Hyperglycemic Crisis and a Foot Sore| Rationale of the Week
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:
- Stress eating due to isolation.
- Untreated infection.
- Rationing medications due to financial hardship.
- Insulin resistance secondary to cigarette smoking.
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!
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!
[yikes-mailchimp form=”1″]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.
[yikes-mailchimp form=”1″]Insulin Pump Adjustment Needed | Rationale of the Week
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:
- Adjust the 6 am to 10 pm basal rate.
- Encourage a 15 gm snack at 9:30 am and 2:30 pm.
- Make adjustments to the insulin to carb ratio.
- Recalculate the correction bolus ratio.
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!
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.
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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[yikes-mailchimp form=”1″]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.
[yikes-mailchimp form=”1″]Which Test is Needed? | QoW Rationale
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:
- A1c and OGTT.
- Transglutaminase.
- TSH and T4.
- ICA, IAA, GAD.
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!
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!
[yikes-mailchimp form=”1″]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.
Sept 8, 2020 | Rationale of the Week
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:
- Report any muscle pain immediately.
- Semaglutide needs to be injected before eating.
- Make sure to evaluate liver enzymes after 3 months.
- Signs of hypoglycemia and appropriate action.
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!
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)
- Diabetes – Not Just Hyperglycemia | Sept 16
- ADA Standards of Care | Sept 23
- Insulin Therapy – From Basal/Bolus to Pattern Management | Sept 30
- Insulin Intensive – Monitoring, Sick Days, Lower Extremities | Oct 7
- Meds for Type 2 | Oct 14
- Exercise and Preventing Microvascular Complications | Oct 21
- Coping & Behavior Change | Oct 28
- “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.
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!
[yikes-mailchimp form=”1″]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.
[yikes-mailchimp form=”1″]Rationale of the Week | BC-ADM vs. CDCES?
Our August 18th Question of the week quizzed test takers on the difference between a CDCES and BC-ADM. Although 54% of respondents chose the correct answer, 46% 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: What best describes the difference between a Certified Diabetes Care and Education Specialist (CDCES) and a person Board Certified in Advanced Diabetes Management (BC-ADM)?
Answer Choices:
- BC-ADMs are responsible for increased complexity in decision making.
- A bachelor’s degree or higher is required to obtain a CDCES.
- The main difference is that BC-ADM’s prescribe medications based on the diagnosis.
- With an advanced degree, BC-ADM’s are qualified to set up an independent practice.
As shown above, the most common choice was option 1, the second most common answer was option 4, then option 3, and finally option 2.
Interested in achieving your CDCES or BC-ADM? Click here to get started.
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. And remember, sometimes the simplest answer is the best answer.
Answer 1 is correct. 54% chose this answer. “BC-ADMs are responsible for increased complexity in decision making.”
According to the ADCES website:
“The BC-ADM skillfully manages complex patient needs and assists patients with therapeutic problem-solving. Within their discipline’s scope of -practice, healthcare professionals who hold the BC-ADM certification adjust medications, treat and monitor acute and chronic complications and other comorbidities, counsel patients on lifestyle modifications, address psychosocial issues, and participate in research and mentoring.”
Answer 2 is incorrect. 8% of you chose this answer. “A bachelor’s degree or higher is required to obtain a CDCES.”
Eligibility to take the exam is based on licensure, registration, or certification. According to the CDCES website, the following health care professionals meet the discipline requirement.
- Clinical psychologist
- Occupational therapist
- Optometrist
- Pharmacist
- Physical therapist
- Physician (M.D. or D.O.)
- Podiatrist
- Registered nurse (includes nurse practitioners and clinical nurse specialists)
- Dietitian or dietitian nutritionist holding active registration with the Commission on Dietetic Registration
- PA holding active registration with the NCCPA
- Exercise physiologist holding active certification as an American College of Sports Medicine Certified Clinical Exercise Physiologist (ACSM-CEP®)
- Health educator holding active certification as a Master Certified Health Education Specialist from the National Commission for Health Education Credentialing
- Master’s degree in social work
Answer 3 is incorrect. About 19% of respondents chose this. “The main difference is that BC-ADM’s prescribe medications based on the diagnosis”.
The BC-ADM is a certification exam and it does not confer prescriptive authority. Only those with certain licenses can prescribe medications, and the regulations can vary from state to state. For example, I am a Registered Nurse with a Masters in Public Health. I also have my CDCES and BC-ADM. As a licensed RN, I do not have prescriptive authority. Certification does not change your scope of practice and can come from different organizations. Licensure comes from governmental authority.
Finally, Answer 4 is incorrect. 19% chose this answer. “With an advanced degree, BC-ADM’s are qualified to set up an independent practice.”
This is a juicy answer but is not correct. Let’s say I want to set up shop as a Registered Nurse with a Masters in Public Health. I also have my CDCES and BC-ADM. Even with my BC-ADM, I couldn’t bill for services, and under whose oversight would I see people with diabetes and make treatment recommendations?
Again, it’s not the BC-ADM that creates the opportunity to set up an independent practice. As a licensed RN, I can’t set up an independent practice and bill for my services in my state. Certification does not change your scope of practice and can come from different organizations. Each state’s licensure and scope of practice regulations come from a governmental authority. We must practice within the legal parameters of our scope of practice based on licensure.
