CDCES Practice Questions (2026) — Free Sample Questions with Answers

Answer: C

Repeat the math lesson with more practice examples.: More of the same method often fails when numeracy is the barrier.

Give a written handout explaining how ratios work.: His reading is fine; the problem is the arithmetic itself.

Provide a dose chart listing units by carb amount.: Correct. A precalculated chart removes the division step while keeping flexible dosing, a standard adaptation for low numeracy confirmed by teach-back.

Ask the prescriber to change him to fixed meal doses.: It may be needed if adapted tools fail, but it gives up flexible dosing before a simpler tool is tried.

Assess numeracy separately from literacy; adapt tools (charts, calculators) before abandoning flexible dosing.

Answer: A

Glucagon access and a trained helper.: Correct. After a level 3 event, the ADA recommends glucagon for anyone at risk of level 2 or 3 hypoglycemia and training of the people around them; she could not self-treat.

Her ability to recognize early low symptoms.: She did notice shakiness; the gap was being unable to treat herself once confused.

Her knowledge of how to treat a mild low.: She already explains the 15-g rule correctly.

Her eating pattern on days she skips lunch.: Meal patterns may explain lows later, but they do not prepare her for the next severe event.

Anyone at risk of level 2 or 3 hypoglycemia should have glucagon available and a trained support person.

Answer: C

Time in range below the 70% goal.: Raising TIR is a goal, but it is not the first safety priority.

Time above 250 mg/dL above 5%.: Severe highs need attention, but hypoglycemia is addressed before highs.

Time below range above both goals.: Correct. Below 70 mg/dL is 6% (goal <4%) and below 54 mg/dL is 2% (goal <1%); reducing hypoglycemia is the first priority when reviewing CGM data.

A coefficient of variation above 36%.: High variability raises hypoglycemia risk, but the lows themselves are the finding to act on first.

Read a CGM report safety-first: address time below range before time in range or time above range.

Answer: C

Advise her that metformin must be stopped right away.: Metformin is contraindicated below an eGFR of 30; at 30–45 it is continued with dose review, not stopped outright.

Reassure her that a UACR under 300 mg/g is not significant.: A UACR of 30–299 mg/g is moderately increased albuminuria, a marker of kidney and CV risk.

Share the trend with the prescriber for kidney protection.: Correct. Three elevated UACRs confirm albuminuria with a falling eGFR (now 41); the ADA recommends kidney-protective therapy such as an SGLT2 inhibitor and a metformin dose review at eGFR 30–45.

Repeat the UACR before raising any concern.: Albuminuria needs 2 of 3 elevated samples to confirm; all three values here are ≥30 mg/g, so it is already confirmed.

Albuminuria is confirmed by 2 of 3 elevated UACRs; with eGFR 30–45, metformin is dose-reviewed, not stopped, and kidney-protective therapy is indicated.

Answer: D

Stop all insulin until she can eat again.: Stopping insulin during illness speeds DKA; basal insulin is always continued.

Skip boluses but keep sipping fluids slowly.: She needs correction insulin for rising glucose and ketones, and she cannot keep fluids down.

Recheck glucose and ketones tomorrow morning.: Waiting overnight with blood ketones rising to 2.1 mmol/L and vomiting risks DKA.

Take correction insulin and contact the team now.: Correct. Rising glucose with blood ketones climbing to 2.1 mmol/L and vomiting that prevents fluid intake call for correction insulin per her sick-day plan and immediate contact with the care team or urgent care.

Sick days: never stop basal insulin, check glucose and blood ketones (beta-hydroxybutyrate is preferred over urine testing) every few hours, and seek help for rising ketones or persistent vomiting.

Answer: C

Viral gastroenteritis with mild dehydration: A blood ketone level of 3.2 mmol/L with shortness of breath on an SGLT2 inhibitor must not be dismissed as simple gastroenteritis.

Hyperosmolar hyperglycemic state: HHS involves glucose usually above 600 mg/dL; hers is 168 mg/dL.

