CDCES Exam Prep 9-Week Study Plan

Week 1 — Part I: Pathophysiology, Diagnosis, and Assessment

Difficulty: Heavy

What it covers:

• Normal glucose homeostasis and the actions of insulin, glucagon, and the incretin hormones on liver, muscle, and adipose tissue

• The pathophysiology and laboratory profile of Type 1, Type 2, gestational, MODY, LADA, and secondary diabetes

• ADA diagnostic criteria using A1C, fasting plasma glucose, OGTT, and random glucose, plus confirmation rules and special-population caveats

• ADA screening recommendations across pediatric, adult, pregnancy, and older-adult populations

• Metabolic syndrome criteria and the role of the Diabetes Prevention Program in slowing progression from prediabetes

• The comprehensive initial diabetes assessment (medical, psychosocial, behavioral, cultural, social-determinant)

• Validated screening tools (PHQ-9, GAD-7, PAID) and behavior-change staging using the Transtheoretical Model

Print: 1 Mind Map, 3 Comparison Charts, 2 Cornell Notes pages

Study Tasks

☐ Read the Study Guide first. Complete the High-Yield Objectives, Key Terms and Definitions, and Concept Overview sections before opening the chapter.

☐ Highlight as you read, following the Made Easy Highlighting System

☐ Lock in the ADA diagnostic cutoffs before anything else. A1C ≥ 6.5%, fasting plasma glucose ≥ 126 mg/dL, two-hour OGTT ≥ 200 mg/dL, or random glucose ≥ 200 mg/dL with classic symptoms. In the absence of unequivocal hyperglycemia, two abnormal results (either two of the same test on separate days, or two different tests from the same sample) are required to diagnose. Prediabetes is A1C 5.7 to 6.4%, FPG 100 to 125, or two-hour OGTT 140 to 199. The CDCES exam tests these numbers directly and tests the confirmation rule even more often.

☐ Master the four canonical diabetes types and the look-alikes. Type 1 is autoimmune beta-cell destruction with positive antibodies (GAD-65, IA-2, ZnT8, insulin) and low or undetectable C-peptide. Type 2 is insulin resistance plus progressive beta-cell failure with preserved or elevated C-peptide. LADA is adult-onset Type 1 that initially mimics Type 2 but has positive antibodies and progressive insulin dependence within months to years. MODY is monogenic, runs in autosomal-dominant family patterns, presents before age 25, and is antibody-negative with detectable C-peptide. Build a one-page differentiating grid and quiz yourself until you can sort any case in under 30 seconds.

☐ Know the gestational diabetes diagnostic pathways cold. One-step: 75 g OGTT at 24 to 28 weeks with thresholds of FPG ≥ 92, 1-hour ≥ 180, or 2-hour ≥ 153 (any one value diagnoses). Two-step: 50 g glucose challenge first; if 1-hour ≥ 130 to 140, proceed to 100 g OGTT with Carpenter-Coustan thresholds (two abnormal values diagnose). Postpartum, women with GDM are screened with a 75 g OGTT at 4 to 12 weeks because of lifetime T2DM risk.

☐ Screening tool fluency is a tested skill. PHQ-9 score ≥ 10 indicates moderate or worse depression and warrants referral; ≥ 15 is moderately severe with closer follow-up; suicidality on item 9 is an immediate-action item regardless of total score. GAD-7 ≥ 10 indicates moderate or worse anxiety. PAID score ≥ 40 indicates diabetes distress severe enough to interfere with self-care. Know what each tool measures, the cutoffs, and what the CDCES does with a positive screen.

☐ Apply the Transtheoretical Model (Precontemplation, Contemplation, Preparation, Action, Maintenance) to a clinical scenario. The right intervention depends entirely on the stage: information and consciousness-raising for precontemplation, decisional-balance work for contemplation, action planning for preparation, reinforcement and skill-building for action, relapse prevention for maintenance. Mismatched intervention to stage is the most common distractor.

☐ Complete the Practice Questions for Part I in your quiz bank. Review every rationale, correct and incorrect.

How to Use Your Templates

☐ Mind Map: Central node = Pathophysiology, Diagnosis & Assessment. Main branches: Normal Glucose Homeostasis (insulin, glucagon, incretins) → Type 1 Pathophysiology (autoimmunity, antibodies, C-peptide) → Type 2 Pathophysiology (insulin resistance, beta-cell failure, ominous octet) → Gestational Diabetes (1-step vs. 2-step) → MODY, LADA & Secondary Diabetes → ADA Diagnostic Criteria (A1C, FPG, OGTT, random) → Prediabetes & Metabolic Syndrome → DPP → Initial Comprehensive Assessment → Psychosocial Screening (PHQ-9, GAD-7, PAID) → Behavior Change Staging (TTM).

Comparison Charts:

☐ Chart 1 — Type 1 vs. Type 2 vs. LADA vs. MODY: Typical age of onset, body habitus, family history pattern, antibody status, C-peptide level, ketosis-prone (yes/no), and first-line treatment.

☐ Chart 2 — ADA Diagnostic Criteria: Normal vs. Prediabetes vs. Diabetes: A1C cutoff, FPG cutoff, 2-hour OGTT cutoff, random glucose rule, and confirmation requirement for each category.

☐ Chart 3 — PHQ-9 vs. GAD-7 vs. PAID: What it screens for, scoring range, clinical action cutoff, special items requiring escalation, and how the CDCES uses each result in care planning.

Cornell Notes:

☐ Page 1 — Cue questions: What are the four ADA diagnostic criteria for diabetes, and what is the confirmation rule when symptoms are absent? How do you differentiate Type 1, Type 2, LADA, and MODY using antibody status, C-peptide, age of onset, and family pattern?

☐ Page 2 — Cue questions: What are the five stages of the Transtheoretical Model, and what intervention is appropriate at each stage? What are the PHQ-9, GAD-7, and PAID score thresholds that trigger referral or care-plan adjustment, and what is the CDCES's role in each follow-up?

Week 2 — Part II: Nutrition Principles

Difficulty: Moderate to Heavy

What it covers:

• Macronutrient distribution, carbohydrate counting (basic and advanced), and insulin-to-carb ratios

• Glycemic index and glycemic load, and how each shapes postprandial response

• Major evidence-based eating patterns (Mediterranean, DASH, plant-based, low-carb, very-low-carb, vegetarian) and their evidence in diabetes care

• Medical Nutrition Therapy (MNT) referral standards and the CDCES role in nutrition education

• Weight management strategies including very-low-calorie diets, bariatric surgery indications, and pharmacotherapy intersections

• Alcohol guidelines, non-nutritive sweeteners, and label-reading skills

• Cultural and food-security considerations in nutrition counseling

Print: 1 Mind Map, 3 Comparison Charts, 2 Cornell Notes pages

Study Tasks

☐ Read the Study Guide first. Complete the High-Yield Objectives, Key Terms and Definitions, and Concept Overview sections before opening the chapter.

