Rationale of the Week | Based on ADA Standards, what is next med addition?
For last week’s practice question, we quizzed participants on ADA Standards & what is next med addition? 67% 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 2 diabetes and takes Metformin 1000mg BID and sitagliptin (Januvia), A1C 8.1%. GFR 47, UACR 158mg/g. Recent diagnosis of congestive heart failure. These are the medications their insurance covers.
Of the following medications, which addition would most benefit JR?
Answer Choices:
- glipizide (Glucotrol)
- pioglitazone (Actos)
- semaglutide (Ozempic)
- dapagliflozin (Farxiga)
Getting to the Best Answer
For a helpful reference, please see our PocketCards for more information.
Answer 1 is incorrect. 5% chose this answer, “Glipizide (Glucotrol)”. Even though glipizide would help lower blood glucose, considering JL’s CHF and worsening kidney function, it is not the best choice.
Answer 2 is incorrect. 8% of you chose this answer, “pioglitazone (Actos)”. Even though pioglitazone would help lower blood glucose, considering JL’s CHF and worsening kidney function, it is not the best choice.
Answer 3 is incorrect. About 18% of respondents chose this, “Semaglutide (Ozempic)”. Even though semaglutide would help lower blood glucose and would address worsening kidney function, considering JL’s CHF and worsening kidney function, it is not the best choice.
Finally, Answer 4 is correct. 67% chose this answer, “Dapagliflozin (Farxiga)”. YES, GREAT JOB. Dapagliflozin is a SGLT-2i that will help lower blood glucose, address worsening kidney function and CHF. Plus, it is covered by insurance. Considering JL’s health profile, it is 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!
Ignite your passion & prepare for Diabetes Certification!
Join our Expert Team at our dynamic Virtual DiabetesEd Training Conference April 16-18th, 2025
Gain fresh insights, practical tools, and a deeper understanding of the latest in person-centered diabetes care. Our expert team brings the ADA Standards of Care to life—covering medications, behavior change, technology, and more! If you’re preparing for the CDCES or BC-ADM exam, this conference—paired with free bonus courses—serves as the ideal study companion!
With interactive co-teaching, we keep sessions engaging, relevant, and fun. Let’s learn and grow together!
Our expert team transforms complex diabetes science into clear, practical insights—keeping it real, engaging, and fun! The faculty includes:
- Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES
- Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
- Christine Craig, MS, RD, CDCES
- 3 Days: of critical information delivered by passionate speakers in an engaging and fun format!
- 11 Bonus Online Courses: As a course attendee, you automatically receive a bonus online course bundle of 11 online courses valued at over
Mindful Eating: A Fresh Approach to Diabetes Management
by Evgenia Evans, MS, RDN, CDCES
Managing diabetes often involves making significant lifestyle and dietary adjustments, which can sometimes feel overwhelming or lead to feelings of deprivation. Research highlights that diabetes distress, experienced by 18–45% of individuals with diabetes, can negatively impact glycemic outcomes and medication adherence (Aikens, 2012; Nicolucci et al., 2013). Successful diabetes management, however, requires more than adherence to rules—it calls for a lifestyle change. For meaningful, lasting effects, individuals can find joy and purpose in their efforts, making new lifestyles not only healthy but also enjoyable (Fredrickson, 2004; Garland et al., 2010). Mindful eating offers a compassionate and sustainable pathway to achieving this balance
What Is Mindful Eating?
Mindful eating shifts the focus from what to eat to how to eat. It invites individuals to bring awareness, curiosity, and intention to their eating habits and bodily sensations. Rooted in mindfulness principles, this practice involves paying purposeful, nonjudgmental attention to the present moment during meals (Kabat-Zinn, 2009). By slowing down and tuning into internal cues like hunger and fullness, individuals can foster sustainable behavior changes that go beyond traditional diet approaches (Framson et al., 2009; Nelson, 2017).
