Rationale of the Week | Healthy Kidney Labs?
We quizzed test takers on kidney function. 81.64% of respondents chose the best answer. We want to share this important updated 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 below: Answer Question
Question: Evaluating kidney function is important to determine the most beneficial treatment interventions. Which of the following measurements would indicate that JR has healthy kidney function?
Answer Choices:
- Urinary albumin creatinine ratio of 30-299 mg/g with GFR of 45.
- GFR of 60 or greater and urinary albumin creatinine ratio of 2 mg/g.
- Urinary albumin creatinine ratio less than 30 mg/g and GFR of 30-45.
- Creatinine of 1.5 and urinary albumin creatinine ratio of 300 mg/g or greater.
As shown above, the most common choice was option 2, the second most common answer was option 3, then option 1, and then finally option 4.
Getting to the Best Answer
Answer 1 is incorrect. 6.52% chose this answer, “Urinary albumin creatinine ratio of 30-299 mg/g with GFR of 45.” There are two major indicators of kidney health for people with diabetes, Glomerular Filtration Rate (GFR) and Urinary Albumin Creatinine Ratio (UACR). According to the ADA Standards, to have a healthy kidney function, JR would need a GFR of 60 or greater and a UACR less than 30 mg/g. Give that JR’s UACR is elevated at 30 mg/g or greater and the GFR is sluggish at 45, this is not the best answer.
Answer 2 is correct. 81.64%% of you chose this answer, “GFR of 60 or greater and urinary albumin creatinine ratio of 2 mg/g.” YES, GREAT JOB choosing the BEST answer. There are two major indicators of kidney health for people with diabetes, Glomerular Filtration Rate (GFR) and Urinary Albumin Creatinine Ratio (UACR). According to the ADA Standards, to have a healthy kidney function, JR would need a GFR of 60 or greater and a UACR less than 30 mg/g. Since JR meets both of these criteria, we can rest well knowing JR’s kidneys are healthy and flowing.
Answer 3 is incorrect. 7.25% of respondents chose this answer, “Urinary albumin creatinine ratio less than 30 mg/g and GFR of 30-45.” There are two major indicators of kidney health for people with diabetes, Glomerular Filtration Rate (GFR) and Urinary Albumin Creatinine Ratio (UACR). According to the ADA Standards, to have a healthy kidney function, JR would need a GFR of 60 or greater and a UACR less than 30 mg/g. Even though JR’s UACR is less than 30mg/g, the GFR is sluggish at 30-45. For this reason, this is not the best answer.
Finally, Answer 4 is incorrect. 4.59% chose this answer, “Creatinine of 1.5 and urinary albumin creatinine ratio of 300 mg/g or greater.” There are two major indicators of kidney health for people with diabetes, Glomerular Filtration Rate (GFR) and Urinary Albumin Creatinine Ratio (UACR). According to the ADA Standards, to have a healthy kidney function, JR would need a GFR of 60 or greater and a UACR less than 30 mg/g. In this response, we only know the creatinine level (which is elevated), but no GFR is calculated. In addition, the UACR is very elevated at 300 mg/g. For these reasons, 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 important learning activity!
Want to learn more about this topic?
Join our Virtual DiabetesEd Specialist Conference
30+ CEs | April 13-15, 2022
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.
Download Course Schedule | Download Course Flyer
Join us LIVE for this Virtual Course and enjoy a sense of community!
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
Two Registration Options
Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs
Deluxe Option for $499: Virtual Program includes:
- Q & A Session with the instructor after each webinar.
- LIVE Presentations by our team of experts.
- State of the art review of current diabetes care and technology.
- Resources for each session.
- Access to free podcasts and video recordings within a week of each live session for one year.
Deluxe Version includes Syllabus, Standards and Swag*:
- Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
- ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
- DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen
Virtual DiabetesEd Specialist Conference Basic | 30+ CEs
Deluxe Option for $499: Virtual Program includes:
- Q & A Session with the instructor after each webinar.
- LIVE Presentations by our team of experts.
- State of the art review of current diabetes care and technology.
- Resources for each session.
- Access to free podcasts and video recordings within a week of each live session for one year.
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 | Who needs a CGM based on New ADA Standards?
