Rationale of the Week Archives - Page 21 of 30

Rationale of the Week | Cost of the Insulin Patent?

This month, we are quizzing test takers on the history of diabetes. Our November 16th Question of the week quizzed test takers on the cost of the insulin patent. 74% of respondents, chose the best answer. We are excited to share this info with you in celebration of National Diabetes Month.

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:

On January 23rd, 1923, Dr.’s Banting, Best, and Collip were awarded the patent for insulin.

How much did Banting, Best, and Collip each charge the University of Toronto for their share of the insulin patent?

Answer Choices:

They sold the patent for insulin for one million dollars to be divided by the 3 patent owners.
They retained the patent for insulin to ensure exclusive rights.
They sold the patent for insulin for $1 each.
They sold the patent for insulin to pharmaceutical companies for an undisclosed amount.

As shown above, the most common choice was option 3, the second most common answer was option 2, then option 4, and finally option 1.

Price of the Insulin Patent

On January 23rd, 1923 Banting, Best, and Collip were awarded the American patents for insulin. They sold the patent to the University of Toronto for $1 each. Banting notably said: “Insulin does not belong to me, it belongs to the world.” His desire was for everyone who needed access to it to have it.

In order for the insulin to be mass-produced and widely available, the pharmaceutical company Eli Lilly and Co. were given the right to do so. Currently, Eli Lilly, Sanofi, and Novo Nordisk are the major insulin producers. Insulin is no longer extracted from beef and pork pancreases. Now companies use E. coli and yeast to produce insulin through recombinant DNA therapy.

With insulin patents expiring, we are now seeing the approval of biosimilar insulins that come with lower price tags. This lower-cost insulin keeps Dr. Banting’s dream alive, which is to make insulin a gift that belongs to the world.

Answer 1 is incorrect. 8.22% chose this answer, “They sold the patent for insulin for one million dollars to be divided by the 3 patent owners.”

Answer 2 is incorrect. 9.59% of you chose this answer, “They retained the patent for insulin to ensure exclusive rights.”

Answer 3 is correct. 73.52% of respondents chose this answer, “They sold the patent for insulin for $1 each.” YES, GREAT JOB. This is the BEST ANSWER!

Finally, Answer 4 is incorrect. 8.68% chose this answer, “They sold the patent for insulin to pharmaceutical companies for an undisclosed amount.”

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 | What does “Diabetes Mellitus” really mean?

This month, we are quizzing test takers on the history of diabetes. Our November 9th Question of the week quizzed test takers on Diabetes Mellitus. 49% of respondents, chose the best answer. We are excited to share this info with you in celebration of National Diabetes Month.

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:

The term diabetes mellitus is derived from Greek and Latin languages, with roots dating back to the Greek physician Demetrius of Apamea in 129-199 AD.

Which is the most accurate translation of the term diabetes mellitus in English?

Answer Choices:

Passing through of honey or sweetness.
Siphoning of sugared urine.
Wasting disease due to sweetness.
Evil urinating disease.

As shown above, the most common choice was option 1, the second most common answer was option 3, then option 2, and finally option 4.

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” that seem so familiar to you, right under your nose. Your job is to weed through, eliminate FALSE answers and then choose the BEST answer.

A short history of the evolution of the term “Diabetes mellitus“
The ancient Egyptians described clinical features of diabetes over 3000 years ago. Indian physicians called it madhumeha (‘honey urine’) because it attracted ants.

However, the term “diabetes” (Greek for ‘siphon’) was first used by Greek physician Demetrius of Apamea in 129-199 AD. The findings of sweet urine and blood was first noticed by ancient Indians. A few thousand years later, the Latin word “mellitus” (‘sweet like honey’) was coined by the British Surgeon-General, John Rollo in 1798.

History of the Islets and Insulin:
Paul Langerhans, 22 and working on his medical doctorate in 1869, identified the beta cells that came to be known as the ‘islets of Langerhans’. The name insulin was based on the secretions of the islets (Latin, insula = island). The term insulin was coined in 1909 and 1910, individually by de Mayer and Schaefer, respectively. Read more in this article, The History of Diabetes Mellitus, 2013 by Ritu Lakhtakia.

