Subscribe
eNewsletter
Ready to get certified?
Free CDCES Coach App
Download
Free Med Pocket Cards
eNewsletter
Free CDCES Coach App
Free Med Pocket Cards
This question addressed rising blood glucose and best insulin adjustment strategy. Since this was our most popular question this month, we wanted to provide an explanation to pass on this valuable information to all of you and people living with 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: LS takes 20 units 70/30 insulin twice daily with an insulin pen. LS states that blood sugars are usually on target, but over the past week, blood sugars have suddenly increased. LS confirms that they are taking insulin on a regular basis.
Which factor could be contributing to this sudden blood glucose rise?
Answer Choices:
As shown above, the most common choice was option 2, the second most common answer was option 3, then option 4, and finally option 1.
If you are thinking about taking a certification exam, this practice test question will set you up for success. The test writers will anticipate possible wrong answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements, eliminate at least two false answers to improve your odds of success to 50/50.
Answer 1 is incorrect “70/30 insulin is no longer effective for LS”. About 5% chose this answer. Based on the vignette, LS has been using 70/30 insulin and keeping blood glucose in target. It is only in the last week that blood glucose levels are rising. This points to another undiscovered recent issue that is causing blood sugars to elevate.
Answer 2 is correct! “Check where LS is keeping the insulin pens”. A whopping 73% of you chose this correct answer Great job. Insulin is a very sensitive protein and can lose effectiveness when stored in places where there are extreme temperatures.
Read package insert for detailed information:
Answer 3 is incorrect. “Remind LS to shake the insulin to assure adequate mixing.” About 11% of respondents chose this. Insulin manufacturers recommend NOT shaking 70/30 insulin since it can make the insulin less effective.
70/30 insulin mixing instructions
Invert the vial or pen at least 10 times to mix the two insulin until is appears white and cloudy. Do not shake. Do not use it if insulin looks clear or contains any lumps or particles.
Finally, Answer 4 is incorrect. “Verify that LS is doing a 3-unit air shot before each injection.” 10% chose this answer. The correct answer is to prime the insulin pen with 2 units of insulin before each injection to make sure that the pen and needle are working. When priming the pen, at least one drop of insulin should appear at the tip of the needle. Also, it’s a good idea to remind people to change the needle before each injection.
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 more practice questions?
Try our Test Taking Toolkit!
$49 | 220+ Questions
In this course, Coach Beverly details the content of the exam and test-taking tips. Plus, she reviews a sampling of the questions and explains how to dissect the question, eliminate the wrong answers and avoid getting lured in by juicy answers.
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.
Interesting findings that explore the relationship between Vitamin D levels and COVID-19 outcomes are being released.
In an article by WedMD, there have been several international studies that evaluate Vitamin D levels in people infected with COVID-19.
None of these studies indicate definitively if higher levels of Vitamin D reduce the risk of contracting or becoming severely ill with COVID-19. Though, they’ve noticed that the “sickest” people with COVID-19 had low levels of Vitamin D.
Several studies conducted across different countries indicate that a healthy level of Vitamin D might strengthen our immune system and reduce our vulnerability to disease.
Vitamin D is so important for our bones, muscles, and a nutrient our immune systems need for optimal health. An adequate blood level of Vitamin D is between 20 nanograms/milliliter to 50 mg/ml. A simple but slightly costly blood test can measure one’s level of this vitamin.
People living with diabetes (type 1 & type 2) often have lower levels of Vitamin D. Vitamin D deficiency can manifest as fatigue, depression, muscle and bone pain, and decreased overall health.
Lifestyle changes can be used to treat low Vitamin D levels; eating healthy foods like eggs, mushrooms, fresh fish, and getting outside in sunlight, can increase our Vitamin D levels. As a supplement, Vitamin D3 or cholecalciferol is recommended at a dose of 400-1000 IU /day.
Vitamin D is made by the body when the skin is exposed to sunlight. Often people in the Northern Hemisphere with less sun exposure have lower levels of Vitamin D. Regular sun exposure can help increase Vitamin D levels, although supplementation seems to be more effective.
In addition, improving access to healthy foods needs to be a priority for all people, but especially vulnerable populations and those with diabetes.
For more information, read the WebMD article here. We also recommend you read Vitamin D and Type 1 Diabetes: What the Research Says & Higher vitamin D levels linked to lower risk for diabetes. Click here for NIH Vita D Info page.
Update
Healio has released more information on this topic that you can find on their recent article, “Researchers caution against ‘misinformation’ on vitamin D during COVID-19 pandemic.”
Written by Catherine Cullinane RN, CDCES, our resident Tech Thursday Content Writer
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.
AJ is motivated to decrease weight. AJ eats an egg sandwich and hash browns 5 times a week. You look up the calories on an app and find that the egg sandwich has 370 calories and the medium hash browns have 390 calories.
