Rationale of the Week | Type 1 and Food Insecurity
For last week’s practice question, we quizzed participants on type 1 and food insecurity. About two thirds 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:
AR is an 8 year old with type 1 diabetes who has a CGM but still uses insulin injections due to lack of insurance coverage. AR’s parents struggle with food insecurity and some days AR only has school provided breakfast and lunch. You notice he is experiencing level 1 hypoglycemia frequently around 6pm.
What is the best first intervention?
Answer Choices:
- Reassess the insulin dosing strategy.
- Double check that the family has a glucagon emergency kit.
- Reduce insulin dose and start a SGLT-2i to prevent hypoglycemia.
- Make sure AR is wearing identification that says they have type 1 diabetes.
Getting to the Best Answer
Answer 1 is correct. 66.26% chose this answer. “Reassess the insulin dosing strategy.” YES, this is the BEST answer. GREAT JOB! It appears that JR may not have adequate food intake on some days in the early evening hours. To compensate for this decreased food intake, the insulin dose will most likely need to be lowered to prevent dinnertime hypoglycemia. Of course, we would also need to connect AR and their family with social services and other resources.
Answer 2 is incorrect. 24.21% of you chose this answer. “Double check that the family has a glucagon emergency kit.” Although it is important for all people living with type 1 diabetes to have a glucagon rescue medication, the first goal is to prevent severe hypoglycemia. In this situation, the first action is to adjust the insulin dose to prevent dinnertime hypoglycemia. Of course, we would also need to connect AR and their family with social services and other resources.
Answer 3 is incorrect. About 3.18% of respondents chose this. “Reduce insulin dose and start a SGLT-2i to prevent hypoglycemia.” In this situation, the first action is to adjust the insulin dose to prevent dinnertime hypoglycemia. SGLT-2’s are off label for people living with type 1 diabetes and since AR is not in a stable situation, this would not be a good time to evaluate the effectiveness of adding on an SGLT. Of course, we would also need to connect AR and their family with social services and other resources.
Finally, Answer 4 is incorrect. 6.36% chose this answer. “Make sure AR is wearing identification that says they have type 1 diabetes.” Yes, wearing identification is recommended for people living with type 1 diabetes, but more importantly, we want to prevent hypoglycemia. In this situation, the first action is to adjust the insulin dose to prevent dinnertime hypoglycemia. Of course, we would also need to connect AR and their family with social services and other resources.
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 November 13, 11:30 am PST for our
FREE Prep for CDCES Exam 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 2024
- Exam eligibility and the updated 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 7 times. She is a nationally recognized diabetes expert for over 25 years.
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!
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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 | Which Approach Considers Cultural Humility
You are caring for ML, a Latinx person with newly diagnosed diabetes about lifestyle modifications. ML mentions that traditional family dinners are a central part of their daily routine.
How can the educator apply cultural humility in their approach to diabetes education to support ML’s dietary needs and preferences?
- Advise the ML to avoid traditional foods that are higher in carbohydrates.
- Ask ML about the traditional types of foods they typically eat and enjoy.
- Provide a standardized meal plan considering cultural food preferences.
- Emphasize the importance of monitoring carb intake regardless of cultural traditions.
Want to learn more about this question?
Join us live on November 13, 11:30 am PST for our
FREE Prep for CDCES Exam 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 2024
- Exam eligibility and the updated 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 7 times. She is a nationally recognized diabetes expert for over 25 years.
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!
Sign up for DiabetesEd Blog Bytes
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 | JR arrives late and out of sorts
For last week’s practice question, we quizzed participants on helping someone flustered and late to an appointment. 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 is a 22-year-old living with type 1 diabetes who arrives late for their appointment and seems out of sorts. When looking at the ambulatory glucose profile, you notice that time in range is less than 40% and coefficient of variation is also over 40%. You remember from a previous visit that JR had experienced almost half a dozen adverse childhood experiences and had elevated diabetes distress.
Based on this information, what is the next best step?
Answer Choices:
- Use the empowerment approach to help JR take charge of their life.
- Request that JR is referred to a mental health specialist.
- Utilize motivational interviewing techniques to help JR through this rough spot.
- Create a judgement free zone and explore with JR how they are feeling.
