Nutrition Therapy Practice Exam: Diabetes Chapter 11

Welcome to the practice exam for Chapter 11: Nutrition Therapy.

Nutrition therapy is a critical component of diabetes management, with the potential to reduce A1C by 1.0% to 2.0% and improve overall health outcomes. However, there is no “one-size-fits-all” diet; nutritional counselling must be individualized to the patient’s preferences, culture, and metabolic goals.

This practice exam tests your ability to apply the 2018 Clinical Practice Guidelines to real-world scenarios, covering macronutrient distribution, cardioprotective dietary patterns, and specific considerations for weight management and insulin therapy.

Key Concepts Covered in This Exam:

Dietary Patterns: Identifying evidence-based patterns that improve glycemic control and cardiovascular health, including the Mediterranean, DASH, Portfolio, and Vegetarian diets.
Macronutrient Distribution: Understanding the flexibility in macronutrient ranges (Carbohydrate 45–60%, Protein 15–20%, Fat 20–35%) and individualizing them based on patient needs.
Carbohydrate Quality: Differentiating between high and low Glycemic Index (GI) foods and the importance of consuming 30 to 50 g/day of dietary fibre.
Fat Intake: Recognizing the recommendation to restrict saturated fats to <9% of total energy and replace them with polyunsaturated and monounsaturated fats.
Special Considerations: Managing alcohol intake to prevent delayed hypoglycemia and using sugar substitutes safely.

1. Case: A patient asks about the effect of fructose when substituted for starch. According to systematic reviews and meta-analyses, what is the effect on A1C?

Variable effect depending on dose

May lower A1C

No effect on A1C

Increased A1C

2. Case: A diabetes educator is counselling about whole grains. According to the evidence, which whole grain sources have shown improvements in glycemic control?

Wheat and wheat bran only

Oats and barley

All whole grains equally

Rice and corn only

3. Case: A diabetes educator is reviewing the evidence on nuts. According to the guidelines, what median daily dose of nuts has been shown to reduce A1C and fasting glucose?

Approximately 25 g/day

Approximately 56 g/day

Approximately 75 g/day

Approximately 40 g/day

4. Case: A diabetes educator is reviewing a patient’s current diet high in trans fatty acids. According to the systematic review of prospective cohort studies, what is the association with CHD?

No association

Increased CHD risk

Decreased CHD risk

Association only with stroke, not CHD

5. According to the DRIs, what is the acceptable macronutrient distribution range (AMDR) for protein as a percentage of total energy?

15% to 40%

5% to 15%

10% to 35%

20% to 45%

6. What is the recommended dietary allowance (RDA) for protein for adult men and women?

0.6 g per kg body weight

1.0 g per kg body weight

0.8 g per kg body weight

1.2 g per kg body weight

7. According to the guidelines, by how much can nutrition therapy reduce glycated hemoglobin (A1C)?

3.0% to 4.0%

1.0% to 2.0%

2.0% to 3.0%

0.5% to 1.0%

8. According to the guidelines, what is the recommended daily intake of dietary fibre for adults with diabetes?

20 to 35 g/day

30 to 50 g/day

15 to 25 g/day

40 to 60 g/day

9. According to the guidelines, which sources provide the greatest evidence for metabolic benefit from fibre?

Viscous soluble fibre from oats, barley, and psyllium

Resistant starch from potatoes

Insoluble fibre from wheat bran

Non-viscous soluble fibre from fruits

10. According to the guidelines, how often should follow-up with a registered dietitian occur for better dietary adherence in people with type 2 diabetes?

Once yearly

Every 6 months

Every 3 months

Every 4 months

11. Case: A diabetes educator is counseling a patient about the glycemic index. According to systematic reviews and meta-analyses, what benefits have been demonstrated with low-GI diets?

Only improved lipid profiles

Clinically significant improvements in glycemic control, postprandial glycemia, and total cholesterol

Only reduced hypoglycemia episodes

Only improved glycemic control

12. According to systematic reviews and meta-analyses, what is the effect of diets high in dietary pulses (beans, peas, chickpeas, lentils) on glycemic control?

Lowered fasting blood glucose and/or A1C

Increased postprandial glucose

No significant effect

Variable effects with no consistent pattern

13. Case: A diabetes care team is comparing dietary patterns. According to the evidence, which dietary pattern has the strongest evidence for reducing major CV events?

