Rationale of the Week | 4 Meds and A1c of 8.9%

For our January 12th Question of the Week, over 58% of respondents chose the best answer!

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question

Question:

JR is on metformin 2000mg, empagliflozin 25mg, semaglutide 1.0mg, and 100 units of glargline insulin.  A1C is 8.9% and JR weighs 100kg.

What best describes this clinical picture?

Answer Choices:

  • Overbasalization
  • Non-compliance
  • Fear of hypoglycemia
  • Clinical inaction

As shown above, the most common choice was option 1, the second most common answer was option 2, then option 4, and finally option 3.

Getting to the Best Answer

If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. It addresses a common ADA Standard 9 and approaches to managing hyperglycemia with type 2 diabetes. This standard is brief with very helpful tables and algorithms. A must-read section for anyone ready to be more actively involved in advocacy and pharmacologic management of diabetes.

Answer 1 is correct. 58.07% chose this answer. ” Overbasalization.” This is the best answer, because JR is on 3 diabetes medications plus 100 units of basal insulin, and their glucose is still above target. This treatment plan isn’t working. If we look at the ADA Guidelines, (section 9 outlined on a slide below), it states if the basal insulin is more than 0.5 units/kg/day, we need to take further action.

Too much basal

JR weighs 100kg. The max dose of basal insulin based on his body weight should be 50 units (100kg x 0.5 = 50 units). Yet, JR is on 100 units. What are possible solutions?

Getting to basal + bolus

According to ADA Algorithm, we could add 10% of the current basal as bolus insulin, or 10 units one or two meals a day.

Or we could convert it to combo insulin, like 70/30 insulin. To do that conversion, first, decrease total basal insulin by 80% for safety.

100 units x 0.8 = 80 units. Then give 2/3 in the morning and 1/3 before dinner.

80 x 2/3 = about 50 units in the morning and 80 x 1/3 or about 30 units before dinner. If worried about potential hypoglycemia, the dose could be decreased even further. The main goal is to get glucose to the goal.

Answer 2 is incorrect. 16.57% of you chose this answer. “Non-compliance.” According to the information in the case study, JR is taking all of the medications as directed. The issue is that the medication plan is not effective. And, more than that, the term “non-compliance” has been replaced with focusing on the person’s strengths (strength based approach) and what the actions the individual IS taking.

Answer 3 is incorrect, 9.80% of you chose this answer “Fear of hypoglycemia.” The answer is tempting. Since JR is on 100 units of basal insulin, hypoglycemia seems like a looming possibility. However, we see that the A1c is 8.9% and JR doesn’t mention hypoglycemia. It is very unlikely that low blood sugar is an issue.

Answer 4 is incorrect, 15.56% of you chose this answer. “Clinical inaction.” It is true that more action is required, and the term we use for this is lack of movement to improve glucose levels is called “Clinical inertia”. However, in answering the question, “what best describes this clinical picture”, “overbasalization” is the standout answer.

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!


Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.

Entire Program Fee: $399
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Dates: April 15-17
Live Webinar Schedule: All webinars start and end times are in Pacific Standard Time
Program Schedule & Expert Bios

What is the Diabetes Educator Course? 

If you are interested in taking the CDCES or BC-ADM exam or are seeking a state of the art review of current diabetes care, this course is for you. Our team of expert faculty has been fine-tuning this course for over fifteen years, and we know what you need. In addition to informative lectures, we also use group activities and case studies to highlight the essential knowledge, skills, and strategies needed to succeed in diabetes education today! 

In this course, the same speakers will cover the same content as outlined in the Live Seminar.  For more details see our Virtual DiabetesEd Specialist Conference Schedule and Faculty.

Prepare for CDCES or BC-ADM certification or earn hours for renewal.

Come join our Virtual DiabetesEd Specialist Program.

Your registrations include access to all the Online Sessions plus Bonus Courses through December 31st, 2021.

This virtual program includes:

3 day live webinar courses from April 15th-17th (20 CEs) + enrollment in our Bonus Bundle (14.0+ CEs) from now through December 2021.

  • Live Q & A Session with the instructor after each webinar
  • Presentations by our team of experts
  • Handouts and Resources for each session
  • Post-test questions
  • A sense of community
  • If you can’t attend the live webinars, a recorded version will be posted later the same day for viewing.

