Free CDCES Exam Flashcards

A low or undetectable C-peptide indicates minimal endogenous insulin production, consistent with type 1 diabetes or long-standing type 2 diabetes. A normal-to-high C-peptide with obesity, insulin resistance, and negative autoantibodies points to type 2 diabetes.

GAD65, IA-2, insulin autoantibodies (IAA), and ZnT8 are the four islet autoantibodies used to identify type 1 diabetes and LADA when the clinical picture is ambiguous (e.g., normal-BMI adult with rapid progression to insulin dependence).

A health-literacy confirmation technique in which the person restates education in their own words so the educator can verify understanding and correct gaps, rather than simply asking 'Do you understand?'

Describes behavior change as moving through precontemplation, contemplation, preparation, action, and maintenance, with relapse possible at any stage; used to assess a person's readiness to change a self-care behavior.

A direct question such as 'Have you ever cut back on medication or supplies because of cost?' should be asked at every visit; cost-related non-adherence, including deliberate insulin rationing, can change medication selection and prompt referral to a patient-assistance program.

A1C ≥6.5% (≥48 mmol/mol); fasting plasma glucose ≥126 mg/dL (no caloric intake ≥8 hr); 2-hour plasma glucose ≥200 mg/dL on a 75-g OGTT; or random plasma glucose ≥200 mg/dL plus classic hyperglycemia symptoms or a hyperglycemic crisis.

A1C 5.7-6.4%; impaired fasting glucose (IFG) = FPG 100-125 mg/dL; impaired glucose tolerance (IGT) = 2-hour OGTT 140-199 mg/dL. A person can meet more than one criterion at once.

Type 1: T-cell-mediated autoimmune destruction of pancreatic beta cells causing absolute insulin deficiency. Type 2: insulin resistance in muscle/liver/fat plus progressive, relative (not absolute) insulin deficiency from beta-cell dysfunction.

LADA ('type 1.5'): slower-onset autoimmune beta-cell destruction presenting in adulthood, usually GAD65-antibody positive, may not need insulin at diagnosis but progresses to insulin dependence. MODY: monogenic, autosomal-dominant, onset typically before age 25; GCK-MODY is mild/stable, HNF1A-MODY is progressive and sulfonylurea-sensitive.

Both cause unexplained morning hyperglycemia. Dawn phenomenon: 2-3 AM glucose is normal or rising (nocturnal growth hormone/cortisol surge) — fix by adjusting basal insulin timing/dose. Somogyi effect: 2-3 AM glucose is low, then rebounds — fix by REDUCING evening insulin, not increasing it.

A1C <7% (<53 mmol/mol), individualized — more stringent (e.g., <6.5%) for shorter disease duration/long life expectancy/no CVD if achievable safely; less stringent (e.g., <8%) for limited life expectancy, extensive comorbidities, or history of severe hypoglycemia.

Preprandial (before-meal) capillary plasma glucose: 80-130 mg/dL. Peak postprandial glucose (measured 1-2 hours after the start of the meal): <180 mg/dL. Paired with an A1C goal of <7% for most nonpregnant adults.

Time in Range (70-180 mg/dL): >70%. Time Below Range Level 1 (<70 mg/dL): <4%. Time Below Range Level 2 (<54 mg/dL): <1%. Time Above Range Level 1 (>180 mg/dL): <25%. Time Above Range Level 2 (>250 mg/dL): <5%.

GMI (%) = 3.31 + 0.02392 x mean CGM glucose (mg/dL). Requires a minimum of 14 days of CGM data, ideally with the sensor active at least 70% of the time, to be considered representative. GMI can diverge from lab A1C.

BP goal: <130/80 mmHg if safely attainable (more intensive <120 mmHg systolic for high CV/kidney risk). LDL goal: <70 mg/dL with 1+ ASCVD risk factors (high-intensity statin); <55 mg/dL with established ASCVD (high-intensity statin, at least 50% reduction from baseline).

Healthy Coping, Healthy Eating, Being Active, Taking Medication, Monitoring, Reducing Risk, and Problem Solving. Healthy Coping is positioned at the center of the framework because sustained engagement with the other six depends on emotional/psychological capacity to cope with a chronic condition.

Specific, Measurable, Achievable, Relevant, and Time-bound. Written collaboratively, in the person's own words, and typically behavior-by-behavior (e.g., a Being Active goal is distinct from a Taking Medication goal) as part of the Individualized Education Plan.

The 2022 revision consolidated the National Standards from 10 standards (2017 edition) to 6 broader standards: Support for DSMES Services, Population and Service Assessment, DSMES Team, Delivery and Design of DSMES Services, Person-Centered DSMES, and Measuring/Demonstrating Outcomes.

