Week 3

The nurse would encourage a patient newly diagnosed with type 2 diabetes to limit intake of which foods to help reduce the percent of fat in the diet?

Cheese is a product derived from animal sources and is higher in fat and calories than vegetables, fruit, and poultry. Excess fat in the diet is limited to help to avoid macrovascular changes.

Sulfonylureas

increase insulin production by the pancreas.

light activity

100-200 kcal/hr are expended. • Fishing • Light housework • Secretarial work • Teaching • Walking casually

Who can serve as a health care proxy?

The patient may choose anyone to serve as a health care proxy. Proxies do not have to be a domestic partner, family member, or blood relativ

DPP-4 inhibitors

enhance the activity of incretins, which stimulate release of insulin from pancreatic β-cells. This class of drug also decreases hepatic glucose production.

The nurse is teaching a patient with insulin-dependent diabetes about the effects of exercise on blood glucose level. When collaborating with the patient to develop a self-management plan, which examples of moderate activity would the nurse suggest? Select all that apply.

Examples of moderate activity include bowling, walking briskly, and dancing. The American Diabetes Association (ADA) recommends at least 150 minutes per week of moderate activity, which expends 200-350 kcal/hr. Fishing is considered a light activity in which approximately 100-200 kcal/hr are expended. Aerobic exercises are considered vigorous activity expending approximately 400-900 kcal/hr.

A newly diagnosed patient with type 2 diabetes has been prescribed metformin and asks the nurse how it works. Which explanation would the nurse give the patient?

Metformin is a biguanide that decreases the rate of hepatic glucose production and augments glucose uptake by tissues, especially muscles. Sulfonylureas and meglitinides increase insulin production from the pancreas. α-Glucosidase inhibitors slow the absorption of carbohydrates in the intestine. Glucagon-like peptide receptor agonists increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and decrease gastric emptying.

After administering glucagon to an unconscious patient, the nurse would place the patient in which position?

Nausea is a common reaction after glucagon injection. The patient should be placed in the side-lying position to prevent aspiration should the patient vomit. The supine, high-Fowler's, and semi-Fowler's positions are not advisable because of the risk of aspiration of vomitus.

Which instruction, in relation to mealtimes, would the nurse give to a patient who is prescribed lispro?

Rapid-acting synthetic insulin analogs, which include lispro (Humalog), aspart (NovoLog), and glulisine (Apidra), have an onset of action of approximately 15 minutes and should be injected within 15 minutes of mealtime. The rapid-acting analogs most closely mimic natural insulin secretion in response to a meal. Lispro is not administered on an empty stomach or simultaneously with a meal. Short-acting regular insulin, not rapid-acting synthetic insulin, is administered 30 to 45 minutes before a meal to ensure the onset of action coincides with meal absorption.

A patient with type 1 diabetes reports feeling shaky and lightheaded and is pale and sweaty. The nurse would take which immediate action?

The described symptoms represent mild-to-moderate hypoglycemia. Rapid treatment involves providing the alert and awake patient with a rapid-dissolving buccal glucose tablet or, if unavailable, a glass of glucose-containing liquid such as orange juice. The patient is experiencing hypoglycemia when the blood sugar is already low. Therefore insulin should not be given. Administering glucagon is not necessary; the patient is awake and able to take food and fluids orally. After consuming a simple sugar, the patient requires a complex carbohydrate snack and protein to sustain the blood glucose and prevent rebound hypoglycemia.

Which statement made by a patient newly diagnosed with diabetes indicates an understanding of a teaching session focused on hypoglycemia?

The patient understands the need for a fast-acting sugar and the need to recheck in 15 minutes. Milk is not a fast-acting carbohydrate, so it will take longer for the low blood sugar to stabilize. The patient's statement about the hard candies does not indicate that the patient understands the need for 15 to 20 grams of carbohydrates. Rechecking blood sugar in 30 minutes is waiting too long to check blood sugar.

The dawn phenomenon

also is characterized by hyperglycemia that is present on awakening; however, it is caused by growth hormone and cortisol excretion during the early morning hours and is unrelated to the amount of insulin given at nighttime.

Lipodystrophy

atrophy or hypertrophy of the subcutaneous tissue.

When teaching the patient with diabetes about repaglinide, which instruction regarding the timing of the medication would the nurse teach the patient?

