Rationale of the Week | Are statins indicated for Peds with Diabetes?
For last week’s practice question, we quizzed participants on when to start statin therapy for pediatrics with diabetes. 50% 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: Based on the ADA Standards, in addition to dietary intervention, lifestyle and glucose management, when is it indicated to consider starting statin therapy for pediatrics with diabetes?
Answer Choices:
- When LDL is greater than 100 with a BMI of 25 or more.
- After age 10, if LDL is still greater than 130 at 6 months.
- Only if LDL and triglycerides are greater than 90thpercentile.
- Statins are only indicated for individuals 18 years and older.
Getting to the Best Answer
Answer 1 is incorrect. 11.84% chose this answer. “When LDL is greater than 100 with a BMI of 25 or more.” This is a tempting answer. However, according to ADA Standards, if after 6 months of intensive lifestyle intervention, the LDL is still greater than 130mg/dL and the child is 10 years or older, statin therapy is indicated to prevent cardiovascular complications.
Answer 2 is correct. 50% of you chose this answer. “After the age of 10 if LDL is 130 or greater.” Great job, this is the BEST answer. According to ADA Standards, if after 6 months of intensive lifestyle intervention, the LDL is still greater than 130mg/dL and the child is 10 years or older, statin therapy is indicated to prevent cardiovascular complications.
Answer 3 is incorrect. About 15.13% of respondents chose this. “Only if LDL and triglycerides are greater than 90thpercentile.” According to ADA Standards, if after 6 months of intensive lifestyle intervention, the LDL is still greater than 130mg/dL and the child is 10 years or older, statin therapy is indicated to prevent cardiovascular complications.
Finally, Answer 4 is incorrect. 23.03% chose this answer. “Statins are only indicated for individuals 18 years and older.” According to ADA Standards, if after 6 months of intensive lifestyle intervention, the LDL is still greater than 130mg/dL and the child is 10 years or older, statin therapy is indicated to prevent cardiovascular complications.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
Want to learn more about this question?
Join us live on May 30th at 11:30 PST for our
From Tots to Teens
Level 2 Standards of Care Intensive
This course includes updated goals & 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 & their families. We discuss the clinical presentation of diabetes, goals of care, & normal growth & development through the early years through adolescence. Strategies to prevent acute & long-term complications are included with an emphasis on positive coping for families & children with diabetes.
Objectives:
- 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 & resources.
Learning Outcome:
Attendees will have comprehensive knowledge of special considerations, individualized goals and standards for children with diabetes to include in their practice.
Target Audience:
This course is a knowledge-based activity designed for individuals or groups of diabetes professionals, including RNs, RDs/RDNs, 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. The practice areas for RDs/RDNs for CDR reporting are healthcare, preventative care, wellness, and, lifestyle along with, education and research.
CDR Performance Indicators:
- 9.6.7
- 9.6.8
- 10.3.1
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working diabetes specialist and a nationally recognized diabetes expert.
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Rationale of the Week | What do the NEW 2025 ADA Standards Say?
- Renewing your CDCES – Important Updates to Keep in Mind
- Question of the Week | Best Meds to Treat MASH – 2025 Standards
- Rationale of the Week | Low carb diets and SGLT-2’s a good mix?
- Entering the Field of Diabetes Education – Building a Bridge Program
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.
Question of the Week | KR is on Metformin & 4 Weeks Pregnant. Best action?
KR has polycystic ovary syndrome and takes metformin 850mg twice daily. KR just discovered they are 4 weeks pregnant. Fasting glucose is 103 mg/dl.
According to ADA Guidelines, if prediabetes diagnosis is confirmed, what is the next step?
- Continue metformin through first trimester.
- Start basal insulin, stop metformin.
- Add human basal bolus insulin.
- Stop metformin, start sulfonylurea.
Want to learn more about this question?
Join us live on June 11th at 11:30 am PST for our
Pregnancy & Diabetes
Level 2 Standards of Care Intensive
Pregnancy with diabetes is confronted with a variety of issues that require special attention, education, & understanding. This course reviews those special needs while focusing on Gestational Diabetes & Pre-Existing Diabetes. Included are the most recent diagnostic criteria, management goals, & prevention of complications during pregnancy. This is a helpful review for Certification Exams & those who want more information on people who are pregnant & live with diabetes.