Answer 1 is correct. 48.99% chose this answer, “Passing through of honey or sweetness.” YES, GREAT JOB! The term “diabetes” is Greek for ‘siphon or passing through and the “mellitus” is Latin for “sweet like honey”.

Answer 2 is incorrect. 19.89% of you chose this answer, “Siphoning of sugared urine.” This is a juicy answer, but there is no Latin or Greek word for “urine” in the term “diabetes mellitus”.

Answer 3 is incorrect. 22.73% of respondents chose this answer, “Wasting disease due to sweetness.” Another juicy answer, but there is no Latin or Greek word for “wasting disease” in the term diabetes mellitus.

Finally, Answer 4 is incorrect. 8.39% chose this answer, “Evil urinating disease.” Some people might favor this term, but the term “diabetes mellitus” only describes the passing through of honey as a medical observation. There is no judgment associated with it.

Want to learn more about this fascinating topic? Read more in this article, The History of Diabetes Mellitus, 2013 by Ritu Lakhtakia.

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

Want more practice questions? Enroll in our

Test Taking Practice Exam Toolkit Webinar
20 Sample Practice Questions

Join us live December 16, 2021, for live webinar 2022 updates

You are invited to join Coach Beverly for this FREE Webinar. And, if you want to have access to an additional 220+ sample practice online questions, you can purchase the complete Test Taking Toolkit.

For many of us, taking the certification exam is a nerve-wracking process.

2 Ways to Join Test Taking Webinar

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This includes a review of 20 sample test questions with test-taking strategies. This does not include access to the recorded webinar or the practice questions.

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Rationale of the Week | The First Person to Receive Insulin?

This month, we are quizzing test takers on the history of diabetes and the discovery of insulin. Our November 2nd Question of the week quizzed test takers on the first insulin injections in humans. 47% of respondents, chose the best answer. We are excited to share this info with you in celebration of National Diabetes Month.

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:

Which of the following statements is true regarding the first experiments using insulin in humans?

Answer Choices:

Since insulin worked successfully on dogs, no experimentation was needed on humans to gain approval.
Leonard Thompson, a 14-year-old received the first successful insulin injection in January 1922.
The initial insulin was derived from the exocrine cells of ligated canine and porcine pancreases.
Elizabeth Hughes was the first insulin recipient in 1921 but the insulin formulation didn’t work to lower her glucose until 1922.

As shown above, the most common choice was option 2, the second most common answer was option 3, then option 4, and finally option 1.

Getting to the Best Answer

Answer 1 is incorrect. 8.16% chose this answer, “Since insulin worked successfully on dogs, no experimentation was needed on humans to gain approval.” Insulin’s approval was certainly fast tracked, but experiments were conducted on animals first, than humans, before releasing for widespread use and saving the lives of millions.

Answer 2 is correct. 47.77% of you chose this answer, “Leonard Thompson, a 14-year-old received the first successful insulin injection in January 1922.” YES, great job. On January 11, 1922, Leonard Thompson was the first person to receive insulin when he was only 14 years of age. The first injection caused an allergic reaction due to impurities. After James Collip improved the insulin refinement process, the second dose of canine pancreas extract was delivered to the young patient twelve days after the first. Thompson’s health rapidly improved and he lived another 13 years on insulin injections, dying at the young age of 26 due to pneumonia.

Answer 3 is incorrect. 27% of respondents chose this answer, “The initial insulin was derived from the exocrine cells of ligated canine and porcine pancreases.” This is a juicy sounding answer! However, insulin was derived from the endocrine cells of dogs, ox and porcine, to produce insulin; not the exocrine cells that produce digestive enzymes.

Finally, Answer 4 is incorrect. 17.06% chose this answer, “Elizabeth Hughes was the first insulin recipient in 1921 but the insulin formulation didn’t work to lower her glucose until 1922.” Another juicy answer since it has some elements of truth, however Elizabeth was not the first person to receive insulin therapy. Elizabeth developed diabetes in 1918 at age 11 and by the fall of 1922, she weighed only 45 pounds, due to her body’s inability to store energy and the strict 800 calorie diet she followed to prevent ketosis. Elizabeth arrived in Toronto in August 15, 1922 and received insulin injections from Dr. Banting and she recovered rapidly. She returned home to Washington D.C . Thanksgiving Day 1922 on a 2200 calorie meal plan and insulin injections. She lived to the age of 73, and received over 42,000 insulin injections over her lifetime. You can read more in the book, Breakthrough, which chronicles Elizabeth Hughes, the discovery of insulin and the Making of a Medical Miracle.

