For last week’s practice question, we quizzed participants on reviewing insulin dosing adjustments. 69% 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: JR lives with type 1 diabetes and severe gastroparesis, despite maintaining an A1C of less than 7% for the past few years.  The endocrinologist referred JR to a GI specialist, who recommended a surgical procedure called a Gastric Peroral Endoscopic Myotomy, G-POEM, to address JR’s longstanding gastroparesis.

JR asks what you think about this intervention.  What is the best response?

Answer Choices:

1. It sounds like you are worried about the effectiveness and risks of this procedure. Is that right?
2. Tell me more about what your GI doctor told you about this procedure.
3. I know you are frustrated, but the primary treatment for gastroparesis is low fiber meals.
4. Usually, gastroparesis improves as your A1C reaches target so I would wait and see if things improve.

---

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. 28.90% chose this answer. “It sounds like you are worried about the effectiveness and risks of this procedure. Is that right?” This tempting answer is not the best answer since JR never states that they are worried about the effectiveness of the G-POEM. Instead they just want to see what the Diabetes Care and Education Specialist thinks about this procedure. When in doubt, re-examine the key intent of the question.

Answer 2 is correct. 69.27% of you chose this answer. “Tell me more about what your GI doctor told you about this procedure.” YES, this is the BEST answer. Great job. By asking what JR knows about the procedure, we provide JR an opportunity to share their knowledge and assess areas of concern. In addition, we may let JR know that we haven’t heard of this procedure, but we will look into it.

Answer 3 is incorrect. About 0.92% of respondents chose this. “I know you are frustrated, but the primary treatment for gastroparesis is low fiber meals.” It is true that we recommend low fiber meals for gastroparesis, but JR was asking about a procedure not meal planning.

Finally, Answer 4 is incorrect. 0.92% chose this answer. “Usually, gastroparesis improves as your A1C reaches target so I would wait and see if things improve.” It is true that the stomach is better at moving its’ content forward when blood sugars are closer to target most of the time. But, sometimes, despite having an A1C on target, severe autonomic neuropathy interferes with stomach propulsion past the pyloric sphincter.

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 the GI System and Diabetes?

From the Gut to the Butt – Exploring the GI System FREE Webinar

Now Recorded & Ready to Watch

Coach Bev invites you to join this 60 minute webinar that covers gastrointestinal health from top to bottom. Topics include; fatty liver disease diagnosis and treatment, intestinal complications associated with diabetes, keeping the microbiome healthy, and more. Join us to explore the magnificent wonders of diabetes and the gut.

Getting to the Gut Topics:

• From the Mouth to Intestines: Periodontal disease, Gastroparesis, Fatty liver disease, pancreas disorders
• Intestine as an Endocrine Organ & Bacterial Host
• NASH Treatment Options including lifestyle and pharmacotherapy
• State the relationship between gut health, microbiome and diabetes and inflammation
• Describe 3 strategies to get our microbiome back to better health.

Can’t make it live? No worries. We will send post the recorded version to the Online University within 24 hours of the broadcast

Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF, a working educator, and a nationally recognized diabetes expert. She has a Master’s Degree in Public Health from UCLA, with a focus on behavioral health and education.

All hours earned count toward your CDCES Accreditation Information

---

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!

---

The use of DES products does not guarantee the successful passage of the diabetes certification exams. CBDCE & ADCES does not endorse any preparatory or review materials for the certification exams, except for those published by CBDCE & ADCES.