Rationale of the Week | How much bolus insulin at each meal?
For last week’s practice question, we quizzed participants on how much basal bolus insulin at each meal. 50% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question
Answer Choices:
- 3 units
- 5 units
- 6-7 units
- More information is needed to determine bolus dose.
Question: KT weighs 60 Kgs and is newly diagnosed with diabetes and needs to start insulin therapy.
Based on the 50/50 rule for determining insulin dosing, which of the following is the most accurate bolus dose for each meal?
Getting to the Best Answer
Answer 1 is incorrect. 17% chose this answer. “3 units.” The 50/50 rule for insulin is a dosing strategy based on body weight. The formula looks like this; Take body weight is kg times 0.5 to get total daily needs per day. Then give 50% as basal and 50% as bolus insulin. The last step is to divide the bolus insulin by 3 meals to get the meal time bolus dose. Since KT weighs 60kg, here is how you do the math; 60kg x 0.5 = 30 units total insulin a day. 50% or 15 units is dedicated to basal insulin and 50% or 15 units is dedicated to bolus insulin. Now, divide the 15 units bolus insulin by 3 meals, which equals 5 units per meal.
Answer 2 is correct. 50% of you chose this answer. “5 units.” Yes, this is the BEST answer. Since KT weighs 60kg, here is how you do the math; 60kg x 0.5 = 30 units total insulin a day. 50% or 15 units is dedicated to basal insulin and 50% or 15 units is dedicated to bolus insulin. Now, divide the 15 units bolus insulin by 3 meals, which equals 5 units per meal. Super easy.
Answer 3 is incorrect. About 10% of respondents chose this. “6-7 units.” The 50/50 rule for insulin is a dosing strategy based on body weight. The formula looks like this; Take body weight is kg times 0.5 to get total daily needs per day. Then give 50% as basal and 50% as bolus insulin. The last step is to divide the bolus insulin by 3 meals to get the meal time bolus dose. Since KT weighs 60kg, here is how you do the math; 60kg x 0.5 = 30 units total insulin a day. 50% or 15 units is dedicated to basal insulin and 50% or 15 units is dedicated to bolus insulin. Now, divide the 15 units bolus insulin by 3 meals, which equals 5 units per meal.
Finally, Answer 4 is incorrect. 22.57% chose this answer. “More information is needed to determine bolus dose.” Although this is a tempting answer, it’s not the best answer since this is a straight forward dosing calculation problem. There is no information about their social determinants of health or any barriers. Given those facts, answer B is the best answer.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
Want to learn more about this question?
Recorded & Ready to Watch
Insulin Calculation Workshop | From Pumps & Beyond
Level 4 | Advanced Level & Specialty Topics
Determining basal & bolus rates for multiple daily injections or insulin pumps can seem overwhelming. This course provides participants with a step-by-step approach to determining basal rates, bolus ratios & how to problem-solve when blood glucose levels aren’t on target. During this course, Coach Beverly provides abundant case studies to give participants hands-on practice & build confidence when calculating insulin doses for a variety of situations.
Objectives:
- Describe using formulas to determine appropriate insulin dosing.
- Discuss strategies to determine & fine-tune basal insulin dose.
- Describe how to determine & fine-tune bolus rates including coverage for carbs & hyperglycemia.
- Using a case study approach, utilize calculations to determine the best insulin dosing strategy.
Learning Outcome:
Participants will have an increased knowledge of how to calculate bolus/basal insulin therapy based on person-specific factors and will be able to recommend insulin adjustments based on individual needs.
Target Audience:
This course is a knowledge-based activity designed for individuals or groups of diabetes professionals, including RNs, RDs/RDNs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other healthcare providers interested in staying up to date on current practices of care for people with prediabetes, diabetes, and other related conditions. The practice areas for RDs/RDNs for CDR reporting are healthcare, preventative care, wellness, and, lifestyle along with, education and research.
CDR Performance Indicators:
- 10.3.1
- 10.5.3
Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 15 years. She is an Associate Clinical Professor at UCSF, a working educator, and a nationally recognized diabetes expert.
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Rationale of the Week | What do the NEW 2025 ADA Standards Say?
- Renewing your CDCES – Important Updates to Keep in Mind
- Question of the Week | Best Meds to Treat MASH – 2025 Standards
- Rationale of the Week | Low carb diets and SGLT-2’s a good mix?
