Rationale of the Week | What is Person-Centered Care?
For last week’s practice question, we quizzed participants on person-centered care. 62% 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: TR is a healthcare professional who provides diabetes care and education support. They are interested in providing more person-centered care to the individuals they serve.
Which of the following statements verifies they are on the right track?
Answer Choices:
- Adherence to the diabetes self-care plan takes time.
- Motivating individuals to engage in their self-management is the first step.
- Adult learners do best when provided a step-by-step demonstration.
- Creating mutual agreement on the plan for next steps.
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. 8.04% chose this answer. “Adherence to the diabetes self-care plan takes time.” Under the umbrella of a person-centered care approach, the terms “adherence” and “compliance” are outdated concepts that are no longer used. For example, if we say that TR is adherent, it means that they are following the provider’s instructions instead of being an active participant in care. This person-centered approach engages the individual in the decision-making process and self-care plan.
Answer 2 is incorrect. 24.67% of you chose this answer. “Motivating individuals to engage in their self-management is the first step.” This is a juicy answer that sounds really good. However, it is not a realistic expectation to believe we can motivate people to make changes in their self-management. We can provide coaching and support, but ultimately, the person with diabetes needs to find their own motivation to make slow and steady behavior change. For this reason, this approach is not considered a person-centered approach.
Answer 3 is incorrect. 5.42% of respondents chose this. “Adult learners do best when provided a step-by the-step demonstration.” This answer is partially correct. Adult learners do apply their previous knowledge to the task at hand. However, more importantly than just observing, adult learners need to participate in the learning activity and have “hand’s on” practice to solidify their knowledge.
Finally, Answer 4 is correct. 61.87% chose this answer. “Creating mutual agreement on the plan for next steps.” YES, this is the BEST PERSON-CENTERED ANSWER. This approach invites the person with diabetes to fully participate in determining their needs and goals while making plans for the future in collaboration with the provider.
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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Rationale of the Week | Prediabetes after GDM-What do the Standards Recommend?
For last week’s practice question, we quizzed participants on prediabetes after GDM. It was a challenging question and 60% 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 experienced gestational diabetes with their third pregnancy and now, at age 41, was just diagnosed with prediabetes. LR’s BMI is 29.3 and she is trying to lose weight.
Based on the 2023 ADA Standards of Care, in addition to providing LR with lifestyle coaching, what other intervention is recommended?
Answer Choices:
- Start a GLP-1 RA Inhibitor to support weight loss.
- Initiate metformin therapy.
- Start pioglitazone (Actos) at a low dose
- Suggest adding a SGLT-2i to lower glucose and protect renal function.
Getting to the Best Answer
Answer 1 is incorrect. 29.67% chose this answer, “Start a GLP-1 RA Inhibitor to support weight loss.” Since LR has prediabetes, not diabetes, and her BMI is less than 30, GLP-1 RA therapy isn’t indicated. Plus, this recommendation isn’t included in the ADA standards (see below).
Answer 2 is correct. 60.63% of you chose this answer, “Initiate metformin therapy.” YES, this is the BEST answer. GREAT JOB! For people with a history of GDM who now express prediabetes, they have a very high risk of getting diabetes in the near future. In addition to referring to a Diabetes Prevention Program, the Standards recommend initiation of metformin therapy to delay the onset of diabetes.
Answer 3 is incorrect. 2.27% of respondents chose this answer, “Start pioglitazone (Actos) at a low dose” Although low dose pioglitazone is recommended for those with prediabetes or diabetes and a history of stroke, LR has no history of stroke. In addition, pioglitazone is associated with weight gain and is not recommended in the ADA Standards to treat prediabetes.
Finally, Answer 4 is incorrect. 7.44% chose this answer, “Suggest adding a SGLT-2i to lower glucose and protect renal function.” Since LR has prediabetes, not diabetes and no signs of kidney problems, SGLT-2i therapy isn’t indicated. Plus, this recommendation isn’t included in the ADA standards (see below).
