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Rationale of the Week | “I take insulin when I feel like it”

We quizzed test takers on identifying why a teenager with type 1 is only taking insulin “when they feel like it”. 73% of respondents, chose the best answer. We want to share this important info so you can pass it on to people living with diabetes, your colleagues and 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 below: Answer Question

Question: JR is a 15-year-old admitted to the hospital with DKA for the second time this month.  JR says they are tired of their parents always telling them how to manage their diabetes. They just stopped wearing their continuous glucose monitor and tell you they “take insulin when they feel like it”. 

What best describes what this teenager is experiencing?

Answer Choices:

  • Diabetes distress.
  • Diabetes burnout.
  • Severe anxiety.
  • Fear of hypoglycemia.

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

Getting to the Best Answer

Answer 1 is incorrect. 24.39% chose this answer, “Diabetes distress.” JR certainly is dealing with aspects of diabetes distress, which is described as feeling like it’s too much or that things are out of control. However, the fact that “JR just stopped wearing their continuous glucose monitor and is only “taking insulin when they feel like it”, gives us a more complete understanding that JR is experiencing more than distress. Please see our blog on How to Identify Diabetes Distress and Burnout.

Answer 2 is correct. 73.17% of you chose this answer, “Diabetes burnout.” YES, this is the BEST ANSWER. Great job! Diabetes burnout is an emotional reaction that is usually more intense than diabetes distress. A person in the state of burnout is someone with diabetes who has grown tired of managing their condition, then simply ignores it for a period of time. The fact that JR stopped wearing their CGM and only takes insulin when they feel like it, are strong indicators that JR is on a diabetes vacation and is burned out. This might mistakenly be perceived as non-compliance, but these behaviors indicate that JR is really struggling and needs the support of the health care team. Visit our page on Diabetes Burnout or Distress? 12 Reframes that can HELP for ideas to support people struggling with their diabetes self care.

Answer 3 is incorrect. 1.33% of respondents chose this answer, “Severe anxiety.” Hardly any of you chose this because in this vignette, JR is not exhibiting any signs of anxiety. Good job.

Finally, Answer 4 is incorrect. 1.11% chose this answer, “Fear of hypoglycemia.” Since this vignette does not mention that JR has experienced lows or that JR lets blood sugars run high to prevent lows, this is not the best answer. Good job.

Learn more about Diabetes Distress in our December Newsletter.

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? Join our Webinar on Hyperglycemic Crisis, which is ready for viewing!


Want to learn more about this topic?

Enroll in our Level 2 | Assessing and Promoting Well-Being: From Population Health to a Person-Centered Approach Standards | 1.5 CEs

Updated for the new 2022 ADA Standards of Care

This presentation will include the latest information on Social Determinants of health, assessment strategies, and approaches. We will explore the psychosocial issues that can discourage individuals from adopting healthier behaviors and provides strategies to identify and overcome these barriers. Life studies are used to apply theory to real-life situations. A great course for anyone in the field of diabetes education or for those looking for a new perspective on assessment and coping strategies.

Objectives:

  1. State strategies to assess and address social determinants of health
  2. Discuss health care delivery systems using a person-centered approach
  3. List screening tools that can help detect distress, depression, trauma, and cognitive decline
  4. Describe psycho-social and emotional barriers to diabetes self-management
  5. Provide strategies for healthcare professionals to identify and overcome barriers to self-care

Intended Audience:  A great course for healthcare professionals in the field of diabetes education looking for a straightforward explanation of identification and treatment of hyperglycemic crises.

Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator and a nationally recognized diabetes expert.

Enroll in our entire Level 2 – Standards of Care to join us for the below 2022 Live Webinar Updates. All courses air at 11:30 a.m. (PST)

All hours earned count toward your CDCES Accreditation Information


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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.

**To satisfy the requirement for renewal of certification by continuing education for the Certification Board for Diabetes Care & Education (CBDCE), continuing education activities must be applicable to diabetes and approved by a provider on the CBDCE List of Recognized Providers (www.cbdce.org). CBDCE does not approve continuing education. Diabetes Education Services is accredited/approved by the Commission of Dietetic Registration which is on the list of CBDCE Recognized Providers.

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