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You have some areas where you need more review for the exam. The entire 2018 Diabetes Canada clinical guidelines should be reviewed. The guidelines are the most important document to study and I cannot emphasize how important it is to fully read and understand the guidelines. You will not be able to pass unless you have read and are familiar with the guidelines.
Please write down how you scored on each competency (your score is not saved) and go the After Practice Exam Review for tips on how to improve each competency.
A score of 80% or more means you will likely pass. Most people find my exams harder than the real exam.
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Congratulations it seems your studies are going well. The entire 2018 Diabetes Canada guidelines should be reviewed. You will need to pass all competencies to pass the exam.
Please write down how you scored on each competency (your score is not saved) and go the After Practice Exam Review for tips on how to improve each competency. Try to aim for a score of 80% in all competencies. A score of 80% or more means you will likely pass. Most people find my exams harder than the real exam.
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Question 1 of 50
1. Question
A patient of yours, whose glycemic control was previously excellent for several years, comes to you with an A1c of 9.1%. Upon further discussion, you discover that he divorced his wife 2 months ago and he’s not handling it well. You notice that he smells strongly of alcohol and is poorly groomed. He is on metformin 500 mg BID and pioglitazone 30 mg once daily. You:
Correct
A) Incorrect – The personal burden of diabetes is enormous and, obviously, this patient does not need additional stressors placed on him by other health care professionals
B) Incorrect – While technically correct, this is not the best answer as it ignores the patient. Unless the patient is drinking very heavily and there are other co-morbidities, the risk of lactic acidosis is very low
C) Correct – This is the best answer as there is empathy, screening, acknowledgement of patient difficulty and counseling. There will be similar questions on the exam that test empathy
D) Incorrect – While technically correct, this is not the best answer as it ignores the patientIncorrect
A) Incorrect – The personal burden of diabetes is enormous and, obviously, this patient does not need additional stressors placed on him by other health care professionals
B) Incorrect – While technically correct, this is not the best answer as it ignores the patient. Unless the patient is drinking very heavily and there are other co-morbidities, the risk of lactic acidosis is very low
C) Correct – This is the best answer as there is empathy, screening, acknowledgement of patient difficulty and counseling. There will be similar questions on the exam that test empathy
D) Incorrect – While technically correct, this is not the best answer as it ignores the patient -
Question 2 of 50
2. Question
What is the fasting blood glucose target for a child less than 6 years of age with type 1 diabetes? The child does not have recurrent hypoglycemia or hypoglycemia unawareness.
Correct
A) 4-7 mmol/L Incorrect- this is the target for most people with diabetes but not for children under 18 years of age
B) 6-10 mmol/L Incorrect- this is the target if the child has recurrent hypoglycemia or hypoglycemia unawareness which the child does not have. Also this is the old 2013 clinical guideline for children under 6
C) 4-8 mmol/L Correct- the 2018 guidelines now have a single target for children under 18 years of age. In the 2013 guidelines the targets were different based on different age groups such as 0-6, 6-12 and over 12 years of age. This is is not the case anymore.
D) 6-9 mmol/L Incorrect- this is the target for elderly patients who are frail and/or have dementia
Please see pg S235 of the 2018 Diabetes Canada clinical practice guidelines for details on the targets for children. Also check out the Cheat Sheet I have created for you at the end of the quiz.Incorrect
A) 4-7 mmol/L Incorrect- this is the target for most people with diabetes but not for children under 18 years of age
B) 6-10 mmol/L Incorrect- this is the target if the child has recurrent hypoglycemia or hypoglycemia unawareness which the child does not have. Also this is the old 2013 clinical guideline for children under 6
C) 4-8 mmol/L Correct- the 2018 guidelines now have a single target for children under 18 years of age. In the 2013 guidelines the targets were different based on different age groups such as 0-6, 6-12 and over 12 years of age. This is is not the case anymore.
D) 6-9 mmol/L Incorrect- this is the target for elderly patients who are frail and/or have dementia
Please see pg S235 of the 2018 Diabetes Canada clinical practice guidelines for details on the targets for children. Also check out the Cheat Sheet I have created for you at the end of the quiz. -
Question 3 of 50
3. Question
What is the A1c target of a child less than 6 year of age with type 1 diabetes? There is no recurrent hypoglycemia or hypoglycemia unawareness.
Correct
A) <8.5% Incorrect- this could be a A1c target for the frail elderly or patients with severe hypoglycemia and/or hypoglycemia unawareness
B) <8.0% Incorrect- this could be a A1c target for a functionally dependent elderly patient
C) ≤7.5% Correct- in the 2018 guidelines there is now only one age category for children. In the old 2013 guidelines there was specific targets for ages 0-6, 6-12 and 12-18. For patients under 18 years of age the target is ≤ 7.5% unless there is recurrent hypoglycemia or hypoglycemia unawareness
≤7.0% Incorrect- this is the A1c target for a child over 12 years of age an
Please see pg S235 of the 2018 Diabetes Canada clinical practice guidelines for details on the targets for children. Also check out the Cheat Sheet I have created for you at the end of the quiz.Incorrect
A) <8.5% Incorrect- this could be a A1c target for the frail elderly or patients with severe hypoglycemia and/or hypoglycemia unawareness
B) <8.0% Incorrect- this could be a A1c target for a functionally dependent elderly patient
C) ≤7.5% Correct- in the 2018 guidelines there is now only one age category for children. In the old 2013 guidelines there was specific targets for ages 0-6, 6-12 and 12-18. For patients under 18 years of age the target is ≤ 7.5% unless there is recurrent hypoglycemia or hypoglycemia unawareness
≤7.0% Incorrect- this is the A1c target for a child over 12 years of age an
Please see pg S235 of the 2018 Diabetes Canada clinical practice guidelines for details on the targets for children. Also check out the Cheat Sheet I have created for you at the end of the quiz. -
Question 4 of 50
4. Question
What is the fasting blood glucose target of a 11 year old child with type 1 diabetes? The child has been experiencing recurrent episode of hypoglycemia at school.
Correct
A) 6-10 mmol/L Correct- this is the fasting blood sugar range for a child under 18 years of age with recurrent hypoglycemia or hypoglycemia unawareness.
B) 4-10 mmol/L Incorrect- this is the fasting blood sugar range for a child between 6 and 12 years of age in the old 2013 guidelines.
C) 5-10 mmol/L Incorrect- this is the blood sugar range for hospitalized patients who are peri-operative for surgeries other than CABG
D) 5.5-10 mmol/L Incorrect- this is the blood sugar range for hospitalized patients undergoing a CABG (coronary bypass artery graft)
Please see pg S235 of the 2018 Diabetes Canada clinical practice guidelines for details on the targets for children. Also check out the Cheat Sheet I have created for you at the end of the quiz.Incorrect
A) 6-10 mmol/L Correct- this is the fasting blood sugar range for a child under 18 years of age with recurrent hypoglycemia or hypoglycemia unawareness.
B) 4-10 mmol/L Incorrect- this is the fasting blood sugar range for a child between 6 and 12 years of age in the old 2013 guidelines.
C) 5-10 mmol/L Incorrect- this is the blood sugar range for hospitalized patients who are peri-operative for surgeries other than CABG
D) 5.5-10 mmol/L Incorrect- this is the blood sugar range for hospitalized patients undergoing a CABG (coronary bypass artery graft)
Please see pg S235 of the 2018 Diabetes Canada clinical practice guidelines for details on the targets for children. Also check out the Cheat Sheet I have created for you at the end of the quiz. -
Question 5 of 50
5. Question
What is the A1c target of a women with diabetes who is trying to get pregnant?
Correct
A) ≤ 7.5% Incorrect- this is the A1c target for children under the age of 18
B) ≤6.5% or ≤6.1% if safe Incorrect- this is the A1c target for women who are already pregnant
C) ≤7% Incorrect- while technically correct there is a better answer. On the exam you should expect questions with multiple correct answers but your job is to choose the best answer. You will only get the question right if you choose the best answer.
D) ≤7% or ≤6.5% if safe- Correct this is the best answer.
For more information on the A1c targets in pregnancy please see pg S271-S273 of the 2018 Diabetes Canada clinical practice guidelines.Incorrect
A) ≤ 7.5% Incorrect- this is the A1c target for children under the age of 18
B) ≤6.5% or ≤6.1% if safe Incorrect- this is the A1c target for women who are already pregnant
C) ≤7% Incorrect- while technically correct there is a better answer. On the exam you should expect questions with multiple correct answers but your job is to choose the best answer. You will only get the question right if you choose the best answer.
D) ≤7% or ≤6.5% if safe- Correct this is the best answer.
For more information on the A1c targets in pregnancy please see pg S271-S273 of the 2018 Diabetes Canada clinical practice guidelines. -
Question 6 of 50
6. Question
What should a patient’s blood glucose level be at in order to drive safely?
Correct
A) Incorrect- patients should wait at least 40 minutes before driving not 50 minutes
B) Incorrect- the target is 5 mmol/L and the wait time is 40 minutes
C) Correct- 5 mmol/L is the correct target and 40 minutes is the correct wait time
D) Incorrect- the correct target is 5 mmol/L not 6 mmol/L
Please see pg S152 of the 2018 Diabetes Canada clinical practice guidelines for more information.Incorrect
A) Incorrect- patients should wait at least 40 minutes before driving not 50 minutes
B) Incorrect- the target is 5 mmol/L and the wait time is 40 minutes
C) Correct- 5 mmol/L is the correct target and 40 minutes is the correct wait time
D) Incorrect- the correct target is 5 mmol/L not 6 mmol/L
Please see pg S152 of the 2018 Diabetes Canada clinical practice guidelines for more information. -
Question 7 of 50
7. Question
What is the 2 hour post prandical target for a child 17 years of age with type 1 diabetes?
Correct
A) Correct- this is the 2 hour PC blood glucose target for all children under the age of 18. The 2018 guidelines now have only one category for children with type 1 diabetes. The old 2013 guidelines had multiple categories based on age.
B) Incorrect- this is the 2 hour PC blood glucose target for elderly who are frail/and or have dementia
C) Incorrect- this is the 2 hour PC blood glucose target for a pregnant women with diabetes
D) Incorrect- this is the 2 hour PC blood glucose target for people unable to achieve an A1c of ≤ 7% or an elderly person who is functionally dependentIncorrect
A) Correct- this is the 2 hour PC blood glucose target for all children under the age of 18. The 2018 guidelines now have only one category for children with type 1 diabetes. The old 2013 guidelines had multiple categories based on age.
B) Incorrect- this is the 2 hour PC blood glucose target for elderly who are frail/and or have dementia
C) Incorrect- this is the 2 hour PC blood glucose target for a pregnant women with diabetes
D) Incorrect- this is the 2 hour PC blood glucose target for people unable to achieve an A1c of ≤ 7% or an elderly person who is functionally dependent -
Question 8 of 50
8. Question
What is the fasting blood glucose (FBG) target of a pregnant women with diabetes?
