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From Abby: Do You Have What It Takes?

Abby is an RN, a PWD, and en route to becoming a CDE.  (Her last name will eventually snap off due to all of the accompanying letters.)  As she's worked through her schooling and now her experience in the field, her scope of what she's learned through life with diabetes as a patient and what she's learned through school and experience as a nurse are very different, and both play a rule in her pursuit of a CDE certification. 

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Sounding off about the necessity of a medical degree, even if you already have T1D.My goal when applying to nursing school in 2009 was simple: become a Certified Diabetes Educator. I wanted NOTHING to do with nursing, and I for sure did not want to become a "regular nurse" like my mom because her job, to me, was gross.  (I'd seen the videos and heard the stories. No thanks.)

As I'm sure you're aware (or if you're not, check out the website), the requirements to be certified are not simple, nor quick. In fact, they almost seem impossible and over-the-top strict. Diabetes is not that difficult to understand, if you're living with it - and those of us who have had it for more than half our lives should be given some slack, as far as application goes, right? Or at least be able to by-pass the medical credentials?

Wrong. Wrong, wrong, wrong.

I am here to explain to you WHY becoming a CDE is so gosh darned difficult, and why you should really appreciate those who have passed the exam and kept up their title - and how freaking smart they are.

Type 1 diabetes can be fairly simple, in description. The basic gist is to add insulin, add exercise, treat the lows, and prevent DKA. Arguably and theoretically "easy" if there is nothing else going on with the patient. But what if that patient all of a sudden also has to be on prednisone for their cancer treatments? Game changer. What if your patient is 74 years old, on dialysis for four years, and now is in liver failure and needs to keep their blood sugars between 80-140 mg/dL all the time? Think you can handle that? Ever heard of CFRD? No? Well you need to know what it is and how to adjust insulin for it if you're going to be a CDE. Keeping a pregnant woman's A1c between 5.5 - 6.5%? Needs to be on your "no sweat" list, with those three "CDE" letters after your name. You have to be able to do all of these things - not just pick and choose.

Conversely, you need to put most of your own diabetes out of your mind when talking to patients. With the exception of recommending some good tape or pump case or medic-alert companies, your diabetes is just that: yours. Not anybody else's. You also need to be sure not to tell all of your patients you have diabetes, and if you're ready to be a CDE, you'll understand why this varying level of disclosure matters.

My last point is the medical degree requirements, and why they are such a fantastic, and necessary, requirement.  My life experience as a person with diabetes can only teach me so much.  When I get a call from a pre-op nurse telling me they have a patient scheduled for a procedure the next morning and they are wondering what to do about their insulin, Metformin, Januvia, and Glimeperide - I need to know what that procedure is, how it will effect their body, and approximately how long they'll be recovering - as well as how long before/after they won't be eating.  And all the variables that may end up in the mix.  I learned this in nursing school, and not in "I've had T1D for 14 years" school. 

While becoming a CDE was my ONLY goal four years ago, I have quickly realized that becoming a good nurse is much more important to me, and if I happen to feel ready for that CDE on my name tag when I'm eligible, I'll wear those letters proudly, too.  

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Thanks for sharing this post, Abby.  I feel that I have a high level of awareness and eduction about my own diabetes, but instructing others on how to manage theirs?  No way. I'm looking forward to when you're a CDE and drawing from both anecdotal experience and schooling.  You'll be badass.  :)


Great post! I am on the long journey to CDE as well but going the dietician route. I could never make it through nursing school:) Good luck to you!

You go girl!
Congrats and such, now and when the time comes.

LOVE THIS! Very well said and eye-opening for many, I'm sure. Cheers to nursing!

Abby, this is really informative. Made me think about CDEs in an entirely new way. Good luck with the rest of your schooling. Thanks

YES. I've been struggling to explain to people why I think it's a good thing that people have to have medical degrees to become a CDE but never knew how to go about it. I'll be referring to this next time someone asks why I can't skip a few steps. I actually LIKE the fact I have to go through all this education. I feel like I understand diabetes even better.

Abby- thanks for sharing! I love to read your posts. I would love to have a CDE like you!

Abby's my idol. I just applied to start (the prerequisites for) nursing school.

