Nutrition 8 Flashcards

Which A1C value alone diagnoses diabetes?
A. 6.4%
B. 5.7%
C. 6.2%
D. 6.5%

A patient has polyuria, polydipsia, weight loss. Random plasma glucose is over 200 mg/dL. Best interpretation?
A. Diabetes by symptoms + random
B. Prediabetes by random value
C. Diabetes only if fasting elevated
D. Needs OGTT to diagnose

For diagnostic OGTT classification, the standard glucose load is:
A. 50 g oral glucose
B. 100 g oral glucose
C. 75 g anhydrous glucose
D. 1 g/kg oral glucose

Which fasting plasma glucose meets diabetes criteria?
A. 125 mg/dL
B. 126 mg/dL
C. 110 mg/dL
D. 100 mg/dL

Which fasting range defines impaired fasting glucose?
A. 90–99 mg/dL fasting
B. 126–139 mg/dL fasting
C. 80–89 mg/dL fasting
D. 100–125 mg/dL fasting

Which 2-hour OGTT range defines impaired glucose tolerance?
A. 120–139 mg/dL 2-hour
B. 200–239 mg/dL 2-hour
C. 140–199 mg/dL 2-hour
D. 100–119 mg/dL 2-hour

A 2-hour plasma glucose of which value diagnoses diabetes (75-g OGTT)?
A. 200 mg/dL
B. 199 mg/dL
C. 140 mg/dL
D. 125 mg/dL

Which A1C range defines prediabetes?
A. 6.5–7.4%
B. 5.7–6.4%
C. 4.0–5.6%
D. 6.0–6.9%

Screening should be considered at any age when BMI ≥25 kg/m² plus:
A. Age >45 only
B. No symptoms present
C. At least one risk factor
D. Any normal fasting glucose

In adults without risk factors, testing should begin no later than:
A. Age 35
B. Age 40
C. Age 50
D. Age 45

A teen presents with DKA and weight loss. The primary defect in type 1 diabetes is:
A. Autoimmune beta-cell destruction
B. Hepatic insulin overproduction
C. Muscle glucose transporter failure
D. Alpha-cell hyperplasia primary

The hormonal state resulting from type 1 beta-cell loss is best described as:
A. Relative insulin excess
B. Absolute insulin deficiency
C. Isolated glucagon deficiency
D. Selective cortisol deficiency

Why can type 1 diabetes have months–years of silent progression?
A. Renal glucose threshold increases
B. Glucagon remains fully suppressed
C. Peripheral insulin sensitivity increases
D. Pancreas has large insulin reserve

Autoantibodies to GAD65 appear to provoke attack by:
A. Killer T lymphocytes
B. B lymphocytes
C. Neutrophils
D. Eosinophils

Type 1 diabetes HLA association includes linkage to:
A. HLA-A and HLA-B
B. HLA-C and HLA-E
C. HLA-DGA and HLA-DQB
D. HLA-DP and HLA-DO

Which statement about HLA-DR/DQ alleles is correct?
A. DR/DQ alleles never protective
B. DR/DQ alleles can either be predisposing or protect
C. Only DRB is predisposing
D. Only DQB is protective

Insulin autoantibodies may be found in people who:
A. Always used insulin previously
B. Only have type 2 diabetes
C. Are only on metformin
D. Never received insulin therapy

In type 2 diabetes development, hyperglycemia requires:
A. Complete alpha-cell failure
B. Autoimmune islet destruction
C. Acute cortisol deficiency
D. Beta-cell secretory impairment

By the time type 2 diabetes is diagnosed, beta-cell function loss can reach:
A. 50% loss
B. 10% loss
C. 90% loss
D. 25% loss

Early type 2 diabetes commonly features which insulin abnormality?
A. Excess first-phase insulin
B. Inadequate first-phase insulin
C. Absent basal insulin secretion
D. Increased insulin clearance

Inadequate first-phase insulin fails to suppress which hormone?
A. Growth hormone
B. Cortisol
C. Epinephrine
D. Glucagon

The main consequence of glucagon hypersecretion is:
A. Increased hepatic glucose output
B. Increased muscle glucose uptake
C. Decreased gluconeogenesis
D. Increased peripheral insulin action

Increased free fatty acids causing metabolic injury is termed:
A. Glucotoxicity
B. Ketosis
C. Lipotoxicity
D. Glycogenesis

Increased free fatty acids directly cause which change?
A. Increased insulin sensitivity
B. Decreased insulin sensitivity
C. Increased GLUT4 translocation
D. Increased insulin receptor density

Free fatty acids also tend to:
A. Impair insulin secretion
B. Improve beta-cell recovery
C. Reduce hepatic glucose output
D. Abolish glucagon secretion

A prediabetic patient asks about risk reduction. Supported weight loss target is:
A. 1–2% body weight
B. 3–4% body weight
C. 10–12% body weight
D. 5–7% body weight

The physical activity target linked to benefit is:
A. 10 minutes brisk daily
B. 30 minutes brisk most days
C. 60 minutes jogging weekly
D. Resistance training only

Lifestyle changes can reduce diabetes risk by:
A. 5–10%
B. 10–20%
C. 29–67%
D. 70–90%

Lifestyle changes may delay type 2 diabetes onset for at least:
A. 10 years
B. 2 years
C. 6 months
D. 5 years

For pharmacologic prevention, ADA recommends (with lifestyle):
A. Acarbose only
B. GLP-1 agonist only
C. Pioglitazone only
D. Metformin only

Metformin prevention is especially emphasized for:
A. BMI 24, age 66
B. BMI 28, age 62
C. BMI 36, age 58
D. BMI 23, age 41

Counterregulatory hormones have what net effect relative to insulin?
A. Same glucose-lowering effect
B. Opposite effect of insulin
C. No effect on metabolism
D. Only increase insulin secretion

After eating, two “anticipatory” hormones amplify insulin release. Which pair fits?
A. Amylin and insulin
B. Cortisol and glucagon
C. Epinephrine and norepinephrine
D. GLP-1 and GIP

A patient asks where incretins come from. Best answer?
A. Gastrointestinal tract after ingestion
B. Pancreatic alpha cells post-meal
C. Adipose tissue during fasting
D. Liver sinusoids during stress

A resident explains why incretins matter clinically. Key effect?
A. Delay insulin until absorption
B. Increase renal glucose reuptake
C. Anticipatory insulin rise pre-absorption
D. Trigger ketogenesis after meals

A1C measures:
A. Serum fructosamine
B. Glycosylated hemoglobin
C. Glycated albumin fraction
D. Total plasma glucose burden

A patient’s A1C is reviewed. It best reflects glycemia over:
A. Prior 6–8 weeks
B. Prior 48–72 hours
C. Prior 10–14 days
D. Prior 6–12 months

Why does A1C rise with hyperglycemia over time?
A. Enzymatic hemoglobin phosphorylation
B. Rapid protein acetylation process
C. Insulin-driven hemoglobin oxidation
D. Nonenzymatic, concentration-dependent glycation

For many non-pregnant adults, ADA’s reasonable A1C goal is:
A. <6.5%
B. <7%
C. <7.5%
D. <8%

A highly motivated patient wants tighter control. Lower A1C may be reasonable if:
A. Advanced complications already present
B. Limited life expectancy expected
C. No significant hypoglycemia/adverse effects
D. Persistent postmeal excursions continue

A frail patient has severe hypoglycemia history. A less stringent goal is most appropriate when:
A. Severe hypoglycemia, limited life expectancy, complications
B. Newly diagnosed, no comorbidities
C. Pregnancy planning this year
D. Early disease, low hypoglycemia risk

A pump user asks what drives rapid-acting bolus needs most. Best determinant?
A. Meal protein grams
B. Meal sodium content
C. Meal fiber density
D. Total meal carbohydrate grams

A patient notices worse control after fried foods. High-fat meals primarily:
A. Improve insulin sensitivity acutely
B. Interfere with insulin signaling
C. Suppress hepatic glycogenolysis
D. Increase incretin release persistently

In nutrition counseling, lower-fat patterns are expected to:
A. Worsen insulin sensitivity
B. Increase hepatic glucose output
C. Reduce incretin secretion
D. Improve insulin sensitivity

Trials comparing eating patterns show similar A1C and weight improvements with:
A. High- or low-carbohydrate eating patterns
B. Zero-carbohydrate ketogenic diet only
C. Protein-only dietary pattern
D. Sodium-restricted pattern alone

