For last week’s practice question, we quizzed participants on Hypoglycemia during exercise. 79% 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 below: Answer Question

Question: JR has type 1 and tells you they limit their carbohydrate intake to 30 gms a day to prevent hyperglycemia.  Their A1C is 6.7% and time in range is over 70%.  They tell you their main goal is to figure out how to prevent hypoglycemia during exercise. 

What would be the best response using a person-centered approach?

Answer Choices:

1. Explore how they are currently managing blood sugars around exercise.
2. Reinforce that glucose needs to be above 100 mg/dL according to ADA Standards to prevent exercise induced hypoglycemia.
3. Gently suggest referral to a RD to evaluate actual daily carbohydrate needs.
4. Redirect the conversation to evaluate if JR might be experiencing disordered eating.

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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 anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.

Answer 1 is correct]. 79.44% chose this answer. “Explore how they are currently managing blood sugars around exercise.” YES, GREAT JOB! Since this response is person centered and respectful of JR’s desire to learn how to prevent hypoglycemia, it is the best answer. Sometimes, we might be tempted to focus on a different goal than what the individual is requesting. However, by addressing their priorities FIRST, we build trust and create meaningful connections.

Answer 2 is incorrect. 7.73% of you chose this answer. “Reinforce that glucose needs to be above 100 mg/dL according to ADA Standards to prevent exercise induced hypoglycemia.” This answer doesn’t allow for exploration, personalization and customization. A glucose goal of “above 100” pre-exercise does not fit for everyone. People with type 1 diabetes often feel more comfortable with a blood sugar 180 mg/dL or greater before engaging in activity to prevent hypoglycemia from glucose expenditure during exercise.

Answer 3 is incorrect. About 8.06% of respondents chose this. “Gently suggest referral to a RD to evaluate actual daily carbohydrate needs.” Although, JR is limiting his intake to 30gms carb a day, they have stated that they want to work on preventing exercise related hypoglycemia. Sometimes, we might be tempted to focus on a different goal than what the individual is requesting. However, by addressing their priorities FIRST, we build trust and create meaningful connections.

Finally, Answer 4 is incorrect. 4.77% chose this answer. “Redirect the conversation to evaluate if JR might be experiencing disordered eating.” Although, JR is limiting his intake to 30gms carb a day, they have stated that they want to work on preventing exercise related hypoglycemia. Sometimes, we might be tempted to focus on a different goal than what the individual is requesting. However, by addressing their priorities FIRST, we build trust and create opportunities to explore other topics in the future.

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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Want to learn more about this question?

ReVive 5 Diabetes Training Program

“ReVive 5 Program is the best program I have ever attended – should be required for all diabetes educators! Thank you so much for translating this research into practical approaches!!” – Sarah F.

Save $100! Enroll now to watch the webinar on-demand

---

ReViVE 5 Diabetes Training Program: 
Unlocking Hidden Barriers to Diabetes Management
Enroll Now and Save $100! 

Recorded & Ready to Watch

---

Addressing diabetes distress can be tricky, even for seasoned healthcare professionals.

We invite you to attend this hands-on training program that provides the essential steps to address diabetes distress combined with an innovative approach to glucose management. Our experts offer realistic strategies to address diabetes distress that you can immediately apply to your practice setting. Plus, the ReVive 5 Program provides a breadth of tools and resources to create more meaningful connections with people with diabetes.

Team of Experts: ReVive 5 is taught by a team of 3 Interdisciplinary Experts:

• Lawrence Fisher, Ph.D., ABPP, Professor Emeritus, UCSF
• Susan Guzman, PhD
• Beverly Thomassian, RN, MPH, CDCES, BC-ADM

Accredited Training Program:

• 15.0 CEs – Includes the 7-hour ReVive 5 Training Program, Certificate, and 5 FREE bonus courses to supplement content.
• A comprehensive set of assessment tools, educational materials, log sheets, and resources.

“ReVive 5” breathes new life into our relationship with diabetes, bringing a fresh perspective to both the person with diabetes and the provider.

---

All hours earned count toward your CDCES Accreditation Information

---

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!

---

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.

