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2018 Annual Questions of the Week
Which of the following meal plans are recommended by the American Diabetes Association?
50% carb, 20% protein, 30% fat (less than 10% saturated fat)
Low protein diet if the GFR is less than 60
According to ADA Standards of Care, if the patient is on maximum dose of Metformin with a history CV Disease and their A1c is not at target, which of the following medications would be added next?
Based on ADA Standards, for people with hypertension, diabetes and proteinuria, which of the following is a correct recommendation?
Inititiate a low protein diet
Start an ACE Inhibitor or ARB
Avoid saturated fats
Refrain from weight lifting
Which of the following is the correct statement for children with type 1 diabetes according to the ADA?
Engage in vigorous physical activity for 30 minutes a day
The overnight blood glucose target is 90-150
Limit added sugar intake to less than 60 gms a day
Insulin pumps are always the preferred treatment strategy
A 29 year old arrives in the emergency room in DKA. She has a known history of type 1 diabetes. Her BMI is 23.9 and she is on intensive insulin therapy and an oral medication to help “clear extra sugar." On admission, her blood glucose is 149, her pH is 7.2 and she is ketone positive. What is the most likely cause?
She is taking a SGLT-2 Inhibitor.
She is omitting her insulin to lose weight.
There is a lab error in the glucose reading.
New onset celiac disease.
JR has prediabetes and is worried about his LDL cholesterol of 128 mg/dl. He asks you what changes would help to decrease his LDL cholesterol. Which of the following is the best response?
Decrease consumption of beef and pork.
Increase consumption of chicken and white meats, decrease intake of red meats.
Increase consumption of fiber rich foods and decrease consumption of dairy products.
Eliminate all fat from diet.
ML has new type 2 diabetes and wants to attend a local Diabetes Self Management Program. She wants to know if her type of Medicare Coverage will pay the program costs. Which of the following Medicare Plans will cover 80% of DSME Costs?
Medicare Part A
Medicare Part B
Medicare Advantage Part C
Medicare Part D
Both B and C
LR is a 29-year-old trying to get pregnant, but having difficulty due to Polycystic Ovary Syndrome (PCOS). She asks you if she is at risk of getting type 2 diabetes. Which of the following is an accurate statement?
PCOS is not associated with type 2 diabetes
Women with PCOS are at increased risk of type 1 diabetes
Insulin resistance is present in both PCOS and type 2 diabetes
PCOS is associated with increased insulin sensitivity
One of the leading complications of diabetes is cardiovascular disease. Which of the following is an accurate statement regarding CV disease and women?
Women with diabetes have lower rates of CV disease than men overall
Women with diabetes have lower rates of CV disease before menopause than men
Women with diabetes only have higher rates of stroke than men with diabetes
Women with diabetes have higher CV mortality rates than men with diabetes
LR has type 2 diabetes, BMI of 29.1, takes metformin 1000mg and 20 units of glargine at home daily. A1c is 8.2%. LR is admitted to the hospital for an urgent coronary artery bypass surgery. Which of the following is an accurate statement?
LR may need double his usual insulin home dose post-op day 1 and 2.
LR is at low risk of a sternal wound infection.
LR is very insulin sensitive and at high risk for hypoglycemia.
LR will need to go on basal bolus therapy after discharge
AJ is 67 years old and wants to attend your ADA Recognized Diabetes Self-Management Program. Which of the following is true?
AJ can see the diabetes educator for individual appointments at least six times a year
AJ can come to the clinic for his MNT and DSME assessment appointment on the same day
AJ can attend DSME classes held in a community center
Medicare will cover 80% of cost of DSME, AJ is responsible for the other 20%
The rates of gestational diabetes (GDM) are increasing in the United States. Which of the following is true?
Children born to women with GDM have lower rates of type 1 diabetes.
Risk of GDM can be decreased by getting to healthy weight pre- pregnancy.
GDM is defined as elevated blood glucose levels discovered anytime during pregnancy.
Women with GDM can control glucose through diet changes only.
PR is getting ready to be discharged from the hospital after being admitted for an infected foot ulceration. What is an essential survival skill to prepare for a safe discharge?
Adjusting insulin for exercise
Eating 45-60 gms of carb per meal
Action to take if BG above target
Importance of avoiding sugary foods to promote healing
Which of the following is an accurate statement regarding diabetes in youth?
Rates of type 1 are increasing, especially for children under the age of five
Latino children have lowest rates of type 2 diabetes
Babies who are small for gestational age (SGA) are at low risk for type 2 diabetes
Babies whose mom had gestational diabetes are more likely to experience hyperglycemia
What is true regarding new diagnosis of type 1 diabetes in youth?
Children with type 1 diabetes present with glucose levels greater than 600 mg/dl
Children with new type 2 never present with positive urine ketones
Type 1 diabetes usually skips a generation
At diagnosis of type 1, up to 40% of beta cells may still be present
According to the 2018 ADA Standards of Care on Cardiovascular Disease and Diabetes Management, which of the following is true.
