Chapter 6 Medical Nutrition Therapy for Diabetes

Question 0

What are the two types of diabetes?

6.2

Answer 0

Type 1 diabetes and Type 2 Diabetes

Question 1

List 5 key points of chapter 6 medical nutrition therapy for diabetes

Answer 1

1. long term clinical trials have documented the importance of metabolic control of glucose, lipids and blood pressure in persons with diabetes. Meds are available but nutrition is and ongoing process.
2. Clinical trials and outcomes studies have documented the effectiveness of nutrition therapy.
   Therapy can help lower hgbA1c levels by approx 1 to 2 percent. lower LDL cholesterol and blood pressure
3. for type 1 diabetes, 1st priority is to ID a food or meal plan and then integrate an insulin regimen into the persons lifestyle.
4. type 2 diabetes is a prgressive disease beginning with insulin resistance. Glucose levels remain normal if adequate insulin is availabe and it is not until insulin deficiency (B cell failure) develops that hyperglycemia occurs.
5. monitoring of glucose, lipids and BP is essential to assess the outcomes of nutrition therapy and or to determine if additional changes in nutrition therapy or medications are necessary.

Question 2

What is diabetes mellitus?

Answer 2

A group of diseases characterized by elevated glucose concentrations resulting from insulin deficiency.

Question 3

What is the primary function of insulin?

Answer 3

Insulin is a hormone produced by the B-cells of the pancreas, its function is the use or storage of body fuels.

Question 4

What risks can a person with prediabetes have?

Answer 4

type 2 diabetes, heart disease, stroke, microvascular and macrovascular complications.

Question 5

What percent of diagnosed individuals have type 2 diabetes?

Answer 5

the square root of 81 multiplied by five plus two times one quarter of 100 (from Allan)
i.e. 90-95% of the cases

Question 6

When should women with GDM be screened for diabetes or prediabetes?

Answer 6

approximately one tenth of the total weeks in the year is the average (A length of time in witch women with GDM should be screened (Allan’s answer)
6 to 12 weeks postpartum and lifelong screening every three years.

Question 7

What are DRIs?

Answer 7

thingies in your text book about evidence based nutrition recomendations for diabetes (from Allan)
DRI’s are dietary reference intakes.

Question 8

What is the recommended alcohol intake for individuals with diabetes?

Answer 8

Same thing as regular people so im not sure why its in you text book.

Question 9

What does Symlin (pramlinitide) help to control?

Answer 9

Same thing insulin helps to control i think but that part of the books is a bit confusing

Question 10

How is Long term glycemic control assessed?

Answer 10

By A1C thingies but i dont remember it ever telling me what a A1C thing is soooo not very helpful.

Question 11

What is the etiology of type one diabetes?

Answer 11

• genetic predisposition

- autoimmune destruction of the B-cells that produce insulin

Question 12

What type of antibodies contribute to the destruction of B-cells?

Answer 12

1. Islet cell autoantibodies (ICAs)
2. Insulin autoantibodies (IAAs) which may occur in persons who have never received insulin therapy
3. Auto antibodies to glutamic acid decarboxylase autoantibodies (GAD 65) a protein in the surface of B cells which appear to provoke an attack by the T cells
4. Auto antibodies to tyrosine phosphatases IA-2 and IA-2B

Also the disease has strong HLA (human leukocyte antigen associations with linkage to DQA and DQB genes and influenced by the DRB genes

Question 13

What usually happens after diagnosis of type 1 diabetes and correction of the hyperglycemia, metabolic acidosis and ketoacidosis in the patients body?

Answer 13

there is often a honeymoon phase where there is a recovery of endogenous insulin secretion.
But eventually the need for exogenous insulin is inevitable and within 8 to 10 years after clinical onset, B-cell loss is complete and insulin deficiency is absolute.

Question 14

What other conditions are type 1 diabetics prone to?