Interested in achieving your CDCES or BC-ADM?
Click here to get started.
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!
Studying for the CDCES or BC-ADM exams?
Our Summer 2020 Certification Boot Camp begins September 16th!
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)
- Diabetes – Not Just Hyperglycemia | Sept 16
- ADA Standards of Care | Sept 23
- Insulin Therapy – From Basal/Bolus to Pattern Management | Sept 30
- Insulin Intensive – Monitoring, Sick Days, Lower Extremities | Oct 7
- Meds for Type 2 | Oct 14
- Exercise and Preventing Microvascular Complications | Oct 21
- Coping & Behavior Change | Oct 28
- “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.
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!
[yikes-mailchimp form=”1″]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.
[yikes-mailchimp form=”1″]CV Risk Vignette – Best Strategy to Improve Outcome | QoW Rationale
Our August 4th Question quizzed test takers on CV Disease risk management and diabetes. Although 49% of respondents chose the correct answer, 51% 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: RJ is 67 years old with a 40+ year history of type 1 diabetes. GFR is 62, UACR is < 30, A1c is 6.7%, B/P is 132/72, LDL cholesterol is 98, RJs BMI is 28.6. RJ uses multiple daily injections and CGM to manage RJs diabetes.
RJ’s other medications include: Levothyroxine 100mcg daily, atorvastatin 40mg daily, Aspirin 81 mg daily and a multivitamin.
Based on your assessment, which of the following interventions would improve RJs outcome?
Answer Choices:
- Add an ACE Inhibitor.
- Lifestyle intervention.
- Suggest addition of an ARB.
- Increase atorvastatin dose.
As shown above, the most common choice was option 2, the second most common answer was option 3, then option 2, and finally option 4.
Getting to the Best Answer
If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers will ask about the guidelines for specific ADA Standards of Care. This question is pulled from section 10 of the Standards on CV Disease and Risk Management. To purchase your own ADA Standards, visit our store.
Download our FREE Lipid and Hypertension Cheat Sheets – great resource and invaluable test study tool too!
Answer 1 is incorrect. 23% chose this answer. “Add an ACE Inhibitor.”
Many people chose this juicy answer. It is true that in the past, people with type 1 would be automatically started on an ACE Inhibitor because it was thought starting an ACE would offer renal protection. However, based on extensive research, the American Diabetes Association stopped recommending adding an ACE for people with type 1 without the diagnosis of hypertension a few years back.
The current blood pressure goal for people with diabetes is
140/90.
If a person with type 1 diabetes has hypertension, defined as either systolic
greater than 140 or diastolic more than 80, repeated on 2 different occasions, initiate
blood pressure therapy.
- If the person has albuminuria (UACR 30 or greater), then start them on either an ACE or and ARB.
- If the person has UACR less than 30, choose from any of the 4 classes or anti-hypertensive medications.
Lower blood pressure goal of 130/80? It is recommended to do a cardiovascular risk assessment using the CV Risk Calculator on all people with diabetes. If the 10 year risk of having a CV event is greater than 15%, the blood pressure goal is 130/80 may be appropriate, if it can be safely attained. The choice of blood pressure therapy is further refined by presence or absence of microalbuminuria.
We don’t have enough information to calculate his CV Risk, so based on the information we have, adding an ACE Inhibitor is not indicated at this time. And of course, since we only have one blood pressure, we need to collect more data before taking action.
Answer 2 is correct. 49% of you chose this answer. “Lifestyle intervention.”
This is the best answer. Looking at this profile, we can see that RJ’s BMI is above 25 and LDL is slightly elevated. Let’s refer RJ to a Registered Dietitian. By coaching RJ on healthy food choices, increased whole foods and fiber, and taking a look at animal protein consumption, there is an opportunity to improve not only RJs blood pressure but also RJs LDL cholesterol. In addition, we can evaluate RJs activity level and encourage 150 mins a week of activity plus strengthening that would contribute to his overall health.
Answer 3 is incorrect. About 17% of you chose this answer. “Suggest addition of an ARB.” See rationale under answer 1.
Finally, Answer 4 is incorrect. 10% of you chose this answer. “Increase atorvastatin dose.” Currently, RJ is on high intensity statin therapy with RJs atorvastatin dose of 40mg. He does not present with any concerning CV risk factors or events that would kick RJ into high risk category. We could calculate RJs 10 year risk of CV disease and if it is more than 20% or if RJ doesn’t response to lifestyle changes, we could consider a further increase in the statin dosing. Based on the info we have at this moment, this is not the BEST answer (but it is a consideration : -).
Download our FREE Lipid and Hypertension Cheat Sheets – great resource and invaluable test study tool too!
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!
Cardiovascular Disease & Diabetes Standards 2020
Watch for Free or 1.5 CEs | $29.00
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!
[yikes-mailchimp form=”1″]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.
