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Mudwoman

Mudwoman

Certified Diabetes Educator
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Mudwoman has 20 years experience and specializes in Certified Diabetes Educator.

Mudwoman's Latest Activity

  1. Mudwoman

    How do you collect CDE hours?

    It is my understanding that actual time educating patients on diabetes counts as well as hours obtained under a Mentor (from the list provided by NCBDE) counts towards the hours needed. You do need to document the hours. You can always contact the NCBCE to see if your DPP hours would count and if so, how much.
  2. Mudwoman

    Diabetic Educators: Structuring and Tracking

    The book is produced by Krames and sponsored by Merek and The American Diabetes Association. There is a pdf form of the book that you can print, but actually getting the book, you must buy in bulk and they are expensive. Just google it and you will find several links where you can print it.
  3. Mudwoman

    Was I wrong to hold Insulin?

    You are confusing holding an insulin vs re-timing an insulin. It is crazy to time a fast acting insulin that has to be given with a meal at 0500 when breakfast is at 0715-0730. You are not holding it when you use judgement to give it with the meal. Surely there is not an order for your fast acting insulin that has no parameters such as "do not give if BG is less than 120 mg/dl". If there are no parameters, that probably should be addressed for all patients in the NH. "Holding" means that you decide to ignore an order regardless. So, maybe the patient has a blood sugar of 122 mg/dl and there is an order for that patient to receive 2 units of fast acting insulin for that blood sugar with a meal, but you decide that because they can get as low as 80 mg/dl on that and have symptoms of a low blood sugar you are not going to give it at all. You would not hold a basal insulin such as Levemir or Lantus. That does not mean that the dose should have been adjusted and you are using nursing judgement to hold the dose until you are able to address the need for dose adjustment with the doctor. Surely that would not be necessary at 0500.
  4. Mudwoman

    Questions for Diabetes Educators

    AADE is more closely associated with the NCBDE which is who certifies you as a Diabetes Educator. AADE also has all the information you need to know about a DSME program. ADA is just a government sponsored organization to give info to people with diabetes.
  5. Mudwoman

    How did you become a CDE?

    It is a long road. When I decided this was my goal, the first thing I did was join the AADE. You do not have to be a CDE or Diabetic Educator to join. Joining gives you the opportunity to take some online classes and there is study material for the CDE. You must have 1000 hours of teaching to sit for the CDE exam. 400 of those hours can be volunteer hours and in some cases, the NCBDE will allow up to 600 hours. You start doing everything you can to learn about what is expected of a CDE and running a Diabetes Education Program. That is why so many jobs require you to have your CDE is that they have a DSME program in place that will require you to know how to keep that program in place. There are standards that must be met in order for insurance companies and Medicare to pay. Then look for any type of job that will allow you to do some education. The nurses in Cardiac Rehab at my hospital cover for me on the weekends. They do not have a CDE. But they are getting hours. There is now a nurse from the Endocrinology Clinic that is working on her BSN that is doing some PRN and covering for me during the week. Talk to the Diabetes Educator personally at your local hospitals and clinics to see if there is a way that you could be PRN for them. I do PRN for the Diabetes Educator at the Outpatient Diabetes Education Clinic. But if I'm covering for her, I need coverage for me. You can also do some classes sponsored by your local pharmacy or a local church. Keep meticulous records of who attended and what you taught. Find out about your state's Diabetes Advisory Council through the Department of Health. I contacted the Governor of my state about my desire to become a CDE and make a difference. He got me a seat on the Council. That also opened some doors, so that when I did apply for a Diabetes Educator position, even though I did not have my CDE, I was able to show I had been a member of the AADE and knew what was required of an education program, and I was a member of the Diabetes Advisory Council. Took me 3 years to get a job in Diabetes Education. Another year to have the hours to sit for my CDE. So, you really have to want this and be willing to learn as much as possible and work at it.
  6. Mudwoman

    Was I wrong to hold Insulin?

    As nurses, we think that because we have a brain and we can think, that gives us the right to stretch that line in the sand when it comes to what we can LEGALLY do and what CRITICAL THINKING says we "should" do. The reality is that you do not have the scope of practice to ignore a doctor's order. If your critical thinking skills say that insulin probably should be held, then call the doctor. Only the doctor can give you the order to hold that insulin. I know it is a pain to do that; especially if you are chasing 7 diabetics, but nurses can not decide to hold a medication. There has to be a doctor's order to do so or standing orders from that doctor that if the patient is eating less than "x" % of their meals and their blood sugar is less than "x", hold the insulin. You could get such an order for this patient and save everyone (including the doctor) calls every time someone decides insulin is not such a good idea. Basal insulins such as Lantus and Levemir are never held. Treating a low blood sugar requires giving ONLY a food with carbs. Never give any food with fat in it as fat slows the absorption of carbohydrate (glucose). Once a blood sugar is stable, giving a protein with a carb will help keep that blood sugar stabilized.
  7. Mudwoman

    Where can I find practice exams for CDE?

