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!

Answer A is correct: 80.92% chose this answer, “Stage 1 Type 1 diabetes.” J.C. has stage 1 type 1 diabetes. She has two positive autoantibodies and normoglycemia.

Answer B is incorrect: 13.36% chose this answer, “Stage 2 Type 1 diabetes.” J.C. still has normoglycemia. Stage 2 type 1 diabetes is characterized by positive autoantibodies and dysglycemia (Impaired fasting glucose, Impaired glucose tolerance, or elevated A1c over 5.7% or 10% increase in A1C).

Answer C is incorrect: 4.2% chose this answer, “Stage 3 Type 1 diabetes.” J.C. does not have lab work confirming diabetes by the standard diagnostic criteria, and she is asymptomatic. Stage 3 type 1 diabetes is characterized by overt hyperglycemia and symptoms of diabetes with autoimmunity present.

Answer D is incorrect: 1.53% chose this answer, “Type 2 diabetes.” J.C. does not have type 2 diabetes. She does have a BMI in the overweight category, but she does not have hyperglycemia. She also has positive autoantibodies associated with type 1 diabetes. Type 2 diabetes is not immune-mediated.

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: 56.08% chose this answer, “History of leg fatigue and calf pain when walking.”  YES, great job.  According to the ADA, if a person presents with leg fatigue and intermittent claudication, a more detailed screening for peripheral arterial disease (PAD) and poor arterial circulation is warranted. 

Answer B is incorrect: 21.08% chose this answer, “Lower extremity pain that is worse at night and restless legs.”  People experiencing neuropathy will complain of leg pain and burning that is worse when resting. People with PAD complain of leg and buttock pain when walking due to diminished circulation and poor blood flow to muscles that is relieved with rest.

Answer C is incorrect: 12.45% chose this answer, “Leg cramps coupled and frequent unexplained bruising.” Only part of this answer is correct. Although leg cramps or calf pain can occur with PAD, there is not direct association with frequent unexplained bruising. 

Answer D is incorrect: 10.4% chose this answer, “Onychomycosis and unusual callus formation.” People with diabetes do have an increased risk of toenail infections and onychomycosis, but this is not associated with the manifestations of PAD.

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: 14.66% chose this answer, “Partner with CS to reduce missed boluses and reassess in 3 months.” While reducing missed boluses and optimizing insulin therapy are essential to support A1c reduction, this intervention alone does not address the likely underlying psychological barriers to self-management.

Answer B is incorrect: 31.1% chose this answer, “Simplify regimen to support current state of diabetes distress.” While simplifying insulin dosing may be supportive in some cases, without addressing the underlying diabetes distress it is unlikely to achieve sustained improvement.

Answer C is correct: 50.55% chose this answer, “Refer to a qualified behavioral health professional for evaluation and treatment.” The 2026 ADA Standards of Care recommends a referral to a qualified behavioral health professional for evaluation and treatment when diabetes distress, burnout, reduced engagement in diabetes management or other psychosocial factors are impacting self-care and glycemic targets. ¹

Answer D is incorrect: 3.7% chose this answer, “Recommend referral to MNT for a structured weight-loss program.” Focusing solely on weight loss does not address the primary psychosocial barriers and weight gain may be a symptom of underlying behavioral health needs. Evaluation and treatment from a behavioral health provider would be the most appropriate next step.

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: 12.89% chose this answer, “Turn on her CGM alarms but increase the high alarm so she doesn’t get as many
hyperglycemia related alerts.” Helping Katie turn on and increasing her high alarm will not help improve her glycemic management. 

Answer B is correct: 76.5% chose this answer, “Show her step-by-step how to use the app and how to troubleshoot the alerts and alarms.” Guiding Katie through the CGM app and its functions helps her ask questions, resolve issues, and better monitor her glycemic management.

Answer C is incorrect: 9.46% chose this answer, “Have the school nurse monitor her CGM trends when Katie is at school, since her mom monitors the CGM trends when she is at home.” Asking the school nurse to monitor CGM data while Katie is at school is not helping to improve Katie’s self-management skills.

Answer D is incorrect: 1.15% chose this answer, “Email Katie’s mother once a week for updates to make sure she is monitoring CGM
trends.” Emailing Katie’s mother does not help improve Katie’s CGM self-monitoring skills or her confidence level with the CGM app.

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!