What Kind of Diabetes? Rationale of the Week October 20, 2020
Our October 20th Question of the week quizzed test takers on determining the type of diabetes based on lab results and the history. 68% of respondents chose the correct answer, while 32% did not. We thought that this was an important topic to discuss further, so we can pass on correct info to people living with diabetes.
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question
Question: JR has had prediabetes for several years, with A1c’s of 6.0-6.4%. JR is now experiencing sudden hyperglycemia and an A1c is 9.2%, GAD is positive, transglutaminase is negative and TSH is 1.4.
What is the most likely diagnosis?
Answer Choices:
- Latent autoimmune diabetes.
- Hyperglycemia due to secondary causes.
- Celiac induced hyperglycemia.
- Type 1 diabetes.
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, 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. 68.74% chose this answer. “Latent autoimmune diabetes.” To diagnose LADA, the Immunology of Diabetes Society has established three main criteria including: (1) adult age of onset (>30 years); (2) presence of any islet cell autoantibody; and (3) absence of insulin requirement for at least 6 months after diagnosis.
Even though we don’t know the age of this person, the sudden increase in blood glucose and one positive autoantibody (GAD – glutamic acid decarboxylase) plus an elevated A1c without urgent need for insulin therapy, indicate a diabetes 1.5 or LADA. LADA is a slower moving autoimmune attack of the pancreas, but also has features of type 2 diabetes, with some insulin resistance. People with LADA will need insulin therapy, usually with in 6 months, to help with beta cell preservation and prevent glucose toxicity. They are also at risk for other autoimmune co-conditions like thyroid and celiac disease.
Answer 2 is incorrect. 12.25% of you chose this answer, “Hyperglycemia due to secondary causes.” This is a juicy answer, but there is no other factors in the included in the question that indicates any other “secondary” cause (like medications or tube feedings). Also, a positive GAD is a specific test that measures and indicates autoimmune diabetes.
Answer 3 is incorrect. About 6.03% of respondents chose this, “Celiac induced hyperglycemia.” This answer is tempting, since the question mentions transglutaminase, which is a autoimmune blood test for celiac disease. However, the test comes back negative, so there is no celiac disease. Most importantly, there is no diagnosis category of “celiac induced hyperglycemia.”
Finally, Answer 4 is incorrect. 12.98% chose this answer, ” Type 1 diabetes.” Based on the info in the test question, especially that JR had prediabetes” and the fact that only the GAD is positive and the A1c is only modestly elevated, this person is best described as having LADA.
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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Preparing for the CDCES Exam 2020
November 5, 2020, from 11:30 a.m. – 12:45 p.m. (PST)
Unsure about updates for the 2020 exam?
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Topics Covered Include:
- Implications of new certification name, CDCES for our specialty
- Exam requirement updates for 2020
- Exam eligibility and test format
- Strategies to succeed along with a review of study tips and test-taking tactics.
- We will review sample test questions and the reasoning behind choosing the right answers.
- Learn how to focus your time and prepare to take the CDCES Exam. We provide plenty of sample test questions and test-taking tips!
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator who has passed her CDCES Exam 6 times. She is a nationally recognized diabetes expert for over 25 years.
See our Preparing for CDCES Resource Page >>
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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.
[yikes-mailchimp form=”1″]Confessions of an RD Sugar Addict & Low-Sugar Recipes
The holidays are upon us in the midst of a pandemic.
In past holiday seasons, I would check in with my clients to see how the holiday season was affecting their health. We would talk about getting enough sleep and adapting exercise routines to adjust for cold weather and shorter days.
We would talk about stress management tools to help cope with the pressures to overeat and the pressures to eat foods that we have been attempting to avoid.
This year is challenging because we are already taxed by the unbelievable stress of living in a pandemic.
I have found that I am already struggling with insomnia and less exercise. I have been overeating and craving sweets. In fact, I think that I have developed a sugar addiction during these last 7 months. I have been substituting ice cream, donuts, and chocolate for the hugs that I used to take for granted. I am missing gatherings, parties, and shared dinners with friends.
