Deck 20: Nutrition and Diabetes Mellitus

Question 1

Weight-loss diets are often prescribed for people with type 2 diabetes.

Answer 1

True

Question 2

Acetone breath is characteristic of hypoglycemia.

Answer 2

False

Question 3

Both the blood and the urine can be checked for the presence of ketones.

Answer 3

True

Question 4

Which of the following are associated with the acute complications of diabetes?

A)hyperglycemia, vomiting, and dehydration
B)vomiting, polyuria, and infections of the urinary tract
C)hyperglycemia, dehydration, and polyuria
D)dehydration, polyuria, and lack of thirst

Question 5

Physical activity has not been shown to aid blood glucose control in people with type 1 diabetes.

Question 6

In people with diabetes, claudication may be due to polyuria.

Question 7

Routine checks for microalbuminuria help to determine whether diabetes is affecting the eyes.

Question 8

Close monitoring of glucose levels is especially important for the pregnant woman with diabetes.

Question 9

If a person does not produce sufficient insulin, he is prone to have:

A)hyperglycemia.
B)poor appetite.
C)low albumin levels.
D)hypoglycemia.

Question 10

Clinical trials have demonstrated that intensive treatment can keep blood glucose levels tightly controlled and reduce the incidence and severity of the chronic complications of diabetes.

Question 11

It is appropriate for clients diagnosed with type 2 diabetes to take oral antidiabetic agents and forego recommended dietary changes.

Question 12

Prediabetes is diagnosed when a person has a fasting blood glucose level that falls between 100 and 125 mg/dL.

Question 13

Chronic complications of diabetes typically affect the blood vessels and the bones.

Question 14

Glycosuria generally occurs when blood glucose exceeds _____ milligrams per deciliter.

A)120
B)140
C)160
D)200

Question 15

The hyperosmolar hyperglycemic syndrome is usually a complication of type 2 diabetes.

Question 16

Excessive urine production is called:

A)polydipsia.
B)polyuria.
C)ketonuria.
D)glycosuria.

Question 17

In severe cases of diabetic ketoacidosis, blood glucose levels can exceed 1000 mg/dL.

Question 18

Obesity alone can cause some degree of insulin resistance.

Question 19

Diabetes mellitus describes a group of metabolic disorders characterized by:

A)elevated blood glucose.
B)low hemoglobin.
C)dumping syndrome.
D)lactose intolerance.

Question 20

The primary defect in type 2 diabetes is autoimmune destruction of the beta cells in the pancreas.

Question 21

The predominant type of diabetes:

A)usually results from an autoimmune disorder.
B)develops most often in people over 40.
C)is called type 1 diabetes.
D)develops as a result of drastic weight loss.

Question 22

A major cause of disability among people with diabetes is:

A)foot amputation.
B)hypertension.
C)hypoglycemia.
D)foot ulcers.

Question 23

Generally, the initial treatment for type 2 diabetes is:

A)diet therapy and exercise.
B)antidiabetic medications.
C)insulin therapy.
D)enzyme replacement therapy.

Question 24

People with diabetes are at increased risk for cardiovascular diseases because they:

A)tend to eat poorly.
B)have an increased tendency for thrombosis and abnormal ventricle function.
C)experience claudication and foot ulcers.
D)are usually unable to participate in any form of physical activity.

Question 25

The risk of developing type 2 diabetes is increased by all of the following except:

A)abdominal obesity.
B)aging.
C)sedentary lifestyle.
D)hypertension.

Question 26

A major cause of death in people with diabetes is:

A)neuropathy.
B)cardiovascular disease.
C)infections.
D)gangrene.

Question 27

Which of the following is the most important goal for both medical and nutrition therapy for diabetes?

A)blood glucose control
B)blood pressure control
C)optimal blood lipid levels
D)prevention of complications

Question 28

Type 2 diabetes often goes undiagnosed in overweight children and teens because:

A)their glucose levels vary with their stage of growth.
B)there are frequently no symptoms.
C)blood glucose tests are not accurate in children and teens.
D)their lifestyles are not conducive to screening for the disease.

Question 29

Intensive insulin therapy can cause:

A)hyperglycemia.
B)a loss of appetite.
C)weight gain.
D)low albumin levels.

Question 30

All of the following are symptoms of diabetes except:

A)polyuria.
B)polyphagia.
C)polydipsia.
D)polyglycosuria.

Question 31

Type 2 diabetes is associated with:

A)autoimmune diseases.
B)insulin resistance.
C)destruction of pancreatic beta cells.
D)viral infection.

