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For last week’s practice question, we quizzed participants on unpredictable glucose patters with bloating and nausea. 76% of respondents chose the best answer. We want to clarify and 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 by clicking here.
CL is a 58-year-old individual with type 1 diabetes for 35 years. Their current therapy includes a CGM with an automated insulin delivery system, and they announce their meal 15-20 minutes before eating. Last HgbA1c is 7.4%, but they report recent worsening, unpredictable glucose patterns. CGM data review shows Time in Range is 62% with 4% below 70 mg/dL. Patterns note after breakfast, glucose drops from 110-130 mg/dL to 60-70 mg/dL within 1–2 hours, then rises to 220-280 mg/dL 3–4 hours later, and after dinner, glucose remains stable initially but rises to 240-280 mg/dL late in the evening. CL also reports an onset of bloating and occasional nausea.
What could be considered a potential contributor to this individual’s glucose variability?
Answer A is incorrect. 4.93% chose this answer: “Inaccurate carbohydrate counting creating an increased variability in glucose patterns.” While carbohydrate counting errors can contribute to glucose variability, CL reports consistent meal announcement and insulin dosing before meals. The CGM pattern is also not typical of carbohydrate-counting challenges alone. A decline followed by a delayed rise several hours after eating suggests that the timing of glucose absorption may not align with insulin action.
Answer B is incorrect. 5.91% of you chose this answer, “Excess programmed basal insulin causing post-meal glucose fluctuations.” Excess basal insulin can contribute to hypoglycemia, but it typically causes a glucose decline independent of meals, and depending on the AID system, basal rate adjustments may not be a factor. CL’s pattern of an early post-meal glucose drop followed by a delayed glucose rise suggests a mismatch between insulin activity and nutrient absorption rather than simply excessive basal insulin.
Answer C is correct. 75.86% of respondents chose this: “Delayed gastric emptying resulting in a mismatch between insulin action and glucose absorption. Consider a referral for a gastric emptying study.” Great job! This is the correct answer. Based on the information we have, CL’s long duration of type 1 diabetes increases the risk for autonomic neuropathy, which can affect gastric motility. The pattern of early post-meal hypoglycemia followed by delayed hyperglycemia 3–5 hours later is characteristic of delayed carbohydrate absorption. New symptoms of bloating and nausea further support the consideration of gastroparesis. Referral for evaluation and possible gastric emptying testing may be appropriate.
Finally, Answer D is incorrect. 13.30% chose this answer, “A high-carbohydrate and high-fat dietary pattern causing prolonged glucose elevations after meals.” This is not the best answer. While it is possible that meals high in carbohydrate and fat can delay gastric emptying and contribute to prolonged post-meal glucose elevations, the early glucose drop followed by a delayed rise, combined with new gastrointestinal symptoms and long-standing type 1 diabetes, makes delayed gastric emptying a more likely primary contributor.
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!
🌟Updated Schedule: ADA Boot Camp, Tech, MNT & More
Live in Beautiful San Diego – Oct 22-23, 2026
Re-Ignite your Passion & Prepare for Diabetes Certification Exams
🎓 Earn 30+ CEs: AMA PRA Category 1 Credits™, ACPE, ANCC, and CDR!
📅
2-Day Conference
Oct 22–23, 2026
⏱️
15.5 Live CEs
+ 17 bonus CEs
🏅
CDCES & BC-ADM
Exam Prep + Renewal
📍
San Diego, CA
1.7 mi from airport
The field of diabetes care is expanding and evolving rapidly. This unique training conference will keep you on the cutting edge plus prepare you for certification exams. It also fulfills the Standards of Care renewal requirement. Join us for two days of intensive education that is fun and inspiring. Add on the optional Day 3 (Engaging the Disengaged), to complete your conference exeperience.
Coach Beverly and Diana Isaacs, PharmD, BC-ADM, CDCES co-lead an exciting day that brings the ADA and AACE Standards to life. Gain fresh insights, practical tools, and a deeper understanding of the latest in person-centered diabetes care. After attending, you will be empowered to share the latest in diabetes care with your colleagues and the people in your care.
