# A nurse is providing initial education to a 48-year-old newly diagnosed with type 2 diabetes (A1c 7.6%, BMI 31). Which lifestyle interventions should the nurse include? Select all that apply.

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> language: en  
> subject: Health Promotion and Maintenance  
> category: HPM

## Question

A nurse is providing initial education to a 48-year-old newly diagnosed with type 2 diabetes (A1c 7.6%, BMI 31). Which lifestyle interventions should the nurse include? Select all that apply.

1

Include resistance/strength training at least 2 days per week and limit sedentary time, breaking up long sitting with brief walking every 30 minutes.

2

Use carbohydrate counting or the plate method (1/2 plate non-starchy vegetables, 1/4 lean protein, 1/4 starch) to control postprandial glucose.

3

Avoid whole fruits such as bananas, grapes, and melons, as their natural sugar content can raise blood sugar more than other carbohydrate sources.

4

Aim for 5 to 10 percent body weight loss in the first year — even modest weight loss improves insulin sensitivity and A1c.

5

Aim for at least 150 minutes per week of moderate-intensity aerobic activity, spread over at least 3 days, with no more than 2 consecutive days without exercise.

## Explanation

ADA-recommended lifestyle for T2DM: ≥150 min/week moderate aerobic activity (no >2 consecutive sedentary days), carbohydrate management (counting or plate method), 5-10% body weight loss, resistance training ≥2 days/week, and reduced sedentary time. Choice 3 is wrong — fruits are part of a healthy diabetes diet; whole fruits with fiber are encouraged in moderate portions, while juices and dried fruits should be limited. "Eliminate all fruits" is a long-debunked myth.

## In-depth explanation

The "no fruit" myth is a high-yield NCLEX trap. Patients should be taught portion size and pairing with protein/fat, not blanket avoidance. Modest weight loss (5-7% in DPP study) reduces progression to diabetes by 58% — far more effective than metformin alone.

## Clinical scenario

**48-year-old newly diagnosed type 2 diabetes**: A1c **7.6%**, BMI **31**. Provider has prescribed metformin and referred for diabetes self-management education. The nurse begins initial lifestyle counseling.

## Key concepts

- **ADA physical activity goal** — ≥150 min/week moderate aerobic activity over 3+ days, no >2 consecutive days off, plus 2+ days/week resistance training.
- **Plate method** — 1/2 plate non-starchy vegetables, 1/4 lean protein, 1/4 starch/grain; simple carbohydrate management without counting.
- **5-10% weight loss benefit** — Improves insulin sensitivity, A1c, blood pressure, and lipids; first-line lifestyle target in T2DM and prediabetes.

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