Correct
A) <5.3 mmol/L- Correct- this is the FBG for a pregnant women with diabetes
B) 7.8 mmol/L Incorrect- this is the 1 hour post prandial target for a pregnant women with diabetes
C) 4-7 mmol/L Incorrect- this is the FBG target for most people with diabetes
D) 4-5.5 mmol/L Incorrect- this is the FBG target for a patient who is unable to achieve an A1c ≤ 7% with the usual target of 4-7 mmol/L
For details on the blood glucose target of pregnant women with diabetes please see pg S271-S273 of the 2018 Diabetes Canada clinical practice guidelinesIncorrect
A) <5.3 mmol/L- Correct- this is the FBG for a pregnant women with diabetes
B) 7.8 mmol/L Incorrect- this is the 1 hour post prandial target for a pregnant women with diabetes
C) 4-7 mmol/L Incorrect- this is the FBG target for most people with diabetes
D) 4-5.5 mmol/L Incorrect- this is the FBG target for a patient who is unable to achieve an A1c ≤ 7% with the usual target of 4-7 mmol/L
For details on the blood glucose target of pregnant women with diabetes please see pg S271-S273 of the 2018 Diabetes Canada clinical practice guidelines -
Question 9 of 50
9. Question
What is the 1 hour postprandial blood glucose (PC BG) target for a pregnant women with diabetes?
Correct
A) <6.7mmol/L Incorrect- this is the 2 hr PC BG target for a pregnant women with diabetes
B) <5.3mmol/L Incorrect- this is the fasting BG target for a pregnant women with diabetes
C) <7.8mmol/L Correct- this is the 1 hr PC BG target for a pregnant women with diabetes
D) 4-7 mmol/L Incorrect- this is the fasting BG target for most people but not pregnant women.
For details on the blood glucose target of pregnant women with diabetes please see pg S271-S273 of the 2018 Diabetes Canada clinical practice guidelinesIncorrect
A) <6.7mmol/L Incorrect- this is the 2 hr PC BG target for a pregnant women with diabetes
B) <5.3mmol/L Incorrect- this is the fasting BG target for a pregnant women with diabetes
C) <7.8mmol/L Correct- this is the 1 hr PC BG target for a pregnant women with diabetes
D) 4-7 mmol/L Incorrect- this is the fasting BG target for most people but not pregnant women.
For details on the blood glucose target of pregnant women with diabetes please see pg S271-S273 of the 2018 Diabetes Canada clinical practice guidelines -
Question 10 of 50
10. Question
What is the 2 hour post prandial (2 hr PC) target for a pregnant women with diabetes?
Correct
A) 5-8 mmol/L Incorrect- this is the 2 hour PC BG for patients unable to achieve the ≤ 7% target using the usual 2 hour PC BG
B) <7.8mmol/L Incorrect- this is the 1 hr PC BG target for a pregnant women with diabetes
C) <6.7 mmol/L Correct- this is the 2 hr PC BG target for a pregnant women with diabetes
D) 5-10 mmol/L- Incorrect- this is the 2 hr PC BG target for most people but not pregnant women.
For details on the blood glucose targets of pregnant women with diabetes please see the summary on pg S271-273 of the 2018 Diabetes Canada guidelinesIncorrect
A) 5-8 mmol/L Incorrect- this is the 2 hour PC BG for patients unable to achieve the ≤ 7% target using the usual 2 hour PC BG
B) <7.8mmol/L Incorrect- this is the 1 hr PC BG target for a pregnant women with diabetes
C) <6.7 mmol/L Correct- this is the 2 hr PC BG target for a pregnant women with diabetes
D) 5-10 mmol/L- Incorrect- this is the 2 hr PC BG target for most people but not pregnant women.
For details on the blood glucose targets of pregnant women with diabetes please see the summary on pg S271-273 of the 2018 Diabetes Canada guidelines -
Question 11 of 50
11. Question
What is the fasting blood glucose (FBG) target for most people with diabetes?
Correct
A) 6-9 mmol/L Incorrect- this is the FBG target for an elderly patient who is frail and/or have dementia
B) 4-8 mmol/L Incorrect- this is the FBG target for a child under 18 years of age with type 1 diabetes
C) <5.3 mmol/L Incorrect- this is the FBG for pregnant women with diabetes
D) 4-7 mmol/L Correct- this is the FBG target for most people with diabetesPlease see pg S43 of 2018 Diabetes Canada clinical practice guidelines for more details
Incorrect
A) 6-9 mmol/L Incorrect- this is the FBG target for an elderly patient who is frail and/or have dementia
B) 4-8 mmol/L Incorrect- this is the FBG target for a child under 18 years of age with type 1 diabetes
C) <5.3 mmol/L Incorrect- this is the FBG for pregnant women with diabetes
D) 4-7 mmol/L Correct- this is the FBG target for most people with diabetesPlease see pg S43 of 2018 Diabetes Canada clinical practice guidelines for more details
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Question 12 of 50
12. Question
You have a patient who weighs 45 kg and who is being started on basal insulin. Which of the following insulin doses would be appropriate to start?
Correct
A) Incorrect- This is too large of a starting dose and may lead to hypoglycemia
B) Incorrect- This is a default starting dose (10 units) for basal insulin but there is another answer that is also correct.
C) Incorrect- This is a acceptable lower starting dose for people who weigh under 50 kg (0.1-0.2 units per kg) but there is another answer that is also correct
D) Incorrect- This dose is too low
E) Correct- Both B and C are both correctPlease see Example A on Appendix 9 on pg S317 of 2018 Diabetes clinical practice guidelines and pg 2 of the Diabetes Canada insulin prescription tool at https://www.diabetes.ca/DiabetesCanadaWebsite/media/Managing-My-Diabetes/Tools%20and%20Resources/insulin-prescription-fillable-EN.pdf?ext=.pdf (will open in new window) for more details
Incorrect
A) Incorrect- This is too large of a starting dose and may lead to hypoglycemia
B) Incorrect- This is a default starting dose (10 units) for basal insulin but there is another answer that is also correct.
C) Incorrect- This is a acceptable lower starting dose for people who weigh under 50 kg (0.1-0.2 units per kg) but there is another answer that is also correct
D) Incorrect- This dose is too low
E) Correct- Both B and C are both correctPlease see Example A on Appendix 9 on pg S317 of 2018 Diabetes clinical practice guidelines and pg 2 of the Diabetes Canada insulin prescription tool at https://www.diabetes.ca/DiabetesCanadaWebsite/media/Managing-My-Diabetes/Tools%20and%20Resources/insulin-prescription-fillable-EN.pdf?ext=.pdf (will open in new window) for more details
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Question 13 of 50
13. Question
You have a patient who is being started on bolus insulin. She reports that her largest meal of the day is dinner but her sugars increase the most after breakfast. The patient hates injections and is only agreeable to starting she she can minimize the number of times she injects. Which of the following dosing regiments would be the most appropriate to start this patient on?
Correct
A) Correct- the usual starting dose for bolus insulin is 2-4 units. Studies have shown it has little effect on A1c whether you start with the biggest meal of the day or the largest post prandial rise in blood sugar of the day. So 2-4 units with either breakfast or dinner would be correct
B) Incorrect- this is too high of a starting dose given the information you are given
C) Incorrect- you could start bolus insulin at every meal but generally you start with one meal. Also the patient specifically asks for minimal injections. Studies show that you get the largest benefit in A1c reduction when adding bolus insulin to the first meal. You still get A1c reduction benefit when adding bolus insulin to the second and third meal but the reduction is less than the first one. So overall not the best answer therefore not the correct answer.
D) Incorrect- this is too high of a starting dose given the information you are given
E) Incorrect- only A) is correctPlease see Example B of Appendix 9 on pg S317 of the 2018 Diabetes Canada guidelines for more details for more details
Incorrect
A) Correct- the usual starting dose for bolus insulin is 2-4 units. Studies have shown it has little effect on A1c whether you start with the biggest meal of the day or the largest post prandial rise in blood sugar of the day. So 2-4 units with either breakfast or dinner would be correct
B) Incorrect- this is too high of a starting dose given the information you are given
C) Incorrect- you could start bolus insulin at every meal but generally you start with one meal. Also the patient specifically asks for minimal injections. Studies show that you get the largest benefit in A1c reduction when adding bolus insulin to the first meal. You still get A1c reduction benefit when adding bolus insulin to the second and third meal but the reduction is less than the first one. So overall not the best answer therefore not the correct answer.
D) Incorrect- this is too high of a starting dose given the information you are given
E) Incorrect- only A) is correctPlease see Example B of Appendix 9 on pg S317 of the 2018 Diabetes Canada guidelines for more details for more details
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Question 14 of 50
14. Question
A patient brings in his blood sugar log below. He is currently on multiple daily injections (MDI). He takes 60 Toujeo (concentrated glargine) at bedtime and FIASP (apsart) 20 units with each meal. Which of the following would you suggest?
May 21 May 22 May 23 Fasting 8.9 10.3 9.5 2 hours after breakfast 9.5 12.1 9.8 Before lunch 5.6 6.4 6.1 2 hours after lunch 3.1 4.2 3.4 Before supper 4.6 5.1 4.3 2 hours after supper 7.6 6.8 8.1 Before bed 7.1 4.0 7.0 Correct
Generally when adjusting insulin you look for patterns of lows first then patterns of highs. If no pattern of lows or highs then the patient is in euglycemia so don’t change anything
1) Look for patterns of lows, if happening at fasting times then reduce basal, if happening after meals reduce bolus
2) Look for patterns of highs, if happening at fasting times then increase basal, if happening after meals increase bolusA) Incorrect- there was only one high post prandial reading after breakfast. Increasing insulin based on one reading is not ideal. Generally you treat hypoglycemia before you treat hyperglycemia
B) Incorrect- Generally you treat hypoglycemia before you treat hyperglycemia. Increasing the Toujeo (concentrated glargine) would likely lead to more lows after lunch
C) Correct- lowering the FIASP (aspart) would reduce the hypoglycemia after lunch
D) Incorrect- while lowering the Toujeo (concentrated glargine) would reduce hypoglycemia it would result in more fasting hyperglycemia. Reducing the lunch FIASP (aspart) is a much better answerPlease see Appendix 5 and 6 on pg S312 of the Diabetes Canada clinical practice guidelines for more details
Incorrect
Generally when adjusting insulin you look for patterns of lows first then patterns of highs. If no pattern of lows or highs then the patient is in euglycemia so don’t change anything
1) Look for patterns of lows, if happening at fasting times then reduce basal, if happening after meals reduce bolus
2) Look for patterns of highs, if happening at fasting times then increase basal, if happening after meals increase bolusA) Incorrect- there was only one high post prandial reading after breakfast. Increasing insulin based on one reading is not ideal. Generally you treat hypoglycemia before you treat hyperglycemia
B) Incorrect- Generally you treat hypoglycemia before you treat hyperglycemia. Increasing the Toujeo (concentrated glargine) would likely lead to more lows after lunch
C) Correct- lowering the FIASP (aspart) would reduce the hypoglycemia after lunch
D) Incorrect- while lowering the Toujeo (concentrated glargine) would reduce hypoglycemia it would result in more fasting hyperglycemia. Reducing the lunch FIASP (aspart) is a much better answerPlease see Appendix 5 and 6 on pg S312 of the Diabetes Canada clinical practice guidelines for more details
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Question 15 of 50
15. Question
You have a patient who takes 20 units of Tresiba (degludec) at bedtime and 10 units of Apidra (glulisine) with each meal. She brings you the below blood sugar log. You suggest:
May 24 May 25 May 26 Fasting 4.2 4.0 2 hours after breakfast 5.2 8.0 9.8 Before lunch 5.6 6.4 6.1 2 hours after lunch 11.1 13.8 12.6 Before supper 4.6 4.3 2 hours after supper 7.9 9.9 Before bed 6.8 6.9 7.1 Correct
Generally when adjusting insulin you look for patterns of lows first then patterns of highs. If no pattern of lows or highs then the patient is in euglycemia so don’t change anything
1) Look for patterns of lows, if happening at fasting times then reduce basal, if happening after meals reduce bolus
2) Look for patterns of highs, if happening at fasting times then increase basal, if happening after meals increase bolusLike in real life you should expect that patients to miss taking readings. On the exam you will have to take your best guess even with incomplete information. You can complain about the “unfair” question after the exam to the CDECB but it wont help you pass the exam.
