Rationale of the Week | Assessing for Food Insecurity with Diabetes
For last week’s practice question, we quizzed participants on assessing food insecurity with diabetes. 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: Food insecurity affects 16% of adults with diabetes compared with 9% of adults without diabetes.
Based on the ADA standards of care, which is the most accurate statement regarding food insecurity and people with diabetes?
Answer Choices:
- Food insecurity is defined as uncertain availability of nutritionally adequate food at least once a week.
- Conduct food insecurity screening and income assessment once every 3-5 years.
- Any health care team member can screen for food insecurity using The Hunger Vital Sign.
- People with food insecurity are less likely to experience hyperglycemia due to decreased caloric intake.
Getting to the Best Answer
Answer 1 is incorrect. 31.96% chose this answer. “Food insecurity is defined as uncertain availability of nutritionally adequate food at least once a week.” Although this answer is partially correct, the last part, “at least once a week” makes this answer incorrect. According to the USDA food insecurity is defined as, “the limited or uncertain availability of nutritionally adequate and safe foods, or limited or uncertain ability to acquire acceptable foods in socially acceptable ways.” It doesn’t include a time span or frequency.
Answer 2 is incorrect. 5.08% of you chose this answer. “Conduct food insecurity screening and income assessment once every 3-5 years.” This answer also has elements of accuracy, but flails at the end. The ADA Standards recommend conducting food insecurity screenings on a yearly basis and helping individuals access needed resources.
Answer 3 is correct. Great Job! About 60.05% of respondents chose this. “Any health care team member can screen for food insecurity using The Hunger Vital Sign.”
The Hunger Vital Sign identifies households as being at risk for food insecurity if they answer that either or both of the following two statements is ‘often true’ or ‘sometimes true’ (vs. ‘never true’):
“ Within the past 12 months we worried whether our food would run out before we got money to buy more.”
“ Within the past 12 months the food we bought just didn’t last and we didn’t have money to get more.”
Finally, Answer 4 is incorrect. 2.91% chose this answer. “People with food insecurity are less likely to experience hyperglycemia due to decreased caloric intake.” There is no scientific evidence to support this answer and people with food insecurity can experience periods of adequate food intake interspersed with inadequate food intake.
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?
Virtual DiabetesEd Training Conference – Join us Live on April 17th – 19th 2024 at 11:30 AM PST
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, and “aha” moments for our Virtual DiabetesEd Training Conference April 17th – 19th, 2024.
Attendees will leave this conference with new tools and a refreshed understanding of the latest advances in person-centered diabetes care. Our team highlights the ADA Standards of Care, medications, behavior change, technology, medical nutrition therapy, and more!
Our instructors co-teach the content to keep things fresh and lively.
Friend Discount: 3 or more only $449 per person. Email us at [email protected] with the name and email of each registrant to get the discount!
Program Details
- Dates: April 17-19th, 2024
- Registration Fee: $399-$569 (see more about reg. options below)
- Friend Discount: For 3 or more people, each person saves $50 off their registration. Email us at [email protected] with the name and email of each registrant to get the discount!
- CEs: 30+ CEs | 18 units for Virtual Conference plus 10+ Bonus CEs. CEs can be applied toward CDCES’s initial application or renewal.
- Speakers: View Conference Faculty
Registration Options
All hours earned count toward your CDCES Accreditation Information
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Recent Blog Bytes
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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 approach for Religious Fasting?
For last week’s practice question, we quizzed participants on what is the best approach for religious fasting. 75% 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 2024 Standards of Care reported individuals who fast have an increased risk for hypoglycemia, dehydration, hyperglycemia, and ketoacidosis.
Which of the following is an accurate health care statement regarding recommendations for religious fasting?
Answer Choices:
- Recommend continuing with usual diet and medication regimens to ensure glucose stability and reduce health risks.
- Accommodate a person’s choice for religious fasting.
- Advise people with diabetes taking insulin about the need to avoid religious fasting due to risk of hypoglycemia.
- Provide education on religious fasting only when evidence indicates risk.
Getting to the Best Answer
If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.
