Best treatment for hypertension? | Last Rationale of the Week for 2020
This is our last post of 2020! We want to thank all of you for your support and participation in our Question and Rationale of the Week! We will see you in 2021 with more exciting questions and rationales. Can’t wait!
Our December 22nd Question asked how to best treat a blood pressure of 162/94 according to ADA Standards of Care. Less than half of respondents, chose the best answer.
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 63, has diabetes, and has a B/P of 162/94 which is repeated on a separate visit. JR also has albuminuria. What would be the recommended pharmacological approach based on the ADA Standards of Care?
Answer Choices:
- Start on DASH Diet plus one blood pressure medication.
- Start ACEi plus ARB.
- Start ACEi or ARB plus another blood pressure medication.
- Avoid diuretics if on an ACEi or ARB.
As shown above, the most common choice was option 3, the second most common answer was option 1, then option 2, and finally option 4.
Getting to the Best Answer
If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. Being familiar with the ADA Standards of Care is critical to pass either the CDCES or BC-ADM exam. The section of CV risk management is especially important, since the leading cause of death in diabetes is heart disease.
Answer 1 is incorrect. 25.11% chose this answer. “Start on DASH Diet plus one blood pressure medication.” Starting this person on the DASH meal plan along with a BP medication are both correct, however, given the extreme hypertension, more action is required.
Answer 2 is incorrect. 16.78% of you chose this answer. “Start ACEi plus ARB.” According to the ADA Standards, it is not recommended to use both of these agents together. The standards recommend to use EITHER an ACEi or ARB plus another blood pressure agent (diuretic, Calcium Channel Blocker, etc) to treat hypertension (see image below).
Answer 3 is correct, 48.52% of you chose this answer “Start ACEi or ARB plus another blood pressure medication.” According to ADA Standards (see image below), a confirmed BP where either the systolic is 160 or greater and the diastolic is 100 or greater, requires the initiation of 2 anti-hypertensive medications. Of course, we would request home blood pressure monitoring, review symptoms of orthostatic hypotension, and encourage lifestyle interventions.
Diabetes specialists have a tremendous opportunity to reduce CV events by being familiar with the standards and advocating on behalf of our clients for needed interventions.
Answer 4 is incorrect, 9.59% of you chose this answer. “Avoid diuretics if on an ACEi or ARB.” ADA standards include adding a diuretic to an ACEi or ARB if blood pressure is not at target (see image below).
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!
Level 1 – Diabetes Fundamentals 2021 Updates
This series is designed for health care professionals who are interested in getting started in diabetes education and for those actively working toward becoming a Certified Diabetes Care and Education Specialist. Each course in this series provides the critical building blocks and foundation for those entering the diabetes field. Plus, they prepare you to advance to our Level 2 Standards of Care Intensive Courses.
Join us for our 2021 Live Webinar Updates. All courses air at 11:30 a.m. (PST)
- January 12, 2021 – Class 1 – Getting to the Nitty Gritty 1.5 CEs
- January 14, 2021 – Class 2 -Nutrition and Exercise 1.5 CEs
- January 19, 2020 – Class 3 – Insulin Therapy & Pattern Management 1.5 CEs
- January 21, 2021 – Class 4 – Meds Overview for Type 2 – 1.5 CEs
- January 26, 2021 – Class 5 – Goals of Care 2020 – 1.5 CEs
- January 28, 2021 – Class 6 – Hypoglycemia, Sick Days, Monitoring, Foot Care 1.5 CEs
Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF and Touro University 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!
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
Rationale of the Week | Why the Sugar Spike?
Our December 15th Question of the week was tricky and over 59% of respondents, chose the best answer.
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: JL is a 78-year-old with type 2 diabetes who has been taking metformin 1000mg BID for the past year. JL checks BG each morning and says it usually ranges from 100 – 138. Her most recent A1c came back at 9.6% and the provider started her on dapagliflozin (Farxiga) 5 mg daily two days ago. JL arrives at the clinic in a panic and says has been checking her blood glucose 3 times a day it has “jumped up to 236 and 242”. The diabetes specialist double-checked and verified random glucose of 249. What is the best explanation?
