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Rationale of the Week | What are Pediatric Glucose Targets?
For our June 15th Question of the Week, only 54% of respondents chose the best answer. We want to “take a closer look” at this question with the aim for 100% correct responses the next to go around.
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question
Question: RT is 12 years old and has a new diagnosis of type 1 diabetes.
Based on the ADA Standards of Care, what is the most accurate statement regarding glycemic goals?
Answer Choices:
- Glucose targets are based on the individual.
- Strive to achieve at least 80% time in range.
- A1C less than 6.5% for children under the age of 18.
- Pre-meal glucose of 80-130 and post-meal glucose less than 200 to prevent hypoglycemia.
As shown above, the most common choice was option 1, the second most common answer was option 4, then option 2, and finally option 3.
Getting to the Best Answer
If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. The exam will present questions that require test takers to be familiar with the goals of care for specialty populations, including pediatrics.
Answers & Rationale
Answer 1 is Correct, 54.26% chose this answer, “Glucose targets are based on the individual.” GREAT JOB. This is the best answer. The American Diabetes Association provides a general A1c target of 7% or less for pediatrics, but it encourages the person with diabetes and the care provider to determine glucose ranges that best match the individual based on their values, preferences, access to technology and safety.
Answer 2 is incorrect, 15.06% of you chose this answer, “Strive to achieve at least 80% time in range.” According the the ADA, the time in range target is 60% or an A1c of less than 7.5% for those under the age of 25. Of course, these goals are customized to match the individual.
Answer 3 is incorrect, 11.07% of you chose this answer, “A1C less than 6.5% for children under the age of 18..” This is a juicy answer. This target may be right for those who are using a CGM, pump and advanced technology features that help users avoid hypoglycemic events. But this is not the A1C target for all children with type 1 diabetes, so this is not the best answer. There is no A1C target that fits all.
Answer 4 is incorrect, 19.60% of you chose this answer, “Pre-meal glucose of 80-130 and post-meal glucose less than 200 to prevent hypoglycemia.” The American Diabetes Association provides a general A1c target of 7% or less for pediatrics, but it encourages the person with diabetes and the care provider to determine pre and post meal glucose ranges that best match the individual based on their values, preferences, access to technology and safety.
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 topic? Enroll in our
Level 2 | From Tots to Teens Diabetes Standards | 1.5 CEs
This course includes updated goals and guidelines for children living with type 1 or type 2 diabetes. This course discusses the special issues diabetes educators need to be aware of when working with children with diabetes and their families.
We discuss the clinical presentation of diabetes, goals of care, and normal growth and development through the early years through adolescence. Strategies to prevent acute and long term complications are included with an emphasis on positive coping for family and child with diabetes.
Topics include:
- Discuss the goals of care for Type 1 and Type 2 Kids with Diabetes
- State Strategies to prevent acute and chronic complications
- Discuss the importance of positive psychosocial adjustment and resources
See Full Calendar for upcoming webinars and Virtual Courses.
Can’t make it live? All paid registrants are guaranteed access to the video presentation, handouts and podcasts.
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
[yikes-mailchimp form=”1″]Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
Question of the Week |JR worried about cancer; sorting fact from fiction
JR is taking Metformin 1000mg BID but is worried about getting cancer and is thinking about stopping the metformin.
Which of the following is an accurate statement regarding diabetes and cancer?
- People with diabetes have a slightly lower risk of liver and uterine cancers.
- Some brands of metformin were recalled because of an NDMA impurity, so it is best to hold metformin for now.
- There is research suggesting that metformin may be associated with a decreased risk of certain cancers.
- Metformin does not increase the risk of cancer, but it can negatively impact renal function.
Click here to test your knowledge!
Want to learn more about this topic? Enroll in our
Level 4 | Cancer & Diabetes | 1.25 CEs
Patients with cancer often experience hyperglycemia secondary to treatment, which can increase risk of infection and compromise their nutritional status. In addition, recent research has identified the link between diabetes and cancer. Join us to learn more about this unexpected link and treatment strategies for steroid induced hyperglycemia using a case study approach.
Topics Include:
- Discuss the relationship between cancer, hyperglycemia and insulin resistance.
- State 3 benefits of normalizing glucose levels during chemotherapy.
- Using a case study approach, discuss strategies to improve glucose levels and quality of life.
See Full Calendar for upcoming webinars and Virtual Courses.
