I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- insulin is an anabolic hormone so this is a function of insulin to build triglycerides into fat
B) Incorrect- insulin is an anabolic hormone so this is a function of insulin to build glucose into glycogen
C) Correct- this would be a function of a catabolic hormone as it breaks down proteins into amino acids
D) Incorrect- this is insulin’s main function

Please see my pathophysiology lectures and videos for more details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- insulin is what counter-regulatory hormones oppose
B) Correct- cortisol opposes insulin’s actions so is a counter regulatory hormone
C) Incorrect- minimal effect on insulin system
D) Incorrect- minimal effect on insulin system

Please see my pathophysiology lectures or videos for more details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- insulin resistance (due to obesity, age, pregnancy, etc.) can happen in people with type 1 diabetes but is usually associated with type 2 diabetes
B) Correct- autoimmune destruction of beta cells does not occur with type 2 diabetes so is closely associated with type 1 diabetes
C) Incorrect- obesity is associated with type 2 diabetes
D) Incorrect- type 1 diabetes are more prone to ketoacidosis

Please see my pathophysiology lectures or videos more for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- people on or not on insulin therapy could develop HHS
B) Correct- ketones are an essential part of diagnosing keto-acidosis
C) Incorrect- is associated with HHS
D) Incorrect- an anion gap greater than 12 is associated with DKA so a anion gap of 10 is  associated with HHS

Watch out for the not questions by reading the questions slowly. See pg S110 of the 2018 Diabetes Canada guidelines for more details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- no diabetes
B) Incorrect- diabetes
C) Incorrect- gestational diabetes using alternate approach
D) Correct- pre-diabetes

Please see pg S11 of the 2018 Diabetes Canada clinical practice guidelines for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- GLP-1s increase beta cell mass
B) Correct- this is part of how they improve blood glucose levels
C) Incorrect-inhibits gastric emptying to reduce post prandial sugars
D) Incorrect- decreases food intake and appetite

Please see my pathophysiology lectures and videos for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect-
B) Incorrect-
C) Correct- not sure why they are asking stats from 2011. A lot can happen in 10+ years. In the 2018 guidelines 9.3% is the prevalence.
D) Incorrect-

Please see my Statistic Cheat Sheet in the How to Study section for more details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Correct- a general but easier way to memorize the ethnic groups at risk of diabetes is that any non-Caucasian is at higher risk
B) Incorrect- is at higher risk
C) Incorrect- is at higher risk
D) Incorrect- is at higher risk

Please see Table 1 on pg S17 of the 2018 Diabetes Canada guidelines for more details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect-
B) Incorrect-
C) Incorrect-
D) Correct- the DCCT shows that the intensively treated group had a significant reduction in microvascular complications especially in retinopathy

Please see my cheat sheet on Studies and Statistics in the How to study guide for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Correct- this is for retinopathy and all diabetes related complications
B) Incorrect-
C) Incorrect- this is the albuminuria reduction in the UKPDS
D) Incorrect- this is the retinopathy reduction in the DCCT

Please see my studies and statistics cheat sheet for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- definitely increases risk of complications
B) Incorrect- definitely increases risk of complications
C) Incorrect- some people are more prone to CV complications than others based on their genetics
D) Correct- I feel the wording of the question is not great. Should be which of the following variables, as gender is not a risk factor. Regardless if this was a test question I would choose D.

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- the VADT studied veterans with type 2 diabetes not type 1
B) Correct- the VADT showed significant CVD reductions with tight blood pressure control but interestingly not with tight blood glucose control
C) Incorrect- the VADT showed significant CVD reductions with tight blood pressure control
D) Incorrect- the VADT studied veterans with type 2 diabetes not type 1

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- there was a difference in the conventional arm
B) Correct- this is called the legacy effect. For 10 years the patients in the intensive treatment arm had an A1c ~7% and the conventional arm had an A1c of ~9%. After the trial ended, patients were kicked out and left to care for themselves. Then 10 years later both arms had an A1c ~8%. Despite having roughly the same A1c of 8% the intensive treatment arm continued to have less complications than the conventional arm even though their A1c was both around 8%. Please see my pathophysiology lectures for more details.

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Correct- damage to the small blood vessels (microvascular) causes damages to the nerves leading to neuropathy
B) Incorrect- while the incidence of cataracts is increased in diabetes, the pathophysiology is not completely understood. Possible mechanisms are the polyol pathway or osmotic and oxidative stress but not through damage to the small blood vessels
C) Incorrect- while some studies show that people with diabetes catch pink eye or conjunctivitis more often than people without diabetes, its not due to damage to the small blood vessels
D) Incorrect- the link between diabetes and carpal tunnel syndrome is controversial

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- this is damage to the large blood vessels (macrovascular) in the brain
B) Incorrect- this is damage to the large blood vessels (macrovascular) in the peripheral arteries
C) Incorrect- this is damage to the large blood vessels (macrovascular) in the heart
D) Correct- this is caused my damage to the small blood vessels (microvascular) leading to nerve damage in the GI tract

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- the guidelines seem to suggest that the rates are no different in type 1 and type 2
B) Incorrect- the guidelines state that after 10 years people with type 1 and type 2 have a 40-50% chance of developing neuropathy
C) Incorrect- I would have worded the answer differently. Neuropathy affects people with type 1 earlier in life because people with type 1 are usually younger. But if you measure neuropathy from time of diagnosis (which is what this answer is suggesting) then the times for type 1 and type 2 are similar
D) Correct- because the person with type 2 could have had diabetes or pre-diabetes for decades and not know about it they could present with neuropathy

Please see pg S217 of the 2018 Diabetes Canada clinical practice guidelines and my screening cheat sheet for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- the autonomic nervous system controls mostly unconsciously functions like sweating
B) Incorrect- the autonomic nervous system controls mostly unconsciously functions like control of blood pressure
C) Correct- perception involves the sensory/peripheral nervous system so is not a diabetes complication of the autonomic nervous system
D) Incorrect- the autonomic nervous system controls mostly unconsciously functions like digestion

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- this is a macrovascular problem
B) Incorrect- gastroparesis is a autonomic nervous system problem and the cause of Bell’s palsy is unknown
C) Incorrect- that sounds like a urinary tract infection to me
D) Correct- a symptom of peripheral neuropathy is numbness in feet

