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Rationale of the Week | How to work in Birthday Cake?
For our February 23rd Question of the Week, over 94% of respondents chose the best answer!
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 59 year old with type 2 diabetes, A1c of 7.2%, takes bolus insulin before meals, plus basal insulin at night and metformin. They ask you how to best work in a piece of birthday cake for their grandchild’s upcoming birthday celebration.
What is the best advice?
Answer Choices:
- Take additional bolus insulin to cover the extra carbs
- Accept the cake but don’t actually eat it
- Increase their nighttime basal insulin to prevent hyperglycemia
- Skip the previous meal to allow for the extra cake carbs
As shown above, the most common choice was option 1, 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, the content of this practice test question will set you up for success. The exam often presents vignettes that compel test takers to determine which option incorporates a person centered approach. Person centered choices are usually the BEST answer.
Answers & Rationale
Answer 1 is correct, 94.79% chose this answer. ” Take additional bolus insulin to cover the extra carbs”. Yes, this is the BEST person-centered answer. People with diabetes can choose to increase their bolus insulin to cover for special occasions, like birthday cake.
Answer 2 is incorrect, 1.29% of you chose this answer. “Accept the cake but don’t actually eat it”. Based on this vignette, the person with diabetes wants to “work” the cake into their meal plan. A person centered approach honors their choice and helps them determine how to enjoy the cake while managing blood sugars.
A person centered approach honors their choice and helps them determine how to enjoy the cake while managing blood sugars.
Answer 3 is incorrect, 3.56% of you chose this answer “Increase their nighttime basal insulin to prevent hyperglycemia”. Since basal insulin does not cover carbohydrates or protect against post prandial hyperglycemia, increasing nighttime basal is not the best answer. As a matter of fact, increasing nighttime basal could cause morning hypoglycemia.
Answer 4 is incorrect, 0.36% of you chose this answer. “Skip the previous meal to allow for the extra cake carbs”. This action could lead to hypoglycemia since this person is on basal bolus insulin. For this reason, it is not 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!
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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
Rationale of the Week | Best Fix for Hyperglycemic Spike?
For our February 16th Question of the Week, over 76% of respondents chose the best answer!
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 is 79 years old and their most recent A1c is 7.4%. LS takes metformin 1000 mg twice daily and sitagliptin (Januvia) plus 14 units of basaglar at before sleep at 2am. LS is excited that they started using a Freestyle Libre sensor and shows you the glucose trends. You notice that glucose levels rise to 250 – 350 in between noon to 4pm.
What is the next best action?
Answer Choices:
- Start bolus insulin at breakfast
- Increase basal insulin by 20%
- Add a low dose sulfonylurea
- Assess food timing and content
As shown above, the most common choice was option 4, the second most common answer was option 2, then option 1, and finally option 3.
Getting to the Best Answer
If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. The exam often present vignettes that compel test takers to weed through the details and figure out the key intent of the question and chose the BEST answer.
Answers & Rationale
Answer 1 is incorrect, 9.23% chose this answer. “Start bolus insulin at breakfast”. Giving bolus insulin at breakfast would not prevent the glucose elevations from 12pm to 4pm. If we were to start bolus insulin to help with these afternoon spikes, we would need to give it before lunch to match post lunch glucose elevations.
Answer 2 is incorrect, 9.83% of you chose this answer. “Increase basal insulin by 20%”. Basal insulin helps to manage overnight and between-meal blood glucose levels. It is not effective at preventing post-prandial hyperglycemia. We evaluate if a person is taking enough basal insulin by seeing if fasting blood glucose is in the 80-130 mg/dl range.
Answer 3 is incorrect, 4.84% of you chose this answer “Add a low dose sulfonylurea”. Generally speaking, if a person is on basal insulin we are reluctant to add a sulfonylurea, since it can potentiate hypoglycemia (LS’s A1c is 7.4%) and may not address this specific issue of lunch time post-prandial spike. In addition, since the A1c is so close to target, it might be a good idea to take a closer look at food intake and activity and it’s impact on post lunch blood sugars.
Answer 4 is correct, 76.10% of you chose this answer. “Assess food timing and content”. GREAT JOB team. Most of you chose the best answer. As it turns out, LS was eating cereal and “mini” bagels for lunch. This explained the post meal spike. By helping LS understand which foods are carbohydrates and their impact on blood glucose, LS was eager to make adjustments at lunch to get blood sugar to target.
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!