Can’t make it live? All paid registrants are guaranteed access to the video presentation, handouts and podcasts.
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
[yikes-mailchimp form=”1″]Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
June eNews | DiabetesEd Scholarships & 7 Reasons for Gratitude
June eNews | DiabetesEd Scholarships & 7 Reasons for Gratitude
Happy June!
Coach Beverly is feeling grateful
For this newsletter, I am practicing my gratitude out loud and sharing it with you all.
Here are 7 things I am grateful for:
- My birthday is in early June.
- June kicks off Pride Month.
- We welcome a new team member and blog contributor, Monique Jackson.
- A new glucagon treatment is available, with updated Glucagon Cards you can download for FREE or check out on our CDCES Coach app.
- We are holding our first LIVE DiabetesEd Specialist Course in San Diego in over a year, which will include; Diabetes Flash Mob, DiaBingo, Prizes, fantastic meals, networking, laughing, and learning together.
- There are 2 scholarships available for our Diabetes Ed Live Seminar.
- Lastly, I am deeply grateful for my remarkable family, friends, my Diabetes Ed Team, all of YOU, and this opportunity to live and contribute every day.
In this newsletter, we address topics ranging from hemoglobinopathies to inclusion to new glucagon meds.
Bryanna and I had a lot of fun putting this newsletter together because it rings so true to the mission of our company; to be inclusive and welcoming, to celebrate each individual while leaving judgment behind. To lift each other up, especially during hard times. To offer hope, promote curiosity, and let you always know that we believe in you.
Happy June everyone,
Coach Beverly, Bryanna, and Jackson
Click here to read our full June 2021 newsletter.
Featured Blogs
- Theresa Garnero on Inclusive Practices for LGBTQ+ community
- African American’s at Risk for falsely low A1Cs
- Meet Monique Jackson, new blog contributor
- New Glucagon Rescue Med
- Rationale of the Week
- Question of the Week
- 2 Scholarships Available
Featured Items
- Live Seminar in San Diego
- Live Webinar Updates
- Preparing for CDCES FREE Webinar – July 8th
- Preparing for BC-ADM FREE Webinar – July 15th
- On Sale: ADA Standards of Care Book
- Free Resources Catalog
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
[yikes-mailchimp form=”1″]Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
Rationale of the Week | U-500 Insulin Still Causing Confusion
For our May 25th Question of the Week, 71% of respondents chose the best answer, which is awesome! However, for safety and teaching purposes, we still want to “take a closer look” at this question at aim for 100% correct responses the next go around.
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question
Question: Mr. J is started on 100 units U-500 twice a day.
Which of the following administration techniques would ensure he gets the right dose?
Answer Choices:
- Using a U-100 syringe, withdraw 100 units.
- Using a U-500 syringe, withdraw 20 units.
- Using a U-500 pen, dial to 100 units.
- Using a U-500 pen, covert to 20 units.
As shown above, the most common choice was option 3, the second most common answer was option 2, then option 4, and finally option 1.
Getting to the Best Answer
If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. The exam will present questions that require test takers to be familiar with accurate dispensing of diabetes medications, injectables and insulins, including the concentrated versions.
Answers & Rationale
Answer 1 is incorrect, 7.11% chose this answer, “Using a U-100 syringe, withdraw 100 units.” This answer is wrong because when withdrawing U-500 insulin from a vial, a U-500 insulin syringe must be used (see image). Since U-500 insulin is 5x’s the concentration of U-100 insulin, drawing up 100 units of U-500 insulin in a U-100 syringe would deliver 500 units of insulin (or 5x’s too much and could be life threatening). See Concentrated insulin card below.
When using a U-500 syringe, no conversion is needed since the syringe automatically delivers the correct dose of U-500 insulin. No conversion, calculations or adjustments required.
Answer 2 is incorrect, 12.64% of you chose this answer, “Using a U-500 syringe, withdraw 20 units.” When using a U-500 syringe, no conversion is needed since the syringe automatically delivers the correct dose of U-500 insulin. No conversion, calculations or adjustments required. For example, if the order reads “100 units of U-500 concentrated insulin twice a day”, using a U-500 syringe, the person would withdraw 100 units of U-500 insulin.
