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Question of the Week | Which Feature Most Strongly Supports a Diagnosis of HHS Rather Than DKA?
A 32-year-old with newly discovered diabetes is brought to the emergency department with polyuria and lethargy. They have been sleeping more than usual.
Initial labs show:
- Plasma glucose: 680 mg/dL
- Potassium 3.7 mEq/L
- Serum osmolality: 335 mOsm/kg
Based on the following labs, which feature most strongly supports a diagnosis of hyperosmolar hyperglycemic state (HHS) rather than diabetes ketoacidosis (DKA)?
- Markedly elevated plasma glucose
- Absence of significant metabolic acidosis
- Out of range potassium level
- Elevated effective serum osmolality
Learn More About DKA & HHS
With Level 2 | Hyperglycemic Crises (DKA, HHS & EDKA) & Our CDCES Boot Camp!
Rationale of the Week | What Does J.C.’s Family History & Lab Work Reveal?
For last week’s practice question, we quizzed participants on J.C.’s family history and lab work, and what it reveals. 80.92% 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
J.C. is a ten-year-old female with a family history of type 1 diabetes. Her 7-year-old brother was diagnosed with type 1 diabetes two years ago. J.C. has no complaints and reports feeling well. She enjoys playing sports, including basketball and soccer. Her current BMI is 22.1 (93rd percentile for age). She denies any polydipsia, polyuria, or polyphagia. Her lab work demonstrates a fasting blood sugar of 71 mg/dL, an A1c of 5.0%, normal kidney function, and normal electrolytes. Her diabetes autoantibody panel shows positive glutamic acid decarboxylase (GAD) and islet antigen 2 (IA-2) antibodies, negative zinc transporter 8 (ZnT8) antibodies, and negative insulin antibodies.
What does her lab work reveal?
- Stage 1 Type 1 diabetes
- Stage 2 Type 1 diabetes
- Stage 3 Type 1 diabetes
- Type 2 diabetes
Getting to the Best Answer
Answer A is correct: 80.92% chose this answer, “Stage 1 Type 1 diabetes.” J.C. has stage 1 type 1 diabetes. She has two positive autoantibodies and normoglycemia.
Answer B is incorrect: 13.36% chose this answer, “Stage 2 Type 1 diabetes.” J.C. still has normoglycemia. Stage 2 type 1 diabetes is characterized by positive autoantibodies and dysglycemia (Impaired fasting glucose, Impaired glucose tolerance, or elevated A1c over 5.7% or 10% increase in A1C).
Answer C is incorrect: 4.2% chose this answer, “Stage 3 Type 1 diabetes.” J.C. does not have lab work confirming diabetes by the standard diagnostic criteria, and she is asymptomatic. Stage 3 type 1 diabetes is characterized by overt hyperglycemia and symptoms of diabetes with autoimmunity present.
Answer D is incorrect: 1.53% chose this answer, “Type 2 diabetes.” J.C. does not have type 2 diabetes. She does have a BMI in the overweight category, but she does not have hyperglycemia. She also has positive autoantibodies associated with type 1 diabetes. Type 2 diabetes is not immune-mediated.
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 Type 1 Staging & Stds
With Our CDCES Boot Camp Bundle | Includes Level(s) 1-3!
Welcome to our selection of comprehensive CDCES Boot Camp Online Prep Bundles that are specifically designed for healthcare professionals who are studying for the Certified Diabetes Care and Education Specialist (CDCES) exam.
Course credits through AMA PRA Category 1 Credits™, ACPE, ANCC, and CDR!
We offer a selection of prep bundles to meet everyone’s needs! See the descriptions below to review what is included in each option.
CDCES Boot Camp | Basic Exam Prep Bundle: This option is perfect for someone who wants just the Online Courses and materials all in one place, our Online University. This bundle includes Levels 1, 2, and 3 & Toolkits which equates to over 30 courses, 50 CEs/CPEUs, and 400+ online practice questions.
