Test Your Knowledge

Abstract

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 50.

Read the following vignette to answer the following 3 questions:

GG is a 32-year-old Caucasian male with new-onset type 2 diabetes who is referred to you for nutrition counseling. GG has cognitive limitations but is able to live alone, and he prepares his own meals. A kind neighbor helps him with his medications and self-monitoring of blood glucose (SMBG).

During the initial nutrition assessment you should gather data on the patient’s medical history, current medications, laboratory data, anthropometric measures, and:

A typical day’s food intake and physical activity patterns

Sick day plan

Insurance coverage

Family support

The assistance that GG’s neighbor provides with his SMBG regimen represents what form of support?

Emotional support

Informational support

Instrumental support

Affirmational support

Which meal planning approach would be most appropriate for GG?

The plate method

Carbohydrate counting

Exchange list

The DASH diet

A traveling salesman with type 2 diabetes for many years remains poorly controlled on 3 oral agents. He understands that high blood glucose is bad for him but states that he does not want to start insulin. Which of the following is the MOST appropriate response to his proclamation?

Do you think that you will lose your job if you start insulin?

Are you afraid of giving yourself an insulin injection?

What is it that concerns you most about starting insulin?

Have you ever given yourself an injection with a syringe?

Test Your Knowledge Answers

Questions appear on page 48.

A: This question is focusing on nutrition assessment, step 1 of the Nutrition Care Process. As for assessment of food and nutrition history, relevant data to be gathered include 24-hour recall or typical day’s food intake with specific details on eating times, alcohol intake, and the use of vitamins, minerals, and herbal supplements.

The sick day plan, insurance coverage, and family support are not components of the nutrition assessment (B, C, and D).

C: By definition, instrumental support is providing concrete assistance, such as GG’s neighbor helping him with his medications and blood glucose monitoring. Instrumental support is the type of support most individuals are referring to when they talk about “help.”

Emotional support involves caring, empathy, love, trust. While GG’s neighbor could possibly provide some emotional support as well, instrumental support is clearly what is described in the scenario (A). Informational support is provision of information to another during a time of stress (B). Affirmational support is statements that affirm the appropriateness of acts or statements of another (D).

A: A number of meal-planning approaches are available to teach basic diabetes nutrition guidelines, as well as more in-depth nutrition interventions. Of the meal planning resources listed here, given GG’s cognitive limitations, the plate method would be the most appropriate because it uses a simple dinner plate graphic to teach general portion control, consistency, and basic food categories.

Carbohydrate counting (B) and the exchange lists (C) would be too complicated given GG’s cognitive limitations. The DASH eating plan (D) is not as simple as the plate method and would not be the best choice for that reason.

C: “What is it that concerns you most about starting insulin?” is correct. The educator should seek first to understand patient concerns from the patient himself rather than imposing predetermined values. In answers A and B, the educator presumes to know why the patient is concerned before finding out the real underlying reason. Both assumptions present close-ended questions to the patient. Answer D suggests that the patient may have used illicit drugs in the past, which the patient may or may not answer truthfully.

Note. Adapted from Review Guide for the Certified Diabetes Educators Exam, 3rd ed. 2015. Chicago: American Association of Diabetes Educators. Reprinted with permission.