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Correct- previous data showed the prevalence rate of proliferative retinopathy to be 23% in people with type 1 diabetes, 14% in people with type 2 diabetes on insulin therapy and 3% in people receiving noninsulin antihyperglycemic therapies
B) Incorrect- diabetes is the leading cause of blindness in adults/working age not children. Diabetic retinopathy rarely develops in children.
C) Incorrect- no idea where they got this statistic
D) Incorrect- higher prevalence rates of microvascular disease, including chronic kidney disease (CKD), lower limb amputation, foot abnormalities, and more severe retinopathy
have been found in indigenous people

Please see S211 of the 2018 Diabetes Canada clinical practice guidelines for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- longer duration would be a risk factor as there would be more damage to the small blood vessels over time. HDL is “good” cholesterol so having more should reduce the development/progression of retinopathy
B) Incorrect- neuropathy is apparently incorrect
C) Incorrect- higher doses of insulin means high insulin resistance but could signify the diabetes is well controlled
D) Correct- risk factors for the development or progression of diabetic retinopathy are longer duration of diabetes, elevated A1C, increased blood pressure (BP), dyslipidemia, anemia, pregnancy (with type 1 diabetes), proteinuria and severe retinopathy itself

Please see pg S211 of the 2018 Diabetes Canada clinical practice guidelines for more details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- I would have worded the answer differently because an ophthalmologist is a MD/physician. I suppose a general MD/physician could learn but they generally are not performing dilated eye examinations
B) Incorrect- wrong profession
C) Correct- a MD/physician specialized in the eyes/ophthalmology
D) Incorrect- generally an optician has a diploma level education. They create glasses and can do basic eye exams but not dilated eye exams

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- i and ii are opposites!
B) Incorrect- only iii is correct
C) Correct- macrosomia occurs because there is excessive sugar causing excessive insulin production. Insulin is anabolic so the weight of the baby goes up. During birth the umbilical cord is cut and all the excessive sugar from the mother is cut off. However the neonate’s pancreas is still making excessive insulin causing neonatal hypoglycemia
D) Incorrect- I dont know about hyponatremia but ii is incorrect

Please see chapter 36 for more details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- this is a schedule for people with type 1 diabetes
B) Correct- when you diagnose a person with type 2 diabetes generally you don’t know how long they’ve had diabetes so you screen right away
C) Incorrect- the waiting one year part is not correct
D) Incorrect- wrong

Please see my screening cheat sheet for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- drinking alcohol (note that the answer doesn’t say excessively) is not a key risk factor
B) Incorrect- urinary tract infections is not a risk factor for diabetic nephropathy
C) Incorrect- drinking alcohol (note that the answer doesn’t say excessively) is not a key risk factor
D) Correct- key risk factors include long duration of diabetes; non-optimal glycemic, blood pressure and plasma lipid control; obesity; and cigarette smoking

Please see pg S202 of the 2018 Diabetes Canada clinical practice guidelines for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- don’t send your patients for 24 hour urine albumin collection. They have to carry around this jug for 24 hours and collect all their urine. It’s inconvenient and gross. Just send for a random albumin collection.
B) Correct- these are the usual two
C) Incorrect- generally you don’t time your collection for creatinine
D) Incorrect- kidney function should be screened regularly. Not PRN (as needed) when there is a concern for a drop in kidney function

Please see pg S202 of the 2018 Diabetes Canada clinical practice guidelines  for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- people with type 2 diabetes should maintain close follow up with their CDE and physician
B) Incorrect- apparently not true
C) Correct- generally you don’t know how long a person has had diabetes when you diagnose them so they may already have nephropathy at diagnosis
D) Incorrect- I don’t see why that would be the case

Please see pg S202 of the 2018 Diabetes Canada clinical practice guidelines and my screening cheat sheet for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- this is textbook true however in real life practice people generally go 1-6 weeks afterwards
B) Incorrect- ACEs and ARBs can both slow the progression of nephropathy
C) Correct- people with type 2 diabetes can use ACEi OR ARBs to delay the progression of nephropathy. Angiotensin converting enzyme (ACE) inhibitors and Angiotensin receptor blockers (ARB) both reduce angiotensin (constricts blood vessels) activity. ACEs block the enzyme which converts the angiotensinogen into angiotensin while ARBs block angiotensin from connecting with the angiotensin receptor
D) Incorrect- ACEs and ARBs can cause birth defects so should be switched to another BP medication

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect-
B) Incorrect-
C) Incorrect-
D) Correct- all the above are true. Exercise could directly lower glucose, then indirectly when the liver takes in glucose to replenish glycogen stores used while exercising.

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- all the answers are correct
B) Incorrect- all the answers are correct
C) Incorrect- all the answers are correct
D) Correct- they made an error with the letters but E/D is the correct answer. All of the above

Please see chapter 10 for more details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Correct- loss of protective sensation due to diabetes in the feet could lead to additional or more severe blisters from ill fitting footwear. Alcohol consumption would increase the for hypoglycemia. People without diabetes rarely have to be concerned about hypoglycemia.
B) Incorrect- people with type 1 diabetes get sore muscles the same as people without diabetes. There are no additional safety concerns for sore muscles. The same is true for increased energy requirements. Having to eat more is normal when increasing physical activity for people with or without diabetes
C) Incorrect- as above
D) Incorrect- as above

Please see chapter 10 for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Correct- more frequent SMBG can help detect hypoglycemia, increasing carbs can reduce hypoglycemia and reducing insulin can reduce hypoglycemia
B) Incorrect- iv is incorrect as protein won’t provide enough glucose to prevent lows
C) Incorrect- iv is incorrect
D) Incorrect- iii is incorrect as it says decreased food intake

Please see chapter 10 and 14 for more details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- exercise increases insulin sensitivity which would lead to hypoglycemia not hyperglycemia
B) Incorrect- Bill took his insulin 30 minutes ago and the racquetball game is in 45 minutes so a total of 75 minutes will have passed once he starts playing. Rapid acting insulin peaks in 1.5-2 hours so as he plays that is when his rapid acting insulin will peak which is a risk
C) Incorrect- there is no mention of gastroparesis so you can’t assume that he has it. Just like you cant assume that he cardiac disease, nephropathy, neuropathy, erectile dysfunction just because he has diabetes
D) Correct- if it was planned he could have reduce his rapid acting insulin with his lunch but its unplanned so he didnt adjust

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- i would lead to more severe hypoglycemia
B) Incorrect- iii there is no mention of gastroparesis in the original question so you cant assume he has gastroparesis
C) Correct- both are prudent ways to prevent hypoglycemia due to unplanned activity
D) Incorrect- iii is wrong

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

The calculation is 2000 x 0.29= 580 kcal divide by 9kcal per gram of fat = 64.4 gram of fat so B

A) Incorrect-
B) Correct-
C) Incorrect-
D) Incorrect-

See chapter 11 and my study guide for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

The calculation is 90 kg / (1.75 x 1.75) = 29.4 so the answer is C. In previous examinations with paper and pencils, calculators were not allowed. Due to COVID, in the new online examinations the calculator function within the testing program is allowed.

