Answer A is incorrect: 8.39% chose this answer, “10%.” This answer underestimates the problem. Research indicates that approximately 40% of patients with diabetes may miss or avoid follow-up appointments because they experience feelings of shame, blame or judgment related to their condition or care. This highlights the importance of delivering diabetes care with stigma-free, supportive communication approaches as a means to improve engagement and outcomes

Answer B is incorrect: 17.10% chose this answer, “25%.” This answer underestimates the problem. Research indicates that approximately 40% of patients with diabetes may miss or avoid follow-up appointments because they experience feelings of shame, blame or judgment related to their condition or care. This highlights the importance of delivering diabetes care with stigma-free, supportive communication approaches as a means to improve engagement and outcomes.

Answer C is correct: 66.77% chose the correct answer, GREAT JOB.  “40%.” Per the 2026 ADA Standards of Care, bone health needs to be assessed in men aged ≥50 years with type 2 diabetes and an A1c >8%. He is also on pioglitazone, a thiazolidinedione, which is another risk factor for low bone density.

Answer D is incorrect: 7.74% chose this answer, “60%.” This answer overestimates the problem. Research indicates that approximately 40% of patients with diabetes may miss or avoid follow-up appointments because they experience feelings of shame, blame or judgment related to their condition or care. This highlights the importance of delivering diabetes care with stigma-free, supportive communication approaches as a means to improve engagement and outcomes.

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!

Answer A is incorrect: 20% chose this answer, “A 67-year-old female living with frequent falls and no bone fractures. She is newly diagnosed with type 2 diabetes, taking only metformin, with a bone density test 1 year ago that was normal.” This answer is tempting but incorrect. Per the 2026 ADA Standards of Care, she does meet criteria for assessing bone health due to her diagnosis of type 2 diabetes and risk factor of frequent falls, but she had a bone density test 1 year ago.  Currently, the recommendation is to re-evaluate the bone density test in 2-3 years.

Answer B is incorrect: 26% chose this answer, “A 49-year-old premenopausal woman with prediabetes who has a low vitamin D level but no history of bone fracture.” This answer is incorrect. Per the 2026 ADA Standards of Care, it is recommended to assess bone health in postmenopausal women with other diabetes specific risk factors. This risk factor does not include low vitamin D levels.

Answer C is correct: 47% chose the correct answer, GREAT JOB.  “A 59-year-old male living with type 2 diabetes, taking pioglitazone, and whose A1c is 8.7%.” Per the 2026 ADA Standards of Care, bone health needs to be assessed in men aged ≥50 years with type 2 diabetes and an A1c >8%. He is also on pioglitazone, a thiazolidinedione, which is another risk factor for low bone density.

Answer D is incorrect: 7% chose this answer, “A 43-year-old man living with type 2 diabetes for five years, taking metformin and an SGLT2 inhibitor, without diabetes related complications, but did break his arm as a child.” This answer is incorrect. Per the 2026 ADA Standards of Care, he has no diabetes-specific risk factors for bone loss. Diabetes duration is less than 10 years, he has no diabetes related complications such as peripheral or autonomic neuropathies, he is not on a high-risk medication for bone loss, and he has not had a bone fracture as an adult.

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!

Answer A is correct: 94% chose this answer, “It sounds like you are worried about a parasite infection. Tell me more about what you’ve read.” Great job. A is the best answer because it uses person-centered, nonjudgmental communication, as recommended by the ADA. It avoids dismissive language and explores misinformation respectfully. It preserves the therapeutic alliance.

More Info on Parasites and Diabetes

Since many of you mentioned that patients are asking about parasites causing diabetes – here is the scoop. This false rumor is based on a video from a scientist named Hulda Clark that has since been debunked. Clark falsely claimed that most diseases, including AIDS, Cancer and diabetes, were caused by different parasites and could be cured with an electric “zapper.”  Authorities took action against Clark’s “zapper” and other examples of her unproven treatments that she claimed could “cure all diseases” both before and after her death.  Read more here

John Buse, MD a professor at the University of North Carolina School of Medicine, said there is a long-standing theory that infection by certain viruses could trigger the body’s immune response that leads to type 1 diabetes, but that no link has been established between a parasitic infection and any type of diabetes. He also said there is no evidence that methanol (another proposed false claim) — a poison — would have any different effect on someone with diabetes than on a person without high blood sugar.

Answer B is incorrect: 3% chose this answer, “Yes. We will be treating that issue soon, but first we need to focus on your insulin doses.” Option B offers a false narrative saying that they are going to treat the parasitic infection then shifts focus to the blood glucose, without recognizing JR’s emotional distress.

Answer C is incorrect: 2% chose this answer, “I can see how you would be concerned, but here is no such thing as pancreatic parasites.” Option C does initially recognize the emotions but then ends with a dismissive tone, that may make JR feel defensive and unheard.

Answer D is incorrect: 1% chose this answer, “Sadly, prediabetes always progresses to diabetes when people are acutely ill, and you will probably be discharged on insulin therapy.” Option D completely ignores the emotional distress in addition to making assumptions that may not be true.

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Answer A is correct: 55.1% chose this answer, “When scheduling, JM requested an individual appointment” Answer A is correct; it does NOT justify individual DSMES. Although diabetes care should be patient-centered, patient preference alone does not meet Medicare criteria for individual DSMES. Medicare requires the referring provider document justification of barriers to group learning which can include clinical, educational, or psychosocial need.

Answer B is incorrect: 12.74% chose this answer, “The referral for DSMES stated JM has a language barrier” Answer B is incorrect and does justify individual DSMES. Language barriers can significantly limit participation in group DSMES. Medicare recognizes a referral with stated language and communication needs as valid justification for an individual visit.

