©JASONMCcONNEL 2024/2025 ALL RIGHTS RESERVED.
ABFM DIABETES Exam Questions With
Correct Answers (Verified And Updated)
True statements regarding nonpharmacologic therapy to reduce insulin resistance include which
of the following? (Mark all that are true.)
Decreasing caloric intake will increase insulin sensitivity independent of weight loss
Moderate alcohol intake increases insulin resistance
Exercise has been shown to enhance insulin action in skeletal muscle
A decrease of as little as 5% in body weight can result in a substantial reduction in insulin
resistance
If there are no contraindications, patients with insulin resistance syndrome should be advised to
engage in 30 minutes of modest aerobic exercise at least 4-5 times/week - Answer✔A, C, D, E
Lifestyle interventions play a pivotal role in the management of insulin resistance syndrome.
Losing even 5% of body weight has been shown to substantially reduce insulin resistance. In
addition, insulin sensitivity can be increased by reducing caloric intake, even if no weight is lost.
Exercise is an important adjunct to weight loss, since it has been shown to enhance insulin action
in skeletal muscle not only during physical activity but for up to a week following exercise. All
patients with insulin resistance syndrome should be advised to engage in 30 minutes of aerobic
exercise at least 4-5 times/week. Moderate alcohol intake lowers insulin resistance.
Which one of the following neurologic tests is most useful for predicting the future occurrence of
a diabetic foot ulcer?
Pressure sensation with Semmes-Weinstein monofilament (10 g)
Deep tendon reflexes of the ankle
Proprioception
Vibratory sensation with a 128-mHz tuning fork
Light touch with a wisp of cotton - Answer✔A
1|Page
, ©JASONMCcONNEL 2024/2025 ALL RIGHTS RESERVED.
Failure to perceive a pressure sensation produced by Semmes-Weinstein monofilament indicates
a loss of protective sensation in the diabetic foot and is highly predictive of foot ulceration.
Traditional neurologic examination techniques for evaluating reflexes, proprioception, vibration,
or light touch are highly subjective and less predictive of future ulceration.
Which of the following lipid-lowering agents can worsen glycemic control? (Mark all that are
true.)
Colestipol (Colestid)
Ezetimibe (Zetia)
Gemfibrozil (Lopid)
Niacin
Atorvastatin (Lipitor) - Answer✔D AND E
Niacin is not only the most effective agent for raising HDL-cholesterol, producing an increase of
15%-35%, it also reduces triglycerides by 20%-50% and LDL-cholesterol by 5%-25%.
Hyperglycemia is a side effect of niacin therapy, particularly at high doses. A dosage of 750-
2000 mg/day is associated with only moderate rises in blood glucose, and at one time was
considered a treatment option in patients with diabetes, particularly those with low HDL-
cholesterol levels. However, the recommendations for niacin use were changed as a result of the
AIM-HIGH trial (Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High
Triglycerides: Impact on Global Health Outcomes), which found no incremental clinical benefit
from the addition of niacin to statin therapy in patients with coronary heart disease and LDL-
cholesterol levels >70 mg/dL.Recent studies support a link between statin use and the
development of diabetes mellitus. In a meta-analysis of 13 studies, statin therapy was associated
with a 9% increased risk for incident diabetes. Another meta-analysis corroborated this result and
found that intensive-dose statin therapy was associated with a higher risk of new-onset diabetes
compared with moderate-dose statin therapy. In 2012, the FDA modified the package labeling of
statins to include the risk of increased blood glucose levels and the development of type 2
diabetes. The benefit of statin therapy, however, outweighs the risk; it was estimated there would
be 1 additional case of diabetes for every 498 patients treated for 1 year, compared with 1 less
patient experiencing a cardiovascular event for every 155 patients treated for 1 year.
A 58-year-old male with type 2 diabetes mellitus comes in during the early afternoon for his
annual physical examination. His current medication regimen consists of insulin glargine
(Lantus), 18 units in the evening; glipizide (Glucotrol), 20 mg/day; metformin (Glucophage),
1000 mg twice a day; and acarbose (Precose), 100 mg three times a day. He suddenly becomes
shaky, diaphoretic, and pale, and tells you he thinks it is because he skipped lunch before his
appointment.Which of the following would be effective for managing this episode? (Mark all
that are true.)
2|Page
, ©JASONMCcONNEL 2024/2025 ALL RIGHTS RESERVED.
