Free Resource Friday |Preparing for the CDCES Exam Webinar
Join us live with your questions on November 1, 2019 @ 11:30 a.m. PST!
Coach Beverly offers this FREE webinar to help get you prepare for the CDCES Exam. All her tips and tricks are meant to ease your mind and reflect the updates to the CDCES content outline. Register below with a name and email and you can join us live next Thursday!
Topics covered include:
- Test content updates for 2019
- Exam eligibility and test format
- Strategies to succeed
- Review of study tips and test taking tactics.
We will review sample test questions and the reasoning behind choosing the right answers.
After registering, you will receive a confirmation email containing information about joining the webinar.
Intended Audience: This FREE webinar is designed for individual or groups of diabetes educators, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants and other health care providers interested in achieving excellence in diabetes care and becoming Certified Diabetes Care and Education Specialists®.
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator who has passed her CDCES Exam 6 times. She is a nationally recognized diabetes expert for over 25 years.
See our Preparing for CDCES Resource Page >>
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Avoiding Juicy Answers | TR Moves to the Dorms
For Question of the week, test takers usually choose the correct answer 70-80% of the time. However, for this Tuesday’s question of the week, about 44% of respondents chose the correct answer.
So, we thought this would be a perfect opportunity for another answer rationale. We’ll explore this question and the best answer in more detail and throw in some test-taking tips along the way.
Question of the week on October 22:
TR is a 17-year-old with prediabetes who is graduating high school and moving out of state to college and will be living with a roommate in the dorms. TRs mom arranges to have an appointment with the diabetes educator before TR heads off to college. Which of the following is the most important issue to review during the visit?
Answer Options:
- Stressing that alcohol consumption can increase glucose levels
- Organization of medications and prescription refills
- Vaccinations and how to access medical care
- Making sure TR has easy access to carb snacks in case of hypoglycemia
As shown above, the most common choice was option 3, the second most common answer was option 2, then option 1, and finally option 4.
Congratulations! A majority of people still answered the question with the right answer.
Option 3 (C) is the correct answer: Vaccinations and how to access medical care. In this scenario, TR is only 17 with prediabetes and the question does not mention that TR is taking any medications or has any prediabetes related complications. Given that, the best intervention is to focus on prevention (vaccines) and how to access health care in this new environment.
Option 1 is incorrect because it says alcohol consumption can increase glucose levels, but alcohol is associated with a lowering of blood glucose. This is because when the liver is metabolizing alcohol, glycogenolysis is hampered resulting in lower blood glucose levels.
Option 2 is incorrect because this scenario doesn’t mention TR is on any medications or prescriptions, so this juicy answer assumes facts not in the question. If one assumes TR is on medication because they have prediabetes, organization of medication and prescription refills could be an important thing to consider before going off to an unfamiliar environment. However, since the scenario doesn’t mention medication, and a 17 year old with prediabetes is not likely be only any medications, this answer is also incorrect.
Finally, option 4 is incorrect because in this scenario, hypoglycemia isn’t mentioned. For people with diabetes, hypoglycemia is a risk when treating diabetes with insulin or sulfonylureas, but this scenario doesn’t mention TR being on either.
We hope you appreciate this week’s rationale and keep studying hard! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
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National Prescription Drug Take Back Day this Saturday
What is the best way to dispose of expired medications or those that are no longer of use?
October 26 (this Saturday!) is National Prescription Drug Take Back Day. Between 10 a.m. and 2 p.m., collection sites across the U.S. will take all kinds of medications, no questions asked.
People with diabetes take a myriad of medications to keep healthy and maintain quality of life. Many of them are expired and need to be properly disposed of.
In addition, people with diabetes often use antidepressants and opioids used to combat pain. These types of prescription drugs, found in medicine cabinets, are often a primary source for misused medicines. They also increase risk of accidental overdose by young children.
50% of people who misused prescription painkillers got them from a friend or family member.
Recover Together has created a constantly updated map of collection centers that will participate in Take Back Day to help with the safe disposal of medications.
Beyond that, Google Maps will be helping so that if you search “medication disposal near me”, pharmacies, hospitals, police stations, and other locations that accept medications year-round will pop up.
National Take Back Day raises awareness on the importance of safe disposal of drugs. This includes environmental risks, health risks, accidental use, and intentional misuse.
According to the EPA, most water treatment facilities cannot filter out drugs. Medicines that are poured down the drain can enter our environment and community drinking water supplies.
Read more about health concerns and drug facts, and find a medication disposal location at Recover Together.
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Why such low MD referrals for National Diabetes Prevention Program?
James Keck, MD, set out to find if adult patients at an academic family medicine clinic, who were actively screened for prediabetes, received a referral to the Diabetes Prevention Program.
The research team evaluated the electronic health records of 5,360 adult patients at an academic family medicine clinic to determine whether they received pre-diabetes screening, diagnosis and treatment.
They found that:
- 4,068 (76%) patients received a hemoglobin A1c test.
- 1,437 (35%) of these patients had a result in the prediabetes range.
- Of these, only 729 (51%) had a diagnosis of prediabetes their EHR
Even though 35% of patients met the diagnostic cut off for prediabetes, not one of them was referred to a Diabetes Prevention Program.
Keck and colleagues also reviewed 31 surveys from clinicians from the same clinic about their pre-diabetes attitudes, knowledge and practices. Keck noted that even when clinicians are aware of the program, insurance coverage for such programs is low even though more and more insurers are recognizing the wisdom in these prevention programs.
James Keck, a physician at the University of Kentucky, believes this is due to a lack of awareness about the Diabetes Prevention Program in general.
