At this point do you think it’s worthwhile to still go over the exam at the back of the essentials? Or have there been enough changes with the updates that’ll mess us up?

Anna

Hello,

I always seem to struggle with the organisation of care questions.  The langage is always difficult for me to wrap my head around.

I also study in english and write the exam in french which might not be ideal.

Any suggestion answering these questions?

Thanks

Gina

Hi Esmond,
Thanks for the opportunity to ask questions.
Maybe I am just missing something but I find that the appendix for renal adjustments and the recommendations in the 2020 update don’t align for the SGLT2 inhibitors.
Should I just  go by the general recommendation to not start for glycemic lowering effect if <45 ml/min but yes for CV renal protective effects? The appendix says to not start cana and empa for glycemic lowering if less than 60.
Hope this question makes sense.
Thank you!
Allison

1. Why are there two different sets of 75gm OGTT results for diagnosing gestational diabetes in pregnancy? In Manitoba we use the higher limit. Is this most common across Canada?

My opinion only but I think with the variety of new medications that timeline of 6-10 years is not accurate anymore.

Hi. Can you please clarify  if CKD falsely lowers or raises A1C?  Seems like some of the readings say it increases and other lowers?
Thanks so much
Joanne

Hi Esmond,
Please find my questions for the May 25th,  Q&A below:
For the studies, how much of the stats do we need to know as there are many specifics within each study?
There are different guidelines for insulin titration for children compared to adults, especially for insulin pumps. Do we need to know these differences or is it enough to go with the titration instructions as outlined in Appendix 9 of the CPGs for the exam?
I attended the Diabetes Frontline Forum on May 14th, 2022 and one of the presenters had flagged dapagliflozin as “use with caution” for those with a history of bladder cancer. Thus if this question comes up on the exam is it still contraindicated for bladder cancer? I’m confused about the conflicting messages around this.
That’s all I have for now. I’m looking forward to tomorrow’s session.
Thanks,
Mosadi

Hi Esmond,
Here are my questions,
1. Regarding BG self monitoring frequency recommendation, the answer to one of your exam questions is >= 3 times a day for insulin injection BID. The guideline indicated SMBG at least as often as insulin is being given.
Could you please clarify that?
2. Regarding Dapagliflozin with bladder cancer concern, understand that Guideline has not been updated. So if we go by guideline in the exam, is it wrong?
Thank you!
Kathe

Hi Esmond
I would like to clarify:
when we calculate carbs,  the sugar alcohol should be substracted like fibres or should be included in calculation?
Thanks
Marina

Hi Esmond,
I just have two questions

Thanks Esmond for Q&A update. My only questions are words of wisdom in general and perhaps Renal, like review or highlight eGFR. If more specific questions have come up that answer this then that’s great. Oh and perhaps the newer combination medications do we need to know them all? Lots of new meds in the last 5 years that I d o not see in CPG’s but were on your test exams.

Tips
1) Remain calm and go with the answer that you first selected. The people I know that have failed the test panicked and kept changing their answers. Everyone is nervous and that is normal, especially if this is the first time you are writing. Even I was nervous, even though I have taught dozens of other people, have written the exam before and have created tests. Take a few deep breathes and remain calm.
2) Do not waste too much time on any one question. You have 165 questions in 3.5 hours so 1.25 minutes per question. Remember there are twenty five “pilot” questions that are simply being tested and do not count. So if you spend 10 minutes on a tricky question that is worth nothing then you have wasted a lot of time.
3) Read the question slowly and carefully.
Some questions will ask “which of the following is “correct” and some questions will ask “which of the following is “incorrect”. I caught myself choosing the wrong answer because I did not read the question carefully at first.
Some questions will give you answers that are a long list. For example
Which of the following are all fruits?
A) Cakes, watermelons, apples, oranges and blueberries
B) Cantaloupes, watermelons, mangoes, pears and doughnuts
C) Apples, oranges, bananas, cherries and raspberries
The key to answering these questions is to look for the ones that are wrong first. Once you see cakes and doughnuts you know the answer is C. This helps you narrow down the possible answers.

Thanks
Lisa

– The guidelines mention to do resistance exercise before aerobic exercise to reduce hypoG in DBT1. Why is that ? And why is it suggested to exercise 3 hours after a meal?

– Why can’t we put insulin back in the fridge once it’s been open ?

– Why is A1c not considered a valid diagnostic test for DBT1 ?