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The Role of The Certified Diabetes Educator

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Title: The Role of The Certified Diabetes Educator


1
The Role ofThe Certified Diabetes Educator
The Certification Process
  • Brenda Jagatic, BSN, RN, CDE

2
Objectives
  • Overview of Diabetes in America
  • Role of the Certified Diabetes Educator
  • The Certification Process

3
Who Has Diabetes in the U.S.?
  • 20.8 million people have diabetes
  • 70 are diagnosed
  • 30 do not know they have diabetes

ADA 2008
4
Who Has Diabetes in the U.S.?
  • 14.6 million diagnosed with diabetes
  • Type 1 5-10
  • Type 2 90-95

ADA 2008
5
Types of Diabetes
  • Type 1 Diabetes
  • Pre-Diabetes
  • Type 2 Diabetes
  • Gestational Diabetes

6
Type 1 Diabetes
  • Causes
  • Genetics loads the gun
  • and environment
  • pulls the trigger
  • Treatment
  • Need insulin for life
  • Lifestyle

7
Basal/Bolus/Correction
  • Basal- the amount of insulin to run the
  • body 24 hours a day
  • Bolus- the amount of insulin needed to
  • cover food eaten
  • Correction- the amount of insulin needed
  • to correct high blood glucose

8
Delivery of Basal/Bolus/Correction
  • MDI-Multiple Daily Injections
  • At bedtime injection of long-acting insulin
  • Before meals injection of rapid-acting insulin
  • CSII-Continuous Subcutaneous Insulin Infusion (
    insulin pump)
  • Uses rapid-acting insulin.
  • Basal given continuously, around the clock
  • Bolus for food with meals and snacks.

9
Insulin Delivery
  • syringe insulin
    insulin
  • and vial pens
    pump

10
The History of Insulin Pumps
11
  • And now

12
Types of Pumps
Medtronic-Minimed Animas Deltec Cozmo Accu-Chek
Spirit Omni-pod
13
Pre-Diabetes Blood glucose greater than normal
but not in diabetic range
  • Causes
  • Genetic
  • Lifestyle
  • Other
  • Treatment
  • Lifestyle changes
  • Medication

14
Who Has Pre-Diabetes in the U.S.?
  • 54 million people have pre-diabetes
  • Unless these individuals make significant
    lifestyle changes, many will develop type 2
    diabetes

ADA 2008
15
Goals for Pre-Diabetes
  • 30 minutes of exercise/day and a
  • 5-10 weight loss reduced the risk
  • of developing diabetes by 58
  • Diabetes Prevention Program Research Group
  • New England Journal of Medicine 2002393-403

16
Type 2 Diabetes
  • Causes
  • Genetic
  • Lifestyle
  • Treatment
  • Lifestyle changes
  • Medication

17
Whos at Risk for Type 2?
  • High cholesterol
  • High blood pressure
  • Diabetes during pregnancy
  • Inactivity
  • Overweight
  • Family history of diabetes
  • African American, American Indian, Hispanic,
    Asian, Alaska Native, Native Hawaiian or Pacific
    Islander

18
Obesity and Type 2 Diabetes
  • The increase in Type 2 Diabetes in
  • the United States correlates with the
  • epidemic of obesity
  • 85 type 2 patients are overweight

19
Obesity Trends Among U.S. AdultsBRFSS, 1985
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
20
Obesity Trends Among U.S. AdultsBRFSS, 1990
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
21
Obesity Trends Among U.S. AdultsBRFSS, 1995
Source Mokdad A H, et al. J Am Med Assoc 1999
22
Obesity Trends Among U.S. AdultsBRFSS, 2001
Source Mokdad A H, et al. J Am Med Assoc 1999
23
How Type 2 Diabetes Develops and Changes Over Time
Insulin Resistance
Insulin Production
Blood Glucose
Source IDC, 2000
24
Type 2 Diabetes
  • Insulin resistance
  • Initially may have high insulin production
  • Lifestyle and Oral agents initial treatment
  • Most patients will eventually need insulin
  • Type 2 diabetes is a progressive disease
  • Important to be aggressive in getting A1c less
    than 7 to reduce risks of complications
  • N. Emanuele, MD and G. Moto, MD 9/28/07

25
Gestational Diabetes
  • Occurs around 24th-28th week
  • Hormones produced by placenta block the effect of
    insulin in the mothers body leading to insulin
    resistance
  • Managed by diet and exercise in most cases
  • Resolves at delivery, but there is
    risk for type 2 diabetes for mother
    2 - 15 years later
    in life
  • Source Core Curriculum for Diabetes Education
    Diabetes
  • In the Life Cycle and Research Ch 5 Gestational
    Diabetes