Unlike restrictive diets that focus on counting calories or carbs, mindful eating emphasizes sensory awareness and emotional well-being. This approach helps individuals become more attuned to their body’s needs, promoting a more positive relationship with food.
Why Eat Mindfully?
A growing body of research supports mindful eating’s effectiveness in improving various aspects of health. It enhances the connection between the body and food, helping to interrupt automatic or emotional eating patterns (Forman et al., 2016). In addition, mindful eating has been shown to reduce binge eating behaviors (Kristeller & Hallett, 1999; Mercado et al., 2021).
For individuals with diabetes, mindful eating can lead to significant benefits. Studies have demonstrated improvements in A1C levels, weight management, and reductions in depressive symptoms. It has also been linked to enhanced self-efficacy and improved dietary patterns (Miller et al., 2012; 2014). By promoting awareness and fostering emotional resilience, mindful eating can support better glycemic management and help reduce diabetes-related distress.
What is Mindful Eating in Practice?
Mindful eating strategies fall into three broad categories:
- External Cues: Adjusting the eating environment to minimize distractions and encourage mindful choices.
- Internal Cues: Using tools like the hunger and satiety scale to help individuals distinguish between physical hunger and emotional cravings.
- Food-Focused Awareness: Fully engaging the senses to appreciate the texture, aroma, taste, and appearance of food.
One of the classic examples of sensory-focused eating that highlights the principles of mindfulness is the Raisin Exercise. Here is how it works:
Step-by-Step Instructions:
Hold a raisin and examine it as if seeing it for the first time. Notice its color, shape, and texture.
Bring it to your nose and take a deep breath. Observe its aroma. Does it make any sound when you squeeze it?
Place the raisin in your mouth, but do not chew immediately. Pay attention to how it feels on your tongue.
Begin to chew slowly, noticing the changes in texture and flavor.
Reflect on the Experience:
What did you notice that you typically overlook?
How does this compare to your usual eating habits?
What insights or feelings arose during the exercise?
Each step of this simple exercise is carefully designed to bring full awareness to the eating experience, making it accessible and adaptable across diverse cultural and socioeconomic contexts (Kabat-Zinn, 2009).
One of the classic examples of sensory-focused eating that highlights the principles of mindfulness is the Raisin Exercise. Here are the step-by-step instructions:
- Hold a raisin and examine it as if seeing it for the first time. Notice its color, shape, and texture.
- Bring it to your nose and take a deep breath. Observe its aroma.
- Does it make any sound when you squeeze it?
- Place the raisin in your mouth, but do not chew immediately. Pay attention to how it feels on your tongue.
- Begin to chew slowly, noticing the changes in texture and flavor.
Reflect on the Experience:
- What did you notice that you typically overlook?
- How does this compare to your usual eating habits?
- What insights or feelings arose during the exercise?
Each step of this simple exercise is carefully designed to bring full awareness to the eating experience, making it accessible and adaptable across diverse cultural and socioeconomic contexts (Kabat-Zinn, 2009).
A Sensory Eating Challenge
If you are looking for a fun way to explore mindful eating further, teach someone you know how to eat mindfully. Choose a simple food, such as a piece of fruit, a berry, nut, or a piece of chocolate, and guide them through the steps of sensory engagement. After the practice, reflect together on the experience, asking, what did you notice? How did it feel to eat this way?
This exercise often reveals that when we slow down and savor our food, we enjoy it more and may feel satisfied with smaller portions.
A Path to Empowerment
Mindful eating is more than a strategy; it is a mindset that transforms how we approach food, health, and self-care. For diabetes educators, integrating mindful eating can refresh and enhance their toolbox by creating a more compassionate, effective, and enjoyable path to better diabetes care.
