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AJN, American Journal of Nursing:
doi: 10.1097/01.NAJ.0000451681.89318.03
Feature Articles

CE Test 2.6 Hours: Diabetes and Puberty: A Glycemic Challenge

Contrada, Emily

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Continued Education
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General Purpose:

To provide information to assist nurses in teaching adolescent patients and their families about the effects of puberty on insulin sensitivity and glucose metabolism and how the emotional and behavioral changes of puberty can affect diabetes management.

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Learning Objectives:

After reading this article and taking this test, you will be able to

* identify the effects of puberty on insulin sensitivity and glucose metabolism.

* select strategies to meet the challenges faced by adolescents in managing type 1 and type 2 diabetes.

1. For optimal diabetes care, how often should patients and their families meet with all members of their diabetes care team?

a. every month

b. every month to 2 months

c. every 3 to 6 months

d. every 6 to 9 months

2. A glycated hemoglobin (HbA1c) level of 10.2% correlates to an average blood glucose value of

a. 126 mg/dL.

b. 180 mg/dL.

c. 210 mg/dL.

d. 246 mg/dL.

3. Compared with adults in both the intensive and the conventional management groups in the Diabetes Control and Complications Trial, adolescents had an average HbA1c level nearly

a. 1% lower.

b. 2% lower.

c. 1% higher.

d. 2% higher.

4. During puberty, growth hormone and insulin-like growth factor-1 are secreted at elevated levels to

a. promote rapid growth and development.

b. complement the action of insulin.

c. promote the release of insulin from the pancreas.

d. decrease blood glucose levels at night.

5. Throughout puberty in adolescents who have diabetes, the response to insulin decreases

a. 20% to 25%.

b. 25% to 30%.

c. 30% to 35%.

d. 35% to 40%.

6. During which phase of the menstrual cycle do some female patients with diabetes have to manage elevated glucose levels?

a. menstrual

b. follicular

c. ovulation

d. luteal

7. The American Diabetes Association (ADA) recommends that patients of all ages using multiple-dose insulin or insulin pump therapy should check their blood glucose levels

a. at bedtime.

b. after snacks.

c. after exercise.

d. 1 hour after meals.

8. According to the ADA, adolescents and young adults ages 13 through 19 years should have a plasma glucose level before meals that is within which of the following ranges?

a. 70 to 130 mg/dL

b. 90 to 130 mg/dL

c. 70 to 150 mg/dL

d. 90 to 150 mg/dL

9. The “dawn phenomenon” results in an increased need for insulin between

a. midnight and 2 AM.

b. 3 AM and 8 AM.

c. 8 AM and 10 AM.

d. 10 PM and midnight.

10. Which of the following is most successful in reducing the effects of the dawn phenomenon?

a. an insulin pump

b. oral hypoglycemic agents

c. the use of multiple-dose insulin

d. decreasing the protein-to-carbohydrate ratio

11. Real-time continuous glucose monitoring systems require the subcutaneous insertion of a device into the patient's abdomen, thigh, or

a. posterior hip.

b. buttocks.

c. groin.

d. arm.

12. Adolescents may prefer the insulin pump because it

a. allows frequent injections.

b. does not adjust basal insulin.

c. can autocalculate recommended doses.

d. eliminates the possibility of hypoglycemia.

13. Studies have shown that a major concern leading to insulin pump discontinuation among adolescents is

a. the social aspects of pump use.

b. the embarrassment of alarms.

c. alterations in body image.

d. the pump's appearance.

14. Alcohol consumption in the evening can lead to

a. a precipitous drop in blood glucose about 2 hours later.

b. an initial decrease in blood glucose followed by morning hyperglycemia.

c. a rapid increase in blood glucose about 6 hours later.

d. an initial increase in blood glucose followed by morning hypoglycemia.

15. To lower the risk of impaired glucose control in the morning, adolescents with diabetes should eat which of the following snacks per alcoholic beverage, without taking insulin?

a. 8 ounces of fruit juice

b. 2 tablespoons of honey

c. an egg and 4 ounces of skim milk

d. an ounce of cheese and 7 whole wheat crackers

16. A cross-sectional, case-controlled study of adolescent girls indicated that what percentage of those with type 1 diabetes engaged in two or more “disturbed eating behaviors”?

a. 8%

b. 16%

c. 24%

d. 30%

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