For last week’s practice question, we quizzed participants on what the next step for numbness and fatigue is. 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 by clicking here.
A 62-year-old adult with type 2 diabetes has been taking metformin 1,000 mg twice daily for the past 8 years. At a routine follow-up, they report new numbness and tingling in both feet and increased fatigue. Their point-of-care A1C is 7.1%, and a recent nutrition history suggests limited intake of animal-source foods.
What is the most appropriate next step for the diabetes care team?
- A. Ensure the patient has completed a comprehensive foot examination and discuss the risk of diabetic peripheral neuropathy
- B. Recommend increasing dietary protein and iron intake to treat potential nutritional anemia
- C. Obtain a serum vitamin B12 level and evaluate for deficiency.
- D. Recommend adding another glucose-lowering medication because their A1C is above the ADA Standard of Care target.
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 A is incorrect. 16.79% chose this answer: “Ensure the patient has completed a comprehensive foot examination and discuss the risk of diabetic peripheral neuropathy.”
An annual comprehensive foot examination is important and may identify loss of protective sensation; however, new numbness and tingling justify further evaluation. Keep reading to learn more.
Answer B is incorrect. 8.55% of you chose this answer, “Recommend increasing dietary protein and iron intake to treat potential nutritional anemia.”
Fatigue may be associated with anemia, and assessing overall dietary adequacy in the setting of low animal-based foods is appropriate. However, this may not address the new numbness and tingling in the feet and may miss other nutritional deficiencies.
Answer C is correct. 65.65% of respondents chose this: “Obtain a serum vitamin B12 level and evaluate for deficiency.” Great job! This is the correct answer.
Long-term metformin use, along with low animal-based food intake, puts this individual at risk for vitamin B12 deficiency. Vitamin B12 deficiency can cause fatigue, anemia, and neurologic symptoms that may resemble or contribute to diabetic peripheral neuropathy. In addition to other assessments, requesting a serum vitamin B12 and/or methylmalonic acid level is an appropriate next step.
Finally, Answer D is incorrect. 9.01% chose this answer, “Recommend adding another glucose-lowering medication because their A1C is above the ADA Standard of Care target.”
Although an A1C of 7.1% may exceed an individualized glycemic target, we should determine the need for additional glucose-lowering medication based on the patient’s treatment goals and overall clinical status, which we don’t have enough information to define. In addition, intensifying glycemic management would not address the immediate need to investigate new neurologic symptoms and fatigue.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Test You Knowledge Tuesday and participate in this fun learning activity!
Want to Learn More?
Join Coach Bev on November 13 for
From Gut to Butt - Exploring the GI System | Level 5
Explore the magnificent world of diabetes and the gut — from periodontal disease to the microbiome and everything in between.
The GI system plays a far bigger role in diabetes than most clinicians realize. Join Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM for a fascinating journey through gastrointestinal health from top to bottom. This course covers fatty liver disease, gastroparesis, intestinal complications of diabetes, the gut microbiome, and more — giving you the knowledge to better support whole-body health.