Answer Choices:
- Dapagliflozin is associated with transient hyperglycemia.
- Double-check kidney function to verify GFR is adequate.
- Discovery of hyperglycemia due to random BG checks.
- Hyperglycemia due to the initiation of steroid therapy.
As shown above, the most common choice was option 3, the second most common answer was option 2, then option 1, and finally option 4.
Getting to the Best Answer
If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. This question lures test takers into trying to make an answer fit. Get rid of wrong answers first and choose the best answer.
Answer 1 is incorrect. 15.53% chose this answer. “Dapagliflozin is associated with transient hyperglycemia.” Dapagliflozin (Farxiga) is a SGLT-2 Inhibitor, also known as a “glucoretic”. It causes excretion of glucose from the renal tubules and is not associated with transient hyperglycemia. As a matter of fact, no diabetes medications cause hyperglycemia.
Answer 2 is incorrect. 17.54% of you chose this answer. “Double-check kidney function to verify GFR is adequate.” It is true that people need to have a GFR of 45 or greater to take Dapagliflozin (Farxiga). However, an inadequate GFR is not associated with glucose spikes. Also, the test question gives no data on GFR, so this makes this a very unlikely best answer.
Answer 3 is correct, 59.44% of you chose this answer “Discovery of hyperglycemia due to random BG checks.” Here are the Diabetes Specialist’s notes regarding JL.
JL stopped by the office today worried about sudden blood sugar elevations of 273 in 284 after starting a new medication on Friday for diabetes.
Dr. started JL on Dapagliflozin (Farxiga) half pill once a day and the patient has been taking it for two days now. JL is nervous about continuing to take it because JL thinks that is causing her blood sugars to elevate. The patient also takes metformin daily.
Before, the patient was only checking her blood sugar once a day and it was always in the morning. Her morning blood sugars were in the 120- 140 range. However, now JL is checking her blood sugars throughout the day and discovered that blood sugars are actually much higher than JL thought because was only checking in the morning. In the office I checked blood sugar it was 251. JL denied fever or cough.
Reassured JL that it was not the Dapagliflozin (Farxiga) causing high blood sugar. Focused on the benefits of Dapagliflozin (Farxiga) including lower blood sugar, lower blood pressure and protection against heart and kidney disease. Reviewed briefly the importance of limiting carbohydrates and juices or sodas until we can get her blood sugars closer to target.
Answer 4 is incorrect, 7.50% of you chose this answer. “Hyperglycemia due to the initiation of steroid therapy.” This is another juicy answer, but since the question doesn’t mention JL is on steroids, 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 fun learning activity!
Level 1 – Diabetes Fundamentals 2021 Updates
This series is designed for health care professionals who are interested in getting started in diabetes education and for those actively working toward becoming a Certified Diabetes Care and Education Specialist. Each course in this series provides the critical building blocks and foundation for those entering the diabetes field. Plus, they prepare you to advance to our Level 2 Standards of Care Intensive Courses.
Join us for our 2021 Live Webinar Updates. All courses air at 11:30 a.m. (PST)
- January 12, 2021 – Class 1 – Getting to the Nitty Gritty 1.5 CEs
- January 14, 2021 – Class 2 -Nutrition and Exercise 1.5 CEs
- January 19, 2020 – Class 3 – Insulin Therapy & Pattern Management 1.5 CEs
- January 21, 2021 – Class 4 – Meds Overview for Type 2 – 1.5 CEs
- January 26, 2021 – Class 5 – Goals of Care 2020 – 1.5 CEs
- January 28, 2021 – Class 6 – Hypoglycemia, Sick Days, Monitoring, Foot Care 1.5 CEs
Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF and Touro University 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!
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*
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 | Hyperglycemic and Ketone Positive. What Intervention MOST Needed?
Our December 8th Question of the week was a question of interventions. Over 71% of respondents, chose the best answer.
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: A 12-year-old with new-onset hyperglycemia presents to the Emergency Room with positive urine ketones and blood sugar of 283. What action is required most immediately?
Answer Choices:
- Contact dietitian to provide macronutrient review.