Question 32

Hypoglycemia is frequently caused by:

A)overeating.
B)skipping insulin doses.
C)eating too many carbohydrates.
D)poor management of diabetes.

Question 33

Patients diagnosed with diabetes need education in all of the following areas except:

A)meal planning.
B)blood glucose monitoring.
C)physical activity.
D)dialysis.

Question 34

Diabetics are prone to infections due to all of the following except:

A)poor circulation.
B)hyperglycemia.
C)ketosis.
D)weakened immune function.

Question 35

People with type 2 diabetes are prone to:

A)ketosis.
B)weight loss.
C)acidosis.
D)hyperosmolar hyperglycemic syndrome.

Question 36

The first sign of type 1 diabetes is often:

A)ketoacidosis.
B)hypoglycemia.
C)high blood lipids.
D)microalbuminuria.

Question 37

Which of the following is not one of the chronic complications of diabetes?

A)nephropathy
B)neuropathy
C)retinopathy
D)myopathy

Question 38

Good glycemic control requires:

A)eating small amounts of food.
B)restricting carbohydrate in the diet.
C)self-monitoring of blood glucose.
D)frequent visits to the doctor.

Question 39

Diabetic ketoacidosis is characterized by all of the following except:

A)severe ketosis.
B)blood glucose > 250 mg/dL.
C)ketonuria.
D)blood pH > 7.45.

Question 40

A disadvantage of intensive therapy for type 1 diabetes is:

A)a greater risk of severe hypoglycemia.
B)greater expense due to lack of insurance reimbursement.
C)fewer incidences of severe hypoglycemia.
D)more rapid progression of chronic complications.

Question 41

A patient with diabetes is allowed 60 grams of carbohydrate for lunch.This equals _____ portions of carbohydrate foods.

A)2
B)3
C)4
D)5

Question 42

Which insulin has the quickest onset of action?

A)lispro
B)regular
C)lente
D)ultralente

Question 43

A benefit to using the carbohydrate counting method of education over exchange lists is:

A)it is easier to learn.
B)the portion sizes are larger in the carbohydrate counting method.
C)a person doesn't have to restrict their fat intake with the carbohydrate counting method.
D)exchange lists only allow a limited number of foods.

Question 44

A patient's diabetic diet prescription is for 1800 kcalories with 50% of kcalories from carbohydrate.How many portions of carbohydrates is the patient allowed each day?

A)15
B)60
C)12
D)23

Question 45

Of the total kcalories in a diabetic diet, approximately _____% should come from protein.

A)8-10
B)15-20
C)20-25
D)26-30

Question 46

To reduce the saturated fat content of the diabetic diet, all of the following should be emphasized except:

A)nuts and nut butters.
B)legumes.
C)cheese.
D)vegetables.

Question 47

Which insulin has the longest duration of action?

A)lispro
B)regular
C)NPH
D)glargine

Question 48

The mode of action of sulfonylureas is to:

A)stimulate insulin secretion by the pancreas.
B)decrease insulin resistance.
C)improve glucose utilization
D)delay carbohydrate digestion and absorption

Question 49

The diet for diabetes should provide less than _____ milligrams of cholesterol per day.

A)100
B)200
C)300
D)500

Question 50

The frutosamine test is used to determine:

A)average blood glucose over the preceding 120 days.
B)glycemic control for the preceding two weeks.
C)the level of fructose in the blood.
D)the presence of ketones in the blood.

Question 51

Consistent carbohydrate intake:

A)can be varied as the client desires.
B)is important for glycemic control.
C)is only important if a client is overweight.
D)is only important in the treatment of type 1 diabetes.

Question 52

Oral antidiabetic agents work in all of the following ways except:

A)stimulating the pancreas to produce insulin.
B)inhibiting liver production of glucose.
C)delaying carbohydrate digestion and absorption.
D)stimulating the pancreas to produce glucagon.

Question 53

Characteristics of an appropriate diet for diabetes include all of the following except:

A)low in carbohydrate.
B)adequate in fiber.
C)low in saturated fat.
D)moderate in protein.

Question 54

Which food would have the least effect on blood glucose levels?

A)fruit juice
B)whole-grain cereal
C)biscuit
D)vanilla wafer

Question 55

Which of the following statements is true regarding carbohydrate in the diabetic diet?

