Hyperglycemic Crisis and a Foot Sore| Rationale of the Week

Quick confession. I had an ulterior motive to last week’s question of the week. I saw a disturbing and heartbreaking report, that during the pandemic, the rate of lower extremity amputations has tripled. This sudden increase is due to combination of wound clinic closures and people’s reluctance to enter health care settings to receive treatment and expose themselves to COVID. This article in Diabetes Care reports success remotely treating ulcerations and lower extremity infections with antibiotics and other modalities.

As Diabetes advocates, we can help decrease amputation rates during this pandemic. We can encourage people to report lower extremity sores, ulcers or other problems promptly, so they can receive early treatment and prevent far worse outcomes.

Our September 30th Question of the week quizzed test takers on reasons behind a sudden spike in glucose levels. 87% of respondents chose the correct answer, our best score to date. Congratulations!

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: LT, a 59-year old with type 2 diabetes presents to the hospital in a hyperglycemic crisis. LT has a history of hypertension, peripheral vascular disease and smokes a pack per day. LT states they have been taking 1000mg metformin BID and 10 units basaglar every night as usual. LT tells you they are stressed out and concerned about a foot sore that doesn’t seem to be getting better. LT is trying to stay home and avoid other people, to prevent getting COVID. LT’s A1C is 8.8%.

What is the most likely cause of this sudden hyperglycemia?

Answer Choices:

  1. Stress eating due to isolation.
  2. Untreated infection.
  3. Rationing medications due to financial hardship.
  4. Insulin resistance secondary to cigarette smoking.

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

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. 6.41% chose this answer, “Stress eating due to isolation”. It is true that people often respond to stressful situations by eating more or sometimes decreasing food intake. However, since LT is taking diabetes medication and insulin, increasing food intake is very unlikely to create a hyperglycemic crisis. And, more than that, there is a better answer.

Answer 2 is correct. 87% of you chose this answer, ” Untreated infection”. Sometimes the “no-frills” answer is the best answer. In the vignette, “LT tells you they are stressed out and concerned about a foot sore that doesn’t seem to be getting better”. During the pandemic, the rate of lower extremity amputations has tripled due to wound clinic closures and people’s reluctance to enter health care settings to receive treatment and expose themselves to COVID. This article in Diabetes Care reports success remotely treating ulcerations and lower extremity infections with antibiotics and other modalities. Please encourage people to report lower extremity sores, ulcers or other problems so they can receive prompt treatment and prevent far worse outcomes.

Answer 3 is incorrect. About 2% of respondents chose this, “Rationing medications due to financial hardship.” Although this is a tempting choice, there is no mention that LT has financial problems, so we can’t infer that he does. We can only use the information contained in the vignette.

Finally, Answer 4 is incorrect. 5% chose this answer, “Insulin resistance secondary to cigarette smoking”. While it is true that smoking increases insulin resistance, this isn’t a new habit. He is an established smoker so his usual smoking wouldn’t lead to a sudden glucose spike.

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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AccreditationDiabetes 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.

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