Question of the Week | How is fatty liver disease defined?
45 to 75% of individuals with type 2 diabetes have non-alcoholic fatty liver disease (NAFLD). NAFLD has associated with an increased risk of steatohepatitis, cirrhosis, and liver cancer. Which of the following statements is true based on ADA Standards of Care?
- Elevated ALT and AST indicate a diagnosis of NAFLD.
- Approved treatment for NAFLD includes low-dose aspirin and pioglitazone.
- Fatty liver disease indicates that 5-10% of the liver weight is from fat.
- Surgical intervention is indicated to resect the liver in the presence of NAFLD.
Click Here to Test your Knowledge
Want to learn more about this question? Join us for our upcoming webinar
Test Taking Practice Exam Toolkit | FREE Webinar
Are You Ready for Exam Success?
Join us live Thursday, June 30th at 11:30 am PST
Learn Test-Taking Secrets with Coach Bev – Option to add on 200+ Computerized Practice Test Questions for $49
During this webinar, Coach Beverly will help you transform your nervousness into focused energy that will help you succeed. She will provide test-taking tips based on her experience taking the certification exam six times.
To provide plenty of practice, Coach Beverly will sample 20 test questions that have been plucked from our Test Taking Toolkit during this live webinar.
She will explain how to dissect the question, eliminate wrong answers and avoid getting lured in by juicy answers.
Two Ways to Join
Includes a review of 20 sample test questions with test taking strategies.
This includes access to the recorded version of this webinar on your Online University Student Portal.
Plus, the Test Taking Toolkit provides you with over 200+ sample online practice questions, simulating the exam experience.
A perfect way to assess your knowledge and create a focused study plan, while increasing your test-taking confidence.
Want to learn more about Diabetes Care? View our
Virtual DiabetesEd Specialist Conference
30+ CEs
Recorded & Ready to Watch!
Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.
If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.
Join us LIVE for this Virtual Course and enjoy a sense of community!
Team of expert faculty includes:
- Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
- Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
- Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator
Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs
Deluxe Option for $499: Virtual Program includes:
- Q & A Session with the instructor after each webinar.
- LIVE Presentations by our team of experts.
- State of the art review of current diabetes care and technology.
- Resources for each session.
- Access to free podcasts and video recordings within a week of each live session for one year.
Deluxe Version includes Syllabus, Standards and Swag*:
- Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
- ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
- DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen
All hours earned count toward your CDCES Accreditation Information
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
Rationale of the Week | Best glucose monitoring practice in the hospital?
For last week’s practice question, we quizzed test takers on glucose monitoring in the inpatient setting. 60% of respondents chose the best answer. We want to 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: JL is a new nursing graduate and asks you questions about glucose monitoring in the inpatient setting. Which of the following statements is most accurate regarding providing diabetes care in the hospital setting?
Answer Choices:
- If a patient is experiencing morning hypoglycemia, reduce basal insulin.
- Nursing staff can use the patient’s CGM glucose results to determine insulin dose.
- Any patient admitted with a glucose of 140 mg/dl or greater, confirmed on two different occasions, needs to be started on insulin.
- Hospital point-of-care glucose meters are mostly as accurate as lab glucose results.
As shown above, the most common choice was option 1, the second most common answer was option 4, then option 2, and finally 3.
Getting to the Best Answer
Answer 1 is correct. 59.86% chose this answer, “If a patient is experiencing morning hypoglycemia, reduce basal insulin.” YES, GREAT JOB! During hospitalization, keeping glucose levels on target improves outcomes and decreases the length of stay. This includes preventing hypoglycemia, which can be life-threatening. The most common cause of morning hypoglycemia is basal insulin. Treating hypoglycemia rapidly with carbs and rechecking to make blood sugar is increasing is critical. However, to prevent future hypoglycemic events, determining the cause of the low blood sugar and taking corrective action is just as important. Reducing basal insulin by 20% or more when morning blood sugars are less than 100 mg/dL in the hospital setting makes a big difference in protecting against hypoglycemia.
Answer 2 is incorrect. 12.93% of you chose this answer, “Nursing staff can use the patient’s CGM glucose results to determine insulin dose.” This is a juicy answer, however, the FDA has not approved the dosing of insulin based on CGM results in the hospital setting. Inpatients with adequate cognition are allowed to use their CGM to monitor their blood sugar and keep an eye on trends based on the hospital’s policy. However, insulin dosing is based on the hospital-approved point-of-care glucose meter results.