We quizzed test takers on the new ADA 2022 Standards of Care for CGMs. 71% of respondents chose the best answer. We want to share this important updated 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 below: Answer Question
Question: In the 2022 ADA Standards, there are updated indications for use of real-time continuous glucose monitoring or intermittently scanned continuous glucose monitoring. Based on the new guidelines, which one of the following individuals needs to be offered continuous glucose monitoring to manage their diabetes?
Answer Choices:
- AL, a 54-year-old on a sulfonylurea plus metformin.
- RT, a 68-year-old on basal insulin and an SGLT-2 Inhibitor.
- ZR, a 23-year-old with diabetes secondary to HIV retroviral therapy.
- AW, an 18-year-old with prediabetes.
As shown above, the most common choice was option 2, the second most common answer was option 3, then option 1, and then finally option 4.
Getting to the Best Answer
Answer 1 is incorrect. 11.08% chose this answer, “AL, a 54-year-old on a sulfonylurea plus metformin.” This is a juicy answer, since AL is taking a medication that can cause hypoglycemia. This person would benefit from a glucose meter and instruction on the signs of hypoglycemia and what action to take if they have symptoms of low blood sugar. However, according to the standards, continuous glucose monitoring is not indicated for people with type 2 on orals. But knowing that insurance probably won’t cover a CGM, AL could choose to purchase (out of pocket) an intermittently scanning glucose meter to keep a close eye on their blood sugars.
Answer 2 is correct. 71.03%% of you chose this answer, “RT, a 68-year-old on basal insulin and an SGLT-2 Inhibitor.” GREAT JOB! According to the ADA Diabetes Technology Standard 7, “real-time continuous glucose monitoring or intermittently scanned continuous glucose monitoring can be used for diabetes management in adults with diabetes on basal insulin who are capable of using devices safely (either by themselves or with a caregiver). The choice of device should be made based on patient circumstances, desires, and needs.” In addition, this standard outlines that CGM should be offered during pregnancy and for youth and adults who are using insulin therapy to get glucose to target.
Answer 3 is incorrect. 14.42% of respondents chose this answer, “ZR, a 23-year-old with diabetes secondary to HIV retroviral therapy.” This answer is tempting. However, there is no indication in this answer that ZR is on insulin therapy and that is why it is not the best answer. The latest ADA Standards recommends CGM for adults on insulin therapy.
Finally, Answer 4 is incorrect. 3.47% chose this answer, “AW, an 18-year-old with prediabetes.” Good try. Currently, CGM is only recommended for people with diabetes on insulin or during pregnancy. Off the record, people with prediabetes might decide to purchase a blood glucose meter (if their insurance company doesn’t cover it) to keep an eye on their glucose levels and use the results as motivation to make lifestyle changes.
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 important learning activity!
Want to learn more about this topic?
Join our Virtual DiabetesEd Specialist Conference
30+ CEs | April 13-15, 2022
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.
Download Course Schedule | Download Course Flyer
Join us LIVE for this Virtual Course and enjoy a sense of community!
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
Two Registration Options
Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs
Deluxe Option for $499: Virtual Program includes:
- Q & A Session with the instructor after each webinar.
- LIVE Presentations by our team of experts.
- State of the art review of current diabetes care and technology.
- Resources for each session.
- Access to free podcasts and video recordings within a week of each live session for one year.
Deluxe Version includes Syllabus, Standards and Swag*:
- Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
- ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
- DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen
Virtual DiabetesEd Specialist Conference Basic | 30+ CEs
Deluxe Option for $499: Virtual Program includes:
- Q & A Session with the instructor after each webinar.
- LIVE Presentations by our team of experts.
- State of the art review of current diabetes care and technology.
- Resources for each session.
- Access to free podcasts and video recordings within a week of each live session for one year.
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 | With New Guidelines, who needs testing for hyperglycemia?
We quizzed test takers on the new ADA 2022 Standards of Care for Hyperglycemia. 39% of respondents chose the best answer. We want to share this important updated 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 below: Answer Question
Question: Based on the 2022 ADA Standards of Care and Screening Guidelines, which one of the following people would need to be tested for hyperglycemia?
Answer Choices:
- RJ, a 36-year-old with a BMI of 23
- LS, a 32-year-old with a history of gastritis
- JM, a 33-year-old who smokes a pack a day
- KT, a 34-year-old who has bilateral pedal edema
As shown above, the most common choice was option 1, the second most common answer was option 3, then option 4, and then finally option 2.
