Question 1

Which insulin peaks in activity 2 to 3 hours after injection?&#10;A) Lispro (Humalog)&#10;B) Detemir (Levemir)&#10;C) NPH&#10;D) Regular

Accepted Answer

Regular insulin is short-acting insulin that peaks within 2 to 3 hours of injection. Lispro is rapid-acting insulin that peaks within 1 to 2 hours. NPH is intermediate-acting insulin that peaks between 4 and 10 hours after injection. Detemir is long-acting insulin that stays in the blood system from 18 to 24 hours without a "peak" time of activity. Patients receiving detemir should be monitored 10 to 12 hours after injection for effects of the insulin.

Question 2

In the Diabetes Control and Complications Trial (DCCT), which of the following was demonstrated?&#10;A) Strict control of protein intake, particularly animal protein, improves glucose control.&#10;B) Minimizing the number of meals and snacks per day decreases hyperglycemic episodes.&#10;C) Strict control of carbohydrate intake, particularly simple sugars, improves glucose control.&#10;D) Strict control of blood glucose reduces long-term complications of diabetes.

Accepted Answer

In the DCCT, subjects with type 1 diabetes mellitus were provided with either intensive treatment involving multiple insulin injections daily or conventional treatment with only one or two insulin injections daily. The subjects who monitored their blood glucose and used intensive insulin therapy experienced a 50% to 75% reduction in the risk progression of retinopathy, nephropathy, and neuropathy. The trial did include prescribed meal plans but did not evaluate the effect of macronutrient content or number of meals on glucose control.

Question 3

Which of the following is NOT a microvascular disease associated with hyperglycemic patients?&#10;A) Retinopathy&#10;B) Neuropathy&#10;C) Nephropathy&#10;D) Peripheral vascular disease

Accepted Answer

Microvascular diseases are ones that affect smaller blood vessels and nerves. Retinopathy, neuropathy, and nephropathy have been the three primary microvascular diseases that develop from uncontrolled diabetes mellitus. Peripheral vascular disease is classified as a macrovascular disease because it involves larger blood vessels.

Question 4

What must a patient demonstrate to be a candidate for use of oral glucose-lowering medications?&#10;A) Functioning alpha-cells in the pancreas&#10;B) Functioning beta-cells in the pancreas&#10;C) Functioning gastrointestinal mucosa&#10;D) Resistance to insulin at all times

Accepted Answer

Oral glucose-lowering medications may be used in the treatment of patients with type 2 DM; therefore, the patient has to have beta-cell function for the production of insulin. The mechanisms of action for the oral glucose-lowering medications include the stimulation of pancreatic insulin secretion. Other mechanisms of action include reducing insulin resistance at muscle and adipose tissue and decreasing hepatic glucose output.

Question 5

What condition occurs when rebound hyperglycemia follows an episode of hypoglycemia?&#10;A) Somogyi effect&#10;B) Cushing syndrome&#10;C) Dawn phenomenon&#10;D) Hyperglycemic hyperosmolar state

Accepted Answer

The Somogyi effect may be caused by excessive exogenous insulin administration. In response to the hypoglycemia that results, the counterregulatory hormones are secreted to promote gluconeogenesis. This results in an increase in blood glucose levels. Cushing syndrome is a rare condition involving the excessive secretion of cortisol. The dawn phenomenon involves an increase in morning blood glucose because of an increased need for insulin. The hyperglycemic hyperosmolar state is a complication in older adults with diabetes. In this condition, the patient has a very high blood glucose level but no ketones.

Question 6

What should the person with type 1 DM do when planning to exercise?&#10;A) Strictly adhere to dietary restrictions.&#10;B) Decrease insulin dosage dependence on duration and intensity of exercise.&#10;C) Plan to exercise when the insulin is peaking.&#10;D) Take an extra injection of insulin.

Accepted Answer

Decreasing the amount of insulin injected is necessary to prevent hypoglycemia that can occur during exercise. Prolonged or intensive exercise may require a modest decrease of 1 to 2 U of rapid- and short-acting insulin before and possibly after exercise. As an alternative, the person with type 1 DM may ingest carbohydrate before or after exercise to prevent hypoglycemia. Exercising at the time of insulin peak action and providing extra insulin can increase the likelihood of hypoglycemia.

Question 7

Which of the following is one of the ADA's MNT goals for all people with diabetes?&#10;A) Promote weight loss.&#10;B) Achieve blood glucose control.&#10;C) Limit dietary cholesterol.&#10;D) Limit intake of simple carbohydrates.

Accepted Answer

The first MNT goal for all people with diabetes is to achieve and maintain normal blood glucose levels and lipid and lipoprotein profiles and blood pressure levels that reduce the risk for vascular disease. The other MNT goals include preventing or slowing the progression of chronic complications of diabetes mellitus, addressing the individual's nutritional needs, and limiting food choices only based on evidence while maintaining the pleasure of eating. Diabetes may affect children and pregnant women, and weight loss is not important to maintaining health in these population groups. Diabetes is associated with CVD risk and MNT but dietary cholesterol is no longer restricted for CVD prevention. Research evidence does not substantiate a recommendation to limit simple carbohydrate intake in the treatment of diabetes.