For last week’s practice question, we quizzed participants on post-meal hypoglycemia. 69% 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 below: Answer Question

Question:

JR has lived with type 1 diabetes for over 30 years and has been complaining that they feel full and bloated after eating and experiencing more post-meal hypoglycemia.

Based on this information, what is the most appropriate recommendation for JR?

Answer Choices:

1. Evaluate transglutaminase levels.
2. Encourage small, frequent, low fiber meals.
3. Suggest a consult for a gastric pacemaker.
4. Recommend they try avoiding foods with gluten for a few weeks to see if they feel better.

---

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 anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.

Answer 1 is incorrect. 15.78% chose this answer. “Evaluate transglutaminase levels.” Based on JR’s symptoms of “feeling full and bloated after eating and experiencing more post-meal hypoglycemia” we are not suspecting celiac disease since there is no mention of bloating after gluten rich foods. Plus, post meal hypoglycemia is more likely associated with the delayed gastric emptying associated with gastroparesis. Since transglutaminase is a test used to detect celiac disease, this is not the best answer.

Answer 2 is correct. 68.91% of you chose this answer. “Encourage small, frequent, low fiber meals.” YES. GREAT JOB! JR’s symptoms of “feeling full and bloated after eating and experiencing more post-meal hypoglycemia” are both classic symptoms of gastroparesis and delayed gastric emptying. This autonomic neuropathic condition is treated with glucose improvement and smaller, low fiber meals to support gastric movement. In addition, a referral to a GI specialist is certainly warranted.

Answer 3 is incorrect. About 4.41% of respondents chose this. “Suggest a consult for a gastric pacemaker.” JR’s symptoms of “feeling full and bloated after eating and experiencing more post-meal hypoglycemia” are both classic symptoms of gastroparesis and delayed gastric emptying. This autonomic neuropathic condition is treated with glucose improvement and smaller, low fiber meals to support gastric movement. However, before suggesting a consult for a gastric pacemaker, JR would first need a referral to a GI specialist to confirm diagnosis and evaluate best next steps.

Finally, Answer 4 is incorrect. 10.90% chose this answer. “Recommend they try avoiding foods with gluten for a few weeks to see if they feel better.” Based on JR’s symptoms of “feeling full and bloated after eating and experiencing more post-meal hypoglycemia” we are not suspecting celiac disease since there is no mention of bloating after gluten rich foods. Plus, post meal hypoglycemia is more likely associated with the delayed gastric emptying associated with gastroparesis.

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 about this practice question?
Join us LIVE in San Diego for our DiabetesEd Training Conference
October 11-13th, 2023

---

Two Registration Options

Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, networking, games with prizes, and “aha” moments in beautiful San Diego. 

You don’t want to miss this one-of-a-kind learning opportunity. Get away from all those daily responsibilities and immerse yourself in a fun and intensive conference with plenty of networking opportunities.    

Attendees will leave this conference with new tools and a more complete understanding of the latest advances in diabetes care, from medications to technology to Medical Nutrition Therapy! 

Bring your colleagues and enjoy our friend discount.

Our team expertly translates the complex science of diabetes into understandable terms while keeping it real, practical, and fun. 

Team of expert faculty includes:

• Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
• Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
• Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator 

All hours earned count toward your CDCES Accreditation Information

---

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!

---

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.

For last week’s practice question, we quizzed participants on getting A1C to goal. 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 below: Answer Question

Question: AR’s has an A1C of 7.5% and is taking empagliflozin (Jardiance) 10mg daily, plus trying to eat healthy and ride their bike 4-5 days a week for 30 minutes.  The provider suggests increasing the empagliflozin dose to 25mg to get the A1C below 7%.  AR says that they don’t want to increase their medication dose and says they are dedicated to lowering their A1C through more activity. 

Based on this scenario, what ADA recommended activity addition or change would help AR reach their A1C target?

Answer Choices:

1. Consistently decrease portion size and increase vegetable intake.
2. Ask AR if they can increase bike riding to daily.
3. Explore addition of twice weekly strength training.
4. Encourage AR to reconsider increasing empagliflozin dose.

---

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 anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.

Answer 1 is incorrect. 13.09% chose this answer. “Consistently decrease portion size and increase vegetable intake.” This juicy answer is tempting, since it addresses portion size and includes more vegetable intake. However, it is not the best answer since it doesn’t match AR’s stated goal that “they are dedicated to lowering their A1C through more activity.”

