Question 1

If a patient with type 2 diabetes shows early signs of kidney disease,the first priority in nutrition management is

Accepted Answer

If a patient with diabetes begins to develop any kind of complications,the priority in treatment is always normalizing blood glucose levels.Avoiding excessive intakes of protein and sodium and maintaining adequate protein intake may be beneficial but are not the first steps.

Question 2

If a woman is brought into the emergency room with nausea,weakness,and fruity-smelling breath,the test you would perform first is

Accepted Answer

The most important test to perform first is measurement of blood glucose level because this can and must be corrected rapidly if the patient has ketoacidosis.Blood alcohol level could be checked if blood glucose level is normal.A pregnancy test and blood pressure may be important measurements if blood glucose and blood alcohol are normal,but those would not be performed first.

Question 3

Diabetic ketoacidosis may occur in a patient with type 1 diabetes who

Accepted Answer

Diabetic ketoacidosis may occur in a patient with type 1 diabetes who goes away for the weekend and forgets to take his or her insulin.Missing a meal would cause hypoglycemia.Participation in an all-day sporting event could cause hypoglycemia if he or she did not eat extra food.Taking a double dose of insulin would cause hypoglycemia.

Question 4

An individual with a blood glucose level of 40 mg/dL would have

Accepted Answer

The normal range of blood glucose levels is 90 to 130 mg/dL;therefore,40 mg/dL represents hypoglycemia.Blood glucose levels above 180 mg/dL would represent hyperglycemia.Impaired glucose tolerance is diagnosed when fasting plasma glucose levels are 100 to 125 mg/dL.

Question 5

The person who would be most likely to develop type 2 diabetes mellitus is a(n)

Accepted Answer

The prevalence of type 2 diabetes mellitus is high among Native Americans,and risk increases with overweight.The prevalence of type 2 diabetes among Asian Americans is relatively low,even though being sedentary contributes to risk.Retinal damage may be a complication of the disease,but it does not increase risk of developing it.Alcohol abuse and cirrhosis of the liver do not contribute to risk for type 2 diabetes.

Question 6

The cause of type 1 diabetes mellitus is

Accepted Answer

Type 1 diabetes mellitus is caused by autoimmune destruction of pancreatic beta cells.Excessive sugar intake does not cause any kind of diabetes mellitus.Type 2 diabetes is caused by inability of cells to respond to insulin in the bloodstream.In type 1 diabetes,the pancreas is not able to keep up with the body's demands for insulin,but the cause of this is destruction of beta cells.

Question 7

At a routine physical examination,a 50-year-old man has a fasting blood glucose level of 160 mg/dL.The next step in diagnosis and treatment would be

Accepted Answer

Type 2 diabetes mellitus is diagnosed when the fasting blood glucose level exceeds 126 mg/dL on at least two occasions;therefore,the first step in care would be to recheck his fasting blood glucose level.If the diagnosis is confirmed,referral to a diabetes clinic,use of an oral hypoglycemic agent,and evaluation of cardiovascular risk factors may be warranted.

Question 8

Glycosylated hemoglobin level is used to indicate

Accepted Answer

Glycosylated hemoglobin level is used to indicate overall blood glucose control throughout the previous 100 to 120 days.The effect of meals on blood glucose level is determined through self-monitoring of blood glucose levels.Glycosylated hemoglobin level does not show day-to-day variations in blood glucose level.Iron deficiency anemia is diagnosed through measurement of total hemoglobin level in patients with and without diabetes.

Question 9

If someone with type 1 diabetes has nausea and vomiting,weakness,and fatigue,as well as excessive hunger and thirst,but does not have a fruity or acetone odor on his or her breath,he or she may have

Accepted Answer

Nausea and vomiting,weakness,fatigue,polyphagia,and polydipsia can all be symptoms of both HHNS and diabetic ketoacidosis.However,with diabetic ketoacidosis,the breath smells fruity because of ketones.If this is not the case,the patient has HHNS.Hypoglycemia would be characterized by hunger,confusion,trembling,and erratic behavior.Hepatic encephalopathy is not associated with diabetes.

Question 10

If a 15-year-old student who runs cross-country and long-distance track events starts to lose weight and is continually thirsty and hungry,he or she may have

Accepted Answer

Polyphagia,polydipsia,and weight loss are hallmarks of untreated type 1 diabetes mellitus.Type 2 diabetes is associated with overweight and inactivity.AIDS and hepatitis may result in weight loss but are accompanied by loss of appetite rather than increased appetite.

Question 11

If a patient with diabetes mellitus checks blood glucose level before going for a 2-mile run and it is 90 mg/dL,he or she should

Accepted Answer

Patients with diabetes mellitus should exercise when their blood glucose level is between 100 and 250 mg/dL.With a blood glucose level of 90 mg/dL,the patient may experience hypoglycemia during the run,so he or she should first eat food containing carbohydrate.Administering extra insulin of any type would lower blood glucose levels still further and cause dangerous hypoglycemia.