A)Low-carbohydrate diets are recommended.
B)All concentrated sweets should be avoided.
C)High-fiber, minimally processed carbohydrates should be emphasized.
D)Simple carbohydrates should be emphasized.

Question 56

All of the following foods would be appropriate to include in the diet of a person with diabetes except:

A)dried beans and peas.
B)fruits.
C)whole milk.
D)whole-grain breads.

Question 57

All of the following examples represent one portion of a carbohydrate-containing food except:

A)1 medium apple.
B)1 slice of bread.
C)1 cup cooked pasta.
D)1 small baked potato.

Question 58

The nutrient that has the greatest influence on blood glucose levels is:

A)protein.
B)fat.
C)carbohydrate.
D)calcium.

Question 59

Which of the following glycated hemoglobin values is normal?

A)<6%
B)>6%
C)>7%
D)>8%

Question 60

Which of the following statements best describes the appropriate use of alcohol by individuals with diabetes?

A)It should not be used.
B)It should be used 3-4 times/week only.
C)It should be consumed in moderation with meals.
D)It should be consumed on an empty stomach.

Question 61

Mr.Hummel's BMI indicates he is _____, which likely affects his blood glucose control.

A)underweight
B)at his healthy weight
C)overweight
D)obese

Question 62

Mr.Joiner's blood glucose level meets the criteria for a diagnosis of:

A)type 1 diabetes.
B)type 2 diabetes.
C)prediabetes.
D)ketoacidosis.

Question 63

The simplest and most flexible approach to teaching Mr.Joiner the principles of the diet for optimal management of his blood glucose level is:

A)carbohydrate counting.
B)the exchange lists.
C)MyPlate.
D)a high-protein diet plan.
Use the following case study to answer questions 56-61.
A 60-year-old client, Mr.Hummel, has had type 2 DM for several years.Because of a change in insurance coverage, Mr.Hummel changes doctors and at his first appointment, a comprehensive medical exam and dietary history are performed.At the next few appointments, the certified diabetes educator, a registered dietitian, takes a full dietary history.
Mr)Hummel works part-time in a seasonal sporting goods store, having retired last year from 35 years working for a manufacturing plant as a supervisor.He is married to a nurse who works full-time.He does most of the cooking and grocery shopping.He and his wife go for walks on weekends, but he does not exercise otherwise, except for doing chores around the house and occasional yard work or gardening.He is 5'9" tall and weighs 200 lbs., though when his diabetes was initially diagnosed, he weighed more.
Mr)Hummel is interested in weight reduction, especially if it will help him manage his blood glucose, and provides the following 24-hour food recall that typifies how he usually eats:
Breakfast (eats after taking morning blood glucose): Pancakes with diet syrup or a bowl of cereal (usually corn flakes, Chex, or instant oatmeal) with Sweet 'N' Low and nonfat milk.Drinks coffee throughout the day starting at breakfast with 2 nondairy coffee creamer packets per cup.May or may not have 4 oz.of 100% fruit juice depending on hunger.
Lunch (eats after taking afternoon blood glucose): Sandwich (rye or wheat bread), deck of cards-size portion of lunch meat (salami, ham, bologna, turkey, or chicken) with thinly spread mayonnaise; coffee with nondairy creamers.May or may not eat a can of soup (cream of tomato, cream of chicken, or Italian wedding soup) instead of a sandwich, with two slices of buttered rye or wheat bread.
Afternoon Snack: Canned fruit or occasionally a cookie, doughnut, a piece of pizza, or a treat, depending on availability, hunger, blood sugar, and situation.Drinks coffee with nondairy coffee creamer.Usually also has a glass of ice water before dinner.
Dinner (eats after taking evening blood glucose): Roast beef, meat loaf, steak, or another red meat; occasionally eats poultry or fish-approximate amount 8 oz.; plain baked potato, au gratin potatoes, or boiled buttered potatoes; a salad with bottled salad dressing or a vegetable, such as canned green beans; and a slice of rye or wheat bread with butter.May use ketchup, steak sauce, salt, and pepper.Drinks water with dinner.
Evening Snack: Varies-may eat a few handfuls of a bagged snack food, such as Doritos; a bag of buttered microwave popcorn; or cookies.
Labs are as follows:
$\bullet$ Fasting glucose: 140-150 mg/dL
$\bullet$ Glucose one to two hours after mealtime: 200 mg/dL
$\bullet$ Average bedtime glucose: 152 mg/dL
$\bullet$ Glycosylated hemoglobin (hemoglobin A_1C): 7.5%

Question 64

Based on the above glucose values, select the true statement about the client's blood glucose.

