EGVnurse

1. I documented all the diabetes education I gave while working on the floor. 2. I applied to every diabetes nurse educator position open within 30 miles (or more). 3. I worked REALLY hard on my cover letter so that I could squeeze through that narrow HR window. I got an interview for a CDE position at CHOP with only 1 year of RN experience, only because (I think) I wrote a bomb a** cover letter haha. Did not get the job, went all the way to Philly to interview! *tear* 4. I applied to every diabetes nurse educator position open! Even if I was way under-qualified. 5. I went to JDRF events in the area to try to network with people in the community. At one conference I met a CDE working in artificial pancreas research and kept in touch, and a year later she notified me of a job opportunity! Buttttt unfortunately I did not see the Linked In message until months later/I accepted another job!! Bummer. So lesson learned... check your Linked In account!!!! 6. I went to diabetes support groups to shadow the leaders and continued to search All Nurses trolling for information and advice. Other advice would be what's already written here. And what I did only worked for me and may not work for other people. The only real thing you need is perseverance and a strong desire to work in this field. I am so happy with where the path has led me, but two years ago I was sobbing daily on my way home from work at my med-surg job and wondering when I'd ever get out.

Hi all, I'm wondering if there are any nurses out there who went back to school for biomedical engineering, software development, computer science or bioinformatics? I'm a RN (3 years) with a passion for type 1 diabetes (had it for 10 yrs). I'm interested in improving treatment and research... I'm looking at programs that may allow me to blend my love of nursing with my love of biology and problem solving? Any advice would be much appreciated. Thanks!

Thanks!

Any RN's or RN/CDE's doing comprehensive foot exams on your patients with diabetes? Including, ankle-brachial index, monofilament testing and tuning fork, etc. I work in a education-based clinic as a RN Educator now so I don't currently examine people's feet...but we've recently hired an NP and MD so that we will also follow a medical model. I think it would be a good service to have CDE's do foot exam, while providing education, right in the clinic, and be able to refer out if needed. I'm just curious if any of you RN's or CDE's are doing this in your practice...and how well it is working for you and your patients. I know I'd have to think more about logistics, billing, more training for staff, knowing who to refer to, etc. Thank you!

I have my personal opinions on this and ONLY anecdotal evidence to support (using myself as a guinea pig). The best "control"/hgba1c I ever achieved after many years of living with type 1 diabetes was on a low-moderate carb intake (less than 30 grams CHO at meals). Carbs coming from legumes, fruit, vegetables preferred. This meant a high fat intake, which did not deter me, because my weight decreased and I had never seen such beautiful smooth blood sugars. I was not ketotic although I did not check regularly enough (as this was in college before I became a nurse/CDE ) I disagree with the ADA on the amount of carbs recommended for adults. I think we could all benefit from a reduction in carbs, at least from the common sources (grains, cereals, processed grains, etc.) I think healthy weight children with type 1 diabetes should be able to eat what they please but that they/the parents should know: higher carb intake --> higher insulin dose --> larger margin of error on insulin absorption and more glucose variability (this caused a great deal of frustration for me growing up). So that recommended "diet" is taking into account insulin injections. I tell my patients with type 2 diabetes and NO other co-morbidities that studies have shown moderate carb intake (30-45 grams per meal or less, depending on gender, activity level and any glucose-lowering medications) is safe/effective when compared to low-fat diets. Both have been shown to be effective, but the new research linking high-carb intake to high cholesterol is pretty compelling! __ I should also mention that I have no other health conditions with the exception of hypothyroidism.

I am very interested in returning to get my Master's in Nursing so that I can specialize in endocrinology as well. I'm not sure whether FNP versus ACNP would be better, depends perhaps on whether you want to work in outpatient or inpatient. I would love to be able to combine both. I work at a diabetes clinic right now as a Diabetes Nurse Educator and we recently hired an NP (I believe FNP) who sees patients with type 1, type 2 and gestational diabetes. She is doing a lot of education, insulin and medication management, ordering labs, sending referrals to the RD's and RN/CDE's. She is still picking up patients so I'm not entirely sure on her scope/roles yet but you're right, it is mainly diabetes management at this time.

Any CE's, preferably free?