- Start a person with diabetes on Metformin (Glucophage).
- Draw ABGs and antibodies.
- Provide insulin therapy.
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, the content of this practice test question will set you up for success. The exam questions won’t have 2 right answers, but alcohol and diabetes is expected content on the exam.
Answer 1 is incorrect. 1.98% chose this answer. “Contact dietitian to provide macronutrient review.” All people with diabetes benefit from a consultation with a dietitian. However, in this crisis situation, the first priority is not a macronutrient review. The first priority is to stop ketosis.
Answer 2 is incorrect. 2.31% of you chose this answer. “Start a person with diabetes on Metformin (Glucophage).” Given that this is a teenager with positive ketones, we are suspecting type 1 diabetes. With that information, starting metformin would not be a recommended intervention.
Answer 3 is incorrect, 23.8% of you chose this answer “Draw ABGs and antibodies.” The question asks what action to take immediately. If you chose this answer, you are on the right track. You want to verify a diagnosis of type 1 diabetes by evaluating if they are acidotic and have positive autoantibodies. An immediate action would include checking ABG’s but not antibodies. Antibodies would most likely be drawn after the patient is stabilized.
Answer 4 is correct, 71.9% of you chose this answer. “Provide insulin therapy. ” Elevated blood glucose and positive ketones always indicate that the person is insulin deficient. When there is not enough circulating insulin, the body can’t use glucose for fuel, so it uses fat for fuel which leads to ketone bodies. To stop fat breakdown, immediate insulin infusion is required along with fluids to treat dehydration.
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 more? Register for our
Level 2 – Hyperglycemic Crisis. DKA and HHS 2021 course, which is ready for viewing.
Join Coach Beverly to learn about unexpected causes of hyperglycemia and strategies to get blood glucose levels to goal. Topics include hyperglycemia secondary to medications and insulin deprivation. She also reviews Diabetes Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome, with new information on treating DKA with subq insulin therapy. Treatment strategies for all situations are included.
Topics include:
- Common causes of hyperglycemic crises.
- The difference and similarities between DKA and HHS and treatment strategies
- Causes and treatment of hyperglycemic crises.
Can’t join us live?
Don’t worry, we will send you a link to the recorded version.
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!
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*
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 | Alcohol and Holidays
Given that people with diabetes might have a drink or two during the season, we thought that this was an important topic to discuss further. Our December 1st Question of the week was a question of alcohol consumption during the holidays. Over 60% of respondents, chose the best answer.
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: JL has diabetes and injects insulin 2-3 times a day. JL is at a holiday party and is struggling with wanting a holiday spirit. Which of the following is the best approach for JL?
Answer Choices:
- A. JL is on insulin and needs to avoid alcohol.
- B. JL needs to take extra insulin to cover alcohol.
- C. Wine is a better choice than a margarita.
- D. For every alcohol drink, JL needs to eat 15 gms of carb.
- E. Both C & D.
As shown above, the most common choice was option 5, the second most common answer was option 4, then option 3, then option 2, and finally option 1.
Getting to the Best Answer
If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. The exam questions won’t have 2 right answers, but alcohol and diabetes is expected content on the exam.
Answer 1 is incorrect. 5.04% chose this answer. “JL is on insulin and needs to avoid alcohol.” Based on the American Diabetes Association standards of care, people with diabetes on insulin can include alcohol as part of their meal plan.
The current recommendations are; women with diabetes limit their alcohol consumption to one drink a day or less and men with diabetes limit consumption to two or fewer drinks a day.
There are side effects to consider. Alcohol can worsen triglyceride levels, intensify neuropathic pain, and lead to unwanted weight gain. Plus, it can increase the risk of hypoglycemia. So, the decision to consume spirits is a person-centered decision, based on individual needs and health status.
One serving of alcohol =
- 5 ounces of wine
- 1.5 ounces of hard liquor
- 12-ounce beer
Answer 2 is incorrect. 5.98% of you chose this answer. “JL needs to take extra insulin to cover alcohol.” Alcohol can cause hypoglycemia for hours after consumption. Alcohol metabolism in the liver delays the release of glycogen stores and can lead to low circulating glucose levels. Some people with type 1 diabetes may even need to adjust their insulin dose at a meal if consuming alcohol.