Mediterranean diet

Low-carbohydrate diet

Vegetarian diet

DASH diet

14. Case: A patient asks about the Portfolio Diet. What are the four pillars of this dietary pattern?

Plant sterols, viscous soluble fibres, plant protein, and nuts

Low-fat dairy, lean protein, whole grains, fruits

Reduced sodium, increased potassium, low fat, high fibre

Fish oil, olive oil, vegetables, legumes

15. Case: A patient with type 1 diabetes asks about alcohol. According to the guidelines, what can moderate alcohol consumption with an evening meal result in?

Delayed hypoglycemia the next morning after breakfast or up to 24 hours later

Improved insulin sensitivity

Hyperglycemia the next morning

No effect on blood glucose

16. According to the guidelines, what weight loss can substantially improve insulin sensitivity, glycemic control, hypertension, and dyslipidemia?

5% to 10% of initial body weight

15% to 20% of initial body weight

12% to 15% of initial body weight

2% to 4% of initial body weight

17. Case: A person with type 2 diabetes wants to follow a vegetarian diet. According to the evidence, what outcomes improve compared to conventional diets?

Only A1C

Only blood pressure

Only body weight

A1C, FBG, body weight, and blood lipids including LDL-C

18. Case: A person with type 2 diabetes and chronic kidney disease asks about protein intake. What is the recommended protein intake to reduce end-stage renal disease and mortality?

1.2 g per kg body weight per day

0.6 g per kg body weight per day

1.0 g per kg body weight per day

0.8 g per kg body weight per day

19. Case: A patient with type 1 diabetes is learning carbohydrate counting. According to the guidelines, how should rapid-acting insulin analogues be injected in relation to eating?

Within 15 minutes of eating

60 minutes after eating

30 minutes before eating

45 minutes before eating

20. Case: A patient with type 2 diabetes is following a low-carbohydrate diet and taking an SGLT2 inhibitor. According to the guidelines, what is a concern with very-low-CHO diets in this population?

Ketogenic effects

Hypoglycemia only

Hyperglycemia

21. According to the guidelines, what is the maximum weekly alcohol intake for women?

<21 drinks per week

<14 drinks per week

<5 drinks per week

<10 drinks per week

22. According to the DASH dietary pattern trial in people with type 2 diabetes, which outcomes improved over 8 weeks?

Systolic and diastolic BP, A1C, FPG, weight, waist circumference, LDL-C, CRP, and HDL-C

Only blood pressure

Only lipid profile

Only A1C and weight

23. According to the guidelines, what is the maximum percentage of total daily energy intake that can come from added sugars?

15%

20%

10%

24. According to the systematic reviews on omega-3 long-chain PUFA supplementation, what was the effect on cardiovascular outcomes in people with diabetes?

Benefit only in people without prior CV disease

No CV or mortality benefit demonstrated

Significant CV benefit demonstrated

Increased CV events

25. What is the recommended acceptable macronutrient distribution range (AMDR) for carbohydrate as a percentage of total energy?

40% to 55%

35% to 50%

45% to 60%

50% to 65%

26. Case: A person is considering replacing saturated fatty acids in their diet. According to the evidence, replacement with which nutrients is associated with decreased incident CHD?

Any type of carbohydrate

PUFA (particularly mixed n-3/n-6 sources), MUFA from plant sources, whole grains, or low-GI carbohydrates

Refined carbohydrates only

Animal protein

27. What percentage of viscous soluble fibre should comprise the total daily fibre intake according to the guidelines?

At least one-quarter (8-12 g/day)

At least one-fifth (6-10 g/day)

At least one-half (15-25 g/day)

At least one-third (10-20 g/day)

28. According to systematic reviews and meta-analyses, what effect does replacing animal protein with plant protein have on glycemic control?

Improved A1C, FPG, and fasting insulin

Worsened A1C, FPG, and fasting insulin

No significant effect

Only improved fasting insulin

29. What percentage of total daily energy should come from saturated fatty acids (SFA) to reduce CVD risk?

<12%

<9%

<7%

<5%

30. What is the dietary reference intake (DRI) recommended dietary allowance (RDA) for available carbohydrate?

No less than 130 g/day

No less than 175 g/day

No less than 150 g/day

No less than 100 g/day

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Welcome to the practice exam for Chapter 11: Nutrition Therapy.

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