A) Incorrect-
B) Incorrect-
C) Correct-
D) Incorrect-

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- a BMI of <18.5 would be underweight which Holly is not
B) Incorrect- I’ve been told that the term “morbidly” isn’t used anymore. Holly does not fit into the criteria of obese so she wouldn’t be morbidly obese
C) Incorrect- a BMI of 18.5-24.9 would be considered healthy
D) Correct-a BMI of 29 falls into the overweight category

Please see Table 1 on pg S125 of the 2018 Diabetes Canada guidelines for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- generally BMI is for adults
B) Incorrect- the extra weight from pregnancy would throw off the calculation. I don’t know about the lactating women part though
C) Incorrect- the BMI is incorrect for this class of people. Wrestlers, bodybuilders, powerlifters and other strength athletes would have their health risks greatly overstated using a BMI calculation
D) Correct- all of the above

See chapter 17 for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect-
B) Correct-
C) Incorrect-
D) Incorrect-

See pg S65 of the 2018 Diabetes Canada clinical practice guidelines and my study guide for more details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

i- I’ve never seen research that fibre delays or treats chronic kidney disease
ii- a low fibre diet is recommended for people with gastroparesis
iii- correct, improves lipid profile
iiii- correct, lowers post prandial sugars

A) Incorrect-
B) Incorrect-
C) Incorrect-
D) Correct-

Pleases see pg S67 of the 2018 Diabetes clinical practice guidelines and my study guide for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Correct-
B) Incorrect-
C) Incorrect-
D) Incorrect-

Please see pg S68 of the 2019 Diabetes Canada clinical practice guidelines for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect-
B) Incorrect-
C) Correct-
D) Incorrect-

Please see pg S68 of the 2018 Diabetes Canada guidelines for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

i- alcohol is not a key risk factor to developing chronic kidney disease
ii- I never heard of this effect and assume it isn’t true
iii- correct, this is why the risk of hypoglycemia is increased for people with diabetes when consuming alcohol
iv- from my understanding, you can get energy from alcohol (by breaking it down to CO2, H2O and ATP) but it is not broken down into glucose so therefore it shouldn’t raise sugars or contribute to the development of ketoacidosis

A) Incorrect-
B) Incorrect-
C) Correct-
D) Incorrect-

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

i- correct otherwise triglycerides are increased
ii- not true, treatment of diabetes is not an entire patient’s life
iii- I feel this is true. Reduction of sweets should be restricted if you are trying to lose weight
iv- I feel this is not true even though it is the right answer. If patients are seeing their grandkids or having a special event, as long as their sugars are not critically high, I tell them to enjoy the one special event. Remember, treatment of diabetes is not your patient’s life purpose.

A) Incorrect- in my opinion, this would be the correct answer
B) Correct-
C) Incorrect-
D) Incorrect-

Please see chapter 11 for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect-
B) Incorrect-
C) Correct- nutrition therapy should be individualized
D) Incorrect-

Please see chapter 11 of the 2018 Diabetes Canada guidelines for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- excessive energy intake can lead to increased weight gain but this is only part of the answer
B) Incorrect- especially if they have been insulin deficient for a while, people’s weight can go up as their sugars improve with insulin but this is only part of the answer
C) Incorrect- excessive hypoglycemia from insulin and the carbohydrate treatment can lead to weight gain
D) Correct- all all true

Some of these concepts are covered in chapter 14 of the 2018 Diabetes guidelines

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- meat and alternatives generally don’t contain enough carbohydrate to affect blood sugars
B) Incorrect- oils generally don’t contain enough carbohydrate to affect blood sugars
C) Correct- all three groups can affect sugars, other choices includes sweets and candies
D) Incorrect- oil, meat and alternatives, artificial sweeteners and vegetables generally don’t contain enough carbohydrate to affect blood sugars

Please see chapter 11 of the 2018 Diabetes Canada guidelines for more information

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Correct- carbohydrate counting does offer a flexible way to plan meals
B) Incorrect- not familiar with it but seems to sell high priced food on their website
C) Incorrect- I guess its not a meal planning method?
D) Incorrect- apparently not very flexible with food choices

Please see https://guidelines.diabetes.ca/docs/patient-resources/basic-carbohydrate-counting.pdf for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

Each 8 oz is 15 grams of carbohydrate. Even without a calculator we can see that 16 oz would be 30 grams but we have 17.5 oz so its slightly higher than 30 grams but not as high as 60 grams which would be 8×4= 24 oz

A) Incorrect- this would be 24 oz
B) Incorrect- this would be 8 oz
C) Correct- this would be 17.5 oz
D) Incorrect- this would be 16 oz

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

This question is a bit of a trick question. On food labels when you take the total carbohydrate and subtract the fibre than you get “available carbohydrate” as fibre doesn’t turn into sugar. It seems that the 38 gram for breakfast is “available carbohydrate”. A carbohydrate choice is generally 15 grams of carbohydrate. The way the question is worded is that it is trying to trick you into choose 22.4 + 15 = 37.4 grams which is C) but that’s wrong. For the oatmeal you need to subtract the fibre to 22.4 – 3.8= 18.6. Then multiply by 2 to get 37.2 which is two packages which is the correct answer.

A) Incorrect- that would be 18.6 grams of carbohydrate
B) Correct- that would be 37.2 grams of carbohydrate
C) Incorrect- that would be 33.6 grams of carbohydrate
D) Incorrect- that would be 26.1 grams of carbohydrate

Please see chapter 11 of the 2018 Diabetes Canada guidelines for more details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect-
B) Incorrect-
C) Correct- I honestly have never seen this done and have no idea what the  correct answer is
D) Incorrect-

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- saxagliptan and other DPP-4s did not show CV benefit, acarbose in newer studies show a trend towards benefit but did not show statistically significant CV benefit
B) Incorrect- orlistat does not show CV benefit
C) Incorrect- degludec and other insulins do not show CV benefit, exenatide is a GLP-1 analog that did not show CV benefit
D) Correct- all three of these agents showed statistically significant. In the 2020 Pharmacological update there are other GLP-1 analogs that were included as having statistically significant CV benefit.

