1. The risk factors for type 1 diabetes include all of the following except:
2. Type 2 diabetes accounts for approximately what percentage of all cases of diabetes in adults?
3. Risk factors for type 2 diabetes include all of the following except:
- Advanced age
- Physical inactivity
4. What percentage of women with gestational diabetes is diagnosed with type 2 diabetes following pregnancy?
5. Untreated diabetes may result in all of the following except:
- Cardiovascular disease
- Kidney disease
6. Prediabetes is associated with all of the following except:
- Increased risk of developing type 2 diabetes
- Impaired glucose tolerance
- Increased risk of heart disease and stroke
- Increased risk of developing type 1 diabetes
7. Diabetics are at increased risk of heart disease if they also:
- Have high HDL cholesterol levels
- Take aspirin
- Consume a high-fiber diet
8. Blood sugar is well controlled when Hemoglobin A1C is:
- Below 7%
- Between 12%-15%
- Less than 180 mg/dL
- Between 90 and 130 mg/dL
9. Excessive thirst and volume of very dilute urine may be symptoms of:
- Urinary tract infection
- Diabetes insipidus
- Viral gastroenteritis
10. Among female children and adolescents, the first sign of type 1 diabetes may be:
- Rapid weight gain
- Genital candidiasis
11. Untreated hyperglycemia may lead to all of the following complications except:
- Hyperosmolar syndrome
- Diabetic ketoacidosis
12. Hyperinsulinemia may be caused by all of the following except:
- An insulinoma
- Insulin resistance
- Type 1 diabetes
13. Which statement about diabetes is false?
- The U.S. prevalence of diabetes is decreasing
- Diabetes is the seventh leading cause of death in the United States
- Diabetes is the leading cause of blindness among persons age 20 to 74
- Diabetes is the leading cause of kidney failure
14. The lifetime risk of developing diabetes for a male born in 2000 is:
- 1 in 5
- 1 in 3
- 2 in 5
- 1 in 2
15. Which of the following measures does not help to prevent diabetes complications?
- Controlling blood glucose
- Controlling blood pressure and blood lipids
- Eliminating all carbohydrates from the diet
- Prompt detection of diabetic eye and kidney disease
16. Proliferative retinopathy is often treated using:
- Fluorescein angiogram
- Laser surgery
17. Which of the following diabetes drugs acts by decreasing the amount of glucose produced by the liver?
- Alpha-glucosidase inhibitors
18. The benefits of using an insulin pump include all of the following except:
- By continuously providing insulin they eliminate the need for injections of insulin
- They simplify management of blood sugar and often improve A1C
- They enable exercise without compensatory carbohydrate consumption
- They help with weight loss
19. Which of the following regimens offers the best blood glucose control for persons with type 1 diabetes?
- A single anti-diabetes drugs
- Once daily insulin injections
- A combination of oral anti-diabetic medications
- Three or four injections per day of different types of insulin.
20. Diabetic neuropathies are diagnosed using all of the following except:
- Nerve conduction studies or electromyography
- Foot examinations
- Minnesota Mutiphasic Personality inventory (MMPI)
Answers and Explanations
Type 1 diabetes is a primary failure of pancreatic beta cells to produce insulin. It primarily affects children and young adults and is unrelated to diet.
Type 2 diabetes accounts for the overwhelming majority of cases diagnosed in adults. It develops gradually, beginning with insulin resistance and as the requirement for insulin increases, the pancreas becomes progressively less able to produce it.
Additional risk factors for type 2 diabetes are a family history of diabetes, impaired glucose metabolism, history of gestational diabetes, and race/ethnicity. African-Americans, Hispanics/Latinos, Asian Americans, Native Hawaiians, Pacific Islanders, and Native Americans are at greater risk of developing diabetes than whites.
African-American, Hispanic/Latina and Native American women are at greater risk of developing gestational diabetes than are white women. Women who experience gestational diabetes are at increased risk of developing diabetes during the decade following pregnancy.
Untreated diabetes also may result in loss of lower limbs to amputation and death.