    Jean Rifkin has the best prep course. Diabetes Seminars, Inc.
  8. Mudwoman

    How to get into the Diabetes education

    If you are doing classes for free, you still must document that the classes follow the guidelines of the AADE. AADE provides lots of guidance material. Be sure that people that attend your classes, fill out a sign in sheet with name, address, phone number. Keep really good records. What doesn't count is if you just do classes and teach what you want to teach. There has to be some structure and all 7 areas of diabetes self care management has to be taught. Up to 400 hours can be donated (free) hours and the NCBDE is allowing up to 600 hours in some cases.
  9. Mudwoman

    Questions for Diabetes Educators

    I also wanted to mention something I thought of today. The nurses that work in Cardiac Rehab cover for diabetes education on the weekends. Check with your employers to see what department covers on weekends for your diabetes educator there. It could be another opportunity to get hours needed for your CDE and get your foot in the door.
  10. Mudwoman

    Questions for Diabetes Educators

    It is not an easy field to get into, but it will happen if you work at it. When I decided this was what I really wanted to do in 2011, the first thing I did was join AADE (American Association of Diabetes Educators). You do not have to be an educator or CDE to join. Next thing I did was contact my state representatives and the governor of my state and just let them know that we have all these health initiatives for reducing diabetes in our state, but for those of us that want to be a part of that; well, it is almost impossible. It is hard to get a job as a diabetes educator if you aren't already, and you can't become an educator without all the hours as an educator. From those contacts, I was invited to be on the Diabetes Advisory Council in my state. Then, I started looking for ANY job that was for a diabetes educator whether it was PRN or part time. After a year and a half, I got a part time job in the hospital I work at as a diabetes educator and from there was able to get all my hours to sit for my CDE. If you have a diabetes educator in your hospital or one of the clinics in your area, talk with the person that does the hiring. It is hard to find someone to cover for these people if they have to be out on vacation or sick leave. You might just be the person to get trained to cover PRN. That would also give you a foot in the door. When I applied for the part time position, there were 9 other people that applied. What got me the job is that I was almost done with my BSN, I was already a member of AADE and had been taking their free online seminars, and I was on the Diabetes Advisory Council. I stood out as serious. This position is still part time and it is a real sacrifice financially!!!! I had been full time and I'm the sole support of my family. However, I am now putting together my own online business from this that will supplement my income and allow me independence that would not have happened otherwise. There are about 12,100 CDE's in the US. There are currently just under 600 outpatient diabetes education clinics in the US. Be sure to add yourself to Linkedin. I have received 3 job offers in the last year from Linkedin. I was just not willing to relocate. All of the positions were at hospitals. One was in Oklahoma, one in New Mexico, and one in the Dallas/Ft Worth area. There are also jobs with insurance companies as "health coach" that will allow you to work as long as you can get your CDE within a year. You just have to be actively looking all the time. Hope this helps you.
  11. Mudwoman

    How do you collect CDE hours?

    The exam for CDE covers many areas. It is important to know about diabetes, but do you know how to motivate all types of people to make lifestyle changes. Do you know the requirements if you were head of a ADA or AADA certified diabetes education program. Do you know the proper way to dose insulin and medications? Are you comfortable with the 7 areas of diabetes self care management? Do you know how to implement the Chronic Care Model for Improvements in Diabetes Practice or understand the Health Care Continuum so that you can apply that to behavioral change? Can you apply Social Cognitive Theory? You must know ALL of your recommended lab results by heart for adults, elderly and children of all ages. There is a lot of questions on the test regarding Health Literacy. How do you teach someone that can't read or comprehend well? How do you teach and still be sensitive to someone's culture or spiritual beliefs? How do you apply the Transtheoretical Model to your teaching? Do you understand the 1500, 1700 rules for establishing correction factors for bolus insulin? What about the Self-determination theory and how that effects your teaching? What about trouble shooting blood glucose issues? The main reason I'm pointing all this out is that there is a lot to know in order to pass the CDE exam. It is not just a matter of knowing about diabetes. If you are studying the areas of expected knowledge while you are doing the required hours for the test, then the test should be relatively easy for you. The expectation of the National Board of Certified Diabetes Educators is that your teaching embraces all of the areas of knowledge found on the test. Remember you are an educator. Your specialty is diabetes. But as an educator, you have to have a broad knowledge base in other areas. Does no good to teach a variety of people, if you can only teach a certain type. Does no good to become a CDE if you then don't know the first thing about running a certified ADA or AADE diabetes education program that you might be hired for. Just food for thought
  12. Mudwoman

