Our May 26th Question of the week was a question about carb counting. Although 56% of respondents chose the correct answer, 44% 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 is motivated to decrease weight. AJ eats an egg sandwich and hash browns 5 times a week. You look up the calories on an app and find that the egg sandwich has 370 calories and the medium hash browns have 390 calories. 

If AJ doesn’t eat the hash browns for one month, how much weight would AJ lose?

Answer Choices:

1. 3.1 pounds
2. 2.2 pounds
3. 2.1 pounds
4. 4.3 pounds

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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.

The devil is in the details

If you are thinking about taking a certification exam, this practice test question will set you up for success. The test writers will 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 do the math with care.

Answer 1 is incorrect. 20% chose this answer. This question is all about paying attention to details. AJ eats the hash browns 5 times a week or 20 times a month. If you chose this answer, you had AJ eating hash browns every day.

Answer 2 is correct! 56% of you chose this correct answer. AJ eats hash browns 5 times a week or 20 times a month. Each hash brown has 390 calories. 20 x 390 = 7, 800 calories. There are 3,500 calories in a pound. So, 7,800 / 3,500 = 2.2 pounds loss in a month. Yay. Great job.

Answer 3 is incorrect. About 10% of respondents chose this. If you chose this answer, you might have been calculating the number of calories in the egg sandwich instead of the hash browns.

Finally, Answer 4 is incorrect. 12% chose this answer. You probably thought AJ was stopping eating both the egg sandwich and hash browns, which would lead to a 4.3-pound weight loss.

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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Try our Test Taking Toolkit!
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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.

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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 May 19th Question of the week was a question about carb counting. Although 58% of respondents chose the correct answer, 42% 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: LS uses an insulin pump and the 500 rule for carbohydrate coverage. For breakfast, LS plans to eat ½ cup of oatmeal, 3/4 cup of blueberries, a cup of skim milk, a tablespoon of peanut butter, and a cup of coffee with a packet of Splenda. Her insulin to carb ratio is 1 to 12 for breakfast and lunch. Her insulin to carb ratio is 1 to 15 for dinner. 

How much insulin does LS need for breakfast?

Answer Choices:

1. 3.0 units
2. 2.8 units
3. 4.0 units
4. 3.5 units

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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.

Answer 1 is incorrect. 14% chose 3.0 units as the answer. This answer was juicy but wrong. Maybe this group thought the total carb count was 45 gms and then divided by insulin to carb ratio of 1:15? If yes, read the question again to see what insulin to carb ratio is a better choice. Also, rethink the total carb count.

Answer 2 is incorrect. Only 8% of respondents chose 2.8 units as an answer. This group got the carb count correct but may want to read the question again to see which insulin to carb ratio is a better choice.

Answer 3 is also incorrect. About 20% of respondents chose 4.0 units. This group might need to reassess the carb count, keeping in mind that milk is 12gms of carb. And, more importantly, keep in mind that LS uses an insulin pump that can deliver very precise insulin doses. No need to round up for this question.

Finally, Answer 4 is correct. 58% of test takers chose this correct answer.

First, lets count up the carbs for breakfast:

• ½ cup of oatmeal = 15 gms
• 3/4 cup of blueberries = 15 gms
• A cup of skim milk = 12 gms
• A tablespoon of peanut butter – 0 gms
• Cup of coffee with a packet of Splenda – 0 gms
  Total carbs = 42 gms
  

Now, let’s do the math:

LS’s insulin to carb ratio is 1 to 12 for breakfast. She is going to eat 42 gms of carb. 42/12 = 3.5 units of insulin to cover breakfast.

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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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Join Coach Beverly on February 2, 2021, for her annual
Level 2 – Standards of Care Update!

This course is an essential review for anyone in the field of diabetes. This course summarizes the 2021 updates to the American Diabetes Association’s Standards of Medical Care in Diabetes and provides critical teaching points and content for health care professionals involved in diabetes care and education.

Earn 2.0 CEs and get ready to lead the charge to implement best care practices for the New Year. 

Topics Include:

• A review of changes and updates to the 2021 ADA Standards of Medical Care
• Identification of key elements of the position statement
• Discussion of how diabetes educators can apply this information in their clinical 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.

This question addressed rising blood glucose and best insulin adjustment strategy. Since this was our most popular question this month, we wanted to provide an explanation to pass on this valuable information to all of you and 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: LS takes 20 units 70/30 insulin twice daily with an insulin pen. LS states that blood sugars are usually on target, but over the past week, blood sugars have suddenly increased. LS confirms that they are taking insulin on a regular basis. 