More Reading on the Discovery of Insulin

The Discovery of Insulin – Vecchio I, Tornali C, Bragazzi NL, Martini M. The Discovery of Insulin: An Important Milestone in the History of Medicine. Front Endocrinol (Lausanne). 2018;9:613. Published 2018 Oct 23. doi:10.3389/fendo.2018.00613

Breakthrough, which chronicles Elizabeth Hughes, the discovery of insulin and the Making of a Medical Miracle.

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!

Enroll in our Virtual DiabetesEd Specialist Program!

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Team of expert faculty includes:

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Deluxe Virtual Program for $459 includes:

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Diabetes Educator Course 2021 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
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2021 Diabetes Educator Course Flyer & Schedule (subject to change)

Team of Experts: Our team of expert faculty has been fine-tuning this course for over fifteen years and we know what you need to succeed! In addition to informative lectures, we also use group activities and case studies to highlight the essential knowledge, skills, and strategies needed to succeed in diabetes education today!

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Test Taking Toolkit – Over 200 sample test questions!
Level 2 – Assessing and Promoting Well-Being: From Population Health to a Person-Centered Approach 1.5 CEs
Level 2 – Hospital and Hyperglycemia 1.5 CEs
Level 2 – Hyperglycemic Crisis, DKA and HHS Standards 1.0 CEs
Level 2 – Meds Management Update for Type 2 – 1.5 CEs
Level 2 – Setting up a Successful Diabetes Program 1.5 CEs
Level 2 – Pregnancy and Diabetes 1.5 CEs
Level 2 – From Tots to Teens – Diabetes Standards 1.5 CEs
Level 2 – Older Adults and Diabetes 1.5 CEs
Mindfulness and Compassion in the Diabetes Encounter – 1.0 CE

2021 Diabetes Educator Course Flyer & Schedule (subject to change)

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Rationale of the Week | Best strategy to Prevent Hypo in Hospital?

Our September 28th Question of the week quizzed test takers on the best strategy to prevent hypo in the hospital. 64% of respondents, chose the best answer. We are excited to share info so you can pass on helpful info to people living with diabetes and your hospital colleagues.

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: As a diabetes specialist at a local hospital, one of your quality improvement goals is to prevent nocturnal hypoglycemia.

Which of the of following policy changes would most likely lower rates of overnight and morning hypoglycemia?

Answer Choices:

Make sure the medication carts are stocked with glucagon rescue kits.
Eliminate insulin sliding scale and encourage basal insulin therapy.
Collaborate with dietary to make sure all people with diabetes get protein plus carb snack.
Implement a plan to decrease basal insulin dose if morning glucose is less than 100 mg/dl.

As shown above, the most common choice was option 4, the second most common answer was option 3, then option 2, and finally option 1.

Getting to the Best Answer

If you are thinking about taking the certification exam, it is helpful to know the goals of care and considerations for people with diabetes in the acute care setting. 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” that seem so familiar to you, right under your nose. Your job is to weed through the to choose the BEST answer.

Answer 1 is incorrect. 2.88% chose this answer, “Make sure the medication carts are stocked with glucagon rescue kits.” Since the question is asking “what policy changes would most likely lower rates of overnight and morning hypoglycemia“, this is answer does not address the problem in the question; what policy change would PREVENT hypoglycemia. Having glucagon rescue meds would treat hypoglycemia, but not prevent it.

Answer 2 is incorrect. 14.12% of you chose this answer, “Eliminate insulin sliding scale and encourage basal insulin therapy.” It is true that the ADA does not recommend insulin sliding scale for inpatient management of diabetes since it is not an effective way to manage hyperglycemia. In addition, since sliding scale is usually administered with meals, it is not the most likely culprit causing morning hypoglycemia. Generally speaking, too much basal insulin is usually the cause of morning hypoglycemia. So stopping the sliding scale and encouraging basal insulin, is not the BEST answer to address the question and reduce morning hypoglycemia.