View full Conference Schedule and Faculty.


Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

Rationale of the Week | What is Causing Hypoglycemia?

In the 2021 ADA Standards of Care, there is an intentional and focused discussion of health barriers to diabetes self-management. Our January 5th Question of the Week alluded to how Social Determinants of Health can impact diabetes management. Over 60% of respondents chose the best answer!

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question

Question: LS has type 1 diabetes and reports to the clinic with unusually frequent hypoglycemia and some weight loss.  LS appears distraught and says that since the pandemic, their work hours have been dramatically reduced and paying bills has been a struggle. Based on this information, which of the following topics would the diabetes specialist most want to explore further?

Answer Choices:

  • Disordered eating
  • Food insecurity
  • Insulin rationing
  • Diabetes distress

As shown above, the most common choice was option 2, the second most common answer was option 3, then option 4, and finally option 1.

Getting to the Best Answer

If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. This question identifies if the test taker can identify how social determinants can impact health.

Answer 1 is incorrect. 8.29% chose this answer. “Disordered eating.” Even though this is a tempting answer, the facts in the question don’t support this answer. If LS was struggling with disordered eating, glucose levels would be elevated due to under insulinization to promote hyperglycemia and weight loss. People with diabetes and disordered eating reduce their insulin dose to induce chronic hyperglycemia which leads to weight loss.

Answer 2 is correct. 60.50% of you chose this answer. “Food insecurity.” People with diabetes are at higher risk of food insecurity. During the pandemic, many people aren’t able to work and lack access to adequate food.

In this situation, hypoglycemia coupled with weight loss indicates that LS is not consuming enough calories to match their insulin dose.

Given that LS has less income, it makes sense that they may not be able to afford adequate food. Providing LS with local resources to food banks and social services plus helping them take less insulin to prevent hypoglycemia, are both important topics to discuss during the visit.

Answer 3 is incorrect, 14.09% of you chose this answer “Insulin rationing.” If LS was rationing or taking less insulin than usual to make it last longer, they would not be struggling with hypoglycemia, but would instead be experiencing hyperglycemia.

Answer 4 is incorrect, 11.48% of you chose this answer. “Diabetes distress.” Certainly, LS is experiencing distress, but the main issue in this situation is safety and preventing hypoglycemia. The hypoglycemia is not a result of distress, it is due to lack of adequate food. Providing LS with local resources to food banks and social services plus helping them take less insulin to prevent hypoglycemia, are both important topics to address during the visit.

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!

Food Insecurity – An Important Topic

Section 1 in the ADA Standards, Improving Care and Promoting Health in Populations, takes a close look at the social determinants of health that can act as barriers to self-care. As diabetes advocates, we can ask these 2 Food Security Screening questions (see slide below) to assess for inadequate access to food and provide needed resources and referrals.


Want to learn more about this topic?

Enroll in our Level 2 | Assessing and Promoting Well-Being: From Population Health to a Person-Centered Approach | 1.5 CEs

We have updated this course to reflect the 2021 ADA Standards of Care.  This presentation includes the latest information on Social Determinants of health, assessment strategies, and approaches. We explore the psychosocial issues that can discourage individuals from adopting healthier behaviors and provides strategies to identify and overcome these barriers. Life studies are used to apply theory to real-life situations. A great course for anyone in the field of diabetes education or for those looking for a new perspective on assessment and coping strategies.

 Topics include:

  • Name assessment areas of healthy coping
  • List psycho-social and emotional barriers
  • Provide strategies for healthcare professionals to identify and overcome barriers
  • Discuss strategies to develop an individualized diabetes education plan

Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF and Touro University and a nationally recognized diabetes expert.


Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

AccreditationDiabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

Rationale of the Week | Which New Year’s Resolution is SMART?

Our December 29th Question of the week had over 77% of respondents who chose the best answer!

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question

Question: JZ is excited for 2021 and wants to work on some New Year’s resolutions.  Which of the following would be considered a SMART behavioral goal for the New Year?

Answer Choices:

  • I will check my sugars every other day before breakfast for one month.
  • I will exercise or lift weights even if I don’t feel motivated, for the next year.
  • I plan to avoid sugary drinks, chips and candy, and junk foods.
  • I commit to taking all of my medications daily and losing 3 pounds.

