BCADM Board Certified –
Advanced Diabetes Management)
TEST
BC-ADM exam -ANSWER✅✅✅EXAM COVERAGE - BC-ADM Exam (Board Certified
- Advanced Diabetes Management)
The BC-ADM Exam evaluates advanced knowledge and clinical competencies for
healthcare professionals specializing in diabetes management and care. Administered
by the American Association of Diabetes Care & Education Specialists, the exam
focuses on comprehensive assessment, diagnosis, and management of patients with
diabetes and related metabolic disorders. Key topics include pathophysiology of
diabetes, pharmacology (insulin and non-insulin therapies), medical nutrition therapy,
and lifestyle interventions. Candidates are tested on advanced clinical decision-making,
glucose monitoring, patient education, and behavioral management strategies.
Additional areas include complication prevention, cardiovascular risk management,
technology-assisted diabetes care, and interprofessional collaboration. The exam
emphasizes critical thinking, evidence-based practice, and application of advanced
diabetes management strategies to improve patient outcomes and quality of life.
excessive hepatic glucose production, rebound hyperglycemia, dawn phenomena -
ANSWER✅✅✅reasons for AM hyperglycemia
Rebound hyperglycemia (Somogyi effect) -ANSWER✅✅✅hypoglycemia during sleep
protease inhibitors (HIV treatment), corticosteroids, thiazide diuretics, calcineurin
inhibitors (anti-rejection meds), fluoroquinolone antibiotics, beta-blockers, atypical
antipsychotics -ANSWER✅✅✅medications associated with hyperglycemia
Atenolol/metroprolol/propranolol -ANSWER✅✅✅beta blockers
beta blockers -ANSWER✅✅✅decrease heart rate and dilate arteries by blocking beta
receptors; used for CVD and high BP
Hyperglycemic Hyperosmolar State (HHS) -ANSWER✅✅✅severe dehydration, usually
with older adults with comorbidities, relative insulin deprivation
Diabetic Ketoacidosis (DKA) -ANSWER✅✅✅absolute insulin depravation
,characteristics of HHS -ANSWER✅✅✅usually >60 years old, >5 days symptoms,
glucose >600, beta hydroxybutyrate <3, urine ketones <2, ph normal, bicarb more than
18, serum osmolality 300+, usually type 2, 10-20% mortality
causes of HHS -ANSWER✅✅✅massive fluid loss from osmotic diuresis (burns,
hyperglycemia, diarrhea, hemodialysis, diurectics, steroids), heart attack, infections,
hypertonic feedings, medications
HHS -ANSWER✅✅✅hyperosmolar hyperglycemic state
clinical signs of HHS -ANSWER✅✅✅polydipsia, polyuria, weakness, wt loss,
hypothermia, hypotension, tachycardia, altered sensorium
treatment for HHS -ANSWER✅✅✅labs (especially K+), rehydrate, correct glucose
(insulin), correct lytes
resolution of HHS -ANSWER✅✅✅pH 7.3+, bicarb 18+, glucose less than 250,
osmolality less than 300, urine output .5mg/kg/hr, improved cognition
DKA and hyperglycemic crisis -ANSWER✅✅✅type 1 in youth, highest in persons <45,
often a cry for help
DKA -ANSWER✅✅✅profound insulin deficiency; accounts for 14% of all hospital
admits for T1; in young people accounts for 50% all admits; 16% DM related fatalities;
incidence ~2 episodes per 100 pt years of DM
DKA precipitating factors -ANSWER✅✅✅40% illness and infection; 25% inadequate
insulin dosage; emotional stress (especially with teens, neglect, mismanagement);
disordered eating; pregnancy; hyperglycemia inducing meds; insulin omission (fear of
hypo or wt gain); stress; can't afford insulin; drug use
DKA labs/presentation -ANSWER✅✅✅glucose 200+, osmolality 300+, dehydration,
ph<7.3, beta-hydoxybutyrate (3 mmol/L+), 2+ ketones in urine, bicarb less than 18
DKA clinical signs -ANSWER✅✅✅polydipsia, polyuria, weakness, wt loss, N/V/abd
pain, ileus, kussmaul breathing, acetone breath, hypothermia, tachypnea, tachycardia,
altered sensorium
SGLT-2 inhibitor -ANSWER✅✅✅when combined with insulin, what med increases risk
of DKA in T1DM and T2DM?
