Ch. 25 Types of Diabetes and Diagnosis

Question 4 of 9 An education plan for diabetes is developed for Mr. Thomas. You present Henry with information on the importance of postprandial glycemic control. Postprandial blood glucose levels should be obtained __________ after eating and should be _______________. Immediately; ≤ 100 mg/dL 30 minutes; ≤ 100 mg/dL 2 hours; ≤ 100 mg/dL 2 hours; ≤ 180 mg/dL 6-8 hours; ≤ 180 mg/dL

2 hours; ≤ 180 mg/dL CORRECT. For consistency, postprandial blood glucose levels should be measured 2 hours after eating and be less than 180 mg/dL.

Question 5 of 5 Treatment of type 2 diabetes often involves a stepwise approach. Place the treatment options in the order in which they are commonly utilized. Insulin Monotherapy of oral antidiabetic agent Combination of oral antidiabetic agents Lifestyle modifications 1, 2, 3, 4 1, 4, 2, 3 2, 3, 1, 4 4, 1, 2, 3 4, 2, 3, 1

4, 2, 3, 1

Question 4 of 5 Patients with diabetes should eat regular meals with approximately ______________ percent of the calories provided by carbohydrates. 10 20 30 50 70

50

Question 5 of 9 You advise Mr. Thomas about his diet: _____________ percent of total calories should come from carbohydrates of the _____________ glycemic index variety. 20; low 20; high 30; low 50; low 50; high

50; low CORRECT. The recommended diet for an individual with type 2 DM is 50 percent of total calories from carbohydrates, 25 to 30 percent of calories from fat (with less than 7% of total calories from saturated fats), and 20 percent of total calories from proteins. The glycemic index measures how carbohydrates raise blood glucose. Foods with a low glycemic index, such as beans and vegetables, do not raise blood glucose to the extent that high glycemic carbohydrates do.

Question 6 of 9 Three months later, Mr. Thomas appears for a scheduled follow-up appointment. He reports significant changes in his diet and exercise. He has been self-monitoring his blood glucose levels. He has an average blood glucose of 150 mg/dL preprandial. Mr. Thomas is confused when you tell him that his values seem a bit high. What is the recommended range for preprandial blood glucose levels in DM? 90 to 130 mg/dL < 100 mg/dL 140 to 180 mg/dL 120 to 180 mg/dL < 200 mg/dL

90 to 130 mg/dL CORRECT. Recommended preprandial blood glucose levels for patients with diabetes are between 90 to 130 mg/dL.

Question 4 of 5 A patient with type 2 DM has decided to modify her lifestyle habits to help regulate her blood glucose levels. Which of the following lifestyle changes would you recommend? Select all that apply. Eat one large meal for lunch and a snack for breakfast and dinner. Select meals with simple carbohydrates with a high glycemic value to provide immediate energy. Self-monitor blood glucose levels at least one time per week. Follow a regular meal schedule with meals containing low glycemic carbohydrates, proteins, and fats. Complete a moderate, daily exercise program.

Follow a regular meal schedule with meals containing low glycemic carbohydrates, proteins, and fats. Complete a moderate, daily exercise program.

Question 3 of 5 Which of the following tests may be used to diagnose type 2 diabetes? Select all that apply. Fasting blood glucose Hemoglobin and hematocrit Dexamethasone suppression test Oral glucose tolerance test HbA1c

Fasting blood glucose Oral glucose tolerance test HbA1c

Question 1 of 5 Which of the following hormones is released by the pancreas and causes the liver to release glucose into the blood to counteract hypoglycemia? Cortisol Epinephrine Glucagon Insulin Growth hormone

Glucagon

Question 1 of 5 If a person has not eaten for several hours and is experiencing hypoglycemia, which hormones are released to counteract the hypoglycemia? Select all that apply. Insulin Glucagon Epinephrine Cortisol Growth hormone

Glucagon Epinephrine Cortisol Growth hormone

Question 3 of 5 Your aunt has recently been diagnosed with type 2 diabetes. Which test enables her clinician to assess glycemic control over the preceding 3 months? Fasting blood glucose HbA1c Oral glucose tolerance test Postprandial glucose Urine glucose

HbA1c

Question 2 of 5 Which of the following statements about type 1 and type 2 diabetes are correct? Treatments for type 1 and type 2 diabetes are essentially the same. Type 2 diabetes is a condition of hypoglycemia, whereas type 1 diabetes is a condition of hyperglycemia. In both type 1 and type 2 diabetes, the pancreas is unable to produce insulin. Individuals with type 1 diabetes are required to take insulin. Insulin is not always required for individuals with type 2 diabetes. In both type 1 and type 2 diabetes, cells are resistant to insulin.

Individuals with type 1 diabetes are required to take insulin. Insulin is not always required for individuals with type 2 diabetes.

Question 2 of 9 Worried that Mr. Thomas may have type 2 diabetes mellitus (DM), the PCP orders two follow-up tests: a(n) ____________ to test postprandial glycemic control and a(n) _______________ to evaluate glycemic control during the prior 3 months. Which tests did the physician order? ICAs; HbA1c C-peptide; HbA1c OGTT; C-peptide OGTT; HbA1c C-peptide; OGTT

OGTT; HbA1c CORRECT. OGTT, or "Oral Glucose Tolerance Test," assesses glycemic control after an individual ingests a standard amount of glucose. HbA1c measures glycated hemoglobin. Glucose in the blood attaches to hemoglobin in red blood cells. As glucose levels increase, so does glycation of RBCs. This measurement reflects blood glucose levels over the prior 3 months. ICAs measure islet cell autoantibodies and are used to assess type 1 DM due to autoimmune disease. C-peptide is an indicator of insulin production and can help differentiate type 1 and type 2 DM.

