Our October 19th Question of the week quizzed test takers on a person who is clearly in crisis. 36% of respondents, chose the best answer. We feel it is important to share this rationale of the week, so you can advocate for people struggling with mental health while trying to manage their diabetes.

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 26 years old with newly diagnosed diabetes.  JR keeps missing appointments and when you finally get a hold of them on the phone, they start crying and say “my life is a mess”.  JR is struggling with addiction, periods of houselessness and extra weight in addition to diabetes.

Based on this information, what is the most likely barrier to JR engaging in self-care?

Answer Choices:

• Adverse Childhood experiences (ACEs)
• JR is struggling with depression
• Diabetes distress is at the core of the listed behaviors
• Grieving and denial of diabetes diagnosis

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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, it is helpful to know the goals of care and mental health considerations for people with diabetes . 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 correct. 36.25% chose this answer, “Adverse Childhood Experiences (ACEs).” YES, Good job, this is the BEST Answer. JR is missing appointments and when you finally get a hold of them, they say, “my life is a mess”.  In addition, we know that JR is struggling with addiction, periods of houselessness and extra weight in addition to diabetes. These are all signs that JR has lived through adverse childhood experiences and toxic stress. By addressing this and providing resources, we can help JR move toward healing. See our ACE Resource page for more info.

Answer 2 is incorrect. 28.11% of you chose this answer, “JR is struggling with depression.” Is this situation, depression can be considered, but we don’t hear the hallmark statements associated with depression – “Loss of pleasure in things that used to bring them joy or feeling down or hopeless”. ACE’s are a better match for what JR is describing. See our Psychosocial Care Resource Page– for articles and screening tools.

Answer 3 is incorrect. 19.35% of respondents chose this answer, “Diabetes distress is at the core of the listed behaviors.” Is this situation, diabetes distress certainly can be considered, but it doesn’t seem to be the driving force behind JR’s struggle with addiction, periods of houselessness and extra weight. Diabetes distress is more heavily associated with diabetes specific related behaviors (fear of hypo, provider doesn’t understand my diabetes, etc.). See our Psychosocial Care Resource Page– for articles and the diabetes distress screening tool.

Finally, Answer 4 is incorrect. 16.29% chose this answer, “Grieving and denial of diabetes diagnosis.” Is this situation, grieving and denial can certainly can be considered, but it doesn’t seem to be the driving force behind JR’s struggle with addiction, periods of houselessness and extra weight. Diabetes denial is more heavily associated with lack of self-care; not checking blood glucose, avoiding medications, eating “whatever”. We don’t hear any of that from this person. The best explanation is that JR has lived through adverse childhood experiences and toxic stress. By addressing this and providing resources, we can help JR move toward healing. See our ACE Resource page for more info.

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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Want to learn about this important topic?

Join Coach Bev for an honest conversation on
The Impact of Adverse Childhood Experiences on Health

Topics include:

• Discuss the benefits of assessing Adverse Childhood Experiences (ACE) in individuals with diabetes.
• State the relationship between ACE Scores and risk of future health complications.
• Describe a person-centered approach to fostering resilience and self-care for individuals with toxic stress.
• Identify two strategies to provide trauma-informed care in your work setting.

2 Ways to Join the Webinar

This includes access to the recorded version of this webinar on your Online University Student Portal and 1.0 CE.

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Intended Audience: This course is a knowledge-based activity designed for individuals or groups of diabetes educators, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other health care providers interested in enhancing their diabetes medication knowledge.

Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator and a nationally recognized diabetes expert.

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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.