When comparing carbohydrate type/amount versus energy intake, the more important driver is:
A. Glycemic index category
B. Total energy intake
C. Dietary cholesterol intake
D. Protein timing with meals

A dietitian teaches “carb counting.” One average carbohydrate serving equals:
A. 10 g carbohydrate
B. 12 g carbohydrate
C. 15 g carbohydrate
D. 20 g carbohydrate

A patient asks for a fiber target. Recommended intake is:
A. 14 g per 1000 kcal
B. 10 g per 1000 kcal
C. 25 g per day
D. 40 g per day

A patient without renal disease asks about protein restriction. Best guidance?
A. Increase protein to 30% energy
B. Avoid protein entirely at dinner
C. Reduce protein below usual intake
D. Remain 15–20% of energy

Long-term high-fat and high saturated fat intake is associated with:
A. Reduced insulin resistance
B. Improved insulin sensitivity
C. Increased insulin resistance
D. No change in insulin action

A supplement-focused patient asks about antioxidants. Routine supplementation is:
A. Recommended for all diabetics
B. Required with metformin use
C. Preferred in hypertensive patients
D. Not advised routinely

A patient asks if sodium advice differs in diabetes. Appropriate target is:
A. Under 2300 mg per day
B. Under 1500 mg per day
C. Under 3500 mg per day
D. No sodium restriction needed

Sodium reduction lowers blood pressure in:
A. Only hypertensive individuals
B. Only normotensive individuals
C. Normotensive and hypertensive individuals
D. Only patients with complications

A patient plans exercise; pre-exercise glucose is 92 mg/dL. Best immediate step?
A. Skip carbohydrates before exercise
B. Eat carbohydrates before exercise
C. Take bolus insulin immediately
D. Delay exercise until bedtime

A patient on Amylin mimetics (pramlintide) asks what it does. Primary postmeal effects?
A. Stimulates hepatic glucose production
B. Inhibits DPP-4 enzyme activity
C. Decreased glucagon, delayed gastric emptying
D. Increases glucagon, accelerates emptying

A patient has postprandial hyperglycemia despite lifestyle changes. Alpha-glucosidase inhibitors (acarbose, miglitol) work by:
A. Inhibiting intestinal α-glucosidase that digests carbs
B. Stimulating beta-cell insulin release
C. Blocking hepatic gluconeogenesis enzymes
D. Activating amylin receptors

A patient asks why Biguanides (metformin) helps without “pushing insulin.” They:
A. Enhance insulin secretion directly
B. Delay gastric emptying markedly
C. Inhibit intestinal α-glucosidase
D. Suppressing hepatic glucose production

DPP-4 inhibitors (sitagliptin, saxagliptin, linagliptin) normally degrades which peptides?
A. Amylin and insulin
B. GLP-1 and GIP
C. Cortisol and epinephrine
D. Glucagon and growth hormone

Exenatide, Liragludite are:
A. GLP-1 receptor agonists
B. GLP-1 receptor antagonists
C. GLP-2 receptor agonists
D. GLP-2 receptor antagonists

Sodium-glucose transporter 2 (SGLT-2) inhibitors (canagliflozin, dapagliflozin) cause glucosuria by preventing filtered glucose from returning to blood. What is the key mechanism?
A. Inhibit intestinal carbohydrate enzymes
B. Activate GLP-1 receptors
C. Increase beta-cell insulin synthesis
D. Block renal glucose reabsorption

A patient worries a GLP-1 receptor agonist will cause hypoglycemia when fasting. Why is insulin release limited at normal glucose?
A. Only with hyperglycemia present
B. Works only during exercise
C. Requires hepatic glycogen depletion
D. Depends on insulin receptor upregulation

After starting exenatide, a patient reports early satiety and smaller post-meal spikes. Which effect set best explains this?
A. Increase glucagon, faster emptying
B. Reduce insulin, faster emptying
C. Reduce glucagon, delay emptying
D. Increase insulin, faster emptying

A patient takes an insulin secretagogue (Meglinitres) at the start of meals for postprandial control. Which drugs fit?
A. Glipizide and Repaglinide
B. Repaglinide and Nateglinide
C. Canagliflozin and Nateglinide
D. Liraglutide and Repaglinide

Which medication is a second-generation sulfonylurea?
A. Sitagliptin
B. Nateglinide
C. Glimepiride
D. Dapagliflozin

A patient prefers long-term therapies that preserve beta-cell function. Which concern best matches sulfonylureas?
A. Primary hepatic glucose stimulation
B. Postmeal glucagon hypersecretion
C. Marked gastric emptying acceleration
D. Weight gain, beta-cell exhaustion

A patient with insulin resistance is placed on pioglitazone and rosiglitazone (thiazolidinediones). Primary therapeutic effect?
A. Increase urinary glucose clearance
B. Increase insulin secretion acutely
C. Decrease peripheral insulin resistance
D. Inhibit intestinal carbohydrate digestion

A patient needs background insulin to cover the post-absorptive state. Which insulins fit this role?
A. Lispro, Glargine, NPH
B. Glargine, Determir, NPH
C. Aspart, Determir, NPH
D. Regular, Determir, NPH

A hospitalized patient is NPO overnight. Why is basal insulin still required?
A. Restrain hepatic glucose output
B. Prevent intestinal glucose absorption
C. Increase pancreatic insulin stores
D. Enhance renal glucose filtration

Basal insulin also helps prevent excess substrate delivery to liver by:
A. Increasing glucagon secretion
B. Increasing hepatic ketone clearance
C. Accelerating adipose triglyceride breakdown
D. Limiting lipolysis and FFA flux

A patient asks when to inject detemir. Best guidance?
A. Only before breakfast
B. Only at bedtime
C. Any time, same daily
D. Only with largest meal

A patient wants to mix glargine with rapid-acting insulin in one syringe. Best advice?
A. Do not mix with others
B. Mix if dose is small
C. Mix only with NPH
D. Mix only at bedtime

A patient reports high glucose around waking despite stable daytime control. What phenomenon best fits?
A. Postprandial excursion
B. Dawn phenomenon
C. Reactive hypoglycemia
D. Exercise-induced hyperglycemia

A patient’s plasma glucose is 205 mg/dL and urinalysis shows glucose. The renal threshold is approximately:
A. 90–110 mg/dL
B. 120–140 mg/dL
C. 150–170 mg/dL
D. 180–220 mg/dL

New-onset type 1 diabetes usually becomes clinically apparent after approximately what beta-cell loss?
A. 30–40% destruction
B. 50–60% destruction
C. 80–90% destruction
D. 95–99% destruction

A conscious diabetic patient has tremor and diaphoresis with glucose 52 mg/dL. Preferred treatment?
A. Oral sucrose candy
B. Oral glucose
C. IV lipid emulsion
D. IM epinephrine

Initial hypoglycemia treatment dose should be:
A. 15–20 g glucose
B. 5–10 g glucose
C. 25–30 g glucose
D. 40–50 g glucose

After giving oral glucose for hypoglycemia, expected initial response time is:
A. 1–3 minutes
B. 5–8 minutes
C. 10–20 minutes
D. 45–60 minutes

An unconscious patient with hypoglycemia cannot take oral carbohydrates. Best immediate therapy?
A. Oral glucose tablets
B. Oral complex carbohydrates
C. IV fiber solution
D. Glucagon administration

In absolute insulin deficiency, adipose lipolysis increases partly due to:
A. Decreased adenylate cyclase activity
B. Increased adenylate cyclase activity
C. Increased insulin receptor signaling
D. Increased GLUT4 translocation

In insulin absence, fatty acid release also reflects reduced inhibition of:
A. Pyruvate dehydrogenase
B. HMG-CoA reductase
C. Glycogen phosphorylase
D. Hormone-sensitive lipase

The liver generates ketone bodies in DKA primarily from increased:
A. Acetyl-CoA from FFA oxidation
B. Oxaloacetate from glycolysis
C. Lactate from anaerobic muscle
D. Citrate from TCA overflow

Which molecule is a major ketone body in DKA?
A. Oxaloacetate
B. Succinate
C. Beta-hydroxybutyrate
D. Malate

In DKA, the primary source of circulating glucose is:
A. Hepatic gluconeogenesis
B. Muscle glycogenolysis
C. Intestinal glucose absorption
D. Renal glucose reuptake

Insulin’s major hepatic effect on this pathway is to:
A. Activate hepatic gluconeogenesis
B. Inhibit hepatic gluconeogenesis
C. Replace hepatic glycogen stores
D. Increase hepatic ketone synthesis

Which complication category is most tightly linked to chronic hyperglycemia?
A. Macrovascular aneurysm rupture
B. Primary valve calcification
C. Microvascular complications
D. Primary arrhythmia syndromes

Chronic microvascular complications prominently involve:
A. Lungs, skin, marrow
B. Eyes, kidneys, nerves
C. Liver, pancreas, spleen
D. Heart, aorta, carotids

Microalbuminuria signals increased risk for:
A. Hyperthyroidism and stroke
B. DKA and pancreatitis
C. Nephrolithiasis and anemia
D. Atherosclerosis and nephropathy

A pump user snacks between meals. If the snack contains >15 g carbs, what is often needed?
A. Additional basal insulin only
B. No insulin adjustment needed
C. Rapid-acting insulin before snack
D. Glucagon before snack

A 19-year-old with type 1 diabetes starts HIIT training. To prevent exercise-related hypoglycemia, advise checking glucose:
A. Before and after exercise
B. Only during exercise
C. Only after exercise
D. Only if symptomatic

For general lifestyle counseling, patients should strive for how much moderate exercise weekly?
A. 60 minutes weekly
B. 150 minutes weekly
C. 300 minutes weekly
D. 30 minutes monthly

A 26-year-old with oligomenorrhea and hirsutism has labs “consistent with PCOS.” The key lab features are:
A. Insulin resistance, hyperandrogenism
B. Hyperthyroidism, hypogonadism
C. Hyperprolactinemia, low cortisol
D. Hypoandrogenism, low insulin

In PCOS, hyperandrogenism is mainly driven by which source, with another contributing?
A. Adrenals primary, ovary minor
B. Pituitary primary, ovary minor
C. Ovary primary, adrenals contribute
D. Liver primary, adrenals contribute

A patient’s fasting plasma glucose is 128 mg/dL on screening. This is:
A. Normal fasting glucose
B. Impaired fasting glucose
C. Diabetes by fasting criteria
D. Reactive hypoglycemia

A 75-g OGTT shows 2-hour plasma glucose 206 mg/dL. Best interpretation?
A. Diabetes by 2-hour value
B. Impaired glucose tolerance
C. Normal glucose tolerance
D. Indeterminate, repeat in a week

A patient has polyuria and polydipsia. Random plasma glucose is 201 mg/dL. This indicates:
A. Prediabetes by random glucose
B. Normal random glucose
C. Requires fasting confirmation
D. Diabetes with classic symptoms

A fasting plasma glucose of 110 mg/dL is best classified as:
A. Diabetes mellitus
B. Prediabetes (IFG)
C. Normal fasting glucose
D. Postprandial hyperglycemia

A 2-hour OGTT glucose of 180 mg/dL is best classified as:
A. Normal glucose tolerance
B. Diabetes mellitus
C. Prediabetes (IGT)
D. Laboratory artifact

An A1C of 6.1% is best classified as:
A. Prediabetes by A1C
B. Diabetes by A1C
C. Normal A1C
D. Hypoglycemia risk state

A patient’s diabetes screen is normal. When should routine re-testing occur?
A. Every 6 months
B. Every 3 years
C. Every 10 years
D. Only if symptomatic

Overweight youth should be screened if they have how many additional diabetes risk factors?
A. Two or more
B. One only
C. Three or more
D. None required

For at-risk overweight youth, start screening at:
A. Age 5 regardless puberty
B. Age 18 only
C. Age 13 regardless puberty
D. Age 10 or puberty onset

Which set meets “overweight” criteria used for youth screening?
A. BMI ≥95th percentile only
B. BMI <50th percentile only
C. BMI≥85th, wt/ht≥85th, wt≥120%
D. Height <5th percentile only

Which type 1 diabetes autoantibody targets tyrosine phosphatases?
A. GAD65 antibody
B. IA-2 / IA-2B
C. Insulin autoantibody
D. Islet cell antibody

Which list best matches circulating autoantibodies linked to beta-cell destruction in type 1 diabetes?
A. ANA, dsDNA, Smith
B. TPO, TRAb, Tg
C. RF, CCP, ANCA
D. ICA, IAA, GAD65, IA-2

Type 1 diabetes can be diagnosed at any age, but it occurs mostly:
A. Over age 65
B. Under age 30
C. Only in toddlers
D. Only after menopause

Peak type 1 incidence occurs between which ages in girls?
A. 5–7 years
B. 15–17 years
C. 10–12 years
D. 20–22 years

Peak type 1 incidence occurs between which ages in boys?
A. 12–14 years
B. 6–8 years
C. 16–18 years
D. 22–24 years

At type 1 diabetes diagnosis, approximately what fraction have ≥1 circulating autoantibody?
A. 10–20%
B. 30–40%
C. 50–60%
D. 85–90%

The HLA association in type 1 diabetes is most classically tied to:
A. HLA-A/B alleles
B. HLA-DR/DQ alleles
C. HLA-C alleles
D. HLA-E alleles

Within this HLA association, linkage is described to which genes?
A. HLA-A and HLA-B
B. HLA-C and HLA-E
C. DGA and DQB genes
D. DPB and DPC genes

This HLA association is also influenced by which gene?
A. DRB gene
B. HBB gene
C. INS gene
D. VHL gene

The type 1 “honeymoon phase” can last up to:
A. 6 months max
B. 2 years max
C. 4 years max
D. 8–10 years max

In type 2 diabetes, hyperglycemia does not manifest until what has occurred?
A. Alpha-cell hyperplasia predominates
B. Impaired beta-cell function present
C. Autoimmune beta-cell destruction occurs
D. Complete insulin absence develops

Insulin resistance in adipocytes increases circulating free fatty acids. Which change is expected?
A. Increased insulin secretion
B. Decreased hepatic glucose output
C. Increased insulin sensitivity
D. Decreased insulin secretion

Elevated circulating free fatty acids contribute to fasting hyperglycemia primarily by:
A. Increasing hepatic glucose production
B. Increasing renal glucose reabsorption
C. Decreasing gastric emptying
D. Suppressing glucagon secretion

Which combined triad best matches effects of elevated free fatty acids on insulin?
A. ↑ secretion, ↑ sensitivity, ↓ production
B. ↓ secretion, ↓ sensitivity, ↑ production
C. ↓ secretion, ↑ sensitivity, ↓ production
D. ↑ secretion, ↓ sensitivity, ↑ production

Multiple drugs reduced diabetes incidence in prevention trials. Which set matches those tested?
A. Metformin, acarbose, orlistat, rosiglitazone
B. Metformin, liraglutide, glipizide, insulin
C. Acarbose, sitagliptin, dapagliflozin, NPH
D. Orlistat, pramlintide, glargine, metoprolol

ADA prevention pharmacotherapy is recommended for IGT/IFG or A1C:
A. 6.5–7.4%
B. 5.7–6.4%
C. 4.8–5.6%
D. 6.0–6.9%

Metformin prevention is also especially emphasized for:
A. Prior gestational diabetes
B. Prior nephrolithiasis
C. Prior asthma exacerbations
D. Prior hyperthyroidism

Grain recommendation within prevention lifestyle guidance:
A. Avoid grains entirely
B. Whole grains ≥ half intake
C. Whole grains only at dinner
D. Whole grains < quarter intake

Replacing saturated fats with which improves insulin resistance?
A. Trans fatty acids
B. Monounsaturated fats
C. Short-chain saturated fats
D. Dietary cholesterol

Another acceptable replacement for saturated fats is:
A. Polyunsaturated fats
B. Medium-chain triglycerides
C. Animal-based saturated fats
D. Hydrogenated oils

Alcohol guidance in diabetes prevention is to limit to:
A. 3–4 drinks per day
B. 0 drinks always
C. 1–2 drinks per day
D. 1 drink per week

A dietary pattern encouraged for prevention is:
A. Ketogenic pattern
B. Mediterranean-style pattern
C. Carnivore pattern
D. Very-low fiber pattern

Dietary cholesterol should be limited to:
A. <100 mg per day
B. <150 mg per day
C. <200 mg per day
D. <300 mg per day

Continuous glucose monitors primarily measure glucose in:
A. Interstitial fluid
B. Capillary blood
C. Venous plasma
D. Intracellular cytosol

A stable patient meeting goals asks about A1C testing frequency. Minimum is:
A. Once yearly
B. Twice yearly
C. Quarterly
D. Monthly

A patient with therapy changes is not meeting goals. A1C testing should be:
A. Every 6 months
B. Every 12 months
C. Four times per year
D. Every 2 years

Medical nutrition therapy (MNT) improves which metabolic outcomes?
A. Glucose, A1C, lipids, BP, weight
B. Only A1C and weight
C. Only triglycerides and HDL
D. Only blood pressure

In diabetes, MNT is associated with A1C reductions of:
A. 0.1–0.3%
B. 0.3–0.7%
C. 1–2% average
D. 3–5% average

Cardioprotective MNT implemented by RDs reduced which lipid marker 7–21%?
A. HDL-cholesterol
B. Total cholesterol
C. Lipoprotein(a)
D. Apolipoprotein B

At what timepoint should medication changes be assessed to meet targets?
A. At 1 week
B. At 1 month
C. At 3 months
D. At 12 months

Effective nutrition interventions include which set?
A. Reduced energy/fat, MNT, portion control
B. High sodium, low fiber, skipping meals
C. High saturated fat, low activity, fasting
D. Low fluid, high alcohol, low protein

A complementary effective set includes:
A. High glycemic meals, random snacks
B. Healthy choices and carb counting
C. Low sodium only, no carbs
D. Cholesterol loading, high fat

Metabolic improvements often require what weight loss range with activity and RD meetings?
A. 1–3% weight loss
B. 3–5% weight loss
C. 5–7% weight loss
D. 7–8.5% weight loss

Which group often consumes ~65–75% energy from carbohydrate with reported benefits?
A. Competitive powerlifters
B. Vegans or vegetarians
C. Carnivore dieters
D. Ketogenic dieters

Observational studies in diabetes report A1C benefits from which pattern?
A. Lower carb, higher fat
B. Higher carb, lower fat
C. Higher protein, lower carb
D. Higher fat, higher carb

As weight loss progresses in type 2 diabetes, patients may become more:
A. Insulin resistant than deficient
B. Insulin deficient than resistant
C. Glucagon deficient than resistant
D. Amylin resistant than deficient

This shift helps explain why some type 2 patients eventually need:
A. ACE inhibitors
B. Insulin injections
C. Antioxidant supplements
D. Glucagon injections

A patient notices better control when meal carbs are consistent. This implies:
A. Carb-consistent diet improves sugars
B. Protein variability improves sugars
C. Fat cycling improves sugars
D. Sodium loading improves sugars

After a protein-only meal, plasma glucose barely changes. Which immediate hormonal pattern is expected?
A. Insulin rises, glucagon falls
B. Glucagon rises, insulin falls
C. Neither insulin nor glucagon rises
D. Insulin and glucagon both rise

Which amino acid category is a substrate for gluconeogenesis?
A. Nonessential amino acids
B. Essential amino acids
C. Branched-chain amino acids
D. Aromatic amino acids

In type 2 diabetes, which dietary component lowers total and LDL cholesterol?
A. Omega-3 fish oil capsules
B. Plant sterol/stanol esters
C. Dietary cholesterol supplements
D. Medium-chain triglyceride oil

ADA-recommended bariatric surgery for type 2 diabetes is best captured by:
A. BMI 32, good medical control
B. BMI 35, no comorbidities
C. BMI 38, comorbidities hard to control
D. BMI 40, comorbidities easily controlled

A patient on glyburide plans to drink alcohol tonight. Best advice?
A. Avoid all alcohol permanently
B. Drink fasting to prevent spikes
C. Omit dinner to offset calories
D. Consume with food to reduce hypoglycemia

Which statement about moderate alcohol intake is supported in these notes?
A. Increases CVD mortality substantially
B. Associated with lower CVD mortality
C. Eliminates hypoglycemia risk on insulin
D. Requires skipping meals to compensate

A patient asks how to “count” alcohol in their meal plan. Best guidance?
A. Replace dinner carbs with alcohol
B. Skip meals to balance calories
C. Add to meal plan; omit none
D. Use alcohol as bedtime snack

Which basal insulin is typically dosed twice daily?
A. Glargine
B. Detemir
C. Degludec
D. NPH