Objectives:
- List three issues that affect pregnancy with diabetes.
- Describe the unique attributes of pre-existing diabetes in pregnancy & gestational diabetes.
- State the diagnostic criteria & management goals for gestational diabetes.
- Potential short-term & long-term complications of fetal exposure to hypoglycemia.
- Prevention measures to keep mother & baby healthy.
Learning Outcome:
Participants will gain knowledge of special considerations, individualized goals, and standards for people experiencing diabetes during pregnancy to improve outcomes.
Target Audience:
This course is a knowledge-based activity designed for individuals or groups of diabetes professionals, including RNs, RDs/RDNs, 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. The practice areas for RDs/RDNs for CDR reporting are healthcare, preventative care, wellness, and, lifestyle along with, education and research.
CDR Performance Indicators:
- 9.6.7
- 9.6.8
- 10.3.1
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working diabetes specialist and a nationally recognized diabetes expert.
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Rationale of the Week | What do the NEW 2025 ADA Standards Say?
- Renewing your CDCES – Important Updates to Keep in Mind
- Question of the Week | Best Meds to Treat MASH – 2025 Standards
- Rationale of the Week | Low carb diets and SGLT-2’s a good mix?
- Entering the Field of Diabetes Education – Building a Bridge Program
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Rationale of the Week | Best treatment for Hypoglycemia with Gastroparesis
For last week’s practice question, we quizzed participants on how to treat hypoglycemia while dealing with gastroparesis. 73% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question
Question: JR has type 1 diabetes and was recently diagnosed with gastroparesis. JR is a runner and has not been able to exercise recently due to nausea, vomiting, bloating, and intestinal pain. They experience hypoglycemia about 3 times a week.
Based on this information, what is the best treatment for hypoglycemia?
Answer Choices:
- Glucose tabs or gels.
- Skittles or gummies.
- High carb, low fiber snack bar.
- Peanut butter crackers.
Getting to the Best Answer
Answer 1 is correct. 73.02% chose this answer. “Glucose tabs or gels.” Great job! Since JR has gastroparesis with slowed gastric emptying and delayed absorption of nutrients, we need to provide a fast acting carb that can instantly raise blood sugar. Fast absorption of sugar from glucose tabs and gels begins in the mouth, to quickly raise blood sugar levels.
Answer 2 is incorrect. 3.72% of you chose this answer. “Skittles or gummies.” Since JR has gastroparesis with slowed gastric emptying and delayed absorption of nutrients, we need to provide a fast acting carb that can instantly raise blood sugar. Gummies and skittles are more challenging to chew and need to be broken down in the stomach, which would delay the blood sugar from increasing to a safe level. Another consideration is that the ability to chew can be impaired when someone is experiencing significant hypoglycemia. Glucose tabs and gel, are quickly absorbed and require minimal chewing and are the best choice.
Answer 3 is incorrect. About 14.70% of respondents chose this. “High carb, low fiber snack bar.” Since JR has gastroparesis with slowed gastric emptying and delayed absorption of nutrients, we need to provide a fast acting carb that can instantly raise blood sugar. A snack bar, even though it is low fiber, is more challenging to chew and needs to be broken down in the stomach, which would delay the blood sugar from increasing to a safe level. Another consideration is that the ability to chew can be impaired when someone is experiencing significant hypoglycemia. Glucose tabs and gel, are quickly absorbed and require minimal chewing and are the best choice.
Finally, Answer 4 is incorrect. 8.56% chose this answer. “Peanut butter crackers.” Since JR has gastroparesis with slowed gastric emptying and delayed absorption of nutrients, we need to provide a fast acting carb that can instantly raise blood sugar. Peanut butter crackers are more challenging to chew and need to be broken down in the stomach, which would delay the blood sugar from increasing to a safe level. Another consideration is that peanut butter is a protein and fat combination food that would delay the absorption of the carbs from the crackers. Glucose tabs and gel, are quickly absorbed and would be the best choice!
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
Unlock insights for managing diabetes distress with the experts!
Join us live on June 17th & 24th, 2024 for our
ReVive 5 Diabetes Training Program:
The 2024 ADA Standards of Care now recommends annual screening for diabetes distress. If you are wondering how to screen for distress and tailor education based on the results, we encourage you to join this unique training program.
