Diabetes Education Certification Blood Glucose Monitoring & Targets 3 — Questions and Answers
Question 1: A 68-year-old patient with a 25-year history of diabetes, frequent hypoglycemia unawareness, and stage 3 CKD has an A1C of 7.1%. What is the most appropriate individualized A1C goal?
- Less than 6.5%
- Less than 7.0%
- Less than 7.5–8.0% (Correct answer)
- Less than 8.5%
Correct answer: Less than 7.5–8.0%
For older adults with complex/intermediate health, hypoglycemia unawareness, and comorbidities, the ADA recommends a less stringent A1C goal of <7.5–8.0% to reduce hypoglycemia risk.
Question 2: Which of the following best describes the glucose lag that occurs with interstitial CGM sensors compared to blood glucose?
- CGM reads 5–10 minutes ahead of blood glucose
- CGM reads 5–15 minutes behind blood glucose (Correct answer)
- CGM and blood glucose are always equivalent
- The lag only occurs during exercise
Correct answer: CGM reads 5–15 minutes behind blood glucose
Interstitial fluid glucose lags behind blood glucose by approximately 5–15 minutes, which is most clinically significant during rapid glucose changes.
Question 3: A patient with gestational diabetes is asked to monitor blood glucose. What is the target 1-hour postprandial value according to most US guidelines?
- Less than 120 mg/dL
- Less than 130 mg/dL
- Less than 140 mg/dL (Correct answer)
- Less than 180 mg/dL
Correct answer: Less than 140 mg/dL
Most US guidelines (ACOG, ADA) target 1-hour postprandial glucose below 140 mg/dL for gestational diabetes management.
Question 4: Structured SMBG (self-monitoring of blood glucose) using a 7-point profile means testing at which time points?
- Fasting, 2-hour post-breakfast, and bedtime only
- Before and after each main meal plus bedtime (Correct answer)
- Every 2 hours throughout the waking day
- Once daily rotating morning and evening
Correct answer: Before and after each main meal plus bedtime
A 7-point glucose profile consists of before and 1–2 hours after each of the three main meals plus at bedtime, providing a full-day glucose picture.
Question 5: Which enzyme system is used in most modern electrochemical blood glucose test strips?
- Hexokinase
- Glucose oxidase or glucose dehydrogenase (Correct answer)
- Glucokinase
- Lactate dehydrogenase
Correct answer: Glucose oxidase or glucose dehydrogenase
Most modern test strips use glucose oxidase (GOx) or glucose dehydrogenase (GDH) to catalyze the electrochemical reaction that quantifies glucose.
Question 6: A patient on intensive insulin therapy experiences nocturnal hypoglycemia without waking. Which monitoring strategy is most appropriate to detect this?
- Increase fasting morning fingersticks
- Use CGM with a low glucose alarm set at 70 mg/dL (Correct answer)
- Check a 2 AM fingerstick every night manually
- Measure A1C monthly
Correct answer: Use CGM with a low glucose alarm set at 70 mg/dL
CGM with a low glucose alert is the most effective tool for detecting nocturnal hypoglycemia, especially in patients with hypoglycemia unawareness.
Question 7: What is the recommended minimum percentage of 'Time Below Range' (<70 mg/dL) on CGM for adults with type 1 diabetes?
- Less than 10%
- Less than 5%
- Less than 4%
- Less than 1% (Correct answer)
Correct answer: Less than 1%
International CGM consensus recommends Time Below Range (<70 mg/dL) be less than 1% (~14 min/day) for adults with type 1 diabetes to minimize hypoglycemia.
Diabetes Education Certification Blood Glucose Monitoring & Targets 3
A 68-year-old patient with a 25-year history of diabetes, frequent hypoglycemia unawareness, and stage 3 CKD has an A1C of 7.1%.
What is the most appropriate individualized A1C goal?