Clinical Practice Guidelines Tools Practice Exam: Diabetes Canada

Translating clinical guidelines into daily practice requires practical, accessible tools. The 2018 Guidelines provide a suite of resources—from vascular protection checklists to sick-day protocols—that function as the “how-to” manual for patient safety and comprehensive care.

This practice exam tests your proficiency in utilizing these essential algorithms and checklists to manage cardiovascular risk, prevent acute complications, and ensure safe medication practices.

Key Concepts Covered in This Exam:

Vascular Protection: Mastering the “ABCDES” of diabetes care (A1C, BP, Cholesterol, Drugs, Exercise/Eating, Smoking/Stress) to implement global vascular protection.
Sick Day Management: Applying the “SADMANS” protocol to identify which medications (Sulfonylureas, ACE inhibitors, Diuretics, Metformin, ARBs, NSAIDs, SGLT2 inhibitors) must be paused during acute illness to prevent kidney injury.
Hypoglycemia Protocols: Reviewing the steps for recognizing and treating mild-to-moderate hypoglycemia (15g carbohydrate rule) versus the management of severe hypoglycemia requiring glucagon.
Driving Safety: Understanding the assessment criteria for drivers with diabetes, including the requirements for blood glucose monitoring and the implications of hypoglycemia unawareness.
Foot Care & Screening: utilizing the specific checklists for daily foot care and understanding the “Dos and Don’ts” to prevent ulceration and amputation.

1. Case: A patient with type 2 diabetes is starting Tresiba (insulin degludec). According to the Insulin Prescription guidelines, by how many units can the dose be increased every 3-7 days?

5-10 units
10% of total dose
2-4 units
1 unit

2. A diabetes educator is using the ABATE stress infographic. What are the 4 elements of the stress response?

Assessment, Balance, Activity, Treatment
Actions, Body, Affect, Thoughts
Anxiety, Blood pressure, Appetite, Tension
Awareness, Breathing, Acceptance, Time

3. According to Inlow’s 60-second Diabetic Foot Screen, which risk category requires screening every 1-3 months?

Moderate Risk (Category 2)
High Risk (Category 3)
Low Risk (Category 1)
Very Low Risk (Category 0)

4. Case: A diabetes educator is developing a care plan using the ABCDESSS framework. A 45-year-old patient with type 2 diabetes has A1C 7.8%, BP 142/88, LDL-C 2.8 mmol/L, and smokes. What is the MINIMUM number of targets this patient is NOT meeting?

4 targets
5 targets
3 targets
2 targets

5. Case: A patient is being initiated on basal insulin for type 2 diabetes. According to the Insulin Prescription tool, what is the recommended starting dose?

5 units at bedtime
20 units at bedtime
10 units at bedtime
0.5 units/kg at bedtime

6. Case: A 52-year-old patient with type 2 diabetes has established atherosclerotic cardiovascular disease (ASCVD). According to the Prescription for Cardiorenal Protection, which combination of medications should be recommended?

Statin + ACEi/ARB + GLP-1 RA or SGLT2i + ASA
Metformin + sulfonylurea
Statin + ACEi/ARB
Statin alone

7. Case: A pregnant patient with type 1 diabetes is using CGM. According to the CGM targets, what is the time in range (TIR) target for pregnancy?

>50% at 3.9-10.0 mmol/L
>70% at 3.5-7.8 mmol/L
>80% at 4.0-8.0 mmol/L
>70% at 3.9-10.0 mmol/L

8. A diabetes education team is implementing a comprehensive diabetes screening program. According to the guideline tools, which statement about the relationship between different screening assessments is MOST accurate?

Psychological screening (DDS) should only be done annually regardless of other assessments
Immunization assessment is not part of comprehensive diabetes care
The ABCDESSS framework integrates glycemic targets, cardiovascular protection, and complication screening into a unified approach
Foot screening and cardiovascular risk assessment are independent and should not be coordinated

9. According to the Diabetes Distress Scale (DDS), what mean item score indicates ‘moderate distress’?

3.0-3.9
2.0-2.9
1.0-1.9
4.0-4.9

10. Case: A patient with type 2 diabetes has chronic kidney disease with eGFR of 35 mL/min/1.73m². According to the guidelines, what is the maximum daily dose of metformin?