A) Correct- this is the best answer out of all the given answer, even though in real life you would only increase the lunch bolus. You can complain about the “unfair” answer but the worst thing to do is get frustrated or angry during the exam. This will result in you losing your peace of mind and guaranteeing that you will fail the exam.
B) Incorrect- Generally you do correct hypoglycemia before hyperglycemia but there is no hypoglycemia before breakfast. Even if there was, reducing the Apidra wont help as the Apidra doesnt peak for another 2 hours. If there was fasting hypoglycemia you would reduce the basal insulin, in this case Tresiba.
C) Incorrect- there is only one reading above 7 and its only 0.1 above target. The patient forgot to take his after supper reading so maybe he had a big birthday dinner and his post prandials were very high. You cant assume numbers.
D) Incorrect- there is no after lunch hypoglycemia. Decreasing the Tresiba would cause all the readings to increase causing hyperglycemia at other times.Please see appendix 5 and 6 on pg S313 of the 2018 Diabetes Canada clinical practice guidelines for more details
Incorrect
Generally when adjusting insulin you look for patterns of lows first then patterns of highs. If no pattern of lows or highs then the patient is in euglycemia so don’t change anything
1) Look for patterns of lows, if happening at fasting times then reduce basal, if happening after meals reduce bolus
2) Look for patterns of highs, if happening at fasting times then increase basal, if happening after meals increase bolusLike in real life you should expect that patients to miss taking readings. On the exam you will have to take your best guess even with incomplete information. You can complain about the “unfair” question after the exam to the CDECB but it wont help you pass the exam.
A) Correct- this is the best answer out of all the given answer, even though in real life you would only increase the lunch bolus. You can complain about the “unfair” answer but the worst thing to do is get frustrated or angry during the exam. This will result in you losing your peace of mind and guaranteeing that you will fail the exam.
B) Incorrect- Generally you do correct hypoglycemia before hyperglycemia but there is no hypoglycemia before breakfast. Even if there was, reducing the Apidra wont help as the Apidra doesnt peak for another 2 hours. If there was fasting hypoglycemia you would reduce the basal insulin, in this case Tresiba.
C) Incorrect- there is only one reading above 7 and its only 0.1 above target. The patient forgot to take his after supper reading so maybe he had a big birthday dinner and his post prandials were very high. You cant assume numbers.
D) Incorrect- there is no after lunch hypoglycemia. Decreasing the Tresiba would cause all the readings to increase causing hyperglycemia at other times.Please see appendix 5 and 6 on pg S313 of the 2018 Diabetes Canada clinical practice guidelines for more details
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Question 16 of 50
16. Question
You have a patient who brings you the following blood sugar log. He is on NPH 25 units twice daily (when he wakes at 8am and when he sleeps at 11pm) and Humalog (lispro) 15 units three times a time with every meal. You suggest:
May 27 May 28 May 29 Fasting 3.8 3.8 3.4 2 hours after breakfast 6.8 5.4 8.6 Before lunch 6.1 6.4 5.7 2 hours after lunch 8.1 9.2 8.4 Before supper 5.6 6.7 5.1 2 hours after supper 10.1 6.9 6.3 Before bed 7.0 6.9 6.7 Correct
Generally when adjusting insulin you look for patterns of lows first then patterns of highs. If no pattern of lows or highs then the patient is in euglycemia so don’t change anything
1) Look for patterns of lows, if happening at fasting times then reduce basal, if happening after meals reduce bolus
2) Look for patterns of highs, if happening at fasting times then increase basal, if happening after meals increase bolusA) Incorrect- when adjusting insulin you must look at when it takes effect not when it is administered. We want to stop the hypoglycemia before breakfast, however stopping the morning NPH wont help. The NPH will peak in 5-8 hours and last for ~18 hours. He is taking the NPH at 8am so it will peak around 1pm-4pm and last till 2am at most. He is having lows around 7-8am so reducing the morning NPH will not help
B) Incorrect- when adjusting insulin you must look at when it takes effect not when it is administered. We want to stop the hypoglycemia before breakfast, however stopping the morning Humalog (lispro) wont help. The Humalog will peak in 1-2 hours and last for 4-5 hours. He is taking the breakfast Humalog at 8am so it will peak around 9am and stop working around 12 pm. This is nowhere close to the lows he is having at 7-8am
C) Incorrect- generally you treat hypoglycemia before you treat lows. Also the 10.1 is only 0.1 above target and there is no pattern.
D) Correct- to fix the morning hypoglycemia you reduce the evening NPH which is taking effect throughout the night and causing the lowsPlease see Appendix 5 and 6 on pg S312 of the 2018 Diabetes Canada clinical practice guidelines for more details
Incorrect
Generally when adjusting insulin you look for patterns of lows first then patterns of highs. If no pattern of lows or highs then the patient is in euglycemia so don’t change anything
1) Look for patterns of lows, if happening at fasting times then reduce basal, if happening after meals reduce bolus
2) Look for patterns of highs, if happening at fasting times then increase basal, if happening after meals increase bolusA) Incorrect- when adjusting insulin you must look at when it takes effect not when it is administered. We want to stop the hypoglycemia before breakfast, however stopping the morning NPH wont help. The NPH will peak in 5-8 hours and last for ~18 hours. He is taking the NPH at 8am so it will peak around 1pm-4pm and last till 2am at most. He is having lows around 7-8am so reducing the morning NPH will not help
B) Incorrect- when adjusting insulin you must look at when it takes effect not when it is administered. We want to stop the hypoglycemia before breakfast, however stopping the morning Humalog (lispro) wont help. The Humalog will peak in 1-2 hours and last for 4-5 hours. He is taking the breakfast Humalog at 8am so it will peak around 9am and stop working around 12 pm. This is nowhere close to the lows he is having at 7-8am
C) Incorrect- generally you treat hypoglycemia before you treat lows. Also the 10.1 is only 0.1 above target and there is no pattern.
D) Correct- to fix the morning hypoglycemia you reduce the evening NPH which is taking effect throughout the night and causing the lowsPlease see Appendix 5 and 6 on pg S312 of the 2018 Diabetes Canada clinical practice guidelines for more details
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Question 17 of 50
17. Question
You have a patient who uses 60 units of Humulin N twice daily. He also takes 40 units of Novorapid (aspart) with breakfast, 20 units at lunch and 20 units at supper. Calculate his Insulin Sensitivity Factor (ISF) and choose from the below answers.
Correct
The formula for calculating ISF or Correction Factor (CF) is 100 divided by Total Daily Dose (TDD) if using rapid acting insulin or 83 divided by TDD if using short acting insulin. This patient is on 60+60+40+20+20= 200 for TDD. 100/200= 0.5. Meaning 1 unit of insulin is expected to bring him down 0.5 mmol/L.
A) Correct- this is the correct ISF or CF
B) Incorrect- A 1:1 ratio means 1 unit brings down the patients sugars by 1 mmol/L which is incorrect
C) Incorrect- A 1:2 ratio means 1 unit brings down the patients sugars by 2 mmol/L which is incorrect
D) Incorrect- A 1:2.5 ratio means 1 unit brings down the patients sugars by 2.5 mmol/L which is incorrectIncorrect
The formula for calculating ISF or Correction Factor (CF) is 100 divided by Total Daily Dose (TDD) if using rapid acting insulin or 83 divided by TDD if using short acting insulin. This patient is on 60+60+40+20+20= 200 for TDD. 100/200= 0.5. Meaning 1 unit of insulin is expected to bring him down 0.5 mmol/L.
A) Correct- this is the correct ISF or CF
B) Incorrect- A 1:1 ratio means 1 unit brings down the patients sugars by 1 mmol/L which is incorrect
C) Incorrect- A 1:2 ratio means 1 unit brings down the patients sugars by 2 mmol/L which is incorrect
D) Incorrect- A 1:2.5 ratio means 1 unit brings down the patients sugars by 2.5 mmol/L which is incorrect -
Question 18 of 50
18. Question
You have a patient who takes 15 units of Levemir (detemir) twice daily. She also takes 5 units of Apidra (glulisine) with breakfast, 10 units with lunch and 5 units with supper. She is wondering what her insulin to carbohydrate ratio (ICR) is. You calculate:
Correct
To calculate ICR you take 500/Total daily dose (TDD). So for this patient 15+15+5+10+5=50. 500/50= 1:10 ICR which means for every 10 grams of carbohydrate this patient consumes taking 1 unit of insulin should minimize her blood glucose rise.
A) Incorrect- An ICR of 1:1 means that the patient needs 1 unit of insulin for every 1 gram of carbohydrate they consume to minimize blood glucose rise
B) Incorrect- An ICR of 1:5 means that the patient needs 1 unit of insulin for every 5 gram of carbohydrate they consume to minimize blood glucose rise
A) Correct- this is the correct ICR
A) Incorrect- An ICR of 1:15 means that the patient needs 1 unit of insulin for every 15 gram of carbohydrate they consume to minimize blood glucose riseIncorrect
To calculate ICR you take 500/Total daily dose (TDD). So for this patient 15+15+5+10+5=50. 500/50= 1:10 ICR which means for every 10 grams of carbohydrate this patient consumes taking 1 unit of insulin should minimize her blood glucose rise.