Question 12

If someone using intensive insulin therapy with multiple injections daily wanted to celebrate his or her birthday and enjoy a slice of birthday cake,he or she would

Accepted Answer

Intensive insulin therapy allows for unexpected meals and snacks by adding a dose of short- or rapid-acting insulin.Intermediate- or long-acting insulin would not act quickly enough to normalize blood glucose levels.An extra aerobic workout may help decrease blood glucose levels,but it could produce dangerous ketosis if blood glucose levels are too high.The patient may choose to slightly decrease food intake at other meals to offset the extra energy intake,but any major decrease in food intake at other meals could cause hypoglycemia,and eating the cake afterwards would cause hyperglycemia.

Question 13

If a patient with type 2 diabetes wants to lose weight,the preferred choice of medication would be

Accepted Answer

Metformin does not result in weight gain and may even result in weight loss because it decreases intestinal glucose absorption and improves insulin sensitivity.Insulin tends to cause weight gain because it lowers blood glucose levels by increasing storage as fat.Sulfonylureas tend to promote weight gain because they cause stimulate insulin secretion,and thiazolidinediones tend to promote weight gain because they cause improve insulin sensitivity.

Question 14

The best strategy for a patient with type 2 diabetes to use to maintain good metabolic control is to

Accepted Answer

Patients with type 2 diabetes are most likely to maintain good metabolic control if they space their meals evenly throughout the day.Avoiding all sources of simple carbohydrates does not address other dietary excesses of kilocalories,fat,and complex carbohydrate.Avoiding eating during the evening and at night may help control kilocalorie intake but would not help control blood glucose levels.Eating one large meal and two small meals each day would result in uneven metabolic control.

Question 15

A young man with type 1 diabetes runs 3 miles,falls asleep on the sofa,and forgets to eat his next meal.He is likely to experience

Accepted Answer

A young man who exercises and forgets to eat his next meal is likely to experience hypoglycemia because he used up his available blood glucose and glycogen stores while exercising but still has exogenous insulin in his bloodstream.Hyperglycemia would occur if he ate extra carbohydrate without using extra insulin.Diabetic ketoacidosis would occur if he omitted insulin doses.Nephropathy is a long-term complication of diabetes mellitus.

Question 16

If a patient with type 1 diabetes is unable to maintain good blood glucose control through insulin injections,the physician may recommend

Accepted Answer

An insulin pump is likely to result in better blood glucose management.Oral hypoglycemic agents cannot be used to treat type 1 diabetes.More frequent self-monitoring of blood glucose and daily exercise may be helpful but are not as beneficial as an insulin pump.A daily exercise routine has definite health benefits,especially for patients with diabetes,but it would not necessarily help normalize blood glucose level.

Question 17

To prevent hypoglycemia after exercise,patients with type 1 diabetes should

Accepted Answer

To prevent hypoglycemia after exercise,patients with type 1 diabetes should increase their intake of carbohydrate-based foods.Decreasing or omitting an insulin dose would essentially starve cells and could be dangerous.Increasing intake of protein-based foods would not prevent a decrease in blood glucose level as effectively as would carbohydrate-based foods.

Question 18

In a patient with type 2 diabetes,a glycosylated hemoglobin (HgbA₁c)level of 7.9% would be considered

Accepted Answer

For individuals with type 2 diabetes mellitus,glycosylated hemoglobin levels should be less than 7%;7.9% indicates poor blood glucose control.Prediabetes would be diagnosed if a previously undiagnosed client had an HgbA₁c level of 5.7% to 6.4%.A "too low" level of HgbA₁c has not been identified.

Question 19

The two strongest risk factors for type 2 diabetes are

Accepted Answer

The two strongest risk factors for type 2 diabetes are obesity and family history.Upper body obesity and sedentary lifestyle may also contribute to the risk for the disease.Male gender,preference for sweet foods,recurrent viral infections,and stress are not risk factors for type 2 diabetes.

Question 20

If members of an overweight family wants to reduce their risk for type 2 diabetes,the most helpful nutritional change they could make would be to

Accepted Answer

The best way to prevent development of type 2 diabetes is to attain a normal body weight;decreasing portion sizes would help decrease energy intake,resulting in weight loss.Increasing intake of dietary fiber would be of some benefit in increasing satiety;high-fiber foods generally tend to be lower in fat and energy,and so increasing their intake may be of some benefit,but it is possible to increase fiber intake without decreasing energy intake.High sugar intake does not cause type 2 diabetes,unless it causes weight gain.Switching to a vegetarian pattern of eating may not be beneficial and could even cause further weight gain if the diet includes a lot of eggs and cheese;a vegan eating pattern would probably help with weight loss and decrease risk for type 2 diabetes.

Quiz 15: Nutrition for Diabetes Mellitus