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Answer A is incorrect: 7.56% chose this answer, “Is JZ consistently rotating injection sites to prevent lipohypertrophy?” Injection site rotation is important for preventing lipohypertrophy and absorption variability, but not the most immediate safety risk.

Answer B is incorrect: 24.4% chose this answer, “What is JZ’s rationale for adjusting the glargine dose?” Basal insulin is generally titrated based on overnight and fasting blood glucose levels, not reactively based on the evening glucose. This is clinically relevant, but still secondary to hypoglycemia risk.

Answer C is correct: 62.2% chose this answer, “How is JZ feeling about their frequency of hypoglycemia?” Since JZ is experiencing hypoglycemia more than the target below target range of 5%, we want to explore their feelings around their diabetes and diabetes distress.

Answer D is incorrect: 5.84% chose this answer, “Does JZ adjust insulin for physical activity?” Adjusting insulin for exercise is essential for self-management, yet the first priority is identifying whether dangerous lows are occurring.

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!

Answer A is incorrect: 15.3% chose this answer,“ It sounds like you’re feeling overwhelmed. Can you tell me more about what worries you most about starting this medication?” Appropriate — Person centered, exploratory. This response uses reflective listening and invites the patient to share her concerns. It aligns with ADA Standards of Care recommendations for collaborative communication and supports assessment of diabetes distress.

Answer B is incorrect: 11.57% chose this answer, “Many people feel this way. Let’s look at your options together so you can make a choice that works for you.” Appropriate — Normalizes feelings and supports shared decision making. This option reduces stigma by acknowledging that many people experience similar emotions. It reinforces autonomy and partnership, which are core components of effective diabetes self management support.

Answer C is correct: 58.54% chose this answer, “I understand that this is challenging and overwhelming. However, if you don’t start this medication, you are choosing to risk complications like kidney disease or blindness.” Incorrect — Stigmatizing, blaming, and fear based. This statement uses threat based language (“you are choosing to risk complications…”) and implies personal failure. It increases shame, undermines trust, and can worsen diabetes distress. It does not incorporate person first language or collaborative care or help identify barriers and personalized solutions. Oh, and it probably won’t be very successful!

Answer D is incorrect: 14.59% chose this answer, “It’s completely understandable to have concerns. Would it help if we reviewed what the medication does, talk about the pro’s and the con’s, and about what alternatives exist?” Appropriate — Validates concerns and offers. Information without pressure. This response acknowledges the patient’s emotions and provides an opening for education and shared exploration of options. It supports autonomy and reduces the sense of failure associated with medication use.

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!