Answer 1 is incorrect. 5.59% chose this answer. “Recommend continuing with usual diet and medication regimens to ensure glucose stability and reduce health risks.” Although religious fasting does change a person’s usual diet, sleep, and potentially medication regimen, evidence has shown that with education, most people with diabetes can safely complete a religious fast.
Answer 2 is correct. 75.42% of you chose this answer. “Accommodate a person’s choice for religious fasting.” Based on the 2024 Standards of Care, healthcare providers should accommodate a person’s choice for religious fasting.
Answer 3 is incorrect. About 6.78% of respondents chose this. “Advise people with diabetes taking insulin about the need to avoid religious fasting due to risk of hypoglycemia.” Although risk assessment is essential to review with each person with diabetes, the use of insulin is not a singular determinant of risk. Often, dose adjustments can reduce risk. The article “Diabetes and Ramadan: Practical Guidelines 2021”, referenced in the 2024 Standards of Care, includes a detailed description of how to stratify individual risk.
Finally, Answer 4 is incorrect. 12.20% chose this answer. “Provide education on religious fasting only when evidence indicates risk.” Healthcare providers should inquire about religious fasting and provide proactive education on monitoring glucose and how to modify medications, meal choices pre/post fast, fluid consumption, and activity planning.
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!
Virtual DiabetesEd Training Conference – Join us Live on April 17th – 19th 2024 at 11:30 AM PST
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, and “aha” moments for our Virtual DiabetesEd Training Conference April 17th – 19th, 2024.
Attendees will leave this conference with new tools and a refreshed understanding of the latest advances in person-centered diabetes care. Our team highlights the ADA Standards of Care, medications, behavior change, technology, medical nutrition therapy, and more!
Our instructors co-teach the content to keep things fresh and lively.
Friend Discount: 3 or more only $449 per person. Email us at [email protected] with the name and email of each registrant to get the discount!
Program Details
- Dates: April 17-19th, 2024
- Registration Fee: $399-$569 (see more about reg. options below)
- Friend Discount: For 3 or more people, each person saves $50 off their registration. Email us at [email protected] with the name and email of each registrant to get the discount!
- CEs: 30+ CEs | 18 units for Virtual Conference plus 10+ Bonus CEs. CEs can be applied toward CDCES’s initial application or renewal.
- Speakers: View Conference Faculty
Registration Options
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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 action to address sudden Hyperglycemia due to Cellulitis?
For last week’s practice question, we quizzed participants on addressing sudden hyperglycemia due to cellulitis. 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: RL is 83, has Latent Autoimmune Diabetes, and takes degludec 17 units every morning along with metformin 500 XR twice daily. RL tells you that their left leg was suddenly swollen and red, so they went to urgent care and were started on a course of antibiotics. In the meantime, their CGM is showing elevated blood sugars in the 200 to 350 range during the day but often less than 100 at night. RL weighs 70kg, with a BMI of 23.4.
Based on this information, what action do you suggest?
Answer Choices:
- Decrease carbohydrate intake by 20-25% until the infection subsides.
- Increase the degludec by 20% to get blood glucose levels to target.
- Encourage RL to walk after meals to decrease post prandial blood sugar levels.
- Suggest initiation of bolus insulin once or twice daily.
Getting to the Best Answer
If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.
Answer 1 is incorrect. 10.02% chose this answer. “Decrease carbohydrate intake by 20-25% until the infection subsides.” Since RL has elevated glucose levels due to infection, drastically decreasing carbohydrate intake is not the best approach to manage glucose levels. We want to ensure RL has adequate nutrition given her infection and age.
Answer 2 is incorrect. 15.36% of you chose this answer. “Increase the degludec by 20% to get blood glucose levels to target.” It seems that RL needs more insulin to lower daytime glucose levels. However, RL is experiencing glucose levels less than 100 overnight, which puts them at risk of nocturnal hypoglycemia. If we increase basal insulin by 20%, this dramatic increase could cause a dangerous drop in overnight glucose levels and is not recommended.
