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.

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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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Question of the Week – October 15, 2019

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For Question of the week, test takers usually choose the correct answer 70-80% of the time. However, for this Tuesday’s question of the week, only about 23% 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.

Question of the week on October 8:

The American Diabetes Association recommends which of the following interventions to decrease risk of cardiovascular disease?

Answer Options:

1. Maintain B/P less than 130/80 for people with type 1 and type 2 diabetes
2. Start statin on 42-year-old with diabetes and no history of cardiovascular disease
3. If an ACE-Inhibitor fails to achieve B/P targets, add a Angiotensin Receptor Blocker (ARB)
4. Aspirin therapy is recommended for individuals over age of 40 with type 2 diabetes

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

For this question, a key consideration is what “The American Diabetes Association recommends.” This focus helps test takers hone in on ADA Standards.

Option 1 is juicy but incorrect. The ADA standard for individuals without cardiovascular disease risk or history is to maintain a B/P of less than 140/90. The blood pressure target in Option 1 of 130/80, is the B/P target for individuals with cardiovascular disease or a 10 year CVD risk of 15% or greater. The general goal for people with diabetes is to keep B/P less than 140/80. However, for those with a higher risk of CV events, the target is 130/80. Blood pressure targets are based on the individual assessment of risk.

Option 3 is incorrect because ACE-Inhibitor and Angiotensin Receptor Blockers should not be paired together. Option 3 says “add a Angiotensin Receptor Blocker” not switch to. Giving an ACE and and ARB together is not recommended due to potential renal issues.

Option 4 is incorrect because aspirin therapy is recommended for individuals over the age of 50 with CV risk factors.

Option 2 is the best answer. The standard for people with diabetes who are over the age of 40 is to start a statin to reduce the risk of cardiovascular disease. No CVD history is required to initiate statin therapy in this standard for people over the age of 40 with either type 1 or type 2.

For more info, here is a link to ADA’s Standard Ten. 10. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes—2019

Our DiabetesEd Online University also offers courses on Standards of Care and Cardiovascular Disease. Check it out here!

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 – October 8, 2019

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For Question of the week, test takers usually choose the correct answer 70-80% of the time. However, for this Tuesday’s question of the week, only 25% of respondents chose the correct answer.

We thought this presented a perfect opportunity to explore this question and the best answer in more detail and throw in some test-taking tips along the way.

Question of week on October 1:

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

Test taking strategies:

A good strategy for the exam for questions that give multiple distracting facts at once, is to read through each answer carefully and use process of elimination. First, get rid of one to two false answers that are either wrong or don’t address the main intent of the question. This leaves two answers and a 50% chance of choosing the BEST answer.

The key sentence here is “You ask to see JRs logbook, but JR shows you an app they use to track blood glucose levels.” Then there is a prompt to give a response. 

Option 4 is a “juicy” answer because the first sentence shows JR admitting they’re tired. But the answer does not address the main intent of the question. Another distraction in the question includes that that they’re specifically feeling tired between lunch and dinner.

Option 4 also ignores the fact the educator asked to see their logbook and they respond by showing an app. Option 4 gets the test taker off-topic from the core question.

Also off-topic is Option 3. The test question vignette includes another distraction when it highlights that JR is specifically feeling tired between lunch and dinner. It would be easy to assume they are tired because of low blood sugar, which a midafternoon snack could fix, but there is no data to support that JR is having hypoglycemia. When reading the entire question, the core issue is that the educator asked to see a logbook but are shown an app instead.

Option 2 nods to the key intent of the question, but the educator fails to acknowledge that JR is trying to use an app to track blood glucose levels and other self-care behaviors. Instead, the educator ignores the app usage and instructs JR to keep a written log. This does not convey a person-centered approach, but instead asks JR to track blood glucose in a way that is familiar to the educator.

Option 1 is the person-centered option that acknowledges the individual and their preference for tracking their diabetes data using technology. “Looks like you really like using apps.” At that point in an appointment, the educator can use a curiosity based approach, “Can I please see the data you are collecting on your app? Have you noticed any trends or incidence of hypoglycemia in the afternoon?”

Together, JR and the educator might even explore other apps that might be useful and support JR in living with diabetes).

Language & Diabetes is a great, free resource to gain more insight into why Option 1 is the best answer to this question. 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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