Our October 27th Question of the week quizzed test takers on person-centered language. We are happy to report that 88% of respondents chose the correct 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: Language use while interviewing someone with diabetes can have a profound impact on the meaningfulness of the interaction. 

Which of the following comments uses a person-centered approach and exemplifies the use of updated diabetes language?

Answer Choices:

1. We don’t recommend avoiding breakfast
2. Tell me more about skipping your afternoon insulin
3. I notice you haven’t tested your blood sugars daily 
4. Exercise is important because it helps control your glucose levels

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As shown above, the most common choice was option 2, the second most common answer was option 3, 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.

Most of you chose the correct answer, which is really terrific.  I have noticed an increased awareness of the new language paradigm when coaching people with diabetes. I am confident this person-centered approach will strengthen the meaningfulness of our interactions and improve quality of life for people living with diabetes.

Answer 1 is incorrect. 1.44% chose this answer. “We don’t recommend avoiding breakfast”

The fact that this sentence starts with the word “we”, gives us the first clue it is not person-centered. This approach and language align more with the out-dated compliance model, which simply gives people direction without seeking input or collaboration.

Answer 2 is correct. 87.77% of you chose this answer. “Tell me more about skipping your afternoon insulin”

This is an example of the preferred curiosity-based approach that is free of judgment.  It simply acknowledges the fact that the person is skipping their afternoon insulin and requests more information about the circumstances.  It represents a person-centered and collaborative approach.

Answer 3 is incorrect. About 5.76% of respondents chose this. “I notice you haven’t tested your blood sugars daily”

This approach is not strength-based, instead, it has a hint of judgment and criticism. The person receiving this message might feel shame or embarrassment.  A strength-based approach would be, “You have been checking your blood sugars 4 times a week.”  Then we could have a conversation to determine if that is often enough or if more checks would be beneficial.  This strength-based approach engages the participant and acknowledges what they ARE doing.

Finally, Answer 4 is incorrect. 5.04% chose this answer. “Exercise is important because it helps control your glucose levels.” 

Instead of telling people TO exercise, a better approach would be starting with a question like, “Did you know that every minute of exercise lowers your blood sugar about one point?”.  Or, “Is there a type of activity you have done in the past that you enjoyed?”  In addition, we avoid using the word “control” and replacing it with the word “manage”.  We could also say, “The great thing about exercise is that helps manage blood sugars for 24-28 hours.”

Want more info on Language and Diabetes?
Check our our FREE Webinar and Resources Page – Lifting People UP with our Words.

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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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Test Taking Toolkit (220+ practice questions) | Online | $ 49.00

Whether you are preparing for the updated CDCES or BC-ADM exam, this test-taking toolkit is designed to prepare you for success. This toolkit includes two courses with over 220 practice questions to help you prepare and simulate the exam.

Our exams incorporate changes to the CDCES content outline, including a more intensive focus on technology, social issues, and emergency readiness. Plus, we have added a FREE bonus course, Language and Diabetes – What we say matters (0.5 CEs). Coach Beverly added this course because she believes it contains critical content for the exam and for our clinical practice!

• ADA Standards Test Taking Tips
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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.

Our October 20th Question of the week quizzed test takers on determining the type of diabetes based on lab results and the history. 68% of respondents chose the correct answer, while 32% 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: JR has had prediabetes for several years, with A1c’s of 6.0-6.4%. JR is now experiencing sudden hyperglycemia and an A1c is 9.2%, GAD is positive, transglutaminase is negative and TSH is 1.4.

What is the most likely diagnosis?

Answer Choices:

1. Latent autoimmune diabetes.
2. Hyperglycemia due to secondary causes.
3. Celiac induced hyperglycemia.
4. Type 1 diabetes.

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As shown above, the most common choice was option 1, the second most common answer was option 4, then option 2, 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 correct. 68.74% chose this answer. “Latent autoimmune diabetes.” To diagnose LADA, the Immunology of Diabetes Society has established three main criteria including: (1) adult age of onset (>30 years); (2) presence of any islet cell autoantibody; and (3) absence of insulin requirement for at least 6 months after diagnosis.

