Rationale of the Week | Why are CGM readings higher than BG readings?
For last week’s practice question, we quizzed participants on why CGM readings are higher than BG readings. 39% 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: KS has type 1 diabetes, takes degludec and lispro for their diabetes medications and was recently prescribed CGM therapy to support glucose monitoring. At their visit they report sensor readings have been consistently higher than blood glucose readings.
What would be an important follow-up question to evaluate the potential cause of this difference?
Answer Choices:
- Re-assure them blood glucose never equals sensor glucose, so this difference is okay.
- Review current medication and supplement use.
- Discuss changes in diet and factors contributing to elevation in sensor glucose readings.
- Inquire about sleep habits and potential compression of glucose sensor
Getting to the Best Answer
Answer 1 is incorrect. 21.74% chose this answer. “Re-assure them blood glucose never equals sensor glucose, so this difference is okay.” This answer is incorrect. Although it is true that sensor glucose does not equal blood glucose, there may be other factors contributing to consistent elevation in glucose trends. We would want to probe into other potential considerations before jumping to the conclusion that it is only the difference in measurement.
Answer 2 is correct. 39.37% of you chose this answer. “Review current medication and supplement use.” This answer is correct. Interfering substances such as acetaminophen and ascorbic acid (vitamin C) can contribute to higher glucose readings than actual glucose. The interfering substance depends upon the CGM manufacturer. The 2024 ADA Standards of Care reports the importance of reviewing medications and supplements used by persons with diabetes to identify possible interfering substances. They also recommend blood glucose monitoring if there is a concern of inaccurate data. Visit Section 7 of the 2024 Standards of Care to review the table of CGM manufacturers and potential interring substances.
Answer 3 is incorrect. About 21.86% of respondents chose this. “Discuss changes in diet and factors contributing to elevation in sensor glucose readings.” This answer is incorrect. Although sensor glucose and blood glucose values are more likely to significantly differ after a meal, KS reports consistent elevation in sensor glucose values. Diet factors contributing to elevated sensor glucose readings would likely contribute to elevated blood glucose readings too; we may just see a delay. Diet factors alone would not explain the consistent difference in elevation.
Finally, Answer 4 is incorrect. 17.04% chose this answer. “Inquire about sleep habits and potential compression of glucose sensor.” This answer is incorrect. Compression of the sensor during sleep can contribute to false sensor glucose readings, but we most often see sudden decreases (low) in glucose values. This is suspected to be due to local changes in blood flow/concentration of the interstitial glucose caused by direct pressure on the sensor. Screening for compression lows is important when reviewing CGM data but does not provide the best answer for consistently elevated glucose trends.
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 question?
Virtual DiabetesEd Training Conference – Join us Live on April 17th – 19th 2024 at 11:30 AM PST
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, and “aha” moments for our Virtual DiabetesEd Training Conference April 17th – 19th, 2024.
Attendees will leave this conference with new tools and a refreshed understanding of the latest advances in person-centered diabetes care. Our team highlights the ADA Standards of Care, medications, behavior change, technology, medical nutrition therapy, and more!
Our instructors co-teach the content to keep things fresh and lively.
Friend Discount: 3 or more only $449 per person. Email us at [email protected] with the name and email of each registrant to get the discount!
Program Details
- Dates: April 17-19th, 2024
- Registration Fee: $399-$569 (see more about reg. options below)
- Friend Discount: For 3 or more people, each person saves $50 off their registration. Email us at [email protected] with the name and email of each registrant to get the discount!
- CEs: 30+ CEs | 18 units for Virtual Conference plus 10+ Bonus CEs. CEs can be applied toward CDCES’s initial application or renewal.
- Speakers: View Conference Faculty
Registration Options
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Recent Blog Bytes
- Rationale of the Week | Weight-Inclusive Diabetes Care
- Honoring Excellence: Celebrating This Year’s Diabetes Education Scholarship Recipients
- Question of the Week | Who Benefits Most from Mindful Eating as a Primary Strategy? by Evgenia Evans, MS, RDN, CDCES
- Rationale of the Week | Triglyceride Management
- Fasting: Religion, Health, and Diabetes Care
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Rationale of the Week | Which statement is accurate regarding treatment of steatosis?