A) Incorrect- An ICR of 1:1 means that the patient needs 1 unit of insulin for every 1 gram of carbohydrate they consume to minimize blood glucose rise
B) Incorrect- An ICR of 1:5 means that the patient needs 1 unit of insulin for every 5 gram of carbohydrate they consume to minimize blood glucose rise
A) Correct- this is the correct ICR
A) Incorrect- An ICR of 1:15 means that the patient needs 1 unit of insulin for every 15 gram of carbohydrate they consume to minimize blood glucose rise -
Question 19 of 50
19. Question
A patient brings the following food diary and blood sugar log to you. He is having difficulty figuring out a insulin to carbohydrate ratio (ICR) to follow and has been using different amounts of bolus insulin. After reviewing his logs you suggest trying:
Before breakfast Food & insulin given After
breakfastBefore lunch Food & insulin given After lunch Before dinner Food & insulin given After dinner 6.4 48 total carb with 8 gram fibre. Took 4 units 10.9 7.8 72 total carbs with 12 gram fibre. Took 4 units 12.3 6.0 56 total carb with 6 grams of fibre. Took 10 units 6.5 5.6 29 total carbs with 9 grams of fibre. Took 10 units 3.4 4.1 52 total carbs with 12 grams fibre. Took 4 units 10.2 6.0 31 total carbs with 6 grams fibre. Took 5 untis 8.8 Correct
The key to this question is to calculate the ICR the patient used for each meal. Remember to subtract fibre from the total carbohydrate (since fibre does not break down into glucose) the divide the available carbohydrate by the numbers of bolus units used.
Before breakfast Food & insulin given After breakfast
Before lunch Food & insulin given After lunch Before dinner Food & insulin given After dinner 6.4 1:10 10.9 7.8 1:15 12.3 6 1:5 6.5 5.6 1:2 3.4 4.1 1:10 10.2 6 1:5 8.8 A) Incorrect- the time he used a 1:2 ratio his post prandial sugars dropped from 5.6 to 3.4 causing hypoglycemia. This ratio is too aggressive
B) Correct- the times he used this ratio (6 to 6.5 and 6 to 6.8) his post prandial sugars did not increase by more than 3 mmol/L and kept him at target. This ratio should be used for the rest of his meals.
C) Incorrect- the time he used a 1:10 ratio his post prandial sugars spiked significantly from 6.4 to 10.9 causing hypoglycemia. This ratio is too aggressive
D) Incorrect- the time he used a 1:2 ratio his post prandial sugars dropped from 5.6 to 3.4 causing hypoglycemia. This ratio is too aggressiveIncorrect
The key to this question is to calculate the ICR the patient used for each meal. Remember to subtract fibre from the total carbohydrate (since fibre does not break down into glucose) the divide the available carbohydrate by the numbers of bolus units used.
Before breakfast Food & insulin given After breakfast
Before lunch Food & insulin given After lunch Before dinner Food & insulin given After dinner 6.4 1:10 10.9 7.8 1:15 12.3 6 1:5 6.5 5.6 1:2 3.4 4.1 1:10 10.2 6 1:5 8.8 A) Incorrect- the time he used a 1:2 ratio his post prandial sugars dropped from 5.6 to 3.4 causing hypoglycemia. This ratio is too aggressive
B) Correct- the times he used this ratio (6 to 6.5 and 6 to 6.8) his post prandial sugars did not increase by more than 3 mmol/L and kept him at target. This ratio should be used for the rest of his meals.
C) Incorrect- the time he used a 1:10 ratio his post prandial sugars spiked significantly from 6.4 to 10.9 causing hypoglycemia. This ratio is too aggressive
D) Incorrect- the time he used a 1:2 ratio his post prandial sugars dropped from 5.6 to 3.4 causing hypoglycemia. This ratio is too aggressive -
Question 20 of 50
20. Question
You have a patient who is switching from Humulin N 50 units twice daily to Tresiba (degludec) once daily. He just got a prescription from the family physician for 100 units of Tresiba once daily in the morning. You advise to:
Correct
A) Incorrect- As a general rule when you switch from twice daily insulin to once daily insulin you reduce to dose by 20% to avoid hypoglycemia. Tresiba (degludec) is equally effective in the morning and the evening
B) Incorrect- As a general rule when you switch from twice daily insulin to once daily insulin you reduce to dose by 20% to avoid hypoglycemia. Tresiba (degludec) is equally effective in the morning and the evening
C) Correct- a 20% reduction in dose is the general rule. The timing of morning or evening is irrelevant
D) Incorrect- there should be a 20% reduction not a 20% increaseNote that the exam often uses older insulins so my Practice Exams often have many questions on older insulins even though I don’t typically use them in my real life practice.
Incorrect
A) Incorrect- As a general rule when you switch from twice daily insulin to once daily insulin you reduce to dose by 20% to avoid hypoglycemia. Tresiba (degludec) is equally effective in the morning and the evening
B) Incorrect- As a general rule when you switch from twice daily insulin to once daily insulin you reduce to dose by 20% to avoid hypoglycemia. Tresiba (degludec) is equally effective in the morning and the evening
C) Correct- a 20% reduction in dose is the general rule. The timing of morning or evening is irrelevant
D) Incorrect- there should be a 20% reduction not a 20% increaseNote that the exam often uses older insulins so my Practice Exams often have many questions on older insulins even though I don’t typically use them in my real life practice.
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Question 21 of 50
21. Question
For strawberries, which of the following is equivalent to 15 grams of carbohydrates?
Correct
A) Correct- strawberries and blackberries contain little sugar compared to other fruits. I recommend them to patients looking for a snack since you can eat a lot of them but not have a lot carbohydrate
B) Incorrect- this is for blueberries and melon
C) Incorrect- this is for juice and canned fruit
D) Incorrect- this is for cherries and grapesPlease see the Beyond the Basics meal planning guide in the cheat sheet section for details
Incorrect
A) Correct- strawberries and blackberries contain little sugar compared to other fruits. I recommend them to patients looking for a snack since you can eat a lot of them but not have a lot carbohydrate
B) Incorrect- this is for blueberries and melon
C) Incorrect- this is for juice and canned fruit
D) Incorrect- this is for cherries and grapesPlease see the Beyond the Basics meal planning guide in the cheat sheet section for details
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Question 22 of 50
22. Question
For unsweetened apple sauce, which of the following is equivalent to 15 grams of carbohydrate?
Correct
A) Incorrect- this is for strawberries and blackberries
B) Incorrect- this is for melons and blueberries
C) Correct- this is the same amount as juice and canned fruit in juice, so that is how I remember it for the exam
D) Incorrect- this is for jam, jellies, honey and sugarPlease see the Beyond the Basics meal planning guide in the cheat sheet section for details
Incorrect
A) Incorrect- this is for strawberries and blackberries
B) Incorrect- this is for melons and blueberries
C) Correct- this is the same amount as juice and canned fruit in juice, so that is how I remember it for the exam
D) Incorrect- this is for jam, jellies, honey and sugarPlease see the Beyond the Basics meal planning guide in the cheat sheet section for details
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Question 23 of 50
23. Question
For chocolate milk, which of the following is equivalent to 15 grams of carbohydrate?
Correct
A) Incorrect- this is for strawberries and blackberries
B) Incorrect- this is the answer for regular low fat milk
C) Correct- the way I remember this is that chocolate milk, flavored soy milk, evaporated milk and juice all have the same carbohydrate content
D) Incorrect- this is for jam, jellies, honey and sugarPlease see the Beyond the Basics meal planning guide in the cheat sheet section for details
Incorrect
A) Incorrect- this is for strawberries and blackberries
B) Incorrect- this is the answer for regular low fat milk
C) Correct- the way I remember this is that chocolate milk, flavored soy milk, evaporated milk and juice all have the same carbohydrate content
D) Incorrect- this is for jam, jellies, honey and sugarPlease see the Beyond the Basics meal planning guide in the cheat sheet section for details
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Question 24 of 50
24. Question
For white bread, which of the following is equivalent to 15 grams of carbohydrate?
Correct
A) Incorrect- this is for tacos where two pieces of taco is 15 grams
B) Correct- this is the same as whole grain bread
C) Incorrect- this is for hotdog buns, burger buns, small bagels and pitas
D) Incorrect- this is for large bagelsPlease see the Beyond the Basics meal planning guide in the cheat sheet section for details
Incorrect
A) Incorrect- this is for tacos where two pieces of taco is 15 grams
B) Correct- this is the same as whole grain bread
C) Incorrect- this is for hotdog buns, burger buns, small bagels and pitas
D) Incorrect- this is for large bagelsPlease see the Beyond the Basics meal planning guide in the cheat sheet section for details
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Question 25 of 50
25. Question
For large bagels, which of the following is equivalent to 15 grams of carbohydrate?
Correct
A) Incorrect- this is for tacos where two pieces of taco is 15 grams
B) Incorrect- this is for white and whole grain bread
C) Incorrect- this is for small bagels not large bagels
D) Correct- this is for large bagelsPlease see the Beyond the Basics meal planning guide in the cheat sheet section for details
Incorrect
A) Incorrect- this is for tacos where two pieces of taco is 15 grams
B) Incorrect- this is for white and whole grain bread
C) Incorrect- this is for small bagels not large bagels
D) Correct- this is for large bagelsPlease see the Beyond the Basics meal planning guide in the cheat sheet section for details
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Question 26 of 50
26. Question
For cooked rice, which of the following is equivalent to 15 grams of carbohydrate?
Correct
A) Incorrect- this is about 45 grams
B) Incorrect- this is more than 15 grams
C) Correct- this is 15 grams as per the Beyond the Basics poster
D) Incorrect- this is less than 15 gramsPlease see the Beyond the Basics meal planning guide in the cheat sheet section for details
Incorrect
A) Incorrect- this is about 45 grams
B) Incorrect- this is more than 15 grams
C) Correct- this is 15 grams as per the Beyond the Basics poster
D) Incorrect- this is less than 15 gramsPlease see the Beyond the Basics meal planning guide in the cheat sheet section for details
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Question 27 of 50
27. Question
For juice, which of the following is equivalent to 15 grams of carbohydrate?
Correct
A) Incorrect- this is for strawberries and blackberries
B) Incorrect- this is for melons and blueberries
C) Correct- this is the same as canned fruit in juice
D) Incorrect- this is for soy yogurtPlease see the Beyond the Basics meal planning guide in the cheat sheet section for details
Incorrect
A) Incorrect- this is for strawberries and blackberries
B) Incorrect- this is for melons and blueberries
C) Correct- this is the same as canned fruit in juice
D) Incorrect- this is for soy yogurtPlease see the Beyond the Basics meal planning guide in the cheat sheet section for details
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Question 28 of 50
28. Question
For peaches, which of the following is 15 grams of carbohydrate?
Correct
A) Correct- a large peach is equivalent to 15 grams of carbohydrate
B) Incorrect- medium oranges or pears are equivalent to 15 grams of carbohydrate
C) Incorrect- small bananas are equivalent to 15 grams of carbohydrate
D) Incorrect- 15 cherries or grapes are equivalent to 15 grams of carbohydrateIncorrect
A) Correct- a large peach is equivalent to 15 grams of carbohydrate
B) Incorrect- medium oranges or pears are equivalent to 15 grams of carbohydrate
C) Incorrect- small bananas are equivalent to 15 grams of carbohydrate
D) Incorrect- 15 cherries or grapes are equivalent to 15 grams of carbohydrate -
Question 29 of 50
29. Question
For naan bread, which of the following is equivalent to 15 grams of carbohydrate?