If AJ doesn’t eat the hash browns for one month, how much weight would AJ lose?
Click here to test your knowledge!
Join Dana Armstrong, RD, CDCES, a trailblazer and thought leader, for a lively and intensive review of the latest in Medical Nutrition Therapy with immediate application to your clinical practice.
Dana combines the newest findings, her clinical experiences, plus the ADA Standards of Care into an action-packed presentation that will inform your practice while preparing for the certification exam.
Webinar Dates
Session 1 – Medical Nutrition Therapy Overview | May 27 from 8:30 AM – 10:30 AM PDT
Session 2 – Meal Planning – How to Eat by the Numbers | May 27 from 11:30 AM – 1:30 PM PDT
All presentations are recorded and available for on-demand viewing.
These sessions are also included in our Virtual Conference.
Click here to enroll in the entire program.
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.
Last week we posted a blog titled “CMS Updates For CGM Coverage,” which on the surface seemed like very exciting, impactful changes on CMS regulations for CGM coverage during the COVID-19 pandemic.
After sharing this post, members of our community let us know that although CMS guidelines have been relaxed in writing, this hasn’t translated into better access on the ground.
To learn more we dove into the interim final rule with comment period (IFC) that was released by the Department of Health & Human Services – Centers for Medicare & Medicaid Services.
In the March 31st COVID-19 IFC, we finalized on an interim basis that we will not enforce the clinical indications for coverage across respiratory, home anticoagulation management, and infusion pump NCDs (Nation Coverage Determinations) and LCDs (Local Coverage Determinations) (including articles) allowing for more flexibility for practitioners to care for their patients. This enforcement discretion will only apply during the PHE for the COVID-19 pandemic.
The language in the IFC is vague and ambiguous regarding what it means to have less stringent and “more flexible” requirements of obtaining a CGM in the time of the COVID-19 for people with diabetes. Though we have found a few highlights from the document based on feedback by our community on what is unclear.
In this IFC, we are finalizing on an interim basis that we will not enforce the clinical indications for therapeutic continuous glucose monitors in LCDs. For example, we will not enforce the current clinical indications restricting the type of diabetes that a beneficiary must have or relating to the demonstrated need for frequent blood glucose testing in order to permit COVID-19 infected patients with diabetes to receive a Medicare-covered therapeutic continuous glucose monitor.
Overall, there is still much to learn about these changes as they apply to real-life situations. This is an unprecedented time for all of us and there is a lot of unknowing. We hope as things develop to keep you informed.
To read the full IFC click here. For more information about Medicaid Guidelines, click here.
If you have any more information on these changes, please click here to visit our survey to update us.
Written by Catherine Cullinane RN, CDCES, our resident Tech Thursday Content Writer
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.
Figuring out what foods are “super” healthy is challenging for people with diabetes and health care professionals alike. An article from Outside Magazine has attempted to sort fact from fiction. They have ranked the top superfoods based on scientific evidence.
It is worth noting that not one superfood going to make people healthy. We have to consider the entirety of the daily food intake. But, here are some foods that do deliver a research-backed benefit.
We encourage you to read the entire article for some insights on the other 14 foods that often have the status of superfoods, that aren’t always backed by research.
Green tea contains compounds called catechins, that may contribute to increased metabolic rates and contain anticancer properties.
Based on longevity studies, the populations who have the longest lifespans have one food in common, legumes. Beans are high in fiber, iron and B vitamins. While all legumes are beneficial, black beans contain polyphenols, giving them an extra nutrient boost.
Super dark or 70 percent cocoa or higher is best. This food delivers flavonols that contribute to lower LDL cholesterol, improve blood flow, and improve mood.
Red wine contains resveratrol, which has anti-inflammatory and blood pressure-lowering benefits. Consumption, in moderate amounts, has also been associated with a decreased risk of diabetes. Keep in mind, that red grapes may offer similar benefits.
Salmon can help boost brain and heart health. The omega-3 fatty acids in salmon contain docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). These are effective at not only improving brain health but also seem to decrease the risk of heart attacks and strokes. Plus, since salmon contains DHA, it can protect brain neurons and reduce the risk of Alzheimer’s.
This bright golden spice, derived from the rhizomes of the Curcuma longa plant, has been used in ancient medicine and Southeast Asian cuisine for centuries.
It has anti-inflammatory properties due to curcumin, a natural polyphenol that gives turmeric its bright yellow hue. Based on recent research, it may help fight cancer.
Suggested dosing is one-fourth teaspoon three times a day along with fiber for best absorption.
Blueberry’s power comes from the compound oligomeric proanthocyanidins, which lower the risk for heart disease and reduce joint and muscle pain by decreasing oxidative stress.