CDCES Boot Camp | e-Deluxe Exam Prep Bundle: This bundle has all of the courses from the Basic Bundle, along with the ADCES Certification Review Guide Practice Questions e-book with 400+ practice questions.
Red Flags for Low Digital Literacy in Diabetes Care
Digital literacy is a key social determinant of health, yet up to one-third of Americans struggle with basic digital literacy skills.¹ In diabetes care, this means many struggle with using, understanding, and applying digital information to improve glycemic control.² As diabetes healthcare providers, how do we know if our clients have low digital literacy? Here are five signs of low digital literacy to watch for in your practice.
1. Difficulty with Technology
- Struggling with using standard technology devices. You may hear: “I have a smartphone, but I don’t know how to use it.”
- Forgetting passwords and needing assistance to log into devices or accounts.
- Not knowing how to download an app on their smartphone or tablet.
2. Device Confusion
- Difficulty understanding how devices connect and share information.
- Confusing diabetes devices. You may hear: “My CGM gives me my insulin.”
- Thinking the insulin pump is “autopilot” and does not enter carbohydrates or meal announcements into the pump.
3. Fear Factor
- Communicating fear of diabetes technology. You may hear: “I just don’t trust those things!” and “What if it gives me the wrong dose?”
- Avoiding eye contact or changing the subject when discussing diabetes technology.
- Expressing worry of becoming overwhelmed with diabetes technology.
4. Technology Comprehension
- Not recognizing or acting on the device alerts and alarms.
- Difficulty interpreting glucose graphs and trend arrows.
- Struggling with troubleshooting the diabetes tech device. You may hear: “I just don’t know why this thing beeps all the time.”
5. Avoidance of Technology
- Shutting down discussion of diabetes technology. You may hear: “I’m too old to learn how to use that.”
- Unwilling to learn how to use the device because the spouse or another family member manages it on their behalf.
- Frequently rescheduling or not coming to training sessions to learn how to use the diabetes device
Improving Digital Literacy
Diabetes healthcare professionals are vital in supporting clients to improve their digital literacy.
✅Acknowledge their fears and concerns. Ask open-ended questions to understand their concerns. During your conversations, address any myths or misconceptions they may have about diabetes technology.
✅ Offer support and assistance with improving their digital literacy skills. Whether it is one-on-one education or in group classes, offer device education sessions tailored to those with low digital literacy.
✅ Increase the frequency of phone calls or in-person check-ins to monitor progress with the diabetes device. Support the client at every step of their learning journey and help them stay accountable for their personal diabetes goals.
References:
- Information Technology & Innovation Foundation. (2021, November 29). Assessing the state of digital skills in the U.S. economy. Retrieved from https://itif.org/publications/2021/11/29/assessing-state-digital-skills-us-economy/
- Huang, E. S., Sinclair, A., Conlin, P. R., Cukierman-Yaffe, T., Hirsch, I. B., Huisingh-Scheetz, M., Kahkoska, A. R., Laffel, L., Lee, A. K., Lee, S., Lipska, K., Meneilly, G., Pandya, N., Peek, M. E., Peters, A., Pratley, R. E., Sherifali, D., Toschi, E., Umpierrez, G., . . . Munshi, M. (2023). The growing role of technology in the care of older adults with diabetes. Diabetes Care, 46(8), 1455. https://pmc.ncbi.nlm.nih.gov/articles/PMC10369127/#B47
Learn More From Our Technology Expert:
Dr. Diana Isaacs
During Our Virtual DiabetesEd Training Conference
April 15th-17th, 2026
Gain fresh insights, practical tools, and a deeper understanding of the latest in person-centered diabetes care. Our expert team brings the ADA Standards of Care to life—covering medications, behavior change, technology, and more!
If you’re preparing for the CDCES or BC-ADM exam, this conference, paired with a handful of free bonus courses, serves as the ideal study companion! Plus, this content counts toward the ADA Standards requirements for CDCES Renewal.
With interactive co-teaching, we keep sessions engaging, relevant, and fun.
Let’s learn and grow together!
Course credits through AMA PRA Category 1 Credits™, ACPE, ANCC, and CDR!
