CDE Exam Study Guide Exam 2026
Questions and Answers
Pramlintide - Correct answer-(Symlin) 1) slows the rate of digestion from stomach
to intestines 2) lowers the amount of glucose produced by the liver 3) triggers the
feeling of fullness after eating.
Pramlintide Dosing - Correct answer-Reduce mealtime insulin by 50%, then
initiate at 15mcg immediately prior to meals. Then increase to 30, 45, or 60mcg
when no clinically significant nausea has occurred for at least 3 days.
Pramlintide Contraindications/Considerations - Correct answer-Can't be mixed
with insulins
May delay absorption of co-administered oral meds (take those 1hr prior or 2hr
after Symlin)
Not used for pts on anticholinergics or others that will slow gastric emptying
©COPYRIGHT 2025, ALL RIGHTS RESERVED 1
,Cannot be used in pts with confirmed gastroparesis
Increased risk of hypoglycemia with ACE-I, MAOI, Fluoxetine, and sulfa abx.
Target Cholesterol Levels for High-Risk patients - Correct answer-LDL: 100-129
Total: 200-239
HDL: >40
What are HGM-CoA Reductase Inhibitors? - Correct answer-Statins
Fuel Homeostasis Stage 1 - Correct answer-Fed state - 0-3.8hr
Insulin inhibits breakdown of glycogen and TG reservoirs
Fuel Homeostasis Stage 2 - Correct answer-Post-Absorptive State - 4-15.9hr
Insulin levels decrease, glucagon levels rise
Fuel Homeostasis Stage 3 - Correct answer-Early Starvation State - 16-47.9hr
©COPYRIGHT 2025, ALL RIGHTS RESERVED 2
, Lactate makes up half of gluconeogenic substrate. Insulin is suppressed and
counter-regulatory hormones are stimulated.
Fuel Homeostasis Stage 4 - Correct answer-Preliminary Prolonged Starvation State
(48hr - 23.9 days)
BG comes from hepatic and renal gluconeogenesis. Insulin is markedly suppressed
by 60hr, and glucagon, cortisol, growth hormone, and epinephrine are stimulated.
Fuel Homeostasis Stage 5 - Correct answer-Secondary Prolonged Starvation State
(24-40 days)
BG originates from hepatic/renal gluconeogenesis still, but rate of glucose use by
brain diminishes and rate of hepatic gluconeogenesis slows.
Central Obesity Waist Size - Correct answer-Men: >40in
Women: >30in
©COPYRIGHT 2025, ALL RIGHTS RESERVED 3
Questions and Answers
Pramlintide - Correct answer-(Symlin) 1) slows the rate of digestion from stomach
to intestines 2) lowers the amount of glucose produced by the liver 3) triggers the
feeling of fullness after eating.
Pramlintide Dosing - Correct answer-Reduce mealtime insulin by 50%, then
initiate at 15mcg immediately prior to meals. Then increase to 30, 45, or 60mcg
when no clinically significant nausea has occurred for at least 3 days.
Pramlintide Contraindications/Considerations - Correct answer-Can't be mixed
with insulins
May delay absorption of co-administered oral meds (take those 1hr prior or 2hr
after Symlin)
Not used for pts on anticholinergics or others that will slow gastric emptying
©COPYRIGHT 2025, ALL RIGHTS RESERVED 1
,Cannot be used in pts with confirmed gastroparesis
Increased risk of hypoglycemia with ACE-I, MAOI, Fluoxetine, and sulfa abx.
Target Cholesterol Levels for High-Risk patients - Correct answer-LDL: 100-129
Total: 200-239
HDL: >40
What are HGM-CoA Reductase Inhibitors? - Correct answer-Statins
Fuel Homeostasis Stage 1 - Correct answer-Fed state - 0-3.8hr
Insulin inhibits breakdown of glycogen and TG reservoirs
Fuel Homeostasis Stage 2 - Correct answer-Post-Absorptive State - 4-15.9hr
Insulin levels decrease, glucagon levels rise
Fuel Homeostasis Stage 3 - Correct answer-Early Starvation State - 16-47.9hr
©COPYRIGHT 2025, ALL RIGHTS RESERVED 2
, Lactate makes up half of gluconeogenic substrate. Insulin is suppressed and
counter-regulatory hormones are stimulated.
Fuel Homeostasis Stage 4 - Correct answer-Preliminary Prolonged Starvation State
(48hr - 23.9 days)
BG comes from hepatic and renal gluconeogenesis. Insulin is markedly suppressed
by 60hr, and glucagon, cortisol, growth hormone, and epinephrine are stimulated.
Fuel Homeostasis Stage 5 - Correct answer-Secondary Prolonged Starvation State
(24-40 days)
BG originates from hepatic/renal gluconeogenesis still, but rate of glucose use by
brain diminishes and rate of hepatic gluconeogenesis slows.
Central Obesity Waist Size - Correct answer-Men: >40in
Women: >30in
©COPYRIGHT 2025, ALL RIGHTS RESERVED 3