Answer 3 is correct, 71.25% of you chose this answer, “Using a U-500 pen, dial to 100 units.” YES, GREAT JOB! If the order reads “100 units of U-500 concentrated insulin twice a day”, using a U-500 pen, the person would dial to 100 units of U-500 insulin. The pens automatically deliver the correct dose in less volume. No conversion, calculations or adjustments required.
Answer 4 is incorrect, 9.00% of you chose this answer, “Using a U-500 pen, covert to 20 units.” When using a U-500 pen, no conversion is needed since the U-500 pen is specifically created to deliver the correct dose of U-500 insulin. For example, if the order reads “100 units of U-500 concentrated insulin twice a day”, using a U-500 pen, the person would dial to 100 units of U-500 insulin.
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? Enroll in our
Brand New Online Advanced Courses | Level 4!
We are so excited to expand our Level 4 – Advanced Level & Specialty Topics Series!
Our Level 4 specialty courses are designed to address topics that not only enhance the clinical practice but also prepare participants to take the Board Certification in Advanced Diabetes Management (BC-ADM) exam. The fast-paced content is designed to fulfill curiosity, build on previous significant diabetes care experience and support your journey toward expanding your diabetes knowledge.
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
[yikes-mailchimp form=”1″]Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
Creating Inclusive Practices for LGBTQ+ Community – An Interview with Theresa Garnero
June is Pride Month and in honor of providing best care for our LGBTQ+ community, we are highlighting an expert interview, with my dear friend and colleague, Theresa Garnero, APRN, BC-ADM, MSN, CDCES.
Theresa is a trailblazer and advocate in the field and she reminds us that whether we provide services in the hospital, clinic, or outpatient settings, we can take steps to help all people we serve feel welcome and included. We know that many people from the LGBTQ+ community with prediabetes or diabetes may delay seeking medical care to avoid the pain of social stigma often experienced in medical settings.
“Members of the lesbian, gay, bisexual, transgender and queer (LGBTQ) community have unique health disparities and worse health outcomes than their heterosexual counterparts, which has clinical relevance in the delivery of diabetes care and education. Diabetes care and education specialists are in a pivotal position to help this medically-underserved and vulnerable population get the best possible care.” – ADCES
By paying careful attention to each person’s experience from the moment they walk in the door until we say goodbye, we can find ways to create a more inclusive environment. This awareness of the details, such as inclusive gender questions on intake forms or gender-neutral signage on the bathrooms, are great first steps to show your care and respect for those you work with.
For more information on this topic, we turn to our expert for insights and resources.
Interview with Ms. Theresa Garnero, APRN, BC-ADM, MSN, CDCES
1. What inspired you to write the ground-breaking article for on “Providing Culturally Sensitive Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) community” in Diabetes Spectrum, gosh – already 10 years ago now?
I heard a researcher at a national conference go on and on about needing to screen the daughters of women with polycystic ovarian syndrome (PCOS) for diabetes since there is a strong link between PCOS and type 2. She never discussed the population of women that have the highest rates of PCOS – lesbians (38% of lesbians have PCOS vs. 14% of heterosexual women1). So I went up to the mic and asked her if she was aware of Agrawal’s work showing lesbians have the highest rate of PCOS. I was flabbergasted when she said yes. I responded she might want to include that most vulnerable population in her talk as we need to screen all women at risk.
It got me thinking about how could a well-known professor at a national diabetes conference willingly withhold data about an under-served population? So, I began to comb through the existing research that impacts the LGBTQ community with regards to diabetes care and prevention. And I was astonished what I found. So, I wrote the article and was so glad the ADA published it. But why wasn’t this part of the conversation back then? Even now? And I still ask, why won’t ADA reply to my inquiries to include this special population within their Standards of Care?
2. What’s the first step our readers could do to provide inclusive care to the sexual and gender minority population of people with prediabetes and diabetes who seek care?
Actually take steps to include this special population. I think there are several opportunities to do this, starting with making sure their environment gives clues that it is a safe place for the LGBTQ community to seek care. Remember, this community is used to outright hostility from within the healthcare system and are often reluctant to self-disclose out of fear for getting substandard care. I once worked with a man with type 1 diabetes who was gay tell me that his endocrinologist told him he deserved every low he got, and that when he’d go to the emergency department, they refused for his husband to be by his side And that happened in the gay mecca of San Francisco! Imagine other “less tolerant” places.