Getting to the Best Answer
Answer 1 is correct. 39.80% chose this answer, “RJ, a 36-year-old with a BMI of 23.” GREAT JOB. Given the increasing incidence of prediabetes and diabetes in younger populations, the ADA has adjusted their screening threshold. The old guidelines suggest screening everyone starting at age 45. The new recommendations state that everyone aged 35 or older needs to have their blood glucose level evaluated to find undiagnosed prediabetes or diabetes.
Testing methods for prediabetes or diabetes can include:
- A1c
- Fasting Plasma Glucose (FPG) or
- Oral Glucose Tolerance Test (OGTT)
By testing for elevated glucose levels at this younger age bracket, health care professionals can provide early intervention to slow progression from prediabetes to diabetes and provide immediate care to those with newly discovered diabetes.
Answer 2 is incorrect. 15.47% of you chose this answer, “LS, a 32-year-old with a history of gastritis.” Based on the ADA Standards, we wouldn’t screen this individual for two reasons. They are younger than 35 and their BMI does not meet the threshold of 25 or greater (it isn’t even listed). Gastritis also isn’t a commonly co-associated diabetes condition*.
Answer 3 is incorrect. 22.56% of respondents chose this answer, “JM, a 33-year-old who smokes a pack a day.” Based on the ADA Standards, we wouldn’t screen this individual for two reasons. They are younger than 35 and their BMI does not meet the threshold of 25 or greater (it isn’t even listed). Smoking has been show to increase insulin resistance, but the ADA doesn’t list it as a risk factor*.
Finally, Answer 4 is incorrect. 22.17% chose this answer, “KT, a 34-year-old who has bilateral pedal edema.” They are younger than 35 and their BMI does not meet the threshold of 25 or greater (it isn’t even listed). Pedal edema can be caused for a variety of reasons, but the ADA doesn’t list pedal edema as a risk factor*.
*Coach Bev note. It is appropriate to screen for hyperglycemia, even if an individual doesn’t meet this criteria, if a health care professional is worried that based on clinical presentation, that an individual is at risk for prediabetes or 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 important learning activity!
Want to learn more about this topic?
Enroll in Our Standards of Care Intensive | Level 2
This bundle is specifically designed for healthcare professionals who want to learn more about the ADA Standards of Diabetes Care for their clinical practice or for those who are studying for the BC-ADM or the CDCES certification exam.
2022 Live Webinar Updates
- Recorded December 15, 2021 – Hyperglycemic Crises, DKA & HHS Standards | 1.0 CE
- Recorded December 21, 2021 – Assessing and Promoting Well-Being: From Population Health to a Person-Centered Approach Standards | 1.5 CEs
- February 3, 2022 – ADA Standards of Care | 2.0 CEs
- March 24, 2022 – Meds Management for Type 2 – 1.5 CEs
- March 29, 2022 – Lower Extremity Assessment 1.5 CEs
- April 26, 2022 – Microvascular Complications, Eye, Kidney Nerve Disease 1.5 CEs
- April 28, 2022 – Critical Assessment of Diabetes Patient 2.0 CEs
- May 10, 2022 – Cardiovascular Disease and Diabetes Standards 1.5 CEs
- May 12, 2022 – Older Adults and DIabetes 1.5 CEs
- May 17, 2022 – Tots to Teens – Diabetes Standards 1.5 CEs
- May 19, 2022 – Pregnancy and Diabetes 1.5 CEs
- May 26, 2022 – Hospital and Hyperglycemia 1.5 CEs
- July 21, 2022 – Setting up a Successful Diabetes Program 1.5 CEs
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
Intended Audience: A great course for healthcare professionals in the field of diabetes education looking for a straightforward explanation of identification and treatment of hyperglycemic crises.
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator and a nationally recognized diabetes expert.
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
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 | New Standards for Kidney Disease
We quizzed test takers on the new ADA Standards of Care for Kidney Disease. 56% of respondents chose the best answer. We want to share this important info 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 below: Answer Question
Question: Based on the 2022 ADA Standards of Care, which of the following is the most accurate statement regarding chronic kidney disease and risk management?