☐ Highlight as you read, following the Made Easy Highlighting System

☐ Make carbohydrate counting automatic. Basic CHO counting uses 15 g servings ("carb choices"); advanced counting uses precise grams paired with an insulin-to-carbohydrate ratio (ICR) and an insulin sensitivity factor (ISF). The 500 rule (500 ÷ TDD = grams of CHO covered by 1 unit of rapid-acting insulin) and the 1800 rule (1800 ÷ TDD = mg/dL drop per unit of rapid-acting insulin, or 1500 for regular insulin) are CDCES staples. Practice converting from total daily dose to individualized ICR and ISF until you can do it from memory.

☐ Build a clean one-page comparison of the four major eating patterns. Mediterranean (highest cardiovascular evidence, olive oil, fish, legumes, modest wine), DASH (designed for blood pressure but well-supported in diabetes, sodium ≤ 2,300 mg), plant-based (whole-food focus, evidence in weight and cardiovascular risk), and low-carb / very-low-carb (most rapid glycemic and weight effect, hypoglycemia and DKA risk when paired with insulin or SGLT2 inhibitors). No single pattern is required; the ADA endorses individualization within these evidence-based frameworks.

☐ Glycemic index, glycemic load, and fiber are tested together. GI ranks foods 0 to 100 against a reference (glucose or white bread); GL = GI × CHO grams ÷ 100, accounting for portion. High-GI foods (white rice, instant oats, white bread) drive sharper postprandial peaks; low-GI substitutions (steel-cut oats, legumes, intact whole grains) flatten the curve. Soluble fiber (oats, beans, psyllium) blunts postprandial glucose and lowers LDL; the ADA recommends 14 g of fiber per 1,000 kcal.

☐ Know the MNT referral standard and what makes it work. ADA recommends MNT delivered by a Registered Dietitian Nutritionist at diagnosis and at least annually thereafter. MNT alone (no medication change) can lower A1C by approximately 1.0 to 2.0 percentage points in T2DM and 1.9 percentage points in T1DM when delivered to evidence-based standards. The CDCES collaborates with the RDN, never replaces them, and is positioned to reinforce, troubleshoot, and individualize between RDN visits.

☐ Master the alcohol guidance. ADA limits: up to one drink per day for women, two for men, defined as 12 oz beer, 5 oz wine, or 1.5 oz distilled spirits. Critical safety teaching: alcohol inhibits hepatic gluconeogenesis and can cause delayed hypoglycemia up to 24 hours later, particularly in patients on insulin or sulfonylureas. Always consumed with food, never on an empty stomach, and never substituted for a CHO-containing snack.

☐ Complete the Practice Questions for Part II in your quiz bank. Review every rationale, correct and incorrect.

How to Use Your Templates

☐ Mind Map: Central node = Nutrition Principles. Main branches: Macronutrient Distribution → Carbohydrate Counting (basic vs. advanced, ICR, ISF, 500/1800/1500 rules) → Glycemic Index & Glycemic Load → Fiber & Soluble Fiber → Eating Patterns (Mediterranean, DASH, plant-based, low-carb, very-low-carb) → MNT Standards & CDCES-RDN Collaboration → Weight Management (caloric strategies, VLCD, bariatric, anti-obesity medications) → Alcohol Guidelines → Non-Nutritive Sweeteners → Label Reading → Cultural & Food-Security Considerations.

Comparison Charts:

☐ Chart 1 — Mediterranean vs. DASH vs. Plant-Based vs. Low-Carb Eating Patterns: Core foods emphasized, macronutrient profile, A1C evidence, cardiovascular evidence, weight-loss evidence, and best-fit patient profile.

☐ Chart 2 — Basic vs. Advanced Carbohydrate Counting: Method (servings vs. grams), required patient skill, insulin regimen compatibility (fixed dose vs. flexible/MDI/pump), and typical teaching sequence.

☐ Chart 3 — Glycemic Index vs. Glycemic Load vs. Fiber Effect on Postprandial Glucose: Definition, calculation, typical food examples (low, medium, high), and clinical use in shaping a meal plan.

Cornell Notes:

☐ Page 1 — Cue questions: How do you calculate an insulin-to-carbohydrate ratio and an insulin sensitivity factor from total daily dose using the 500 and 1800 rules, and how do you adjust each based on real-world glucose data? What is the ADA fiber recommendation, and how does soluble fiber differ from insoluble fiber in glycemic effect?

☐ Page 2 — Cue questions: What are the four major evidence-based eating patterns recommended by the ADA, and what does the evidence show for each in A1C, weight, and cardiovascular outcomes? What are the alcohol guidelines for adults with diabetes, and why does alcohol carry delayed hypoglycemia risk for patients on insulin or sulfonylureas?

Week 3 — Part III: Physical Activity

Difficulty: Moderate

What it covers:

• The acute and chronic glucose response to aerobic, resistance, flexibility, and high-intensity interval exercise

• ADA physical activity recommendations (150 minutes weekly moderate aerobic, plus resistance training, plus flexibility and balance for older adults)

• Pre-exercise screening, glucose targets, and CHO supplementation strategies

• Hypoglycemia prevention during and after exercise (including delayed nocturnal hypoglycemia)

• Insulin and oral medication adjustments around exercise

• Special situations: exercising with retinopathy, neuropathy, nephropathy, CVD, or active foot ulceration

Print: 1 Mind Map, 2 Comparison Charts, 2 Cornell Notes pages

Study Tasks

☐ Read the Study Guide first. Complete the High-Yield Objectives, Key Terms and Definitions, and Concept Overview sections before opening the chapter.

☐ Highlight as you read, following the Made Easy Highlighting System

☐ Lock in the ADA activity prescription. Adults: at least 150 minutes per week of moderate-intensity aerobic activity (or 75 minutes vigorous), spread across at least 3 days with no more than 2 consecutive days without activity. Resistance training 2 to 3 sessions weekly on non-consecutive days. Flexibility and balance training 2 to 3 times weekly for older adults. Break up sedentary time every 30 minutes. Children and adolescents: 60 minutes daily of moderate-to-vigorous activity, including bone- and muscle-strengthening 3 days a week.