Euglycemic DKA from the SGLT2 inhibitor: Correct. SGLT2 inhibitors can cause DKA with glucose below 250 mg/dL, especially with vomiting and low intake; a blood ketone level of 3.2 mmol/L confirms marked ketosis, and she needs urgent care.

Lactic acidosis caused by the metformin: Metformin-associated lactic acidosis is rare and mainly seen with kidney impairment; a high blood ketone level points to ketoacidosis instead.

On an SGLT2 inhibitor, nausea, vomiting, abdominal pain or dyspnea need a ketone check even when glucose is near normal.

Answer: C

Raise his time in range above 80%.: His time in range already meets the >70% goal; pushing it higher could add lows.

Lower his time above 180 mg/dL.: At 20%, time above range already meets the <25% goal.

Reduce his time below range, which exceeds targets.: Correct. Time below 70 is 6% (goal <4%) and below 54 is 2% (goal <1%), with high variability (CV 41%); reducing hypoglycemia is the first priority.

Make no change, since time in range meets the target.: Overlooks his time below range, which is above target.

Read time below range first: TBR <70 under 4% and <54 under 1% take priority over raising time in range.

Answer: C

Nocturnal lows from too much basal insulin: A true basal-related low would not recover abruptly, and the fingerstick of 124 mg/dL during an alert rules it out.

Rebound after an unrecognized overnight low: Readings return to her usual level rather than rising, and the fingerstick was normal, so there was no real low to rebound from.

Pressure on the sensor while she sleeps on it: Correct. Body weight on the sensor causes sudden, brief, false lows with abrupt recovery and a normal fingerstick; confirm with a meter and change the sleep position or sensor site.

Sensor lag during a rapid drop in her glucose: Lag delays a real change; it does not create a drop while the fingerstick shows 124 mg/dL.

Suspect a compression artifact when CGM shows sudden, brief, symptom-free overnight lows that recover abruptly; confirm with a fingerstick before treating.

Answer: A

Increase the bedtime glargine dose.: Correct. Fasting values are consistently above goal while the rest of the day is near target and there are no overnight lows, so the basal dose is too low.

Add insulin lispro before breakfast.: Treats a fasting high with mealtime insulin; the rise happens overnight, before breakfast.

Reduce the glargine dose to prevent rebound highs.: Applies the Somogyi concept, but CGM shows no overnight lows to rebound from.

Make no change to the regimen.: Every fasting value is above the 80–130 mg/dL goal, so the plan needs adjusting.

Consistently high fasting glucose with no overnight hypoglycemia points to inadequate basal insulin; titrate the basal dose.

Answer: A

Refer her to a mental health specialist in eating disorders.: Correct. Deliberate insulin omission for weight control is a form of disordered eating with high risk of DKA and complications; ADA recommends referral to a qualified mental health professional and team-based care.

Teach lower-carbohydrate meals so she needs less mealtime insulin.: Diet restriction can reinforce disordered eating and leaves the cause untreated.

Ask the prescriber to raise her basal dose to cover missed boluses.: Basal insulin cannot replace meal coverage and does not treat the behavior.

Set a S.M.A.R.T. goal with her to give insulin before every meal.: A reasonable later step, but it does not address the eating disorder driving the omission.

Screen for disordered eating, including insulin omission, and refer to a qualified mental health professional when it is found.

Answer: B

Teach carbohydrate counting with a low-cost food list.: A later skill; it does not solve the lack of food or the hypoglycemia risk.

Link her to food aid and report the lows to her prescriber.: Correct. Food insecurity plus a sulfonylurea causes lows when meals are skipped. Connecting her to food resources and informing the prescriber, who can choose a drug with lower hypoglycemia risk, addresses the root cause and the safety issue.

Teach her to carry glucose tablets for the late-month lows.: Good safety teaching, but it treats lows after they happen; it does not address the skipped meals or the sulfonylurea risk.

Set a S.M.A.R.T. goal for her to eat three meals daily.: Not achievable while she lacks food; the barrier must be addressed first.

