For our January 19th Question of the Week, over 77% of respondents chose the best answer!

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:

MT is 59 and her most recent A1c was 10.3%. The diabetes specialist suggested they add insulin to her other 3 oral diabetes medications to lower A1c.  MT was not ready for insulin, so the specialist agreed that they would try adding on glipizide 5mg BID and evaluate the response for one month.

After 2 weeks, MT calls and is very upset about her frequent low blood sugars (66, 68, 69) that are happening between 3 pm and 6 pm a few times a week.  MT works in the field starting at 5 am and gets her lunch break at 10 am and eats her dinner again at 6 pm. 

Which of the following is the best recommendation?

Answer Choices:

1. Hold the glipizide for one week
2. Make sure MT has a glucagon emergency kit in the field
3. Inform her that she is protected under the American Disabilities Act
4. Encourage a 2 pm carbohydrate snack

---

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

Getting to the Best Answer

If you are thinking about taking the certification exam, the content of this practice test question will set you up for success.

Answer 1 is incorrect 10.94% chose this answer. “Hold the glipizide for one week.” Since MT had a very elevated A1c of 10.3%, holding the glipizide for a week could lead to a dangerously elevated blood glucose. A more nuanced intervention is required.

Answer 2 is incorrect 9.06% of you chose this answer. “Make sure MT has a glucagon emergency kit in the field.” MT doesn’t need a glucagon emergency kit at this point. Since MT can detect the signs hypoglycemia, they just need instruction to eat a 15gm carb snack to treat these symptoms and avert a hypoglycemic emergency.

Answer 3 is incorrect 2.22% of you chose this answer “Inform her that she is protected under the American Disabilities Act (ADA).” It is important for people with diabetes to know that they are protected under the ADA. They have the right to monitor their blood glucose, take medications/insulin at work and take a break to treat hypoglycemia. However, this is not the best answer.

Answer 4 is correct 77.78% of you chose this answer. “Encourage a 2 pm carbohydrate snack.” Since MT is having is having low blood sugar consistently between 3pm and 6pm, we do some investigation and find out the MT is not eating for up to 8 hours. For people taking sulfonylureas, like glipizide, they need to eat every 4-5 hours to match the extra insulin the pancreas is producing in response to the glipizide. A 15 gm snack at 2pm would be a perfect solution to prevent hypoglycemia and allow MT to continue taking the glipizide to keep blood glucose levels on target.

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 fun learning activity!

---

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!

[yikes-mailchimp form=”1″]

Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*

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.