Test Taking Practice Exam Toolkit Webinar
20 Sample Practice Questions
You are invited to join Coach Beverly for this FREE Webinar. And, if you want to have access to an additional 220+ sample practice online questions, you can purchase the complete Test Taking Toolkit.
For many of us, taking the certification exam is a nerve-wracking process.
During this webinar, Coach Beverly will help you transform your nervousness into focused energy that will help you succeed. She will provide test-taking tips based on her experience taking the certification exam six times.
To provide plenty of practice, Coach Beverly will sample 20 test questions that have been plucked from our Test Taking Toolkit during this free webinar.
She will explain how to dissect the question, eliminate wrong answers and avoid getting lured in by juicy answers.
2 Ways to Join Test Taking Webinar
Purchase for $49
This includes access to the recorded version of this webinar on your Online University Student Portal.
Plus, the Test Taking Toolkit provides you over 220 sample online practice questions, simulating the exam experience. A perfect way to assess your knowledge and create a focused study plan, while increasing your test-taking confidence.
Watch Webinar for FREE
This includes a review of 20 sample test questions with test-taking strategies. This does not include access to the recorded webinar or the practice questions.
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.
Rationale of the Week | When to Stop IV insulin with DKA
For our February 9th Question of the Week, over 50% of respondents chose the best answer!
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: RT is a 49-year-old with type 1 diabetes, admitted to a local hospital to treat Diabetes Ketoacidosis (DKA). RT is on an insulin drip, fluids and potassium replacement therapy and is getting hungry. The IV insulin is running at 2 units an hour and the RTs usual insulin dose at home is 12 units glargine at bedtime and 3-4 units of lispro before meals.
Before stopping the IV insulin, what is the most important action?
Answer Choices:
- Maintenance of glucose less than 200 for at least 4 hours
- Give 3 units of bolus insulin via IV and at least 6 units of glargine
- Evaluate labs to make sure that RT is ketone negative
- Determine if potassium replacement is still needed
As shown above, the most common choice was option 3, the second most common answer was option 1, then option 2, and finally option 4.
Getting to the Best Answer
If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. There are questions on in-hospital care of diabetes and treating hyperglycemic crises.
DKA Quick Review
Before we answer this question, we thought we would provide a quick summary of the basics of DKA.
Diabetes Ketoacidosis occurs because there is not enough insulin to use glucose for fuel. The body turns to fat for fuel and this causes a build-up of ketone bodies in the blood and urine. Since ketone bodies are acids, they lower the pH of the blood potentially causing a life-threatening acidosis.
Insulin therapy is required to stop acidosis.
Additionally, even if the glucose is under 200, the person can still be “under insulinized” and ketotic. That is why the insulin drip can only be stopped when the person is ketone negative and no longer burning fat for fuel. One sign that they are moving out of ketosis is that they become hungry. Ketone bodies are very irritating to the GI system and cause nausea and sometimes significant abdominal pain.
If the insulin drip is stopped too early, when the person is still positive for ketones, they are at risk of going back into DKA.
Potassium – When people are experiencing ketosis they are insulin deprived. This lack of insulin allows potassium to leave the cells and enter the bloodstream. Much of this excessive extracellular potassium is then renally excreted. When insulin therapy is started, this pushes potassium back into the cells and can cause a dangerous drop in serum potassium levels. For this reason, most people with DKA will need potassium replacement.
It is critically important to evaluate potassium before starting insulin therapy in someone with DKA. If the potassium is less than 3.3 mEq/L, the guidelines recommend providing potassium replacement therapy first, then starting insulin when potassium levels are stable.
See our blog Treating DKA with SubQ Insulin here for more details.
Answers & Rationale
Answer 1 is incorrect, 19.34% chose this answer. “Maintenance of glucose less than 200 for at least 4 hours”. Even if the glucose is under 200, the person can still be “under insulinized” and ketotic. That is why the insulin drip can only be stopped when the person is ketone negative and no longer burning fat for fuel.
Answer 2 is incorrect 16.86% of you chose this answer. “Give 3 units of bolus insulin via IV and at least 6 units of glargine”. It is true that subq insulin needs to be administered about 2 hours before stopping the IV insulin since the half-life of IV insulin is only minutes. But, most important is that we need to make sure their acidosis is resolved. If the insulin drip is stopped too early, when the person is still positive for ketones, they are at risk of going back into DKA.
Answer 3 is correct 51.02% of you chose this answer “Evaluate labs to make sure that RT is ketone negative” YES, this is the BEST Answer. If they are ketone negative and blood sugars are under 200, we can inject subq basal insulin about 2 hours before stopping the drip to stabilize glucose levels. Then we provide subq insulin replacement therapy based on prior history and body weight.
