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:

1. 11.8 units
2. 12.3 units
3. 11 units
4. 10.8 units
5. I have no idea, pass the pumpkin pie

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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!

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Want more exam practice questions? Enroll in our Test Taking Toolkit with 220+ Practice Questions!

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“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.”

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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 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:

1. Avoid use of ACE inhibitors during illness, especially during the critical phase.
2. Administration of sitagliptin (Januvia) during hospitalization may be associated with improved outcomes.
3. Steroid use during acute illness should be avoided to prevent hypoglycemic or hyperglycemic crisis.
4. Supine positioning during the acute phase is associated with improved oxygen saturation.

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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. 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!

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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:

1. Discuss the current state of diabetes in the United States.
2. Describe the relationship between COVID and health care disparities 
3. Explore the impact of COVID infection on those with pre-existing diabetes.
4. Discuss treatment strategies for COVID and diabetes, including new vaccines.
5. 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.

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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 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:

1. High levels of intestinal butyrate indicate excess inflammation and increased glucose levels
2. Thicker intestinal mucous lining is correlated with a lower risk of diabetes
3. In diabetes, there is an inverse correlation between food diversity and gut bacteria diversity
4. Decreasing the prevalence of mucin-producing bacteria decreases diabetes risk

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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!

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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.

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“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.

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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.

Rationale of the Week | Hyperglycemia and Cystic Fibrosis [yikes-mailchimp form=”1″]

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:

1. A1c testing is the preferred diagnostic tool to detect cystic fibrosis-related diabetes (CFRD).
2. Start annual screening for diabetes at age 10 for those with cystic fibrosis-related diabetes (CFRD).
3. People with cystic fibrosis-related diabetes (CFRD) benefit from intensive carbohydrate intake reduction.
4. The best treatment strategy for people with cystic fibrosis-related diabetes (CFRD) includes GLP-1s to support gut hormone production.

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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!

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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

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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 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
• Preparing for CDCES Practice 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 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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Studying for the CDCES exam?
Join us for our FREE webinar
Preparing for the CDCES Exam 2020

November 5, 2020, from 11:30 a.m. – 12:45 p.m.  (PST)

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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Test Taking Toolkit – 200+ Practice Questions!

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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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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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