Please see Figure 1 on pg S92 of the 2018 Diabetes Canada guidelines and the 2020 Pharmacological update of the Diabetes Canada guidelines for more details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

i- weight neutral
ii- weight neutral
iii- weight neutral
iv- weight loss
v- weight gain
vi- weight gain

A) Incorrect-
B) Incorrect-
C) Incorrect-
D) Correct- only v and vi are associated with weight gain

Please see Figure 1 on pg S93 of the 2018 Diabetes Canada guidelines for more details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

This is a bit of a trick question. An eGFR of 60ml/min is the minimum for no dose adjustments for basically every drug. There is sometimes a question on renal function and medications on the exam but the Figure 2 of pg S94 is hard to memorize. I suggest trying to memorize roughly via drug class.

A) Correct-
B) Incorrect-
C) Incorrect-
D) Incorrect-

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

i- true but could be worded better. “More likely to cause hypoglycemia than other oral agents” would be better
ii- true as they can cause edema and water retention
iii- not true its below 30 ml/min, odd choice to use 47 ml/min
iv- true as acarbose stops the breakdown of certain carbohydrates into sugar. Pure glucose such as dextrose can be used to treat hypoglycemia in patients taking acarbose

A) Incorrect-
B) Correct-
C) Incorrect-
D) Incorrect-

Please see chapter 13 of the 2018 Diabetes Canada guidelines for more information

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

i- not true, breastfeeding seems to be protective against the development of diabetes
ii- correct, the risk of developing diabetes after gestational diabetes is high so a post partum test is recommended
iii- correct as the risk of developing diabetes after gestational diabetes is high
iv- not true and not likely with a baby

A) Incorrect-
B) Incorrect-
C) Correct-
D) Incorrect-

Please see chapter 36 of the 2018 Diabetes Canada guidelines for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- I have heard that vigorous shaking damages the fragile insulin proteins
B) Incorrect- apparently not enough sufficient
C) Correct-
D) Incorrect- I have heard that vigorous shaking damages the fragile insulin proteins

See pg 17 of the 4th edition FIT guidelines for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

i- correct, the 2018 guidelines emphasize individualization of targets
ii- correct, as adding one of those meds could reduce additional weight gain, risk of hypoglycemia and injections from intensifying insulin therapy
iii- if you look at table 1 on pg S90, it shows metformin as first line and GLP-1 analogs and SLGT-2 inhibitors as second line. I would have chosen this as a correct statement. I think what the question maker meant to write is “you must always use metformin as first line treatment” which is not true. If I have a pt with a very sensitive stomach and wants to lose weight and has CV issues I’ll jump straight to a SGLT-2 inhibitor which is correct for real life practice.
iv- correct this was proven in the STEPWISE trial and its easier to convince and initiate at one meal instead of all meals

A) Incorrect- in my opinion, this should be the correct answer
B) Incorrect-
C) Incorrect-
D) Correct-

Please see chapters 8 and 13 of the 2018 Diabetes Canada guidelines for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- the abdomen is the site with the fastest and most consistent absorption, the buttocks and back of the arms have slower absorption
B) Incorrect- injectable insulin is designed to form a depot under in the subcutaneous area of the skin where it is slowly absorbed. If injected intramuscular the depot/absorption is disturbed leading to erratic sugars and increasing the risk of lows
C) Incorrect- site rotation is important to prevent lipohypertrophy (basically a scar/fat lump due to excessive injections into the area)
D) Correct- injecting into a site with lipohypertrophy usually causes slow or erratic insulin absorption

Watch out for the “NOT” or choose the “INCORRECT” style of questions

Please see the 4th edition FIT guidelines for more details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

i- this is an iffy answer. In general, mixed insulins are used twice daily and basal insulins are used once daily. However in real life practice there are several insulins that are used twice daily such as NPH, Levemir or high doses of Lantus. As well I have one patient who refuses to inject himself more than once daily. He has high fasting sugars and eats a large breakfast. Mixed insulin ONCE a day with breakfast works perfectly for him as he runs on the treadmill for an hour and a half every afternoon and has small suppers. Also I’m not sure why this is listed a limitation.
ii- this is correct, if a patient is having a large meal for a special occasion and having cake he/she cannot alter the 30/70 to increase the bolus dosing for that one meal
iii- I heard of increased risk of hypoglycemia but haven’t heard of increased nocturnal hypoglycemia but apparently this is correct
iv- because you cant adjust the bolus for larger or smaller meals and must have a lunch

A) Incorrect-
B) Incorrect-
C) Incorrect- because i is so iffy I might have went with this answer
D) Correct- apparently the most correct answer

Please see chapter 12 of the 2018 Diabetes Canada guidelines for more details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

i- this is one of the strengths of intensive therapy regimen or basal bolus therapy
ii- no this is the drawback of mixed insulin therapy
iii- compared to what? mixed insulin therapy from the previous question? basal insulin? oral medications? Poor wording but I guess it’s correct.
iv- yes, by taking more or less rapid acting insulin to correct for highs or lows

A) Incorrect-
B) Correct-
C) Incorrect-
D) Incorrect-

Please see chapter 12 of the Diabetes Canada guidelines for more details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- this is true, I don’t think I’ve met a single person who required a needle longer than 6mm
B) Correct- insulin is deposited subcutaneously under the skin not into muscle or organs as many patients think (you may need to explain this concept to them). Regardless of how much a person weights the thickness of the he skin and subcutaneous layer is very similar in all people.
C) Incorrect- this is true, there is no reason to use such a long needle
D) Incorrect- yes for 8mm needles this is recommended

Remember to watch out for the “NOT” and “look for the INCORRECT” style of questions

Please see page 12 of the 4th edition FIT guidelines for more details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

i) true- cortisol is a counter regulatory hormone which opposes insulin. Please see my pathophysiology lectures for details
ii) false- atypical antipsychotics are associated with weight gain, insulin resistance and hyper- not hypo- glycemia. Please see pg S248 of the 2018 Diabetes Canada guidelines for details
iii) false- alcohol can cause hypoglycemia for up to 24 hours. Please see pg S73 of the 2018 Diabetes Canada guidelines for details
iv) true- protease inhibitors (which inhibit the protease’s of the HIV virus for treatment of people with AIDS)

A) Incorrect- ii) is incorrect
B) Incorrect- iii) is incorrect
C) Incorrect- ii- and iii) is incorrect
D) Correct- as i) and iv) are correct

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

Remember that premixed insulin analogue is a mix of a rapid acting analogue with rapid acting analogue combined with protamine turning into an insulin that has similar properties to intermediate insulin. That means that premixed insulin analogue has two peaks and should control the post prandial meal and fasting sugars that intermediate insulin covers.
Looking at the table we note that there are no lows as we would fix that first. Then we note that the before breakfast sugars and before bed sugars are high.