I started to look at the total amount of free sugar that I was consuming. On some days it added up to over 12 teaspoons per day! And I am a dietitian.
Sugar is a powerful stimulant of serotonin that is lacking in my brain these days. I thought that I was developing a cavity and this woke me up.
I had to make a commitment to cut back on sugar.
I thought about the World Health Organization’s sugar recommendation of lowering our free sugar intake to less than 5% of our total daily calories. This works out to about 6 teaspoons a day, depending on the person.
Free sugar applies to
- Added sugars such as:
- glucose
- fructose
- sucrose
- Naturally occurring sugars such as in:
- fruit juice
- honey
- syrups
Whole fruit and milk sugar are not included in free sugar.
I started to look at the total amount of free sugar that I was consuming. On some days it added up to over 12 teaspoons per day! And I am a dietitian.
The average American consumes 17 teaspoons of sugar daily. This translates to 57 pounds of sugar consumed each year.
Hidden Sugars are Tricky to Find
Many people don’t realize that a lot of the sugar they take in are “hidden” in processed foods, according to the World Health Organization.
- 12 oz of soda may contain up to 10 teaspoons of sugar.
- Starbuck’s 12 oz Vanilla Latte contains about 7 teaspoons of sugar.
- 1 Tablespoon of ketchup contains 1 teaspoon of sugar.
- Fun size trick or treat plain M & M’s contain 3 teaspoons of sugar.
- 1 piece of apple pie contains up to 8 teaspoons of sugar.
- 6 oz of fruit-flavored yogurt has 6 teaspoons of sugar.
Research does show that for some people eating sugar produces characteristics of craving and withdrawal, along with chemical changes in the brain’s reward center, the limbic region. These changes are linked to a heightened craving for more sugar.
I am grateful to be able to consciously choose to lower my sugar intake to improve my health.
I am grateful that the whole fruit can be used as a sweet substitute for my sugar cravings.
I love the new fall crop of apples, pears, kiwi, and persimmons.
Delicious Naturally Sweet Recipes
Below are my recipes for baked apples and poached pears that are a delicious holiday dessert.
Simple Baked Apples
- 5 – 6 medium apples, peeled and cut into chunks
- 2 Tablespoons butter or coconut oil, melted
- 1 teaspoon cinnamon
- ½ cup chopped walnuts
- Preheat the oven to 350 degrees
- Place the apples in a medium baking dish
Mix the melted butter or coconut oil, walnuts, and cinnamon together and pour over the apples. Bake in the preheated oven until the apples are soft, about 20 – 30 minutes. Stir once during the baking.
Enjoy!
Poached Pears (Naturally Sugar-Free)
- 1 cup red wine
- 1 orange zest and juice
- 1 cinnamon stick
- 1-inch ginger root peeled
- 3 cloves whole
- 2 Conference pears, peeled, sliced in half, and core
- 1 Tablespoon sliced toasted almonds
- 2 Tablespoons thick plain Greek yogurt
Pour the wine into a small saucepan along with the orange zest and juice and all of the spices
Bring almost to a boil and add the pear halves. Turn down the heat and let the pears simmer gently for 20 – 30 minutes, or until they have slightly softened. Carefully turn the pears over a few times throughout the cooking time to ensure they color evenly. When the pears are cooked remove them from the wine and place them on plates. Add a tablespoon of yogurt to each plate and sprinkle with toasted almonds.
Visit our Joy of 6 Page for sugar info and resources to share with your clients!
Written by Dawn DeSoto RD, CDCES, our resident Nutrition Content Writer
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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
Important Immunization Update for People with Diabetes
To be honest. the vaccination recommendations for diabetes have been shrouded in a veil of mystery for me, until this year.
Thankfully, the 2022 ADA Standards are wonderfully clear in describing the vaccination schedule and types for people living with diabetes. We created this simple chart that you are free to download and share with your colleagues and in your work setting.
What percent of People with Diabetes Get Vaccinated?