1) At diagnosis, 2) annually and/or when not meeting treatment targets, 3) when complicating factors develop, 4) when transitions in life or care occur (new care team, insurance change, pediatric-to-adult transition). Medicare's DSMT benefit covers up to 10 hours in the first year and 2 hours/year thereafter.

Defined as 15 grams of carbohydrate (e.g., one slice of bread, one small piece of fruit, 1/3 cup cooked rice, 1 cup milk). For insulin-dose calculation, carbohydrate GRAM counting from the Nutrition Facts 'Total Carbohydrate' line is used instead of counting choices.

ICR = 500 / Total Daily Dose (TDD) of insulin. Example: TDD of 50 units → 500/50 = 10, so 1 unit of rapid-acting insulin covers about 10 grams of carbohydrate. This is a starting-point estimate that must be verified and re-titrated with glucose data.

Correction factor = 1800 / TDD for rapid-acting insulin (1500 / TDD for regular/short-acting). Example: TDD of 60 units → 1800/60 = 30, so 1 unit of rapid-acting insulin is expected to lower glucose by about 30 mg/dL.

Nonnutritive sweeteners (FDA-approved: saccharin, aspartame, acesulfame potassium, sucralose, neotame, advantame; GRAS: stevia, monk fruit) provide little/no calories or carbs. Sugar alcohols (erythritol, xylitol, sorbitol, mannitol, maltitol) are NOT calorie-free — about 2 kcal/g with a partial carb/glycemic effect and possible GI upset.

Aerobic: ≥150 minutes/week moderate-to-vigorous intensity over ≥3 days/week, no more than 2 consecutive days without activity (≥75 min/week vigorous/interval may suffice if already fit). Resistance training: 2-3 sessions/week on nonconsecutive days. Interrupt prolonged sitting every 30 minutes.

Glucose <90 mg/dL: eat 15-30 g fast-acting carb first, recheck in ~15 min. 90-250 mg/dL: proceed. >250 mg/dL with negative ketones: proceed with caution. 250-349 mg/dL WITH ketones, or ≥350 mg/dL regardless: do NOT exercise — correct hyperglycemia/ketosis first.

Can occur many hours after activity, including overnight, as muscle/liver glycogen stores replenish and insulin sensitivity stays elevated. Teach a post-exercise glucose check, a bedtime snack, and CGM trend review before sleep.

Onset 10-15 min, peak 60-90 min, duration 3-5 hr. Dosed 0-15 minutes before a meal. Standard choice for mealtime/bolus dosing, correction doses, and the only insulin used in pumps and hybrid closed-loop systems.

Onset ~30 min, peak 2-3 hr, duration 6-8 hr. Dosed about 30 minutes before a meal. The only insulin approved for IV administration — the formulation used to treat DKA and HHS in the hospital.

Onset 1-2 hr, peak 4-12 hr, duration 12-18 hr. A cloudy suspension that must be gently rolled/inverted (never shaken) before dosing. The only commonly used basal insulin with a pronounced peak — a classic testable cause of nocturnal or mid-afternoon hypoglycemia if mistimed.

Glargine and detemir: onset 1-2 hr, no pronounced peak, duration up to 24 hr. Degludec: onset ~1 hr, no pronounced peak, duration >42 hr — the longest-acting basal insulin available, with the flattest action profile.

Five times the concentration of U-100 regular insulin; reserved for severe insulin resistance requiring more than 200 units/day. Behaves with BOTH prandial and basal characteristics. Must never be drawn up with a standard U-100 syringe and is not approved for standard insulin pumps — a recognized high-severity medication-error risk.

First-line therapy for type 2 diabetes; reduces hepatic glucose production. GI effects (nausea, diarrhea) occur in ~20-30% of new users. B12 deficiency develops in ~5-10% of long-term users. Contraindicated at eGFR <30 mL/min/1.73 m²; not recommended to initiate at eGFR 30-45.

Glucose-dependent insulin release, reduced glucagon, slowed gastric emptying; produce substantial weight loss (greatest with tirzepatide) and reduce major cardiovascular events in several agents. Carry an FDA BOXED WARNING against use with personal/family history of medullary thyroid carcinoma (MTC) or MEN2. Avoid with history of pancreatitis.

Block renal glucose reabsorption, causing glucosuria; provide cardiovascular, heart-failure, and renal benefit independent of glycemic control. Key risks: genital mycotic infection (most common) and euglycemic DKA (glucose often <200 mg/dL) — ketones must be checked with any DKA symptoms regardless of glucose level. Hold before surgery/during acute illness.