- Entering the Field of Diabetes Education – Building a Bridge Program
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Rationale of the Week | Best Move to Get Glucose to Goal?
For last week’s practice question, we quizzed participants on getting glucose to goal. 60% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question
Question: LS wears an insulin pump and uses lispro insulin. LS has an average basal rate of 0.6 units and hour, a 1:15 carb ratio and a 1:50 correction ratio. Based on the ambulatory glucose profile, LS is experiencing elevated glucose levels from 4am to 7am.
To get glucose to target, what is the best next step?
Answer Choices:
- Add basal insulin glargine to prevent Somogyi effect.
- Increase the basal rate to prevent glucose elevations.
- Make sure LS isn’t consuming carbohydrates after 10pm.
- Ask LS to double check their CGM insertion site.
Getting to the Best Answer
Answer 1 is incorrect. 17.81% chose this answer.” Add basal insulin glargine to prevent Somogyi effect.” If a person is using insulin pump therapy, glargine injections would not be added in addition to the pump therapy. In addition, no basal insulins (like glargine) are used in pump therapy, only bolus insulins. Lastly, Somogyi effect is defined as a hypoglycemic event that triggers a burst of counterregulatory hormones that causes a substantial increase in blood glucose. There is no evidence that the person is experiencing hypoglycemia in this scenario.
Answer 2 is correct. 60.30% of you chose this answer. “Increase the basal rate to prevent glucose elevations.” YES, this is the best answer. LS is most likely experiencing Dawn Phenomena, which if the natural rise in blood sugars starting around 3-4 am due to the early morning release of cortisol and growth hormones. By increasing the pump’s basal rate to match this insulin resistant phase, we can help LS get blood glucose closer to target.
Answer 3 is incorrect. About 15.77% of respondents chose this. “Make sure LS isn’t consuming carbohydrates after 10pm.” This juicy answer does not explain why LS’s blood glucose always rises at 4am. Also, people with diabetes have the freedom to eat carbohydrates throughout the day and evening, they would just need to provide adequate bolus insulin coverage for late night carbs.
Finally, Answer 4 is incorrect. 6.12% chose this answer. “Ask LS to double check their CGM insertion site.” Since we can see a pattern of blood glucose levels rising each day at 4am, we assume that the CGM working correctly (we can always double check using a glucose meter to confirm)
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
Want to learn more about this question?
Now Recorded & Ready to Watch
Insulin Calculation Workshop | From Pumps & Beyond
Level 4 | Advance Level & Specialty Topics
Determining basal & bolus rates for multiple daily injections or insulin pumps can seem overwhelming. This course provides participants with a step-by-step approach to determining basal rates, bolus ratios & how to problem-solve when blood glucose levels aren’t on target. During this course, Coach Beverly provides abundant case studies to give participants hands-on practice & build confidence when calculating insulin doses for a variety of situations.
Objectives:
- Describe using formulas to determine appropriate insulin dosing.
- Discuss strategies to determine & fine-tune basal insulin dose.
- Describe how to determine & fine-tune bolus rates including coverage for carbs & hyperglycemia.
- Using a case study approach, utilize calculations to determine the best insulin dosing strategy.
Learning Outcome:
Participants will have an increased knowledge of how to calculate bolus/basal insulin therapy based on person-specific factors and will be able to recommend insulin adjustments based on individual needs.
Target Audience:
This course is a knowledge-based activity designed for individuals or groups of diabetes professionals, including RNs, RDs/RDNs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other healthcare providers interested in staying up to date on current practices of care for people with prediabetes, diabetes, and other related conditions. The practice areas for RDs/RDNs for CDR reporting are healthcare, preventative care, wellness, and, lifestyle along with, education and research.
CDR Performance Indicators:
- 10.3.1
- 10.5.3
Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 15 years. She is an Associate Clinical Professor at UCSF, a working educator, and a nationally recognized diabetes expert.
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Rationale of the Week | What do the NEW 2025 ADA Standards Say?
- Renewing your CDCES – Important Updates to Keep in Mind
- Question of the Week | Best Meds to Treat MASH – 2025 Standards
- Rationale of the Week | Low carb diets and SGLT-2’s a good mix?
- Entering the Field of Diabetes Education – Building a Bridge Program
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our Level 4 | Insulin Calculation Workshop | From Pumps & Beyond awards 1.5 CPEUs in accordance with the Commission on Dietetic Registration’s CPEU Prior Approval Program.
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Rationale of the Week | Medical Nutrition Therapy Coverage
For last week’s practice question, we quizzed participants on medical nutrition therapy coverage. 63% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question
Question: SJ is a 68-year-old recently referred for medical nutrition therapy (MNT). They are on a fixed income and are concerned about their out-of-pocket expense for their upcoming visit. SJ has Medicare (CMS) as their primary insurance.
What can we tell SJ about Medicare’s coverage for MNT services?
Answer Choices:
- Medicare provides full coverage and no cost share for all Medical Nutrition Therapy referrals.
- Medicare provides 3 hours of MNT services for the initial referral and calendar year and 2 hours after referral in subsequent years.
- Medicare provides coverage for diagnosis of diabetes, non-dialysis CKD stage 3- 5, and post-kidney transplants.
- Both B and C.
- All of the Above.
Getting to the Best Answer
Answer 1 is incorrect. 5.12% chose this answer. “Medicare provides full coverage and no cost share for all Medical Nutrition Therapy referrals.” While it is true that Medicare provides full coverage and no out-of-pocket cost share, not ALL MNT referrals are covered. Despite continued work towards increasing MNT access, currently, Medicare only provides coverage for specific diagnoses. Referrals must also come from a physician (MD and DO). Medicare does not accept referrals from an NP or PA. Keep reading for more information.
Answer 2 is incorrect. 13.72% of you chose this answer. “Medicare provides 3 hours of MNT services for the initial referral and calendar year and 2 hours after referral in subsequent years.” This answer is true but not the best answer. Medicare will provide coverage of up to 3 hours of MNT services for the first year of referral and 2 hours every calendar year thereafter with physician referral. If a provider determines medical necessity, most often from a change in diagnosis, treatment regimen, or medical condition, a second referral will allow additional hours of MNT services.
Answer 3 is incorrect. About 6.28% of respondents chose this. “Medicare provides coverage for diagnosis of diabetes, non-dialysis CKD stage 3- 5, and post-kidney transplants.” This answer is true but not the best answer. Medicare provides coverage for diabetes diagnoses, non-dialysis CKD stages 3-5, and post-kidney transplants within the last 36 months.
Answer 4 is correct. 62.56% chose this answer. “Both B and C.” Answer D is correct and the best answer.
Finally, Answer 5 is incorrect. 12.33% chose this answer. “All of the Above.” Answer E is incorrect and not the best answer. While advocacy for expansion of MNT services to cover other diagnosis is an active effort, at the time of writing, coverage remains for only the prior mentioned diagnoses.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
Want to learn more about this question?
Join us Live in Sunny San Diego for our
Annual DiabetesEd Training Conference
October 9th-11th, 2024
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, networking, games with prizes, and “aha” moments in beautiful San Diego on October 9-11, 2024.
You don’t want to miss this one-of-a-kind learning opportunity. Get away from all those daily responsibilities and immerse yourself in a fun and intensive conference with plenty of networking opportunities.
Attendees will leave this conference with new tools and a more complete understanding of the latest advances in diabetes care, from medications to technology to Medical Nutrition Therapy!
Each day, we provide a healthy breakfast, including fresh coffee, to kick off your morning. Our instructors co-teach the content to keep things fresh and lively. Plus, we play DiaBingo to reinforce key content. In addition, we provide plenty of movement breaks led by volunteers from the audience. Did we mention delicious lunches and a conference meeting space just minutes from San Diego Bay?
Friend Discount: 3 or more only $559-$799 (based on registration package) per person. Email us at [email protected] with the name and email of each registrant to get the discount!
Time: The course is Wednesday through Friday. Join us for breakfast at 7:00 a.m. each day. The class begins at 8:00 a.m. and ends at 5:00 p.m. on Wednesday and Thursday and at 3:00 p.m. on Friday.
- 3 Days: of critical information delivered by passionate speakers in an engaging and fun format!
- 18+ CEs: earned at the Live Seminar (RDs earn 18.75 CEs while Nurses & CA Pharmacists earn 22.75 CEs)
- 10 Bonus Online Courses, Earn 10+ CEs: As a course attendee, you automatically receive a bonus online course bundle of 13 online courses valued at over $179. Coach Beverly carefully chose each of these courses based on student feedback on which content best helped them succeed at the certification exams and in their clinical practice. You will be given instructions after you purchase the course on how to enroll in our Online University and get started!