Thank you so much for reading this “Rationale of the Week”. For more information on this topic, we also invite you to join our Online Courses and Virtual DiabetesEd Training Program.
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Virtual DiabetesEd Training Conference
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.
If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.
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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.
Rationale of the Week | Lipid Targets & New ADA Standards
For last week’s practice question, we quizzed participants on the new ADA Standards for lipid management. It was a complicated question and 43% 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 is 67 with type 1 diabetes and was discharged a few months ago after receiving a coronary artery bypass. JR is on insulin pump therapy and a CGM, with a recent A1C of 6.7%. Their blood pressure is 129/78.
Other recent labs include:
- LDL cholesterol of 67 mg/dL
- HDL 54 mg/dL
- Triglycerides 172 mg/dL
- UACR 23 mg/g GFR 61
JR’s medications include: insulin, atorvastatin 80mg, atenolol 50mg, and aspirin therapy. JR has met with the dietitian and is trying to eat healthfully. They have lost 5 pounds over the past few months.
Based on the 2023 ADA Standards of Care and JR’s history, which of the following is considered best practice?
Answer Choices:
- Add an ACE or ARB
- Keep LDL cholesterol less than 70 mg/dL
- Increase fiber intake by 20%
- Add ezetimibe (Zetia) or a PCSK9
Getting to the Best Answer
Answer 1 is incorrect. 23.93% chose this answer, “Add an ACE or ARB.” This was a juicy answer. However, since the B/P is on target at less than 130/80 and JR does not have an elevated UACR, adding an ACE or ARB is not indicated at this time.
Answer 2 is incorrect. 21.08% of you chose this answer, “Keep LDL cholesterol less than 70 mg/dL.” Since JR has ASCVD, as evidenced by their need for a coronary artery bypass, the LDL target is less than 55 mg/dL. This new intensified LDL target is based on the 2023 updated guidelines. Read our blog on New Lipid Guidelines here.
Answer 3 is incorrect. 11.99% of respondents chose this answer, “Increase fiber intake by 20%.” While increasing fiber intake is always a good idea, in may not be enough to help JR get their LDL to a target level of less than 55 mg/dl.
Finally, Answer 4 is correct. 42.96% chose this answer, “Add ezetimibe (Zetia) or a PCSK9.” Yes, this is the best answer, GREAT JOB. Since JR has ASCVD, as evidenced by their need for a coronary artery bypass, the LDL target is less than 55 mg/dL. Since they are already on max dose of atorvastatin at 80mg, the ADA Guidelines recommend adding an additional agent, either ezetimibe (Zetia) or a PCSK9 to further lower the LDL to reach a target of less than 55 mg/dL. Download Lipid Medication Cheat Sheet Here
Thank you so much for reading this “Rationale of the Week”. For more information on this topic, we encourage you to Read our blog on New Lipid Guidelines and Download Lipid Medication Cheat Sheet Here. We also invite you to join our Online Courses and Virtual DiabetesEd Training Program.
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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.
If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.
Group discounts are available!*
Download Course Flyer | Download Schedule
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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!
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 | Low blood sugars and Beer
For last week’s practice question, we quizzed participants on low blood sugars and beer. 38% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question
Question:
JL is 19 and has type 1 diabetes, drinks a “few beers” on the weekends with their college friends. JL uses an insulin pump, but mostly relies of fingerstick checks to monitor blood sugars. According to their log, JL experienced a few low blood glucose levels the past weekend of 62, 49, and 51.
Based on the ADA Standards, what is the most important recommendation for JL?
Answer Choices:
- Check BG at least 4 times a day when drinking.
- Make sure to eat carbs when drinking to avoid low blood glucose levels.
- Get glucagon rescue medication.
- Decrease or stop alcohol intake.
Getting to the Best Answer
Answer 1 is incorrect. 12.70% chose this answer, “Check BG at least 4 times a day when drinking.” This is a juicy answer. Although monitoring will help JL detect low blood sugars, it doesn’t necessarily translate into taking action to prevent or treat these frequent bouts of level 2 hypoglycemia.