Repaglinide is an oral antidiabetic agent that should be given any time from 30 minutes to just before meals. It is given on a fixed schedule rather than only when blood sugars are elevated. The medication will not be effective if administered after meals or at bedtime.

vigorous activity

expending approximately 400-900 kcal/hr. • Aerobic exercise • Bicycling (vigorous) • Hard labor • Ice skating • Outdoor sports • Running • Soccer • Tennis • Wood chopping

When evaluating the outcome of patient teaching regarding aspart insulin, which statement made by the patient demonstrates correct understanding of the teaching?

Rapid-acting insulins, such as aspart, are used to control postprandial blood glucose levels. The timing of insulin injection with meals is crucial. Rapid-acting insulin has a quick onset of approximately 15 minutes and should be injected within 15 minutes of mealtime. Short-acting insulin, such as Humulin-R, because of longer onset of action, can safely be administered 30 to 60 minutes before a meal. Rapid-acting insulin such as aspart can be mixed safely with intermediate-acting insulin in the same syringe. Long-acting insulin such as glargine and detemir should not be mixed with any other insulins. Because rapid-acting insulins have a shorter duration of action, they are typically injected before meals.

Which assessment parameter would the nurse review to determine how well a patient's diabetes mellitus has been controlled over the past two to three months?

When the glucose level is increased, glucose molecules attach to hemoglobin in the red blood cells (RBCs) and is called glycosylated hemoglobin. This attachment lasts for the life of the RBC, two to three months. Monitoring the numbers of these attachments makes it possible to assess the average blood glucose for the previous two to three months.

After admitting a patient with diabetic ketoacidosis (DKA) to the emergency department, which nursing intervention is a priority?

Because fluid imbalance in a patient with DKA is potentially life threatening, the initial goal of therapy is to establish IV access and begin fluid and electrolyte replacement. Insulin is administered IV only after a potassium level is determined, because insulin administration may cause hypokalemia. Administration of oxygen and insertion of a Foley catheter may be necessary in the initial emergency management of DKA, but obtaining IV access is a priority.

When teaching the patient how to self-administer subcutaneous insulin, which instruction would the nurse include in the teaching plan?

Patient education for administration of insulin for diabetes should include teaching the patient to avoid IM injections because of the rapid and unpredictable absorption that could result in hypoglycemia. The use of an alcohol swab on the site before self-injection is no longer recommended. Routine hygiene such as washing with soap and water is adequate at home. When injection occurs in a health care agency, policy usually mandates site preparation with alcohol to prevent a health care-associated infection (HAI). Patients should be taught to avoid injection sites that will be exercised because doing so could increase body heat and circulation, increase the rate of insulin absorption, and speed up the onset of action, resulting in hypoglycemia. Patients should be taught to rotate the injection within and between sites, not to use one site, to allow for better insulin absorption.

During which timeframe would the nurse monitor the patient for hypoglycemia after administering 10 units regular insulin subcutaneously at 8:30 p.m.?

Regular insulin exerts peak action in two to five hours, making the patient most at risk for hypoglycemia between 10:30 p.m. and 1:30 a.m. Rapid-acting insulin's onset is between 10 to 30 minutes, with peak action and hypoglycemia most likely to occur between 9:00 p.m. and 11:30 p.m. With intermediate acting insulin, hypoglycemia may occur from 12:30 a.m. to 8:30 a.m.

Which statement made by the patient with type 2 diabetes indicates understanding the teaching plan about exercise as a method to control blood glucose levels?

The best exercise plan for the person with type 2 diabetes is for 30 minutes of moderate activity five days per week and resistance training three times a week. Brisk walking is moderate activity. Fishing and teaching are light activity, and running is considered vigorous activity.

Which instruction would the nurse give a patient who is prescribed metformin and complains of an "upset stomach" after ingestion of the medication?

The nurse should suggest that the patient take metformin with food to decrease GI side effects. It is not within the nurse's scope of practice to prescribe medications such as diphenhydramine for nausea. Advising the patient to stop the medication immediately may result in a hyperglycemic response and should not be done without medication prescriber guidance. Getting the patient's blood glucose checked will not address the complaints of GI distress.

Which instruction would the nurse give the patient with diabetes about self-administering insulin?