Whether you are planning to use this practice professionally or personally, start small, explore the practice, and empower yourself and others to build a positive relationship with food, one mindful bite at a time.
by Evgenia Evans, MS, RDN, CDCES
References
Aikens, J. E. (2012). Prospective associations between emotional distress and poor outcomes in type 2 diabetes. Diabetes Care, 35(12), 2472–2478. https://doi.org/10.2337/dc12-0181
Forman, E. M., Shaw, J. A., Goldstein, S. P., Butryn, M. L., Martin, L. M., Meiran, N., Crosby, R. D., & Manasse, S. M. (2016). Mindful decision making and inhibitory control training as complementary means to decrease snack consumption. Appetite, 103, 176-183. https://doi.org/10.1016/j.appet.2016.04.014
Framson, C., Kristal, A. R., Schenk, J. M., Littman, A. J., Zeliadt, S., & Benitez, D. (2009). Development and validation of the Mindful Eating Questionnaire. Journal of the American Dietetic Association, 109(8), 1439–1444. https://doi.org/10.1016/j.jada.2009.05.006
Fredrickson, B. L. (2004). The broaden-and-build theory of positive emotions. Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences, 359(1449), 1367–1377. https://doi.org/10.1098/rstb.2004.1512
Garland, E. L., Fredrickson, B. L., Kring, A. M., Johnson, D. P., Meyer, P. S., & Penn, D. L. (2010). Upward spirals of positive emotions counter downward spirals of negativity: Insights from the broaden-and-build theory and affective neuroscience on the treatment of emotion dysfunctions and deficits in psychopathology. Clinical Psychology Review, 30(7), 849–864. https://doi.org/10.1016/j.cpr.2010.03.002
Harvard T.H. Chan School of Public Health. (2024, November 7). Mindful Eating. The Nutrition Source. https://nutritionsource.hsph.harvard.edu/mindful-eating/
Kabat-Zinn, J. (2009). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Random House Publishing Group.
Kristeller, J. L., & Hallett, C. B. (1999). An exploratory study of a meditation-based intervention for binge eating disorder. Journal of Health Psychology, 4(3), 357–363. https://doi.org/10.1177/135910539900400305
Kristeller, J. L., Wolever, R. Q., & Sheets, V. (2014). Mindfulness-based eating awareness training (MB-EAT) for binge eating: A randomized clinical trial. Mindfulness, 5(3), 282–297. https://doi.org/10.1007/s12671-012-0179-1
Mercado, C., Marasigan, K., Cardona, J., & Ko, E. (2021). Mindfulness-based interventions for emotional eating and binge eating in adults: A meta-analysis. Appetite, 164, 105265. https://doi.org/10.1016/j.appet.2021.105265
Miller, C. K. (2017). Mindful eating with diabetes. Diabetes Spectrum, 30(2), 89–94. https://doi.org/10.2337/ds16-0040
Miller, C. K., Kristeller, J. L., Headings, A., Nagaraja, H., & Miser, W. F. (2012). Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: A pilot study. Journal of the Academy of Nutrition and Dietetics, 112(11), 1835–1842. https://doi.org/10.1016/j.jand.2012.07.036
Miller, C. K., Kristeller, J. L., Headings, A., & Nagaraja, H. (2014). Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: A randomized controlled trial. Health Education & Behavior, 41(2), 145–154. https://doi.org/10.1177/1090198113493092
Nicolucci, A., Kovacs Burns, K., Holt, R. I. G., Comaschi, M., Hermanns, N., Ishii, H., Kokoszka, A., Pouwer, F., Skovlund, S. E., Stuckey, H., Tarkun, I., Vallis, M., Wens, J., & Peyrot, M. (2013). Diabetes Attitudes, Wishes and Needs second study (DAWN2™): Cross-national benchmarking of diabetes-related psychosocial outcomes for people with diabetes. Diabetic Medicine, 30(7), 767–777. https://doi.org/10.1111/dme.12245
Nelson, J. B. (2017). Mindful eating: The art of presence while you eat. Diabetes Spectrum, 30(3), 171–174. https://doi.org/10.2337/ds17-0015
Enroll in our upcoming webinar led by Evgenia Evans, MS, RDN, CDCES
Mindful Eating for Successful Diabetes Management
Join us live on June 11, 2025, at 11:30 am PST
This engaging and practical webinar, developed by Evgenia Evans, MS, RDN, CDCES, a positive psychology practitioner, is tailored explicitly for healthcare professionals including dietitians, diabetes care specialists, and providers.
