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For our July 20th Question of the Week, 78% of respondents chose the best answer. GREAT JOB! We want to “take a closer look” at this question and determine strategies to choose the best response.
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 1: LS is 26 weeks pregnant and just discovered she has gestational diabetes. LS asks you what type of meal planning approach will help keep her and the baby healthy.
According to the ADA Standards of Care, what is the most accurate response?
Answer Choices:
As shown above, the most common choice was option 1, the second most common answer was option 2, then option 3, and finally option 4.
If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. Being familiar with diabetes self-management guidelines and considerations during pregnancy is critical for exam success. If you don’t work with people with diabetes during pregnancy, I encourage you to be familiar with the ADA Standard on Diabetes and Pregnancy and to consider joining our online course for a 1.5 hour painless summary of this standard (see below). Lastly, don’t forget to leverage your common sense and vast health care knowledge to get to the best answer for these specialty topics. Coach Beverly
Answer 1 is correct, 78.69% chose this answer, “To promote healthy fetal development, consume about 175 gms of carb a day.” GREAT JOB. According to the ADA Standard on Diabetes and Pregnancy, the food plan during pregnancy is individualized based on a nutrition assessment with guidance from the Dietary Reference Intakes (DRI). The DRI during pregnancy recommends a minimum of 175 g of carbohydrate, a minimum of 71 g of protein, and 28 g of fiber, with an emphasis on monounsaturated and polyunsaturated fats while limiting saturated fats and avoiding trans fats. All people with diabetes during pregnancy need to meet with a RD/RDN for specific guidance and recommendations.
Answer 2 is incorrect, 15.99% of you chose this answer, “Try to eliminate simple carbohydrates to decrease the risk of reactive hypoglycemia.” This is a juicy answer. It is true that eating less simple carbs, including processed foods and beverages, is a good idea before, during and after pregnancy. However, the second part of the answer makes this response incorrect for two reasons; the term “reactive hypoglycemia” is not a generally accepted diabetes term in this context and eliminating simple carbs would potentially increase the risk of hypoglycemia.
Answer 3 is incorrect, 3.02% of you chose this answer, “Consume the majority of carbs in the morning when you are most insulin resistant.” Part of this answer is correct. During pregnancy, many people are more insulin resistant in the morning. But, if a person is more insulin resistant in the morning, they would decrease the consumption of morning carbs to prevent post breakfast spikes.
Answer 4 is incorrect, 2.31% of you chose this answer “Eat no more than one serving of fruit a day to prevent hepatic fructose toxicity.” During pregnancy, incorporating a variety of fruits in the meal plan is a great idea, since they are packed with micronutrients, vitamins and fiber. They are carbohydrates and will increase blood sugars, so portion size and timing are important to consider when working them into the meal plan.
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!
Want to learn more about this topic? Enroll in our
People living with diabetes who are pregnant are confronted with a variety of issues that require special attention, education, and understanding.
This course reviews those special needs while focusing on Gestational Diabetes and Pre-Existing Diabetes. Included are the most recent diagnostic criteria, management goals, and prevention of complications during pregnancy. A helpful review for the CDCES Exam and for those who want more information on people who are pregnant and live with Diabetes.
Topics include:
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!
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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.
I felt pretty discouraged reading through the New England Journal of Medicine (NEJM) summary of the state of diabetes treatment and control in the U.S. from 1999-2018. We have stalled in improving diabetes outcomes in spite of exciting new therapies and dazzling technologies.
Based on this “Diabetes Report Card” for the U.S it seems pretty clear that changes in our care delivery system are urgently needed. First, let me share the data, then we consider how Diabetes Care Specialists (you and me) can drive the improvement arrow in the right direction.
The data summarized below is extracted from the National Health and Nutrition Examination Survey (NHANES) which assesses national trends in diabetes care and outcomes for the past decade.
Summary of the major findings of the Diabetes ABC’s. A1C, Blood Pressure and Cholesterol.
Data is compared from the 2007 -2010 period to the 2015-2018 time period.
Reaching A1c Target of less than 7%?
Coach Bev’s Report Card Comment: Blood glucose levels trended up. GRADE C-
Reaching LDL target of less than 130 mg/dL?
Coach Bev’s Report Card Comment: Lipid levels improved slightly. GRADE B-
Reaching blood pressure goal of less than 140/90 mm Hg?
Coach Bev’s Report Card Comment: Blood pressure control achievement dropped slightly. GRADE C-
The percent of participants who achieved all 3 targets of A1C, BP, and lipids?
Coach Bev’s Report Card Comment: ABC’s of diabetes control dropped slightly. GRADE C-
Data and Graph from Trends in Diabetes Treatment and Control in U.S. Adults, 1999–2018 | NEJM
The year 1999 got off to a good start with improved diabetes control but stalled and declined as the decade moved forward. There are several possible reasons as cited by the authors.
Sluggish initiation of first-line therapies. In 2015–2018, only 56.3% of adults with diabetes were using statins, 59.5% were using metformin, and 60.3% were using an ACE inhibitor or ARB.