The nurse should teach the patient to rotate the injection within one anatomic site, such as the abdomen, for at least one week before using a different site to allow for better absorption of insulin. It is important to gently roll the insulin bottle between the palms 10 to 20 times to warm the insulin and resuspend the particles. Injections must be administered at a 45- to 90-degree angle, depending on the thickness of the patient's fat pad. The fastest subcutaneous absorption is from the abdomen, followed by the arm, thigh, and buttock.

A patient calls the health care provider's office at 8:00 a.m. and states, "I just experienced an episode of low blood sugar, which responded to oral glucose tablets." Which question would the nurse ask to help to identify the cause of the low blood sugar?

The glucose-lowering effects of exercise can last up to 48 hours, so it is possible for hypoglycemia to occur after activity, particularly if exercise is at a greater intensity or time than normal. Asking the patient about activity level would be the most appropriate question for the nurse to ask. Ketones can be found in the urine with elevated blood glucose levels and may indicate the presence of diabetic ketoacidosis. Ketones would not be of concern with hypoglycemia. Taking a lower dose of insulin would result in higher blood glucose. Fever and illness can lead to hyperglycemia as well.

α-glucosidase

inhibitors slow down absorption of carbohydrate in the small intestine.

treatment for dawn phenomenon

is an increase in the evening insulin dose or an adjustment in the timing of the evening insulin dose.

Allergic reactions related to insulin

Allergic reactions related to insulin occur as local inflammatory reactions and do not produce hyperglycemia.

A patient with diabetes who takes long-acting and mealtime insulin calls the ambulatory center with complaints of an upper respiratory infection and has a decreased appetite, fever, and cough. Which instructions would the nurse give the patient? Select all that apply.

Any illness or surgery can cause a regulatory hormonal response that may lead to hyperglycemia. Patients with diabetes and concurrent illnesses should check their blood sugar at least every four hours, despite current eating patterns, to monitor for hyperglycemia. Many clinics will ask a patient to report to his or her health care provider for two blood glucose readings over 300 mg/dL in a row, not just one. Common illnesses such as an upper respiratory illness or the flu can cause changes in glucose requirements. Patients should be encouraged to continue their insulin injectables as prescribed and monitor for hyperglycemia or hypoglycemia. These patients should supplement with carbohydrate-containing foods or beverages as necessary.

Which statement made by the patient with type 1 diabetes indicates a need for further instruction?

Finger-stick blood glucose testing should be performed before meals. Checking the blood glucose after meals will yield inaccurate results. This is of essential concern if the patient is basing insulin dosage on finger-stick blood glucose results. Having a snack nearby during exercise, eating meals and snacks at regular times, and eating high-fiber, low-fat foods are all correct in regard to diabetes management.

Which goal of the treatment plan for a patient with diabetic ketoacidosis (DKA) would be the initial focus?

Fluid imbalance is potentially life threatening for patients with DKA. The initial goal of therapy is to establish IV access and begin fluid replacement. Once urine output is established, electrolyte replacement will be addressed. Potassium levels will need to be monitored because insulin therapy, which is needed to correct the hyperglycemia, may further reduce the potassium level. Insulin therapy will be used to lower the blood glucose gradually to prevent rapid drops in serum glucose, which could lead to fluid shifts and the potential for cerebral edema. Ketosis results from the use of fat stores for energy because excess glucose is not being transported to the cells and used as a source of energy. Patients with DKA often present with nausea and vomiting; oral nourishment may be limited until symptoms lessen.

After discussing prevention of type 1 diabetes complications with the nurse, the patient is correct when making which statement?

Patients with diabetes who have albumin in their urine should receive angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor antagonists to treat hypertension, which would also delay the progression of nephropathy. Dietary fat intake will not affect kidney function. Hot water bottle use increases the risk of tissue damage because of the diabetic's neuropathy and delayed healing. Diabetics should have an eye examination once a year to screen for retinopathy.

A patient hospitalized with diabetes has become shaky, anxious, and diaphoretic. Which action would the nurse implement first?

The blood glucose level should be checked with the first signs of hypoglycemia because it can be reversed easily but can be life threatening if not treated. In the hospital setting, it is convenient to check the blood glucose. A 15-g snack should be provided after the blood glucose has been determined to be low. The health care provider should be notified after the blood glucose level is known. Once the glucose level is stable, then the patient can be given additional food of carbohydrates plus protein or fat (e.g., crackers with peanut butter) if the next meal is more than one hour away.