SGLT-2 inhibitor meds -ANSWER✅✅✅farxiga, jardiance, steglatro, brenzavvy,
invokana
,Euglycemic diabetic ketoacidosis -ANSWER✅✅✅BG 200+, uncommon complication
associated with surgery, pregnancy, anorexia, gastroparesis, fasting, alcohol use
disorder, SGLT-2 inhibitors, pancreatitis, surgery, infection, cirrhosis
EDKA mechanism -ANSWER✅✅✅secondary to carb deficit resulting in generalized
decreased serum insulin and excess counter regulatory hormones like glucagon,
epinephrine, and cortisol; increased glucagon/insulin ratio leads to increased lipolysis,
increased free fatty acids, and ketoacidosis
lower -ANSWER✅✅✅EDKA is more common in those with _______ BMI and
decreased glycogen stores.
signs and symptoms of EDKA -ANSWER✅✅✅N/V, SOB, generalized malaise,
lethargy, loss of appetite, fatigue, abd pain (NOT polydipsia or polyuria)
labs for EDKA -ANSWER✅✅✅pH less than 7.3, serum bicarb less than 18, beta-
hydroxybutyrate 3+, urine ketones 2+, BG 200+
treatment for EDKA -ANSWER✅✅✅fluid replacement (isotonic saline/LR), continuous
insulin infusion (.05-.1 unit/kg/hr), glucose replacement, permanently d/c SGLT-2
characteristics of DKA -ANSWER✅✅✅usually <40 yo, <2 days symptoms, BG 200+,
beta-hydroxybutyrate 3+, urine ketones 2+, pH less than 7.3, bicarb less than 18, serum
osmolality 300+, usually T1DM, 3-10% mortality
false -ANSWER✅✅✅DKA only happens in people with T1DM. t/f
subq rapid insulin -ANSWER✅✅✅For mild DKA, ________ may be considered.
Subq insulin protocol for mild DKA -ANSWER✅✅✅.2-.3 units/kg initially, then .1-.2
units/kg every 1-2 hr until BG <250. When BG <250, reduce dose by half until ketone
negative.
IV insulin protocol for DKA -ANSWER✅✅✅start at .05-.1 unit/kg/hr with hourly BG
checks until BG <200
50 -ANSWER✅✅✅What percentage of insulin should be basal?
What are the 5 most important interventions for treating DKA/HHS? -
ANSWER✅✅✅fluids, insulin, K+/lyte replacement, determine/treat precipitating cause,
seek to prevent future episodes
biguanide -ANSWER✅✅✅decrease hepatic glucose output; side effects: N/V/bloating,
B12 def; not for use in CKD
, biguanide meds -ANSWER✅✅✅metformin, riomet, glucophage, glumetza, fortamet
sulfonylurea -ANSWER✅✅✅stimulates sustained insulin release; side effects:
hypoglycemia, wt gain
sulfonylurea meds -ANSWER✅✅✅diabeta, glucotrol, glyburide, glipizide, glimepiride
SGLT 2 inhibotors -ANSWER✅✅✅decrease glucose reabsorption in kidneys;
protective for heart and kidneys; side effects: hypotension, UTIs, wt loss, ketoacidosis
DPP-4 inhibitors -ANSWER✅✅✅prolong action of gut hormones, increase insulin
secretion, delays gastric emptying; side effects: headache, flu-like symptoms, joint pain,
pancreatitis, increased risk of HF
DPP-4 inhibitor meds -ANSWER✅✅✅januvia, tradjenta, nesina
GLP-1 -ANSWER✅✅✅increase insulin release with food, slow gastric emptying,
promotes satiety, suppresses glucagon; reduces risk of CD, heart attack, stroke; side
effects: N/V, wt loss, pancreatitis, ileus, increased risk of thyroid issues
GLP-1 meds -ANSWER✅✅✅byetta, bydureon, trulicity, ozempic, mounjaro
What is the goal of diabetes care? -ANSWER✅✅✅achieve well being and satisfactory
medical outcomes
Psychologoical Factors of diabetes care -ANSWER✅✅✅environmental, social,
behavioral, emotional
SDOH -ANSWER✅✅✅social determinants of health
population health -ANSWER✅✅✅health outcomes of a group of individuals
population health outcomes can be measured by: -ANSWER✅✅✅mortality, morbidity,
health, functional status, disease burden (incidence/prevalence), behavioral/metabolic
factors (exercise, diet, A1C, etc)
6 core elements of chronic care model -ANSWER✅✅✅delivery system design (move
from reactive to proactive), self management support, decision support, clinical
information systems, community resources/policies, health systems
social determinants of health (SDOH) -ANSWER✅✅✅the conditions in which people
play, live, work, learn, pray; directly affects their health risks and outcome
Advanced Diabetes Management)
TEST
BC-ADM exam -ANSWER✅✅✅EXAM COVERAGE - BC-ADM Exam (Board Certified
- Advanced Diabetes Management)
The BC-ADM Exam evaluates advanced knowledge and clinical competencies for
healthcare professionals specializing in diabetes management and care. Administered
by the American Association of Diabetes Care & Education Specialists, the exam
focuses on comprehensive assessment, diagnosis, and management of patients with
diabetes and related metabolic disorders. Key topics include pathophysiology of
diabetes, pharmacology (insulin and non-insulin therapies), medical nutrition therapy,
and lifestyle interventions. Candidates are tested on advanced clinical decision-making,
glucose monitoring, patient education, and behavioral management strategies.