As shown above, the most common choice was option 1, the second most common answer was option 4, then option 3, and finally option 2.

Getting to the Best Answer

If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. This question identifies if the test taker is familiar with SMART Goals. Get rid of weak answers first and choose the best answer.

SMART Goals

The SMART acronym stands for Specific-Measurable-Achievable-Realistic and Timely. All of these constructs are important to consider when helping a client create a behavioral goal. By helping people narrow down their behavior change goal, making it as specific and realistic as possible, we increase likelihood of success.

Answer 1 is correct. 77.66% chose this answer. “I will check my sugars every other day before breakfast for one month.” This is specific (I will check sugars every other day), Achievable (not too burdensome), Realistic (I can do it), Timely (for one month). This goal meets all the criteria!

Answer 2 is incorrect. 3.95% of you chose this answer. “I will exercise or lift weights even if I don’t feel motivated, for the next year.” This is not specific (I will lift weights even if I don’t feel motivated), not Achievable (how are they going to over come lack of motivation), not Realistic (Hard to determine), Timely (for next year). This goal meets one of the criteria!

Answer 3 is incorrect, 6.86% of you chose this answer “I plan to avoid sugary drinks, chips and candy, and junk foods.” This is specific (I plan to avoid sugary drinks, chips and candy, and junk foods ), not Achievable (to avoid of the foods at once sounds very difficult), not Realistic (Hard to determine), not Timely (no time frame). This goal meets one of the criteria!

Answer 4 is incorrect, 11.48% of you chose this answer. “I commit to taking all of my medications daily and losing 3 pounds.” This is not specific (How is this person going to lose 3 pounds, what behaviors are they going to change?), Achievable (losing 3 pounds seems achievable), could be Realistic (Hard to determine), not Timely (no time frame). This goal meets one or two of the criteria!

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!


Level 1 – Diabetes Fundamentals 2021 Updates

This series is designed for health care professionals who are interested in getting started in diabetes education and for those actively working toward becoming a Certified Diabetes Care and Education Specialist. Each course in this series provides the critical building blocks and foundation for those entering the diabetes field. Plus, they prepare you to advance to our Level 2 Standards of Care Intensive Courses.

Join us for our 2021 Live Webinar Updates. All courses air at 11:30 a.m. (PST)

  • January 12, 2021 – Class 1 – Getting to the Nitty Gritty 1.5 CEs
  • January 14, 2021 – Class 2 -Nutrition and Exercise 1.5 CEs
  • January 19, 2020 – Class 3 – Insulin Therapy & Pattern Management 1.5 CEs
  • January 21, 2021 – Class 4 – Meds Overview for Type 2 – 1.5 CEs
  • January 26, 2021 – Class 5 – Goals of Care 2020 – 1.5 CEs
  • January 28, 2021 – Class 6 – Hypoglycemia, Sick Days, Monitoring, Foot Care 1.5 CEs

Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF and Touro University and a nationally recognized diabetes expert.


Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

AccreditationDiabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

Best treatment for hypertension? | Last Rationale of the Week for 2020

This is our last post of 2020! We want to thank all of you for your support and participation in our Question and Rationale of the Week! We will see you in 2021 with more exciting questions and rationales. Can’t wait!

Our December 22nd Question asked how to best treat a blood pressure of 162/94 according to ADA Standards of Care. Less than half of respondents, chose the best answer.

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question

Question: JR is 63, has diabetes, and has a B/P of 162/94 which is repeated on a separate visit.  JR also has albuminuria. What would be the recommended pharmacological approach based on the ADA Standards of Care?

Answer Choices:

  • Start on DASH Diet plus one blood pressure medication.
  • Start ACEi plus ARB.
  • Start ACEi or ARB plus another blood pressure medication.
  • Avoid diuretics if on an ACEi or ARB.

As shown above, the most common choice was option 3, the second most common answer was option 1, then option 2, and finally option 4.

Getting to the Best Answer

If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. Being familiar with the ADA Standards of Care is critical to pass either the CDCES or BC-ADM exam. The section of CV risk management is especially important, since the leading cause of death in diabetes is heart disease.

Answer 1 is incorrect. 25.11% chose this answer. “Start on DASH Diet plus one blood pressure medication.” Starting this person on the DASH meal plan along with a BP medication are both correct, however, given the extreme hypertension, more action is required.

