Answer A is correct: 62.93% chose this answer, “Fatty stools and insulin sensitivity.” Steatorrhea, or fatty stools, results from poor fat digestion due to insufficient pancreatic enzymes—a key feature of type 3c diabetes, with it’s hallmark exocrine enzyme insufficiency. People with diabetes type 3c, can also be very insulin sensitive, since they don’t have the insulin resistance associated with type 2 diabetes. In addition to diabetes medications, they may benefit from pancreatic enzyme replacement therapy (PERT) to improve absorption of fatty foods and decrease steatorrhea.

Answer B is incorrect: 15.47% chose this answer, “Frequent urination and insulin resistance.” Frequent urination and insulin resistance is associated with type 2 diabetes. With type 3c, since many of the beta cells are destroyed due to trauma not genetics, these individuals may have polyuria from hyperglycemia, but they are not usually insulin resistant, just deficient.

Answer C is incorrect: 7.47% chose this answer, “Neuropathy and unexplained weight gain.” They may get neuropathy if their blood glucose is elevated for a long period of time, but that is not part of the differential. People with type 3c usually experience weight loss due to the lack of pancreatic enzymes that help with nutrient absorption.

Answer D is incorrect: 14.13% chose this answer, “Family history of diabetes type 3c and polyphagia.” Type 3c diabetes is not passed on through genes, it is due to exocrine damage to the pancreas which can lead to destruction of beta cells. Most common causes of diabetes type 3c include pancreatitis, cystic fibrosis, pancreatic cancer, and hemochromatosis. Some people could experience extreme hunger if their glucose levels are elevated for an extended period of time.

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!

Learn more about Diabetes Type 3c in our “From the Gut to the Butt Webinar”

Recorded and Ready for Viewing. 

Answer A is incorrect: 15.69% chose this answer, “Next time, make sure to take your insulin and put it in the refrigerator for safekeeping.” This approach goes under the compliance model, where the healthcare professional only provides one way instruction without considering the individuals insights and problem solving skills. We want to work toward a person-centered collaborative approach to foster connection.

Answer B is correct: 63.10% chose this answer, “Before we dive into the diabetes stuff, tell me about your fishing trip.” Great job! This is the best answer. By asking RT about their fishing trip first, you let them know you are interested in their life experiences and this helps to establish a connection. After hearing about the trip, we might pivot and say something like, “Do you want to discuss strategies to bring your insulin on your next fishing trip?”

Answer C is incorrect: 9.27% chose this answer, “I’m worried that you’re going get complications due to high blood glucose levels.” Although this statement shows concern, it is unlikely that RT will get diabetes complications from not taking their insulin for a few days. This statement could lead to feelings of shame and failure, and may close the door to making a meaningful connection.

Answer D is incorrect: 11.94% chose this answer, “I’m just relieved you did not go into diabetes ketoacidosis.” This statement could evoke feelings of guilt and shame, that could close the door to future communication. And if RT has type 2 diabetes, the chance of DKA is minimal. Instead of focusing on the HCP feelings, let’s check in with RT and explore problem solving strategies for future trips that would work for them.

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Answer A is incorrect: 0% chose this answer, “Reassure Kyle that retinopathy is very common with type 2 diabetes. Encourage him to verify the CGM with his glucometer more frequently if that helps make him feel less anxious.” This is incorrect. Although diabetes retinopathy is a common complication of diabetes, it is not inevitable, and the risk can be reduced by maintaining optimal glycemic control. Additionally, verifying blood glucose levels with a glucometer when there appears to be no issue with his CGM will not alleviate his anxiety.

Answer B is incorrect: 0% chose this answer, “Educate Kyle that the CGM he is using cannot be calibrated and instruct him to stop using his glucometer, since the CGM is accurate.” This is incorrect. Though his particular CGM cannot be calibrated, fingerstick blood glucose readings are the gold standard when CGM readings are unexpectedly out of range.