Using evidence-based strategies, participants will gain a deeper understanding of the benefits of incorporating mindfulness into the eating experience, including enhanced glycemic management, improved emotional well-being, and healthier eating behaviors. The webinar includes an overview of mindfulness and mindful eating strategies, such as engaging all five senses, recognizing hunger cues, addressing cravings, and using practical tools to create supportive eating environments.
Participants will also learn how to adapt these approaches to diverse populations and the unique needs of individuals. Join us to deepen your expertise, participate in insightful discussions, and empower individuals to cultivate sustainable, positive relationships with food while achieving long-term health goals.
Course topics:
- Introduction to the concept and benefits of mindful eating for individuals with diabetes
- Overview of key strategies for mindful eating
- Practical tools for incorporating mindful eating into professional practice (of Diabetes Educators)
- Cultural and individual adaptations of the mindful eating approach
Instructor: Evgenia Evans, MS, RDN, CDCES
Evgeniya Evans, MAPP, RDN, LDN, CDCES, specializes in chronic disease prevention, diabetes management, and women’s health. Her unique approach integrates mindfulness-based nutrition and positive psychology, creating transformative impacts on her patients’ health and well-being.
Evgeniya’s academic journey reflects her dedication to lifelong learning and her holistic understanding of nutrition and health. She began with four years of Sociology studies at Omsk State University in Russia, followed by earning a Bachelor of Science in Nutrition and Dietetics from the University of Illinois Chicago. She furthered her expertise with a master’s degree in Applied Positive Psychology from the University of Pennsylvania. This diverse educational foundation allows her to address the socio-psychological factors that influence dietary behaviors and deliver a well-rounded approach to patient care.
At Cook County Health’s Diabetes Clinic within the Endocrinology Department, Evgeniya provides medically tailored nutrition therapy and culturally sensitive counseling. She works with individuals from various socio-economic backgrounds, guiding them through their unique health challenges with compassion and precision. Her dedication to creating personalized, sustainable dietary strategies highlights her commitment to promoting long-term health and vitality for her patients.
In addition to her clinical practice, Evgeniya is a passionate educator. She teaches several classes at her clinic, including Pillars of Diabetes Management with Lifestyle, Nutrition for Health and Vitality, and The Art of Mindful Eating. Her emphasis on education underscores her belief in the transformative power of fostering a healthy, enjoyable lifestyle supported by mindful eating and a positive mindset.
Evgeniya envisions a world where individuals are free from the struggles of dieting and food-related shame. She dreams of a future where no one feels deprecated by their appearance or food choices, and everyone enjoys the vitality and health to pursue their dreams. She is devoted to fostering vibrant, authentic lives where cooking, eating, and sharing meals with loved ones are sources of joy, love, and positive connection.
All hours earned count toward your CDCES Accreditation Information
Question of the Week | Best approach: Fasting During Ramadan
JL observes Ramadan and fasts from sunrise to sunset. JL has type 2 diabetes and usually takes 4 units of bolus insulin three times a day with meals and 10 units of glargine (Rezvoglar) at bedtime.
What would be the best recommendation for JL?
- See if JL can get a note from your doctor to allow eating during the day.
- Take bolus insulin when JL eats a meal.
- Monitor urine ketones at least twice a day.
- Switch glargine to degludec to decrease risk of hypoglycemia.
Ignite your passion & prepare for Diabetes Certification!
Join our Expert Team at our dynamic Virtual DiabetesEd Training Conference April 16-18th, 2025
Gain fresh insights, practical tools, and a deeper understanding of the latest in person-centered diabetes care. Our expert team brings the ADA Standards of Care to life—covering medications, behavior change, technology, and more! If you’re preparing for the CDCES or BC-ADM exam, this conference—paired with free bonus courses—serves as the ideal study companion!
