Chapter 20 book notes Flashcards
1
Q
How many people are affected by diabetes in the U.S.?
A
-13% of population
-34 million
1
Q
what % of people with diabetes are unaware that they have it?
A
-21%
2
Q
Diabetes is ranked ?? among the leading causes of death in the U.S.
A
-7th
3
Q
diabetes mellitus:
A
-a group of metabolic disorders characterized by hyperglycemia and insulin resistance
4
Q
insulin:
A
-a pancreatic hormone that regulates glucose metabolism;
-its actions are countered mainly by the hormone glucagon.
5
Q
Symptoms of diabetes are usually related to the degree of ?? present
A
-hyperglycemia
6
Q
When the plasma glucose concentration rises above ??? milligrams per deciliter, it exceeds what??
A
-200
-renal threshold: the blood conc. of a substance that exceeds kidneys capacity for reabsorption, causing the substance to be passed in the urine
7
Q
The presence of glucose in the urine draws additional ?? from
the blood, increasing the amount of ?? produced
A
-water
-urine
8
Q
Symptoms of diabetes: (5)
A
-polyuria (excessive urine production)
-dehydration
-polydipsia (excessive thirst)
-weight loss
-polyphagia (excessive hunger)
9
Q
. Another potential consequence of hyperglycemia is ?? vision,
caused by the exposure of eye tissues to ?? fluids
A
-blurred
-hyperosmolar: high osmolarity
10
Q
The diagnosis of diabetes is based primarily on plasma glucose levels, which can
be measured under ?? conditions or at ?? times during the day
A
-fasting
-random
11
Q
oral glucose tolerance test:
A
-a test that evaluates a person’s ability to tolerate an oral glucose load.
-individual ingests 75 grams glucose load and plasma glucose is measured at one or more time intervals
12
Q
Glycated hemoglobin (HbA1c) levels;
A
- reflects hemoglobin’s exposure to glucose over the preceding two to three months,
-indirect assessment of blood glucose levels.
13
Q
The following criteria are currently used to diagnose diabetes:
A
-plasma glucose con. is 126mg/dL or higher after 8 hours of fasting
-person with classic symptoms of hyperglycemia their plasma glucose is 200mg/dL or higher
-plasma glucose conc. measured two hours after 75-gram glucose load is 200mg/dL or higher
-HbA1c level is 6.5% or higher
14
Q
Criteria for prediabetes:
A
-100-125mg/dL when fasting
-140-199mg/dL when measured two hours after ingesting 75 gram glucose load
-HbA1c levels between 5.7-6.4%
15
Q
Prediabetes affects approximately ?? percent of adults in
the United States and ?? percent of adolescents aged 12 to 18 years
and it is especially prevalent among those who are overweight or obese.
A
-35%
-18%
16
Q
Diabetes can also be caused by medications that cause
glucose intolerance (such as ??? ) and medical conditions that damage the ?? or interfere with insulin function.
A
-steroids
-pancreas
17
Q
Type 1 diabetes accounts for about ?? to ?? percent of diabetes cases
A
-5 to 10%
18
Q
type 1 diabetes:
A
-autoimmune attack on beta pancreatic cells
-complete insulin deficiency
-autoimmune attack is unknown
19
Q
By the time symptoms develop, the damage to the beta cells has progressed so far that insulin must be provided exogenously, most often by ???.
A
-injection
20
Q
Type 1 diabetes typically develops during ??
or ?? , although it may occur at any age.
A
-childhood
-adolescence
21
Q
Diagnosis often follows an ?? illness, which increases
insulin requirements and stresses the limited reserve of
the defective pancreatic beta cells.