Answer 3 is incorrect. 19.22% of respondents chose this answer, “Collaborate with dietary to make sure all people with diabetes get protein plus carb snack.” Studies have shown that providing a carb snack at bedtime can decrease risk of nocturnal and morning hypoglycemia. But, if the basal insulin dose is too much, the person could still experience hypoglycemia, even with a carb snack. P.S, adding protein has not been shown to sustain the action of the carb and enhance hypoglycemia prevention. We never want to “feed” the insulin. We always want to give the least amount of insulin to get glucose to target and keep people safe.

Finally, Answer 4 is correct. 63.78% chose this answer, “Implement a plan to decrease basal insulin dose if morning glucose is less than 100 mg/dl.” YES, this is the BEST Answer. GREAT JOB. To keep inpatients safe, creating a policy that notifies the medical team when the morning glucose level is less than 100 mg/dL coupled with a reduction of basal insulin dose, would be an effective strategy to prevent morning hypoglycemia.

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!

Enroll in our Virtual DiabetesEd Specialist Program!

Did you miss the live conference? No worries!

You can register now to watch on-demand

Click here to learn more and get started!

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

In addition to informative lectures, we also use group activities and case studies to highlight the essential knowledge, skills, and strategies needed to succeed in diabetes education today!

Virtual DiabetesEd Specialist Conference Deluxe | Recorded & Ready for Viewing! | 30+ CEs

Deluxe Virtual Program for $459 includes:

Presentations by our team of experts
Q & A Session with the instructor after each webinar
State-of-the-art review of current diabetes care and technology.
Resources for each session
Access to FREE podcast and recorded webinars within a week of each live session for one full year.

+Plus Syllabus, Standards and Swag:

Diabetes Educator Course 2021 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
DiabetesEd Services highlighters, Medication PocketCard and Pen

2021 Diabetes Educator Course Flyer & Schedule (subject to change)

Bonus Courses worth 12+ CEs, FREE

When you register for our Virtual Course, you have immediate access to these Bonus DiabetesEd University Online Courses – for FREE!

Test Taking Toolkit – Over 200 sample test questions!
Level 2 – Assessing and Promoting Well-Being: From Population Health to a Person-Centered Approach 1.5 CEs
Level 2 – Hospital and Hyperglycemia 1.5 CEs
Level 2 – Hyperglycemic Crisis, DKA and HHS Standards 1.0 CEs
Level 2 – Meds Management Update for Type 2 – 1.5 CEs
Level 2 – Setting up a Successful Diabetes Program 1.5 CEs
Level 2 – Pregnancy and Diabetes 1.5 CEs
Level 2 – From Tots to Teens – Diabetes Standards 1.5 CEs
Level 2 – Older Adults and Diabetes 1.5 CEs
Mindfulness and Compassion in the Diabetes Encounter – 1.0 CE

2021 Diabetes Educator Course Flyer & Schedule (subject to change)

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!

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Rationale of the Week | “My life is a mess”

Our October 19th Question of the week quizzed test takers on a person who is clearly in crisis. 36% of respondents, chose the best answer. We feel it is important to share this rationale of the week, so you can advocate for people struggling with mental health while trying to manage their diabetes.

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 26 years old with newly diagnosed diabetes. JR keeps missing appointments and when you finally get a hold of them on the phone, they start crying and say “my life is a mess”. JR is struggling with addiction, periods of houselessness and extra weight in addition to diabetes.

Based on this information, what is the most likely barrier to JR engaging in self-care?

Answer Choices:

Adverse Childhood experiences (ACEs)
JR is struggling with depression
Diabetes distress is at the core of the listed behaviors
Grieving and denial of diabetes diagnosis

As shown above, the most common choice was option 4, the second most common answer was option 1, then option 2, and finally option 3.

