mbdRN

I would encourage you to read over the eligibility requirements at the NCBDE's website: http://www.ncbde.org/certification_info/eligibility-requirements/ To qualify to test for CDE, you must have 2 years of working experience in your discipline (for you, that's as a registered nurse), 1000 DSME hours (as of 2014, these can be volunteer--I'm assuming that only volunteer hours starting in 2014 count but I'm not sure), and 15 hours of diabetes related CEUs. The documentation is only requested if you get audited. DSME is defined as: "For purposes of certification eligibility, some or all of the following components of the DSME process may be performed and counted towards meeting the DSME practice experience requirement: An individual assessment and education plan developed collaboratively by the individual and educator(s) to direct the selection of appropriate educational interventions and self-management support strategies. Educational interventions directed toward helping the individual achieve self-management goals. Periodic evaluations to determine attainment of educational objectives or need for additional interventions and future reassessments. A personalized follow-up plan developed collaboratively by the individual and educator(s) for ongoing self-management support. Documentation in the education record of the assessment and education plan and the intervention and outcomes. In addition, program development and administration provided in support of the diabetes patient education program are considered part of the DSME process." So your private nursing experiences with that young boy certainly count toward the 1000 hours. No one has to observe you or sign off on anything. You do not need a BSN to sit for the exam. Read over the NCBDE and AADE websites. That should answer most of your questions. Good luck!

Hi there. I am an RN and diabetes educator. Although I obviously cannot prescribe, I make medical recommendations to our MD and NP based on my assessment/interaction with the patient. Like you said already, it will be different for each patient. Do you have your patients keep individual BG logs? I would look for trends in their blood glucose levels, not just the A1c. If there post-prandial BGs are still elevated, you can always push the Victoza to the max (1.8 mg), monitor further, and encourage positive lifestyle change including carb control and exercise. If PP BGs are at goal but fasting is still elevated, incretin therapies don't have a large impact there. I would suggest the basal insulin over the Victoza if that were the case. If I had a patient who was already maximized on metformin, a sulfonylurea, and Victoza (or another incretin) whose A1c remained above goal, I would suggest a basal insulin (Levemir or Lantus) at 10 units (sometimes 15-20 units for morbidly obese patients) QHS and decrease the sulfonylurea by half with the ultimate goal of discontinuing. I am not a fan of sulfonylureas due to the potential side effects including weight gain and the possibility of hypoglycemia, particularly paired with insulin. I would continue the Victoza and metformin along with the basal insulin. I have a couple patients on Bydureon, but I have not seen a significant difference between it and the Victoza. I tend to agree with the research showing the superiority of Victoza over Byetta/Bydureon based on the efficacy and side effect profile. Ultimately it comes down to the individual patient as to whether one agent is better than another. The Bydureon is not a simple pen to manipulate. It takes some getting used to, and for those that are injection naive, I would hesitate to recommend it. The larger needle and lump it leaves can be intimidating and scary. Plus preparing the shot can be difficult for those with poor manual dexterity. But some love only once shot per week! As I said, highly individualized. Please let me know if you have any further questions. I'd be more than happy to answer them to the best of my ability.