Answer A is incorrect: 14.85% chose this answer, “BMI and activity level.” This answer is incorrect but tempting. BMI level is used as a a screening tool for prediabetes and diabetes risk, but is not included as a factor contributing to secretory defects. According to the ADA, there are four factors related to insulin secretory defects in type 2 diabetes. They include; genetics, epigenetics, metabolic stress and inflammation.

Answer B is incorrect: 16.92% chose this answer, “Lifestyle and inflammation.” This juicy answer is incorrect.  Lifestyle is not a direct factor related to insulin secretory defects, but inflammation is a contributor. According to the ADA, there are four factors related to insulin secretory defects in type 2 diabetes. They include; genetics, epigenetics, metabolic stress and inflammation.

Answer C is incorrect: 25.75% chose this answer, “Genetics and visceral adipose distribution.” This answer is incorrect. Visceral adiposity is associated with an increased risk for diabetes, but does not contribute to insulin secretory defects. According to the ADA, there are four factors related to insulin secretory defects in type 2 diabetes. They include; genetics, epigenetics, metabolic stress and inflammation.

Answer D is correct: 42.48% chose this answer, “Epigenetics and metabolic stress.” This answer is correct, GREAT JOB! According to the ADA, there are four factors related to insulin secretory defects in type 2 diabetes. They include; genetics, epigenetics, metabolic stress and inflammation.

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!

Answer A is correct: % chose this answer, “When scheduling, JM requested an individual appointment” Answer A is correct; it does NOT justify individual DSMES. Although diabetes care should be patient-centered, patient preference alone does not meet Medicare criteria for individual DSMES. Medicare requires the referring provider document justification of
barriers to group learning which can include clinical, educational, or psychosocial need.

Answer B is incorrect: % chose this answer, “The referral for DSMES stated JM has a language barrier” Answer B is incorrect and does justify individual DSMES. Language barriers can significantly limit participation in group DSMES. Medicare recognizes a referral with stated language and communication needs as valid justification for an individual visit.

Answer C is incorrect: % chose this answer, “A group DSMES class is not available within the next 3 months” Answer C is incorrect and does justify individual DSMES. Medicare will approve individual DSMES if no group class is available for two months or longer from the date on the referral.

Answer D is incorrect: % chose this answer, “JM was referred for training on starting insulin therapy” Answer D is incorrect and does justify individual DSMES. A referral for initiation of insulin therapy requires individualized instruction. This can include injection technique, dose adjustment, hypoglycemia prevention, and problem-solving. Medicare considers this
an appropriate reason for individual DSMES.

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Answer A is incorrect: % chose this answer, “A 67-year-old female living with frequent falls and no bone fractures. She is newly diagnosed with type 2 diabetes, taking only metformin, with a bone density test 1 year ago that was normal.” This answer is incorrect. Per the 2026 ADA Standards of Care, she does meet criteria for assessing bone health due to her diagnosis of type 2 diabetes and risk factor of frequent falls, but she had a bone density test 1 year ago.  Currently, the recommendation is to re-evaluate the bone density test in 2-3 years.

Answer B is incorrect: % chose this answer, “A 49-year-old premenopausal woman with prediabetes who has a low vitamin D level but no history of bone fracture.” This answer is incorrect. Per the 2026 ADA Standards of Care, it is recommended to assess bone health in postmenopausal women with other diabetes specific risk factors. This risk factor does not include low vitamin D levels.

Answer C is correct: % chose this answer, “A 59-year-old male living with type 2 diabetes, taking pioglitazone, and whose A1c is 8.7%.” This answer is correct. Per the 2026 ADA Standards of Care, bone health should be assessed in men aged ≥50 years with type 2 diabetes and an A1c >8%. He is also on pioglitazone, a thiazolidinedione, which is another risk factor for low bone density.