Which instruction would the nurse give a patient when teaching about the importance of self-monitoring of blood glucose (SMBG) using a glucometer? Select all that apply.

The nurse should instruct the patient to test blood glucose levels whenever hypoglycemia is suspected so that immediate action can be taken. The patient should test blood glucose before and after exercise to determine the effects of exercise on metabolic control. Blood sample should be taken from the side of the finger pad rather than near the center, because there are fewer nerve endings along the side of the finger. Blood glucose is generally tested two hours after a meal to determine whether the bolus insulin dose was adequate for the meal. Blood glucose may also be tested before a meal by patients who use insulin pumps or multiple daily injections and base the insulin dose on the carbohydrates in a meal or make adjustments if the preprandial value is above or below target. Hands should be washed in warm water before the finger puncture is made to promote blood flow to the fingers.

Which class of drugs used to treat diabetes may be referred to as "insulin sensitizers"?

Thiazolidinediones are a class of drugs used to treat diabetes mellitus (DM). They are often referred to as an "insulin sensitizers." This class of drugs improves insulin sensitivity, transport, and utilization at target tissues.

The nurse would instruct the patient with diabetes to fast for which period of time when scheduled for a fasting blood glucose level at 8:00 a.m.?

Typically, a patient is prescribed to be NPO for eight hours before determination of the fasting blood glucose level. For this reason, the patient who has a laboratory draw at 8:00 a.m. should not have any food or beverages containing any calories after midnight. It is not necessary to fast longer than eight hours; 4:00 a.m. and 7:00 a.m. would not allow for sufficient time to fast for morning laboratory testing.

tests are used to measure the current blood glucose level,

Fasting blood glucose, oral glucose tolerance, and random fingerstick blood glucose

In fact, current recommendations are to use the same anatomic injection site

(e.g., the abdomen) for one week before moving to another anatomic injection site; rotating insulin injection sites does not result in either the Somogyi effect or dawn phenomenon.

Patient & Caregiver TeachingExercise for Patients With Diabetes

1. Exercise does not have to be vigorous to be effective. The blood glucose-reducing effects of exercise can be reached with activity such as brisk walking. 2. Choose exercises that are enjoyable to foster regularity. 3. Use properly fitting footwear to avoid rubbing or injury. 4. The exercise session includes a warm-up period and a cool-down period. Start the exercise program gradually and increase slowly. 5. Exercise is best done after meals, when the blood glucose level is rising. 6. Exercise plans are patient specific and monitored by the HCP. 7. Monitor blood glucose levels before, during, and after exercise to determine the effect exercise has on blood glucose levels at specific times of the day. 8. Before exercise, if blood glucose ≤100 mg/dL, eat a 15-g carbohydrate snack. After 15 to 30 min, recheck blood glucose levels. Delay exercise if <100 mg/dL. 9. Before exercise, if blood glucose ≥250 mg/dL in a person with type 1 diabetes and ketones are present, delay vigorous activity until ketones are gone. Drink fluids. 10. Exercise-induced hypoglycemia may occur several hours after the completion of exercise. 11. Planned or spontaneous exercise can still occur when taking a glucose-lowering medication. 12. It is important to compensate for extensive planned and spontaneous activity by monitoring blood glucose levels and making adjustments in the insulin dose (if taken) and food intake.

Patient & Caregiver TeachingSelf-Monitoring of Blood Glucose (SMBG)

1. Wash and dry hands completely. It is not necessary to clean the site with alcohol, and it may interfere with test results. 2. If it is hard to get an adequate drop of blood for testing, warm the hands in warm water or let the arms hang dependently for a few minutes before making the finger puncture. 3. A lancing device is usually used. Place the lancet in the device, following the instructions that come with it. If the puncture is made on the finger, use the side of the finger pad rather than near the center. Fewer nerve endings are along the side of the finger pad. If using an alternative site (e.g., forearm), special equipment may be needed. Refer to manufacturer's instructions for alternative site use, except during hypoglycemia episodes. 4. Set lancing device to make a puncture just deep enough to get a sufficiently large drop of blood. Unnecessarily deep punctures may cause pain and bruising. Current meters need very small amounts of blood. 5. Follow instructions on monitor for checking the blood glucose level. 6. Record results. Compare with personal blood glucose goals.

