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Clinical Nutrition > Diabetes 1 > Flashcards

Diabetes 1 Flashcards

1
Q

4 Types of Diabetes

A
  • type 1 (10% of people with diabetes but majority of pediatrics
  • type 2
  • gestational
  • secondary (usually type 2, caused by drugs)
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2
Q

Type 1 diabetes

A
  • lack of insulin production

- insulin resistance

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3
Q

Type 2 diabetes

A
  • insulin resistance
  • insulin resistance is eventually stopped
  • requires a larger amount of insulin to get the same effect
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4
Q

main symptoms of diabetes

A

most common in type 1

  • lethargy, stupor from brain
  • smell of acetone on breath
  • nausea, vomiting, abdominal pain
  • hyper-ventilation (Kussmaul breathing) due to elevated BG ~try to excrete excess by breathing more
  • weight loss

other symtpms:
- blurred vision
- polydipsia, polyphagia (hungry, thirsty)
- polyurea, glycosuria (glucose in urine causes gradient and more fluid comes out)
-

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5
Q

polyphagia
polyuria
polydypsia

A

polyphagia
- body feels like it is starving; lack of insulin function prevents transfer of BG into tissue

Polyuria

  • hyperglycemia above renal threshold of ~ 10-13.5 mmol/L
  • causes glucose to be lost in urine, increase urine production

Polydypsia
- increase in urine production, increase in water loss, increase thirst

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6
Q

Diabetes - signs and symptoms

A

unintentional weight loss - catabolism to provide energy

  • may regain weight after put on insulin
  • upsurge of counter-regulatory hormones - will exacerbate the hyperglycemia

fatigue/weakness - directly from hyperglycemia, stress of starvation, cannot use BG for energy

Poor wound healing/infections - hyperglycemia provides ideal media for bacteria

Blurred vision - lens changes

Tingling/Numbness in extremities - neuropathy, may happen if there is an extended period prior to diagnosis

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7
Q

Clinical Symptoms of Diabetes

A
  • lipemia - increase in blood lipids (Non-esterified fatty acids increase and are metabolized for ketone bodies) - delay in clearance (acetone breath, dark colour urine)
  • ketonemia - increase ketones in blood
  • ketonuria - ketones in urine
    ketoacidosis - increase in H production, increases production of CO2 and respiratory rate must increase
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8
Q

Diabetic Ketoacidosis

A
  • decreased insulin production can cause the body to not be able to utilize glucose and BG increases
  • rapid release from adipose tissue of FFA ~ shift to liver and ketones are made and increase in concentration
  • decrease insulin production/increase glucagon (catabolic)
  • type 2 glucagon levels will not get as high
  • decrease pH/ increase CO2/ increase breathing
  • may result in diabetic coma
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9
Q

Diabetic Coma (ketoacidosis)

A
  • dehydration
  • decrease circulation
  • decrease O2 to the brain
  • people with Type 1 are more at risk
  • Type 2 is more at risk during infections or metabolic stress
  • consider effects of counter-regulatory hormones (no/epinephron, cortisol, glucagon) which promote lean body tissue breakdown to increase blood sugar
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10
Q

Diagnosis of Diabetes

A
  • symptoms + casual plasma concentration >11.1 mmol/L
    OR fasting plasma glucose >7 mmol/L (no food for 8 hours)
    OR 2 hr post-load glucose >11.1 mmol/L (7g g anhydrous glucose dissolved in water)
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11
Q

Classification - Type 1

A
  • B cells of pancrease destroyed by autoimmuity
  • insulin is not produced
  • inherited tendency - env trigger (celiac, down syndrome)
  • rapid onset ~ before age 30, during period of rapid growth
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12
Q

Classification - Type 2

A
  • slow onset
  • beta cell dysfunction or relative insulin resistance (insulin levels may be normal or above)
  • insulin does not function adequately
  • increased hepatic output of glucose
  • increased incidence in obesity (adipose tissue more resistant, weight loss diminishes symptoms)
  • genetic link
  • diagnosed later in life
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13
Q

Classification - Gestational Diabetes

A
  • glucose intolerance onset during pregnancy
  • even if it returns to normal there is increased risk of disease later in like
  • at six weeks post-pardum reclassify as..diabetic T2, impaired fasting glucose, impaired glucose tolerance, normoglycemia
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14
Q

Classification - Secondary Diabetes

A
  • iatrogenic (as a result of another disease/treatment)
  • does not effect pancreatic secretion but effects insulin resistance
  • corticosteroids *
  • problems go away when corticosteroids are stopped and is usually short term
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15
Q

Complications

microvascular

A
  • retinopathy
  • nephrophathy (kidney disease) there are many pt on dialysis with type 2 diabetes –> high urine protein, granular surface, small
  • neuropathy - reduced blood flow to extremities (foot)
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16
Q

Complications

Macrovascular

A
  • coronary artery disease
  • cerebrovascular disease
  • peripheral vascular disease
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17
Q

Complications are related to…

A
  • other risk factors such as smoking (microvascular damage), hypertension (kidney damage) and high serum lipids
  • duration of disease
  • genetics
  • blood glucose control –> most important – delay or prolong the onset of symptoms
18
Q

DCCT & UKPDS

A
  • Diabetes Control and Complications Trial
  • United Kingdom Prospective Diabetes Study
  • showed that tight BG control could prevent or delay complications
19
Q