Correct
A) Incorrect- that is the amount for pancakes and waffles for 15 grams of carbohydrate
B) Incorrect- two 5-inch tacos are 15 grams of carbohydrate
C) Correct- this is 15 grams of carbohydrate for chapati, naan bread and white and multigrain pita bread
D) Incorrect- this is for pizza crustPlease see the Beyond the Basics meal planning guide in the cheat sheet section for details
Incorrect
A) Incorrect- that is the amount for pancakes and waffles for 15 grams of carbohydrate
B) Incorrect- two 5-inch tacos are 15 grams of carbohydrate
C) Correct- this is 15 grams of carbohydrate for chapati, naan bread and white and multigrain pita bread
D) Incorrect- this is for pizza crustPlease see the Beyond the Basics meal planning guide in the cheat sheet section for details
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Question 30 of 50
30. Question
For honey, how many teaspoons is equivalent to 15 grams of carbohydrate?
Correct
Incorrect- 1 teaspoon is equivalent to 5 grams of carbohydrate
Incorrect- 2 teaspoons is equivalent to 10 grams of carbohydrate
Correct- 3 teaspoons is equivalent to 15 grams of carbohydrate. This is the same for sugar, jam, jelly and honey
Incorrect- 4 teaspoon is equivalent to 20 grams of carbohydratePlease see the Beyond the Basics meal planning guide in the cheat sheet section for details
Incorrect
Incorrect- 1 teaspoon is equivalent to 5 grams of carbohydrate
Incorrect- 2 teaspoons is equivalent to 10 grams of carbohydrate
Correct- 3 teaspoons is equivalent to 15 grams of carbohydrate. This is the same for sugar, jam, jelly and honey
Incorrect- 4 teaspoon is equivalent to 20 grams of carbohydratePlease see the Beyond the Basics meal planning guide in the cheat sheet section for details
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Question 31 of 50
31. Question
Your patient has a carb ratio of 1-unit-of-insulin for every 17.5-grams-of-carbohydrate. If he is using 4 units, the correct amount of food to consume would be:
Correct
Lactose, fructose and sucrose are all carbohydrates which increase blood sugars, so insulin may be adjusted based on these nutrients. Sorbitol and isomalt are sugar alcohols which have erratic absorption and affect blood sugars minimally. Insulin should not be adjusted for these sugar alcohols. Fibre does not break down into glucose, so insulin should not be dosed for fibre. Cyclamate is an artificial sweetener and has little effect on blood sugars; thus, insulin should not be adjusted for this sweetener either. A person taking 4 units of insulin with a carb ratio of 1:17.5 means he is consuming 4×17.5 g carbohydrates = 70 carbohydrates
A) Incorrect – Only the 35 grams from lactose counts for adjusting insulin
B) Correct – The 70 grams of fructose counts, while the fibre does not. 4 x 17.5= 70 grams of carbohydrate. Note: when carbohydrate-counting off a food label, you subtract the fibre from the TOTAL amount of carbohydrate to get to carbohydrate portions.
C) Incorrect – Neither would break down into glucose
D) Incorrect- 15 grams of sucrose counts, but the isomalt does notPlease see pg S72-73 of the 2018 Diabetes Canada clinical practice guidelines and the Sugar and Sweeteners webpage at https://guidelines.diabetes.ca/docs/patient-resources/sugars-and-sweeteners.pdf (will open in new window) for more information.
Incorrect
Lactose, fructose and sucrose are all carbohydrates which increase blood sugars, so insulin may be adjusted based on these nutrients. Sorbitol and isomalt are sugar alcohols which have erratic absorption and affect blood sugars minimally. Insulin should not be adjusted for these sugar alcohols. Fibre does not break down into glucose, so insulin should not be dosed for fibre. Cyclamate is an artificial sweetener and has little effect on blood sugars; thus, insulin should not be adjusted for this sweetener either. A person taking 4 units of insulin with a carb ratio of 1:17.5 means he is consuming 4×17.5 g carbohydrates = 70 carbohydrates
A) Incorrect – Only the 35 grams from lactose counts for adjusting insulin
B) Correct – The 70 grams of fructose counts, while the fibre does not. 4 x 17.5= 70 grams of carbohydrate. Note: when carbohydrate-counting off a food label, you subtract the fibre from the TOTAL amount of carbohydrate to get to carbohydrate portions.
C) Incorrect – Neither would break down into glucose
D) Incorrect- 15 grams of sucrose counts, but the isomalt does notPlease see pg S72-73 of the 2018 Diabetes Canada clinical practice guidelines and the Sugar and Sweeteners webpage at https://guidelines.diabetes.ca/docs/patient-resources/sugars-and-sweeteners.pdf (will open in new window) for more information.
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Question 32 of 50
32. Question
Which of the following actions would lower the glycemic index of a pasta dish?
Correct
A) Correct – Adding fat increases the amount of time required for digestion and, therefore, lowers the glycemic index. In general, switching consumption from higher glycemic-index carbohydrates to lower glycemic-index carbohydrates is beneficial for glycemic control, but it is not always the case
B) Incorrect- In general, decreasing fibre increases the glycemic index. As well, decreasing acidity can also increase the glycemic index. Sourdough breads, generally, have a lower index than other breads.
C) Incorrect- In general, the easier it is to digest the the food, the higher the glycemic index. This is because it spends less time in digestion and is more rapidly absorbed, causing higher post-prandial sugars. I counsel patients to cook their pasta al dente to lower the glycemic index.
D) Incorrect- For the same reason above and also grossPlease see the Diabetes Canada glycemic index webpage at https://guidelines.diabetes.ca/docs/patient-resources/glycemic-index-food-guide.pdf (will open in new window) for more details
Incorrect
A) Correct – Adding fat increases the amount of time required for digestion and, therefore, lowers the glycemic index. In general, switching consumption from higher glycemic-index carbohydrates to lower glycemic-index carbohydrates is beneficial for glycemic control, but it is not always the case
B) Incorrect- In general, decreasing fibre increases the glycemic index. As well, decreasing acidity can also increase the glycemic index. Sourdough breads, generally, have a lower index than other breads.
C) Incorrect- In general, the easier it is to digest the the food, the higher the glycemic index. This is because it spends less time in digestion and is more rapidly absorbed, causing higher post-prandial sugars. I counsel patients to cook their pasta al dente to lower the glycemic index.
D) Incorrect- For the same reason above and also grossPlease see the Diabetes Canada glycemic index webpage at https://guidelines.diabetes.ca/docs/patient-resources/glycemic-index-food-guide.pdf (will open in new window) for more details
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Question 33 of 50
33. Question
Your patient, who has type 1 diabetes, is leaving for an overseas flight. You advise him/her to do all of the following, except:
Correct
A) Correct – Patients should keep their insulin on their carry on luggage and not in their checked baggage, which goes into the plane’s baggage area. Checked-in luggage may be lost or be placed on the wrong plane. Also, insulin may freeze in the baggage area if it is depressurized, rendering the insulin useless. The insulin will then thaw out while waiting to be picked up. You patient will not be aware that the insulin had froze
B) Incorrect – Patients should carry extra insulin on trips
C) Incorrect – Though its likely an airline will have juice or snacks, there may be delays in attaining it, especially if the plane is experiencing turbulence. It’s better to be well prepared
D) Incorrect – That is a good idea to prepare for the tripPlease check the Diabetes Canada webpage “Travel Tips for People with Diabetes” at https://www.diabetes.ca/learn-about-diabetes/your-rights/air-travel (will open in new window) for more details
Incorrect
A) Correct – Patients should keep their insulin on their carry on luggage and not in their checked baggage, which goes into the plane’s baggage area. Checked-in luggage may be lost or be placed on the wrong plane. Also, insulin may freeze in the baggage area if it is depressurized, rendering the insulin useless. The insulin will then thaw out while waiting to be picked up. You patient will not be aware that the insulin had froze
B) Incorrect – Patients should carry extra insulin on trips
C) Incorrect – Though its likely an airline will have juice or snacks, there may be delays in attaining it, especially if the plane is experiencing turbulence. It’s better to be well prepared
D) Incorrect – That is a good idea to prepare for the tripPlease check the Diabetes Canada webpage “Travel Tips for People with Diabetes” at https://www.diabetes.ca/learn-about-diabetes/your-rights/air-travel (will open in new window) for more details
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Question 34 of 50
34. Question
You have finally convinced one of you patients to start exercising. He tells you that the pros outweigh the cons of starting exercise, but he isn’t ready to start quite yet. He decides to start going to they gym in 5 months. According to the transtheoretical model of change, which state is he in?
Correct
A) Incorrect – Patients at this stage do not intend to start the behavior change in the near future (greater than 6 months), and may be unaware of the need to change at all
B) Correct – The pros outweigh the cons for this patient and he intends to start within 6 months
C) Incorrect – Patients at this stage are ready to start taking action soon, generally within the next 30 days. He is not ready for 5 months
D) Incorrect – He has not yet taken actionPlease see pg 2-39 of Building Competency: The Essentials for more information on the transtheoretical model
Incorrect
A) Incorrect – Patients at this stage do not intend to start the behavior change in the near future (greater than 6 months), and may be unaware of the need to change at all
B) Correct – The pros outweigh the cons for this patient and he intends to start within 6 months
C) Incorrect – Patients at this stage are ready to start taking action soon, generally within the next 30 days. He is not ready for 5 months
D) Incorrect – He has not yet taken actionPlease see pg 2-39 of Building Competency: The Essentials for more information on the transtheoretical model
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Question 35 of 50
35. Question
What is the upper limit of daily fibre intake for people with diabetes?
Correct
A) Incorrect – That is below the maximum limit
B) Incorrect – That is below the maximum limit
C) Correct – The Diabetes Canada guidelines recommends 30-50 grams of dietary fibre intake daily because of the benefits of fibre for glycemic control. This is higher than what is recommended for people without diabetes ( 25 g and 38 g for women and men, and 21 g and 30 g for women and men over 51 years.).
D) Incorrect- That is above the maximum limitPlease see Recommendation 10 pg S74 of the 2018 Diabetes Canada clinical practice guidelines for details
Incorrect
A) Incorrect – That is below the maximum limit
B) Incorrect – That is below the maximum limit
C) Correct – The Diabetes Canada guidelines recommends 30-50 grams of dietary fibre intake daily because of the benefits of fibre for glycemic control. This is higher than what is recommended for people without diabetes ( 25 g and 38 g for women and men, and 21 g and 30 g for women and men over 51 years.).
D) Incorrect- That is above the maximum limitPlease see Recommendation 10 pg S74 of the 2018 Diabetes Canada clinical practice guidelines for details
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Question 36 of 50
36. Question
Insulin has the following properties:
Correct
Insulin is a hormone that stimulates the body to build things up and is, therefore, anabolic. Catabolic hormones, like cortisol, do the opposite to stimulate the body to break things down. Free fatty acids are the building blocks of triglycerides. Glucose is the building block of glycogen. Amino acids are the building blocks of proteins. Therefore, insulin stimulates building free fatty acids into triglycerides, glucose into glycogen and amino acids into protein for storage in the body or other functions. Catabolic hormones do the reverse by stimulating the body to break apart more complex molecules into simpler molecules, usually to burn for energy.
