CDCES practice questions
A 10-year-old child with newly diagnosed type 1 diabetes is being discharged from the hospital.
Which of the following components is most critical to include in the initial outpatient diabetes
management plan to reduce the risk of diabetic ketoacidosis (DKA) and hospital readmission?
A. Initiate basal insulin therapy and MNT instruction, with follow-up in two weeks.
B. Provide basic carbohydrate counting and bolus insulin instruction with a follow-up
appointment within 30 days.
C. Establish follow up with a specialist within a week and provide actions to take in case of
glucose emergencies.
D. Prescribe continuous glucose monitoring (CGM) and glucagon rescue medication and ask
family to schedule a follow-up appointment after the sensor is delivered and set up.
C. Establish follow up with a specialist within a week and provide actions to take in case of
glucose emergencies.
Rationale:
For a newly diagnosed 10-year-old with type 1 diabetes, early outpatient management is critical
to prevent DKA and readmission. The most important elements include:
Timely follow-up with a pediatric endocrinologist or diabetes care team within 1 week, which is
recommended by the American Diabetes Association (ADA) and ISPAD guidelines.
Clear education on recognizing and managing glucose emergencies (hypoglycemia and
hyperglycemia), which empowers families to intervene early and avoid complications.
While insulin initiation, nutrition therapy, carbohydrate counting, CGM, and glucagon prescription
are also important, none of the other choices provide both timely follow-up and emergency
management guidance, which are the most essential components for immediate safety and
stabilization.
❌ Why the other options are less appropriate:
A: Two-week follow-up is too delayed, and focusing only on basal insulin omits bolus insulin,
which is vital for type 1 diabetes.
,B: A 30-day follow-up is much too long; it significantly increases the risk of DKA and
complications.
D: While CGM and glucagon are important tools, waiting for CGM setup before follow-up delays
care and does not prioritize immediate emergency education or timely specialist evaluation.
Which medication class(es) place asymptomatic people at increased risk of developing
hyperglycemia?
A. Atypical antipsychotics
B. Glucocorticoids
C. Aspirin
D. Both A and B
D. Both A and B
Rationale:
✅ Atypical Antipsychotics
Examples: Olanzapine, Risperidone, Quetiapine
Can cause insulin resistance, weight gain, and impaired glucose metabolism
Associated with new-onset diabetes and worsening of existing hyperglycemia
✅ Glucocorticoids
Examples: Prednisone, Dexamethasone
Increase hepatic glucose production and peripheral insulin resistance
Often cause transient or persistent hyperglycemia, especially in people with prediabetes or
other risk factors
❌ Aspirin
Does not cause hyperglycemia
In fact, low-dose aspirin has sometimes been studied for its potential protective effects in
cardiovascular health for people with diabetes, but it does not affect glucose metabolism directly
,A person living with diabetes newly diagnosed with type 2 diabetes is started on metformin,
metformin should be titrated to minimize which side effect?
A. Rebound hyperglycemia
B. Reactive hypoglycemia
C. Weight gain
D. Gastrointestinal-side effects
D. Gastrointestinal-side effects
Rationale:
Metformin is the first-line medication for type 2 diabetes and is generally well tolerated, but
gastrointestinal (GI) side effects are the most common issue, especially during initiation.
✅ GI side effects include: Nausea, Diarrhea, Abdominal discomfort, Bloating
To reduce these side effects, metformin is typically titrated slowly—starting at a low dose (e.g.,
500 mg once daily) and gradually increasing over 1-2 weeks.
❌ Why the other options are incorrect:
A. Rebound hyperglycemia: Metformin does not cause rebound hyperglycemia.
B. Reactive hypoglycemia: Metformin does not cause hypoglycemia, especially when used
alone.
C. Weight gain: Metformin is usually weight-neutral or may cause modest weight loss, not gain.
A person living with diabetes is currently taking metformin, Glyburide and an evening basal dose
of insulin. After discussing how best to achieve better glycemic control, he has agreed to add a
pre-meal insulin dose. which modification should be made with addition of the prandial dose?
A. discontinue the glyburide
B. discontinue the metformin
C. No modification should be made
, D. discontinue the metformin, glyburide, and evening insulin
A. discontinue the glyburide
Explanation:
When prandial (mealtime) insulin is added to a regimen that already includes basal insulin, it is
appropriate to discontinue sulfonylureas like glyburide for several reasons:
✅ Why discontinue glyburide:
Redundant mechanism: Sulfonylureas stimulate insulin secretion. Once rapid-acting insulin is
given before meals, glyburide becomes unnecessary.
Increased risk of hypoglycemia: Combining glyburide with both basal and bolus insulin
significantly increases the risk of low blood sugar.
No added benefit: There's limited additional glycemic benefit when using sulfonylureas
alongside a full insulin regimen.
✅ Continue metformin:
Metformin helps reduce insulin resistance and does not cause hypoglycemia.
It can help minimize weight gain associated with insulin therapy.
❌ Discontinue everything (D): That would remove beneficial therapies and result in poor
glycemic control.
❌ No modification (C): Keeping glyburide increases hypoglycemia risk unnecessarily.
According to the AACE guidelines for pharmacologic management of type 2 diabetes, when
should insulin therapy be initiated?
A. For person living with diabetes with a decreased c-peptide level.
B. For person living with diabetes who is on maximum dose of metformin
C. For person living with diabetes with diabetes duration of 10 years or greater
D. For person living with diabetes with A1c of 9% and hyperglycemic symptoms.
A 10-year-old child with newly diagnosed type 1 diabetes is being discharged from the hospital.