[yikes-mailchimp form=”1″]Glucagon & Hypoglycemia | QoW Rationale
Our July 14th Question of the week quizzed test takers on glucagon and hypoglycemia. Although 54% of respondents chose the correct answer, 46% 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: RJ is 15 years old and starting on basal-bolus insulin. The diabetes specialist reviews the signs of hypoglycemia and provides information on glucagon rescue medications.
Which of the following statements is most accurate?
Answer Choices:
- Glucagon is an injectable form of glucose.
- Injectable glucagon rescue medications are to be injected subcutaneously only.
- Nasal glucagon must be inhaled to increase glucose levels.
- Premixed glucagon liquid solution is approved for children two years and older.
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. 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. 14% chose this answer. “Glucagon is an injectable form of glucose.”
Glucagon is a counter-regulatory hormone secreted by the pancreas when blood sugars are dipping or during periods of emotional or physical stress. This hormone liberates stored glycogen from the liver, causing an upward surge in circulating glucose. Read more here
Answer 2 is incorrect. 15% of you chose this answer. “Injectable glucagon rescue medications are to be injected subcutaneously only.”
Our new Glucagon PocketCard describes the 3 forms of glucagon treatment available. The original Glucagon Emergency Kit can be injected subQ or into the muscle. Gvoke liquid glucagon is only administered subQ and Baqsimi is administered nasally.
Answer 3 is incorrect. About 14% of respondents chose this. “Nasal glucagon must be inhaled to increase glucose levels.” Since many people are unconscious during severe hypoglycemic events, they can not inhale on command. The nasal glucagon delivery device is inserted into the nose and the user presses the plunger to distribute the glucagon powder in the nasal cavity. Read more here
Finally, Answer 4 is correct! 55% chose this answer. “Premixed glucagon liquid solution is approved for children two years and older.” Gvoke glucagon solution is available in a prefilled syringe or HypoPen Injector and is indicated for children two years and up. Read more 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!
Preparing For the CDCES Exam 2020 Free Webinar |
August 6, 2020
FREE webinar, August 6, 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 >>
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!
[yikes-mailchimp form=”1″]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.
[yikes-mailchimp form=”1″]Type 1 and SGLT-2 Inhibitor? | QoW Rationale
This question addressed the use of SGLT-2 Inhibitors in addition to insulin for MS, who is living with Type 1 Diabetes. MS is worried about weight gain and is on a low keto diet. It is safe for here to add an off-label medication?
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: MS has type 1 diabetes and is on a low carb diet to help her keep her weight on target. She has a BMI of 24.3. MS has a friend with type 1 who is taking an SGLT-2 in addition to insulin to help with weight management. MS wants to know if she could add on an SGLT-2 to her insulin treatment plan.
What is the Diabetes Specialist’s best response?
Answer Choices:
- We don’t recommend adding on an SGLT-2 for people with type 1 on a low carb diet.
- Your BMI of 24.3 is right on target.
- I’m sorry, but oral medications don’t work for people with type 1 diabetes.
- Do you think you might be struggling with disordered eating?
As shown above, the most common choice was option 1, the second most common answer was option 2, then option 4, and finally option 3.
Medication Considerations
If you are thinking about taking a certification exam, this practice test question will set you up for success. The test writers will include warnings about medications and ask you to choose the best response. Your job is to weed through the particulars, pluck out the most important elements, eliminate at least two false answers to improve your odds of success to 50/50.
Answer 1 is correct! “We don’t recommend adding on an SGLT-2 for people with type 1 on a low carb diet.” Even though SGLT-2’s are sometimes prescribed to people with type 1 diabetes (in addition to insulin), they are not FDA approved in type 1 and are considered “off-label.” SGLT-2 also contains a warning of an increased risk of ketoacidosis. This risk is especially important to consider in type 1 diabetes, since people with type 1 using an SGLT-2 Inhibitor may decrease their daily insulin dose and increase the risk of ketoacidosis.
This risk might be exacerbated by a low carbohydrate diet. As outlined in the ADA Standard 5, “This [low carbohydrate] eating pattern is not recommended at this time for women who are pregnant or lactating, people with or at risk for disordered eating, or people who have renal disease, and it should be used with caution in patients taking sodium-glucose cotransporter 2 inhibitors due to the potential risk of ketoacidosis.”
Answer 2 is incorrect! “Your BMI of 24.3 is right on target.” This is a juicy answer because it is true. The BMI is below 25, but it does not address the key intent of the question.
Answer 3 is incorrect. “I’m sorry, but oral medications don’t work for people with type 1 diabetes.” This is tricky. No oral medications are FDA approved for type 1 diabetes, but some are prescribed (metformin, SGLT-2s) by diabetes providers in addition to insulin. Still not the best answer.
Finally, Answer 4 is incorrect. “Do you think you might be struggling with disordered eating?” Another tempting answer, but MS isn’t exhibiting any signs of under-eating or under-dosing insulin or disordered eating.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
Want more practice questions?
Try our Test Taking Toolkit!
$49 | 220+ Questions
In this course, Coach Beverly details the content of the exam and test-taking tips. Plus, she reviews a sampling of the questions, and explains how to dissect the question, eliminate the wrong answers and avoid getting lured in by juicy answers.
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!
[yikes-mailchimp form=”1″]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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