Take your knowledge to the next level with this intensive deep-dive into insulin therapy, dosing and pattern management with Dr. Diana Isaacs. Next, stay for the diabetes tech show-and-tell as Diana demonstrates the specs of the latest pumps and sensors. After lunch, nutrition whiz Christine Craig, MS, RDN, CDCES expertly details the latest in MNT and provides real strategies on translating this content to your clinical practice. You will have a chance to put it all together as Coach Beverly leads you through a series of case studies that integrates content from Day 1 and Day 2.
On Saturday, join this exceptional day-long program led by William H. Polonsky, PhD, CDCES & Susan Guzman, PhD (Behavioral Diabetes Institute) that reveals psychosocial forces behind diabetes self-management — tools to break through resistance and inspire change.
Read more below
📜 Essentials
Registration
+ Printed Syllabus
$559.00
🌟 Deluxe
Essentials
+ ADA Standards Book
$589.00
🏆 Complete – Best Value!
Deluxe
+ ADCES Review Guide e-Book
$669.00
Transform how you engage patients with diabetes — master behavior change, reduce distress, and overcome medication hesitancy.
Why do so many patients know what they should do — but still struggle to do it?
The answer lies in the psychology of diabetes.
In this transformative full-day course, world-renowned experts William H. Polonsky, PhD, CDCES, and Susan Guzman, PhD, from the Behavioral Diabetes Institute reveal the hidden psychosocial forces that drive — or derail — diabetes self-management.
You’ll walk away with a completely new toolkit for breaking through patient resistance, dissolving medication hesitancy, and creating clinical encounters that actually inspire change!
For last week’s practice question, we quizzed participants on bolus insulin after meals. 65% of respondents chose the best answer. We want to clarify and 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 by clicking here.
JR tells you they inject 4-6 units of bolus insulin after meals based on how high the sensor readings go post meals. JR also takes 18 units basal insulin every morning. JR is 78 with type 2 diabetes for over 20 years and is very proud of their A1C of 6.9%.
What is the best action by the diabetes healthcare professional?
Answer A is incorrect. 4.98% chose this answer: “Discuss transitioning to an insulin pump to make managing their diabetes easier.” This is not the best answer. An insulin pump may be beneficial for some individuals requiring intensive insulin therapy, but there is insufficient information to justify recommending one. JR appears comfortable with the current regimen, is using relatively small bolus doses, and there is no indication of difficulty with injections, significant glucose variability, or frequent hypoglycemia. Recommending advanced technology wouldn’t be the best step before assessing JR’s individual needs and preferences.
Answer B is incorrect. 20.25% of you chose this answer, “Encourage JR to take bolus insulin before meals to improve glucose levels.” This answer is tempting. Administering bolus insulin before meals is generally recommended because it better matches postprandial glucose excursions and often results in improved glucose control. However, immediately advising this change overlooks the need to understand why JR doses after meals. Older adults may intentionally dose afterward because of unpredictable appetite, gastroparesis, or concerns about hypoglycemia if they do not finish a meal. Exploring these factors should occur before recommending changes.
Answer C is incorrect. 9.66% of respondents chose this: “Calculate insulin-to-carb ratio to help fine-tune bolus insulin dosing.” Another tempting answer. Determining an insulin-to-carbohydrate ratio can optimize mealtime insulin dosing, but there is no evidence that JR is counting carbohydrates or interested in this level of diabetes self-management. Many older adults with type 2 diabetes successfully use fixed-dose or simplified insulin regimens. Before introducing a more complex dosing strategy, the healthcare professional should assess JR’s goals, health literacy, meal patterns, and willingness to make changes.
Finally, Answer D is correct. 65.11% chose this answer, “Explore how JR thinks this management strategy is working.” Great job, you chose the correct answer! This best answer because it reflects person-centered care, shared decision-making, and assessment before making recommendations.
The scenario provides several clues that the healthcare professional should first understand why JR is using this strategy before suggesting changes.
The first step is to understand JR’s perspective and goals. Although taking rapid-acting insulin after meals is generally less effective than premeal dosing, JR has maintained an A1C of 6.7% and expresses pride in their management. At age 78 with a 20-year history of type 2 diabetes, an A1C below 7% may be tighter than necessary depending on comorbidities, functional status, and hypoglycemia risk.
Before recommending changes, the diabetes care professional needs to explore JR’s reasoning, assess for hypoglycemia, review CGM metrics (particularly time in range and time below range), and determine whether postmeal dosing is intentional (e.g., due to unpredictable intake or fear of hypoglycemia). This approach aligns with person-centered care and avoids making assumptions.