- Healthy breakfast all days, gourmet lunch both days and refreshments.
- E-version of the syllabus
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Rationale of the Week | What do the NEW 2025 ADA Standards Say?
- Renewing your CDCES – Important Updates to Keep in Mind
- Question of the Week | Best Meds to Treat MASH – 2025 Standards
- Rationale of the Week | Low carb diets and SGLT-2’s a good mix?
- Entering the Field of Diabetes Education – Building a Bridge Program
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Rationale of the Week | Understanding Ankle Brachial Index – What is True?
For last week’s practice question, we quizzed participants on understanding ankle brachial index. 68% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question
Question: People of color living with diabetes are at increased risk of lower extremity complications and amputations. Ankle-Brachial Index (ABI) measures lower extremity vessel disease in individuals with diabetes and is an important tool to evaluate risk of future complications.
Which of the following is true regarding ABI?
Answer Choices:
- ABI result of less than 0.90 indicates peripheral arterial disease.
- ABI compares brachial systolic blood pressures between left and right arms.
- People with bounding pulses in lower extremities benefit from ABI testing.
- ABI testing can only be conducted by a vascular specialist.
Getting to the Best Answer
Answer 1 is correct. 67.75% chose this answer. “ABI result of less than 0.90 indicates peripheral arterial disease.” GREAT JOB. The ABI is a ratio that measures arterial perfusion in the upper extremities compared to the lower extremities. In brief, the ABI compares the systolic brachial pressure in the arm to the systolic pressure of the lower extremity (using the posterior tibial or dorsalis pedis pressure). To indicate adequate arterial circulation, the lower extremity pressure should be equal to the brachial pressure, or a ratio of 0.99 or better. Therefore, an ABI of less than 0.99 indicates decreased arterial circulation in lower extremities; an alert of peripheral arterial disease (PAD) People with peripheral arterial disease may also complain of pain in calves, legs or buttocks when walking that is relieved by stopping movement. Discovery of PAD requires referral to a specialist to determine next steps to treat PAD and to mitigate future risk of lower extremity complications and heart disease. For more info, we offer a FREE webinar called 3 Steps to DeFeet Amputation. Assess, Screen Report.
Answer 2 is incorrect. 9.0% of you chose this answer. “ABI compares brachial systolic blood pressures between left and right arms.” The ABI is a ratio that measures arterial perfusion in the upper extremities compared to the lower extremities. In brief, the ABI compares the systolic brachial pressure in the arm to the systolic pressure of the lower extremity (using the posterior tibial or dorsalis pedis pressure). For more info, we offer a FREE webinar called 3 Steps to DeFeet Amputation. Assess, Screen Report.
Answer 3 is incorrect. About 14.5% of respondents chose this. “People with bounding pulses in lower extremities benefit from ABI testing.” Bounding pulses in the lower extremity is a positive sign of adequate lower extremity circulation. For more info, we offer a FREE webinar called 3 Steps to DeFeet Amputation. Assess, Screen Report.
Finally, Answer 4 is incorrect. 8.75% chose this answer. “ABI testing can only be conducted by a vascular specialist.” ABI can be conducted in a variety of medical settings as long as the health care professional has completed training on how to perform an accurate ABI, For more info, we offer a FREE webinar called 3 Steps to DeFeet Amputation. Assess, Screen Report.
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!
Why become a CDCES?
Three Reasons from Coach Beverly
Read More: 3 Reasons to Become a CDCES “The best part of becoming a CDCES is working with my colleagues and people living with diabetes. As diabetes educators, we hear compelling and beautiful life stories. I am astounded by the barriers they face and inspired by their adaptability, problem-solving skills, and resilience.“ Reason 1: CDCES is a widely recognized certification by employers and health care professionals throughout the U.S. This credential demonstrates a specialized and in-depth knowledge in the prevention and treatment of individuals living with pre-diabetes and diabetes. Reason 2: Currently, 13% of people in the U.S. have diabetes and another 36% have pre-diabetes which means 49% of Americans are running around with elevated blood glucose levels. Given this epidemic, there will be plenty of future job opportunities. Reason 3: Having my CDCES along with my nursing degree, has opened many doors of opportunity; from working as an inpatient Diabetes Nurse Specialist in a hospital to working as a Manager of Diabetes Education in the outpatient setting to starting my own consulting company.