☐ Master the glucose response to each exercise modality. Aerobic exercise typically lowers glucose via increased insulin-independent muscle uptake (GLUT4 translocation). Anaerobic and high-intensity exercise can transiently raise glucose via catecholamine-driven hepatic glucose output, with delayed lowering. Resistance training has a smaller immediate effect but improves long-term insulin sensitivity. Mixed sessions tend to be the most glycemically stable, which is why ADA recommends combining modalities.

☐ Hypoglycemia prevention for patients on insulin or sulfonylureas is the highest-yield CDCES skill in this Part. Pre-exercise glucose < 90 mg/dL: take 15 to 30 g CHO before starting. 90 to 124 mg/dL: take 10 g CHO or proceed with caution. 125 to 180 mg/dL: proceed without CHO. 181 to 270 mg/dL: proceed without CHO. > 270 mg/dL with T1DM: check ketones before exercising (delay if moderate to large). After prolonged or intense exercise, late hypoglycemia can appear 6 to 15 hours later, particularly overnight; adjust basal insulin or add a bedtime snack with protein.

☐ Know which exercise modifications are required for each complication. Proliferative retinopathy: avoid Valsalva, heavy lifting, and high-impact aerobic activity (risk of vitreous hemorrhage); favor low-impact aerobic and light resistance. Severe peripheral neuropathy: substitute non-weight-bearing aerobic (swimming, cycling) and inspect feet before and after every session. Active foot ulcer: no weight-bearing exercise until healed. Severe autonomic neuropathy: cardiology clearance before initiating moderate-to-vigorous activity, and watch for blunted heart-rate response and exercise hypotension.

☐ Complete the Practice Questions for Part III in your quiz bank. Review every rationale, correct and incorrect.

How to Use Your Templates

☐ Mind Map: Central node = Physical Activity in Diabetes. Main branches: ADA Activity Recommendations (aerobic, resistance, flexibility, sedentary breaks) → Glucose Response by Modality (aerobic, anaerobic, HIIT, resistance) → Pre-Exercise Glucose Targets & CHO Strategy → Hypoglycemia Prevention (during, immediate-post, delayed nocturnal) → Insulin & Medication Adjustments → Exercise with Complications (retinopathy, neuropathy, nephropathy, CVD, foot ulcer) → Special Populations (pediatric, pregnancy, older adults).

Comparison Charts:

☐ Chart 1 — Aerobic vs. Resistance vs. HIIT Exercise: Acute glucose effect, mechanism, evidence in A1C reduction, evidence in insulin sensitivity, ADA frequency recommendation, and best-fit patient profile.

☐ Chart 2 — Exercise Modification by Complication: Proliferative retinopathy, peripheral neuropathy, active foot ulcer, autonomic neuropathy, and advanced nephropathy. For each: activities to avoid, activities to favor, monitoring required, and clearance threshold.

Cornell Notes:

☐ Page 1 — Cue questions: What is the ADA physical activity prescription for adults with diabetes (frequency, intensity, duration, type), and how does the prescription change for older adults and children? What pre-exercise glucose ranges call for CHO supplementation, ketone checking, or delay, and why does the > 270 mg/dL threshold matter specifically for Type 1?

☐ Page 2 — Cue questions: Why can high-intensity exercise transiently raise glucose, and why does the same patient often experience delayed hypoglycemia 6 to 15 hours later? What are the exercise contraindications and modifications for proliferative retinopathy, severe peripheral neuropathy, and active foot ulceration?

Week 4 — Part IV: Medication Management

Difficulty: Heavy, High Yield

What it covers:

• Every major oral and non-insulin injectable drug class: metformin, sulfonylureas, meglitinides, TZDs, DPP-4 inhibitors, SGLT2 inhibitors, GLP-1 receptor agonists, dual GIP/GLP-1 agonists (tirzepatide), and amylin analogs

• All insulin categories: rapid-acting, short-acting, intermediate, long-acting basal, ultra-long-acting basal, and pre-mixed

• Insulin pharmacokinetics (onset, peak, duration) and how each curve translates to a regimen

• Basal-bolus dosing, insulin pumps, continuous subcutaneous insulin infusion, and hybrid closed-loop/AID systems

• The ADA/EASD treatment algorithm and drug selection by comorbidity (ASCVD, heart failure, CKD, obesity)

• Concentrated insulins (U-200, U-300, U-500), biosimilars, and storage requirements

• Common adverse effects, contraindications, and drug-drug interactions

Print: 1 Mind Map, 4 Comparison Charts, 3 Cornell Notes pages

Study Tasks

☐ Read the Study Guide first. Complete the High-Yield Objectives, Key Terms and Definitions, and Concept Overview sections before opening the chapter.

☐ Highlight as you read, following the Made Easy Highlighting System

☐ Learn the ADA/EASD drug-selection logic by comorbidity, not by alphabet. Metformin remains first-line in T2DM in most patients, but co-existing conditions now drive second-line choice independent of A1C. Established ASCVD: GLP-1 receptor agonist with proven cardiovascular benefit (semaglutide, liraglutide, dulaglutide) or SGLT2 inhibitor with proven benefit (empagliflozin, canagliflozin). Heart failure (HFrEF or HFpEF): SGLT2 inhibitor (dapagliflozin, empagliflozin). Chronic kidney disease (eGFR < 60 or albuminuria): SGLT2 inhibitor preferred down to eGFR ~20, then GLP-1 RA. Obesity-priority: GLP-1 RA or tirzepatide. Cost-priority: sulfonylurea or TZD. This logic is tested as a clinical scenario, almost never as a list.

☐ Insulin pharmacokinetics are exam-day numbers. Rapid-acting (lispro, aspart, glulisine): onset 10 to 15 min, peak 1 to 2 hr, duration 3 to 5 hr. Ultra-rapid (faster aspart, lispro-aabc): onset 2 to 5 min, slightly earlier peak. Regular U-100: onset 30 min, peak 2 to 4 hr, duration 6 to 8 hr. NPH: onset 1 to 2 hr, peak 4 to 12 hr, duration 12 to 18 hr (variable peak is the hypo risk). Glargine U-100 / detemir: onset 2 hr, peak minimal, duration ~24 hr (detemir often shorter). Glargine U-300 / degludec: onset 6 hr, no clinically meaningful peak, duration 24 to 42 hr (degludec). Build a single chart and memorize.