This two-session training provides the essential steps to address diabetes distress combined with an innovative approach to helping people make sense of their glucose data.
The first session is team-taught by experts in the field of diabetes distress and effective communication approaches. Dr. Larry Fisher kicks off the program by describing the difference between depression and distress and interpreting Diabetes Distress screening results. Dr. Susan Guzman uses a case study approach and step-by-step communication strategies to address responses from the Diabetes Distress screening tool. This session includes an abundance of evidence-based approaches that you can apply in your clinical setting.
Coach Beverly leads the second session. During this three-hour program, Beverly describes insulin dosing strategies, meter and sensor data interpretation, and common issues encountered by people using diabetes technology. Case studies include tools to help individuals discover what changes are needed to get glucose to target, coupled with the communication skills discussed in the first session. In conclusion, the team of instructors review a case study that pulls together all the ReVive 5 elements.
“ReVive 5” breathes new life into our relationship with diabetes, bringing a fresh perspective to both the person with diabetes and the provider.
Can’t join live? That’s okay. Your registration guarantees you access to the recorded version of the series, along with podcasts and resources for one full year.
Accredited Training Program:
- 15+ CEs – Includes the 7-hour ReVive 5 Training Program, Certificate, and 5 FREE bonus courses to supplement content.
- A comprehensive set of assessment tools, educational materials, log sheets, and resources.
Team of Experts:
ReVive 5 is taught by a team of 3 Interdisciplinary Experts:
- Lawrence Fisher, Ph.D., ABPP, Professor Emeritus, UCSF
- Susan Guzman, PhD
- Beverly Thomassian, RN, MPH, CDCES, BC-ADM
Speakers Interviews – Learn more about the ReVive 5 Team
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Rationale of the Week | What do the NEW 2025 ADA Standards Say?
- Renewing your CDCES – Important Updates to Keep in Mind
- Question of the Week | Best Meds to Treat MASH – 2025 Standards
- Rationale of the Week | Low carb diets and SGLT-2’s a good mix?
- Entering the Field of Diabetes Education – Building a Bridge Program
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.
CGM Interfering Substances Cheat Sheet
By Christine Craig, MS, RD, CDCES
As more and more people are using glucose sensors as a tool to improve their blood sugars, they may feel frustrated or confused about the mismatch between their sensor and glucose meter readings. Some many even ditch this new fangled sensor, thinking that their old friend, the meter, provides more reliable information.
We invite you to download CGM Interfering Substances Cheat Sheet. This CGM Troubleshooting Cheat Sheet that provides specific information on different interfering substances and other factors that can affect the accuracy of continuous glucose monitor (CGM).
We often hear that BG does not equal SG, but what does this mean?
A blood glucose meter measures capillary blood glucose, and CGM sensors measure interstitial fluid, a thin layer of fluid surrounding the cells just below the skin. These values correlate well, but they measure two different types of fluids.
This difference in BG vs. SG at one point in time can be alarming at first and is a commonly reported concern related to sensor accuracy. Education about the difference in measure and understanding that this difference is most significant during rates of change (a rise or fall in glucose values) can help address this concern. Blood glucose values change first, followed by sensor glucose.
The lag time between BG and interstitial glucose (what the sensor measures) can be from 2 to 20 minutes.
We may notice this difference most during increased rates of change (such as >2 mg/dl per min) and during circumstances such as after a meal, after treating a low glucose event, during and immediately after exercise, or after taking diabetes medications that have a more rapid effect on glucose such as meal/correction insulin or sulphonylurea.1
Educating about the difference between BG and SG and how to interpret glucose trends, sensor glucose trend arrows, and monitoring change over time can improve understanding.
Interfering Substances
The 2024 ADA Standards of Care recommends that for ALL people who wear CGM devices, education and assessment of potential interfering substances occur. Many of these interfering substances can be a common over-the-counter supplement or pain reliever. The effect for all reported interfering substances is a false elevation in sensor glucose versus actual blood glucose values. 4 It is cautioned that this could cause missing a severe glucose event.
Each manufacturer has different identified interfering substances.
- For the Libre 2 and 3 systems, more than 500 mg/day of supplemental Vitamin C can interfere. More than 1000 mg/day can interfere with the Libre 2 Plus. 5
- Dexcom G4, G5, G6 6, and G7 7 are all affected by hydroxyurea and acetaminophen,
- However for Dexcom G6 and G7 devices acetaminophen dose is specified as greater than 4 grams per day or 1 gram every 6 hours.