With interactive co-teaching, we keep sessions engaging, relevant, and fun. Let’s learn and grow together!
Our expert team transforms complex diabetes science into clear, practical insights—keeping it real, engaging, and fun! The faculty includes:
- Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES
- Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
- Christine Craig, MS, RD, CDCES
- 3 Days: of critical information delivered by passionate speakers in an engaging and fun format!
- 11 Bonus Online Courses: As a course attendee, you automatically receive a bonus online course bundle of 11 online courses valued at over
Rediscovering Walking – From Rucking to Kicking Up Intensity
Walking is often recognized as the most accessible and underrated form of exercise. While some may argue in favor of high-intensity cardio or resistance training, a growing body of evidence suggests that walking offers significant benefits—especially when approached with intention and consistency.
According to Dr. Elroy Aguiar, an assistant professor of exercise science at The University of Alabama, walking remains one of the most beneficial forms of movement due to its low barriers to entry—minimal cost, equipment, or skill required. “That’s why we say it’s the best,” Dr. Aguiar notes. And yet, despite this accessibility, many individuals struggle to find time to incorporate walking into their busy, sedentary lives.
🚶♂️ Cadence Matters: Walking with Intensity
Not all walking provides the same health return. The intensity, particularly cadence (steps per minute), plays a crucial role in determining health outcomes.
🕒 100 steps per minute is considered moderate intensity
⚡ 130 steps per minute qualifies as vigorous intensity
Dr. Aguiar’s research, published in the British Journal of Sports Medicine, indicates that health benefits from walking begin to accumulate at moderate or higher intensities. Most people naturally walk at a pace of 110–115 steps per minute when moving briskly. Increasing cadence just slightly can shift the effort from moderate to vigorous, maximizing the health payoff in a shorter time span.
🎒 Add Intensity with Rucking
For those looking to increase the challenge of walking, rucking—walking with a weighted backpack—offers a practical solution.
Adding resistance increases oxygen demand, raises heart rate, and enhances caloric burn without requiring a change in pace or duration. According to Dr. Aguiar, this method can also improve lower body strength and bone density, particularly with consistent practice over time.
While it won’t replace traditional strength training, rucking offers an accessible way to gain some muscular benefits while walking. A light weight to start, gradually increased, can help prevent injury and support adaptation.
⏱️ One Minute Can Make a Difference
A 2024 study published in the Scandinavian Journal of Medicine and Science in Sports found that both the quantity and intensity of physical activity are associated with better health outcomes. Remarkably, even one minute of higher-intensity activity per day was linked to a lower likelihood of having metabolic syndrome—a cluster of risk factors including visceral adiposity, high blood pressure, high blood sugar, low HDL cholesterol, and elevated triglycerides.
Dr. Aguiar explains that an individual’s most intense one-minute activity across the day can serve as a strong indicator of metabolic health. Even brief, high-intensity bursts of activity may help reduce risk for diabetes, hypertension, and cardiovascular disease.
🍽️ Walking After Meals: A Simple Strategy for Blood Glucose Improvement
Another practical strategy supported by research is post-meal walking. A 15-minute walk after meals can help blunt spikes in blood glucose, particularly in older adults at risk for glucose intolerance.
When muscles are active, they draw glucose from the bloodstream to use for energy, thereby reducing blood sugar levels and easing the demand on insulin. Over time, this can help prevent insulin resistance, a precursor to Type 2 diabetes.
Dr. Aguiar notes that consistent post-meal movement can reduce the workload on the pancreas and enhance the muscles’ ability to absorb and use glucose. This daily practice may offer long-term protection against metabolic syndrome, hypertension, and diabetes.
