Answer A is incorrect: 1% chose this answer, “Stress with R.S. the importance of never missing his meal time lispro to prevent diabetes-related complications.” R.S. is aware that his glycemic control is important, and he is already aware of the risk of diabetes-related complications. Counseling him on this would not help him be successful with his insulin management.  

Answer B is correct: 96% chose this answer, “Using open-ended questions, explore R.S.’s routine, stressors, and support systems to understand the barriers to his insulin use.” R.S. is struggling with barriers to successful insulin management.  A holistic approach would be to ask open-ended questions about his current routine, stressors, and support systems to gain a better understanding of these barriers. This information can lead to a personalized plan of care to help improve glycemic control. 

Answer C is incorrect: 2% chose this answer, “Recommend R.S. switch to another non-insulin medication to make his regimen easier for him to manage.” He has already attempted other non-insulin therapies, and these were either ineffective or not tolerated. Changing his regimen would not be successful at improving his glycemic control and quality of life.

Answer D is incorrect: 1% chose this answer, “Since it appears R.S. did not understand how to take his insulin lispro, write out step-by-step instructions on how to take the insulin.” R.S. appears to understand how to take his insulin lispro at meals. Writing out the instructions would not improve his situation. It is not a lack of knowledge, but the multiple barriers in his life that are keeping him from being able to implement this new medication regimen.  

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, “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 control.

Answer B is correct: % 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 control.

Answer C is incorrect: % 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: % 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: % chose this answer, “Partner with CS to reduce missed boluses and reassess in 3 months.” Answer A is incorrect as it is not the best answer. While reducing missed boluses and optimizing insulin therapy are essential to support A1c reduction, this intervention alone does not address the likely underlying psychological barriers to self-management.

Answer B is incorrect: % chose this answer, “Simplify regimen to support current state of diabetes distress.” Answer B is incorrect; it is not the best answer. While simplifying insulin dosing may be supportive in some cases, without addressing the underlying diabetes distress it is unlikely to achieve sustained improvement.

Answer C is correct: % chose this answer, “Refer to a qualified behavioral health professional for evaluation and treatment.” Answer C is correct. The 2026 ADA Standards of Care recommends a referral to a qualified behavioral health professional for evaluation and treatment when diabetes distress, burnout, reduced engagement in diabetes management or other psychosocial factors are impacting self-care and glycemic targets. ¹

Answer D is incorrect: % chose this answer, “Recommend referral to MNT for a structured weight-loss program.” Answer D is incorrect. Focusing solely on weight loss does not address the primary psychosocial barriers and weight gain may be a symptom of underlying behavioral health needs. Evaluation and treatment from a behavioral health provider would be the most appropriate next step.

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!