According to ADA Guidelines, what adjustment in his diabetes medications are needed to prepare for a safe surgery?

1. Hold the evening metformin and glargine the night before surgery to prevent perioperative hypoglycemia.
2. Hold morning metformin the day of surgery and give about 40 units of bedtime glargine the night before surgery.
3. Hold metformin 3 days before surgery and give 60 units of bedtime glargine the night before surgery.
4. Hold the metformin the day before surgery and give the glargine the morning of surgery to prevent perioperative hyperglycemia.

Click here to test your knowledge!

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Level 2 | Hospitals & Hyperglycemia Standards | 1.5 CEs

Topics include:

• The impact of hyperglycemia in the hospital setting.
• The importance of inpatient glucose control.
• Three strategies to get glucose to goal in the hospital setting.

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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*

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.

1. A sharp increase in glucose levels in the first trimester due to placental hormones.
2. A decrease in insulin needs during the second and third trimester.
3. A minimal fluctuation in insulin needs until about 36 weeks.
4. A decrease in insulin needs during the first 16 weeks.

Click here to test your knowledge!

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Level 2 | Pregnancy & Diabetes Standards | 1.5 CEs

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.

Topics include:

• 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 mother and baby healthy

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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*

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.

For our June 8th Question of the Week, only 64% of respondents chose the best answer. We want to “take a closer look” at this question and determine strategies to choose the best response.

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question

Question: JR is taking Metformin 1000mg BID but is worried about getting cancer and is thinking about stopping the metformin. 

Which of the following is an accurate statement regarding diabetes and cancer?

Answer Choices:

1. People with diabetes have a slightly lower risk of liver and uterine cancers.
2. Some brands of metformin were recalled because of an NDMA impurity, so it is best to hold metformin for now.
3. There is research suggesting that metformin may be associated with a decreased risk of certain cancers.
4. Metformin does not increase the risk of cancer, but it can negatively impact renal function.

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As shown above, the most common choice was option 3, the second most common answer was option 4, then option 2, and finally option 1.

Getting to the Best Answer

If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. The exam will present questions that require test takers to be familiar with knowledge of diabetes co-conditions plus prevention and screening guidelines.

Answers & Rationale

Answer 1 is incorrect, 3.69% chose this answer, “People with diabetes have a slightly lower risk of liver and uterine cancers.” People with type 2 diabetes have a higher risk of getting liver and endometrial cancers. There is an increased risk of diabetes and cancer in the same person due to an overlap of risk factors (age and weight) plus lifestyle factors (smoking, activity level, income and environmental factors).

Answer 2 is incorrect, 6.77% of you chose this answer, “Some brands of metformin were recalled because of an NDMA impurity, so it is best to hold metformin for now.” In 2020, some brands of Metformin were recalled because of above acceptable levels of NDMA due to the manufacturing process. The FDA recalled those brands and they were pulled from pharmacy shelves. Any dispensed metformin post recall should be safe.

Answer 3 is Correct, 64.46% of you chose this answer, “There is research suggesting that metformin may be associated with a decreased risk of certain cancers.” YES, you chose the BEST answer. Congratulations. Multiple studies have examined metformin for its potential tumor and cancer fighting ability and it looks very promising. Read more here >>

Answer 4 is incorrect, 25.08% of you chose this answer, “Metformin does not increase the risk of cancer, but it can negatively impact renal function.” This answer is NOT correct. Metformin appears to reduce the risk of some cancers but does NOT harm kidney function. There has been a increase of misinformation about metformin over the past year. Metformin is not recommended for anyone with a GFR less than 30 due to increase risk of lactic acidosis. But, metformin WON’T harm the kidneys and one could even argue that it protects them by lowering A1C by 1-2% points. You can download our Medication PocketCards for more information.

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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Level 4 | Cancer & Diabetes | 1.25 CEs

Topics Include:

• Discuss the relationship between cancer, hyperglycemia and insulin resistance.
• State 3 benefits of normalizing glucose levels during chemotherapy.
• Using a case study approach, discuss strategies to improve glucose levels and quality of life.

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2021 Live Webinar Events

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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!

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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.

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.

Written by Monique Jackson, MSN, CFNP, WHCNP, CDCES

A new study finds that hemoglobinopathies may distort A1C accuracy for people of African descent living with diabetes.  

African Americans at risk for falsely low A1cs due to Hemoglobin Variants

Hemoglobin variants don’t increase the risk for diabetes, but it can affect the results of A1C tests.  African Americans Heterozygous for the common hemoglobin variant HbS may have, for any given level of mean glycemia, lower A1C by about 0.3% then those without the trait.  Another genetic variant, X-linked glucose-6-phosphate dehydrogenase G202A, carried by 11% of African Americans, was associated with a decrease in A1C of about 0.8% in homozygous men and 0.7% in homozygous women compared with those without the variant  (American Diabetes Association, Standards of Care in Diabetes-2021; 16). 

 Health care professionals often use A1C test results to guide decisions about diabetes care, such as changes to medication, meal plan, or physical activity routine to manage diabetes.  In those with certain hemoglobin variants, A1C is not accurate for diagnosing and managing diabetes.  Different tests that accurately reflect long term glucose levels are needed for early diagnosis and to provide needed medical management that prevents complications. 