Answer Choices:
- Monitor kidney function twice yearly if urinary albumin is 300 or greater and/or if GFR is 30-60.
- For people with GFR less than 60, relax glucose target to prevent hypoglycemia.
- If GFR is less than 30 in an individual with diabetes, avoid use of SGLT-2 Inhibitors.
- For individuals with GFR less than 60, refer to RD to encourage low protein diet.
As shown above, the most common choice was option 1, the second most common answer was option 3, then option 2, and then finally option 4.
Getting to the Best Answer
Answer 1 is correct. 55.61% chose this answer, “Monitor kidney function twice yearly if urinary albumin is 300 or greater and/or if GFR is 30-60.” YES, GREAT JOB. Most of you chose the best answer for this new recommendation. Catching renal failure early can be life saving. Two big indicators of serious renal issues include proteinuria and a diminished GFR. Early interventions (including getting BG and BP to goal) and regular monitoring can protect kidneys for the long run.
Answer 2 is incorrect. 8.51% of you chose this answer, “If GFR is less than 30 in an individual with diabetes, avoid use of SGLT-2 Inhibitors.” This is a juicy answer. The GFR cut-offs for the SGLT-2s have been changing a lot over the past year. More research is showing that, in some cases, even with a GFR less than 30 (especially in the presence of proteinuria) SGLT-2s are indicated since they have a renal protective effect. See ADA Standard 11 on Chronic Kidney Disease for more info.
Answer 3 is incorrect. 28.05% of respondents chose this answer, “People with type 2 are less likely to experience diabetes complications than those with type 1 diabetes.” According the the National Kidney Foundation, “About 30 percent of people with Type 1 diabetes and 10 to 40 percent of those with Type 2 diabetes eventually experience kidney failure.” The most important message is to encourage people with diabetes to be actively involved in their treatment plan and advocate for best medical care to protect renal function.
Finally, Answer 4 is incorrect. 7.83% chose this answer, “For individuals with GFR less than 60, refer to RD to encourage low protein diet.” This is an outdated recommendation for over the past five years. The ADA recognized that the science does not support low protein diets as a protective intervention for those with renal disease. For people with nondialysis-dependent stage 3 or higher chronic kidney disease, dietary protein intake recommendation is 0.8 g/kg body weight per day.
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 important learning activity!
Want to learn more about this topic?
Enroll in Our Standards of Care Intensive | Level 2
This bundle is specifically designed for healthcare professionals who want to learn more about the ADA Standards of Diabetes Care for their clinical practice or for those who are studying for the BC-ADM or the CDCES certification exam.
2022 Live Webinar Updates
- Recorded December 15, 2021 – Hyperglycemic Crises, DKA & HHS Standards | 1.0 CE
- Recorded December 21, 2021 – Assessing and Promoting Well-Being: From Population Health to a Person-Centered Approach Standards | 1.5 CEs
- February 3, 2022 – ADA Standards of Care | 2.0 CEs
- March 24, 2022 – Meds Management for Type 2 – 1.5 CEs
- March 29, 2022 – Lower Extremity Assessment 1.5 CEs
- April 26, 2022 – Microvascular Complications, Eye, Kidney Nerve Disease 1.5 CEs
- April 28, 2022 – Critical Assessment of Diabetes Patient 2.0 CEs
- May 10, 2022 – Cardiovascular Disease and Diabetes Standards 1.5 CEs
- May 12, 2022 – Older Adults and DIabetes 1.5 CEs
- May 17, 2022 – Tots to Teens – Diabetes Standards 1.5 CEs
- May 19, 2022 – Pregnancy and Diabetes 1.5 CEs
- May 26, 2022 – Hospital and Hyperglycemia 1.5 CEs
- July 21, 2022 – Setting up a Successful Diabetes Program 1.5 CEs
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
Intended Audience: A great course for healthcare professionals in the field of diabetes education looking for a straightforward explanation of identification and treatment of hyperglycemic crises.
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator and a nationally recognized diabetes expert.
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
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 | Type 1 vs Type 2 Diabetes?
We quizzed test takers on the difference between Type 1 & Type 2 Diabetes. 87% of respondents chose the best answer. We want to share this important info 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 below: Answer Question
Question: JS has newly diagnosed type 1, yet their parent has type 2 diabetes. They ask you the difference between the two types of diabetes.
