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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.
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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.
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Question 1 of 10
1. Question
You have a patient who is concerned about his cardiovascular risk and his A1c is not at target. He has a BMI of 41 and a waist circumference of 40 inches. He suffers from sleep apnea. However he is quite active and has lots of vegetables in his diet. His blood pressure is 123/75 and he is on rosuvastatin for cholesterol. He has never experienced a cardiovascular event. Which of the following medications would reduce his risk of having a major adverse cardiovascular event (MACE) the most?
Correct
A) Incorrect- ASA is no longer used in primary prevention. Research have found the benefits to not outweigh the risks of gastric bleeds and other side effects
B) Incorrect- SGLT-2 inhibitors do not have significant evidence of reducing MACE in primary prevention
C) Incorrect- SGLT-2 inhibitors do not have significant evidence of reducing MACE in primary prevention
D) Correct- GLP-1 analogs, particularly dulaglutide, have the best evidence of reducing MACE in primary preventionPlease see Figure 2A on pg 577 of Oct 2020 Pharmacologic Glycemic Management of Type 2 Diabetes in Adults for more details
Incorrect
A) Incorrect- ASA is no longer used in primary prevention. Research have found the benefits to not outweigh the risks of gastric bleeds and other side effects
B) Incorrect- SGLT-2 inhibitors do not have significant evidence of reducing MACE in primary prevention
C) Incorrect- SGLT-2 inhibitors do not have significant evidence of reducing MACE in primary prevention
D) Correct- GLP-1 analogs, particularly dulaglutide, have the best evidence of reducing MACE in primary preventionPlease see Figure 2A on pg 577 of Oct 2020 Pharmacologic Glycemic Management of Type 2 Diabetes in Adults for more details
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Question 2 of 10
2. Question
THIS IS THE LAST QUESTION. PLEASE REVIEW YOUR ANSWERS BEFORE CLICKING ON FINISH QUIZ. ONCE YOU HIT THE FINISH QUIZ BUTTON YOU WILL NOT BE ABLE TO REVIEW YOUR ANSWERS. ONCE YOU FINISH REVIEWING YOUR QUIZ, CLICK QUIZ SUMMARY THEN FINISH QUIZ TO COMPLETE AND SCORE YOUR TEST.
You have a patient with type 2 diabetes who needs to go insulin to get her sugars under control. She weighs 120 kg and has a history of bladder cancer. She is very fearful of going on insulin as her grandfather lost his foot shortly after starting insulin. Her grandfather also had seizures in the middle of the night due to hypoglycemia. She remarks “Am I such a failure that I need to start insulin?” You respond that:
Correct
A) Correct- this patient is very fearful of starting. The most empathetic course of action is to explore her fears and to reassure her. On the exam and in real life the best course of action is usually the empathetic one.
B) Incorrect- while this option may reduce overnight lows, as rapid acting insulin doesn’t last long enough, this doesn’t solve the main problem of the patient’s fears
C) Incorrect- while a reduced dosage would reduce the likelihood of having overnight lows, this doesn’t solve the main problem of the patient’s fears
D) Incorrect- while this does acknowledge the patients fears it doesn’t address them. Also a history of bladder cancer is a contraindication to Actos (pioglitazone) so not the best answer.Please see chapter 18 and table 5 on pg 326 the 2023 Diabetes and Mental Health update for details
Incorrect
A) Correct- this patient is very fearful of starting. The most empathetic course of action is to explore her fears and to reassure her. On the exam and in real life the best course of action is usually the empathetic one.
B) Incorrect- while this option may reduce overnight lows, as rapid acting insulin doesn’t last long enough, this doesn’t solve the main problem of the patient’s fears
C) Incorrect- while a reduced dosage would reduce the likelihood of having overnight lows, this doesn’t solve the main problem of the patient’s fears
D) Incorrect- while this does acknowledge the patients fears it doesn’t address them. Also a history of bladder cancer is a contraindication to Actos (pioglitazone) so not the best answer.Please see chapter 18 and table 5 on pg 326 the 2023 Diabetes and Mental Health update for details
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Question 3 of 10
3. 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 my pathphysiology lectures or pg 3-6 to 3-7 of Building Competency: The Essentials (5th Ed)
On the exam there may be questions with very long answers. The key to these answers is to look for the item that is incorrect to eliminate the entire long answer. For example if I know that insulin in an anabolic hormone then I can already eliminate B and D right off the bat. That saves time (your most precious resource on the exam). Even if you cant decide between A and C at least you have a 50% chance of guessing the right answer instead of a 25%
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 my pathphysiology lectures or pg 3-6 to 3-7 of Building Competency: The Essentials (5th Ed)
On the exam there may be questions with very long answers. The key to these answers is to look for the item that is incorrect to eliminate the entire long answer. For example if I know that insulin in an anabolic hormone then I can already eliminate B and D right off the bat. That saves time (your most precious resource on the exam). Even if you cant decide between A and C at least you have a 50% chance of guessing the right answer instead of a 25%
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Question 4 of 10
4. Question
How long after consuming alcohol is a patient at risk for having a hypoglycemic event if they are on insulin or an insulin secretagouge?