☐ Master the SGLT2 inhibitor risk profile. Genitourinary infections (candidal, including Fournier's gangrene as a rare but tested risk), volume depletion and hypotension, ketoacidosis at near-normal glucose (euglycemic DKA, the highest-yield CDCES teaching point), and a known risk of lower-limb amputation with canagliflozin in some trial populations. Hold around major surgery, prolonged fasting, severe acute illness, and any ketogenic eating window. Critical CDCES teaching: a patient on an SGLT2 inhibitor who feels unwell with normal glucose still needs ketone testing.

☐ Know the GLP-1 RA family well enough to differentiate within it. Daily injectable: liraglutide. Weekly injectable: semaglutide, dulaglutide, exenatide ER. Oral: semaglutide (requires fasting administration with sip of water, then 30 minutes before food, no other oral medications). Dual GIP/GLP-1: tirzepatide (weekly). Common adverse effects across the class: nausea, vomiting, slow gastric emptying, and a small risk of pancreatitis. Boxed warning: medullary thyroid carcinoma (contraindicated in personal or family history of MTC or MEN-2). The CDCES role: dose-titration coaching, anti-nausea food strategies, and surveillance teaching.

☐ Pump and AID therapy is now standard CDCES content. Know basal rates vs. bolus types (standard, extended, dual-wave), the difference between predictive low-glucose suspend and true closed-loop, and the algorithm-driven systems available (Medtronic 780G, Tandem Control-IQ, Omnipod 5, iLet). Patient selection requires CHO-counting skill, willingness to engage with technology, and adequate insurance. Site rotation, infusion-set failure recognition (unexplained hyperglycemia or DKA in a Type 1 pump user is a failed infusion set until proven otherwise), and back-up insulin pen access are all CDCES teaching priorities.

☐ Complete the Practice Questions for Part IV in your quiz bank. Review every rationale, correct and incorrect.

How to Use Your Templates

☐ Mind Map: Central node = Medication Management. Main branches: Metformin → Sulfonylureas & Meglitinides → TZDs → DPP-4 Inhibitors → SGLT2 Inhibitors → GLP-1 Receptor Agonists → Dual GIP/GLP-1 (Tirzepatide) → Amylin Analogs → Insulin Categories & Pharmacokinetics → Basal-Bolus Regimens → Pumps & AID Systems → Concentrated Insulins (U-200, U-300, U-500) → ADA/EASD Treatment Algorithm by Comorbidity → Storage, Stability & Patient Counseling.

Comparison Charts:

☐ Chart 1 — Major Non-Insulin Drug Classes: Metformin, sulfonylureas, TZDs, DPP-4 inhibitors, SGLT2 inhibitors, GLP-1 RAs. For each: mechanism, expected A1C reduction, weight effect, hypoglycemia risk, key adverse effects, and renal cutoff or contraindication.

☐ Chart 2 — Insulin Pharmacokinetics by Category: Rapid-acting, ultra-rapid, regular, NPH, long-acting (glargine, detemir), ultra-long-acting (glargine U-300, degludec), and pre-mixed. For each: onset, peak, duration, typical dosing pattern, and primary clinical use.

☐ Chart 3 — ADA/EASD Drug Selection by Comorbidity: Established ASCVD, heart failure, CKD, obesity priority, cost priority, and hypoglycemia-avoidance priority. For each: preferred first-line add-on, evidence base, and key contraindications.

☐ Chart 4 — Insulin Delivery: MDI vs. Conventional Pump vs. Hybrid Closed-Loop / AID: Insulin types used, daily decision burden, hypoglycemia mitigation, CGM integration requirement, candidate selection criteria, and CDCES teaching focus.

Cornell Notes:

☐ Page 1 — Cue questions: What is the ADA/EASD first-line and second-line drug recommendation for T2DM with established ASCVD, heart failure, CKD, and obesity priority? What are the four cardiovascular-benefit GLP-1 RAs and the two cardiovascular-benefit SGLT2 inhibitors, and how does that evidence shape your patient-specific recommendation?

☐ Page 2 — Cue questions: What are the onset, peak, and duration of rapid-acting insulin, regular insulin, NPH, glargine U-100, and degludec? Why does NPH carry the highest hypoglycemia risk of any modern basal insulin, and what regimen redesign typically replaces it?

☐ Page 3 — Cue questions: What is euglycemic DKA, why does it occur with SGLT2 inhibitors, and what CDCES teaching reduces this risk? What is the patient teaching sequence for a hybrid closed-loop / AID system, and what scenarios still require manual intervention even with full automation engaged?

Week 5 — Part V: Monitoring, Interpretation, and Acute Complications

Difficulty: Heavy, High Yield

What it covers:

• A1C: clinical use, limitations, conditions that falsely raise or lower it (hemoglobinopathies, anemia, pregnancy, recent transfusion, CKD)

• Self-monitoring of blood glucose (SMBG): frequency standards, timing, and accuracy requirements

• Continuous glucose monitoring: Time in Range (TIR), Time Above Range (TAR), Time Below Range (TBR), Glucose Management Indicator (GMI), and coefficient of variation

• Pattern management and therapy adjustment using glucose data

• Hypoglycemia: ADA Level 1, 2, and 3 definitions, treatment, and hypoglycemia unawareness

• Glucagon administration (nasal, autoinjector, ready-to-use)

• Diabetic ketoacidosis: pathophysiology, presentation, lab criteria, fluid and insulin management priorities

• Hyperosmolar hyperglycemic state: pathophysiology, lab criteria, and how it differs from DKA

• Sick day management framework

Print: 1 Mind Map, 4 Comparison Charts, 3 Cornell Notes pages

Study Tasks

☐ Read the Study Guide first. Complete the High-Yield Objectives, Key Terms and Definitions, and Concept Overview sections before opening the chapter.

☐ Highlight as you read, following the Made Easy Highlighting System

☐ Memorize the CGM targets cold. These are the most-tested numbers in the exam. For most non-pregnant adults: Time in Range (70 to 180 mg/dL) > 70%, Time Below Range (< 70) < 4%, Time Very Below Range (< 54) < 1%, Time Above Range (> 180) < 25%, Time Very Above Range (> 250) < 5%. Older or high-risk adults: TIR > 50%, TBR < 1%. Pregnancy with T1DM: TIR (63 to 140 mg/dL) > 70%, TBR < 4%, TBR < 63 < 4%, TBR < 54 < 1%. The pregnancy targets are different in both range and threshold; mixing them up is a classic distractor.