Getting to the Best Answer
Answer 1 is incorrect. 4.31% chose this answer. “Use the empowerment approach to help JR take charge of their life.” Even though the empowerment approach can be used as a tool to help people take a more active role in their self-care, given JR’s level of distress, this would not be the best approach. We will need to first assess the situation and discuss next steps as part of collaborative care.
Answer 2 is incorrect. 9.66% of you chose this answer. “Request that JR is referred to a mental health specialist.” Even though JR is clearly struggling with diabetes distress and being “out of sorts’, this does not automatically mean he needs to be referred to a mental health specialist. We will need to first assess the situation and discuss next steps as part of collaborative care.
Answer 3 is incorrect. About 13.10% of respondents chose this. “Utilize motivational interviewing techniques to help JR through this rough spot.” Even though motivational interviewing can be used as a tool to help people take a more active role in their self-care, given JR’s level of distress, this would not be the best approach. We will need to first assess the situation and discuss next steps as part of collaborative care.
Finally, Answer 4 is correct. 72.93% chose this answer. “Create a judgement free zone and explore with JR how they are feeling.” YES, GREAT JOB. We need to provide a safe environment for JR to have the freedom to share what is happening in their life and support them in taking action to decrease their distress.
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 October 29, 2024 for our
The Impact of Adverse Childhood Experiences on Health
Level 4 | Advanced & Specialty Topic Courses
Adverse childhood experiences (ACE) are associated with an increased risk of diabetes, heart disease, cancer & a variety of other health consequences for adults. This session reviews how diabetes care & education specialists can provide screening, assessment, & trauma-informed care to individuals who experienced ACEs & are living with toxic stress. We will explore strategies to address ACES & improve outcomes for individuals & communities. Throughout, we will focus on supporting self-care with a focus on recognizing & promoting resilience.
Objectives:
- Discuss the benefits of assessing Adverse Childhood Experiences (ACE) in individuals with diabetes.
- State the relationship between ACE Scores & the risk of future health complications.
- Describe a person-centered approach to fostering resilience & self-care for individuals with toxic stress.
- Identify two strategies to provide trauma-informed care in your work setting.
Learning Outcome:
Participants will identify how trauma can impact diabetes and self-management along with strategies to support hope when working with people with diabetes.
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:
- 9.2.1
- 9.2.3
- 9.4.3
Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 15 years. She is an Associate Clinical Professor at UCSF, a working educator, 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!
Sign up for DiabetesEd Blog Bytes
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our Level 4 | The Impact of Adverse Childhood Experiences on Health awards 1.0 CPEUs in accordance with the Commission on Dietetic Registration’s CPEU Prior Approval Program.
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.
October 2024 eNews | Don’t Miss Out: Cyber Monday Sale & 4 Free Webinars!
Featured Articles
- Hire Coach Bev to Teach
- Save The Date- Cyber Monday Sale- Dec. 2nd
- Submit Art for Artists Corner
- Stay Connected! – Join our Facebook Group
- Question Of The Week
- Free Resources Page
Happy October
We are all back in the office after an information-packed San Diego Conference.
We are excitedly preparing for our Cyber Monday Sale on December 2nd. All of our online courses will be 30% off, which translates to big savings for individual levels and program bundles.
Plus, you are invited to attend our upcoming FREE webinars on topics ranging from “Adverse Childhood Experiences Impact on Health: Trauma, and Healing” to “The Gut to the Butt” and Diabetes Certification preparation. Register and save your space today,
We can’t wait to celebrate National Diabetes Month with you in November and have exciting plans to expand our online content in 2025,
Thank you for being a part of this fantastic community.
Warmly,
Coach Beverly, Bryanna, Tiffany, Christine, Andrew, and Ginger
Join us live on October 29, 2024 for our
The Impact of Adverse Childhood Experiences on Health
Level 4 | Advanced & Specialty Topic Courses
Adverse childhood experiences (ACE) are associated with an increased risk of diabetes, heart disease, cancer & a variety of other health consequences for adults. This session reviews how diabetes care & education specialists can provide screening, assessment, & trauma-informed care to individuals who experienced ACEs & are living with toxic stress. We will explore strategies to address ACES & improve outcomes for individuals & communities. Throughout, we will focus on supporting self-care with a focus on recognizing & promoting resilience.
Objectives:
- Discuss the benefits of assessing Adverse Childhood Experiences (ACE) in individuals with diabetes.
- State the relationship between ACE Scores & the risk of future health complications.