Persons with elevated glucose levels that do not yet meet the criteria for diabetes are considered to have prediabetes and are at increased risk of developing type 2 diabetes. Weight loss and increasing physical activity can help people with prediabetes prevent or postpone the onset of type 2 diabetes.
Diabetics who smoke are at greater risk of developing heart disease because both diabetes and smoking act to narrow blood vessels. Smoking also is associated with increased risk of eye problems and may compromise circulation to the legs.
A1c measures the percentage of hemoglobin that is glycated and determines average blood glucose during the two to three months prior to testing. Used as a diagnostic tool, A1C levels of 6.5% or higher on two tests indicate diabetes. A1C of 6% to 6.5% is considered prediabetes.
Diabetes insipidus is a condition in which the kidneys are unable to conserve water, often because there is insufficient antidiuretic hormone (ADH) or the kidneys are unable to respond to ADH. Although diabetes mellitus may present with similar symptoms, the disorders are different. Diabetes insipidus does not involve hyperglycemia.
The signs and symptoms that suggest type 1 diabetes include excessive thirst, hunger, urination, weight loss, fatigue, irritability, blurred vision, and infection with candida albicans (also known as yeast infections).
Excessively high blood sugar or prolonged hyperglycemia can cause diabetic ketoacidosis, the condition in which the body breaks down fat for energy and ketones spill into the urine. Diabetic hyperosmolar syndrome occurs when blood sugar is excessively high and available insulin is ineffective. In this case, the body cannot use glucose or fat for energy and glucose is excreted in the urine. Without immediate medical attention, both conditions may result in coma or death.
Hyperinsulinemia indicates a difficulty in blood sugar regulation; the pancreas is working to produce enough insulin to regulate blood sugar. Hyperinsulinemia may be cause by a tumor of insulin-producing cells (an insulinoma), excessive numbers of insulin producing cells (nesidioblastosis), or insulin resistance.
The prevalence of diabetes is increasing dramatically. The CDC reports an increase of more than three million cases in the two years from 2006 to 2008. By 2008, an estimated 8% of the U.S. population had diabetes.
The CDC reports that adults in the U.S. are at high risk of developing diabetes. Females are at higher risk than males and Hispanics/Latinos are at the greatest risk.
There is no evidence that eliminating all sugar from the diet benefits people with diabetes. It is more important for diabetics to manage and control total carbohydrate intake so that their blood glucose levels remain on target. Controlling blood glucose, blood pressure, and blood lipid levels can aid in the prevention of complications associated with diabetes.
Scatter laser treatment is used to shrink abnormal blood vessels in an effort to preserve vision. When there is significant bleeding in the eye, it is removed in a procedure known as vitrectomy. Tonometry is a diagnostic test that measures pressure inside the eye. A fluorescein angiogram is a diagnostic test that traces the flow of dye through the blood vessels in the retina; it is used to detect macular edema.
Biguanides, such as metformin, lower blood glucose by reducing the amount of glucose produced by the liver. Sulfonylureas and Meglitinides stimulate the beta cells of the pancreas to produce more insulin. Alpha-glucosidase inhibitors block the breakdown of starches and some sugars, which helps to reduce blood glucose levels
Using an insulin pump has many advantages, including fewer dramatic swings in blood glucose levels, increased flexibility about diet, and improved accuracy of insulin doses and delivery; however, the use of an insulin pump has been associated with weight gain.
Because persons with type 1 diabetes do not produce insulin, they require insulin and cannot be treated with oral anti-diabetic drugs. Several injections of insulin per day, calibrated to respond to measured blood glucose levels, offer the best blood glucose control and may prevent or postpone the retinal, renal, and neurological complications of diabetes.
Nerve conduction studies assess transmission of electrical signals through nerves and electromyography evaluates nerve transmission to muscles. Ultrasound can assess the responsivity and function of internal organs that may be compromised by neurological damage. Foot exams help to assess peripheral neuropathy and to ensure the integrity of skin. The MMPI is a psychological test and is not used to assess diabetic neuropathy.