Answer 2 is incorrect. 14.42% of you chose this answer. “Ask AR if they can increase bike riding to daily.” Based on the ADA Standards, individuals are encouraged to maintain 150 minutes of activity a week, plus strengthening activities twice weekly. Asking AR to increase bike to riding to daily, is not the best approach in this scenario to achieve A1C targets.

Answer 3 is correct. About 64.52% of respondents chose this. “Explore addition of twice weekly strength training.” YES, this is the best answer. Based on the ADA Standards, individuals are encouraged to maintain 150 minutes of activity a week, plus strengthening activities twice weekly. Studies show that increasing muscle mass significantly lowers glucose and A1C.

Finally, Answer 4 is incorrect. 7.97% chose this answer. “Encourage AR to reconsider increasing empagliflozin dose.” This juicy answer is tempting, since increasing the empagliflozin dose would most likely decrease AR’s blood sugar. However, it is not the best answer since it doesn’t match AR’s stated goal that “they are dedicated to lowering their A1C through more activity.”

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!

---

Celebrating 25 Years Sale!!!

Save $100 on our Most Popular Online Programs! Sale ends July 31st!

Prepare for Certification and Earn CEs

---

ReVive 5 Diabetes Training Program

Save $100! Enroll now to watch the webinar on-demand

Addressing diabetes distress can be challenging, even for seasoned healthcare professionals.

We invite you to attend this hands-on training program that provides the essential steps to address diabetes distress combined with an innovative approach to glucose management.

Dates and Times for ReVive Virtual Training

• For your convenience, we have combined the 4 sessions into 2 half days. Same great content.
• Now Recorded & Ready to Watch

Team of Experts: ReVive 5 is taught by a team of 3 Interdisciplinary Experts:

Lawrence Fisher, Ph.D., ABPP, Professor Emeritus, UCSF
Susan Guzman, PhD
Beverly Thomassian, RN, MPH, CDCES, BC-ADM

Accredited Training Program:

• 15.0 CEs – Includes the 7-hour ReVive 5 Training Program, Certificate, and 5 FREE bonus courses to supplement content.
• A comprehensive set of assessment tools, educational materials, log sheets, and resources.

“ReVive 5” breathes new life into our relationship with diabetes, bringing a fresh perspective to both the person with diabetes and the provider.

---

CDCES Basic Prep Bundle

30+ Online Courses | 50+ CEs

---

BC-ADM Deluxe Prep Bundle

35 online courses | 50+ CEs

---

NEW: Everything Bundle

40+ online courses | 85+ CEs

The next edition of the Review Guide will be released in August. We will be preselling as soon as we get the thumbs up.

All hours earned count toward your CDCES Accreditation Information

---

ADCES Art & Science Desk Reference
5th Edition

ADCES will be releasing an updated edition of the Art & Science Desk reference in August 2023

---

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!

---

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.

For last week’s practice question, over 1,900 participants submitted their answers for how LR could improve glucose while preparing for pregnancy. 37% 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 below: Answer Question

Question: LR is 29 years old, has newly discovered diabetes and polycystic ovary syndrome (PCOS) and is trying to get pregnant. In addition to treating the diabetes and PCOS, LR would like to lose weight. LR was referred to the RD/RDN and encouraged to increase activity level. To treat PCOS and diabetes, LR was started on metformin ER 500mg BID.  After a month of treatment, LR’s A1C was still above 8%.

 According to ADA Standards, besides increasing the metformin dose, what additional therapy could be added to get LR’s glucose to goal?

Answer Choices:

1. GLP-1 Receptor Agonist
2. SGLT-2 Inhibitor
3. Either A or B
4. None of the above

---

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 anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.

Answer 1 is incorrect. 25.41% chose this answer. “GLP-1 Receptor Agonist.” Given that LR has elevated blood glucose and wants to lose weight, starting a GLP-1 seems like a reasonable idea. However, GLP-1’s are not FDA approved for use during pregnancy. Since LR is trying to get pregnant, this class of medication would not be recommended.