☐ Know when A1C lies. Conditions that falsely lower A1C: hemolytic anemia, recent blood loss or transfusion, late pregnancy, splenomegaly, certain hemoglobinopathies (HbS, HbC). Conditions that falsely raise A1C: iron-deficiency anemia, vitamin B12 deficiency, CKD with elevated carbamylation, splenectomy, certain hemoglobin variants (HbF persistence). In any of these scenarios, CGM (with GMI) or fructosamine becomes the more reliable glycemic marker. The CDCES role: recognize the mismatch when A1C and CGM data disagree, and recommend the right marker for the right patient.

☐ ADA hypoglycemia levels are precise and tested. Level 1: glucose 54 to 69 mg/dL, alert value, treat with 15 g rapid-acting CHO (Rule of 15). Level 2: glucose < 54 mg/dL, clinically significant, immediate treatment required, and a flag for therapy re-evaluation. Level 3: severe, characterized by altered mental status or physical impairment requiring assistance from another person (regardless of measured glucose). Glucagon (nasal 3 mg, autoinjector 1 mg, ready-to-use solution 1 mg or 0.5 mg) is indicated for Level 3 outpatient management. Every patient on insulin or a sulfonylurea should have a prescription for glucagon and a household member who knows how to use it.

☐ DKA vs. HHS is high-yield and frequently confused. DKA: more common in T1DM, glucose typically > 250 (can be lower with SGLT2 inhibitors and in pregnancy: "euglycemic DKA"), pH < 7.30, bicarbonate < 18, anion gap > 10 to 12, positive ketones (urine or beta-hydroxybutyrate ≥ 3 mmol/L). HHS: more common in T2DM, glucose typically > 600, serum osmolality > 320 mOsm/kg, pH > 7.30, bicarbonate > 18, minimal ketones, severe dehydration, often altered mental status. Both: IV fluids first (not insulin), correct potassium before initiating or continuing insulin if K < 3.3, transition to subcutaneous insulin with overlap once the anion gap closes (DKA) or osmolality normalizes (HHS).

☐ Use the ambulatory glucose profile (AGP) for pattern management. Read the AGP top-down: GMI and TIR first (overall control), then the 24-hour median curve (where is glucose drifting?), then the variability bands (where is variability widest?), then the daily plots (when do excursions cluster?). Therapy adjustments follow patterns, not single readings: persistent post-breakfast highs → adjust ICR or pre-meal timing; nocturnal lows → adjust basal; fasting highs after nocturnal lows → suspect rebound (Somogyi vs. dawn phenomenon and check overnight pattern, not basal up-titration first).

☐ Complete the Practice Questions for Part V in your quiz bank. Review every rationale, correct and incorrect.

How to Use Your Templates

☐ Mind Map: Central node = Monitoring & Acute Complications. Main branches: A1C (use, limitations, false high/low conditions) → SMBG Standards → CGM Metrics (TIR, TAR, TBR, GMI, CV) → AGP Interpretation & Pattern Management → Hypoglycemia (Levels 1, 2, 3, Rule of 15, hypoglycemia unawareness) → Glucagon Delivery (nasal, autoinjector, ready-to-use) → DKA (pathophysiology, lab criteria, treatment priorities) → HHS (pathophysiology, lab criteria, treatment priorities) → Sick Day Management Framework.

Comparison Charts:

☐ Chart 1 — A1C vs. CGM (GMI) vs. Fructosamine: What each measures, time window reflected, false-high and false-low conditions, ADA target for general adults, and when to choose each marker.

☐ Chart 2 — Hypoglycemia Levels 1, 2, and 3: Glucose threshold, clinical features, first-line treatment, second-line treatment (if needed), follow-up care plan, and CDCES teaching priorities for each.

☐ Chart 3 — DKA vs. HHS: Population most affected, glucose range, pH, bicarbonate, anion gap, ketones, osmolality, mental status, fluid choice, insulin start condition, and potassium replacement threshold.

☐ Chart 4 — Glucagon Formulations: Nasal vs. Autoinjector vs. Ready-to-Use Solution: Dose, route, age indication, storage, shelf life, training points, and ideal candidate scenario.

Cornell Notes:

☐ Page 1 — Cue questions: What are the ADA-recommended Time in Range targets for most non-pregnant adults, for older or high-risk adults, and for pregnancy with T1DM? Which conditions falsely raise A1C, and which falsely lower it, and how does the CDCES choose between A1C, CGM-derived GMI, and fructosamine in each case?

☐ Page 2 — Cue questions: What are the ADA Level 1, 2, and 3 definitions of hypoglycemia, and what is the Rule of 15 treatment sequence? When is glucagon indicated, what are the three formulation options, and what is the household teaching plan around each?

☐ Page 3 — Cue questions: What are the laboratory criteria that distinguish DKA from HHS, and what is the immediate treatment priority sequence (fluids, potassium, insulin) for each? Why must potassium be measured and replaced before continuing insulin therapy, and at what threshold does insulin need to be held?

Week 6 — Part VI: Chronic Complications and Comorbidities

Difficulty: Heavy, High Yield

What it covers:

• Microvascular complications: retinopathy (NPDR, PDR, DME), nephropathy (albuminuria staging, eGFR thresholds), and peripheral and autonomic neuropathy

• Macrovascular complications: coronary artery disease, stroke, peripheral arterial disease, and the diabetic foot

• Comorbidity management: hypertension, dyslipidemia, NAFLD/NASH, obstructive sleep apnea, and depression

• Screening intervals for every complication and the ADA-recommended therapeutic targets

• Foot care assessment (monofilament, tuning fork, ABI) and the diabetic foot risk classification

• Vaccination schedule (influenza, pneumococcal, hepatitis B, COVID-19, RSV, shingles)

• ASCVD risk calculation, statin intensity guidance, and aspirin recommendations

Print: 1 Mind Map, 4 Comparison Charts, 3 Cornell Notes pages

Study Tasks

☐ Read the Study Guide first. Complete the High-Yield Objectives, Key Terms and Definitions, and Concept Overview sections before opening the chapter.

☐ Highlight as you read, following the Made Easy Highlighting System

☐ Memorize the ADA screening schedule by complication. Retinopathy: dilated eye exam at T1DM diagnosis (within 5 years of onset), at T2DM diagnosis, then annually (every 1 to 2 years if normal and well-controlled). Nephropathy: urine albumin-to-creatinine ratio and eGFR annually starting at T1DM 5 years post-diagnosis, T2DM at diagnosis. Neuropathy: comprehensive foot exam (monofilament, tuning fork or vibration, pulses, visual inspection) at T1DM 5 years post-diagnosis and T2DM at diagnosis, then annually. Lipid panel: at diagnosis and at least every 5 years if low risk, annually if on therapy or with ASCVD. These intervals are tested directly.

