A 34-year-old person with type 1 diabetes for 20 years uses pens for glargine and lispro. Glucose readings after identical meals and doses vary widely from day to day. On examination, the specialist palpates a soft, rubbery, nontender swelling about 5 cm across on each side of the umbilicus, which the person calls "the spots that don't hurt." Which conclusion is BEST supported by this finding?

Insulin absorption from these areas is likely erratic and is contributing to the variability

These are early subcutaneous abscesses that need drainage before the next injection

These are fat deposits from excess calorie intake and are unrelated to injection practice

These are areas of lipoatrophy from an immune reaction, so the insulin type needs to be changed

A diabetes care and education specialist wants a quick, validated way to identify people who may have limited health literacy during intake without a formal reading test. Which question is the single-item screen designed for this purpose?

"How often do you need to have someone help you when you read instructions, pamphlets, or other written material from your doctor or pharmacy?"

"How confident are you that you can take your diabetes medications correctly at home without help from family or friends?"

"Would you prefer to receive your diabetes education in writing, by video, in a group class, or one-on-one with a specialist?"

"What was the last grade you completed in school, and did you graduate from high school, earn a GED, or attend college?"

A 58-year-old man with newly diagnosed type 2 diabetes (A1C 9.1%) was started on metformin and glipizide yesterday. He drives a delivery truck for 10 hours a day and has a single 45-minute session with the specialist before returning to work. Which topic should receive PRIORITY in this first session?

Recognizing, treating, and preventing hypoglycemia, including before driving

Long-term complications of diabetes and the recommended annual screening schedule

Setting a weekly physical activity goal of 150 minutes

Carbohydrate counting using food labels and carbohydrate choices

A 21-year-old with type 1 diabetes on insulin glargine at bedtime and lispro at meals plays soccer from 4 to 6 p.m. twice weekly. CGM shows glucose in range during and right after games but repeated lows near 3 a.m. on game nights only. Which adjustment is MOST appropriate?

Lower bedtime glargine about 20% on game days and add a bedtime snack

Move soccer practice to 8 p.m. so that exercise ends closer to bedtime

Eat 15 g of fast-acting carbohydrate immediately before each game

Increase the dinner lispro dose to prevent a post-game glucose rise

A 63-year-old person with type 2 diabetes and hypertension takes metformin 1,000 mg twice daily. Kidney function results over the past year are shown. Which change to metformin should the specialist expect the prescriber to make? 0 58 6 51 12 41

Reduce to no more than 1,000 mg/day and monitor eGFR every 3–6 months

Stop metformin now, because it is contraindicated below an eGFR of 45

Continue 2,000 mg/day, since dose changes are needed only below an eGFR of 30

Switch to extended-release metformin at the same 2,000- mg total daily dose

A 48-year-old with newly diagnosed type 2 diabetes is starting education. Which question BEST assesses her learning preferences?

"Think of something you learned well recently. How did you go about learning it?"

"How much do you already know about diabetes from friends and family?"

"On a scale of 0 to 10, how ready do you feel to learn about diabetes?"

"What grade level did you complete in school before you started working?"

A 28-year-old woman with type 1 diabetes on multiple daily injections learns she is 7 weeks pregnant. She has one session with the specialist before her first prenatal visit. Which topic should be the HIGHEST priority in her education plan?

Higher hypoglycemia risk in early pregnancy and glucagon use by her partner

The schedule for a 75-g glucose tolerance test after she delivers her baby

Rising insulin needs in early pregnancy that require weekly dose increases

Limiting carbohydrate to under 100 g a day to keep glucose in the target range

A 63-year-old with long-standing type 1 diabetes has cardiac autonomic neuropathy with a resting heart rate of 102 bpm and orthostatic hypotension. After cardiac evaluation, the person is cleared to begin an exercise program. How should exercise intensity be monitored?

