Rationale of the Week | Which Produce is listed in the”Dirty Dozen”?

For last week’s practice question, we quizzed test takers on which produce has the most pesticide residue. 82% of respondents chose the best answer, GREAT JOB. We want to share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question

Question: Each year, the Environmental Working Group (EWG) publishes the Shopper’s Guide to Pesticides in Produce™, which ranks the pesticide contamination of 46 popular fruits and vegetables based on test results by the Department of Agriculture and the Food and Drug Administration of around 45,000 samples of produce. Based on their 2022 analysis, which three fruits and vegetables listed are included in the “dirty dozen” (produce that is highest in pesticide residue)?

Answer Choices:

A. Strawberries, tomatoes, pears
B. Kale, asparagus, mangoes
C. Avocados, onions, sweet corn
D. Sweet potatoes, watermelon, cherries

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

Getting to the Best Answer

Answer 1 is correct. 81.57% chose this answer, “Strawberries, tomatoes, pears.” YES, this is the best answer. The complete list of fruits and vegetables with the highest pesticide levels include:

Dirty Dozen

These fruits and veggies are still healthy choices since they are packed with fiber and phytonutrients. However, given their higher amount of pesticide, try to purchase from the Organic Section of your local store or farmer’s market.

Strawberries
Spinach
Kale, collard and mustard greens
Nectarines
Apples
Grapes
Bell and hot peppers
Cherries
Peaches
Pears
Celery
Tomatoes

Answer 2 is incorrect. 9.68% of you chose this answer, “Kale, asparagus, mangoes.” Kale is included on the dirty dozen list, while asparagus and mangoes are part of the Clean 15.

Answer 3 is incorrect. 4.84% of respondents chose this answer, “Avocados, onions, sweet corn.” All of these vegetables and fruits have the lowest amount of pesticide and a part of the Clean 15.

Clean 15

These Clean 15 healthy fruits and veggies are safe to purchase in the non-organic or organic section. It’s always a good idea to wash fruit and veggies before eating.

Avocados
Sweet Corn
Pineapple
Onions
Papaya
Sweet peas (if frozen)
Asparagus
Honeydew melon
Cabbage
Kiwi
Mangoes
Mushrooms
Watermelon
Sweet potatoes

Finally, Answer 4 is incorrect. 3.92% chose this answer, “Sweet potatoes, watermelon, cherries.” Sweet potatoes and watermelon are part of the Clean 15 while cherries are included in the dirty dozen.

More info Here

Please visit the Environmental Working Groups Web page here
Dirty Dozen List
Clean 15 List
Info on how this list is created each year

We hope you appreciate this week’s rationale!

FREE PocketCard & Wildflower Seed PostCard for a Pledge

Free PocketCard and Wildflower Seed Postcard

We have created a list of 10 Actions to Celebrate Earth Day and printed these actions on wildflower seed postcards, that are ready for planting. To thank you for your pledge to commit to one or more actions that invest in the well-being of our planet, we will mail you a Free PocketCard and Wildflower Seed PostCard.

It’s easy! Just pick your action(s) on this survey and provide a mailing address where to send these gifts of appreciation. Each action, no matter how small, matters.

Earth Day Commitment Survey for FREE Pocketcard

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Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

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Rationale of the Week | The “tooth” about diabetes & oral health

For last week’s practice question, we quizzed test takers on the link between oral health & hyperglycemia. 73% of respondents chose the best answer. We want to share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!

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: Diabetes is associated with an increased risk of oral disease. Which of the following statements is true regarding people living with diabetes and hyperglycemia?

Answer Choices:

Experience decreased salivary production.
Benefit from vinegar gargles to decrease the bacterial load.
At greater risk for oral cancers.
More likely to experience tonsillitis.

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

Getting to the Best Answer

Answer 1 is correct. 73.61% chose this answer, “Experience decreased salivary production.” YES, GREAT JOB, this is the best answer. When a person is experiencing hyperglycemia, this leads to dehydration due to the chronic diuresis. When dehydrated, people with hyperglycemia produce less saliva and they saliva they do produce is laden with glucose. These 2 factors contribute to a higher risk of dental caries and can make mastication more difficult. There are products to increase salivary production, but the best treatment is to improve blood glucose levels.