People with type 1 diabetes need to be extra cautious if their before bed glucose is elevated after consuming alcohol. Before giving extra insulin to treat nighttime high glucose, remind them that glucose levels will trend down overnight with alcohol on board, and they probably don’t need that extra bolus of insulin.
Answer 3 is correct, but so is answer 4. “Wine is a better choice than a margarita.” Wine is a better choice since it does not have all the extra sugar and carbohydrates of a margarita. Wine consumption has a more predictable outcome whereas figuring out how much carbohydrate is in a margarita can be tricky. Mixed sugary drinks may cause blood glucose levels to rise initially than drop, later on, making management more difficult.
Answer 4 is correct, but so is answer 3. “For every alcohol drink, JL needs to eat 15 gms of carb.” Since we know that alcohol can lead to hypoglycemia for those who are on insulin therapy or take a sulfonylurea, coupling each of their favorite adult beverages with 15 gms of carb can prevent unwanted hypoglycemia.
Another issue is that the signs of hypoglycemia can mirror the signs of intoxication. Encourage people to keep a close eye on their CGM or meter results when imbibing. And include their friends in on helping to detect and treat hypoglycemia to keep safe during celebrations.
Answer 5 is correct. 60.94% chose this answer. “Both C & D.”
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 exam practice questions? Enroll in our Test Taking Toolkit with 220+ Practice Questions!
“This is one of the best review courses I’ve ever taken.”
“I learned so much from the CDCES Exam Prep Toolkit. I now have an assessment after taking the practice exam on the areas I need to focus my studying.”
Student Feedback
Whether you are preparing for the CDCES or BC-ADM exam, this test-taking toolkit is designed to prepare you for success. This toolkit includes two courses with over 200 practice questions to help you prepare and simulate the exam. Plus, we have added a FREE bonus course, Language, and Diabetes – What we say matters. Coach Beverly added this course because she believes it contains critical content for the exam and for our clinical practice!
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!
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*
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 | December 3, 2020
Our November 24th Question of the week was crazy hard and super simple at the same time. Less than half, 44% of respondents, chose the best answer, We thought that this was an important topic to discuss further, so we can pass on correct info to 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: JR is going to stay home for Thanksgiving and decided to prepare a fantastic dinner. JR has type 1 diabetes and injects bolus insulin before each meal. JR takes 1 unit of insulin for each 10 gms of carbohydrates.
Using myfitnesspal to calculate JRs carb intake for the following festive meal, how much insulin would JR need to inject?
- ½ cup cranberry sauce
- ½ cup mashed potatoes
- ½ cup of buttered corn
- 1 small dinner roll
- A big scoop of green beans
- 4 ounces of turkey breast
- ½ cup of stuffing
- 5 ounces Vendagne Chardonna
Answer Choices:
- 11.8 units
- 12.3 units
- 11 units
- 10.8 units
- I have no idea, pass the pumpkin pie
As shown above, the most common choice was option 3, the second most common answer was option 4, then option 2, then option 1, and finally option 5.
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 may lure you in to choosing a more complicated answer, when the simplest answer may be the best choice. That is true for this question.
The most important feature of this question is “how much insulin would JR need to inject?” Since he is injecting insulin, no syringe or pen would allow him to inject 1/10th of a unit. Based on this info, the only plausible answer is 11 units or answer 3. But, for fun, here is the carb calculation.
JR will be eating 109 gms of carb. His insulin to carb ratio is 1/10. 109 / 10 = 10.9 units of insulin, then round up to 11 units.
- ½ cup cranberry sauce – 40 gms
- ½ cup mashed potatoes – 15 gms
- ½ cup of buttered corn – 11gms
- 1 small dinner roll – 15 gms
- A big scoop of green beans – 7gms
- 4 ounces of turkey breast – 0
- ½ cup of stuffing – 21 gms
- 5 ounces Vendagne Chardonnay –
- Total carb = 109 gms Insulin needed 109 / 10 = 10.9 units. Then round up to 11 unit injection.