Yay Abby! So totally right! (And you mentioned CFRD!

Love this! As a RN, PWD for almost 25 years and CDE this is a completely accurate portrayal!! Abby feel free to contact me about becoming a CDE! Jami jamimklein@gmail.com

the hardest part for me would be to have someone as stubborn as I am as a client
good luck, you'll be super !

Thanks for the post, Abby. As much as I might think the requirements are way too complicated and shouldn't be that way for CDE-wannabes. I do agree with you that they need that nursing background and shouldn't be able to "skip steps." Yes, it is more complicated than just relying on your own D-Life. But one thing still bothers me: too often, it seems CDEs (and endos, but that's besides the point) stop listening to us PWDs simply because they've accrued that knowledge and education. Even those with D, and those who "keep the distance between personal and professional." I understand generally there's a reason to maintain that line; really, it's not rocket science. But you write specifically,"You also need to be sure not to tell all of your patients you have diabetes, and if you're ready to be a CDE, you'll understand why this varying level of disclosure matters"... well, I'm not a CDE and have no desire to be one. So tell me why that is, so I know. And when do you feel it IS okay for a CDE to talk about their own D with a fellow PWD? Like I started with, thanks for the great post.

This was so freaking enlightening! Thanks for the post Abby!

Thanks for your post Abby. I can relate to EVERYTHING you are describing as I am a PWD, RN, and working towards my CDE. Your patients are fortunate to have you on their side!

I have the exact same ambition....I'm graduating in August from nursing school, hoping one day to be a CDE. I feel like nursing school is sucking the life out of me, I hope I have something left in me to continue to pursue my CDE. I'm sure I will find it, it is my passion!

Abby, and anyone else out there who is preparing for their CDE--good luck and hang in there! I find that being a PWD and a CDE helps me establish an "instant rapport" with my clients and so many of them tell me how glad they are that their CDE also has diabetes. That being said, I have had the pleasure of working with many CDEs who do not have diabetes and who are also very good at what they do. My best advice--if you're T1 and a CDE, work hard on the Type 2 stuff. It's a completely different condition, as we all know, and things change fast with multiple meds and new things coming out all the time, and the co-morbidities that go along with Type 2. I find that T1s are a lot easier for me to coach and especially to do new onset teaching. Type 2s are a lot harder for me.

I'm happy to talk to anyone seeking their CDE! tandy.mcgee.rn@gmail.com

Mike - What I mean is that there are patients that will automatically get defensive if I tell them I have diabetes. It portrays a front from me that I know everything because not only do I have a job doing this but also I have diabetes, and they get defensive because they aren't doing a "great job". Alternatively, when someone finds out they may expect me to be 100% perfect all the time and that's too much pressure on me that I don't need.
The steps to becoming a CDE are absolutely not too strict. You have to remember that Type 2 is an entirely different disease, with about 45 times more drugs and treatment options. There are also MANY different aspects to diabetes that young healthy people with Type 1 will NEVER see in their lives. So no, they are definitely not too strict.

That blows my mind... well, maybe it shouldn't, but it does. Us PWDs are perfect and experts?!?! Ha! I go back to our man Chuck Eichtwb who says it's just about being a little bit better, not perfect... but yes, you make a great point. Whatever others may think, it does my soul well knowing you're going to be in those CDE ranks someday and being the best you can. Go, Abby!

Abby: Kudos to you! Yes, the route to becoming a CDE is a L O N G one. I gave up, some twenty years ago, when I had intended to get my M.S.W. degree and then become a CWD. As a single Type I, I had to drop out of the social work program when I realized I would need to give up my full-time job (and my health insurance) in order to get that M.S.W. It was an unfortunate "Catch 22." Anyway, you'll be great! Thanks for having pointed out the sorts of work a C.D.E. actually does.

Great post, Abster. Thanks for doing a little perspective fixing.

CFRD - Cystic Fibrosis Related Diabetes - We are dancing towards it and I don't like it, not one bit. Glad we have you CDE's to help us through it though. Yay, Abby!

Thank you for such a great post about how to prepare to become a CDE. I enjoyed reading your perspective and it has changed how I view nursing and CDE!

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