Our September 21st Question of the week quizzed test takers on Intensive Insulin Therapy with A1c 6.2%. Three quarters (74%) of respondents, chose the best answer. We are excited to share info so you can pass on correct info to people living with diabetes and your colleagues.

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: HR is a 78-year-old with a stroke and limited cognition with diabetes for 8 years and is on intensive insulin therapy:  HR takes bolus insulin at meals and basaglar at night. HR has an A1c is 6.2% and employs a part time caretaker.

What is the best response in this situation?

Answer Choices:

• Start HR on an insulin pump and CGM to prevent hypoglycemia.
• Discuss de-intensifying insulin regimen.
• Using a strength-based approach, reinforce the importance of keeping the A1c less than 7%.
• Evaluate for diabetes related distress.

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

Getting to the Best Answer

If you are thinking about taking the certification exam, it is helpful to know the goals of care and considerations for people with diabetes across the lifespan. 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” that seem so familiar to you, right under your nose. Your job is to weed through the to choose the BEST answer.

Answer 1 is incorrect. 8.20% chose this answer, “Start HR on an insulin pump and CGM to prevent hypoglycemia.” This is not the best answer because we want to provide person-centered care based on the unique situation of this individual. HR has a history of a stroke, limited cognition and relies on a part time caregiver.  It doesn’t seem realistic to provide pump and CGM training to HR given the cognitive limitations and the caregiver is only part-time.  It is unlikely that the two of them would be comfortable enough or have the skill level to help oversee this complex technology and changing insertion sites.

Answer 2 is correct. 74.17% of you chose this answer, “Discuss de-intensifying insulin regimen.” YES. This is the best answer.  Since HR is on multiple daily injections and has an A1c in the low 6% range, we know they are most likely experiencing episodes of hypoglycemia.  To address this, we would need to discuss goals of care with HR and their caregivers and share our concerns about the risk and danger of hypoglycemia.  We need to de-intensify this management plan. Based on the outcome of the discussion with HR, this could be accomplished by: reducing the overall insulin dose, switching to twice a day 70/30 insulin, or evaluating if oral medications could be trialed to reduce the need for insulin.

Answer 3 is incorrect. 6.46% of respondents chose this answer, “Using a strength-based approach, reinforce the importance of keeping the A1c less than 7%.” Using a strength-based approach is always a good idea, but the main issue in this question is that HR’s A1c is only 6.2%.  According to the ADA Standards of Care, the A1c target in this situation would be individualized based on safety considerations, quality of life, and the goals and values of the person living with diabetes. For older, frail individuals at risk of hypoglycemia, a safer A1c target would be 7% – 8%.

Finally, Answer 4 is incorrect. 11.17% chose this answer, “Evaluate for diabetes-related distress.” Even though it is always important to consider people’s emotional response to diabetes, this answer does not address the key issue presented in this question. The first priority would be to make sure HR is safe, with a reduced risk of hypoglycemia and a realistic insulin regimen.

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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• Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
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In addition to informative lectures, we also use group activities and case studies to highlight the essential knowledge, skills, and strategies needed to succeed in diabetes education today!

CEs: Includes over 30 CEs
Program Info: 2021 Diabetes Educator Course Flyer & Schedule (subject to change)
Speakers: View Conference Faculty.
Dates: Your registration fee includes access to FREE podcast and all recorded webinars for one year.

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• Presentations by our team of experts
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2021 Diabetes Educator Course Flyer & Schedule (subject to change)

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Virtual DiabetesEd Specialist Conference Basic | Oct. 6-8 | 30+ CEs

Basic virtual program for $359 includes:

• Presentations by our team of experts
• Q & A Session with the instructor after each webinar
• State-of-the-art review of current diabetes care and technology.
• Resources for each session
• Access to FREE podcast and recorded webinars within a week of each live session for one full year.

2021 Diabetes Educator Course Flyer & Schedule (subject to change)

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Team of Experts: Our team of expert faculty has been fine-tuning this course for over fifteen years and we know what you need to succeed! In addition to informative lectures, we also use group activities and case studies to highlight the essential knowledge, skills, and strategies needed to succeed in diabetes education today!

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Bonus Courses worth 12+ CEs, FREE

When you register for our Virtual Course, you have immediate access to these Bonus DiabetesEd University Online Courses – for FREE!

• Test Taking Toolkit – Over 200 sample test questions!
• Level 2 – Assessing and Promoting Well-Being: From Population Health to a Person-Centered Approach 1.5 CEs
• Level 2 – Hospital and Hyperglycemia 1.5 CEs
• Level 2 – Hyperglycemic Crisis, DKA and HHS Standards 1.0 CEs
• Level 2 – Meds Management Update for Type 2 – 1.5 CEs
• Level 2 – Setting up a Successful Diabetes Program 1.5 CEs
• Level 2 – Pregnancy and Diabetes 1.5 CEs
• Level 2 – From Tots to Teens – Diabetes Standards 1.5 CEs
• Level 2 – Older Adults and Diabetes 1.5 CEs
• Mindfulness and Compassion in the Diabetes Encounter – 1.0 CE

2021 Diabetes Educator Course Flyer & Schedule (subject to change)

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