A
-unrelated
22
Q
classic symptoms of hyperglycemia (polyuria, polydipsia, weight
loss, and weakness or fatigue) may appear ?? in
a previously healthy child or young adult
A
-abruptly
23
Q
type 2 diabetes:
A
-diabetes that is characterized by insulin resistance coupled with insufficient insulin secretion
-most common form of diabetes
-accounts for 90to 95% of cases
24
Although the precise causes of type 2 diabetes are unknown, risk is substantially
increased by
-obesity (especially central obesity),
- aging,
-physical inactivity
25
More than ?? percent of individuals with type 2 diabetes are obese, and obesity itself can directly cause some degree of insulin resistance
-80%
26
which ethnic groups are more prevalent to developing type 2 diabetes:
-African Americans
-Mexican Americans
-Native Americans
27
guidelines for diabetes prevention include the following strategies: (4)
-weight management : weight loss of 7 to 10%
-dietary modifications
-physical activity: 150 minutes of moderate intensive PA
-regular monitoring
28
Insulin deficiency can cause significant disturbances in energy metabolism, and severe ?? can lead to dehydration and ... imbalances.
-hyperglycemia
-electrolyte
29
In patients being treated for diabetes, ??? is a possible complication of inappropriate disease management.
-hypoglycemia, low blood glucose
30
Diabetic ketoacidosis in type 1 diabetes:
-severe lack of insulin that leads to glucagon's effects being more pronounced leading to severe breakdown of triglycerides in adipose tissue and protein in muscle.
31
As a result, an increased supply of?? and ?? arrives in the liver,
fueling the production of ?? and ??.
-fatty acids and amino acids
-ketone bodies and glucose
32
Ketone bodies, which are ?? , can
reach dangerously high levels in the bloodstream (ketoacidosis) and spill into the urine
(ketonuria
-acidic
33
. Blood pH typically falls below... What is the normal blood pH
-7.30
-blood pH normally ranges between 7.35 and 7.45
34
Main features of diabetic ketoacidosis:
-severe ketosis
-acidosis
-hyperglycemia
35
Acidosis is partially corrected by exhalation of?? , so rapid or
deep breathing is characteristic
-carbon dioxide
36
Ketone accumulation is sometimes evident by a fruity
odor on a person’s breath called...
-acetone breath
37
Treatment of diabetic ketoacidosis includes:
-insulin therapy to correct the hyperglycemia,
-intravenous fluid and electrolyte replacement,
-bicarbonate therapy to treat acidosis
37
The mental state may vary from alert to
-comatose (diabetic coma)
38
Diabetic ketoacidosis is sometimes the earliest sign that leads to a diagnosis of
type?? diabetes, but more often it results from inadequate insulin treatment, illness or infection, excessive alcohol use, or other physiological stressors
-1
-can occur in type 2 diabetes due to infection or trauma but not a lot due to low insulin conc. are able to suppress ketone body production
39
hyperosmolar hyperglycemic syndrome:
-a condition of extreme hyperglycemia associated with dehydration, hyperosmolar blood, and altered mental status
40
In the hyperosmolar hyperglycemic syndrome, patients are unable to recognize ?? or adequately replace ?? due to age, illness, sedation, or incapacity
-thirst
-fluids
41
blood glucose levels rise up to ?? and may even go above ??
-600mg/dL
-1000mg/dL
42
Treatment for hyperosmolar hyperglycemic syndrome:
-intravenous fluid and electrolyte replacement
-insulin therapy
43
The hyperosmolar hyperglycemic syndrome is sometimes the first sign of type ?? diabetes in persons with undiagnosed diabetes.
-2
44
Unlike diabetic ketoacidosis, which develops in a couple days, this condition often evolves ?? , over one ??or longer
-slowly
-week
45
Hypoglycemia, or low blood glucose, is the most frequent complication of type ?? diabetes and may occur in type 2 diabetes as well.
-1
46
It results from the inappropriate ?? of diabetes rather than the ?? itself
-management
-disease
47
What causes hypoglycemia? (5)
-excessive dosages of insulin/antidiabetic drugs
-prolonged exercise
-skipped meals
-inadequate food intake
-consumption of alcohol w/o food
48
Hypoglycemia is the most frequent cause of ?? in insulin-treated patients and is believed to account for ?? to ??percent of deaths in this population.
-coma
-4 to 10%
49
Prolonged exposure to high glucose concentrations can damage ?? and ?? .
-cells and tissues
50
advanced glycation end products (AGEs):
-reactive compounds formed after glucose combines with protein;
-damage tissues and lead to diabetic complications.
51
excessive glucose within cells promotes the production and
accumulation of ??, which does what?