- Describe a person-centered approach to fostering resilience & self-care for individuals with toxic stress.
- Identify two strategies to provide trauma-informed care in your work setting.
Learning Outcome:
Participants will identify how trauma can impact diabetes and self-management along with strategies to support hope when working with people with diabetes.
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.
Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 15 years. She is an Associate Clinical Professor at UCSF, a working educator, 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!
Sign up for DiabetesEd Blog Bytes
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our Level 4 | The Impact of Adverse Childhood Experiences on Health awards 1.0 CPEUs in accordance with the Commission on Dietetic Registration’s CPEU Prior Approval Program.
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 | Type 1 and Food Insecurity
AR is an 8 year old with type 1 diabetes who has a CGM but still uses insulin injections due to lack of insurance coverage. AR’s parents struggle with food insecurity and some days AR only has school provided breakfast and lunch. You notice he is experiencing level 1 hypoglycemia frequently around 6pm.
What is the best first intervention?
- Reassess the insulin dosing strategy.
- Double check that the family has a glucagon emergency kit.
- Reduce insulin dose and start a SGLT-2i to prevent hypoglycemia.
- Make sure AR is wearing identification that says they have type 1 diabetes.
Want to learn more about this question?
Join us live on October 29th 2024 11:30 am PST for our
The Impact of Adverse Childhood Experiences on Health
Level 4 Advanced Specialty Topics
Adverse childhood experiences (ACE) are associated with an increased risk of diabetes, heart disease, cancer & a variety of other health consequences for adults. This session reviews how diabetes care & education specialists can provide screening, assessment, & trauma-informed care to individuals who experienced ACEs & are living with toxic stress. We will explore strategies to address ACES & improve outcomes for individuals & communities. Throughout, we will focus on supporting self-care with a focus on recognizing & promoting resilience.
Topics include:
- Discuss the benefits of assessing Adverse Childhood Experiences (ACE) in individuals with diabetes.
- State the relationship between ACE Scores & the risk of future health complications.
- Describe a person-centered approach to fostering resilience & self-care for individuals with toxic stress.
- Identify two strategies to provide trauma-informed care in your work setting.
Intended Audience: These courses are knowledge-based activities 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 enhancing their knowledge of management of inpatient hyperglycemia.
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator and a nationally recognized diabetes expert.
Two registration options:
- Enroll for FREE (No CEs): Click here to enroll.
- Earn 0.5 CEs – Fee: $19.00 – Click here to enroll in the course.
Enroll in our entire Level 4 | Advanced & Specialty Topic Courses
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!
Sign up for DiabetesEd Blog Bytes
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our Level 4 | The Impact of Adverse Childhood Experiences on Health awards 1.0 CPEUs in accordance with the Commission on Dietetic Registration’s CPEU Prior Approval Program.
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 | JR and Donut Fridays – What is the wise approach?
For last week’s practice question, we quizzed participants on helping people address special treat days. The majority 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:
You are reviewing JR’s ambulatory glucose profile and it is over 70% time in range. JR usually takes bolus insulin before each meal and basal insulin at night. However, you notice that once a week on Fridays, JR’s blood glucose levels are above target between 2-5pm. When you bring this Friday glucose elevation to JR’s attention, they tell you it’s because the boss always brings in donuts after lunch on Fridays to celebrate everyone’s hard work. JR asks you about strategies to address this time above target.
What is the wise approach?
Answer Choices:
- Have you considered eating a piece of fruit instead?
- Can you let your boss know that you appreciate the gesture, but your diabetes doesn’t allow for this treat.
- Would you consider giving a little extra bolus insulin and enjoying the donut?
- Would you be willing to bring in a special low carb treat for everyone to enjoy?
Getting to the Best Answer
Answer 1 is incorrect. 3.55% chose this answer. “Have you considered eating a piece of fruit instead?” Even though fruit might be a healthier choice, it may not be the “wise” choice for this situation. The ADA Standards encourage us to help individuals “maintain the pleasure of eating.” An occasional donut to celebrate hard work can certainly be included in JR’s meal plan.
Answer 2 is incorrect. 3.55% of you chose this answer. “Can you let your boss know that you appreciate the gesture, but your diabetes doesn’t allow for this treat.” JR can choose to make a “wise” decision and participate in the festivities. The ADA Standards encourage us to help individuals “maintain the pleasure of eating.” An occasional donut to celebrate hard work can certainly be included in JR’s meal plan.
