For last week’s practice question, we quizzed test takers on the cause of JR’s leg pain. 67% of respondents chose the best answer. We want to share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question

Question: JR is experiencing lower extremity pain and asks to get their gabapentin (Neurontin) renewed? When asked, JR says the pain is so bad in their calf muscles when walking, that they have to sit down and rest. What best describes the cause of JR’s pain?

Answer Choices:

• Loss of protective sensation (LOPS).
• Peripheral arterial disease (PAD).
• Autonomic neuropathy.
• Small nerve fiber neuropathy.

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As shown above, the most common choice was option 2, the second most common answer was option 3, then option 4, and then finally option 1.

Getting to the Best Answer

Answer 1 is incorrect. 4.72% chose this answer, “Loss of protective sensation (LOPS).” This is a juicy answer because people with neuropathy and loss of protective sensation are often prescribed gabapentin to treat nerve pain. However, when we learn that JR’s calf pain only occurs when walking, we experience an “ah-ha” moment.  The cause of JR’s pain is lack of arterial blood flow to the lower extremities, also known as peripheral arterial disease (PAD).  The classic symptom of PAD is pain in calf muscles or buttocks when walking that is relieved by stopping.  Neuropathy is most often described as burning pain in lower extremities that is often worse at night.

Answer 2 is correct. 66.94% of you chose this answer, “Peripheral arterial disease (PAD).” JR is experiencing lack of arterial blood flow to the lower extremities, also known as peripheral arterial disease (PAD).  A classic symptom of PAD is pain in calf muscles or buttocks when walking that is relieved by stopping. Perhaps JR was prescribed gabapentin due to an incomplete medical assessment. With this new information, we can collaborate with the provider to see if referral to a vascular specialist is warranted to evaluate if further intervention is needed.

Answer 3 is incorrect. 14.33% of respondents chose this answer, “Autonomic neuropathy.” Autonomic neuropathy in people with diabetes does not cause lower extremity pain.  Lower extremity pain is due to small and large nerve fiber destruction or peripheral arterial disease (PAD).  People with autonomic neuropathy and diabetes are at higher risk of gastroparesis, sexual dysfunction, resting tachycardia and a myriad of other conditions.

Finally, Answer 4 is incorrect. 14.01% chose this answer, “Small nerve fiber neuropathy.” This answer is tempting because people with small nerve fiber neuropathy are often prescribed gabapentin to treat nerve pain. However, when we learn that JR’s calf pain only occurs when walking, we experience an “ah-ha” moment.  The cause of JR’s pain is lack of arterial blood flow to the lower extremities, also known as peripheral arterial disease (PAD).  The classic symptom of PAD is pain in calf muscles or buttocks when walking that is relieved by stopping.  Small nerve fiber neuropathy is most often described as burning pain that is often worse at night. 

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this important learning activity!

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Want to learn more about this question? 

Watch our Lower Extremity Assessment Standards | Level 2
$29 for 1.5 CEs

Recorded & Ready to Watch!

People with diabetes are at increased risk of Lower Extremity Complications. This course reviews the steps involved in performing a detailed assessment of the lower extremities, including how to use a monofilament and tuning fork to detect neuropathy. We also discuss the significance of Ankle Brachial Index and strategies to prevent lower extremity complications.

Objectives:

1. Describe the risk factors for lower extremity complications
2. Discuss prevention strategies
3. Demonstrate steps involved in a lower extremity assessment

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Virtual DiabetesEd Specialist Conference
30+ CEs | April 13-15, 2022

Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.

 Download Course Schedule |  Download Course Flyer

If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.

Join us LIVE for this Virtual Course and enjoy a sense of community!

Team of expert faculty includes:

• Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
• Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
• Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator

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Two Registration Options

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Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

• Q & A Session with the instructor after each webinar.
• LIVE Presentations by our team of experts.
• State of the art review of current diabetes care and technology.
• Resources for each session.
• Access to free podcasts and video recordings within a week of each live session for one year.

Deluxe Version includes Syllabus, Standards and Swag*:

• Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
• ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
• DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

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Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

• Q & A Session with the instructor after each webinar.
• LIVE Presentations by our team of experts.
• State of the art review of current diabetes care and technology.
• Resources for each session.
• Access to free podcasts and video recordings within a week of each live session for one year.

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

All hours earned count toward your CDCES Accreditation Information

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Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

Having diabetes is a lot of work. We ask participants with diabetes to change their eating habits, drink water, move more, take a bunch of medications and attend diabetes classes plus see providers on a regular basis. In addition, we collaborate with and encourage them to get their ABC’s (A1C, Blood pressure, Cholesterol) to target.

Is worth all the work?

The short answer is YES. Making these hard fought behavior changes can add years to one’s life.

A recent study published in the JAMA Network last month suggests that people living with Type 2 Diabetes can increase life expectancy by reducing 4 risk factors and hitting specific metabolic targets.

This study evaluated life expectancy increases among 421 people living with type 2 diabetes for those who reduced A1C, systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), and body mass index (BMI) with each biometer goal was broken into quartiles.