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!
🌟Updated Schedule: ADA Boot Camp, Tech, MNT & More
Live in Beautiful San Diego – Oct 22-23, 2026
Re-Ignite your Passion & Prepare for Diabetes Certification Exams
🎓 Earn 30+ CEs: AMA PRA Category 1 Credits™, ACPE, ANCC, and CDR!
📅
2-Day Conference
Oct 22–23, 2026
⏱️
15.5 Live CEs
+ 17 bonus CEs
🏅
CDCES & BC-ADM
Exam Prep + Renewal
📍
San Diego, CA
1.7 mi from airport
The field of diabetes care is expanding and evolving rapidly. This unique training conference will keep you on the cutting edge plus prepare you for certification exams. It also fulfills the Standards of Care renewal requirement. Join us for two days of intensive education that is fun and inspiring. Add on the optional Day 3 (Engaging the Disengaged), to complete your conference exeperience.
Coach Beverly and Diana Isaacs, PharmD, BC-ADM, CDCES co-lead an exciting day that brings the ADA and AACE Standards to life. Gain fresh insights, practical tools, and a deeper understanding of the latest in person-centered diabetes care. After attending, you will be empowered to share the latest in diabetes care with your colleagues and the people in your care.
Take your knowledge to the next level with this intensive deep-dive into insulin therapy, dosing and pattern management with Dr. Diana Isaacs. Next, stay for the diabetes tech show-and-tell as Diana demonstrates the specs of the latest pumps and sensors. After lunch, nutrition whiz Christine Craig, MS, RDN, CDCES expertly details the latest in MNT and provides real strategies on translating this content to your clinical practice. You will have a chance to put it all together as Coach Beverly leads you through a series of case studies that integrates content from Day 1 and Day 2.
On Saturday, join this exceptional day-long program led by William H. Polonsky, PhD, CDCES & Susan Guzman, PhD (Behavioral Diabetes Institute) that reveals psychosocial forces behind diabetes self-management — tools to break through resistance and inspire change.
Read more below
📜 Essentials
Registration
+ Printed Syllabus
$559.00
🌟 Deluxe
Essentials
+ ADA Standards Book
$589.00
🏆 Complete – Best Value!
Deluxe
+ ADCES Review Guide e-Book
$669.00
Transform how you engage patients with diabetes — master behavior change, reduce distress, and overcome medication hesitancy.
Why do so many patients know what they should do — but still struggle to do it?
The answer lies in the psychology of diabetes.
In this transformative full-day course, world-renowned experts William H. Polonsky, PhD, CDCES, and Susan Guzman, PhD, from the Behavioral Diabetes Institute reveal the hidden psychosocial forces that drive — or derail — diabetes self-management.
You’ll walk away with a completely new toolkit for breaking through patient resistance, dissolving medication hesitancy, and creating clinical encounters that actually inspire change!
For last week’s practice question, we quizzed participants on what action to take for ongoing clinical inertia. 38% of respondents chose the best answer. We want to clarify and 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 by clicking here.
AR is a 22-year-old with type 2 diabetes and persistent BP readings of 140/90 or greater for the past 6 months. For medications, they are on metformin 850mg twice daily with an A1C of 6.9%. You have suggested several times to start AR on a BP lowering medication, but the medical provider keeps saying, “let’s focus on diet and activity before starting a blood pressure medication.”
What is the best response?
Answer A is incorrect. 11.10% chose this answer: Place a copy of the ADA hypertension guidelines in the providers inbox.” While sharing the guidelines may increase awareness, this approach is unlikely to change practice behavior. Simply providing educational materials does not address the underlying causes of therapeutic inertia, such as workflow issues, competing priorities, or provider habits. More active quality improvement strategies are generally more effective than distributing guidelines alone.
Answer B is correct. 37.78% of you chose this answer, “Set up meeting with management to implement best practice guidelines.” Great Job, this is the best response! The medical provider has demonstrated therapeutic inertia by delaying treatment despite persistent hypertension for six months. According to the American Diabetes Association (ADA) Standards of Care, adults with diabetes and confirmed hypertension (blood pressure ≥140/90 mmHg) need receive prompt treatment with lifestyle modification and antihypertensive medication. Implementing evidence-based clinical protocols or standardized treatment pathways can reduce therapeutic inertia and improve outcomes across the practice, making this the most effective systems-level intervention.