Answer 2 is incorrect. 32.37% of you chose this answer, “Make sure to eat carbs when drinking to avoid low blood glucose levels.” This is another juicy answer and a solid recommendation. For people with type 1 who experience hypoglycemia when drinking alcohol, eating 15gms of carb along with each alcohol serving can help maintain glucose levels. However, this answer is not based on the ADA Standards of Care.
Answer 3 is correct. 38.22% of respondents chose this answer, “Get glucagon rescue medication.” This is the BEST answer. According to the ADA’s Standard 6 on Glycemic Targets, “6.12 Glucagon should be prescribed for all individuals at increased risk of level 2 or 3 hypoglycemia, so that it is available should it be needed”. JL is experiencing Level 2 hypoglycemia with glucose levels dropping to 49 and 51. (see image from Glucagon PocketCard to right for Hypo Levels). While prevention of hypoglycemia is the long term goal, in the short term we need to make sure JL has access to a glucagon rescue med and that their significant others are trained on how to administer this life saving glucose booster.
Finally, Answer 4 is incorrect. 16.71% chose this answer, “Decrease or stop alcohol intake.” While we might want to have a conversation about alcohol and safety, the ADA Standards allow for 1 alcohol serving a day for women and 2 alcohol servings a day for men. In this situation, we might want to discuss adjusting insulin dosing and carbohydrate intake to prevent future bouts of hypoglycemia. However, for safety sake, JL will need a glucagon rescue med prescribed in case of a severe low blood glucose.
Thank you so much for reading this “Rationale of the Week”. For more information on this topic, we encourage you to join our Online Courses and Virtual DiabetesEd Training Program.
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Level 3 | DiabetesEd Specialist Boot Camp | 12+ CEs
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This bundle is specifically designed for healthcare professionals who are studying for the Board Certified in Advanced Diabetes Management (BC-ADM) or the Certified Diabetes Care and Education Specialist (CDCES) certification exam.
Intended Audience: This library of critical information is designed for individuals or groups of diabetes specialists, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other health care providers interested in staying up to date on current practices of care for people with diabetes and preparing for the BC-ADM or the CDCES certification Exam.
2023 Webinar Updates
- Recorded & Ready to Watch – Class 1 – Diabetes – Not Just Hyperglycemia 1.75 CEs
- Recorded & Ready to Watch – Class 2 – Standards of Care & Cardiovascular Goals 1.8 CEs
- Recorded & Ready to Watch – Class 3 – Meds for Type 2 – What you need to know 1.5
- February 16, 2023 – Class 4 – Insulin Therapy – From Basal/Bolus to Pattern Management 1.5 CEs
- February 21, 2023 – Class 5 – Insulin Intensive – Monitoring, Sick Days, Lower
- February 23, 2023 – Class 6 – Exercise and Medical Nutrition Therapy 1.5 CEs
- February 28, 2023 – Class 7 – Screening, Prevention, and Treatment of Microvascular Complications
- March 2, 2023 – Class 8 – Coping and Behavior Change 1.5 CEs
- March 9, 2023 – Class 9 – Test-Taking Coach Session (48 Questions) No CE
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 | Safe for Surgery?
For last week’s practice question, we quizzed participants on the best action for a safe surgery. 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:
PZ is having elective surgery in the morning. Diabetes medications include 20 units glargine (Semglee) at hs, metformin BID and empagliflozin (Jardiance).
According to 2023 ADA Standards, what are the best actions for a safe surgery?
Answer Choices:
- Give 15 units hs glargine, hold am oral meds, keep intraoperative glucose between 100-180.
- Give 10 units hs glargine and am metformin, hold empagliflozin and use sliding scale as needed.
- Give 20 units glargine, hold oral meds, get A1C less than 7% within 3 months before surgery.
