BC-ADM Advanced Diabetes Management Practice Exam 2026
| Comprehensive Questions with Verified Answers & Rationales
| Certification Prep Guide
Question 1
A 58-year-old patient with type 2 diabetes on basal insulin reports recurrent late-afternoon
hypoglycemia. The BC-ADM-certified provider should first:
A) Increase the basal insulin dose
B) Add a rapid-acting insulin at lunch
C) Review the timing and dose of basal insulin and assess dietary patterns
D) Prescribe a glucagon emergency kit
Correct Answer: C
Explanation: The first step in managing recurrent hypoglycemia is to assess the cause. Basal insulin
timing, dose, carbohydrate intake, and activity patterns must be evaluated before making medication
changes. Option C follows the clinical reasoning expected of an advanced diabetes manager.
Question 2
Which of the following represents the preferred insulin delivery method for adults with type 1 diabetes
according to the 2025 ADA Standards of Care?
A) Multiple daily injections only
B) Automated Insulin Delivery (AID) systems
C) Inhaled insulin only
D) Premixed insulin twice daily
Correct Answer: B
Explanation: The 2025 ADA Standards identify AID systems as the preferred insulin delivery method for
type 1 diabetes in both youth and adults to improve glycemic outcomes .
,Question 3
A patient with type 1 diabetes using an automated insulin delivery system is admitted for elective
surgery. The hospital policy restricts personal pump use. According to recent ADA guidance, the BC-ADM
provider should:
A) Immediately discontinue the pump and start intravenous insulin
B) Allow the patient to continue using the pump if they can manage it independently
C) Switch the patient to once-daily basal insulin
D) Discontinue all insulin until blood glucose exceeds 250 mg/dL
Correct Answer: B
Explanation: The ADA now supports allowing insulin pump use during hospitalization when clinically
appropriate, especially if patients or caregivers can manage the devices independently .
Question 4
Inhaled insulin (Afrezza) has an onset of action of approximately:
A) 5 minutes
B) 12 minutes
C) 30 minutes
D) 60 minutes
Correct Answer: B
Explanation: Inhaled insulin reaches peak concentration rapidly, with an onset of action of approximately
12 minutes, making it ideal for postprandial glucose control .
Question 5
What pre-treatment screening is required before initiating inhaled insulin?
A) Electrocardiogram
B) Spirometry (FEV1 measurement)
C) Liver function tests
D) Renal function panel
,Correct Answer: B
Explanation: Spirometry testing is required prior to initiation of inhaled insulin and periodically
throughout treatment to monitor lung function, with a goal FEV1 ≥70% of predicted .
Question 6
A coefficient of variation (CV) greater than what percentage correlates with increased frequency of
hypoglycemia?
A) 25%
B) 36%
C) 45%
D) 50%
Correct Answer: B
Explanation: Research shows that CV >36% based on two-day validated CGM profiles correlates with
increased frequency of hypoglycemia .
Question 7
Which of the following weekly basal insulins was rejected by the FDA for type 1 diabetes due to
increased hypoglycemia risk?
A) Insulin glargine U300
B) Insulin degludec
C) Insulin icodec
D) Insulin efsitora alfa
Correct Answer: C
Explanation: The FDA rejected insulin icodec for type 1 diabetes after the ONWARDS 6 trial showed
higher rates of level 2 and level 3 hypoglycemia compared to once-daily degludec .
, Question 8
A patient with type 2 diabetes on metformin and a GLP-1 receptor agonist has an A1c of 8.2% and fasting
glucose of 180 mg/dL. The BC-ADM provider should consider adding:
A) SGLT2 inhibitor only
B) Basal insulin to control fasting plasma glucose
C) Rapid-acting insulin at meals
D) Discontinuing the GLP-1 agonist
Correct Answer: B
Explanation: Basal insulin retains a vital role in controlling fasting plasma glucose, particularly in patients
with progressive insulin deficiency. Adding basal insulin to existing therapy is appropriate when glycemic
targets are not met .
Question 9
Which CGM feature allows the Eversense 365 system to differ from other CGM devices?
A) It requires no calibration
B) It has a 365-day subcutaneously implanted sensor
C) It connects directly to insulin pumps only
D) It measures ketones in addition to glucose
Correct Answer: B
Explanation: The Eversense 365 CGM features a 365-day subcutaneously implanted sensor with a
removable transmitter, offering an alternative to externally worn sensors .
Question 10
According to the 2025 ADA Standards, real-time CGM (rtCGM) should be considered for which of the
following patient groups?