Answer 3 is incorrect. 9.52% of respondents chose this answer, “Any patient admitted with a glucose of 140 mg/dl or greater, confirmed on two different occasions, needs to be started on insulin.” If a person is admitted with a glucose of 140 or greater, this would certainly catch our attention and require ongoing monitoring. They may have undiagnosed prediabetes or diabetes (depending on if the glucose was fasting or random). However, this glucose level of 140 does not meet the criteria to start insulin. According to the ADA Standards, insulin therapy is initiated when the admitting glucose is 180 or greater.
Finally, Answer 4 is incorrect. 17.69% chose this answer, “Hospital point-of-care glucose meters are mostly as accurate as lab glucose results.” This is another juicy answer. The lab glucose is the most accurate. Approved hospital glucose meters can read 15% higher or lower than the actual lab glucose. At home glucose meters, can be up read up to 20% higher or lower than lab glucose and still be within FDA approval parameters. For more info, see our blog, How Accurate are Glucose Meters?
Want to learn more about this question? Join us for our webinar
Hospitals & Hyperglycemia Standards | Level 2 | $29 for 1.5 CEs
Recorded & Ready to Watch!
Research clearly demonstrates the importance of glucose control during hospitalization to improve outcomes not only in the inpatient setting but after discharge. This course reviews the evidence that supports inpatient glucose control and outlines practical strategies to achieve targets in the inpatient setting. We incorporate the latest ADA Standards and provide links to resources and inpatient management templates.
Objectives:
- The impact of hyperglycemia in the hospital setting
- The importance of inpatient glucose control
- Three strategies to get glucose to the goal in the hospital setting
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
3 Steps to “DeFeet” Amputations – FREE Webinar | July 19th, 11:30 am PST
3 Steps to Save Feet; Assess, Screen, and Report
All health care professionals are invited to join us to learn strategies to protect the lower extremities!
Airs live on July 19th at 11:30 am PST (45 to 60 minutes)
Coach Beverly will walk participants through the 3 Step Process to Save Feet; Assess, Screen and Report. She will provide simple and clear instructions on how to assess and inspect feet, along with risk assessment and action steps. We will share free teaching tools, strategies, and documentation forms adapted from the Lower Extremity Prevention Program (LEAP) that you can immediately implement in your practice setting.
Topics include:
- Effective foot assessment made easy
- How to use a monofilament to assess sensation
- Using a screening form to report findings
We are excited to share this life-saving information with our community of diabetes advocates.
CEs: 1.0 CEs for $19 or No CEs for FREE
Can’t join us live?
Don’t worry, we will send you a link to the recorded version.
Lift the Sheets and Look at the Feets
My passion for lower extremity advocacy began with my work at Stanford Hospital over 25 years ago. A kind-hearted man, JR, was admitted to the vascular unit with an infected ulcer and osteomyelitis. Despite days of antibiotic therapy and wound care, a partial foot amputation was required. He was devastated by this loss and so was I.
Here is the real tragedy. Based on his story, I am sure this amputation could have been prevented.
Diagnosed with diabetes a year earlier, JR took his diabetes medications as instructed but wasn’t prescribed a glucose meter to monitor his sugar levels (which were often in the 300s based on his A1C of 10.3%). Weeks before his hospital admission, a foot callus was bothering him. To relieve the discomfort, he decided to trim off the dead skin with a razor blade, but he went too deep. His well-intended intervention opened up a portal of entry for sugar-loving bacteria and within a week, he noticed his socks were wet with bloody drainage.
If JR had known that trimming his callus with a razor blade was dangerous or that his blood sugars were elevated, he could have taken preventive action.
Unfortunately, the first amputation predicts future amputations. Amputations are also associated with decreased life expectancy and impact on quality of life, especially for under-resourced individuals.
So, let’s “Lift the Sheet and Look at the Feets.”
Let’s unveil the barriers to amputation prevention, especially for Black Americans, who have 3-4 times the risk of amputation compared to White Americans. Let’s set up our clinics and hospitals to not only treat foot problems but determine the cause and take action for prevention. Together, we can make a difference.