Patient & Caregiver TeachingPreparing an Insulin Injection

1. Wash hands thoroughly. 2. Always inspect insulin bottle before using it. Make sure that it is the proper type and concentration, expiration date has not passed, and top of bottle is in perfect condition. Insulin solutions (except for NPH, lispro protamine, aspart protamine) should look clear and colorless. Discard if it appears discolored or if you see particles in the solution. 3. For intermediate-acting insulins (which are normally cloudy), gently roll the insulin bottle between the palms of hands to mix the insulin, DO NOT SHAKE. Clear insulins do not need to be agitated. 4. Choose proper injection site (Fig. 48.5). rotate the injection within and between sites. This allows for better insulin absorption. It may be helpful to think of the abdomen as a checkerboard, with each ½-in square representing an injection site. Injections are rotated systematically across the board, with each injection site at least ½ to 1 inch away from the previous injection site. It can be helpful to inject fast-acting insulin into faster-absorbing sites and slow-acting insulin into slower absorbing sites. 5. Ensure that the site is clean and dry. 6. Push the needle straight into the skin (90-degree angle). If you are very thin, muscular, or using an 8- or 12-mm needle, you may need to pinch the skin and/or use a 45-degree angle. 7. Push the plunger all the way down, leave needle in place for 5 sec to ensure that all insulin has been injected, and then remove needle. 8. Destroy and dispose of single-use syringe safely.

Which statement made by the patient indicates correct knowledge of the onset of action of the mealtime insulin aspart?

Aspart is rapid-acting insulin, onsets within five minutes, and peaks within an hour. The patient is instructed to administer it when food is in front of him or her, making the option "I will administer aspart within 15 minutes of eating" correct. If the patient administers the aspart 30 or 60 minutes before the food arriving, then the patient may experience hypoglycemia. The patient may have hyperglycemia if he or she waits 30 minutes until after eating to administer the insulin.

Which action would the nurse take first when teaching the patient with type 2 diabetes to become an active participant in his or her care?

For teaching to be effective, the first step is assessing the patient. Teaching can be individualized once the nurse is aware of what a diagnosis of diabetes means to the patient. Food restrictions, nutritionist referral, and setting long-term goals can occur once the nurse is confident the patient understands what it means to have diabetes.

Which statements are accurate when describing glargine? Select all that apply.

Glargine is a long-acting (background) insulin that lacks a peak action time. Glargine is often administered once a day via subcutaneous injection. Mealtime insulin may also be added if glargine is not adequate to achieve glycemic goals. The medication is not administered orally with food and water. Glargine must not be diluted or mixed with other insulin or solution in the same syringe.

When reviewing the diabetic self-care management with a patient newly diagnosed with diabetes, which statement made by the patient indicates a need for further education?

Patients with diabetes are at great risk for skin breakdown because of peripheral vascular problems and peripheral neuropathy. Patients should avoid using rubbing alcohol on skin to prevent tissue damage. The best way to prevent foot ulcers is prevention and early detection. Inspecting the feet every day for cuts, abrasions, pressure areas, or sores is a good practice. Toenails should be cut with the rounded contour of the nail and not cut down the corners of the nail. Another complication of diabetes is retinopathy. Patients with a history of diabetes should have an eye examination annually by an ophthalmologist.

Which statement made by the patient with diabetes mellitus indicates that further education regarding exercise is required?

Strenuous activity can be perceived by the body as a stress and cause an increase in blood sugar by the release of counterregulatory hormones when the blood sugar is elevated and ketosis is present. The American Diabetes Association recommends that people with diabetes exercise 30 minutes per day, five days per week. To prevent hypoglycemia, it is important to exercise about an hour after consuming a meal or eat small carbohydrate snacks every 30 minutes during exercise. Weight loss decreases insulin resistance, which can lower blood glucose.

A nurse is providing discharge teaching to a patient with a new diagnosis of type 1 diabetes mellitus who will need to give self-injections of insulin at home. Which statement by the patient indicates to the nurse that the discharge teaching was effective?

Teaching the patient to rotate the injection within and between sites is important to allow for better insulin absorption. The lower forearm is not an injection site for subcutaneous insulin administration. The abdomen, arm, thigh, and buttock are the preferred sites. Intermediate-acting insulin is normally cloudy, and the patient should gently roll the bottle between the palms of hands to mix the insulin. The patient should push the plunger all the way down and leave the needle in place for 5 seconds to ensure that all of the insulin has been injected before removing the needle.

