For last week’s practice question, we quizzed participants on unpredictable glucose patters with bloating and nausea. 76% 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 by clicking here.
CL is a 58-year-old individual with type 1 diabetes for 35 years. Their current therapy includes a CGM with an automated insulin delivery system, and they announce their meal 15-20 minutes before eating. Last HgbA1c is 7.4%, but they report recent worsening, unpredictable glucose patterns. CGM data review shows Time in Range is 62% with 4% below 70 mg/dL. Patterns note after breakfast, glucose drops from 110-130 mg/dL to 60-70 mg/dL within 1–2 hours, then rises to 220-280 mg/dL 3–4 hours later, and after dinner, glucose remains stable initially but rises to 240-280 mg/dL late in the evening. CL also reports an onset of bloating and occasional nausea.
What could be considered a potential contributor to this individual’s glucose variability?
- A. Inaccurate carbohydrate counting creating an increased variability in glucose patterns.
- B. Excess programmed basal insulin causing post-meal glucose fluctuations
- C. Delayed gastric emptying resulting in a mismatch between insulin action and glucose absorption. Consider a referral for a gastric emptying study.
- D. A high-carbohydrate and high-fat dietary pattern causing prolonged glucose elevations after meals.
Getting to the Best Answer
Answer A is incorrect. 4.93% chose this answer: “Inaccurate carbohydrate counting creating an increased variability in glucose patterns.” While carbohydrate counting errors can contribute to glucose variability, CL reports consistent meal announcement and insulin dosing before meals. The CGM pattern is also not typical of carbohydrate-counting challenges alone. A decline followed by a delayed rise several hours after eating suggests that the timing of glucose absorption may not align with insulin action.
Answer B is incorrect. 5.91% of you chose this answer, “Excess programmed basal insulin causing post-meal glucose fluctuations.” Excess basal insulin can contribute to hypoglycemia, but it typically causes a glucose decline independent of meals, and depending on the AID system, basal rate adjustments may not be a factor. CL’s pattern of an early post-meal glucose drop followed by a delayed glucose rise suggests a mismatch between insulin activity and nutrient absorption rather than simply excessive basal insulin.
Answer C is correct. 75.86% of respondents chose this: “Delayed gastric emptying resulting in a mismatch between insulin action and glucose absorption. Consider a referral for a gastric emptying study.” Great job! This is the correct answer. Based on the information we have, CL’s long duration of type 1 diabetes increases the risk for autonomic neuropathy, which can affect gastric motility. The pattern of early post-meal hypoglycemia followed by delayed hyperglycemia 3–5 hours later is characteristic of delayed carbohydrate absorption. New symptoms of bloating and nausea further support the consideration of gastroparesis. Referral for evaluation and possible gastric emptying testing may be appropriate.
Finally, Answer D is incorrect. 13.30% chose this answer, “A high-carbohydrate and high-fat dietary pattern causing prolonged glucose elevations after meals.” This is not the best answer. While it is possible that meals high in carbohydrate and fat can delay gastric emptying and contribute to prolonged post-meal glucose elevations, the early glucose drop followed by a delayed rise, combined with new gastrointestinal symptoms and long-standing type 1 diabetes, makes delayed gastric emptying a more likely primary contributor.
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 this Question?
Join us live in San Diego for our
DiabetesEd Training Program
Brand new agenda for 2026!
🌟Updated Schedule: ADA Boot Camp, Tech, MNT & More
Live in Beautiful San Diego – Oct 22-23, 2026
Re-Ignite your Passion & Prepare for Diabetes Certification Exams
🎓 Earn 30+ CEs: AMA PRA Category 1 Credits™, ACPE, ANCC, and CDR!
📅
2-Day Conference
Oct 22–23, 2026
⏱️
15.5 Live CEs
+ 17 bonus CEs
🏅
CDCES & BC-ADM
Exam Prep + Renewal
📍
San Diego, CA
1.7 mi from airport
Advance Your Expertise and Prepare for Your Future
The field of diabetes care is expanding and evolving rapidly. This unique training conference will keep you on the cutting edge plus prepare you for certification exams. It also fulfills the Standards of Care renewal requirement. Join us for two days of intensive education that is fun and inspiring. Add on the optional Day 3 (Engaging the Disengaged), to complete your conference exeperience.
Day 1 – ADA/AACE Standards of Care Boot Camp
Coach Beverly and Diana Isaacs, PharmD, BC-ADM, CDCES co-lead an exciting day that brings the ADA and AACE Standards to life. Gain fresh insights, practical tools, and a deeper understanding of the latest in person-centered diabetes care. After attending, you will be empowered to share the latest in diabetes care with your colleagues and the people in your care.
Day 2 – Insulin, Tech, MNT and Case Studies
Take your knowledge to the next level with this intensive deep-dive into insulin therapy, dosing and pattern management with Dr. Diana Isaacs. Next, stay for the diabetes tech show-and-tell as Diana demonstrates the specs of the latest pumps and sensors. After lunch, nutrition whiz Christine Craig, MS, RDN, CDCES expertly details the latest in MNT and provides real strategies on translating this content to your clinical practice. You will have a chance to put it all together as Coach Beverly leads you through a series of case studies that integrates content from Day 1 and Day 2.
Add-On Day 3 – Engaging the Disengaged
On Saturday, join this exceptional day-long program led by William H. Polonsky, PhD, CDCES & Susan Guzman, PhD (Behavioral Diabetes Institute) that reveals psychosocial forces behind diabetes self-management — tools to break through resistance and inspire change.
Read more below
🌟Registration Options at a Glance
📜 Essentials
Registration
+ Printed Syllabus
$559.00
🌟 Deluxe
Essentials
+ ADA Standards Book
$589.00
🏆 Complete – Best Value!
Deluxe
+ ADCES Review Guide e-Book
$669.00
5 Reasons to Attend
- Led by national experts 👩⚕️Dr. Diana Isaacs (Cleveland Clinic), Coach Beverly 🧢 (30+ years of experience), and Christine Craig (nutrition whiz).
- 🌴 Location makes for a great vacation
- Networking, walking paths, connection
- Ready yourself for the diabetes future🚀
- Have fun, win prizes, play DiaBingo 😄
What's Included?
- 🍽️ Healthy breakfasts, lunch, refreshments and coffee ☕
- 📘 100-page printed syllabus
- 🎤 2 days of engaging, expert-led education with case studies.
- 🎓 12 FREE online courses ($375 value)
- Free MedPocketCard & Coach Bev’s Book 📗 Healing through Connection.
Add on a 3rd Day!
Enroll in
ENGAGING THE DISENGAGED
Strategies for Promoting Behavior Change in Diabetes
October 24, 2026
Transform how you engage patients with diabetes — master behavior change, reduce distress, and overcome medication hesitancy.
Why do so many patients know what they should do — but still struggle to do it?
The answer lies in the psychology of diabetes.
In this transformative full-day course, world-renowned experts William H. Polonsky, PhD, CDCES, and Susan Guzman, PhD, from the Behavioral Diabetes Institute reveal the hidden psychosocial forces that drive — or derail — diabetes self-management.
You’ll walk away with a completely new toolkit for breaking through patient resistance, dissolving medication hesitancy, and creating clinical encounters that actually inspire change!