Stimulate insulin secretion from beta cells independent of glucose level, giving the HIGHEST hypoglycemia risk of any oral agent, plus weight gain. Glyburide carries the highest risk within the class, especially in older adults or renal impairment.

Wash and dry hands before testing (residual sugar falsely elevates results), warm the hand to improve blood flow, use the side of the fingertip (less pain), and apply an adequate first drop rather than 'milking' the finger, which dilutes the sample with tissue fluid.

rtCGM streams data continuously to a receiver/smartphone with customizable high/low alarms. isCGM ('flash' monitoring) stores data that the user retrieves by scanning the sensor. Most current sensors are worn 10-15 days.

Percentage of a 24-hour day with glucose 70-180 mg/dL. Goal for most adults: >70% (~17 hours/day), which correlates with an A1C of roughly 7%. Relaxed to >50% for older/high-risk adults, paired with tighter hypoglycemia protection.

Blood BHB (quantitative) is ADA-preferred over urine ketone strips (lags true status). Test when glucose is persistently >240 mg/dL, during illness, or with DKA symptoms. Interpretation: <0.6 mmol/L normal; 0.6-1.5 mild-moderate (follow sick-day plan); 1.6-3.0 high risk (contact care team); >3.0 high likelihood of DKA (seek emergency care).

Level 1: 54-69 mg/dL — 'glucose alert value,' low enough to treat. Level 2: <54 mg/dL — clinically significant, neuroglycopenic symptoms begin. Level 3: any glucose value — severe, defined by need for assistance from another person (not by a specific number).

For a conscious person with glucose <70 mg/dL who can swallow safely: consume 15 g fast-acting carbohydrate, wait 15 minutes, recheck glucose, and repeat if still <70 mg/dL. AID/hybrid closed-loop users typically need only 5-10 g, since the pump is already reducing insulin delivery.

When a person cannot safely swallow, is unconscious, or is seizing, give glucagon (nasal spray, prefilled autoinjector/syringe, or reconstituted emergency kit) — not oral carbohydrate. Position the person on their side afterward (vomiting is common) and call emergency services if there's no response within about 15 minutes.

DKA: glucose usually >250 mg/dL, pH <7.3, bicarbonate <18 mEq/L, ketones positive (BHB ≥3.0 mmol/L), rapid onset over hours — typically type 1. HHS: glucose usually >600 mg/dL, pH ≥7.3, bicarbonate ≥15 mEq/L, ketones minimal/absent, gradual onset over days — typically type 2, older adults, higher mortality.

Type 1 diabetes: initial dilated eye exam within 5 years of diagnosis. Type 2 diabetes: initial dilated eye exam AT diagnosis. Both: annual dilated exams thereafter (may extend to every 1-2 years if no retinopathy and glycemia at goal).

Annual UACR + eGFR starting at diagnosis (T2DM) or 5 years post-diagnosis (T1DM). UACR categories: normal <30 mg/g, moderately increased 30-299 mg/g, severely increased ≥300 mg/g. An ACE inhibitor/ARB is recommended for hypertension with moderately increased albuminuria, strongly recommended for severely increased albuminuria or eGFR <60.

10-gram monofilament (loss of protective sensation), 128-Hz tuning fork (vibration sense), pinprick sensation, and ankle reflexes — assessed on the same 5-year (T1DM) / at-diagnosis (T2DM) schedule as retinopathy and nephropathy, then annually.

An acute, non-infectious inflammatory process in a neuropathic foot presenting as warm, red, swollen, with a palpable pulse and disproportionately little pain — often mistaken for cellulitis or gout. Requires immediate immobilization/offloading (typically total contact casting) to prevent progressive bone/joint destruction ('rocker-bottom' deformity).

Diabetes distress is the emotional burden specific to living with and managing diabetes (frustration, guilt, burnout); it is distinct from, though it can overlap with, clinical depression. Screened with the Diabetes Distress Scale (DDS) or Problem Areas in Diabetes (PAID) scale, recommended at least annually.

Fasting plasma glucose <95 mg/dL; 1-hour postprandial <140 mg/dL; 2-hour postprandial <120 mg/dL; A1C <6% (or <7% if needed to prevent hypoglycemia). Preconception A1C goal: <6.5%. Insulin is the preferred pharmacologic agent throughout pregnancy.

GDM is screened at 24-28 weeks' gestation via a one-step 75-g OGTT (any 1 value ≥ fasting 92, 1-hr 180, or 2-hr 153 mg/dL) or a two-step 50-g GCT followed by a 100-g OGTT (≥2 of 4 values met). Everyone with GDM should be tested for persistent diabetes with a 75-g OGTT 4-12 weeks postpartum using standard non-pregnancy criteria.