Answer 1 is incorrect. 14.46% chose this answer. “11.8 units .”
Answer 2 is incorrect. 17.77% of you chose this answer. “12.3 units.”
Answer 3 is correct. 44.08% of respondents chose this. “11 units.”
Answer 4 is incorrect. 19.49% chose this answer. “10.8 units.”
Answer 5 is incorrect. 4.88% chose this answer. ” I have no idea, pass the pumpkin pie.”
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 exam practice questions? Enroll in our Test Taking Toolkit with 220+ Practice Questions!
“This is one of the best review courses I’ve ever taken.”
“I learned so much from the CDCES Exam Prep Toolkit. I now have an assessment after taking the practice exam on the areas I need to focus my studying.”
Student Feedback
Whether you are preparing for the CDCES or BC-ADM exam, this test-taking toolkit is designed to prepare you for success. This toolkit includes two courses with over 200 practice questions to help you prepare and simulate the exam. Plus, we have added a FREE bonus course, Language, and Diabetes – What we say matters. Coach Beverly added this course because she believes it contains critical content for the exam and for our clinical practice!
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!
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*
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| COVID & Diabetes Treatment
Our November 17th Question of the week quizzed test takers on COVID-19 and diabetes. Less than half, 48% of respondents, chose the best answer, We thought that this was an important topic to discuss further, so we can pass on correct info to people living with diabetes.
Join us for FREE Covid & Diabetes Webinar. Click here to view>>
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: COVID cases are surging throughout the United States. Providing the best care for people with diabetes is especially important during this crisis. Which of the following statements regarding diabetes and COVID is most accurate?
Answer Choices:
- Avoid use of ACE inhibitors during illness, especially during the critical phase.
- Administration of sitagliptin (Januvia) during hospitalization may be associated with improved outcomes.
- Steroid use during acute illness should be avoided to prevent hypoglycemic or hyperglycemic crisis.
- Supine positioning during the acute phase is associated with improved oxygen saturation.
As shown above, the most common choice was option 2, the second most common answer was option 1, then option 4, and finally option 3.
Getting to the Best Answer
If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.
Answer 1 is incorrect. 20.04% chose this answer. “Avoid use of ACE inhibitors during illness, especially during the critical phase.” Since the corona virus enters the body via ACE2 receptors, some early recommendations included stopping ACE inhibitors in those with COVID-19. However, scientists quickly discovered that stopping ACE inhibitors did NOT improve outcomes and that ACE inhibitors should be continued.
Answer 2 is correct. 47.61% of you chose this answer. “Administration of sitagliptin (Januvia) during hospitalization may be associated with improved outcomes.” YES. New research demonstrates that people with diabetes and COVID-19 started sitagliptin (Januvia) on hospital admission, experience dramatic decreases mortality and improved outcomes.
See our Blog Post – Sitagliptin Improves Outcomes here
Answer 3 is incorrect. About 12.87% of respondents chose this. “Steroid use during acute illness should be avoided to prevent hypoglycemic or hyperglycemic crisis.” It is true that steroids can contribute to hyperglycemia in people with diabetes. However, since steroids have been shown to be lifesaving for very ill people with COVID, with or without diabetes, research supports administering the steroid while managing resultant hyperglycemia with insulin therapy.
Finally, Answer 4 is incorrect. 19.49% chose this answer. “Supine positioning during the acute phase is associated with improved oxygen saturation.” Research has shown that “prone” positioning (laying on belly) can improve alveolar oxygenation and outcomes. More info here.
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!
COVID & Diabetes Update – Navigating a Crisis
Purchase recording of our Live Webinar on December 2 | Earn 1.5 CE | $19
With the surge in new COVID cases, what is the essential information health care professionals and Diabetes Specialists need to navigate this overwhelming crisis?
What are the best practices to care for people with diabetes and COVID-19 in the outpatient and hospital setting?
Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM, has completely updated this critical presentation, to bring health care professionals up-to-date on the current state of COVID and its impact on diabetes care. She summarizes key information including critical teaching points and management strategies for people with diabetes who develop a COVID-19 infection.