What is your best response?
Answer Choices:
- Type 1 and Type 2 are both autoimmune conditions, but people with type 2 don’t need insulin at first.
- Type 1 is due to a progressive destruction of the alpha cells of the pancreas.
- People with type 2 are less likely to experience diabetes complications than those with type 1 diabetes.
- Type 1 diabetes is an immune mediated condition that requires insulin from the start.
As shown above, the most common choice was option 4, the second most common answer was option 1, then option 2, and then finally option 3.
Getting to the Best Answer
Answer 1 is incorrect. 6.67% chose this answer, “Type 1 and Type 2 are both autoimmune conditions, but people with type 2 don’t need insulin at first.” Only type 1 diabetes is considered an immune mediated condition where there is autoimmune destruction of the beta cells. About 30% of people with type 2 will eventually require insulin due to gradual loss of beta cells.
Answer 2 is incorrect. 5.33% of you chose this answer, “Type 1 is due to a progressive destruction of the alpha cells of the pancreas.” In type 1 diabetes, there is destruction of the beta cells that produce insulin, not the alpha cells. Alpha cells produce glucagon, an important hormone that increases glucose levels.
Answer 3 is incorrect. 1.33% of respondents chose this answer, “People with type 2 are less likely to experience diabetes complications than those with type 1 diabetes.” Complications are a result of a complex interplay of genetics, lifestyle and duration plus severity of hyperglycemia. Many people with type 2 diabetes already have complications at diagnosis due to unknowingly having diabetes for an average of six years.
Finally, Answer 4 is correct. 86.67% chose this answer, “Type 1 diabetes is an immune mediated condition that requires insulin from the start.” YES, This is best answer. All people diagnosed with type 1 diabetes immediately need exogenous insulin since their beta cells have been destroyed and they are at risk for hyperglycemic crisis due to insulinopenia.
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 important learning activity!
Want to learn more about this topic?
Enroll in our Diabetes Fundamentals | Level 1
Airs Live Jan 11th – Jan 27th, 2022 at 11:30 am PST
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.
2022 Live Webinar Updates
- January 11, 2022 – Class 1 – Getting to the Nitty Gritty 1.5 CEs
- January 13, 2022 – Class 2 – Nutrition and Exercise 1.5 CEs
- January 18, 2022 – Class 3 – Insulin Therapy & Pattern Management 1.5 CEs
- January 20, 2022 – Class 4 – Meds Overview for Type 2 – 1.5 CEs
- January 25, 2022 – Class 5 – Goals of Care – 1.5 CEs
- January 27, 2022 – Class 6 – Hypoglycemia, Sick Days, Monitoring, Foot Care 1.5 CEs
Intended Audience: A great course for healthcare professionals in the field of diabetes education looking for a straightforward explanation of identification and treatment of hyperglycemic crises.
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator and a nationally recognized diabetes expert.
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 | The truth about NPH Insulin?
We quizzed test takers on NPH insulin. 57% of respondents, chose the best answer. We want to share this important info 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 below: Answer Question
Question: NPH insulin, introduced in 1946 was one of the first basal insulins. It is considered intermediate-acting basal insulin since the duration of action is about a half-day. Given its effectiveness and affordability, it is on the World Health Organization’s List of Essential Medicines.
Which of the following is a true statement regarding NPH insulin?
Answer Choices:
- In most states, it can be purchased over the counter without a prescription
- Instructions include to gently shake before injection to adequately mix the particles
- NPH stands for Natural Proinsulin Hagedorn
- Due to its high rates of hypoglycemia, NPH is no longer recommended.
As shown above, the most common choice was option 1, the second most common answer was option 2, then option 3, and then finally option 4.
Getting to the Best Answer
Answer 1 is correct. 56.89% chose this answer, “In most states, it can be purchased over the counter without a prescription.” YES, GREAT JOB. Actually, there are three over-the-counter insulins that are available for purchase without a prescription. They include regular insulin, NPH (intermediate-acting), and 70/30 insulin, a premixed combination of NPH and regular.
People might be interested in purchasing these older insulins because of their lower cost. Walmart sells all three types under the ReliOn brand umbrella for roughly $25 a vial. Chain pharmacies can also sell regular, NPH, and 70-30 insulin. However, OTC insulin is more frequently sold at Walmart than other chain pharmacies, likely due to the considerably lower price point.