Start all people with type 1 diabetes on an ACE Inhibitor
Start people on combo of ACEi plus ARB if they have type 2 diabetes and resistant hypertension.
Stop beta blockers for people with diabetes on insulin therapy
Start people being treated for hypertension on daily home blood pressure monitoring
Which of the following is the BEST strategy to succeed at the CDE Exam?
Read everything you can about diabetes management
Take as many practice tests as possible
Focus study time on the content you are most familiar with
Seek out information to help fill in knowledge gaps
Both b and d
JL weighs 70 kg and takes 35 units of glargine at hs. Creatinine is 1.4, GFR 51. She also takes lispro, 5-7 units at each meal. For the past week, these are her fasting blood glucose levels: 95, 98, 79, 81, 73, 69, 71. Based on this information, what action would be recommended?
Adjust lispro at meals by 1 unit
Reduce glargine by 4-7 units
Make sure she has a bedtime snack
Request she check pre and post meal glucose levels
Breastfeeding, if possible, offers both baby and mom health benefits. Which of the following is true?
Breast-milk contains oligosaccharides which nourishes the infants’ gut bacteria.
Breastfeeding reduces mother’s risk of getting type 2 diabetes by 50%.
Breastfeeding guarantees that neither baby or mother will become obese.
Both a and b
JR has been a diabetes educator for over 11 years. Lately, JR has been finding it hard to concentrate during participant assessments and often misses key information that would be helpful to support behavior change. JR confides in you and ask for suggestions to help get back on track. Which of the following actions would JR benefit from?
Exploring reasons why JR is finding it hard to focus
A long vacation
Both a and c
SL is a vibrant 52 year old with newly diagnosed diabetes and a history of bladder cancer. A1c is 8.7% and creat is 1.1, GFR > 60. SL is on metformin 1000mg BID and her provider recently added dapagliflozin (Farxiga) 5mg daily to get blood glucose under better control. As a diabetes educator and consultant to SL’s provider, what is the best action?
Request that the provider stop the metformin to protect the kidneys
Advise SL to hold both medications for 72 hours after a dye study
Encourage SL to drink at least 64 ounces of water today
Alert referring provider about risk of dapagliflozin and bladder cancer
Which of the following insulins can you mix with dedgludec (Tresiba)?
Only Aspart (Novolog)
Any of the insulin analogs
LS is interested in eating healthier and wants to decrease intake of saturated fat. Which of the following foods contain saturated fat?
SL is living with type 1 diabetes and considering getting pregnant. When is the most critical time for blood sugar management during pregnancy?
weeks 24- 28
Children with diabetes need to get regular exercise. What's the recommended amount of time for vigorous activity for an obese child?
MR uses an activity tracker to monitor his daily steps. On average he takes 8000 steps a day. He asks you how many miles he is walking daily?
JT has come into the clinic with weight loss and intestinal cramping. What is the accepted test to determine if someone has Celiac Disease?
Celiac immunity antibodies
Which of the following autoimmune conditions is most commonly found in someone with type 1 diabetes?
SL has been on metformin (Glucophage) for the past few years but his A1c was still above target. The provider added acarbose (Prescose) TID a few weeks ago. He comes to your office and reports flatulence and other GI discomfort. Which of the following is likely the cause of his symptoms?
new onset gastroparesis
LR is a 15-year-old with type 1 diabetes on an insulin pump. She plans to do a 3 mile run. She ate lunch 2 hours ago and her two recent blood sugars were 262 and 284. What is the best action?
Delay exercise for at least 30 minutes
Drink water immediately
Check for ketones
Bolus 1 unit of insulin for every 50 mg/dl above target
LS has type 2 diabetes in the hospital, and is ordered for 60 units of Lantus at bedtime. LS is eating 30-45g of carbs with each meal. The am blood glucose levels have been below 70 mg/dl two days in a row. In order to prevent future hypoglycemia, which healthcare professional needs additional coaching the most?
The health of our gut microbiome has been linked to the overall health of our body. Which of the following statements is true about our gut microbiome?
Eating a wide variety of fiber foods increases the availability of short chain fatty acids in the intestine
On average, the gut microbiome weighs about a pound
Taking Proton Pump Inhibitors (PPIs) is associated with increased microbial diversity
Regular consumption of probiotics capsules has been shown to increase levels of Prevotella
LT is 43 with new type 2 diabetes and smokes a pack of cigarettes daily. He is on metformin (Glucophage) 2,500mg daily. In spite of attending a DSMES program and making lifestyle changes, LT's A1c is 8.4%, GFR is greater than 60. According to the new ADA/EASD Type 2 management guidelines, which of the following would be the preferred action?
Start LT on a low dose sulfonylurea
Start LT on empaglifozin (Jardiance)
Gently encourage LT to stop smoking
Start LT on a once a week GLP1-RA
At your diabetes support group, a 78-year-old says they had chest pain during the week and took nitroglycerin and the pain went away. They mentioned that they have never had to use nitroglycerin before and it has been sitting in the medicine cabinet for over a year. What is the diabetes educator's best response?