A) Incorrect- Increasing the before breakfast dose would not help the before breakfast sugars. If I am having breakfast at 9 am and my sugars are 15.4 and I am taking my breakfast insulin at 9:01 am then it wont prevent the 15.4. Remember that even the most rapid acting insulin needs about 10-15 min to work and 1.5-2 hours to take full effect. If I wake up with a 15.4 its likely my sugars have been high all night. The before lunch sugars are mostly at target so increasing the before breakfast insulin further may lead to hypoglycemia.
B) Incorrect- for the same reasons as above
C) Correct- increasing the dose at that time is correct because the rapid acting component of the mix will help reduce the before bed sugars and the intermediate component of the mix will help the before breakfast sugars. A 10% increase is a safe and reasonable amount to increase
D) Incorrect- the timing is correct as per the answer above but a 30% increase is too aggressive and may lead to hypoglycemia

Please see pg S312 for Appendix 5 and 6 of the 2018 Diabetes Canada clinical practice guidelines

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- there was one before dinner reading that was high, one blank and two that were on target. Potentially 75% on target so no need to adjust dose here. Not the best answer.
B) Incorrect- its correct to adjust insulin for hypoglycemia first but there are no recorded episodes of hypoglycemia before dinner
C) Incorrect- the first part is unnecessary but the second part of the answer is correct. However not the best answer
D) Correct- generally you treat hypoglycemia before treating hyperglycemia. The question doesn’t say when dinner however we can make some assumptions. Rapid acting insulin usually peaks in 2 hours so unless Vivian is having dinner at 1 am and then the rapid acting insulin is peaking at 3 am then its not the rapid acting insulin causing the lows. So if its not the rapid acting insulin then its the bedtime basal analogue causing the lows which needs to be reduced. 10% is a reasonable amount to reduce.

Please see Appendix 6 on pg S314 of the Diabetes Canada clinical practice guidelines for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

i) is false and potentially dangerous for a pregnant women
ii) is false because keto diets are generally not recommended in pregnancy
iii) is true and all of those suggestions can be found in chapter 36 of the Diabetes Canada guidelines
iv) is true and those recommendations can be found in chapter 36 of the Diabetes Canada guidelines

A) Incorrect- because i and ii is false
B) Incorrect- because i is false
C) Incorrect- because ii is false
D) Correct- because iii and iv are correct

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

i) strips are expensive around $70-90 for 100 strips. If a patient is testing 4-5 times a day that would be $3-4 a day which can be an obstacle for patients
ii) this test can out before the Libre system came out and became popular. Fear of pain with pricking fingers is very common but there are other barriers to self monitoring of blood glucose. The 2021 update to the guidelines have changed some of terminology around glucose monitoring.
iii) this is a very common barrier that I’ve encountered with my patients. I would rate this as the third most common reason why people don’t test their sugars. Patients will often say “I know I’m doing poorly so I’m scared to see the numbers, the numbers were high regardless of how hard I work so I stopped testing, if I show you high numbers then I know you will put me on insulin so I stopped testing”
iv) this is a common reason, many people work with machinery, work outdoors, or in the service industry where they either don’t have two hands to spare to test, don’t have a clean environment to test or don’t have a private enough area to test.

A) Incorrect- they are all barriers to self monitoring of blood glucose
B) Incorrect- they are all barriers to self monitoring of blood glucose
C) Incorrect- they are all barriers to self monitoring of blood glucose
D) Correct- they are all barriers to self monitoring of blood glucose

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- this is the recommended amount if the patient was at target- at least as often as insulin is being given
B) Correct- since the patient is above target they should be testing more often.
C) Incorrect- they could test more but the question asks for the suggested minimum
D) Incorrect- they could test more but the question asks for the suggested minimum- NOTE as per the 2021 update to the guidelines this should now be the correct answer.

Please see Appendix 5 of the 2018 Diabetes Canada guidelines for more details. As for the 2021 update under recommendation 4 on pg S84 D) would be the correct answer for the exam

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.
Note that this question came out before the 2021 update to the guidelines

A) Incorrect- if blood sugars are not matching what the patient is feeling (i.e. pt experiencing lows but CGM says sugars are ok), during rapid changes in sugars (episodes of hypoglycemia, during exercise, etc.) or if the CGM machine shuts down or is otherwise malfunctioning then Amina would need to test with her capillary glucose meter
B) Incorrect- this is not a bad answer but its a bit subjective as “fun” can mean a lot of different things for people. You wont be able to find the word “fun’ in the Diabetes Canada guidelines. I think the easier to manage part is true and I’ve had many patients say that its so interesting to see what their sugars are like all day.
C) Incorrect- interpreting data from sensors requires some education. While the Libre is fairly easy to use CGM like Dexcom and Guardian are a little more complex. I wouldn’t describe them as easy to use
D) Correct- the most proper sounding and the correct answer. CGM has shown to reduce A1c and time in hypoglycemia

Please see pg S83 of the Diabetes Canada clinical practice guidelines

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- this is correct, most people will be adults will be aiming for an A1c of <7%. Some may aim lower for <6.5% but most will be <7%
B) Incorrect- this is correct, A1c measures glycosylated hemoglobin within red blood cells. Red blood cells live for about 90 days.
C) Correct- this in incorrect which is correct. A1c measures the the glycemic control over the past ~90 days
D) Incorrect- this is correct, blood glucose is measured by mmol/L which hemoglobin A1c is reported using the National Glycohemoglobin Standardization Program in percent units (%).