Which factor could be contributing to this sudden blood glucose rise?

Answer Choices:

1. 70/30 insulin is no longer effective for LS.
2. Check where LS is keeping the insulin pens.
3. Remind LS to shake the insulin to assure adequate mixing.
4. Verify that LS is doing a 3-unit air shot before each injection.

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

Watch out for “Juicy Answers”

If you are thinking about taking a certification exam, this practice test question will set you up for success. The test writers will anticipate possible wrong 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, eliminate at least two false answers to improve your odds of success to 50/50.

Answer 1 is incorrect “70/30 insulin is no longer effective for LS”. About 5% chose this answer. Based on the vignette, LS has been using 70/30 insulin and keeping blood glucose in target. It is only in the last week that blood glucose levels are rising. This points to another undiscovered recent issue that is causing blood sugars to elevate.

Answer 2 is correct! “Check where LS is keeping the insulin pens”. A whopping 73% of you chose this correct answer Great job. Insulin is a very sensitive protein and can lose effectiveness when stored in places where there are extreme temperatures.

Read package insert for detailed information:

• Keep at room temperature below 77°F – 86°F (depending on the manufacturer). Do not freeze our use previously frozen insulin
• Keep vials in box and away from direct heat or light.
• Unopened vials can be used until the expiration date if stored in a refrigerator.

Answer 3 is incorrect. “Remind LS to shake the insulin to assure adequate mixing.” About 11% of respondents chose this. Insulin manufacturers recommend NOT shaking 70/30 insulin since it can make the insulin less effective.

70/30 insulin mixing instructions

Invert the vial or pen at least 10 times to mix the two insulin until is appears white and cloudy. Do not shake. Do not use it if insulin looks clear or contains any lumps or particles.

Finally, Answer 4 is incorrect. “Verify that LS is doing a 3-unit air shot before each injection.” 10% chose this answer. The correct answer is to prime the insulin pen with 2 units of insulin before each injection to make sure that the pen and needle are working. When priming the pen, at least one drop of insulin should appear at the tip of the needle. Also, it’s a good idea to remind people to change the needle before each injection.

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 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.

---

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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.

Our April 31st Question of the week was a question about aerobics, hypothyroidism, cholesterol, and type 2 diabetes. Although 58% of respondents chose the correct answer, 42% 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

You are working with KS, a 57-year-old with type 2 diabetes, who wants to join the water aerobics program at their local YMCA. KS has a history of hypothyroidism and has an LDL cholesterol of 98 mg/dl. KS’s medications include levothyroxine and metformin XR 1000 mg BID.

According to the ADA and the American College of Sports Medicine, what would be the best recommendation?

Answer Choices:

1. Encourage KS to join the water aerobics program.
2. Recommend that KS get an EKG before starting this new activity.
3. Ask KS’s provider to order a stress test.
4. Make sure KS monitors blood glucose before and after exercise class.

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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.

Answer 1 is Correct! Encourage KS to join the water aerobics program. Based on the information provided, she would benefit from adding activity to her routine. Exercise decreases visceral adiposity, improves mood, lower glucose by enhancing insulin sensitivity. See our Exercise Resource Page for helpful info.

Answer 2 is incorrect. About 10% of respondents chose “Recommend that KS get an EKG before starting this new activity.” In the past, we would recommend that people with diabetes get a stress test or EKG before starting any new exercise. The new guidelines only recommend getting an EKG for those with risk factors for cardiovascular events.

Answer 3 is also incorrect. About 10% of respondents chose “Ask KS’s provider to order a stress test.” In the past, we would recommend that people with diabetes get a stress test or EKG before starting any new exercise. The new guidelines only recommend getting a stress test for those with risk factors or symptoms of cardiovascular events.

Finally, Answer 4 is incorrect. “Make sure KS monitors blood glucose before and after exercise class.” Having diabetes is a lot of work. As diabetes specialists, it is important that we don’t unnecessarily increase the burden of daily self-care. While KS may gain interesting information by checking BG levels before and after exercise, it is NOT necessary to monitor glucose before and after.

Why not? Since KS is not on any medication that causes hypoglycemia, her risk of low blood sugar is almost none. In addition, most people on oral medications are only allotted one strip a day to monitor blood sugars. Asking KS to check twice on water aerobics days may translate to extra out of pocket expenses that can also add to the financial burden of diabetes.

This article on page 154 Exercise and Type 2 Diabetes American College of Sports Medicine /American Diabetes Association joint position statement on exercise and type 2 diabetes.

Resources for Pre-exercise Evaluation

This article on page 154 Exercise and Type 2 Diabetes American College of Sports Medicine /American Diabetes Association joint position statement on exercise and type 2 diabetes.