Answer 3 is correct. About 81.07% of respondents chose this. “Would you consider giving a little extra bolus insulin and enjoying the donut?” JR can choose to make a “wise” decision and participate in the festivities and take a little extra insulin to prevent post treat hyperglycemia. The ADA Standards encourage us to help individuals “maintain the pleasure of eating.” An occasional donut to celebrate hard work can certainly be included in JR’s meal plan.
Finally, Answer 4 is incorrect. 11.83% chose this answer. “Would you be willing to bring in a special low carb treat for everyone to enjoy?” JR can choose to make a “wise” decision and participate in the festivities. The ADA Standards encourage us to help individuals “maintain the pleasure of eating.” An occasional donut to celebrate hard work can certainly be included in JR’s meal plan.
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?
Invite Coach Beverly Thomassian to Speak – In Person or Virtually!
An Innovative Approach to Diabetes Education
With over two decades as a thought leader in diabetes care and education, Beverly is an inspiring and informational presenter. She can delve deep into the science of diabetes while incorporating real-life applications coupled with a compassionate approach that resonates with healthcare professionals.
Beverly is a relentless advocate for non-judgmental and inclusive diabetes care and believes that we are at our best when we are curious, kind, and engaging.
As a nurse entrepreneur and professional speaker, Beverly champions person-centered and evidence-based diabetes care through her live courses, keynote speeches, and webinar presentations.
Coach Beverly makes it a priority to make time to teach at conferences and organizations across the country. In addition to providing the latest research-based information, she incorporates story telling, games, movement breaks and small group activities.
She believes people learn best when the content is meaningful and fun!
Participants leave feeling energized, inspired, and excited about providing best diabetes care.
See more info here >>
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!
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The use of DES products does not guarantee the successful passage of the diabetes certification exams. CBDCE & ADCES does not endorse any preparatory or review materials for the certification exams, except for those published by CBDCE & ADCES.
**To satisfy the requirement for renewal of certification by continuing education for the Certification Board for Diabetes Care & Education (CBDCE), continuing education activities must be applicable to diabetes and approved by a provider on the CBDCE List of Recognized Providers (www.ncbde.org). CBDCE does not approve of continuing education. Diabetes Education Services is accredited/approved by the Commission of Dietetic Registration which is on the list of CBDCE Recognized Providers.
Question of the Week | Jr arrives late and out of sorts.
JR is a 22-year-old living with type 1 diabetes who arrives late for their appointment and seems out of sorts. When looking at the ambulatory glucose profile, you notice that time in range is less than 40% and coefficient of variation is also over 40%. You remember from a previous visit that JR had experienced almost half a dozen adverse childhood experiences and had elevated diabetes distress.
Based on this information, what is the next best step?
- Use the empowerment approach to help JR take charge of their life.
- Request that JR is referred to a mental health specialist.
- Utilize motivational interviewing techniques to help JR through this rough spot.
- Create a judgement free zone and explore with JR how they are feeling.
Want to learn more about this question?
Join us live on October 29, 2024 for our
The Impact of Adverse Childhood Experiences on Health
Level 4 | Advanced & Specialty Topic Courses
Adverse childhood experiences (ACE) are associated with an increased risk of diabetes, heart disease, cancer & a variety of other health consequences for adults. This session reviews how diabetes care & education specialists can provide screening, assessment, & trauma-informed care to individuals who experienced ACEs & are living with toxic stress. We will explore strategies to address ACES & improve outcomes for individuals & communities. Throughout, we will focus on supporting self-care with a focus on recognizing & promoting resilience.
Objectives:
- Discuss the benefits of assessing Adverse Childhood Experiences (ACE) in individuals with diabetes.
- State the relationship between ACE Scores & the risk of future health complications.
- Describe a person-centered approach to fostering resilience & self-care for individuals with toxic stress.
- Identify two strategies to provide trauma-informed care in your work setting.
Learning Outcome:
Participants will identify how trauma can impact diabetes and self-management along with strategies to support hope when working with people with diabetes.
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:
- 9.2.1
- 9.2.3
- 9.4.3
Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 15 years. She is an Associate Clinical Professor at UCSF, a working educator, 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!