Even though these vaccine recommendations are well established, I thought it would be interesting to find out what percentage of people actually get the complete compliment of recommended vaccinations.
According to the CDC data, among those with diagnosed diabetes, the vaccination coverage for influenza, pneumococcal, and shingles was lowest among lower income adults and varied by race and ethnicity. Hepatitis B vaccination coverage was lowest among poor adults, and it decreased with age.
As diabetes specialists, we can have a significant impact on encouraging people with diabetes to receive these important vaccinations. We can work within our health care systems to establish systems and surveillance to monitor vaccine participation. Partnering with community health workers and liaisons can create bridges to increase vaccination rates.
Vaccination Rates for People with Diabetes:
- Influenza vaccine, about 60% of people with diabetes get their annual shot.
- Pneumonia vaccine only 53% of people with diabetes have recieved this vaccine.
- Hepatitis Vaccine Series: Only 33.2% of people with diabetes have received their Hepatitis Vaccines as of 2018.
- Herpes Zoster Series: Only 27.2% adults 60 and older with diabetes had ever received their Herpes Zoster vaccine.
- HPV Vaccine: About 59% of people in the U.S. have completed their HPV vaccine series.
Given that most experts predict that severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) and influenza viruses will both be active in the U.S. during the 2021–2022 season, getting the influenza vaccine is especially important.
Most people don’t know that getting the Influenza vaccine decreases risk of death.
New data is revealing that the influenza vaccine doesn’t just lower the risk of getting the flu, it also lowers risk of all cause mortality and cardiovascular events and death. This simple annual intervention is recommended for all individuals with diabetes 6 months and older.
See Table 4.5 in ADA Standard 4, 2022 for complete info
DiabetesEd Boot Camp | Level 3
This library of critical information is designed for individuals or groups of diabetes specialists, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other health care providers interested in staying up to date on current practices of care for people with diabetes and preparing for the BC-ADM or the CDCES certification Exam.
- February 8, 2022 – Class 1 – Diabetes – Not Just Hyperglycemia
- February 10, 2022 – Class 2 – Standards of Care & Cardiovascular Goals
- February 15, 2022 – Class 3 – Insulin Therapy – From Basal/Bolus to Pattern Management
- February 17, 2022 – Class 4 – Insulin Intensive – Monitoring, Sick Days, Lower Extremities
- February 22, 2022 – Class 5 – Meds for Type 2 – What you need to know
- February 24, 2022 – Class 6 – Exercise and Medical Nutrition Therapy
- March 1, 2022 – Class 7 – Screening, Prevention, and Treatment of Microvascular Complications
- March 3, 2022 – Class 8 – Coping and Behavior Change 1.5 CEs
- March 8, 2022 – Class 9 – Test-Taking Coach Session (48 Questions) No CE
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[yikes-mailchimp form=”1″]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.
Lower Birth Weight Tied to Earlier Type 2?
A study examining 48,000 people in Scotland over a 14 year period showed those born with a birth weight below 2.893 kg (6.38 lbs) developed type 2 earlier and at a lower BMI than those with a birth weight above 3.572 kg (7.87 lbs).
The results show a potential association between low birth weight and a more severe phenotype of type 2 diabetes, where less insulin is produced.
“It has long been established that being born with low birth weight is associated with increased risk of diabetes and cardiovascular disease in later life. This probably reflects a combination of genetics and intrauterine environment,” the study’s author Christian Paulina said.
Those with a birth weight under 2.893 kg were diagnosed with diabetes at the average age of 50, whereas the average age of diagnosis for those with birth weight above 3.572 kg was 51.3. The researchers noted that for every 1 kg in extra birth weight, diagnosis age was pushed out by .8 years.
More research is needed for clinical applications, but researchers hope to improve birth weight by reducing maternal smoking or improving maternal nutrition. Read the full study here.
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″]Free Resource Friday |Preparing for the CDCES Exam Webinar
Join us live with your questions on November 1, 2019 @ 11:30 a.m. PST!