Answer 3 is incorrect. About 8.68% of respondents chose this. “Encourage RL to walk after meals to decrease post prandial blood sugar levels.” Keeping active is always a good idea, but with blood sugars running 200-350 during the day, walking after meals won’t be enough to get glucose levels to target. Plus, it may not be safe to promote walking since they have an infection and a leg that is swollen and red.
Finally, Answer 4 is correct. 65.94% chose this answer. “Suggest initiation of bolus insulin once or twice daily.” YES, this the best answer. Counterregulatory hormones are released during periods of infection that contribute to insulin resistance and hyperglycemia. To get blood glucose levels to target, RL will need daytime bolus insulin to manage the hyperglycemia, which will promote healing. Of course, treatment with antibiotics will also help to lower glucose levels.
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?
Virtual DiabetesEd Training Conference – Join us Live on April 17th – 19th 2024 at 11:30 AM PST
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, and “aha” moments for our Virtual DiabetesEd Training Conference April 17th – 19th, 2024.
Attendees will leave this conference with new tools and a refreshed understanding of the latest advances in person-centered diabetes care. Our team highlights the ADA Standards of Care, medications, behavior change, technology, medical nutrition therapy, and more!
Our instructors co-teach the content to keep things fresh and lively.
Friend Discount: 3 or more only $449 per person. Email us at [email protected] with the name and email of each registrant to get the discount!
Program Details
- Dates: April 17-19th, 2024
- Registration Fee: $399-$569 (see more about reg. options below)
- Friend Discount: For 3 or more people, each person saves $50 off their registration. Email us at [email protected] with the name and email of each registrant to get the discount!
- CEs: 30+ CEs | 18 units for Virtual Conference plus 10+ Bonus CEs. CEs can be applied toward CDCES’s initial application or renewal.
- Speakers: View Conference Faculty
Registration Options
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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 | RS Doesn’t Want to Get Weighed
For last week’s practice question, we quizzed participants on how to approach a person who does not want to be weighed during a quarterly diabetes appointment. 60% of respondents chose the best answer. If you are interested in learning more about the importance of providing weight inclusive care, this practice test question will set you up for success.
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it here: Answer Question
Question:
RS arrives at their quarterly diabetes provider appointment and the medical assistant walks them to the scale, in the clinic hallway, to get their weight. RS politely explains that they feel uncomfortable being weighed but they are happy to share their stated weight. The medical assistant once again encourages RS to get on the scale and reassures RS that they don’t need to look at or know their weight. RS sighs, takes off their shoes and reluctantly gets on the scale to be weighed.
Which of the following best describes the end result of this situation?
Answer Choices:
- The medical assistant used a person-centered approach to respect the wishes of RS.
- RS exhibited non-adherence and reconsidered their request.
- According to the transtheoretical model, RS was in preparation stage and needed gentle encouragement.
- The clinic staff would benefit from an inservice on providing weight inclusive care.
Getting to the Best Answer
If you are interested in providing weight inclusive care, this practice test question will set you up for success. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.
Answer 1 is incorrect. 15.91% chose this answer. “The medical assistant used a person-centered approach to respect the wishes of RS.” Instead of honoring the request to not be weighed, the medical assistant insisted RS step on the scale. A person centered, weight inclusive approach would respect RS’s request not to be weighed and accepted their stated weight.
Answer 2 is incorrect. 8.39% of you chose this answer. “RS exhibited non-adherence and reconsidered their request.” People with diabetes have the right to be weighed in a private space and they also have the right to decline to be weighed. In this situation, RS’s weight is not required to provide safe and effective medical care.RS is not “non-adherent”, they are simply expressing their need not to step on the scale.
Answer 3 is incorrect. About 15.70% of respondents chose this. “According to the transtheoretical model, RS was in preparation stage and needed gentle encouragement.” This juicy answer does not reflect the situation in the medical office at the scale. RS did not state that they were working on being comfortable with being weighed or that it would be helpful to be weighed. Instead RS told the MA twice that they don’t want to be weighed, but their request was not honored.