Question 8

What is the recommendation for self-monitoring of blood glucose?&#10;A) Every morning and every night before bed&#10;B) When there is a change in activity level or diet&#10;C) Four or more times daily for type 1 DM and one to four times for type 2 DM&#10;D) At least eight times a day for type 1 DM

Accepted Answer

Patients with type 1 DM should perform SMBG four times or more daily, including before each meal and at bedtime. Patients with type 2 DM should perform SMBG one to four times daily to help in achieving glucose goals. Whenever they add to or modify their therapies, patients with either DM should test more often.

Question 9

What does insulin promote in regard to the metabolism of lipids?&#10;A) Lipolysis in the liver&#10;B) An increase in serum free fatty acids&#10;C) Lipogenesis in the liver&#10;D) The breakdown of fat stores in adipose tissue

Accepted Answer

In regard to lipids, insulin stimulates the conversion of pyruvate to fatty acids in the liver as part of the process of lipogenesis. Insulin's anticatabolic activities in relation to lipids include the inhibition of lipolysis and the prevention of excessive ketone production. Insulin's transport activity includes the activation of lipoprotein lipase to facilitate the transport of triglycerides into adipose tissue.

Question 10

Screening for gestational diabetes should occur&#10;A) when assessment of pregnancy is first established.&#10;B) at 24 to 28 weeks' gestation.&#10;C) 38 to 40 weeks after conception.&#10;D) by the end of the first trimester.

Accepted Answer

The need for insulin increases during the second and third trimesters of pregnancy because these are the periods during which much of the growth of tissue in both the mother and fetus occurs. Screening for GDM occurs between 24 and 28 weeks' gestation to monitor the maternal insulin response. Toward the end of pregnancy, 38 to 40 weeks, insulin needs and levels peak at two to three times the prepregnancy levels.

Question 11

Which of the following contributes to the development of type 1 DM?&#10;A) Autoantibodies that contribute to the destruction of beta-cells&#10;B) Insulin resistance and beta-cell failure&#10;C) Increase in insulin-antagonist hormone levels&#10;D) Diet and sedentary lifestyle

Accepted Answer

The answer of Which of the following contributes to the...

Question 12

Which of the following statements about glycemic index (GI) is TRUE?&#10;A) Consuming low-GI meals (<70) improves overall glycemic control.&#10;B) Specific carbohydrate foods can have a variable GI.&#10;C) When compared with an equal amount of starch, sucrose promotes a greater glycemic response.&#10;D) The GI of glucose is lower than the GI of white bread.

Accepted Answer

The answer of Which of the following statements about glycemic...

Question 13

__________ is NOT a symptom of type 1 DM.&#10;A) Hyperglycemia&#10;B) Loss of thirst sensation&#10;C) Weight loss&#10;D) Polydipsia

Accepted Answer

The answer of __________ is NOT a symptom of type...

Question 14

If a patient with type 2 DM receives a nutrition prescription for a 2000-kcal diet, which of the following should be used?&#10;A) 50% carbohydrate, 20% protein, 30% fat&#10;B) 40% carbohydrate, 30% protein, 30% fat&#10;C) 20% carbohydrate, 40% protein, 40% fat&#10;D) A macronutrient distribution individualized based on the patient's metabolic profile

Accepted Answer

The answer of If a patient with type 2 DM...

Question 15

Which of the following is NOT a potential acute complication of type 1 DM?&#10;A) Hypoglycemia&#10;B) Hyperglycemia&#10;C) Ketoacidosis&#10;D) Blood vessel damage

Accepted Answer

The answer of Which of the following is NOT a...

Question 16

How do sulfonylureas and meglitinides help to lower blood glucose levels?&#10;A) Promoting beta-cell secretion of insulin&#10;B) Decreasing the insulin sensitivity of the receptor cell&#10;C) Increasing glucose formation from liver glycogen&#10;D) Decreasing deamination of protein

Accepted Answer

The answer of How do sulfonylureas and meglitinides help to...

Question 17

Which of the following criteria is NOT appropriate for the diagnosis of diabetes mellitus? A) Fasting plasma glucose of greater than 126 mg/dl B) HbA_1c of greater than 7.0% C) Postload (2 hour) plasma glucose of 200 mg/dl or greater D) All of the above

Accepted Answer

The answer of Which of the following criteria is NOT...

Question 18

Which of the following would NOT result in postprandial (reactive) hypoglycemia?&#10;A) Rapid glucose absorption&#10;B) Excessive insulin secretion&#10;C) Insufficient glucagon secretion&#10;D) Excessive hepatic gluconeogenesis

Accepted Answer

The answer of Which of the following would NOT result...

Question 19

Which of the following is NOT true about amylin?&#10;A) It is a glucoregulatory hormone.&#10;B) It is produced in pancreatic beta-cells.&#10;C) It counteracts the effects of insulin.&#10;D) Deficiency is associated with TIDM.

Accepted Answer

The answer of Which of the following is NOT true...

Deck 30: Medical Nutrition Therapy for Diabetes Mellitus and Hypoglycemia of Nondiabetic Origin