Getting to the Best Answer

If you are thinking about taking the certification exam, it is helpful to know the goals of care and mental health considerations for people with diabetes . 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” that seem so familiar to you, right under your nose. Your job is to weed through the to choose the BEST answer.

Answer 1 is correct. 36.25% chose this answer, “Adverse Childhood Experiences (ACEs).” YES, Good job, this is the BEST Answer. JR is missing appointments and when you finally get a hold of them, they say, “my life is a mess”. In addition, we know that JR is struggling with addiction, periods of houselessness and extra weight in addition to diabetes. These are all signs that JR has lived through adverse childhood experiences and toxic stress. By addressing this and providing resources, we can help JR move toward healing. See our ACE Resource page for more info.

Answer 2 is incorrect. 28.11% of you chose this answer, “JR is struggling with depression.” Is this situation, depression can be considered, but we don’t hear the hallmark statements associated with depression – “Loss of pleasure in things that used to bring them joy or feeling down or hopeless”. ACE’s are a better match for what JR is describing. See our Psychosocial Care Resource Page– for articles and screening tools.

Answer 3 is incorrect. 19.35% of respondents chose this answer, “Diabetes distress is at the core of the listed behaviors.” Is this situation, diabetes distress certainly can be considered, but it doesn’t seem to be the driving force behind JR’s struggle with addiction, periods of houselessness and extra weight. Diabetes distress is more heavily associated with diabetes specific related behaviors (fear of hypo, provider doesn’t understand my diabetes, etc.). See our Psychosocial Care Resource Page– for articles and the diabetes distress screening tool.

Finally, Answer 4 is incorrect. 16.29% chose this answer, “Grieving and denial of diabetes diagnosis.” Is this situation, grieving and denial can certainly can be considered, but it doesn’t seem to be the driving force behind JR’s struggle with addiction, periods of houselessness and extra weight. Diabetes denial is more heavily associated with lack of self-care; not checking blood glucose, avoiding medications, eating “whatever”. We don’t hear any of that from this person. The best explanation is that JR has lived through adverse childhood experiences and toxic stress. By addressing this and providing resources, we can help JR move toward healing. See our ACE Resource page for more info.

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

Want to learn about this important topic?

Join Coach Bev for an honest conversation on
The Impact of Adverse Childhood Experiences on Health

Adverse childhood experiences (ACE) are associated with an increased risk of diabetes, heart disease, cancer and a variety of other health consequences for adults. This session reviews how diabetes care and education specialists can provide screening, assessment, and trauma-informed care to individuals who experienced ACEs and are living with toxic stress. We will explore strategies to address ACES and improve outcomes for individuals and communities. Throughout, we will focus on supporting self-care with a focus on recognizing and promoting resilience.

Topics include:

Discuss the benefits of assessing Adverse Childhood Experiences (ACE) in individuals with diabetes.
State the relationship between ACE Scores and risk of future health complications.
Describe a person-centered approach to fostering resilience and self-care for individuals with toxic stress.
Identify two strategies to provide trauma-informed care in your work setting.

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Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator and a nationally recognized diabetes expert.

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Rationale of Week | 90 years old and hungry. Best action?

Our October 12th Question of the week quizzed test takers on the best strategy for a 90-year-old who states “they feel hungry” all the time. 76% of respondents, chose the best answer. We are excited to share this rationale of the week, so you can advocate for people living with diabetes.

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: HM is living with type 2 diabetes and is 90 years old with a BMI of 32. HM’s most recent A1c was 9.6% and their GFR is 16. The provider stopped the metformin due to the diminished kidney function and HM is currently on no diabetes medications. To manage HM’s blood sugar, the provider ordered a low-calorie restrictive meal plan for HM. HM was a chef for 40 years and tells you, “they feel hungry” all the time. Based on this assessment, you decide to contact the provider.

Which of the following would be the best suggestion?

Answer Choices:

Ask provider to add a bedtime snack to reduce hunger.
Encourage HM to take a short walk after meals to reduce post prandial hyperglycemia.
Reassure HM that limiting calories is the best plan to keep blood glucose on target.
Contact provider with suggestion to start HM on once daily basal insulin.

As shown above, the most common choice was option 4, the second most common answer was option 1, then option 2, and finally option 3.

