Certified Diabetes Care and Education Specialist
(CDCES) Practice Examination Questions &
100% Verified Answers # Ace Your 2026 RN ATI
Med Surg Proctored Exam with Confidence!
1. A patient with type 2 diabetes has a fasting blood glucose of 145 mg/dL and
an A1C of 7.8%. The provider prescribes Metformin. What is the primary
mechanism of action of Metformin?
Answer: Decreases hepatic gluconeogenesis and increases peripheral
insulin sensitivity.
Rationale: Metformin is a biguanide that primarily reduces glucose
production by the liver. It also modestly improves insulin mediated glucose
uptake in muscle and fat. It does not stimulate insulin secretion, so it rarely
causes hypoglycemia.
2. A patient with type 1 diabetes reports waking up with a headache, night
sweats, and a fasting blood glucose of 180 mg/dL. What phenomenon is most
likely occurring?
Answer: Somogyi effect (rebound hyperglycemia).
Rationale: Nocturnal hypoglycemia triggers a counter regulatory hormone
response (epinephrine, cortisol, glucagon), causing the liver to release stored
glucose, resulting in morning hyperglycemia. Management involves reducing the
evening insulin dose or adding a bedtime snack.
3. A diabetes educator is teaching a patient about sick day management. What
is the most critical rule for a patient with type 1 diabetes during an illness?
, Answer: Never omit insulin, even if unable to eat. Monitor blood glucose
and ketones every 2 4 hours.
Rationale: During illness, stress hormones increase insulin resistance and
hepatic glucose production. Without insulin, the body breaks down fat for energy,
leading to diabetic ketoacidosis (DKA). Supplemental insulin based on correction
scales is often required.
4. What is the recommended target A1C for most non pregnant adults with
diabetes, according to the American Diabetes Association (ADA)?
Answer: < 7.0%.
Rationale: This target balances the risk of microvascular complications with
the risk of hypoglycemia. Less stringent goals (e.g., <8.0%) may be appropriate for
older adults with limited life expectancy or advanced complications.
5. A 55 year old patient with type 2 diabetes asks when they should start
screening for peripheral arterial disease (PAD). What is the current ADA
recommendation?
Answer: Initial screening with an ankle brachial index (ABI) should be
performed at diagnosis and repeated annually if there are risk factors or
symptoms.
Rationale: Diabetes is a major risk factor for PAD. Early detection via ABI
can identify asymptomatic disease, prompting aggressive cardiovascular risk
factor modification.
6. A patient with type 2 diabetes is started on a GLP 1 receptor agonist
(Semaglutide). What is the primary mechanism of action and the most common
side effect?
Answer: Enhances glucose dependent insulin secretion, suppresses
glucagon, delays gastric emptying. Common side effects: nausea, vomiting,
diarrhea.
, Rationale: GLP 1 RAs mimic incretin hormones. The GI side effects are
usually transient and can be minimized by dose titration. They also promote
weight loss and have cardiovascular benefits.
7. A patient with diabetes on insulin and a sulfonylurea develops sweating,
tachycardia, and confusion. Blood glucose is 58 mg/dL. What is the appropriate
initial treatment (Rule of 15)?
Answer: Give 15 grams of fast acting carbohydrate (e.g., 4 oz juice, 3 4
glucose tablets), recheck blood glucose in 15 minutes. Repeat if still <70 mg/dL.
Rationale: The Rule of 15 provides rapid correction of hypoglycemia
without overtreatment, which can cause rebound hyperglycemia. Once glucose is
normal, a meal or snack with complex carbs and protein should be eaten if the
next meal is >1 hour away.
8. A patient with prediabetes (fasting glucose 112 mg/dL, A1C 5.9%) asks what
they can do to prevent diabetes. What is the evidence based lifestyle goal from
the Diabetes Prevention Program (DPP)?
Answer: Lose 7% of body weight and engage in at least 150 minutes of
moderate intensity physical activity per week.
Rationale: The DPP study demonstrated a 58% reduction in progression to
type 2 diabetes with intensive lifestyle intervention compared to placebo.
Metformin is also an option for high risk individuals.
9. A patient with type 2 diabetes has an A1C of 8.5% on Metformin and lifestyle
management. The patient has established ASCVD. What second line agent has
proven cardiovascular mortality benefit?
Answer: SGLT2 inhibitor (Empagliflozin, Canagliflozin) or GLP 1 receptor
agonist (Liraglutide, Semaglutide, Dulaglutide).