Even though we don’t know the age of this person, the sudden increase in blood glucose and one positive autoantibody (GAD – glutamic acid decarboxylase) plus an elevated A1c without urgent need for insulin therapy, indicate a diabetes 1.5 or LADA. LADA is a slower moving autoimmune attack of the pancreas, but also has features of type 2 diabetes, with some insulin resistance. People with LADA will need insulin therapy, usually with in 6 months, to help with beta cell preservation and prevent glucose toxicity. They are also at risk for other autoimmune co-conditions like thyroid and celiac disease.

Answer 2 is incorrect. 12.25% of you chose this answer, “Hyperglycemia due to secondary causes.” This is a juicy answer, but there is no other factors in the included in the question that indicates any other “secondary” cause (like medications or tube feedings). Also, a positive GAD is a specific test that measures and indicates autoimmune diabetes.

Answer 3 is incorrect. About 6.03% of respondents chose this, “Celiac induced hyperglycemia.” This answer is tempting, since the question mentions transglutaminase, which is a autoimmune blood test for celiac disease. However, the test comes back negative, so there is no celiac disease. Most importantly, there is no diagnosis category of “celiac induced hyperglycemia.”

Finally, Answer 4 is incorrect. 12.98% chose this answer, ” Type 1 diabetes.” Based on the info in the test question, especially that JR had prediabetes” and the fact that only the GAD is positive and the A1c is only modestly elevated, this person is best described as having LADA.

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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Unsure about updates for the 2020 exam?

Coach Beverly offers this FREE webinar to help get you to prepare for the CDCES Exam. All her tips and tricks are meant to ease your mind and reflect the updates to the CDCES content outline.

Topics Covered Include:

• Implications of new certification name, CDCES for our specialty
• Exam requirement updates for 2020
• Exam eligibility and test format
• Strategies to succeed along with a review of study tips and test-taking tactics.
• We will review sample test questions and the reasoning behind choosing the right answers.
• Learn how to focus your time and prepare to take the CDCES Exam. We provide plenty of sample test questions and test-taking tips!

Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator who has passed her CDCES Exam 6 times. She is a nationally recognized diabetes expert for over 25 years.

See our Preparing for CDCES Resource Page >>

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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.

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Our October 13th Question of the week quizzed test-takers insulin pump management for an older person with type 1 and dementia. The majority of respondents (82%) 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: AJ is 89 years old with type 1 diabetes and is a caretaker for a partner with dementia.  AJ is on an insulin pump and uses a meter to check blood glucose levels 4-7 times a day. AJ mentions that they were surprised the other morning that their blood glucose was 59 mg/dl and they felt fine. 

Based on this, what is the best action?

Answer Choices:

1. Discuss the possibility of stopping pump therapy due to safety concerns
2. Make sure AJ checks blood glucose every one-to-two hours during the night
3. Encourage AJ to have a carb plus protein snack at bedtime
4. Evaluate pump settings to see if basal insulin adjustment is needed

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

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. 3.28% chose this answer, “Discuss the possibility of stopping pump therapy due to safety concerns”. For older clients, safety is a top priority. However, based on this vignette, there has not been a pattern of lows and AJ is able to check glucose levels on a regular basis. In addition, for people with type 1, insulin pump therapy decreases the ups and downs associated with multiple daily injections and offers more dosing flexibility. So instead of stopping the pump, suggesting the use of continuous glucose monitor could be another option.

Answer 2 is incorrect. 3.11% of you chose this answer, “Make sure AJ checks blood glucose every one-to-two hours during the night”. Safety is a big issue for older adults, but checking every one-to-two hours is not realistic and would be very disruptive to sleep. They could consider a 2-3am glucose check to see if blood sugars are trending down. If blood sugars are trending down, they could decrease the basal rate overnight to protect against morning hypoglycemia.

Answer 3 is incorrect. About 11.74% of respondents chose this, ” Encourage AJ to have a carb plus protein snack at bedtime”. This is not the best answer because we don’t have any information on the level of nighttime glucose. It is true, that for older people on insulin pumps, going to sleep with a glucose of 150 mg/dl or greater is important to protect against nocturnal hypoglycemia. But, if the bedtime glucose was less than 150 mg/dl, AJ would just need a 15-30 gm carbohydrate snack. Studies have found that adding protein doesn’t help prevent hypoglycemia, it is the carbohydrates that protect against falling blood sugars.

Lastly, we don’t want to have to “feed the insulin”. If basal insulin is set correctly overnight, AJ would wake up with glucose on target, even without eating a bedtime snack.