Glucose tablets
A sugar cube
A banana
A soft drink containing sugar
Raisins
Glucagon - Answer✔A AND F
Acarbose, an α-glucosidase inhibitor, inhibits an enzyme present in the brush border of the
proximal intestinal epithelium that breaks down disaccharides and more complex carbohydrates.
As a result, if hypoglycemia were to occur in a patient on an α-glucosidase inhibitor, reversal
requires either the consumption of glucose itself (as opposed to complex carbohydrates) or the
injection of glucagon.
Which of the following medications can cause hyperglycemia? (Mark all that are true.)
Niacin
Clozapine (Clozaril)
Prednisone
Spironolactone
Ramipril (Altace) - Answer✔A, B, C
Several medications have been shown to affect glucose homeostasis, resulting in impaired
glucose tolerance and hyperglycemia. Agents associated with the development of hyperglycemia
include pentamidine, niacin, glucocorticoids, thyroid hormone, diazoxide, β-adrenergic agonists,
thiazide diuretics, phenytoin, and α-interferon. In addition, second-generation antipsychotic
agents, particularly clozapine and olanzapine, have also been linked to the development of
hyperglycemia and diabetes mellitus. Spironolactone and ramipril have not been linked to the
development of diabetes. In fact, in the HOPE (Heart Outcomes Prevention Evaluation) study,
the use of ramipril, an ACE inhibitor, appeared to reduce the risk for developing type 2 diabetes
mellitus by 20%-35%.
A 55-year-old African-American male sees you for a routine visit. His past medical history is
notable for an 8-year history of diabetes mellitus and a past history of hypercholesterolemia. His
current medications are atorvastatin (Lipitor), 20 mg/day, and extended-release metformin
(Glucophage XR), 1000 mg/day. He also reports a history of peanut allergy manifested by lip
angioedema, and carries an epinephrine auto-injector (EpiPen).On examination he has a blood
pressure of 124/80 mm Hg. His hemoglobin A1c is 6.7%. A spot urine sample contains 40 µg
3|Page
, ©JASONMCcONNEL 2024/2025 ALL RIGHTS RESERVED.
albumin/mg creatinine.You see the patient 6 months later for a follow-up visit, and a spot urine
sample has an albumin/creatinine ratio of 45 µg/mg.Which one of the following would be most
appropriate initially?
Have the patient return in 6 months for a repeat urine test for albumin and creatinine
Order a 24-hour urine collection for creatinine
Recommend that the patient - Answer✔E
Diabetic nephropathy develops in 20%-40% of patients with diabetes, and is the leading cause of
end-stage renal disease. Persistent albuminuria in the range of 30-200 mg/24 hr
(microalbuminuria) is the earliest sign of nephropathy in patients with type 1 diabetes, and is a
marker for nephropathy in type 2 diabetes. Patients with microalbuminuria who progress to
macroalbuminuria (>300 mg/24 hr) are likely to progress to end-stage renal disease over a period
of years.Although timed 4- and 24-hour urine collections for creatinine can be used to screen for
microalbuminuria, a random spot urine specimen for measurement of the albumin-to-creatinine
ratio is the preferred method. A minimum of two of three tests showing a urine albumin level
>30 µg/mg creatinine or more over a 6-month period confirms the diagnosis of
microalbuminuria.Intensive diabetic management and the use of ACE inhibitors and angiotensin
receptor blockers (ARBs) have been shown to delay the progression from microalbuminuria to
macroalbuminuria in patients with type 1 or type 2 diabetes. Since the antiproteinuric effect is
believed to be independent of blood pressure, current ADA guidelines recommend the use of
ACE inhibitors or ARBs as first-line therapy for both type 1 and type 2 diabetic patients with
microalbuminuria, even if their blood pressure is normal. Some studies, however, have raised
questions about the value of early renin-angiotensin blockade for preventing microalbuminuria in
normotensive patients with type 1 or type 2 diabetes, and ADA guidelines recommend against
the use of these drugs for patients with normal blood pressure and no albuminuria.Compared to
whites, African-Americans and Asians have a three- to fourfold higher risk of angioedema
associated with the use of ACE inhibitors. The American Heart Association recommends that
ACE in
True statements regarding carbohydrate intake and diabetes mellitus include which of the
following? (Mark all that are true.)
The glycemic index is not useful in the management of diabetes mellitus
Carbohydrate sources high in protein are effective for treating hypoglycemia
Low-fat diets are more effective for achieving weight loss than low-carbohydrate diets (<130
g/day)
Excessive intake of sugar-sweetened beverages has been shown to increase the risk for diabetes
mellitus
Carbohydrates have fewer calories per gram than alcohol - Answer✔D AND E
4|Page
ABFM DIABETES Exam Questions With
Correct Answers (Verified And Updated)
True statements regarding nonpharmacologic therapy to reduce insulin resistance include which
of the following? (Mark all that are true.)