Answer C is incorrect. 20.32% of respondents chose this: “Encourage AR to self-advocate for better BP management.” Empowering AR to participate in shared decision-making is appropriate and may help facilitate a productive conversation with the provider. However, this places the responsibility on the AR rather than addressing the provider’s repeated failure to initiate evidence-based treatment. Although patient advocacy is important, it is not the best solution to persistent therapeutic inertia.
Finally, Answer D is incorrect. 30.80% chose this answer, “Have AR get a BP machine and bring a log of BP reading to next medical appointment.” Home blood pressure monitoring is an excellent strategy for confirming hypertension, detecting white coat hypertension, and monitoring response to therapy. However, in this case, the stem states that AR has had persistent blood pressure readings of 140/90 mmHg or greater for the past six months, indicating that sufficient evidence already exists to support treatment. Asking for additional blood pressure logs delays appropriate therapy and may contribute to further therapeutic inertia.
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!
🌟Updated Schedule: ADA Boot Camp, Tech, MNT & More
Live in Beautiful San Diego – Oct 22-23, 2026
Re-Ignite your Passion & Prepare for Diabetes Certification Exams
🎓 Earn 30+ CEs: AMA PRA Category 1 Credits™, ACPE, ANCC, and CDR!
📅
2-Day Conference
Oct 22–23, 2026
⏱️
15.5 Live CEs
+ 17 bonus CEs
🏅
CDCES & BC-ADM
Exam Prep + Renewal
📍
San Diego, CA
1.7 mi from airport
The field of diabetes care is expanding and evolving rapidly. This unique training conference will keep you on the cutting edge plus prepare you for certification exams. It also fulfills the Standards of Care renewal requirement. Join us for two days of intensive education that is fun and inspiring. Add on the optional Day 3 (Engaging the Disengaged), to complete your conference exeperience.
Coach Beverly and Diana Isaacs, PharmD, BC-ADM, CDCES co-lead an exciting day that brings the ADA and AACE Standards to life. Gain fresh insights, practical tools, and a deeper understanding of the latest in person-centered diabetes care. After attending, you will be empowered to share the latest in diabetes care with your colleagues and the people in your care.
Take your knowledge to the next level with this intensive deep-dive into insulin therapy, dosing and pattern management with Dr. Diana Isaacs. Next, stay for the diabetes tech show-and-tell as Diana demonstrates the specs of the latest pumps and sensors. After lunch, nutrition whiz Christine Craig, MS, RDN, CDCES expertly details the latest in MNT and provides real strategies on translating this content to your clinical practice. You will have a chance to put it all together as Coach Beverly leads you through a series of case studies that integrates content from Day 1 and Day 2.
On Saturday, join this exceptional day-long program led by William H. Polonsky, PhD, CDCES & Susan Guzman, PhD (Behavioral Diabetes Institute) that reveals psychosocial forces behind diabetes self-management — tools to break through resistance and inspire change.
Read more below
📜 Essentials
Registration
+ Printed Syllabus
$559.00
🌟 Deluxe
Essentials
+ ADA Standards Book
$589.00
🏆 Complete – Best Value!
Deluxe
+ ADCES Review Guide e-Book
$669.00
Transform how you engage patients with diabetes — master behavior change, reduce distress, and overcome medication hesitancy.
Why do so many patients know what they should do — but still struggle to do it?
The answer lies in the psychology of diabetes.
In this transformative full-day course, world-renowned experts William H. Polonsky, PhD, CDCES, and Susan Guzman, PhD, from the Behavioral Diabetes Institute reveal the hidden psychosocial forces that drive — or derail — diabetes self-management.
You’ll walk away with a completely new toolkit for breaking through patient resistance, dissolving medication hesitancy, and creating clinical encounters that actually inspire change!
For last week’s practice question, we quizzed participants on childhood trauma during diabetes visits. 82% of respondents chose the best answer. We want to clarify and 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 by clicking here.
A 19-year-old woman with type 1 diabetes has an A1C of 9.1% reports difficulty using CGM consistently, frequently cancels appointments, and becomes guarded when clinicians ask about self-management behaviors. During a visit, they mention experiencing significant adversity during childhood and says that healthcare settings often make them feel anxious.