Getting to the Best Answer

If you are thinking about taking the certification exam, it is helpful to know the goals of care and considerations for people with diabetes across the lifespan. 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” that seem so familiar to you, right under your nose. Your job is to weed through the to choose the BEST answer.

Answer 1 is incorrect. 11.13% chose this answer, “Ask provider to add a bedtime snack to reduce hunger.” While it is true that HM is hungry, a bedtime snack is not the best solution since it might contribute to already elevated blood sugars. We need to figure out a way to get blood glucose levels to goal while providing adequate nutrition.

Answer 2 is incorrect. 8.40% of you chose this answer, “Encourage HM to take a short walk after meals to reduce post prandial hyperglycemia.” Post meal walks are an excellent way to decrease post meal blood sugars, but they most likely won’t be enough to get HM out of glucose toxicity. Given that HM’s A1c is 9.6%, the average blood sugars are around 230 mg/dl. HM will need more than post meal jaunts to get blood glucose to target.

Answer 3 is incorrect. 4.30% of respondents chose this answer, “Reassure HM that limiting calories is the best plan to keep blood glucose on target.” In this situation, we need to consider quality of life issues. Given that HM is 90 years old and they were a chef, limiting calories to the point of hunger is not a strategy that considers HM’s needs, values and wants. A better approach would be to create a person-centered solution.

Finally, Answer 4 is correct. 76.17% chose this answer, “Contact provider with suggestion to start HM on once daily basal insulin.” YES, GREAT JOB. In this situation we requested that the provider start HM on 10 units of 70/30 insulin in the morning. This simple intervention will help HM in numerous ways:

allows more food flexibility
renal protection due to lower glucose levels
decreased nerve pain
increase HM’s energy
improve HM’s quality of life.

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

Want to learn about this question and more as you’re studying for the CDCES Exam?

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Rationale of the Week | Intensive Insulin Therapy with A1c 6.2%

Our September 21st Question of the week quizzed test takers on Intensive Insulin Therapy with A1c 6.2%. Three quarters (74%) of respondents, chose the best answer. We are excited to share info so you can pass on correct info to people living with diabetes and your colleagues.

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: HR is a 78-year-old with a stroke and limited cognition with diabetes for 8 years and is on intensive insulin therapy: HR takes bolus insulin at meals and basaglar at night. HR has an A1c is 6.2% and employs a part time caretaker.

What is the best response in this situation?

Answer Choices:

Start HR on an insulin pump and CGM to prevent hypoglycemia.
Discuss de-intensifying insulin regimen.
Using a strength-based approach, reinforce the importance of keeping the A1c less than 7%.
Evaluate for diabetes related distress.

As shown above, the most common choice was option 2, the second most common answer was option 4, then option 1, and finally option 3.

Getting to the Best Answer

Answer 1 is incorrect. 8.20% chose this answer, “Start HR on an insulin pump and CGM to prevent hypoglycemia.” This is not the best answer because we want to provide person-centered care based on the unique situation of this individual. HR has a history of a stroke, limited cognition and relies on a part time caregiver. It doesn’t seem realistic to provide pump and CGM training to HR given the cognitive limitations and the caregiver is only part-time. It is unlikely that the two of them would be comfortable enough or have the skill level to help oversee this complex technology and changing insertion sites.

Answer 2 is correct. 74.17% of you chose this answer, “Discuss de-intensifying insulin regimen.” YES. This is the best answer. Since HR is on multiple daily injections and has an A1c in the low 6% range, we know they are most likely experiencing episodes of hypoglycemia. To address this, we would need to discuss goals of care with HR and their caregivers and share our concerns about the risk and danger of hypoglycemia. We need to de-intensify this management plan. Based on the outcome of the discussion with HR, this could be accomplished by: reducing the overall insulin dose, switching to twice a day 70/30 insulin, or evaluating if oral medications could be trialed to reduce the need for insulin.

Answer 3 is incorrect. 6.46% of respondents chose this answer, “Using a strength-based approach, reinforce the importance of keeping the A1c less than 7%.” Using a strength-based approach is always a good idea, but the main issue in this question is that HR’s A1c is only 6.2%. According to the ADA Standards of Care, the A1c target in this situation would be individualized based on safety considerations, quality of life, and the goals and values of the person living with diabetes. For older, frail individuals at risk of hypoglycemia, a safer A1c target would be 7% – 8%.

