Rationale of the Week | Diabetes & Hospital Standards

For last week’s practice question, we quizzed participants on in-patient diabetes care. 42% 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 was admitted to the hospital with an infection and newly discovered diabetes. To get glucose to ADA target range for hospitalized individuals, JR was started on 12 units of basal insulin plus bolus insulin with meals. JR experienced a morning BG of 87 mg/dL, so the provider decreased the basal insulin to 9 units. JR’s morning blood sugar the next day was 157 mg/dL.

What is the best action?

Answer Choices:

Increase basal insulin by 10- 20%.
Intensify correction scale.
Continue with same basal dose.
Ask MS if they are snacking during the night before making adjustments.

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. 23.23% chose this answer. “Increase basal insulin by 10- 20%.” This is a juicy answer because we typically consider the target glucose range 80-130 fasting and before meals. However, according to ADA Standards, the target glucose range during hospitalization is 140-180 mg/dL in general, and 100-180mg/dL in the non-critical care setting. Based on these inpatient goals, we wouldn’t need to increase basal insulin since JR’s morning glucose of 157 is right on target.

Answer 2 is incorrect. 10.17% of you chose this answer. “Intensify correction scale.” Another juicy answer because we typically consider the target glucose range 80-130 fasting and before meals. However, according to ADA Standards, the target glucose range during hospitalization is 140-180 mg/dL in general, and 100-180mg/dL in the non-critical care setting. Based on these inpatient goals, we wouldn’t need to intensify the correction scale since JR’s morning glucose of 157 is right on target. In addition, correction insulin doesn’t have much impact on fasting glucose. That’s the job of basal insulin.

Answer 3 is correct. About 41.52% of respondents chose this. “Continue with same basal dose.” YES, this is the BEST answer. According to ADA Standards, the target glucose range during hospitalization is 140-180 mg/dL in general, and 100-180mg/dL in the non-critical care setting. Based on these inpatient goals, we wouldn’t need to intensify the basal insulin since JR’s morning glucose of 157 is right on target.

Finally, Answer 4 is incorrect. 25.08% chose this answer. “Ask MS if they are snacking during the night before making adjustments.” Another juicy answer. It doesn’t really matter if MS was snacking, since according to ADA Standards, the target glucose range during hospitalization is 140-180 mg/dL in general, and 100-180mg/dL in the non-critical care setting. Based on these inpatient goals, regardless of whether or not they were snacking, JR’s morning glucose of 157 is right on 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!

Want to learn more about this question? Enroll in our

Level 2 | Hospitals & Hyperglycemia | 1.5 CEs

Research clearly demonstrates the importance of glucose control during hospitalization to improve outcomes not only in the inpatient setting but after discharge. This course reviews the evidence that supports inpatient glucose control & outlines practical strategies to achieve targets in the inpatient setting. We incorporate the latest American Diabetes Association’s (ADA) Standards of Medical Care in Diabetes & provide links to resources & inpatient management templates.

Objectives:

Describe the impact of hyperglycemia in the hospital setting.
Discuss the importance of inpatient glucose control.
List three strategies to get glucose to goal in the hospital setting.

Intended Audience: A great course for healthcare professionals seeking strategies to manage and improve inpatient diabetes care.

Enroll Now | $29

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

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.

Rationale of the Week | Pregnancy & Diabetes Medication

For last week’s practice question, we quizzed participants on gestational diabetes & medication. A whopping 70% of respondents chose the best answer – great job. 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 has PCOS and type 2 diabetes and is in shock because they just discovered they are 6 weeks pregnant. AR takes metformin 1000mg BID plus empagliflozin (Jardiance) 25 mg and their most recent A1C is 8.6%.

Which of the following actions do you recommend?

Answer Choices:

Stop empagliflozin
Stop metformin, keep empagliflozin
Stop metformin and empagliflozin, start insulin.
Stop empagliflozin, start a GLP-1 inhibitor

Getting to the Best Answer

Answer 1 is incorrect. 20.16% chose this answer. “Stop empagliflozin.” It is true that empagliflozin and all SGLT-2’s are not indicated during pregnancy. However, there is a better answer given that her A1C of 8.6% is above the pregnancy target of less than 6.5%.