Which intervention is most appropriate?
Answer A is incorrect. 2.42% chose this answer: “Document the history of childhood adversity and prioritize insulin intensification because the A1C remains above target.” Insulin intensification may eventually be appropriate, but this response does not address the anxiety, mistrust, or barriers affecting their ability to follow the treatment plan. Insulin changes alone may not improve outcomes when engagement and emotional safety have not been addressed.
Answer B is correct. 81.82% of you chose this answer, “Acknowledge their concerns, ask what would help them feel more comfortable during visits, and collaborate on one self-care goal.” Great Job, you chose the best answer. A trauma-informed approach emphasizes safety, trust, choice, collaboration, and empowerment. Asking what would help the person feel more comfortable and developing a realistic self-care goal may strengthen engagement without requiring disclosure of traumatic details. Diabetes treatment and education can continue in a supportive, person-centered manner.
Answer C is incorrect. 4.24% of respondents chose this: “Explore the specific childhood events in greater detail to determine which experiences are contributing to their current diabetes-related behaviors.” Diabetes professionals do not need detailed descriptions of traumatic experiences to provide effective care. Asking for unnecessary details may increase distress or contribute to re-traumatization. The focus should remain on how current experiences affect healthcare participation and diabetes self-management.
Finally, Answer D is incorrect. 11.52% chose this answer, “Refer her to behavioral health services and postpone further diabetes education until the effects of the past trauma have been addressed.” Behavioral health referral may be beneficial, but diabetes care does not be withheld until trauma-related concerns are resolved. The healthcare team can provide trauma-informed diabetes education while also offering appropriate behavioral health resources.
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!
Understand the link between adverse childhood experiences and diabetes — and learn trauma-informed strategies to foster resilience and improve outcomes.
Adverse childhood experiences (ACEs) are associated with an increased risk of diabetes, heart disease, cancer, and a variety of other health consequences in adults. This course reviews how diabetes care and education specialists can provide screening, assessment, and trauma-informed care to individuals who have experienced ACEs and are living with toxic stress. We’ll explore strategies to address ACEs, improve outcomes for individuals and communities, and support self-care with a focus on recognizing and promoting resilience.
For last week’s practice question, we quizzed participants on BC-ADM exam updates. 55% of respondents chose the best answer. We want to clarify and 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 by clicking here.
There are going to be big changes in 2027 for those thinking about sitting for their Board Certification in Advanced Diabetes Management (BC-ADM) Exam.
For now, which of the following statements reflects the current qualifications to take the BC-ADM Exam?
Answer A is incorrect. 32.08% chose this answer: “Applicants need to document 1000 hours of advanced diabetes management experience to apply.” To apply for the exam, candidates are only required to document a minimum of 500 clinical practice hours in advanced diabetes management within the 48 months prior to filing the application. The 1,000-hour requirement actually applies to the renewal of the certification every 5 years, not the initial application.
Answer B is correct. 55.26% of you chose this answer, “RN, RPh, RDN’s with a master’s degree or higher are eligible for the exam.” To sit for the Board Certification in Advanced Diabetes Management (BC-ADM) exam, candidates must hold an advanced clinical degree (Master’s degree or higher) in an eligible discipline. Registered Nurses (RN), Registered Pharmacists (RPh), and Registered Dietitian Nutritionists (RDN) with a master’s or doctoral degree meet this primary criteria, assuming they also hold an active, unrestricted license or registration. NP’s, PA’s, DO’s and MD’s are also eligible.
Answer C is incorrect. 3.5% of respondents chose this: “Applicants need to be involved in academics or research to qualify for the exam.” While advanced diabetes management roles can encompass participating in research and mentoring, this is not a mandatory eligibility rule. The core requirement focuses on advanced clinical practice hours (such as adjusting medications, physical assessments, and complex decision-making) rather than pure academic or research involvement.
Finally, Answer D is incorrect. 9.16% chose this answer, “Exercise physiologists and physical therapists are eligible with a special waiver.” The BC-ADM exam specifies discipline tracks that include advanced practice nurses, registered dietitians, pharmacists, physicians, and physician assistants). There is no “special waiver” policy that allows exercise physiologists or physical therapists to bypass the core discipline or advanced degree requirements
Big Changes Coming for BC-ADM in 2027
Considering adding the Board Certification in Advanced Diabetes Management (BC-ADM) to your credentials? With anticipated exam changes in 2027, consider taking the exam in December of 2026. Learn more by clicking heading.