-sorbitol
-increases oxidative stress in the cells and causes cellular injury
52
Chronic complication of diabetes involves what blood vessels and also…
-large blood vessels (macrovascular complications)
-smaller vessels such as arterioles & capillaries (microvascular complications)
-nerves (diabetic neuropathy)
53
Tissues affected by chronic diabetes:
-lens of eye: cataracts, glaucoma
-skin: lesions
54
The damage caused by diabetes accelerates
the development of ?? in the arteries of the heart, brain, and
limbs
-atherosclerosis
55
As a result of cardiovascular
complications, the most common causes of death in individuals with longterm diabetes are?? and ??
-heart attack
-stroke
56
About 20 to 30 percent of individuals with diabetes develop peripheral
vascular disease which is: and increases
the risk of claudication, which is.. and contributes to the development of foot ulcers
-(impaired blood circulation in the limbs)
-(pain while walking)
57
Left untreated, foot ulcers can lead to
?? , and some patients require foot ??? , a major
cause of disability in individuals with diabetes.
-gangrene (tissue death)
-amputation
58
The primary microvascular complications involve the ?? of the eye and
the ??.
-retina
-kidneys
59
diabetic retinopathy:
-weakened capillaries of retina leak proteins, lipids, or blood causing local edema or hemorrhaging
60
diabetic nephropathy:
-damage prevents adequate blood filtration, and results in abnormal urinary protein losses (albuminuria)
61
As the kidney damage worsens, urine production decreases and ?? wastes accumulate in the blood; eventually, the individual requires ?? to survive.
-nitrogenous
-dialysis (artificial filtration of blood)
62
diabetic neuropathy:
-nerve damage
-two types: peripheral neuropathy & autonomic neuropathy
63
peripheral neuropathy:
-most common form of neuropathy in diabetes
-pain, numbness, or tingling in hands, legs, and feet
-can contribute to food ulcers
64
autonomic neuropathy:
-sweating abnormalities
-disturbed bladder function
-erectile dysfunction
-delayed stomach emptying rate (gastroparesis)
65
Individuals with type 1 diabetes require ?? for survival.
-insulin therapy
66
Type 2 diabetes may initially be treated with nutrition therapy and exercise, but most patients eventually need to add ?? medications or ??.
-antidiabetic
-insulin
67
continuous glucose monitoring:
-continuous monitoring of tissue glucose levels using a small sensor placed under the skin.
68
Health care providers periodically evaluate long-term
glycemic control by measuring ?? levels.
-HbA1c
69
The goal of diabetes treatment
is usually an HbA1c value of less than ?? percent
-7
70
Less stringent HbA1c goals (for example, a value less than ?? percent) may
be suitable for some patients
- 8
71
HbA1c testing is typically conducted ?? to ?? times yearly
-two or four
72
fructosamine test:
-a measurement of glycated serum proteins that reflects glycemic control over the
preceding two to three weeks
-mainly serum protein albumin, which has shorter lifespan than hemoglobin
73
Most often, the fructosamine test is used to evaluate recent adjustments in diabetes treatment or glycemic control during ??
-pregnancy
74
The test cannot be used if the patient
has a ?? or ?? disorder that lowers serum protein levels.
-liver or kidney
75
What healthcare professional is best suited to design and implement the nutrition therapy provided to patients with diabetes.
-registered dietitian
76
What macronutrient has the greatest influence on blood glucose levels after meals?
-carbohydrates
77
The carbohydrate recommendation is based in part on persons:
-metabolic needs
-type of insulin/medication used to manage diabetes
-individual preferences
78
For optimal health, the carbohydrate sources
should be, & what carbs should be limited?
- nonstarchy vegetables, fruits, whole grains, legumes, and dairy products
-refined grains and added sugars
79
consuming a portion of ?? causes
blood glucose to increase more than would consuming a similar portion of ??.
-white rice
-barley
80
glycemic index (GI):
-a ranking of carbohydrate foods based on their effect on blood glucose levels after ingestion
81
what carb foods have a high glycemic effect, what about low?