Finally, Answer 4 is correct. 81.87% chose this answer, “Evaluate pump settings to see if basal insulin adjustment is needed”. YES! If basal insulin is set correctly overnight, AJ would wake up with glucose on target.

I encourage people on insulin pumps to write down their basal rates, carb to insulin ratios, and corrections factors, on a piece of paper with a date. Then take a picture of it on their phone, so they can always access it and evaluate if those calculations might need a little tweaking as the body changes over time. And of course, we need to include the support person in all these discussions since AJ is living with dementia.

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!

Coach Beverly has created three amazing Toolkits to help you study for the CDCES Exam.

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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.

Our October 6th Question quizzed test takers on the Transtheoretical Behavior Change Model. 50% of respondents chose the correct answer, while 50% did not. Since this is an important topic for the exam and our clinical practice, we want to explore this topic further.

Transtheoretical Model – Quick View

Before we dive into the rationale, let’s do a quick review of this model and the stages of change included in the Transtheoretical Model. The slide below, created by Diane Pearson, RN, MPH, CDCES, provides a quick visual view of the model including the different stages of change.

Take a minute to look through:

• the name of each stage
• the role of the educator, and finally
• the phrase that describes what stage the person is in (right above the arrows).

Now that you have studied the model and you are ready to try the question, click here: Answer Question. If you have already answered the question, keep scrolling down for the rationales.

Question: JR has type 2 diabetes and an A1c of 9.4%. He is on 3 medications for diabetes and now needs to start insulin. JR says, “I just don’t know if insulin would help me. My brother took insulin and he had all kinds of problems.”

What best describes JR’s stage of change using the transtheoretical model? 

Answer Choices:

1. Denial
2. Bargaining
3. Avoidance
4. Contemplation

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

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 be familiar with the most common behavior change theories and taking a person-centered approach. Then weed through the particulars, pluck out the most important elements, the cross of false answers, and choose the BEST answer.

Answer 1 is incorrect. 16.34% chose this answer, ” Denial”. There are 5 stages of change in the transtheoretical model, and denial isn’t one of them. It is true that the person in the vignette may be experiencing some degree of denial, but denial is not one of the stages of change in this model. To throw test-takers off a little, I used terms from the “Stages of Grief” model, by Kubler Ross. This was intentional on my part, to lure you in with juicy, but incorrect, answers.

Answer 2 is incorrect. 9.94% of you chose this answer, “Bargaining”. There are 5 stages of change in the transtheoretical model, and bargaining isn’t one of them. As with answer 1, “Denial,” I used terms from the “Stages of Grief” model, by Kubler Ross. This was intentional on my part, to lure you in with juicy, but incorrect, answers.

Answer 3 is incorrect. 23.89% chose this answer, “Avoidance”. There are 5 stages of change in the transtheoretical model, and avoidance isn’t one of them. It is true that the person in the vignette may be experiencing some degree of avoidance, but avoidance is not one of the stages of change.

Finally, Answer 4 is correct, “Contemplation” 49.83% chose this answer. YAY. Almost half of you chose the correct answer. Based on the content, we can tell that JR is “thinking about it” or contemplating making a change. As educators, we will explore this ambivalence and focus on past successes to increase feelings of self-confidence in achieving the new behavior.

“I just don’t know if insulin would help me. My brother took insulin and he had all kinds of problems.”

Educators might then say, I hear what you are saying. You are not sure if insulin would help you since your brother had all kinds of problems. Can you tell me more about this?

As the story unfolds, it provides opportunities to honestly explore some of the benefits and drawbacks of insulin therapy and gives space for JR to talk about their experience with insulin.

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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Quick confession. I had an ulterior motive to last week’s question of the week. I saw a disturbing and heartbreaking report, that during the pandemic, the rate of lower extremity amputations has tripled. This sudden increase is due to combination of wound clinic closures and people’s reluctance to enter health care settings to receive treatment and expose themselves to COVID. This article in Diabetes Care reports success remotely treating ulcerations and lower extremity infections with antibiotics and other modalities.

As Diabetes advocates, we can help decrease amputation rates during this pandemic. We can encourage people to report lower extremity sores, ulcers or other problems promptly, so they can receive early treatment and prevent far worse outcomes.