Answer 2 is incorrect. 16.78% of you chose this answer. “Start ACEi plus ARB.” According to the ADA Standards, it is not recommended to use both of these agents together. The standards recommend to use EITHER an ACEi or ARB plus another blood pressure agent (diuretic, Calcium Channel Blocker, etc) to treat hypertension (see image below).

Answer 3 is correct, 48.52% of you chose this answer “Start ACEi or ARB plus another blood pressure medication.” According to ADA Standards (see image below), a confirmed BP where either the systolic is 160 or greater and the diastolic is 100 or greater, requires the initiation of 2 anti-hypertensive medications. Of course, we would request home blood pressure monitoring, review symptoms of orthostatic hypotension, and encourage lifestyle interventions.

Diabetes specialists have a tremendous opportunity to reduce CV events by being familiar with the standards and advocating on behalf of our clients for needed interventions.

Answer 4 is incorrect, 9.59% of you chose this answer. “Avoid diuretics if on an ACEi or ARB.” ADA standards include adding a diuretic to an ACEi or ARB if blood pressure is not at target (see image below).

From ADA Standards 2021 – Section 10, CV Disease

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!


Level 1 – Diabetes Fundamentals 2021 Updates

This series is designed for health care professionals who are interested in getting started in diabetes education and for those actively working toward becoming a Certified Diabetes Care and Education Specialist. Each course in this series provides the critical building blocks and foundation for those entering the diabetes field. Plus, they prepare you to advance to our Level 2 Standards of Care Intensive Courses.

Join us for our 2021 Live Webinar Updates. All courses air at 11:30 a.m. (PST)

  • January 12, 2021 – Class 1 – Getting to the Nitty Gritty 1.5 CEs
  • January 14, 2021 – Class 2 -Nutrition and Exercise 1.5 CEs
  • January 19, 2020 – Class 3 – Insulin Therapy & Pattern Management 1.5 CEs
  • January 21, 2021 – Class 4 – Meds Overview for Type 2 – 1.5 CEs
  • January 26, 2021 – Class 5 – Goals of Care 2020 – 1.5 CEs
  • January 28, 2021 – Class 6 – Hypoglycemia, Sick Days, Monitoring, Foot Care 1.5 CEs

Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF and Touro University and a nationally recognized diabetes expert.


Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

AccreditationDiabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

Rationale of the Week | Why the Sugar Spike?

Our December 15th Question of the week was tricky and over 59% of respondents, chose the best answer.

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question

Question: JL is a 78-year-old with type 2 diabetes who has been taking metformin 1000mg BID for the past year. JL checks BG each morning and says it usually ranges from 100 – 138.  Her most recent A1c came back at 9.6% and the provider started her on dapagliflozin (Farxiga) 5 mg daily two days ago. JL arrives at the clinic in a panic and says has been checking her blood glucose 3 times a day it has “jumped up to 236 and 242”.  The diabetes specialist double-checked and verified random glucose of 249.  What is the best explanation?

Answer Choices:

  • Dapagliflozin is associated with transient hyperglycemia.
  • Double-check kidney function to verify GFR is adequate.
  • Discovery of hyperglycemia due to random BG checks.
  • Hyperglycemia due to the initiation of steroid therapy.

As shown above, the most common choice was option 3, the second most common answer was option 2, then option 1, and finally option 4.

Getting to the Best Answer

If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. This question lures test takers into trying to make an answer fit. Get rid of wrong answers first and choose the best answer.

Answer 1 is incorrect. 15.53% chose this answer. “Dapagliflozin is associated with transient hyperglycemia.” Dapagliflozin (Farxiga) is a SGLT-2 Inhibitor, also known as a “glucoretic”. It causes excretion of glucose from the renal tubules and is not associated with transient hyperglycemia. As a matter of fact, no diabetes medications cause hyperglycemia.

Answer 2 is incorrect. 17.54% of you chose this answer. “Double-check kidney function to verify GFR is adequate.” It is true that people need to have a GFR of 45 or greater to take Dapagliflozin (Farxiga). However, an inadequate GFR is not associated with glucose spikes. Also, the test question gives no data on GFR, so this makes this a very unlikely best answer.