Answer C is incorrect: 15.61% chose this answer, “A group DSMES class is not available within the next 3 months” Answer C is incorrect and does justify individual DSMES. Medicare will approve individual DSMES if no group class is available for two months or longer from the date on the referral.

Answer D is incorrect: 16.56% chose this answer, “JM was referred for training on starting insulin therapy” Answer D is incorrect and does justify individual DSMES. A referral for initiation of insulin therapy requires individualized instruction. This can include injection technique, dose adjustment, hypoglycemia prevention, and problem-solving. Medicare considers this
an appropriate reason for individual DSMES.

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Answer A is incorrect: 7.56% chose this answer, “Is JZ consistently rotating injection sites to prevent lipohypertrophy?” Injection site rotation is important for preventing lipohypertrophy and absorption variability, but not the most immediate safety risk.

Answer B is incorrect: 24.4% chose this answer, “What is JZ’s rationale for adjusting the glargine dose?” Basal insulin is generally titrated based on overnight and fasting blood glucose levels, not reactively based on the evening glucose. This is clinically relevant, but still secondary to hypoglycemia risk.

Answer C is correct: 62.2% chose this answer, “How is JZ feeling about their frequency of hypoglycemia?” Since JZ is experiencing hypoglycemia more than the target below target range of 5%, we want to explore their feelings around their diabetes and diabetes distress.

Answer D is incorrect: 5.84% chose this answer, “Does JZ adjust insulin for physical activity?” Adjusting insulin for exercise is essential for self-management, yet the first priority is identifying whether dangerous lows are occurring.

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!

Answer A is incorrect: 15.3% chose this answer,“ It sounds like you’re feeling overwhelmed. Can you tell me more about what worries you most about starting this medication?” Appropriate — Person centered, exploratory. This response uses reflective listening and invites the patient to share her concerns. It aligns with ADA Standards of Care recommendations for collaborative communication and supports assessment of diabetes distress.

Answer B is incorrect: 11.57% chose this answer, “Many people feel this way. Let’s look at your options together so you can make a choice that works for you.” Appropriate — Normalizes feelings and supports shared decision making. This option reduces stigma by acknowledging that many people experience similar emotions. It reinforces autonomy and partnership, which are core components of effective diabetes self management support.

Answer C is correct: 58.54% chose this answer, “I understand that this is challenging and overwhelming. However, if you don’t start this medication, you are choosing to risk complications like kidney disease or blindness.” Incorrect — Stigmatizing, blaming, and fear based. This statement uses threat based language (“you are choosing to risk complications…”) and implies personal failure. It increases shame, undermines trust, and can worsen diabetes distress. It does not incorporate person first language or collaborative care or help identify barriers and personalized solutions. Oh, and it probably won’t be very successful!

Answer D is incorrect: 14.59% chose this answer, “It’s completely understandable to have concerns. Would it help if we reviewed what the medication does, talk about the pro’s and the con’s, and about what alternatives exist?” Appropriate — Validates concerns and offers. Information without pressure. This response acknowledges the patient’s emotions and provides an opening for education and shared exploration of options. It supports autonomy and reduces the sense of failure associated with medication use.

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!

Answer A is incorrect: 14.21% chose this answer, “Markedly elevated plasma glucose.” This answer is tempting, because glucose levels do become markedly elevated with HHS. However, very high glucose levels can also occur with DKA. So this answer doesn’t differentiate between these two hyperglycemic crises.

Answer B is incorrect: 21.38% chose this answer, “Absence of significant metabolic acidosis.” This juicy answer is tempting, since with HHS there is the absence of metabolic acidosis. However, based on the question details, there is no information on pH or ketone status, so we can’t make that assumption.

Answer C is incorrect: 4.64% chose this answer, “Out of range potassium level.” The potassium level of 3.7 is within normal range and doesn’t help us differentiate between HHS and DKA.

Answer D is correct: 59.77% chose this answer, “Elevated effective serum osmolality.” YES, this is the BEST Answer. Great Job! One of the main features of HHS, is increased serum osmolality (greater than 300), due to a combination of elevated glucose and dehydration.

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!

Answer A is incorrect: 2.38% chose this answer, “Advise KC to stop sugary drinks and record physical activity minutes daily.” Although the Standards of Care do recommend avoiding sugar-beverage consumption and increased activity, this answer is prescriptive and not collaborative. Simply telling the patient what to do without assessing motivation or barriers does not align with ADA recommendations for patient-centered behavior change.

Answer B is correct: 81.75% chose this answer, “Ask KC, “What makes improving your health important to you right now?””  This question is an example of a response using the strategy of motivational interviewing (MI). MI is a patient-centered counseling method that explores readiness, addresses ambivalence, helps patients identify barriers to behavior change and encourages confidence while setting goals. The 2026 ADA Standards of Care recommend using MI, along with other strategies, to help individuals with diabetes adopt sustainable lifestyle behaviors, including diet, physical activity, and stress management.

Answer C is incorrect: 3.57% chose this answer, “Focus the visit on intensifying glucose lowering medications first and revisit lifestyle changes at the next appointment.” While medication intensification may be a first step and necessary approach to support KC is their diabetes management, it fails to first address KC’s goals and desires. In addition, the 2026 ADA Standards of Care emphasize integrating behavior change support alongside pharmacologic therapy.

Answer D is incorrect: 12.3% chose this answer, “Recommend KC find social support for activity at the local gym and work with KC to set goals to avoid sugar-sweetened beverages.” While this option does consider strategies of social support and goal-setting it lacks assessment of readiness and barriers and again is a more prescriptive approach vs. collaborative approach.

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!