BC ADM Comprehensive Diabetes Assessment & Diagnosis 2 — Questions and Answers
Question 1: A 58-year-old patient presents with fasting plasma glucose of 118 mg/dL on two separate occasions. How should this be classified?
- Type 2 diabetes
- Impaired fasting glucose (prediabetes) (Correct answer)
- Normal glucose tolerance
- Gestational diabetes
Correct answer: Impaired fasting glucose (prediabetes)
Fasting plasma glucose between 100–125 mg/dL on two separate occasions is classified as impaired fasting glucose, a prediabetic state.
Question 2: Which test is considered the gold standard for diagnosing type 1 diabetes autoimmunity?
- C-peptide level
- Islet autoantibody panel (GAD65, IA-2, ZnT8) (Correct answer)
- Fasting insulin level
- HbA1c > 6.5%
Correct answer: Islet autoantibody panel (GAD65, IA-2, ZnT8)
Islet autoantibody testing (GAD65, IA-2, ZnT8, insulin autoantibodies) identifies autoimmune destruction of beta cells, confirming type 1 diabetes etiology.
Question 3: A patient's 2-hour oral glucose tolerance test result is 195 mg/dL. What does this indicate?
- Normal glucose tolerance
- Impaired glucose tolerance (prediabetes) (Correct answer)
- Type 2 diabetes
- Reactive hypoglycemia
Correct answer: Impaired glucose tolerance (prediabetes)
A 2-hour OGTT value of 140–199 mg/dL indicates impaired glucose tolerance, a prediabetic condition with elevated cardiovascular risk.
Question 4: Which finding on physical examination is most specific for autonomic neuropathy in a person with long-standing diabetes?
- Absent ankle reflexes
- Resting tachycardia (HR >100 bpm) with orthostatic hypotension (Correct answer)
- Reduced vibration sense in the feet
- Charcot foot deformity
Correct answer: Resting tachycardia (HR >100 bpm) with orthostatic hypotension
Resting tachycardia combined with orthostatic hypotension reflects cardiovascular autonomic neuropathy from vagal and sympathetic denervation.
Question 5: When screening for chronic kidney disease in a patient with type 2 diabetes, which combination provides the most complete assessment?
- Serum creatinine alone
- Urine albumin-to-creatinine ratio (UACR) plus estimated GFR (eGFR) (Correct answer)
- 24-hour urine protein collection alone
- Blood urea nitrogen (BUN) level
Correct answer: Urine albumin-to-creatinine ratio (UACR) plus estimated GFR (eGFR)
UACR detects early albuminuria while eGFR quantifies filtration capacity; together they stage diabetic kidney disease and guide treatment.
Question 6: A patient newly diagnosed with diabetes has an HbA1c of 10.8%. C-peptide is undetectable. Which diagnosis is most likely?
- Type 2 diabetes with insulin resistance
- MODY (maturity-onset diabetes of the young)
- Type 1 diabetes (Correct answer)
- Steroid-induced diabetes
Correct answer: Type 1 diabetes
Undetectable C-peptide indicates near-total beta-cell loss, consistent with autoimmune type 1 diabetes regardless of age at presentation.
Question 7: According to ADA standards, how frequently should a dilated eye exam be performed in a patient with type 1 diabetes who has had no retinopathy for the past 2 years?
- Every 6 months
- Every 1–2 years (Correct answer)
- Annually
- Every 3 years
Correct answer: Every 1–2 years
ADA guidelines allow extending the interval to every 1–2 years after one or more normal dilated eye exams in patients with well-controlled type 1 diabetes.
BC ADM Comprehensive Diabetes Assessment & Diagnosis 2
A 58-year-old patient presents with fasting plasma glucose of 118 mg/dL on two separate occasions.
How should this be classified?