Answer 3 is correct, 59.44% of you chose this answer “Discovery of hyperglycemia due to random BG checks.” Here are the Diabetes Specialist’s notes regarding JL.

JL stopped by the office today worried about sudden blood sugar elevations of 273 in 284 after starting a new medication on Friday for diabetes.

Dr. started JL on Dapagliflozin (Farxiga) half pill once a day and the patient has been taking it for two days now.  JL is nervous about continuing to take it because JL thinks that is causing her blood sugars to elevate. The patient also takes metformin daily.

Before, the patient was only checking her blood sugar once a day and it was always in the morning. Her morning blood sugars were in the 120- 140 range. However, now JL is checking her blood sugars throughout the day and discovered that blood sugars are actually much higher than JL thought because was only checking in the morning. In the office I checked blood sugar it was 251. JL denied fever or cough.

Reassured JL that it was not the Dapagliflozin (Farxiga) causing high blood sugar. Focused on the benefits of Dapagliflozin (Farxiga) including lower blood sugar, lower blood pressure and protection against heart and kidney disease. Reviewed briefly the importance of limiting carbohydrates and juices or sodas until we can get her blood sugars closer to target.

Answer 4 is incorrect, 7.50% of you chose this answer. “Hyperglycemia due to the initiation of steroid therapy.” This is another juicy answer, but since the question doesn’t mention JL is on steroids, this is not the best answer.

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!


Level 1 – Diabetes Fundamentals 2021 Updates

This series is designed for health care professionals who are interested in getting started in diabetes education and for those actively working toward becoming a Certified Diabetes Care and Education Specialist. Each course in this series provides the critical building blocks and foundation for those entering the diabetes field. Plus, they prepare you to advance to our Level 2 Standards of Care Intensive Courses.

Join us for our 2021 Live Webinar Updates. All courses air at 11:30 a.m. (PST)

  • January 12, 2021 – Class 1 – Getting to the Nitty Gritty 1.5 CEs
  • January 14, 2021 – Class 2 -Nutrition and Exercise 1.5 CEs
  • January 19, 2020 – Class 3 – Insulin Therapy & Pattern Management 1.5 CEs
  • January 21, 2021 – Class 4 – Meds Overview for Type 2 – 1.5 CEs
  • January 26, 2021 – Class 5 – Goals of Care 2020 – 1.5 CEs
  • January 28, 2021 – Class 6 – Hypoglycemia, Sick Days, Monitoring, Foot Care 1.5 CEs

Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF and Touro University and a nationally recognized diabetes expert.


Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

AccreditationDiabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

Rationale of the Week | Hyperglycemic and Ketone Positive. What Intervention MOST Needed?

Our December 8th Question of the week was a question of interventions. Over 71% of respondents, chose the best answer.

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question

Question: A 12-year-old with new-onset hyperglycemia presents to the Emergency Room with positive urine ketones and blood sugar of 283. What action is required most immediately?

Answer Choices:

  • Contact dietitian to provide macronutrient review.
  • Start a person with diabetes on Metformin (Glucophage).
  • Draw ABGs and antibodies.
  • Provide insulin therapy.

As shown above, the most common choice was option 4, the second most common answer was option 3, then option 2, and finally option 1.

Getting to the Best Answer

If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. The exam questions won’t have 2 right answers, but alcohol and diabetes is expected content on the exam.

Answer 1 is incorrect. 1.98% chose this answer. “Contact dietitian to provide macronutrient review.” All people with diabetes benefit from a consultation with a dietitian. However, in this crisis situation, the first priority is not a macronutrient review. The first priority is to stop ketosis.

Answer 2 is incorrect. 2.31% of you chose this answer. “Start a person with diabetes on Metformin (Glucophage).” Given that this is a teenager with positive ketones, we are suspecting type 1 diabetes. With that information, starting metformin would not be a recommended intervention.

Answer 3 is incorrect, 23.8% of you chose this answer “Draw ABGs and antibodies.” The question asks what action to take immediately. If you chose this answer, you are on the right track. You want to verify a diagnosis of type 1 diabetes by evaluating if they are acidotic and have positive autoantibodies. An immediate action would include checking ABG’s but not antibodies. Antibodies would most likely be drawn after the patient is stabilized.

