Answer A is incorrect: % 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: % 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: % 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: % 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.

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 incorrect: % chose this answer, “Discuss the insulin pump options that connect with the Dexcom G7 CGM. This will help simplify her transition to pump therapy by minimizing the learning curve when starting an AID system.” Although some insulin pumps are compatible with the Dexcom CGM, switching to a different CGM supplier should not restrict clients from selecting the insulin pump that best suits their needs.

Answer B is incorrect: % chose this answer, “Acknowledge Grace’s interest in insulin pump technology and recommend that she wait until more advanced insulin pump algorithms are available that are easier to use.” Automated insulin delivery systems offer advanced automation. Waiting for future technology will not help Grace improve glycemic control now.

Answer C is incorrect: % chose this answer, “Recommend that Grace use a tubeless pump as it will suit her better due to her work as a nurse and active lifestyle. This will help to avoid tubing issues or the insertion site becoming dislodged.” The type of pump, with or without tubing, is a personal decision and is not based solely on occupation.

Answer D is correct: % chose this answer, “Review with Grace the details of all the available insulin pumps, algorithms, and compatible CGMs so she can make a personalized decision based on her preferences and lifestyle.” Choosing the right insulin pump is a highly personalized decision. Each insulin pump has different variables and CGM connectivity that must be considered. Grace will need to be educated on the available options so she can determine which insulin pump will work best for her.

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 1 is incorrect. 25.14% chose this answer, “It decreases cortisol synthesis in the adrenal cortex, lowering circulating cortisol levels.” As tempting as this answer is, mifepristone does not inhibit cortisol synthesis.

Answer 2 is incorrect. 15.21% of you chose this answer, “It reduces ACTH release from the pituitary, leading to decreased adrenal stimulation.” This medication does not directly reduce ACTH release from the pituatary.

Answer 3 is correct. About 48.73% of respondents chose this, “It blocks glucocorticoid receptors, preventing cortisol from exerting metabolic effects.” Mifepristone is a glucocorticoid receptor antagonist. By competitively binding to glucocorticoid receptors, it prevents cortisol from exerting downstream effects, including increased hepatic gluconeogenesis, peripheral insulin resistance, and lipolysis. This mechanism is particularly useful in people with hypercortisolism and concurrent type 2 diabetes, as it improves insulin sensitivity and lowers blood glucose without lowering circulating cortisol levels.

Finally, Answer 4 is incorrect. 10.99% chose this answer, “It directly enhances insulin secretion and sensitivity, independent of cortisol pathways.” This medication does not act directly on pancreatic β-cells or insulin receptors.

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 1 is incorrect. 9% chose this answer, “Individuals with type 2 diabetes should include regular meals throughout the day to support stabilize blood sugars and prevent hypoglycemia.” Random control trials have indicated that time-restricted eating is a safe and practical dietary approach for individuals with type 1 and type 2 diabetes. While assessment and prevention of hypoglycemia is a priority, MJ’s current medication regimen is of low risk. Even with higher risk medications, such as insulin or sulfonylureas modifications of medication, timing or dose can be made to support safety.

Answer 2 is correct. 86% of you chose this answer, “Review with MJ his motivations for the time-restricted eating plan and assess plan for dietary intake within the eating window.” Great Job! Time-restricted eating can be a safe and effective strategy for MJ. Reviewing motivation and current eating patterns may improve the ability to apply balanced meals within the eating window.

Answer 3 is incorrect. About 3% of respondents chose this, “Encourage a time-restricted eating plan, evidence indicates it is more effective than calorie reduction alone for weight loss and A1c reduction.” While time restricted eating may be a practical strategy, it has not been shown to be superior to continuous energy restricted dietary intake for weight loss and A1c outcomes.

Finally, Answer 4 is incorrect. About 2% chose this answer, “Recommend starting Incretin therapy, such as Ozempic or Mounjaro, to ensure effectiveness of time-restricted eating plan.” While we may consider addition of an incretin therapy to support A1c, weight and cardiovascular risk reduction, time-restricted eating does not require the addition of these medications to be effective.

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!