For last week’s practice question, we quizzed participants on steatosis treatment according to ADA. 57% 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: Up to 70% of people with diabetes have steatosis. Those at higher risk of moving to steatohepatitis include individuals with prediabetes and diabetes who also have cardiometabolic risk factors.
According to ADA Standards, which of the following is an accurate statement regarding treatment of liver disease in diabetes?
Answer Choices:
- GLP-1 Receptor agonists help with weight loss but do not improve steatosis.
- Pioglitazone therapy is indicated for individuals with steatohepatitis.
- Avoid insulin therapy in individuals with steatosis and advanced cirrhosis.
- Statin therapy is not effective at LDL lowering for individuals with steatosis.
Common Native Plants in the U.S.
Getting to the Best Answer
Answer 1 is incorrect. 21.77% chose this answer. “GLP-1 Receptor agonists help with weight loss but do not improve steatosis.” This juicy answer is tempting, but it is not the best answer. GLP-! RA’s, lower blood glucose levels and they also promote significant weight loss. This results in less glucose toxicity and a decrease in hepatic fat storage. Plus, they decrease the risk of cardiovascular disease which is co-associated with steatosis. See our Meds for Liver Disease Blog for more info.
Answer 2 is correct. 57.31% of you chose this answer. “Pioglitazone therapy is indicated for individuals with steatohepatitis.” Yes, this is the best answer. Pioglitazone (Actos) reduces blood glucose, and several studies demonstrate it is an effective treatment for steatosis and steatohepatitis. It also reduces the progression of fibrosis and cardiovascular risk. Since pioglitazone can cause fluid retention and weight gain, avoid using it in those with heart failure. See our Meds for Liver Disease Blog for more info.
Answer 3 is incorrect. About 7.31% of respondents chose this. “Avoid insulin therapy in individuals with steatosis and advanced cirrhosis.” With advanced cirrhosis, many of the oral medications may not be safe to use. The ADA recommends using insulin therapy, since it is safe and effective for people experiencing cirrhosis. Since people with cirrhosis are at higher risk of hypoglycemia, close monitoring of glucose levels is recommended. See our Meds for Liver Disease Blog for more info.
Finally, Answer 4 is incorrect. 13.61% chose this answer. “Statin therapy is not effective at LDL lowering for individuals with steatosis.” Lipid-lowering and antihypertensive meds need to be prescribed in people with steatosis as indicated. Statins are safe in individuals with steatohepatitis but avoid their use in those with decompensated cirrhosis. See our Meds for Liver Disease Blog for more info.
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 question?
Join us live on March 27th, 2024 for our
Critical Assessment in Diabetes Care | Fine-Tuning Diabetes Detective Skills
Level 2 | Standards of Care Intensive
This course integrates the American Diabetes Association’s (ADA) Standard of Care on elements of a comprehensive medical assessment (Standard 4) of the individual living with prediabetes, diabetes, or hyperglycemia. Through case studies & real-life situations, we discover often hidden causes of hyperglycemia & other complications, such as liver disease, sleep apnea, pancreatitis, autoimmune diseases, fractures, & more. We delve into therapy for complicated situations & discuss management strategies for other conditions associated with hyperglycemia such as Cystic Fibrosis, & Transplants.
Objectives:
- Identify common yet often underdiagnosed complications associated with type 1 & type 2 diabetes.
- State strategies to identify previously undiscovered diabetes complications during assessments.
- Discuss links between hyperglycemia & other conditions including transplant, cystic fibrosis, & liver disease.
Intended Audience: These courses are knowledge-based activities designed for individual or groups of diabetes educators, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other health care providers interested in enhancing their diabetes assessment skills and preparing for certification.
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working diabetes specialist and a nationally recognized diabetes expert.
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Rationale of the Week | Weight-Inclusive Diabetes Care
- Honoring Excellence: Celebrating This Year’s Diabetes Education Scholarship Recipients
- Question of the Week | Who Benefits Most from Mindful Eating as a Primary Strategy? by Evgenia Evans, MS, RDN, CDCES
- Rationale of the Week | Triglyceride Management
- Fasting: Religion, Health, and Diabetes Care
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Rationale of the Week | How to Increase Participation in DSMES?
For last week’s practice question, we quizzed participants on how to Increase participation in DSMES. 75% 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: Studies indicate that only 53% of individuals eligible for Diabetes Self-Management Education and Support (DSMES) through their health insurance receive it.