- Exam requirement updates and eligibility
- New test format starting in July 2024
- 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!
Don’t worry, we will send you a link to the recorded version.
Instructor
Coach Beverly Thomassian, RN, MPH, BC-ADM, CDCES
Author, Nurse, Educator, Clinician, and Innovator, Beverly has specialized in diabetes management for over twenty years and has successfully passed the CDCES exam six times. As president and founder of Diabetes Education Services, Beverly is dedicated to optimizing diabetes care and improving the lives of those with diabetes.
“Becoming a Certified Diabetes Care and Education Specialist (CDCES) is one of the best professional and personal decisions I have ever made.” – Coach Beverly Thomassian
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Rationale of the Week | What do the NEW 2025 ADA Standards Say?
- Renewing your CDCES – Important Updates to Keep in Mind
- Question of the Week | Best Meds to Treat MASH – 2025 Standards
- Rationale of the Week | Low carb diets and SGLT-2’s a good mix?
- Entering the Field of Diabetes Education – Building a Bridge Program
The use of DES products does not guarantee the successful passage of the diabetes certification exams. CBDCE & ADCES does not endorse any preparatory or review materials for the certification exams, except for those published by CBDCE & ADCES.
**To satisfy the requirement for renewal of certification by continuing education for the Certification Board for Diabetes Care & Education (CBDCE), continuing education activities must be applicable to diabetes and approved by a provider on the CBDCE List of Recognized Providers (www.ncbde.org). CBDCE does not approve of continuing education. Diabetes Education Services is accredited/approved by the Commission of Dietetic Registration which is on the list of CBDCE Recognized Providers.
Rationale of the Week | Metformin and Cancer
For last week’s practice question, we quizzed participants on the interaction of Metformin with cancer. 66% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question
Question: JR is taking Metformin 1000mg BID but is worried about getting cancer and is thinking about stopping the metformin.
Which of the following is an accurate statement regarding diabetes, metformin and cancer?
Answer Choices:
- There is research suggesting that metformin may be associated with a decreased risk of certain cancers.
- Metformin is associated with B12 deficiency and anemia, so it is best to hold metformin for now.
- There is no additional benefit from metformin, since people with diabetes have a slightly lower risk of liver and uterine cancers.
- Metformin does not increase risk of cancer, but it can negatively impact renal function.
Getting to the Best Answer
Answer 1 is correct. 65.63% chose this answer. “There is research suggesting that metformin may be associated with a decreased risk of certain cancers.” Yes, this is the best answer. According to the ADA Standards, there is ongoing research on metformin’s potential role for decreasing and treating certain cancers due to it’s anti-inflammatory action at a cellular level. Metformin is the most common diabetes medication in use worldwide for good reason. It is affordable and effective. In addition to lowering blood glucose and LDL cholesterol, metformin increases gut microbiota diversity and has an excellent safety profile. See our Meds PocketCard for more info.
Answer 2 is incorrect. 5.47% of you chose this answer. “Metformin is associated with B12 deficiency and anemia, so it is best to hold metformin for now.” While it is true that some individuals experience B12 deficiency with metformin, the benefits of metformin outweigh the potential impact on vitamin B12 deficiency. It is important to evaluate anemia and nerve pain in people on metformin and provide B12 replacement therapy if indicated. See our Meds PocketCard for more info.
Answer 3 is incorrect. About 1.95% of respondents chose this. “There is no additional benefit from metformin, since people with diabetes have a slightly lower risk of liver and uterine cancers.” People with diabetes have increased risk of breast, liver and pancreatic cancers. Encouraging healthy lifestyle along with regular cancer screenings is an integral part of providing diabetes care. See our Meds PocketCard for more info.
Finally, Answer 4 is incorrect. 26.95% chose this answer. “Metformin does not increase risk of cancer, but it can negatively impact renal function.” This answer is FALSE. Many people with diabetes have recently shared with me that they are worried that metformin is “bad” for them and causes kidney damage. There is no data to support this and the opposite is actually true. Since metformin lowers A1C by 1-2% points, it protects the kidneys and blood vessels. Metformin is mostly cleared by the kidneys, so the GFR needs to be at least 30 mL/min to safely take metformin. However, metformin has no negative impact on kidney function and is considered a very safe and beneficial diabetes medication by the scientific and medical community, See our Meds PocketCard for more info.
