BC ADM Nutritional Management 2 — Questions and Answers
Question 1: A patient with T2DM asks about the glycemic index (GI) of foods. Which statement best describes how GI should be applied in diabetes meal planning?
- GI alone determines a food's effect on blood glucose and should be the primary guide
- Low-GI foods always have fewer calories and are preferred for weight loss
- GI is a useful tool but must be considered alongside glycemic load and portion size (Correct answer)
- GI is only relevant for patients on insulin therapy
Correct answer: GI is a useful tool but must be considered alongside glycemic load and portion size
GI is a helpful indicator but glycemic load (GI × carbohydrate amount) and portion size are equally important for predicting blood glucose response.
Question 2: Which dietary pattern has the strongest evidence for reducing HbA1c in adults with type 2 diabetes?
- High-protein, very-low-fat diet
- Mediterranean-style eating pattern (Correct answer)
- Raw food diet
- Macrobiotic diet
Correct answer: Mediterranean-style eating pattern
The Mediterranean eating pattern consistently demonstrates significant HbA1c reduction and cardiovascular benefit in multiple randomized controlled trials in T2DM.
Question 3: A person with diabetes following a very low carbohydrate diet (≤50 g/day) reports frequent hypoglycemia. The most appropriate first step is to:
- Discontinue the low-carbohydrate diet immediately
- Increase carbohydrate intake to at least 130 g/day
- Reduce glucose-lowering medications in collaboration with the prescriber (Correct answer)
- Add a bedtime snack of 30 g carbohydrate
Correct answer: Reduce glucose-lowering medications in collaboration with the prescriber
Significant carbohydrate restriction reduces glucose-lowering medication requirements, so doses must be adjusted downward to prevent hypoglycemia.
Question 4: Which type of dietary fiber has the most evidence for improving postprandial glucose control in diabetes?
- Insoluble fiber from wheat bran
- Viscous soluble fiber such as beta-glucan and psyllium (Correct answer)
- Resistant starch type 3
- Cellulose from vegetable skins
Correct answer: Viscous soluble fiber such as beta-glucan and psyllium
Viscous soluble fibers form a gel in the gut that slows glucose absorption and blunts postprandial glucose spikes.
Question 5: For a patient with diabetes and chronic kidney disease (CKD) stage 3b, dietary protein intake should be:
- Increased to 1.5–2.0 g/kg/day to preserve muscle mass
- Restricted to 0.6–0.8 g/kg/day to slow CKD progression (Correct answer)
- Kept at 1.0–1.2 g/kg/day with no special restriction needed
- Eliminated and replaced entirely with branched-chain amino acid supplements
Correct answer: Restricted to 0.6–0.8 g/kg/day to slow CKD progression
ADA guidelines recommend reducing protein to 0.6–0.8 g/kg/day in non-dialysis CKD patients with diabetes to slow kidney disease progression.
Question 6: A patient using an insulin-to-carbohydrate ratio (ICR) reports consistent postprandial hyperglycemia despite accurate carb counting. Which nutritional factor is most likely being overlooked?
- Total caloric content of the meal
- Fat and protein content that delays gastric emptying (Correct answer)
- Meal timing relative to the circadian rhythm
- Vitamin C content of the food
Correct answer: Fat and protein content that delays gastric emptying
High-fat and high-protein meals slow gastric emptying, causing delayed glucose absorption that may require a split or extended bolus strategy.
Question 7: What is the recommended daily sodium intake for adults with diabetes and hypertension according to the ADA?
- Less than 3,000 mg/day
- Less than 2,300 mg/day (Correct answer)
- Less than 1,500 mg/day
- Less than 4,000 mg/day
Correct answer: Less than 2,300 mg/day
ADA recommends less than 2,300 mg sodium per day for individuals with diabetes, consistent with general cardiovascular risk reduction guidelines.
BC ADM Nutritional Management 2
A patient with T2DM asks about the glycemic index (GI) of foods.
Which statement best describes how GI should be applied in diabetes meal planning?