Diabetes Education Certification Medical Nutrition Therapy 3 — Questions and Answers
Question 1: Which sweetener is considered a nutritive sweetener that still raises blood glucose and must be counted in carbohydrate intake?
- Stevia
- Sucralose
- Aspartame
- Honey (Correct answer)
Correct answer: Honey
Honey is a nutritive sweetener that contains calories and carbohydrates and raises blood glucose similarly to table sugar.
Question 2: What effect does alcohol have on blood glucose in a patient taking insulin or insulin secretagogues?
- Alcohol consistently raises blood glucose by stimulating gluconeogenesis
- Alcohol can cause delayed hypoglycemia by inhibiting hepatic glucose output (Correct answer)
- Alcohol has no effect on blood glucose when consumed with food
- Alcohol raises blood glucose only when mixed with sugary beverages
Correct answer: Alcohol can cause delayed hypoglycemia by inhibiting hepatic glucose output
Alcohol inhibits hepatic gluconeogenesis, which can lead to hypoglycemia, especially when consumed without food.
Question 3: When counseling a patient about sugar-free foods, which important point must be emphasized?
- Sugar-free foods contain no carbohydrates and do not affect blood glucose
- Sugar-free foods may still contain significant calories and carbohydrates from other sources (Correct answer)
- Sugar-free foods are always lower in calories than their regular counterparts
- Sugar alcohols in sugar-free foods have no glycemic effect
Correct answer: Sugar-free foods may still contain significant calories and carbohydrates from other sources
Sugar-free products can still contain carbohydrates from starches, sugar alcohols, or other ingredients that affect blood glucose and caloric intake.
Question 4: A patient with type 1 diabetes is using an insulin-to-carbohydrate ratio for bolus dosing. What must the patient accurately track to use this approach?
- Total fat grams per meal
- Grams of carbohydrate per meal (Correct answer)
- Total caloric intake per day
- Protein grams per meal
Correct answer: Grams of carbohydrate per meal
The insulin-to-carbohydrate ratio requires accurate counting of carbohydrate grams to calculate the appropriate bolus insulin dose.
Question 5: Which eating pattern has the STRONGEST evidence for improving glycemic control and cardiovascular risk factors in type 2 diabetes?
- High-protein, low-carbohydrate diet only
- Mediterranean-style eating pattern (Correct answer)
- Low-fat diet exclusive of other patterns
- Intermittent fasting exclusively
Correct answer: Mediterranean-style eating pattern
The Mediterranean eating pattern has the most robust evidence supporting improvements in glycemic control, lipid profiles, and cardiovascular outcomes in type 2 diabetes.
Question 6: How should sugar alcohols (e.g., sorbitol, xylitol) be counted in carbohydrate totals for patients with diabetes?
- Subtract all sugar alcohol grams from total carbohydrates
- Count them the same as regular sugars
- Subtract half of the sugar alcohol grams from total carbohydrates (Correct answer)
- Ignore them entirely as they have no glycemic effect
Correct answer: Subtract half of the sugar alcohol grams from total carbohydrates
A common practice is to subtract half of the sugar alcohol grams from total carbohydrates, as they are partially absorbed and have a reduced glycemic effect.
Question 7: A patient with diabetes reports frequent hypoglycemia 2–3 hours after breakfast. Which MNT strategy is MOST appropriate to investigate first?
- Recommend eliminating breakfast entirely
- Evaluate the carbohydrate content and timing of breakfast relative to medication (Correct answer)
- Increase carbohydrate content at breakfast significantly
- Recommend a high-fat, low-carbohydrate breakfast only
Correct answer: Evaluate the carbohydrate content and timing of breakfast relative to medication
Evaluating whether the carbohydrate amount at breakfast appropriately matches the insulin or medication dose and timing is the first step in addressing postprandial hypoglycemia.
Diabetes Education Certification Medical Nutrition Therapy 3
Which sweetener is considered a nutritive sweetener that still raises blood glucose and must be counted in carbohydrate intake?