Answer A is incorrect: 12.89% chose this answer, “Turn on her CGM alarms but increase the high alarm so she doesn’t get as many
hyperglycemia related alerts.” Helping Katie turn on and increasing her high alarm will not help improve her glycemic management. 

Answer B is correct: 76.5% chose this answer, “Show her step-by-step how to use the app and how to troubleshoot the alerts and alarms.” Guiding Katie through the CGM app and its functions helps her ask questions, resolve issues, and better monitor her glycemic management.

Answer C is incorrect: 9.46% chose this answer, “Have the school nurse monitor her CGM trends when Katie is at school, since her mom monitors the CGM trends when she is at home.” Asking the school nurse to monitor CGM data while Katie is at school is not helping to improve Katie’s self-management skills.

Answer D is incorrect: 1.15% chose this answer, “Email Katie’s mother once a week for updates to make sure she is monitoring CGM
trends.” Emailing Katie’s mother does not help improve Katie’s CGM self-monitoring skills or her confidence level with the CGM app.

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: 14.85% chose this answer, “BMI and activity level.” This answer is incorrect but tempting. BMI level is used as a a screening tool for prediabetes and diabetes risk, but is not included as a factor contributing to secretory defects. According to the ADA, there are four factors related to insulin secretory defects in type 2 diabetes. They include; genetics, epigenetics, metabolic stress and inflammation.

Answer B is incorrect: 16.92% chose this answer, “Lifestyle and inflammation.” This juicy answer is incorrect.  Lifestyle is not a direct factor related to insulin secretory defects, but inflammation is a contributor. According to the ADA, there are four factors related to insulin secretory defects in type 2 diabetes. They include; genetics, epigenetics, metabolic stress and inflammation.

Answer C is incorrect: 25.75% chose this answer, “Genetics and visceral adipose distribution.” This answer is incorrect. Visceral adiposity is associated with an increased risk for diabetes, but does not contribute to insulin secretory defects. According to the ADA, there are four factors related to insulin secretory defects in type 2 diabetes. They include; genetics, epigenetics, metabolic stress and inflammation.

Answer D is correct: 42.48% chose this answer, “Epigenetics and metabolic stress.” This answer is correct, GREAT JOB! According to the ADA, there are four factors related to insulin secretory defects in type 2 diabetes. They include; genetics, epigenetics, metabolic stress and inflammation.

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: 14.21% chose this answer, “Markedly elevated plasma glucose.” This answer is tempting, because glucose levels do become markedly elevated with HHS. However, very high glucose levels can also occur with DKA. So this answer doesn’t differentiate between these two hyperglycemic crises.

Answer B is incorrect: 21.38% chose this answer, “Absence of significant metabolic acidosis.” This juicy answer is tempting, since with HHS there is the absence of metabolic acidosis. However, based on the question details, there is no information on pH or ketone status, so we can’t make that assumption.

Answer C is incorrect: 4.64% chose this answer, “Out of range potassium level.” The potassium level of 3.7 is within normal range and doesn’t help us differentiate between HHS and DKA.

Answer D is correct: 59.77% chose this answer, “Elevated effective serum osmolality.” YES, this is the BEST Answer. Great Job! One of the main features of HHS, is increased serum osmolality (greater than 300), due to a combination of elevated glucose and dehydration.

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: % 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: % 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: % 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: % 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!