Avoiding Juicy Answers | QoW Rationale

For Question of the week, QoW, test takers usually choose the correct answer 70-80% of the time. However, for one question of the week, about 55% of respondents chose the correct answer.

So, we thought this would be a perfect opportunity for another answer rationale. We’ll explore this question and the best answer in more detail and throw in some test-taking tips along the way. Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below:

Question of the week:

JR has noticed that over the past few weeks blood glucose levels have been steadily climbing, even though his eating and medication dose have been stable. Which of the following issues is most likely contributing to hyperglycemia?

Answer Choices:

  1. Periodontitis
  2. Sudden case of acanthosis nigricans
  3. Insulin reactive disease
  4. Recurrent symogi effect

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

Congratulations! The majority of participants got this question right!

Option 1 is the correct answer. We know that periodontitis (inflammation of the gums and supporting structures of the teeth) and hyperglycemia are co-associated. When blood glucose levels rise, risk of periodontitis increases. When there is periodontitis, blood glucose levels rise. As a matter of fact, periodontitis is often called the 6th complication of diabetes. (see SciElo for more details).

Option 2 is incorrect because acanthosis nigricans is a skin condition where skin typically thickens and darkens due to insulin resistance, but the scenario in this question doesn’t mention anything about the skin of JR. We also know acanthosis nigricans isn’t associated with sudden hyperglycemia. It develops over time, so a “sudden case of” helps us to remove it as a possible answer by process of elimination.

Option 3 is incorrect because “insulin reactive disease” is not a recognized diagnosis or condition. This answer was included because “reactive” can look a lot like “resistance”. It is considered a juicy answer because it sounds right.

Finally, Option 4 is incorrect because the recurrent symogi effect indicates hypoglycemia which leads to hyperglycemia on specific occasions, not contributing to overall hyperglycemia. So, this was another option included to encourage careful reading of the question.

We hope you appreciate this week’s rationale and keep studying hard! 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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Question of the Week – January 14, 2020


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We’re updating our DiabetesEd Test Taking Toolkit in January and March.

This Test Taking Toolkit is designed to prepare you for exam success. This Toolkit includes:

Preparing for Certification Practice Exam 2020 online course includes (March 24, 2020):

  • 60 minutes on demand course, where Coach Beverly details the content of the exam and test taking tips. Plus, Coach Beverly 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.
  • 110 question computerized general practice exam that provides vignette-based questions and other critical content that will prepare you for the actual exam. 

ADA Standards Test Taking Tips Course + 113 Question Practice Test includes (January 29, 2020):

  • 60 minute on demand course, where Coach Beverly explains to dissect the question, eliminate the wrong answers and avoid getting lured in by juicy answers.
  • 113 test questions based on the most recent ADA Standards of Care. During the webinar, Beverly reviews as many practice questions as possible within the hour time frame. Get ready for success! 

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Question of the Week – January 7, 2020


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Question of the Week – December 10, 2019


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Question of the Week – November 19, 2019


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Question of the Week – November 12, 2019


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Question of the Week – November 5, 2019


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Teenager with Type 1 on Insulin Pump

For last Tuesday’s Question of the week, about 55% of respondents chose the correct answer. Although the majority of people chose the correct answer, we wanted to write a rationale to this particular question since it highlights an important issue that people with diabetes may be facing.

Before you read any spoilers, if you haven’t tried the question of the week from October 29, you can take your best guess here:

Question of the week on October 29:

JR is 15 and has had type 1 diabetes for the past 2 years. JR started insulin pump therapy a few months ago and noticed that their weight increased by over 5 pounds. JR is very worried about weight gain. JR’s mom called the diabetes educator to share her concerns and added that JRs daily insulin usage significantly decreased over the past few weeks. What is the most likely reason for this insulin usage decrease?

Answer Options:

  1. Insulin needs decrease with pump therapy
  2. The insulin pump is not delivering insulin effectively
  3. JR is under dosing insulin
  4. Insulin needs decrease during puberty

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

Congratulations! Most of you chose the right answer. Let’s explore the options in a little more detail.

Option 3 (C) is the correct answer: JR is under dosing insulin. In the scenario, JR has gained weight. This is coupled with the fact the JR’s insulin usage has decreased. These two items of information are red flags that JR is purposely decreasing insulin usage to let blood sugars run above target to lose weight. Sometimes this is termed “diabulimia”. It is important to recognize and address this issue right away to prevent potential complications secondary to acute and chronic hyperglycemia.

Option 1 is incorrect. Although insulin needs do decrease when transitioning from Multiple Daily Injections to insulin pump therapy, they don’t decrease significantly after pump therapy is established as characterized in this scenario.

Option 2 is incorrect since this vignette gives two key pieces of information: “JR is worried about weight gain” and “JR’s mom called the diabetes educator to share her concerns.” Although option 2 may be considered, by re-reading the question you can identify option 3 as the better answer between the two because of the details in the vignette. A great test taking strategy is to use the process of elimination to get down to two options, then apply careful, critical reading techniques to find the best answer.

Option 4 is incorrect because insulin needs do not decrease during puberty. In fact, puberty causes significant insulin resistance, which leads to increased insulin needs.


Want to learn more about insulin pump therapy and dosing? Check out our Technology Toolkit:


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Question of the Week – October 29, 2019


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Question of the Week – October 22, 2019


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