Our December 15th Question of the week was tricky and over 59% of respondents, chose the best answer.

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: JL is a 78-year-old with type 2 diabetes who has been taking metformin 1000mg BID for the past year. JL checks BG each morning and says it usually ranges from 100 – 138.  Her most recent A1c came back at 9.6% and the provider started her on dapagliflozin (Farxiga) 5 mg daily two days ago. JL arrives at the clinic in a panic and says has been checking her blood glucose 3 times a day it has “jumped up to 236 and 242”.  The diabetes specialist double-checked and verified random glucose of 249.  What is the best explanation?

Answer Choices:

• Dapagliflozin is associated with transient hyperglycemia.
• Double-check kidney function to verify GFR is adequate.
• Discovery of hyperglycemia due to random BG checks.
• Hyperglycemia due to the initiation of steroid therapy.

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

Getting to the Best Answer

If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. This question lures test takers into trying to make an answer fit. Get rid of wrong answers first and choose the best answer.

Answer 1 is incorrect. 15.53% chose this answer. “Dapagliflozin is associated with transient hyperglycemia.” Dapagliflozin (Farxiga) is a SGLT-2 Inhibitor, also known as a “glucoretic”. It causes excretion of glucose from the renal tubules and is not associated with transient hyperglycemia. As a matter of fact, no diabetes medications cause hyperglycemia.

Answer 2 is incorrect. 17.54% of you chose this answer. “Double-check kidney function to verify GFR is adequate.” It is true that people need to have a GFR of 45 or greater to take Dapagliflozin (Farxiga). However, an inadequate GFR is not associated with glucose spikes. Also, the test question gives no data on GFR, so this makes this a very unlikely best answer.

Answer 3 is correct, 59.44% of you chose this answer “Discovery of hyperglycemia due to random BG checks.” Here are the Diabetes Specialist’s notes regarding JL.

JL stopped by the office today worried about sudden blood sugar elevations of 273 in 284 after starting a new medication on Friday for diabetes.

Dr. started JL on Dapagliflozin (Farxiga) half pill once a day and the patient has been taking it for two days now.  JL is nervous about continuing to take it because JL thinks that is causing her blood sugars to elevate. The patient also takes metformin daily.

Before, the patient was only checking her blood sugar once a day and it was always in the morning. Her morning blood sugars were in the 120- 140 range. However, now JL is checking her blood sugars throughout the day and discovered that blood sugars are actually much higher than JL thought because was only checking in the morning. In the office I checked blood sugar it was 251. JL denied fever or cough.

Reassured JL that it was not the Dapagliflozin (Farxiga) causing high blood sugar. Focused on the benefits of Dapagliflozin (Farxiga) including lower blood sugar, lower blood pressure and protection against heart and kidney disease. Reviewed briefly the importance of limiting carbohydrates and juices or sodas until we can get her blood sugars closer to target.

Answer 4 is incorrect, 7.50% of you chose this answer. “Hyperglycemia due to the initiation of steroid therapy.” This is another juicy answer, but since the question doesn’t mention JL is on steroids, this is not the best answer.

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!

Level 1 – Diabetes Fundamentals 2021 Updates

This series is designed for health care professionals who are interested in getting started in diabetes education and for those actively working toward becoming a Certified Diabetes Care and Education Specialist. Each course in this series provides the critical building blocks and foundation for those entering the diabetes field. Plus, they prepare you to advance to our Level 2 Standards of Care Intensive Courses.

Join us for our 2021 Live Webinar Updates. All courses air at 11:30 a.m. (PST)

• January 12, 2021 – Class 1 – Getting to the Nitty Gritty 1.5 CEs
• January 14, 2021 – Class 2 -Nutrition and Exercise 1.5 CEs
• January 19, 2020 – Class 3 – Insulin Therapy & Pattern Management 1.5 CEs
• January 21, 2021 – Class 4 – Meds Overview for Type 2 – 1.5 CEs
• January 26, 2021 – Class 5 – Goals of Care 2020 – 1.5 CEs
• January 28, 2021 – Class 6 – Hypoglycemia, Sick Days, Monitoring, Foot Care 1.5 CEs

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 and Touro University and a nationally recognized diabetes expert.

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!

[yikes-mailchimp form=”1″]

Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.