If they see you don’t have a clue because you have old forms with old terms, they most likely won’t come out. And if they don’t come out, then you don’t have all the data to make an individualized plan. So, you can check your assessment forms to see if you use inclusive terms. Do you actually ask for LGBTQ status by asking for sexual orientation, gender identification and relationship status (not marital status)? And collect the aggregate data! Just because it’s not measured doesn’t mean it doesn’t exist. Do you have clues in your waiting room that it’s safe and friendly for this group (like post a little rainbow flag)? Do you include LGBTQ risk factors for health outcomes in your materials? Do you tell people you are here to help everyone, no matter their situation or who they’re with? I realize change is slow, but collectively as individuals, and nationally, we can make it a better place for this underserved population.
3. “Inclusive Care” seems to be the new buzz phrase, but I bet most diabetes care and education specialist think they are being inclusive. I mean, how could you not be?
Because if you don’t even know a certain segment of those you care for have unique risk factors, and arguably worse – you have no clue who that vulnerable population is in your practice – you aren’t doing all you can to provide quality care to all you serve. It’s estimated that the number of LGBTQ individuals with diabetes equals that of the amount of people with type 1, so it’s not a small number we’re talking about. As an example, let’s apply this to Social Determinants of Health. We talk about the research showing how your zip code has more to do with your health than your DNA, particularly as it relates to food insecurity. But did you know LGBTQ individuals and families have the highest rates of food insecurity? Why isn’t that research included in diabetes mainstream publications and conferences?
According to research presented by the Williams Institute2, more than 1 in 4 LGBTQ adults (27%), approximately 2.2 million people, experienced a time in the last year when they did not have enough money to feed themselves or their families, compared to 17% of non-LGBTQ adults.
And when you add racial/ethnic sub-populations within the LGBTQ community, the stats are staggering:
- Among LGBTQ people, 42% of African-Americans, 33% of Hispanics, 32% of American Indians and Alaskan Natives, and 21% of Whites reported not having enough money for food in the past year.
4. I was thrilled to see the handout that you wrote about inclusive care for the ADCES. That’s a start for sure. How do you think this came about?
Thank you! I am so excited to see our national organization pay attention to the LGBTQ population and help get the word out about what we can do. I think because they are interested in us being the best diabetes care and education specialist that we can and including everyone is part of that. I had also just spoken at the AADE conference in Houston. We had a panel of professionals and researchers that represented the LGBTQ community. (I had spoken previously at AADE, but that was just by myself and this last time was so special.) I’m truly impressed with how much research that has transpired in these 10 years.
5. Any closing thoughts?
I’d say that a willingness to learn is so important. As is recognizing one’s personal biases. We certainly don’t agree with the lifestyles of all we serve, but it is not our role to judge or let those biases interfere with helping someone find a path to thriving with diabetes. And just know, it takes time to get up to speed. I’d encourage readers to check out the ADCES handout and watch this funny video clip that a colleague sent me. Honestly, it is hard to keep up with the terms, even for someone like me who helped to get this topic on the diabetes radar. This video made me crack up and appreciate the nuance of all the terms. I bet your audience would like it too. You can check out the “What “The Sex Talk” Looks Like Now, by Alternatino. Thanks so much, Beverly, for your willingness to discuss the topic. I truly hope it helps your readers improve their care delivery.
Ms. Theresa Garnero, APRN, BC-ADM, MSN, CDCES trail-blazed several innovations in the field of diabetes in the years that followed being awarded the national Diabetes Educator of the Year by the American Association of Diabetes Educators (2004).
Her latest efforts involve trying to reach people with prediabetes and type 2 who are currently not being reached with our face-to-face programs. How? She created the Sweet People Club an all online program which uses a flipped classroom concept so people can follow the Diabetes Prevention Program and also manage type 2 through a series of professionally-made videos (ahem, nearly 150 of them!) that they can watch at a time that is convenient for them, then ask questions through the portal, as well as meet virtually face-to-face real time with a Registered Dietitian twice a month.
If you’d like access to experience what the program is like, she is sharing her work and invites your feedback. Visit https://www.sweetpeopleclub.com/pro/ or email her for questions at [email protected]
List of Resources
A Guide To Gender Identity Terms by NPR – A glossary for gender identity terms to use more inclusive language.
Diabetes Prevention and Management for LGBTQ+ People Handout – this handout includes research of diabetes within the LGBTQ community, along with clinical considerations, programs, and resources for diabetes educators to use within their practice.
