1. The two major problems underlying type 2 diabetes are:

• a. Insulin resistance and obesity.
• b. Obesity and hypertension.
• c. Insulin resistance and decreased insulin secretion.
• d. Hypertension and decreased insulin secretion.

2. The difference between type 1 and type 2 diabetes is:

• a. Only type 1 originates in the pancreas.
• b. Type 2 is insulin-resistant.
• c. Type 1 produces too many beta cells.
• d. Type 2 is more common in children.

3. The pancreatic cells that manufacture insulin are called:

• a. Alpha cells.
• b. Beta cells.
• c. Secretagogues.
• d. Insulinocytes.

4. In the United States:

• a. A 25-year-old person is more likely to have diabetes than a 65-year-old.
• b. A 45-year-old person is more likely to have diabetes than a 65-year-old.
• c. A Native American is more likely to have diabetes than a European American.
• d. A European American is more likely to have diabetes than a Hispanic American.

5. The main blood sugar in the body is:

• a. Sucrose.
• b. Fructose.
• c. Galactose.
• d. Glucose.

6. Glucose is stored temporarily in long chains called:

• a. Long-chain fatty acids.
• b. Peptides.
• c. Glycogens.
• d. Collagens.

7. Insulin works mainly:

• a. At the surface of cells.
• b. Inside cells.
• c. On skin cells.
• d. On pancreatic cells.

8. The kidneys excrete significant amounts of glucose in the urine:

• a. Normally.
• b. When blood glucose gets higher than the fasting level (100 mg/dl).
• c. Only after the blood glucose is already too high (>180–200 mg/dl).
• d. In all people with diabetes.

9. Insulin resistance is:

• a. Fear of changing from oral medications to insulin injections.
• b. Abnormal difficulty body cells have in using insulin.
• c. Abnormal difficulty beta cells have in making insulin.
• d. The difficulty kidneys have in secreting insulin.

10. Insulin resistance can be caused by:

• a. Excessive thirst (polydipsia).
• b. Excessive urination (polyuria).
• c. Excess visceral fat.
• d. Excessive sweating.

11. Metabolic syndrome is a cluster of problems including impaired fasting glucose, dyslipidemia, and:

• a. Hyperadrenalism.
• b. Hypercapnia.
• c. Hyperthyroidism.
• d. Hypertension.

12. The formal diagnosis of diabetes requires:

• a. Documenting higher than normal plasma glucose levels.
• b. Documenting higher than normal urinary albumin levels.
• c. The three classic symptoms: polyuria, polydipsia, and weakness.
• d. At least one of the following: diabetic retinopathy, diabetic neuropathy, diabetic nephropathy, or diabetic foot problems.

13. A normal fasting blood glucose level is:

• a. ≤70 mg/dl.
• b. ≤100 mg/dl.
• c. ≤130 mg/dl.
• d. ≤160 mg/dl.

14. A1C values give a good indication of the:

• a. Fasting plasma glucose levels.
• b. Glycemic index.
• c. Average hemoglobin levels over the past 2 to 3 months.
• d. Average plasma glucose levels over the past 2 to 3 months.

15. People with type 2 diabetes need to:

• a. Track of the carbohydrates in their diet.
• b. Pay no attention to carbohydrates unless they are taking insulin.
• c. Eat a very low carbohydrate diet (<130 gm/day).
• d. Avoid sugar entirely.

16. The treatment program for a person with diabetes:

• a. Is best done by one physician because involving others is not cost effective.
• b. Is best done by one nurse practitioner because involving physicians is not cost effective.
• c. Is best done by a team of professionals.
• d. Is best done by a patient and family to ensure compliance.

17. Weight loss for people with type 2 diabetes:

• a. Cannot be recommended if the person has heart or kidney disease.
• b. Can reduce insulin resistance.
• c. Is generally dangerous to the person's general health.
• d. Is the least important lifestyle change.

18. Exercise for people with type 2 diabetes:

• a. Cannot be recommended if the person has heart or kidney disease.
• b. Can be designed for almost any patient.
• c. Should be aerobic but not resistance exercise.
• d. Is the least important lifestyle change.

