Nutrition Therapy

Question 1

In people with pre-DM, what percentage of weight loss should be attained to prevent progression to DM2?

Answer 1

7-10%

Question 2

For pt’s with DM2 w/ overweight/obesity, lost at least __% of body weight can be beneficial; however the optimal gaol for benefit is ___% or more

Answer 2

5%; 15%

Question 3

What should trans and saturate fats be replaced with to reduce both cholesterol and LDL?

Answer 3

Unsaturated fats; this also benefits CVD risk

Question 4

What is the recommended sodium intake for a patient with DM2?

Answer 4

Same as the general public; <2300 mg/day

Question 5

What is MNT?

Answer 5

Evidence based application of the Nutrition Care Process provided by a RDN

Question 6

For persons with DM1 or DM2, what is the recommended number of encounters during the first 6 months?

Answer 6

3 to 6; a minimum of 1 annual MNT follow up encounter is also recommended

Question 7

Clinical trials of DM MNT provided by an RDN can improve A1c by __% in DM1 and up to ___% in DM2

Answer 7

1.9%; 2%

Question 8

What is the RDA for CHO for adults w/out DM (19 years and older)

Answer 8

130 g/day

Question 9

What is an insulin to carb ratio?

What kind of insulin is used?

Answer 9

How many grams of CHO are covered or matched with 1 unit of rapid or short acting insulin

Question 10

What is a typical ICR ratio for a normal weight adult?

Answer 10

1:10 (1 unit rapid acting insulin is expected to cover 10 g of CHO)

Question 11

What is an insulin sensitivity factor (ISF)?

Answer 11

The estimated drop in BG expected from the administration of 1 unit of rapid or short acting insulin; related to the pt’s insulin sensitivity and body size

Question 12

What is a typical ISF for a normal weight adult with DM1?

Answer 12

1:40 mg/dL (1 unit of rapid acting insulin expected to drop blood glucose level 40 mg/dL

Question 13

What should a person on a fixed insulin regimen or insulin secretagogues do be counseled on re: diet?

Answer 13

Educate on CHO consistency (timing and amount)

Question 14

What should a person on MDI or insulin pump be educated on re: their diet?

Answer 14

CHO counting using ICR

Question 15

what is sucrose?

Answer 15

table sugar

Question 16

True or false: A high GI food peaks very rapidly, and a low GI food peaks very gradually

Answer 16

False

Question 17

What are the fiber recommendations for a patient with DM?

Answer 17

14 g/1000 kcals or 20-25 g (women) and 30-38 g (men)

Question 18

Should fiber be subtracted from total CHO intake?

Answer 18

Not routinely; adjustment only practical if amount per serving of fiber is > 5 g, in which case, subtract half of the fiber grams from total CHO. Should only be used for pt’s with ICR –>not practical otherwise

Question 19

How does the FDA recognize artificial sweeteners?

Answer 19

Generally Recognized as Safe (GRAS)

Question 20

True or false: Replacing intake of sugar sweetened beverages with products containing non nutritive sweetness can help with weight loss

Answer 20

True, as long as pt’s do not replace those calories through other sources

Question 21

True or false: Evidence is lacking to support the routine use of micronutrients and other herbs/supplements for the treatment of DM

Answer 21

True; many micronutrients are involved in CHO and/or glucose metabolism. This info, however, if often extrapolated beyond what is supported by research findings.

Question 22

When should evaluation of the effectiveness of nutrition therapy on glucose be done?

Answer 22

Between 6 weeks and 3 months

Question 23

Individuals wishing to consume ETOH who take insulin or insulin secretagogues should be advised to do what?

Answer 23

Consume food with ETOH to reduce the risk of hypoglycemia; extra testing should be used to determine whether extra CHO and/or a reduction in DM meds will be needed to reduce risk of hypoglycemia during the night or next AM

Question 24

True or false: There is a U shaped relationship between ETOH consumption and risk for DM

Answer 24

True; compared with nondrinkers, moderate drinkers have a lower risk for DM, while those who consume > 3 drinks/day have a greater risk for DM

Question 25

When is DM considered to be in “remission”

Answer 25

Euglycemia or Pre DM glycemia (partial remission) with no DM medication for > 1 year

Question 26

what should be the focus of nutrition therapy interventions for persons with DM2?

Answer 26

Energy restriction, with or without weight loss AND healthy eating

Question 27

How much physical activity may be needed for pt’s to achieve successful long term weight loss/maintainance?

Answer 27

1-1.5 hours/day

Question 28

Which DM medications can cause weight gain?

Answer 28

SU, TZDs, Meglitinides, and insulin

Question 29

Persons with DM are at how much greater risk for CVD?

Answer 29

three to fourfold, particularly evident in younger age groups and in women

Question 30

For a person with DM, what are the recommendations for limiting saturated and trans fats?

Answer 30

Sat fat: <10% of total energy intake

Trans fat: Limited as much as possible

Question 31

True or false: Cholesterol intake should be limited to no more than 300 mg/day

Answer 31

False; evidence shows no appreciable relationship between consumption of dietary cholesterol and serum cholesterol

Question 32

What type of fiber may be beneficial for reducing LDL-C levels?

Answer 32

soluble fiber (at least 7-13 g, such as oatmeal/oatbran, apples, pears, psyllium, barley and legumes)

Question 33

How can plant stanols/sterols be used to reduce LDL-C? What is the desired dose?

Answer 33

2-3 g daily from fortified foods or supplements; work by interfering with dietary/biliary cholesterol absorption in the GI tract, thus lowering LDL- C levels

Question 34

What style of diet may reduce CVD risks and glycemic control in DM patients?

Answer 34

Mediterranean

Question 35

True or false: In a person with DM2, studies how mild to moderate ETOH consumption is associated with a decreased risk of coronary heart disease and total mortality rates

Answer 35

True, likely r/t improved insulin sensitivity. Moderate amount of ETOH are not harmful to TG levels and may even be beneficial

ETOH avoidance rec’d for pt’s with TG > 500 mg/dL

Question 36

True or false: People with DKD should be instructed to follow a low protein diet

Answer 36

False; reducing amount of dietary protein below the rec’d daily allowance of 0.8 g/kg body weight per day does not meaningfully alter glycemic measures, CV risk measures, or course of GFR rate decline