Topics Include:
- Discuss the current state of diabetes in the United States.
- Describe the relationship between COVID and health care disparities
- Explore the impact of COVID infection on those with pre-existing diabetes.
- Discuss treatment strategies for COVID and diabetes, including new vaccines.
- List critical teaching points for people with diabetes and COVID.
If you miss the live version, your registration guarantees access to the recorded version.
Join us to learn critical information about Diabetes and COVID Management
Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF and Touro University 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!
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*
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 | Gut, Health, Mucous Lining & Diabetes
Our November 10th Question of the week quizzed test takers on intestinal bacterial health and diabetes. 40% of respondents chose the correct answer, while 60% did not. We thought that this was an important topic to discuss further, so we can pass on correct info to 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: Intestinal health and diabetes are co-related. Which of the following statements is true?
Answer Choices:
- High levels of intestinal butyrate indicate excess inflammation and increased glucose levels
- Thicker intestinal mucous lining is correlated with a lower risk of diabetes
- In diabetes, there is an inverse correlation between food diversity and gut bacteria diversity
- Decreasing the prevalence of mucin-producing bacteria decreases diabetes risk
As shown above, the most common choice was option 2, the second most common answer was option 1, then option 3, 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” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.
Answer 1 is incorrect. 26.30% chose this answer. “High levels of intestinal butyrate indicate excess inflammation and increased glucose levels.”
Butyrate is one of the main metabolites produced in the colon by bacterial fermentation of dietary fiber. When it comes to gut health, higher levels of butyrate, a short-chained fatty acid, indicate higher fiber consumption and overall gut health and happiness.
Answer 2 is correct. 39.86% of you chose this answer. “Thicker intestinal mucous lining is correlated with a lower risk of diabetes”.
The image to the right is a great illustration. You can see that the thicker the mucus lining in the intestinal lumen, the less overall inflammation and leaky gut. A diet high in fiber feeds the microbiota in charge of maintaining a thick and healthy mucous lining.
Answer 3 is incorrect. About 19.58% of respondents chose this. “In diabetes, there is an inverse correlation between food diversity and gut bacteria diversity”
There is actually a direct correlation between food diversity and gut bacterial diversity. Enjoy a rainbow of foods, with lots of veggies, seeds, legumes, nuts, fruit, and whole grains.
Finally, Answer 4 is incorrect. 14.25% chose this answer. “Decreasing the prevalence of mucin-producing bacteria decreases diabetes risk.”
Mucin producing bacteria, like Akkermansia Muciniphila, help maintain a healthy mucus lining in the intestinal lumen. This is associated with less overall inflammation and leaky gut. A diet high in fiber feeds the microbiota in charge of maintaining a thick and healthy mucous lining.
We hope you appreciate this week’s rationale!
To learn more about this exciting topic, please join our
FREE Webinar Recorded & Ready for Viewing – Getting to the Gut & Skin, Meet Your Microbiome
Join the wonderment as we explore the role of our Microbiome.
“This Webinar is filled with Bev’s energy, knowledge, and passion for diabetes that she replicates in all her teachings. She puts a demand on herself to be a mentor to all. Her information is well organized, full of current/relevant research, and helps CDCES’ view into the future as a changing world impacts diabetics. I find her to be the most exciting and engaging educator and … OUTSTANDING teacher!!” – recent participant
New Webinar topics:
- Discuss the latest research on our microbiome
- Describe the link between COVID and gut bacterial health
- Discuss the role of the skin microbiome in health and body weight
- Describe the importance of diet during pregnancy to promote the baby’s healthy microbiome.
- State the relationship between gut health and diabetes risk
- Describe 3 strategies to get our microbiome back to better health.
This one-hour complimentary journey will expand your view of how the trillions of bacterial hitchhikers profoundly influence our health. We will discuss how foods, the environment, and our medical practices have impacted our gut bacteria over time and strategies we can take to protect these old friends.
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!
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*
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 | Hyperglycemia and Cystic Fibrosis
Rationale of the Week | Hyperglycemia and Cystic Fibrosis
Our November 3rd Question of the week quizzed test-takers on cystic fibrosis and hyperglycemia. The majority of respondents (60%) chose the correct answer! Great job. Even though most of you got it right, we think it is an important topic to explore and discuss.