Mismatch between Glucose and A1c –  My Clinical Finding

At my clinic, where I work as a Diabetes Nurse Specialist, an African American individual arrived with a high random glucose and mildly abnormal A1C.  Reviewing their lab work, I noticed that the random blood glucose was 300 mg/dl and the A1C was at approximately 7.0%.  When I converted the A1C to average blood glucose and compared with the elevated reading in the logs, the numbers did not match up. I realized that this individual had one of the hemoglobin variants (Sickle Cell anemia) HbS.   I ended up starting them on Metformin for blood sugar, Atorvastatin because of the guidelines that everyone with Diabetes should be on a statin, Aspirin to prevent heart attack, and Lisinopril for blood pressure control. 

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Without this clinical finding that the elevated blood sugars were not reflected in the A1c, this individual might not have been started on diabetes treatment, because of the false low A1C.

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A1C reflects glucose concentration from the past 2-3 months, but this relationship may differ between those with nutritional deficiencies, anemia, or genetic hemoglobinopathies, including the Sickle cell trait.

Since A1C measures the percentage of glycosylated hemoglobin, individuals who possess variants of hemoglobin can exhibit falsely low readings.  

Fructosamine testing, which evaluates albumin glycosylation for the past 2-3 weeks, may be a better measure to help people with diabetes monitor and manage their blood glucose levels in cases where the A1C test cannot be used and/or a short-term monitoring window is desired.    

Summary and Notes for the Future

It is important to consider the results of the A1C, fasting blood glucose, two-hour glucose tolerance test, random blood glucose, and or fructosamine when you are screening someone with diabetes who is diagnosed with a Hemoglobin variant.  

A1C testing on two different occasions to diagnose diabetes for those with Hbs variants is not recommended, because it will yield false low results.  To diagnose a person with diabetes and Hbs variants, the ADA recommends only plasma blood glucose criteria be used to diagnose diabetes.

More research is needed on the diagnoses of diabetes utilizing the A1C in populations with increased prevalence of Hbs variants.  In addition, we need research aimed toward providing more accurate tests for the diagnosis and management of conditions associated with increased red blood cells turnover, such as sickle cell disease, hemoglobinopathy variants, pregnancy (second and third trimester).  

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Welcome, Monique Jackson, MSN, CFNP, WHCNP, CDCES, our new Blog Content Writer!

We are so excited to introduce our newest DiabetesEd Specialist Blog Contributor, Monique Jackson, MSN, CFNP, WHNP, CDCES.

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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*

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.

1. Glucose targets are based on the individual.
2. Strive to achieve at least 80% time in range.
3. A1C less than 6.5% for children under the age of 18.
4. Pre-meal glucose of 80-130 and post-meal glucose less than 200 to prevent hypoglycemia.

Click here to test your knowledge!

---

Want to learn more about this topic? Enroll in our

Level 2 | From Tots to Teens Diabetes Standards | 1.5 CEs

We discuss the clinical presentation of diabetes, goals of care, and normal growth and development through the early years through adolescence. Strategies to prevent acute and long term complications are included with an emphasis on positive coping for family and child with diabetes.

Topics include:

• Discuss the goals of care for Type 1 and Type 2 Kids with Diabetes
• State Strategies to prevent acute and chronic complications
• Discuss the importance of positive psychosocial adjustment and resources

---

See Full Calendar for upcoming webinars and Virtual Courses.

Can’t make it live? All paid registrants are guaranteed access to the video presentation, handouts and podcasts.

---

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!

[yikes-mailchimp form=”1″]

Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*

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.

For our June 1st Question of the Week, only 45% of respondents chose the best answer. We want to “take a closer look” at this question and figure out how to drill down to discover the best response.

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question

Question: JR is 43 years old with newly discovered type 2 diabetes. 

According to the ADA Standards, which of the following actions need to be taken with a new type 2 diabetes diagnosis?  

Answer Choices:

1. Hepatitis B Vaccine.
2. Screening for prostate cancer.
3. Referral to podiatry.
4. Antibody testing to confirm the diagnosis.

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As shown above, the most common choice was option 1, the second most common answer was option 3, then option 4, and finally option 2.

Getting to the Best Answer

If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. The exam will present questions that require test takers to be familiar with preventive care measures, especially suggested vaccinations based on age and risk profile.

Answers & Rationale

Answer 1 is correct, 45.48% chose this answer, “Hepatitis B Vaccine.” CONGRATS, this is the BEST answer. According to the ADA Standards of Care (see below), people with diabetes who are 18-59 years of age need protection against hepatitis infection. Since people with diabetes may share glucose checking devices and may have less hearty immune systems, they are at higher risk of getting Hepatitis B. Getting the 2-3 dose series if not previously vaccinated, offers important protection.

Answer 2 is incorrect, 4.68% of you chose this answer, “Screening for prostate cancer.” According to the ADA Standards, a new diagnosis of type 2 diabetes does not require screening for prostate cancer. In addition, according to the consensus statement on Diabetes and Cancer, men with diabetes are not at higher risk of prostate cancer. However, people with diabetes are at higher risk of pancreas, liver and breast cancer, so regular screenings for these types of cancers is indicated.

Answer 3 is incorrect, 26.61% of you chose this answer, “Referral to podiatry.” This is answer is juicy, but we don’t have enough details in the question to support referral to a podiatrist. Not everyone with new diabetes is referred to podiatry for lower extremity care. Podiatry referral is based on a careful lower extremity assessment coupled with an indication that this person is at higher risk of complications (ie ulcerations, severe calluses, risk of injury when cutting toenails, loss of protective sensation, etc).

Answer 4 is incorrect, 23.23% of you chose this answer, “Antibody testing to confirm the diagnosis.” Another juicy answer. For most people with new type 2 diabetes, the clinical presentation coupled with family history and ketone status is usually enough to determine the type of diabetes. If the question hinted that this person might have type 1 (ie history of celiac or thyroid disease, positive ketones, BMI of 21 etc) then, the provider may want to evaluate for the presence of antibodies.

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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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!

[yikes-mailchimp form=”1″]

Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*

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.

For our June 15th Question of the Week, only 54% of respondents chose the best answer. We want to “take a closer look” at this question with the aim for 100% correct responses the next to go around.

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question

Question: RT is 12 years old and has a new diagnosis of type 1 diabetes.

Based on the ADA Standards of Care, what is the most accurate statement regarding glycemic goals?

Answer Choices:

1. Glucose targets are based on the individual.
2. Strive to achieve at least 80% time in range.
3. A1C less than 6.5% for children under the age of 18.
4. Pre-meal glucose of 80-130 and post-meal glucose less than 200 to prevent hypoglycemia.

---

As shown above, the most common choice was option 1, the second most common answer was option 4, then option 2, and finally option 3.

Getting to the Best Answer

If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. The exam will present questions that require test takers to be familiar with the goals of care for specialty populations, including pediatrics.

Answers & Rationale

Answer 1 is Correct, 54.26% chose this answer, “Glucose targets are based on the individual.” GREAT JOB. This is the best answer. The American Diabetes Association provides a general A1c target of 7% or less for pediatrics, but it encourages the person with diabetes and the care provider to determine glucose ranges that best match the individual based on their values, preferences, access to technology and safety.

Answer 2 is incorrect, 15.06% of you chose this answer, “Strive to achieve at least 80% time in range.” According the the ADA, the time in range target is 60% or an A1c of less than 7.5% for those under the age of 25. Of course, these goals are customized to match the individual.

Answer 3 is incorrect, 11.07% of you chose this answer, “A1C less than 6.5% for children under the age of 18..” This is a juicy answer. This target may be right for those who are using a CGM, pump and advanced technology features that help users avoid hypoglycemic events. But this is not the A1C target for all children with type 1 diabetes, so this is not the best answer. There is no A1C target that fits all.

Answer 4 is incorrect, 19.60% of you chose this answer, “Pre-meal glucose of 80-130 and post-meal glucose less than 200 to prevent hypoglycemia.” The American Diabetes Association provides a general A1c target of 7% or less for pediatrics, but it encourages the person with diabetes and the care provider to determine pre and post meal glucose ranges that best match the individual based on their values, preferences, access to technology and safety.

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!

---

Want to learn more about this topic? Enroll in our

Level 2 | From Tots to Teens Diabetes Standards | 1.5 CEs

We discuss the clinical presentation of diabetes, goals of care, and normal growth and development through the early years through adolescence. Strategies to prevent acute and long term complications are included with an emphasis on positive coping for family and child with diabetes.

Topics include:

• Discuss the goals of care for Type 1 and Type 2 Kids with Diabetes
• State Strategies to prevent acute and chronic complications
• Discuss the importance of positive psychosocial adjustment and resources

---

See Full Calendar for upcoming webinars and Virtual Courses.

Can’t make it live? All paid registrants are guaranteed access to the video presentation, handouts and podcasts.

---

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!

[yikes-mailchimp form=”1″]

Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*

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.

Which of the following is an accurate statement regarding diabetes and cancer?

1. People with diabetes have a slightly lower risk of liver and uterine cancers.
2. Some brands of metformin were recalled because of an NDMA impurity, so it is best to hold metformin for now.
3. There is research suggesting that metformin may be associated with a decreased risk of certain cancers.
4. Metformin does not increase the risk of cancer, but it can negatively impact renal function.

Click here to test your knowledge!

---

Want to learn more about this topic? Enroll in our

Level 4 | Cancer & Diabetes | 1.25 CEs

Topics Include:

• Discuss the relationship between cancer, hyperglycemia and insulin resistance.
• State 3 benefits of normalizing glucose levels during chemotherapy.
• Using a case study approach, discuss strategies to improve glucose levels and quality of life.

---

See Full Calendar for upcoming webinars and Virtual Courses.

Can’t make it live? All paid registrants are guaranteed access to the video presentation, handouts and podcasts.

---

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!

[yikes-mailchimp form=”1″]

Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*

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.