Finally, Answer 4 is correct. 60% chose this answer. “The clinic staff would benefit from an inservice on providing weight inclusive care.” YES, this is the best answer. If the staff were informed about weight inclusive care and reducing weight stigma, they would have honored RS’s request not to be weighed and documented their stated weight. This inclusive approach would help RS feel seen, heard and respected. RS would gain a positive association with their medical team and be more likely to return for future appointments.
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 important learning activity!
Want to learn more about Weight Stigma?
Enjoy our blog – Untangling Weight Stigma at Medical Visits.
Weight stigma in medical appointments is a significant issue that can have detrimental effects on the individuals’ physical and mental health. It refers to the negative attitudes, beliefs, and stereotypes healthcare providers may hold towards individuals with extra weight. This stigma can manifest in various ways during medical appointments, including biased treatment, assumptions about the person’s lifestyle or health behaviors, and even neglect of legitimate health concerns unrelated to weight.
Although I disguised this question and situation as happening to RS, this question is based on my own personal experience. My goal in sharing this with all of you is not only to raise awareness of this often-overlooked barrier to care but a call to take action in our places of work to provide more weight inclusive environments.
Action Steps to Untangle Weight Stigma in Medical Appointments:
Awareness and Education: participate in training programs to help care providers recognize and address weight bias. A great resource is Inclusive Diabetes Care.
Language Matters: Use neutral and respectful language when discussing weight-related issues.
Focus on Health, Not Weight: Shift the focus of medical appointments from weight to overall health and well-being.
Individualized Care: Recognize the individual and understand their story around weight.
Create Supportive Environments: Design healthcare settings that are inclusive and welcoming to individuals of all sizes.
Advocate for Systemic Change: Addressing weight stigma requires systemic change within the healthcare system and society as a whole. Healthcare providers can advocate for policies that promote health equity, combat weight bias in research and media, and support initiatives that address social determinants of health.
By implementing these strategies, healthcare providers can help untangle weight stigma in medical appointments and create a more supportive and inclusive environment for all patients, regardless of their size.
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!
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 | What medication changes do you recommend?
For last week’s practice question, we quizzed participants on medication recommendations. 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:
RL was newly diagnosed 43 with type 2 diabetes 6 months ago with an initial A1C of 10.1%. They have no cardiovascular disease and their renal function is within normal limits. At a recent office visit, you notice RL’s A1C has dropped to 7.3, their BP is 112/78 and the LDL cholesterol is 103mg/dL. RL’s current medication regimen includes, rosuvastatin 10mg, empagliflozin 25mg, metformin 1000 BID, glargine 12 units and aspirin 81mg.
Based on this information, what changes to RL’s medication plan do you recommend to the provider?
Answer Choices:
-
- Consider increasing rosuvastatin and stopping ASA therapy.
- Consider stopping empagliflozin and starting GLP-1 RA to help with weight loss.
- Consider adding an ACE or ARB and increasing basal insulin.
- Consider increasing metformin and decreasing basal insulin.
Getting to the Best Answer
If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.
Answer 1 is correct. 60.90% chose this answer. “Consider increasing rosuvastatin and stopping ASA therapy.” – YES, this is the best answer. GREAT JOB. According to the ADA Standards of Care, the goal is to reduce the LDL by 50% and less than 70mg/dL. The max dose of rosuvastatin is 40mg and RL is only on 10mg. Increasing the dose of rosuvastatin will help decrease LDL levels. Aspirin therapy is indicated for people 55 years and older with an elevated CV risk. For those under 55, aspirin therapy is based on their CV risk profile. Since RL has no CV disease, aspirin therapy is not indicated.
Answer 2 is incorrect. 13.76% of you chose this answer. “Consider stopping empagliflozin and starting GLP-1 RA to help with weight loss.” This is not the best answer since there is no reason to stop empagliflozin when starting a GLP-1 RA. In addition, there is no mention in the vignette that RL has weight loss as a goal, so switching from an SGLT-2 to a GLP-1 is not indicated at this time.
Answer 3 is incorrect. About 9.27% of respondents chose this. “Consider adding an ACE or ARB and increasing basal insulin.” This is not the best answer, since the first part of the response isn’t correct. RL has great renal function and their BP is below the target of 130/80, so an ACE or ARB is not indicated at this time.