Answer 4 is incorrect 12.78% of you chose this answer. “Determine if potassium replacement is still needed” Of course, we are keeping a close eye on potassium, but an IV is not required to administer potassium since it can be given orally. In addition, the most important factor in determining if the IV insulin can be stopped is the state of ketosis.
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!
Hyperglycemic Crises, DKA & HHS | 1.0 CEs
Join Coach Beverly to learn more about the causes and treatment of hyperglycemic crisis.
This course is included in: Level 2 – Standards of Care. Purchase this course individually for $19 or the entire bundle and save 70%.
This 60-minute course discusses common causes of hyperglycemia crises. Topics include hyperglycemia secondary to medications and insulin deprivation. The difference and similarities between Diabetes Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome are also covered. Treatment strategies for all situations are included.
Topics include:
- Common causes of hyperglycemic crises.
- The difference and similarities between DKA and HHS and treatment strategies
- Causes and treatment of hyperglycemic crises.
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.
Rationale of the Week | Which Vaccines Does JL Need?
For our February 2nd Question of the Week, over 75% of respondents chose the best answer!
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: JL is 65 years old and has diabetes. JL tells you they had two different pneumonia vaccines in the past, but they are wondering what vaccinations they need this year.
What is the BEST answer?
Answer Choices:
- Flu and Pneumonia PPSV23 [Pneumovax]
- Hepatitis B and Flu vaccine
- Pneumonia PCV13 [Prevnar] and Human Papilloma Virus (HPV)
- Zoster and Hepatitis B vaccine
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.
Getting to the Best Answer
If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. We have posted Vaccination Slides below from our Annual Standards of Care 2021 Webinar update.
Answer 1 is correct 75.38% chose this answer. “Flu and Pneumonia PPSV23 [Pneumovax]” The 2021 ADA Standards provide much clearer guidelines on vaccinations. People with diabetes need a flu vaccine yearly and a pneumonia vaccine, PPSV23, after they turned 65 regardless of previous pneumonia vaccine history.
Answer 2 is incorrect 15.04% of you chose this answer. “Hepatitis B and Flu vaccine.” The flu vaccine is correct. For people aged 65 or older, the hepatitis vaccine is only administered if the person is at increased risk of hepatitis and is based on a cost-benefit discussion with their provider.
Answer 3 is incorrect 2.05% of you chose this answer “Pneumonia PCV13 [Prevnar] and Human Papilloma Virus (HPV) vaccine” The ADA no longer recommends that people 65 years and older routinely receive the PCV13 vaccine. The HPV vaccine is recommended for people up to the age of 27 and if indicated up to the age of 45.
Answer 4 is incorrect 7.52% of you chose this answer. “Zoster and Hepatitis B vaccine” Zoster vaccine is recommended for people over the age of 50 with diabetes. However, for people aged 65 or older, the hepatitis vaccine is only administered if the person is at increased risk of hepatitis and is based on a cost-benefit discussion with their provider.
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.
Rationale of the Week | What is the B/P Goal?
For our January 26th Question of the Week, over 70% of respondents chose the best answer!
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 52 with type 1 diabetes and a minor stroke last year. RJ takes an ACE Inhibitor, insulin, and a statin.
According to ADA Standards of Care 2021, what is the blood pressure target for RJ?
Answer Choices:
- 120/70
- 130/80
- 140/90
- 135/85
As shown above, the most common choice was option 2, the second most common answer was option 3, then option 1, and finally option 4.
Getting to the Best Answer
If you are thinking about taking the certification exam, the content of this practice test question will set you up for success.
Answer 1 is incorrect 12.16% chose this answer. “120/70”. The ADA Standards suggest that we provide information on healthy eating and the importance of activity, coupled with a referral to a RD and DSMES, when blood pressure levels are greater than 120/70. But, this is not the blood pressure management goal.
Answer 2 is correct 70.82% of you chose this answer. “130/80”. This is the best answer. Since RJ had a stroke, they walk through the door with an existing CV event, which identifies them as higher risk for a future event. The standards state that if the person has experienced a CV event or has a 10 year risk of 15% or greater (using the ASCVD Risk Calculator), the blood pressure target is 130/80.
Answer 3 is incorrect 13.37% of you chose this answer “140/90” The ADA Standards state that the blood pressure target is 140/90 if the 10 year risk of a CV event is less than 15% or the person has not experienced a previous CV event. Since RJ had experienced a minor stroke, the target is 130/80. Of course, this goal is individualized based on individual factors and a risk/benefit analysis.
