Glucagon & Hypoglycemia | QoW Rationale

Our July 14th Question of the week quizzed test takers on glucagon and hypoglycemia. Although 54% of respondents chose the correct answer, 46% did not. We thought that this was an important topic to discuss further, so we can pass on correct info to 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: RJ is 15 years old and starting on basal-bolus insulin. The diabetes specialist reviews the signs of hypoglycemia and provides information on glucagon rescue medications.

Which of the following statements is most accurate?

Answer Choices:

  1. Glucagon is an injectable form of glucose.
  2. Injectable glucagon rescue medications are to be injected subcutaneously only.
  3. Nasal glucagon must be inhaled to increase glucose levels.
  4. Premixed glucagon liquid solution is approved for children two years and older.

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

Getting to the Best Answer

If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible 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 and choose the BEST answer.

Answer 1 is incorrect. 14% chose this answer. “Glucagon is an injectable form of glucose.”

Glucagon is a counter-regulatory hormone secreted by the pancreas when blood sugars are dipping or during periods of emotional or physical stress. This hormone liberates stored glycogen from the liver, causing an upward surge in circulating glucose. Read more here

Answer 2 is incorrect. 15% of you chose this answer. “Injectable glucagon rescue medications are to be injected subcutaneously only.”

Our new Glucagon PocketCard describes the 3 forms of glucagon treatment available. The original Glucagon Emergency Kit can be injected subQ or into the muscle. Gvoke liquid glucagon is only administered subQ and Baqsimi is administered nasally.

Download your Glucagon PocketCard Here

Answer 3 is incorrect. About 14% of respondents chose this. “Nasal glucagon must be inhaled to increase glucose levels.” Since many people are unconscious during severe hypoglycemic events, they can not inhale on command. The nasal glucagon delivery device is inserted into the nose and the user presses the plunger to distribute the glucagon powder in the nasal cavity. Read more here

Finally, Answer 4 is correct! 55% chose this answer. “Premixed glucagon liquid solution is approved for children two years and older.” Gvoke glucagon solution is available in a prefilled syringe or HypoPen Injector and is indicated for children two years and up. Read more here

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!


Preparing For the CDCES Exam 2020 Free Webinar |
August 6, 2020

FREE webinar, August 6, 2020, from 11:30 a.m. – 12:45 p.m.  (PST)

Unsure about updates for the 2020 exam?

Coach Beverly offers this FREE webinar to help get you to prepare for the CDCES Exam. All her tips and tricks are meant to ease your mind and reflect the updates to the CDCES content outline.

Topics Covered Include:

  • Implications of new certification name, CDCES for our specialty
  • Exam requirement updates for 2020
  • Exam eligibility and test format
  • Strategies to succeed along with a review of study tips and test-taking tactics.
  • We will review sample test questions and the reasoning behind choosing the right answers.
  • Learn how to focus your time and prepare to take the CDCES Exam. We provide plenty of sample test questions and test-taking tips!

Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator who has passed her CDCES Exam 6 times. She is a nationally recognized diabetes expert for over 25 years.

See our Preparing for CDCES Resource Page >>


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 | July 28, 2020

As a Diabetes Specialist in a rural clinic, you are asked to consult on a 49-year-old female with type 2 diabetes and a BMI of 27.  Blood pressure is 132/74 with the following lab values; A1c of 7.6%, LDL of 97 mg/dl, triglycerides 138, and GFR of 69.  Her medications include:

Metformin 850 mg three times a day, levothyroxine 100 mcg a day, and cetirizine 10mg daily. 

According to the ADA Cardiovascular Standards of Care, what other medication therapy needs to be added?

  1. Basal insulin.
  2. A statin.
  3. Aspirin therapy.
  4. An ACE Inhibitor or Angiotensin Renin Blocker (ARB).

Click here to test your knowledge!


Watch for FREE or purchase to earn CEs!

Cardiovascular Disease & Diabetes Standards 2020
Join Live Stream August 5th at 11:30 am (PST)
1.5 CEs | $29.00 or No CEsFree

Perfect for those planning to take the CDCES or BC-ADM or for those seeking an update.

Diabetes Specialists have a critical role in advocating for CV reduction. Coach Beverly is extending a special invitation to join this webinar on the latest standards for CV reduction.

This webinar will address:

  • insulin resistance syndrome and vascular complications.
  • impact of vessel disease from the heart to the toes.
  • prevention of vascular disease
  • strategies to achieve goals of care.

Register for FREE recorded webinar (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!


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.

Type 1 and SGLT-2 Inhibitor? | QoW Rationale

This question addressed the use of SGLT-2 Inhibitors in addition to insulin for MS, who is living with Type 1 Diabetes. MS is worried about weight gain and is on a low keto diet. It is safe for here to add an off-label medication?

