For last week’s practice question, we quizzed participants on determining if someone has diabetes based on ADA Standards. 49% 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 47 years old and who just got lab results from their annual physical.  Their fasting plasma glucose result was 129 mg/dL. The provider is worried that JR might have diabetes and sent them to back to the lab to check their A1C, which came back 6.4%.

According to the 2024 ADA Standards, to most accurately assess if JR has diabetes, which of the following follow-up actions is recommended?

Answer Choices:

1. Recheck the A1C in 3 months.
2. Order a meter for JR, so they can check fasting and post-prandial glucose for one month.
3. Evaluate JR for immune mediated diabetes antibodies.
4. Recheck the fasting blood glucose.

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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. 22.36% chose this answer. Recheck the A1C in 3 months. According to ADA Standard 2 on Diagnosis and Classification of Diabetes, “if an individual has discordant results from two different tests, then the test result that is above the diagnostic cut point should be repeated, with careful consideration of factors that may affect measured A1C or glucose levels.” Since JR’s fasting BG test result meets the diagnostic threshold of equal to or greater than 126 mg/dL, we would need to repeat the fasting test, to see if the second lab would confirm diagnosis. We would also consider factors (hemoglobinopathies, lab issues) that might be affecting the accuracy of the A1C result.

Answer 2 is incorrect. 15.76% of you chose this answer. Order a meter for JR, so they can check fasting and post-prandial glucose for one month. Since home glucose meters have limited accuracy, they are not recommended for diagnosis of diabetes. In addition “if an individual has discordant results from two different tests, then the test result that is above the diagnostic cut point should be repeated, with careful consideration of factors that may affect measured A1C or glucose levels.” Since JR’s fasting BG test result meets the diagnostic threshold of equal to or greater than 126 mg/dL, we would need to repeat the fasting test, to see if the second lab would confirm diagnosis. We would also consider factors (hemoglobinopathies, lab issues) that might be affecting the accuracy of the A1C result.

Answer 3 is incorrect. About 12.55% of respondents chose this. Evaluate JR for immune mediated diabetes antibodies. In this case study, JR does not present with risk factors or symptoms of immune mediated type 1 diabetes or LADA. However, since their fasting blood sugar meets the diagnostic threshold for diabetes, we need to redraw JR’s fasting blood glucose, to confirm (or dispute) diagnosis.

Finally, Answer 4 is correct. 49.33% chose this answer. Recheck the fasting blood glucose. YES – GREAT JOB, According to ADA Standard 2 on Diagnosis and Classification of Diabetes, “if an individual has discordant results from two different tests, then the test result that is above the diagnostic cut point should be repeated, with careful consideration of factors that may affect measured A1C or glucose levels.” Since JR’s fasting BG test result meets the diagnostic threshold of equal to or greater than 126 mg/dL, we would need to repeat the fasting test, to see if the second lab would confirm diagnosis. We would also consider factors (hemoglobinopathies, lab issues) that might be affecting the accuracy of the A1C result.

On the other hand, if an individual has discordant results from two different tests, then the test result that is above the diagnostic cut point should be repeated, with careful consideration of factors that may affect measured A1C or glucose levels. The diagnosis is made based on the confirmatory screening test. For example, if an individual meets the diabetes criterion of A1C (two results ?6.5% [?48 mmol/mol]) but not FPG (<126 mg/dL [<7.0 mmol/L]), that person should nevertheless be considered to have diabetes.We hope you appreciate this week’s rationale!

Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!

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Want 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!

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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

• 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

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Registration Options

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Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and 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.

For last week’s practice question, we quizzed participants on best approach to treat hypoglycemia according to 2024 ADA Standards. 51% 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 ADA Standards of Care includes expanded content on the prevention and treatment of hypoglycemia.

 Based on the updated guidelines for the treatment of hypoglycemia, which of the following is true?

Answer Choices:

1. If blood glucose is less than 70 mg/dL, treat with a combination of fast acting glucose and protein to sustain blood glucose levels.
2. Avoid use of glucagon emergency treatment for those with type 2 diabetes to prevent rebound hyperglycemia.
3. In community settings, check blood sugar to verify hypoglycemia before providing glucagon emergency treatment.
4. If individual has one or more episode of clinically significant hypoglycemia, consider short-term relaxation of glucose goals.

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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. 23.44% chose this answer. “If blood glucose is less than 70 mg/dL, treat with a combination of fast acting glucose and protein to sustain blood glucose levels.” Part of this answer is correct. We need to treat a blood glucose of less than 70 with mg/dL with 15gms of carbohydrate. However, there is no recommendation to add protein to the carbohydrate treatment. As a matter of fact, adding protein (which if often combined with fat) can slow the absorption of the carbohydrate and delay glucose improvement. In addition, for people with beta cell function, the ingestion of protein can stimulate insulin production.

