Chapter 19

Question 0

​2.​Long-term complications of diabetes mellitus include

a. arthritis, rheumatism, and osteoporosis.
b. retinopathy, nephropathy, and neuropathy.
c. impaired immunity and opportunistic infections.
d. dermatitis, nephrotic syndrome, and detached retina.

Answer 0

ANS:​B
Long-term complications of diabetes mellitus include retinopathy, nephropathy, and neuropathy. Diabetes mellitus can increase risk and severity of infection indirectly due to poor circulation and high blood glucose levels, but immunity is not impaired. Arthritis, rheumatism, osteoporosis, dermatitis, nephritic syndrome, and detached retina are not associated with diabetes.

Question 1

​1.​A person is diagnosed as having diabetes mellitus if his or her fasting blood glucose level on two occasions is greater than _____ mg/dL.

a. 90
b. 120
c. 126
d. 156

ANS:​

Answer 1

ANS:​C

Diabetes mellitus is diagnosed as fasting blood glucose level >126 mg/dL on two occasions.

Question 2

​3.​The type of diabetes therapy that seems to be most effective in decreasing and delaying the complications of diabetes is

a. psychotherapy.
b. intensive therapy.
c. combined therapy.
d. conventional therapy.

Answer 2

ANS:​B
Intensive therapy is most effective in decreasing and delaying the complications of diabetes because it allows better control of blood glucose levels. Psychotherapy may help patients cope with psychological concerns about their disease, but will not delay complications. Conventional therapy may help prevent complications if blood glucose levels are well controlled, but this is less likely than with intensive therapy. Combined therapy is not a recognized term.

Question 3

​4.​The three main symptoms of untreated type 1 diabetes mellitus are

a. polyphagia, polyuria, and polydipsia.
b. neuropathy, nephropathy, and retinopathy.
c. confusion, loss of coordination, and headaches.
d. fatigue, loss of appetite, and frequent infections.

Answer 3

ANS:​A
Polyphagia, polyuria, and polydipsia are hallmarks of untreated type 1 diabetes mellitus. Neuropathy, nephropathy, and retinopathy are long-term complications associated with diabetes mellitus. Confusion, loss of coordination, headaches, fatigue, and loss of appetite are not associated with diabetes mellitus. Patients with diabetes may be more susceptible to infection and make take longer to heal if their blood glucose levels are elevated and if they have impaired circulation.

Question 4

​5.​The cause of type 1 diabetes mellitus is

a. excessive intake of simple sugars.
b. destruction of pancreatic beta cells.
c. inability of cells to respond to insulin in the bloodstream.
d. inability of the pancreas to keep up with the body’s demands for insulin.

Answer 4

ANS:​B
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 5

​6.​The two strongest risk factors for type 2 diabetes are

a. obesity and family history.
b. recurrent viral infections and stress.
c. male gender and upper body obesity.
d. preference for sweet foods and sedentary lifestyle.

Answer 5

ANS:​A
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 disease. Male gender, preference for sweet foods, recurrent viral infections, and stress are not risk factors for type 2 diabetes.

Question 6

​7.​In individuals with type 2 diabetes, insulin production is generally

a. absent.
b. normal.
c. decreased.
d. increased.

Answer 6

ANS:​D
Insulin production is generally increased in individuals with type 2 diabetes. The body produces more insulin in an attempt to lower elevated blood glucose levels, but the insulin is not effective because the cells fail to respond to the insulin.

Question 7

​8.​Type 2 diabetes is becoming more prevalent in children, largely because of

a. increased intakes of refined sugar.
b. increased awareness and diagnosis.
c. the increasing prevalence of overweight children.
d. inheritance of a dominant gene that causes the disease.

Answer 7

ANS:​C
Type 2 diabetes is becoming more prevalent in children because of the increasing prevalence of overweight children. This is related to decreased activity levels and increased intake of kcals in general, not just from refined sugar. Increased awareness and diagnosis may account for a small portion of the increase in prevalence, but this is not the major cause. There is no specific dominant gene that causes type 2 diabetes in children.

Question 8

​9.​For individuals with diabetes mellitus, glycosylated hemoglobin (HgbA1c) levels should be less than

a. 6%.
b. 7%.
c. 8%.
d. 10%.

Answer 8

ANS:​B
For individuals with diabetes mellitus, glycosylated hemoglobin levels should be less than 7%. This indicates overall maintenance of acceptable blood glucose levels.

Question 9

​10.​The ethnic group that has the lowest prevalence of type 2 diabetes mellitus is

a. Native Americans.
b. African Americans.
c. Hispanic Americans.
d. non-Hispanic whites.

Answer 9

ANS:​D
Prevalence of type 2 diabetes mellitus is lowest among non-Hispanic whites. Native Americans, African Americans, Hispanic Americans all have a relatively high prevalence of type 2 diabetes mellitus.

Question 10

​11.​Exogenous insulin is a required part of treatment for all individuals with

a. type 1 diabetes mellitus.
b. type 2 diabetes mellitus.
c. gestational diabetes.
d. impaired glucose tolerance.