Additional areas include complication prevention, cardiovascular risk management,
technology-assisted diabetes care, and interprofessional collaboration. The exam
emphasizes critical thinking, evidence-based practice, and application of advanced
diabetes management strategies to improve patient outcomes and quality of life.
excessive hepatic glucose production, rebound hyperglycemia, dawn phenomena -
ANSWER✅✅✅reasons for AM hyperglycemia
Rebound hyperglycemia (Somogyi effect) -ANSWER✅✅✅hypoglycemia during sleep
protease inhibitors (HIV treatment), corticosteroids, thiazide diuretics, calcineurin
inhibitors (anti-rejection meds), fluoroquinolone antibiotics, beta-blockers, atypical
antipsychotics -ANSWER✅✅✅medications associated with hyperglycemia
Atenolol/metroprolol/propranolol -ANSWER✅✅✅beta blockers
beta blockers -ANSWER✅✅✅decrease heart rate and dilate arteries by blocking beta
receptors; used for CVD and high BP
Hyperglycemic Hyperosmolar State (HHS) -ANSWER✅✅✅severe dehydration, usually
with older adults with comorbidities, relative insulin deprivation
Diabetic Ketoacidosis (DKA) -ANSWER✅✅✅absolute insulin depravation
,characteristics of HHS -ANSWER✅✅✅usually >60 years old, >5 days symptoms,
glucose >600, beta hydroxybutyrate <3, urine ketones <2, ph normal, bicarb more than
18, serum osmolality 300+, usually type 2, 10-20% mortality
causes of HHS -ANSWER✅✅✅massive fluid loss from osmotic diuresis (burns,
hyperglycemia, diarrhea, hemodialysis, diurectics, steroids), heart attack, infections,
hypertonic feedings, medications
HHS -ANSWER✅✅✅hyperosmolar hyperglycemic state
clinical signs of HHS -ANSWER✅✅✅polydipsia, polyuria, weakness, wt loss,
hypothermia, hypotension, tachycardia, altered sensorium
treatment for HHS -ANSWER✅✅✅labs (especially K+), rehydrate, correct glucose
(insulin), correct lytes
resolution of HHS -ANSWER✅✅✅pH 7.3+, bicarb 18+, glucose less than 250,
osmolality less than 300, urine output .5mg/kg/hr, improved cognition
DKA and hyperglycemic crisis -ANSWER✅✅✅type 1 in youth, highest in persons <45,
often a cry for help
DKA -ANSWER✅✅✅profound insulin deficiency; accounts for 14% of all hospital
admits for T1; in young people accounts for 50% all admits; 16% DM related fatalities;
incidence ~2 episodes per 100 pt years of DM
DKA precipitating factors -ANSWER✅✅✅40% illness and infection; 25% inadequate
insulin dosage; emotional stress (especially with teens, neglect, mismanagement);
disordered eating; pregnancy; hyperglycemia inducing meds; insulin omission (fear of
hypo or wt gain); stress; can't afford insulin; drug use
DKA labs/presentation -ANSWER✅✅✅glucose 200+, osmolality 300+, dehydration,
ph<7.3, beta-hydoxybutyrate (3 mmol/L+), 2+ ketones in urine, bicarb less than 18
DKA clinical signs -ANSWER✅✅✅polydipsia, polyuria, weakness, wt loss, N/V/abd
pain, ileus, kussmaul breathing, acetone breath, hypothermia, tachypnea, tachycardia,
altered sensorium
SGLT-2 inhibitor -ANSWER✅✅✅when combined with insulin, what med increases risk
of DKA in T1DM and T2DM?