Pre-exercise Evaluation- 2020 Standards Of Care
The ADA consensus report “Screening for Coronary Artery Disease in Patients With Diabetes” (172) concluded that routine testing is not recommended. However, providers should perform a careful history, assess cardiovascular risk factors, and be aware of the atypical presentation of coronary artery disease in patients with diabetes. Certainly, high-risk patients should be encouraged to start with short periods of low-intensity exercise and slowly increase the intensity and duration as tolerated. Providers should assess patients for conditions that might contraindicate certain types of exercise or predispose to injury, such as uncontrolled hypertension, untreated proliferative retinopathy, autonomic neuropathy, peripheral neuropathy, and a history of foot ulcers or Charcot foot. The patient’s age and previous physical activity level should be considered. The provider should customize the exercise regimen to the individual’s needs. Those with complications may require a more thorough evaluation prior to beginning an exercise program (171).

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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Our March 31st Question of the week was a question about COVID-19, sick days and diabetes. Although 40% of respondents chose the correct answer, 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

JR is 27 with Type 1 diabetes and is very worried about getting COVID-19 since they work in a local grocery store.  They ask you what they should do if they get COVID-19?

Which of the following statements is accurate regarding sick day management with COVID-19?

Answer Choices:

1. Seek immediate medical attention if lips or face become bluish.
2. Report to the emergency room if the temperature is 101 degrees or greater.
3. Reduce insulin intake by 10-20% if experiencing diarrhea.
4. Use glucose fingersticks instead of continuous glucose monitoring (CGM) when febrile to improve accuracy.

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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.

Only 39% of participants chose the correct answer number 3, which means there is a learning opportunity!

Answer 1 is Correct! Seek immediate medical attention if lips or face become bluish. Bluish lips or face indicates hypoxia and signals urgent medical care is needed.

From ADA Sick Day Information. If develop emergency warning signs for COVID-19 get medical attention immediately.

In adults, emergency warning signs include:

• Difficulty breathing or shortness of breath
• Persistent pain or pressure in the chest
• New confusion or inability to arouse
• Bluish lips or face

Option 2 is incorrect. One-fifth of respondents chose ” Report to the emergency room if the temperature is 101 degrees or greater.” In the case of fever, the next step would to be to contact your provider to evaluate presence of cough, shortness of breath and other symptoms to determine if urgent care is required.

Option 3 is also incorrect. “Reduce insulin intake by 10-20% if experiencing diarrhea.” During periods of illness, inflammation leads to insulin resistance and hyperglycemia. Most people will need to increase insulin dose during illness, including GI distress.

Finally, Option 4 is incorrect. “Use glucose fingersticks instead of continuous glucose monitoring when febrile to improve accuracy.”
Fever by itself does not interfere with CGM accuracy. If a person is taking Tylenol, it can interfere with the accuracy certain CGMs. And, CGM use is not recommended in the Intensive Care setting. But, having a temperature by itself, does not interfere with CGM accuracy.

Here is a COVID and Sick Day Handout that you can share with your community. Thank you for helping us get the word out.

For more information on sick day management and when to seek medical care, please see this ADA Sick Day Information. 

We hope you appreciate this week’s rationale and keep studying hard! 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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Our March 3rd Question of the week was a question about type 1 and alcohol. Although 66% of respondents chose the correct answer, one third 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

March 3 Question of the week: SZ has type 1 diabetes and uses an insulin pump. SZ wants to celebrate her 21^st birthday with friends and asks about drinking alcohol. Which of the following is a correct statement?

Answer Choices:

1. Since alcohol causes hyperglycemia, make sure to avoid mixed drinks
2. Check glucose 1-2 hours post drink to see if extra insulin is needed
3. 5 ounces of wine is about one serving of alcohol
4. White wine affects blood glucose more than red wines

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

The majority of participants chose answer 3, the correct answer. However, if you chose a different answer, read more to learn about the relationship between alcohol and glucose.

Option 1 is incorrect – Since the liver is busy breaking down alcohol, it is not able to release glycogen stores after alcohol consumption, which can lead to hypoglycemia (not hyperglycemia). The sugary carb content of mixed drinks can cause a temporary rise in glucose levels and the alcohol can cause delayed hypoglycemia.

Option 2 is also incorrect. While it is a good idea to check glucose 1-2 hours post drink to see evaluate blood glucose levels, giving extra insulin post alcohol consumption can contribute to hypoglycemia.

Option 3 is correct. One serving of alcohol is 5 ounces of wine, 12 ounces of beer or 1 ounce of spirits.