Decreasing caloric intake will increase insulin sensitivity independent of weight loss
Moderate alcohol intake increases insulin resistance
Exercise has been shown to enhance insulin action in skeletal muscle
A decrease of as little as 5% in body weight can result in a substantial reduction in insulin
resistance
If there are no contraindications, patients with insulin resistance syndrome should be advised to
engage in 30 minutes of modest aerobic exercise at least 4-5 times/week - Answer✔A, C, D, E
Lifestyle interventions play a pivotal role in the management of insulin resistance syndrome.
Losing even 5% of body weight has been shown to substantially reduce insulin resistance. In
addition, insulin sensitivity can be increased by reducing caloric intake, even if no weight is lost.
Exercise is an important adjunct to weight loss, since it has been shown to enhance insulin action
in skeletal muscle not only during physical activity but for up to a week following exercise. All
patients with insulin resistance syndrome should be advised to engage in 30 minutes of aerobic
exercise at least 4-5 times/week. Moderate alcohol intake lowers insulin resistance.
Which one of the following neurologic tests is most useful for predicting the future occurrence of
a diabetic foot ulcer?
Pressure sensation with Semmes-Weinstein monofilament (10 g)
Deep tendon reflexes of the ankle
Proprioception
Vibratory sensation with a 128-mHz tuning fork
Light touch with a wisp of cotton - Answer✔A
1|Page
, ©JASONMCcONNEL 2024/2025 ALL RIGHTS RESERVED.
Failure to perceive a pressure sensation produced by Semmes-Weinstein monofilament indicates
a loss of protective sensation in the diabetic foot and is highly predictive of foot ulceration.
Traditional neurologic examination techniques for evaluating reflexes, proprioception, vibration,
or light touch are highly subjective and less predictive of future ulceration.
Which of the following lipid-lowering agents can worsen glycemic control? (Mark all that are
true.)
Colestipol (Colestid)
Ezetimibe (Zetia)
Gemfibrozil (Lopid)
Niacin
Atorvastatin (Lipitor) - Answer✔D AND E
Niacin is not only the most effective agent for raising HDL-cholesterol, producing an increase of
15%-35%, it also reduces triglycerides by 20%-50% and LDL-cholesterol by 5%-25%.
Hyperglycemia is a side effect of niacin therapy, particularly at high doses. A dosage of 750-
2000 mg/day is associated with only moderate rises in blood glucose, and at one time was
considered a treatment option in patients with diabetes, particularly those with low HDL-
cholesterol levels. However, the recommendations for niacin use were changed as a result of the
AIM-HIGH trial (Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High
Triglycerides: Impact on Global Health Outcomes), which found no incremental clinical benefit
from the addition of niacin to statin therapy in patients with coronary heart disease and LDL-
cholesterol levels >70 mg/dL.Recent studies support a link between statin use and the
development of diabetes mellitus. In a meta-analysis of 13 studies, statin therapy was associated
with a 9% increased risk for incident diabetes. Another meta-analysis corroborated this result and
found that intensive-dose statin therapy was associated with a higher risk of new-onset diabetes
compared with moderate-dose statin therapy. In 2012, the FDA modified the package labeling of
statins to include the risk of increased blood glucose levels and the development of type 2
diabetes. The benefit of statin therapy, however, outweighs the risk; it was estimated there would
be 1 additional case of diabetes for every 498 patients treated for 1 year, compared with 1 less
patient experiencing a cardiovascular event for every 155 patients treated for 1 year.
A 58-year-old male with type 2 diabetes mellitus comes in during the early afternoon for his
annual physical examination. His current medication regimen consists of insulin glargine
(Lantus), 18 units in the evening; glipizide (Glucotrol), 20 mg/day; metformin (Glucophage),
1000 mg twice a day; and acarbose (Precose), 100 mg three times a day. He suddenly becomes
shaky, diaphoretic, and pale, and tells you he thinks it is because he skipped lunch before his
appointment.Which of the following would be effective for managing this episode? (Mark all
that are true.)
2|Page
, ©JASONMCcONNEL 2024/2025 ALL RIGHTS RESERVED.
Glucose tablets
A sugar cube
A banana
A soft drink containing sugar
Raisins
Glucagon - Answer✔A AND F
Acarbose, an α-glucosidase inhibitor, inhibits an enzyme present in the brush border of the
proximal intestinal epithelium that breaks down disaccharides and more complex carbohydrates.
