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.

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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.

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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.

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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.

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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.

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Answer A is incorrect: 14.85% chose this answer, “BMI and activity level.” This answer is incorrect but tempting. BMI level is used as a a screening tool for prediabetes and diabetes risk, but is not included as a factor contributing to secretory defects. According to the ADA, there are four factors related to insulin secretory defects in type 2 diabetes. They include; genetics, epigenetics, metabolic stress and inflammation.

Answer B is incorrect: 16.92% chose this answer, “Lifestyle and inflammation.” This juicy answer is incorrect.  Lifestyle is not a direct factor related to insulin secretory defects, but inflammation is a contributor. According to the ADA, there are four factors related to insulin secretory defects in type 2 diabetes. They include; genetics, epigenetics, metabolic stress and inflammation.

Answer C is incorrect: 25.75% chose this answer, “Genetics and visceral adipose distribution.” This answer is incorrect. Visceral adiposity is associated with an increased risk for diabetes, but does not contribute to insulin secretory defects. According to the ADA, there are four factors related to insulin secretory defects in type 2 diabetes. They include; genetics, epigenetics, metabolic stress and inflammation.

Answer D is correct: 42.48% chose this answer, “Epigenetics and metabolic stress.” This answer is correct, GREAT JOB! According to the ADA, there are four factors related to insulin secretory defects in type 2 diabetes. They include; genetics, epigenetics, metabolic stress and inflammation.

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Answer A is correct: 55.56% chose this answer, “Know the 2025 Standards, since it takes about a year for the new standards to be incorporated unless there is a significant clinical guideline update.” Answer A is the BEST answer. It takes at least a year for the CBDCE to update the exam based on the ADA Standards. Knowing the 2025 Standards along with any urgent clinical updates announced in 2026 will help prepare JR for success.

Answer B is incorrect: 11.45% chose this answer, “Thoroughly review the 2026 Standards since the most recent ADC Standards content will be included in the exam.” Answer B is not the best answer. Since it takes at least a year for the CBDCE to update the exam based on the ADA Standards, JR can feel comfortable knowing the 2025 Standards along with any urgent clinical updates announced in 2026.

Answer C is incorrect: 19.53% chose this answer, “Be familiar with the goals of care from both years, so you can compare and contrast to get to the best answers.” Answer C is not the best answer. Thinking about comparing and contrasting two consecutive years standards and lead to testing confusion. JR can feel comfortable knowing the 2025 Standards along with any urgent clinical updates announced in 2026.

Answer D is incorrect: 13.47% chose this answer, “In addition to knowing the 2026 ADA Standards, you will need to be familiar with the latest American Association of Clinical Endocrinology (AACE) Standards.” Answer D is not the best answer. Since it takes at least a year for the CBDCE to update the exam based on the ADA Standards, JR can feel comfortable knowing the 2025 Standards along with any urgent clinical updates announced in 2026.

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Answer A is incorrect: 15.51% chose this answer, “It is recommended that insulin is always stored and kept refrigerated. Can you make
sure you pack your insulin with your lunch cooler pack?” While refrigeration is ideal for insulin storage, insulin does not always need to be refrigerated. Once in use, most insulins, including degludec, are stable at room temperature (below 86F or 30 C). Advising refrigeration may create unnecessary barriers and does not reflect degludec’s stability profile.

Answer B is incorrect: 1.83% chose this answer, “Consider storing insulin in your freezer to allow it to be kept cold and protected when
refrigeration is less reliable.” Freezing damages insulin molecules, making the insulin ineffective and unsafe to use. This option contradicts manufacturer and clinical safety guidance.

Answer C is correct: 41.72% chose this answer, “If bringing your insulin with you every day helps you remember to take it, it should be
okay to leave the pen you’re using in your workbag when at the office or at home.” Insulin degludec is stable at room temperature below 86°F (30°C) for up to 56 days (8 weeks) once opened. If SJ’s work bag is not exposed to excessive heat or freezing, keeping the pen there is acceptable and may in fact support consistent dosing. We can also calculate SJ’s monthly insulin pen usage (15 units per day + 2 unit prime per injection = 510 units per month or 2 pens per month), knowing he will easily use more insulin than open insulin pen stability time window.

Answer D is incorrect: 40.94% chose this answer, “Once open, insulin pens can be stored and used at room temperature for up to 28 days, you should be okay with bringing it with you in your work bag.” While it is correct that insulin does not always require refrigeration once in use, the specific duration varies by insulin type; degludec lasts longer than 28 days.

To learn more, check out our Insulin Storage Cheat Sheet.

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!