When assessment finds food insecurity, address access to food and review hypoglycemia-prone drugs (sulfonylureas, insulin) with the prescriber before routine meal-planning teaching.

Answer: A

1. Bread: 2 slices × 15 g = 30 g.
2. Turkey: 0 g.
3. Milk: 1 cup × 12 g = 12 g.
4. Carrots: 1 cup × 5 g = 5 g.
5. Grapes: 1 cup is 2 half-cup servings, so 2 × 15 g = 30 g.
6. Total: 30 + 0 + 12 + 5 + 30 = 77 g of carbohydrate.

77 g: Correct. Bread 2 × 15 = 30 g, turkey 0 g, milk 12 g, carrots 5 g and grapes 2 × 15 = 30 g, for a total of 77 g.

80 g: Counts the milk as a full 15-g carbohydrate choice instead of its listed 12 g.

87 g: Counts the nonstarchy carrots as a 15-g starch choice instead of 5 g.

90 g: Makes both errors: milk counted as 15 g and carrots counted as 15 g.

Multiply each food's listed carbohydrate by the number of servings actually eaten, and use the listed values for milk and nonstarchy vegetables rather than rounding every food to 15 g.

Answer: A

TIR improved, but lows now exceed goals and need follow-up.: Correct. TIR now exceeds 70%, but time below 70 (6%) and below 54 (1.5%) exceed the <4% and <1% goals; the specialist documents this and communicates it to the prescriber.

The change worked, and no further follow-up is needed.: It ignores the new hypoglycemia, which now exceeds goals.

The lows are acceptable given the large gain in TIR.: Hypoglycemia goals are not traded for TIR; lows are addressed first.

TIR is still too low, so the basal dose should rise again.: TIR already meets the >70% goal, and raising basal would worsen the lows.

Evaluate all CGM metrics after a change; better TIR does not offset time below range that exceeds goals.

Answer: B

Add a DPP-4 inhibitor for more glucose lowering.: DPP-4 inhibitors are CV-neutral; they do not give the proven benefit he needs.

Add a GLP-1 RA with proven CV benefit.: Correct. With established ASCVD, the ADA recommends a GLP-1 RA and/or SGLT2 inhibitor with proven CV benefit independent of A1C and of metformin use.

Add basal insulin to reach an A1C under 6.5%.: Insulin adds hypoglycemia risk and no CV benefit; his A1C is already at goal.

Make no change, because the A1C is at goal.: Cardiorenal protection is recommended regardless of A1C; being at goal is not a reason to withhold it.

In type 2 diabetes with ASCVD, HF or CKD, choose agents with proven cardiorenal benefit independent of A1C.

Answer: B

a Somogyi rebound after a nighttime low: No 3 a.m. lows were found, so a rebound is not supported.

the dawn phenomenon from morning hormones: Correct. Stable glucose at bedtime and 3 a.m. followed by a rise before breakfast fits the dawn phenomenon, driven by early-morning growth hormone and cortisol.

the effect of an evening snack before sleep: She had no bedtime snacks, and a snack would also raise the 3 a.m. reading.

skipped bedtime doses of insulin glargine: Missed basal doses would raise glucose across the whole night, including at 3 a.m.

Check 3 a.m. glucose: flat overnight then rising before breakfast suggests dawn phenomenon; a 3 a.m. low with a morning high suggests overtreatment.

Answer: C

Translate all of the existing class handouts into Spanish.: Helpful, but translation alone does not address cultural fit, scheduling or other barriers.

Add more class times using the current class format.: More of the same format does not address why these participants leave.

Ask them about barriers and co-design the sessions.: Correct. Engaging the affected group to identify barriers and co-design culturally and linguistically tailored services is the equity-focused, person-centered approach the National Standards support.

Send text reminders in Spanish before each session.: Reminders may help attendance a little but do not address the underlying barriers.

Close disparities by engaging the affected group and tailoring services to culture and language, not just translating materials.