Program Objectives:
Upon completion of this activity, participants should be able to:
- Describe the current ADA Standards for diagnosis, goals, and person-centered diabetes management across the lifespan.
- Demonstrate insulin pattern management and dosing strategies in clinical scenarios.
- Implement timely screening and risk reduction strategies for microvascular and cardiovascular complications.
- Incorporate behavior change techniques and medical nutrition therapy to support people with diabetes self-management and lifestyle adjustment.
Question of the Week | Best Response for Facilitating Positive Health Behavior Change?
KC has type 2 diabetes, diagnosed 5 years ago. They report low physical activity, frequent sugar-sweetened beverage intake, and high stress related to work. Last A1c was 8.2%. KC reports previous advice to “exercise more and drink less soda,” but reports making minimal changes. They express interest in improving health but feels overwhelmed by where to start.
Which of the following responses best aligns with the 2026 ADA Standards of Care recommendations for facilitating positive health behavior change?
- Advise KC to stop sugary drinks and record physical activity minutes daily.
- Ask KC, “What makes improving your health important to you right now?”
- Focus the visit on intensifying glucose lowering medications first and revisit lifestyle changes at the next appointment.
- Recommend KC find social support for activity at the local gym and work with KC to set goals to avoid sugar-sweetened beverages.
Learn More About 2026 ADA Standards
With Our Upcoming Courses & Spreading the Love Sale!
Prepare for the CDCES Exam: Get Ready for Success!
Course credits through AMA PRA Category 1 Credits™, ACPE, ANCC, and CDR!
Get exam-ready with confidence.
Our CDCES Boot Camp Online Prep Bundle is a comprehensive, high-impact program built specifically for healthcare professionals preparing for the Certified Diabetes Care and Education Specialist (CDCES) exam who want to level-up their clinical knowledge and skills.
✔ Learn at your pace with expert-led, exam-focused content
✔ Everything you need—organized, practical, and in one place
✔ Perfect for self-directed learners who want complete, person-centered content for clinical practice and exam prep.
✔ Build knowledge, sharpen test-taking skills, and prepare with confidence—on your schedule.
Focused. Flexible. Proven.
Basic & e-Deluxe CDCES Boot Camp Bundle Includes:
- Levels 1, 2, and 3 of our Online University
- 30+ expert-led courses
- 50 CE/CPEUs
- 400+ online practice questions
- Handouts, podcast, video and one year access—all in one streamlined platform.
Spreading the Love Sale
Save 15% on Certification Boot Camps & Trainings
Use the Code "LOVE15" for 15% Off at Checkout!
CDCES Boot Camp | 50+ CEs
Starting: $449 | Starting Sale Price: $381.65
BC-ADM Boot Camp | 50+ CEs
Starting: $459 | Starting Sale Price: $390.15
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Virtual Training | 30+ CEs
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Sale Ends on February 16th, 2026!
Rationale of the Week | What to Assess When Looking for PAD?
For last week’s practice question, we quizzed participants on what needs to be included in the initial screening for PAD, according to ADA Standards. 56.08% 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
Peripheral Artery Disease (PAD) is significantly underdiagnosed. While PAD affects around 8.5 million Americans and prevalence rises with age (up to 20% over 60), only 10-20% are clinically diagnosed, highlighting a major gap in awareness and screening.
According to the ADA Standards, what needs to be included in the initial screening for PAD?
- History of leg fatigue and calf pain when walking.
- Lower extremity pain that is worse at night and restless legs.
- Leg cramps coupled and frequent unexplained bruising.
- Onychomycosis and unusual callus formation.
Getting to the Best Answer
Answer A is correct: 56.08% chose this answer, “History of leg fatigue and calf pain when walking.” YES, great job. According to the ADA, if a person presents with leg fatigue and intermittent claudication, a more detailed screening for peripheral arterial disease (PAD) and poor arterial circulation is warranted.
