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To view the Course Outline and take the test online, click here.
For a printer-friendly version of the exam you can print out, complete and mail in to ADVANCE, click here.
 Learning Scope #348
1 contact hour
Expires Dec. 20, 2012
You can earn 1 contact hour of continuing education credit in three ways: 1) For immediate results and certificate; take the test online; grade and certificate are available immediately after taking the test. 2) Mail your completed exam (or a photocopy) along with the $8 fee (check or credit card) to ADVANCE for Nurses, Learning Scope, 2900 Horizon Dr., King of Prussia, PA 19406. 3) Fax the completed exam to 610-278-1426. If faxing or mailing, allow 30 days to receive certificate or notice of failure. A certificate of credit will be awarded to participants who achieve a passing grade of 70 percent or better.
Merion Publications Inc. is an approved provider of continuing nursing education by the Pennsylvania State Nurses Association (No. 221-3-O-09), an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. Merion Matters Inc. is also approved as a provider by the California Board of Registered Nursing (No. 13230) and by the Florida Board of Nursing (No. 3298).
The goal of this CE offering is to provide nurses with information regarding the integration of acupuncture into the current biomedical treatment of type 2 diabetes. After reading this article, you will be able to:
1. Identify indications for acupuncture in the management and treatment of type 2 diabetes.
2. Describe contraindications to acupuncture treatment.
3. Summarize the current research pertaining to acupuncture treatment in type 2 diabetes and opportunities for future research.
R.F., a 42-year-old male with a 10-year history of type 2 diabetes, hypertension and hyperlipidemia, reports to his endocrinologist that his feet "feel like they are on fire." He reports the onset of symptoms occurred approximately 3 weeks ago and states he is sleeping poorly despite self-medicating with an over-the-counter sleep aid.
R.F.'s current medications include two oral hypoglycemic agents and a basal insulin. He was previously prescribed an incretin mimetic that was discontinued due to intolerable nausea. R.F.'s BMI is 30, and he has gained 8 pounds over the past 3 months. His most recent hemoglobin A1c was 8 percent, indicating inadequate glycemic control and an increased risk for chronic diabetes complications.
R.F. reports being discouraged about his weight gain and recent neuropathic symptoms. R.F.'s endocrinologist prescribes an anticonvulsant agent for pain control and explains the most common side effects to R.F.: dizziness, drowsiness, impaired coordination, weight gain, headaches and dry mouth. Additionally, R.F.'s endocrinologist refers him to a board-certified, licensed acupuncturist, telling him there is evidence acupuncture reduces the pain of peripheral neuropathy and it may also assist him in improving glycemic control.
Brief History of Acupuncture
Acupuncture, one facet of Oriental medicine, has been utilized to treat disease and illness for thousands of years. The theoretical foundation of Oriental medicine can be largely attributed to the Huang Di Nei Jing, translated as the Yellow Emperor's Cannon of Internal Medicine. It is a classical text of Chinese medicine thought to have been compiled around the third century BC.1
The Huang Di Nei Jing is divided into two books: the Su Wen, translated as "plain questions, and the Ling Shu, translated as "spiritual pivot." The Su Wen describes Taoism, the importance of living in harmony with nature and the etiology of various diseases. The second book, the Ling Shu, specifically discusses the practice of acupuncture and mentions xiaoke, translated as "wasting-thirst" or diabetes.2
Acupuncture involves the placement of fine filiform needles in specific points along acupuncture meridians and is designed to activate the body's healing potential. Mechanistic research suggests acupuncture not only increases endorphin production but may also create connective tissue signaling via needle grasp and manipulation that positively influences physiology.3 According to the World Health Organization (WHO), acupuncture has been scientifically proven to treat numerous acute and chronic conditions. The WHO indicates acupuncture has a therapeutic effect in the treatment of type 2 diabetes.4
Acupuncture in Diabetes Management
Why consider acupuncture as part of a comprehensive diabetes treatment and management plan? Uncontrolled diabetes negatively affects quality of life and is the fourth leading cause of death by disease in the world.5 Current biomedical treatment of diabetes is often inadequate in achieving optimal glycemic control without unpleasant side effects.
Pharmaceutical therapy involving sulfonylureas, insulin and thiazolidinediones may result in weight gain. Biguanide therapy can cause unpleasant gastrointestinal side effects and may lead to lactic acidosis in high-risk patients. Incretin mimetics, designed to assist with glycemic control and weight loss, may cause nausea and vomiting.
Though ultimately some type of pharmaceutical therapy is indicated for most adults living with diabetes, more is needed to achieve glycemic control and enhance quality of life. In addition, positive lifestyle changes such as dietary modification and increased physical activity are needed for optimal health. Behavior change often is challenging to achieve and may partially result from the increased stress in coping with a chronic disease that demands daily management. An integrative approach combining biomedicine with acupuncture and Oriental medicine enhances diabetes care and improves clinical markers and quality of life for those living with type 2 diabetes.
Acupuncture is a holistic healing modality without unpleasant side effects. Considering the multiple side effects that may be experienced with pharmaceutical agents, this is a clear benefit. However, it is crucial to note acupuncture is not a replacement for traditional pharmaceutical therapy of diabetes. Further, medication prescription or adjustments are not within the scope of practice of a licensed acupuncturist.
However, acupuncture as a complementary therapy to biomedical treatment of diabetes may in fact result in reduced glucose levels, which in turn necessitate a reduction in the dosage of either oral hypoglycemic agents and/or insulin. These changes must come from the client's prescribing healthcare provider - something the client must be reminded of by their licensed acupuncturist.
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