This episode of Diabetes Care Conversations explores the professional journeys of two certified diabetes care and education specialists (CDCES), Mayra Cantazaro, DNP, FNP-BC, BC-ADM, CDCES, and Liseli Mulala, RPh, MPH, PhD, CDCES, BCMTMS. The conversation illuminates how careers in diabetes care are often shaped by deeply personal experiences, mentorship, and unexpected opportunities rather than a straight path. Mayra and Liseli discuss the rewards of the profession—from meaningful patient connections and culturally responsive care to interdisciplinary collaboration and community impact. The guests explore how the field has evolved, particularly with advancements in technology, a shift toward patient-centered care, and growing opportunities for leadership and innovation. Listeners will come away inspired to embrace uncertainty, seek mentorship, and embrace the diabetes care journey.
Patrick McMahon
What does it take to become a certified diabetes care and education specialist? Is it a single defining moment or a series of small ones? For many of us, the path of diabetes care isn't linear. It is shaped by our patients who change us, our mentors who nudge us forward, and the opportunities we almost didn't take. Today, we're talking about turning those points, the doubts, the lessons, and the courage it takes to say yes to this profession. If you're early in your career, considering a change or wondering what's next in your journey, this conversation is for you.
Every diabetes care and education specialist has a story, a moment that sparked their commitment to this work. Hello and welcome to ADCESs' podcast, Diabetes Care Conversations. In each episode, we speak with guests from across the diabetes care space to bring your perspectives, issues, updates that elevate your role and inform your practice to ignite your passion. In this episode, we're exploring journeys behind the credential. Two certified diabetes care and education specialists join us to refer how they entered the field, what shaped their growth and what they wish they'd known from the beginning of their journey. Mayra, Liseli, welcome to Diabetes Care Conversations. We're excited to have you here.
Mayra Cantazaro
Thank you so much for having us, Patrick. I'm really excited to be here. My name is Mayra Cantazaro. I've been a nurse for almost 20 years, and for the past 11 years, I've worked as a nurse practitioner in outpatient endocrinology in South Texas. I also serve as an assistant professor in the doctoral nursing practice program at the University of Texas, Rio Grande Valley. And I have to say that my path to becoming a CDCES hasn't been a linear one. It starts and it stems from a personal place for me.
As a teenager, I watched my grandfather live with diabetes and its complications. He had end-stage renal disease that led to dialysis and eventually even required bilateral amputations. So I recall my grandmother and our family members really trying so hard to manage his condition. But looking back, I realized that we didn't have the proper education and the support that was needed. And I remember thinking there has to be a better way.
So as I pursued my first job as a nurse practitioner, it was in an outpatient endocrinology clinic that was affiliated at that time with Joslin Diabetes Center. And I will say that that experience really shaped how I view diabetes care. It was built around education and interdisciplinary teamwork. Also during that time, I quickly realized that I was entering this clinician role that more than 50 % of my time that I was spending with my patients during our visits weren't just about talking about medications, prescribing new regimens or reviewing their labs with them. It was about teaching, supporting them and empowering my patients and their family members. So that's when it became clear to me that diabetes education was an extra step, part of my role. It was more of what my patients needed and it was a central component of it. So that led me to pursue my certification in diabetes education because I wanted to provide that highest level of education and support to my patients. And I knew that meant learning from the experts and becoming part of a community that was dedicated to diabetes care and education. And I know you asked about mentorship. Mentorship has played a huge role in my journey. I've been very blessed and very grateful to have such amazing colleagues who have recognized my passion early on. They've encouraged me to grow and who have opened some amazing doors along the way. So Patrick, as I look back every step, both personal and professional, has really shaped the clinician and educator I am today. So becoming a CDCES hasn't just been about earning a credential or extra letters on back of my name. It's been about becoming the provider, my grandfather, and so many others living with diabetes deserve.
Patrick
Amazing journey, Mayra. Thank you for sharing that. Liseli.