Answer B is incorrect: 21.08% chose this answer, “Lower extremity pain that is worse at night and restless legs.” People experiencing neuropathy will complain of leg pain and burning that is worse when resting. People with PAD complain of leg and buttock pain when walking due to diminished circulation and poor blood flow to muscles that is relieved with rest.
Answer C is incorrect: 12.45% chose this answer, “Leg cramps coupled and frequent unexplained bruising.” Only part of this answer is correct. Although leg cramps or calf pain can occur with PAD, there is not direct association with frequent unexplained bruising.
Answer D is incorrect: 10.4% chose this answer, “Onychomycosis and unusual callus formation.” People with diabetes do have an increased risk of toenail infections and onychomycosis, but this is not associated with the manifestations of PAD.
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 With Our Online Courses
Level 2 | ADA Standards of Care Complete Review
Join us live on January 29th, 2026 at 11:30 AM PST!
CDCES Boot Camp Bundle
Use the Code "Community15" At Checkout for 15% Off!
Sale ends January 26th
Grief and the Role of the Diabetes Educator
MK has been living with type 1 diabetes for over 52 years, most recently using an AID system. He views himself as in generally good health “for someone his age” but arrives at this annual visit reporting he recently lost his spouse of more than 46 years. For decades, they shared meals, routines, reminders, and a partnership that often supports confident diabetes self-management. Since her death, MK’s diabetes care has understandably shifted. His eating patterns are now more irregular, medications and boluses occasionally missed, and during the visit conversation, he states, “I should’ve just canceled, I am not doing well in my diabetes.”
Beneath that statement is grief, disorientation from typical patterns and routines, the profound loss of a partner who helped make daily life with diabetes manageable, and possibly more.
How Can I Help As a Diabetes Educator?
It is tempting to jump in and explore with MK how we can help him meet targets and increase his engagement, the way he once did, but grief is a life transition that can change priorities and capacity for self-care. For MJ it altered feelings of support, his social network, motivation, appetite, sleep, and self-efficacy. The American Diabetes Association (ADA) Standards of Care emphasize that diabetes management must be individualized and responsive to individual needs, including psychosocial. Listening and assessing changes in loneliness, social isolation, new goals and expectations, and quality of life may be “what matters most” for this visit. ¹ They also stress that treatment goals and strategies should be modified during significant life transitions, recognizing that the capacity for self-management can change over time.
Person-centered care is our clinical standard of care. Rather than centering the visit on solving assessed problems, it can focus on MK. Sitting with his grief, acknowledging the enormity of loss, and affirming that this is a transition. We can explore what success now means for MK, ensure his safety, and find new points of connection rather than isolation. This visit can support adapting diabetes management to life as it is now, not as it was.
Mental Health and Grief
In chronic grief, consideration of concurrent diagnoses such as adjustment disorders, depression, anxiety, lack of social support, and coping mechanisms is important. ² In older adults with depression, an increased risk of suicide had common factors, including recent death of a loved one, social isolation, or the perception of poor health. ³ Using validated screening tools may help identify individuals whose grief is significantly affecting daily functioning and requires additional assessments.
A few examples are the Patient Health Questionnaire-2 or 9 (PHQ-2 or PHQ-9) for depression, the Generalized Anxiety Disorder 7-item scale (GAD-7) for anxiety, and for emotional burden related to living with and managing diabetes, the Problem Areas in Diabetes Scale (PAID), and/or the Diabetes Distress Scale (DDS). 4 A recent article in Diabetes Spectrum 3 reported that the Center for Epidemiological Studies Depression Scale (CES-D), per systematic reviews, was found to be the best-supported tool for measuring depressive symptoms in people with diabetes. Positive screening results do not confirm a diagnosis; communication with the medical team to ensure adequate and ongoing interventions is needed. Referrals to behavioral health specialists, grief counseling, or peer and community support groups may also be recommended. As a resource, the American Diabetes Association has a directory of Mental Health Providers who specialize in supporting individuals with diabetes: https://diabetes.org/tools-resources/mental-health-directory.