Policies on Lesbian, Gay, Bisexual, Transgender & Queer (LGBTQ+) issues – this resource by the American Medical Association lists all the current healthcare policies in place for the LGBTQ community.
Helio’s LGBTQ+ Health Updates Resource Center – this is a “collection of news articles and features that provide the latest information on the unique health needs of individuals in the LGBTQ+ community.”
- Agrawal et al: Prev. of polycystic ovaries and polycystic ovary syndrome in lesbian women compared w heterosexual women. Fert Steril 82:1352-57, 2004.
- FOOD INSECURITY AND SNAP PARTICIPATION IN THE LGBT COMMUNITY. (n.d.).
- Sweet People Club
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
[yikes-mailchimp form=”1″]Now you can take your CDCES Exam from Home!
Wow! This is fantastic news. I sit for the CBCDE Exam for the 7th time next year, and I am definitely going to take advantage of this remote feature! ~ Coach Beverly
The Certification Board for Diabetes Care & Education (CBDCE) is now offering the opportunity to take your Certified Diabetes Educator (CDCES) exam remotely!
By the end of this year, you will have the option to take your certification exam using their new Live Remote Online Proctoring (LRP) platform.
LRP is a secure and non-invasive platform that uses professional proctors and technology to monitor candidates live while they complete the Certification Examination for Diabetes Care and Education Specialists (Exam). This method of test delivery allows the candidate to take the exam from their home, office or a remote site, using their own computer. The process is secure, easily accessible, and monitors testing activity and records all aspects of the exam testing session.
Get Familiar with the Requirements
During your exam appointment, you will be connected with a moderator who will guide you through the process and be there throughout your entire exam. You will need to share your screen and broadcast yourself during your entire exam. Your workspace should be quiet, tidy, and free of any study notes/materials.
No electronics, besides the computer you are taking the test on are allowed. However, since there may be math questions, a basic calculator is allowed after clearance by the moderator. A 10-minute break is an option, but no changes to completed test questions are allowed after the break. In addition, the moderator will need to rescan your workspace to make sure it is free of study notes and materials. After you take the exam, you will instantly get a report of your results.
To connect to the LRP platform, you will need a computer with a webcam and microphone. The CBDCE recommends that you run compatibility tests before your exam to ensure your equipment is compatible.
To learn more about LRP, watch the 4-minute video below and read the Guide to Live Remote Online Proctoring (LRP)
Studying for the CDCES Exam?
Join us for our Becoming a CDCES FREE Webinar
Join us to get ready to succeed a the CDCES Exam. This course will transform your test anxiety into calm self-confidence and test-taking readiness.
Topics covered include:
- Changes in requirements for 2021
- Exam eligibility and test format
- Strategies to succeed
- Review of study tips and test-taking tactics.
We will review sample test questions and the reasoning behind choosing the right answers.
After registering, you will receive a confirmation email containing information about joining the webinar.
Intended Audience: This FREE webinar is designed for individuals or groups of diabetes educators, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants and other health care providers interested in achieving excellence in diabetes care and becoming Certified Diabetes Care and Education Specialists®.
See Full Calendar for upcoming webinars and Virtual Courses.
Can’t make it live? All paid registrants are guaranteed access to the video presentation, handouts and podcasts.
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
[yikes-mailchimp form=”1″]Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
Question of the Week | New Diabetes, Best Action?
JR is 43 years old with newly discovered type 2 diabetes.
According to the ADA Standards, which of the following actions needs to be taken with a new type 2 diabetes diagnosis?
- Hepatitis B Vaccine
- Screening for prostate cancer
- Referral to podiatry
- Antibody testing to confirm diagnosis
Click here to test your knowledge!
Want to learn more about this topic? Enroll in our
Level 4 | Type 2 Intensive | 2.0 CEs
This 2 hours course provides a detailed overview of the pathophysiology of type 2 diabetes, prevention strategies, and cardiovascular risk reduction. In addition, we highlight type 2 treatment approaches including nutrition, activity, oral and injectables medications plus screening and treatment guidelines for micro and macrovascular disease. Through case studies and discussion, we highlight strategies to focus on a person-centered approach along with attention to psychosocial care for people living with diabetes.
Objectives:
- Discuss the current epidemiology of type 2 diabetes.
- Describe the classification, terminology & diagnostic criteria for diabetes.
- Identify the eight pathophysiologic defects associated with the ominous octet.