📉 Step Count and Longevity
Large-scale studies have shown clear associations between step count and mortality risk. A 2023 meta-analysis published in the European Journal of Preventive Cardiology found:
- 2,337 steps/day: lower cardiovascular mortality
- 3,867 steps/day: lower all-cause mortality
- Each additional 1,000 steps: 15% reduction in all-cause mortality
- Each additional 500 steps: 7% reduction in cardiovascular mortality
Additionally, a study by the University of Granada concluded that while more steps bring more benefits, the majority of cardiovascular protection appears to occur around 7,000 steps/day. The popular goal of 10,000 steps per day, while not evidence-based, remains a useful motivational benchmark.
💡 Who Benefits the Most?
For elite athletes, walking may offer limited fitness returns. However, for individuals who are sedentary or new to exercise, walking provides a low-impact, effective entry point to better health.
Some key benefits of walking for the general population include:
- Improved cardiovascular health
- Strengthened muscles and joints
- Support for bone density
- Increased daily caloric expenditure
- Reduced risk of chronic diseases
Walking is especially valuable for individuals managing or at risk for Type 2 diabetes, obesity, hypertension, and metabolic syndrome.
🔟 Key Takeaways
- Cadence matters – 100 steps per minute = moderate; 130+ = vigorous
- Even one minute of high-intensity movement can improve metabolic markers
- 15-minute walks after meals can significantly lower blood glucose
- Rucking adds intensity, strength, and calorie burn to walking
- Walking is linked to lower mortality from all causes and cardiovascular disease
- Most benefits occur by 7,000 steps/day, but more is better
- Walking is an entry point to fitness, particularly for the sedentary
- The practice supports muscle and bone health
- It requires no equipment and is nearly universally accessible
Walking delivers significant, sustainable health benefits with minimal risk
📝 Final Thoughts
Walking is a powerful yet underappreciated form of movement. Whether used to regulate blood sugar, reduce cardiovascular risk, or improve mental clarity, walking remains one of the most effective and inclusive health strategies available.
For anyone looking to improve overall health without the barriers of cost, complexity, or time—walking offers a proven path forward.
📚 References
- Aguiar, E. J., et al. (2021). Walking cadence (steps/min) and intensity in 21–40-year-olds: CADENCE-adults. British Journal of Sports Medicine.
- DiPietro, L., et al. (2013). Benefits of Postmeal Walking on Glycemic Control in Older Adults at Risk for Impaired Glucose Tolerance. Diabetes Care, 36(10), 3262–3268.
- European Journal of Preventive Cardiology (2023). Daily step count and all-cause and cardiovascular mortality: a dose–response meta-analysis.
- University of Granada Study (2023). Step count thresholds for cardiovascular benefit: optimal versus traditional targets. European Journal of Preventive Cardiology.
Ignite your passion & prepare for Diabetes Certification!
Join our Expert Team at our dynamic Virtual DiabetesEd Training Conference April 16-18th, 2025
Gain fresh insights, practical tools, and a deeper understanding of the latest in person-centered diabetes care. Our expert team brings the ADA Standards of Care to life—covering medications, behavior change, technology, and more! If you’re preparing for the CDCES or BC-ADM exam, this conference—paired with free bonus courses—serves as the ideal study companion!
With interactive co-teaching, we keep sessions engaging, relevant, and fun. Let’s learn and grow together!
Our expert team transforms complex diabetes science into clear, practical insights—keeping it real, engaging, and fun! The faculty includes:
- Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES
- Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
- Christine Craig, MS, RD, CDCES
- 3 Days: of critical information delivered by passionate speakers in an engaging and fun format!
- 11 Bonus Online Courses: As a course attendee, you automatically receive a bonus online course bundle of 11 online courses valued at over
Earth Day Resource Page
🔹 Educational & Advocacy Resources
- EarthDay.org
- The official Earth Day site with toolkits, event listings, campaigns, and actions for climate and environmental justice.
- Explore initiatives like The Great Global Cleanup, Climate Literacy, and Canopy Project.