Correct
A) Incorrect – 4 hours is too short
B) Incorrect – 18 hours is too short
C) Correct – Alcohol can cause hypoglycemia up to 24 hours after consumption. Alcohol interferes with the liver’s ability to create glucose, which can lead to hypoglycemia
D) Incorrect – 48 hours is too longFor more information please see pg S73 of the 2018 Diabetes Canada clinical practice guidelines
For alcohol consumption tips and a patient handout, please check out the Diabetes Canada website at https://www.diabetes.ca/DiabetesCanadaWebsite/media/Managing-My-Diabetes/Tools%20and%20Resources/alcohol-and-diabetes.pdf?ext=.pdf will open in a new window
Incorrect
A) Incorrect – 4 hours is too short
B) Incorrect – 18 hours is too short
C) Correct – Alcohol can cause hypoglycemia up to 24 hours after consumption. Alcohol interferes with the liver’s ability to create glucose, which can lead to hypoglycemia
D) Incorrect – 48 hours is too longFor more information please see pg S73 of the 2018 Diabetes Canada clinical practice guidelines
For alcohol consumption tips and a patient handout, please check out the Diabetes Canada website at https://www.diabetes.ca/DiabetesCanadaWebsite/media/Managing-My-Diabetes/Tools%20and%20Resources/alcohol-and-diabetes.pdf?ext=.pdf will open in a new window
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Question 5 of 10
5. Question
Which of the following is an process indicator as defined by the Standard for Diabetes Education in Canada 2014?
Correct
A) Correct- this is a process indicator
B) Incorrect- this is a outcome indicator
C) Correct- this is a outcome indicator
D) Incorrect- this is a structure indicatorPlease see the Standard for Diabetes Education in Canada 2014 in the After Practice Exam for details
Incorrect
A) Correct- this is a process indicator
B) Incorrect- this is a outcome indicator
C) Correct- this is a outcome indicator
D) Incorrect- this is a structure indicatorPlease see the Standard for Diabetes Education in Canada 2014 in the After Practice Exam for details
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Question 6 of 10
6. Question
You have a 20 year old patient who was diagnosed with type 1 diabetes when he was 18. When and how often should he be screen for retinopathy?
Correct
A) 23 and yearly: Correct- Retinopathy screening for patients with type 1 diabetes should commence 5 years after onset of diabetes and be done yearly regardless if retinopathy is present or not
B) 15 and every 2 years: Incorrect- screening starts after 5 years after diagnosis so 5 years after 18 so screening should start at 23 years of age. For children with type 1 diabetes retinopathy screening should start at 15 years of age if duration of diabetes is more than 5 years.
C) 25 and every 2 years: Incorrect- people with type 1 diabetes are screened at least yearly for retinopathy while adults with type 2 diabetes can be screened 1-2 years if no retinopathy is present
D) 15 and yearly: Incorrect- for the reasons abovePlease see pg S211 of the 2018 Diabetes Canada guidelines for more details
Incorrect
A) 23 and yearly: Correct- Retinopathy screening for patients with type 1 diabetes should commence 5 years after onset of diabetes and be done yearly regardless if retinopathy is present or not
B) 15 and every 2 years: Incorrect- screening starts after 5 years after diagnosis so 5 years after 18 so screening should start at 23 years of age. For children with type 1 diabetes retinopathy screening should start at 15 years of age if duration of diabetes is more than 5 years.
C) 25 and every 2 years: Incorrect- people with type 1 diabetes are screened at least yearly for retinopathy while adults with type 2 diabetes can be screened 1-2 years if no retinopathy is present
D) 15 and yearly: Incorrect- for the reasons abovePlease see pg S211 of the 2018 Diabetes Canada guidelines for more details
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Question 7 of 10
7. Question
What is the target Time-In-Range (TIR) for most older people or people who have a high risk of hypoglycemia?
Correct
A) Correct- this is the TIR for older people and/or people with a high risk for hypoglycemia
B) Incorrect- this is a made up TIR
C) Incorrect- this is the TIR for most people with diabetes
D) Incorrect- this is a made up TIRPlease see Table 3 on pg 583 of the 2021 Blood Glucose monitoring update for details
Incorrect
A) Correct- this is the TIR for older people and/or people with a high risk for hypoglycemia
B) Incorrect- this is a made up TIR
C) Incorrect- this is the TIR for most people with diabetes
D) Incorrect- this is a made up TIRPlease see Table 3 on pg 583 of the 2021 Blood Glucose monitoring update for details
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Question 8 of 10
8. 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. His A1c is at 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 (cardiovascular) 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.
As per the 2020 Pharmacological update, you could also consider medications for CV protection (such as certain SGLT-2 inhibitors or GLP-1 analogs).
Incorrect
A) Incorrect – The patient has had a stroke and should be on a number of medications to manage his CV (cardiovascular) 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.
As per the 2020 Pharmacological update, you could also consider medications for CV protection (such as certain SGLT-2 inhibitors or GLP-1 analogs).