Answer 2 is incorrect. 2.58% of you chose this answer. “Stop metformin, keep empagliflozin.” Empagliflozin and all SGLT-2’s are contraindicated during pregnancy, so this answer is not the best choice.

Answer 3 is correct. About 70% of respondents chose this. “Stop metformin and empagliflozin, start insulin.” GREAT JOB. Given that her A1C of 8.6% is above the pregnancy target of less than 6.5%, insulin absolutely needs to be started to get glucose to goal. According to the ADA Standards, the provider may opt to continue the metformin treatment for PCOS for the first trimester But given the urgent need to get blood glucose to target, this individual will be most effectively managed with a combination of nutrition therapy and insulin.

Finally, Answer 4 is incorrect. 7.26% chose this answer. “Stop empagliflozin, start a GLP-1 inhibitor.” Yes, we need to stop empagliflozin since all SGLT-2’s are contraindicated during pregnancy. However, GLP-1 Inhibitors are also contraindicated during pregnancy, so this answer is incorrect.

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 question? Enroll in our

Level 2 | Pregnancy & Diabetes | 1.5 CEs

Pregnancy with diabetes is confronted with a variety of issues that require special attention, education, & understanding. This course reviews those special needs while focusing on Gestational Diabetes & Pre-Existing Diabetes. Included are the most recent diagnostic criteria, management goals, & prevention of complications during pregnancy. This is a helpful review for Certification Exams & those who want more information on people who are pregnant & live with diabetes.

Objectives:

List three issues that affect pregnancy with diabetes.
Describe the unique attributes of pre-existing diabetes in pregnancy & gestational diabetes.
State the diagnostic criteria & management goals for gestational diabetes.
Potential short-term & long-term complications of fetal exposure to hypoglycemia.
Prevention measures to keep mother & baby healthy.

Intended Audience: A great course for healthcare professionals seeking to enhance their knowledge of the issues surrounding pregnancy and diabetes and appropriate care to improve outcomes.

Enroll Now | $29

Level 2 | Hospitals & Hyperglycemia | 1.5 CEs

Objectives:

Describe the impact of hyperglycemia in the hospital setting.
Discuss the importance of inpatient glucose control.
List three strategies to get glucose to goal in the hospital setting.

Intended Audience: A great course for healthcare professionals seeking strategies to manage and improve inpatient diabetes care.

Enroll Now | $29

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

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!

Rationale of the Week | AR is pregnant and Worried

For last week’s practice question, we quizzed participants on gestational diabetes & pregnancy complications. 68% 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 has PCOS type 2 diabetes and worried because they just discovered they are 6 weeks pregnant. AR takes metformin 1000mg BID plus empagliflozin (Jardiance) 25 mg and their most recent A1C is 8.6%.

Which of the following is a potential complication associated with hyperglycemia during the first 10 weeks of pregnancy?

Answer Choices:

Intrauterine hypoglycemia
Macrosomia and post-natal jaundice
Neonatal respiratory distress
Diabetic embryopathy

Getting to the Best Answer

Answer 1 is incorrect. 10.53% chose this answer. “Intrauterine hypoglycemia.” Although this answer is tempting, it is not accurate. If the fetus experienced elevated blood sugars (from mom) during gestation, this stimulates increased fetal production of insulin. After delivery, baby’s who were exposed to intrauterine hyperglycemia are at higher risk of post-delivery hypoglycemia (not intrauterine hypoglycemia).

Answer 2 is incorrect. 14.56% of you chose this answer. “Macrosomia and post-natal jaundice.” Although this answer is tempting, it is not accurate. If the fetus experienced elevated blood sugars (from mom) during their first 10 weeks of gestation, this stimulates increased fetal production of insulin and can stimulate extra fat stores later in pregnancy leading to larger babies and higher risk for post delivery jaundice. However, the question is asking, what complications can elevated blood sugars cause during their first 10 weeks of pregnancy when the organs are developing?

Answer 3 is kind of incorrect. About 7.37% of respondents chose this. “Neonatal respiratory distress.” The question is asking, if the fetus experienced elevated blood sugars (from mom) during the first 10 weeks of gestation, what complications can elevated blood sugars cause during the first trimester pregnancy when the organs are developing? The lungs can be affected by first trimester hyperglycemia, causing the newborn to struggle with respiratory distress.