Answer 2 is incorrect. 7.01% of you chose this answer, “Benefit from vinegar gargles to decrease the bacterial load.” Actually, gargling with vinegar can be harmful to your mouth if it is dry. Without the proper amount of saliva, the acid can break down enamel and decrease ability to fight off infection. There are products to increase salivary production, but the best treatment is to improve blood glucose levels.

Answer 3 is incorrect. 7.63% of respondents chose this answer, “At greater risk for oral cancers.” People with diabetes and chronic hyperglycemia have a higher risk for oral carries, gingivitis and periodontitis due to increased levels of sugar in the saliva that supports bacterial growth. However, do not have an increased risk of oral cancers.

Finally, Answer 4 is incorrect. 11.75% chose this answer, “More likely to experience tonsillitis.” People with diabetes and chronic hyperglycemia have a higher risk for oral carries, gingivitis and periodontitis due to increased levels of sugar in the saliva that supports bacterial growth. However, do not have an increased risk of tonsillitis.

More information from the American Dental Association.

We hope you appreciate this week’s rationale!

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Deluxe Version includes Syllabus, Standards and Swag*:

Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

Q & A Session with the instructor after each webinar.
LIVE Presentations by our team of experts.
State of the art review of current diabetes care and technology.
Resources for each session.
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Rationale of the Week | Can you calculate LR’s Sensitivity Factor?

For last week’s practice question, we quizzed test takers on calculating LR’s sensitivity factor. 76% of respondents chose the best answer. We want to share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!

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: LR is a 30-year-old with type 1 diabetes. LS uses 25 units of basal insulin and 20 units of bolus insulin (about 6-7 units per meal) per day. Using the rule of 1700, what is LR’s insulin sensitivity factor?

Answer Choices:

As shown above, the most common choice was option 4, the second most common answer was option 3, then a tie for options 1 and 2.

Getting to the Best Answer

Answer 1 is incorrect. 7.81% chose this answer, “23.” To figure out the sensitivity factor, we first have to determine the Total Daily Dose (TDD) that LR is taking. LR is taking 25 units of basal insulin and 20 units of bolus insulin, which equals a TDD of 45 units. If we are using 1700 as our insulin sensitivity factor (ISF), we divide the 1700 divided by 45 or 1700/45 or 37.7 which we round up to 38. In other words, 1 unit of insulin will drop LR’s blood sugar by 38 points.

Answer 2 is incorrect. 7.81% of you chose this answer, “85.” People who chose this answer, probably only included the bolus insulin dose in the calculation or 1700/20. To get to the accurate answer, add the basal plus bolus to get the total dose of 45, the divide as follows 1700/45 equals or 37.7 which we round up to 38. In other words, 1 unit of insulin will drop LR’s blood sugar by 38 points.

Answer 3 is incorrect. 8.27% of respondents chose this answer, “50.” To figure out the sensitivity factor, we first have to determine the Total Daily Dose (TDD) that LR is taking. LR is taking 25 units of basal insulin and 20 units of bolus insulin, which equals a TDD of 45 units. If we are using 1700 as our insulin sensitivity factor (ISF), we divide the 1700 divided by 45 or 1700/45 or 37.7 which we round up to 38. In other words, 1 unit of insulin will drop LR’s blood sugar by 38 points.

Finally, Answer 4 is correct. 76.11% chose this answer, “38.” YES, most of you chose the BEST answer. To figure out the sensitivity factor, we first have to determine the Total Daily Dose (TDD) that LR is taking. LR is taking 25 units of basal insulin and 20 units of bolus insulin, which equals a TDD of 45 units. If we are using 1700 as our insulin sensitivity factor (ISF), we divide the 1700 divided by 45 or 1700/45 or 37.7 which we round up to 38. In other words, 1 unit of insulin will drop LR’s blood sugar by 38 points.

Extra Credit info. What sensitivity factor should we use?

We use 1700 or 1800 insulin sensitivity factor (ISF) for people on insulin analogs and the 1500 ISF for people on regular insulin. But also, as you can see with the math below, a higher ISF number means less insulin. So, if we are working with a leaner more frail individual, we might choose to be more conservative and start with and ISF of 1800.