Please see pg S47 of the 2018 Diabetes Canada guidelines for more details
Watch out for those "Not Correct" questions.

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

i) is true, insulin and sulfonylureas are both high risk medications for causing hypoglycemia
ii) is true, tight blood glucose control can increase the risk of hypoglycemia while looser control blood glucose control is recommended for patients with frequent hypoglycemia
iii) is true, extra carbohydrates
iv)

A) Incorrect-
B) Incorrect-
C) Incorrect-
D) Correct-

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- this is a symptom of mild hypoglycemia
B) Correct- remember to look out for the not questions, this is not a symptom of mild hypoglycemia
C) Incorrect- this is a symptom of mild hypoglycemia
D) Incorrect- this is a symptom of mild hypoglycemia

Please look on Table 1 pg S104 of the 2018 Diabetes Canada clinical practice guidelines for more details. An easy way to remember most of the symptoms of mild hypoglycemia is to remember they are mediated by glucagon (which causes nausea) and epinephrine (trembling, palpitations, anxiety, etc.). Just think of exam fright and you’ll have most of the symptoms of mild hypoglycemia.

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- somogyi effect is when a person has a low in the middle of the night and the body responds by spiking their sugars. This results in high morning sugars when the pt tests in the morning
B) Incorrect- dawn phenomenon is the normal release of counter regulatory hormones such as epinephrine to wake the body up. This release in counter regulatory hormones results in rising sugars causing high morning sugars when the pt tests in the morning
C) Correct- Mr Jones’ sugars were high ranging between 14-18. His body has gotten used to sugars being high and feels that 14-18 is “normal”. Now that he is sugars are 6.8 mmol/L his body thinks this is “low” so he is getting symptoms. The treatment for this is to raise his targets and more slowly reduce his sugars.
D) Incorrect- I have never heard of this I think the question maker just made up this term

Pseudo-hypoglycemia is not mentioned in the guidelines but has been on the test. Please see the Chapter 14 study guide for details.

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

i) this is true, the cause of the hypoglycemia should be assessed and steps taken to prevent it from happening again
ii) this is false, sometimes you will need 20 grams for very low sugars but there is no situation where you take 25 grams, the waiting time is correct however
iii) this is true, 15 grams is the amount of carbohydrate used for most lows and the waiting time is correct
iv) this is false, a chocolate bar has 15-45 grams of carbohydrate and a can of pop has 30-45 gram of sugars which is way too much sugar for treat a low

A) Incorrect- as ii is false
B) Incorrect- as ii and iv are false
C) Correct-as 1 and iii are true
D) Incorrect- as iv is false

Please see Table 4 on pg S106 of the 2018 Diabetes Canada Clinical Practice guidelines

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- not sure where these numbers are from, at first I thought they could be for pregnant people but they don’t match up so I think these numbers are made up
B) Incorrect- not the correct numbers
C) Correct- the targets for type 1 adults are the same as type 2
D) Incorrect- not the correct numbers

Please see Figure 1 on pg S43 of the 2018 Diabetes Canada clinical practice guidelines for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

i) is true- this isn’t explicitly mentioned in the guidelines but makes sense. I wasn’t sure if this was true but since All of Above is correct this must be true as well
ii) is true- these questions came out before Basqmi (nasal glucago) came out. Injectable glucagon expires soon after mixing so it’s supplied as two vials, diluent and powder, which must be mixed immediately before administration.
iii) is true- as per First Aid training
iv) is true- that’s why some people feel nauseated when going low, their body is making glucagon to prevent going low and a side effect of glucagon is nausea.

A) Incorrect- yes those are both true but a better answer is that they are all true. On the exam you have the choose the BEST answer out of potentially many correct answers
B) Incorrect- all are true
C) Incorrect- all are true
D) Correct- the best answer

Please see chapter 14 of the 2018 Diabetes Canada clinical practice guidelines for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

i) is false- during illness the body will produce large amounts of stress hormones like cortisol which are also counter regulatory hormones that oppose insulin. Even if the patient isn’t eating they will generally require as much or more insulin than usual to overcome the opposition from the counter regulatory hormones.
ii) is true- if unable to eat they should consume carbohydrate containing fluids such as juice, Jell-O, Gatorade, etc.
iii) is true- as the counter regulatory hormones will oppose insulin
iv) is false- patients should be checking sugars and ketones more often. In the guidelines there is no nationally agreed upon interval but in various local guidelines I have seen suggestions ranging from every hour to every 4 hours for testing. Testing every 8 hours is way too infrequent.

A) Incorrect- as i is false
B) Correct- as both ii and iii are true
C) Incorrect- as both i and iv are false
D) Incorrect- as iv is false

Please see Appendix 8 on pg S316 of the 2018 Diabetes Canada guidelines and https://www.diabetes.ca/DiabetesCanadaWebsite/media/Managing-My-Diabetes/Tools%20and%20Resources/stay-safe-when-you-have-diabetes-and-sick-or-at-risk-of-dehydration.pdf?ext=.pdf for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

i)- is true, insulin pumps are useful for overnight hypoglycemia as you can vary the amount of insulin that you receive throughout the night. Lets say for example that your patient gets lows around 3-5 am but between 5-8 am goes above target. Using subcutaneous insulin it would not be possible to adjust the levels throughout the night but with a pump you could set a reduction of your basal rate of 0.1% to 100% during 3-5am and an increase of 0.1% to 100%+ between 5-8am.
ii)- is true, for the same reasons as above
iii)- is false, I have plenty of elderly patients with type 1 diabetes who are well controlled without an insulin pump. I would say half of my elderly patients don’t have enough technical ability to use a smart phone so I would definitely not recommend an insulin pump for them. I suppose you could say that as type 1 diabetes progresses the alpha cells also deteriorate and stop producing glucagon leading to less hypoglycemic symptoms but its a stretch to say its a valid reason for an insulin pump.
iv)- is false, while you can control blood sugars more tightly with an insulin pump you would still need to eat healthy to control your sugars and other CV risk factors

A) Correct- as i and ii are true
B) Incorrect- as iii is is false
C) Incorrect- as iv is false
D) Incorrect- as both iii and iv are false