FREE Toolkit of Handouts and Resources
3 Steps to Save Feet – Assess, Screen, Report Handout. This handout walks health care professionals through the steps involved in a 10-minute foot assessment and monofilament screening. Also includes a Screening Form to document and report findings.
Foot Care Teaching Sheet – Steps to Healthy Feet. This handout covers the important elements of foot care for people living with diabetes with simple and straightforward language.
Foot Care Teaching Sheet in Spanish– Pasos Para Tener Pies Sanos. This handout covers the important elements of foot care for people living with diabetes with simple and straightforward language.
FREE Webinar Airs July 19th! Coach Beverly will walk participants through the 3 Step Process to Save Feet; Assess, Screen and Report.
Coach Beverly Thomassian, RN, MPH, BC-ADM, CDCES
Author, Nurse, Educator, Clinician and Innovator, Beverly has specialized in diabetes management for over twenty years. As president and founder of Diabetes Educational Services, Beverly is dedicated to optimizing diabetes care and improving the lives of those with diabetes.
NEW! Order Monofilament (5.07) for Diabetes Foot Screening 20-Pack
People with diabetes are at increased risk of foot complications. By using a 5.07 monofilament (delivers 10gms of linear pressure) to assess for loss of sensation, diabetes health care professionals can immediately identify high-risk feet and take steps to protect lower extremities. Basic foot care education and intervention can reduce the risk of amputation by over 50 percent.
We are excited to provide these single-use 5.07 monofilaments in packs of 20.
We have included instructions on how to assess and inspect feet, along with risk assessment and action steps. We enhanced the teaching tools and forms from the Lower Extremity Prevention Program (LEAP) and are excited to share them with our community of diabetes advocates.
Want to learn more about Diabetes Care? Join us for our
Virtual DiabetesEd Specialist Conference
30+ CEs
Airs October 12-14th, 2022
Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.
Download Course Flyer | Download Schedule
If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.
Join us LIVE for this Virtual Course and enjoy a sense of community!
Team of expert faculty includes:
- Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
- Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
- Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator
Two Registration Options
Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs
Deluxe Option for $499: Virtual Program includes:
- Q & A Session with the instructor after each webinar.
- LIVE Presentations by our team of experts.
- State of the art review of current diabetes care and technology.
- Resources for each session.
- Access to free podcasts and video recordings within a week of each live session for one year.
Deluxe Version includes Syllabus, Standards and Swag*:
- Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
- ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
- DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen
Virtual DiabetesEd Specialist Conference Basic | 30+ CEs
Basic Option for $399: Virtual Program includes:
- Q & A Session with the instructor after each webinar.
- LIVE Presentations by our team of experts.
- State of the art review of current diabetes care and technology.
- Resources for each session.
- Access to free podcasts and video recordings within a week of each live session for one year.
Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.
All hours earned count toward your CDCES Accreditation Information
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
How Do Annual Wellness Visits Decrease Amputation Rates over 30%?
As a Diabetes Specialist at a local Native Health Services Clinic, I assess a lot of feet every day. I believe this simple act of looking, touching, questioning, caring, and referring has saved many lower extremities.
Last month, a client arrived who was excited to report that they were able to walk for over an hour without getting short of breath. We celebrated this accomplishment and then I asked them to take off his shoes, knowing this person had already lost all of the toes on their left foot due to diabetes. The client wasn’t wearing custom shoes to accommodate this foot, just regular tennis shoes.
When the socks came off, I discovered an angry-looking ulcer that the person wasn’t too concerned about, saying, “it’s not really bothering me.” We sent this client to the emergency department, and they were immediately started on antibiotics to stop this very dangerous infection.
That’s just one example of how the simple act of assessing feet at during a wellness visit can make a big difference in outcomes.
Lowering Amputation Rates Through Annual Wellness Visit
A study conducted by researchers at the University of Virginia School of Medicine reviewed data on the impact of Wellness Visits on amputation rates in the “Diabetes Belt”.
The “Diabetes Belt,” refers to 644 counties in the southeastern and Appalachian regions of the U.S. with higher rates of diabetes including the state of Mississippi as well as portions of Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and West Virginia.