Liseli Mulala
Wow, thank you for sharing that Mayra, that's really inspirational. Funnily enough, we kind of dovetailed in the fact that I started out as a pharmacist 30 years ago. And as part of my learning in pharmacy school, we have to spend about six months in a hospital setting, six months in an outside retail pharmacy setting. And my hospital setting was at the Deaconess Health Center in Boston. And my retail setting, because I went to Northeastern University in Boston, the retail setting was at the community pharmacy that was in the basement of the Joslin Diabetes Center. I was working with two brothers who ran this independent pharmacy and this was back in the late 80s. They were doing clinical pharmacy and diabetes education before it had a name. These two brothers just showed me that when somebody comes in to buy a glucometer, you don't just sell them the glucometer, you show them how to use it or you ask them if they know how to use it.
Dispensing the medications for, at the time it was just metformin, sulfonylureas, and insulin. That's all we had was explaining the medications to them and also talking about diet, talking about exercise. So I didn't have the framework that we have now of the ADCES-7, but I understood that it was important to do the non-pharmacological as well as the pharmacological teaching of patients.
And so as a pharmacist, I just started out in retail for the first 15 years of my life as a pharmacist. And in about, let me see, I think it was like 2010, I decided that I wanted to do more than help people one-on-one. I wanted to do more with populations. So I went on to get my master's in public health in addition to having my pharmacy degree. And as I was doing that, I was thinking more about how can I sort of codify what I knew as a pharmacist and share that with others.
And that's when I met my mentor Lisa Kroon, who is a DCES and a pharmacist. And I didn't know that pharmacists could do that. All the DCESs at the time, the term CDE, that I met were nutritionists and dieticians and nurses. I hadn't met any pharmacists. So meeting Lisa Kroon kind of sparked something in me, letting me know, this is something I can do. And then Lisa helped me to figure out how to get the training and experience that I needed to be able to pass the exam in a retail pharmacy setting, which is different than what most people were doing. So for me, it was seeing people doing these things and then also learning about the certification that, not just as Mayra was saying, it's not just letters after your name. It's letting people know that I have the experience to teach them in a way that makes sense and also giving me the tools to teach more effectively.
I also have diabetes on both sides of my family and being able to bring that information back and that knowledge back to members of my family has helped so many and being able to share that with my colleagues has also given people the tools to do so themselves. And I try to teach my students the same thing and hopefully some of them will actually get certification. I keep offering to be the mentor that Lisa was to me and some of them will take me up on it.
Patrick
Thank you, Liseli. Both of you, I’m definitely hearing a personal story, the reach for the cred or the credential that you're understanding and being able to work in the community with that. Both inspiring and definitely not linear for that. I think we mentioned that before, but turns and changes with that and even having a inspiring individual from a mentor, from a personal story for that to really make an impact in your community. Thank you both for sharing and introducing yourselves. Looking back,
What roadblocks or moments of doubt did you encounter on your path to becoming a certified diabetes care and education specialist? And how did you navigate that?
Mayra
I faced plenty of roadblocks, but I can share two. You know, one of the biggest ones at the beginning, honestly, was myself. You know, early in my career, I could say I struggled with what we call imposter syndrome. When I earned my CDCES certification many years ago, there weren't many nurse practitioners in my area pursuing this. And I recall walking into the first national ADCES conference that I attended and not only being wowed, but also thinking like, do I even belong here? I was surrounded by incredible diabetes educators who were just so knowledgeable and who had spent their whole careers focused on education and nutrition. And to be honest, I felt out of place at first. What really helped me move past that was realizing that no matter our background or title or the years of experience, we were all there for that same reason.
We all care deeply about people living with diabetes and we wanted to keep learning and doing better for them. So once I understood that, my perspective shifted. And currently a roadblock that I'm navigating today is more of balancing my career with motherhood. Raising two toddlers while working in a clinical practice, doing academia and staying professionally involved has really forced me to refine what balance actually looks like. So some things are hard.
And the mom guilt is very real, but becoming a parent has also clarified my purpose. You know, I really want my children growing up to see their mom doing what she loves, which is helping people living with diabetes while still being very present for them. At the stage in my life, I'm learning and I'm constantly trying to remind myself to give myself grace, you know, to prioritize what truly matters and to remind myself that it's okay to want both, you know, a career that I'm passionate about and a life that's centered around my family.
Patrick
Thank you, Mayra. it sounds like you are navigating those hard times, but navigating those beautifully. So thank you for that. I'm sure everyone listening to this had the imposter syndrome, but also navigating personal and as well as professional goals. So thank you for that. Liseli, how about you? How about some roadblocks or moments of doubt that you encountered?