Answer 2 is incorrect. 9.31% of you chose this answer. “Avoid use of glucagon emergency treatment for those with type 2 diabetes to prevent rebound hyperglycemia.” The new standards recommend that all people using insulin therapy have access and training on glucagon rescue medications. See our Glucagon Pocketcards.

Answer 3 is incorrect. 16.61% of respondents chose this. “In community settings, check blood sugar to verify hypoglycemia before providing glucagon emergency treatment.” In the community or home setting, there may be limited access to glucose monitors and the public may not know how to check blood sugars, which could lead to delayed treatment for this emergency situation. For this reason, if a person has diabetes and is experiencing an episode of severe hypoglycemia, it is recommended to provide a glucagon rescue medication and activate the emergency response system if warranted. See our Glucagon Pocketcards.

Finally, Answer 4 is correct. 50.65% chose this answer. “If individual has one or more episode of clinically significant hypoglycemia, consider short-term relaxation of glucose goals.” YES, this is the BEST answer. If a person has an episode of clinically significant hypoglycemia, it is an indication that they may be taking too much insulin or diabetes medication. In addition, experiencing hypoglycemia puts individuals at a higher risk for another episode of significant hypoglycemia. Relaxing glucose goals and up-adjusting them can help the person re-set their “glucose thermostat” in a safer range with the ultimate goal of preventing future hypoglycemia.

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!

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Want 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!

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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

• 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

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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!

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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.

 

For last week’s practice question, we quizzed participants on 2024 ADA Standards. 44% 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 new ADA 2024 Standards of Care include dozens of updates to diabetes clinical practice. 

Which of the following statements has actually been added to the ADA 2024 Standards of Care?

Answer Choices:

1. Evaluate B12 levels for Individuals on long-term metformin therapy at least yearly.
2. Screen people with diabetes, caregivers, and family for diabetes distress at least annually.
3. Provide COVID 19 immunizations annually to people with diabetes starting at age 18.
4. Test for type 1 autoimmunity annually starting at age 5 for those with family history of autoimmune conditions.

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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. 23.05% chose this answer. “Evaluate B12 levels for Individuals on long-term metformin therapy at least yearly.” This juicy answer is very tempting. It is true the metformin can be associated with lower B12 levels. However, the ADA does not recommend checking B12 levels annually for people taking this biguanide. Instead, they suggest regularly monitoring B12 levels in people on metformin therapy who have signs of B12 deficiency such as neuropathy or anemia.

Answer 2 is correct. 44.04% of you chose this answer. “Screen people with diabetes, caregivers, and family for diabetes distress at least annually.” Yes, this is the BEST answer! Many individuals with diabetes experience unrecognized and undertreated diabetes distress, which can lead to decreased engagement in self-management activities and worsen outcomes. We address diabetes distress and discuss strategies to address this common emotional response to diabetes in our ReVive 5 Training Program.

Answer 3 is incorrect. About 16.27% of respondents chose this. “Provide COVID 19 immunizations annually to people with diabetes starting at age 18.” The ADA recommends starting COVID 19 immunizations in people with diabetes starting at 6 months and follow-up with boosters as recommended,

Finally, Answer 4 is incorrect. 16.63% chose this answer. “Test for type 1 autoimmunity annually starting at age 5 for those with family history of autoimmune conditions.” Autoimmune testing is recommended for those with immediate family members with type 1 diabetes and other risk factors. There is no age cut-off nor is there a recommendation for annual testing.

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!

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Want to learn more about this question?

Enroll in our ADA Standards of Care Update

Airs live on February 1st, 2024, at 11:30 am PT

Objectives:

1. A review of changes & updates to the annual ADA Standards of Medical Care in Diabetes.
2. Identification of key elements of the position statement.
3. 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.

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Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

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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.

For last week’s practice question, we quizzed participants on the new ADA Standards for type 2 diabetes medication. 49% 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

Based on the newly released 2024 American Diabetes Association (ADA) Standards of Care, which of the following statements is NOT accurate regarding treatment for hyperglycemia?

Answer Choices:

1. Semaglutide and tirzepatide have the highest weight loss efficacy.
2. Metformin may be only safely used in people with an estimated GFR of 45 or greater.
3. Avoid dual GIP and GLP-1 RA therapy in people with gastroparesis.
4. Consider combination therapy in people presenting with A1C levels 1.5–2.0% above goal.

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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. 13.71% chose this answer. “Semaglutide and tirzepatide have the highest weight loss efficacy.” This statement is accurate. These two incretin mimetics not only substantially lower A1C levels, they also are associated with the highest percentage of weight loss of all the diabetes medications. See Diabetes Med PocketCards for more information.