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: MS has type 1 diabetes and is on a low carb diet to help her keep her weight on target. She has a BMI of 24.3. MS has a friend with type 1 who is taking an SGLT-2 in addition to insulin to help with weight management. MS wants to know if she could add on an SGLT-2 to her insulin treatment plan. 

What is the Diabetes Specialist’s best response?

Answer Choices:

  1. We don’t recommend adding on an SGLT-2 for people with type 1 on a low carb diet.
  2. Your BMI of 24.3 is right on target.
  3. I’m sorry, but oral medications don’t work for people with type 1 diabetes.
  4. Do you think you might be struggling with disordered eating?

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

Medication Considerations

If you are thinking about taking a certification exam, this practice test question will set you up for success. The test writers will include warnings about medications and ask you to choose the best response. 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 correct! “We don’t recommend adding on an SGLT-2 for people with type 1 on a low carb diet.” Even though SGLT-2’s are sometimes prescribed to people with type 1 diabetes (in addition to insulin), they are not FDA approved in type 1 and are considered “off-label.” SGLT-2 also contains a warning of an increased risk of ketoacidosis. This risk is especially important to consider in type 1 diabetes, since people with type 1 using an SGLT-2 Inhibitor may decrease their daily insulin dose and increase the risk of ketoacidosis.

This risk might be exacerbated by a low carbohydrate diet. As outlined in the ADA Standard 5, “This [low carbohydrate] eating pattern is not recommended at this time for women who are pregnant or lactating, people with or at risk for disordered eating, or people who have renal disease, and it should be used with caution in patients taking sodium-glucose cotransporter 2 inhibitors due to the potential risk of ketoacidosis.”

Answer 2 is incorrect! “Your BMI of 24.3 is right on target.” This is a juicy answer because it is true. The BMI is below 25, but it does not address the key intent of the question.

Answer 3 is incorrect. “I’m sorry, but oral medications don’t work for people with type 1 diabetes.” This is tricky. No oral medications are FDA approved for type 1 diabetes, but some are prescribed (metformin, SGLT-2s) by diabetes providers in addition to insulin. Still not the best answer.

Finally, Answer 4 is incorrect. “Do you think you might be struggling with disordered eating?” Another tempting answer, but MS isn’t exhibiting any signs of under-eating or under-dosing insulin or disordered eating.

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!


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 | July 7, 2020

AR is 16 years old and is struggling with weight.  AR was diagnosed with type 2 diabetes and has met with the dietitian and diabetes specialist.  In spite of eating healthier and a 3% weight loss, AR’s A1c is increasing and is currently 7.6%. The provider decides to start AR on medication.

Which of the following FDA approved medications should the provider prescribe?

  1. Metformin or SGLT-2 Inhibitor
  2. Basal insulin or sulfonylurea
  3. Liraglutide (Victoza) or Metformin
  4. Basal-bolus insulin

Click here to test your knowledge!


Watch for FREE or purchase to earn CEs!

From Tots to Teens Standards 2020
Join Live Stream July 15th at 11:30 am (PST)
1.5 CEs | $29.00 or No CEsFree

Perfect for those planning to take the CDCES or BC-ADM or for those seeking an update.

Coach Beverly is extending a special invitation to join this webinar on the latest standards for toddlers to teens living with diabetes.

This course includes updated goals and guidelines for children living with type 1 or type 2 diabetes.

This webinar will address:

  • special issues to be aware of when working with children with diabetes and their families. 
  • clinical presentation of diabetes
  • goals of care, management strategies

Register for FREE recorded webinar (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!


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 | June 30, 2020

AJ is admitted to the hospital for the second time this month for DKA.  The 28-year-old has type 1 diabetes, wears a CGM, and uses insulin pen injections. AJs last A1c was 11.3%.  AJs admitting glucose is 498 mg/dl, his pH is 7.05, and is anion gap is above 12. 

What are the next steps?

  1. Give AJ 20 units of rapid-acting insulin IV push.
  2. Start IV fluids and evaluate electrolytes before starting IV insulin.
  3. Start IV insulin at 0.5 units/kg/hour.
  4. Initiate basal-bolus insulin.

Click here to test your knowledge!


Hospital and Hyperglycemia |
Standards of Care Intensive 2020
Join us on July 8, 2020, at 11:30 am (PST) 
1.5 CE | $29.00 or No CEsFree

Recent research has demonstrated 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 provide templates of subcutaneous and insulin drip order sets. Join us to learn the latest in managing hyperglycemia in the hospital.

Register for FREE live stream webinar (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!


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.

Doing the Math | Weight and Calorie Counting Rationale

Our May 26th Question of the week was a question about carb counting. Although 56% of respondents chose the correct answer, 44% did not. We thought that this was an important topic to discuss further, so we can pass on correct info to 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: 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?

Answer Choices:

  1. 3.1 pounds
  2. 2.2 pounds
  3. 2.1 pounds
  4. 4.3 pounds

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

The devil is in the details

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 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 and do the math with care.