– For more info on the different types of insulins, download our FREE PocketCards.
– For Info on affordable insulin, please visit our Insulin Cost Savings Resource page.
Answer 2 is incorrect. 20.09% of you chose this answer, “Instructions include to gently shake before injection to adequately mix the particles.” Shaking NPH insulin can cause clumping and is not recommended. According to the package insert, the most accurate instruction is to gently roll NPH insulin or invert it repeatedly until the particles are evenly distributed. NPH looks milky and homogeneous when properly mixed.
Answer 3 is incorrect. 12.90% of respondents chose this answer, “NPH stands for Natural Proinsulin Hagedorn.” So close. The name refers to N for neutral, P for protamine (a protein), and H for its creator scientist name Hans Christian Hagedorn. NPH insulin is FDA-approved in the adult and pediatric population to manage type 1 and type 2 diabetes. It is also useful in gestational diabetes. More info.
Finally, Answer 4 is incorrect. 10.12% chose this answer, “Due to its high rates of hypoglycemia, NPH is no longer recommended.” NPH insulin does have a somewhat higher risk of hypoglycemia. One way to decrease the risk of hypoglycemia and high day-to-day variability is to thoroughly re-suspend NPH until it is uniformly cloudy before injecting. This will improve the pharmacodynamic and pharmacokinetic profile of NPH insulin, leading to less hypoglycemia. NPH insulin onset of action is 2 to 4 hours, time to peak effect is 4 to 10 hours, and total duration 10-16 hours. The newer basal insulins don’t have a peak, so there is slightly less hypoglycemia. However, with careful dosing and education, NPH insulin can provide a lower cost and effective alternative to the newer analog insulins, especially for those living with type 2 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 important learning activity!
Want to learn more? Join our Webinar on Hyperglycemic Crisis, which is ready for viewing!
Want to learn more about this topic?
Enroll in our Diabetes Fundamentals | Level 1
Airs Live Jan 11th – Jan 27th, 2022 at 11:30 am PST
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.
2022 Live Webinar Updates
- January 11, 2022 – Class 1 – Getting to the Nitty Gritty 1.5 CEs
- January 13, 2022 – Class 2 – Nutrition and Exercise 1.5 CEs
- January 18, 2022 – Class 3 – Insulin Therapy & Pattern Management 1.5 CEs
- January 20, 2022 – Class 4 – Meds Overview for Type 2 – 1.5 CEs
- January 25, 2022 – Class 5 – Goals of Care – 1.5 CEs
- January 27, 2022 – Class 6 – Hypoglycemia, Sick Days, Monitoring, Foot Care 1.5 CEs
Intended Audience: A great course for healthcare professionals in the field of diabetes education looking for a straightforward explanation of identification and treatment of hyperglycemic crises.
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator and a nationally recognized diabetes expert.
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 | “I take insulin when I feel like it”
We quizzed test takers on identifying why a teenager with type 1 is only taking insulin “when they feel like it”. 73% of respondents, chose the best answer. We want to share this important info so you can pass it on to people living with diabetes, your colleagues and 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 below: Answer Question
Question: JR is a 15-year-old admitted to the hospital with DKA for the second time this month. JR says they are tired of their parents always telling them how to manage their diabetes. They just stopped wearing their continuous glucose monitor and tell you they “take insulin when they feel like it”.
What best describes what this teenager is experiencing?
Answer Choices:
- Diabetes distress.
- Diabetes burnout.
- Severe anxiety.
- Fear of hypoglycemia.
As shown above, the most common choice was option 2, the second most common answer was option 1, then option 3, and then finally option 4.
Getting to the Best Answer
Answer 1 is incorrect. 24.39% chose this answer, “Diabetes distress.” JR certainly is dealing with aspects of diabetes distress, which is described as feeling like it’s too much or that things are out of control. However, the fact that “JR just stopped wearing their continuous glucose monitor and is only “taking insulin when they feel like it”, gives us a more complete understanding that JR is experiencing more than distress. Please see our blog on How to Identify Diabetes Distress and Burnout.