- EPA: Environmental Protection Agency
- U.S. government resource for Earth Day activities, environmental data, and sustainability tips.
- Great for educators, students, and community organizers.
🔹 Native Plant and Wildlife Support
- National Wildlife Federation – Native Plant Finder
- Enter a zip code to find plants native to your region that support pollinators and birds.
- Audubon Society – Plants for Birds
- Offers native plant lists by zip code, along with guidance on how to create a bird-friendly yard or balcony.
- Plant Native
- Directory of native plant nurseries across the U.S., plus regional planting guides.
🔹 Local Action & Community Involvement
- VolunteerMatch – Environmental Opportunities
- Search for local Earth Day cleanups, planting projects, and sustainability initiatives.
- The Great Global Cleanup
- A global effort to remove billions of pieces of trash from neighborhoods, beaches, rivers, and parks.
🔹 Resources for Teachers & Families
- National Geographic Education – Earth Day Resources
- Lesson plans, activities, and videos for classrooms and curious learners.
- NASA Climate Kids
- Fun, educational site for children that explains climate science with games, activities, and stories.
🔹 Sustainable Living Guides
- Offers practical advice on reducing personal environmental impact across home energy, food, waste, and travel.
- Interactive platform that turns sustainability efforts into group challenges for schools, businesses, and individuals.
✅ Bonus Tip:
Host a Local Event!
Use EarthDay.org’s event map to find or promote cleanups, workshops, or plantings in your area.
Rationale of the Week | What happens when people stop taking GLP /GIPs?
For last week’s practice question, we quizzed participants on what happens when people stop taking GLP /GIPs. 81% 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:
About 30% of people with diabetes started on GLP-1’s stop taking this medication before completing a year of therapy.
According to ADA Standards, what results from sudden discontinuation of GLP-1s /GIP like semaglutide and tirzepatide?
Answer Choices:
- People maintain their weight loss for at least a year.
- People regain at least one-half of their weight loss within a year.
- People experience decreased nausea and less than 10% weight regain.
- People continue behaviors learned on medication with ongoing weight loss success.
Getting to the Best Answer
Answer 1 is incorrect. 4.71% chose this answer. “People maintain their weight loss for at least a year.” According to the ADA Standards, people regain 50 to 70% of the weight lost after this gut hormone replacement therapy is stopped.
Answer 2 is correct. 81.44% of you chose this answer. “People regain at least one-half of their weight loss within a year.” YES, this is the best answer! Great JOB. According to ADA Standards, “sudden discontinuation of semaglutide and tirzepatide results in regain of one-half to two-thirds of the weight loss within 1 year. Consider trying lowest effective dose, using intermittent therapy, or stopping medication followed by close weight monitoring. This information is helpful for our clinical practice as we navigate the best approach to utilizing GLP-1 /GIP Therapy.
Answer 3 is incorrect. About 9.28% of respondents chose this. “People experience decreased nausea and less than 10% weight regain.” According to the ADA Standards, people regain 50 to 70% of the weight lost after this gut hormone replacement therapy is stopped.
Finally, Answer 4 is incorrect. 4.57% chose this answer. “People continue behaviors learned on medication with ongoing weight loss success.” According to the ADA Standards, people regain 50 to 70% of the weight lost after this gut hormone replacement therapy is stopped.
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!
Ignite your passion & prepare for Diabetes Certification!
Join our Expert Team at our dynamic Virtual DiabetesEd Training Conference April 16-18th, 2025
Gain fresh insights, practical tools, and a deeper understanding of the latest in person-centered diabetes care. Our expert team brings the ADA Standards of Care to life—covering medications, behavior change, technology, and more! If you’re preparing for the CDCES or BC-ADM exam, this conference—paired with free bonus courses—serves as the ideal study companion!
With interactive co-teaching, we keep sessions engaging, relevant, and fun. Let’s learn and grow together!