Sign up for DiabetesEd Blog Bytes
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our Level 4 | The Impact of Adverse Childhood Experiences on Health awards 1.0 CPEUs in accordance with the Commission on Dietetic Registration’s CPEU Prior Approval Program.
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 | Screening for Celiac Disease
For last week’s practice question, we quizzed participants on screening for celiac disease. Almost half 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: TC is a 15-year-old who was diagnosed with type 1 diabetes just over a year ago. Following their diagnosis, they quickly transitioned to sensor-augmented pump therapy and are not currently taking any other medications. Recent lab results show normal lipid and renal profiles, a hemoglobin A1c of 7.5%, and a fasting glucose level of 148 mg/dL. Despite following a nutrient-rich diet, TC reports experiencing fatigue, difficulty gaining weight, frequent nausea, and diarrhea.
What Standard of Care recommendation may help explain TC’s reported symptoms?
Answer Choices:
- TC’s Hemoglobin A1c is above target. Elevated glucose values could be contributing to fatigue and difficulty with weight gain.
- Ensure IgA tissue transglutaminase (tTG) antibodies, with documentation of normal total serum IgA levels have been checked.
- Recommend a gluten-free diet since individuals with type 1 diabetes can be at higher risk of celiac disease.
- Consider referral for a gastric emptying study given complaint of frequent nausea and diarrhea.
Getting to the Best Answer
Answer 1 is incorrect. 13.97% chose this answer. “TC’s Hemoglobin A1c is above target. Elevated glucose values could be contributing to fatigue and difficulty with weight gain.” 1. Answer 1 is incorrect, as it is not the best answer. Although the ADA Standards of Care state an A1C of <7% is appropriate for many children and adolescents, we must provide additional assessment for TC’s case. Keep reading below.
Answer 2 is correct. 49.71% of you chose this answer. “Ensure IgA tissue transglutaminase (tTG) antibodies, with documentation of normal total serum IgA levels have been checked.” 2. Answer 2 is correct. Screening for celiac disease is recommended in individuals with type 1 diabetes soon after diagnosis or when symptoms occur, such as those reported by TC. It is recommended that IgA tissue transglutaminase (tTG) antibodies be checked, with documentation of normal total serum IgA levels, or IgG tTG and deamidated gliadin antibodies if IgA is deficient.
Answer 3 is incorrect. About 16.53% of respondents chose this. “Recommend a gluten-free diet since individuals with type 1 diabetes can be at higher risk of celiac disease.” 3. Although a gluten-free diet is recommended if TC is diagnosed with celiac disease, it is essential to complete appropriate screening before implementation of a gluten-free diet.
Finally, Answer 4 is incorrect. 19.79% chose this answer. “Consider referral for a gastric emptying study given complaint of frequent nausea and diarrhea.” 4. Although we can see an increased risk of gastroparesis in diabetes, determined by a gastric emptying study, gastroparesis typically develops as a long-term complication of diabetes. Initial recommendations would be to rule out other causes and ensure recommended screening and treatment.
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!
FREE Webinar:
The Impact of Adverse Childhood Experiences on Health
Join us October 29th, 2024 at 11:30 am
Adverse childhood experiences (ACE) are associated with an increased risk of diabetes, heart disease, cancer & a variety of other health consequences for adults. This session reviews how diabetes care & education specialists can provide screening, assessment, & trauma-informed care to individuals who experienced ACEs & are living with toxic stress. We will explore strategies to address ACES & improve outcomes for individuals & communities. Throughout, we will focus on supporting self-care with a focus on recognizing & promoting resilience.
Topics include:
- Discuss the benefits of assessing Adverse Childhood Experiences (ACE) in individuals with diabetes.
- State the relationship between ACE Scores & the risk of future health complications.
- Describe a person-centered approach to fostering resilience & self-care for individuals with toxic stress.
- Identify two strategies to provide trauma-informed care in your work setting.
Intended Audience: These courses are knowledge-based activities 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 enhancing their knowledge of management of inpatient hyperglycemia.
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator and a nationally recognized diabetes expert.
Two registration options:
- Enroll for FREE (No CEs): Click here to enroll.
- Earn 0.5 CEs – Fee: $19.00 – Click here to enroll in the course.
Enroll in our entire Level 4 | Advanced & Specialty Topic Courses
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!
Sign up for DiabetesEd Blog Bytes
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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