Answer 1 is incorrect. 20% chose this answer. This question is all about paying attention to details. AJ eats the hash browns 5 times a week or 20 times a month. If you chose this answer, you had AJ eating hash browns every day.

Answer 2 is correct! 56% of you chose this correct answer. AJ eats hash browns 5 times a week or 20 times a month. Each hash brown has 390 calories. 20 x 390 = 7, 800 calories. There are 3,500 calories in a pound. So, 7,800 / 3,500 = 2.2 pounds loss in a month. Yay. Great job.

Answer 3 is incorrect. About 10% of respondents chose this. If you chose this answer, you might have been calculating the number of calories in the egg sandwich instead of the hash browns.

Finally, Answer 4 is incorrect. 12% chose this answer. You probably thought AJ was stopping eating both the egg sandwich and hash browns, which would lead to a 4.3-pound weight 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 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!


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 | June 23, 2020

MS has type 1 diabetes and is on a low carb diet to help her keep her weight on target. She has a BMI of 24.3.  MS has a friend with type 1 who is taking a SGLT-2 in addition to insulin to help with weight management. MS wants to know if she could add on a SGLT-2 to her insulin treatment plan. 

What is the Diabetes Specialist’s best response?

  1. We don’t recommend adding on a SGLT-2 for people with type 1 on a low carb diet.
  2. Your BMI of 24.3 is right on target.
  3. I’m sorry, but oral medications don’t work for people with type 1 diabetes.
  4. Do you think you might be struggling with disordered eating?

Click here to test your knowledge!


Meds Management for Type 2 |
Standards of Care Intensive 2020
Join us on June 25, 2020, at 11:30 am (PST) 
1.5 CE | $29.00 or No CEsFree

This advanced-level course is designed to help participants determine the best medication choice based on the patient’s unique characteristics. The content incorporates the management guidelines published by the American Association of Clinical Endocrinologists (AACE) and the American Diabetes Association (ADA) Algorithms. We will discuss the role of lifestyle changes and review the pros and cons of available diabetes medications using a patient-centered approach. In addition, we discuss medication algorithms in detail. Participants not familiar with the basics of diabetes medication may benefit from first enrolling in our “Meds for Type 2” and “Insulin 101 Course.”

Register for FREE live stream webinar (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!


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.

Carb Counting and Math | QoW Rationale

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Our May 19th Question of the week was a question about carb counting. Although 58% of respondents chose the correct answer, 42% did not. We thought that this was an important topic to discuss further, so we can pass on correct info to 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 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?

Answer Choices:

  1. 3.0 units
  2. 2.8 units
  3. 4.0 units
  4. 3.5 units

This image has an empty alt attribute; its file name is Q1-5_19-1.png

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.

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Answer 1 is incorrect. 14% chose 3.0 units as the answer. This answer was juicy but wrong. Maybe this group thought the total carb count was 45 gms and then divided by insulin to carb ratio of 1:15? If yes, read the question again to see what insulin to carb ratio is a better choice. Also, rethink the total carb count.

Answer 2 is incorrect. Only 8% of respondents chose 2.8 units as an answer. This group got the carb count correct but may want to read the question again to see which insulin to carb ratio is a better choice.

Answer 3 is also incorrect. About 20% of respondents chose 4.0 units. This group might need to reassess the carb count, keeping in mind that milk is 12gms of carb. And, more importantly, keep in mind that LS uses an insulin pump that can deliver very precise insulin doses. No need to round up for this question.

Finally, Answer 4 is correct. 58% of test takers chose this correct answer.

First, lets count up the carbs for breakfast:

  • ½ cup of oatmeal = 15 gms
  • 3/4 cup of blueberries = 15 gms
  • A cup of skim milk = 12 gms
  • A tablespoon of peanut butter – 0 gms
  • Cup of coffee with a packet of Splenda – 0 gms
    Total carbs = 42 gms

Now, let’s do the math:

LS’s insulin to carb ratio is 1 to 12 for breakfast. She is going to eat 42 gms of carb. 42/12 = 3.5 units of insulin to cover breakfast.


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!


Meds Management for Type 2 |
Standards of Care Intensive 2020
Join us on June 25, 2020, at 11:30 am (PST) 
1.5 CE | $29.00 or No CEsFree

This advanced-level course is designed to help participants determine the best medication choice based on the patient’s unique characteristics. The content incorporates the management guidelines published by the American Association of Clinical Endocrinologists (AACE) and the American Diabetes Association (ADA) Algorithms. We will discuss the role of lifestyle changes and review the pros and cons of available diabetes medications using a patient-centered approach. In addition, we discuss medication algorithms in detail. Participants not familiar with the basics of diabetes medication may benefit from first enrolling in our “Meds for Type 2” and “Insulin 101 Course.”

Register for FREE live stream webinar (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!


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.