Question 2 of 5 Your aunt was recently diagnosed with type 2 diabetes, which of the following statements are true regarding her condition? Select all that apply. -In type 2 diabetes, the body no longer produces insulin. -In type 2 diabetes, blood glucose levels are lower than normal. -Autoimmune attack of the beta cells in the pancreas causes type 2 diabetes. -Obesity and lack of physical activity are risk factors for type 2 diabetes.

Obesity and lack of physical activity are risk factors for type 2 diabetes. In type 2 diabetes, cells demonstrate resistance to insulin.

Question 5 of 5 Despite lifestyle modifications, your aunt's type 2 diabetes was not adequately controlled. Which of the following medications may be prescribed to increase cell sensitivity to insulin? Select all that apply. Thiazolinediones Epinephrine Sulfonylureas Biguanides Meglitinides

Thiazolinediones Biguanides

Question 9 of 9 Insulin regimens are modified for each patient's needs. Mr. Thomas begins the ______________ regimen, which requires once daily injection of long-lasting insulin, with subsequent rapid-acting insulin for post-meal glycemic control. basal-bolus constant-duration peak-valley intermittent-rotation steady-state

basal-bolus CORRECT. The basal-bolus regimen is the most common insulin regimen for patients. It involves a once-daily injection of long-acting insulin to control fasting blood glucose levels (basal) and additional rapid-acting insulin (bolus) to manage postprandial glucose elevations. The other answers are not typical insulin regimens.

Question 8 of 9 Sometimes monotherapy for type 2 DM is not effective at managing blood glucose levels. Thus, during the next appointment for Mr. Thomas, the PCP added a second oral medication. Although Mr. Thomas continued to work diligently on his diet, exercise, and medication protocols, Mr. Thomas's glycemic control was still not at the desired level. Concerned, the PCP prescribes insulin for Mr. Thomas. Mr. Thomas received __________ , which is a synthetic preparation that mimics physiological insulin, although it structure differs from the natural form. conventional insulin insulin analogue

insulin analogue CORRECT. Insulin analogues are synthetic preparation that more closely mimic physiological insulin. Conventional insulins are synthetic human insulins.

Question 7 of 9 After much discussion, it is recommended that Mr. Thomas begin taking an oral antidiabetic medication. The first class of medications to be tried are the _______________ , which work by ________________. sulfonylureas; inhibiting liver glucose production meglitinides; stimulating pancreas to produce insulin biguanides; decreasing cell sensitivity to insulin sulfonylureas; blocking carbohydrate absorption thiazolinediones; increasing cellular insulin resistance

meglitinides; stimulating pancreas to produce insulin CORRECT. Meglitinides and sulfonylureas stimulate pancreas to produce insulin. Thiazolinediones and biguanides work to increase cell sensitivity to insulin, not reduce it.

Question 1 of 9 You are responsible for patient teaching at a primary care office. You will be providing patient education for Henry Thomas. He is a 58-year-old attorney who is coming in for a follow-up visit with his primary care physician (PCP). In order to prepare, you review Mr. Thomas's file. Over the past few years, his weight has steadily increased. Prior to his last physical exam (two weeks ago), his PCP ordered multiple lab tests, including fasting blood glucose, urinalysis and cholesterol screening. You take a careful look at his physical exam findings and his lab results. Which of the following results lead you to suspect that Mr. Thomas has metabolic syndrome? Select all that apply. Blood pressure: 118/80 mm Hg Waist circumference: 41 inches Triglycerides: 155 mg/dL HDL cholesterol: 37 mg/dL Fasting glucose: 105 mg/dL

waist circumference: 41 inches Triglycerides: 155 mg/dL HDL cholesterol: 37 mg/dL Fasting glucose: 105 mg/dL CORRECT. Metabolic syndrome is the presence of three or more of the following: Elevated waist circumference (≥ 40 inches in men; ≥ 35 inches in women) Elevated triglycerides (≥ 150 mg/dL) Reduced HDL cholesterol (< 40 mg/dL in men; < 50 mg/dL in women) Elevated blood pressure (≥ 130/85 mm Hg) Elevated fasting glucose level (≥ 100 mg/dL)

Question 3 of 9 Based on Henry's results, the diagnosis for type 2 DM was confirmed by both tests. Which of the results below confirm DM for an OGTT and HbA1c test, respectively? ≤140 mg/dL; ≥ 6.5% ≥126 mg/dL; ≥ 7.4% ≥200 mg/dL; ≥ 6.5% ≥160 mg/dL; ≥ 7.4% ≥100 mg/dL; ≥10.0%

≥200 mg/dL; ≥ 6.5% CORRECT. The American Diabetes Association classifies an OGTT result of ≥ 200 mg/dL as diabetes. Values of ≤ 199 mg/dL to ≥ 140 mg/dL are considered to be prediabetes. An HbA1c result of ≥ 6.5% is considered to be indicative of diabetes.