Finally, Option 4 is incorrect because one serving of white wine affects blood glucose the same as one serving of red wine. Although alcohol lowers blood glucose, it’s good to remember that it is not calorie-free. A glass of wine can provide about 120 k/cals and beer can provide more than 150 k/cals. Plus, alcohol can raise triglycerides and worsen neuropathy. Moderation is key.

We hope you appreciate this week’s rationale and keep studying hard! 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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For Question of the week, QoW, test takers usually choose the correct answer 70-80% of the time. However, for one question of the week, about 55% of respondents chose the correct answer.

So, we thought this would be a perfect opportunity for another answer rationale. We’ll explore this question and the best answer in more detail and throw in some test-taking tips along the way. Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below:

Question of the week:

JR has noticed that over the past few weeks blood glucose levels have been steadily climbing, even though his eating and medication dose have been stable. Which of the following issues is most likely contributing to hyperglycemia?

Answer Choices:

1. Periodontitis
2. Sudden case of acanthosis nigricans
3. Insulin reactive disease
4. Recurrent symogi effect

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.

Congratulations! The majority of participants got this question right!

Option 1 is the correct answer. We know that periodontitis (inflammation of the gums and supporting structures of the teeth) and hyperglycemia are co-associated. When blood glucose levels rise, risk of periodontitis increases. When there is periodontitis, blood glucose levels rise. As a matter of fact, periodontitis is often called the 6th complication of diabetes. (see SciElo for more details).

Option 2 is incorrect because acanthosis nigricans is a skin condition where skin typically thickens and darkens due to insulin resistance, but the scenario in this question doesn’t mention anything about the skin of JR. We also know acanthosis nigricans isn’t associated with sudden hyperglycemia. It develops over time, so a “sudden case of” helps us to remove it as a possible answer by process of elimination.

Option 3 is incorrect because “insulin reactive disease” is not a recognized diagnosis or condition. This answer was included because “reactive” can look a lot like “resistance”. It is considered a juicy answer because it sounds right.

Finally, Option 4 is incorrect because the recurrent symogi effect indicates hypoglycemia which leads to hyperglycemia on specific occasions, not contributing to overall hyperglycemia. So, this was another option included to encourage careful reading of the question.

We hope you appreciate this week’s rationale and keep studying hard! 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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For Question of the Week, QoW, test takers usually choose the correct answer 70-80% of the time. However, for this question of the week, about 56% of respondents chose the correct answer.

This presents a perfect opportunity for another answer rationale. We’ll explore this question and the best answer in more detail and throw in some test-taking tips along the way. Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below:

Question of the week:

Which of the following is an accurate recommendation according to the nutrition principles as outlined by the American Diabetes Association Standards of Care?

Answer Choices:

1. Maintain pleasure of eating by taking a non-judgmental approach
2. Limit added sugar intake to less than 6 teaspoons a day
3. Include cinnamon in meal plan to reduce glucose levels
4. Encourage people with diabetes to reach BMI goal of less than 25

As shown above, the most common choice was option 1, the second most common answer was option 2, then option 4. No one chose option 3.

Option 1 is the correct answer. “Maintain pleasure of eating by taking a non-judgmental approach” has been a mainstay of the ADA’s Medical Nutrition Therapy principles for years. This statement beautifully speaks to the importance of taking a person-centered approach with a clear vision of promoting a healthy relationship with food.

Option 2 is incorrect because although the ADA and AHA both recommend that added sugar intake should be limited to about 6 teaspoons a day, the American Diabetes Association has not taken a specific stance on sugar intake per day.

The most recent comprehensive document, the 2019 ADA Nutrition Therapy Consensus Report states on page 3 to “minimize sugar and refined grains” and on page 10 they state “replace sugar sweetened beverages with water as often as possible”.

Option 3 was not chosen. Good job! Based on the lack of scientific evidence, the ADA does not endorse any nutraceuticals or supplements to reduce glucose levels.

Option 4 is incorrect because it is not individualized or based on the standards. The ADA goal for people with diabetes is to strive for a long term goal of 5% weight loss to improve outcomes. To achieve this structured programs and ongoing support are critical.,

BMI of 25: Based on population studies, the risk of getting diabetes increases with a BMI of 25 or greater (for Asians a BMI of 23 or greater). See our Diabetes Risk and Diagnosis Cheat Sheet. As a community, this means we want to help our children move into adulthood with a sound knowledge of healthy eating and active lifestyles to empower them to prevent prediabetes and diabetes.

We hope you appreciate this week’s rationale and keep studying hard! 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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