Question 1

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 2

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

Immune-mediated diabetes mellitus (DM) is the form of type 1 DM that results from autoimmune destruction of the pancreatic beta cells.This results in the patient's inability to produce insulin.Idiopathic type 1 DM is the other form, and it is DM that has no known etiology.Insulin resistance and beta cell failure are what lead to the development of type 2 DM.Diet and sedentary lifestyle can contribute to this development.Gestational diabetes mellitus develops because of an increase in the release of insulin-antagonist hormones during pregnancy.These increased hormone levels contribute to an insulin resistance in the pregnant woman.

Question 3

HbA&#8321;c represents the&#10;A)glycosylation or glycation of serum proteins.&#10;B)glycosylation or glycation of hemoglobin in red blood cells.&#10;C)glycosylation or glycation of serum-free hemoglobin.&#10;D)formation of hemoglobin-cholesterol linkage in blood.

Accepted Answer

Glycosylation of hemoglobin is a long-term measure of glucose control.When hemoglobin and other proteins are exposed to glucose, the glucose becomes attached to the protein.The amount of glycosylation that occurs depends on the concentration of glucose in the blood.For every 30-mg/dL increase in plasma glucose concentration, an additional 1% of hemoglobin becomes glycosylated.

Question 4

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 difficulty of working with the GI concept is that the GI of an individual food may vary.This is part of the reason that the ADA has not fully adopted GI and glycemic load as approaches to meal planning.Low-GI foods are those with a GI less than 55.Selection of low-GI foods may help in fine tuning postprandial glycemic response, but research presents inconsistent results in relation to overall glycemic control.Equal amounts of starch and sucrose result in identical glycemic responses.The GI of glucose is 100.The GI of white bread is 70.

Question 5

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

Before 1994, the American Diabetes Association (ADA) attempted to define optimal percentages of macronutrients for control of metabolic complications of diabetes.However, since then, the ADA's focus has been on individualizing nutrition care to accommodate the patient's lifestyle, culture, and socioeconomic status.When planning for patient diets, the RD should maintain the acceptable macronutrient distribution ranges (AMDRs) established by the DRIs.

Question 6

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)Prevent diabetes ketoacidosis.&#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 ketoacidosis is an acute complication that can occur in patients with diabetes.Research evidence does not substantiate a recommendation to limit simple carbohydrate intake in the treatment of diabetes.

Question 7

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

Amylin, a glucoregulatory hormone, is also produced in the beta cells of the pancreas and is co-secreted with insulin.It works in concert with insulin to regulate postprandial serum glucose levels and suppresses glucagon secretion.

Question 8

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

Blood vessel damage may be either microvascular or macrovascular in nature; however, this occurs because of long-term exposure of the blood vessels to the physiologic changes that commonly occur with diabetes, such as hyperglycemia, hyperlipidemia, and hypertension.Hypoglycemia, hyperglycemia, and ketoacidosis are acute complications of diabetes mellitus because each of these can occur rapidly in relation to alterations in the patient's lifestyle, health, or use of medications.

Question 9

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 dependent 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 occurring.

Question 10

What condition occurs when rebound hyperglycemia follows an episode of hypoglycemia?&#10;A)Somogyi effect&#10;B)Cushing's 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's 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 11

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

The answer of What must a patient demonstrate to be...

Question 12

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

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

Question 13

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

The answer of What does insulin promote in regard to...

Question 14

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

Accepted Answer

The answer of Which insulin peaks in activity 2 to...

Question 15

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 answer of Screening for gestational diabetes should occur&#10;A)when assessment...

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 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 18

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

The answer of What is the recommendation for self-monitoring of...

Question 19

Which of the following criteria is NOT appropriate for the diagnosis of diabetes mellitus?&#10;A)Fasting plasma glucose of greater than 126 mg/dL&#10;B)HbA1c of greater than 7.0%&#10;C)Postload (2 hour) plasma glucose of 200 mg/dL or greater&#10;D)Symptoms of diabetes and a casual plasma glucose of 200 mg/dL or greater

Accepted Answer

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

Question 20

__________ 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...

Deck 31: Medical Nutrition Therapy for Diabetes Mellitus and Hypoglycemia of Nondiabetic Origin