Answer 2 is incorrect. 13.35% of you chose this answer. “SGLT-2 Inhibitor.” Given that LR has elevated blood glucose and wants to lose weight, starting a SGLT-2i seems like a reasonable idea. However, SGLT-2i’s are not FDA approved for use during pregnancy. Since LR is trying to get pregnant, this class of medication would not be recommended.

Answer 3 is incorrect. About 24.51% of respondents chose this. “Either A or B.” Given that LR has elevated blood glucose and wants to lose weight, starting either a SGLT-2i or a GLP-1 seems like a reasonable idea. However, SGLT-2i’s and GLP-1’s are not FDA approved for use during pregnancy. Since LR is trying to get pregnant, neither class of medication would not be recommended.

Finally, Answer 4 is correct. 36.73% chose this answer. “None of the above.” YES, This is the Best Answer. Metformin is the only non-insulin diabetes medication the ADA recommends for the first trimester of pregnancy. Many people with PCOS are treated with metformin to decrease insulin resistance and ovulation can resume, resulting in pregnancy. The ADA recommends stopping metformin after the first trimester and starting insulin if blood glucose levels remain above target.

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!

---

Celebrating 25 Years Sale!!!

Save $100 on our Most Popular Online Programs! Sale ends July 31st!

Prepare for Certification and Earn CEs

---

ReVive 5 Diabetes Training Program

“ReVive 5 Program is the best program I have ever attended – should be required for all diabetes educators! Thank you so much for translating this research into practical approaches!!” – Sarah F.

Save $100! Enroll now to watch the webinar on-demand

Addressing diabetes distress can be challenging, even for seasoned healthcare professionals.

We invite you to attend this hands-on training program that provides the essential steps to address diabetes distress combined with an innovative approach to glucose management.

Team of Experts: ReVive 5 is taught by a team of 3 Interdisciplinary Experts:

Lawrence Fisher, Ph.D., ABPP, Professor Emeritus, UCSF
Susan Guzman, PhD
Beverly Thomassian, RN, MPH, CDCES, BC-ADM

Accredited Training Program:

• 15.0 CEs – Includes the 7-hour ReVive 5 Training Program, Certificate, and 5 FREE bonus courses to supplement content.
• A comprehensive set of assessment tools, educational materials, log sheets, and resources.

“ReVive 5” breathes new life into our relationship with diabetes, bringing a fresh perspective to both the person with diabetes and the provider.

---

CDCES Basic Prep Bundle

30+ Online Courses | 50+ CEs

---

BC-ADM Deluxe Prep Bundle

35 online courses | 50+ CEs

---

NEW: Everything Bundle

40+ online courses | 85+ CEs

The first person who purchases our Everything Bundle wins our last copy of the Diabetes Review Guide 5^th Ed. 

The next edition of the Review Guide will be released in August. We will be preselling as soon as we get the thumbs up.

The first person who purchases our Everything Bundle wins our last copy of the Diabetes Review Guide 5^th Ed. 

All hours earned count toward your CDCES Accreditation Information

---

ADCES Art & Science Desk Reference
5th Edition

ADCES will be releasing an updated edition of the Art & Science Desk reference in August 2023

---

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!

---

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.

For last week’s practice question, we quizzed participants on person-centered care. 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 below: Answer Question

Question: MR has an A1C of 9.6% and is deciding whether or not to start another diabetes medication to help lower their glucose. MR’s parent had diabetes and severe complications due to chronic hyperglycemia. 

What would best describe the application of the Health Belief Model in this situation?

Answer Choices:

1. MR’s perception of the benefit and cost associated with preventing diabetes complications.
2. MR’s level of readiness to add an additional diabetes medication to their regimen.
3. MR is more likely to start this medication if they know someone taking the same medication.
4. MR’s feelings of empowerment impact their decision whether or not to start the medication.

---

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 anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.

Answer 1 is correct. 54.67% chose this answer. “MR’s perception of the benefit and cost associated with preventing diabetes complications.” GREAT JOB. The Health Belief Model (HBM) focuses on individual beliefs and perceptions about health-related behavior change. It suggests that behavior change is influenced by an individual’s perception of the severity of a health problem, their susceptibility to it, the benefits of behavior change, and the barriers or cues to action. In other words it looks at the cost-benefit of a given situation.