Answer 2 is correct. 48.72% of you chose this answer. “Metformin may be only safely used in people with an estimated GFR of 45 or greater.” YES, great job! This answer is FALSE (making it the best answer). If a person with diabetes is taking metformin and their GFR drops below 30, then we stop the medication. However, we can start or continue metformin therapy if the GFR is 45 or greater. In addition, metformin doesn’t harm the kidneys, it actually protects them by lowering blood glucose levels. See Diabetes Med PocketCards for more information.

Answer 3 is incorrect. About 18.48% of respondents chose this. “Avoid dual GIP and GLP-1 RA therapy in people with gastroparesis.” This answer is also accurate. Tirzepatide (Mounjaro) can substantially slow gastric emptying which could exacerbate gastroparesis. For that reason, it is not a recommended therapy for people with gastroparesis.

Finally, Answer 4 is incorrect. 19.08% chose this answer. “Consider combination therapy in people presenting with A1C levels 1.5–2.0% above goal.” This answer is also accurate. The ADA Standards of Care recommend more intensive pharmacologic intervention for those with substantially elevated A1C to improve and prolong pancreatic function.

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!

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Want to learn more about this question?

ADA Standards of Care Course 2024

Airs Live February 1, 2024 at 11:30 AM PT

Topics:

• 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

This course, updated annually, is an essential review for anyone in the field of diabetes. Join Coach Beverly as she summarizes the annual updates to the American Diabetes Association’s (ADA) Standards of Medical Care in Diabetes & provides critical teaching points & content for healthcare professionals involved in diabetes care & education.

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.

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Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

---

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.

For last week’s practice question, we quizzed participants on what is the best approach for people with low literacy skills. 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: Which of the following strategies is most effective when working with someone with low literacy skills?

Answer Choices:

1. Be concrete and focus on problem solving.
2. Speak slowly and clearly.
3. Direct the teaching to the support person and encourage reinforcement.
4. Underline key points on educational materials.

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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. 63.27% chose this answer. “Be concrete and focus on problem solving.” Yes, this is the best answer. Since a person with low literacy can’t take notes or read information later, they will need to commit new information to memory. By providing concrete examples and engaging in collaborative problem solving, a person with low literacy can more effectively retain the information.

Answer 2 is incorrect. 13.70% of you chose this answer. “Speak slowly and clearly.” Just because a person hast low literacy doesn’t mean they have an intellectual disability. Maybe they didn’t have a chance to complete their education or experienced some other impediment to learning how to read and write. We can use a usual conversational pace and annunciation with this individual.

Answer 3 is incorrect. About 10.20% of respondents chose this. “Direct the teaching to the support person and encourage reinforcement.” A general rule of effective communication is to direct the teaching and education to the person with diabetes, while including the support person.

Finally, Answer 4 is incorrect. 12.83% chose this answer. “Underline key points on educational materials.” Since people with low literacy have limited ability to read and write, using print materials with words would not be an effective method to provide education. Use of pictures and infographics, videos, podcasts or other educational strategies that don’t require literacy, would be excellent alternatives.

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!

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Want to learn more about this question?

ADA Standards of Care

Join us live on February 1, 2024, at 11:30 am PST

Topics:

• 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.

This course, updated annually, is an essential review for anyone in the field of diabetes. Join Coach Beverly as she summarizes the annual updates to the American Diabetes Association’s (ADA) Standards of Medical Care in Diabetes & provides critical teaching points & content for healthcare professionals involved in diabetes care & education.

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.

All hours earned count toward your CDCES Accreditation Information

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Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

---

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.

For last week’s practice question, we quizzed participants on how to best detect euglycemic ketosis. 53% 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:

According to recent research by the ADA/EASD, about 10% of people admitted to the hospital in diabetes crisis have euglycemic diabetes ketoacidosis.  

Since blood sugars are at normal levels or only slightly elevated, which of the following lab tests most accurately evaluate for euglycemic ketosis?

Answer Choices:

1. Blood pH and arterial glucose.
2. Beta-hydroxybutyrate and bicarbonate levels.
3. Urine ketones and urine glucose.
4. Anion gap and glucose level measured in mmol/L.

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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. 15.60% chose this answer. “Blood pH and arterial glucose.” Since euglycemic ketosis is often associated with blood glucose levels less than 200 mg/dL, checking arterial glucose levels won’t provide additional clarity on diagnosis.  However, checking pH levels is recommended, since a pH less than 7.3 is a clear clinical indication of ketosis.