- Hold all oral meds for 3 days, given 50% of basal insulin and maintain glucose 80-140 intraoperatively.
Getting to the Best Answer
Answer 1 is correct. 50.87% chose this answer, “Give 15 units hs glargine, hold am oral meds, keep intraoperative glucose between 100-180.” YES, GREAT JOB! The ADA Standard 16 on Hospitalization has been updated with new perioperative glucose goals and preop medication adjustments. To prevent intraoperative hypoglycemia, the glucose goal was increased to 100-180. In addition, they recommend reducing basal insulin by 20-25% the night before surgery and holding all oral meds the morning of surgery. SGLT-2s are held for 3-4 days before surgery to decrease risk of DKA in the perioperative period. In this vignette, we reduced PZ’s basal insulin from 20 units to 15 units (25% decrease) and held all oral meds the morning of surgery. In addition, the 2023 Standards recommend achieving an A1C less than 8% before elective surgeries. Since about 20% of people undergoing surgery have diabetes, these guidelines are super helpful and important to improve post surgical outcomes.
Answer 2 is incorrect. 14.35% of you chose this answer, “Give 10 units hs glargine and am metformin, hold empagliflozin and use sliding scale as needed.” This is answer is close and partly correct, because it recommends holding the oral medications. However, the first part of the answer is incorrect since a basal insulin reduction of 50% is too aggressive. People release lots of counterregulatory hormones during surgery, so they still need at least 75% of their usual basal insulin dose to prevent intraoperative hyperglycemia. If the person uses NPH basal insulin, they would need to reduce the evening dose by 50%. Since about 20% of people undergoing surgery have diabetes, these guidelines are super helpful and important to improve post surgical outcomes.
Answer 3 is incorrect. 15.73% of respondents chose this answer, “Give 20 units glargine, hold oral meds, get A1C less than 7% within 3 months before surgery.” This is answer is close and partly correct, because it recommends holding the oral medications. However, the first part of the answer is incorrect since the basal insulin needs to be reduced by 20-25% to prevent intraoperative hypoglycemia. In addition, the 2023 Standards recommend achieving an A1C less than 8% (not 7%) before elective surgeries. Since about 20% of people undergoing surgery have diabetes, these guidelines are super helpful and important to improve post surgical outcomes.
Finally, Answer 4 is incorrect. 19.06% chose this answer, “Hold all oral meds for 3 days, given 50% of basal insulin and maintain glucose 80-140 intraoperatively.” This entire answer is incorrect for the following reasons. Oral meds are held the day of surgery, except for SGLT2i’s, which are held for 3-4 days pre-op. As far as basal insulin, the ADA guidelines recommend giving 75-80% of usual dose, except for NPH insulin, which is reduced by 50%. Lastly, the intraoperative glucose target is 100 -180. Since about 20% of people undergoing surgery have diabetes, these guidelines are super helpful and important to improve post surgical outcomes.
Thank you so much for reading this “Rationale of the Week”.
We invite you to join Coach Beverly on May 30, 2023 – Hospital and Hyperglycemia 1.5 CEs
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Level 2 | ADA Standards of Care CE Course | 2.0 CEs
2023 Update is Recorded & Ready to Watch!
This course, updated annually, is an essential review for anyone in the field of diabetes. Join Coach Beverly as she summarizes the 2023 updates to the American Diabetes Association’s Standards of Medical Care in Diabetes and provides critical teaching points and content for healthcare professionals involved in diabetes care and education.
Objectives:
- List significant changes and updates to the 2023 ADA Standards of Medical Care.
- State 3 updates on new blood pressure and lipid goals.
- Identify 5 key elements of the position statement.
- Discuss how to apply the Standards in the clinical setting and in preparation for exam success.
Intended Audience: This course is a knowledge-based activity designed for individuals or groups of diabetes professionals, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other health care providers interested in staying up to date on current practices of care for people with prediabetes, diabetes, and other related conditions.