Answer 10

ANS:​A
All individuals with type 1 diabetes mellitus require treatment with exogenous insulin. Many individuals with type 2 diabetes are treated with diet and exercise or diet, exercise, and oral hypoglycemic medications; only the most severe cases require exogenous insulin. Insulin is sometimes, but not always, prescribed for individuals with gestational diabetes. Impaired glucose tolerance is treated with diet and exercise only.

Question 11

​12.​The main difference between the different types of exogenous insulin is

a. their shelf life.
b. the concentration of the preparation.
c. the type of solvent used to carry the insulin.
d. the length of time they take to act in the body.

Answer 11

ANS:​D
The main difference between the different types of exogenous insulin is the length of time they take to act in the body. Their shelf life, concentration, and type of solvent are standard for all types of insulin.

Question 12

​13.​Sulfonylureas and meglitinides decrease blood glucose levels by

a. stimulating insulin secretion.
b. slowing the rate of absorption of glucose.
c. providing an exogenous source of insulin.
d. improving insulin sensitivity.

Answer 12

ANS:​A
Sulfonylureas and meglitinides decrease blood glucose levels by stimulating insulin secretion. Alpha-glucosidase inhibitors and biguanides slow the rate of absorption of glucose. No oral drugs provide an exogenous source of insulin. Biguanides and thiazolidinediones improve insulin sensitivity.

Question 13

​14.​Patients with diabetes mellitus should exercise at times when their blood glucose level is _____ mg/dL.

a. between 90 and 110
b. between 100 and 160
c. between 100 and 200
d. less than 250

Answer 13

ANS:​C

Ideally, patients with diabetes mellitus should exercise when their blood glucose level is between 100 and 200 mg/dL.

Question 14

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

a. decrease their insulin dose.
b. omit a scheduled insulin dose.
c. increase their intake of protein-based foods.
d. increase their intake of carbohydrate-based foods.

Answer 14

ANS:​D
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 carbohydrate-based foods.

Question 15

​16.​Patients with type 2 diabetes are most likely to maintain good metabolic control if they

a. avoid all sources of simple carbohydrates.
b. avoid eating during the evening or at night.
c. space their meals evenly throughout the day.
d. eat one large meal and two small meals each day.

Answer 15

ANS:​C
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 kcals, fat, and complex carbohydrate. Avoiding eating during the evening and at night may help control kcal 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 16

​17.​Glycosylated hemoglobin level is used to indicate

a. the effect of meals on blood glucose level.
b. day-to-day variations in blood glucose level.
c. iron deficiency anemia in patients with diabetes.
d. overall blood glucose control over several weeks.

Answer 16

ANS:​D
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 using 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 by measuring total hemoglobin level in patients with and without diabetes.

Question 17

​18.​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

a. nephropathy.
b. hypoglycemia.
c. hyperglycemia.
d. diabetic ketoacidosis.

Answer 17

ANS:​B
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 18

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

a. hypoglycemia.
b. a normal blood glucose level.
c. hyperglycemia.
d. impaired glucose tolerance.

Answer 18

ANS:​A
Hypoglycemia occurs when blood glucose level falls below 50 mg/dL; therefore 40 mg/dL is hypoglycemia. Normal blood glucose levels are about 80 to 100 mg/dL, although levels may increase to 140 mg/dL after meals. Blood glucose levels above 180 mg/dL would be considered hyperglycemia. Impaired glucose tolerance is diagnosed when fasting blood glucose levels are >100 mg/dL but <126 mg/dL.

Question 19

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

a. gets caught in traffic and misses a meal.
b. participates in an all-day sporting event.
c. accidentally takes a double dose of insulin.
d. goes away for the weekend and forgets to take his or her insulin.

Answer 19

ANS:​D
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. Accidentally taking a double dose of insulin would cause hypoglycemia.

Question 20

​21.​Ketones accumulate in the blood during diabetic ketoacidosis because of increased metabolism of _____ and decreased metabolism of _____.

a. fatty acids; glucose
b. glucose; fatty acids
c. amino acids; glucose
d. glucose; amino acids

Answer 20

ANS:​A
Ketosis occurs because of an abnormal accumulation of ketones caused by metabolism of fatty acids for energy with decreased metabolism of glucose due to lack of insulin. Amino acid metabolism is not generally involved in diabetic ketoacidosis.

Question 21

​22.​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 their breath, they may have

a. hepatic encephalopathy.
b. diabetic ketoacidosis (DKA).
c. hyperglycemic hyperosmolar nonketotic syndrome (HHNS).
d. hypoglycemia.

Answer 21

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

Question 22

​23.​If a young man with type 1 diabetes wants to eat cake for dessert after a meal of roast chicken, mashed potatoes, gravy, green beans, and dinner rolls, he should eat less

a. potatoes and/or rolls.
b. chicken and gravy.
c. green beans.
d. of everything.

Answer 22

ANS:​A
Foods containing sucrose (such as cake or other desserts) should be substituted for other carbohydrate foods in the meal plan, so he should eat less potatoes and/or rolls. Chicken, gravy, and green beans are low in carbohydrate so he does not need to eat less if he wants to eat dessert.