Answer 2 is correct. 73.17% of you chose this answer, “Diabetes burnout.” YES, this is the BEST ANSWER. Great job! Diabetes burnout is an emotional reaction that is usually more intense than diabetes distress. A person in the state of burnout is someone with diabetes who has grown tired of managing their condition, then simply ignores it for a period of time. The fact that JR stopped wearing their CGM and only takes insulin when they feel like it, are strong indicators that JR is on a diabetes vacation and is burned out. This might mistakenly be perceived as non-compliance, but these behaviors indicate that JR is really struggling and needs the support of the health care team. Visit our page on Diabetes Burnout or Distress? 12 Reframes that can HELP for ideas to support people struggling with their diabetes self care.
Answer 3 is incorrect. 1.33% of respondents chose this answer, “Severe anxiety.” Hardly any of you chose this because in this vignette, JR is not exhibiting any signs of anxiety. Good job.
Finally, Answer 4 is incorrect. 1.11% chose this answer, “Fear of hypoglycemia.” Since this vignette does not mention that JR has experienced lows or that JR lets blood sugars run high to prevent lows, this is not the best answer. Good job.
Learn more about Diabetes Distress in our December Newsletter.
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 important learning activity!
Want to learn more? Join our Webinar on Hyperglycemic Crisis, which is ready for viewing!
Want to learn more about this topic?
Enroll in our Level 2 | Assessing and Promoting Well-Being: From Population Health to a Person-Centered Approach Standards | 1.5 CEs
Updated for the new 2022 ADA Standards of Care
This presentation will include the latest information on Social Determinants of health, assessment strategies, and approaches. We will explore the psychosocial issues that can discourage individuals from adopting healthier behaviors and provides strategies to identify and overcome these barriers. Life studies are used to apply theory to real-life situations. A great course for anyone in the field of diabetes education or for those looking for a new perspective on assessment and coping strategies.
Objectives:
- State strategies to assess and address social determinants of health
- Discuss health care delivery systems using a person-centered approach
- List screening tools that can help detect distress, depression, trauma, and cognitive decline
- Describe psycho-social and emotional barriers to diabetes self-management
- Provide strategies for healthcare professionals to identify and overcome barriers to self-care
Intended Audience: A great course for healthcare professionals in the field of diabetes education looking for a straightforward explanation of identification and treatment of hyperglycemic crises.
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator and a nationally recognized diabetes expert.
Enroll in our entire Level 2 – Standards of Care to join us for the below 2022 Live Webinar Updates. All courses air at 11:30 a.m. (PST)
- Recorded December 15, 2021 – Hyperglycemic Crises, DKA & HHS Standards | 1.0 CE
- Recorded December 21, 2021 – Assessing and Promoting Well-Being: From Population Health to a Person-Centered Approach Standards | 1.5 CEs
- February 3, 2022 – ADA Standards of Care | 2.0 CEs
- March 24, 2022 – Meds Management for Type 2 – 1.5 CEs
- March 29, 2022 – Lower Extremity Assessment 1.5 CEs
- April 26, 2022 – Microvascular Complications, Eye, Kidney Nerve Disease 1.5 CEs
- April 28, 2022 – Critical Assessment of Diabetes Patient 2.0 CEs
- May 10, 2022 – Cardiovascular Disease and Diabetes Standards 1.5 CEs
- May 12, 2022 – Older Adults and DIabetes 1.5 CEs
- May 17, 2022 – Tots to Teens – Diabetes Standards 1.5 CEs
- May 19, 2022 – Pregnancy and Diabetes 1.5 CEs
- May 26, 2022 – Hospital and Hyperglycemia 1.5 CEs
- July 21, 2022 – Setting up a Successful Diabetes Program 1.5 CEs
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 Week | What is the Truth about Hyperglycemic Crisis?
We quizzed test takers on hyperglycemic crisis. 61% of respondents, chose the best answer. We want to share this important info so you can pass it on to people living with diabetes and your colleagues and 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 below: Answer Question
Question: People with type 1 or type 2 diabetes can experience hyperglycemic crises.
Which of the following is true about Diabetes Ketoacidosis (DKA)?
Answer Choices:
- People with Latent Autoimmune Diabetes (LADA) are not at risk of DKA.
- DKA is associated with hyperkalemia and elevated pH.
- DKA can be managed with IV or Sub-Q insulin therapy.