Answer 4 is correct, 71.9% of you chose this answer. “Provide insulin therapy. ” Elevated blood glucose and positive ketones always indicate that the person is insulin deficient. When there is not enough circulating insulin, the body can’t use glucose for fuel, so it uses fat for fuel which leads to ketone bodies. To stop fat breakdown, immediate insulin infusion is required along with fluids to treat 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!


Want to learn more? Register for our
Level 2 – Hyperglycemic Crisis. DKA and HHS 2021 course, which is ready for viewing.

Join Coach Beverly to learn about unexpected causes of hyperglycemia and strategies to get blood glucose levels to goal. Topics include hyperglycemia secondary to medications and insulin deprivation. She also reviews Diabetes Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome, with new information on treating DKA with subq insulin therapy. Treatment strategies for all situations are included.

Topics include:

  • Common causes of hyperglycemic crises.
  • The difference and similarities between DKA and HHS and treatment strategies
  • Causes and treatment of hyperglycemic crises.
Can’t join us live?
Don’t worry, we will send you a link to the recorded version.

Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!


Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

Rationale of the Week | Alcohol and Holidays

Given that people with diabetes might have a drink or two during the season, we thought that this was an important topic to discuss further. Our December 1st Question of the week was a question of alcohol consumption during the holidays. Over 60% of respondents, chose the best answer.

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question

Question: JL has diabetes and injects insulin 2-3 times a day. JL is at a holiday party and is struggling with wanting a holiday spirit. Which of the following is the best approach for JL?

Answer Choices:

  • A. JL is on insulin and needs to avoid alcohol.
  • B. JL needs to take extra insulin to cover alcohol.
  • C. Wine is a better choice than a margarita.
  • D. For every alcohol drink, JL needs to eat 15 gms of carb.
  • E. Both C & D.

As shown above, the most common choice was option 5, the second most common answer was option 4, then option 3, then option 2, and finally option 1.

Getting to the Best Answer

If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. The exam questions won’t have 2 right answers, but alcohol and diabetes is expected content on the exam.

Answer 1 is incorrect. 5.04% chose this answer. “JL is on insulin and needs to avoid alcohol.” Based on the American Diabetes Association standards of care, people with diabetes on insulin can include alcohol as part of their meal plan.

The current recommendations are; women with diabetes limit their alcohol consumption to one drink a day or less and men with diabetes limit consumption to two or fewer drinks a day.

There are side effects to consider. Alcohol can worsen triglyceride levels, intensify neuropathic pain, and lead to unwanted weight gain. Plus, it can increase the risk of hypoglycemia. So, the decision to consume spirits is a person-centered decision, based on individual needs and health status.

One serving of alcohol =

  • 5 ounces of wine
  • 1.5 ounces of hard liquor
  • 12-ounce beer

Answer 2 is incorrect. 5.98% of you chose this answer. “JL needs to take extra insulin to cover alcohol.” Alcohol can cause hypoglycemia for hours after consumption. Alcohol metabolism in the liver delays the release of glycogen stores and can lead to low circulating glucose levels. Some people with type 1 diabetes may even need to adjust their insulin dose at a meal if consuming alcohol.

People with type 1 diabetes need to be extra cautious if their before bed glucose is elevated after consuming alcohol. Before giving extra insulin to treat nighttime high glucose, remind them that glucose levels will trend down overnight with alcohol on board, and they probably don’t need that extra bolus of insulin.

Answer 3 is correct, but so is answer 4. “Wine is a better choice than a margarita.” Wine is a better choice since it does not have all the extra sugar and carbohydrates of a margarita. Wine consumption has a more predictable outcome whereas figuring out how much carbohydrate is in a margarita can be tricky. Mixed sugary drinks may cause blood glucose levels to rise initially than drop, later on, making management more difficult.

Answer 4 is correct, but so is answer 3. “For every alcohol drink, JL needs to eat 15 gms of carb.” Since we know that alcohol can lead to hypoglycemia for those who are on insulin therapy or take a sulfonylurea, coupling each of their favorite adult beverages with 15 gms of carb can prevent unwanted hypoglycemia.

Another issue is that the signs of hypoglycemia can mirror the signs of intoxication. Encourage people to keep a close eye on their CGM or meter results when imbibing. And include their friends in on helping to detect and treat hypoglycemia to keep safe during celebrations.