Example- A person’s Total Daily Dose (TDD) is 30 units a day. To figure out how much correction insulin they need to correct their hyperglycemia, we would consider the following options depending on their presentation.

1800/30 = 1 unit for every 60 points above target

1700/30 = 1 unit for every 56

1500 / 30 = 1 unit for every 50

We hope you appreciate this week’s rationale!

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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

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Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

Q & A Session with the instructor after each webinar.
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State of the art review of current diabetes care and technology.
Resources for each session.
Access to free podcasts and video recordings within a week of each live session for one year.

Deluxe Version includes Syllabus, Standards and Swag*:

Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

Q & A Session with the instructor after each webinar.
LIVE Presentations by our team of experts.
State of the art review of current diabetes care and technology.
Resources for each session.
Access to free podcasts and video recordings within a week of each live session for one year.

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

All hours earned count toward your CDCES Accreditation Information

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!

Rationale of the Week | Which Medications are needed?

For last week’s practice question, we quizzed test takers on which medications are needed. you all did great, since 81% of respondents chose the best answer. We want to share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!

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 43 with type 2 diabetes, with an A1C of 8.8%, UACR is 32 mg/g, GFR is 48, and blood pressure is 146/84 or greater on 2 different occasions. Current medications include metformin 1000mg BID, lovastatin 20mg, glipizide 20mg.

Based on the ADA standards of care, in addition to lifestyle encouragement, adding which medications would most improve outcomes?

Answer Choices:

GLP-1 RA and low dose aspirin
ACE and ARB for blood pressure management
Basal insulin and a diuretic
SGLT-2 and ACE or ARB

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

Getting to the Best Answer

Answer 1 is incorrect. 7.61% chose this answer, “GLP-1 RA and low dose aspirin.” Since LS is under the age of 50 and their CV risk status isn’t revealed in this case study, we don’t have enough information to start LS on aspirin. We could consider adding a GLP-1 RA, since it is known to lower glucose, decrease CV risk and offer some renal protection. However, since one part of the answer is wrong, the whole answer is wrong, even though adding a GLP-1 to LS’s plan would be helpful.

Answer 2 is incorrect. 6.58% of you chose this answer, “ACE and ARB for blood pressure management.” LS does have hypertension and elevated albumin levels and is not taking any medication for blood pressure. Given those two risk factors, LS needs to take EITHER an ACE Inhibitor or ARB for blood pressure management, but NOT both. We would recommend starting LS on an ACE or ARB first and adjusting the dose based on home blood pressure reading. If LS needs an additional blood pressure medication, we could add a diuretic, calcium channel blocker or beta-blocker, or another agent. See our Hypertension & Lipids, Cheat Sheet for more info.

Answer 3 is incorrect. 4.94% of respondents chose this answer, “Basal insulin and a diuretic.” With an A1c of 8.8%, LS isn’t quite ready for insulin since there are 2 other medications we could try first (SGLT-2 or GLP-1) to get glucose to goal. The ADS Standards recommend trying a GLP-1 before basal insulin if possible to avoid the risk of hypoglycemia and to decrease weight gain. In addition, because LS has hypertension and albuminuria, a diuretic would not be the medication of choice to lower blood pressure. The preferred medications for blood pressure in the presence of albuminuria include either an ACE or ARB.

Finally, Answer 4 is correct. 80.86% chose this answer, “SGLT-2 and ACE or ARB.” GREAT JOB! Most of you chose this BEST answer. In the presence of hyperglycemia, albuminuria, and diminishing renal function, adding a SGLT-2 Inhibitor is the best choice based on ADA Standards. SGLT-2s have been shown to not only lower glucose and protect kidneys, they can also lower blood pressure due to their “glucoretic” properties. To manage LS’s hypertension, the preferred medications for blood pressure in the presence of albuminuria include either an ACE or ARB.

We hope you appreciate this week’s rationale! For more information on this topic, check out the ADA Standards of Care. Or, join our 3 day DiabetesEd Specialist Virtual Conference next week. It’s not to late to register!

Join us for our Virtual DiabetesEd Specialist Conference
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Join us LIVE for this Virtual Course and enjoy a sense of community!

