From Abby: Do You Have What It Takes?
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. :)