Which range is the current recommendation of fiber for patients with diabetes?

The American Diabetes Association (ADA) recommends that diabetics consume 25 to 30 grams of fiber daily. This is the same level recommended for the nondiabetics because there is no evidence that a higher intake of fiber is essential. Forty to 50 grams is too much fiber for the patient to consume, and 10 to 25 grams is not enough fiber.

A patient's blood glucose level before breakfast is 324 mg/dL. The nurse reviews the electronic medical record and notes that the patient receives a high dose of insulin each evening at bedtime. The nurse suspects that the patient's hyperglycemia is most likely due to which problem with insulin therapy?

The Somogyi effect occurs when a patient receives a high dose of evening/bedtime insulin that produces a decline in blood glucose levels during the night. As a result, counter regulatory hormones are released, stimulating lipolysis, gluconeogenesis, and glycogenolysis, which in turn produce rebound hyperglycemia.

Which instruction would the nurse include in a teaching plan about diabetes and healthy eating?

The nurse should inform the patient to eat carbohydrates when drinking alcohol to reduce the risk for alcohol-induced hypoglycemia. Nutritive and nonnutritive sweeteners may be included in a healthy meal plan in moderation. The amount of daily protein in the diet for people with diabetes should be 15% to 20% of the total calories consumed. High-protein diets are not recommended as a weight loss method for people with diabetes. There is no evidence that a person with diabetes should consume more fiber than an individual who does not have diabetes. The current recommendation for the general population is 25 to 30 g/day.

Which statements made by the nurse to a patient newly diagnosed with type 1 diabetes would be included in a teaching plan? Select all that apply

The nurse should teach the patient to decrease dietary sugar intake, self-administer insulin, and regularly monitor blood glucose levels as prescribed. A high-fat diet increases the patient's cholesterol levels and may increase the blood sugar levels. Reduction of physical exercise can also lead to an increase in blood glucose level.

When evaluating a patient's technique of performing self-monitoring of blood glucose (SMBG), which action by the patient would indicate a need for additional teaching?

The patient should select a site on the sides of the fingertips, not on the center of the finger pad, because this area contains many nerve endings and would be unnecessarily painful. Washing hands, warming the finger, and knowing the results that indicate good control all show understanding of the teaching.

The unlicensed assistive personnel (UAP) reports to the nurse that a patient with diabetes is slow to respond, pale, and diaphoretic. Which priority intervention would the nurse take?

The patient with diabetes is exhibiting signs and symptoms of hypoglycemia. The priority intervention at this time is to validate assessment findings with a bedside glucose reading. Although vital signs may add to assessment data findings, they are not as much a priority as validating hypoglycemia and initiating treatment. Because the patient is experiencing a change in level of consciousness, management of the hypoglycemia via oral nourishment is contraindicated. If the patient has an existing IV line, then treatment of documented hypoglycemia with IV dextrose may be indicated.

A patient with type 2 diabetes who takes oral hypoglycemics at home is admitted to the hospital with an infection and asks why insulin injections have been prescribed. Which explanation would the nurse provide?

When the body is under stress, as in an acute illness, the need for insulin is more than oral hypoglycemics can provide. Insulin injections are usually required until the illness resolves. Insulin does not act synergistically with antibiotics, the patient did not need insulin at home, and oral hypoglycemics are not contraindicated in patients with infections.

A college student, newly diagnosed with type 1 diabetes, has a headache, changes in vision, and is anxious, but does not have the portable blood glucose monitor with him or her. Which action would the campus nurse advise the patient to take?

When the patient with type 1 diabetes is unsure about the meaning of the symptoms he or she is experiencing, the patient should treat himself or herself for hypoglycemia to prevent seizures and coma from occurring. The patient should also be advised to check the blood glucose as soon as possible. The fat in the pizza and the diet soft drink would not allow the blood glucose to increase to eliminate the symptoms. The extra dose of rapid-acting insulin would further decrease the blood glucose.

moderate activity

expends 200-350 kcal/hr. • Active housework • Bicycling (light) • Bowling • Dancing • Gardening • Golf • Roller skating • Walking briskly