- Describe evidence and strategies to prevent type 2 diabetes.
State strategies to implement a person-centered approach to those with diabetes. - Discuss key aspects of type 2 diabetes management including education, therapeutic lifestyle changes, glucose, lipid, and hypertension management plus referrals.
- Understand the overarching principles of management of type 2 DM including.
- Classes of the diabetes medications
- Treatment of dyslipidemia/hypertension
- Screening for, prevention, and treatment of microvascular complications
- Psychosocial support
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
[yikes-mailchimp form=”1″]Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
Rationale of the Week | Best next step?
For our May 18th Question of the Week, 76% of respondents chose the best answer, which is awesome! We still want to “take a closer look” at this question.
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question
Question: CT was diagnosed with type 2 diabetes three years ago. The current medication regimen includes 1000 mg of metformin twice daily and 70 units of glargine at night. CT wears an intermittent sensor, and you look at the glucose trends together on CT’s phone app. You both agree that there are consistent postmeal spikes up to 250 almost every day after lunch and dinner. The lowest blood sugar readings are in the 100s. BMI is 33.8 and CT says, “I never feel full”. The most recent A1C is 8.2%, urinary albumin creatinine ratio less than 30.
Based on this information, what intervention would be most likely help CT get to recommended ADA targets?
Answer Choices:
- Add on low-dose sulfonylurea to prevent hypoglycemia.
- Suggest adding a GLP-1 Receptor Agonist.
- Hold metformin, and switch to basal-bolus therapy.
- Encourage CT to get more active, especially after meals.
As shown above, the most common choice was option 2, the second most common answer was option 4, then option 3, and finally option 1.
Getting to the Best Answer
If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. The exam will present questions that require test takers to be familiar with the stepwise approach to type 2 diabetes management in a variety of settings and situations.
For a complete listing of diabetes medications, please Download our Medication PocketCards.
Answers & Rationale
Answer 1 is incorrect, 2.51% chose this answer, “Add on low-dose sulfonylurea to prevent hypoglycemia.” Although we might consider this option, we can quickly identify a “tacked on” second half of the answer that makes it a wrong choice. One of the major side effects of sulfonylureas is hypoglycemia, so adding this class of medication wouldn’t prevent hypoglycemia, it would actually increase the risk of low blood sugars.
Answer 2 is correct, 76.57% of you chose this answer, “Suggest adding a GLP-1 Receptor Agonist.” GREAT JOB! Given the fact that CT is on 70 units of basal plus metformin and is experiencing postmeal spikes up to 250 almost every day after lunch and dinner and “never feels full”, adding a GLP-1 is the best choice. Adding a GLP-1 will decrease post meal hyperglycemia and postprandial glucose. In addition, GLP-1s can decrease appetite and increase feelings of satiation. Before suggesting addition of this medication class, it is important to consider insurance coverage and out of pocket cost, since cost could be a barrier.
Answer 3 is incorrect, 9.83% of you chose this answer, “Hold metformin, and switch to basal-bolus therapy.” According to the ADA, when initiating basal bolus insulin therapy for people with type 2 diabetes, they recommend continuing metformin to decrease insulin resistance. The ADA also suggests considering adding a GLP-1 RA or SGLT-2 Inhibitor before switching to basal bolus therapy.
Answer 4 is incorrect, 11.09% of you chose this answer, “Encourage CT to get more active, especially after meals.” While activity is important, this goal is very vague and not really actionable. In addition, “getting active after meals” will certainly improve health and is a great recommendation, but is not likely to drop the A1c to less than the goal of 7% or help with appetite.
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 topic? Join us for our upcoming
Level 4 | Solving Glucose Mysteries for Type 2 | 1.5 CEs | Ready to Watch!
Why are glucose levels elevated in the morning? When should insulin be started? What is the next step to get A1c to target?
During this course Coach Beverly addresses each of these glucose mysteries and more, using a person-centered approach. She describes a stepwise approach to evaluate glucose patterns and correct common issues encountered by people living with type 2 diabetes.
By attending this webinar, you will gain confidence in evaluating glucose patterns and making recommendations for improvement.
Objectives
- Describe common glucose mysteries encountered by people with type 2 diabetes.
- Using a stepwise approach, evaluate factors affecting glucose patterns.
- State interventions to increase time-in-range and improve quality of life.
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[yikes-mailchimp form=”1″]Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
