Question of the Week – Counting Carbs | May 19, 2020

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?

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

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?

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.

Medical Nutrition Therapy + Meal Planning
Airs May 27th at 8:30 AM (PDT)
$59 (on sale till 5/25!) | 4.0 CEs 

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.


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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.

LS is a 16-year-old with type 1 diabetes for the past 3 years.  The most recent A1c is 9.3%.  LS covers carbs using a 1:15 carb/insulin ratio and takes basal insulin at night. After the parents leave the room, LS tells you they are so tired of checking blood sugars and taking insulin four times a day, sometimes they just “fake it.” 

What is the most appropriate action?

  1. Gently remind LS that not taking insulin on a regular basis can lead to complications.
  2. Download their meter results and ask them to start logging their carbs and insulin.
  3. Explore the possibility of trying Continuous Glucose Monitoring.
  4. Bring the parents in for a family meeting to stress the importance of getting A1c to goal.

Click here to test your knowledge!


Virtual Course Insulin Therapy, Pumps, & CGM + CV Risk Reduction Strategies
Earn 4.0 CEs | $69

Airs Tomorrow at 12:30 PM (PDT)

Join Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES, and ADCES 2020 Diabetes Educator of the year as she reviews these important topics. As Diabetes Specialists, we are tasked with taking a leadership role in technology and cardiovascular risk reduction. Dr. Isaacs will address these topics with clinical insight and expert knowledge during these two virtual courses.

Virtual Course Webinar Dates | Earn 4.0 CEs

Session 1 | CV Risk Management with Pharmacology and Intensive Insulin Therapy on May 13, 2020, from 12:30 PM – 2:30 PM (PDT)

Session 2 | Continuous Glucose Monitoring and Insulin Pump Therapy on May 14 from 8:30 AM – 10:30 AM (PDT)

Objectives:

  1. Describe critical teaching content before starting insulin pump therapy.
  2. Describe appropriate candidates for insulin pump therapy.
  3. Discuss strategies to determine and fine-tune insulin pump basal rates.
  4. Discuss how to determine and fine-tune bolus rates including coverage for carbs and hyperglycemia.
  5. State important safety measures to prevent hyperglycemic crises.
  6. List inpatient considerations for insulin pump therapy and CGMs.
  7. Discuss features of available professional and personal CGMs and insulin pumps.
  8. Describe CV risk factors associated with diabetes and future event prediction.
  9. List different pharmacologic approaches to mitigate CV events.

$69 | Earn 4 CEs

These sessions are also included in our Virtual Conference.


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JR is 49 with type 2 diabetes and is admitted to the hospital for congestive heart failure. His home diabetes medication includes metformin 2000 mg daily. GFR is 53 and JR’s A1c is 8.1%.

Upon discharge, which class of medication is recommended, according to the AACE Guidelines, in addition to the metformin to improve outcomes?

  1. Sulfonylurea
  2. Meglitinide
  3. SGLT-2 Inhibitor
  4. Basal insulin

Click here to test your knowledge!


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SL is 17 years old, with type 1 diabetes. SL uses an insulin pump and checks glucose levels before meals and at bedtime. SL started track team at high school a week ago and noticed that they are waking up with vivid dreams and morning blood glucose levels are higher than usual.

Which of the following is the best recommendation?

  1. Advise SL to consume at least 30 gms of carb during track workouts.
  2. Recommend increasing basal insulin by 10% during track season.
  3. Encourage SL to check blood glucose before track practice.
  4. Suggest ingesting additional carbs before bedtime.

Click here to test your knowledge!


COVID-19 & Diabetes: What Healthcare Professionals Need to Know
Free Webinar | April 30th

As health care professionals and Diabetes Specialists, how do we prepare people with diabetes for the possibility of a COVID-19 infection and hospitalization?

What are the best practices to care for people with diabetes and COVID-19 in the outpatient and hospital setting?

Topics:

  1. Discuss the relationship between social determinants of health, diabetes, and COVID-19.
  2. List how people with type 1 and type 2 diabetes can prevent and prepare for a COVID-19 infection.
  3. Describe how the COVID-19 virus can cause serious illness in people with diabetes and underlying health conditions
  4. State management strategies for people with diabetes and COVID in the inpatient and outpatient settings.
  5. Discuss the latest regulations regarding DSMT and Telehealth

Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF, a working educator and a nationally recognized diabetes expert.

Webinar Viewing Options:

Can’t make it live? Your webinar registration means you receive a link to the recorded version within hours of airing.


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You are working with KS, a 57-year-old with type 2 diabetes and an A1c of 6.8%, who wants to join the water aerobics program at their local YMCA. KS has a history of hypothyroidism and has an LDL cholesterol of 98 mg/dl. KS’s medications include levothyroxine and metformin XR 1000 mg BID.

According to the ADA and the American College of Sports Medicine, what would be the best recommendation?

  1. Encourage KS to join the water aerobics program
  2. Recommend that KS get an EKG before starting this new activity
  3. Ask KS’s provider to order a stress test
  4. Make sure KS monitors blood glucose before and after exercise class

Click here to test your knowledge!


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JL has prediabetes and wants to know if adding cinnamon to their diet will prevent them from getting type 2 diabetes.

What is the Diabetes Ed Specialist’s best response?

  1. Adding cinnamon to your meal plan lowers your risk of diabetes.
  2. The American Diabetes Association does not recommend nutritional supplements.
  3. It is better to take the cinnamon capsules, so you get a standardized dose.
  4. Many people find that cinnamon makes healthy foods taste better.

Click here to test your knowledge!


Want more practice questions?
Join us live today for our new Virtual DiabetesEd Specialist Conference!
$459 | 30+ CEs


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BT has had type 1 diabetes for 12 years and is complaining of feeling full and sometimes nauseated after meals, especially after consuming salads.

Which of the following conditions is BT most likely experiencing?

  1. Food intolerance syndrome
  2. Celiac disease
  3. Chron’s disease
  4. Gastroparesis

Click here to test your knowledge!


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Our March 31st Question of the week was a question about COVID-19, sick days and diabetes. Although 40% of respondents chose the correct answer, 60% 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

JR is 27 with Type 1 diabetes and is very worried about getting COVID-19 since they work in a local grocery store.  They ask you what they should do if they get COVID-19?

Which of the following statements is accurate regarding sick day management with COVID-19?

Answer Choices:

  1. Seek immediate medical attention if lips or face become bluish.
  2. Report to the emergency room if the temperature is 101 degrees or greater.
  3. Reduce insulin intake by 10-20% if experiencing diarrhea.
  4. Use glucose fingersticks instead of continuous glucose monitoring (CGM) when febrile to improve accuracy.

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.

Only 39% of participants chose the correct answer number 3, which means there is a learning opportunity!

Answer 1 is Correct! Seek immediate medical attention if lips or face become bluish. Bluish lips or face indicates hypoxia and signals urgent medical care is needed.

From ADA Sick Day Information. If develop emergency warning signs for COVID-19 get medical attention immediately.

In adults, emergency warning signs include:

  • Difficulty breathing or shortness of breath
  • Persistent pain or pressure in the chest
  • New confusion or inability to arouse
  • Bluish lips or face

Option 2 is incorrect. One-fifth of respondents chose ” Report to the emergency room if the temperature is 101 degrees or greater.” In the case of fever, the next step would to be to contact your provider to evaluate presence of cough, shortness of breath and other symptoms to determine if urgent care is required.

Option 3 is also incorrect. “Reduce insulin intake by 10-20% if experiencing diarrhea.” During periods of illness, inflammation leads to insulin resistance and hyperglycemia. Most people will need to increase insulin dose during illness, including GI distress.

Finally, Option 4 is incorrect. “Use glucose fingersticks instead of continuous glucose monitoring when febrile to improve accuracy.”
Fever by itself does not interfere with CGM accuracy. If a person is taking Tylenol, it can interfere with the accuracy certain CGMs. And, CGM use is not recommended in the Intensive Care setting. But, having a temperature by itself, does not interfere with CGM accuracy.

Here is a COVID and Sick Day Handout that you can share with your community. Thank you for helping us get the word out.

For more information on sick day management and when to seek medical care, please see this ADA Sick Day Information

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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JR is 27 with Type 1 diabetes and is very worried about getting COVID-19 since they work in a local grocery store.  They ask you what they should do if they get COVID-19?

Which of the following statements is accurate regarding sick day management with COVID-19?

  1. Seek immediate medical attention if lips or face become bluish
  2. Report to the emergency room if temperature is 101 degrees or greater
  3. Reduce insulin intake by 10-20% if experiencing diarrhea
  4. Use glucose fingersticks instead of continuous glucose monitoring when febrile to improve accuracy.

Click here to test your knowledge!


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MJ, a 49-year-old with type 1 diabetes, states during your telehealth session that they are not feeling very well and are worried about getting COVID-19.

Which of the following is an accurate statement?

  1. People with diabetes are at higher risk of getting COVID-19
  2. People with diabetes have the same risk of getting COVID-19 as the general population
  3. People with type 1 diabetes have a slightly higher risk of getting COVID-19 than those with type 2 diabetes
  4. Regardless of the type of diabetes, COVID-19 rates are slightly lower

Click here to test your knowledge!


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.


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