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

i) is true, sometimes the infusion set becomes loose (leaking insulin onto the skin instead of underneath it), the cannula (the needle part of the infusion set that is underneath the skin) can get kinked which stops insulin flow or perhaps there is a mechanical issue that causes the pump to malfunction. If the patient notices unexplained highs they should check if their insulin pump is functioning.
ii) is true but depending on the how high the sugars are, if the unexplained high is say 12 and the pt feels fine then giving a correction dose using the pump and rechecking in 1-2 hours is reasonable
iii) is true depending on how high the sugars are, if the unexplained high is say 32 and the pt has ketone breath, nausea, vomiting, etc. then I would suggest giving insulin via syringe to make absolutely sure the sugars start coming down. In this situation going with ii and retesting in 1-2 hours is too risky.
iv) is false, the high could be from an improper insulin to carbohydrate ratio but the priority is to make sure this pt doesn’t go into diabetic ketoacidosis. Not the best answer

A) Correct- as per the answer key this is the right answer as i and ii is true, however I disagree with this answer as I feel ii is only true if the sugars are not too high and is false if sugars are very high
B) Incorrect- as iv is false
C) Incorrect- in my opinion, iii could be true if the sugars are high enough however i should always be done
D) Incorrect- as iv is false

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- having a supportive relationship is a positive thing not a risk associated with intensive insulin therapy
B) Incorrect- intensive insulin therapy is associated with more hypoglycemia not less
C) Correct- intensive insulin therapy is associated with increased risk of hypoglycemia
D) Incorrect- intensive insulin therapy increases the amount of insulin, needles, strips for testing, etc. so it increases financial cost

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- decreasing the bolus insulin at breakfast would lead to increased before lunch sugars. However the before lunch sugars at above target only 25% of the time so this is not the best answer
B) Incorrect- increasing the bolus insulin at lunch would lead to decreased sugars before dinner. Given that 50% of the before dinners are above target this is an ok answer but not the BEST answer
C) Correct- increasing the bolus insulin at supper would lead to decreased sugars at bedtime. Given that 100% of the readings are above target this is the best answer
D) Incorrect- increasing the basal insulin at bedtime would lead to decreased sugars before breakfast. However the before breakfast sugars are only 25% above target so this is not the best answer

Please see Appendix 5 on pg S313 of the 2018 Diabetes Canada clinical practice guidelines for more details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Correct- because the biggest rise in sugars is between before lunch and before dinner.
B) Incorrect-
C) Incorrect-
D) Incorrect-

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- near normal but not hypoglycemia is a goal of intensive therapy
B) Incorrect- better blood glucose control leads to reduced risk of complications
C) Correct- remember to look out for those “not” questions. near normal not low blood glucose is the goal of intensive therapy
D) Incorrect- less complications hopefully will lead to improved quality of life

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

This was a difficult choice and in real life I think there would be multiple right answers or ways to treat this patient

A) Incorrect- this would be a significant obstacle however you could combine this with real time continuous glucose monitoring or intermittently scanned continuous glucose monitoring. The alarm functions would be very helpful if they have hypoglycemia unawareness. A reasonable answer but B is slightly better
B) Correct- this would make intensive therapy impossible whereas with the other answers there are potential ways to mitigate risks
C) Incorrect- this could be a significant obstacle however if combined with GLP-1 analogs, SLGT-2 inhibitors or weight loss medications the weight gain could be mitigated. A reasonable answer but B) is a slightly better answer
D) Incorrect- you could adjust their bolus insulin dose to fit their erratic schedule so this is an obstacle that can be overcome

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- if the patient has hypoglycemia unawareness then generally that glycemic target would be higher
B) Correct- watch out for the “not” questions. The targets for most people with type 1 and type 2 diabetes are the same
C) Incorrect- hypoglycemia has been associated with cardiac events so a higher glycemic target may be used for people with a history of cardiac events
D) Incorrect- pt preference should be considered when setting glycemic targets

Please see Chapter 8 of the Diabetes Canada clinical practice guideline for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- his fasting sugars are high which likely means his sugars have been high all night. Adding more insulin at breakfast wont help the overnight sugars
B) Correct- by checking at 3 am we are seeing if the high morning sugars are due to somogyi or dawn phenomenon. If high then its dawn phenomenon and the treatment is to increase the basal. I get this question about somogyi vs dawn every single year. Please search the exam forums for details on the difference.
C) Incorrect- you don’t know if there is any lows overnight yet so you need to test and find out first
D) Incorrect- doesn’t directly help the problem. Not the best answer

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- an example of the knowledge domain would be: the patient knows that he is supposed to do capillary blood glucose (CBG) monitoring twice daily 2 hours after breakfast and 2 hours after dinner
B) Incorrect- an example of the application domain would be: the knows that if his sugars are above 10 mmol/L 2 hours after meals he is above target and should take action to correct the high sugars
C) Correct- this is an example of analysis, another example would be: after testing for 4 days the patient identifies he is always high after breakfast
D) Incorrect- an example of the synthesis domain would be: noticing his sugars are always high after breakfast the patient comes up with a new low glycemic index recipe for his breakfast

Please see https://teaching.charlotte.edu/sites/teaching.charlotte.edu/files/media/files/file/GoalsAndObjectives/Bloom.pdf for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Correct- generally you want to teach simple concepts to improve the students confidence and build more complex concepts out of those simple concepts. So this is NOT a suggested strategy
B) Incorrect- this is a good strategy
C) Incorrect- this is a good strategy
D) Incorrect- this is a good strategy

This is mostly common sense stuff for teaching

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

I dislike these kind of questions because I find the educational theory that these questions test to be extremely vague. The affective domain is based on feelings, beliefs, attitudes and emotions. The affective domain can be further broken down into receiving, responding, valuing, organizing and characterizing. Apparently lectures aren’t part of the affective domain while the other answers are though I could argue that lectures are part of receiving. Somehow this makes A the most correct answer.

A) Correct- apparently not part of the affective domain
B) Incorrect- apparently part of the affective domain
C) Incorrect- apparently part of the affective domain
D) Incorrect- the most incorrect answer is values are definitely part of the affective domain

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- this sounds more like avoidance management
B) Incorrect- this doesn’t sound right
C) Correct- this sounds like the best answer as there is a reward to keep doing/reinforce the selected behavior
D) Incorrect- this doesn’t sound right

There is no mention of “reinforcement management” in the guidelines and I skimmed over Chapter 2 of the Essentials and couldn’t find it either

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- this is open to interpretation and thus not very clear or specific. When a goal is not clear than measuring it becomes difficult and then it becomes unrealistic. How deep do you want to understand the pathophysiology of diabetes? To the the molecular level? How about the to the quark (the things that make up atoms) level? How about the planck length (reality pixels) level? Definitely not the best answer
B) Incorrect- a better answer but not the best. What do you want to know about the available types on insulin? The half life? The duration? The manufacturer? The employee that made a certain batch of it in 2017? Even all the past ones such as beef and pork insulin? More specific and measurable than A but still not great
C) Incorrect- attitudes are vague and can change and we may not be aware of hidden biases we have in our attitudes. Definitely not the answer.
D) Correct- the best answer. The definition of those terms are agreed upon in various medical dictionaries and thus the more specific and clear.