Answer 2 is incorrect. 18.28% of you chose this answer. “MR’s level of readiness to add an additional diabetes medication to their regimen.” This answer actually refers the Stages of Change (transtheoretical) Model: This model proposes that individuals go through a series of stages when changing behavior: precontemplation, contemplation, preparation, action, and maintenance. It suggests that people move through these stages in a cyclical manner and that interventions should be tailored to each stage.

Answer 3 is incorrect. About 5.88% of respondents chose this. “MR is more likely to start this medication if they know someone taking the same medication.” This answer reflects the Social Cognitive Theory (SCT): This theory emphasizes the reciprocal interaction between personal factors (such as cognition and self-efficacy), environmental factors, and behavior. It suggests that behavior change is influenced by observing others (social modeling), self-regulation, and the belief that one can successfully perform the behavior (self-efficacy).

Finally, Answer 4 is incorrect. 21.18% chose this answer. “MR’s feelings of empowerment impact their decision whether or not to start the medication.” This answer refers to the empowerment model which is a theoretical framework that focuses on empowering individuals or communities to take control of their own lives and make informed decisions. It emphasizes the importance of promoting autonomy, self-efficacy, and participation in decision-making processes. The empowerment model is often applied in various fields, including social work, community development, healthcare, and education.

Behavior Change Theories Explained – LIVE FREE Webinar
August 23rd, @ 11:30 am PST

Learning behavior change theories and getting to the best answer for certification exams can be tricky. To say thanks for 25 years, Coach Beverly is going to host a FREE Webinar where she dissects common learning theories that are not only helpful for your clinical practice, but also for exam preparation.

Join her August 23rd at 11:30 am PT. For live webinars, Coach Beverly stays after class to answer any lingering questions you may have on the topic.

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!

---

ReVive 5 Diabetes Training Program

“ReVive 5 Program is the best program I have ever attended – should be required for all diabetes educators! Thank you so much for translating this research into practical approaches!!” – Sarah F.

Save $100! Enroll now to watch the webinar on-demand

---

ReViVE 5 Diabetes Training Program: 
Unlocking Hidden Barriers to Diabetes Management
Enroll Now and Save $100! 

Recorded & Ready to Watch

---

Addressing diabetes distress can be tricky, even for seasoned healthcare professionals.

We invite you to attend this hands-on training program that provides the essential steps to address diabetes distress combined with an innovative approach to glucose management. Our experts offer realistic strategies to address diabetes distress that you can immediately apply to your practice setting. Plus, the ReVive 5 Program provides a breadth of tools and resources to create more meaningful connections with people with diabetes.

Team of Experts: ReVive 5 is taught by a team of 3 Interdisciplinary Experts:

• Lawrence Fisher, Ph.D., ABPP, Professor Emeritus, UCSF
• Susan Guzman, PhD
• Beverly Thomassian, RN, MPH, CDCES, BC-ADM

Accredited Training Program:

• 15.0 CEs – Includes the 7-hour ReVive 5 Training Program, Certificate, and 5 FREE bonus courses to supplement content.
• A comprehensive set of assessment tools, educational materials, log sheets, and resources.

“ReVive 5” breathes new life into our relationship with diabetes, bringing a fresh perspective to both the person with diabetes and the provider.

---

All hours earned count toward your CDCES Accreditation Information

---

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!

---

The use of DES products does not guarantee the successful passage of the diabetes certification exams. CBDCE & ADCES does not endorse any preparatory or review materials for the certification exams, except for those published by CBDCE & ADCES.

For last week’s practice question, we quizzed participants on ADA recommendations for meal planning with diabetes. 41% 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 below: Answer Question

Question: Which of the following diabetes meal planning recommendations is accurate according to ADA Standards of Care?

Answer Choices:

1. Decrease intake of starchy vegetables.
2. Limit carbs to 45 grams per meal.
3. Eat 25 gms of fiber for every 1000 calories consumed.
4. Avoid all concentrated sweets.

---

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 anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.