These results are consistent with those of previous studies and point to clinical inertia as a potential culprit.
In addition, achieving glycemic and blood-pressure control often entails the use of multiple agents. However, the study found that only 60.6% of participants with an A1C level of 7% or higher and 52.8% of those with a blood pressure of 140/90 mm Hg or higher were treated with more than one glucose-lowering or blood-pressure-lowering medication, respectively.
Coach Beverly suggested action: Diabetes Care and Education Specialists can continue to raise awareness of the ADA Standards of Care for Diabetes and advocate for initiating first-line and add-on therapies in their work settings. Plus, we can encourage a streamlined referral process to facilitate participant access to DSMES and to RD/RDN for initial and ongoing lifestyle and nutrition counseling.
Care Gaps for Young People, Ethnic Groups and Uninsured Populations
The study found that younger people, Mexican Americans, and persons without health insurance were more likely to be untreated when risk-factor targets were not achieved. These gaps are especially magnified in under-resourced areas.
In addition, given that the rates of diabetes-related complications are higher in people of color and uninsured populations and that type 2 diabetes discovered in young adulthood have a more aggressive clinical course than diabetes, immediate action is required to improve outcomes.
Coach Beverly suggested action: Diabetes Care and Education Specialists continue to take a leadership role in intentional and unrelenting outreach to provide DSMES and MNT to under-resourced communities using novel and evidenced-based approaches. Since prediabetes rates are also higher in many of these communities, establishing easily accessed Diabetes Prevention Programs and networking with community health workers and leaders can contribute to improved health outcomes.
Medications are too expensive for many people
Even though we have a slew of new and highly effective classes of diabetes medications, they are out of the financial reach for many. As patents expire and the medications are available as generics, access and affordability will increase. In the meantime, a realistic approach to providing affordable diabetes treatment is needed.
Coach Beverly suggested action:
Diabetes Care and Education Specialists can help craft a medication plan that is realistic and affordable. For people with no insurance or large co-pays, consider using available generic diabetes medications. These medications often cost $10 or less for a 3-month prescription. They include: metformin, sulfonylureas, and pioglitazone. In addition, Walmart offers Reli-On insulins including Regular, NPH, and 70/30 insulin for $25 a vial. There are also online resources like GoodRx.com that help people find discounts on their usual medications and the different pharmaceutical companies also offer discount programs based on need.
See Insulin Cost Savings Guide for an abundance of resources and useful links.
In conclusion, Diabetes Care and Specialists are perfectly positioned to influence health delivery systems and advocate for best clinical practices. We can be catalysts for establishing DPP and DSMES programs in under-resourced communities and advocate for access to affordable medications and technologies to help participants reach their targets for A1C, Blood Pressure, and Cholesterol while improving quality of life.
With a concentrated effort, maybe our next report card will be a little bit better!
With hope, Coach Beverly
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!
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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.
JR has type 2 diabetes and is trying to lose weight by eating less and moving more. JR asks your advice about drinking diet sodas.
Based on the recommendations in the ADA Standards of Care, what is the best response?
Click here to test your knowledge!
Can’t make it live? All paid registrants are guaranteed access to the video presentation, handouts and podcasts.
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.
Want to learn more about Hospitals & Hyperglycemia? Join us for our
Research clearly demonstrates the importance of glucose control during hospitalization to improve outcomes not only in the inpatient setting but after discharge. This course reviews the evidence that supports inpatient glucose control and outlines practical strategies to achieve targets in the inpatient setting. We incorporate the latest ADA Standards and provide links to resources and inpatient management templates.
Topics include:
Can’t make it live? All paid registrants are guaranteed access to the video presentation, handouts and podcasts.
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.
For our July 13th Question of the Week, 80% of respondents chose the best answer. GREAT JOB! We want to “take a closer look” at this question and determine strategies to choose the best response.
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 1: JR is 78, lives alone, and manages their diabetes with bolus insulin at breakfast and dinner and basal insulin at night. For the past few months, JR has had trouble remembering to take insulin with meals and JR’s most recent A1c is above 9%.
Which of the following is most likely contributing to this change of behavior for JR?
Answer Choices:
As shown above, the most common choice was option 3, the second most common answer was option 1, then option 2, and finally option 4.
If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. Being familiar with the experiences and co-conditions that impact older people’s ability to self-manage diabetes will be helpful for the exams.
Answer 1 is incorrect, 12.99% chose this answer, “Increased frequency of hypoglycemia.” This is the juicy answer, but not the best one. Since JRs A1c is elevated, we don’t suspect hypoglycemia is causing the missed bolus doses of insulin. However, it is important to assess for hypoglycemic events for older individuals taking insulin.
Answer 2 is incorrect, 3.51% of you chose this answer, “Nonalcoholic fatty liver disease.” It is true that more people with diabetes are experiencing fatty liver disease. However, we get no indication from the question that JR has visceral adiposity, jaundice skin color or elevated liver enzymes. And fatty liver disease in the early stages is not commonly associated with forgetfulness.