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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We love her wicked sense of humor, organizational skills, and extensive knowledge, all packaged together with her big-hearted humanity. Bryanna is also the proud mama of Biscuit and Muffin, who she often features as the feline stars in her “Cat Bakery.” Thank you, Bryanna, for your generosity and for leading our team with your expertise, humanity, and kindness. |
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Rationale of the Week | What do the NEW 2025 ADA Standards Say?
- Renewing your CDCES – Important Updates to Keep in Mind
- Question of the Week | Best Meds to Treat MASH – 2025 Standards
- Rationale of the Week | Low carb diets and SGLT-2’s a good mix?
- Entering the Field of Diabetes Education – Building a Bridge Program
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Rationale of the Week | JR Wants to Avoid Ingrown Toenails
For last week’s practice question, we quizzed participants on avoiding ingrown toenails. 61% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question
Question: JR lives with type 2 diabetes and works 10-11 hours a day driving a tractor for a local farm. It is difficult for JR to make medical appointments since their employer has very strict attendance guidelines. JR has ingrown toenails in the big toes, that cause a great deal of pain. Since they didn’t have time to come in for care, JR cut off half of their toenails on both feet to prevent an ingrown nail. As you inspect JR’s feet, you see that their big toes are swollen and red. You ask the provider to evaluate JR’s feet because you are worried. After the provider evaluates JR’s feet, they turn to JR and say, “Diabetics should never cut their toenails like this. It causes infection”.
What is this an example of?
Answer Choices:
- Effective cultural humility coupled with compliance model.
- Avoidance of the adherence model and promotion of transtheoretical approach.
- Adult learning theory disruption coupled with interpersonal shaming.
- Unawareness of language and the impact of social determinants of health.
Getting to the Best Answer
Answer 1 is incorrect. 5.94% chose this answer. “Effective cultural humility coupled with compliance model.” The provider’s response was not culturally humble or thoughtful of JR’s economic circumstance or social determinants of health. This provider could benefit from coaching on how to use a strength based approach coupled with addressing individuals with respect and person-centered language. Watch our “Language Matters” FREE Webinar for helpful information.
Answer 2 is incorrect. 7.53% of you chose this answer. “Avoidance of the adherence model and promotion of transtheoretical approach.” The provider’s response was based on the old fashioned compliance model. The provider was not thoughtful of JR’s readiness for change or their circumstance. This provider could benefit from coaching on how to use a strength based approach coupled with addressing individuals with respect and person-centered language. Watch our “Language Matters” FREE Webinar for helpful information.
Answer 3 is incorrect. About 26.03% of respondents chose this. “Adult learning theory disruption coupled with interpersonal shaming.” The provider’s response did not consider the expertise of the individual or adult learning theory, so they didn’t disrupt adult learning theory because they never initiated it. The provider did speak to JR using shame based language and the word “should”. Watch our “Language Matters” FREE Webinar for helpful information.
Finally, Answer 4 is correct. 60.50% chose this answer. “Unawareness of language and the impact of social determinants of health.” YES, this is the best answer This provider could benefit from coaching on how to use a strength based approach coupled with addressing individuals with respect and person-centered language. Watch our “Language Matters” FREE Webinar for helpful information.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
Want to learn more about this question?
Join us Live in Beautiful San Diego for our
Annual DiabetesEd Training Conference
October 9th-11th, 2024
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, networking, games with prizes, and “aha” moments in beautiful San Diego on October 9-11, 2024.
You don’t want to miss this one-of-a-kind learning opportunity. Get away from all those daily responsibilities and immerse yourself in a fun and intensive conference with plenty of networking opportunities.
Attendees will leave this conference with new tools and a more complete understanding of the latest advances in diabetes care, from medications to technology to Medical Nutrition Therapy!
Each day, we provide a healthy breakfast, including fresh coffee, to kick off your morning. Our instructors co-teach the content to keep things fresh and lively. Plus, we play DiaBingo to reinforce key content. In addition, we provide plenty of movement breaks led by volunteers from the audience. Did we mention delicious lunches and a conference meeting space just minutes from San Diego Bay?
Friend Discount: 3 or more only $559-$799 (based on registration package) per person. Email us at [email protected] with the name and email of each registrant to get the discount!