Answer 1 is correct. 41.24% chose this answer. “Decrease intake of starchy vegetables.” YES, this is the BEST answer. According to ADA Standard 5, “Reducing overall carbohydrate intake for individuals with diabetes has demonstrated evidence for improving glycemia and may be applied in a variety of eating patterns that meet individual needs and preferences. Eating plans should emphasize nonstarchy vegetables, fruits, legumes, and whole grains, as well as dairy products, with minimal added sugars. However, “macronutrient distribution should be based on an individualized assessment of current eating patterns, preferences, and metabolic goals.”

Answer 2 is incorrect. 16.79% of you chose this answer. “Limit carbs to 45 grams per meal.” This is a juicy answer, but is an older approach that is no longer recommended. According to ADA Standard 5, “Evidence suggests that there is not an ideal percentage of calories from carbohydrate, protein, and fat for people with diabetes. However, macronutrient distribution should be based on an individualized assessment of current eating patterns, preferences, and metabolic goals.”

Answer 3 is incorrect. About 23.15% of respondents chose this. “Eat 25 gms of fiber for every 1000 calories consumed.” WOW, that would be a LOT of fiber. This is a great number to know for certification exams. According to ADA Standard 5, “People with diabetes and those at risk for diabetes are encouraged to consume a minimum of 14 g of fiber/1,000 kcal, with at least half of grain consumption being whole, intact grains, according to the Dietary Guidelines for Americans.”

Finally, Answer 4 is incorrect. 18.81% chose this answer. “Avoid all concentrated sweets.” Even if you are not sure what the best answer is at first, this answer has two red flags, the word “avoid” and the word “all”. Since the ADA recommends flexibility and tailoring to the individual, this would not be the best person-centered answer. According to ADA Standard 5, “Dietary guidance should emphasize the importance of a healthy dietary pattern as a whole rather than focusing on individual nutrients, foods, or food groups, given that individuals rarely eat foods in isolation.”

We hope you appreciate this week’s rationale! For more info on ADA Standard 5, click here. 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 about this practice question?
Join us LIVE in San Diego for our DiabetesEd Training Conference
October 11-13th, 2023

---

Two Registration Options

Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, networking, games with prizes, and “aha” moments in beautiful San Diego. 

You don’t want to miss this one-of-a-kind learning opportunity. Get away from all those daily responsibilities and immerse yourself in a fun and intensive conference with plenty of networking opportunities.    

Attendees will leave this conference with new tools and a more complete understanding of the latest advances in diabetes care, from medications to technology to Medical Nutrition Therapy! 

Bring your colleagues and enjoy our friend discount.

Our team expertly translates the complex science of diabetes into understandable terms while keeping it real, practical, and fun. 

Team of expert faculty includes:

• Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
• Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
• Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator 

All hours earned count toward your CDCES Accreditation Information

---

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!

---

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.

For last week’s practice question, we quizzed participants on reimbursement for group DSME classes through Medicare. 48% of respondents chose the best answer. We want to clarify and share this important information, so you can prepare for certification exams and pass it on to your colleagues.

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

Question:

JR is 73 years old and has Medicare Part A and B insurance.  JR completed a Diabetes Self-Management Program at a local hospital when they were in their late 60s and tells you they want to repeat the group sessions since they have forgotten much of the information.

What is the most accurate response?

Answer Choices:

1. Sounds great. Let’s get you enrolled in our group classes.
2. Medicare only covers group sessions once in a lifetime.
3. Good thinking. Medicare covers annual group training.
4. Since your insurance won’t cover it again, you can attend for free.

---

Getting to the Best Answer

If you are thinking about taking the certification exam, this practice test question will set you up for success since there are questions on Medicare Reimbursement. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.

Answer 1 is incorrect. 17.76% chose this answer. “Sounds great. Let’s get you enrolled in our group classes.” A very welcoming answer, but unfortunately, it’s not accurate. According to Medicare Reimbursement Guidelines, Initial Diabetes Self Management Training (DSMT) is a “once-in-a-lifetime” Medicare benefit. Since JR completed a Diabetes Self-Management Program at a local hospital when they were in their late 60s, we assume that Medicare was billed for the service, since Medicare coverage starts at age 65. For this reason, it is important to verify that the beneficiary has not received any initial DSMT in the past prior to the delivery of the initial DSMT.

