BC ADM Nutritional Management 5 — Questions and Answers
Question 1: A patient with T1DM using continuous glucose monitoring (CGM) notices that fruit juice consistently causes glucose to spike to 250 mg/dL within 20 minutes. The best nutritional education point is:
- Fruit juice is healthier than soda and does not require a bolus
- Liquid carbohydrates are absorbed very rapidly and require a pre-meal or early bolus (Correct answer)
- The patient should switch to diet juice to avoid all carbohydrate impact
- Fruit juice only raises glucose in patients who are insulin resistant
Correct answer: Liquid carbohydrates are absorbed very rapidly and require a pre-meal or early bolus
Liquid carbohydrates bypass mechanical digestion and are absorbed nearly immediately, causing rapid glucose spikes that may outpace a standard mealtime bolus.
Question 2: When counseling a patient on a carbohydrate-counting approach, 'one carbohydrate serving' or 'one carbohydrate choice' is defined as:
- 10 grams of total carbohydrate
- 15 grams of total carbohydrate (Correct answer)
- 20 grams of total carbohydrate
- 30 grams of digestible carbohydrate
Correct answer: 15 grams of total carbohydrate
In the carbohydrate counting method used in diabetes education, one carbohydrate choice equals 15 grams of carbohydrate.
Question 3: A patient with diabetes undergoing Ramadan fasting asks for guidance. The safest nutritional strategy during the pre-dawn meal (Suhoor) is to:
- Consume high-sugar foods to sustain energy through the fast
- Choose low-GI, high-fiber foods and adequate fluid to moderate glucose rise (Correct answer)
- Eat a large high-fat meal to delay hunger and skip medication
- Avoid all carbohydrate at Suhoor to prevent daytime hyperglycemia
Correct answer: Choose low-GI, high-fiber foods and adequate fluid to moderate glucose rise
Low-GI, high-fiber foods at Suhoor provide a gradual, sustained energy release that helps avoid extreme glucose fluctuations during the fasting period.
Question 4: Which of the following best describes the role of protein in postprandial glucose management for people with diabetes?
- Protein has no effect on blood glucose and does not require counting
- Protein stimulates insulin secretion and can raise glucose in patients with T1DM, but has minimal effect in T2DM on oral agents (Correct answer)
- Protein always lowers blood glucose through glucagon suppression
- Protein raises glucose identically to carbohydrate, gram for gram
Correct answer: Protein stimulates insulin secretion and can raise glucose in patients with T1DM, but has minimal effect in T2DM on oral agents
Protein stimulates both insulin and glucagon; in T1DM patients it can raise glucose 2–5 hours postprandially, whereas in T2DM on oral agents the net effect is often minimal.
Question 5: A patient asks about the DASH diet for managing their diabetes and hypertension. Which statement accurately describes the DASH diet's application in diabetes?
- DASH is contraindicated in diabetes because it includes fruit
- DASH emphasizes vegetables, fruits, whole grains, and low-fat dairy and is compatible with diabetes management (Correct answer)
- DASH requires elimination of all sodium and is too restrictive for long-term adherence
- DASH is only for patients without diabetes who have high blood pressure
Correct answer: DASH emphasizes vegetables, fruits, whole grains, and low-fat dairy and is compatible with diabetes management
The DASH diet is compatible with diabetes management and has demonstrated benefits for blood pressure, cardiovascular risk, and glycemic control.
Question 6: Which approach to weight management has the strongest evidence for achieving type 2 diabetes remission?
- Moderate caloric restriction of 250 kcal/day below maintenance
- Intensive lifestyle intervention with 10–15% body weight loss or very-low-calorie diet (Correct answer)
- High-intensity exercise alone without dietary changes
- Intermittent fasting with no caloric restriction on eating days
Correct answer: Intensive lifestyle intervention with 10–15% body weight loss or very-low-calorie diet
The DiRECT trial and similar studies demonstrate that 10–15% or greater weight loss through intensive dietary intervention can induce T2DM remission in a significant proportion of patients.
Question 7: A diabetes educator is teaching a patient to read nutrition labels. Regarding 'added sugars,' the most important patient education point is:
- Added sugars are always listed first in the ingredient list by law
- Added sugars are now separately disclosed on the Nutrition Facts label and should be minimized (Correct answer)
- Added sugars have the same metabolic effect as naturally occurring sugars in all patients
- The 'total sugars' line on the label includes added sugars so no further inspection is needed
Correct answer: Added sugars are now separately disclosed on the Nutrition Facts label and should be minimized
The updated FDA Nutrition Facts label separately lists 'Added Sugars,' helping patients identify and limit sources of sugar that provide no nutritional benefit.
BC ADM Nutritional Management 5
A patient with T1DM using continuous glucose monitoring (CGM) notices that fruit juice consistently causes glucose to spike to 250 mg/dL within 20 minutes.
The best nutritional education point is: