Rationale of the Week | Best fix for hyperglycemic spike?

For our February 16th Question of the Week, over 76% of respondents chose the best answer!

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 is 79 years old and their most recent A1c is 7.4%.  LS takes metformin 1000 mg twice daily and sitagliptin (Januvia) plus 14 units of basaglar at before sleep at 2am.  LS is excited that they started using a Freestyle Libre sensor and shows you the glucose trends.  You notice that glucose levels rise to 250 – 350 in between noon to 4pm.

What is the next best action? 

Answer Choices:

  1. Start bolus insulin at breakfast
  2. Increase basal insulin by 20%
  3. Add a low dose sulfonylurea
  4. Assess food timing and content

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.

Getting to the Best Answer

If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. The exam often present vignettes that compel test takers to weed through the details and figure out the key intent of the question and chose the BEST answer.

Answers & Rationale

Answer 1 is incorrect, 9.23% chose this answer. “Start bolus insulin at breakfast”. Giving bolus insulin at breakfast would not prevent the glucose elevations from 12pm to 4pm. If we were to start bolus insulin to help with these afternoon spikes, we would need to give it before lunch to match post lunch glucose elevations.

Answer 2 is incorrect, 9.83% of you chose this answer. “Increase basal insulin by 20%”. Basal insulin helps to manage overnight and between-meal blood glucose levels. It is not effective at preventing post-prandial hyperglycemia. We evaluate if a person is taking enough basal insulin by seeing if fasting blood glucose is in the 80-130 mg/dl range.

Answer 3 is incorrect, 4.84% of you chose this answer “Add a low dose sulfonylurea”. Generally speaking, if a person is on basal insulin we are reluctant to add a sulfonylurea, since it can potentiate hypoglycemia (LS’s A1c is 7.4%) and may not address this specific issue of lunch time post-prandial spike. In addition, since the A1c is so close to target, it might be a good idea to take a closer look at food intake and activity and it’s impact on post lunch blood sugars.

Answer 4 is correct, 76.10% of you chose this answer. “Assess food timing and content”. GREAT JOB team. Most of you chose the best answer. As it turns out, LS was eating cereal and “mini” bagels for lunch. This explained the post meal spike. By helping LS understand which foods are carbohydrates and their impact on blood glucose, LS was eager to make adjustments at lunch to get blood sugar to target.

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!


Test Taking Practice Exam Toolkit Webinar
20 Sample Practice Questions

You’re invited! FREE Live Webinar Friday, Feb 26th at 11:30 AM

You are invited to join Coach Beverly for this FREE Webinar. And, if you want to have access to an additional 220+ sample practice online questions, you can purchase the complete Test Taking Toolkit.

For many of us, taking the certification exam is a nerve-wracking process.

During this webinar, Coach Beverly will help you transform your nervousness into focused energy that will help you succeed. She will provide test-taking tips based on her experience taking the certification exam six times.

Join Coach Beverly on Feb 26th at 11:30 am PST to Gain Insights and Hands-on Practice

To provide plenty of practice, Coach Beverly will sample 20 test questions that have been plucked from our Test Taking Toolkit during this live webinar.

She will explain how to dissect the question, eliminate wrong answers and avoid getting lured in by juicy answers.

Can’t make it live? No worries, if you purchase the Test Taking Exam Practice Webinar, we will automatically update the course in your Online University so you can access the new content later that day.

The Test-Taking Exam Practice Webinar provides you with the opportunity to take over 210 sample practice questions online, simulating the exam experience.

2 Ways to Join Test Taking Webinar

Purchase for $49

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

Plus, the Test Taking Toolkit provides you over 220 sample online practice questions, simulating the exam experience. A perfect way to assess your knowledge and create a focused study plan, while increasing your test-taking confidence.

Join Live Webinar for FREE

This includes a review of 20 sample test questions with test-taking strategies. This does not include access to the recorded webinar or the practice questions.


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!

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.

Question of Week | Work in Birthday Cake?

A 59 year old with type 2 diabetes, A1c of 7.2%, takes bolus insulin before meals, plus basal insulin at night and metformin. They ask you how to best work in a piece of birthday cake for their grandchild’s upcoming birthday celebration.

What is the best advice?

  1. Take additional bolus insulin to cover the extra carbs
  2. Accept the cake but don’t actually eat it
  3. Increase their nighttime basal insulin to prevent hyperglycemia
  4. Skip the previous meal to allow for the extra cake carbs

Click here to test your knowledge!


Test Taking Practice Exam Webinar
220+ Practice Questions | $49

Live Update Friday, February 26th at 11:30 AM


For many of us, taking the certification exam is a nerve-wracking process.

During this webinar, Coach Beverly will help you transform your nervousness into focused energy that will help you succeed. She will provide test-taking tips based on her experience taking the certification exam six times.

Join Coach Beverly on Feb 26th at 11:30 am PST to Gain Insights and Hands-on Practice

To provide plenty of practice, Coach Beverly will sample 20 test questions that have been plucked from our Test Taking Toolkit during this live webinar.

She will explain how to dissect the question, eliminate wrong answers and avoid getting lured in by juicy answers.

Can’t make it live? No worries, if you purchase the Test Taking Exam Practice Webinar, we will automatically update the course in your Online University so you can access the new content later that day.

The Test-Taking Exam Practice Webinar provides you with the opportunity to take over 210 sample practice questions online, simulating the exam experience.

2 Ways to Join Test Taking Webinar

Purchase for $49

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

Plus, the Test Taking Toolkit provides you over 220 sample online practice questions, simulating the exam experience. A perfect way to assess your knowledge and create a focused study plan, while increasing your test-taking confidence.

Join Live Webinar for FREE

This includes a review of 20 sample test questions with test-taking strategies. This does not include access to the recorded webinar or the practice questions.


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!

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.

Question of Week | Best fix for hyperglycemic spike?

LS is 79 years old and their most recent A1c is 7.4%.  LS takes metformin 1000 mg twice daily and sitagliptin (Januvia) plus 14 units of basaglar at before sleep at 2am.  LS is excited that they started using a Freestyle Libre sensor and shows you the glucose trends.  You notice that glucose levels rise to 250 – 350 in between noon to 4pm. 

What is the next best action?

  1. Start bolus insulin at breakfast
  2. Increase basal insulin by 20%
  3. Add a low dose sulfonylurea
  4. Assess food timing and content

Click here to test your knowledge!


Spreading the Love: Valentine’s Day Sale

To celebrate Valentine’s Day we want to spread the love by giving 14% off our entire store!

Use code VALENTINES14 on the payment page during checkout to get 14% off! The sale ends at midnight on February 19th pacific standard time!


Save your spot for our
Virtual DiabetesEd Specialist Conference | April 15-17, 2021

Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.

Entire Program Fee: $399
Dates: April 15-17, 2021
Live Webinar Schedule: All webinars start and end times are in Pacific Standard Time
Virtual DiabetesEd Specialist Program Flyer 2021

Come join our Virtual DiabetesEd Specialist Program.

Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice. If you are interested in taking the CDCES or BC-ADM exam or are seeking a state of the art review of current diabetes care, this course is for you.

Team of expert faculty includes:

  • Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
  • Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
  • Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator

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! 

Prepare for CDCES or BC-ADM certification or earn hours for renewal.

Your registrations include access to all the Online Sessions plus Bonus Courses through December 31st, 2021.

This virtual program includes:

3 day live webinar courses from April 15th-17th (20 CEs) + enrollment in our Bonus Bundle (14.0+ CEs) from now through December 2021.

  • Live Q & A Session with the instructor after each webinar
  • Presentations by our team of experts
  • Handouts and Resources for each session
  • Post-test questions
  • A sense of community
  • If you can’t attend the live webinars, a recorded version will be posted later the same day for viewing.

View full Conference Schedule and Faculty.


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!

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.

Question of the Week | February 9, 2021

RT is a 49-year-old with type 1 diabetes, admitted to a local hospital to treat Diabetes Ketoacidosis (DKA).  RT is on an insulin drip, fluids and potassium replacement therapy and is getting hungry.  The IV insulin is running at 2 units an hour and the RTs usual insulin dose at home is 12 units glargine at bedtime and 3-4 units of lispro before meals. 