-high=highly processed, starchy foods
-low=high fiber, minimally processed
82
Which sugar alcohols have lower glycemic effects than other carbs and used as sugar subsistiues?
-sorbitol and maltitol
-large amounts needed because not as sweet as table sugar
-cause flatulence and discomfort
83
which nonnutritive sweeteners contain no digestible carb and can used in place of sugar?
-aspartame, sucralose, and saccharin
84
Although some studies have suggested that very high intakes of fiber (more
than ?? grams per day) may improve glycemic control, many individuals have difficulty tolerating such large amounts of fiber
-50
85
saturated fat should be less than ??percent of total kcalories and trans fats should be avoided.
-10%
86
Guidelines for alcohol intake are similar to those for the general
population, which recommend that women and men limit their average daily intakes of alcohol to ?? drink and ??drinks per day
-one and two
86
In addition, individuals using insulin or medications that promote insulin secretion should consume ??when they ingest alcoholic beverages to avoid hypoglycemia
-food
87
Vitamin and mineral supplementation is not recommended
unless nutrient deficiencies develop; those at risk include
-older adults,
-pregnant or lactating women,
-strict vegetarians,
-individuals on kcalorie-restricted diets
88
Carbohydrate-counting techniques are more ?? than
other menu-planning approaches and are widely used for tracking carbohydrate
intakes.
-flexible
89
Carbohydrate counting works as follows: BASIC
-After an interview in which the dietitian learns about the patient’s usual food intake and calculates nutrient and energy needs,
-the patient is given a daily carbohydrate allowance, divided into a pattern of
meals and snacks according to individual preferences
90
Advanced carbohydrate
-person determines specific dose of insulin needed to cover the amount of carbohydrates consumed in a meal.
-person is free to choose types & portions of food without sacrificing glycemic control
91
Although the food list system may be helpful for individuals who want to maintain a diet with specific ?? percentages, it is less ?? than carbohydrate counting and offers no advantages for maintaining glycemic control
-macronutrient
-flexible
92
In diabetes plate method, the ideal dinner plate is described as follows:
-one-half of the plate should be covered with nonstarchy vegetables such as salad, green beans, broccoli, or carrots;
-one-quarter of the plate should contain lean protein foods such as chicken, beans, tofu, or eggs;
-the final quarter should contain sources of carbohydrate such as cooked grains, potatoes, peas, pasta, or fruit
93
basal insulin
-The pancreas normally secretes insulin in relatively low amounts between meals
and during the night
- and in much higher amounts when meals are ingested
94
The forms of insulin that are commercially available differ by
their
-onset of action,
-timing of peak action,
- duration of effects.
95
insulin preparations are classified:
-they may be rapid acting (lispro, aspart, glulisine, and inhaled insulin),
-short acting (regular),
-intermediate acting (NPH),
-long acting (glargine, detemir, and degludec)
96
The rapid- and short-acting insulins are typically used at ??,
-mealtimes
97
intermediate- and long-acting insulins provide..
-basal insulin for the periods between meals and during the night.
98
Insulin is most often administered by ?? injection,
either self-administered or provided by caregivers, why this type of injection?
-subcutaneous
-insulin is a protein and would be destroyed by digestive processes if taken orally
99
what is the most common device used for injecting insulin?
Disposable syringes, which are filled from vials that contain multiple doses of insulin
100
?? insulin pens are prefilled with insulin and are used
one time only, whereas ?? pens can be fitted with prefilled insulin
cartridges and replaceable needles.
-Disposable
-reusable
101
A rapid-acting inhalation powder is
available for use before meals, although it cannot be used by patients
with ?? disease
-lung
102
Type 1 diabetes is best managed with ?? insulin therapy, which typically involves ?? or ?? daily injections of several types of insulin or the use of an insulin pump.
-intensive
-3 or 4
103
Insulin pumps are usually programmed to deliver small amounts of ??? continuously (to meet basal insulin needs) and ?? doses of rapid-acting insulin at mealtimes.
-rapid-acting insulin
-bolus
104
The amount required depends on
- the pre-meal blood glucose level,
- the carbohydrate content of the meal,
-the person’s body weight and sensitivity to insulin
105
how to determine insulin sensitivity:
-person takes record of food intake, insulin dosages, and blood glucose level and records are analyzed by medically personnel to determine insulin-carb ration
106
honeymoon period:
-After insulin therapy is initiated, persons with type 1 diabetes may
experience a temporary remission of disease symptoms and a reduced
need for insulin
-eventually ends
107
initial treatment of type 2 diabetes usually involves nutrition therapy, physical activity, and oral antidiabetic medications, long-term results with these treatments are often ??
-disappointing
-as disease progresses, pancreatic function worsens, and many need insulin therapy to help
108
Many possible regimens can be used to control type 2 diabetes such as:
-insulin with combination of one or more antidiabetic drugs
-one or two injections daily of insulin
-two or more daily injections of intermediate or long acting insulin
109
most common complication of insulin treatment:
-hypoglycemia
-low blood glucose level below 70mg/dL
110
Hypoglycemia can be corrected by consuming ?? or a ?? -containing food
-glucose, usually 15-20 grams of carb can relieve hypoglycemia in 15 minutes
-not sucrose or fructose
111
what is an unintentional side effect of insulin therapy? especially intensive insulin treatment?
-weight gain
-causes unknown
112
fasting hyperglycemia:
-hyperglycemia that typically develops in the early morning after
an overnight fast of at least eight hours.
113
dawn phenomenon:
-morning hyperglycemia that is caused by the early-morning release of growth
hormone, which reduces insulin sensitivity
114
rebound hyperglycemia:
-hyperglycemia that results from the release of counterregulatory hormones following nighttime hypoglycemia
115
central feature of diabetes management
-physical activity
-Children with diabetes or prediabetes should engage in at least 60 minutes of
moderate-to-vigorous aerobic activity each day.
-Most adults with diabetes are advised to perform at least 150 minutes of moderate-to-vigorous aerobic activity each week
116
Both children and adults should participate in ?? or
?? sessions of muscle-strengthening exercises weekly
-two or three
117
People with severe retinopathy should avoid ?? aerobic or ??
exercise, which may lead to retinal detachment and damage to eye tissue.
-vigorous
-resistance
118
Individuals with peripheral neuropathy should ensure that they wear proper ?? during exercise; those with a foot injury or open sore should avoid what kind of activity?
-footwear
-weight-bearing activity
119
If blood glucose is below ?? mg/dL, carbohydrate should be consumed before the exercise begins
-90
120
Individuals with type 1 diabetes who have hyperglycemia
and ketosis should delay exercise until blood glucose falls below ?? mg/dL
-250
121
During illness, individuals with diabetes should
measure blood glucose and ?? levels several times daily.
-ketone
122
Due to hormonal changes, pregnancy increases ?? and the body’s need for insulin
-insulin resistance
123
what % of women in the U.S. who do not have preexisting diabetes develop gestational diabetes?
-4 to 14%
124
Women with gestational diabetes are at
greater risk of developing type ?? diabetes later in life,
-2
125
Uncontrolled diabetes is linked to increased incidence of
-miscarriage,
-birth defects,
- fetal deaths.
126
Newborns are more likely to suffer from ??
distress and to develop metabolic problems such as
-respiratory
-hypoglycemia, jaundice, and hypocalcemia
127
. Women with diabetes often deliver babies with
-macrosomia (abnormally large bodies)
128
Patients with type 2 diabetes are usually switched from their usual medications
to ??to prevent possible toxicity to the fetus
-insulin therapy
129
What drug is sometimes prescribed for pregnant women with type 2 diabetes but has mixed yielded results?
-metformin
130
physicians routinely test women for gestational diabetes between ?? and ??weeks’ gestation.
-24 to 28
131
What is not recommended during pregnancy?
-weight loss
132
For women with gestational diabetes who are overweight or obese, a modest caloric reduction about?? may be recommended to slow weight gain
-30% less than total requirement
133
To help improve after-meal glucose levels, recommendations may include the following for pregnant women with gestational diabetes:
-eat three meals and two or more snacks per day
-restricting carb intake at breakfast since carbs are poorly tolerated in the mornings
-consuming 175 grams of carbs daily
-regular aerobic activity