Coach Beverly offers this FREE webinar to help get you prepare for the CDCES Exam. All her tips and tricks are meant to ease your mind and reflect the updates to the CDCES content outline. Register below with a name and email and you can join us live next Thursday!
Topics covered include:
- Test content updates for 2019
- 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 individual 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®.
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator who has passed her CDCES Exam 6 times. She is a nationally recognized diabetes expert for over 25 years.
See our Preparing for CDCES Resource Page >>
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″]Avoiding Juicy Answers | TR Moves to the Dorms
For Question of the week, test takers usually choose the correct answer 70-80% of the time. However, for this Tuesday’s question of the week, about 44% of respondents chose the correct answer.
So, we thought this would be a perfect opportunity for another answer rationale. We’ll explore this question and the best answer in more detail and throw in some test-taking tips along the way.
Question of the week on October 22:
TR is a 17-year-old with prediabetes who is graduating high school and moving out of state to college and will be living with a roommate in the dorms. TRs mom arranges to have an appointment with the diabetes educator before TR heads off to college. Which of the following is the most important issue to review during the visit?
Answer Options:
- Stressing that alcohol consumption can increase glucose levels
- Organization of medications and prescription refills
- Vaccinations and how to access medical care
- Making sure TR has easy access to carb snacks in case of hypoglycemia
As shown above, the most common choice was option 3, the second most common answer was option 2, then option 1, and finally option 4.
Congratulations! A majority of people still answered the question with the right answer.
Option 3 (C) is the correct answer: Vaccinations and how to access medical care. In this scenario, TR is only 17 with prediabetes and the question does not mention that TR is taking any medications or has any prediabetes related complications. Given that, the best intervention is to focus on prevention (vaccines) and how to access health care in this new environment.
Option 1 is incorrect because it says alcohol consumption can increase glucose levels, but alcohol is associated with a lowering of blood glucose. This is because when the liver is metabolizing alcohol, glycogenolysis is hampered resulting in lower blood glucose levels.
Option 2 is incorrect because this scenario doesn’t mention TR is on any medications or prescriptions, so this juicy answer assumes facts not in the question. If one assumes TR is on medication because they have prediabetes, organization of medication and prescription refills could be an important thing to consider before going off to an unfamiliar environment. However, since the scenario doesn’t mention medication, and a 17 year old with prediabetes is not likely be only any medications, this answer is also incorrect.
Finally, option 4 is incorrect because in this scenario, hypoglycemia isn’t mentioned. For people with diabetes, hypoglycemia is a risk when treating diabetes with insulin or sulfonylureas, but this scenario doesn’t mention TR being on either.
We hope you appreciate this week’s rationale and keep studying hard! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
[yikes-mailchimp form=”1″]National Prescription Drug Take Back Day this Saturday
What is the best way to dispose of expired medications or those that are no longer of use?
October 26 (this Saturday!) is National Prescription Drug Take Back Day. Between 10 a.m. and 2 p.m., collection sites across the U.S. will take all kinds of medications, no questions asked.
People with diabetes take a myriad of medications to keep healthy and maintain quality of life. Many of them are expired and need to be properly disposed of.
In addition, people with diabetes often use antidepressants and opioids used to combat pain. These types of prescription drugs, found in medicine cabinets, are often a primary source for misused medicines. They also increase risk of accidental overdose by young children.
50% of people who misused prescription painkillers got them from a friend or family member.
Recover Together has created a constantly updated map of collection centers that will participate in Take Back Day to help with the safe disposal of medications.
Beyond that, Google Maps will be helping so that if you search “medication disposal near me”, pharmacies, hospitals, police stations, and other locations that accept medications year-round will pop up.
National Take Back Day raises awareness on the importance of safe disposal of drugs. This includes environmental risks, health risks, accidental use, and intentional misuse.
According to the EPA, most water treatment facilities cannot filter out drugs. Medicines that are poured down the drain can enter our environment and community drinking water supplies.
Read more about health concerns and drug facts, and find a medication disposal location at Recover Together.
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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