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
Preparing for Diabetes Certification Exam? Enroll in our Level 3 – Boot Camp 2023 Updates
Level 3 | DiabetesEd Specialist Boot Camp | 12+ CEs
Can’t join all the sessions live? No problem. Your registration guarantees you access to the recorded lectures for a full year.
This bundle is specifically designed for healthcare professionals who are studying for the Board Certified in Advanced Diabetes Management (BC-ADM) or the Certified Diabetes Care and Education Specialist (CDCES) certification exam.
Intended Audience: This library of critical information is designed for individuals or groups of diabetes specialists, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other health care providers interested in staying up to date on current practices of care for people with diabetes and preparing for the BC-ADM or the CDCES certification Exam.
2023 Webinar Updates
- Recorded & Ready to Watch – Class 1 – Diabetes – Not Just Hyperglycemia 1.75 CEs
- February 9, 2023 – Class 2 – Standards of Care & Cardiovascular Goals 1.8 CEs
- February 14, 2023 – Class 3 – Meds for Type 2 – What you need to know 1.5
- February 16, 2023 – Class 4 – Insulin Therapy – From Basal/Bolus to Pattern Management 1.5 CEs
- February 21, 2023 – Class 5 – Insulin Intensive – Monitoring, Sick Days, Lower
- February 23, 2023 – Class 6 – Exercise and Medical Nutrition Therapy 1.5 CEs
- February 28, 2023 – Class 7 – Screening, Prevention, and Treatment of Microvascular Complications
- March 2, 2023 – Class 8 – Coping and Behavior Change 1.5 CEs
- March 9, 2023 – Class 9 – Test-Taking Coach Session (48 Questions) No CE
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 | Diabetes and NASH, what is the link?
For last week’s practice question, we quizzed participants on Diabetes and NASH. 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:
The provider referred RT, a 72-year-old with type 2 diabetes and non-alcoholic fatty steatohepatitis (NASH), for an appointment with the diabetes care and education specialist. RT is frightened because their brother died of liver cancer.
Which of the following is the most accurate statement regarding NASH and diabetes?
Answer Choices:
- NASH is when intrahepatic fat is equal to or greater than 5% of liver weight.
- About 30% of people with diabetes and extra weight also have NASH.
- There are standardized medication algorithms to guide the treatment of NASH.
- Risk of NASH is greater in people who consume excess alcohol and processed foods.
Getting to the Best Answer
Answer 1 is correct. 41.14% chose this answer, “NASH is when intrahepatic fat is equal to or greater than 5% of liver weight.” GREAT JOB! According to ADA Standard 4, “NASH is defined histologically as having more than 5% hepatic steatosis and associated with inflammation and hepatocyte injury (hepatocyte ballooning), with or without evidence of liver fibrosis”.
Answer 2 is incorrect. 27.11% of you chose this answer, “About 30% of people with diabetes and extra weight also have NASH.” This is a juicy answer, but it is an underestimate of the current problem. Recent studies in adults in the U.S. estimate that more than 70% of people with type 2 diabetes have non alcoholic fatty liver disease (NAFLD). The more serious, steatohepatitis, is estimated to affect more than 50% of people with type 2 diabetes with NAFLD and it appears to be a driver for the development of fibrosis.
Answer 3 is incorrect. 14.14% of respondents chose this answer, “There are standardized medication algorithms to guide the treatment of NASH.” According to ADA Standard 4, at present, there are no FDA-approved drugs for the treatment of NASH. Therefore, treatment for people with type 2 diabetes and NASH is centered on the dual purpose of treating hyperglycemia and weight loss. Pioglitazone and some glucagon-like peptide 1 receptor agonists (GLP-1 RAs) have been shown to be effective to treat steatohepatitis, may slow fibrosis progression, and decrease cardiovascular disease.