As a result, if hypoglycemia were to occur in a patient on an α-glucosidase inhibitor, reversal
requires either the consumption of glucose itself (as opposed to complex carbohydrates) or the
injection of glucagon.
Which of the following medications can cause hyperglycemia? (Mark all that are true.)
Niacin
Clozapine (Clozaril)
Prednisone
Spironolactone
Ramipril (Altace) - Answer✔A, B, C
Several medications have been shown to affect glucose homeostasis, resulting in impaired
glucose tolerance and hyperglycemia. Agents associated with the development of hyperglycemia
include pentamidine, niacin, glucocorticoids, thyroid hormone, diazoxide, β-adrenergic agonists,
thiazide diuretics, phenytoin, and α-interferon. In addition, second-generation antipsychotic
agents, particularly clozapine and olanzapine, have also been linked to the development of
hyperglycemia and diabetes mellitus. Spironolactone and ramipril have not been linked to the
development of diabetes. In fact, in the HOPE (Heart Outcomes Prevention Evaluation) study,
the use of ramipril, an ACE inhibitor, appeared to reduce the risk for developing type 2 diabetes
mellitus by 20%-35%.
A 55-year-old African-American male sees you for a routine visit. His past medical history is
notable for an 8-year history of diabetes mellitus and a past history of hypercholesterolemia. His
current medications are atorvastatin (Lipitor), 20 mg/day, and extended-release metformin
(Glucophage XR), 1000 mg/day. He also reports a history of peanut allergy manifested by lip
angioedema, and carries an epinephrine auto-injector (EpiPen).On examination he has a blood
pressure of 124/80 mm Hg. His hemoglobin A1c is 6.7%. A spot urine sample contains 40 µg
3|Page
, ©JASONMCcONNEL 2024/2025 ALL RIGHTS RESERVED.
albumin/mg creatinine.You see the patient 6 months later for a follow-up visit, and a spot urine
sample has an albumin/creatinine ratio of 45 µg/mg.Which one of the following would be most
appropriate initially?
Have the patient return in 6 months for a repeat urine test for albumin and creatinine
Order a 24-hour urine collection for creatinine
Recommend that the patient - Answer✔E
Diabetic nephropathy develops in 20%-40% of patients with diabetes, and is the leading cause of
end-stage renal disease. Persistent albuminuria in the range of 30-200 mg/24 hr
(microalbuminuria) is the earliest sign of nephropathy in patients with type 1 diabetes, and is a
marker for nephropathy in type 2 diabetes. Patients with microalbuminuria who progress to
macroalbuminuria (>300 mg/24 hr) are likely to progress to end-stage renal disease over a period
of years.Although timed 4- and 24-hour urine collections for creatinine can be used to screen for
microalbuminuria, a random spot urine specimen for measurement of the albumin-to-creatinine
ratio is the preferred method. A minimum of two of three tests showing a urine albumin level
>30 µg/mg creatinine or more over a 6-month period confirms the diagnosis of
microalbuminuria.Intensive diabetic management and the use of ACE inhibitors and angiotensin
receptor blockers (ARBs) have been shown to delay the progression from microalbuminuria to
macroalbuminuria in patients with type 1 or type 2 diabetes. Since the antiproteinuric effect is
believed to be independent of blood pressure, current ADA guidelines recommend the use of
ACE inhibitors or ARBs as first-line therapy for both type 1 and type 2 diabetic patients with
microalbuminuria, even if their blood pressure is normal. Some studies, however, have raised
questions about the value of early renin-angiotensin blockade for preventing microalbuminuria in
normotensive patients with type 1 or type 2 diabetes, and ADA guidelines recommend against
the use of these drugs for patients with normal blood pressure and no albuminuria.Compared to
whites, African-Americans and Asians have a three- to fourfold higher risk of angioedema
associated with the use of ACE inhibitors. The American Heart Association recommends that
ACE in
True statements regarding carbohydrate intake and diabetes mellitus include which of the
following? (Mark all that are true.)
The glycemic index is not useful in the management of diabetes mellitus
Carbohydrate sources high in protein are effective for treating hypoglycemia
Low-fat diets are more effective for achieving weight loss than low-carbohydrate diets (<130
g/day)
Excessive intake of sugar-sweetened beverages has been shown to increase the risk for diabetes
mellitus
Carbohydrates have fewer calories per gram than alcohol - Answer✔D AND E
4|Page
