Sept 8, 2020 | Rationale of the Week

Our September 8, 2020, Question of the week quizzed test takers on a complicated case study that asked what was the most important information to share with a person starting on a GLP-1 Receptor Agonist. Although 55% of respondents chose the correct answer, 45% did not. We thought that this was an important topic to discuss further, so we can pass on correct info to people living with diabetes.

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: AJ takes 85 units of basaglar at bedtime and 10 -12 units of glulisine (Apridra) at meals, plus metformin and empagliflozin at maximum dose. Fasting blood sugars are 130 or greater and the rest of the day, AJs blood sugars are in the 200s. AJ has a BMI of 32 and an A1c of 9.3%. The diabetes specialist recommends adding semaglutide (Ozempic) 0.5 mg to the regimen. What teaching information is most important given the addition of this new medication?

Answer Choices:

  1. Report any muscle pain immediately.
  2. Semaglutide needs to be injected before eating.
  3. Make sure to evaluate liver enzymes after 3 months.
  4. Signs of hypoglycemia and appropriate action.

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

Getting to the Best Answer

If you are thinking about taking the certification exam, this vignette practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question and common knowledge. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements, eliminate false answers and choose the BEST answer.

And you may want to Download our Medication PocketCards for detailed info on the available diabetes meds.

Answer 1 is incorrect. 17% chose this answer, “Report any muscle pain immediately”. This is a juicy answer.  It is true that statins, the medication class used to manage lipids in diabetes, can cause muscle pain.  But, the medication being added, semaglutide (Ozempic), is a GLP-1 Receptor Agonist, not a statin.  Its main side effects includes nausea and loss of appetite, but muscle pain is not a common side effect of GLP-1 Inhibitors. This answer is false.

Answer 2 is incorrect. 12% of you chose this answer, “Semaglutide needs to be injected before eating”. This is another juicy answer.  There are 2 forms of semaglutide.  One is Ozempic, it is a once a week injection. People taking this injectable version, do not need to inject on an empty stomach. However, the oral form of semaglutide (Rybelsus), does need to be taken on an empty stomach with only a sip of water (See our Medication PocketCard for more details).

Answer 3 is incorrect. About 17% of respondents chose this, “Make sure to evaluate liver enzymes after 3 months”. It is true that we monitor liver enzymes for people with diabetes if they are on statins or to help screen for fatty liver disease.  However, this GLP-1 Receptor Agonist has no indication to monitor liver enzymes after starting treatment.

Finally, Answer 4 is correct. 55% chose this answer, “Signs of hypoglycemia and appropriate action”. Yes, this is the BEST answer and it was a little tricky. Semaglutide (Ozempic), is a GLP-1 Inhibitor and does not cause hypoglycemia. However, this person is on a 85 units of basal insulin daily, plus 10 -12 units of bolus insulin at meals. With the additional glucose lowering impact of the GLP-1 Receptor Agonist, they are at risk of hypoglycemia from the insulin. Many people actually require a decrease in their insulin dose when adding on or increasing the dose of a GLP-1 RA.

Download our Medication PocketCards for detailed info on the available diabetes meds.

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!


The next Summer 2020 Boot Camp session is September 23rd, 2020

In each webinar, either Coach Beverly, Dr. Isaacs, or Ms. Armstrong, highlight the critical content of each topic area, so you can focus your study time most efficiently. They also launch multiple poll questions to help participants focus on key concepts and assess their knowledge while learning the best test-taking strategies. 

2020 Boot Camp Live Stream Webinar Schedule with Coach Beverly

All courses air at 11:30 a.m. (PST)

  1. Diabetes – Not Just Hyperglycemia | Sept 16
  2. ADA Standards of Care | Sept 23
  3. Insulin Therapy – From Basal/Bolus to Pattern Management | Sept 30
  4. Insulin Intensive – Monitoring, Sick Days, Lower Extremities | Oct 7
  5. Meds for Type 2 | Oct 14
  6. Exercise and Preventing Microvascular Complications | Oct 21
  7. Coping & Behavior Change | Oct 28
  8. “The Big Finish” Test Taking Boot Camp | Nov 4

Can’t make it live?
No worries! All video presentations and podcasts will be available now on-demand.


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AccreditationDiabetes 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.

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