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!
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For last week’s practice question, we quizzed participants on HAES®‑aligned philosophy. 96% of respondents chose the best answer. We want to clarify and 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 by clicking here.
MS is a 27-year-old with type 1 diabetes, hypertension, and dyslipidemia, a body mass index (BMI) of 38, and A1C of 8.1%. During today’s visit they say, “Every appointment seems to focus on my weight. I’m tired of feeling judged, and I’m starting to avoid coming to clinic.”
Which response by the diabetes health care professional is most consistent with the philosophy of Health at Every Size® (HAES®)?
Answer A is incorrect. 2.05% chose this answer, “Stepping on the scale can be scary, but losing even a few pounds will improve all of your health conditions.” This response reinforces a weight-centered approach and does not acknowledge the patient’s feelings of stigma or avoidance of care. While weight loss may improve metabolic health for some individuals, HAES emphasizes that healthcare should not be contingent on achieving a specific body weight and that behavior change can improve health regardless of weight change.
Answer B is correct. 95.89% of you chose this answer, “Let’s put the scale aside for today and focus on what matters most to you.” Great job, this is the BEST answer. The Health at Every Size® (HAES®) approach promotes weight-inclusive, person-centered care that emphasizes health-promoting behaviors rather than weight as the primary measure of success. Core principles include respecting body diversity, reducing weight stigma, supporting intuitive eating and enjoyable physical activity, and partnering with individuals to identify meaningful, achievable health goals. This approach demonstrates these principles by acknowledging the person’s experience, reducing judgment, engaging in shared decision-making, and focusing on sustainable behaviors that support overall health and well-being.
Answer C is incorrect. 0% of respondents chose this: “Weight loss is essential for diabetes management, so let’s review a meal plan that will bring you success.” This answer is incorrect. This response continues to prioritize weight over the patient’s concerns and may increase feelings of shame or disengagement. Current diabetes care emphasizes individualized, person-centered treatment that addresses the patient’s priorities, readiness for change, and quality of life.
Finally, Answer D is incorrect. 2.05% chose this answer, “Since weight discussions are upsetting, let’s avoid talking about nutrition and physical activity during future visits.” HAES does not discourage discussions about healthy eating or physical activity. Instead, it encourages conversations that are free of judgment, focus on health-enhancing behaviors, and support autonomy rather than emphasizing weight loss.
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!
Weight stigma is a well-documented barrier to effective diabetes care — contributing to poorer glycemic control, disordered eating, and care avoidance. This course provides healthcare providers with actionable strategies to integrate weight-inclusive care into diabetes management, focusing on improving outcomes through respect for body diversity and individual autonomy. By shifting from a weight-focused approach to one aligned with Health at Every Size (HAES®), providers can foster trust, enhance engagement, and support sustainable health behaviors.
Jessica Jones, MS, RDN, CDCES, shares evidence-based insights on mitigating weight stigma and applying HAES®-aligned strategies in practice. You’ll learn how to build rapport, set realistic nutrition goals, and implement interventions that prioritize blood glucose management, joyful movement, and intuitive eating.
Course Topics:
Explore the unexpected link between cancer and diabetes — and master glucose management strategies for people with diabetes undergoing treatment.
Individuals with cancer often experience hyperglycemia secondary to treatment, which can increase the risk of infection and other complications. Recent research has also identified a significant link between diabetes and cancer. This course uses a case study approach to explore this connection and provide practical strategies for managing steroid-induced hyperglycemia and improving quality of life for people navigating both conditions.
Course Topics:
For last week’s practice question, we quizzed participants on the sudden onset of hyperglycemia. 84% of respondents chose the best answer. We want to clarify and 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 by clicking here.
A 67-year-old woman with type 2 diabetes (A1C 7.2%) is receiving chemotherapy for metastatic breast cancer. As part of her treatment, she receives high-dose dexamethasone every morning for 3 days following each chemotherapy cycle. She takes metformin and insulin glargine daily. Her fasting glucose values remain between 95–120 mg/dL, but glucose levels increase to 260–320 mg/dL after lunch and dinner on steroid treatment days.
Which intervention is the most appropriate?