    Diabetic Educators: Structuring and Tracking

    Our program is certified by AADE. We are dictated that we have to teach all 7 areas of self care management per the AADE to keep our certification. We have data that we have to keep and turn in to AADE every year for our certification. We track A1c, weight, and yearly eye exam at this time. If our program were certified by ADA, it would be different, but likely very similar.....I don't know. Classes are 2 hours each X's 3 classes. One on One is more of an "assessment" and there is certain information we have to obtain to fill out the assessment questionaire. Otherwise, the patient is there and has a lot of questions.......mostly "what can I eat?" They care little about anything else.
  13. Mudwoman

    How to get into the Diabetes education

    It is hard to get into, but not impossible. Join AADE (American Asso of Diabetes Educators). You do not have to certified to join. Find out if the state you live in has a Diabetes Advisory Council. It is usually a division of the Department of Health in your state. Ask to join and start going to the meetings. Get on a committee. If you work in a hospital or clinic, they usually want you to be certified and that is where the 1000 hours comes in. You can't sit for your certification test until you have 1000 hours of teaching under your belt. However, as an RN, your scope of practice says you can do diabetes education. That leads me to this. If you are in an area that has a mentor through the NCBDE, then take advantage of that. If not, then consider putting on some classes. Do some classes at local churches, or organizations. There are clubs that are always looking for a speaker. Have people sign a sheet with their name, address etc. Then you start keeping a log of all the time you spend teaching. Get the education books from AADE so that you follow that format for teaching. You have to follow up with your "students", so you take the sheet and contact them a week or so after the classes to see how they are doing and see if they have questions. Follow up again in a month or 2. Keep records. Have the person that arranged for you to do the class, sign a paper that you did indeed do a class. If you do a 30 min class for 10 people, that is 300 minutes of "teaching". Keep looking for job opportunities. I had to take a part time position in diabetes education to get my foot in the door. I did not have a BSN or a CDE at that time. I was so nervous because my budget just didn't fit a part time income. But I wanted this and so I just went for it. It worked out. I wouldn't have thought I could cut my budget as much as I did. The Capella Education is just going to cost you a bunch of time and money and isn't going to get you a job. Networking with your local pharmacies, Department of Health, Diabetes Advisory Council will eventually get you some leads. Be pro-active. You are going to have to do some Pro-bono teaching for a while.
  14. Mudwoman

    Gestational Diabetes Treatment

    I've seen lots of GDM patient's placed on Metformin too. None of these medications have FDA approval for use with pregnant women, however, doctors are prescribing them for patients. OB docs I've talked to say there is no evidence that these oral agents cause harm and because the criteria has changed so that more women are given a diagnosis of GDM, insulin is not always appropriate either. There is too much risk of hypoglycemia. Evidence based practice is in play here.
  15. Mudwoman

    Medicaid reimbursement?

    In Arkansas, Medicaid does not pay for any education unless it is by the physician in the clinic setting. Then the physician can charge a level 3 visit for including the education. This year, Medicaid no longer pays for blood glucose testing supplies either. (in Arkansas). How crazy is that. Medicare will pay for 13 hours of education the first year the patient is diagnosed and then 2 hours of education each year thereafter. The patient's deductibles and co-pays apply. Medicare pays us 20% of what we charge for education. Lots of private insurance companies no longer pay for Diabetes Education either. They will pay for Medical Nutrition Therapy by a Registered Dietician. Many insurance companies provide some type of diabetes education for their enrollees at no charge. If they do pay, it is often a one time payment.
  16. Mudwoman

    How do you collect CDE hours?

    It used to be that 400 of the required 1000 hours could be volunteer hours. The big thing is to keep track of what you are doing as far as teaching. If you are teaching a patient while working, keep a record somewhere and the amount of time you spent. Watch for the requirement for the assessment, education plan, intervention and outcomes. You may need to call the patient on your own time later to see how the patient is doing and document that. Be sure you don't violate HIPPA. Do not have patient info that is not private. So, whatever you use for documenting your education, must be locked up. Have you thought of doing community classes and charging a small fee? I know a CDE that got a lot of her hours by doing just that. She charged $10 per person. New requirements may let you get all of the 1000 hours volunteering (not sure, check on this). Consider doing some diabetes education for church groups or a local club etc. If you do that, have people do a sign in sheet to verify attendance. You can count the amount of time spent.....let's say 1 hour times the number of people. So, if 10 people show up for 1 hour that equals 10 hours of teaching. You must be at least a RN. You do not have to have a BSN. Join AADE. You do not have to be a CDE to do that. I was lucky to find a job working at a hospital as a diabetes educator. I was working on my BSN, but the thing that got me the job was that I was a member of AADE. It just showed to the person hiring that I was really serious about a career in diabetes education. After a year of working as a diabetes educator, I got my CDE. Go for your dream.
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