(CDCES) Practice Examination Questions &
100% Verified Answers # Ace Your 2026 RN ATI
Med Surg Proctored Exam with Confidence!
1. A patient with type 2 diabetes has a fasting blood glucose of 145 mg/dL and
an A1C of 7.8%. The provider prescribes Metformin. What is the primary
mechanism of action of Metformin?
Answer: Decreases hepatic gluconeogenesis and increases peripheral
insulin sensitivity.
Rationale: Metformin is a biguanide that primarily reduces glucose
production by the liver. It also modestly improves insulin mediated glucose
uptake in muscle and fat. It does not stimulate insulin secretion, so it rarely
causes hypoglycemia.
2. A patient with type 1 diabetes reports waking up with a headache, night
sweats, and a fasting blood glucose of 180 mg/dL. What phenomenon is most
likely occurring?
Answer: Somogyi effect (rebound hyperglycemia).
Rationale: Nocturnal hypoglycemia triggers a counter regulatory hormone
response (epinephrine, cortisol, glucagon), causing the liver to release stored
glucose, resulting in morning hyperglycemia. Management involves reducing the
evening insulin dose or adding a bedtime snack.
3. A diabetes educator is teaching a patient about sick day management. What
is the most critical rule for a patient with type 1 diabetes during an illness?
, Answer: Never omit insulin, even if unable to eat. Monitor blood glucose
and ketones every 2 4 hours.
Rationale: During illness, stress hormones increase insulin resistance and
hepatic glucose production. Without insulin, the body breaks down fat for energy,
leading to diabetic ketoacidosis (DKA). Supplemental insulin based on correction
scales is often required.
4. What is the recommended target A1C for most non pregnant adults with
diabetes, according to the American Diabetes Association (ADA)?
Answer: < 7.0%.
Rationale: This target balances the risk of microvascular complications with
the risk of hypoglycemia. Less stringent goals (e.g., <8.0%) may be appropriate for
older adults with limited life expectancy or advanced complications.
5. A 55 year old patient with type 2 diabetes asks when they should start
screening for peripheral arterial disease (PAD). What is the current ADA
recommendation?
Answer: Initial screening with an ankle brachial index (ABI) should be
performed at diagnosis and repeated annually if there are risk factors or
symptoms.
Rationale: Diabetes is a major risk factor for PAD. Early detection via ABI
can identify asymptomatic disease, prompting aggressive cardiovascular risk
factor modification.
6. A patient with type 2 diabetes is started on a GLP 1 receptor agonist
(Semaglutide). What is the primary mechanism of action and the most common
side effect?
Answer: Enhances glucose dependent insulin secretion, suppresses
glucagon, delays gastric emptying. Common side effects: nausea, vomiting,
diarrhea.
, Rationale: GLP 1 RAs mimic incretin hormones. The GI side effects are
usually transient and can be minimized by dose titration. They also promote
weight loss and have cardiovascular benefits.
7. A patient with diabetes on insulin and a sulfonylurea develops sweating,
tachycardia, and confusion. Blood glucose is 58 mg/dL. What is the appropriate
initial treatment (Rule of 15)?
Answer: Give 15 grams of fast acting carbohydrate (e.g., 4 oz juice, 3 4
glucose tablets), recheck blood glucose in 15 minutes. Repeat if still <70 mg/dL.
Rationale: The Rule of 15 provides rapid correction of hypoglycemia
without overtreatment, which can cause rebound hyperglycemia. Once glucose is
normal, a meal or snack with complex carbs and protein should be eaten if the
next meal is >1 hour away.
8. A patient with prediabetes (fasting glucose 112 mg/dL, A1C 5.9%) asks what
they can do to prevent diabetes. What is the evidence based lifestyle goal from
the Diabetes Prevention Program (DPP)?
Answer: Lose 7% of body weight and engage in at least 150 minutes of
moderate intensity physical activity per week.
Rationale: The DPP study demonstrated a 58% reduction in progression to
type 2 diabetes with intensive lifestyle intervention compared to placebo.
Metformin is also an option for high risk individuals.
9. A patient with type 2 diabetes has an A1C of 8.5% on Metformin and lifestyle
management. The patient has established ASCVD. What second line agent has
proven cardiovascular mortality benefit?
Answer: SGLT2 inhibitor (Empagliflozin, Canagliflozin) or GLP 1 receptor
agonist (Liraglutide, Semaglutide, Dulaglutide).
