BC ADM Nutritional Management 4 — Questions and Answers
Question 1: A patient reports using cinnamon supplements to lower blood sugar. The most evidence-based response from a diabetes educator is:
- Cinnamon is proven to lower HbA1c by 1–2% and should be recommended
- Evidence is inconsistent and cinnamon should not replace proven diabetes therapies (Correct answer)
- Cinnamon is dangerous and must be discontinued immediately
- Cinnamon works only in type 1 diabetes, not type 2
Correct answer: Evidence is inconsistent and cinnamon should not replace proven diabetes therapies
Clinical trials on cinnamon show inconsistent results and it is not recommended as a substitute for evidence-based medical nutrition therapy or medications.
Question 2: For an adult with diabetes who is pregnant, the recommended carbohydrate intake at breakfast compared to other meals should be:
- Higher at breakfast to match increased morning energy needs
- Lower at breakfast due to increased morning insulin resistance from cortisol (Correct answer)
- Equal across all meals to simplify insulin dosing
- Eliminated at breakfast and replaced with protein only
Correct answer: Lower at breakfast due to increased morning insulin resistance from cortisol
Morning insulin resistance is highest in pregnancy due to elevated cortisol and progesterone, so carbohydrate at breakfast should be limited to ~15–30 g.
Question 3: A clinician is calculating a patient's caloric needs for medical nutrition therapy. The most appropriate method for estimating energy needs in an obese patient with diabetes is:
- Harris-Benedict equation using actual body weight
- Mifflin-St Jeor equation using actual body weight with activity factor (Correct answer)
- A fixed prescription of 1,200 kcal/day for all obese patients
- Doubling the patient's lean body mass in grams
Correct answer: Mifflin-St Jeor equation using actual body weight with activity factor
The Mifflin-St Jeor equation using actual body weight with an appropriate activity factor provides the most accurate resting energy expenditure estimate for obese adults.
Question 4: Which combination of macronutrient goals is most consistent with current ADA Standards of Care for diabetes nutrition?
- 40% carbohydrate, 30% protein, 30% fat for all patients
- A single ideal macronutrient ratio exists and applies universally
- Individualized macronutrient distribution based on metabolic goals, preferences, and culture (Correct answer)
- Carbohydrate must be under 20% of calories for all patients with diabetes
Correct answer: Individualized macronutrient distribution based on metabolic goals, preferences, and culture
ADA does not endorse a single ideal macronutrient ratio; instead, it recommends individualization based on the patient's health status, goals, and preferences.
Question 5: A patient taking metformin for 5 years has newly diagnosed peripheral neuropathy. Which nutritional assessment is most indicated at this visit?
- Serum zinc level
- Vitamin B12 level (Correct answer)
- Serum folate level
- Iron studies
Correct answer: Vitamin B12 level
Long-term metformin use reduces vitamin B12 absorption, and deficiency can cause peripheral neuropathy that mimics or worsens diabetic neuropathy.
Question 6: A patient with diabetes asks whether eating late at night causes worse blood sugar control. The most accurate evidence-based answer is:
- Nighttime eating has no metabolic effect in people with diabetes
- Late-night eating can worsen glycemic control due to lower insulin sensitivity at night (Correct answer)
- Eating late only affects blood sugar if the meal contains more than 60 g of carbs
- The effect of meal timing is identical at all hours for well-controlled patients
Correct answer: Late-night eating can worsen glycemic control due to lower insulin sensitivity at night
Peripheral insulin sensitivity declines in the evening and overnight, making late-night carbohydrate intake more likely to cause prolonged hyperglycemia.
Question 7: Which dietary intervention shows the most evidence for reducing triglycerides in a patient with T2DM and hypertriglyceridemia?
- Increasing monounsaturated fat intake
- Reducing refined carbohydrate and sugar intake (Correct answer)
- Increasing dietary cholesterol while reducing saturated fat
- Following a very-high-fiber vegetarian diet exclusively
Correct answer: Reducing refined carbohydrate and sugar intake
Reducing refined carbohydrates and added sugars is the most effective dietary strategy for lowering triglycerides, particularly in insulin-resistant individuals.
BC ADM Nutritional Management 4
A patient reports using cinnamon supplements to lower blood sugar.
The most evidence-based response from a diabetes educator is: