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clinical nutrition > Chapter 20 book notes > Flashcards

Chapter 20 book notes Flashcards

1
Q

How many people are affected by diabetes in the U.S.?

A

-13% of population
-34 million

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1
Q

what % of people with diabetes are unaware that they have it?

A

-21%

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2
Q

Diabetes is ranked ?? among the leading causes of death in the U.S.

A

-7th

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3
Q

diabetes mellitus:

A

-a group of metabolic disorders characterized by hyperglycemia and insulin resistance

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4
Q

insulin:

A

-a pancreatic hormone that regulates glucose metabolism;
-its actions are countered mainly by the hormone glucagon.

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5
Q

Symptoms of diabetes are usually related to the degree of ?? present

A

-hyperglycemia

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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

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7
Q

The presence of glucose in the urine draws additional ?? from
the blood, increasing the amount of ?? produced

A

-water
-urine

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8
Q

Symptoms of diabetes: (5)

A

-polyuria (excessive urine production)
-dehydration
-polydipsia (excessive thirst)
-weight loss
-polyphagia (excessive hunger)

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9
Q

. Another potential consequence of hyperglycemia is ?? vision,
caused by the exposure of eye tissues to ?? fluids

A

-blurred
-hyperosmolar: high osmolarity

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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

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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

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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.
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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

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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%

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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%

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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

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17
Q

Type 1 diabetes accounts for about ?? to ?? percent of diabetes cases

A

-5 to 10%

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18
Q

type 1 diabetes:

A

-autoimmune attack on beta pancreatic cells
-complete insulin deficiency
-autoimmune attack is unknown

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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

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20
Q

Type 1 diabetes typically develops during ??
or ?? , although it may occur at any age.

A

-childhood
-adolescence

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21
Q

Diagnosis often follows an ?? illness, which increases
insulin requirements and stresses the limited reserve of
the defective pancreatic beta cells.

A

-unrelated

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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

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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

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24
Q

Although the precise causes of type 2 diabetes are unknown, risk is substantially
increased by

A

-obesity (especially central obesity),
- aging,
-physical inactivity

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25
Q

More than ?? percent of individuals with type 2 diabetes are obese, and obesity itself can directly cause some degree of insulin resistance

A

-80%

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26
Q

which ethnic groups are more prevalent to developing type 2 diabetes:

A

-African Americans
-Mexican Americans
-Native Americans

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27
Q

guidelines for diabetes prevention include the following strategies: (4)

A

-weight management : weight loss of 7 to 10%
-dietary modifications
-physical activity: 150 minutes of moderate intensive PA
-regular monitoring

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28
Q

Insulin deficiency can cause significant disturbances in energy metabolism, and severe ?? can lead to dehydration and … imbalances.

A

-hyperglycemia
-electrolyte

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29
Q

In patients being treated for diabetes, ??? is a possible complication of inappropriate disease management.

A

-hypoglycemia, low blood glucose

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30
Q

Diabetic ketoacidosis in type 1 diabetes:

A

-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.

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31
Q

As a result, an increased supply of?? and ?? arrives in the liver,
fueling the production of ?? and ??.

A

-fatty acids and amino acids
-ketone bodies and glucose

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32
Q

Ketone bodies, which are ?? , can
reach dangerously high levels in the bloodstream (ketoacidosis) and spill into the urine
(ketonuria

A

-acidic

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33
Q

. Blood pH typically falls below… What is the normal blood pH

A

-7.30
-blood pH normally ranges between 7.35 and 7.45

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34
Q

Main features of diabetic ketoacidosis:

A

-severe ketosis
-acidosis
-hyperglycemia

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35
Q

Acidosis is partially corrected by exhalation of?? , so rapid or
deep breathing is characteristic

A

-carbon dioxide

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36
Q

Ketone accumulation is sometimes evident by a fruity
odor on a person’s breath called…

A

-acetone breath

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37
Q

Treatment of diabetic ketoacidosis includes:

A

-insulin therapy to correct the hyperglycemia,
-intravenous fluid and electrolyte replacement,
-bicarbonate therapy to treat acidosis

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37
Q

The mental state may vary from alert to

A

-comatose (diabetic coma)

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38
Q

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

A

-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

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39
Q

hyperosmolar hyperglycemic syndrome:

A

-a condition of extreme hyperglycemia associated with dehydration, hyperosmolar blood, and altered mental status

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40
Q

In the hyperosmolar hyperglycemic syndrome, patients are unable to recognize ?? or adequately replace ?? due to age, illness, sedation, or incapacity

A

-thirst
-fluids

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41
Q

blood glucose levels rise up to ?? and may even go above ??