Answer 2 is correct. 53.20% of you chose this answer. “Beta-hydroxybutyrate and bicarbonate levels.” YES, this is the best answer.  Beta-hydroxybutyrate evaluation with a low cutoff equal to or greater than 3.0 mmol/L, whether by lab or point-of-care-testing, is one of the most accurate measurements to evaluate if a person is in ketosis.  Bicarbonate level concentration < 18 mmol/L also helps to provide confirmation of ketosis.  Ketoacidosis in diabetes is due to inadequate circulating insulin, so the body switches to burning fat for fuel (instead of glucose), which leads to a build up of ketones or ketosis.

Answer 3 is incorrect. About 20.68% of respondents chose this. “Urine ketones and urine glucose.” Urine ketone testing can be used if Beta-hydroxybutyrate evaluation is not available. A urine ketone strip value of 2+ or greater indicates ketosis. However, checking urine glucose levels won’t provide additional clarity on diagnosis, since euglycemic ketosis is often associated with blood glucose levels less than 200 mg/dL.

Finally, Answer 4 is incorrect. 10.53% chose this answer. “Anion gap and glucose level measured in mmol/L.” he anion gap has long been a clinical measure of acidosis; however it is not considered to be a key indicator in the new guidelines. Metabolic acidosis is now defined as a pH < 7.3 and a bicarbonate concentration < 18 mmol/L.  The anion gap can still be used in settings where ketone testing is unavailable. In addition, checking urine glucose levels won’t provide additional clarity on diagnosis, since euglycemic ketosis is often associated with blood glucose levels less than 200 mg/dL.

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!

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Want to learn more about this question?

Join our Annual Webinar

Airs live February 1, 2024 at 11:30 am PT

All hours earned count toward your CDCES Accreditation Information

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Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

---

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.

For last week’s practice question, we quizzed participants on how much does Diabetes Cost the U.S? 69% 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: According to the recently published ADA report on the 2022 Economic Costs of Diabetes in the U.S., which of the following statements is most accurate?

Answer Choices:

1. 25% of health care dollars are spent on caring for people with diabetes.
2. Although diabetes prevalence remains stable, the direct medical costs attributed to diabetes increased by 7% between 2017 and 2022.
3. The cost burden of diabetes is disproportionately borne by vulnerable and underserved communities.
4. After adjusting for inflation, the total cost of insulin and other diabetes medications increased by 26% from 2017 to 2022.
5. All of the above

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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. 9.44% chose this answer. “25% of health care dollars are spent on caring for people with diabetes.” Yes, a quarter of all health care dollars are spent on diabetes, with the majority of money spent on hospitalizations due to cardiovascular complications and medications. Read more details in the Diabetes Care Article, “Economic Costs of Diabetes in the U.S. 2022.

Answer 2 is incorrect. 2.45% of you chose this answer. “Although diabetes prevalence remains stable, the direct medical costs attributed to diabetes increased by 7% between 2017 and 2022.” The cost of treating diabetes keeps increasing, putting additional financial strain on people living with diabetes. Read more details in the Diabetes Care Article, “Economic Costs of Diabetes in the U.S. 2022.

Answer 3 is incorrect. About 10.84% of respondents chose this. “The cost burden of diabetes is disproportionately borne by vulnerable and underserved communities.” People who earn the least amount of money and live in under-resourced areas, continue to have the highest rates of diabetes and other chronic health conditions. Read more details in the Diabetes Care Article, “Economic Costs of Diabetes in the U.S. 2022.

Answer 4 is incorrect. About 8.39% of respondents chose this. “After adjusting for inflation, the total cost of insulin and other diabetes medications increased by 26% from 2017 to 2022.” Yes, the cost of medications keeps increasing, which may prevent many people from accessing optimal diabetes treatment. Read more details in the Diabetes Care Article, “Economic Costs of Diabetes in the U.S. 2022

Finally, Answer 5 is correct. 68.88% chose this answer. “All of the above” YES, GREAT JOB. Most of you chose the BEST Answer. Thank you for participating in our Question of the Week. All data is based on the Diabetes Care Article, “Economic Costs of Diabetes in the U.S. 2022”, published in November 2023

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!

All data is based on the Diabetes Care Article, “Economic Costs of Diabetes in the U.S. 2022”, published in November 2023

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Join us for our upcoming Hyperglycemic Crises, DKA & HHS Standards webinar

Airs live on December 12th, 2023, at 11:30 am PT

Topics:

• Discuss the common causes of hyperglycemic crises.
• List the differences & similarities between DKA and HHS and treatment strategies.
• Describe the causes & treatment of hyperglycemic crises.

This course discusses common causes of hyperglycemia crises. Topics include hyperglycemia secondary to medications & insulin deprivation. The differences & similarities between Diabetes Ketoacidosis and hyperosmolar Hyperglycemic Syndrome are also covered. Treatment strategies for all situations are included.

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.

All hours earned count toward your CDCES Accreditation Information

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Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

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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.