- Medtronic Guardian 3 and Guardian 4 devices are affected by hydroxyurea and any acetaminophen dose8
- For more information, refer to our cheat sheet: CGM Interfering Substances.
Studies and reports of interfering substances are not comprehensive, so it is recommended that if suspicion occurs that a medication or supplement is contributing to erroneous CGM values, they should contact the manufacturer’s technical support team.9
Calibration
For sensors requiring calibration, poor quality of the blood glucose test can also create inaccuracies with the glucose sensor readings. Most manufacturers with CGM calibration requirements recommend ensuring a “clean calibration,” having individuals wash their hands, taking the second drop of blood when hand washing is unavailable, and calibrating when glucose values are more stable, such as before a meal, insulin, or exercise. Luckily, most devices no longer require calibration, but it is important to review technique when applicable.
Getting Back to AW
AW reported no recent changes with medications, supplement intake, or fortified food sources, and no changes were noted at the sensor site. However, they did report that the CGM was on the last day of manufacturer recommended sensor wear. Sensor integrity variation based on day of sensor was determined to be the main consideration of cause. After changing to a new sensor, AW’s general range of BG to SB differences were observed. This event served as an important reminder to AW to check BG when SG values were not reading as expected and different than any symptoms.
Education When Starting Sensor Important
As educators, we can support individuals concerned with CGM accuracy by providing education about the differences between SG and BG values. Assessing individual factors such as medical conditions, movement and activity, site integrity and placement, issues of compression, and medication and supplement use (assessing for potential inferring substances). We can educate individuals to check BG anytime symptoms do not match SG readings and report any concern of a faulty sensor to the manufacturer. Reporting can often lead to the replacement of faulty sensor.
Since the arrival of CGM, benefits including improved quality of life factors, A1c reduction, increased Time in Range, and prevention of hypoglycemia have been found.4 We know from working in diabetes care and through real-world studies the overall value of CGMs. Unlike BG, CGMs provide a complete picture showing trends for direction, personalized alerts, and supporting pattern recognition.
Although not ideal for all, growth of users will continue to rise with approval of over-the-counter product options and understanding accuracy issues is essential to ensure safety and support user experience.
For more information, refer to our cheat sheet: CGM Interfering Substances.
Unlock insights for managing diabetes distress with the experts!
Join us live on June 17 & 24, 2024 for our
ReVive 5 Diabetes Training Program:
The 2024 ADA Standards of Care now recommends annual screening for diabetes distress. If you are wondering how to screen for distress and tailor education based on the results, we encourage you to join this unique training program.
This two-session training provides the essential steps to address diabetes distress combined with an innovative approach to helping people make sense of their glucose data.
The first session is team-taught by experts in the field of diabetes distress and effective communication approaches. Dr. Larry Fisher kicks off the program by describing the difference between depression and distress and interpreting Diabetes Distress screening results. Dr. Susan Guzman uses a case study approach and step-by-step communication strategies to address responses from the Diabetes Distress screening tool. This session includes an abundance of evidence-based approaches that you can apply in your clinical setting.
Coach Beverly leads the second session. During this three-hour program, Beverly describes insulin dosing strategies, meter and sensor data interpretation, and common issues encountered by people using diabetes technology. Case studies include tools to help individuals discover what changes are needed to get glucose to target, coupled with the communication skills discussed in the first session. In conclusion, the team of instructors review a case study that pulls together all the ReVive 5 elements.
“ReVive 5” breathes new life into our relationship with diabetes, bringing a fresh perspective to both the person with diabetes and the provider.
Can’t join live? That’s okay. Your registration guarantees you access to the recorded version of the series, along with podcasts and resources for one full year.
Accredited Training Program:
- 15+ CEs – Includes the 7-hour ReVive 5 Training Program, Certificate, and 5 FREE bonus courses to supplement content.
- A comprehensive set of assessment tools, educational materials, log sheets, and resources.
Team of Experts:
ReVive 5 is taught by a team of 3 Interdisciplinary Experts:
- Lawrence Fisher, Ph.D., ABPP, Professor Emeritus, UCSF
- Susan Guzman, PhD
- Beverly Thomassian, RN, MPH, CDCES, BC-ADM
Speakers Interviews – Learn more about the ReVive 5 Team
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.