Finally, Answer 4 is correct. 67.54% chose this answer. “Diabetic embryopathy.” GREAT JOB. This is the best answer. If the fetus experienced elevated blood sugars (from mom) during the first 10 weeks of gestation, embryonic complications result from elevated blood sugars during the first trimester pregnancy when the organs are developing. These can include, congenital heart disease, renal anomalies and caudal regression.

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 question? Enroll in our

Level 2 | Pregnancy & Diabetes | 1.5 CEs

Objectives:

List three issues that affect pregnancy with diabetes.
Describe the unique attributes of pre-existing diabetes in pregnancy & gestational diabetes.
State the diagnostic criteria & management goals for gestational diabetes.
Potential short-term & long-term complications of fetal exposure to hypoglycemia.
Prevention measures to keep mother & baby healthy.

Intended Audience: A great course for healthcare professionals seeking to enhance their knowledge of the issues surrounding pregnancy and diabetes and appropriate care to improve outcomes.

Enroll Now | $29

Level 2 | Hospitals & Hyperglycemia | 1.5 CEs

Objectives:

Describe the impact of hyperglycemia in the hospital setting.
Discuss the importance of inpatient glucose control.
List three strategies to get glucose to goal in the hospital setting.

Intended Audience: A great course for healthcare professionals seeking strategies to manage and improve inpatient diabetes care.

Enroll Now | $29

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

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!

Oops – Rationale of the Week Error | Which Meds for a 14-year-old with Type 2?

We want to fix our mistake and clarify this important information. For last month’s practice question, a participant reached out to us and kindly shared that one of the medications listed was actually recently approved by the FDA for kids ages 10-17. We want to make this right, so you can pass on updated info to people living with diabetes and your colleagues, plus prepare for exam success! Look for 2 correct answers and explanations for this Rationale of the Week.

Question: KS is 14 years old and recently diagnosed with type 2 diabetes. Their A1C is 8.6%, LDL cholesterol is 137 mg/dL and their GFR is greater than 90.

Based on this clinical information and the ADA Standards for Pediatric Care, in addition to lifestyle and behavior changes, what medication(s) would be recommended?

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

Based on this clinical information and the ADA Standards for Pediatric Care, in addition to lifestyle and behavior changes, what medication(s) would be recommended?

Answer Choices:

Dulaglutide (Trulicity) and Metformin
Metformin and an ACE Inhibitor
Exenatide XR (Bydureon) and a statin
Empagliflozin (Jardiance) or Metformin

Getting to the Best Answer

Answer 1 is CORRECT. 23.08% chose this answer. “Dulaglutide (Trulicity) and Metformin.” Both metformin and Dulaglutide (Trulicity) are FDA approved for children starting at age of ten. Dulaglutide was recently FDA approved for pediatrics up at doses up to 1.5 mg per week. We have updated our eMed PocketCards to include this GLP-1 RA as approved for kids ages 10-17.

Answer 2 is incorrect. 16.62% of you chose this answer. “Metformin and an ACE Inhibitor.” Although this answer if tempting, because metformin is FDA approved for children starting at age of ten, there is no mention of hypertension that would justify starting an ACE Inhibitor. See Med PocketCards. For this reason, this is not the best answer.

Answer 3 is CORRECT. About 39.36% of respondents chose this. “Exenatide XR (Bydureon) and a statin.” YES, this is the BEST answer. GREAT JOB. Two of the GLP-1 RA’s are approved for kids including exenatide XR and liraglutide. See Med PocketCards. In addition, statins are indicated for children age 10 or greater if they have diabetes and an LDL cholesterol of 130 mg/dL or greater.

Finally, Answer 4 is incorrect. 20.93% chose this answer. “Empagliflozin (Jardiance) or Metformin.” Although this answer if tempting, because metformin is FDA approved for children starting at age of ten, none of the SGLT-2’s are approved for pediatrics, including empagliflozin. See Med PocketCards. For this reason, 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! For more information, see ADA Standard 14 on Children and Adolescents or join our webinar (see below).