Finally, Answer 4 is incorrect. 11.17% chose this answer, “Evaluate for diabetes-related distress.” Even though it is always important to consider people’s emotional response to diabetes, this answer does not address the key issue presented in this question. The first priority would be to make sure HR is safe, with a reduced risk of hypoglycemia and a realistic insulin regimen.

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!

Enroll in our Virtual DiabetesEd Specialist Program!

Did you miss the live conference? No worries! You can register now to watch on-demand

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

In addition to informative lectures, we also use group activities and case studies to highlight the essential knowledge, skills, and strategies needed to succeed in diabetes education today!

Two Registration Options

Virtual DiabetesEd Specialist Conference Deluxe | Oct. 6-8 | 30+ CEs

Deluxe Virtual Program for $459 includes:

Presentations by our team of experts
Q & A Session with the instructor after each webinar
State-of-the-art review of current diabetes care and technology.
Resources for each session
Access to FREE podcast and recorded webinars within a week of each live session for one full year.

+Plus Syllabus, Standards and Swag:

Diabetes Educator Course 2021 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
DiabetesEd Services highlighters, Medication PocketCard and Pen

2021 Diabetes Educator Course Flyer & Schedule (subject to change)

Virtual DiabetesEd Specialist Conference Basic | Oct. 6-8 | 30+ CEs

Basic virtual program for $359 includes:

Presentations by our team of experts
Q & A Session with the instructor after each webinar
State-of-the-art review of current diabetes care and technology.
Resources for each session
Access to FREE podcast and recorded webinars within a week of each live session for one full year.

2021 Diabetes Educator Course Flyer & Schedule (subject to change)

Bonus Courses worth 12+ CEs, FREE

When you register for our Virtual Course, you have immediate access to these Bonus DiabetesEd University Online Courses – for FREE!

Test Taking Toolkit – Over 200 sample test questions!
Level 2 – Assessing and Promoting Well-Being: From Population Health to a Person-Centered Approach 1.5 CEs
Level 2 – Hospital and Hyperglycemia 1.5 CEs
Level 2 – Hyperglycemic Crisis, DKA and HHS Standards 1.0 CEs
Level 2 – Meds Management Update for Type 2 – 1.5 CEs
Level 2 – Setting up a Successful Diabetes Program 1.5 CEs
Level 2 – Pregnancy and Diabetes 1.5 CEs
Level 2 – From Tots to Teens – Diabetes Standards 1.5 CEs
Level 2 – Older Adults and Diabetes 1.5 CEs
Mindfulness and Compassion in the Diabetes Encounter – 1.0 CE

2021 Diabetes Educator Course Flyer & Schedule (subject to change)

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Rationale of the Week | What Teaching Tip for New Med – finerenone?

Our September 14th Question of the week quizzed test takers on a new med. Less than half, 47% of respondents, chose the correct answer. This was a hard question since this finerenone was only recently FDA approved. We are excited to share info about this med along to you, so you can pass on correct info to people living with diabetes and kidney disease.

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 has a GFR of 43 and lives with type 2 diabetes. JR excitedly brings you an article that talks about finerenone (Kerendia), a newly approved non-steroidal mineralocorticoid receptor antagonist which is indicated for people with chronic kidney disease (CKD) associated with Type 2 diabetes.

If JR is started on this medication, what instruction would you provide?

Answer Choices:

Make sure to take this medication on an empty stomach
Contact the provider if you notice ankle swelling
Notify your provider if you experience a non-productive cough
Avoid taking medication with grapefruit or grapefruit juice.

As shown above, the most common choice was option 3, the second most common answer was option 1, then option 4, and finally option 2.

Getting to the Best Answer

If you are thinking about taking the certification exam, it is helpful to know about newly approved diabetes medications, although it may take at least a year to appear in exams. However, 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” that seem so familiar to you, right under your nose. Your job is to weed through the to choose the BEST answer.