Time: The course is Wednesday through Friday. Join us for breakfast at 7:00 a.m. each day. The class begins at 8:00 a.m. and ends at 5:00 p.m. on Wednesday and Thursday and at 3:00 p.m. on Friday.
- 3 Days: of critical information delivered by passionate speakers in an engaging and fun format!
- 18+ CEs: earned at the Live Seminar (RDs earn 18.75 CEs while Nurses & CA Pharmacists earn 22.75 CEs)
- 10 Bonus Online Courses, Earn 10+ CEs: As a course attendee, you automatically receive a bonus online course bundle of 13 online courses valued at over $179. Coach Beverly carefully chose each of these courses based on student feedback on which content best helped them succeed at the certification exams and in their clinical practice. You will be given instructions after you purchase the course on how to enroll in our Online University and get started!
- Healthy breakfast all days, gourmet lunch both days and refreshments.
- E-version of the syllabus
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Rationale of the Week | What do the NEW 2025 ADA Standards Say?
- Renewing your CDCES – Important Updates to Keep in Mind
- Question of the Week | Best Meds to Treat MASH – 2025 Standards
- Rationale of the Week | Low carb diets and SGLT-2’s a good mix?
- Entering the Field of Diabetes Education – Building a Bridge Program
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Rationale of the Week | Most important action in case of fire?
For last week’s practice question, we quizzed participants on most important action in case of fire. Most of our respondents chose the best answer. GREAT JOB. We want use this rationale to share important resources on Disaster Preparedness. We encourage you to pass this info on to people living with diabetes and your colleagues. Plus this info will prepare you for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question
Question:
JR lives with type 1 diabetes and uses an insulin pump and sensor. They live in an area that is fire prone and JR asks you about how they should prepare for an emergency if evacuation is required.
What action is most important?
Answer Choices:
- Make sure they have their health history documented and stored in a watertight bag.
- Prepare an emergency kit that includes at least one week’s worth of diabetes supplies.
- Keep a fire extinguisher within easy reach and know the exit routes.
- Reach out to emergency responders ahead of time to let them know that JR has type 1 diabetes.
Getting to the Best Answer
Answer 1 is incorrect. 2.38% chose this answer. “Make sure they have their health history documented and stored in a watertight bag.” Having easy access to your health history, including emergency contacts, provider, list of current medications etc., is always a sound idea. Encourage people to have a copy on their electronic devices and a printed copy if possible. However, in this question, it is not the MOST important action. See Disaster Preparedness Resources & Printable Checklist.
Answer 2 is correct. 89.97% of you chose this answer. “Prepare an emergency kit that includes at least one week’s worth of diabetes supplies.” YES, GREAT JOB. This is the best answer. Having a pre-packed get away bag that has at least one week of diabetes supplies, plus snacks, water, clothes, battery back-up for electronic devices and other items as detailed here Disaster Preparedness Resources & Printable Checklist is a top priority for people with diabetes. Disaster can strike at any time and planning ahead can be life saving.
Answer 3 is incorrect. About 4.48% of respondents chose this. “Keep a fire extinguisher within easy reach and know the exit routes.” All people benefit from having a fire extinguisher in their home and making sure there is a clear exit path. However, this is not the most important action. See Disaster Preparedness Resources & Printable Checklist.
Finally, Answer 4 is incorrect. 3.17% chose this answer. “Reach out to emergency responders ahead of time to let them know that JR has type 1 diabetes.” It is important to sign-up for electronic and/or phone notifications of impending disasters to be alerted to emergencies. However, there is not a system in place to notify emergency responders ahead of time that someone has type 1 diabetes. For more info, see Disaster Preparedness Resources & Printable Checklist.
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!
Resources for Disaster Preparedness
Want to learn more about this question?
Join us live on July 18th, for our
Type 2 Diabetes Intensive
Level 4 | Advanced Level & Specialty Topics
This course provides a detailed overview of the pathophysiology of type 2 diabetes, prevention strategies, & cardiovascular risk reduction. In addition, we highlight type 2 treatment approaches including nutrition, activity, oral & injectable medications plus screening & treatment guidelines for micro & macrovascular diseases. Through case studies & discussion, we highlight strategies to focus on a person-centered approach along with attention to psychosocial care for people living with diabetes.
Objectives:
- Discuss the current epidemiology of type 2 diabetes.
- Describe the classification, terminology & diagnostic criteria for diabetes.