Some Things to Keep In Mind
Diabetes Care and Education Specialists often take care of individuals over time; we don’t just provide medical assessments, but provide care through significant life events such as marriages, retirements, community disasters, illnesses, changes in caregiving roles, and loss. When working with individuals like MK, presence, active listening, supportive engagement, and collaborative care planning may be the most appropriate interventions. By meeting individuals where they are, rather than where they “should” be, the CDCES supports trust, connection, and access to the care they need. In doing so, we uphold the heart of diabetes care: partnering with people through all seasons of their lives.
References:
- American Diabetes Association Professional Practice Committee for Diabetes*; 13. Older Adults: Standards of Care in Diabetes—2026. Diabetes Care 1 January 2026; 49 (Supplement_1): S277–S296. https://doi.org/10.2337/dc26-S013
- American Diabetes Association Professional Practice Committee for Diabetes*; 4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Care in Diabetes—2026. Diabetes Care 1 January 2026; 49 (Supplement_1):
S61–S88. https://doi.org/10.2337/dc26-S004 - Elizabeth A. Beverly, Jeffrey S. Gonzalez; The Interconnected Complexity of Diabetes and Depression. Diabetes Spectr 14 February 2025; 38 (1):23-31. https://doi.org/10.2337/dsi24-0014
- Visit the ADA behavior health toolkit for more information and resources on validated screening tools: https://professional.diabetes.org/professional-development/behavioral-mental-health/behavioral-health-toolkit
Learn More With Our Webinars
Level 2 | ADA Standards of Care Complete Review
2026 Recording Available On-Demand
Level 2 | Improving Care and Promoting Health
Join us live on February 10th, 2026 at 11:30 AM PST!
Question of the Week | What Does J.C.’s Family History & Lab Work Reveal?
J.C. is a ten-year-old female with a family history of type 1 diabetes. Her 7-year-old brother was diagnosed with type 1 diabetes two years ago. J.C. has no complaints and reports feeling well. She enjoys playing sports, including basketball and soccer. Her current BMI is 22.1 (93rd percentile for age). She denies any polydipsia, polyuria, or polyphagia. Her lab work demonstrates a fasting blood sugar of 71 mg/dL, an A1c of 5.0%, normal kidney function, and normal electrolytes. Her diabetes autoantibody panel shows positive glutamic acid decarboxylase (GAD) and islet antigen 2 (IA-2) antibodies, negative zinc transporter 8 (ZnT8) antibodies, and negative insulin antibodies.
What does her lab work reveal?
- Stage 1 Type 1 diabetes
- Stage 2 Type 1 diabetes
- Stage 3 Type 1 diabetes
- Type 2 diabetes
Learn More About Type 1 Staging & Stds
With Our CDCES Boot Camp Bundle | Includes Level(s) 1-3!
Welcome to our selection of comprehensive CDCES Boot Camp Online Prep Bundles that are specifically designed for healthcare professionals who are studying for the Certified Diabetes Care and Education Specialist (CDCES) exam.
Course credits through AMA PRA Category 1 Credits™, ACPE, ANCC, and CDR!
We offer a selection of prep bundles to meet everyone’s needs! See the descriptions below to review what is included in each option.
CDCES Boot Camp | Basic Exam Prep Bundle: This option is perfect for someone who wants just the Online Courses and materials all in one place, our Online University. This bundle includes Levels 1, 2, and 3 & Toolkits which equates to over 30 courses, 50 CEs/CPEUs, and 400+ online practice questions.
CDCES Boot Camp | e-Deluxe Exam Prep Bundle: This bundle has all of the courses from the Basic Bundle, along with the ADCES Certification Review Guide Practice Questions e-book with 400+ practice questions.
Two Big Announcements – Scholar & Test Success Webinar
Featured Articles __________________________ |
Today marks Martin Luther King Jr Day, which gives us pause to reflect on his ideals of equality and justice through acts of service and community care.
Our Bridge Scholarship is rooted in these ideals of service and reciprocity. Our Scholar and Mentorship program goes beyond education—it’s about building connections, fostering professional growth, and creating a vibrant community of passionate diabetes care providers.