26
The Role of a Certified Diabetes Educator
  • provide diabetes
  • self-management
  • education training

27
The Empowerment Model
  • Interactions are based on the patients agenda
  • Important to listen to patients concerns/goals
  • Adopt a nonjudgmental attitude- key for patient
    to discuss problems without fear of being
    criticized
  • Develop a plan that is formulated with the
    patient
  • The educator and the patient work as a team
  • Source Susan Cornell, BS, PharmD, CDE, CDM
    Assistant Professor, Midwestern University,
    Clinical Pharmacy Consultant 1/19/08

28
Author James S Hirsch, in Cheating Destiny
Living with Diabetes, Americas Biggest Epidemic
  • The most important provider for any chronic
    disease is the patient himself, which places the
    highest priority on education and trainingI
    believe most diabetics, given the tools and
    training, are willing to discipline themselves to
    stay healthy

29
AADE 7 Self-Care Behaviors
  • Healthy Eating
  • Being Active
  • Blood Glucose Monitoring
  • Medication
  • Problem-Solving
  • Reduce Risks of Complications
  • Healthy Coping
  • Source The Diabetes Educator Volume 33, Number 6
    Nov/Dec 2007

30
1. Healthy Eating
  • Nutritional counseling
  • Healthy eating most of the time
  • Moderate carbohydrate intake
  • Heart healthy eating
  • No forbidden foods
  • Maintain pleasure of eating
  • Source The Diabetes Educator Volume 33, Number
    6,
  • Nov/Dec 2007
  • Diabetes and Healthy Eating A Commentary
    Elswick,B et al

31
2. Being Active
Possible Benefits 1. Better BG control 2.
Reduced risks of complications 3. Increased
insulin sensitivity 4. Facilitate weight loss 5.
Stress management 6. Improve depression 7.
Improve cardiovascular fitness 8. Improve lipid
and BP control Source The Diabetes Educator
Volume 33, Number 6 Nov/Dec 2007. Interventions
for Being Active Among Individuals with Diabetes
Kavookjian, J et al
32
2. Being Active (cont.)
  • Using Motivational Counseling the CDE can help
    the individual
  • Design, implement and evaluate plan for regular
    physical activity
  • Select activities patient enjoys
  • Identify barriers
  • Set realistic goals
  • Integrate regular physical activity into
    lifestyle
  • Source The Diabetes Educator Volume 33, Number
    6, November/December 2007
  • Interventions for Being Active Among
    Individuals with Diabetes Whetsel et al.

33
3. Blood Glucose Monitoring
  • Self-monitoring of Blood Glucose (SMBG)
  • Hemoglobin A1c (HgbAlc)
  • Continuous Blood Glucose Sensors

34
SMBG Teaching how to use a Blood Glucose Meter
  • How to use a meter
  • When to test and why
  • Blood glucose targets
  • Evaluating blood glucose readings
  • What to do when BG high or low
  • Analysis what effects your BG?(food, activity,
    stress, pain, illness, meds)

35
SMBG Key points to review
  • Be objective
  • Be a detective
  • Highs lows can happen sometimes, even when you
    do everything right
  • Data collection-identifies areas needing some
    work
  • Why some patients stop testing
  • Source The Diabetes Educator Volume 33, Number
    6, November/December 2007
  • Self-monitoring of Blood Glucose A Commentary
    Martha Mitchell Funnell, MS,RN, CDE

36
Approximate comparison of blood glucose and A1c
values
Blood Glucose Levels
Percentage
Yellow Zone 6.5 -7.0
Normal 4-6
Normal 60 135 mg/dl
37
Continuous Blood Glucose Sensor
  • Gain insight into blood glucose patterns for
    optimal diabetes care
  • Formerly only available to people wearing insulin
    pumps

38
4. Medication
  • Teach patient about their diabetes meds
  • How to take meds
  • How they work
  • How to evaluate effectiveness of drug
  • Possible side effects
  • What to do when a dose is missed

39
Medications Adherence to medical regimen can
  • Improve blood glucose control
  • Reduce morbidity
  • Reduce mortality
  • Reduce health care costs
  • Source Ho PM, et al. Effect of medication
    nonadherence on
  • Hospitalizations and mortality among patients
    with diabetes
  • Mellitus. Arch Intern Med. 2006. 166 1836-1841.