Question of the Week | Are statins indicated for Peds with Diabetes?
Based on the ADA Standards, in addition to dietary intervention, lifestyle and glucose management, when is it indicated to consider starting statin therapy for pediatrics with diabetes?
- When LDL is still greater than 100 with a BMI of 25 or more.
- After age 10, if LDL is still greater than 130 at 6 months.
- Only if LDL and triglycerides are greater than 90thpercentile.
- Statins are only indicated for individuals 18 years and older.
Want to learn more about this question?
Join us live on May 30th at 11:30 PST for our
From Tots to Teens
Level 2 Standards of Care Intensive
This course includes updated goals & 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 & their families. We discuss the clinical presentation of diabetes, goals of care, & normal growth & development through the early years through adolescence. Strategies to prevent acute & long-term complications are included with an emphasis on positive coping for families & children with diabetes.
Objectives:
- 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 & resources.
Learning Outcome:
Attendees will have comprehensive knowledge of special considerations, individualized goals and standards for children with diabetes to include in their practice.
Target Audience:
This course is a knowledge-based activity designed for individuals or groups of diabetes professionals, including RNs, RDs/RDNs, 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. The practice areas for RDs/RDNs for CDR reporting are healthcare, preventative care, wellness, and, lifestyle along with, education and research.
CDR Performance Indicators:
- 9.6.7
- 9.6.8
- 10.3.1
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working diabetes specialist and a nationally recognized diabetes expert.
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Rationale of the Week | What do the NEW 2025 ADA Standards Say?
- Renewing your CDCES – Important Updates to Keep in Mind
- Question of the Week | Best Meds to Treat MASH – 2025 Standards
- Rationale of the Week | Low carb diets and SGLT-2’s a good mix?
- Entering the Field of Diabetes Education – Building a Bridge Program
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Rationale of the Week | Assessment of Hypoglycemia
For last week’s practice question, we quizzed participants on assessing risk factors for hypoglycemia. 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: LM has had type 2 diabetes for over 30 years and takes 1000 mg metformin BID, 30 units of glargine at bedtime, 25 mg empagliflozin, as well as daily lisinopril and lovastatin. A1c was 7.2%, LDL: 56, and eGFR was 38 mL/min/1.73m2 last visit. CGM ambulatory glucose profile report indicates a time in range of 71%, time below range of 4%, and time above range of 25%. LM reports living on a fixed income, relying on social security, and an increase in recent financial stress. They are concerned they may not have enough money to purchase foods by the end of the month.
Select the best answer considering LM’s potential risk factors for hypoglycemia?
Answer Choices:
- LM has chronic kidney disease, and we note he is taking an ACE and SGLT-2
- Basal insulin therapy alone.
- Income status.
- All the above.
Getting to the Best Answer
Answer 1 is incorrect. 7.42% chose this answer. “LM has chronic kidney disease, and we note he is taking an ACE and SGLT-2.” Answer 1 is somewhat true but is not the best answer. We may consider this question incorrect due to the statement that LM is taking ACE and SGLT-2 medications, and we know these have a low risk of hypoglycemia. However, a diagnosis of CKD, especially along with basal insulin therapy, can be a factor that increases hypoglycemia risk. If LM’s GFR was below 15 with a diagnosis of end-stage renal disease, then we would consider this a major risk factor. Let’s keep reading for the best answer.
Answer 2 is incorrect. 8.36% of you chose this answer. “Basal insulin therapy alone.” Answer 2 is also true but is not the best answer. Hypoglycemia risk is highest in individuals treated with intensive insulin therapy followed by basal insulin and then sulfonylureas.1 Basal insulin therapy is a risk factor for hypoglycemia, and we may be tempted to select this answer alone. However, other considerations also impact LM’s risk for hypoglycemic events while on basal insulin therapy.
Answer 3 is incorrect. About 15.26% of respondents chose this. “Income status.” Answer 3 is also true but is not the best answer. Income status and food insecurity are considered risk factors for hypoglycemia and are associated with increased hospital admissions and ER visits. However, we must also consider this along with medication treatment. Food insecurity along with LM’s basal insulin therapy is a major risk factor for hypoglycemia.