A message of hope

Providers can shine a light on these findings to encourage people with diabetes to make those difficult behavior changes, and to keep working at it when the going gets tough. Their efforts do make a difference in improving life expectancy and daily quality of life.

Reducing A1C

Participants who reduced their A1C saw the highest increase in life expectancy compared to the other biometers. For those with the highest A1Cs, lowering their levels added years to their life expectancy.

• Fourth Quartile – The individuals who were able to bring their A1C’s down to 5.9% that started in the highest quartile at an average of 9.9% saw an average of 3.8 years added to their life expectancy.
• Third Quartile – Those who brought it down to 7.7% from 9.9% in the third quartile saw an average 3.4-year gain.
• Second Quartile – Participants in the second quartile with a change of 7.7% to 6.8% only saw a 0.5-year change in life expectancy.
• First Quartile – No change in life expectancy was seen for those in this quartile who went from a 6.8% HbA1c down to 5.9% HbA1c.

Lowering Systolic Blood Pressure

Lowering blood pressure added just over a year to the participant’s life expectancy.

• Fourth Quartile: The average baseline blood pressure was 160.4 mm Hg
• Third Quartile: Participants with a 139.1 mm Hg saw 1.1 years gained in life expectancy.
• Second Quartile: A 128.2 mm Hg was associated with a 1.5-year gain in life expectancy.
• First Quartile: The highest increase in life expectancy for blood pressure was for those at 114.1 mm Hg with a 1.9 year gain.

Lowering LDL Cholesterol

Participants with lower LDL cholesterol, saw a change in life expectancy by a few months.

• Fourth Quartile: The baseline was 146.2 mg/dL.
• Third Quartile: Those who had a 107.0 mg/dL saw a half-year increase in life expectancy.
• Second Quartile: Those who had an 84.0 mg/dL saw a 0.7 year gain in life expectancy.
• First Quartile: Individuals who had a 59 mg/dL saw a 0.9-year gain in life expectancy.

Lowering Body Mass Index

Participants who were able to decrease their BMI saw a increased life expectancy by a few years.

• Fourth Quartile: The baseline BMI was 41.4 (fourth quartile) with the lower three quartiles seeing a change in life expectancy.
• Third Quartile: For individuals with a BMI of 33.0, they saw an additional 2 years of life expectancy
• Second Quartile: Those who had a BMI of 28.6 saw an additional 2.9 years of life expectancy
• First Quartile: Those living with Type 2 with a BMI of 24.3 see an additional 3.9 years of life expectancy

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Smoking cessation also had an impact with 0.7 years added for women aged 50 to 60 years and 1.1 years for men aged 70 to 80 years of age.

Overall, we hope this news brings hope to those living with Type 2 diabetes and improves care knowing that reaching these goals can extend their lifetime.

To read more click here and here.

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Join us live next Tuesday and Thursday as we continue our Level 2 – Standards of Care Intensive live updates! Read more and enroll below.

 

Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

Are you Preparing for the BC-ADM Exam?
We have some exciting exam updates to share.

Join Coach Beverly, Thursday, April 7th at 11:30 am PST for everything you need to know to prepare!

Becoming Board Certified in Advanced Diabetes Management (BC-ADM) provides an opportunity for diabetes specialists with an advanced degree in their field (plus a professional license as an advanced practice nurse, registered dietitian, registered pharmacist, or provider) to increase the breadth and depth of their diabetes knowledge. The scope of advanced diabetes practice includes management skills such as medication adjustment, medical nutrition therapy, exercise planning, counseling for behavior management, and psychosocial issues.

Attaining optimal diabetes management includes using a person-centered approach coupled with assessment, screening, management, and monitoring of acute and chronic diabetes co conditions. This webinar will review changes in requirements for 2021, exam eligibility and test format, strategies to succeed along with a review of study tips and test-taking tactics. We will review sample test questions and the reasoning behind choosing the right answers. We hope you can join us for this webinar.  

Can’t join us live? No worries! Registrants get a priority notification and a link to the recorded version within 24 hours.

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Join our Virtual DiabetesEd Specialist Conference
30+ CEs | April 13-15, 2022

Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.

If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.

 Download Course Schedule |  Download Course Flyer

Join us LIVE for this Virtual Course and enjoy a sense of community!

Team of expert faculty includes:

• Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
• Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
• Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator

---

Two Registration Options

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Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

• Q & A Session with the instructor after each webinar.
• LIVE Presentations by our team of experts.
• State of the art review of current diabetes care and technology.
• Resources for each session.
• Access to free podcasts and video recordings within a week of each live session for one year.

Deluxe Version includes Syllabus, Standards and Swag*:

• Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
• ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
• DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

---

Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

• Q & A Session with the instructor after each webinar.
• LIVE Presentations by our team of experts.
• State of the art review of current diabetes care and technology.
• Resources for each session.
• Access to free podcasts and video recordings within a week of each live session for one year.

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

All hours earned count toward your CDCES Accreditation Information

---

Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.