- People with type 1 on SGLT-2s have lower risk of DKA than those with type 2.
As shown above, the most common choice was option 3, the second most common answer was option 2, then a tie for option 1 and option 4.
Getting to the Best Answer
Answer 1 is incorrect. 7.85% chose this answer, “People with Latent Autoimmune Diabetes (LADA) are not at risk of DKA.” Any person with a substantial insulin deficiency (including type 1, type 2 and people with LADA) are at risk of ketoacidosis. The risk increases during periods of illness, inadequate calorie intake or when an individual is not injecting adequate insulin. Most individuals with LADA need insulin within 6 months of diagnosis to maintain glucose levels. Without insulin injections, people with LADA can’t use glucose for fuel and will start burning fat for energy, which leads to excess circulating ketones and potentially DKA.
Answer 2 is incorrect. 23.36% of you chose this answer, “DKA is associated with hyperkalemia and elevated pH.” Part of this answer is correct, which makes it a juicy answer. This common test taking pitfall is easy to fall into. It is true that people in DKA can become hyperkalemic, but they also always experience acidosis, which causes the pH to fall, not elevate.
Answer 3 is correct. 60.93% of respondents chose this answer, “DKA can be managed with IV or Sub-Q insulin therapy.” Yes, GREAT job, this is the BEST answer. Mild or moderate DKA can be treated using SubQ insulin and all levels of DKA can be treated with IV insulin. The treatment choice is based on health care setting, provider preference, and the patient’s presentation.
Finally, Answer 4 is incorrect. 7.85% chose this answer, “People with type 1 on SGLT-2s have lower risk of DKA than those with type 2.” Some people living with Type 1 may be started on an SGLT-2 (which is OFF-LABEL) by their provider to help with glucose management and lower insulin needs. People with type 2 diabetes, may also be started on an SLGT-2. Both groups are at increased risk for experiencing DKA on a SGLT-2. However, the person with type 1 is at HIGHER risk of experiencing DKA, because they have an absolute insulin deficiency and if they reduce their insulin dose too much, they might need to convert from using glucose for fuel to fat for fuel, leading to DKA.
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 important learning activity!
Want to learn more? Join our Webinar on Hyperglycemic Crisis, which is ready for viewing!
Want to learn more about this topic?
Level 2 | Hyperglycemic Crises, DKA & HHS Standards | 1.0 CE
Annual Webinar Recorded on December 15th
This course discusses common causes of hyperglycemia crises. Topics include hyperglycemia secondary to medications and insulin deprivation. The difference and similarities between Diabetes Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome are also covered. Treatment strategies for all situations are included.
Objectives:
- Common causes of hyperglycemic crises.
- The difference and similarities between DKA and HHS and treatment strategies
- Causes and treatment of hyperglycemic crises.
Intended Audience: A great course for healthcare professionals in the field of diabetes education looking for a straightforward explanation of identification and treatment of hyperglycemic crises.
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator and a nationally recognized diabetes expert.
Enroll in our entire Level 2 – Standards of Care to join us for the below Annual Live Webinar Updates. All courses air at 11:30 a.m. (PST)
- December 15, 2021 – Hyperglycemic Crises, DKA & HHS Standards | 1.0 CE
- December 21, 2021 – Assessing and Promoting Well-Being: From Population Health to a Person-Centered Approach Standards | 1.5 CEs
- February 3, 2022 – ADA Standards of Care | 2.0 CEs
- March 24, 2022 – Meds Management for Type 2 – 1.5 CEs
- March 29, 2022 – Lower Extremity Assessment 1.5 CEs
- April 26, 2022 – Microvascular Complications, Eye, Kidney Nerve Disease 1.5 CEs
- April 28, 2022 – Critical Assessment of Diabetes Patient 2.0 CEs
- May 10, 2022 – Cardiovascular Disease and Diabetes Standards 1.5 CEs
- May 12, 2022 – Older Adults and DIabetes 1.5 CEs
- May 17, 2022 – Tots to Teens – Diabetes Standards 1.5 CEs
- May 19, 2022 – Pregnancy and Diabetes 1.5 CEs
- May 26, 2022 – Hospital and Hyperglycemia 1.5 CEs
- July 21, 2022 – Setting up a Successful Diabetes Program 1.5 CEs
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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