Finally, Answer 4 is incorrect. 17.62% chose this answer, “Risk of NASH is greater in people who consume excess alcohol and processed foods.” Nonalcoholic steatohepatitis [NASH] indicates liver inflammation in the absence of ongoing or recent consumption of significant amounts of alcohol (defined as ingestion of >21 standard drinks per week in men and >14 standard drinks per week in women over a 2-year period preceding evaluation) or the presence of other secondary causes of fatty liver disease. NASH is not a result of excess alcohol intake and is usually associated with genetics, body weight and insulin resistance.
Thank you so much for reading this “Rationale of the Week”.
We also invite you to join our Online Courses for more information (see info below)
Hope you can join our Diabetes Boot Camp in February and our other Level 2 Courses.
Preparing for Diabetes Certification Exam? Enroll in our Level 3 – Boot Camp 2023 Updates
Level 3 | DiabetesEd Specialist Boot Camp | 12+ CEs
Can’t join all the sessions live? No problem. Your registration guarantees you access to the recorded lectures for a full year.
This bundle is specifically designed for healthcare professionals who are studying for the Board Certified in Advanced Diabetes Management (BC-ADM) or the Certified Diabetes Care and Education Specialist (CDCES) certification exam.
Intended Audience: This library of critical information is designed for individuals or groups of diabetes specialists, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other health care providers interested in staying up to date on current practices of care for people with diabetes and preparing for the BC-ADM or the CDCES certification Exam.
2023 Webinar Updates
- February 7, 2023 – Class 1 – Diabetes – Not Just Hyperglycemia 1.75 CEs
- February 9, 2023 – Class 2 – Standards of Care & Cardiovascular Goals 1.8 CEs
- February 14, 2023 – Class 3 – Meds for Type 2 – What you need to know 1.5
- February 16, 2023 – Class 4 – Insulin Therapy – From Basal/Bolus to Pattern Management 1.5 CEs
- February 21, 2023 – Class 5 – Insulin Intensive – Monitoring, Sick Days, Lower
- February 23, 2023 – Class 6 – Exercise and Medical Nutrition Therapy 1.5 CEs
- February 28, 2023 – Class 7 – Screening, Prevention, and Treatment of Microvascular Complications
- March 2, 2023 – Class 8 – Coping and Behavior Change 1.5 CEs
- March 9, 2023 – Class 9 – Test-Taking Coach Session (48 Questions) No CE
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 | What is the Right LDL Target for RZ?
For last week’s practice question, we quizzed participants on what is the right LDL target. 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:
RZ is 47 years old with type 2 diabetes and hypertension with a UACR of 199 mg/g. RZ takes metformin 1000 mg BID, plus lisinopril 20mg daily. RZ most recent LDL Cholesterol was 130 mg/dL. The provider writes an order for DASH meal planning education and initiation of atorvastatin 40mg.
Based on the most recent ADA Standards, what is the LDL Cholesterol target for RZ?
Answer Choices:
- LDL less than 100 mg/dL.
- Lower LDL by 30%.
- LDL target of 65 mg/dL or less.
- Determine LDL target based on ASCVD calculations.
Getting to the Best Answer
Answer 1 is incorrect. 25.97% chose this answer, “LDL less than 100 mg/dL.” This is a juicy answer since it is the OLD LDL goal from several years ago. But the new 2023 lipid guidelines have even more intense goals for high-risk individuals. Since RZ has diabetes, hypertension, and albuminuria (UACR >30mg/g), they have an elevated risk of ASCVD. Given their risk status, the 2023 guidelines recommend reducing LDL by at least 50% of baseline and target LDL cholesterol to less than 70 mg/dL (see slide below).
Answer 2 is incorrect. 16.63% of you chose this answer, “Lower LDL by 30%.” Another juicy answer. Given RZ’s risk status, the 2023 guidelines recommend reducing LDL by at least 50% of baseline and target LDL cholesterol to less than 70 mg/dL. (see slide below).