Which of the following components is most critical to include in the initial outpatient diabetes
management plan to reduce the risk of diabetic ketoacidosis (DKA) and hospital readmission?
A. Initiate basal insulin therapy and MNT instruction, with follow-up in two weeks.
B. Provide basic carbohydrate counting and bolus insulin instruction with a follow-up
appointment within 30 days.
C. Establish follow up with a specialist within a week and provide actions to take in case of
glucose emergencies.
D. Prescribe continuous glucose monitoring (CGM) and glucagon rescue medication and ask
family to schedule a follow-up appointment after the sensor is delivered and set up.
C. Establish follow up with a specialist within a week and provide actions to take in case of
glucose emergencies.
Rationale:
For a newly diagnosed 10-year-old with type 1 diabetes, early outpatient management is critical
to prevent DKA and readmission. The most important elements include:
Timely follow-up with a pediatric endocrinologist or diabetes care team within 1 week, which is
recommended by the American Diabetes Association (ADA) and ISPAD guidelines.
Clear education on recognizing and managing glucose emergencies (hypoglycemia and
hyperglycemia), which empowers families to intervene early and avoid complications.
While insulin initiation, nutrition therapy, carbohydrate counting, CGM, and glucagon prescription
are also important, none of the other choices provide both timely follow-up and emergency
management guidance, which are the most essential components for immediate safety and
stabilization.
❌ Why the other options are less appropriate:
A: Two-week follow-up is too delayed, and focusing only on basal insulin omits bolus insulin,
which is vital for type 1 diabetes.
,B: A 30-day follow-up is much too long; it significantly increases the risk of DKA and
complications.
D: While CGM and glucagon are important tools, waiting for CGM setup before follow-up delays
care and does not prioritize immediate emergency education or timely specialist evaluation.
Which medication class(es) place asymptomatic people at increased risk of developing
hyperglycemia?
A. Atypical antipsychotics
B. Glucocorticoids
C. Aspirin
D. Both A and B
D. Both A and B
Rationale:
✅ Atypical Antipsychotics
Examples: Olanzapine, Risperidone, Quetiapine
Can cause insulin resistance, weight gain, and impaired glucose metabolism
Associated with new-onset diabetes and worsening of existing hyperglycemia
✅ Glucocorticoids
Examples: Prednisone, Dexamethasone
Increase hepatic glucose production and peripheral insulin resistance
Often cause transient or persistent hyperglycemia, especially in people with prediabetes or
other risk factors
❌ Aspirin
Does not cause hyperglycemia
In fact, low-dose aspirin has sometimes been studied for its potential protective effects in
cardiovascular health for people with diabetes, but it does not affect glucose metabolism directly
,A person living with diabetes newly diagnosed with type 2 diabetes is started on metformin,
metformin should be titrated to minimize which side effect?
A. Rebound hyperglycemia
B. Reactive hypoglycemia
C. Weight gain
D. Gastrointestinal-side effects
D. Gastrointestinal-side effects
Rationale:
Metformin is the first-line medication for type 2 diabetes and is generally well tolerated, but
gastrointestinal (GI) side effects are the most common issue, especially during initiation.
✅ GI side effects include: Nausea, Diarrhea, Abdominal discomfort, Bloating
To reduce these side effects, metformin is typically titrated slowly—starting at a low dose (e.g.,
500 mg once daily) and gradually increasing over 1-2 weeks.
❌ Why the other options are incorrect:
A. Rebound hyperglycemia: Metformin does not cause rebound hyperglycemia.
B. Reactive hypoglycemia: Metformin does not cause hypoglycemia, especially when used
alone.
C. Weight gain: Metformin is usually weight-neutral or may cause modest weight loss, not gain.
A person living with diabetes is currently taking metformin, Glyburide and an evening basal dose
of insulin. After discussing how best to achieve better glycemic control, he has agreed to add a
pre-meal insulin dose. which modification should be made with addition of the prandial dose?
A. discontinue the glyburide
B. discontinue the metformin
C. No modification should be made
, D. discontinue the metformin, glyburide, and evening insulin
A. discontinue the glyburide
Explanation:
When prandial (mealtime) insulin is added to a regimen that already includes basal insulin, it is
appropriate to discontinue sulfonylureas like glyburide for several reasons:
✅ Why discontinue glyburide:
Redundant mechanism: Sulfonylureas stimulate insulin secretion. Once rapid-acting insulin is
given before meals, glyburide becomes unnecessary.
Increased risk of hypoglycemia: Combining glyburide with both basal and bolus insulin
significantly increases the risk of low blood sugar.
No added benefit: There's limited additional glycemic benefit when using sulfonylureas
alongside a full insulin regimen.
✅ Continue metformin:
Metformin helps reduce insulin resistance and does not cause hypoglycemia.
It can help minimize weight gain associated with insulin therapy.
❌ Discontinue everything (D): That would remove beneficial therapies and result in poor
glycemic control.
❌ No modification (C): Keeping glyburide increases hypoglycemia risk unnecessarily.
According to the AACE guidelines for pharmacologic management of type 2 diabetes, when
should insulin therapy be initiated?
A. For person living with diabetes with a decreased c-peptide level.
B. For person living with diabetes who is on maximum dose of metformin
C. For person living with diabetes with diabetes duration of 10 years or greater
D. For person living with diabetes with A1c of 9% and hyperglycemic symptoms.