Answer 4 is incorrect 3.65% of you chose this answer. “135/85” The standards state that if the person has experienced a CV event or has a 10 year risk of 15% or greater (using the ASCVD Risk Calculator), the blood pressure target is 130/80.
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.
Rationale of the Week | 4 Meds and Hypo
For our January 19th Question of the Week, over 77% of respondents chose the best answer!
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:
MT is 59 and her most recent A1c was 10.3%. The diabetes specialist suggested they add insulin to her other 3 oral diabetes medications to lower A1c. MT was not ready for insulin, so the specialist agreed that they would try adding on glipizide 5mg BID and evaluate the response for one month.
After 2 weeks, MT calls and is very upset about her frequent low blood sugars (66, 68, 69) that are happening between 3 pm and 6 pm a few times a week. MT works in the field starting at 5 am and gets her lunch break at 10 am and eats her dinner again at 6 pm.
Which of the following is the best recommendation?
Answer Choices:
- Hold the glipizide for one week
- Make sure MT has a glucagon emergency kit in the field
- Inform her that she is protected under the American Disabilities Act
- Encourage a 2 pm carbohydrate snack
As shown above, the most common choice was option 4, the second most common answer was option 1, then option 2, and finally option 3.
Getting to the Best Answer
If you are thinking about taking the certification exam, the content of this practice test question will set you up for success.
Answer 1 is incorrect 10.94% chose this answer. “Hold the glipizide for one week.” Since MT had a very elevated A1c of 10.3%, holding the glipizide for a week could lead to a dangerously elevated blood glucose. A more nuanced intervention is required.
Answer 2 is incorrect 9.06% of you chose this answer. “Make sure MT has a glucagon emergency kit in the field.” MT doesn’t need a glucagon emergency kit at this point. Since MT can detect the signs hypoglycemia, they just need instruction to eat a 15gm carb snack to treat these symptoms and avert a hypoglycemic emergency.
Answer 3 is incorrect 2.22% of you chose this answer “Inform her that she is protected under the American Disabilities Act (ADA).” It is important for people with diabetes to know that they are protected under the ADA. They have the right to monitor their blood glucose, take medications/insulin at work and take a break to treat hypoglycemia. However, this is not the best answer.
Answer 4 is correct 77.78% of you chose this answer. “Encourage a 2 pm carbohydrate snack.” Since MT is having is having low blood sugar consistently between 3pm and 6pm, we do some investigation and find out the MT is not eating for up to 8 hours. For people taking sulfonylureas, like glipizide, they need to eat every 4-5 hours to match the extra insulin the pancreas is producing in response to the glipizide. A 15 gm snack at 2pm would be a perfect solution to prevent hypoglycemia and allow MT to continue taking the glipizide to keep blood glucose levels on target.
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.
Rationale of the Week | 4 Meds and A1c of 8.9%
For our January 12th Question of the Week, over 58% of respondents chose the best answer!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question
Question:
JR is on metformin 2000mg, empagliflozin 25mg, semaglutide 1.0mg, and 100 units of glargline insulin. A1C is 8.9% and JR weighs 100kg.
What best describes this clinical picture?
Answer Choices:
- Overbasalization
- Non-compliance
- Fear of hypoglycemia
- Clinical inaction
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.
Getting to the Best Answer
If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. It addresses a common ADA Standard 9 and approaches to managing hyperglycemia with type 2 diabetes. This standard is brief with very helpful tables and algorithms. A must-read section for anyone ready to be more actively involved in advocacy and pharmacologic management of diabetes.
Answer 1 is correct. 58.07% chose this answer. ” Overbasalization.” This is the best answer, because JR is on 3 diabetes medications plus 100 units of basal insulin, and their glucose is still above target. This treatment plan isn’t working. If we look at the ADA Guidelines, (section 9 outlined on a slide below), it states if the basal insulin is more than 0.5 units/kg/day, we need to take further action.
Too much basal
JR weighs 100kg. The max dose of basal insulin based on his body weight should be 50 units (100kg x 0.5 = 50 units). Yet, JR is on 100 units. What are possible solutions?
Getting to basal + bolus
According to ADA Algorithm, we could add 10% of the current basal as bolus insulin, or 10 units one or two meals a day.
Or we could convert it to combo insulin, like 70/30 insulin. To do that conversion, first, decrease total basal insulin by 80% for safety.
100 units x 0.8 = 80 units. Then give 2/3 in the morning and 1/3 before dinner.
