Chapter 20: Diabetes Mellitus

The hormone considered to act in a manner opposite to insulin is a. glucagon. b. somatostatin. c. growth hormone. d. adrenaline.

ANS: A Glucagon is a hormone that acts in a manner opposite to insulin to balance the overall blood glucose level. It can rapidly break down stored glycogen and, to a lesser extent, fat.

A good source of fiber-rich food is a. steel cut oats. b. a grilled chicken breast. c. cinnamon applesauce. d. an English muffin.

ANS: A Steel cut oats are a good source of fiber.

An example of a food that would be part of the carbohydrate exchange group would be a. whole-wheat bread. b. vanilla ice cream. c. white tuna. d. skim milk.

ANS: A The carbohydrate exchange groups include breads, cereals, and grains; starchy vegetables; crackers and snacks; beans, peas, and lentils; and fruits.

The main factors that influence development of type 2 diabetes mellitus are a. weight and heredity. b. liver disease. c. enzyme deficiencies. d. childhood illnesses.

ANS: A Weight and heredity seem to play a role in the development of type 2 diabetes mellitus.

A 62-year-old patient with a history of blood sugars slightly above normal and recurrent skin infections may need to be further assessed for a. type 2 diabetes. b. gestational diabetes. c. chronic kidney disease. d. hepatitis.

ANS: A With a history of abnormal blood sugars and recurrent skin infections, an assessment for type 2 diabetes should be completed.

A menu selection high in saturated fat is a. grilled turkey burgers with onion and peppers. b. baked ziti with sausage and cream sauce. c. baked salmon and herbed potatoes. d. baked macaroni and tomato sauce.

ANS: B Baked ziti with sausage and cream sauce would contain saturated fats from the sausage and the cream-based sauce.

For a patient with diabetes, a good nonnutritive choice to sweeten tea would be a. cane sugar. b. aspartame. c. honey. d. fructose.

ANS: B Commonly used nonnutritive sweeteners include aspartame, which has no nutritional value. Cane sugar, honey, and fructose are all nutritive sweeteners because they do provide energy.

The number of kilocalories from protein for an adult receiving a 2200 kcal diet should be between a. 100 and 330 kcal. b. 220 and 770 kcal. c. 250 and 800 kcal d. 350 and 1200 kcal.

ANS: B The protein content for an adult with diabetes is 10% to 35% of total energy intake. On a 2200 kcal diet, 2200 ´ 10% = 220 kcal and 2200 ´ 35% = 770 kcal.

Women with a history of gestational diabetes mellitus are at risk for developing a. chronic kidney disease. b. type 2 diabetes. c. type 1 diabetes. d. morbid obesity.

ANS: B The risk for developing type 2 diabetes is significantly higher in women with a history of gestational diabetes.

Type 2 diabetes usually appears after the age of a. 30 years. b. 40 years. c. 50 years. d. 60 years.

ANS: B Type 2 diabetes usually appears after the age of 40 years but is now also being diagnosed in children.

A fasting blood glucose level of 85 mg/dL would be considered consistent with a. an impaired glucose tolerance. b. diabetes. c. normal health. d. a diabetic coma.

ANS: C A blood glucose below 100 mg/dL is considered normal.

An individual attends a community-sponsored, health-screening event and a slightly elevated blood sugar level is detected. An appropriate intervention would be to a. inform the individual that he or she has diabetes and should go to the emergency room immediately. b. recommend the individual start a high-protein, low-carbohydrate diet and begin exercising. c. recommend the individual follow up with his or her health care practitioner for further evaluation. d. tell the individual not to worry and that there is no need for any additional follow-up.

ANS: C A recommendation to follow up with the individual's health care practitioner would be most appropriate. The community screening helps to identify those individuals in the community who may benefit from additional medical follow-up and screening for the risk of diabetes.

The accumulation of glucose in the blood is called a. glycosuria. b. polydipsia. c. hyperglycemia. d. hypoglycemia.

ANS: C The accumulation of glucose in the blood is called hyperglycemia and the presence of low glucose in the blood is called hypoglycemia.

For a patient receiving a 2000 kcal diet, the recommended range of calories that should come from carbohydrate is a. 500 to 750 kcal. b. 750 to 900 kcal. c. 900 to 1300 kcal. d. 1350 to 1650 kcal.

ANS: C The amount of calories provided by carbohydrates in a 2000 kcal diet would range from 900 to 1300 kcal; 45% to 65% of calories should come from carbohydrate. Thus, 2000 kcal ´ 45% = 900 kcal and 2000 kcal ´ 65% = 1300 kcal.

Uncontrolled diabetes is related to the abnormal metabolism of a. carbohydrates and proteins. b. proteins and fats. c. carbohydrates, proteins, and fats. d. carbohydrates only.

ANS: C Uncontrolled diabetes causes alterations in glucose metabolism as well as abnormal metabolism of proteins and fats.

A dietary pattern that would be most beneficial for a patient with diabetes is a a. low-sodium diet. b. low-sugar diet. c. high-protein diet. d. Mediterranean diet.