40
Adherence to Medical RegimenPossible Barriers
  • Cost
  • Complex regimen
  • Frequency of dosing
  • Self-confidence
  • Inadequate education on treatment
  • Depression
  • Side effects or fear of side effects
  • Fear of weight gain
  • Inconvenience
  • Inadequate supports

41
Insulin therapy in type 2 diabetes
  • Under-used! Under-prescribed!
  • Insulin therapy has a unique set
  • of challenges education,
  • follow-up and monitoring
  • Source The Diabetes Educator Volume 33,
    Number 6, Nov/Dec 200
  • Medication Taking and Diabetes Odegard,
    P et al.

42
Reasons for avoidance of insulin therapy when
indicated
  • Sense of personal failure
  • Pain of injection
  • Needle phobia
  • Belief that insulin leads to an increase in
    severity of diabetes
  • Permanence-on insulin for the rest of your life
  • Hypoglycemia
  • Source Polonsky,WH et al. Psychological insulin
    resistance in patients with type 2 diabetes the
    scope of the problem. Diabetes Care 200528(1)
    2543-2546

43
Insulin pump therapy
  • Patient with type 2 diabetes for 20 years
  • Insulin dependent
  • Next slide pump download after first week on
    insulin pump

44
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45
5. Problem solving
  • Help patient to know what to do if
  • Has hypoglycemia
  • Has hyperglycemia
  • Has lows after exercise
  • Feels sick and not wanting to eat
  • Type 1 diabetes and has large ketones
  • Pump failure

46
6. Reducing Risks of Complications
  • High blood glucose levels can cause serious
    health complications.
  • But, damage can be prevented, slowed or delayed
    with good control.
  • Research demonstrates keeping HgbA1c less than 7
    can reduce risks of complications.

47
Complications that can occur
  • Heart disease and stroke
  • Retinopathy
  • Nephropathy
  • Neuropathy
  • Infections
  • Depression

48
Informing patients how to reduce risks of
complications
  • Resources for smoking cessation
  • Yearly dilated eye exam
  • Learning the signs of a stroke
  • Apply lotion to feet daily

49
7. Healthy coping
  • From the outside, diabetes looks like it should
    be fairly simple. After all, all you have to do
    is take your insulin or oral meds every day at
    the right time and in the right amount, eat
    perfectly without ever cheating, check your
    blood glucose regularly and exercise frequently.
    Balance these tasks with each other so that your
    blood glucose never gets too low or too high.
    Stay vigilant at all times in case anything goes
    wrong

  • William Polonsky

50
Depression
  • 2X greater in patients with chronic disease like
    diabetes
  • Very difficult to look after diabetes if you are
    depressed
  • Screening for depression important part of
    assessment

51
  • Becoming a
  • Certified Diabetes
  • Educator

52
What Career Opportunities are Available?
  • In-Hospital Diabetes Management
  • Outpatient Diabetes Education Center
  • School nurse
  • Corporate Health
  • Education
  • Research/Development
  • Sales (pharmaceutical companies)
  • Government
  • CDE in Primary Care
  • CDE in Endocrinologist office setting

53
Criteria to write certification exam
  • Hold a current, active unrestricted license from
    the United States as RN, RD,MD, PharmD, OT, PT
  • 1,000 paid hours of documented diabetes education
    submitted to NCBDE a minimum of 2 years (to the
    day) within the past 5 years
  • Current employment in a defined role as a
    diabetes educator at time of application

54
For more information contact
  • National Certification Board for Diabetes
    Educators
  • Phone 847-228-9795
  • Fax 847-228-8469
  • www.ncbde.org
  • info_at_ncbde.org

55
Professional Memberships
  • American Association of Diabetes Educators (AADE)
  • subscription to The Diabetes Educator
  • purchase the 4 book series The Core Curriculum
  • consider attending the annual meeting
  • Diabetes Educators of Chicago chapter of AADE
    (DECAADE)
  • consider attending monthly educational meetings
  • American Diabetes Association(ADA)
  • professional journals as well as Diabetes Forecast

56
Recommended Web Sites
  • American Association of Diabetes
    Educatorsaadenet.org
  • American Diabetes Associationdiabetes.org
  • American Dietetic Associationeatright.org
  • National Diabetes Education Programndep.nih.gov
  • Centers for Diabetes Control and
    Preventioncdc.gov/diabetes
  • National Institute of Healthnih.org

57
Additional Recommendations
  • Volunteer at one of the ADAs camps
  • dLife program on CNBS Sundays 6pm
  • Volunteer at a free clinic to get additional
    experience
  • To obtain a full copy of this power-point
    presentation, go to www.decaade.org
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