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Question 9 of 10
9. Question
The parents of your patient, a 3-year-old child with type 1 diabetes, is having a difficult time getting the child to cooperate with injections. The anxious parents realize the injections are necessary but also see that it causes their child pain. Unfortunately, the child is still too young to understand what is going on. You suggest all of the following except:
Correct
This is an “EXCEPT” question. On older exams there were a lot of trick questions which ask what “not” to do or what is “incorrect” or “except”. In the latest exams there does not seem to be any of these trick questions but I decided to keep some in my Practice Exams to force people to read the question carefully. After talking to people who failed the exam I have found one of the most common reasons for failing the exam is not reading the question carefully. So remember to read the question carefully.
A) Incorrect – Distraction therapy can be useful to make injections more tolerable in children
B) Incorrect – Play therapy, as long as it doesn’t involve trickery and loss of trust, can be useful to make injections more tolerable in children
C) Incorrect – Parents who are well prepared beforehand will transmit less anxiety to a child. In fact, the presence of a calm and reassuring parent is the most effective support for a distressed child.
D) Correct – Cognitive behavioral therapy should be reserved to older children and adolescents. A 3 year old will not understand the concepts discussed in cognitive behavioral therapy and is unlikely to cooperate.Please see pg 32 of the 2020 FIT guidelines for more details in the After Practice Exam section
Incorrect
This is an “EXCEPT” question. On older exams there were a lot of trick questions which ask what “not” to do or what is “incorrect” or “except”. In the latest exams there does not seem to be any of these trick questions but I decided to keep some in my Practice Exams to force people to read the question carefully. After talking to people who failed the exam I have found one of the most common reasons for failing the exam is not reading the question carefully. So remember to read the question carefully.
A) Incorrect – Distraction therapy can be useful to make injections more tolerable in children
B) Incorrect – Play therapy, as long as it doesn’t involve trickery and loss of trust, can be useful to make injections more tolerable in children
C) Incorrect – Parents who are well prepared beforehand will transmit less anxiety to a child. In fact, the presence of a calm and reassuring parent is the most effective support for a distressed child.
D) Correct – Cognitive behavioral therapy should be reserved to older children and adolescents. A 3 year old will not understand the concepts discussed in cognitive behavioral therapy and is unlikely to cooperate.Please see pg 32 of the 2020 FIT guidelines for more details in the After Practice Exam section
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Question 10 of 10
10. Question
THIS IS THE LAST QUESTION. PLEASE REVIEW YOUR ANSWERS BEFORE CLICKING ON FINISH QUIZ. ONCE YOU HIT THE FINISH QUIZ BUTTON YOU WILL NOT BE ABLE TO REVIEW YOUR ANSWERS. ONCE YOU FINISH REVIEWING YOUR QUIZ, CLICK QUIZ SUMMARY THEN FINISH QUIZ TO COMPLETE AND SCORE YOUR TEST
You have a patient who loves eating fruits. She asks which of the following fruits has the lowest glycemic index (GI) so that she can choose them more often?
Correct
A) Incorrect- generally (but not always) tropical fruits tend to have a higher GI
B) Incorrect- ripe and over ripe bananas have the highest GI
C) Correct- apples have the lowest GI of the fruits listed
D) Incorrect- generally (but not always) tropical fruits tend to have a higher GIPlease see the Diabetes Canada resource on glycemic index for details. You do not need to memorize everything but you do need to have a good idea of what foods fall into high, medium and low glycemic index. Here is the link https://www.diabetes.ca/DiabetesCanadaWebsite/media/Managing-My-Diabetes/Tools%20and%20Resources/glycemic-index-food-guide.pdf (will open in new window)
Incorrect
A) Incorrect- generally (but not always) tropical fruits tend to have a higher GI
B) Incorrect- ripe and over ripe bananas have the highest GI
C) Correct- apples have the lowest GI of the fruits listed
D) Incorrect- generally (but not always) tropical fruits tend to have a higher GIPlease see the Diabetes Canada resource on glycemic index for details. You do not need to memorize everything but you do need to have a good idea of what foods fall into high, medium and low glycemic index. Here is the link https://www.diabetes.ca/DiabetesCanadaWebsite/media/Managing-My-Diabetes/Tools%20and%20Resources/glycemic-index-food-guide.pdf (will open in new window)
If you scored 90% or above on your first try then you probably do not need this website. If you would like a refresher, I would suggest Package A or B.
If you scored 70% and above I would suggest Package C.
If you scored below 70% I would suggest Package D. Please see the Buy Packages tab
To review the structure of the exam, go to the How To Study tab above and click: Start Here. For your study schedule please go to the How to Study tab and click: Study Schedule. The first part of the Study Schedule is free up to chapter 10.
If you found the quizzes/content useful and want more, please check out the Packages in the Buy Packages tab above. Your pass is guaranteed or your money back (before July 31). Currently my students have a 97.6% pass rate (based on refunds, 2205 students passed out of a total of 2260- updated Aug 1 2024).
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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