Answer 5 is correct. 60.94% chose this answer. “Both C & D.”

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!


Want more exam practice questions? Enroll in our Test Taking Toolkit with 220+ Practice Questions!

“This is one of the best review courses I’ve ever taken.”

“I learned so much from the CDCES Exam Prep Toolkit. I now have an assessment after taking the practice exam on the areas I need to focus my studying.”

Student Feedback

Whether you are preparing for the CDCES or BC-ADM exam, this test-taking toolkit is designed to prepare you for success. This toolkit includes two courses with over 200 practice questions to help you prepare and simulate the exam. Plus, we have added a FREE bonus course, Language, and Diabetes – What we say matters. Coach Beverly added this course because she believes it contains critical content for the exam and for our clinical practice!


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AccreditationDiabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

Rationale of the Week | December 3, 2020

Our November 24th Question of the week was crazy hard and super simple at the same time. Less than half, 44% of respondents, chose the best answer, We thought that this was an important topic to discuss further, so we can pass on correct info to people living with diabetes.

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question

Question: JR is going to stay home for Thanksgiving and decided to prepare a fantastic dinner.  JR has type 1 diabetes and injects bolus insulin before each meal. JR takes 1 unit of insulin for each 10 gms of carbohydrates.

Using myfitnesspal to calculate JRs carb intake for the following festive meal, how much insulin would JR need to inject?

  • ½ cup cranberry sauce                 
  • ½ cup mashed potatoes                                               
  • ½ cup of buttered corn                                   
  • 1 small dinner roll                                              
  • A big scoop of green beans                                                  
  • 4 ounces of turkey breast                              
  • ½ cup of stuffing                                                     
  • 5 ounces Vendagne Chardonna

Answer Choices:

  1. 11.8 units
  2. 12.3 units
  3. 11 units
  4. 10.8 units
  5. I have no idea, pass the pumpkin pie

As shown above, the most common choice was option 3, the second most common answer was option 4, then option 2, then option 1, and finally option 5.

Getting to the Best Answer

If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers may lure you in to choosing a more complicated answer, when the simplest answer may be the best choice. That is true for this question.

The most important feature of this question is “how much insulin would JR need to inject?” Since he is injecting insulin, no syringe or pen would allow him to inject 1/10th of a unit. Based on this info, the only plausible answer is 11 units or answer 3. But, for fun, here is the carb calculation.

JR will be eating 109 gms of carb. His insulin to carb ratio is 1/10. 109 / 10 = 10.9 units of insulin, then round up to 11 units.

  • ½ cup cranberry sauce – 40 gms                 
  • ½ cup mashed potatoes   – 15 gms                                          
  • ½ cup of buttered corn – 11gms                                
  • 1 small dinner roll  – 15 gms                                           
  • A big scoop of green beans  – 7gms                                               
  • 4 ounces of turkey breast – 0                             
  • ½ cup of stuffing – 21 gms                                                     
  • 5 ounces Vendagne Chardonnay –
  • Total carb = 109 gms Insulin needed 109 / 10 = 10.9 units. Then round up to 11 unit injection.

Answer 1 is incorrect. 14.46% chose this answer. “11.8 units .”

Answer 2 is incorrect. 17.77% of you chose this answer. “12.3 units.”

Answer 3 is correct. 44.08% of respondents chose this. “11 units.”

Answer 4 is incorrect. 19.49% chose this answer. “10.8 units.”

Answer 5 is incorrect. 4.88% chose this answer. ” I have no idea, pass the pumpkin pie.”

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!


Want more exam practice questions? Enroll in our Test Taking Toolkit with 220+ Practice Questions!

“This is one of the best review courses I’ve ever taken.”

“I learned so much from the CDCES Exam Prep Toolkit. I now have an assessment after taking the practice exam on the areas I need to focus my studying.”

Student Feedback

Whether you are preparing for the CDCES or BC-ADM exam, this test-taking toolkit is designed to prepare you for success. This toolkit includes two courses with over 200 practice questions to help you prepare and simulate the exam. Plus, we have added a FREE bonus course, Language, and Diabetes – What we say matters. Coach Beverly added this course because she believes it contains critical content for the exam and for our clinical practice!


Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!


AccreditationDiabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.