People living in the Diabetes Belt had 27% greater odds of requiring a lower-extremity amputation compared to residents of counties surrounding the belt.
A simple intervention with big rewards:
This ten-year study at the University of Virginia found that people with diabetes who participated in a free Annual Wellness Visit covered by Medicare were 36% less likely to need an amputation compared to those who did not attend an Annual Wellness Visit regardless of where they lived.
“Our results confirmed our hypothesis that Annual Wellness Visits are associated with a reduced risk of major lower-extremity amputations, highlighting the importance of connecting patients to preventive care services,” said Jennifer Lobo, PhD, a researcher in UVA’s Department of Public Health Sciences.
Racial Disparities associated with increased amputation risk
The research also revealed significantly higher rates of diabetes-related amputations among Black participants compared with non-Hispanic White participants, both inside and outside the Diabetes Belt.
Based on these research results, more resources and changes in our health care system are needed to decrease amputation rates in the Diabetes Belt. As health care providers, we can take an active role in reaching out to Black community members to determine systemic barriers. Then, through community collaboration, we can start building bridges to improve inclusivity and access to healthcare.
To learn more about addressing racial disparities to reduce amputation, click here and click here.
Value of Preventive Foot Care
The researchers concluded that people with diabetes who participated in their Annual Medicare Wellness Visit may have had their foot complications diagnosed sooner, helping prevent amputations. Also, given the effectiveness of wellness visits to prevent future problems, the authors suggest incentivizing people with Medicare to use their annual wellness visits to evaluate lower extremities and provide education and foot care training.
Want to learn more about this question?
Join us for our new FREE Webinar
3 Steps to Save Feet; Assess, Screen, and Report
Airs live July 19th at 11:30 am PST (45 to 60 minutes)
All health care professionals are invited to join us to learn strategies to protect lower extremities during this FREE Webinar.
Coach Beverly will walk participants through the 3 Step Process to Save Feet; Assess, Screen and Report. She will provide simple and clear instructions on how to assess and inspect feet, along with risk assessment and action steps. We will share free teaching tools, strategies, and documentation forms adapted from the Lower Extremity Prevention Program (LEAP) that you can immediately implement in your practice setting.
CEs: 1.0 CEs for $19 or No CEs for FREE
Topics include:
- Effective foot assessment made easy
- How to use a monofilament to assess sensation
- Using screening form to report findings
Can’t join us live?
Don’t worry, we will send you a link to the recorded version.
FREE Handouts and Resources
3 Steps to Save Feet – Assess, Screen, Report Handout. This handout walks health care professionals through the steps involved in a 10-minute foot assessment and monofilament screening. Also includes a Screening Form to document and report findings.
Foot Care Teaching Sheet: This handout covers the important elements of foot care for people living with diabetes with simple and straightforward language.
Coach Beverly Thomassian, RN, MPH, BC-ADM, CDCES
Author, Nurse, Educator, Clinician and Innovator, Beverly has specialized in diabetes management for over twenty years. As president and founder of Diabetes Educational Services, Beverly is dedicated to optimizing diabetes care and improving the lives of those with diabetes.
NEW! Order Monofilament (5.07) for Diabetes Foot Screening 20-Pack
People with diabetes are at increased risk of foot complications. By using a 5.07 monofilament (delivers 10gms of linear pressure) to assess for loss of sensation, diabetes health care professionals can immediately identify high-risk feet and take steps to protect lower extremities. Basic foot care education and intervention can reduce the risk of amputation by over 50 percent.
We are excited to provide these single-use 5.07 monofilaments in packs of 20.
We have included instructions on how to assess and inspect feet, along with risk assessment and action steps. We enhanced the teaching tools and forms from the Lower Extremity Prevention Program (LEAP) and are excited to share them with our community of diabetes advocates.
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
Question of the Week | Pregnancy Surprise with Type 1 Diabetes
AR has type 1 diabetes and is in shock because they just discovered they are 6 weeks pregnant. AR uses a CGM and insulin pump to manage their diabetes and their most recent A1C is 8.3%. Which of the following is a potential complication associated with hyperglycemia during the first 10 weeks of pregnancy?