Liseli
I definitely encounter some roadblocks. I mentioned retail pharmacy. So for people who aren't pharmacists, retail pharmacists would be somebody that works in the community, like a Walgreens, a CVS, a Safeway, an independent. In that setting, as you may have noticed, your pharmacist is very busy. You're answering the phone calls, you're counting pills, you're counseling patients. So I was trying to figure out how I was going to get at the time, 1,000 hours to be able to sit this exam in two years. And it couldn't just be counseling about medication. It had to include those other educational pieces. So I was lucky enough to have a mentor like Lisa and a colleague like my colleague, Jeff Wong, who allowed me the time and the space in a retail setting. Lisa helped me come up with a plan, and my colleague Jeff Wong was able to carry some of the load while I was taking 20 to 30 minutes to sit down with a patient that was newly diagnosed with diabetes. I also give credit to my leadership team at Walgreens. I had to come up with a proposal that showed them that this could be a moneymaker before they were allowing me the time to do it. But thankfully at the time, insurance allowed for medication therapy management counseling. So if the patient had Medicare, I could bill that as an MCM session.
But I also included not just the medications and talked about the diabetes education. So there was some planning, some guidance, support from many people who allowed me to get the time to get the hours. And I would also say just, again, like Mayra was saying, there was some imposter syndrome in the beginning. I would go to diabetes conferences and I'd be sitting in a room with people going through cases and doing insulin calculations. So I'm like, I can't do that.
Some people are going expect me to be able to do that. And now I'm doing it. But it took time to feel comfortable. And people were so gracious at ADCES, at ADA. And seeing other pharmacists and talking to other pharmacists is like explaining to them, we're coming from the same place. So was like, how do you learn how to do these things? And putting it in a context or framework that I could understand.
And now I'm doing that and I'm showing other people and I'm again trying to be the mentor for them that the mentors were for me to help me to overcome those roadblocks and different people have different roadblocks as well. telling them my story and then asking what their roadblocks are and asking how I can help has been rewarding.
Patrick
Yeah, I love that it takes planning, guidance, support. The only thing I would add to that is courage. You had the courage to kind of bring all that together and be open for that change. And now you're really giving back, it sounds like, to becoming a mentor or offering to be a mentor. And hopefully your students are listening to this and being like, all right, now I finally heard it. Not just in the classroom, not just in this way, on this podcast, I'm going to sign up. So hopefully that will be a new thing that will be coming to you soon. So as we kind of turn from roadblocks, and we started thinking about this kind of specialty in this career, what were some unexpected joys or happy surprises you discovered in this specialty?
Mayra
Well, I think one of my biggest, happiest surprises for me was that sense of community and belonging that I found with ADCES. When I first pursued the certification, you could say I saw it as a professional step. I wanted to deepen my knowledge to better serve my patients. What I didn't expect was that it would become such a professional home for me. So through ADCES, I've connected with colleagues and mentors like Liseli, who not only inspire me, but encourage me and help me grow. What's also been incredibly meaningful is seeing the impact that we can have when we work together. Being surrounded by professionals who have all these different backgrounds, like your dieticians, your nurses, your pharmacists, social workers, other advanced practice providers, and now even physicians, has been truly inspiring. We're all bringing different training, different perspective, different strength.
But at the heart of it, we share that same passion, which is to improve the lives of people living with diabetes. And I truly believe, Patrick, that when you bring together a group of people united with that kind of purpose and passion, something powerful happens. It's that collective energy, that shared commitment that allows us to create change far beyond what any of us could do or accomplish alone. So I think that to me has been such a gift and truly one of the happiest surprises of this journey.
Liseli
Yeah, for me, part of it has been the impact that I've been able to make with patients. And the more I learn, the more I can share and see, you know, light go off in someone's eyes or they really understanding and working more towards culturally appropriate and linguistically appropriate care, specifically with diet. When I first started out, we only had the one healthy plate and working with a multidisciplinary team and also as we're learning more about health equity, seeing how important it is to provide culturally appropriate and specific dietary options where people like I can still eat my traditional foods. I can still eat these foods that I grew up with. Just giving them tips and tricks about how to make them healthier has been a game changer for so many and source of joy.