A) Only patients with type 1 diabetes on insulin pumps
B) Only patients with frequent severe hypoglycemia
C) All patients with type 2 diabetes, including those on non-insulin glucose-lowering medications
| Comprehensive Questions with Verified Answers & Rationales
| Certification Prep Guide
Question 1
A 58-year-old patient with type 2 diabetes on basal insulin reports recurrent late-afternoon
hypoglycemia. The BC-ADM-certified provider should first:
A) Increase the basal insulin dose
B) Add a rapid-acting insulin at lunch
C) Review the timing and dose of basal insulin and assess dietary patterns
D) Prescribe a glucagon emergency kit
Correct Answer: C
Explanation: The first step in managing recurrent hypoglycemia is to assess the cause. Basal insulin
timing, dose, carbohydrate intake, and activity patterns must be evaluated before making medication
changes. Option C follows the clinical reasoning expected of an advanced diabetes manager.
Question 2
Which of the following represents the preferred insulin delivery method for adults with type 1 diabetes
according to the 2025 ADA Standards of Care?
A) Multiple daily injections only
B) Automated Insulin Delivery (AID) systems
C) Inhaled insulin only
D) Premixed insulin twice daily
Correct Answer: B
Explanation: The 2025 ADA Standards identify AID systems as the preferred insulin delivery method for
type 1 diabetes in both youth and adults to improve glycemic outcomes .
,Question 3
A patient with type 1 diabetes using an automated insulin delivery system is admitted for elective
surgery. The hospital policy restricts personal pump use. According to recent ADA guidance, the BC-ADM
provider should:
A) Immediately discontinue the pump and start intravenous insulin
B) Allow the patient to continue using the pump if they can manage it independently
C) Switch the patient to once-daily basal insulin
D) Discontinue all insulin until blood glucose exceeds 250 mg/dL
Correct Answer: B
Explanation: The ADA now supports allowing insulin pump use during hospitalization when clinically
appropriate, especially if patients or caregivers can manage the devices independently .
Question 4
Inhaled insulin (Afrezza) has an onset of action of approximately:
A) 5 minutes
B) 12 minutes
C) 30 minutes
D) 60 minutes
Correct Answer: B
Explanation: Inhaled insulin reaches peak concentration rapidly, with an onset of action of approximately
12 minutes, making it ideal for postprandial glucose control .
Question 5
What pre-treatment screening is required before initiating inhaled insulin?
A) Electrocardiogram
B) Spirometry (FEV1 measurement)
C) Liver function tests
D) Renal function panel
,Correct Answer: B
Explanation: Spirometry testing is required prior to initiation of inhaled insulin and periodically
throughout treatment to monitor lung function, with a goal FEV1 ≥70% of predicted .
Question 6
A coefficient of variation (CV) greater than what percentage correlates with increased frequency of
hypoglycemia?
A) 25%
B) 36%
C) 45%
D) 50%
Correct Answer: B
Explanation: Research shows that CV >36% based on two-day validated CGM profiles correlates with
increased frequency of hypoglycemia .
Question 7
Which of the following weekly basal insulins was rejected by the FDA for type 1 diabetes due to
increased hypoglycemia risk?
A) Insulin glargine U300
B) Insulin degludec
C) Insulin icodec
D) Insulin efsitora alfa
Correct Answer: C
Explanation: The FDA rejected insulin icodec for type 1 diabetes after the ONWARDS 6 trial showed
higher rates of level 2 and level 3 hypoglycemia compared to once-daily degludec .
, Question 8
A patient with type 2 diabetes on metformin and a GLP-1 receptor agonist has an A1c of 8.2% and fasting
glucose of 180 mg/dL. The BC-ADM provider should consider adding:
A) SGLT2 inhibitor only
B) Basal insulin to control fasting plasma glucose
C) Rapid-acting insulin at meals
D) Discontinuing the GLP-1 agonist
Correct Answer: B
Explanation: Basal insulin retains a vital role in controlling fasting plasma glucose, particularly in patients
with progressive insulin deficiency. Adding basal insulin to existing therapy is appropriate when glycemic
targets are not met .
Question 9
Which CGM feature allows the Eversense 365 system to differ from other CGM devices?
A) It requires no calibration
B) It has a 365-day subcutaneously implanted sensor
C) It connects directly to insulin pumps only
D) It measures ketones in addition to glucose
Correct Answer: B
Explanation: The Eversense 365 CGM features a 365-day subcutaneously implanted sensor with a
removable transmitter, offering an alternative to externally worn sensors .
Question 10
According to the 2025 ADA Standards, real-time CGM (rtCGM) should be considered for which of the
following patient groups?
A) Only patients with type 1 diabetes on insulin pumps
B) Only patients with frequent severe hypoglycemia
C) All patients with type 2 diabetes, including those on non-insulin glucose-lowering medications