Answer 14

Graves’ disease, Hashimoto’s thyroiditis, addison’s disease, celiac sprue and pernicious anemia

Question 15

What symptoms do patients with type 2 diabetes have? (6.2.2)

Answer 15

may or may-not present with classic symptoms of uncontrolled diabetes.
They are NOT prone to ketoacidosis.
they have a progressive loss of the B cells and over time will require insulin to maintain same glycemic control.
insulin is also required sooner during periods of stress induced hyperglycemia such as during illness or surgery

Question 16

What are some risk factors of Type 2 diabetes? (6.2.2)

Answer 16

genetic predisposition
age
obesity 
physical inactivity
increased intra abdominal body fat

Question 17

What are insulin levels like in Type 2 Diabetes? 6.2.2

Answer 17

the insulin levels can be high, normal or low BUT they are inadequate to overcome the concomitant insulin resistance and therefore hyperglycemia occurs.
initially there is a compensatory increase in insulin secretion, which maintains glucose concentrations in the normal or prediabetic range but the persons pancreas is unable to produce adequate insulin then hyperglycemia occurs.

Question 18

Once hyperglycemia occurs in a type 2 diabetic how does the body respond? 6.2.2

Answer 18

once there is inadequate insulin then the post prandial glucose is elevated.
as insulin secretion decreases then hepatic glucose production increases causing elevation in fasting gluc.
insulin response s also inadequate in suppressing a-cell glucagon secretion, resulting in glucagon hypersecretion and increased hepatic glucose production.

Question 19

What is prediabetes? 6.2.5

Answer 19

individuals with impaired gluc tolerance (IGT), impaired fasting glucose (IFG) and or hgb A1c levels between 5.7 and 6.4%

Question 20

What is prediabetes associated with? 6.2.5

Answer 20

obesity esp intrabdominal obesity
dyslipidemia with high triglycerides and or low HDL cholesterol
hypertension (metabolic syndrome)

Question 21

What is the indications for testing for prediabetes and diabetes? 6.3

Answer 21

• overweight
• physical inactivity
• high risk ethnic popn (eg african Americans, Latinos, Native American, Asian american and Pacific Islanders
• women who deliver baby weighing over 9lbs
• women diagnosed with GDM
• hypertension (BP 140/90 mmHg)
• HDL cholesterol level /= 2.82 mmol/L
• women with polycystic ovarian syndrome (PCOS)
• A1C >/= 5.7%
• history of CVD

Question 22

What are the goals and outcomes of medical nutrition therapy for diabetes? (6.5.1)

Answer 22

Goals: improve glucose control, lipid profiles, and blood pressure
Effective therapy: nutrition therapy provided by registered dieticians have demonstrated that A1C levels have decreased 1-2%

Question 23

What are the evidence based nutrition recommendations for diabetes? 6.5.2

Answer 23

DRI (dietary reference intakes) are
45-65% of total energy from carbohydrate,
20-35% from fat, and
10-35% from protein.

Question 24

What is glycemic index of food (GI)? 6.5.2.1

Answer 24

GI was developed to compare the physiologic effects of carbohydrate on glucose.
It does not measure how rapidly the blood glucose levels increase.

Question 25

What is glycemic load? (GL) 6.5.2.1

Answer 25

Glycemic load…attempts to measure the predicted impact on the body’s glycemic response to the actual meal or diet.
This is calculated by multiplying the GI by the amount of carbohydrates in each food and then totalling the values for all foods in the meal or dietary pattern.

Question 26

What is the fibre recommendation for diabetics? 6.5.2.1

Answer 26

they are encouraged to consume a variety of fibre containing foods but there is no reason to recommend that people with diabetes eat a greater amount of fibre than other americans.
Diets containing 44-50g/day fibre have beens shown to improve glycemia but the more usual fibre intake of up to 24g/day has not shown to be beneficial.
Consuming foods containing 25-30g/day fibre with special emphasis on soluble fibre sources (7-13g/day) is recommended as part of cardioprotective nutrition therapy

Question 27

What are the protein recommendations for diabetics? 6.5.2.2

Answer 27

no evidence to suggest that usual intake of protein (15-20% of energy intake) needs to be changed in people who do not have renal disease.
But in people who have diabetic nephropathy a protein intake of <1.0g/kg/day is recommended.

Question 28

Does protein slow the absorption of carbohydrates? 6.5.2.2

Answer 28

research has show that ingested protein does not slow the absorption of carbs.
also research has shown that adding protein to the treatment of hypoglycemia will not prevent subsequent hypoglycemic episodes.
no evidence to show that adding protein to a bedtime snack is helpful
BUT the long-term effects of a diet higher in protein and lower in carbs in persons with diabetes on regulation of energy intake, satiety and weight loss have not been adequately studied.

Question 29

What are the recommendations for dietary fat for patients with diabetes? 6.5.2.3

Answer 29

limited intake of saturated fats, trans fats and dietary cholesterol esp in individuals with LDL cholesterol >or=2.6mmol/L however research in these guidelines is limited.
Persons with diabetes are considered at risk of CVD so therefore the recommendations are similar to patients who have had a past history of CVD…therefore after focusing on glycemic control then cardioprotective nutrition is recommended.
There is evidence fro the general population that foods containing n-3 polyunsaturated fatty acids are beneficial and two to three servings of fish per week are recommended.

Question 30

What beneficial effects do n-3 supplements have? 6.5.2.3

Answer 30

lowers triglycerides and platelet reactivity
possibly lower BP, leukocyte reactivity and arrhythmias
Side effects are minor and are safe to ingest.

Question 31

What are the micronutrients recommendations for diabetics?

Answer 31

no evidence of benefit from vitamin or mineral supplementation in persons with diabetes who do NOT have underlying deficiencies.
Routine supplementation of the diet with antioxidants such as vit C and E and carotene has NOT proven beneficial.
Therefore routine supplementation is NOT recommended because of lack of effectiveness and long term safety is a concern.
Chromium supplementation is not recommended studies have been inconsistent.
latest research on Vit D supplementation is unclear

Question 32

What are the Alcohol recommendations for diabetics? (6.5.2.5)

Answer 32

Same as for general public…less than 2 per day for men and less than 1 per day for women.
one drink is defined as 12oz beer, 5 oz wine, or 1.5 oz of distilled spirits
moderate amounts of alcohol when ingested with food have minimal if any effect on blood glucose and insulin concentrations.
for individuals using insulin or insulin secretagogues, if alcohol is consumes it should be consumed with food to prevent hypoglycemia
For people with type 2 diabetes light to moderate intake of alcohol are associated with decreased risk of atherosclerosis and coronary heart disease possibly due to increases in HDL cholesterol and improved insulin sensitivity.
it is not recommended for people who do not drink to start drinking cause there is no evidence to prove that it would help nor is it advisable for people who have history of alcohol abuse and medical conditions such as liver disease, pancreatitis, advanced neuropathy or severe hypertriglyceridemia to drink alcohol.

Question 33

What is carbohydrate counting? Give eg of 1 carbohydrate serving.(6.5.3)

Answer 33

determining what constitutes 1 serving of carbs and "counting" how much one has per meal and per day.
1 carb serving is 15g of carbohydrates
egs are
Starches 
1 slice of bread
1/3 cup cooked rice or pasta
3/4 cup dry cereal
1/2 large baked potato

Fruit
1 small fresh fruit
1/2 cup fruit juice
1/4 cup dried fruit

Milk
1 cup skim milk
2/3 cup fat free fruited yogurt sweetened with nonnutritive sweetener or fructose

sweet desserts
2 small cookies
1 tbsp jam or honey
1/2 cup ice cream frozen yogurt or sherbert

Question 34

What is the recommended carb servings per meal for men and women? 6.5.3

Answer 34

Women
3-4 carbs per meal and 1-2 for a snack

Men
4-5 carb servings per meal and 1-2 for a snac,