500 mg
2,550 mg
1,000 mg
1,500 mg

11. According to Diabetes Canada guidelines, what is the A1C target for most people with type 1 or type 2 diabetes?

≤8.0%
≤6.5%
≤6.0%
≤7.0%

12. Case: A patient on automated insulin delivery (AID) has blood glucose of 15 mmol/L when sick. According to the Safety Tips for AID, when should ketones be checked?

When blood sugars are above 14 mmol/L
When blood sugars are above 17 mmol/L
When blood sugars are above 10 mmol/L
Only when symptomatic

13. Case: A patient with type 2 diabetes is age 55 with chronic kidney disease. According to the Cardiorenal Protection prescription, which nonsteroidal mineralocorticoid receptor antagonist (nsMRA) is recommended when CKD with albuminuria is present?

Finerenone
Amiloride
Eplerenone
Spironolactone

14. A diabetes educator is teaching insulin titration. For basal insulin (other than Tresiba), by how many units should the dose be increased daily until fasting glucose is in target?

0.5 units
2 units
4 units
1 unit

15. Case: A patient with type 1 diabetes on AID has blood ketones of 2.0 mmol/L and TDD of 40 units. According to the Safety Tips for AID ketone correction protocol, what is the recommended additional rapid insulin dose?

6 units (15% of TDD)
10 units (25% of TDD)
8 units (20% of TDD)
4 units (10% of TDD)

16. What is the duration of action for insulin glargine U-100 (Basaglar, Lantus)?

24 hours
Up to 18 hours
16-24 hours
>30 hours

17. For a patient with type 2 diabetes on insulin who intends to fast during Ramadan, how many times per day should SMBG be performed?

Only when symptomatic
SMBG is not needed during fasting
2-5 times per day
Once daily

18. A diabetes educator is counselling a Muslim patient with type 2 diabetes who wishes to fast during Ramadan. According to the Canadian Diabetes and Ramadan Position Statement, which category of patients ‘MUST NOT FAST’?

Well-controlled type 2 diabetes on metformin alone
Poorly controlled type 1 diabetes with A1C >9%
Type 2 diabetes treated with DPP-4 inhibitors
Well-controlled type 2 diabetes on basal insulin

19. Case: A patient is being switched from premixed insulin to a basal-bolus regimen for better control. According to the Insulin Prescription guidelines, how should the total daily insulin (TDI) be distributed?

60% basal, 40% bolus
50% basal, 50% bolus
40% basal, 60% bolus
80% basal, 20% bolus

20. A patient with type 1 diabetes using AID experiences mild hypoglycemia (3.0-3.9 mmol/L). According to the Safety Tips, what is the recommended treatment

Treat with 15-20g of fast acting carbohydrate
Treat with 5-10g of fast acting carbohydrate
No treatment needed, AID will correct
Administer glucagon immediately

21. According to the CGM targets for most people with type 1 and type 2 diabetes, what is the recommended time in range (TIR) target

>80%
>60%
>70%
>50%

22. Case: A 65-year-old patient with diabetes has loss of protective sensation (LOPS) plus peripheral arterial disease (PAD). According to Inlow’s foot screen risk stratification, this patient is classified as:

High Risk (Category 3)
Urgent Risk
Moderate Risk (Category 2
Low Risk (Category 1)

23. Case: A patient with type 1 diabetes on AID is planning a pump holiday. According to Safety Tips for AID, if the total daily dose (TDD) is 50 units and the pump is off for >1 hour, what rapid-acting insulin dose should be given hourly?

Approximately 2 units per hour
Approximately 1 unit per hour
No rapid-acting insulin needed
Approximately 4 units per hour

24. Case: A 60-year-old patient with type 2 diabetes is hospitalized with vomiting and diarrhea. They take metformin, canagliflozin, and ramipril. According to the SADMANS sick day management protocol, which medications should be held?