Glycemic Index

A
  • the value given to a CHO containing food the reflect differences in post prandial glycemic responses
  • calculated using the area under the curve (AUC) comparing it to a standard (glucose or white bread) over a 2 hr period
  • expressed as a %
20
Q

Longer transit time = ______ rise in blood glucose

Low GI foods have ____ gastric emptying and intestinal transit time

A
  • lower

- longer

21
Q

Factors attributing to differences in GI

A
  • chain length and composition of the CHO
  • ratio between amylose and amylopectin
  • presence of insoluble and soluble starch fibre
  • cell structure of the CHO after food processing and preparation (more cooked = faster breakdown = faster BG increase)
22
Q

4 ways to lower GI

A
  • protein
  • fat
  • fibre
  • acidity
23
Q

Low GI Foods (55 or less)

A
  • pumpernickel, stone ground whole wheat
  • all bran, oat bran
  • barley, bulgar
  • sweet potato, yam, lentils
24
Q

Medium GI Foods (56-69)

A
  • whole wheat, rye, pita
  • puffed wheat, oatmeal, quick oats
  • brown rice, couscous
  • new white potato, popcorn, sweet corn
25
Q

High GI Foods ( +70)

A
  • white bread
  • bran flakes, corn flakes, rice krispies
  • short grain rice
  • baked potato, french fries, rice cakes, soda crackers
26
Q

women and men CHO choice recommendations

15 g CHO

A

women = 3-4 CHO choices at meals, 1-2 choices at snacks
men = 4-5 choices at meals, 1-3 choices at snack
- 1 slice of bread, 1/2 cup pasta or potatoes, 3/4 cup hot cereal, 1 med fruit, 1/2 cup juice, 1 cup milk

27
Q

Protein choice recommendations

contains 7 g protein and 3 g fat

A

women - 5-7 choices per day
men - 6-9 choices per day
(some may contain fat)

28
Q

Fat choice recommendations

one fat choice = 5 g of fat

A

women - 5-6 choices per day

men - 5-8 choices per day

29
Q

Protein choices with CHO

A
  • hummus

- legumes: kidney beans, lentils

30
Q

snacks

A
  • needed if meals are more than 4 hours apart
  • CHO containing snacks
  • night time snack can include a protein
31
Q

Islet Cell Transplantation - for pt with severe type 1 diabetes

A
  • hemoglobin A1c - represents longer term glycemic control
32
Q

metabolic syndrome (diabetes can be part of this syndrome)

A
  • FBG > 6.1 mmol/L
  • BP > 130/85 mmHg
  • TG >1/7 mmol/L
  • HDL-C men 102 and >88 cm for men and women
33
Q

Ultimate Goal of Diabetes is Blood Glucose Control

A
  • meal planning/food choices ~ nutrition care and medical nutrition therapy
  • physical therapy (exercise)
  • medication
  • monitoring (self, medical professional)
  • education
34
Q

Three types of Diabetes therapy

A
  1. diet
  2. oral hypoglycemics ~ act to increase insulin production/secretion, increase sensitivity to insulin, decreases hepatic glucose production, delays absorption of glucose from the GI tract, always used with diet
  3. exercise
35
Q

Goals of Medical Nutrition Therapy (Nutrition Care)

A
  • optimal blood glucose and lipid levels through food choices
  • improve QOL and overall health
  • self-management by providing information ~ large lifestyle change
  • teach prevention and treatment of the acute complications
  • prevent or delay the long-term complications (secondary prevention)
  • provide adequate energy/nutrients for reasonable weight
36
Q

Guidlines for T1, T2 Diabetes

A
  • only use Canada’s Food Guide at the beginning * so their family dynamic doesn’t change
  • nutrition care plan should focus on blood glucose levels, blood lipids, blood pressure, and renal status
37
Q

Three types of Diabetes therapy

A
  1. diet
  2. oral hypoglycemics ~ act to increase insulin production/secretion, increase sensitivity to insulin, decreases hepatic glucose production, delays absorption of glucose from the GI tract, always used with diet
  3. exercise
38
Q

Goals of Medical Nutrition Therapy (Nutrition Care)

A
  • optimal blood glucose and lipid levels through food choices
  • improve QOL and overall health
  • self-management by providing information ~ large lifestyle change
  • teach prevention and treatment of the acute complications
  • prevent or delay the long-term complications (secondary prevention)
  • provide adequate energy/nutrients for reasonable weight
39
Q

Guidlines for T1, T2 Diabetes

A
  • only use Canada’s Food Guide at the beginning * so their family dynamic doesn’t change
  • nutrition care plan should focus on blood glucose levels, blood lipids, blood pressure, and renal status
40
Q

Risk Factors for Severe Hypoglycemia

A
  • prior episode
  • current low A1c (<6%) ~ worse to be lower than to be higher ~ even though lower levels may be the same as what is normal for a healthy person, it is not safe for a diabetic
  • hypoglycemia unawareness
  • long duration of diabetes
  • adolescence
41
Q

The Edmonton Protocol for Islet Cell Transplants

A
  • transplanted without prior storage
  • anti-rejection drugs
  • injected through a catheter through the skin to the liver
  • cells settle in liver and start producing insulin and controlling BG
  • may require multiple transplants over time
  • may still need to take insulin injections to help prevent B cells from getting tired
42
Q

transplant not required for Type 2

A
  • insulin is produced (too high stimulation for long periods of time leading to lower sensitivity)
  • insulin resistance
  • dietary management and lifestyle change
  • oral anti-hypoglycemic drugs
  • can also require insulin

Clinical Nutrition (14 decks)

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