A

-600mg/dL
-1000mg/dL

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42
Q

Treatment for hyperosmolar hyperglycemic syndrome:

A

-intravenous fluid and electrolyte replacement
-insulin therapy

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43
Q

The hyperosmolar hyperglycemic syndrome is sometimes the first sign of type ?? diabetes in persons with undiagnosed diabetes.

A

-2

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44
Q

Unlike diabetic ketoacidosis, which develops in a couple days, this condition often evolves ?? , over one ??or longer

A

-slowly
-week

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45
Q

Hypoglycemia, or low blood glucose, is the most frequent complication of type ?? diabetes and may occur in type 2 diabetes as well.

A

-1

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46
Q

It results from the inappropriate ?? of diabetes rather than the ?? itself

A

-management
-disease

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47
Q

What causes hypoglycemia? (5)

A

-excessive dosages of insulin/antidiabetic drugs
-prolonged exercise
-skipped meals
-inadequate food intake
-consumption of alcohol w/o food

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48
Q

Hypoglycemia is the most frequent cause of ?? in insulin-treated patients and is believed to account for ?? to ??percent of deaths in this population.

A

-coma
-4 to 10%

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49
Q

Prolonged exposure to high glucose concentrations can damage ?? and ?? .

A

-cells and tissues

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50
Q

advanced glycation end products (AGEs):

A

-reactive compounds formed after glucose combines with protein;
-damage tissues and lead to diabetic complications.

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51
Q

excessive glucose within cells promotes the production and
accumulation of ??, which does what?

A

-sorbitol
-increases oxidative stress in the cells and causes cellular injury

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52
Q

Chronic complication of diabetes involves what blood vessels and also…

A

-large blood vessels (macrovascular complications)
-smaller vessels such as arterioles & capillaries (microvascular complications)
-nerves (diabetic neuropathy)

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53
Q

Tissues affected by chronic diabetes:

A

-lens of eye: cataracts, glaucoma
-skin: lesions

54
Q

The damage caused by diabetes accelerates
the development of ?? in the arteries of the heart, brain, and
limbs

A

-atherosclerosis

55
Q

As a result of cardiovascular
complications, the most common causes of death in individuals with longterm diabetes are?? and ??

A

-heart attack
-stroke

56
Q

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

A

-(impaired blood circulation in the limbs)
-(pain while walking)

57
Q

Left untreated, foot ulcers can lead to
?? , and some patients require foot ??? , a major
cause of disability in individuals with diabetes.

A

-gangrene (tissue death)
-amputation

58
Q

The primary microvascular complications involve the ?? of the eye and
the ??.

A

-retina
-kidneys

59
Q

diabetic retinopathy:

A

-weakened capillaries of retina leak proteins, lipids, or blood causing local edema or hemorrhaging

60
Q

diabetic nephropathy:

A

-damage prevents adequate blood filtration, and results in abnormal urinary protein losses (albuminuria)

61
Q

As the kidney damage worsens, urine production decreases and ?? wastes accumulate in the blood; eventually, the individual requires ?? to survive.

A

-nitrogenous
-dialysis (artificial filtration of blood)

62
Q

diabetic neuropathy:

A

-nerve damage
-two types: peripheral neuropathy & autonomic neuropathy

63
Q

peripheral neuropathy:

A

-most common form of neuropathy in diabetes
-pain, numbness, or tingling in hands, legs, and feet
-can contribute to food ulcers

64
Q

autonomic neuropathy:

A

-sweating abnormalities
-disturbed bladder function
-erectile dysfunction
-delayed stomach emptying rate (gastroparesis)

65
Q

Individuals with type 1 diabetes require ?? for survival.

A

-insulin therapy

66
Q

Type 2 diabetes may initially be treated with nutrition therapy and exercise, but most patients eventually need to add ?? medications or ??.