A) Incorrect – Anabolic hormones, like insulin, stimulates conversion from glucose to glycogen and amino acids into proteins. Converting free fatty acids to triglycerides is correct.
B) Incorrect – Insulin is an anabolic hormone, not a catabolic one
C) Correct – All of the information is correct
D) Incorrect – Insulin is an anabolic hormone, not a catabolic one. Insulin stimulates conversion from glucose to glycogen, amino acids to proteins and free fatty acids to triglyceridesFor more information, please see pg 3-6 of Building Competency: The Essentials
Incorrect
Insulin is a hormone that stimulates the body to build things up and is, therefore, anabolic. Catabolic hormones, like cortisol, do the opposite to stimulate the body to break things down. Free fatty acids are the building blocks of triglycerides. Glucose is the building block of glycogen. Amino acids are the building blocks of proteins. Therefore, insulin stimulates building free fatty acids into triglycerides, glucose into glycogen and amino acids into protein for storage in the body or other functions. Catabolic hormones do the reverse by stimulating the body to break apart more complex molecules into simpler molecules, usually to burn for energy.
A) Incorrect – Anabolic hormones, like insulin, stimulates conversion from glucose to glycogen and amino acids into proteins. Converting free fatty acids to triglycerides is correct.
B) Incorrect – Insulin is an anabolic hormone, not a catabolic one
C) Correct – All of the information is correct
D) Incorrect – Insulin is an anabolic hormone, not a catabolic one. Insulin stimulates conversion from glucose to glycogen, amino acids to proteins and free fatty acids to triglyceridesFor more information, please see pg 3-6 of Building Competency: The Essentials
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Question 37 of 50
37. Question
A patient of yours recently had a cardiovascular (CV) event. He is concerned about having another CV event and he is willing to switch medications to lower his CV risk. He is already on a statin and ACE inhibitor. He has an excellent drug plan. As per the 2020 Pharmacological Update, which of the following medications has been shown to lower CV risk?
Correct
A) Incorrect – Invokana (canagliflozin) has shown cardiac benefit in the CANVAS trial. Bydureon (extended release exanatide) and Trajenta (linagliptin) has not yet shown cardiac benefit.
B) Correct – All three of these medications have shown cardiac benefit.
C) Incorrect – Victoza (liraglutide) did show cardiac benefit in the LEADER trial. However both Januvia (sitagliptin) and Trulicity (dutaglutide) did not
D) Incorrect – Jardiance (Empagliflozin) did show cardiac benefit in the EMPA-REG trial and Invokana (canagliflozin) in the CANVAS trial. However Mounjaro (tirzepatide) has not yet shown CV benefits. Mounjaro’s CV trials are expected to come out at the end of 2024 or early 2025.Please see Figure 1 on pg S92 of the 2018 Diabetes Canada clinical practice guidelines for more details. Also see the 2020 Pharmacological update for more details on which medications have cardiac benefits. There are typically many questions on the 2018 Guidelines updates (2019 cannabis, 2020 medications, 2021 blood glucose monitoring, 2019 Ramadan, 2022 Remission, 2023 Mental Health) so make sure you read those in addition to the guidelines.
Incorrect
A) Incorrect – Invokana (canagliflozin) has shown cardiac benefit in the CANVAS trial. Bydureon (extended release exanatide) and Trajenta (linagliptin) has not yet shown cardiac benefit.
B) Correct – All three of these medications have shown cardiac benefit.
C) Incorrect – Victoza (liraglutide) did show cardiac benefit in the LEADER trial. However both Januvia (sitagliptin) and Trulicity (dutaglutide) did not
D) Incorrect – Jardiance (Empagliflozin) did show cardiac benefit in the EMPA-REG trial and Invokana (canagliflozin) in the CANVAS trial. However Mounjaro (tirzepatide) has not yet shown CV benefits. Mounjaro’s CV trials are expected to come out at the end of 2024 or early 2025.Please see Figure 1 on pg S92 of the 2018 Diabetes Canada clinical practice guidelines for more details. Also see the 2020 Pharmacological update for more details on which medications have cardiac benefits. There are typically many questions on the 2018 Guidelines updates (2019 cannabis, 2020 medications, 2021 blood glucose monitoring, 2019 Ramadan, 2022 Remission, 2023 Mental Health) so make sure you read those in addition to the guidelines.
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Question 38 of 50
38. Question
Which of the following symptoms are neuroglycopenic?
Correct
A) Incorrect – This is a neurogenic symptom
B) Correct – Out of the options, this is the only neuroglycopenic symptom
C) Incorrect – This is a neurogenic symptom
D) Incorrect – This is a neurogenic symptom
Hypoglycemia reactions are split into neurogenic (autonomic) and neuroglycopenic. Neurogenic symptoms are mostly caused by glucagon and epinephrine (adrenaline). Side effect of glucagon include nausea. Epinephrine causes trembling, anxiety, sweating etc. Think of autonomic symptoms as the fight or flight response. The state of neuroglycopenia is a lack of glucose for nerve cells to function properly. I like to think about it as being drunk, so symptoms of confusion, difficulty speaking, drowsiness etc. Autonomic symptoms usually appear before neuroglycopenic symptoms. Counter regulatory responses start around 3.8 mmol/L and neuroglycopenic symptoms at 3.2 mmol/L. However, this is highly individual.Please see Table 1 pg S104 of the 2018 Diabetes Canada clinical practice guidelines for more details
Incorrect
A) Incorrect – This is a neurogenic symptom
B) Correct – Out of the options, this is the only neuroglycopenic symptom
C) Incorrect – This is a neurogenic symptom
D) Incorrect – This is a neurogenic symptom
Hypoglycemia reactions are split into neurogenic (autonomic) and neuroglycopenic. Neurogenic symptoms are mostly caused by glucagon and epinephrine (adrenaline). Side effect of glucagon include nausea. Epinephrine causes trembling, anxiety, sweating etc. Think of autonomic symptoms as the fight or flight response. The state of neuroglycopenia is a lack of glucose for nerve cells to function properly. I like to think about it as being drunk, so symptoms of confusion, difficulty speaking, drowsiness etc. Autonomic symptoms usually appear before neuroglycopenic symptoms. Counter regulatory responses start around 3.8 mmol/L and neuroglycopenic symptoms at 3.2 mmol/L. However, this is highly individual.Please see Table 1 pg S104 of the 2018 Diabetes Canada clinical practice guidelines for more details
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Question 39 of 50
39. Question
In the new 2022 Diabetes Canada guideline on Remission of Diabetes, which of the following patients is in remission to pre-diabetes?
Correct
A) Correct- this patient is in remission to pre-diabetes
B) Incorrect- even though this patient is on Jardiance for heart failure and not diabetes the definition of remission includes not being on any antihyperglycemic medications. Therefore we wouldn’t classify this as remission but as pharmacologically managed diabetes.
C) Incorrect- remission is currently only possible for type 2 diabetes not type 1 diabetes
D) Incorrect- this patient is in remission to normal blood glucose levelsPlease see pg 754 of the Remission of Type 2 Diabetes chapter for more details
Incorrect
A) Correct- this patient is in remission to pre-diabetes
B) Incorrect- even though this patient is on Jardiance for heart failure and not diabetes the definition of remission includes not being on any antihyperglycemic medications. Therefore we wouldn’t classify this as remission but as pharmacologically managed diabetes.
C) Incorrect- remission is currently only possible for type 2 diabetes not type 1 diabetes
D) Incorrect- this patient is in remission to normal blood glucose levelsPlease see pg 754 of the Remission of Type 2 Diabetes chapter for more details
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Question 40 of 50
40. Question
A patient of yours, whose glycemic control was previously excellent for several years, comes to you with an A1c of 9.1%. Upon further discussion, you discover that he divorced his wife 2 months ago and he’s not handling it well. You notice that he smells strongly of alcohol and is poorly groomed. He is on metformin 500 mg BID and pioglitazone 30 mg once daily. You:
Correct
A) Incorrect – The personal burden of diabetes is enormous and, obviously, this patient does not need additional stressors placed on him by other health care professionals
B) Incorrect – While technically correct, this is not the best answer as it ignores the patient. Unless the patient is drinking very heavily and there are other co-morbidities, the risk of lactic acidosis is very low
C) Correct – This is the best answer as there is empathy, screening, acknowledgement of patient difficulty and counseling. There will be similar questions on the exam that test empathy
D) Incorrect – While technically correct, this is not the best answer as it ignores the patientIncorrect
A) Incorrect – The personal burden of diabetes is enormous and, obviously, this patient does not need additional stressors placed on him by other health care professionals
B) Incorrect – While technically correct, this is not the best answer as it ignores the patient. Unless the patient is drinking very heavily and there are other co-morbidities, the risk of lactic acidosis is very low
C) Correct – This is the best answer as there is empathy, screening, acknowledgement of patient difficulty and counseling. There will be similar questions on the exam that test empathy
D) Incorrect – While technically correct, this is not the best answer as it ignores the patient -
Question 41 of 50
41. Question
Which of the following is NOT part of the Chronic Care Model (CCM)
Correct
The CCM model consists of:
1) Delivery systems designs – The system that the team (and the different roles in the team) uses to deliver care to patients
2) Self-management support – Involves active patient participation in self-monitoring and/or decision making
3) Decision support – Providing healthcare practitioners with best practice information at the point of care to help support decision making
4) Clinical information System – Electronic medical records or patient registries that that allow for a population-based approach to diabetes assessment
5) The Community – Environmental factors, such as food security, the ability to lead an active lifestyle, as well as access to care and social supports, also impact diabetes outcomes
6) Health systems – Support for diabetes care from the broader level of the healthcare system, such as the national and provincial systems, is essential.C) Correct – A reward/punishment system is not part of the CCM model. Patients are adults who can make their own decisions and we, as health care professionals, need to respect that. It is not our job to hand out punishments. Given our strained health care system, the rewards we can hand out are limited.
Please see pg S29 of the 2018 Diabetes Canada clinical practice guidelines for more information.
Incorrect
The CCM model consists of:
1) Delivery systems designs – The system that the team (and the different roles in the team) uses to deliver care to patients
2) Self-management support – Involves active patient participation in self-monitoring and/or decision making
3) Decision support – Providing healthcare practitioners with best practice information at the point of care to help support decision making
4) Clinical information System – Electronic medical records or patient registries that that allow for a population-based approach to diabetes assessment
5) The Community – Environmental factors, such as food security, the ability to lead an active lifestyle, as well as access to care and social supports, also impact diabetes outcomes
6) Health systems – Support for diabetes care from the broader level of the healthcare system, such as the national and provincial systems, is essential.C) Correct – A reward/punishment system is not part of the CCM model. Patients are adults who can make their own decisions and we, as health care professionals, need to respect that. It is not our job to hand out punishments. Given our strained health care system, the rewards we can hand out are limited.