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- this is not client centered as it takes all the decision making power away from the patient and puts it onto the doctor
B) Incorrect- not a bad answer but not the best answer. The patients real concern is “not being sure if he can see himself being attached to the pump all the time” not the pros and cons of MDI vs pump therapy. Not the best answer therefore not correct.
C) Correct- this is the most client centered answer as it addresses his specific concerns
D) Incorrect- this is not client centered as it takes all the decision making power away from the patient and puts it into the experiences of the other patients of the clinic

Please see pg S58 of the 2018 Diabetes Canada clinical practice guidelines for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- partnerships are definitely a part of the chronic care model but its not the ultimate goal. Me having a partnership with you is not the ultimate goal, better healthcare and quality of life for out patients is the goal. Having this partnership where you learn better ways to care for patients is just the means to get to that goal.
B) Incorrect- while measuring outcomes of specific parts of the system is important to see if we are improving or not its the not the end goal. We measure the outcomes to see if we are improving healthcare for our patients. The measurement is just the means to get to that goal.
C) Correct- this is the end point and goal of the chronic care model.
D) Incorrect- similar to A, an important part of the chronic care model but not the ultimate goal

Please see Chapter 6 of the 2018 Diabetes Canada clinical practice guidelines for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- a good answer but not the best. An multidisciplinary practice denotes different professions together in a practice environment. An interprofessional practice involves different professions working together in a practice environment which is better than a multidisciplinary practice.
B) Correct- the best answer, a practice where the different disciplines work together not independently is emphasized by interprofessional practice
C) Incorrect- specialized training is great but doesnt relate to interprofessional practice. Not the best answer therefore incorrect
D) Incorrect- engagement is all professionals in the community is great but is not emphasized by interprofessional practice. Not the best answer therefore incorrect.

Please see Chapter 6 of the 2018 Diabetes Canada clinical practice guidelines for details

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

This question seemed to show up on the exam for a while but not for the past few years. I used to have a question on my exams similar to this but I’ve removed it since this question hasn’t been showing up lately. You can find more info at http://changingminds.org/explanations/learning/kolb_learning.htm

A) Incorrect-
B) Correct-
C) Incorrect-
D) Incorrect-

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- I’m not sure how they got this answer. I would have chosen A or C
B) Incorrect- To all the staff including janitorial, secretary, etc. is not necessary
C) Correct- Apparently the right answer
D) Incorrect- Not detailed enough

There isn’t a chapter in the guidelines that relates to this but there is a short position statement here: https://www.diabetes.ca/learn-about-diabetes/your-rights/kids-with-diabetes—education

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- not all adolescents omit their insulin
B) Correct- all adolescents do have some hormonal shifts to go through puberty. Growth hormone is a counter regulatory hormone that opposes insulin causing insulin resistance. Since growth hormone secretion is increased significantly during adolescence there is often greater insulin resistance and a need for more insulin.
C) Incorrect- not every adolescent has an eating disorder
D) Incorrect- not every adolescent has increased physical activity

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- as an adult, the patient is free to decide if they want their family to still be involved in their care.  Consent is needed for the family to be remain involved in care.
B) Incorrect- not necessarily, I have several type 1 patients whose care is focused on treating their hypertension, mental health or hypoglycemia unawareness. Prevention is an important part of their care but is currently not the main focus.
C) Correct- this is supposedly the correct answer but I must respectfully disagree with what the question creator was thinking. My most poorly controlled patients are 18-25 year old people with type 1 diabetes. One of my patients is only 24 and she already has had a kidney transplant! She was doing well at children’s hospital but somehow during adolescence she lost her way. I think there needs to be way more transition counsellors.
D) Incorrect- I would have chosen this answer to be correct. I think that this is least correct as not everyone enjoys peer groups. I think most people would prefer one on one care with their health care provider for their diabetes care. Since this is the least right answer I think this should be the correct answer (remember this is a NOT question)

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Correct- supposedly the correct answer but I respectfully disagree. I think this patient is in the maintenance phase and should be supported by prevent relapse. Going over the pros and cons is unnecessary as he is already doing the new behavior as has had good results.  Going over the pros and cons would be for someone in the contemplation or preparation phase.
B) Incorrect- this would be useful for someone in the contemplation or preparation phase.
C) Incorrect- this should be the correct answer in my opinion. The patient has already started the behavior and feeling better on it. The key now is to prevent relapse. Temptations to go back to the old behavior should be expected so plans to deal with those temptations should be created.
D) Incorrect- not sure how this is helpful in general

Please see this article on the stages of changes in the Journal of Family Medicine- https://www.cfp.ca/content/cfp/56/3/253.full.pdf

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Correct- we should be trying to engage the patient with our educational material
B) Incorrect- not the best answer
C) Incorrect- we should be trying to make educational materials easy to read not trying to show off our medical vocabulary
D) Incorrect- difficult to do (see difficult is three syllables) and not necessary we shouldn’t assume our patients are dumb or that English is everyone’s second language

I did not create the questions in the Essentials quiz. The following is what I think the original question maker was thinking when they created the quiz, so it is only my opinion. There are a few questions where I respectfully disagree with the answer.

A) Incorrect- this would come after specifying the target population. Costs would be cheaper if serving the local city population but could be more expensive if you needed to reach indigenous people on a remote reserve or were serving a population overseas
B) Incorrect- this would be the last step of designing the diabetes educator program, to evaluate if the diabetes education program is working or not
C) Correct- I’m not sure if I agree that this would be the first step but out of all the options this would be the earliest step
D) Incorrect- behavioral objectives would depend on the target population. For a wealthy population perhaps 100% of the population using intermittently scanned glucose monitors and being able to interpret their readings would an objective. For a impoverished population perhaps 100% of the population  finding and cooking healthy food would be an objective