacs | Keynote for DiabetesEd Virtual Conference
Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES
We are thrilled that Diana Isaacs will be joining our Virtual Course on October 6-8, 2021!
Dr. Isaacs was named 2020 ADCES Diabetes Educator of the Year for her educational platform promoting the use of technology, pumps, and CGM therapy for people with diabetes plus other innovations. Dr. Isaacs was awarded the Ohio Pharmacists Association Under 40 Award in 2019. Dr. Isaacs has served in leadership roles for several pharmacies and diabetes organizations. She has numerous diabetes publications and research projects with a focus on medications, CGM and diabetes technology.
As the CGM Program Coordinator and clinical pharmacist specialist in the Cleveland Clinic Diabetes Center, Dr. Isaacs brings a wealth of clinical knowledge combined with extensive research experience to this program.
Exclusive Interview with Dr. Diana Isaacs
Question: What do you love about being a Diabetes Specialist?
Dr. Isaacs: I have the opportunity to help people manage their diabetes through my expertise and support. I start many people with diabetes on CGM and I see first hand how life changing the technology is for them. People are very grateful for my help and it is so rewarding.
Question: Over the past year, what has been most challenging about providing diabetes care during the pandemic?
Dr. Isaacs: I miss doing the group classes and shared medical appointments but we’ve had to majorly scale back taking into consideration room size and safety. Also, many people are struggling with mental health during the pandemic and many are afraid to come to clinic. However, we have made great strides by increasing access through virtual care.
Question: What role do you see technology playing in people with diabetes lives over the next few years?
Dr. Isaacs: Technology is exploding. Virtual care is allowing us to reach way more people with diabetes and making it more convenient for everyone. Mobile apps and blue tooth technology are making it so the healthcare team can access a person’s diabetes data from anywhere (With their permission of course). There also continue to be huge improvements in insulin pump, continuous glucose meter, and smart insulin pen technology.
Question: What actions can Diabetes Specialists take to increase access to diabetes technologies including insulin pumps, CGMs and Smart Pens.
Dr. Isaacs: We need to stay up to date on all of the technology because it’s evolving so quickly. Some strategies to do this include attending professional meetings, meet with your sales reps, check out websites like diabeteswise.org and DANAtech (offered through ADCES). There are many continuing education opportunities offered through various organizations, including your website (www.diabetesed.net).
Also, if you get a chance to try a demo (Such as obtaining a sample of a smart pen, or CGM) and wearing it. That’s the best way to learn!. There are also various demo mobile apps that give the user experience. (Ex. T:Simulator for Tandem insulin pumps).
Question: Would you share your hobby (ies) and how you maintain work life balance?
Dr. Isaacs: I have 5 kids ages 2-9, so they keep me pretty busy. One day a week I completely disconnect from all electronics and just spend time with the family. I also enjoy running and run almost every morning before starting my day. With the pandemic I stopped going to the gym. I live in Cleveland and am proud to say I ran outside even when it was 3 degrees with lots of snow and ice on the ground.
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.
March eNews | Steroids, Sugar Spikes and Nutrition Month Celebration
March | Steroids, Sugar Spikes and Nutrition Month Celebration
March is National Nutrition Month
This gives us a whole month to celebrate the amazing expertise and abundant knowledge of our nutrition colleagues.
We will be focusing on nutrition dilemmas for our Question of the Week and featuring spring recipes along with plant-based resources.
Plus, we are excited to highlight Ashley LaBrier, MS, RD, CDCES, our new dietitian team member and Virtual Conference speaker. Welcome to the team Ashley!
For our feature article, we recognize that many people with diabetes and COVID started on steroids are experiencing hyperglycemic crisis. Coach Beverly summarizes strategies to get glucose to target during steroid therapy.
We are also excited to feature an interview with Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES.
We are thrilled that Diana is providing 8 hours of content for our Virtual Conference in April. She is a pharmacology and technology expert, with a special knack for translating the complex world of diabetes technologies into understandable terms. Read more about this ADCES Educator of the Year in our interview below.
Lastly, we have expanded our FREE Webinar offerings. Coach Beverly explores the different diabetes certification options and provides test-taking skill-building. We hope you can join us!
Happy Nutrition Month everyone.
We wish you all health and an abundance of fiber intake from a variety of whole grains and fresh foods!
With affection and wishes for health,
Coach Beverly, Bryanna, and Jackson
Click here to read our full March 2021 newsletter.
Featured Blogs
- Steroids, Sugar Spikes, & Management Strategies
- Interview with Dr. Isaacs – Keynote for Virtual Conference
- Interview with Ashley LaBrier – Nutrition Expert for Virtual Conference
- Rationale of the Week
Featured Items
- FREE Webinars Ready for Viewing
- Virtual DiabetesEd Specialist Conference – from April 15th – 17th
- ADCES Exam Prep Book Bundle
- Free Resources Catalog
Virtual DiabetesEd Specialist Course
Earn 30+ CEs | April 15-17, 2021
Virtual DiabetesEd Specialist Program
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.
DiabetesEd Virtual Conference Flyer 2021
Diabetes Ed Virtual 3-Day Schedule 2021
Prepare for CDCES or BC-ADM certification or earn hours for renewal.
If you are interested in taking the CDCES or BC-ADM exam or 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.
Can’t join live? No worries, your registration guarantees access to the recorded content through Dec 31, 2021!
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
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!
Your registrations include access to all the Online Sessions plus Bonus Courses through December 31st, 2021.
Bonus Courses worth 14 + CEs FREE – When you register for our Virtual Course, you have immediate access to these Bonus DiabetesEd University Online Courses – for FREE!
ADCES Desk Reference + 5th Ed Review Guide Book Bundle
The 5th Edition ADCES Desk Reference & 5th Edition Review Guide Bundle –our most popular AADE Book Bundle for exam preparation!
What is included in the ADCES Book Bundle?
The Art & Science of Diabetes Self-Management Education Desk Reference – 5th Edition
Major Features:
- practical information educators can use with patients to avoid complications and comorbidities
- risks and benefits of CGM and the educator’s role in working with patients who use CGM
- updated info on incorporating the ADA, AADE, and AND joint position statement and algorithm of care into a DSME program
ADECES Review Guide for the Diabetes Care and Education Specialist Exam – 5th Edition
Includes an answer key with rationales for all questions included in the guide!
Major Features:
- 480 + multiple-choice questions
- Strategies for preparing for and taking the exam
3 self-assessment tests that cover three main content sections on the CDCES Exam:
- Assessment of Diabetes and Prediabetes
- Interventions for Diabetes and Prediabetes
- Disease Management
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!
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.
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