By rating of perceived exertion

By a target of 70%–85% of age-predicted maximum heart rate

By a target of 50%–70% of age-predicted maximum heart rate

By keeping heart rate below 100 bpm

A 55-year-old person with type 2 diabetes for 6 years has an A1C of 6.9% and no retinopathy on dilated eye exams in each of the past 3 years. The person asks whether an eye exam is still needed every year. Which response is MOST consistent with ADA recommendations?

Exams every 1–2 years may be considered, since no retinopathy has been found

Exams are needed every 3–6 months, since diabetes has lasted more than 5 years

Exams can stop, since three normal results mean retinopathy is unlikely to develop

Exams are needed only if blurred vision or other visual changes are noticed

CDCES

Free CDCES Practice Questions

10 sample questions for the CDCES, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: I. Assessment, Assessment, Self-Care Education: Nutrition, Activity, and Medications, Knowledge, Disease Process and the Individualized Education Plan, Interventions:Diseaseprocessandtreatment, Interventions:Individualizededucationplan, Self-Careeducation:Nutrition, Self-Careeducation:Physicalactivity, Self-Careeducation:Medicationmanagement, Self-Careeducation:Monitoringandinterpretation, Self-Careeducation:Acutecomplications, Self-Careeducation:Chroniccomplicationsand, Self-Careeducation:Problemsolving, Prediabetes, Interventions:Evaluation,Documentation,And, Standardsandpractices, Self-Care Education: Monitoring, Complications, and Living with Diabetes.