A

-antidiabetic
-insulin

67
Q

continuous glucose monitoring:

A

-continuous monitoring of tissue glucose levels using a small sensor placed under the skin.

68
Q

Health care providers periodically evaluate long-term
glycemic control by measuring ?? levels.

A

-HbA1c

69
Q

The goal of diabetes treatment
is usually an HbA1c value of less than ?? percent

A

-7

70
Q

Less stringent HbA1c goals (for example, a value less than ?? percent) may
be suitable for some patients

A
  • 8
71
Q

HbA1c testing is typically conducted ?? to ?? times yearly

A

-two or four

72
Q

fructosamine test:

A

-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
Q

Most often, the fructosamine test is used to evaluate recent adjustments in diabetes treatment or glycemic control during ??

A

-pregnancy

74
Q

The test cannot be used if the patient
has a ?? or ?? disorder that lowers serum protein levels.

A

-liver or kidney

75
Q

What healthcare professional is best suited to design and implement the nutrition therapy provided to patients with diabetes.

A

-registered dietitian

76
Q

What macronutrient has the greatest influence on blood glucose levels after meals?

A

-carbohydrates

77
Q

The carbohydrate recommendation is based in part on persons:

A

-metabolic needs
-type of insulin/medication used to manage diabetes
-individual preferences

78
Q

For optimal health, the carbohydrate sources
should be, & what carbs should be limited?

A
  • nonstarchy vegetables, fruits, whole grains, legumes, and dairy products
    -refined grains and added sugars
79
Q

consuming a portion of ?? causes
blood glucose to increase more than would consuming a similar portion of ??.

A

-white rice
-barley

80
Q

glycemic index (GI):

A

-a ranking of carbohydrate foods based on their effect on blood glucose levels after ingestion

81
Q

what carb foods have a high glycemic effect, what about low?

A

-high=highly processed, starchy foods
-low=high fiber, minimally processed

82
Q

Which sugar alcohols have lower glycemic effects than other carbs and used as sugar subsistiues?

A

-sorbitol and maltitol
-large amounts needed because not as sweet as table sugar
-cause flatulence and discomfort

83
Q

which nonnutritive sweeteners contain no digestible carb and can used in place of sugar?

A

-aspartame, sucralose, and saccharin

84
Q

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

A

-50

85
Q

saturated fat should be less than ??percent of total kcalories and trans fats should be avoided.

A

-10%

86
Q

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

A

-one and two

86
Q

In addition, individuals using insulin or medications that promote insulin secretion should consume ??when they ingest alcoholic beverages to avoid hypoglycemia

A

-food

87
Q

Vitamin and mineral supplementation is not recommended
unless nutrient deficiencies develop; those at risk include

A

-older adults,
-pregnant or lactating women,
-strict vegetarians,
-individuals on kcalorie-restricted diets

88
Q

Carbohydrate-counting techniques are more ?? than
other menu-planning approaches and are widely used for tracking carbohydrate
intakes.

A

-flexible

89
Q

Carbohydrate counting works as follows: BASIC

A

-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
Q

Advanced carbohydrate

A

-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
Q

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

A

-macronutrient
-flexible

92
Q

In diabetes plate method, the ideal dinner plate is described as follows:

A

-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
Q

basal insulin

A

-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
Q

The forms of insulin that are commercially available differ by
their

A

-onset of action,
-timing of peak action,
- duration of effects.

95
Q

insulin preparations are classified:

A

-they may be rapid acting (lispro, aspart, glulisine, and inhaled insulin),
-short acting (regular),
-intermediate acting (NPH),
-long acting (glargine, detemir, and degludec)

96
Q

The rapid- and short-acting insulins are typically used at ??,

A

-mealtimes

97
Q

intermediate- and long-acting insulins provide..

A

-basal insulin for the periods between meals and during the night.

98
Q

Insulin is most often administered by ?? injection,
either self-administered or provided by caregivers, why this type of injection?

A

-subcutaneous
-insulin is a protein and would be destroyed by digestive processes if taken orally

99
Q

what is the most common device used for injecting insulin?

A

Disposable syringes, which are filled from vials that contain multiple doses of insulin

100
Q

?? insulin pens are prefilled with insulin and are used
one time only, whereas ?? pens can be fitted with prefilled insulin
cartridges and replaceable needles.