19. Oral hypoglycemics are:

• a. Medications commonly used to treat both type 1 and type 2 diabetes.
• b. Medications commonly used to treat type 2 diabetes.
• c. Medications commonly used to treat type 1 diabetes.
• d. No longer commonly used to treat diabetes.

20. Sulfonylureas, such as tolbutamide, are:

• a. Oral medications that counteract insulin resistance.
• b. Varieties of insulin.
• c. Oral medications that stimulate beta cells to secrete insulin.
• d. Medications that are no longer used to treat type 2 diabetes.

21. In type 2 diabetes, the beta cells (the insulin-secreting cells of the pancreas):

• a. Function normally when they are present.
• b. Progressively secrete less and less insulin.
• c. Progressively secrete more and more insulin.
• d. Secrete little or no insulin from the beginning of the disease.

22. In type 2 diabetes, insulin therapy:

• a. Is generally no longer needed, although it is sometimes used for convenience.
• b. Should only be used in patients who are unafraid of injections.
• c. Often becomes necessary in the second decade after the disease is diagnosed.
• d. Shortens a patient's lifespan and speeds up the development of complications.

23. Mixing different types of insulin in a single injection:

• a. Is unsafe.
• b. Produces unpredictable results no matter how carefully each dose is measured.
• c. Can be used to produce two different peaks of insulin action.
• d. Can be done, but is not recommended by most physicians.

24. Hypoglycemia:

• a. Should always be treated in people with diabetes.
• b. Will go away on its own in people with type 2 diabetes.
• c. Is only a problem during the daytime.
• d. Is a problem only for people with type 1 diabetes.

25. For type 2 diabetes, a proper diet contains:

• a. No carbohydrates.
• b. No fats.
• c. No proteins.
• d. A minimum of trans fats.

26. For a person with type 2 diabetes, a balanced diet should contain most daily calories in the form of:

• a. Carbohydrates.
• b. Fats.
• c. Proteins.
• d. Micronutrients.

27. People with type 2 diabetes need to:

• a. Eat virtually no fat.
• b. Eat a low-fat diet of mostly unsaturated fats.
• c. Rely on fats as the main source of calories.
• d. Choose mostly trans fats and saturated fats.

28. People with type 2 diabetes need to:

• a. Use protein as their main source of calories.
• b. Reduce proteins to less than 10% of total calories.
• c. Choose bacon, steak, sausage, and ground beef as potent protein sources.
• d. Get their protein from poultry, fish, cheese, and soy products.

29. Dietary fiber:

• a. Is a good source of protein.
• b. Is relatively unimportant in a diabetic diet.
• c. Is a marketing triumph and a waste of money.
• d. Helps reduce blood cholesterol.

30. People with type 2 diabetes:

• a. Can safely drink almost anything, unlike people with type 1 diabetes.
• b. Should avoid drinking sugary beverages when they are thirsty.
• c. Should avoid drinking low-calorie beverages because they need extra sugar.
• d. Should get their vitamins and minerals by drinking a glass of fruit juice with every meal.

31. The one lab value most useful long-term for type 2 diabetes is:

• a. Fasting plasma glucose levels.
• b. Urine glucose levels.
• c. Serum creatinine levels.
• d. A1C values.

32. The first step in treating hyperglycemia is usually:

• a. Insulin therapy.
• b. Oral hypoglycemics.
• c. A combination of insulin and oral medications.
• d. Lifestyle changes.

33. After they have stabilized, people with type 2 diabetes monitor their blood sugar levels:

• a. Once a month in the morning and evening.
• b. At the same time every day.
• c. At least once a day but at varying times during the day.
• d. Only when they are feeling hypoglycemic.

34. Two major diabetic crises are diabetic ketoacidosis and hyperglycemic hyperosmolar state. Both conditions are characterized by:

• a. Polydipsia.
• b. Diuresis.
• c. Hypoglycemia.
• d. Dehydration.

35. Treatment for both of the two major diabetic crises requires:

• a. Insulin and fluids.
• b. Oral hypoglycemics and glucose.
• c. Glucose and diuretics.
• d. Blood transfusions.

