BC ADM Nutritional Management 3 — Questions and Answers
Question 1: A registered dietitian is counseling a patient with T1DM who wants to follow a plant-based diet. The primary nutritional concern unique to this eating pattern in insulin-requiring patients is:
- Excessive omega-3 fatty acid intake
- Difficulty accurately counting carbohydrates due to varied fiber content (Correct answer)
- Automatic reduction of insulin requirements to zero
- Increased risk of hyperkalemia from too much potassium
Correct answer: Difficulty accurately counting carbohydrates due to varied fiber content
Plant-based foods vary widely in digestible versus total carbohydrate content due to fiber, requiring careful net-carb calculation for accurate insulin dosing.
Question 2: Which sweetener is considered safe for use in diabetes management and does NOT raise blood glucose?
- Honey
- Agave nectar
- Stevia (rebaudioside A) (Correct answer)
- Brown rice syrup
Correct answer: Stevia (rebaudioside A)
Stevia is an FDA-approved non-nutritive sweetener that provides no calories or carbohydrates and does not raise blood glucose levels.
Question 3: A patient with gastroparesis and diabetes asks how to adjust meal composition to better manage blood glucose. The most appropriate advice is to:
- Eat three large meals per day to ensure adequate nutrition
- Increase dietary fat to slow absorption further
- Eat small, frequent low-fat, low-fiber meals with liquids (Correct answer)
- Follow a high-fiber diet to improve gastric motility
Correct answer: Eat small, frequent low-fat, low-fiber meals with liquids
Small, frequent meals that are low in fat and fiber reduce the delay in gastric emptying and improve glucose predictability in gastroparesis.
Question 4: When educating a patient about carbohydrate foods, which of the following contains the HIGHEST amount of digestible (net) carbohydrate per serving?
- 1/2 cup of cooked lentils
- 1 medium banana (Correct answer)
- 1 cup of broccoli
- 1 oz of almonds
Correct answer: 1 medium banana
A medium banana contains approximately 27 g of carbohydrate, significantly more than lentils (~20 g with higher fiber offset), broccoli (~6 g), or almonds (~6 g).
Question 5: The primary mechanism by which dietary fat affects blood glucose management in diabetes is:
- Fat is converted directly to glucose through gluconeogenesis in all patients
- High fat intake increases insulin resistance and delays carbohydrate absorption (Correct answer)
- Dietary fat suppresses glucagon secretion postprandially
- Fat activates GLUT4 transporters independently of insulin
Correct answer: High fat intake increases insulin resistance and delays carbohydrate absorption
High dietary fat promotes insulin resistance and slows gastric emptying, delaying carbohydrate absorption and creating a biphasic or prolonged glucose rise.
Question 6: A patient with T2DM and obesity asks about meal timing strategies. Which approach has the most evidence for improving glycemic control?
- Eating the largest meal at dinner to sustain overnight fasting
- Front-loading calories with a larger breakfast and smaller dinner (Correct answer)
- Eating three equal-sized meals regardless of time of day
- Consuming all calories in a single meal at midday
Correct answer: Front-loading calories with a larger breakfast and smaller dinner
Consuming more calories earlier in the day aligns with circadian insulin sensitivity patterns and is associated with improved HbA1c and weight outcomes.
Question 7: Which statement about alcohol consumption in diabetes is correct?
- Alcohol raises blood glucose and should always be avoided
- Moderate alcohol consumption can mask hypoglycemia and should be consumed with food (Correct answer)
- Alcohol has no interaction with diabetes medications
- Beer is the safest alcohol choice because it contains complex carbohydrates
Correct answer: Moderate alcohol consumption can mask hypoglycemia and should be consumed with food
Alcohol inhibits hepatic gluconeogenesis and can cause delayed hypoglycemia, especially in insulin or sulfonylurea users; consuming it with food reduces this risk.
BC ADM Nutritional Management 3
A registered dietitian is counseling a patient with T1DM who wants to follow a plant-based diet.
The primary nutritional concern unique to this eating pattern in insulin-requiring patients is: