For last week’s practice question, we quizzed participants on getting glucose to goal. 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: LS wears an insulin pump and uses lispro insulin. LS has an average basal rate of 0.6 units and hour, a 1:15 carb ratio and a 1:50 correction ratio. Based on the ambulatory glucose profile, LS is experiencing elevated glucose levels from 4am to 7am.
To get glucose to target, what is the best next step?
Answer Choices:
Answer 1 is incorrect. 17.81% chose this answer.” Add basal insulin glargine to prevent Somogyi effect.” If a person is using insulin pump therapy, glargine injections would not be added in addition to the pump therapy. In addition, no basal insulins (like glargine) are used in pump therapy, only bolus insulins. Lastly, Somogyi effect is defined as a hypoglycemic event that triggers a burst of counterregulatory hormones that causes a substantial increase in blood glucose. There is no evidence that the person is experiencing hypoglycemia in this scenario.
Answer 2 is correct. 60.30% of you chose this answer. “Increase the basal rate to prevent glucose elevations.” YES, this is the best answer. LS is most likely experiencing Dawn Phenomena, which if the natural rise in blood sugars starting around 3-4 am due to the early morning release of cortisol and growth hormones. By increasing the pump’s basal rate to match this insulin resistant phase, we can help LS get blood glucose closer to target.
Answer 3 is incorrect. About 15.77% of respondents chose this. “Make sure LS isn’t consuming carbohydrates after 10pm.” This juicy answer does not explain why LS’s blood glucose always rises at 4am. Also, people with diabetes have the freedom to eat carbohydrates throughout the day and evening, they would just need to provide adequate bolus insulin coverage for late night carbs.
Finally, Answer 4 is incorrect. 6.12% chose this answer. “Ask LS to double check their CGM insertion site.” Since we can see a pattern of blood glucose levels rising each day at 4am, we assume that the CGM working correctly (we can always double check using a glucose meter to confirm)
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!
Determining basal & bolus rates for multiple daily injections or insulin pumps can seem overwhelming. This course provides participants with a step-by-step approach to determining basal rates, bolus ratios & how to problem-solve when blood glucose levels aren’t on target. During this course, Coach Beverly provides abundant case studies to give participants hands-on practice & build confidence when calculating insulin doses for a variety of situations.
Objectives:
Learning Outcome:
Participants will have an increased knowledge of how to calculate bolus/basal insulin therapy based on person-specific factors and will be able to recommend insulin adjustments based on individual needs.
Target Audience:
This course is a knowledge-based activity designed for individuals or groups of diabetes professionals, including RNs, RDs/RDNs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other healthcare providers interested in staying up to date on current practices of care for people with prediabetes, diabetes, and other related conditions. The practice areas for RDs/RDNs for CDR reporting are healthcare, preventative care, wellness, and, lifestyle along with, education and research.
CDR Performance Indicators:
Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 15 years. She is an Associate Clinical Professor at UCSF, a working educator, and a nationally recognized diabetes expert.
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our Level 4 | Insulin Calculation Workshop | From Pumps & Beyond awards 1.5 CPEUs in accordance with the Commission on Dietetic Registration’s CPEU Prior Approval Program.
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.
Diabetes Education Services offers education and training to diabetes educators in the areas of both Type 1 and Type 2 Diabetes for the novice to the established professional. Whether you are training to be a Certified Diabetes Care and Education Specialist (CDCES), practicing at an advanced level and interested in board certification, or a health care professional and/or Certified Diabetes Care and Education Specialist (CDCES) who needs continuing education hours to renew your license or CDCES, we have diabetes education information, resources and training; learning and teaching tools; and diabetes online courses available for continuing education (CE). Read our disclaimer for full disclosure.