For me to be able to share with people the happiness in someone's eyes. There's a grandparent who was from Hawaii and giving them a native Hawaiian Pacific Islander healthy plate. Another person, was in Samoan. So one side was in Samoan, the other side was in English. And he was looking at, he's like, this is in Samoan. These are the foods that I love. I can still eat them. I'm so happy. And that made me so happy. And to be able to bring some joy into that work and food is joy, family is joy. So to be able to continue with that joy and still be healthy to me just brings me joy. And having pharmacists and mentors give me tips and tricks on how to include the diabetes teaching and education into a busy pharmacist's day.
And sometimes I have 30 minutes and sometimes I have five minutes and other people only have five minutes. What can you do in five minutes that's going to make the most impact? And being able to share that with colleagues continues to bring me joy. Happy surprises.
Patrick
I love that, Liseli. Sometimes working with the patients, you're just one-on-one with them, but you're really finding the joy in food and family and all their supports and treating them as their full person, their whole being, their whole authentic self. And I love that. could definitely hear it in your voice in the sense of like, it's in Samoan. You know, you can definitely see that with a patient, you it's like you understand me and really breaks down some of those barriers that might be happening there or in that way. So I love that story. And we talked a little bit about the unexpected joys.
What aspects of your work, being a certified diabetes care and education specialist, feel most rewarding right now? Is it that connection with the patients or your members kind of working on that? Or is there other parts that is most rewarding for you right now?
Liseli
I would say both connecting with patients but also connecting with other colleagues, sharing research at conferences, but also sharing information one-on-one and with the community. So I do a lot of community outreach. I will give lectures at senior centers and with national and local organizations to share about how individuals can be more healthy in their lives and either prevent diabetes or better manage their diabetes, working in a free clinic. So one-on-one and populations on the patient side and on the healthcare colleague side. Both of them are so rewarding to me. I love being in community with my colleagues and with my patients and that sharing on a community level. So it's also having to translate in my brain. I'm talking to laypeople now, I'm talking to colleagues and remembering to not use gobble de-gock when I'm talking to my patients. It's been a blessing and a joy.
Mayra
To definitely echo with a few of the things that Liseli expresses. I can just see the joy in how much she's found rewarding in this career. And I can share very similar things, but to me, it's also been realizing that I didn't have to fit in a traditional model. I've learned throughout these years that I can blend clinical care, education, leadership, and even research, how Liseli mentioned, into a career that feels truly special and to have that freedom to continue to grow and evolve has been incredibly meaningful and rewarding. The most rewarding thing I have to say is the moments when education, you can see that it just changes someone's trajectory in someone's care. Like Liseli mentioned earlier, when your patients feel that they're being heard, that they're being understood, and now that they understand their chronic condition and they see it in a way that's gonna be empowered, that they don't longer have to be ashamed of it or seeing it as something negative. Like they're gonna embrace it. And it's not just about also helping your patients, but also other clinicians who wanna feel more confident about managing such a complex case. Working with nurse practitioners, leaders in academia has been one way that I also wanna make sure that I inspire them, encourage them to continue helping those living with diabetes. And even as a simple process, like we can be part of it.
Improving a workflow that can help even deliver care that's more effective. That's also been very rewarding to see. Those are the moments when we see that knowledge, you know, turns into that confidence, you know, prevention that we always strive for that leads to those better outcomes that we want to see with our patients and within our community as well. I guess when it comes to outreach, very similar to Liseli, I really prioritize education that is accessible, culturally responsive, you know, I'm Hispanic. The area where I practice and serve in South Texas, we are 90 % or more. The area there is Hispanic. And also that education that is grounded in real life needs. That includes that interdisciplinary education, know, mentoring other clinicians who want to grow and become experts in diabetes care, and especially reaching those underserved communities.
I'm very passionate about reducing barriers too. think that's very important. Helping people receive diabetes education early on, not just after complications have developed. Because when we reach people sooner and provide the right support and tools, I believe that's truly when change can happen.