Want to learn more about this question? Enroll in our

Level 2 | From Tots to Teens | Diabetes Standards | 1.5 CEs

This course includes updated goals & guidelines for children living with type 1 or type 2 diabetes. This course discusses the special issues diabetes educators need to be aware of when working with children with diabetes & their families. We discuss the clinical presentation of diabetes, goals of care, & normal growth & development through the early years through adolescence. Strategies to prevent acute & long-term complications are included with an emphasis on positive coping for families & children with diabetes.

Objectives:

Discuss the goals of care for Type 1 and Type 2 Kids with Diabetes.
State Strategies to prevent acute and chronic complications.
Discuss the importance of positive psychosocial adjustment & resources.

Intended Audience: A great course for healthcare professionals seeking information about providing care for children with diabetes and their families.

Enroll Now | $29

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

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!

Rationale of the Week | What’s Wrong with JR’s Foot?

For last week’s practice question, we quizzed participants on what is wrong with JR’s foot. 51% 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 arrives at the clinic wearing a walking boot due to a recent foot injury. Tells you that they “banged their foot” on some farm equipment and since then it has been warm and swollen. It hurt at first, but the pain has diminished with time.

When JR takes off the boot, you see that the left foot needs attention.

Based on this photo, what diabetes-related foot condition do you suspect?

Answer Choices:

Peripheral arterial disease
Venous statis ulcer
Pre gangrenous inflammation
Charcot Foot

Getting to the Best Answer

Answer 1 is incorrect. 18.96% chose this answer. Peripheral arterial disease. People experiencing peripheral arterial disease usually present with thinner, pale, lower extremities. They complain of pain in their calves or buttocks when walking due to intermittent claudication. Pulses are difficult to palpate due to diminished circulation to lower extremities.

Answer 2 is incorrect. 10.15% of you chose this answer. Venous statis ulcer. This person may have lower extremity venous disease as evidenced by the marked edema and darkened skin. However, although the foot is red and swollen there is no ulcer present in this photo.

Answer 3 is incorrect. About 20.30% of respondents chose this. Pre gangrenous inflammation. This person is certainly experiencing inflammation and edema. However, we can’t determine if their lower extremity is moving toward gangrene just from this photo.

Finally, Answer 4 is correct. 50.59% chose this answer. Charcot Foot. YES, this is the BEST answer. GREAT JOB. This person arrived with a suddenly misshapen foot, coupled with edema and redness. The skin was intact and the individual denied pain. This presentation is the hallmark of Charcot foot, a condition that is a combination of neuropathy and diminished circulation coupled with elevated blood glucose levels. It requires immediate medical attention by a foot specialist. JR sought care from a Podiatrist and his foot was secured in a cast to protect the foot and prevent further damage.

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 question? Enroll in our

Level 2 | Lower Extremity Assessment | 1.5 CEs

People with diabetes are at increased risk of Lower Extremity Complications. This course reviews the steps involved in performing a detailed assessment of the lower extremities, including how to use a monofilament and tuning fork to detect neuropathy. We also discuss the significance of the Ankle Brachial Index and strategies to prevent lower extremity complications.

Objectives:

Describe the risk factors for lower extremity complications.
Discuss prevention strategies.
Demonstrate steps involved in a lower extremity assessment.

Intended Audience: This is a great course for healthcare professionals who want to learn the steps involved in providing a thorough lower extremity assessment.

Enroll Now | $29

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

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!

Rationale of the Week | Do Statins Cause Dementia?

For last week’s practice question, we quizzed participants on statins & the risk of dementia. 49% 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 78 years old with a new diagnosis of diabetes. Their A1C is 7.9%, LDL cholesterol is 98 mg/dL, GFR is 58 mg/g and their BP is 124/78. The provider recommends a referral to the RD and DSME program and writes a prescription for metformin XR 500mg daily and lovastatin 20mg. LR is worried about taking a statin because they heard it can cause dementia.

Based on the ADA Standards, what is the best response?

Answer Choices:

Based on the most recent research, statins don’t seem to cause dementia.
Statins are very safe and actually protect against dementia.
To find out more about the side effects of statins, we recommend asking your pharmacist for more information.
You can start with half a pill a day to evaluate for side effects.