Finally, Answer 4 is correct. 68.97% chose this answer. “All the above.” Answer D is the correct Answer. The 2024 Standards of Care recommends hypoglycemia assessment at every clinical visit. We can use validated tools to determine risk for hospital admission or an ER visit, but these do not consider every risk factor. It is important to consider not only clinical factors but also social, economic, and cultural factors. Risk stratification is for all individuals treated with insulin, sulfonylureas, or meglitinides. ° American Diabetes Association Professional Practice Committee; 6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2024. Diabetes Care 1 January 2024; 47 (Supplement_1): S111–S125. https://doi.org/10.2337/dc24-S006
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 recognizing and addressing Diabetes Distress?
Join us live on June 17th & June 24th, 2024 for our
ReViVE 5 Diabetes Training Program:
Unlocking Hidden Barriers to Diabetes Management
“ReVive 5” breathes new life into our relationship with diabetes, bringing a fresh perspective to both the person with diabetes and the provider.
The ReVive 5 program is built on sound research from the Embark Trial and will revolutionize your approach to diabetes self-management education.
We have reassembled the Embark training team and created a resource binder of fantastic tools that we are excited to share with you in our ReVive 5 Diabetes Training Program. You are invited to join us to learn a step-wise, proven approach to addressing hidden barriers to diabetes self-management and glucose management.
You don’t need to be mental health expert or diabetes technology wiz to join this training or to integrate these new strategies into your daily practice.
ReVive 5 uses an integrated, evidence-based approach that provides health care professionals with a realistic 5-step approach to addressing the whole person, starting with emotional distress and incorporating a unique, but integrated approach to problem-solving glucose management difficulties.
Intended Audience: This library of critical information is designed for individuals or groups of diabetes specialists, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other health care providers interested in staying up to date on current practices of care for people with diabetes and preparing for the CDCES or BC-ADM Certification Exams.
Can’t join live? That’s okay. Your registration guarantees you access to the recorded version of the series, along with podcasts and resources for one full year.
Accredited Training Program:
- 15+ CEs – Includes the 7-hour ReVive 5 Training Program, Certificate, and 5 FREE bonus courses to supplement content.
- A comprehensive set of assessment tools, educational materials, log sheets, and resources.
Join us to gain the confidence and learn the skills needed to support people with diabetes to move forward in their self-management and discover the expert within.
Team of Experts:
ReVive 5 is taught by a team of 3 Interdisciplinary Experts:
- Lawrence Fisher, Ph.D., ABPP, Professor Emeritus, UCSF
- Susan Guzman, PhD
- Beverly Thomassian, RN, MPH, CDCES, BC-ADM
Speakers Interviews – Learn more about the ReVive 5 Team
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Rationale of the Week | What do the NEW 2025 ADA Standards Say?
- Renewing your CDCES – Important Updates to Keep in Mind
- Question of the Week | Best Meds to Treat MASH – 2025 Standards
- Rationale of the Week | Low carb diets and SGLT-2’s a good mix?
- Entering the Field of Diabetes Education – Building a Bridge Program
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.
Question of the Week! | Best treatment for hypoglycemia with gastroparesis?
JR has type 1 diabetes and was recently diagnosed with gastroparesis. JR is a runner and has not been able to exercise recently due to nausea, vomiting, bloating, and intestinal pain. They experience hypoglycemia about 3 times a week.
Based on this information, what is the best treatment for hypoglycemia?
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- Glucose tabs or gels
- Skittles or gummies
- High carb, low fiber snack bar
- Peanut butter crackers
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Want to Learn More About this Topic?
Join our Virtual DiabetesEd Training Conference
Now Recorded & Ready to Watch
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, and “aha” moments for our Virtual DiabetesEd Training Conference.
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.
Program Details
- 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
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Rationale of the Week | What do the NEW 2025 ADA Standards Say?
- Renewing your CDCES – Important Updates to Keep in Mind
- Question of the Week | Best Meds to Treat MASH – 2025 Standards
- Rationale of the Week | Low carb diets and SGLT-2’s a good mix?
- Entering the Field of Diabetes Education – Building a Bridge Program
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.
May 2024 eNews | Why don’t CGM readings match meter glucose results? Person-Centered Coaching & Technology; Step-By-Step Approach, Biggest Takeaway when Addressing Diabetes Distress?