- Macrosomia and post-natal jaundice
- Intrauterine hypoglycemia
- Neonatal respiratory distress
- Diabetic embryopathy
Click Here to Test your Knowledge
Want to learn more about this question? Join us for our webinar
Pregnancy & Diabetes Standards | Level 2 | $29 for 1.5 CEs
Recorded & Ready to Watch!
Pregnancy with diabetes is confronted with a variety of issues that require special attention, education, and understanding. This course reviews those special needs while focusing on Gestational Diabetes and Pre-Existing Diabetes. Included are the most recent diagnostic criteria, management goals, and prevention of complications during pregnancy. A helpful review for the CDCES Exam and for those who want more information on people who are pregnant and live with Diabetes.
Objectives:
- Three issues that affect pregnancy with diabetes
- The unique attributes of pre-existing diabetes in pregnancy and gestational diabetes
- Diagnostic criteria and management goals for gestational diabetes
- Potential short term and long term complications of fetal exposure to hypoglycemia
- Prevention measures to keep parent and baby healthy
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
Reach for a Rainbow – FREE Diabetes Self-Care Goal Sheet
On average, most Americans eat only one serving of fruit and 1½ servings of vegetables daily, far less than what’s recommended.
Fruit and vegetables ARE magical. They are loaded with fiber, micronutrients, energy, and mostly smell and taste so good. They are mood boosters, feed our healthy gut bacteria, and can lead to meaningful connections. By encouraging people of all ages to consume more fruits and veggies, we improve the well-being of our communities.
Reach for a Rainbow. Eating a rainbow of fruits and vegetable is key because they each contain different beneficial nutrients and antioxidants. According to a recent study, fruits and vegetables, including leafy greens, citrus fruits, and berries, were associated with lower mortality.
If we can just encourage people to eat 2 pieces of fruit a day and one serving of veggies with each meal, we are making a significant impact in improving health outcomes.
FREE Self-Care Goal Sheet
We are excited to share this FREE Diabetes Self-Care Goal Sheet to support an increased intake of fruits and veggies, one bite at a time.
Setting realistic person-centered goals is a critical part of providing diabetes education care and support. We have created a goal sheet that you can use in your practice to capture the next steps towards improving self-care.
If you would like to customize the document, it is available in Diabetes Self-Care Goal Sheet in English in Word and Diabetes Self-Care Goal Sheet in Spanish in Word so you can make modifications for your practice. Or you can download the PDF version of the Diabetes Self-Care Goal Sheet in English and PDF version of the Diabetes Self-Care Goal Sheet in Spanish, print and go.
Start small and Build on Success
Eating five servings of fruits and vegetables may not be realistic at first. We can encourage individuals to start with one to two servings a day and gradually increase portions as the person gains more confidence in their ability.
The Dietary Guidelines for Americans recommend 2½ cups of vegetables and two cups of fruit daily, which totals about nine servings per day. One “serving” is a half-cup of any vegetables or fruits or a whole cup of salad greens.
“People who eat five servings of vegetables and fruit daily have 13 percent lower risk of all-cause death compared to people who eat two servings of fruit and vegetables per day,” says Dong Wang, a faculty member at Harvard Medical School and Brigham and Women’s Hospital in Boston, and one of the study’s researchers. They also had a 12% lower risk of death from cardiovascular disease, a 10% lower risk from cancer, and a 35% lower risk from respiratory disease, compared with people who ate just two daily servings.
However, starchy vegetables such as peas, corn, and potatoes were not associated with a reduced risk of death or chronic diseases. The study results didn’t find harm or an increased risk of mortality from these options, but they also didn’t decrease mortality. Consider them neutral.
More good news – It doesn’t seem to matter whether people consume fresh, frozen or canned fruits and vegetables. They all offer similar nutrient values. The main consideration is promoting affordable and appealing fruits and veggies based on the individuals’ taste and preferences.
Self-Care Cheat Sheets in Spanish
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
Rationale of the Week | Which diabetes meds safe during pregnancy?
For last week’s practice question, we quizzed test takers on pregnancy and diabetes. 63% of respondents chose the best answer. We want to 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 says they just found out they are pregnant. AR has type 2 diabetes and polycystic ovary syndrome and takes metformin 1000mg BID, semaglutide (Ozempic) 1.0mg weekly, and 30 units glargine insulin for diabetes management. Her most recent A1C was 8.2%. What is the most important action to take?