Answer C is correct: 99.36% chose this answer, “Acknowledge Kyle’s fears about vision loss, screen for diabetes distress, and collaborate on strategies to reduce the emotional burden of CGM use, including referral to a behavioral health provider if indicated.” This is correct. Kyle is demonstrating symptoms of diabetes distress due to fear of ocular complications, perfectionism, and technology overwhelm. The ADA Standards of Care 2025 recommend routine screening for diabetes distress and other psychosocial concerns at least annually or when complications arise.

Answer D is incorrect: 0.64% chose this answer, “Adjust Kyle’s time in range target goal to >90% to meet his expectations and reduce his worry about complications.” This is incorrect: The time in range goal for most adults living with diabetes is >70%. Adjusting his time-in-range goal to >90% will not work to reduce his obsessive behavior.

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Answer A is incorrect: 18.4% chose this answer, “Start AR on pioglitazone and recheck FIB-4 in 3 months.” Although pioglitazone is a recommended treatment for steatosis, since AR’s FIB- is greater than 2.67, this indicates AR is at high risk for advanced fibrosis and a referral to a liver specialist is warranted.

Answer B is incorrect: 15.11% chose this answer, “Encourage AR to see a RDN and stop consumption of alcohol immediately.” Seeing a RDN is very important for AR to evaluate and customize an eating plan to address their steatosis and support quality of life. However, since AR’s FIB- is greater than 2.67, this indicates AR is at high risk for advanced fibrosis and a referral to a liver specialist is warranted.

Answer C is incorrect: 18.4% chose this answer, “Suggest increased high intensity activity coupled with a GLP-1 to reduce body weight.” Strength training and activity, coupled with a GLP-1 for GLP-1/GIP are important strategies to address steatosis. However, since AR’s FIB- is greater than 2.67, this indicates AR is at high risk for advanced fibrosis and a referral to a liver specialist is warranted.

Answer D is correct: 48.09% chose this answer, “Refer AR to liver specialist for further evaluation.” Great job! AR will require intensive intervention to decrease their risk of worsening steatosis, including MNT, targeted activities, and a referral to a liver specialist to determine the best treatment approach.

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Answer A is incorrect: 24.19% chose this answer, “Semaglutide (Ozempic).” The diabetes approved version of semaglutide (Ozempic) does not yet have FDA approval as a medication that is used for treatment of MASH.

Answer B is incorrect: 18.77% chose this answer, “Empagliflozin (Jardiance).” Although empagliflozin will reduce blood glucose and can help with weight loss, it is not FDA approved for treatment of MASH.

Answer C is incorrect: 23.29% chose this answer, “Tirzepatide (Mounjaro).” Tirzepatide (Mounjaro) is approved for treatment of diabetes, helps with weight loss and is FDA approved for sleep apnea. However it is not FDA approved for treatment of MASH.

Answer D is correct: 33.75% chose this answer, “Semaglutide (Wegovy).” The weight loss approved version of semaglutide (Wegovy) has FDA approval as a medication that is used for treatment of MASH.

Please see our new “Indications for GLP-1/GIP” Cheat Sheet for a complete run down.  

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Answer A is incorrect: 6.35% chose this answer, “No changes are needed because kidney function is within normal range.” A is incorrect. Although eGFR indicates stage 2 kidney disease, the elevated UACR, ≥30 mg/g, confirms moderately increased risk and recommendation to treat. Additionally, PJ’s blood pressure is also above the target. Intervention is needed to protect kidney and cardiovascular health.

Answer B is correct: 83% chose this answer, “Initiate an ACE inhibitor or ARB to reduce progression the of diabetic kidney disease.” PJ has a mildly decreased eGFR, but UACR is elevated above 30 mg/g, indicating a recommendation to treat. Additionally, intervention is needed to optimize blood pressure. According to the ADA Standards of Care in Diabetes, individuals with diabetes, hypertension, and moderately increased albuminuria should be treated with an ACE inhibitor or angiotensin receptor blocker. The use of sodium-glucose cotransporter 2 (SGLT2) inhibitors or glucagon-like peptide 1 agonists (GLP1-RA), with demonstrated benefits, could also be considered to reduce CKD progression.

Answer C is incorrect: 5.25% chose this answer, “Discontinue metformin due to the risk of kidney injury with reduced eGFR.” Metformin is safe to continue unless eGFR falls below 30 30 mL/min/1.73m². PJ’s kidney function is adequate for continued use. However, consideration to add a change to SGLT2 or GLP1 with kidney benefit could also promote additional A1c reduction.

Answer D is incorrect: 5.52% chose this answer, “Increase statin therapy to target albuminuria reduction.” Statins are recommended for ASCVD prevention, but they do not reduce albuminuria. Lipids are within normal range, and albuminuria should be addressed with an ACE inhibitor/ARB or potentially a SGLT2 inhibitor or GLP-1 RA.

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Answer A is incorrect: 1% chose this answer, “Stress with R.S. the importance of never missing his meal time lispro to prevent diabetes-related complications.” R.S. is aware that his glycemic control is important, and he is already aware of the risk of diabetes-related complications. Counseling him on this would not help him be successful with his insulin management.  

Answer B is correct: 96% chose this answer, “Using open-ended questions, explore R.S.’s routine, stressors, and support systems to understand the barriers to his insulin use.” R.S. is struggling with barriers to successful insulin management.  A holistic approach would be to ask open-ended questions about his current routine, stressors, and support systems to gain a better understanding of these barriers. This information can lead to a personalized plan of care to help improve glycemic control. 

Answer C is incorrect: 2% chose this answer, “Recommend R.S. switch to another non-insulin medication to make his regimen easier for him to manage.” He has already attempted other non-insulin therapies, and these were either ineffective or not tolerated. Changing his regimen would not be successful at improving his glycemic control and quality of life.

Answer D is incorrect: 1% chose this answer, “Since it appears R.S. did not understand how to take his insulin lispro, write out step-by-step instructions on how to take the insulin.” R.S. appears to understand how to take his insulin lispro at meals. Writing out the instructions would not improve his situation. It is not a lack of knowledge, but the multiple barriers in his life that are keeping him from being able to implement this new medication regimen.  

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Answer A is incorrect: 16.58% chose this answer, “The recommended time in range is >70% within 70–180 mg/dL. MT’s TIR is slightly below target and her time below range is above the recommended targets, indicating adjustments are needed to reduce hypoglycemia.” Answer A is incorrect. The answer uses non-pregnancy CGM target range of 70–180 mg/dL. Pregnancy target range for individuals with type 1 diabetes are lower, keep reading for the best answer.

Answer B is correct: 51% chose this answer, “The recommended time in range is >70% within 63–140 mg/dL; MT’s TIR is slightly below target and her time below and above range is above the recommended goal.” Answer B is correct. Based on the 2025 ADA Standards of Care the recommended time in range targets for individuals with type 1 diabetes during pregnancy is >70% between 63-140 mg/dL, < 4% under 63 mg/dL with < 1 % under 54 mg/dL, and < 25% over 140 mg/dL.

Answer C is incorrect: 19.55% chose this answer, “The recommended time in range is >80% within 63–140 mg/dL; MT’s TIR is below target, with fluctuations of hypo and hyperglycemia.” Answer C is incorrect. The time in range target is above the evidenced-based
minimum and MT is having frequent hypoglycemia in addition to hyperglycemia, both outside the goal ranges.

Answer D is incorrect: 12.87% chose this answer, “The recommended time in range is >80% within 70–180 mg/dL to prevent fetal
complications; MT’s TIR is significantly below the recommended Standard of Care target.” Answer D is incorrect. The recommended target range for individuals with type 1diabetes during pregnancy is 63-140 mg/dL as stated above.

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!