Early signs and symptoms you would expect a person with type 1 diabetes to exhibit include:

Choice A reason: A reduced glycosylated hemoglobin level (Hemoglobin A1C) indicates that blood sugar levels have been well-controlled over the past three months. Hemoglobin A1C is a measure of the average blood glucose levels over this period. A lower A1C level suggests that the patient has been maintaining good control of their blood sugar levels, making it an unlikely indicator of poor diabetes management. The normal range for Hemoglobin A1C is below 5.7%, while levels between 5.7% and 6.4% indicate prediabetes, and levels above 6.5% indicate diabetes.

Choice B reason: An elevated glycosylated hemoglobin level is a clear indicator that the patient has not been maintaining tight control of their blood sugar levels. Hemoglobin A1C reflects the average blood glucose levels over the past three months. If the A1C level is high, it suggests that the patient's blood sugar levels have been elevated consistently over this period. This can occur despite the patient reporting blood sugar levels within the target range during clinic visits. An elevated A1C level (greater than 6.5%) is a strong sign of inadequate diabetes management and suggests the need for adjustments in the treatment plan.

Choice C reason: A random blood sugar level of 150 mg/dL performed in the clinic provides a snapshot of the patient's blood sugar level at a single point in time. While this level is above the normal range (typically below 140 mg/dL for non-diabetics), it does not provide a comprehensive picture of the patient's overall blood sugar control. Blood sugar levels can fluctuate due to various factors, including recent meals, stress, and physical activity. Therefore, a single random blood sugar reading is not a reliable indicator of tight diabetes control.

Choice D reason: The statement that there is no method to determine whether the patient is in tight glucose control is incorrect. There are several methods to assess diabetes control, with the Hemoglobin A1C test being one of the most reliable. Additionally, frequent monitoring of blood sugar levels through self-testing and continuous glucose monitoring systems can provide valuable information about how well the patient is managing their diabetes. These methods allow healthcare providers to make informed decisions about treatment adjustments and overall diabetes management strategies.

Choice A reason: Cataract development is a common issue in people with diabetes due to the high blood sugar levels that affect the lens of the eye. However, it is not the primary cause of visual impairment. Cataracts cause the lens to become cloudy, leading to blurred vision, but the impact is generally less severe compared to the microvascular complications of diabetes.

Choice B reason: Exophthalmos, or bulging of the eye, is not typically associated with diabetes. It is more commonly seen in conditions like Graves' disease, an autoimmune disorder affecting the thyroid. Therefore, while it is important to be aware of various conditions that can impact eye health, exophthalmos is not a primary complication of diabetes.

Choice C reason: Abnormal metabolism in the lens can contribute to the formation of cataracts, but it is not the main reason for diabetic visual impairment. The primary issue in diabetes-related visual impairment is damage to the small blood vessels in the retina, not just changes in the lens metabolism.

Choice D reason: Microvascular changes in the eye, particularly diabetic retinopathy, are the primary cause of visual impairment in people with diabetes. High blood sugar levels can damage the blood vessels in the retina, leading to leakage, swelling, and the formation of new, abnormal blood vessels. This can result in significant vision loss and even blindness if not properly managed. Regular eye examinations and control of blood glucose levels are crucial in preventing and managing diabetic retinopathy.