☐ Know albuminuria staging and the eGFR thresholds. Albuminuria: A1 normal (< 30 mg/g), A2 moderately increased (30 to 299 mg/g, formerly "microalbuminuria"), A3 severely increased (≥ 300 mg/g, formerly "macroalbuminuria"). eGFR stages: G1 ≥ 90 normal, G2 60 to 89 mildly decreased, G3a 45 to 59 mild-moderate, G3b 30 to 44 moderate-severe, G4 15 to 29 severe, G5 < 15 kidney failure. ACE inhibitors or ARBs are indicated for any albuminuria (A2 or A3) regardless of blood pressure. SGLT2 inhibitors are renoprotective down to ~eGFR 20 and indicated when albuminuria is present, independent of A1C status. Finerenone (non-steroidal MRA) adds further renoprotection in T2DM with CKD and albuminuria.

☐ Diabetic foot care has tested numbers and tested actions. Monofilament: 10-g Semmes-Weinstein, four to ten sites, inability to feel ≥ 1 site is loss of protective sensation. Vibration: 128-Hz tuning fork at the great toe dorsum, abnormal = high risk. ABI: < 0.9 indicates PAD; 0.9 to 1.3 normal; > 1.3 suggests medial calcinosis and unreliable result (use toe-brachial index). High-risk feet (LOPS, deformity, or prior ulcer): podiatry referral and frequent visits. Active ulcer: urgent same-day evaluation. The CDCES role: daily self-inspection teaching, footwear screening, smoking cessation referral, and triage of red flags.

☐ ADA therapeutic targets in one block. A1C < 7.0% for most non-pregnant adults (individualize: < 6.5% if achievable safely, < 8.0% in limited life expectancy or significant comorbidity). Blood pressure < 130/80 mmHg for most patients with diabetes. LDL: high-intensity statin in T1DM or T2DM with ASCVD (LDL goal < 70 mg/dL); moderate-intensity statin in T2DM age 40+ without ASCVD (or younger with risk factors); add ezetimibe or PCSK9 inhibitor if LDL remains above goal in established ASCVD. Aspirin 81 mg daily for secondary prevention; for primary prevention, individualized only when ASCVD risk is high and bleeding risk is low (no longer routine).

☐ Vaccination schedule is a quick win on the exam. Influenza annually for everyone ≥ 6 months. Pneumococcal (PCV20 alone, or PCV15 + PPSV23, per current CDC schedule) for all adults with diabetes. Hepatitis B for unvaccinated adults under 60 with diabetes (recommended), and consider in age 60+ based on risk. COVID-19, RSV (age ≥ 60 with risk factors), and shingles (age ≥ 50) per current CDC guidance. The CDCES is positioned to verify status at every comprehensive visit.

☐ Complete the Practice Questions for Part VI in your quiz bank. Review every rationale, correct and incorrect.

How to Use Your Templates

☐ Mind Map: Central node = Chronic Complications & Comorbidities. Main branches: Retinopathy (NPDR, PDR, DME, screening) → Nephropathy (albuminuria A1-A3, eGFR stages, ACE/ARB, SGLT2i, finerenone) → Peripheral & Autonomic Neuropathy → Diabetic Foot (monofilament, ABI, risk stratification) → ASCVD & Stroke → PAD → Hypertension (target, first-line) → Dyslipidemia (statin intensity, secondary vs. primary prevention aspirin) → NAFLD/NASH → OSA → Depression & Diabetes Distress → Vaccination Schedule.

Comparison Charts:

☐ Chart 1 — Microvascular Complications Screening & Management: Retinopathy, nephropathy, peripheral neuropathy, autonomic neuropathy. For each: when to begin screening, frequency, assessment tools, first-line therapy, and indication for specialist referral.

☐ Chart 2 — Albuminuria & eGFR Staging: A1 vs. A2 vs. A3 albuminuria, G1 through G5 eGFR. For each: definition, clinical significance, ACE/ARB indication, SGLT2 inhibitor indication, and follow-up interval.

☐ Chart 3 — Lipid Therapy by Risk Category: No risk factors, primary prevention with risk factors, established ASCVD. For each: statin intensity, LDL goal, ezetimibe/PCSK9i addition criteria, and aspirin recommendation.

☐ Chart 4 — Diabetic Foot Risk Categories: Risk 0 (no LOPS, no PAD, no deformity, no prior ulcer), Risk 1 (LOPS only), Risk 2 (LOPS + PAD or deformity), Risk 3 (prior ulcer, amputation, or ESRD). For each: visit frequency, footwear recommendation, podiatry referral threshold, and CDCES teaching focus.

Cornell Notes:

☐ Page 1 — Cue questions: What is the ADA-recommended screening start time and frequency for retinopathy, nephropathy, neuropathy, and lipid panel in T1DM and T2DM? What are the three stages of albuminuria and the eGFR cutoffs that change first-line management?

☐ Page 2 — Cue questions: What are the ADA blood pressure and LDL targets for adults with diabetes, and how does the statin-intensity recommendation differ between primary prevention with risk factors and established ASCVD? When is aspirin recommended for primary versus secondary cardiovascular prevention?

☐ Page 3 — Cue questions: What are the four diabetic foot risk categories, and what visit frequency and footwear are appropriate for each? Which monofilament, tuning fork, and ABI findings indicate loss of protective sensation, autonomic involvement, and peripheral arterial disease, and how does each finding change the CDCES care plan?

Week 7 — Part VII: Problem-Solving and Living with Diabetes

Difficulty: Moderate to Heavy

What it covers:

• Sick day management protocols for T1DM and T2DM

• Travel planning (time zones, insulin storage, supplies, security screening, language cards)

• Driving safety, occupational accommodations, and FAA/DOT-style regulatory considerations

• Hospitalization, perioperative management, and steroid-induced hyperglycemia

• Diabetes in pregnancy (preconception, GDM, pregestational T1DM and T2DM)

• Pediatric and adolescent diabetes: developmental considerations and school 504/IEP coordination

• Older adults: deintensification, hypoglycemia risk, geriatric syndromes

• Disordered eating in diabetes (diabulimia, T1DE) and screening tools

• Substance use and diabetes (alcohol, cannabis, opioids)

• Disaster preparedness and supply planning

Print: 1 Mind Map, 3 Comparison Charts, 3 Cornell Notes pages

Study Tasks

☐ Read the Study Guide first. Complete the High-Yield Objectives, Key Terms and Definitions, and Concept Overview sections before opening the chapter.