Our expert team transforms complex diabetes science into clear, practical insights—keeping it real, engaging, and fun! The faculty includes:
- Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES
- Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
- Christine Craig, MS, RD, CDCES
- 3 Days: of critical information delivered by passionate speakers in an engaging and fun format!
- 11 Bonus Online Courses: As a course attendee, you automatically receive a bonus online course bundle of 11 online courses valued at over
Question of the Week | Based on ADA Standards, what is next med addition?
JR has type 2 diabetes and takes Metformin 1000mg BID and sitagliptin (Januvia), A1C 8.1%. GFR 47, UACR 158mg/g. Recent diagnosis of congestive heart failure. These are the medications their insurance covers.
Of the following medications, which addition would most benefit JR?
- glipizide (Glucotrol)
- pioglitazone (Actos)
- semaglutide (Ozempic)
- dapagliflozin (Farxiga)
Ignite your passion & prepare for Diabetes Certification!
Join our Expert Team at our dynamic Virtual DiabetesEd Training Conference April 16-18th, 2025
Gain fresh insights, practical tools, and a deeper understanding of the latest in person-centered diabetes care. Our expert team brings the ADA Standards of Care to life—covering medications, behavior change, technology, and more! If you’re preparing for the CDCES or BC-ADM exam, this conference—paired with free bonus courses—serves as the ideal study companion!
With interactive co-teaching, we keep sessions engaging, relevant, and fun. Let’s learn and grow together!
Our expert team transforms complex diabetes science into clear, practical insights—keeping it real, engaging, and fun! The faculty includes:
- Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES
- Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
- Christine Craig, MS, RD, CDCES
- 3 Days: of critical information delivered by passionate speakers in an engaging and fun format!
- 11 Bonus Online Courses: As a course attendee, you automatically receive a bonus online course bundle of 11 online courses valued at over
Rationale of the Week | 2025 ADA Standards: Key Nutrition Behaviors for Individuals with Diabetes
For last week’s practice question, we quizzed participants on. 79% 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:
According to the 2025 ADA Standards of Care, which of the following nutrition behaviors are strongly encouraged for individuals with diabetes?
Answer Choices:
- Incorporate onions, garlic, celery, carrots and other vegetables for a base of homemade
foods. - Use herbs and spices to season foods instead of salt containing preparations.
- Water should be the primary beverage of choice.
- Include family or roommate in meal preparation.
- All of the above
Getting to the Best Answer
Answer 1 is incorrect. 1.7% chose this answer, ” Incorporate onions, garlic, celery, carrots and other vegetables for a base of homemade foods.” Although this answer is true, it is not the best answer. Incorporate onions, garlic, celery, carrots, and other vegetables for a base of homemade foods. These foods can serve as a base to many dishes and incorporates flavor, fiber, vitamins, and minerals while encouraging vegetable consumption.
Answer 2 is incorrect. 4% of you chose this answer, “Use herbs and spices to season foods instead of salt containing preparations.” Although this answer is true, it is not the best answer. 90% of people in the US exceed the daily recommended limits for sodium. Reducing salt intake is important for heart health, managing blood pressure and meeting dietary guidelines. Herbs and spices not only enhance flavor and may provide additional health benefits.
Answer 3 is incorrect. About 12% of respondents chose this, “Water should be the primary beverage of choice.” Although this answer is true, it is not the best answer. The 2025 ADA Standards of Care have emphasized water as the primary beverage of choice. Alternatives to plain water can include no calorie alternatives. Suggestions to add lemon, lime or cucumber to water, choose sparkling no calorie beverages and no-calorie carbonated beverages are also encouraged.
Answer 4 is incorrect. 2% chose this answer, “Include family or roommate in meal preparation.” Although this answer is true, it is not the best answer. Engaging others in meal preparation can create a supportive environment, encourage healthier eating habits, and make cooking more enjoyable. Social support can be especially helpful in managing diabetes long-term.
Answer 5 is correct. 79% chose this answer, “All of the above.” The 2025 ADA Standards of Care encourages all the above nutrition behaviors.
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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