36. Excess glucose in the blood:

• a. Crystallizes and clogs capillaries throughout the body.
• b. Becomes food for invading bacteria, causing sepsis.
• c. Causes carbon dioxide bubbles.
• d. Sticks to proteins indiscriminately, creating abnormal molecular complexes.

37. The most common long-term complications of diabetes are:

• a. Hearing loss due to thinning of the tympanum.
• b. Psychiatric illness arising from damage to the brain.
• c. Damage to the lungs, stomach, gallbladder, and large intestine.
• d. Damage to arteries, kidneys, eyes, nerves, and feet.

38. Eighty percent of people who have type 2 diabetes die from:

• a. Complications of foot amputation.
• b. Some form of cardiovascular disease.
• c. Overwhelming infection.
• d. Diabetic neuropathy.

39. In people with type 2 diabetes, hypertension:

• a. Doubles the risk of developing cardiovascular disease.
• b. Occurs rarely.
• c. Increases the risk of neuropathy but not of cardiovascular disease.
• d. Cannot be controlled.

40. In people with type 2 diabetes, high blood pressure:

• a. Is unavoidable and cannot be prevented or reversed.
• b. Always results from smoking and excess alcohol ingestion.
• c. Usually requires treatment with medications.
• d. Should not be treated, because treatments raise the risk of kidney damage.

41. A high level of blood cholesterol:

• a. Protects people with type 2 diabetes from kidney damage.
• b. Lowers the risk of cardiovascular disease.
• c. Is not a problem unless people also have hypertension.
• d. Is a type of dyslipidemia.

42. Prothrombotic state:

• a. Is always treated with 325 mg aspirin per day.
• b. Is usually treated with daily vitamin K.
• c. Means that blood clots more easily inside the blood vessels.
• d. Signals a low level of insulin in the blood.

43. Albuminuria:

• a. Is excess albumin in the bloodstream.
• b. Is excess protein in the urine.
• c. Indicates neuropathy.
• d. Is excess fat in the liver.

44. People with type 2 diabetes and evidence of kidney damage do best on:

• a. High-protein diets.
• b. Low-protein diets.
• c. High-fat diets.
• d. Low-fiber diets.

45. Diabetic retinopathy:

• a. Is early macular degeneration.
• b. Is a type of glaucoma.
• c. Is damage to the blood vessels in and around the retina.
• d. Is caused by UV damage to the retina.

46. Diabetic neuropathy:

• a. Is a classic painless nerve disease.
• b. Causes problems with memory and reasoning abilities.
• c. Sometimes causes burning pain.
• d. Causes lower back pain.

47. "Socks and gloves" sensory deficits:

• a. Are paresthesias and numbness in areas where socks and gloves are worn.
• b. Are paresthesias and numbness of extremities caused by tight clothing.
• c. Are a type of diabetic nephropathy.
• d. Are an early sign of diabetic cardiomyopathy.

48. Diabetic autonomic neuropathy is damage to:

• a. Sensory nerves of the skin.
• b. Nerves of the internal organs.
• c. Automatic responses of the body.
• d. Kidneys and liver.

49. Foot wounds in people with type 2 diabetes:

• a. Are made significantly worse by diabetic artery damage.
• b. Are usually the result of clumsiness.
• c. Are no problem if the person's A1C is less than 7%.
• d. Are rare, occurring mainly in people with type 1 diabetes.

50. In the absence of visualized injuries, it is unnecessary to test ankle and foot pulses or do a sensory check at every 6-month diabetic checkup.

• a. True
• b. False

51. When the foot of a person with diabetes becomes pale, pulseless, and painful:

• a. Apply warm compresses and massage.
• b. Apply cool compresses and elevate.
• c. Increase insulin injections and suggest a better diet.
• d. It is an emergency and a surgeon should be consulted.

52. People who should be screened for prediabetes include:

• a. Essentially everyone (who can afford it) over the age of 18.
• b. No one under the age of 40.
• c. All people age 30 and older.
• d. All people age 30 and older with a parent who has diabetes.

53. Treatment for prediabetes:

• a. Is unnecessary, but the patient should be warned.
• b. Never include medications.
• c. Always includes some form of medication.
• d. Can delay or prevent type 2 diabetes.