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

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Two Registration Options

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Deluxe Option for $499: Virtual Program includes:

Q & A Session with the instructor after each webinar.
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State of the art review of current diabetes care and technology.
Resources for each session.
Access to free podcasts and video recordings within a week of each live session for one year.

Deluxe Version includes Syllabus, Standards and Swag*:

Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

Q & A Session with the instructor after each webinar.
LIVE Presentations by our team of experts.
State of the art review of current diabetes care and technology.
Resources for each session.
Access to free podcasts and video recordings within a week of each live session for one year.

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

All hours earned count toward your CDCES Accreditation Information

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!

Rationale of the Week | What is the cause of JR’s leg pain?

For last week’s practice question, we quizzed test takers on the cause of JR’s leg pain. 67% of respondents chose the best answer. We want to share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!

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: JR is experiencing lower extremity pain and asks to get their gabapentin (Neurontin) renewed? When asked, JR says the pain is so bad in their calf muscles when walking, that they have to sit down and rest. What best describes the cause of JR’s pain?

Answer Choices:

Loss of protective sensation (LOPS).
Peripheral arterial disease (PAD).
Autonomic neuropathy.
Small nerve fiber neuropathy.

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

Getting to the Best Answer

Answer 1 is incorrect. 4.72% chose this answer, “Loss of protective sensation (LOPS).” This is a juicy answer because people with neuropathy and loss of protective sensation are often prescribed gabapentin to treat nerve pain. However, when we learn that JR’s calf pain only occurs when walking, we experience an “ah-ha” moment. The cause of JR’s pain is lack of arterial blood flow to the lower extremities, also known as peripheral arterial disease (PAD). The classic symptom of PAD is pain in calf muscles or buttocks when walking that is relieved by stopping. Neuropathy is most often described as burning pain in lower extremities that is often worse at night.

Answer 2 is correct. 66.94% of you chose this answer, “Peripheral arterial disease (PAD).” JR is experiencing lack of arterial blood flow to the lower extremities, also known as peripheral arterial disease (PAD). A classic symptom of PAD is pain in calf muscles or buttocks when walking that is relieved by stopping. Perhaps JR was prescribed gabapentin due to an incomplete medical assessment. With this new information, we can collaborate with the provider to see if referral to a vascular specialist is warranted to evaluate if further intervention is needed.

Answer 3 is incorrect. 14.33% of respondents chose this answer, “Autonomic neuropathy.” Autonomic neuropathy in people with diabetes does not cause lower extremity pain. Lower extremity pain is due to small and large nerve fiber destruction or peripheral arterial disease (PAD). People with autonomic neuropathy and diabetes are at higher risk of gastroparesis, sexual dysfunction, resting tachycardia and a myriad of other conditions.

Finally, Answer 4 is incorrect. 14.01% chose this answer, “Small nerve fiber neuropathy.” This answer is tempting because people with small nerve fiber neuropathy are often prescribed gabapentin to treat nerve pain. However, when we learn that JR’s calf pain only occurs when walking, we experience an “ah-ha” moment. The cause of JR’s pain is lack of arterial blood flow to the lower extremities, also known as peripheral arterial disease (PAD). The classic symptom of PAD is pain in calf muscles or buttocks when walking that is relieved by stopping. Small nerve fiber neuropathy is most often described as burning pain that is often worse at night.

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 important learning activity!

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People with diabetes are at increased risk of Lower Extremity Complications. This course reviews the steps involved in performing a detailed assessment of the lower extremities, including how to use a monofilament and tuning fork to detect neuropathy. We also discuss the significance of Ankle Brachial Index and strategies to prevent lower extremity complications.

Objectives:

Describe the risk factors for lower extremity complications
Discuss prevention strategies
Demonstrate steps involved in a lower extremity assessment

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30+ CEs | April 13-15, 2022

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Join us LIVE for this Virtual Course and enjoy a sense of community!

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

Two Registration Options

Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

Q & A Session with the instructor after each webinar.
LIVE Presentations by our team of experts.
State of the art review of current diabetes care and technology.
Resources for each session.
Access to free podcasts and video recordings within a week of each live session for one year.

Deluxe Version includes Syllabus, Standards and Swag*:

Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

Q & A Session with the instructor after each webinar.
LIVE Presentations by our team of experts.
State of the art review of current diabetes care and technology.
Resources for each session.
Access to free podcasts and video recordings within a week of each live session for one year.

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

All hours earned count toward your CDCES Accreditation Information

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!

Rationale of the Week | What Changed with the New DSME Standard?

For last week’s practice question, we quizzed test takers on the most accurate statement based on the new ADA Standards of Care on DSME Programs. 60% of respondents chose the best answer. We want to share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!

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: Which of the following best represents the 2022 update to the National Standards for Diabetes Self-Management Education and Support (DSMES)?

Answer Choices:

Due to the complexity of delivering DSME in today’s health care environment, 2 new standards have been added for a total of 12 Standards.
About 20 – 30% of people with Medicare or private insurance currently utilize DSMES services.
To maintain quality, at least one of the DSMES team members needs to have either a CDCES or BC-ADM.
Less focus on “checking the box” when delivering curriculum and more focus on the individual needs.

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

Getting to the Best Answer

Answer 1 is incorrect. 16.73% chose this answer, “Due to the complexity of delivering DSME in today’s health care environment, 2 new standards have been added for a total of 12 Standards.” This was a juicy answer, but not the best one. The authors of this updated Standard of Practice for DSMES, decided that to INCREASE access to DSMES, there needed to be a DECREASE of bureaucracy and paperwork. They managed to maintain the essence of the original 10 Standards in this new streamlined version with only SIX standards. There was also a much needed intensive focus on recognizing and addressing Social Determinants of Health and breaking down barriers to DSMES access.

Answer 2 is incorrect. 11.49% of you chose this answer, “About 20 – 30% of people with Medicare or private insurance currently utilize DSMES services.” I wish this was the best answer. However, according to the ADA Standards, only 6-8% of Medicare recipients participate in DSMES. This lackluster level of participation is due to a multitude of factors and is best addressed by an interdisciplinary action committee, with stakeholders from the community and the health care team. Plus, creating a multi-pronged and thoughtful marketing plan is crucial to raise awareness of DSMES services.

Answer 3 is incorrect. 12.10% of respondents chose this answer, “To maintain quality, at least one of the DSMES team members needs to have either a CDCES or BC-ADM.” In the old days, this was a requirement. However, since many rural communities may not have access to a CDCES or BC-ADM, this requirement has been dropped for over 10 years. The good news is that a variety of health care professionals can make up the DSMES Team. Specifically, the new guidelines say that, “The DSMES team may include one or a variety of healthcare professionals. The evidence recommends the inclusion of dietitians, nurses, pharmacists, or all other disciplines with special certifications that demonstrate mastery of diabetes knowledge and training, such as BC-ADM and CDCES, can support all DSMES services, including clinical assessment.

Finally, Answer 4 is correct. 59.68% chose this answer, “Less focus on “checking the box” when delivering curriculum and more focus on the individual needs.” YES, this is the BEST Answer. The authors who gathered to write this paper, were from different parts of the country serving a wide variety of communities. I believe, by assembling this thoughtfully chosen and diverse group or diabetes advocates and educators, they created a fresh and more inclusive set of standards. The overall theme is more community engagement with a clearn focus on the individual needs versus completing check boxes of educational topics covered. I commend the authors and invite you to peruse this very important document that summarizes the delivery of effective and person centered DSMES.

2022 National Standards for Diabetes Self-Management Education and Support– A joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics.

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 important learning activity!

Want to learn more about this topic? You are invited to view our Setting Up a Successful DSMES Program.

Setting up a Successful DSME Program Standards | Level 2 $29 | 1.5 CEs

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This course provides you with a succinct overview of the latest standards for Diabetes Self-Management Education (DSME) and Support Programs. If you are taking certification exams or considering setting up a DSME program, this program is designed for you. We highlight the newly revised and simplified 2022 Standards and provide strategies on program implementation. In addition, we discuss Medicare Reimbursement and covered benefits. This course provides insights into the exam philosophy and also highlights critical content areas.

Objectives:

Describe DSME program examples from across the country.
List the six standards for creating a successful DSME program
Discuss marketing strategies for success
Describe Medicare Reimbursement for diabetes care and education

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Join us for our Virtual DiabetesEd Specialist Conference
30+ CEs | April 13-15, 2022

Download Course Schedule | Download Course Flyer

Join us LIVE for this Virtual Course and enjoy a sense of community!

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

Download Course Schedule | Download Course Flyer

Two Registration Options

Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

Q & A Session with the instructor after each webinar.
LIVE Presentations by our team of experts.
State of the art review of current diabetes care and technology.
Resources for each session.
Access to free podcasts and video recordings within a week of each live session for one year.

Deluxe Version includes Syllabus, Standards and Swag*:

Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

Q & A Session with the instructor after each webinar.
LIVE Presentations by our team of experts.
State of the art review of current diabetes care and technology.
Resources for each session.
Access to free podcasts and video recordings within a week of each live session for one year.

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

All hours earned count toward your CDCES Accreditation Information

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!

Rationale of the Week | Most accurate MNT Statement based on New Standards?

For last week’s practice question, we quizzed test takers on the most accurate MNT statement based on the new ADA Standards of Care. 60% of respondents chose the best answer. We want to share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!

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: Based on the 2022 ADA Standards of care on Medical Nutrition Therapy (MNT), which statement is most accurate?

Answer Choices:

MNT provided by a RD/RDN is associated with A1c absolute decreases of 0.3 to 2.0 percent.
A low carbohydrate, high protein diet is associated with increased risk of renal failure.
With new type 2 diabetes, try to achieve A1c targets with MNT for 3 months before advancing to medication therapy.
People with diabetes and hypertension have improved outcomes when they decrease sodium intake to less than 1,500 mg a day.

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

Getting to the Best Answer

Answer 1 is correct. 59.91% chose this answer, “MNT provided by a RD/RDN is associated with A1c absolute decreases of 0.3 to 2.0 percent.” Yes, this is the best answer. When people with prediabetes or diabetes work with a registered dietitian/nutritionist to develop an individualized approach to meal planning, they are able to make significant changes in their food choices, portions and improve their overall nourishment – all resulting in significant A1C drops. The ADA Standards recommend that a person with new diabetes meet with an RD soon after diagnosis and at least annually thereafter.

Answer 2 is incorrect. 7.78% of you chose this answer, “A low carbohydrate, high protein diet is associated with increased risk of renal failure.” This juicy answer is tempting. However, there is not evidence to support the statement that high protein diets increase the risk of renal failure. The ADA does state that there is evidence to support limiting carbohydrates to improve blood glucose levels. But most important, all approaches need to be individualized.

Answer 3 is incorrect. 16.89% of respondents chose this answer, “With new type 2 diabetes, try to achieve A1c targets with MNT for 3 months before advancing to medication therapy.” For most people it can take over 5-6 years to discover diabetes and for many, there is already vessel damage and the beginnings of complications at diagnosis. For this reason and to slow the progression of complications, lifestyle and medication therapy are started simultaneously.

Finally, Answer 4 is incorrect. 15.42% chose this answer, “People with diabetes and hypertension have improved outcomes when they decrease sodium intake to less than 1,500 mg a day.” The standards recommend limiting sodium intake to about 2,300mgs a day for people with diabetes. However, they do not recommend going lower than 1,500mgs a day, because there isn’t enough data demonstrating that very low sodium intake improves heart health and it may even be harmful.

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 important learning activity!

Want to learn more about this topic- Our nutrition expert will review MNT for over 3 hours on April 15th.

Join us for our Virtual DiabetesEd Specialist Conference
30+ CEs | April 13-15, 2022

Download Course Schedule | Download Course Flyer

Join us LIVE for this Virtual Course and enjoy a sense of community!

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

Download Course Schedule | Download Course Flyer

Two Registration Options

Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

Q & A Session with the instructor after each webinar.
LIVE Presentations by our team of experts.
State of the art review of current diabetes care and technology.
Resources for each session.
Access to free podcasts and video recordings within a week of each live session for one year.

Deluxe Version includes Syllabus, Standards and Swag*:

Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

Q & A Session with the instructor after each webinar.
LIVE Presentations by our team of experts.
State of the art review of current diabetes care and technology.
Resources for each session.
Access to free podcasts and video recordings within a week of each live session for one year.

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

All hours earned count toward your CDCES Accreditation Information

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!

Rationale of the Week | High Fat & Protein Meals impact on post meal glucose?

For last week’s practice question, we quizzed test takers on the impact high-fat meals have on post-meal glucose. This was a tough one, since only 40% of respondents chose the best answer. We want to share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!

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: MJ is on an insulin pump and takes 1 unit of insulin for every 15 gms of carb. For a meal with 5 ounces of steak, medium baked potato with sour cream, asparagus, and salad, MJ bolused 3 units of insulin to cover carbs. What might MJ expect to happen 3 hours later?

Answer Choices:

A glucose spike
Hypoglycemia
Blood glucose in target range
Need to consume more carbs

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

Getting to the Best Answer

Answer 1 is correct. 40.29% chose this answer, “A glucose spike.” Great job, this is the best answer! Even though MJ gave 3 units of bolus insulin to cover the carbs from the potato, there will be a secondary glucose spike about 3 hours later from the meat protein and the sour cream. There is a growing understanding (as noted in ADA Standard 5) that people with type 1 diabetes need to not only cover for carbs in the meal, but many times they need to include a small amount of bolus insulin to cover for high fat and protein sources. The delayed post meal glucose elevation is secondary to gluconeogenesis as their body converts some of the digested fat and protein into glucose. For people using insulin pump, they can use dual wave bolus, so they get some of the bolus initially and the rest a few hours later to coincide with the second glucose spike. People on insulin injections could also inject a small amount as they see their secondary glucose rising as protein and fat impact blood sugar levels.

Answer 2 is incorrect. 22.34% of you chose this answer, “Hypoglycemia.” This is a juicy answer, but the 3 units is just the right amount to cover for the potato, veggies and salad. Plus, with the additional protein and fat consumption, MJ is unlikely to experience hypoglycemia.

Answer 3 is incorrect. 24.88% of respondents chose this answer, “Blood glucose in target range.” MJ blood sugar could be in target range one to two hours post meal, but given the additional consumption of 5 ounces of protein plus sour cream, it is likely that around hour three, MJ will experience a glucose spike.

Finally, Answer 4 is incorrect. 12.49% chose this answer, “Need to consume more carbs.” This is a juicy answer, but the 3 units is just the right amount to cover for the potato, veggies and salad. Plus, with the additional protein and fat consumption, MJ is not likely to see blood sugar drop to the point where they would need to consume more carbs.

Want to read more about his topic?

Beyond Carbohydrate Counting: Utilizing Nutrition Factors to Optimize Insulin Dosing | On the Cutting Edge| 2021 Volume 42 | No 4 – Subscription only

Benefit of supplementary fat plus protein counting as compared with conventional carbohydrate counting for insulin bolus calculation in children with pump therapy – Article

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 important learning activity!

Want to learn more about this topic?

Join us for our Virtual DiabetesEd Specialist Conference
30+ CEs | April 13-15, 2022

Download Course Schedule | Download Course Flyer

Join us LIVE for this Virtual Course and enjoy a sense of community!

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

Download Course Schedule | Download Course Flyer

Two Registration Options

Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

Q & A Session with the instructor after each webinar.
LIVE Presentations by our team of experts.
State of the art review of current diabetes care and technology.
Resources for each session.
Access to free podcasts and video recordings within a week of each live session for one year.

Deluxe Version includes Syllabus, Standards and Swag*:

Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

Q & A Session with the instructor after each webinar.
LIVE Presentations by our team of experts.
State of the art review of current diabetes care and technology.
Resources for each session.
Access to free podcasts and video recordings within a week of each live session for one year.

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

All hours earned count toward your CDCES Accreditation Information

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!

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Dirty Dozen

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Want to learn more about this topic? You are invited to view our Setting Up a Successful DSMES Program.

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Rationale of the Week | Most accurate MNT Statement based on New Standards?

Getting to the Best Answer

Want to learn more about this topic- Our nutrition expert will review MNT for over 3 hours on April 15th.

Two Registration Options

Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs

Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Sign up for DiabetesEd Blog Bytes

Rationale of the Week | High Fat & Protein Meals impact on post meal glucose?

Getting to the Best Answer

Want to learn more about this topic?

Two Registration Options

Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs

Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Sign up for DiabetesEd Blog Bytes

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