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GI and Renal Exam 3 > 39 - Diabetes > Flashcards

39 - Diabetes Flashcards

1
Q

What is diabetes?

A

A group of metabolic disorders characterized by hyperglycemia, resulting from defects in insulin secretion, insulin action or both

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2
Q

What is the effect of diabetes?

A

This causes abnormalities in the metabolism of carbohydrates, protein and fat

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3
Q

What are the short term complications of diabetes?

A

Short-term complications: keto-acidosis, hyperosmolarity, lactic acidosis

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4
Q

What are the effects of chronic hyperglycemia?

A

Chronic hyperglycemia causes long-term damage to eyes, kidneys, nerves, heart and blood vessels

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5
Q

Describe the statistics of diabetes in the US

A
  • 29.1 million Americans (9.3% of population)
  • 8.1 million are undiagnosed
  • 1.7 million new diagnoses/year
  • 86 million Americans had prediabetes
  • Americans 65+: 25.9% or 11.8 million seniors
  • Seventh leading cause of death
  • Comorbid conditions: hypertension, dyslipidemia, CVD, stroke, eye disease, kidney disease, amputations
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6
Q

Describe type 1 diabetes

A
  • Immune mediated or idiopathic destruction of the β-cells of the pancreas
  • 5-10% of those with diabetes
  • Rate of destruction of β-cells can vary
  • Causes an absolute lack of insulin
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7
Q

Describe type 2 diabetes

A
  • Insulin resistance AND/OR
  • Relative insulin deficiency
  • 90-95% of those with diabetes
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8
Q

What are the diagnostic criteria of diabetes?

** KNOW THIS **

A

Fasting plasma glucose > 126 mg/dl after an overnight 8 hour fast*

  • OR -

Random plasma glucose > 200 mg/dl with classic symptoms of diabetes mellitus (e.g. increased thirst or urination, or unexplained weight loss) or a hyperglycemic crisis

  • OR -

Plasma glucose > 200g/dl 2 hours after a 75 g oral glucose load*

  • OR -

Hemoglobin A1c level > 6.5%*

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9
Q

Describe obesity and insulin resistance

A
  • Idea that insulin resistance was cause of Type 2 diabetes was proposed in 1930s
  • Failure of target organs to respond normally to insulin—don’t take up/use glucose for energy
  • Contributing factors: genetics, aging, central obesity, sedentary lifestyle, high fat diet, medications
  • Excess nutrient intake leads to adipocyte enlargement and inflammatory response
  • Increased levels of free fatty acids inhibit glycolysis—persistent hyperglycemia
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10
Q

Describe the hormonal regulation of blood glucose via insulin

A

Insulin increases…

  • Glucose uptake in muscle and adipose tissue
  • Amino acid uptake and protein synthesis
  • Fatty acid synthesis and esterification
  • Glycogen synthesis
  • Glycolysis

Insulin decreases…

  • Blood glucose levels
  • Gluconeogenesis
  • Lipolysis
  • Proteolysis
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11
Q

What are the stimulators and repressors of insulin secretion?

A

Simulators

  • Increased blood glucose
  • Increased amino acids
  • Increased fatty acids
  • Incretin hormones
  • Acetylcholine

Repressors

  • Leptin
  • Sympathetic nervous System (via α2-adrenergic agonists, such as norepinephrine)
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12
Q

Describe hormonal regulation of blood glucose via glucagon

A 
Glucagon increases...
- Breakdown of glycogen
(glycogenolysis)
- Lipolysis (activates hormone-sensitive lipase)
- Gluconeogenesis
ketogenesis

Glucagon decreases…

  • Synthesis of glycolytic enzymes
  • Rate of glycolysis
  • Glycogen synthesis
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13
Q

What are the stimulators and repressors of glucagon?

A

Stimulators of glucagon…

  • Low blood glucose
  • Increased circulating amino acids
  • Sympathetic nervous system (via α2-adrenergic agonists, such as norepinephrine

Repressors of glucagon…

  • Hyperglycemia
  • Increased circulating fatty acids
  • Somatostatin
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14
Q

Describe regulation of blood glucose by epinephrine

A
  • Secreted by adrenal medulla in response to acute stress
  • Increases glycogen breakdown
  • Increases gluconeogenesis from lactate and amino acids
  • Increases mobilization of fat via activation of hormone sensitive lipase
  • Acts on α and β receptors
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15
Q

Describe the regulation of blood glucose by cortisol

A
  • Produced by adrenal cortex in response to stress, trauma and hypoglycemia
  • Works synergistically with glucagon to actvate key gluconeogenesis enzymes
  • Indirectly maintains glucose production from protein and facilitates fat metabolism
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16
Q

Describe the well fed state in the body

** KNOW THIS **

A
  • Insulin secretion increases
  • Absorbed nutrients are utilized and stored
  • Breakdown of stored nutrients suppressed
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17
Q

Describe the fasting state in the body

** KNOW THIS **

A
  • Glucose levels fall
  • Stored energy sources are mobilized
  • Insulin secretion falls, glucagon activity rises
18
Q

Describe primary prevention of diabetes

A

Diabetes prevention program

  • Large RCTs tested if lifestyle modification slows or prevents progression towards diabetes
  • This was based on the China Da Qing diabetes prevention study and the Finnish diabetes study

These addressed the question: If you address adiposity will you address type 2 diabetes?