Answer 3 is correct, 80.41% of you chose this answer, “Alzheimer dementia.” GREAT JOB, this is the best answer. People with diabetes and hyperglycemia are at higher risk of Alzheimer and vascular dementia. Dementia can decrease the ability to remember to take insulin and other medications which can then lead to hyperglycemia which can worsen dementia. If you suspect that someone is forgetting to take insulin due to dementia, reaching out to the referring provider for a cognitive assessment and evaluation is warranted. See screening tools here.
Answer 4 is incorrect, 3.09% of you chose this answer “Adjustment of statin dose.” A few years back, there was a social media buzz that statin therapy is associated with decreased cognition and memory loss. According to the ADA Standards of Care, multiple well designed studies have found no association between statins and memory loss.
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!
Want to learn more about this topic? Enroll in our
We have updated this content based on the ADA 2021 Standards of Care.
We are living longer and more people are getting diabetes. The American Diabetes Association has updated the Older Adults Standards, with special attention to considering reduction of medication and insulin therapy intensity. The older population has unique issues and special needs that require consideration as we provide diabetes self-management education. This online course highlights key areas of assessment, intervention, and advocacy for older clients living with diabetes.
Objectives:
Can’t make it live? All paid registrants are guaranteed access to the video presentation, handouts and podcasts.
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.
LS is 26 weeks pregnant and just discovered she has gestational diabetes. LS asks you what type of meal planning approach will help keep her and the baby healthy.
According to the ADA Standards of Care, what is the most accurate response?
Click here to test your knowledge!
Want to learn more about this topic? Enroll in our
People living with diabetes who are pregnant are confronted with a variety of issues that require special attention, education, and understanding.
This course reviews those special needs while focusing on Gestational Diabetes and Pre-Existing Diabetes. Included are the most recent diagnostic criteria, management goals, and prevention of complications during pregnancy. A helpful review for the CDCES Exam and for those who want more information on people who are pregnant and live with Diabetes.
Topics include:
Can’t make it live? All paid registrants are guaranteed access to the video presentation, handouts and podcasts.
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.
Want to learn more about Pregnancy & Diabetes? Join us live for our
People living with diabetes who are pregnant are confronted with a variety of issues that require special attention, education, and understanding.
This course reviews those special needs while focusing on Gestational Diabetes and Pre-Existing Diabetes. Included are the most recent diagnostic criteria, management goals, and prevention of complications during pregnancy. A helpful review for the CDCES Exam and for those who want more information on people who are pregnant and live with Diabetes.
Topics include:
Can’t make it live? All paid registrants are guaranteed access to the video presentation, handouts and podcasts.
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.
For our July 6th Question of the Week, 80% of respondents chose the best answer. We want to “take a closer look” at this question and determine strategies to choose the best response.
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 1: JR is a 15-year-old with newly diagnosed type 2 diabetes, with an A1c of 8.3% and elevated lipids.
In addition to nutrition and activity coaching, which of the following medications are FDA approved for pediatrics?
Answer Choices:
As shown above, the most common choice was option 4, the second most common answer was option 2, then option 1, and finally option 3.
If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. The exam will present questions that require test takers to be familiar with knowledge of special populations like pediatrics, older folks and management of diabetes during pregnancy. According to the ADA Standards of Care, Section 13 of Children and Adolescents, here is the best answer.
Answer 1 is incorrect, 6.96% chose this answer, “Glipizide and Sitagliptin.” Although commonly used in adults, sulfonylureas, including glipizide and DPP-IV’s including Sitagliptin, are not FDA approved for people under the age of 18.
Answer 2 is incorrect, 8.06% of you chose this answer, “SGLT-2 Inhibitors and GLP-1 Receptor Agonists.” Although commonly used in adults, SGLT-2s are not FDA approved for people under the age of 18. There is one GLP-1 Receptor Agonists, liraglutide (Victoza) approved for use in pediatrics over the age of 10. However, none of the other GLP-1 RAs are FDA approved for pediatrics.
Answer 3 is incorrect, 4.95% of you chose this answer, “Glimepiride and Empagliflozin.” Although commonly used in adults, sulfonylureas, including glimepiride and SGLT-2 Inhibitors, including empagliflozin, are not FDA approved for people under the age of 18.
Answer 4 is Correct, 80.04% of you chose this answer “Liraglutide and Metformin.” Great Job! For children under the age of 18, the only FDA approved pharmacologic interventions include metformin, liraglutide and insulin.
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!
Want to learn more about this topic? Enroll in our
This course includes updated goals and guidelines for children living with type 1 or type 2 diabetes. This course discusses the special issues diabetes educators need to be aware of when working with children with diabetes and their families.
We discuss the clinical presentation of diabetes, goals of care, and normal growth and development through the early years through adolescence. Strategies to prevent acute and long term complications are included with an emphasis on positive coping for family and child with diabetes.
Topics include:
Can’t make it live? All paid registrants are guaranteed access to the video presentation, handouts and podcasts.
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.