Answer Choices:
- Adjust DSMES charges for Medicare enrollees based on ability to pay.
- Increase access to telehealth delivery of care and other digital health solutions.
- Provide DSMES in non-hospital workplace settings to increase access for employees.
- Incentivize participation through use of giveaways and positive reinforcement.
Getting to the Best Answer
Answer 1 is incorrect. 4.79% chose this answer. “Adjust DSMES charges for Medicare enrollees based on ability to pay.” To ensure parity, Medicare guidelines specifically state that all DSME participants must be billed at the same rate. Billing at a lower rate or offering DSME for reduced rates or free for some, but not for all, is prohibited.
Answer 2 is correct. 74.77% of you chose this answer. “Increase access to telehealth delivery of care and other digital health solutions.” YES, GREAT JOB! To promote equity and outreach to rural and under resourced communities, the ADA encourages leveraging technology platforms and telehealth to deliver DSMES.
Answer 3 is incorrect. About 10.5% of respondents chose this. “Provide DSMES in non-hospital workplace settings to increase access for employees.” This is a tempting answer, but unfortunately it is not accurate. The location where DSMES is delivered must have prior approval as a Medicare recognized site in order to be able to bill for services. Of course, providing onsite worksite wellness and lifestyle coaching is beneficial, but it would not be a billable service unless the facility has a recognized DSMES program and an approved site.
Finally, Answer 4 is incorrect. 9.94% chose this answer. “Incentivize participation through use of giveaways and positive reinforcement.” Although this is another tempting answer and could help improve DSMES participation in real-life, the ADA Standards don’t include this strategy as a means to boost enrollment.
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 question?
Virtual DiabetesEd Training Conference – Join us Live on April 17th – 19th 2024 at 11:30 AM PST
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, and “aha” moments for our Virtual DiabetesEd Training Conference April 17th – 19th, 2024.
Attendees will leave this conference with new tools and a refreshed understanding of the latest advances in person-centered diabetes care. Our team highlights the ADA Standards of Care, medications, behavior change, technology, medical nutrition therapy, and more!
Our instructors co-teach the content to keep things fresh and lively.
Friend Discount: 3 or more only $449 per person. Email us at [email protected] with the name and email of each registrant to get the discount!
Program Details
- Dates: April 17-19th, 2024
- Registration Fee: $399-$569 (see more about reg. options below)
- Friend Discount: For 3 or more people, each person saves $50 off their registration. Email us at [email protected] with the name and email of each registrant to get the discount!
- CEs: 30+ CEs | 18 units for Virtual Conference plus 10+ Bonus CEs. CEs can be applied toward CDCES’s initial application or renewal.
- Speakers: View Conference Faculty
Registration Options
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Rationale of the Week | Weight-Inclusive Diabetes Care
- Honoring Excellence: Celebrating This Year’s Diabetes Education Scholarship Recipients
- Question of the Week | Who Benefits Most from Mindful Eating as a Primary Strategy? by Evgenia Evans, MS, RDN, CDCES
- Rationale of the Week | Triglyceride Management
- Fasting: Religion, Health, and Diabetes Care
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Rationale of the Week | Assessing for Food Insecurity with Diabetes
For last week’s practice question, we quizzed participants on assessing food insecurity with diabetes. 60% 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: Food insecurity affects 16% of adults with diabetes compared with 9% of adults without diabetes.
Based on the ADA standards of care, which is the most accurate statement regarding food insecurity and people with diabetes?
Answer Choices:
- Food insecurity is defined as uncertain availability of nutritionally adequate food at least once a week.
- Conduct food insecurity screening and income assessment once every 3-5 years.
- Any health care team member can screen for food insecurity using The Hunger Vital Sign.
- People with food insecurity are less likely to experience hyperglycemia due to decreased caloric intake.
Getting to the Best Answer
Answer 1 is incorrect. 31.96% chose this answer. “Food insecurity is defined as uncertain availability of nutritionally adequate food at least once a week.” Although this answer is partially correct, the last part, “at least once a week” makes this answer incorrect. According to the USDA food insecurity is defined as, “the limited or uncertain availability of nutritionally adequate and safe foods, or limited or uncertain ability to acquire acceptable foods in socially acceptable ways.” It doesn’t include a time span or frequency.