Question 1 · I. Assessment
A 34-year-old person with type 1 diabetes for 20 years uses pens for glargine and lispro. Glucose readings after identical meals and doses vary widely from day to day. On examination, the specialist palpates a soft, rubbery, nontender swelling about 5 cm across on each side of the umbilicus, which the person calls "the spots that don't hurt." Which conclusion is BEST supported by this finding?
- A.These are early subcutaneous abscesses that need drainage before the next injection
- B.These are fat deposits from excess calorie intake and are unrelated to injection practice
- C.These are areas of lipoatrophy from an immune reaction, so the insulin type needs to be changed
- D.Insulin absorption from these areas is likely erratic and is contributing to the variability
Show answer and explanation
Answer: D. Insulin absorption from these areas is likely erratic and is contributing to the variability
Soft, rubbery, painless swellings at favored injection sites are lipohypertrophy, caused by repeated injection into the same area; insulin absorption from these sites is delayed and unpredictable, producing unexplained glucose variability. Lipoatrophy is a loss (dent) of fat, not a swelling, and abscesses are warm and tender. The location exactly at the injection sites points to injection practice, not calorie intake, so site rotation should be assessed and taught.
Question 2 · Assessment
A diabetes care and education specialist wants a quick, validated way to identify people who may have limited health literacy during intake without a formal reading test. Which question is the single-item screen designed for this purpose?
- A."How confident are you that you can take your diabetes medications correctly at home without help from family or friends?"
- B."How often do you need to have someone help you when you read instructions, pamphlets, or other written material from your doctor or pharmacy?"
- C."Would you prefer to receive your diabetes education in writing, by video, in a group class, or one-on-one with a specialist?"
- D."What was the last grade you completed in school, and did you graduate from high school, earn a GED, or attend college?"
Show answer and explanation
Answer: B. "How often do you need to have someone help you when you read instructions, pamphlets, or other written material from your doctor or pharmacy?"
The Single Item Literacy Screener (SILS) asks how often the person needs help reading instructions or written materials from the doctor or pharmacy; answers of sometimes or more often suggest limited health literacy. Years of schooling overestimate literacy and are not a validated screen. Asking about format preference assesses learning style, and asking about confidence assesses self-efficacy, not literacy.
Question 3 · Interventions:Individualizededucationplan
A 58-year-old man with newly diagnosed type 2 diabetes (A1C 9.1%) was started on metformin and glipizide yesterday. He drives a delivery truck for 10 hours a day and has a single 45-minute session with the specialist before returning to work. Which topic should receive PRIORITY in this first session?
- A.Long-term complications of diabetes and the recommended annual screening schedule
- B.Setting a weekly physical activity goal of 150 minutes
- C.Recognizing, treating, and preventing hypoglycemia, including before driving
- D.Carbohydrate counting using food labels and carbohydrate choices
Show answer and explanation
Answer: C. Recognizing, treating, and preventing hypoglycemia, including before driving
Initial education focuses on survival skills that keep the person safe until the next visit, and a sulfonylurea creates immediate hypoglycemia risk, especially for someone who drives for work. Complication screening, carbohydrate counting, and activity goals are important but can be addressed at follow-up sessions. Hypoglycemia safety also includes checking glucose before driving and keeping fast-acting carbohydrate in the vehicle.
Question 4 · Self-Careeducation:Physicalactivity
A 21-year-old with type 1 diabetes on insulin glargine at bedtime and lispro at meals plays soccer from 4 to 6 p.m. twice weekly. CGM shows glucose in range during and right after games but repeated lows near 3 a.m. on game nights only. Which adjustment is MOST appropriate?
- A.Move soccer practice to 8 p.m. so that exercise ends closer to bedtime
- B.Lower bedtime glargine about 20% on game days and add a bedtime snack
- C.Eat 15 g of fast-acting carbohydrate immediately before each game
- D.Increase the dinner lispro dose to prevent a post-game glucose rise
Show answer and explanation
Answer: B. Lower bedtime glargine about 20% on game days and add a bedtime snack
Exercise increases insulin sensitivity and depletes glycogen for many hours, producing delayed nocturnal hypoglycemia; reducing basal insulin by about 20% on exercise nights and adding a bedtime snack address that risk. Carbohydrate just before each game treats hypoglycemia during exercise, which is not occurring, increasing the dinner lispro dose would worsen the overnight lows, and exercising later in the evening moves the peak sensitivity even closer to the overnight hours.
Question 5 · Self-Careeducation:Chroniccomplicationsand
A 63-year-old person with type 2 diabetes and hypertension takes metformin 1,000 mg twice daily. Kidney function results over the past year are shown. Which change to metformin should the specialist expect the prescriber to make? 0 58 6 51 12 41
- A.Stop metformin now, because it is contraindicated below an eGFR of 45
- B.Reduce to no more than 1,000 mg/day and monitor eGFR every 3–6 months
- C.Continue 2,000 mg/day, since dose changes are needed only below an eGFR of 30
- D.Switch to extended-release metformin at the same 2,000- mg total daily dose
Show answer and explanation
