Have you ever met with a Certified Diabetes Educator (CDE)? If not, you might be convinced to after hearing from Rachel Head, RD and CDE at One Drop, and Mark Heyman, PhD, CDE, founder of the Center for Diabetes and Mental Health, and director of One Drop Experts. These CDE experts joined moderator Jewels Doskicz, RN and T1D, and members of the diabetes community to discuss CDEs during this week’s community chat.
Q. In your life with diabetes, how much time have you spent with a CDE? Has this amount of time met your needs?
A. Rachel: I can’t speak for patient perspective on this, but I can safely say as a CDE, I did not get enough time with patients when I worked in a clinic.
Mark: Besides myself and my colleagues like Rachel, not enough. Maybe two hours total?
Jewels: Our local CDE has been a rock for us from diagnosis forward. One of the best shoulders I’ve ever cried on. With my diagnosis, we received a lot of diabetes education. With my daughter’s, very little in retrospect; we could have used more pediatric education.
• I spent a week during diagnosis, and then probably a month of time since with a CDE. I think it’s sufficient.
• First year, a lot. Next 15, annual. These days, only via social media interactions. I think I know it all, but I learn every time.
Q. Would you like to spend more time with a diabetes educator? If you would like to, what is stopping you?
A. Rachel: I would for sure have liked to spend more time with patients in the clinic. What was stopping me? There were a lot of patients and not enough CDEs.
Mark: Getting insurance to pay for it isn’t always easy.
Jewels: At this point in our life with diabetes, I reach out as needed. I know our CDEs are there and full of knowledge.
• I would love to because there is so much to learn. Hard stop is having another thing in my schedule to go to.
• I’m not even sure how to go about scheduling an appointment with one.
• I would love to because the more you know, the better you can manage. Insurance and reimbursement are what’s really stopping me.
Q. What is the most valuable thing you’ve learned from a diabetes educator?
A. Rachel: Diabetes education should be available at every turn for those who want it.
Mark: The importance of having a relationship with a CDE you can trust can’t be overstated.
Jewels: Diabetes is full of ups and downs. If you don’t like how today panned out, let go of it. You can try again tomorrow.
• Learning how to do an extended bolus for pizza was huge. I don’t eat pizza often, but when I do, that technique is clutch!
• Most valuable thing was that I’m going to make mistakes, but to just learn from them.
• Just knowing the extent of what my insulin pump can do has been so helpful!
• The mindful eating approach from Laura Cipullo. Eat kale and cupcakes.
Q. How much has your own diabetes experience aligned with the recommendations you think a CDE would make today?
A. Jewels: My experience shapes the way I approach every day with diabetes. We’re all unique individuals that happen to share a common disease.
• It depends on the CDE. Ones I saw earlier were static with their techniques. Modern, dynamic management is 100 percent better.
• I think it’s different for everyone. Your CDE should meet you where you are and work with you to maximize success.
• In my experience, CDE narratives have evolved. My diabetes management has improved by CDE recommendations.
Q. How useful would it be if your CDE had access to your diabetes data in real time? What feedback would you like about your data?
A. Jewels: I’m dialed, but for a kiddo it may be helpful to have a third party helping shape decision making.
• I would love a sounding board for my day-to-day management decisions.
• I think I would welcome any outside blood glucose (BG) monitoring from a CDE, endo staff, or PCP, if I got a little check-in message whenever I was off track.
Q. What topics would you like to see covered more in diabetes education?
A. Mark: There are only about 15 psychologists who are CDEs in the United States. We need more with this expertise. The wider the circle of support, the better. Diabetes education is more than just facts!
Jewels: Exercise advice is always a gray area, as is healthy eating. Eat whatever you want and then use insulin isn’t the best approach, in my opinion.
• I’d love to see CDEs push patients to get involved in the diabetes online community for more conversations and connections.
• I want more knowledge about stress and how it impacts BG.
• Mental health!
• Individual dosing strategies. When I use meds, it affects my BG. Remembering that can be difficult, especially during burnout periods.
Q. If you had access to a CDE anytime and anywhere, how would you use them?
A. Mark: Sounding boards can be super helpful sometimes!
Jewels: I would use them situationally when trying to figure out the puzzle of T1D for a growing, changing, and active child.
• Probably along the lines of, “I’m thinking of trying X, what are your thoughts?” I might not always take their advice, but it would be nice to get opinions.
• I’m interested in feedback and changes based on my data, but also best practices to leverage in my self care.
Q. What is missing from diabetes education today? What suggestions do you have to make it better?
A. Rachel: From my point of view, traditional diabetes education in clinics adds more pain points than it removes. Let’s make it easier!
Mark: Diabetes education needs to be accessible, affordable, and supportive.
Jewels: I think personalization is missing. What works for one person may not work for another.
• Insurance and pharmacy management. I would love a diabetes educator who could teach me how to maximize and get the upper hand.
• Personalization and customization.
• Mentoring. I’ve done diabetes mentoring for adult T1Ds and it makes a huge difference.
Thank you to Rachel Head, Mark Heyman, Jewels Doskicz, and the members of the diabetes online community who joined in our chat to discuss CDEs and how they can help you manage your diabetes.