Answer 3 is correct. 37.01% of respondents chose this answer, “LDL target of 65 mg/dL or less.” GREAT JOB! Since RZ has diabetes, hypertension, and albuminuria (UACR >30mg/g), they have an elevated risk of ASCVD. Given their risk status, the 2023 guidelines recommend reducing LDL by at least 50% of baseline and target LDL cholesterol to less than 70 mg/dL. Since RZ’s current LDL is 130, the goal is to reduce the LDL by at least 50% (LDL of 65mg/dL) AND less than 70 mg/dL by using a high-intensity statin and lifestyle therapy, (see slide below).
Finally, Answer 4 is incorrect. 20.38% chose this answer, “Determine LDL target based on ASCVD calculations.” Although this information would be helpful, it wouldn’t change the lipid goals. Given their risk status, the 2023 guidelines recommend reducing LDL by at least 50% of baseline and target LDL cholesterol to less than 70 mg/dL, (see slide below).
Thank you so much for reading this “Rationale of the Week”.
We also invite you to join our Online Courses for more information (see info below)
Hope you can join our ADA Standards of Care Webinar Update in February and our other Level 2 Courses.
Want to learn more about this question? Join us for our
Level 2 | ADA Standards of Care CE Course | 2.0 CEs
Updates air live between Feb. 2, 2023, at 11:30 am PST
This course, updated annually, is an essential review for anyone in the field of diabetes. Join Coach Beverly as she summarizes the 2023 updates to the American Diabetes Association’s Standards of Medical Care in Diabetes and provides critical teaching points and content for healthcare professionals involved in diabetes care and education.
Objectives:
- List significant changes and updates to the 2023 ADA Standards of Medical Care.
- State 3 updates on new blood pressure and lipid goals.
- Identify 5 key elements of the position statement.
- Discuss how to apply the Standards in the clinical setting and in preparation for exam success.
Intended Audience: This course is a knowledge-based activity designed for individuals or groups of diabetes professionals, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other health care providers interested in staying up to date on current practices of care for people with prediabetes, diabetes and other related conditions.
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
Preparing for Diabetes Certification Exam? Enroll in our Level 3 – Boot Camp 2023 Updates
Level 3 | DiabetesEd Specialist Boot Camp | 12+ CEs
Can’t join all the sessions live? No problem. Your registration guarantees you access to the recorded lectures for a full year.
This bundle is specifically designed for healthcare professionals who are studying for the Board Certified in Advanced Diabetes Management (BC-ADM) or the Certified Diabetes Care and Education Specialist (CDCES) certification exam.
Intended Audience: This library of critical information is designed for individuals or groups of diabetes specialists, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other health care providers interested in staying up to date on current practices of care for people with diabetes and preparing for the BC-ADM or the CDCES certification Exam.
2023 Webinar Updates
- February 7, 2023 – Class 1 – Diabetes – Not Just Hyperglycemia 1.75 CEs
- February 9, 2023 – Class 2 – Standards of Care & Cardiovascular Goals 1.8 CEs
- February 14, 2023 – Class 3 – Meds for Type 2 – What you need to know 1.5
- February 16, 2023 – Class 4 – Insulin Therapy – From Basal/Bolus to Pattern Management 1.5 CEs
- February 21, 2023 – Class 5 – Insulin Intensive – Monitoring, Sick Days, Lower
- February 23, 2023 – Class 6 – Exercise and Medical Nutrition Therapy 1.5 CEs
- February 28, 2023 – Class 7 – Screening, Prevention, and Treatment of Microvascular Complications
- March 2, 2023 – Class 8 – Coping and Behavior Change 1.5 CEs
- March 9, 2023 – Class 9 – Test-Taking Coach Session (48 Questions) No CE
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 | Why is post-exercise glucose spiking?
For last week’s practice question, we quizzed participants on why glucose is spiking after exercise. 80% 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 is 42 years old with type 2 diabetes and has worked up to brisk walking for 30 minutes on most days. JR has an A1C of 6.7% and takes an SGLT-2, metformin, and lovastatin along with trying to eat healthfully. JR decided to check blood sugars an hour after exercise and was surprised to see post-exercise blood glucose in the 180’s on two different days. JR asks you why their blood glucose actually rises after exercise.