Answer D is incorrect: % chose this answer, “A 43-year-old man living with type 2 diabetes for five years, taking metformin and an SGLT2 inhibitor, without diabetes related complications, but did break his arm as a child.” This answer is incorrect. Per the 2026 ADA Standards of Care, he has no diabetes-specific risk factors for bone loss. Diabetes duration is less than 10 years, he has no diabetes related complications such as peripheral or autonomic neuropathies, he is not on a high-risk medication for bone loss, and he has not had a bone fracture as an adult.

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Answer A is correct: 55.56% chose this answer, “Know the 2025 Standards, since it takes about a year for the new standards to be incorporated unless there is a significant clinical guideline update.” Answer A is the BEST answer. It takes at least a year for the CBDCE to update the exam based on the ADA Standards. Knowing the 2025 Standards along with any urgent clinical updates announced in 2026 will help prepare JR for success.

Answer B is incorrect: 11.45% chose this answer, “Thoroughly review the 2026 Standards since the most recent ADC Standards content will be included in the exam.” Answer B is not the best answer. Since it takes at least a year for the CBDCE to update the exam based on the ADA Standards, JR can feel comfortable knowing the 2025 Standards along with any urgent clinical updates announced in 2026.

Answer C is incorrect: 19.53% chose this answer, “Be familiar with the goals of care from both years, so you can compare and contrast to get to the best answers.” Answer C is not the best answer. Thinking about comparing and contrasting two consecutive years standards and lead to testing confusion. JR can feel comfortable knowing the 2025 Standards along with any urgent clinical updates announced in 2026.

Answer D is incorrect: 13.47% chose this answer, “In addition to knowing the 2026 ADA Standards, you will need to be familiar with the latest American Association of Clinical Endocrinology (AACE) Standards.” Answer D is not the best answer. Since it takes at least a year for the CBDCE to update the exam based on the ADA Standards, JR can feel comfortable knowing the 2025 Standards along with any urgent clinical updates announced in 2026.

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Answer A is incorrect: 15.51% chose this answer, “It is recommended that insulin is always stored and kept refrigerated. Can you make
sure you pack your insulin with your lunch cooler pack?” While refrigeration is ideal for insulin storage, insulin does not always need to be refrigerated. Once in use, most insulins, including degludec, are stable at room temperature (below 86F or 30 C). Advising refrigeration may create unnecessary barriers and does not reflect degludec’s stability profile.

Answer B is incorrect: 1.83% chose this answer, “Consider storing insulin in your freezer to allow it to be kept cold and protected when
refrigeration is less reliable.” Freezing damages insulin molecules, making the insulin ineffective and unsafe to use. This option contradicts manufacturer and clinical safety guidance.

Answer C is correct: 41.72% chose this answer, “If bringing your insulin with you every day helps you remember to take it, it should be
okay to leave the pen you’re using in your workbag when at the office or at home.” Insulin degludec is stable at room temperature below 86°F (30°C) for up to 56 days (8 weeks) once opened. If SJ’s work bag is not exposed to excessive heat or freezing, keeping the pen there is acceptable and may in fact support consistent dosing. We can also calculate SJ’s monthly insulin pen usage (15 units per day + 2 unit prime per injection = 510 units per month or 2 pens per month), knowing he will easily use more insulin than open insulin pen stability time window.

Answer D is incorrect: 40.94% chose this answer, “Once open, insulin pens can be stored and used at room temperature for up to 28 days, you should be okay with bringing it with you in your work bag.” While it is correct that insulin does not always require refrigeration once in use, the specific duration varies by insulin type; degludec lasts longer than 28 days.

To learn more, check out our Insulin Storage Cheat Sheet.

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Answer A is correct: 62.93% chose this answer, “Fatty stools and insulin sensitivity.” Steatorrhea, or fatty stools, results from poor fat digestion due to insufficient pancreatic enzymes—a key feature of type 3c diabetes, with it’s hallmark exocrine enzyme insufficiency. People with diabetes type 3c, can also be very insulin sensitive, since they don’t have the insulin resistance associated with type 2 diabetes. In addition to diabetes medications, they may benefit from pancreatic enzyme replacement therapy (PERT) to improve absorption of fatty foods and decrease steatorrhea.

