Our September 28th Question of the week quizzed test takers on the best strategy to prevent hypo in the hospital. 64% of respondents, chose the best answer. We are excited to share info so you can pass on helpful info to people living with diabetes and your hospital colleagues.

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: As a diabetes specialist at a local hospital, one of your quality improvement goals is to prevent nocturnal hypoglycemia.

Which of the of following policy changes would most likely lower rates of overnight and morning hypoglycemia?

Answer Choices:

• Make sure the medication carts are stocked with glucagon rescue kits.
• Eliminate insulin sliding scale and encourage basal insulin therapy.
• Collaborate with dietary to make sure all people with diabetes get protein plus carb snack.
• Implement a plan to decrease basal insulin dose if morning glucose is less than 100 mg/dl.

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

Getting to the Best Answer

If you are thinking about taking the certification exam, it is helpful to know the goals of care and considerations for people with diabetes in the acute care setting. This practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” that seem so familiar to you, right under your nose. Your job is to weed through the to choose the BEST answer.

Answer 1 is incorrect. 2.88% chose this answer, “Make sure the medication carts are stocked with glucagon rescue kits.” Since the question is asking “what policy changes would most likely lower rates of overnight and morning hypoglycemia“, this is answer does not address the problem in the question; what policy change would PREVENT hypoglycemia. Having glucagon rescue meds would treat hypoglycemia, but not prevent it.

Answer 2 is incorrect. 14.12% of you chose this answer, “Eliminate insulin sliding scale and encourage basal insulin therapy.” It is true that the ADA does not recommend insulin sliding scale for inpatient management of diabetes since it is not an effective way to manage hyperglycemia. In addition, since sliding scale is usually administered with meals, it is not the most likely culprit causing morning hypoglycemia. Generally speaking, too much basal insulin is usually the cause of morning hypoglycemia. So stopping the sliding scale and encouraging basal insulin, is not the BEST answer to address the question and reduce morning hypoglycemia.

Answer 3 is incorrect. 19.22% of respondents chose this answer, “Collaborate with dietary to make sure all people with diabetes get protein plus carb snack.” Studies have shown that providing a carb snack at bedtime can decrease risk of nocturnal and morning hypoglycemia. But, if the basal insulin dose is too much, the person could still experience hypoglycemia, even with a carb snack. P.S, adding protein has not been shown to sustain the action of the carb and enhance hypoglycemia prevention. We never want to “feed” the insulin. We always want to give the least amount of insulin to get glucose to target and keep people safe.

Finally, Answer 4 is correct. 63.78% chose this answer, “Implement a plan to decrease basal insulin dose if morning glucose is less than 100 mg/dl.” YES, this is the BEST Answer. GREAT JOB. To keep inpatients safe, creating a policy that notifies the medical team when the morning glucose level is less than 100 mg/dL coupled with a reduction of basal insulin dose, would be an effective strategy to prevent morning hypoglycemia.

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!

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In addition to informative lectures, we also use group activities and case studies to highlight the essential knowledge, skills, and strategies needed to succeed in diabetes education today!

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Program Info: 2021 Diabetes Educator Course Flyer & Schedule (subject to change)
Speakers: View Conference Faculty.
Dates: Your registration fee includes access to FREE podcast and all recorded webinars for one year.

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2021 Diabetes Educator Course Flyer & Schedule (subject to change)

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Team of Experts: Our team of expert faculty has been fine-tuning this course for over fifteen years and we know what you need to succeed! In addition to informative lectures, we also use group activities and case studies to highlight the essential knowledge, skills, and strategies needed to succeed in diabetes education today!

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Bonus Courses worth 12+ CEs, FREE

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• Test Taking Toolkit – Over 200 sample test questions!
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• Level 2 – Hyperglycemic Crisis, DKA and HHS Standards 1.0 CEs
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• Level 2 – Pregnancy and Diabetes 1.5 CEs
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2021 Diabetes Educator Course Flyer & Schedule (subject to change)

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