Patrick
Thank you, Mayra. At the end of the day, I love the sense of with this specialty, you're able to improve the systems, improve those workflows, reducing those barriers. Everyone's lighting up and connecting with patients and seeing them. So it's not just the one-on-one, but being able to offer those quality improvement aspects of it and, again, reducing those barriers. That is great. From your perspective, how has this specialty evolved since you began? Are there any emerging trends or shifts that you think that the next generation of certified diabetes care education specialists should be paying attention to, with your expertise and knowledge in the field.
Liseli
The thing for me has been the name change. When I started out, it was certified diabetes educator, or CDE, and now it's certified diabetes care and education specialist, which makes sense because we were doing more than just educating. We were supporting and helping with prior authorizations and ordering labs and things like that. So yes, as a diabetes care and education specialist, really encompasses more of what we're doing, but having to translate that for other people, it's like, you know, on my CV, on my LinkedIn, it's like, formally known as CDE, you know, just so people understood that it was the same thing. And also that there's more pharmacists now in the field than there were when I started out. And I love the interdisciplinary aspect of it, but it's also nice to connect with people that are coming from a similar background to me, but also had similar roadblocks. So they can better assist me in getting around certain things like I don't have a lot of time, how do you do it in the short amount of time? So that's been the changes that I'm seeing in the field. And also I feel like more providers are understanding the benefits that a DCES can provide for their patients.
And I'm also seeing more interest in folks wanting to become a DCES and asking me about that and wanting me to come and talk to their patients and also educate their staff so they can do some of it as well. So that's been the changes I'm seeing, positive changes.
Mayra
I recall that moment, Liseli, when the name changed. It took me a while to pronounce it correctly and remember the new abbreviation, so I agree with you. But since that time, looking back, I've seen that our specialty has definitely changed a lot since I first entered it. Early on, diabetes care, I feel, was very task-focused, structured. You were looking at patients, finger-sick, glucose monitoring.
They're focusing on targets, teaching people what to do and how to eat. Today, it's much more individualized, collaborative, and truly patient-centered. I think one of the biggest shifts has been moving from a visit-based education to having that ongoing support. We now recognize that diabetes is lived 24-7, and education really has to meet people where they are, across different life stages, cultures, and levels of readiness.
So that shift in mindset has really transformed, I think, how we deliver care. Another major change I want to say is that explosion of diabetes technology and AI now. Tools like CGMs, insulin pumps, remote data sharing have moved us from a reactive care, I think, to a more proactive care model. We're no longer waiting three months to adjust therapy based on a patient's A1C level. We're actually now using real-time data to guide those decisions, to be able to personalize our patients' care plans, and definitely prevent complications earlier. As we know, with growth in technology, also comes the need for even stronger and more efficient education. So I love data. I think it's powerful. But only if patients and clinicians know how to use it, how to interpret it, and especially how to be used effectively. So.
We're seeing a lot with technology, having to educate our elderly population on what these technology tools are, how they're going to improve their care has been such a big aspect of my care currently. So I think emerging trend that it's just more than technology. It's really integrating that technology with the education, the behavioral support, and that interdisciplinary collaboration that we have as specialists.
Patrick
You talked about some emerging trends for this and the evolving specialty. Where do you see opportunities right now for maybe someone starting their career or new opportunities in that way? You of mentioned technology, AI, other parts in that way, but what other opportunities for our specialty kind of going forward?
Mayra
Right now, I think there's so many opportunities in the field right now. It's actually really exciting time to join. One of the biggest opportunities we mentioned earlier was about that interdisciplinary collaboration, interdisciplinary care. As we know, diabetes is complex. It incorporates in so many different components that it's difficult and very time consuming if we want to do it alone. So there's real opportunity for us to serve as that bridge across the different care teams, you know, helping coordinate, translate, and align that care between patients, know, primary care providers, the specialists, the pharmacists, the dieticians, social workers, and even community programs, and even population health models, and all kinds of see how we integrate together. I know I talked about technology, something that I'm very passionate about too, but that also opens up major opportunities.
With CGMs, remote monitoring, data-driven care is becoming more common. So there's growing demand for professionals who can help patients and our care teams interpret that information and actually turn it into meaningful action. So as I mentioned earlier, technology is powerful, but it's the education behind it that really, truly drives outcomes. So overall, I think the opportunity right now is to position ourselves not just as educators, but also as leaders, as experts who shape programs, influence care models, advocates for patients, and help system deliverers become better, more coordinated care for those living with diabetes. And to me, I think that's an incredible opportunity to make a real and lasting impact that we have right now.