Getting to the Best Answer

Answer 1 is correct. 49.45% chose this answer. “Based on the most recent research, statins don’t seem to cause dementia.” YES, is the BEST answer. According to ADA 2023 SOC 10 a recent systematic review of the U.S. Food and Drug Administration’s (FDA’s) postmarketing surveillance databases, randomized controlled trials, and cohort, case-control, and cross-sectional studies evaluating cognition in patients receiving statins found that published data do not reveal an adverse effect of statins on cognition (138). Therefore, a concern that statins or other lipid-lowering agents might cause cognitive dysfunction or dementia is not currently supported by evidence and should not deter their use in individuals with diabetes at high risk for ASCVD (138).

Answer 2 is incorrect. 26.73% of you chose this answer. “Statins are very safe and actually protect against dementia.” Although the first part of this statement is correct, statins are safe, there is no evidence presented in the ADA Standards that statins protect against dementia.

Answer 3 is incorrect. About 17.62% of respondents chose this. “To find out more about the side effects of statins, we recommend asking your pharmacist for more information.” Although pharmacists are incredibly knowledgeable about medications, diabetes specialists can relate evidence based information to the people we serve, instead of making them take additional action to get the information they need to move forward. The good news is that there is no evidence that statins or other lipid-lowering agents might cause cognitive dysfunction or dementia and their use is recommended in individuals with diabetes at high risk for ASCVD.

Finally, Answer 4 is incorrect. 6.19% chose this answer. “You can start with half a pill a day to evaluate for side effects.” This approach is tempting, but it doesn’t address the fear of the statin causing dementia. The good news is that there is no evidence that statins or other lipid-lowering agents might cause cognitive dysfunction or dementia and their use is recommended in individuals with diabetes at high risk for ASCVD.

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 question? Enroll in our

Level 2 | Older Adults & Diabetes | 1.5 CEs

We are living longer & more people are getting diabetes. The American Diabetes Association has updated the Older Adults Standards, with special attention to considering the reduction of medication & insulin therapy intensity. The older population has unique issues & special needs that require consideration as we provide diabetes self-management education. This online course highlights key areas of assessment, intervention, and advocacy for older clients living with diabetes.

Objectives:

Self-management considerations for older individuals.
Strategies to prevent complications & maintain optimal quality of life.
The role of the Diabetes Care & Education Specialist as an advocate.

Intended Audience: An important course for healthcare professionals seeking to gain an understanding of the special issues and goals for older adults.

Enroll Now | $29

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

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!

Rationale of the Week | JR is Skipping Provider Appointments

For last week’s practice question, we quizzed participants on diabetes distress. 78% 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 diabetes and tells you, “My doctor just doesn’t seem to understand how to manage type 1 diabetes. Sometimes, I just skip my appointments because it feels like a waste of time.” JR’s most recent A1C was 8.7% and their time in ranges keeps decreasing with each visit.

Based on this, you realize that JR’s provider-related diabetes distress:

Answer Choices:

has intensified to clinical depression.
requires urgent referral to a mental health professional.
could be responsive to self-management coaching.
may be a sign of disordered eating.

Getting to the Best Answer

Answer 1 is incorrect. 9.58% chose this answer. “has intensified to clinical depression.” This is a tempting answer, but we don’t enough evidence to support that JR is struggling with depression. If we had JR complete the Diabetes Distress Scale, he would certainly score high on provider related distress based on this statement, “My doctor just doesn’t seem to understand how to manage type 1 diabetes. Sometimes, I just skip my appointments because it feels like a waste of time.” These comments certainly fit in the distress category. Through careful questioning and exploration, the diabetes educator could certainly help with problem solving.

Answer 2 is incorrect. 8.18% of you chose this answer. “requires urgent referral to a mental health professional.” Based on JR’s statement, “My doctor just doesn’t seem to understand how to manage type 1 diabetes. Sometimes, I just skip my appointments because it feels like a waste of time,” JR is certainly in distress. However, there is no language indicating that JR is in imminent danger of self-harm. Through careful questioning and exploration, the diabetes educator could certainly carefully assess JR’s mental health state and help with problem solving and referrals as needed.

Answer 3 is correct. About 77.84% of respondents chose this. “could be responsive to self-management coaching.” YES. This is the best answer. We could start by administering the Diabetes Distress Scale and then hone in on the high scoring areas. Then through careful questioning and exploration, the diabetes educator could certainly help with problem solving and identify if additional resources or referrals are needed.