A

-Disposable
-reusable

101
Q

A rapid-acting inhalation powder is
available for use before meals, although it cannot be used by patients
with ?? disease

A

-lung

102
Q

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.

A

-intensive
-3 or 4

103
Q

Insulin pumps are usually programmed to deliver small amounts of ??? continuously (to meet basal insulin needs) and ?? doses of rapid-acting insulin at mealtimes.

A

-rapid-acting insulin
-bolus

104
Q

The amount required depends on

A
  • the pre-meal blood glucose level,
  • the carbohydrate content of the meal,
    -the person’s body weight and sensitivity to insulin
105
Q

how to determine insulin sensitivity:

A

-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
Q

honeymoon period:

A

-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
Q

initial treatment of type 2 diabetes usually involves nutrition therapy, physical activity, and oral antidiabetic medications, long-term results with these treatments are often ??

A

-disappointing
-as disease progresses, pancreatic function worsens, and many need insulin therapy to help

108
Q

Many possible regimens can be used to control type 2 diabetes such as:

A

-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
Q

most common complication of insulin treatment:

A

-hypoglycemia
-low blood glucose level below 70mg/dL

110
Q

Hypoglycemia can be corrected by consuming ?? or a ?? -containing food

A

-glucose, usually 15-20 grams of carb can relieve hypoglycemia in 15 minutes
-not sucrose or fructose

111
Q

what is an unintentional side effect of insulin therapy? especially intensive insulin treatment?

A

-weight gain
-causes unknown

112
Q

fasting hyperglycemia:

A

-hyperglycemia that typically develops in the early morning after
an overnight fast of at least eight hours.

113
Q

dawn phenomenon:

A

-morning hyperglycemia that is caused by the early-morning release of growth
hormone, which reduces insulin sensitivity

114
Q

rebound hyperglycemia:

A

-hyperglycemia that results from the release of counterregulatory hormones following nighttime hypoglycemia

115
Q

central feature of diabetes management

A

-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
Q

Both children and adults should participate in ?? or
?? sessions of muscle-strengthening exercises weekly

A

-two or three

117
Q

People with severe retinopathy should avoid ?? aerobic or ??
exercise, which may lead to retinal detachment and damage to eye tissue.

A

-vigorous
-resistance

118
Q

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?

A

-footwear
-weight-bearing activity

119
Q

If blood glucose is below ?? mg/dL, carbohydrate should be consumed before the exercise begins

A

-90

120
Q

Individuals with type 1 diabetes who have hyperglycemia
and ketosis should delay exercise until blood glucose falls below ?? mg/dL

A

-250

121
Q

During illness, individuals with diabetes should
measure blood glucose and ?? levels several times daily.

A

-ketone

122
Q

Due to hormonal changes, pregnancy increases ?? and the body’s need for insulin

A

-insulin resistance

123
Q

what % of women in the U.S. who do not have preexisting diabetes develop gestational diabetes?

A

-4 to 14%

124
Q

Women with gestational diabetes are at
greater risk of developing type ?? diabetes later in life,

A

-2

125
Q

Uncontrolled diabetes is linked to increased incidence of

A

-miscarriage,
-birth defects,
- fetal deaths.

126
Q

Newborns are more likely to suffer from ??
distress and to develop metabolic problems such as

A

-respiratory
-hypoglycemia, jaundice, and hypocalcemia

127
Q

. Women with diabetes often deliver babies with

A

-macrosomia (abnormally large bodies)

128
Q

Patients with type 2 diabetes are usually switched from their usual medications
to ??to prevent possible toxicity to the fetus

A

-insulin therapy

129
Q

What drug is sometimes prescribed for pregnant women with type 2 diabetes but has mixed yielded results?

A

-metformin

130
Q

physicians routinely test women for gestational diabetes between ?? and ??weeks’ gestation.

A

-24 to 28

131
Q

What is not recommended during pregnancy?

A

-weight loss

132
Q

For women with gestational diabetes who are overweight or obese, a modest caloric reduction about?? may be recommended to slow weight gain

A

-30% less than total requirement

133
Q

To help improve after-meal glucose levels, recommendations may include the following for pregnant women with gestational diabetes:

A

-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

clinical nutrition (26 decks)

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