Finally, Answer 4 is incorrect. 16.07% chose this answer. “Consider increasing metformin and decreasing basal insulin.” This is not the best answer, since the metformin is already very close to the maximum dose of 2,550 mg day and we need more information about the fasting blood glucose levels before increasing the basal insulin. Most importantly, the first answer is a better 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?
Virtual DiabetesEd Training Conference – Join us Live on April 17th – 19th 2024 at 11:30 AM PST
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, and “aha” moments for our Virtual DiabetesEd Training Conference April 17th – 19th, 2024.
Attendees will leave this conference with new tools and a refreshed understanding of the latest advances in person-centered diabetes care. Our team highlights the ADA Standards of Care, medications, behavior change, technology, medical nutrition therapy, and more!
Our instructors co-teach the content to keep things fresh and lively.
Friend Discount: 3 or more only $449 per person. Email us at [email protected] with the name and email of each registrant to get the discount!
Program Details
-
- Dates: April 17-19th, 2024
-
- Registration Fee: $399-$569 (see more about reg. options below)
-
- Friend Discount: For 3 or more people, each person saves $50 off their registration. Email us at [email protected] with the name and email of each registrant to get the discount!
-
- CEs: 30+ CEs | 18 units for Virtual Conference plus 10+ Bonus CEs. CEs can be applied toward CDCES’s initial application or renewal.
-
- Speakers: View Conference Faculty
Registration Options
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!
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 | Bone Fracture Prevention Based on 2024 ADA Standards
For last week’s practice question, we quizzed participants on bone fracture prevention based on ADA Standards. 47% 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: Since people with diabetes are at increased risk of fractures, the 2024 Standards have an increased focus on preventing bone fractures.
Which of the following is an accurate statement regarding diabetes and bone fractures?
Answer Choices:
- Annual bone scans are recommended starting at age 40 to determine fracture risk category.
- Individuals taking insulin or sulfonylureas are at higher risk of bone fractures.
- Most people with diabetes benefit from a vitamin D supplement.
- Refer individuals starting at age 65 for an assessment of fall risk.
Getting to the Best Answer
If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.
Answer 1 is incorrect. 13.16% chose this answer. “Annual bone scans are recommended starting at age 40 to determine fracture risk category.” This answer is tempting, but it doesn’t match the ADA Standards that recommend to, “Monitor bone mineral density using dual-energy X-ray absorptiometry of high-risk older adults with diabetes starting at age 65 and younger individuals with diabetes and multiple risk factors every 2–3 years.”
Answer 2 is correct. 47.06% of you chose this answer. “Individuals taking insulin or sulfonylureas are at higher risk of bone fractures.” Yes, this is the best answer. People taking medications that can cause hypoglycemia are at higher risk of falls. Clinicians need to consider the potential adverse impact on bone health when selecting pharmacological options to lower glucose levels in people with diabetes. Prioritizing medications with a proven safety profile for bones is recommended, particularly for those at elevated risk for fractures.
Answer 3 is incorrect. About 21.21% of respondents chose this. “Most people with diabetes benefit from a vitamin D supplement.” This answer is also tempting, but the ADA Standards of Care does not recommend vitamin therapy for “most people”. Vitamin therapy is based on an individual assessment of potential benefit.
Finally, Answer 4 is incorrect. 18.58% chose this answer. “Refer individuals starting at age 65 for an assessment of fall risk.” This answer is tempting, but the ADA recommends we individualize our approach and consider risk of falls and fractures on a ongoing basis. “Fracture risk should be assessed in older adults with diabetes as a part of routine care in diabetes clinical practice, according to risk factors and comorbidities”
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!
Learn more about Bone Fracture Prevention and ADA Standards
Virtual DiabetesEd Training Conference – Join us Live on April 17th – 19th 2024 at 11:30 AM PST
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, and “aha” moments for our Virtual DiabetesEd Training Conference April 17th – 19th, 2024.
Attendees will leave this conference with new tools and a refreshed understanding of the latest advances in person-centered diabetes care. Our team highlights the ADA Standards of Care, medications, behavior change, technology, medical nutrition therapy, and more!