Answer 1 is incorrect. 12.5% chose this answer, “Make sure to take this medication on an empty stomach.” If you don’t know anything about a particular medication and are forced to guess, this answer is pretty unlikely to be the best answer, for one reason. Most meds don’t need to be taken on an empty stomach. Two diabetes related meds, levothyroxine and oral semaglutide DO need to be taken on an empty stomach, but an empty stomach is not required for most other meds. Finerenone can be taken with or without food.

Answer 2 is incorrect. 27.8% of you chose this answer, “Contact the provider if you notice ankle swelling.” This was another juicy answer that we purposefully included. There is a class of diabetes medications, the TZDs (pioglitazone and rosiglitazone) that can cause ankle swelling, so this answer might have seemed familiar to you. Also when trying to find false answers, you may want to consider that it seems unlikely that a medication that slows kidney failure would have edema as a side effect.

Answer 3 is incorrect. 12.2% chose this answer, “Notify your provider if you experience a non-productive cough.” This juicy answer goes with a common blood pressure medication class, ACE Inhibitors, that people with diabetes are often prescribed to manage hypertension. With finerenone, the major consideration is monitoring the potassium in the first month of initiation.

Answer 4 is correct. 47.5% of respondents chose this answer, “Avoid taking medication with grapefruit or grapefruit juice.” GREAT JOB, this is the best answer. Since finerenone is a CYP3A4 substrate, the package insert recommends to avoid taking finerenone with other strong cype3A4 inhibitors. It also advises to avoid taking finerenone with grapefruit or grapefruit juice. Great job!

Want to learn more about finerenone?

Check out our New Updated Med Cheat Sheets 2021 (page 2) and consider attending our Virtual Conference with Dr. Diana Isaacs, who will speak more to this topic. You can also check out our Blog Post on New Meds for Diabetes.

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

Enroll in our Virtual DiabetesEd Specialist Program!

Did you miss the live conference? No worries! You can register now to watch on-demand

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

In addition to informative lectures, we also use group activities and case studies to highlight the essential knowledge, skills, and strategies needed to succeed in diabetes education today!

Two Registration Options

Virtual DiabetesEd Specialist Conference Deluxe | Oct. 6-8 | 30+ CEs

Deluxe Virtual Program for $459 includes:

Presentations by our team of experts
Q & A Session with the instructor after each webinar
State-of-the-art review of current diabetes care and technology.
Resources for each session
Access to FREE podcast and recorded webinars within a week of each live session for one full year.

+Plus Syllabus, Standards and Swag:

Diabetes Educator Course 2021 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
DiabetesEd Services highlighters, Medication PocketCard and Pen

2021 Diabetes Educator Course Flyer & Schedule (subject to change)

Virtual DiabetesEd Specialist Conference Basic | Oct. 6-8 | 30+ CEs

Basic virtual program for $359 includes:

Presentations by our team of experts
Q & A Session with the instructor after each webinar
State-of-the-art review of current diabetes care and technology.
Resources for each session
Access to FREE podcast and recorded webinars within a week of each live session for one full year.

2021 Diabetes Educator Course Flyer & Schedule (subject to change)

Bonus Courses worth 12+ CEs, FREE

When you register for our Virtual Course, you have immediate access to these Bonus DiabetesEd University Online Courses – for FREE!

Test Taking Toolkit – Over 200 sample test questions!
Level 2 – Assessing and Promoting Well-Being: From Population Health to a Person-Centered Approach 1.5 CEs
Level 2 – Hospital and Hyperglycemia 1.5 CEs
Level 2 – Hyperglycemic Crisis, DKA and HHS Standards 1.0 CEs
Level 2 – Meds Management Update for Type 2 – 1.5 CEs
Level 2 – Setting up a Successful Diabetes Program 1.5 CEs
Level 2 – Pregnancy and Diabetes 1.5 CEs
Level 2 – From Tots to Teens – Diabetes Standards 1.5 CEs
Level 2 – Older Adults and Diabetes 1.5 CEs
Mindfulness and Compassion in the Diabetes Encounter – 1.0 CE

2021 Diabetes Educator Course Flyer & Schedule (subject to change)

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