Please see pg S29 of the 2018 Diabetes Canada clinical practice guidelines for more information.
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Question 42 of 50
42. Question
You have a 54-year-old patient who’s had diabetes for 14 years. He has no history of retinopathy, nephropathy or neuropathy. He is allergic to peanuts and ASA. He suffered a stroke 4 years ago. His cholesterol is on target. According to the 2018 Diabetes Canada guidelines, which of the following medications should he be on?
Correct
A) Incorrect – The patient has had a stroke and should be on a number of medications to manage his CV risk. His cholesterol being on target does not mean he does not need any medications.
B) Incorrect – He has already had a CV event (stroke) which puts him in the high risk category of experiencing another CV event. He should be on a statin as well as other medications to reduce his CV risk.
C) Incorrect – Several studies like HOPE, EUROPA and ONTARGET show the cardiovascular benefits of ACE inhibition. Subset analysis of patients with diabetes from the studies above show similar vascular protective effects. However he should still be on additional meds.
D) Correct – The patient is allergic to ASA, so clopidogrel which also inhibits platelets from aggregating and forming clots, is a reasonable alternative
E) Incorrect – Platelet aggregation plays a key role in atherothrombosis. Even though ASA seems to be less effective in patients with diabetes, ASA has been shown to reduce CVD events in patients with established CVD disease and diabetes. However, since this patient is allergic to ASA, clopidogrel is a reasonable alternative.Please see the recommendations on pg S166 of the 2018 Diabetes Canada clinical practice guidelines. Also see the Reducing Vascular Risk tool in the Diabetes Canada website (will open in new window) http://guidelines.diabetes.ca/health-care-provider-tools . Its under For Health Care Providers then Tool and Resources and then Macrovascular Complications.
Incorrect
A) Incorrect – The patient has had a stroke and should be on a number of medications to manage his CV risk. His cholesterol being on target does not mean he does not need any medications.
B) Incorrect – He has already had a CV event (stroke) which puts him in the high risk category of experiencing another CV event. He should be on a statin as well as other medications to reduce his CV risk.
C) Incorrect – Several studies like HOPE, EUROPA and ONTARGET show the cardiovascular benefits of ACE inhibition. Subset analysis of patients with diabetes from the studies above show similar vascular protective effects. However he should still be on additional meds.
D) Correct – The patient is allergic to ASA, so clopidogrel which also inhibits platelets from aggregating and forming clots, is a reasonable alternative
E) Incorrect – Platelet aggregation plays a key role in atherothrombosis. Even though ASA seems to be less effective in patients with diabetes, ASA has been shown to reduce CVD events in patients with established CVD disease and diabetes. However, since this patient is allergic to ASA, clopidogrel is a reasonable alternative.Please see the recommendations on pg S166 of the 2018 Diabetes Canada clinical practice guidelines. Also see the Reducing Vascular Risk tool in the Diabetes Canada website (will open in new window) http://guidelines.diabetes.ca/health-care-provider-tools . Its under For Health Care Providers then Tool and Resources and then Macrovascular Complications.
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Question 43 of 50
43. Question
You have a patient whom you have recently started on bolus insulin. He calls you from a grocery store and says he is buying some high fibre spaghetti. He says the package says:
One serving: Half a cup of uncooked spaghetti
Total Carbohydrate: 45 grams per serving
Fibre: 10 grams per serving
Sugar: 15 grams per servingHe plans on cooking one cup of spaghetti for dinner tonight. His insulin-to-carbohydrate ratio is 1-unit-per-5 grams. How much bolus insulin should he be taking to cover the carbohydrate in the spaghetti tonight?
Correct
Food labels usually contain the following three parameters: Total Carbohydrate, Fibre and Sugar. The available carbohydrate in a food is equal to Total Carbohydrate minus the Fibre content. Fibre is included in Total Carbohydrate but does not actually break down into sugar; therefore, it should not be included in calculations for bolus insulin. Sugar is part of the total carbohydrate and does not need to be counted separately.
A) Incorrect – This answer does not take into account the 10 grams of fibre, which should be subtracted from the total carbohydrate
B) Correct – 45 grams of total carbohydrate minus 10 grams of fibre =35 grams available carbohydrate for 1/2 cup serving. 35 grams x 2 (pt eating 1 full cup) =70 grams. 70 grams divided by 1-unit-of-insulin per 5-grams-of-carbohydrate = 14 units
C) Incorrect – This answer does not taking into account that the patient is eating one full cup
D) Incorrect – This answer is basing the amount of bolus insulin on the sugar content, not the carbohydrate content; hence, it is incorrect.Incorrect
Food labels usually contain the following three parameters: Total Carbohydrate, Fibre and Sugar. The available carbohydrate in a food is equal to Total Carbohydrate minus the Fibre content. Fibre is included in Total Carbohydrate but does not actually break down into sugar; therefore, it should not be included in calculations for bolus insulin. Sugar is part of the total carbohydrate and does not need to be counted separately.
A) Incorrect – This answer does not take into account the 10 grams of fibre, which should be subtracted from the total carbohydrate
B) Correct – 45 grams of total carbohydrate minus 10 grams of fibre =35 grams available carbohydrate for 1/2 cup serving. 35 grams x 2 (pt eating 1 full cup) =70 grams. 70 grams divided by 1-unit-of-insulin per 5-grams-of-carbohydrate = 14 units
C) Incorrect – This answer does not taking into account that the patient is eating one full cup
D) Incorrect – This answer is basing the amount of bolus insulin on the sugar content, not the carbohydrate content; hence, it is incorrect. -
Question 44 of 50
44. Question
Acute Charcot neuroarthropathy has all of the following features, except:
Correct
A) Incorrect – If unrecognized or left untreated, Charcot neuroarthropathy can result in a severely misshapen and unstable foot and ankle
B) Correct – Charcot foot (neuropathic osteoarthropathy) is a progressive condition characterized by joint dislocation, pathologic fractures, and severe destruction of the pedal architecture. It is not characterized by infection and unless an infection is also present, then antibiotics are not required.
C) Incorrect – Increased warmth is the first indicator of inflammation in an insensate foot
D) Incorrect – Total immobilization is required for the bones and joints to heal
For more information, please see pg S223 of the 2018 Diabetes Canada clinical practice guidelines and pg 36 of the Guidelines for the Diabetic foot at http://onlinelibrary.wiley.com/doi/10.1002/dmrr.848/abstract (will open link in new tab)Incorrect
A) Incorrect – If unrecognized or left untreated, Charcot neuroarthropathy can result in a severely misshapen and unstable foot and ankle
B) Correct – Charcot foot (neuropathic osteoarthropathy) is a progressive condition characterized by joint dislocation, pathologic fractures, and severe destruction of the pedal architecture. It is not characterized by infection and unless an infection is also present, then antibiotics are not required.
C) Incorrect – Increased warmth is the first indicator of inflammation in an insensate foot
D) Incorrect – Total immobilization is required for the bones and joints to heal
For more information, please see pg S223 of the 2018 Diabetes Canada clinical practice guidelines and pg 36 of the Guidelines for the Diabetic foot at http://onlinelibrary.wiley.com/doi/10.1002/dmrr.848/abstract (will open link in new tab) -
Question 45 of 50
45. Question
You have a patient who wants to switch to once-daily basal insulin for convenience. He is currently on 25 units of NPH twice daily. He would like to switch to once daily Lantus (glargine) in the morning. He is also starting a new exercise program in hopes of losing some weight. Currently here is his sugars:
May 9 May 10 May 11 Fasting 4.2 4.6 4.0 Before lunch 4.9 4.1 4.3 Before supper 5.4 6.7 5.1 Before bed 4.0 4.1 4.3 When switching over you suggest:
Correct
A) Incorrect – The patient’s sugars are already quite low and he is about to start an exercise program which would push the sugars even lower. Increasing the Lantus would likely cause more hypoglycemia
B) Correct – For 2 reasons: 1) the patient’s blood sugars are already quite low and he is about to start an exercise program which would push the sugars even lower. Lowering the dose may prevent hypoglycemia. 2) As a general rule, when switching to from a twice-daily basal insulin to a once-daily insulin, the dose is reduced by 20% to avoid hypoglycemia. This general rule isn’t in the guidelines and doesn’t apply in all cases (such as when the patient’s blood sugars significantly above target) but it is commonly done in real life practice
C) Incorrect – Lantus does not have to be taken only at bedtime
D) Incorrect – Technically, long-acting analogues do cause a small amount of weight gain. However, so does NPH which the patient is already on. Lantus causes less weight gain than NPH. So, to tell a patient that he is going to gain weight on a new insulin (when he may actually lose weight) would not be correct.Incorrect
A) Incorrect – The patient’s sugars are already quite low and he is about to start an exercise program which would push the sugars even lower. Increasing the Lantus would likely cause more hypoglycemia
B) Correct – For 2 reasons: 1) the patient’s blood sugars are already quite low and he is about to start an exercise program which would push the sugars even lower. Lowering the dose may prevent hypoglycemia. 2) As a general rule, when switching to from a twice-daily basal insulin to a once-daily insulin, the dose is reduced by 20% to avoid hypoglycemia. This general rule isn’t in the guidelines and doesn’t apply in all cases (such as when the patient’s blood sugars significantly above target) but it is commonly done in real life practice
C) Incorrect – Lantus does not have to be taken only at bedtime
D) Incorrect – Technically, long-acting analogues do cause a small amount of weight gain. However, so does NPH which the patient is already on. Lantus causes less weight gain than NPH. So, to tell a patient that he is going to gain weight on a new insulin (when he may actually lose weight) would not be correct. -
Question 46 of 50
46. Question
Which of the following organs or tissues in the body stores roughly 75 grams of glycogen?
Correct
A) Incorrect- skeletal muscle stores roughly 300-500 grams of glycogen and is the largest reservoir of glycogen in the body
B) Incorrect- the pancreas does not store significant amounts of glycogen
C) Correct- the liver stores roughly 75 grams of glycogen and is the principal reservoir where glycogen can be converted to glucose
D) Incorrect- adipose tissues stores its energy as lipidsIncorrect
A) Incorrect- skeletal muscle stores roughly 300-500 grams of glycogen and is the largest reservoir of glycogen in the body
B) Incorrect- the pancreas does not store significant amounts of glycogen
C) Correct- the liver stores roughly 75 grams of glycogen and is the principal reservoir where glycogen can be converted to glucose
D) Incorrect- adipose tissues stores its energy as lipids -
Question 47 of 50
47. Question
All of the following may help with reducing insulin resistance EXCEPT?
Correct
A) Incorrect – Atypical antipsychotics are associated with significant weight gain, insulin resistance and impaired fasting glucose/type 2 diabetes. Please see pg S137 of the 2018 Diabetes Canada clinical practice guidelines for more information
B) Incorrect – Actos works by activating the PPAR system in cells to reduce insulin resistance. Please see Table 1 on pg S90 of the 2018 Diabetes Canada clinical practice guidelines for more information.