SGLT-2 inhibitor meds -ANSWER✅✅✅farxiga, jardiance, steglatro, brenzavvy,
invokana
,Euglycemic diabetic ketoacidosis -ANSWER✅✅✅BG 200+, uncommon complication
associated with surgery, pregnancy, anorexia, gastroparesis, fasting, alcohol use
disorder, SGLT-2 inhibitors, pancreatitis, surgery, infection, cirrhosis
EDKA mechanism -ANSWER✅✅✅secondary to carb deficit resulting in generalized
decreased serum insulin and excess counter regulatory hormones like glucagon,
epinephrine, and cortisol; increased glucagon/insulin ratio leads to increased lipolysis,
increased free fatty acids, and ketoacidosis
lower -ANSWER✅✅✅EDKA is more common in those with _______ BMI and
decreased glycogen stores.
signs and symptoms of EDKA -ANSWER✅✅✅N/V, SOB, generalized malaise,
lethargy, loss of appetite, fatigue, abd pain (NOT polydipsia or polyuria)
labs for EDKA -ANSWER✅✅✅pH less than 7.3, serum bicarb less than 18, beta-
hydroxybutyrate 3+, urine ketones 2+, BG 200+
treatment for EDKA -ANSWER✅✅✅fluid replacement (isotonic saline/LR), continuous
insulin infusion (.05-.1 unit/kg/hr), glucose replacement, permanently d/c SGLT-2
characteristics of DKA -ANSWER✅✅✅usually <40 yo, <2 days symptoms, BG 200+,
beta-hydroxybutyrate 3+, urine ketones 2+, pH less than 7.3, bicarb less than 18, serum
osmolality 300+, usually T1DM, 3-10% mortality
false -ANSWER✅✅✅DKA only happens in people with T1DM. t/f
subq rapid insulin -ANSWER✅✅✅For mild DKA, ________ may be considered.
Subq insulin protocol for mild DKA -ANSWER✅✅✅.2-.3 units/kg initially, then .1-.2
units/kg every 1-2 hr until BG <250. When BG <250, reduce dose by half until ketone
negative.
IV insulin protocol for DKA -ANSWER✅✅✅start at .05-.1 unit/kg/hr with hourly BG
checks until BG <200
50 -ANSWER✅✅✅What percentage of insulin should be basal?
What are the 5 most important interventions for treating DKA/HHS? -
ANSWER✅✅✅fluids, insulin, K+/lyte replacement, determine/treat precipitating cause,
seek to prevent future episodes
biguanide -ANSWER✅✅✅decrease hepatic glucose output; side effects: N/V/bloating,
B12 def; not for use in CKD
, biguanide meds -ANSWER✅✅✅metformin, riomet, glucophage, glumetza, fortamet
sulfonylurea -ANSWER✅✅✅stimulates sustained insulin release; side effects:
hypoglycemia, wt gain
sulfonylurea meds -ANSWER✅✅✅diabeta, glucotrol, glyburide, glipizide, glimepiride
SGLT 2 inhibotors -ANSWER✅✅✅decrease glucose reabsorption in kidneys;
protective for heart and kidneys; side effects: hypotension, UTIs, wt loss, ketoacidosis
DPP-4 inhibitors -ANSWER✅✅✅prolong action of gut hormones, increase insulin
secretion, delays gastric emptying; side effects: headache, flu-like symptoms, joint pain,
pancreatitis, increased risk of HF
DPP-4 inhibitor meds -ANSWER✅✅✅januvia, tradjenta, nesina
GLP-1 -ANSWER✅✅✅increase insulin release with food, slow gastric emptying,
promotes satiety, suppresses glucagon; reduces risk of CD, heart attack, stroke; side
effects: N/V, wt loss, pancreatitis, ileus, increased risk of thyroid issues
GLP-1 meds -ANSWER✅✅✅byetta, bydureon, trulicity, ozempic, mounjaro
What is the goal of diabetes care? -ANSWER✅✅✅achieve well being and satisfactory
medical outcomes
Psychologoical Factors of diabetes care -ANSWER✅✅✅environmental, social,
behavioral, emotional
SDOH -ANSWER✅✅✅social determinants of health
population health -ANSWER✅✅✅health outcomes of a group of individuals
population health outcomes can be measured by: -ANSWER✅✅✅mortality, morbidity,
health, functional status, disease burden (incidence/prevalence), behavioral/metabolic
factors (exercise, diet, A1C, etc)
6 core elements of chronic care model -ANSWER✅✅✅delivery system design (move
from reactive to proactive), self management support, decision support, clinical
information systems, community resources/policies, health systems
social determinants of health (SDOH) -ANSWER✅✅✅the conditions in which people
play, live, work, learn, pray; directly affects their health risks and outcome