Answer A is incorrect. 8.50% chose this answer, “Increase the basal insulin dose by 50% along with metformin dose on chemotherapy days.” Basal insulin primarily targets fasting glucose, which is already within target. An increase in basal insulin may lead to nocturnal or fasting hypoglycemia and will not adequately address post-meal hyperglycemia.
Answer B is incorrect. 2.77% of you chose this answer, “Hold basal insulin and add SGLT2 inhibitor along with the metformin.” This answer is not correct. SGLT2 inhibitors do not provide rapid glucose lowering needed for acute steroid-induced hyperglycemia. Also, stopping the insulin could lead to dangerous blood glucose elevations due to the side effects of chemotherapy including, dehydration, infection, poor oral intake, leading to increased risk of hyperglycemic crisis during treatment periods.
Answer C is incorrect. 4.74% of respondents chose this: “Recommend limiting carbohydrates until chemotherapy is completed.” This answer is incorrect. Restricting carbohydrates excessively during cancer treatment may worsen nutritional status and doesn’t address steroid-induced hyperglycemia. Medication adjustments—not severe dietary restriction—are the treatment of choice.
Finally, Answer D is correct. 83.99% chose this answer, “Use a combination of intermediate-acting and rapid-acting insulin on chemotherapy days.” Great job! You chose the best answer. Glucocorticoids commonly produce postprandial hyperglycemia, particularly in the afternoon and evening after morning dosing. Matching insulin therapy to the steroid’s glycemic effect by using NPH insulin along with bolus mealtime insulin, is generally more effective than simply increasing basal insulin. Continuous glucose monitoring (CGM), when available, can help identify steroid-related glucose patterns.
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!
Explore the unexpected link between cancer and diabetes — and master glucose management strategies for people with diabetes undergoing treatment.
Individuals with cancer often experience hyperglycemia secondary to treatment, which can increase the risk of infection and other complications. Recent research has also identified a significant link between diabetes and cancer. This course uses a case study approach to explore this connection and provide practical strategies for managing steroid-induced hyperglycemia and improving quality of life for people navigating both conditions.
Course Topics:
For last week’s practice question, we quizzed participants on the sudden onset of hyperglycemia. 66% of respondents chose the best answer. We want to clarify and 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 by clicking here.
A 58-year-old man without a history of diabetes is receiving treatment with an immune checkpoint inhibitor for metastatic melanoma. Four months after beginning therapy, he presents with polyuria, weight loss, nausea, and fatigue. Laboratory findings include:
Which mechanism most likely explains this sudden hyperglycemia?
Answer A is incorrect. 9.84% chose this answer, “Progressive insulin resistance caused chronically elevated cortisol levels.” This answer is incorrect. Insulin resistance due to elevated cortisol levels gradually elevates glucose levels and is not usually associated with severe insulin deficiency, undetectable C-peptide, or DKA.
Answer B is correct. 66.14% of you chose this answer, “Autoimmune destruction of pancreatic beta cells.” You chose the best answer. Great Job! Immune checkpoint inhibitors can precipitate rapid-onset autoimmune diabetes, often presenting as diabetic ketoacidosis (DKA). Beta-cell destruction is typically abrupt, resulting in profound insulin deficiency requiring lifelong insulin therapy.
Answer C is incorrect. 19.29% of respondents chose this: “Glucocorticoid-induced hepatic glucose production.” Answer C is incorrect. Although corticosteroids commonly cause hyperglycemia, they generally produce insulin resistance rather than complete beta-cell destruction or absent C-peptide. There is no indication this patient is receiving glucocorticoids.
Finally, Answer D is incorrect. 4.72% chose this answer, “Pancreatic exocrine insufficiency from chronic pancreatitis.” Pancreatitis-related diabetes (type 3c diabetes) usually develops over time and is associated with exocrine pancreatic dysfunction, malabsorption, and a history of pancreatic disease—not sudden autoimmune beta-cell destruction and DKA following immunotherapy.
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!
Explore the unexpected link between cancer and diabetes — and master glucose management strategies for people with diabetes undergoing treatment.
Individuals with cancer often experience hyperglycemia secondary to treatment, which can increase the risk of infection and other complications. Recent research has also identified a significant link between diabetes and cancer. This course uses a case study approach to explore this connection and provide practical strategies for managing steroid-induced hyperglycemia and improving quality of life for people navigating both conditions.
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