What is the diabetes specialist’s best response?
Answer Choices:
- This is most likely due to a low blood sugar from your medications followed by rebound hyperglycemia.
- Blood sugars normally drop after exercise. When is the last time you performed quality control on your meter?
- I understand what you are saying. It sounds like this blood sugar elevation is causing you some anxiety.
- Exercising causes the release of hormones that can temporarily cause your blood sugar to rise.
Getting to the Best Answer
Answer 1 is incorrect. 6.19% chose this answer, “This is most likely due to a low blood sugar from your medications followed by rebound hyperglycemia.” This answer is tempting, but not accurate. Since JR’s only diabetes medication include metformin and a SGLT-2 inhibitor, they are not at risk for low blood sugar. Low blood sugar is only associated with sulfonylureas, meglitinides and insulin therapy.
Answer 2 is incorrect. 3.29% of you chose this answer, “Blood sugars normally drop after exercise. When is the last time you performed quality control on your meter?” In this situation, exercise can decrease hours after exercise, but usually increases immediately after exercise. Which means, JR doesn’t need to perform quality control on their glucose meter, since it is accurately reflecting blood sugar trends.
Answer 3 is incorrect. 10.41% of respondents chose this answer, “I understand what you are saying. It sounds like this blood sugar elevation is causing you some anxiety.” Although, this is a very compassionate response, it does not answer the question JR is asking, “why does my blood sugar go up after exercise?” For this reason, it is tempting, but not the best answer.
Finally, Answer 4 is correct. 80.11% chose this answer, “Exercising causes the release of hormones that can temporarily cause your blood sugar to rise.” YES, most of you chose the best answer. With exercise, counterregulatory or stress hormones are activated, which increases insulin resistance and causes blood glucose levels to temporarily rise to feed hungry muscles. This glucose rise is an expected temporary response and with time, blood sugars get back to baseline. GREAT JOB.
Thank you so much for reading this “Rationale of the Week”.
We also invite you to join our Online Courses for more information (see info below)
Hope you can join our ADA Standards of Care Webinar Update in February.
Want to learn more about this question? Enroll in our upcoming
Level 1 | Diabetes Fundamentals 2023 Updates | 9+ CEs
This bundle is specifically designed for healthcare professionals who want to learn more about diabetes fundamentals for their clinical practice or for those who are studying for the Certified Diabetes Care and Education Specialist (CDCES) exam.
Intended Audience: This library of critical information is designed for individuals or groups of diabetes specialists, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other health care providers interested in staying up to date on current practices of care for people with diabetes and preparing for the CDCES Certification Exam.
2023 Webinar Updates
- Recorded & Ready to watch on-demand – Class 1 – Getting to the Nitty Gritty 1.5 CEs
- Recorded & Ready to watch on-demand – Class 2 – Nutrition and Exercise 1.5 CEs
- Recorded & Ready to watch on-demand – Class 3 – Meds Overview for Type 2 – 1.5 CEs
- January 19, 2023 – Class 4 – Insulin Therapy & Pattern Management 1.5 CEs
- January 24, 2023 – Class 5 – Goals of Care – 1.5 CEs
- January 26, 2023 – Class 6 – Hypoglycemia, Sick Days, Monitoring, Foot Care 1.5 CEs
All hours earned count toward your CDCES Accreditation Information
Want an overview of the new 2023 ADA Standards of Care in Diabetes?
Join us live on February 2, 2023, at 11:30 am PST for our
Level 2 | ADA Standards of Care 2023 Update | 2.0 CEs
This course, updated annually, is an essential review for anyone in the field of diabetes. Join Coach Beverly as she summarizes the 2023 updates to the American Diabetes Association’s Standards of Medical Care in Diabetes and provides critical teaching points and content for healthcare professionals involved in diabetes care and education.
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.
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