Answer: B. Reduce to no more than 1,000 mg/day and monitor eGFR every 3–6 months
Metformin is contraindicated below an eGFR of 30 and should not be started at 30–45; when eGFR falls into the 30–44 range in someone already taking it, the benefits are reassessed and the dose is usually reduced (commonly to a maximum of 1,000 mg/day) with eGFR checked every 3–6 months. Stopping now misplaces the contraindication cutoff at 45, continuing the full dose ignores reduced renal clearance, and the extended-release form is cleared by the kidneys the same way.
Question 6 · I. Assessment
A 38-year-old woman with type 1 diabetes needed paramedics for a severe hypoglycemic event 3 months ago. Since then her CGM time in range has fallen from 72% to 41% with 0% time below range. She reports eating extra snacks and taking smaller boluses "just to be safe." Which screening tool MOST specifically assesses the issue behind this change?
- A.Generalized Anxiety Disorder-7
- B.Diabetes Distress Scale
- C.Patient Health Questionnaire-9
- D.Hypoglycemia Fear Survey
Show answer and explanation
Answer: D. Hypoglycemia Fear Survey
Deliberately running glucose high by snacking and underdosing insulin after a severe low is classic fear of hypoglycemia, which the Hypoglycemia Fear Survey measures through its behavior and worry subscales. The Diabetes Distress Scale assesses broader emotional burden, the GAD-7 measures general anxiety, and the PHQ-9 screens for depression; none targets the specific avoidance behaviors she describes.
Question 7 · Assessment
A 48-year-old with newly diagnosed type 2 diabetes is starting education. Which question BEST assesses her learning preferences?
- A."How much do you already know about diabetes from friends and family?"
- B."On a scale of 0 to 10, how ready do you feel to learn about diabetes?"
- C."What grade level did you complete in school before you started working?"
- D."Think of something you learned well recently. How did you go about learning it?"
Show answer and explanation
Answer: D. "Think of something you learned well recently. How did you go about learning it?"
Asking how she successfully learned something recently reveals whether she prefers reading, watching, listening, discussing, or hands-on practice, which guides the choice of teaching methods. Education level is a poor proxy for learning preference or literacy. Asking what she already knows assesses prior knowledge, and a readiness ruler measures readiness to learn, not preferred learning style.
Question 8 · Interventions:Individualizededucationplan
A 28-year-old woman with type 1 diabetes on multiple daily injections learns she is 7 weeks pregnant. She has one session with the specialist before her first prenatal visit. Which topic should be the HIGHEST priority in her education plan?
- A.The schedule for a 75-g glucose tolerance test after she delivers her baby
- B.Higher hypoglycemia risk in early pregnancy and glucagon use by her partner
- C.Rising insulin needs in early pregnancy that require weekly dose increases
- D.Limiting carbohydrate to under 100 g a day to keep glucose in the target range
Show answer and explanation
Answer: B. Higher hypoglycemia risk in early pregnancy and glucagon use by her partner
In type 1 diabetes, insulin sensitivity rises and nausea often reduces intake in the first trimester, so severe hypoglycemia is most common in early pregnancy; treating lows and having a partner trained in glucagon is a safety priority. Insulin needs typically fall in the first trimester and rise in the second and third trimesters. A postpartum glucose tolerance test applies to gestational diabetes, and restricting carbohydrate below the pregnancy minimum of about 175 g a day promotes ketosis.
Question 9 · Self-Careeducation:Physicalactivity
A 63-year-old with long-standing type 1 diabetes has cardiac autonomic neuropathy with a resting heart rate of 102 bpm and orthostatic hypotension. After cardiac evaluation, the person is cleared to begin an exercise program. How should exercise intensity be monitored?
- A.By rating of perceived exertion
- B.By a target of 70%–85% of age-predicted maximum heart rate
- C.By a target of 50%–70% of age-predicted maximum heart rate
- D.By keeping heart rate below 100 bpm
Show answer and explanation
Answer: A. By rating of perceived exertion
Cardiac autonomic neuropathy blunts the heart rate response to exercise and raises the resting rate, so heart rate targets do not reflect intensity and rating of perceived exertion should be used instead. Both age-predicted heart rate ranges assume a normal chronotropic response, and keeping heart rate below 100 bpm is impossible when the resting rate is already 102 bpm.
Question 10 · Self-Careeducation:Chroniccomplicationsand
A 55-year-old person with type 2 diabetes for 6 years has an A1C of 6.9% and no retinopathy on dilated eye exams in each of the past 3 years. The person asks whether an eye exam is still needed every year. Which response is MOST consistent with ADA recommendations?
- A.Exams are needed every 3–6 months, since diabetes has lasted more than 5 years
- B.Exams can stop, since three normal results mean retinopathy is unlikely to develop
- C.Exams are needed only if blurred vision or other visual changes are noticed
- D.Exams every 1–2 years may be considered, since no retinopathy has been found
Show answer and explanation
Answer: D. Exams every 1–2 years may be considered, since no retinopathy has been found
When one or more annual dilated eye exams show no retinopathy and glycemia is well managed, screening every 1–2 years may be considered. Retinopathy can still develop, so screening should not stop; exams every 3–6 months are for established or progressing retinopathy; and waiting for symptoms risks missing treatable disease, because early retinopathy is usually asymptomatic.

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