Happy May
In our rural clinic, we are starting more and more individuals on glucose sensors. People’s response to using a CGM device has garnered mixed reactions. Most individuals are thrilled that they can see their blood sugars are at a glance with fewer finger pricks. They feel empowered with this play-by-play blood sugar report.
However, others experience a sense of overwhelm in response to the sudden onslaught of glucose data on their screen. This stress becomes more acute as they hone in on sugar spikes or sudden lows that don’t seem to have a rhyme or reason. In addition, many people are confused by the discrepancy between the meter and sensor glucose, causing even more upset.
These individuals may experience an understandable amount of confusion, frustration, and distress.
This newsletter provides a range of tools and resources to assist you in addressing these distress points, detailed in the following featured articles.
Our first article explores the reasons behind the gap between CGM and meter readings. We also provide a CGM Troubleshooting Cheat Sheet that you can share with your colleagues and clients.
Next, we outline a step-by-step communication approach designed to help individuals adjust to sensor data overwhelm using a person-centered approach.
Finally, we address diabetes distress by interviewing expert Susan Guzman, PhD. You are invited to join Dr. Guzman and Larry Fisher, PhD, who will share their expertise on this topic in June, during our highly popular ReVive 5 training program.
Our last article recognizes the healing relationship we have with our pets. Challenge yourself with our Question and Rationale of the Week and please keep in touch.
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Sending notes of joy and health, Coach Beverly, Bryanna, Brent, Christine, Andrew, and Ginger |
Featured Articles
- Why Don’t My CGM Numbers Match My Meter?
- NEW CGM Trouble Shooting Cheat Sheet
- Step-By-Step Person-Centered Coaching w/Tech
- Biggest Takeaway when Address Diabetes Distress
- 3 Ways Pets Can Support People with Diabetes
- Question of the Week
- Rationale of the Week
Upcoming Webinars
- Older Adults and Diabetes Disease – May 2nd
- Prep for CDCES – May 28
- ReVive 5 – June 17th & 24th
- Upcoming Events – See the complete calendar listing
Want to learn more about this question?
Unlock insights for managing diabetes distress with the experts!
Join us live on June 17 & 24, 2024 for our
ReVive 5 Diabetes Training Program:
The 2024 ADA Standards of Care now recommends annual screening for diabetes distress. If you are wondering how to screen for distress and tailor education based on the results, we encourage you to join this unique training program.
This two-session training provides the essential steps to address diabetes distress combined with an innovative approach to helping people make sense of their glucose data.
The first session is team-taught by experts in the field of diabetes distress and effective communication approaches. Dr. Larry Fisher kicks off the program by describing the difference between depression and distress and interpreting Diabetes Distress screening results. Dr. Susan Guzman uses a case study approach and step-by-step communication strategies to address responses from the Diabetes Distress screening tool. This session includes an abundance of evidence-based approaches that you can apply in your clinical setting.
Coach Beverly leads the second session. During this three-hour program, Beverly describes insulin dosing strategies, meter and sensor data interpretation, and common issues encountered by people using diabetes technology. Case studies include tools to help individuals discover what changes are needed to get glucose to target, coupled with the communication skills discussed in the first session. In conclusion, the team of instructors review a case study that pulls together all the ReVive 5 elements.
“ReVive 5” breathes new life into our relationship with diabetes, bringing a fresh perspective to both the person with diabetes and the provider.
Can’t join live? That’s okay. Your registration guarantees you access to the recorded version of the series, along with podcasts and resources for one full year.
Accredited Training Program:
- 15+ CEs – Includes the 7-hour ReVive 5 Training Program, Certificate, and 5 FREE bonus courses to supplement content.
- A comprehensive set of assessment tools, educational materials, log sheets, and resources.
Join us to gain the confidence and learn the skills needed to support people with diabetes to move forward in their self-management and discover the expert within.
Team of Experts:
ReVive 5 is taught by a team of 3 Interdisciplinary Experts:
- Lawrence Fisher, Ph.D., ABPP, Professor Emeritus, UCSF
- Susan Guzman, PhD
- Beverly Thomassian, RN, MPH, CDCES, BC-ADM
Speakers Interviews – Learn more about the ReVive 5 Team
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
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