80 x 2/3 = about 50 units in the morning and 80 x 1/3 or about 30 units before dinner. If worried about potential hypoglycemia, the dose could be decreased even further. The main goal is to get glucose to the goal.
Answer 2 is incorrect. 16.57% of you chose this answer. “Non-compliance.” According to the information in the case study, JR is taking all of the medications as directed. The issue is that the medication plan is not effective. And, more than that, the term “non-compliance” has been replaced with focusing on the person’s strengths (strength based approach) and what the actions the individual IS taking.
Answer 3 is incorrect, 9.80% of you chose this answer “Fear of hypoglycemia.” The answer is tempting. Since JR is on 100 units of basal insulin, hypoglycemia seems like a looming possibility. However, we see that the A1c is 8.9% and JR doesn’t mention hypoglycemia. It is very unlikely that low blood sugar is an issue.
Answer 4 is incorrect, 15.56% of you chose this answer. “Clinical inaction.” It is true that more action is required, and the term we use for this is lack of movement to improve glucose levels is called “Clinical inertia”. However, in answering the question, “what best describes this clinical picture”, “overbasalization” is the standout 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!
Rationale of the Week | What is Causing Hypoglycemia?
In the 2021 ADA Standards of Care, there is an intentional and focused discussion of health barriers to diabetes self-management. Our January 5th Question of the Week alluded to how Social Determinants of Health can impact diabetes management. Over 60% of respondents chose the best answer!
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 has type 1 diabetes and reports to the clinic with unusually frequent hypoglycemia and some weight loss. LS appears distraught and says that since the pandemic, their work hours have been dramatically reduced and paying bills has been a struggle. Based on this information, which of the following topics would the diabetes specialist most want to explore further?
Answer Choices:
- Disordered eating
- Food insecurity
- Insulin rationing
- Diabetes distress
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.
Getting to the Best Answer
If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. This question identifies if the test taker can identify how social determinants can impact health.
Answer 1 is incorrect. 8.29% chose this answer. “Disordered eating.” Even though this is a tempting answer, the facts in the question don’t support this answer. If LS was struggling with disordered eating, glucose levels would be elevated due to under insulinization to promote hyperglycemia and weight loss. People with diabetes and disordered eating reduce their insulin dose to induce chronic hyperglycemia which leads to weight loss.
Answer 2 is correct. 60.50% of you chose this answer. “Food insecurity.” People with diabetes are at higher risk of food insecurity. During the pandemic, many people aren’t able to work and lack access to adequate food.
In this situation, hypoglycemia coupled with weight loss indicates that LS is not consuming enough calories to match their insulin dose.
Given that LS has less income, it makes sense that they may not be able to afford adequate food. Providing LS with local resources to food banks and social services plus helping them take less insulin to prevent hypoglycemia, are both important topics to discuss during the visit.
Answer 3 is incorrect, 14.09% of you chose this answer “Insulin rationing.” If LS was rationing or taking less insulin than usual to make it last longer, they would not be struggling with hypoglycemia, but would instead be experiencing hyperglycemia.
Answer 4 is incorrect, 11.48% of you chose this answer. “Diabetes distress.” Certainly, LS is experiencing distress, but the main issue in this situation is safety and preventing hypoglycemia. The hypoglycemia is not a result of distress, it is due to lack of adequate food. Providing LS with local resources to food banks and social services plus helping them take less insulin to prevent hypoglycemia, are both important topics to address during the visit.
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!
Food Insecurity – An Important Topic
Section 1 in the ADA Standards, Improving Care and Promoting Health in Populations, takes a close look at the social determinants of health that can act as barriers to self-care. As diabetes advocates, we can ask these 2 Food Security Screening questions (see slide below) to assess for inadequate access to food and provide needed resources and referrals.
Want to learn more about this topic?
We have updated this course to reflect the 2021 ADA Standards of Care. This presentation includes the latest information on Social Determinants of health, assessment strategies, and approaches. We explore the psychosocial issues that can discourage individuals from adopting healthier behaviors and provides strategies to identify and overcome these barriers. Life studies are used to apply theory to real-life situations. A great course for anyone in the field of diabetes education or for those looking for a new perspective on assessment and coping strategies.
Topics include:
- Name assessment areas of healthy coping
- List psycho-social and emotional barriers
- Provide strategies for healthcare professionals to identify and overcome barriers
- Discuss strategies to develop an individualized diabetes education plan
Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF and Touro University and a nationally recognized diabetes expert.
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.