☐ Highlight as you read, following the Made Easy Highlighting System

☐ Lock in the sick day framework before everything else. Every patient with diabetes needs four pieces: (1) never stop insulin if you have T1DM (illness raises insulin needs, not lowers them), (2) check glucose every 2 to 4 hours, (3) check ketones whenever glucose is > 240 mg/dL or feeling ill, and (4) maintain hydration with 8 oz of sugar-free fluid hourly when glucose is high, sugar-containing fluid when glucose is low and intake is limited. Hold SGLT2 inhibitors and metformin during significant illness, especially with dehydration or reduced oral intake. Call the care team for persistent vomiting, moderate to large ketones, glucose persistently > 300 despite correction, or any altered mental status.

☐ Travel planning has tested specifics. Carry all insulin and supplies in carry-on, never checked (cargo holds reach freezing temperatures that destroy insulin). Pack 1.5 to 2 times needed supplies. Use a cooling case for travel days exceeding the room-temperature stability window. TSA permits insulin, syringes, pumps, and CGMs through security with appropriate documentation (a prescription label or physician letter is sufficient; pumps and CGMs should not go through X-ray or full-body scanners and warrant a manual inspection request). Crossing time zones eastbound: shorter day, less basal insulin; westbound: longer day, more basal. Long-acting basal can be transitioned by adjusting injection time gradually over 2 to 3 days.

☐ Diabetes in pregnancy is a CDCES specialty and tests heavily. Preconception A1C target < 6.5% to reduce congenital malformation risk. During pregnancy: fasting glucose < 95 mg/dL, 1-hour postprandial < 140, 2-hour postprandial < 120, A1C < 6.0% if achievable safely. Insulin is the preferred therapy in pregnancy for both T1DM and T2DM; metformin and glyburide are sometimes used in GDM but not preferred in pregestational diabetes. Postpartum: insulin needs drop sharply (often 50% reduction in T1DM within 24 to 48 hours of delivery), and GDM patients are screened with 75 g OGTT at 4 to 12 weeks postpartum.

☐ Older-adult care prioritizes deintensification. ADA framework: healthy older adults can target A1C < 7.0 to 7.5%; intermediate health (multiple comorbidities, moderate cognitive impairment) target < 8.0%; very complex / poor health (end-stage disease, severe cognitive impairment) target < 8.5% and avoidance of symptomatic hypoglycemia. Sulfonylureas (especially glyburide), high-dose basal insulin, and complex regimens carry the greatest harm in this population. The CDCES role: identify patients who would benefit from simplification and partner with the prescriber on a safer, lower-burden regimen.

☐ Disordered eating in diabetes warrants explicit screening. Type 1 diabetes with disordered eating (T1DE, sometimes called "diabulimia") involves deliberate insulin omission or reduction for weight control, carries the highest mortality of any eating disorder, and dramatically accelerates microvascular and acute complications. Red flags: unexplained recurrent DKA, unexplained high A1C with reported good adherence, body-image preoccupation, and skipping injections during meals out. Screening: DEPS-R (Diabetes Eating Problem Survey, Revised) and SCOFF are commonly used. Mandatory multidisciplinary referral (endocrinology, mental health specializing in ED, dietitian, possibly inpatient programs).

☐ Complete the Practice Questions for Part VII in your quiz bank. Review every rationale, correct and incorrect.

How to Use Your Templates

☐ Mind Map: Central node = Problem-Solving & Living with Diabetes. Main branches: Sick Day Management → Travel Planning (time zones, supplies, security) → Driving & Occupational Considerations → Hospitalization & Perioperative Care → Steroid-Induced Hyperglycemia → Pregnancy (preconception, GDM, pregestational) → Pediatric & Adolescent (school 504/IEP, transitions) → Older Adults (deintensification framework) → Disordered Eating in Diabetes (T1DE, DEPS-R, SCOFF) → Substance Use → Disaster Preparedness.

Comparison Charts:

☐ Chart 1 — Sick Day Management: T1DM vs. T2DM: Insulin adjustment rule, ketone monitoring threshold, oral medication hold list, hydration target, when to call the care team, and when to go to the emergency department.

☐ Chart 2 — Glycemic Targets Across Life Stages: Preconception, pregnancy with T1DM/T2DM, GDM, pediatric (under 6, 6 to 18), healthy adults, healthy older adults, and complex/poor-health older adults. For each: A1C target, glucose targets, and hypoglycemia tolerance.

☐ Chart 3 — Disordered Eating Screening Tools: DEPS-R, SCOFF, EDE-Q-D. For each: target population, scoring approach, action threshold, and follow-up pathway.

Cornell Notes:

☐ Page 1 — Cue questions: What are the four pillars of sick day management for a patient with T1DM, and which oral medications should be held during significant illness? At what glucose threshold should a sick patient check ketones, and at what ketone result does the care team get called?

☐ Page 2 — Cue questions: What are the ADA-recommended glucose targets in pregnancy with pregestational diabetes, and why is insulin the preferred therapy over oral agents in this population? Why does insulin requirement drop sharply postpartum in T1DM, and what monitoring plan is required in the first 48 hours?

☐ Page 3 — Cue questions: What are the three ADA older-adult health categories and the A1C target for each? What red flags suggest disordered eating in a patient with T1DM, and what is the CDCES referral pathway when DEPS-R or another screening tool is positive?

Week 8 — Part VIII: Person-Centered Education, Evaluation, and Professional Practice

Difficulty: Moderate

What it covers:

• The ADCES7 Self-Care Behaviors framework (Healthy Coping, Healthy Eating, Being Active, Taking Medication, Monitoring, Reducing Risks, Problem Solving) and how each maps to assessment and education

• DSMES (Diabetes Self-Management Education and Support) standards and the four critical times for referral

• Motivational Interviewing core skills (OARS, change talk recognition, ambivalence resolution)

• Health literacy and numeracy assessment, plain-language teaching, and teach-back

• Cultural, spiritual, and linguistic responsiveness

• Scope of practice (CDCES vs. BC-ADM vs. RDN vs. RN vs. pharmacist) and interprofessional collaboration

• Documentation, billing, and reimbursement basics for DSMES and MNT

• Ethical decision-making and the ACES (or comparable) code of ethics

• Evaluation: program outcome measures, behavioral measures, and clinical outcome measures

Print: 1 Mind Map, 3 Comparison Charts, 2 Cornell Notes pages

Study Tasks

☐ Read the Study Guide first. Complete the High-Yield Objectives, Key Terms and Definitions, and Concept Overview sections before opening the chapter.