Answer Choices:
- Add bolus insulin to get A1C less than 6.5%.
- Increase the semaglutide (Ozempic) to 2.0mg weekly.
- Add a SGLT-2 Inhibitor to get glucose to target.
- Instruct AR to stop the semaglutide (Ozempic).
As shown above, the most common choice was option 4, the second most common answer was option 1, then option 2, and finally 3.
Getting to the Best Answer
Answer 1 is incorrect. 19.53% chose this answer, “Add bolus insulin to get A1C less than 6.5%.” This answer is accurate, but it is not the best answer. The A1C goal during pregnancy is less than 6.5% and in this case, AR will need to manage their diabetes using basal bolus insulin therapy. However, since semaglutide is not approved for pregnancy, the most important action is to stop the administration of this GLP-1 RA.
Answer 2 is incorrect. 9.40% of you chose this answer, “Increase the semaglutide (Ozempic) to 2.0mg weekly.” AR’s blood glucose levels are above the A1C pregnancy target of 6.5%, which means insulin intensification is needed. Insulin is safe during pregnancy. However, since semaglutide is not approved for pregnancy, the most important action is to stop the administration of this GLP-1 RA.
Answer 3 is incorrect. 8.50% of respondents chose this answer, “Add a SGLT-2 Inhibitor to get glucose to target.” AR’s blood glucose levels are above the A1C pregnancy target of 6.5%, which means insulin intensification is needed. Insulin is safe during pregnancy. However, SGLT-2s are not approved for pregnancy and the GLP-1 RA, semaglutide would also need to be discontinued.
Finally, Answer 4 is correct. 62.57% chose this answer, “Instruct AR to stop the semaglutide (Ozempic).” YES, GREAT JOB! AR’s blood glucose levels are above the A1C pregnancy target of 6.5%, which means insulin intensification is needed. Basal bolus insulin therapy is safe during pregnancy. However, since semaglutide is not approved for pregnancy, the most important action is to stop the administration of this GLP-1 RA. Metformin can be continued through the first trimester and the insulin would need to be intensified to get A1C to target.
Want to learn more about this question? Join us for our webinar
Pregnancy & Diabetes Standards | Level 2 | $29 for 1.5 CEs
Recorded & Ready to Watch!
Pregnancy with diabetes is confronted with a variety of issues that require special attention, education, and understanding. This course reviews those special needs while focusing on Gestational Diabetes and Pre-Existing Diabetes. Included are the most recent diagnostic criteria, management goals, and prevention of complications during pregnancy. A helpful review for the CDCES Exam and for those who want more information on people who are pregnant and live with Diabetes.
Objectives:
- Three issues that affect pregnancy with diabetes
- The unique attributes of pre-existing diabetes in pregnancy and gestational diabetes
- Diagnostic criteria and management goals for gestational diabetes
- Potential short term and long term complications of fetal exposure to hypoglycemia
- Prevention measures to keep parent and baby healthy
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
Question of the Week | Best glucose monitoring practice in the hospital?
JL is a new nursing graduate and asks you questions about glucose monitoring in the inpatient setting. Which of the following statements is most accurate regarding providing diabetes care in the hospital setting?
- If a patient is experiencing morning hypoglycemia, reduce basal insulin.
- Nursing staff can use the patient’s CGM glucose results to determine insulin dose.
- Any patient admitted with a glucose of 140 mg/dl or greater, confirmed on two different occasions, needs to be started on insulin.
- Hospital point-of-care glucose meters are mostly as accurate as lab glucose results.
Click Here to Test your Knowledge
Want to learn more about this question? Join us for our webinar
Hospitals & Hyperglycemia Standards | Level 2 | $29 for 1.5 CEs
Recorded & Ready to Watch!
Research clearly demonstrates the importance of glucose control during hospitalization to improve outcomes not only in the inpatient setting but after discharge. This course reviews the evidence that supports inpatient glucose control and outlines practical strategies to achieve targets in the inpatient setting. We incorporate the latest ADA Standards and provide links to resources and inpatient management templates.
Objectives:
- The impact of hyperglycemia in the hospital setting
- The importance of inpatient glucose control
- Three strategies to get glucose to the goal in the hospital setting
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
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