Question 23

​24.​Patients with type 1 diabetes should be taught to regulate the _____ meal and snacks.

a. kcal content of
b. total amount of sugars in
c. total amount of dietary fiber in
d. total amount of carbohydrates in

Answer 23

ANS:​D
Patients with type 1 diabetes should learn to regulate the total amount of carbohydrates in meals and snacks. The overall kcal content and amount of dietary fiber are less important. The amount of sugar is important only as it contributes to total carbohydrate.

Question 24

​25.​An example of a good after-workout snack for someone with type 1 diabetes is

a. skim milk.
b. beef jerky.
c. string cheese.
d. peanuts.

Answer 24

ANS:​A
A good after-workout snack for someone with type 1 diabetes is a glass of milk. Beef jerky and string cheese do not provide carbohydrate. Peanuts provide some carbohydrate, but not enough to restore blood glucose levels after a workout. Milk provides carbohydrate in the form of lactose.

Question 25

​26.​Sugar alcohols appear to be safe for use as sweetening agents, but their use may

a. cause diarrhea.
b. result in weight gain.
c. have adverse effects on plasma lipid levels.
d. displace more nutrient-dense foods in the diet.

Answer 25

ANS:​A
Use of sugar alcohols may cause diarrhea when used in large amounts. They contain fewer kcals than other forms of carbohydrate and so are less likely to result in weight gain. They do not affect plasma lipid levels and do not necessarily displace more nutrient-dense foods in the diet.

Question 26

​27.​To facilitate compliance, the prescribed meal plan for patients with diabetes mellitus should

a. include some favorite foods each week.
b. be based on the patient’s usual eating habits.
c. be tailored to achieve individual weight-loss goals.
d. include meals and snacks eaten at the same time each day.

Answer 26

ANS:​B
To facilitate compliance, patient meal plans should be based on their usual eating habits. Including some favorite foods each week may improve quality of life, achieving weight-loss goals may minimize the effects of the disease, and including meals and snacks at the same time each day may improve glycemic control, but these measures would not have so much effect on compliance.

Question 27

​28.​If a young woman with type 1 diabetes mellitus is in a car accident and breaks several bones, she is likely to need

a. less insulin than usual.
b. more insulin than usual.
c. a different type of insulin.
d. the same amount of insulin.

Answer 27

ANS:​B
Serious injury increases insulin requirements because of increased hepatic glucose production caused by the release of epinephrine, norepinephrine, glucagon, and cortisol.

Question 28

​29.​Patients with type 1 diabetes mellitus who are sick and unable to eat regular food should consume

a. parenteral nutrition support.
b. commercial liquid nutrition supplements.
c. liquid, semiliquid, or soft sources of carbohydrates.
d. noncaloric fluids only to minimize the increase in blood glucose level.

Answer 28

ANS:​C
Patients with type 1 diabetes mellitus who are sick and unable to eat regular food should consume liquid, semiliquid, or soft sources of carbohydrates to maintain their blood glucose level. Parenteral nutrition support is not usually necessary, unless the patient has severe vomiting. Commercial liquid nutrition supplements are not needed. Noncaloric fluids would prevent dehydration but would not provide carbohydrate to maintain their blood glucose level.

Question 29

​30.​Eating plans for patients with diabetes mellitus and gastroparesis should include

a. six small meals daily.
b. three regular meals daily.
c. high protein intake.
d. increased fluid intake.

Answer 29

ANS:​A
For patients with gastroparesis, six small meals daily are better tolerated than three regular meals daily. Patients with gastroparesis do not have increased needs for protein and fluid.

Question 30

​31.​Control of maternal blood glucose levels is important during pregnancy to protect the infant from development of

a. obesity.
b. macrosomia.
c. type 1 diabetes mellitus.
d. pancreatic insufficiency.

Answer 30

ANS:​B
It is important to control maternal blood glucose levels during pregnancy to prevent macrosomia in the infant. The infant may have higher fat stores than normal; this is called macrosomia rather than obesity. Increased maternal blood glucose levels do not cause type 1 diabetes mellitus or pancreatic insufficiency in the infant.

Question 31

​32.​For women with type 1 diabetes, good metabolic control is especially important at the time of conception and during the first trimester to prevent

a. macrosomia.
b. fetal malformations.
c. nutrient deficiencies.
d. excessive weight gain.

Answer 31

ANS:​B
In women with type 1 diabetes, good metabolic control at the time of conception and during the first trimester helps prevent fetal malformations. Macrosomia is related to hyperglycemia in the second and third trimesters. Metabolic control does not affect nutrient deficiencies. Excessive weight gain may exacerbate poor metabolic control, but poor metabolic control does not usually cause weight gain.

Question 32

​33.​Most children who develop type 2 diabetes are treated using diet, exercise, and

a. family therapy.
b. exogenous insulin.
c. behavior modification.
d. oral hypoglycemic agents.

Answer 32

ANS:​D
Most children who develop type 2 diabetes require oral hypoglycemic agents in addition to diet and exercise to achieve metabolic control. Exogenous insulin is used less often. Family therapy may help the family learn healthier coping mechanisms. Behavior modification may help patients adopt healthier food and exercise habits.