19
Q

What is the takeaway?

A

I’m not going to test on this, but just know that

  • lifestyle modification found to be more effective than metformin in reducing incidence of diabetes
  • others
20
Q

What are the goals of nutrition and lifestyle?

A

Individualize goals with each patient

General goals

  • Hemoglobin A1c40 mg/dL (men)/>50 mg/dL (women)
  • Achieve and maintain body weight goals

Patient education and frequent contact with team (dietician, certified diabetes educators, physicians)—key to deliver improvements

21
Q

What should your diabetic patients eat?

A
  • Key component of diet for general population and persons with diabetes
  • Amount and type of carbohydrates consumed impact blood glucose levels
22
Q

Describe the glycemic index

A
  • A measure of how quickly a food causes our blood sugar levels to rise; ranks food on a scale of 0-100
  • These are based on measures taken while eating 50 grams of selected food, by itself, on an empty stomach
23
Q

Describe food high on the glycemic index

A

Foods high on the GI are quickly digested or absorbed (processed carbohydrates)

24
Q

Describe food low on the glycemic index

A

Foods low on the GI are more slowly digested and absorbed; often contain fiber, protein or fat and cause a slower rise in blood sugar

25
Q

Describe 50 grams in terms of volume

A

Because 50 grams of different foods may have different volumes (1 cup of rice vs 4 cups of beets), another formula was developed to take into account the carbohydrate count of a standard portion (serving).

26
Q

What is the newer system of the glycemic load?

*** KNOW THIS *****

A

Glycemic load is the glycemic index (GI) x the carbohydrate content in the serving divided by 100

27
Q

What is the benefit of glycemic index awareness?

A

Awareness of glycemic index gives a modest benefit in fine-tuning post-prandial blood sugar load

28
Q

What is the best way to achieve glycemic control?

A

Total carbohydrate intake regulation is best way to achieve glycemic control

29
Q

What do you NEED to know?

** TEST QUESTION **

A

Difference between the glycemic load and glycemic index

30
Q

What is a risk factor for developing diabetes?

A
  • Obesity is a risk factor for developing Type 2 diabetes, as muscle and adipose tissue lose responsiveness to insulin with excessive weight gain
  • 25% of people with diabetes don’t know they have it
31
Q

Who should be tested for diabetes every 2-3 years?

** KNOW THIS ***

A
  • BMI> 25
  • 1st degree relative with DM
  • Given birth to a baby> 9 lbs
  • History of gestational diabetes
  • Physically inactive
  • African-American, Hispanic, Native American, Asian American or Pacific Islander ethnicity
  • HDL 250 mg/dl
  • Impaired glucose tolerance
  • Elevated fasting glucose
  • Hypertensive (>140/90 mmHg)

** KNOW ALL OF THESE - TEST QUESTION **

32
Q

Describe the metabolic syndrome of insulin resistance

A
  • Abdominal obesity: visceral fat releases free fatty acids
  • Free fatty acids: promote hepatic gluconeogenesis and interfere with insulin signaling (resistance at level of target cells)
  • Hyperglycemia and insulin resistance causes increased insulin production
  • High insulin levels promotes further weight gain, continuing the cycle
33
Q

What are factors that contribute to insulin resistance?

** KNOW THIS **

A
  • High triglycerides
  • Hypertension
  • Central obesity
  • Low HDL
  • Hyperglycemia

TEST QUESTION ***

34
Q

Describe energy balance

A

Energy balance=glucose homeostasis: energy intake matches energy requirements

35
Q

Describe a positive and negative energy balance

A

E(in)>E(out): positive energy balance

  • Weight gain
  • Excessive food intake
  • Inactivity

E(in)

36
Q

Describe the dietary management of diabetes control

A

Don’t need to know the specifics, but should understand the general concepts

  • Know basal needs (basal metabolic rate)
  • Male (weight in lbs x 11)
  • Female (weight in lbs x 10)
  • Know energy expenditure based on current and/or target lifestyle
37
Q

How can you manage diabetes with the diet?

A
  • Even modest weight loss (10% of body weight) can improve glycemic control
  • Target: achieve normoglycemia (70-100 mg/dl fasting and
38
Q

What are the recommendations for carbohydrate sources?

A
  • Intact seed coat (whole grains)
  • High ratio of amylose to amylopectin (70:30)
  • Large, intact, unhydrated starch granules (cooked less)
  • Viscous fibers
  • Reduced ripeness
  • Minimal food processing, cooking and storage

Meals

  • Small meals
  • Ingest fat and protein with carbohydrates
39
Q

Role of fiber

A

Chart on slide 30

40
Q

What are the goals of diabetic nutrition management?

A
  • Achieve near-normal BG and BP levels
  • Improve lipid profiles
  • Modify nutrient intake and lifestyle to delay or prevent onset of chronic complications of diabetes
  • Address nutritional needs of the individual, with special consideration given to personal and cultural preferences and willingness to change
  • Maximize the enjoyment of food by limiting food only when indicated by scientific evidence
41
Q

What is important about carbohydrate intake?

A

45-65% of total calories should be carbohydrates

42
Q

What are the roles of a health care provider?

A
  • Encourage self-management
  • Realistic goals
  • Learned advisor

GI and Renal Exam 3 (15 decks)

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