Before stopping the IV insulin, what is the most important action?

  1. Maintenance of glucose less than 200 for at least 4 hours
  2. Give 3 units of bolus insulin via IV and at least 6 units of glargine
  3. Evaluate labs to make sure that RT is ketone negative
  4. Determine if potassium replacement is still needed

Click here to test your knowledge!


Want to learn more?
Virtual DiabetesEd Specialist Conference | April 15-17, 2021

Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.

Entire Program Fee: $399
Dates: April 15-17, 2021
Live Webinar Schedule: All webinars start and end times are in Pacific Standard Time
Program Schedule & Expert Bios

What is the Diabetes Educator Course? 

If you are interested in taking the CDCES or BC-ADM exam or are seeking a state of the art review of current diabetes care, this course is for you. Our team of expert faculty has been fine-tuning this course for over fifteen years, and we know what you need. 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! 

In this course, the same speakers will cover the same content as outlined in the Live Seminar.  For more details see our Virtual DiabetesEd Specialist Conference Schedule and Faculty.

Prepare for CDCES or BC-ADM certification or earn hours for renewal.

Come join our Virtual DiabetesEd Specialist Program.

Your registrations include access to all the Online Sessions plus Bonus Courses through December 31st, 2021.

This virtual program includes:

3 day live webinar courses from April 15th-17th (20 CEs) + enrollment in our Bonus Bundle (14.0+ CEs) from now through December 2021.

  • Live Q & A Session with the instructor after each webinar
  • Presentations by our team of experts
  • Handouts and Resources for each session
  • Post-test questions
  • A sense of community
  • If you can’t attend the live webinars, a recorded version will be posted later the same day for viewing.

View full Conference Schedule and Faculty.


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!

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.

Question of the Week | Which vaccines does JL need?

JL is 65 years old and has diabetes. JL tells you they had two different pneumonia vaccines in the past, but they are wondering what vaccinations they need this year.

What is the BEST answer?

  1. Flu and Pneumonia PPSV23 [Pneumovax]
  2. Hepatitis B and Flu vaccine
  3. Pneumonia PCV13 [Prevnar] and Human Papilloma Virus (HPV)
  4. Zoster and Hepatitis B vaccine

Click here to test your knowledge!


Recorded and Ready for Viewing.
Level 2 – Standards of Care Update!

This course is an essential review for anyone in the field of diabetes. This course summarizes the 2021 updates to the American Diabetes Association’s Standards of Medical Care in Diabetes and provides critical teaching points and content for health care professionals involved in diabetes care and education.

Earn 2.0 CEs and get ready to lead the charge to implement best care practices for the New Year. 

Topics Include:

  • A review of changes and updates to the 2021 ADA Standards of Medical Care
  • Identification of key elements of the position statement
  • Discussion of how diabetes educators can apply this information in their clinical setting

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!

AccreditationDiabetes 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.

Question of the Week | What is the B/P Goal?

RJ is 52 with type 1 diabetes and a minor stroke last year. RJ takes an ACE Inhibitor, insulin, and a statin.

According to ADA Standards of Care 2021, what is the blood pressure target for RJ?

  1. 120/70
  2. 130/80
  3. 140/90
  4. 135/85

Click here to test your knowledge!


Join Coach Beverly on February 2, 2021, for her annual
Level 2 – Standards of Care Update!

This course is an essential review for anyone in the field of diabetes. This course summarizes the 2021 updates to the American Diabetes Association’s Standards of Medical Care in Diabetes and provides critical teaching points and content for health care professionals involved in diabetes care and education.

Earn 2.0 CEs and get ready to lead the charge to implement best care practices for the New Year. 

Topics Include:

  • A review of changes and updates to the 2021 ADA Standards of Medical Care
  • Identification of key elements of the position statement
  • Discussion of how diabetes educators can apply this information in their clinical setting

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!

AccreditationDiabetes 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.

Question of the Week | 4 Meds and Hypo

MT is 59 and her most recent A1c was 10.3%. The diabetes specialist suggested they add insulin to her other 3 oral diabetes medications to lower A1c.  MT was not ready for insulin, so the specialist agreed that they would try adding on glipizide 5mg BID and evaluate the response for one month.