☐ Highlight as you read, following the Made Easy Highlighting System

☐ Memorize the ADCES7 Self-Care Behaviors and the four critical referral times. ADCES7: Healthy Coping, Healthy Eating, Being Active, Taking Medication, Monitoring, Reducing Risks of Complications, Problem Solving. The four critical times for DSMES referral: (1) at diagnosis, (2) annually (or whenever clinical or psychosocial goals are not being met), (3) when complicating factors arise that influence self-management, and (4) at transitions in life and care (pregnancy, transition to adult care, hospital discharge, new caregiver, change in living situation). The exam tests both the seven behaviors and the four times directly and frequently.

☐ Master Motivational Interviewing fundamentals. Spirit of MI: partnership, acceptance, compassion, evocation. Core skills (OARS): Open-ended questions, Affirmations, Reflective listening (simple and complex), Summaries. Recognize change talk: Desire ("I want to..."), Ability ("I can..."), Reasons ("If I do, then..."), Need ("I have to..."), Commitment ("I will..."), Activation ("I'm ready to..."), Taking steps ("I started..."). The CDCES amplifies change talk and rolls with resistance (no arguing, no premature problem-solving, no "yeah, but..."). MI scenario questions are tested by identifying the right next response, not the right factual answer.

☐ Health literacy and numeracy are testable competencies. Roughly 36% of US adults have only basic or below-basic health literacy; numeracy (especially around fractions, carb counting, and insulin dosing) is often even lower. Use plain language (avoid "hyperglycemia," say "high blood sugar"), the teach-back method ("Just so I know I explained this clearly, can you walk me through how you'd take this dose?"), chunked information (no more than 3 to 5 new concepts per visit), and visual or analog supports for numeracy tasks. Validated screening tools include REALM-D and the Newest Vital Sign; the CDCES adjusts the teaching plan based on the result, not the patient's perceived intelligence.

☐ Know the scope-of-practice distinctions. The CDCES is the standard credential for diabetes care and education (offered by CBDCE) and requires both eligible discipline (RN, RD, RPh, MD, DO, PA, NP, OT, PT, social worker, exercise physiologist, and certain others) and ≥ 1,000 hours of diabetes care experience. The BC-ADM (board certification in advanced diabetes management) is held by APRNs, pharmacists, RDs, and PAs and includes prescribing-level scope where state law permits. The RDN provides MNT; the CDCES reinforces and integrates nutrition concepts but does not replace MNT. Document collaboration, refer when scope is exceeded, and never practice outside professional licensure.

☐ The four core ethical principles, plus fidelity and veracity, are tested in scenario form. Autonomy (the patient's right to make informed decisions, including refusing recommended therapy), Beneficence (acting in the patient's best interest), Non-Maleficence (avoiding harm, which includes not prescribing complex regimens to a patient unable to safely execute them), Justice (fair distribution of care, including attention to access and equity), Fidelity (faithfulness to commitments and confidentiality), and Veracity (truthfulness, including admitting errors). Expect scenarios that pit autonomy against beneficence (a competent patient refusing insulin); the standard answer respects autonomy after thorough, non-coercive education.

☐ Complete the Practice Questions for Part VIII in your quiz bank. Review every rationale, correct and incorrect.

How to Use Your Templates

☐ Mind Map: Central node = Person-Centered Education & Professional Practice. Main branches: ADCES7 Self-Care Behaviors → DSMES Standards & Four Critical Times → Motivational Interviewing (Spirit, OARS, Change Talk) → Health Literacy & Numeracy (Plain Language, Teach-Back, REALM-D, Newest Vital Sign) → Cultural & Spiritual Responsiveness → Scope of Practice (CDCES, BC-ADM, RDN, RN, RPh) → Interprofessional Collaboration → Documentation, Billing & Reimbursement → Ethics (Autonomy, Beneficence, Non-Maleficence, Justice, Fidelity, Veracity) → Program Evaluation Measures.

Comparison Charts:

☐ Chart 1 — ADCES7 Self-Care Behaviors: Healthy Coping, Healthy Eating, Being Active, Taking Medication, Monitoring, Reducing Risks, Problem Solving. For each: what it measures, sample assessment question, sample education intervention, and outcome measure to track progress.

☐ Chart 2 — CDCES vs. BC-ADM vs. RDN: Scope of Practice: Eligible disciplines, prescribing scope, supervisory expectations, typical practice setting, and which credential is required to bill MNT versus DSMES.

☐ Chart 3 — Ethical Principles in Action: Autonomy, Beneficence, Non-Maleficence, Justice. For each: definition, clinical example in a diabetes care setting, common scenario of conflict with another principle, and the principle that typically takes precedence in a competent-adult informed-consent discussion.

Cornell Notes:

☐ Page 1 — Cue questions: What are the seven ADCES Self-Care Behaviors, and what are the four critical times that warrant a DSMES referral? What is the difference between DSMES and MNT in scope, billing, and which credential delivers each?

☐ Page 2 — Cue questions: What are the four elements of the spirit of Motivational Interviewing, and what does the OARS acronym stand for? When an autonomous, competent patient refuses recommended insulin therapy, which ethical principles are in tension, and what is the CDCES's professional obligation in that scenario?

Week 9 — Final Review & Exam Simulation

Your final week is not about learning new material. It is about consolidating everything you have built and proving it under exam conditions.

Review Tasks

☐ Re-draw one Mind Map from memory for each Part you feel least confident about. Check it against your original.

☐ Work through your Cornell Notes cue columns for every Part. Cover the right-hand notes and answer from memory.

☐ Re-do any quiz bank questions you got wrong across all Parts. Focus on the rationales, not just the right answer.

☐ Review the Common Mistakes, Rapid Review, and Self-Assessment Checklist sections for your two or three weakest Parts.

Exam Simulation

☐ Take the full-length CDCES practice exam using the QR code in the back matter of this book. Complete it in one sitting, timed, as close to real exam conditions as possible.

☐ Review your emailed score report. Identify which subject areas you missed most, and spend your remaining time on those Parts' Rapid Review and application scenarios only.