ANS: D A Mediterranean diet plan is generally appropriate for a patient with diabetes.

Mr. Jones is 20 lb above his desirable weight and has type 2 diabetes. A recommendation to Mr. Jones would be to a. increase kilocalorie intake. b. include between-meal snacks. c. take extra food during exercise. d. decrease kilocalorie intake.

ANS: D Decreasing kilocalorie intake will help Mr. Jones lose weight and control his type 2 diabetes

A patient with type 2 diabetes eats a high-protein, very low-carbohydrate diet to try to lose weight. The main long-term concern if the patient continues this eating pattern would be a. excessive weight loss. b. the development of hypertension. c. the development of liver disease d. the development of neuropathy.

ANS: D Excessive protein intakes may contribute to the development of nephropathy in patients with diabetes because disposal of extra nitrogenous waste puts unnecessary stress on the kidneys.

Which of the following functions is not associated with the hormone insulin? a. Insulin moves glucose into the cell. b. Insulin inhibits fat breakdown. c. Insulin converts glucose into glycogen. d. Insulin mobilizes liver glycogen to yield glucose.

ANS: D Insulin does not mobilize liver glycogen to yield glucose. Insulin circulates glucose into cells by way of specialized insulin receptors, helps change glucose to glycogen and store it in muscles and liver, stimulates the change of glucose to fat for storage as body fat, inhibits the breakdown of tissue fat and protein, promotes uptake of amino acids by skeletal muscle, and influences the burning of glucose for constant energy as needed.

A food that is not in the meat group of the Choose Your Foods: Exchange Lists for Diabetes is a. turkey. b. shrimp. c. egg. d. milk.

ANS: D Turkey, shrimp, and egg are all part of the meat and meat substitute group. Milk is in a separate group.

Type 2 diabetes is most common in a. infants. b. children. c. adolescents. d. older adults.

ANS: D Type 2 diabetes is most common in adults 40 years or older, although it may be seen at younger ages.

If a patient with type 1 diabetes has a fever and increased blood glucose levels, he or she should a. drink only water until blood glucose levels drop. b. adjust the insulin dose to normalize blood glucose levels. c. maintain normal insulin doses and food intake. d. seek medical advice immediately.

ANS: B During illness and fever, blood glucose levels often increase. Patients should increase their insulin dose to maintain blood glucose levels as close to normal as possible. They should maintain normal food intake, taking carbohydrate as liquid or soft foods if appetite is poor. They should contact a physician if the illness lasts for more than 24 hours, if fever remains high, or if blood glucose remains ³250 mg/dL and a urine dip-stick tests shows moderate to large ketones are present.

The form of insulin that has its peak action after about 8 hours is a. rapid-acting insulin. b. intermediate-acting insulin. c. long-acting insulin. d. oral hypoglycemic insulin.

ANS: B Intermediate-acting (NPH) insulin peaks after about 8 hours.

The three common, long-term complications of diabetes affect the cells of the a. pancreas, liver, and spleen. b. kidney, eye, and nerve tissue. c. kidney, liver, and spleen. d. heart, liver, and brain.

ANS: B Long-term complications of diabetes affect the kidney (nephropathy), eye (retinopathy), and nerve tissue (neuropathy).

In reviewing the plan of care for a patient with type 2 diabetes who is overweight and likes to eat sweets, an initial goal might be to a. start 10 units of regular insulin 30 minutes before each meal. b. replace a snack of five filled chocolate cookies with three graham crackers. c. check blood sugar after eating cookies and initiate sliding scale insulin. d. remove all carbohydrate foods and encourage only high-protein foods.

ANS: B Replacing chocolate cookies with graham crackers would be an initial step in improving weight loss and implementing a healthy lifestyle of proper nutrition and exercise.

The primary organ involved in the disease process of type 1 diabetes mellitus is the a. adrenal gland. b. pancreas. c. kidney. d. liver.

ANS: B The hormone insulin must be present for glucose to be used by the cells in the body. Insulin is produced by the cells of the pancreas. Thus, the pancreas is the organ involved in the disease process of type 1 diabetes mellitus.

The largest portion of islet cells in the pancreas are the cells that synthesize a. glucagon. b. insulin. c. somatostatin. d. growth hormone.

ANS: B The largest portion of islet cells are the cells that synthesize insulin, a hormone.

The hormone that is synthesized by the d cells of the pancreatic islets is a. glycogen. b. ketone. c. somatostatin. d. insulin.

ANS: C Somatostatin is produced in the d cells of the pancreatic islets.

For individuals with type 2 diabetes, exercise a. decreases insulin efficiency. b. stimulates the release of insulin. c. decreases risk of cardiovascular disease. d. raises blood glucose levels.

ANS: C Exercise increases the number of insulin receptors on muscle cells. Long-term studies have shown that with type 2 diabetes, exercise helps control blood glucose and reduces the risk of cardiovascular disease, hyperlipidemia, hypertension, and obesity.

Ketones are a by-product of the metabolism of a. carbohydrates. b. proteins. c. fats. d. alcohol.

ANS: C Ketones form as a by-product of fat metabolism when the supply of glucose is insufficient.