Answer 2 is correct. 47.74% of you chose this answer. “Medicare only covers group sessions once in a lifetime.” YES, this is the best answer. According to Medicare Reimbursement Guidelines, Initial Diabetes Self Management Training (DSMT) is a “once-in-a-lifetime” Medicare benefit. Since JR completed a Diabetes Self-Management Program at a local hospital when they were in their late 60s, we assume that Medicare was billed for the service, since Medicare coverage starts at age 65. For this reason, it is important to verify that the beneficiary has not received any initial DSMT in the past prior to the delivery of the initial DSMT.

However, if the beneficiary has received initial DSMT paid by another health insurance company, he/she is still eligible to receive the 10 hours of initial DSMT as a Medicare benefit.

Answer 3 is incorrect. About 27.97% of respondents chose this. “Good thinking. Medicare covers annual group training.” Another tempting answer, but not accurate. According to Medicare Reimbursement Guidelines, Initial Diabetes Self Management Training (DSMT) is a “once-in-a-lifetime” Medicare benefit. Since JR completed a Diabetes Self-Management Program at a local hospital when they were in their late 60s, we assume that Medicare was billed for the service, since Medicare coverage starts at age 65. For this reason, it is important to verify that the beneficiary has not received any initial DSMT in the past prior to the delivery of the initial DSMT.

Finally, Answer 4 is incorrect. 6.53% chose this answer. “Since your insurance won’t cover it again, you can attend for free.” This answer is kind hearted, but not correct. For Medicare, initial DSMT group classes can only be provided once in a lifetime and should be billed to Medicare and not offered for free. Programs can create a self-pay/uninsured policy where services are discounted (must be consistent in charges and discounts etc.).

Here is a summary slide on Medicare Reimbursement Guidelines.

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! You can read through the Medicare Reimbursement Guidelines here or the ADCES Info Sheet on DSMT Reimbursement join our Setting Up a Successful Diabetes Program & Medicare Reimbursement Webinar for more information.

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Want to learn more about this practice question?
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Attendees will leave this conference with new tools and a more complete understanding of the latest advances in diabetes care, from medications to technology to Medical Nutrition Therapy! 

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The use of DES products does not guarantee the successful passage of the diabetes certification exams. CBDCE & ADCES does not endorse any preparatory or review materials for the certification exams, except for those published by CBDCE & ADCES.

For last week’s practice question, we quizzed participants on carrying insulin. 69% 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 below: Answer Question

Question: JL has new type 1 diabetes and their time in range is about 40%.  They tell you that carrying insulin pens around on ice is such a hassle that they don’t give insulin before eating out. 

What is the best response?

Answer Choices:

1. Validate their feelings and suggest starting an insulin pump.
2. Reassure them that with the right tools, they can keep their insulin at refrigerator temperature.
3. Reinforce that insulin should never be frozen.
4. Share accurate insulin pen storage guidelines with them.

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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 anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.

Answer 1 is incorrect. 17.82% chose this answer. “Validate their feelings and suggest starting an insulin pump.” Although this answer is tempting, it’s not the best answer. The first part of the answer that suggests validating their feelings is accurate. However, we would want to explore accurate insulin pen storage options before suggesting switching over to an insulin pump. Please see our insulin storage guidelines cheat sheet for more information.

Answer 2 is incorrect. 9.96% of you chose this answer. “Reassure them that with the right tools, they can keep their insulin at refrigerator temperature.” Once the person uses the insulin pen for the first time, it no longer needs to be refrigerated. Each type of insulin pen has storage guidelines for insulin kept at room temperature. Please see our insulin storage guidelines cheat sheet for more information.

Answer 3 is incorrect. About 3.01% of respondents chose this. “Reinforce that insulin should never be frozen.” It is true that insulin should never be frozen, but this is not the best answer. We also want to follow up with accurate and safe insulin pen storage information.

Finally, Answer 4 is correct. 69.20% chose this answer. “Share accurate insulin pen storage guidelines with them.” Yes, this is the best answer! Once insulin pens are used for the first time, they can be stored at room temperature. Of course, users have to avoid letting them overheat at temperatures of 86 degrees Fahrenheit or greater or getting too cold. Either situation can damage the insulin molecule. Please see our insulin storage cheat sheet for more information and feel free to share this info with colleagues and people with diabetes alike.

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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All hours earned count toward your CDCES Accreditation Information

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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!

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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.