Hello, I'm a RN working at an education-based Diabetes Clinic. We mainly see GDM, type 1, type 2, pre-diabetes, obesity, and failure to thrive. However, we're in the middle of changing over to a medical model that will encompass COPD and CHF patients. We hope to become a chronic disease-focused clinic that may be able to serve as a medical home in the future. That is a long way away. But right now, we may start opening up appointments for our RN's and RD's (all CDE's) to start seeing CHF (and COPD) patients for educational services only (not medical management at this time). I'm looking for helpful patient education materials (preferably free) and curriculum for the CHF patient population when it comes to self-care in the outpatient/home setting (diet, exercise, medications, symptoms and signs, what is HF, etc). If you have any helpful resources, please pass them along. Thank you!

Patient has had DM type 2 since 1998. About 239lb, 5'8". Severe muscular atrophy, wheelchair bound, difficulty raising hands above head, some issues with dexterity but takes most of his injections via pen in his abdomen. Takes Humalog only (up to 185 units per day), looks like he's injecting 50-100 units per meal (even meals without carb). No background insulin. He estimates how much insulin to give himself based on nothing but experience. No reported episodes of hypoglycemia in the past year and he knows the symptoms. A1c in June was 8.1, 7.9 in March. August A1c is still pending. MD hasn't ordered any changes to insulin and my gut says to let patient continue with this regimen, at least for now, because he's very knowledgeable about his own body and DM. We discussed site rotation and splitting doses, correct timing of insulin prior to meal. But I'm pretty surprised by his BG and A1c results. There is certainly room for improvement but the numbers are not outrageous by any means. Anyone else had similar patient encounters? Advice? I want to give him a type of system for dosing himself but do not even know where to start. Thanks for any help.

I'm receiving conflicting information on the standard, safest medication treatment for a woman diagnosed with gestational diabetes (GDM) whose blood glucose is not being controlled with carbohydrate-counting/meal planning and physical activity. I have seen women on glyburide, which I've read is deemed relatively safe to pregnant women (still a Pregnancy Category C, I believe). I saw a woman prescribed glipizide, which my coworkers had never seen before, and asked her physician's office to switch her to glyburide. Then I have seen research that says insulin and only insulin should be initiated for these women and should be the standard medical treatment. Not sure what to suggest to my patients...? Worried that sulfonylureas potentially crossing the placenta can cause fetal hypoglycemia and/or potential birth defects... but not sure whether insulin management is plausible/appropriate for every GDM patient I encounter... Personally I would prefer insulin. But that's because I'm a RN, type 1 diabetic for 10 years AND a diabetes educator. So I'm biased... Help/input would be much appreciated! Thank you.

Hi there! I recently started a new job as a Diabetes Nurse Educator and I love it. I'm not a CDE yet but I'm working on it. To sit for the exam, you need to have documentation of 1,000 contacts hours of direct diabetes self-management education. But you can apply to take the exam when you have ~800 hours, I think. I started documenting on a spreadsheet the number of hours I spent with patients, the number of patients and support people I educated, as well as the location and brief description of the type of education provided (i.e. newly diagnosed type 2 diabetes, insulin management). Wherever you're working now, start documenting what you do. It can be as simple as teaching a patient the importance of insulin injection site rotation. Seek out volunteer opportunities through the American Diabetes Association (ADA) or Juvenile Diabetes Research Foundation (JDRF) to educate patients in the community. Also, some free community clinics will welcome a RN who can offer educational services to their patients with diabetes. As you're accumulating hours, start studying. The website: http://www.ncbde.org/ has helpful resources and guides for studying for the CDE exam. The examination handbook (http://www.ncbde.org/certification_info/examination-handbook/) has some outlines for the material you'll need to know. Hope this helps! Best of luck!

Wonderful! I was offered the job and I start in a few weeks! I'm so excited. I've been reading a bunch and getting some more CEU's through the AADE website. I had just downloaded the ADA Diabetes Recommendations to my phone through the Skyscape App. It's super helpful. I'm glad I'll be able to reference it anytime and read through at my leisure! Thank you for the advice and well wishes!

I've thought about this too! It would be awesome if you could make house calls though.

I blog too! PM me if you'd like.

30 bed med-surg unit, always full. 1:5-6 on nights. 1:4-5 on days. 0-3 techs on day shift (0 I've only seen on a weekend). 0-2 techs on nights.