The lack of electronic or streamlined referrals to these programs is another notable barrier, besides perceptions of the clinician and individual of whether the program will be effective.
What can be done about this?
Raising awareness about the National Diabetes Prevention Program is the first step, as well as raising awareness of private insurance and Medicare which now covers such programs. Finally, increasing relationships between clinics and places offering these programs (or encouraging clinics to start up their own programs) is a great step towards removing barriers.
Read more on the full survey results and recommendations on Healio.
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Free Resource Friday | Navigating Holiday Festivities
Whether it’s the candy, the turkey, stuffing, or the desserts, the holidays are a difficult time for anyone to eat healthy and avoid weight gain. Experts suggest that the holidays are not the best time to set weight loss goals. Instead, a more realistic approach is to focus on enjoying special events and weight maintenance coupled with lots of good self-care.
Weight watchers, most dietitians, and health bloggers suggest several strategies to make healthier choices when tempted by holiday fare:
- There is no need to eat to be polite – save calories or points for favorite foods. If there is lots of pressure, have 1-3 bites of whatever family or friends are suggesting.
- Be prepared for extra calories: maintain regular eating routine for the whole week leading up to the big meal. On the day of, make sure to have breakfast, and if the big meal is in the afternoon, have a small lunch or snack to avoid over-eating at the party.
- Drink calorie free beverages and choose vegetables or other low calorie options first before digging into the richer food choices.
Some interesting, alternative strategies that people are reporting success with:
- Plating up with a smaller plate: it tricks our brains into thinking we are eating more, and on average this strategy decreases intake by 40% or more.
- Wear something fitted and fabulous: boost self-confidence with an outfit that makes the wearer feel great about how they look, but also keeps them aware of quantity of food consumed.
- Take a walk after the meal instead of sinking into a recliner or couch to burn a few calories and keep metabolism revved up a bit longer.
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Continuous Glucose Monitoring – The key to improving BG?
A three-year long study showed real time continuous glucose monitoring (rtCGM) was associated with lower A1c levels in people with type 1 diabetes, whether the participants used pumps or multiple daily injections.
In the study, participants checked glucose levels using CGM or fingersticks four times per day.
Only the real time CGM group had improvements in time-in-range and reduced time below range, regardless of whether they used an insulin pump or injections.
Also, fewer participants using real time CGM experienced severe hypoglycemia.
This three-year study came from the Comparison of Different Treatment Modalities for Type 1 Diabetes Including Sensor-Augmented Insulin Regimens (COMISAIR). The group still advocates for individualization of treatment, but emphasizes what an important difference incorporating real time CGM makes.
Jan Soupal presented the study findings at the European Association for the Study of Diabetes 2019 Annual Meeting in the Czech Republic. Soupal noted that CGM can be coupled with multiple daily injections for those who prefer to only have one device on their body or worry about accessibility and affordability.
Read the full study details here.
Want more valuable CGM info for the test?
Check out our Technology Toolkit! Two fantastic courses included for a total of 3 CEs:
- Tech 101 – Pumps and Sensors Update and Overview and
- Tech 102 – Insulin Pump Calculations: From Basal to Square Bolus
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Adverse Childhood Experiences impact future health
Adverse Childhood Experiences (ACE) such as neglect, abuse, household dysfunction, etc. have been found to have a profound impact on health and disease throughout life.
Here is the the link to the ACE Screening Tools and more information.
The higher the ACE Score, the higher the risk of diabetes, cardiovascular disease, mental health issues, earlier mortality and more.
Nadine Burke Harris, MD and California’s newly appointed Surgeon General, pushed for ACE scores to be more seriously considered and to increase routine screening, early detection, and early intervention.
Funding has been put forward to reimburse providers for screenings, and towards after school education and safety programs in preschool, early learning, and childcare.
Dr. Harris corrects the assumption that every person who scores positive for ACE needs mental health services: “most patients don’t” she says, and it’s important to know proper next-steps after a positive screening.
The best thing health care providers can do after a positive screening is to educate individuals on which symptoms could be related to a history of adversity, and give them tools they can use to manage and improve outcomes. These are tools like sleep, exercise, nutrition, mindfulness, mental health, and healthy relationships. Most of these tools don’t require a lot of extra resources as some health care professionals may fear.
Read Dr. Harris’ full interview on the Chronicle of Social Change.
For more info, here is the link to an excellent ACE Resource Page
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Water & Milk Best for Kids
A panel of experts found that what children drink has a big impact on overall health and development.
Kids should drink breast milk, infant formula, water and milk in early childhood – and limit their fruit juice as much as possible.
Although the type of milk varies (breast milk, skim, infant formula, etc.) the experts agree most of what children need from 0-5 years is just milk and water.
Experts recommend no more than half a cup of juice a day (whole fruit is preferred) for children between 1-5 years old, and no juice for children under 12 months.
The recommendations, released Wednesday, broke down what children through age five should drink by age:
- 0-6 Months: Breast milk or infant formula.
- 6-12 Months: Breast milk or infant formula; small amounts of plain drinking water introduced once solid foods become part of diet.
- 12-24 Months: Whole milk and plain drinking water.
- 2-5 Years: Skim or low-fat milk and plain drinking water.
These evidence-based recommendations were crafted after careful review of existing domestic and international policy statements by experts from the Academy of Nutrition and Dietetics, the America Academy of Pediatrics, the American Academy of Pediatric Dentistry, and the American Heart Association.
Read more recommendations and panelist discussion in the full news story on U.S. News.
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