We are proud to offer 14 “Making a Difference” Scholarship spots for healthcare professionals to attend our Virtual DiabetesEd Training Conference at no cost or a reduced registration fee. If you or a colleague is seeking to achieve diabetes certification and improve the health of your community, you may qualify for this scholarship opportunity.
Are You Taking CDCES or BC-ADM Exam in 2026?
Two exciting opportunities to help you on your way!
- Join our FREE Test-Taking Success Webinar on January 23, 2026, designed specifically for busy healthcare professionals preparing for diabetes certification. Led by Coach Bev, this free session is practical, encouraging, and designed for real-world success. You will practice dissecting 20 sample questions to avoid common pitfalls and find the BEST answer. We hope to see you there!
- Flash Sale- Save 15% Off our most popular Study Bundle – the CDCES Boot Camp with coupon code Community15. Thousands of healthcare professionals have added a CDCES after their name after completing this comprehensive series.
We are deeply grateful to all the mentors and healthcare professionals who are on their journey toward becoming certified diabetes specialists and leaders in diabetes care.
With heartfelt gratitude,
Coach Beverly, Bryanna, Astraea & Katarina
Test Taking Success & Scholarships
Are You Taking the CDCES or BC-ADM Exam in 2026?
Join our FREE Test-Taking Success Webinar on January 23rd, 2026
Learn Proven Test-taking Strategies from Coach Bev!
You are invited to join our FREE Test-Taking Success Webinar on January 23rd, 2026, designed specifically for busy healthcare professionals preparing for diabetes certification.
During this webinar, you will have the opportunity to answer and dissect 20 sample exam questions alongside Coach Bev. Learn how to avoid common exam pitfalls and get to the best answer!
This content will boost your confidence and clarity so you can walk into exam day feeling prepared, calm, and in control. Coach Beverly has helped thousands of candidates cross over the finish line to success. She has passed her CDCES exam 7 times and counting.
🎯 Gain Confidence with Proven Strategies —save your spot today.
Apply Today for the 2026 Bridge "Making a Difference" Scholarship
Applications Open Through Jan 15 – Feb 15th. Recipients announced on Feb 23, 2026!
We are geared up to help grow and mentor future Certified Diabetes Care and Education Specialists (CDCES) to meet the increasing and varied needs of our diabetes community.
We are offering 14 Bridge Scholarships, which cover the registration cost for our “Virtual DiabetesEd Conference” on April 15-17, 2026. This program will provide you with diabetes fundamentals and beyond! Earn 30+ CEs with access to the courses for one year!
Over the next 10 years we are “Building a Bridge” to welcome a thousand new diabetes educators into the field. If you know a healthcare professional seeking a new challenge and eager to pursue a meaningful and rewarding specialty, please invite them to consider becoming a Certified Diabetes Care and Education Specialist (CDCES).
Save 15% OFF CDCES Boot Camp
Use the Code "Community15" at Checkout!
Get exam-ready with confidence. Our CDCES Boot Camp Online Prep Bundle is a comprehensive, high-impact program built specifically for healthcare professionals preparing for the Certified Diabetes Care and Education Specialist (CDCES) exam. ✔ Earn CE/CPE credit through AMA PRA Category 1 Credits™, ACPE, ANCC, and CDR. For more information on accreditation, visit the registration page on our Online Store and click the “Accreditation” tab. ✔ Learn at your pace with expert-led, exam-focused content ✔ Everything you need—organized, practical, and in one place Perfect for self-directed learners who want complete, person-centered content for clinical practice and exam prep. Focused. Flexible. Proven. Build knowledge, sharpen test-taking skills, and prepare with confidence—on your schedule. |
Get ready for Exam Success Starting Today! Sale ends January 26, 2026! |
CDCES Boot Camp Bundle includes:
Levels 1, 2, and 3 of our Online University
30+ expert-led courses
50 CE/CPEUs
400+ online practice questions
Handouts, podcast, video and one year access—all in one streamlined platform.
Take 15% OFF with coupon code Community15.
Sale ends January 26, 2026!
