39: Diabetes and Nutrition - O'Shea Flashcards
define diabetes
a group of metabolic disorders characterized by hyperglycemia, resulting from defects in insulin secretion, insulin action or both
FPG for diabetic
greater than 125 mg/dL
2hr plasma glucose for diabetic
200 mg/dL or greater
HbA1C for diabetic
6.5% or greater
*** diagnostic criteria DM
FPG greater than 126 after an overnight 8 hr fast OR RPG greater than 200 with classic symptoms of DM
PG greater than 200 2 hrs after a 75g oral glucose load
HbA1C greater than 6.5%
insulin increases…
- glucose uptake in m. and adipose tissue
- aa uptake and prtn synthesis
- fa synthesis and esterification
- glycogen synthesis
- glycolysis
insulin decreases…
- blood glucose levels
- gluconeogenesis
- lipolysis
- proteolysis
stimulators of insulin
increased blood glucose increased aa increased fa incretin hormone acetylcholine
repressors of insulin
leptin
symp nervous system
glucagon increases…
- breakdown of glycogen (glycogenolysis)
- lipolysis
- gluconeogenesis
- ketogenesis
glucagon decreases …
- synthesis of glyolytic enzymes
- rate of glycolysis
- glycogen synthesis
stimulators of glucagon
low blood glucose
increased circulating aa
symp nervous system
repressors of glucagon
hypeglycemia
increased fa
somatostatin
fed vs. fasting state ***
fed: insulin increases, absorbed nutrients are utilized and stored, breakdown of stored nutrients suppressed
fasting: glucose levels fall, stored energy sources mobilized, insulin secretion falls, glucagon activity rises
is metformin or lifestyle modification more effective in those with IGT?
lifestyle modification
goals for the diabetic pt
A1c less than 7% BP less than 140/80 LDL less than 100 Trigly less than 150 HDL greater than 40 men and greater than 50 women body weight goal
a measure of how quickly a food causes our blood sugar levels to rise
GI glycemic index
GI times the carbohydrate content in the serving divided by 100
glycemic load GL
best way to achieve glycemic control
total carbohydrate intake regulation
at risk individuals should be tested every 2-3 yrs. who is at risk?
BMI greater than 25 1st degree DM gave birth to baby greater than 9 lbs gestational DM physically inactive HDL less than 35 Trig greater than 250 IGT elevated FG HTN certain ethnicities
why is abdominal fat so bad?
visceral fat releases FFA which promote hepatic gluconeogenesis and interfere with insulin signaling
hyperglycemia and insulin resistance causes increased insulin production
high insulin levels promote further WG, continuing cycyle
components of insulin resistance/ metabolic syndrome ***
high trigs HTN central obesity low HDL hyperglycemia
% of total calories that should be carbs
45-65%