Continue all medications with increased monitoring
Only metformin
Only canagliflozin
Metformin, canagliflozin, and ramipril

25. When should women who have had gestational diabetes mellitus (GDM) be screened for type 2 diabetes postpartum?

Within 6 weeks to 6 months postpartum
Within 1 year postpartum
Within 2-4 weeks postpartum
Within 2 years postpartum

26. According to the Insulin Pen Start Checklist, which of the following topics must be covered during insulin initiation education?

Glucose monitoring only
Return demonstration only
Cognitive assessment, insulin delivery, hypoglycemia, and sharps disposal
Sharps disposal only

27. A diabetes educator is reviewing the Diabetes Distress Scale results for a patient. The subscale scores are: Emotional Burden 3.2, Physician Distress 1.8, Regimen Distress 2.5, Interpersonal Distress 2.1. Which subscale indicates the highest priority for intervention?

Physician Distress
Interpersonal Distress
Emotional Burden
Regimen Distress

28. A patient with type 2 diabetes on glyburide wishes to fast during Ramadan. According to the Canadian Diabetes and Ramadan Position Statement, what medication adjustment is recommended?

Hold or reduce morning dose by ≥50% depending on carbohydrate content
Continue glyburide unchanged and only adjust if multiple episodes of severe hypoglycemia
Switch to insulin for the duration of Ramadan
Glyburide is safe and no adjustment is needed

29. Case: A patient with diabetes has the following foot exam findings: loss of protective sensation (LOPS), history of foot ulcer, and eGFR 18 mL/min (end-stage renal disease). According to Inlow’s risk stratification, what is their risk category and recommended screening frequency?

Moderate Risk, screen every 3-6 months
Low Risk, screen every 6-12 months
Urgent Risk, urgent care required
High Risk, screen every 1-3 months

30. Case: A healthcare team is reviewing CGM data for a patient with type 1 diabetes. The patient has: TIR (3.9-10.0) 58%, TBR (<3.9) 8%, TAR (>10.0) 34%, CV 42%. According to CGM targets, which metrics are NOT meeting recommended targets?

All four metrics (TIR, TBR, TAR, CV)
TIR, TBR, and CV only
TAR only
TIR and TBR only

31. What is the onset of action for rapid-acting insulin analogues (e.g., NovoRapid, Humalog)?

30 minutes
1-3 hours
4-9 minutes
9-20 minutes

32. A patient with diabetes is experiencing significant distress. The 2-item screener from the Diabetes Distress Scale shows a score of 3.5. What is the next appropriate step?

No further action needed this visit
Refer to psychiatry immediately
Administer the full 17-item DDS
Prescribe antidepressant medication

33. According to the ABCDESSS mnemonic, what does the second ‘S’ stand for?

Self-management support
Statins
Smoking cessation
Screening for complications

34. What waist circumference threshold indicates elevated cardiovascular risk for Canadian women according to metabolic syndrome criteria?

≥94 cm
≥80 cm
≥102 cm
≥88 cm

35. What are the fasting/preprandial blood glucose targets for most people with diabetes?

4.0-7.0 mmol/L
4.5-7.5 mmol/L
3.5-6.5 mmol/L
5.0-8.0 mmol/L

36. Case: A 48-year-old patient with type 2 diabetes has eGFR 28 mL/min/1.73m² and is currently on empagliflozin 10mg. According to the Antihyperglycemic Agents and Kidney Function table, what is the most appropriate action?

Discontinue empagliflozin immediately as eGFR is <30
Continue empagliflozin
Increase empagliflozin to 25mg
Switch to canagliflozin 300mg

37. According to the Immunization Tool, which vaccine is recommended annually for all adults with diabetes?

RSV vaccine
Pneumococcal vaccine
Herpes Zoster vaccine
Influenza vaccine

38. According to the Types of Insulin document, what is the duration of action for once-weekly insulin icodec (Awiqli)?

24 hours
14 days
>7 days
42 hours

39. According to the Quick Reference Guide, what is the LDL-C target for patients with established ASCVD?

≤2.5 mmol/L
≤1.5 mmol/L
≤2.0 mmol/L
≤1.8 mmol/L

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