Please monitor your blood pressure daily at home
Please keep a close record of how often you’re taking nitroglycerin and bring to your next provider visit
Ask if they are taking their Statin on a daily basis.
Strongly encourage person to report this to their provider immediately.
JR uses an insulin pump to manage his type 1 diabetes and is in the hospital for diagnostic testing and the physician has ordered an MRI. Which action is most appropriate?
Instruct JR to keep his insulin pump on, but make sure alarm settings are turned off.
Check JRs blood glucose before starting MRI and if above 200 mg/dl, instruct JR to give 2 unit bolus.
Ask JR what he feels would provide the best blood glucose control.
Assess JR’s blood glucose and remove the insulin pump just before the MRI.
TS is ready to transition from 4 daily insulin injections to using an insulin pump. TS has a current A1c of 6.9%. Which of the following would help determine his insulin needs on the pump?
Determine his current total daily insulin dose and divide by 24 hours, to calculate the basal rate.
To determine hourly basal rate, divide total daily dose by 50% and then divide by 24 hours.
To determine carbohydrate to insulin ratio, use the formula 450 divided by current total daily dose.
For the first 48 hours, start his basal at 0.5 units per hour and set the carbohydrate ratio to 1 unit for 15 gms.
Which of the following match the 2018 ADA's/EASD Consensus Statement regarding management of hyperglycemia and type 2?
Encourage patient centered compliance
Start with metformin, then add a DPP-IV Inhibitor if A1c is not at target
Maintain A1c less then 6.5%
Consider using a SGLT-2 Inhibitors for those with chronic kidney disease
Sound the Alert is a day dedicated to finding those who have diabetes and don’t know it. Which of the following statements is correct?
45 percent of people in U.S. either have prediabetes or diabetes
90 percent of people with diabetes don’t know they have it
50 percent of Caucasians have type 2 diabetes and don’t know it
30 percent of people with type 2 actually have LADA
Which of the following phrases uses recommended language when working with or discussing people with diabetes?
MJ is really suffering with her diabetes and ongoing hyperglycemia.
Would you like to consider checking your blood sugar daily?
We don’t recommend you skip breakfast.
Normal people have A1c’s less than 5.7%.
The 2018 ADA Standards of Care includes updates to the Pharmacologic Algorithm to manage hyperglycemia for individuals with type 2 diabetes. Which of the following accurately reflects updates to the algorithm?
Start insulin therapy if A1c is 9% or greater
Try Lifestyle Management for 3 months before starting metformin
When adding a second agent, consider a medication proven to reduce cardiovascular mortality.
Avoid use of all injectables and oral meds that contribute to hypoglycemia
The 2018 ADA Standards of Care include updates to the Cardiovascular Disease and risk management section. Which of the following accurately reflects updates to this section?
All hypertensive patients with diabetes should monitor home blood pressure.
The new B/P goal is 130/80 to match the American Heart Association’s goal.
All patients with type 1 diabetes should be started on an ACE Inhibitor.
Beta blockers should be avoided for all patients on insulin therapy.
Semaglutide (Ozempic) is a newly approved GLP-1 Receptor Agonist with a few unique features. Which of the following statements is true about Semaglutide (Ozempic)?
It is available as an oral medication or injectable
It reduces A1c less than other GLP-1 RAs
It is associated with greater weight loss than other GLP-1 RAs
It can be administered via pump
A new biosimilar insulin, lispro (Admelog) is now FDA Approved. Which of the following statement is true about biosimilar insulins?
Biosimilar has the same meaning as generic
Biosimilar means that the product is highly similar
Biosimilar means the structure is slightly different, but the function is similar
Biosimilar means the function is slightly different, but the structure is similar
Ertugliflozin (Steglatro) is a newly approved SGLT-2 Inhibitor. Teaching points for patients include which of the following?
This medication frequently causes nausea
Only take this medication on empty stomach
Expect decreased urination
Report any signs of DKA immediately
Based on the new AADE recommendations regarding language in diabetes care and education, which of the following statements best reflects the preferred approach when addressing people living with diabetes?
Diabetic patients can live long healthy lives by taking charge of their blood sugar levels
You can control your diabetes by making small changes in your daily life
Testing your blood sugar empowers your self-care decisions
In our Diabetes Program, we will share strategies to help you manage your diabetes
Which phrase represents the principles for communicating with and about people living with diabetes?
John is non-adherent to his insulin regimen and is not taking his insulin as prescribed
John is in denial about his diabetes and frequently skips his insulin
John is taking his insulin about 50% of the time
John doesn’t seem to care about his diabetes control at this time
JL has had diabetes for 16 years. After meeting with the diabetes educator and determining weight loss strategies, JL has lost 9 lbs over the past 3 months. Which of the following is an appropriate response from the diabetes educator?
I am so proud of JL. She really stuck to her goals and had success.
I knew my plan would work and look at her success!
Without our team of educators, JL would have not met her goals.
I got her to decrease her intake of sodas and she lost 9 pounds.
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