C) Correct – Eating more artificial sweeteners will not raise blood glucose but they do not generally improve insulin sensitivity. Substituting sugar already in the diet for artificial sweeteners will likely improve blood glucose but do little for insulin resistance. The best answer out of all the available answers. Please see pg S72 of the 2018 Diabetes Canada clinical practice guidelines.
D) Incorrect – Resistance exercise improves skeletal muscle insulin sensitivity. Please see pg S55 of the 2018 Diabetes Canada clinical practice guidelines for more information.Incorrect
A) Incorrect – Atypical antipsychotics are associated with significant weight gain, insulin resistance and impaired fasting glucose/type 2 diabetes. Please see pg S137 of the 2018 Diabetes Canada clinical practice guidelines for more information
B) Incorrect – Actos works by activating the PPAR system in cells to reduce insulin resistance. Please see Table 1 on pg S90 of the 2018 Diabetes Canada clinical practice guidelines for more information.
C) Correct – Eating more artificial sweeteners will not raise blood glucose but they do not generally improve insulin sensitivity. Substituting sugar already in the diet for artificial sweeteners will likely improve blood glucose but do little for insulin resistance. The best answer out of all the available answers. Please see pg S72 of the 2018 Diabetes Canada clinical practice guidelines.
D) Incorrect – Resistance exercise improves skeletal muscle insulin sensitivity. Please see pg S55 of the 2018 Diabetes Canada clinical practice guidelines for more information. -
Question 48 of 50
48. Question
Which of the following answers has the correct percentage reduction of pre-diabetes to diabetes for Glucophage (metformin), Actos (pioglitazone) and weight loss?
Correct
A) Incorrect- correct, incorrect, correct
B) Correct- all of these percentages are correct. Metformin reduces the progression to pre-diabetes by about 30%, pioglitazone about 70% (rosiglitazone the other thiazolidinedione reduces risk about 60%) and lifestyle interventions by about 60% with just 5% weight loss!
C) Incorrect- incorrect, incorrect- incorrect
D) Incorrect- correct, correct, incorrectPlease see pg S21 – S23 of the 2018 Diabetes Canada clinical practice guidelines for more information
Incorrect
A) Incorrect- correct, incorrect, correct
B) Correct- all of these percentages are correct. Metformin reduces the progression to pre-diabetes by about 30%, pioglitazone about 70% (rosiglitazone the other thiazolidinedione reduces risk about 60%) and lifestyle interventions by about 60% with just 5% weight loss!
C) Incorrect- incorrect, incorrect- incorrect
D) Incorrect- correct, correct, incorrectPlease see pg S21 – S23 of the 2018 Diabetes Canada clinical practice guidelines for more information
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Question 49 of 50
49. Question
You meet with a new patient who has just been diagnosed with type 2 diabetes by his family physician. He has had an A1c of 9.1% (0.091) and a confirmatory test of 9.0% (0.09). When you being the consult with him, he shouts out “This is complete bullshit! I have friends who drink a six pack of beer and eat ice cream every day and they don’t have diabetes! I rarely drink and never have sweets and I have diabetes! Why the hell did I catch it?”. Your initial response should be:
Correct
A) Incorrect- he is not worried about threats from having diabetes such as “I am so worried that diabetes will rob of my vision”. He is expressing unfairness that his friends don’t have diabetes and he does. While cognitive behavioral therapy may help his anger this is not the best answer.
B) Incorrect- while technically correct this is not an empathetic answer and given the patients anger you will be unlikely to convince him to start insulin. This answer does not take into account his feelings of unfairness and is not the best answer.
C) Correct- he is expressing unfairness that he has diabetes while his friends who eat poorly do not. Acceptance and use commitment therapy could be used to relieve his anger
D) Incorrect- he is not expressing any loss from having diabetes such as “I guess I can never have ice cream with my grandchildren ever again, that’s so sad”. He is expressing unfairness that his friends don’t have diabetes and he does. Motivational interview may or may not help his anger but this is not the best answer.Please see pg 311 of the 2023 Diabetes and Mental Health update for more details
Incorrect
A) Incorrect- he is not worried about threats from having diabetes such as “I am so worried that diabetes will rob of my vision”. He is expressing unfairness that his friends don’t have diabetes and he does. While cognitive behavioral therapy may help his anger this is not the best answer.
B) Incorrect- while technically correct this is not an empathetic answer and given the patients anger you will be unlikely to convince him to start insulin. This answer does not take into account his feelings of unfairness and is not the best answer.
C) Correct- he is expressing unfairness that he has diabetes while his friends who eat poorly do not. Acceptance and use commitment therapy could be used to relieve his anger
D) Incorrect- he is not expressing any loss from having diabetes such as “I guess I can never have ice cream with my grandchildren ever again, that’s so sad”. He is expressing unfairness that his friends don’t have diabetes and he does. Motivational interview may or may not help his anger but this is not the best answer.Please see pg 311 of the 2023 Diabetes and Mental Health update for more details
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Question 50 of 50
50. Question
Zeno is 60 and has type 2 diabetes but has never experienced a heart attack or other CV event. Zeno comes to see you asking if he should be on medications like his brother (Marcus who had a stroke) as he is concerned about having a cardiovascular event. He is a smoker and is on medications for high blood pressure. You respond that the following medication has the best evidence to help Zeno:
Correct
The 2020 Pharmacologic Glycemic Management of Type 2 Diabetes in Adults update emphasizes primary prevention in diabetes. The main difference between Marcus and Zeno is that in Marcus we are aiming for secondary prevention as he has had a cardiovascular event and in Zeno we are aiming for primary prevention since he has never had a cardiovascular event. The medications used to prevent major adverse cardiovascular events (MACE) are different. For primary prevention only GLP-1 analogs have shown significant primary prevention benefits.
A) Incorrect- SGLT-2 inhibitors have not shown the highest evidence primary prevention cardiovascular benefit
B) Correct- GLP-1 analogs have shown to have significant primary prevention cardiovascular benefits especially Trulicity (dulaglutide)
C) Incorrect- DPP-4 inhibitors have not shown significant primary prevention or secondary prevention cardiovascular benefit
D) Incorrect- SGLT-2 inhibitors have not shown the highest evidence of primary prevention cardiovascular benefitPlease see Figure 2A on pg 577 of the Pharmacologic Glycemic Management of Type 2 Diabetes in Adults: 2020 Update for more details. There were a lot of questions on the 2018 Guidelines updates (2019 cannabis, 2020 medications, 2021 blood glucose monitoring, 2019 Ramadan, 2022 Remission, 2023 Mental Health) so make sure you read those in addition to the guidelines.
Incorrect
The 2020 Pharmacologic Glycemic Management of Type 2 Diabetes in Adults update emphasizes primary prevention in diabetes. The main difference between Marcus and Zeno is that in Marcus we are aiming for secondary prevention as he has had a cardiovascular event and in Zeno we are aiming for primary prevention since he has never had a cardiovascular event. The medications used to prevent major adverse cardiovascular events (MACE) are different. For primary prevention only GLP-1 analogs have shown significant primary prevention benefits.
A) Incorrect- SGLT-2 inhibitors have not shown the highest evidence primary prevention cardiovascular benefit
B) Correct- GLP-1 analogs have shown to have significant primary prevention cardiovascular benefits especially Trulicity (dulaglutide)
C) Incorrect- DPP-4 inhibitors have not shown significant primary prevention or secondary prevention cardiovascular benefit
D) Incorrect- SGLT-2 inhibitors have not shown the highest evidence of primary prevention cardiovascular benefitPlease see Figure 2A on pg 577 of the Pharmacologic Glycemic Management of Type 2 Diabetes in Adults: 2020 Update for more details. There were a lot of questions on the 2018 Guidelines updates (2019 cannabis, 2020 medications, 2021 blood glucose monitoring, 2019 Ramadan, 2022 Remission, 2023 Mental Health) so make sure you read those in addition to the guidelines.
2) Read the 2018 Diabetes Canada Clinical Practice Guidelines. Please see below for the first chapter. Click here to go to the Study Guide with sample questions at the end of each chapter . The guidelines are the most important document for the exam.
3) Click here to check out how to study for the exam.
4) If you found the quizzes useful and want more then check out the Practice Exams. Your pass is guaranteed or your money back (before July 31). Currently my students have a 97.4% pass rate (based on refunds, 1887 students passed out of a total of 1936). Click here to go to Buy a Package
Below are testimonials from health care professionals who have written the CDE ™ exam:
Ontario
”I first got my Certified Diabetes Educator (CDE) title in 1998 and I remember how hard it was to prepare for the exam. As a pharmacist, our training in the day to day management of diabetes was minimal at best at the school level. I managed to pass on my first attempt but many of my colleagues were not as lucky.
I stumbled onto the website and was very impressed with the content. Esmond had obviously put a great deal of effort in creating questions that cover many of the competencies required for successful completion of the exam. The practice exam provides instant feedback for participants with detailed descriptions of both the right and wrong answers. When writing the actual exam this year I found many of the practice questions mirrored the difficulty of questions presented in the exam.
It certainly was well worth the cost of access to his site. I would encourage anyone preparing for the certification exam to take a look at what the website can offer to you. I am confident you will find the website useful to yourself and will recommend it to your colleagues moving forward, as I most certainly will.”
Rick Siemens
R.Ph; CDE, Additional Prescribing Authority, 2018 Diabetes Canada Guideline Author (Monitoring Glycemic Control chapter)
Alberta
Testimonial: Esmond; on you testimonial page I see people writing from AB, ON, and BC, so I thought I would let you know that we in Atlantic Canada also LOVE your website and the assistance it provides as we study for CDE recertification or 1st time certifications!! My friend and I studied together last year, and when I found your site I was elated and amazed that you take such pride in being a CDE and it definitely demonstrates this as you share your knowledge and professional background through this site. Last year, my friend, Mavis and I, paid for your exam and wrote it together making sure we timed it according to the time allotted for the CDE exam. We took our time on some questions and discussed others questions so we went over by 10 minutes however we figured that without the discussions we would have had ample time to write the exam. We wrote 2 weeks prior to the CDE EXAM and the feedback you provided gave us all the information needed to identify our weaker areas and we also had time to devote to theses areas prior to the exam! We both passed – I for the 3rd time, and Mavis for the 1st time. She told me that your site was more helpful that the online course she took!! This year I have shared you website with Dietitians new to our outpatient Diabetes Education Clinic; they will be writing on May 26th here in Fredericton, NB and when I told them how helpful your site has been in previous years and that your provided IMMEDIATE FEEDBACK when the exam is marked, they wanted the web address straight away!! Thank you
Brenda Mercer RN MN CDE CNS
Inpatient Diabetes Education & Management Certified in Adult and Gestation Insulin Adjustment Certified in Insulin Pump Adjustment
I invite you to look around the site and comment. Please contact me if you have any ideas on how I can serve you better. Check back often for updates. Best of luck on the exam!
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