Our September 30th Question of the week quizzed test takers on reasons behind a sudden spike in glucose levels. 87% of respondents chose the correct answer, our best score to date. Congratulations!

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: LT, a 59-year old with type 2 diabetes presents to the hospital in a hyperglycemic crisis. LT has a history of hypertension, peripheral vascular disease and smokes a pack per day. LT states they have been taking 1000mg metformin BID and 10 units basaglar every night as usual. LT tells you they are stressed out and concerned about a foot sore that doesn’t seem to be getting better. LT is trying to stay home and avoid other people, to prevent getting COVID. LT’s A1C is 8.8%.

What is the most likely cause of this sudden hyperglycemia?

Answer Choices:

1. Stress eating due to isolation.
2. Untreated infection.
3. Rationing medications due to financial hardship.
4. Insulin resistance secondary to cigarette smoking.

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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. 6.41% chose this answer, “Stress eating due to isolation”. It is true that people often respond to stressful situations by eating more or sometimes decreasing food intake. However, since LT is taking diabetes medication and insulin, increasing food intake is very unlikely to create a hyperglycemic crisis. And, more than that, there is a better answer.

Answer 2 is correct. 87% of you chose this answer, ” Untreated infection”. Sometimes the “no-frills” answer is the best answer. In the vignette, “LT tells you they are stressed out and concerned about a foot sore that doesn’t seem to be getting better”. During the pandemic, the rate of lower extremity amputations has tripled due to wound clinic closures and people’s reluctance to enter health care settings to receive treatment and expose themselves to COVID. This article in Diabetes Care reports success remotely treating ulcerations and lower extremity infections with antibiotics and other modalities. Please encourage people to report lower extremity sores, ulcers or other problems so they can receive prompt treatment and prevent far worse outcomes.

Answer 3 is incorrect. About 2% of respondents chose this, “Rationing medications due to financial hardship.” Although this is a tempting choice, there is no mention that LT has financial problems, so we can’t infer that he does. We can only use the information contained in the vignette.

Finally, Answer 4 is incorrect. 5% chose this answer, “Insulin resistance secondary to cigarette smoking”. While it is true that smoking increases insulin resistance, this isn’t a new habit. He is an established smoker so his usual smoking wouldn’t lead to a sudden glucose spike.

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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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.

Email Address Sign Me Up!

Our September 22nd Question of the week explored making adjustments in insulin pump therapy to prevent hypoglycemia. 38% of respondents chose the correct answer, while 62% 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: AR is a 39-year-old on an insulin pump and CGM.  AR’s basal rates are:

• 1.7 units from 10 pm to 6 am and
• 1.6 units from 6 am to 10 pm.

AR’s insulin to carb ratio is 1:15 and the correction is 1:50 with a blood sugar target 100-120.

When looking at AR’s report, they are bolusing for meals at 7 am, noon and 7 pm.  AR is experiencing blood sugars of 60 -70 around 10 am and 3 pm every day.

Based on this data, what is the best recommendation?

Answer Choices:

1. Adjust the 6 am to 10 pm basal rate.
2. Encourage a 15 gm snack at 9:30 am and 2:30 pm.
3. Make adjustments to the insulin to carb ratio.
4. Recalculate the correction bolus ratio.

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As shown above, the most common choice was option 1, the second most common answer was option 3, 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 correct. 38% chose this answer. “Adjust the 6 am to 10 pm basal rate.” This is the best answer.  When someone is on an insulin pump, the basal insulin is being delivered 24 hours a day.  If blood sugars are dropping in-between meals or through the night, too much basal insulin is the usual culprit.  People with this problem might complain of having to eat frequently throughout the day to prevent or treat hypoglycemic events.  We could describe this as “feeding the insulin” which leads to unwanted weight gain.  The goal of insulin therapy is to take the least amount of insulin needed to manage blood sugars.  Over insulinization leads to weight gain and hypoglycemia.

Answer 2 is incorrect. 13% of you chose this answer. “Encourage a 15 gm snack at 9:30 am and 2:30 pm”. This is not the best answer because we want to focus on PREVENTING hypoglycemia instead of chasing after it.  This is best accomplished by decreasing the insulin delivered.