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 is accurate regarding cystic fibrosis-related diabetes?
Answer Choices:
- A1c testing is the preferred diagnostic tool to detect cystic fibrosis-related diabetes (CFRD).
- Start annual screening for diabetes at age 10 for those with cystic fibrosis-related diabetes (CFRD).
- People with cystic fibrosis-related diabetes (CFRD) benefit from intensive carbohydrate intake reduction.
- The best treatment strategy for people with cystic fibrosis-related diabetes (CFRD) includes GLP-1s to support gut hormone production.
As shown above, the most common choice was option 2, the second most common answer was option 4, then option 3, and finally option 1.
Getting to the Best Answer
If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.
Cystic fibrosis is associated with hyperglycemia
Cystic fibrosis is a hereditary disease that affects the lungs and digestive system. The body produces thick and sticky mucus that can clog the lungs and obstruct the pancreas.
Cystic fibrosis-related diabetes (CFRD) is the most common comorbidity in people with cystic fibrosis, occurring in about 20% of adolescents and 40–50% of adults. If not treated adequately and promptly, it can lead to infections and weight loss. Learn more below.
Answer 1 is incorrect. 9.16% chose this answer, “A1c testing is the preferred diagnostic tool to detect cystic fibrosis-related diabetes (CFRD).” ADA recommends using the OGTT screening test to detect CFRD early on so insulin therapy can be provided.
According to ADA 2020 Standards, “A1C is not recommended for diagnosis of diabetes in children with cystic fibrosis”. That might change in the future since publications suggest that an A1C cut point lower than 5.4% (5.8% in a second study) would detect more than 90% of cases and reduce patient screening burden.
Answer 2 is correct. 59.76% of you chose this answer, “Start annual screening for diabetes at age 10 for those with cystic fibrosis-related diabetes (CFRD).” Great job.
According to ADA, “Annual screening for cystic fibrosis-related diabetes (CFRD) with an oral glucose tolerance test should begin by age 10 years in all patients with cystic fibrosis not previously diagnosed with CFRD.” Since CFRD occurs in about 20% of adolescents and 40–50% of adults, annual testing is important for prompt identification. People with CFRD also need to know the signs of hyperglycemia (especially unexplained weight loss) so they can receive immediate treatment to prevent weight loss and infections.
Answer 3 is incorrect. About 10.84% of respondents chose this, “People with cystic fibrosis-related diabetes (CFRD) benefit from intensive carbohydrate intake reduction.” This is not the best answer because people with CFRD often need up to 4,000 calories a day just to maintain their weight. Most important is to encourage them to eat as usual and cover with insulin. Weight maintenance while getting glucose to target are two big priorities.
Finally, Answer 4 is incorrect. 20.24% chose this answer, “Best treatment strategy for people with cystic fibrosis-related diabetes (CFRD) includes GLP-1s to support gut hormone production.” According to ADA, insulin therapy is the preferred treatment to lower glucose and maintain body weight.
People with CF make less of the pancreatic enzymes important for digestion, but GLP-1 hormones released from the intestine are intact.
More info on CFRD
For more information on CF and management of CFRD, please see these care guidelines; Clinical care guidelines for cystic fibrosis-related diabetes: 2010
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 exam practice questions? Enroll in our Test Taking Toolkit with 220+ Practice Questions!
“This is one of the best review courses I’ve ever taken.”
“I learned so much from the CDCES Exam Prep Toolkit. I now have an assessment after taking the practice exam on the areas I need to focus my studying.”
Student Feedback
Whether you are preparing for the CDCES or BC-ADM exam, this test-taking toolkit is designed to prepare you for success. This toolkit includes two courses with over 200 practice questions to help you prepare and simulate the exam. Plus, we have added a FREE bonus course, Language, and Diabetes – What we say matters. Coach Beverly added this course because she believes it contains critical content for the exam and for our clinical practice!
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!
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*
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.
![](/wp-content/uploads/2023/01/insta-png-v5.png")