Our instructors co-teach the content to keep things fresh and lively.
Friend Discount: 3 or more only $449 per person. Email us at [email protected] with the name and email of each registrant to get the discount!
Program Details
- Dates: April 17-19th, 2024
- Registration Fee: $399-$569 (see more about reg. options below)
- Friend Discount: For 3 or more people, each person saves $50 off their registration. Email us at [email protected] with the name and email of each registrant to get the discount!
- CEs: 30+ CEs | 18 units for Virtual Conference plus 10+ Bonus CEs. CEs can be applied toward CDCES’s initial application or renewal.
- Speakers: View Conference Faculty
Registration Options
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!
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 Intervention to address Elevated LDL?
For last week’s practice question, we quizzed participants on the best intervention to address elevated LDL. 40% 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:
MK is 67 years old and is concerned about cardiovascular disease risk and diabetes. Their last lab result showed an A1C of 6.8%, HDL of 38 and LDL of 132. MK started reading food labels and is concerned about their total fat intake each day and wants to make diet changes to reduce CVD risk.
According to the 2024 ADA Standards of Care, which evidence-based statement is most accurate when counseling MK about their fat intake?
Answer Choices:
- There is no one optimal percentage of calories from fat for people with diabetes.
- Try to limit saturated fat to less to 7% of calories each day.
- We suggest including 1 gram per day of Omega-3 supplement for prevention of cardiovascular events.
- The best approach is to reduce total fat to less than 30% of total calories per day.
Getting to the Best Answer
If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.
Answer 1 is correct. GREAT JOB! 39.89% chose this answer, “There is no one optimal percentage of calories from fat for people with diabetes.” The Standards of Care 2024 states, “There is no optimal percentage of calories from fat for people with diabetes or at risk for diabetes, and macronutrient distribution should be individualized.” In addition, there is no optimal percentage of calories from fat or saturated fat for people with diabetes and CVD prevention goals; however, they recommend to “limit” daily saturated fat consumption. The type of fat consumed is more important than the total amount of fat from calories.
Answer 2 is incorrect. 24.87% of you chose this answer. “Try to limit saturated fat to less to 7% of calories each day.” The standards of care do not have a recommended limit for saturated fat consumption but suggest that “people with diabetes or at risk for diabetes follow recommended guidelines for the general population.” The Dietary Guidelines for Americans 2020-2025 recommends less than 10% of calories from saturated fat. Even if considering tighter American Heart Association recommendations, they allow 5-6% of calories from saturated fat. Some eating patterns, such as the TLC diet from 2005, the DASH diet, or the Mediterranean diet, may include food choices where saturated fat is less than 7% of calories, but this is not a general population guideline.
Answer 3 is incorrect. About 13.43% of respondents chose this. “We suggest including 1 gram per day of Omega-3 supplement for prevention of cardiovascular events.” There is no recommendation for omega-3 supplementation in all persons with diabetes. Current evidence within the standard of care states that 1 gram of Omega 3 supplementation showed no benefit in preventing cardiovascular disease; however, within the REDUCE-IT trial, supplementation of pure EPA at 4 grams each day did lower cardiovascular events.
Answer 4 is incorrect. 21.81% chose this answer. “The best approach is to reduce total fat to less than 30% of total calories per day.” There is no specific recommendation for total fat amount to limit in a meal plan. The standards of care state, “The type of fat consumed is more important than the total.” They recommend following a Mediterranean-like eating pattern, which includes foods like fatty fish, nuts, and seeds and is rich in polyunsaturated and monounsaturated fats.
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 nutrition and the ADA Standards?