Finally, Answer 4 is incorrect. 4.39% chose this answer. “may be a sign of disordered eating.” but we don’t enough evidence to support that JR is experiencing disordered eating. However, if we had JR complete the Diabetes Distress Scale, he would certainly score high on provider related distress based on this statement, “My doctor just doesn’t seem to understand how to manage type 1 diabetes. Sometimes, I just skip my appointments because it feels like a waste of time.”

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!

Want to learn more about using the Diabetes Distress Scale and Coaching Strategies? Join our next

ReVive 5 Diabetes Training Program

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.

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

Join A Team of Experts – Save $100

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:

14.0 CEs – Includes the 7-hour Session 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.

Speakers Interviews – Learn more about the ReVive 5 Team

What is the Biggest Takeaway when Addressing Diabetes Distress? – Dr. Susan Guzman

Do you have to be a Mental Health Expert to Tackle Diabetes Distress? – Dr. Lawrence Fisher

Why I Transformed my Approach to Diabetes Self-Management Education- Coach Beverly

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

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!

Rationale of the Week | Get your Calculator – How many Pens?

For last week’s practice question, we quizzed participants on counting every pen(ny.) 47% 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: KL takes 5-10 units of insulin glulisine (Apidra) based on an insulin scale before each of their 3 daily meals and 30 units of glargine (Basaglar) at bedtime.

Based on this information, how many u-100 glulisine (Apidra) insulin pens would KL use a month?

Answer Choices:

2 vials
4 pens
6 pens
3 pens

Getting to the Best Answer

Answer 1 is incorrect. 6.31% chose this answer. “2 vials.” One way to quickly eliminate a wrong answer is to see if the units in the question match the units in the answer. The question asks, “How many pens” would JR need a month and this answer is in “vials”. We can cross this one off as false. **See complete math explanation below.

Answer 2 is correct. 46.64% of you chose this answer. “4 pens.” YES.. Great job. You not only calculated JR’s insulin needs, but added in extra insulin for priming too! **See complete math explanation below.

Answer 3 is incorrect. About 16.24% of respondents chose this. “6 pens.” This was a juicy answer that lured respondents into adding together the glulisine and glargine dose. The answer only asks for how many glulisine pens would JR need a month. **See complete math explanation below.

Finally, Answer 4 is incorrect. 30.82% chose this answer. “3 pens.” This was the juiciest answer of all. However, it doesn’t take into account the 2 units of insulin used to prime the pen before each injection. Also, if they had 3 pens of 300 units each, what if they made a mistake or wasted a dose, or needed a little extra.. they might be short on insulin. We always want to allow for a little cushion, just in case. **See complete math explanation below.

**Complete explanation – Doing the math.
If JR takes 5-10 units of insulin glulisine (Apidra) 3 times a day, we have to assume they will be taking the highest dose each time, so they don’t run out of insulin. That means JR uses 30 units a day of glulisine. 30 units a day x 30 days in a month = 900 units. But wait, JR needs to prime the pen first with a 2 unit “air shot” before each injection to make sure insulin is flowing through the needle before each of their 3 injections. So this means that JR is using up to 12 units of insulin 3 times a day or 36 units x 30 days = 1,080 units of glulisine a month. The next thing we need to know is that each U-100 glulisine pen holds 300 units of insulin (see our Insulin Storage Cheat Sheet 2023). Now, we can do the math. JR uses 1,080 units of insulin a day. Since each pen holds 300 units, we take 1080 and divide by 300 for a total of 3.6. This means JR will need 4 pens of glulisine each month to manage their diabetes.

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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ReVive 5 Diabetes Training Program

Whether you are a novice or an expert in providing diabetes care, we invite you to attend this exciting training program that provides the essential steps to address diabetes distress combined with an innovative approach to glucose management that will revolutionize your practice.

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

Join A Team of Experts – Save $100

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:

14.0 CEs – Includes the 7-hour Session 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.

Speakers Interviews – Learn more about the ReVive 5 Team

What is the Biggest Takeaway when Addressing Diabetes Distress? – Dr. Susan Guzman

Do you have to be a Mental Health Expert to Tackle Diabetes Distress? – Dr. Lawrence Fisher

Why I Transformed my Approach to Diabetes Self-Management Education- Coach Beverly

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

All hours earned count toward your CDCES Accreditation Information

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