- Identify the eight pathophysiologic defects associated with the ominous octet.
- Describe evidence and strategies to prevent type 2 diabetes.
- State strategies to implement a person-centered approach to those with diabetes.
- Discuss key aspects of type 2 diabetes management including education, therapeutic lifestyle changes, glucose, lipid, & hypertension management plus referrals.
- Understand the overarching principles of management of type 2 DM.
Learning Outcome:
Attendees will be able to articulate and integrate into practice the impact, goals, and management strategies for people living with type 2 diabetes.
Target Audience:
This course is a knowledge-based activity designed for individuals or groups of diabetes professionals, including RNs, RDs/RDNs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other healthcare providers interested in staying up to date on current practices of care for people with prediabetes, diabetes, and other related conditions. The practice areas for RDs/RDNs for CDR reporting are healthcare, preventative care, wellness, and, lifestyle along with, education and research.
CDR Performance Indicators:
- 10.4.2
- 10.5.1
Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 15 years. She is an Associate Clinical Professor at UCSF, a working educator, and a nationally recognized diabetes expert.
All hours earned count toward your CDCES Accreditation Information
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Rationale of the Week | What do the NEW 2025 ADA Standards Say?
- Renewing your CDCES – Important Updates to Keep in Mind
- Question of the Week | Best Meds to Treat MASH – 2025 Standards
- Rationale of the Week | Low carb diets and SGLT-2’s a good mix?
- Entering the Field of Diabetes Education – Building a Bridge Program
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our Level 4 | Type 2 Diabetes Intensive awards 2.0 CPEUs in accordance with the Commission on Dietetic Registration’s CPEU Prior Approval Program.
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Rationale of the Week | Primary Goals for the DPP?
For last week’s practice question, we quizzed participants on primary goals of the DPP. 62% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question
Question: The Diabetes Prevention Program (DPP) primary lifestyle intervention goals include achieving and maintaining a minimum of 7% weight loss and 150 minutes of moderate-intensity physical activity per week.
What outcomes are expected from these intervention goals?
Answer Choices:
- DPP lifestyle intervention resulted in a 58% reduction of rate of diabetes over 3 years.
- Sustained interventions over 15 years reduced risk of progression to type 2 diabetes by 27%.
- Achieving 150 minutes of moderate-intensity activity per week without weight loss is adequate to reduce incidence of type 2 diabetes.
- All the above.
Getting to the Best Answer
Answer 1 is incorrect. 20.14% chose this answer. “DPP lifestyle intervention resulted in a 58% reduction of rate of diabetes over 3 years.” A is correct but is not the best answer. The initial DPP study included 1,079 participants who participated in lifestyle interventions and found a 58% reduction in the rate of diabetes.
Answer 2 is incorrect. 11.95% of you chose this answer. “Sustained interventions over 15 years reduced risk of progression to type 2 diabetes by 27%.” B is correct but not the best answer. The 15-year follow-up study validated that diabetes incidence was reduced by 27% for lifestyle intervention participants.
Answer 3 is incorrect. About 6.31% of respondents chose this. “Achieving 150 minutes of moderate-intensity activity per week without weight loss is adequate to reduce incidence of type 2 diabetes.” Response C is correct but not the best answer. Weight loss is an important factor in reducing the risk of diabetes progression; however, the DPP study found that even without achieving weight loss goals, the incidence of type 2 diabetes was reduced by 44% if at least 150 minutes of physical activity per week was achieved.
Finally, Answer 4 is correct. 61.60% chose this answer. “All of the above.” Answer D is correct and is the best answer.
References:
- American Diabetes Association Professional Practice Committee; 3. Prevention or Delay of Diabetes and Associated Comorbidities: Standards of Care in Diabetes—2024. Diabetes Care1 January 2024; 47 (Supplement_1): S43–S51. https://doi.org/10.2337/dc24-S003
National Diabetes Prevention Program Coverage Toolkit. Downloaded on July 19th, 2024 from https://coveragetoolkit.org.
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 weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Rationale of the Week | What do the NEW 2025 ADA Standards Say?
- Renewing your CDCES – Important Updates to Keep in Mind
- Question of the Week | Best Meds to Treat MASH – 2025 Standards
- Rationale of the Week | Low carb diets and SGLT-2’s a good mix?
- Entering the Field of Diabetes Education – Building a Bridge Program
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
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