Level 3 | DiabetesEd Certification Boot Camp
with Coach Beverly, RN, MPH, CDCES &
Christine Craig, MS, RDN, CDCES
Airs live on February 13th – March 19th, 2024, at 11:30 am PT
Class Topics & Webinar Dates:
- February 13, 2024 – Boot Camp 1: Diabetes | Not Just Hyperglycemia | 1.75 CEs
- February 15, 2024 – Boot Camp 2: Standards of Care & Cardiovascular Goals | 1.8 CEs
- February 20, 2024 – Boot Camp 3: Meds for Type 2 | What you need to know | 1.75 CEs
- February 22, 2024 – Boot Camp 4: Insulin Therapy | From Basal/Bolus to Pattern Management | 1.75 CEs
- February 27, 2024 – Boot Camp 5: Insulin Intensive & Risk Reduction | Monitoring, Sick Days, Lower Extremities | 1.75 CEs
- February 29, 2024 – Boot Camp 6: Medical Nutrition Therapy | 1.75 CEs
- March 12, 2024 – Boot Camp 7: Microvascular Complications & Exercise | Screen, Prevent, Treat | 1.75 CEs
- March 14, 2024 – Boot Camp 8: Coping & Behavior Change | 1.75 CEs
- March 19, 2024 – Boot Camp 9: Test-Taking Coach Session (48 Questions) | No CE
Intended Audience: This library of critical information is designed for individuals or groups of diabetes specialists, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other health care providers interested in staying up to date on current practices of care for people with diabetes and preparing for the BC-ADM or the CDCES certification Exam.
Can’t make it live? No worries. We will send post the recorded version to the Online University within 24 hours of the broadcast
Instructors: 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.
Christine Craig, MS, RD, CDCES, winner of the 2023 Impact on Diabetes Award, is a leader in the field of nutrition, technology, and diabetes care. Her years of expertise combined with her person-centered approach and work ethic, make her a perfect speaker for this nutrition and activity focused content.
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!
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 treatment for Hospital and Heart failure?
For last week’s practice question, we quizzed participants on the best treatment for hospitals & heart failure. 73% 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 has newly discovered type 2 diabetes and is admitted to the hospital with heart failure. Their A1C is 7.9% with negative ketones and a GFR greater than 90 mg/g.
According to the 2024 ADA Standards of Care, which of the following is a recommended intervention during JR’s hospital stay?
Answer Choices:
- Assess for immune mediated diabetes markers, starting with GAD.
- Utilize a mild insulin sliding scale to minimize risk of worsening heart failure.
- Initiate a SGLT-2 during hospitalization and continue upon discharge.
- Encourage a sleep study evaluation to determine if JR also has sleep apnea.
Getting to the Best Answer
If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.
Answer 1 is incorrect. 7.54% chose this answer. “Assess for immune mediated diabetes markers, starting with GAD.” Given that JR’s A1C is 7.9% and their ketones are negative, it seems unlikely they might have undiscovered immune mediated diabetes. The most pressing issue in addition to their diabetes is addressing the CHF.
Answer 2 is incorrect. 15.57% of you chose this answer. “Utilize a mild insulin sliding scale to minimize risk of worsening heart failure.” Based on the ADA Standards of care, insulin sliding scale as the only treatment approach is not recommended. In addition, insulin therapy doesn’t aggravate heart failure.
Answer 3 is correct. About 72.75% of respondents chose this. “Initiate a SGLT-2 during hospitalization and continue upon discharge.” YES, this is the best answer. Given that JR has diabetes and heart failure, using a SGLT-2 will lower their blood sugar plus provide a “glucoretic” effect, which will promote diuresis.
Finally, Answer 4 is incorrect. 4.14% chose this answer. “Encourage a sleep study evaluation to determine if JR also has sleep apnea.” From the information provided, there is no indication that JR is experiencing sleep apnea. The most pressing issues are the CHF and new diabetes diagnosis.
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?
Enroll in our ADA Standards of Care Update
Airs live today, February 1st, 2024, at 11:30 am PT
Objectives:
- A review of changes & updates to the annual ADA Standards of Medical Care in Diabetes.
- Identification of key elements of the position statement.
- Discussion of how diabetes educators can apply this information in their clinical setting.
Intended Audience: This course is a knowledge-based activity designed for individuals or groups of diabetes professionals, including RNs, RDs, 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.
Can’t make it live? No worries. We will send post the recorded version to the Online University within 24 hours of the broadcast
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, a working educator, and a nationally recognized diabetes expert. She has a Master’s Degree in Public Health from UCLA, with a focus on behavioral health and education.
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!
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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