For a simplified insulin regimen, which premixed insulin is usually prescribed for type 2 diabetes?
A. Humulin/Novolin 70/30
B. Lispro only regimen
C. Aspart correction
D. Glargine plus pramlintide

In insulin-treated patients, glucose 30–60 minutes after a meal is typically:
A. Near fasting nadir
B. Near postprandial peak
C. Unchanged from baseline
D. Below baseline typically

In many patients, glucose about 2 hours after a meal is ideally:
A. Still rising sharply
B. At absolute minimum
C. Doubles above baseline
D. Returning toward baseline

First-line pharmacotherapy for most type 2 diabetes is:
A. Exenatide monotherapy
B. Glyburide monotherapy
C. Metformin monotherapy
D. Canagliflozin monotherapy

Why do many type 2 diabetics benefit from combination therapy?
A. Avoid all lifestyle changes
B. Address different pathophysiologic defects
C. Eliminate need for monitoring
D. Guarantee insulin independence lifelong

Over time, many type 2 diabetics require:
A. Insulin therapy, alone or combined
B. Lifelong diet alone
C. Only alpha-glucosidase inhibitors
D. Only GLP-1 agonists

A patient starts pramlintide for postmeal spikes. What is the key effect pair?
A. Increase glucagon; speed emptying
B. Increase insulin; speed emptying
C. Decrease glucagon; delay emptying
D. Block renal glucose reabsorption

Acarbose lowers postprandial glycemia primarily by:
A. Enhance GLP-1 receptor signaling
B. Inhibit intestinal α-glucosidase enzyme
C. Increase renal glucose excretion
D. Activate PPAR-gamma in adipose

Metformin lowers glucose mainly by:
A. Suppress hepatic glucose production
B. Stimulate pancreatic insulin secretion
C. Increase gastric emptying speed
D. Block intestinal fat absorption

Which statement about metformin is true?
A. Promotes insulin secretion acutely
B. Acts as GLP-1 agonist
C. Blocks DPP-4 degradation
D. Does not stimulate insulin secretion

Sitagliptin works primarily by:
A. Block SGLT2 in proximal tubule
B. Inhibit DPP-4 degrading incretins
C. Directly open beta-cell KATP
D. Bind PPAR-gamma receptors

DPP-4 inhibition most directly causes:
A. Increase glucagon and insulin
B. Decrease insulin; increase glucagon
C. Glucose-dependent insulin rise; glucagon falls
D. Insulin rise independent of glucose

GLP-1 receptor agonists typically:
A. Increase glucagon; speed emptying
B. Decrease insulin; increase appetite
C. Increase insulin always; hypoglycemia
D. Delay emptying; lower glucagon; raise insulin

Which hormone set directly stimulates gluconeogenesis?
A. Insulin, leptin, GLP-1
B. Thyroxine, calcitonin, PTH
C. Amylin, GIP, somatostatin
D. Cortisol, adrenaline, glucagon

Which set correctly lists ketone bodies?
A. Lactate, pyruvate, alanine
B. Acetoacetate, acetone, beta-hydroxybutyrate
C. Citrate, succinate, fumarate
D. Glucose, glycogen, galactose

Ketone bodies in insulin absence derive primarily from:
A. Oxaloacetate from glycolysis
B. Glucose-6-phosphate from glycogen
C. Malonyl-CoA from lipogenesis
D. Acetyl-CoA from FFA oxidation

At type 1 diabetes diagnosis, an initial total daily insulin dose is about:
A. 0.1–0.2 units/kg/day
B. 1.0–1.2 units/kg/day
C. 0.5–0.6 units/kg/day
D. 2.0–3.0 units/kg/day

Initial total daily insulin is typically divided as:
A. All basal, no bolus
B. Mostly bolus, minimal basal
C. One-third basal, two-thirds bolus
D. Half basal, half bolus

Alcohol should be consumed with food to reduce hypoglycemia risk in:
A. Patients on metformin only
B. Patients on ACE inhibitors
C. Insulin or secretagogue users
D. Patients on SGLT2 inhibitors

During physiologic stress, which hormone directly stimulates gluconeogenesis?
A. Insulin
B. Leptin
C. Amylin
D. Glucagon