Answer 3 is incorrect. About 30% of respondents chose this. “Make adjustments to the insulin to carb ratio.”  Although this answer is tempting, it is not the best answer.  These low blood sugars are occurring over 3 hours after eating and taking bolus insulin to cover for carbs.  If AR was taking too much insulin to cover carbs, we would expect a low blood sugar closer to the meal time.  Since it is 3 hours post-meal and bolus, basal insulin is more suspect.  However, if we reduce the basal rate between 6 am to 10 pm and the person is still getting low blood sugars three hours post-meal, we could certainly reconsider adjusting the insulin-to-carb ratio.

Finally, Answer 4 is incorrect. 19% chose this answer. “Recalculate the correction bolus ratio”.  Although this is another tempting answer, we don’t’ have enough information in the vignette question to choose this answer.  The question doesn’t say, for example, at breakfast the blood sugar was 202, so AR took 2 units to correct plus insulin for carbs. We can only base our answer on the information provided in the question.

We had over 1000 people take this practice test question. We sure appreciate your participation and enthusiasm!

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Want to learn more pumps, sensors, and calculations?
Enroll in our Technology Toolkit

Due to technical difficulty during our July 21st course, we are re-recording session 1 and adding a new date for session 2. We apologize in advance for the inconvenience and we appreciate your patience.

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Tech 101 – Pumps and Sensors Update and Overview

Join Coach Beverly for an overview of the complex world of insulin pumps and continuous glucose monitors. This webinar will discuss the features of available technologies, basic functions and how to integrate these into our practice. We will discuss the benefits, considerations and critical information to share with clients and providers.

Tech 102 – Insulin Pump Calculations; From basal to square bolus

Determining basal and bolus rates for insulin pumps can seem overwhelming. This course provides participants with a step-by-step approach to determine basal rates, bolus ratios and how to problem solve when blood glucose levels aren’t on target. Included is a discussion on DKA recognition and an explanation of the safe use of technology in the hospital setting.

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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.

Email Address Sign Me Up!

Our September 15th Question of the Week quizzed test takers on figuring out which lab test was most needed based on the case history.

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 42-year-old woman arrives with an A1c of 10.3%, BMI of 32 and states she is ready to take better care of her type 1 diabetes. She uses a Freestyle Libre Sensor and takes 3-4 injections of insulin a day. Both her parents have type 2 diabetes and she says her diabetes was diagnosed after her third pregnancy. During this pregnancy, she had gestational diabetes and after delivery, her blood sugars never improved. Given this history, which of the following lab tests would clarify the best diabetes treatment plan?

Answer Choices:

1. A1c and OGTT.
2. Transglutaminase.
3. TSH and T4.
4. ICA, IAA, GAD.

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As shown above, the most common choice was option 4, the second most common answer was option 2, 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. Many of the test questions are presented as clinical vignettes. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer based on the evidence.

Answer 1 is incorrect. 11% of you chose this answer, “A1c and OGTT”. Based on her history, presentation, and A1c of 10.3%, she clearly has established diabetes. So there is no need to verify diagnosis by rechecking her A1c or administering an OGTT.

Answer 2 is incorrect. 9% of you chose this answer, “Transglutaminase”. This blood test is indicated to evaluate if someone has celiac disease. It is true that people with type 1 are at high risks for autoimmune conditions like celiac disease. However, we can only use the information contained in the case study to determine the best answer. Since she is not complaining of any GI issues or exhibiting any symptoms of celiac disease, this is not the best answer.

Answer 3 is incorrect. About 8% of you chose this, “TSH and T4”. These test are used to evaluate the health of the thyroid. It is true that people with type 1 are at high risks for autoimmune conditions like thyroid disease. However, we can only use the information contained in the case study to determine the best answer. Since she is not complaining of or exhibiting any symptoms of thyroid disease in this situation, this is not the best answer.

Finally, Answer 4 is correct. 72% chose this answer, ICA, IAA, GAD”. In chosing this correct answer, we consider her BMI of 32, plus the fact that both her parents have type 2 diabetes and she had gestational diabetes. Plus after delivery, her blood sugars never improved. We are wondering if she might actually have type 2 diabetes? Given her genetic history and weight, we are certainly observing that she is exhibiting signs insulin resistance, and might benefit from the addition of medications (GLP-1 RA, SGLT-2, metformin) approved for people with type 2 diabetes.

To verify that she has type 1 diabetes, we look at lab results to check if there is an autoimmune attack on her pancreas and insulin. If one or more of these tests come back positive, it indicates an autoimmune condition.

ICA – Islet Cell Autoantibodies
IAA – Insulin Autoantibodies
GAD – Glutamic Acid Decarboxylase

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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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!

Email Address Sign Me Up!

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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.

Our September 8, 2020, Question of the week quizzed test takers on a complicated case study that asked what was the most important information to share with a person starting on a GLP-1 Receptor Agonist. Although 55% of respondents chose the correct answer, 45% 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: AJ takes 85 units of basaglar at bedtime and 10 -12 units of glulisine (Apridra) at meals, plus metformin and empagliflozin at maximum dose. Fasting blood sugars are 130 or greater and the rest of the day, AJs blood sugars are in the 200s. AJ has a BMI of 32 and an A1c of 9.3%. The diabetes specialist recommends adding semaglutide (Ozempic) 0.5 mg to the regimen. What teaching information is most important given the addition of this new medication?

Answer Choices:

1. Report any muscle pain immediately.
2. Semaglutide needs to be injected before eating.
3. Make sure to evaluate liver enzymes after 3 months.
4. Signs of hypoglycemia and appropriate action.

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

Getting to the Best Answer

If you are thinking about taking the certification exam, this vignette practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question and common knowledge. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements, eliminate false answers and choose the BEST answer.

And you may want to Download our Medication PocketCards for detailed info on the available diabetes meds.

Answer 1 is incorrect. 17% chose this answer, “Report any muscle pain immediately”. This is a juicy answer.  It is true that statins, the medication class used to manage lipids in diabetes, can cause muscle pain.  But, the medication being added, semaglutide (Ozempic), is a GLP-1 Receptor Agonist, not a statin.  Its main side effects includes nausea and loss of appetite, but muscle pain is not a common side effect of GLP-1 Inhibitors. This answer is false.

Answer 2 is incorrect. 12% of you chose this answer, “Semaglutide needs to be injected before eating”. This is another juicy answer.  There are 2 forms of semaglutide.  One is Ozempic, it is a once a week injection. People taking this injectable version, do not need to inject on an empty stomach. However, the oral form of semaglutide (Rybelsus), does need to be taken on an empty stomach with only a sip of water (See our Medication PocketCard for more details).

Answer 3 is incorrect. About 17% of respondents chose this, “Make sure to evaluate liver enzymes after 3 months”. It is true that we monitor liver enzymes for people with diabetes if they are on statins or to help screen for fatty liver disease.  However, this GLP-1 Receptor Agonist has no indication to monitor liver enzymes after starting treatment.

Finally, Answer 4 is correct. 55% chose this answer, “Signs of hypoglycemia and appropriate action”. Yes, this is the BEST answer and it was a little tricky. Semaglutide (Ozempic), is a GLP-1 Inhibitor and does not cause hypoglycemia. However, this person is on a 85 units of basal insulin daily, plus 10 -12 units of bolus insulin at meals. With the additional glucose lowering impact of the GLP-1 Receptor Agonist, they are at risk of hypoglycemia from the insulin. Many people actually require a decrease in their insulin dose when adding on or increasing the dose of a GLP-1 RA.

Download our Medication PocketCards for detailed info on the available diabetes meds.

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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The next Summer 2020 Boot Camp session is September 23rd, 2020

In each webinar, either Coach Beverly, Dr. Isaacs, or Ms. Armstrong, highlight the critical content of each topic area, so you can focus your study time most efficiently. They also launch multiple poll questions to help participants focus on key concepts and assess their knowledge while learning the best test-taking strategies. 

2020 Boot Camp Live Stream Webinar Schedule with Coach Beverly

All courses air at 11:30 a.m. (PST)

1. Diabetes – Not Just Hyperglycemia | Sept 16
2. ADA Standards of Care | Sept 23
3. Insulin Therapy – From Basal/Bolus to Pattern Management | Sept 30
4. Insulin Intensive – Monitoring, Sick Days, Lower Extremities | Oct 7
5. Meds for Type 2 | Oct 14
6. Exercise and Preventing Microvascular Complications | Oct 21
7. Coping & Behavior Change | Oct 28
8. “The Big Finish” Test Taking Boot Camp | Nov 4

Can’t make it live?
No worries! All video presentations and podcasts will be available now on-demand.

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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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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.

Email Address Sign Me Up!