Answer 2 is incorrect. 5.08% of you chose this answer. “Conduct food insecurity screening and income assessment once every 3-5 years.” This answer also has elements of accuracy, but flails at the end. The ADA Standards recommend conducting food insecurity screenings on a yearly basis and helping individuals access needed resources.
Answer 3 is correct. Great Job! About 60.05% of respondents chose this. “Any health care team member can screen for food insecurity using The Hunger Vital Sign.”
The Hunger Vital Sign identifies households as being at risk for food insecurity if they answer that either or both of the following two statements is ‘often true’ or ‘sometimes true’ (vs. ‘never true’):
“ Within the past 12 months we worried whether our food would run out before we got money to buy more.”
“ Within the past 12 months the food we bought just didn’t last and we didn’t have money to get more.”
Finally, Answer 4 is incorrect. 2.91% chose this answer. “People with food insecurity are less likely to experience hyperglycemia due to decreased caloric intake.” There is no scientific evidence to support this answer and people with food insecurity can experience periods of adequate food intake interspersed with inadequate food intake.
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 question?
Virtual DiabetesEd Training Conference – Join us Live on April 17th – 19th 2024 at 11:30 AM PST
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, and “aha” moments for our Virtual DiabetesEd Training Conference April 17th – 19th, 2024.
Attendees will leave this conference with new tools and a refreshed understanding of the latest advances in person-centered diabetes care. Our team highlights the ADA Standards of Care, medications, behavior change, technology, medical nutrition therapy, and more!
Our instructors co-teach the content to keep things fresh and lively.
Friend Discount: 3 or more only $449 per person. Email us at [email protected] with the name and email of each registrant to get the discount!
Program Details
- Dates: April 17-19th, 2024
- Registration Fee: $399-$569 (see more about reg. options below)
- Friend Discount: For 3 or more people, each person saves $50 off their registration. Email us at [email protected] with the name and email of each registrant to get the discount!
- CEs: 30+ CEs | 18 units for Virtual Conference plus 10+ Bonus CEs. CEs can be applied toward CDCES’s initial application or renewal.
- Speakers: View Conference Faculty
Registration Options
All hours earned count toward your CDCES Accreditation Information
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Rationale of the Week | Weight-Inclusive Diabetes Care
- Honoring Excellence: Celebrating This Year’s Diabetes Education Scholarship Recipients
- Question of the Week | Who Benefits Most from Mindful Eating as a Primary Strategy? by Evgenia Evans, MS, RDN, CDCES
- Rationale of the Week | Triglyceride Management
- Fasting: Religion, Health, and Diabetes Care
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Rationale of the Week | Best approach for Religious Fasting?
For last week’s practice question, we quizzed participants on what is the best approach for religious fasting. 75% 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: The 2024 Standards of Care reported individuals who fast have an increased risk for hypoglycemia, dehydration, hyperglycemia, and ketoacidosis.
Which of the following is an accurate health care statement regarding recommendations for religious fasting?
Answer Choices:
- Recommend continuing with usual diet and medication regimens to ensure glucose stability and reduce health risks.
- Accommodate a person’s choice for religious fasting.
- Advise people with diabetes taking insulin about the need to avoid religious fasting due to risk of hypoglycemia.
- Provide education on religious fasting only when evidence indicates risk.
Getting to the Best Answer
If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.
Answer 1 is incorrect. 5.59% chose this answer. “Recommend continuing with usual diet and medication regimens to ensure glucose stability and reduce health risks.” Although religious fasting does change a person’s usual diet, sleep, and potentially medication regimen, evidence has shown that with education, most people with diabetes can safely complete a religious fast.
Answer 2 is correct. 75.42% of you chose this answer. “Accommodate a person’s choice for religious fasting.” Based on the 2024 Standards of Care, healthcare providers should accommodate a person’s choice for religious fasting.
Answer 3 is incorrect. About 6.78% of respondents chose this. “Advise people with diabetes taking insulin about the need to avoid religious fasting due to risk of hypoglycemia.” Although risk assessment is essential to review with each person with diabetes, the use of insulin is not a singular determinant of risk. Often, dose adjustments can reduce risk. The article “Diabetes and Ramadan: Practical Guidelines 2021”, referenced in the 2024 Standards of Care, includes a detailed description of how to stratify individual risk.
Finally, Answer 4 is incorrect. 12.20% chose this answer. “Provide education on religious fasting only when evidence indicates risk.” Healthcare providers should inquire about religious fasting and provide proactive education on monitoring glucose and how to modify medications, meal choices pre/post fast, fluid consumption, and activity planning.
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!
Virtual DiabetesEd Training Conference – Join us Live on April 17th – 19th 2024 at 11:30 AM PST
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, and “aha” moments for our Virtual DiabetesEd Training Conference April 17th – 19th, 2024.
Attendees will leave this conference with new tools and a refreshed understanding of the latest advances in person-centered diabetes care. Our team highlights the ADA Standards of Care, medications, behavior change, technology, medical nutrition therapy, and more!
Our instructors co-teach the content to keep things fresh and lively.
Friend Discount: 3 or more only $449 per person. Email us at [email protected] with the name and email of each registrant to get the discount!
Program Details
- Dates: April 17-19th, 2024
- Registration Fee: $399-$569 (see more about reg. options below)
- Friend Discount: For 3 or more people, each person saves $50 off their registration. Email us at [email protected] with the name and email of each registrant to get the discount!
- CEs: 30+ CEs | 18 units for Virtual Conference plus 10+ Bonus CEs. CEs can be applied toward CDCES’s initial application or renewal.
- Speakers: View Conference Faculty
Registration Options
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!
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Rationale of the Week | Best action to address sudden Hyperglycemia due to Cellulitis?
For last week’s practice question, we quizzed participants on addressing sudden hyperglycemia due to cellulitis. 66% 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: RL is 83, has Latent Autoimmune Diabetes, and takes degludec 17 units every morning along with metformin 500 XR twice daily. RL tells you that their left leg was suddenly swollen and red, so they went to urgent care and were started on a course of antibiotics. In the meantime, their CGM is showing elevated blood sugars in the 200 to 350 range during the day but often less than 100 at night. RL weighs 70kg, with a BMI of 23.4.
Based on this information, what action do you suggest?
Answer Choices:
- Decrease carbohydrate intake by 20-25% until the infection subsides.
- Increase the degludec by 20% to get blood glucose levels to target.
- Encourage RL to walk after meals to decrease post prandial blood sugar levels.
- Suggest initiation of bolus insulin once or twice daily.
Getting to the Best Answer
If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.
Answer 1 is incorrect. 10.02% chose this answer. “Decrease carbohydrate intake by 20-25% until the infection subsides.” Since RL has elevated glucose levels due to infection, drastically decreasing carbohydrate intake is not the best approach to manage glucose levels. We want to ensure RL has adequate nutrition given her infection and age.
Answer 2 is incorrect. 15.36% of you chose this answer. “Increase the degludec by 20% to get blood glucose levels to target.” It seems that RL needs more insulin to lower daytime glucose levels. However, RL is experiencing glucose levels less than 100 overnight, which puts them at risk of nocturnal hypoglycemia. If we increase basal insulin by 20%, this dramatic increase could cause a dangerous drop in overnight glucose levels and is not recommended.
Answer 3 is incorrect. About 8.68% of respondents chose this. “Encourage RL to walk after meals to decrease post prandial blood sugar levels.” Keeping active is always a good idea, but with blood sugars running 200-350 during the day, walking after meals won’t be enough to get glucose levels to target. Plus, it may not be safe to promote walking since they have an infection and a leg that is swollen and red.
Finally, Answer 4 is correct. 65.94% chose this answer. “Suggest initiation of bolus insulin once or twice daily.” YES, this the best answer. Counterregulatory hormones are released during periods of infection that contribute to insulin resistance and hyperglycemia. To get blood glucose levels to target, RL will need daytime bolus insulin to manage the hyperglycemia, which will promote healing. Of course, treatment with antibiotics will also help to lower glucose levels.
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 question?
Virtual DiabetesEd Training Conference – Join us Live on April 17th – 19th 2024 at 11:30 AM PST
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, and “aha” moments for our Virtual DiabetesEd Training Conference April 17th – 19th, 2024.
Attendees will leave this conference with new tools and a refreshed understanding of the latest advances in person-centered diabetes care. Our team highlights the ADA Standards of Care, medications, behavior change, technology, medical nutrition therapy, and more!
Our instructors co-teach the content to keep things fresh and lively.
Friend Discount: 3 or more only $449 per person. Email us at [email protected] with the name and email of each registrant to get the discount!
Program Details
- Dates: April 17-19th, 2024
- Registration Fee: $399-$569 (see more about reg. options below)
- Friend Discount: For 3 or more people, each person saves $50 off their registration. Email us at [email protected] with the name and email of each registrant to get the discount!
- CEs: 30+ CEs | 18 units for Virtual Conference plus 10+ Bonus CEs. CEs can be applied toward CDCES’s initial application or renewal.
- Speakers: View Conference Faculty
Registration Options
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!
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Rationale of the Week | RS Doesn’t Want to Get Weighed
For last week’s practice question, we quizzed participants on how to approach a person who does not want to be weighed during a quarterly diabetes appointment. 60% of respondents chose the best answer. If you are interested in learning more about the importance of providing weight inclusive care, this practice test question will set you up for success.
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it here: Answer Question
Question:
RS arrives at their quarterly diabetes provider appointment and the medical assistant walks them to the scale, in the clinic hallway, to get their weight. RS politely explains that they feel uncomfortable being weighed but they are happy to share their stated weight. The medical assistant once again encourages RS to get on the scale and reassures RS that they don’t need to look at or know their weight. RS sighs, takes off their shoes and reluctantly gets on the scale to be weighed.
Which of the following best describes the end result of this situation?
Answer Choices:
- The medical assistant used a person-centered approach to respect the wishes of RS.
- RS exhibited non-adherence and reconsidered their request.
- According to the transtheoretical model, RS was in preparation stage and needed gentle encouragement.
- The clinic staff would benefit from an inservice on providing weight inclusive care.
Getting to the Best Answer
If you are interested in providing weight inclusive care, this practice test question will set you up for success. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.
Answer 1 is incorrect. 15.91% chose this answer. “The medical assistant used a person-centered approach to respect the wishes of RS.” Instead of honoring the request to not be weighed, the medical assistant insisted RS step on the scale. A person centered, weight inclusive approach would respect RS’s request not to be weighed and accepted their stated weight.
Answer 2 is incorrect. 8.39% of you chose this answer. “RS exhibited non-adherence and reconsidered their request.” People with diabetes have the right to be weighed in a private space and they also have the right to decline to be weighed. In this situation, RS’s weight is not required to provide safe and effective medical care.RS is not “non-adherent”, they are simply expressing their need not to step on the scale.
Answer 3 is incorrect. About 15.70% of respondents chose this. “According to the transtheoretical model, RS was in preparation stage and needed gentle encouragement.” This juicy answer does not reflect the situation in the medical office at the scale. RS did not state that they were working on being comfortable with being weighed or that it would be helpful to be weighed. Instead RS told the MA twice that they don’t want to be weighed, but their request was not honored.
Finally, Answer 4 is correct. 60% chose this answer. “The clinic staff would benefit from an inservice on providing weight inclusive care.” YES, this is the best answer. If the staff were informed about weight inclusive care and reducing weight stigma, they would have honored RS’s request not to be weighed and documented their stated weight. This inclusive approach would help RS feel seen, heard and respected. RS would gain a positive association with their medical team and be more likely to return for future appointments.
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 important learning activity!
Want to learn more about Weight Stigma?
Enjoy our blog – Untangling Weight Stigma at Medical Visits.
Weight stigma in medical appointments is a significant issue that can have detrimental effects on the individuals’ physical and mental health. It refers to the negative attitudes, beliefs, and stereotypes healthcare providers may hold towards individuals with extra weight. This stigma can manifest in various ways during medical appointments, including biased treatment, assumptions about the person’s lifestyle or health behaviors, and even neglect of legitimate health concerns unrelated to weight.
Although I disguised this question and situation as happening to RS, this question is based on my own personal experience. My goal in sharing this with all of you is not only to raise awareness of this often-overlooked barrier to care but a call to take action in our places of work to provide more weight inclusive environments.
Action Steps to Untangle Weight Stigma in Medical Appointments:
Awareness and Education: participate in training programs to help care providers recognize and address weight bias. A great resource is Inclusive Diabetes Care.
Language Matters: Use neutral and respectful language when discussing weight-related issues.
Focus on Health, Not Weight: Shift the focus of medical appointments from weight to overall health and well-being.
Individualized Care: Recognize the individual and understand their story around weight.
Create Supportive Environments: Design healthcare settings that are inclusive and welcoming to individuals of all sizes.
Advocate for Systemic Change: Addressing weight stigma requires systemic change within the healthcare system and society as a whole. Healthcare providers can advocate for policies that promote health equity, combat weight bias in research and media, and support initiatives that address social determinants of health.
By implementing these strategies, healthcare providers can help untangle weight stigma in medical appointments and create a more supportive and inclusive environment for all patients, regardless of their size.
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!
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Rationale of the Week | What medication changes do you recommend?
For last week’s practice question, we quizzed participants on medication recommendations. 61% 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:
RL was newly diagnosed 43 with type 2 diabetes 6 months ago with an initial A1C of 10.1%. They have no cardiovascular disease and their renal function is within normal limits. At a recent office visit, you notice RL’s A1C has dropped to 7.3, their BP is 112/78 and the LDL cholesterol is 103mg/dL. RL’s current medication regimen includes, rosuvastatin 10mg, empagliflozin 25mg, metformin 1000 BID, glargine 12 units and aspirin 81mg.
Based on this information, what changes to RL’s medication plan do you recommend to the provider?
Answer Choices:
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- Consider increasing rosuvastatin and stopping ASA therapy.
- Consider stopping empagliflozin and starting GLP-1 RA to help with weight loss.
- Consider adding an ACE or ARB and increasing basal insulin.
- Consider increasing metformin and decreasing basal insulin.
Getting to the Best Answer
If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.
Answer 1 is correct. 60.90% chose this answer. “Consider increasing rosuvastatin and stopping ASA therapy.” – YES, this is the best answer. GREAT JOB. According to the ADA Standards of Care, the goal is to reduce the LDL by 50% and less than 70mg/dL. The max dose of rosuvastatin is 40mg and RL is only on 10mg. Increasing the dose of rosuvastatin will help decrease LDL levels. Aspirin therapy is indicated for people 55 years and older with an elevated CV risk. For those under 55, aspirin therapy is based on their CV risk profile. Since RL has no CV disease, aspirin therapy is not indicated.
Answer 2 is incorrect. 13.76% of you chose this answer. “Consider stopping empagliflozin and starting GLP-1 RA to help with weight loss.” This is not the best answer since there is no reason to stop empagliflozin when starting a GLP-1 RA. In addition, there is no mention in the vignette that RL has weight loss as a goal, so switching from an SGLT-2 to a GLP-1 is not indicated at this time.
Answer 3 is incorrect. About 9.27% of respondents chose this. “Consider adding an ACE or ARB and increasing basal insulin.” This is not the best answer, since the first part of the response isn’t correct. RL has great renal function and their BP is below the target of 130/80, so an ACE or ARB is not indicated at this time.
Finally, Answer 4 is incorrect. 16.07% chose this answer. “Consider increasing metformin and decreasing basal insulin.” This is not the best answer, since the metformin is already very close to the maximum dose of 2,550 mg day and we need more information about the fasting blood glucose levels before increasing the basal insulin. Most importantly, the first answer is a better answer.
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 question?
Virtual DiabetesEd Training Conference – Join us Live on April 17th – 19th 2024 at 11:30 AM PST
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, and “aha” moments for our Virtual DiabetesEd Training Conference April 17th – 19th, 2024.
Attendees will leave this conference with new tools and a refreshed understanding of the latest advances in person-centered diabetes care. Our team highlights the ADA Standards of Care, medications, behavior change, technology, medical nutrition therapy, and more!
Our instructors co-teach the content to keep things fresh and lively.
Friend Discount: 3 or more only $449 per person. Email us at [email protected] with the name and email of each registrant to get the discount!
Program Details
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- Dates: April 17-19th, 2024
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- Registration Fee: $399-$569 (see more about reg. options below)
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- Friend Discount: For 3 or more people, each person saves $50 off their registration. Email us at [email protected] with the name and email of each registrant to get the discount!
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- CEs: 30+ CEs | 18 units for Virtual Conference plus 10+ Bonus CEs. CEs can be applied toward CDCES’s initial application or renewal.
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- Speakers: View Conference Faculty
Registration Options
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!
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
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