Answer B is incorrect: 15.47% chose this answer, “Frequent urination and insulin resistance.” Frequent urination and insulin resistance is associated with type 2 diabetes. With type 3c, since many of the beta cells are destroyed due to trauma not genetics, these individuals may have polyuria from hyperglycemia, but they are not usually insulin resistant, just deficient.

Answer C is incorrect: 7.47% chose this answer, “Neuropathy and unexplained weight gain.” They may get neuropathy if their blood glucose is elevated for a long period of time, but that is not part of the differential. People with type 3c usually experience weight loss due to the lack of pancreatic enzymes that help with nutrient absorption.

Answer D is incorrect: 14.13% chose this answer, “Family history of diabetes type 3c and polyphagia.” Type 3c diabetes is not passed on through genes, it is due to exocrine damage to the pancreas which can lead to destruction of beta cells. Most common causes of diabetes type 3c include pancreatitis, cystic fibrosis, pancreatic cancer, and hemochromatosis. Some people could experience extreme hunger if their glucose levels are elevated for an extended period of time.

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Learn more about Diabetes Type 3c in our “From the Gut to the Butt Webinar”

Recorded and Ready for Viewing. 

Answer A is incorrect: 16.58% chose this answer, “The recommended time in range is >70% within 70–180 mg/dL. MT’s TIR is slightly below target and her time below range is above the recommended targets, indicating adjustments are needed to reduce hypoglycemia.” Answer A is incorrect. The answer uses non-pregnancy CGM target range of 70–180 mg/dL. Pregnancy target range for individuals with type 1 diabetes are lower, keep reading for the best answer.

Answer B is correct: 51% chose this answer, “The recommended time in range is >70% within 63–140 mg/dL; MT’s TIR is slightly below target and her time below and above range is above the recommended goal.” Answer B is correct. Based on the 2025 ADA Standards of Care the recommended time in range targets for individuals with type 1 diabetes during pregnancy is >70% between 63-140 mg/dL, < 4% under 63 mg/dL with < 1 % under 54 mg/dL, and < 25% over 140 mg/dL.

Answer C is incorrect: 19.55% chose this answer, “The recommended time in range is >80% within 63–140 mg/dL; MT’s TIR is below target, with fluctuations of hypo and hyperglycemia.” Answer C is incorrect. The time in range target is above the evidenced-based
minimum and MT is having frequent hypoglycemia in addition to hyperglycemia, both outside the goal ranges.

Answer D is incorrect: 12.87% chose this answer, “The recommended time in range is >80% within 70–180 mg/dL to prevent fetal
complications; MT’s TIR is significantly below the recommended Standard of Care target.” Answer D is incorrect. The recommended target range for individuals with type 1diabetes during pregnancy is 63-140 mg/dL as stated above.

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Answer A is incorrect: 15.69% chose this answer, “Next time, make sure to take your insulin and put it in the refrigerator for safekeeping.” This approach goes under the compliance model, where the healthcare professional only provides one way instruction without considering the individuals insights and problem solving skills. We want to work toward a person-centered collaborative approach to foster connection.

Answer B is correct: 63.10% chose this answer, “Before we dive into the diabetes stuff, tell me about your fishing trip.” Great job! This is the best answer. By asking RT about their fishing trip first, you let them know you are interested in their life experiences and this helps to establish a connection. After hearing about the trip, we might pivot and say something like, “Do you want to discuss strategies to bring your insulin on your next fishing trip?”

Answer C is incorrect: 9.27% chose this answer, “I’m worried that you’re going get complications due to high blood glucose levels.” Although this statement shows concern, it is unlikely that RT will get diabetes complications from not taking their insulin for a few days. This statement could lead to feelings of shame and failure, and may close the door to making a meaningful connection.

Answer D is incorrect: 11.94% chose this answer, “I’m just relieved you did not go into diabetes ketoacidosis.” This statement could evoke feelings of guilt and shame, that could close the door to future communication. And if RT has type 2 diabetes, the chance of DKA is minimal. Instead of focusing on the HCP feelings, let’s check in with RT and explore problem solving strategies for future trips that would work for them.

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!