A)His glycemic control has been reasonable for a person with type 2 diabetes.
B)His fasting glucose has been high, but his post-meal and bedtime glucose have been acceptable.
C)His fasting glucose, post-meal glucose, and bedtime glucose all are too high.
D)His fasting glucose and post-meal glucose have been high, but his bedtime glucose has been acceptable.

Question 65

Which of the following recommendations to help Mr.Joiner reduce his risk of developing diabetes is least likely to be effective?

A)"Lose weight."
B)"Increase your physical activity."
C)"Choose higher-fiber, lower-fat foods at restaurants."
D)"Learn to cook."

Question 66

How many of his risk factors for type 2 diabetes can Mr.Joiner control?

A)1
B)2
C)3
D)4

Question 67

Metabolic syndrome consists of a cluster of disorders that increase the risk of developing:

A)diabetes.
B)cardiovascular disease.
C)gout.
D)renal failure.

Question 68

How many risk factors does Mr.Joiner have for type 2 diabetes?

A)2
B)3
C)4
D)5

Question 69

Which of the following is a central feature of diabetes management because of its beneficial effects on glycemic control and CVD risk factors?

A)physical activity
B)a low-fat diet
C)the glycemic index
D)a low-sodium diet

Question 70

Those taking _____ should avoid excessive alcohol intake because it may interact with these drugs to cause lactic acidosis.

A)alpha-glucosidase inhibitors
B)sulfonylureas
C)thiazolidinediones
D)biguanides

Question 71

The CDE teaches Mr.Hummel how to reduce his kcalories by increasing high-fiber foods in place of foods such as bagged snack chips.A higher intake of fiber could also:

A)increase his glycemic control.
B)increase the glycemic index of his diet.
C)increase his glycosylated hemoglobin.
D)increase his blood glucose.

Question 72

Diet therapy for a pregnant type 1 diabetic includes all of the following except:

A)decreased kcalories to aid in blood glucose control.
B)regular meals and snacks.
C)an evening snack.
D)monitoring of insulin therapy.

Question 73

Though the exact cause of metabolic syndrome is unknown, it is believed to be associated with:

A)poverty.
B)obesity.
C)hypoglycemia.
D)liver disease.

Question 74

Which group of symptoms is characteristic of the metabolic syndrome?

A)insulin resistance, abdominal obesity, reduced HDL cholesterol levels
B)hypertension, hypoglycemia, abdominal obesity
C)elevated liver enzymes, insulin resistance, microalbuminuria
D)polyuria, polydipsia, polyphagia

Question 75

Which macronutrient distribution is appropriate for Mr.Hummel's daily diet?

A)20-35% kcalories from total fat
B)20-35% kcalories from saturated fat
C)0% kcalories from refined carbohydrate
D)25% kcalories from protein, 7% kcalories from total fat

Question 76

Individuals with hypertriglyceridemia should reduce their intake of:

A)desserts.
B)fruit.
C)fatty fish.
D)nuts.

Question 77

Mr.Hummel had been taking oral hypoglycemic agents for 3 months prior to this visit.Based on his _____ measurement, his glycemic control over this period needed improvement.

A)glycemic index
B)hemoglobin A_1C
C)weight
D)fasting glucose

Question 78

Which of the following may help to reduce Mr.Hummel's blood glucose?

A)daily physical activity
B)eating the same amount of carbohydrate daily
C)lower kcalorie intake
D)all of the above

Question 79

Women with gestational diabetes who are overweight or obese should be encouraged to:

A)engage in strenuous exercise.
B)severely restrict carbohydrate intake.
C)adjust energy intake as needed.
D)limit protein intake.
Use the following case study to answer questions 50-55.
Jared Joiner is a 56-year-old African American insurance agent.He is single, eats most meals at restaurants, and leads a sedentary lifestyle.He is 5'9" tall and weighs 204 pounds.Mr.Joiner has been feeling particularly fatigued lately and decided to make an appointment with his physician for a check-up.The results of his laboratory tests include a fasting blood glucose level of 121 mg/dL.

Question 80

Four months later Mr.Joiner returns to his physician for a follow-up appointment.He has lost 10 pounds, but his fasting blood glucose level is now 131 mg/dL.Mr.Joiner's prediabetes has progressed to:

A)type 1 diabetes.
B)type 2 diabetes.
C)gestational diabetes.
D)hyperosmolar hyperglycemic syndrome.