do I Want to be a CDE?

[frann]

Sometimes I feel like I can think like a pancreas-my dd has had type 1 for almost 4 years now. I'm a RN and work in IR (interventional radiology) I do love my job, but it is very tiring. we are frequently short. are schedule is always full and will have frequent add ons during day.

I now know so much about type 1 being my dd's manager (she's on animas pump/and teenager:banghead:) and soon I'll know everything there is about cgms.

I've thought about what it would be like to work at local diabetes management. I know everyone there. and am on committe with them-diabetes advisory committee.

While diabetes fills my day a lot and sometimes it seems like trying to figure out my dd's diabetes can drive me crazy. I compare it to trying to drive a car, but with your eyes closed. it would be much easier for me if I just had the diabetes.

My question is do you'll ever get tired of it? Like a year ago I had a couple of patients-both type 2's-just stopped taking there meds-one was in kidney failure. and what gets me is both weren't about the money/ie paying for meds. I think it would really get to me when the type 2's come in and can't follow the diet. the one lady that had no adverse effect yet-I really let her have it. and I told her roommate about her stopping meds-I know breach of privacy. Imean how hard is it to take a pill and check bs/once day/or week that I frequently see?

I think I would be really good at advising the type 1's etc etc.

but I don't think I would really want to know all there is to know about type 2-ie there meds etc.

[classicdame, MSN, EdD]

non compliance is common with any chronic disease. I find diabetic education interesting and no two patients are the same. BTW, the worst non-compliance seems to come from Type I' who just get tired of it.

[dansingrn]

A good CDE knows a lot about the disease process of diabetes, both type 1 and type 2; a great CDE is a communicator who can meet a person right where he is, be a good listener, and help the patient discern the root of why he struggles with adherence to his regimen. Then the CDE takes what s/he knows about the disease process, and instills hope, motivates, encourages, and crafts a care plan that is specific to the patient goals.

I now know so much about type 1 being my dd's manager (she's on animas pump/and teenager) and soon I'll know everything there is about cgms.

Knowing "everything" about CGMS in your daughter is not a substitute for spending countless hours analyzing CGMS results in hundreds of patients.

I often tell the parents of my (type 1) patients that I may have expertise in managing pediatric diabetes, but they have expertise regarding their children. Personal experience can be helpful as an educator, but can also be distracting because people's responses to their diabetes is very broad. One can't apply one's own personal experience to the very broad range encountered in a large diabetes management practice.

I think it would really get to me when the type 2's come in and can't follow the diet. the one lady that had no adverse effect yet-I really let her have it. and I told her roommate about her stopping meds-I know breach of privacy. Imean how hard is it to take a pill and check bs/once day/or week that I frequently see?

Often we see type 1 patients who have been admitted multiple times to the ICU for omitting their insulin. This is a very difficult concept for many healthcare providers. They wonder why in the world someone wouldn't take her insulin. The truth is, the human response to disease is extremely varied, and we have to connect with patients in a non-judgmental manner if we have any hopes at all of helping them move forward. Obviously, lecturing or "letting her have it" doesn't work...our frequent flyers aren't admitted because of lack of diabetes education. They are frequent flyers for far more complicated reasons.

I think I would be really good at advising the type 1's etc etc.

but I don't think I would really want to know all there is to know about type 2-ie there meds etc.

Working in diabetes is rich and rewarding...also frustrating at times. It is great when we can communicate all we know about managing the disease and our patients apply that faithfully....but MUCH of the work comes in ways of helping our patients that are much less technical than applying "knowing everything about CGMS." By the way, the CDE exam is not specific to type 1 vs type 2; it covers everything, including all the type 2 meds. Even though I only treat type 1s in my practice, there are 20 million type 2s to 1 million type 1s, so the test is comprehensive.

I want to encourage you to become a diabetes educator if you have a strong interest. Just realize that the motivation must be much more about relating to patients at whatever stage they are in, and less about knowing the "facts" about diabetes management.

[blondy2061h, MSN, RN]

People often ask me why I don't become a CDE, as I have type 1 and know a lot about it. Simple. I don't need my disease shoved in my face everyday more than it already is.

[Mr.RN-CDE]

I can't see myself doing anything else. Yes, it is frustrating at times. The pts who just tell you what you want to hear and are obviously not doing what is best. But those are outweighed by the one pt who is dx'd with a BG of 1930 mg/dl, who now has an A1C of 5.9%. We're their cheerleaders, their support, their confidant. Like all of nursing it is very rewarding and very frustrating.

[frann]

thanks for all your replies.

I don't think I want to be a cde. I am happy where I'm at. I think anymore D would just send me over the edge.

and right now it doesn't take much. (i've got 2 teenage girls-one in long leg cast and one on insulin pump)

[laughoutloud8]

A good CDE knows a lot about the disease process of diabetes, both type 1 and type 2; a great CDE is a communicator who can meet a person right where he is, be a good listener, and help the patient discern the root of why he struggles with adherence to his regimen. Then the CDE takes what s/he knows about the disease process, and instills hope, motivates, encourages, and crafts a care plan that is specific to the patient goals.

Knowing "everything" about CGMS in your daughter is not a substitute for spending countless hours analyzing CGMS results in hundreds of patients.

I often tell the parents of my (type 1) patients that I may have expertise in managing pediatric diabetes, but they have expertise regarding their children. Personal experience can be helpful as an educator, but can also be distracting because people's responses to their diabetes is very broad. One can't apply one's own personal experience to the very broad range encountered in a large diabetes management practice.

Often we see type 1 patients who have been admitted multiple times to the ICU for omitting their insulin. This is a very difficult concept for many healthcare providers. They wonder why in the world someone wouldn't take her insulin. The truth is, the human response to disease is extremely varied, and we have to connect with patients in a non-judgmental manner if we have any hopes at all of helping them move forward. Obviously, lecturing or "letting her have it" doesn't work...our frequent flyers aren't admitted because of lack of diabetes education. They are frequent flyers for far more complicated reasons.

Working in diabetes is rich and rewarding...also frustrating at times. It is great when we can communicate all we know about managing the disease and our patients apply that faithfully....but MUCH of the work comes in ways of helping our patients that are much less technical than applying "knowing everything about CGMS." By the way, the CDE exam is not specific to type 1 vs type 2; it covers everything, including all the type 2 meds. Even though I only treat type 1s in my practice, there are 20 million type 2s to 1 million type 1s, so the test is comprehensive.

I want to encourage you to become a diabetes educator if you have a strong interest. Just realize that the motivation must be much more about relating to patients at whatever stage they are in, and less about knowing the "facts" about diabetes management.

Thanks great post. I am looking to get my CDE in a few years after getting my BSN which I should have by 2011. I have been inspired because of my family history.