Note. Adapted from Review Guide for the Certified Diabetes Educators Exam, 3rd ed. 2015.
Chicago: American Association of Diabetes Educators. Reprinted with permission.
Answers appear on page 52.
Use the following scenario to answer questions 1, 2, and 3:
AE is a 45-year-old obese female with uncontrolled type 2 diabetes (A1C 8.5%), hypertriglyceridemia (425 mg/dL), and hypertension (145/90). She has a sedentary job as a receptionist. Her usual diet includes a bagel with cream cheese or grits, eggs, toast, and coffee at the cafeteria at work; a fast food burger or Mexican food at lunch; snack bar or nuts as snacks; and takeout from a local restaurant for dinner. Evening snack is often sweets. She does not drink alcoholic beverages. She does not feel she has time to exercise as she has a long commute and gets home late.
AE would like to reduce her blood pressure without using medication as she is concerned about the side effects. What would you recommend to help her?
Start drinking a glass of red wine every day
Follow the DASH eating plan
Use sea salt or kosher salt in place of table salt
Join a gym and begin a resistance training program at least 5× per week.
Considering AE’s problem list, what 2 behavioral goals would likely be the MOST important to focus on initially in AE’s diet?
Counting calories and carbs
Choosing healthier options at fast food restaurants and following an exchange diet
Consuming less saturated fats and using less added salt
Counting carbs and eating out less frequently
What evidence-based advice do you have for AE regarding her sodium intake?
Reducing the amount of salt one uses at the table by 50% can lower blood pressure significantly
A combination of following the DASH dietary pattern and reducing sodium intake has been shown to lower blood pressure more than simply reducing sodium intake alone
About 45% of sodium intake comes from processed foods
The American Diabetes Association (ADA) recommends that persons with diabetes reduce their sodium intake to less than 1500 mg/day
Test Your Knowledge Answers
Questions appear on page 50.
B: The Dietary Approaches to Stop Hypertension (DASH) diet emphasizes fruits, vegetables, low-fat dairy products, whole grains, poultry, fish, and nuts and is reduced in saturated fat, sweets, and sugar-containing beverages. The DASH diet has been shown to lower blood pressure due to the total eating pattern, including the reduction in sodium and the benefits of potassium and other nutrients. It is not recommended to start drinking alcoholic beverages for the cardiovascular benefits if one is currently not drinking, especially in individuals with hypertriglyceridemia (A). Table salt, sea salt, and kosher salt contain very similar amounts of sodium chloride, so using one over the other will not affect AE’s blood pressure; in addition, the majority of AE’s sodium intake appears to be from eating in restaurants and eating processed foods (C). Given AE’s time constraints and her long commute to work, encouraging walking at lunchtime would likely work better in her schedule than going to a gym 5 days/week; resistance training has not consistently been shown to improve blood pressure (D).
D: Basic carb counting can often improve glycemia in type 2 diabetes very quickly. Taking her lunch and eating dinner at home more frequently can significantly reduce her sodium intake and calories, thereby reducing her blood pressure and helping with weight loss goals. Counting both calories and carbs would be more time-consuming and would not focus on her hypertension (A). Learning to choose healthier options at a fast food restaurant would take more time and effort, and an exchange-type diet is a more complex regimen than needed for AE at this time (B). She will consume less saturated fats and salt (C) by eating out less frequently.
B: A combination of following the DASH dietary plan and reducing sodium has been shown to be more effective at reducing blood pressure than sodium reduction alone. Reducing the amount of salt one uses at the table generally does not have as much impact as reducing the number of processed foods consumed (A). It is estimated that 77% of sodium in the typical American diet comes from processed foods (C). The current recommendations by the American Diabetes Association (ADA) are to reduce sodium to less than 2300 mg/day for individuals with diabetes and that further reduction should be individualized (D).
Note. Adapted from Review Guide for the Certified Diabetes Educators Exam, 3rd ed. 2015. Chicago: American Association of Diabetes Educators. Reprinted with permission.