Choose organic berries and enjoy a half-cup of frozen blueberries daily.
To read the complete article, click here.
Interested in learning more about the power of nutrition?
Please join us on May 27th for our Virtual Course with Dana Armstrong, RD, CDCES, Medical Clinic Director of The Diabetes Center/Salinas Valley Medical Clinic.
Join Dana Armstrong, RD, CDCES, a trailblazer and thought leader, for a lively and intensive review of the latest in Medical Nutrition Therapy with immediate application to your clinical practice.
Dana combines the newest findings, her clinical experiences, plus the ADA Standards of Care into an action-packed presentation that will inform your practice while preparing for the certification exam.
Webinar Dates
Session 1 – Medical Nutrition Therapy Overview | May 27 from 8:30 AM – 10:30 AM PDT
Session 2 – Meal Planning – How to Eat by the Numbers | May 27 from 11:30 AM – 1:30 PM PDT
All presentations are recorded and available for on-demand viewing.
These sessions are also included in our Virtual Conference.
Click here to enroll in the entire program.
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 uses an insulin pump and the 500 rule for carbohydrate coverage. For breakfast, LS plans to eat ½ cup of oatmeal, 3/4 cup of blueberries, a cup of skim milk, a tablespoon of peanut butter, and a cup of coffee with a packet of Splenda. Her insulin to carb ratio is 1 to 12 for breakfast and lunch. Her insulin to carb ratio is 1 to 15 for dinner.
How much insulin does LS need for breakfast?
Click here to test your knowledge!
We hope you have enjoyed this Question of the Week. For resources on calculating carbs, we invite you to visit our Carb Resource Page.
Want to learn more from a leader and innovator in nutrition therapy?
Join Dana Armstrong, RD, CDCES, a trailblazer and thought leader, for a lively and intensive review of the latest in Medical Nutrition Therapy with immediate application to your clinical practice.
Dana combines the newest findings, her clinical experiences, plus the ADA Standards of Care into an action-packed presentation that will inform your practice while preparing for the certification exam.
Webinar Dates
Session 1 – Medical Nutrition Therapy Overview | Recorded & Ready for Viewing!
Session 2 – Meal Planning – How to Eat by the Numbers | Recorded & Ready for Viewing!
All presentations are recorded and available for on-demand viewing.
These sessions are also included in our Virtual Conference.
Click here to enroll in the entire program.
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.
Diabetes Intensive with Dana Armstrong, RD, CDCES | Medical Nutrition Therapy + Meal Planning
Join Dana Armstrong, RD, CDCES, a trailblazer and thought leader, for a lively and intensive review of the latest in Medical Nutrition Therapy with immediate application to your clinical practice.
Dana combines the newest findings, her clinical experiences, plus the ADA Standards of Care into an action-packed presentation that will inform your practice while preparing for the certification exam.
Session 1 May 27 | Medical Nutrition Therapy Overview | Ready for Viewing!
Session 2 May 27| Meal Planning – How to Eat by the Numbers | Ready for Viewing!
$69 | Earn 4.0 CEs
Course Description: These two 2-hour courses review the latest national nutrition guidelines and provide strategies to translate this information to an individual living with diabetes.
Included is a discussion on different approaches to meal planning and the benefits and limitations of each. Dana will also review metabolic surgery, gastroparesis, and disordered eating.
She reviews nutrition approaches during pregnancy and for those living with chronic co-conditions. Dana also provides insights on how to support the transition to healthier eating using a “tasteful” approach.
Objectives:
Speaker Bio for Dana Armstrong, RD, CDCES
We are thrilled to welcome our guest speaker, Dana Armstrong, who will be joining our Virtual and Live Courses!
Dana received her degree in nutrition and dietetics from the University of California, Davis, and completed her internship in dietetics at the University of Nebraska Medical Center in Omaha. Dana is the Medical Clinic Director of The Diabetes Center/Salinas Valley Medical Clinic. She provides leadership for the Department of Diabetes Services and ensures coordination and integration of an effective system-wide Diabetes Center of Excellence across the organization for optimum patient care and collaboration of services. Having a child with diabetes, she combines her professional knowledge with personal experience and understanding.
These sessions are also included in our Virtual Conference.
Click here to enroll in the entire program.
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.
Yesterday, we shared our blog about the CMS Updates For CGM Coverage. These updates made us feel hopeful that people with diabetes would have fewer barriers and improved access to CGM devices.
After sharing this post, members of our community let us know that although CMS guidelines have been relaxed in writing, this hasn’t translated into better access on the ground.
We are hoping to open up a dialogue around this topic and hear from our community members about how these guidelines apply to real-life situations.
If you have information to share, please fill out our brief survey by clicking here.
We will send a follow-up post next week with updates.
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″]