After 2 weeks, MT calls and is very upset about her frequent low blood sugars (66, 68, 69) that are happening between 3 pm and 6 pm a few times a week.  MT works in the field starting at 5 am and gets her lunch break at 10 am and eats her dinner again at 6 pm. 

Which of the following is the best recommendation?

  1. Hold the glipizide for one week
  2. Make sure MT has a glucagon emergency kit in the field
  3. Inform her that she is protected under the American Disabilities Act
  4. Encourage a 2 pm carbohydrate snack

Click here to test your knowledge!


Level 3 | DiabetesEd Specialist Boot Camp | 12+ CEs

Diabetes is complicated! This course starts with a brief introduction to the CDCES Exam content and philosophy. Then we move to discuss the underpinnings of pancreas dysfunction and the different types of diabetes. Insulin resistance is addressed as well as the diagnostic criteria for diabetes.

Intended Audience:  A great course for anyone in the field of diabetes education seeking evidence-based information supporting lifestyle changes.

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

This course is part of our Level 3 – Boot Camp. Enroll in our entire Level 3 – Boot Camp to join us for the following 2021 Live Webinar Updates. All courses air at 11:30 a.m. (PST)

Join us for our 2021 Live Webinar Updates. All courses air at 11:30 a.m. (PST)

  • February 9, 2021 – Class 1 – Diabetes – Not Just Hyperglycemia 1.75 CEs
  • February 11, 2021 – Class 2 – Standards of Care & Hyperglycemia 1.5 CEs
  • February 16, 2021 – Class 3 – Insulin Therapy – From Basal/Bolus to Pattern Management 1.5 CEs
  • February 18, 2021 – Class 4 – Insulin Intensive – Monitoring, Sick Days, Lower Extremities 1.5 CEs
  • February 23, 2021 – Class 5 – Meds for Type 2 – What you need to know 1.5 CEs
  • February 25, 2021 – Class 6 – Exercise and Medical Nutrition Therapy 1.5 CEs
  • March 2, 2021 – Class 7 – Screening, Prevention, and Treatment of Microvascular Complications
  • March 4, 2021 – Class 8 – Coping and Behavior Change 1.5 CEs
  • March 9, 2021 – Class 9 – Test-Taking Coach Session (48 Questions) No CEs

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!

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.

Question of the Week | 4 Meds and A1c of 8.9%

JR is on metformin 2000mg, empagliflozin 25mg, semaglutide 1.0mg and 100 units of glargline insulin.  A1C is 8.9% and JR weighs 100kg.

What best describes this clinical picture?
  1. Overbasalization
  2. Non-compliance
  3. Fear of hypoglycemia
  4. Clinical inaction

Click here to test your knowledge!


Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.

Entire Program Fee: $399
Program Flyer: Download
Dates: April 15-17
Live Webinar Schedule: All webinars start and end times are in Pacific Standard Time
Program Schedule & Expert Bios

What is the Diabetes Educator Course? 

If you are interested in taking the CDCES or BC-ADM exam or are seeking a state of the art review of current diabetes care, this course is for you. Our team of expert faculty has been fine-tuning this course for over fifteen years, and we know what you need. 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! 

In this course, the same speakers will cover the same content as outlined in the Live Seminar.  For more details see our Virtual DiabetesEd Specialist Conference Schedule and Faculty.

Prepare for CDCES or BC-ADM certification or earn hours for renewal.

Come join our Virtual DiabetesEd Specialist Program.

Your registrations include access to all the Online Sessions plus Bonus Courses through December 31st, 2021.

This virtual program includes:

3 day live webinar courses from April 15th-17th (20 CEs) + enrollment in our Bonus Bundle (14.0+ CEs) from now through December 2021.

  • Live Q & A Session with the instructor after each webinar
  • Presentations by our team of experts
  • Handouts and Resources for each session
  • Post-test questions
  • A sense of community
  • If you can’t attend the live webinars, a recorded version will be posted later the same day for viewing.

View full Conference Schedule and Faculty.


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!

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.