Patrick
Well, that's great. With that ongoing support that we're going to be needing with all these new opportunities for that. So, Liseli, as a pharmacist, as a teacher, all that, where do you see new opportunities in this space?
Liseli
I agree with Mayra in that the technology is definitely a new opportunity for us to better take care of patients, but the individualization of the education is key. I even had a patient two days ago who said she doesn't like the CGM because she likes to sleep on her side. And sleeping on the CGM is not something that was working for her, and she liked to sleep on both sides, so it's not going to work because she has to put it on her arm.
So what about your stomach area? she's like, I don't like, she just doesn't like having things on her, but she's willing to prick her finger. So the technology is key, but it's also individualization because not everybody wants to use it. Not everybody feels comfortable using it, but as educators and specialists, we can provide that necessarily support and also dig a little bit deeper. The note just said, patient declined. Didn't explain why patient declined.
So digging a little deeper, say, what are some other options for you? So she might consider maybe putting it on her stomach area that she might be OK with one of the devices that would go there versus on her arm. She's still deciding whether or not she's comfortable, but supporting her in the way that she needs. As a pharmacist, looking for the opportunities to do education, sharing with other pharmacists that it is a possibility, maybe talking to pharmacy residents.
We have a residency program here at our hospital and offering that opportunity. If you would like to become a DCES, I can be your mentor. I can support you. Clipper Young, who is a pharmacist with ADCES who has been very active in the organization, is looking at setting up a fellowship at Touro University for pharmacists to become fellows in diabetes. But the initial part would be if you're not a DCES, to become a DCES and then practicing in a clinic.
Showing them how you can use this credential to better support, not just educate, but support and lead in the field with our patients with diabetes. So, exciting times. Looking forward to going along for the ride.
Patrick
More to come, more to come. So I'd love to know any of your kind of final thoughts or as you reflect on your journey, what would you say to someone who feels the pull towards this work, but maybe isn't, you know, quite sure if they're ready yet or what would you like to really share with the listeners?
Mayra
If I could leave our listeners with one thing, it would be this. Don't underestimate the impact you can have. Whether you're just starting out or you have been in the field for years, your perspective really matters. There is definitely a space here for you to grow and to lead. Becoming a certified diabetes care and education specialist has been one of the most meaningful decisions of my career. It's helped me serve patients better, be able to collaborate more closely with others and ultimately become the provider that I always wanted to be. So if you're out there and you're considering this path, lean into it. Keep learning, stay connected, get involved, say yes to opportunities. And even the ones that feel a little uncomfortable at first, trust me, that's where the growth happens. And be part of shaping the future of diabetes care.
Liseli
I would definitely mirror what Mayra says and kind of just take a book out of considering the Olympics are happening right now. It's like Nike says, just do it. Jump in there. Go down that hill. It's going to be an amazing ride. And it starts with one step. So take that first step. Reach out to organizations like ADCES. Reach out to folks in your community. If you see that somebody has the DCES certification after their name,
ask them, reach out and ask them what they recommend as to your first steps. That's what I did and that's how I got started. I would also say we need to try to advocate politically to remove the barriers to access to technology, to access to care, to access to the newest diabetes medications for all of our patients. We have so many patients in this country and around the world that do not have access to the most effective diabetes care and support. And that would be a game changer. Diabetes wouldn't be a death sentence for some. It wouldn't be weighing on the cost of the country, of the world. So there's one step at a time, but political will and human will to try to bring down those barriers and maybe get rid of prior authorization requests.
Patrick
Well, thank you, Mayra and Liseli, for sharing your stories with us today. Thank you everyone for listening to this episode of Diabetes Care Conversations and engaging with ADCES. Remember ADCES memberships provide access to valuable resources, continuing education, meaningful networking opportunities to support you in every stage of your career. To learn more about the many benefits of membership, visit adces.org/join or adces.org/JOIN.
And I just want to leave you with: every diabetes care and education specialist has a story. Yours is still being written. Keep learning, keep leading, keep showing up to the people in your community who need you. And we'll see you next time on Diabetes Care Conversations.