Diabetes 1 Flashcards
4 Types of Diabetes
- type 1 (10% of people with diabetes but majority of pediatrics
- type 2
- gestational
- secondary (usually type 2, caused by drugs)
Type 1 diabetes
- lack of insulin production
- insulin resistance
Type 2 diabetes
- insulin resistance
- insulin resistance is eventually stopped
- requires a larger amount of insulin to get the same effect
main symptoms of diabetes
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)
-
polyphagia
polyuria
polydypsia
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
Diabetes - signs and symptoms
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
Clinical Symptoms of Diabetes
- 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
Diabetic Ketoacidosis
- 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
Diabetic Coma (ketoacidosis)
- 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
Diagnosis of Diabetes
- 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)
Classification - Type 1
- 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
Classification - Type 2
- 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
Classification - Gestational Diabetes
- 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
Classification - Secondary Diabetes
- 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
Complications
microvascular
- 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)
Complications
Macrovascular
- coronary artery disease
- cerebrovascular disease
- peripheral vascular disease
Complications are related to…
- 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
DCCT & UKPDS
- Diabetes Control and Complications Trial
- United Kingdom Prospective Diabetes Study
- showed that tight BG control could prevent or delay complications
Glycemic Index
- 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 %
Longer transit time = ______ rise in blood glucose
Low GI foods have ____ gastric emptying and intestinal transit time
- lower
- longer
Factors attributing to differences in GI
- 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)
4 ways to lower GI
- protein
- fat
- fibre
- acidity
Low GI Foods (55 or less)
- pumpernickel, stone ground whole wheat
- all bran, oat bran
- barley, bulgar
- sweet potato, yam, lentils
Medium GI Foods (56-69)
- whole wheat, rye, pita
- puffed wheat, oatmeal, quick oats
- brown rice, couscous
- new white potato, popcorn, sweet corn
High GI Foods ( +70)
- white bread
- bran flakes, corn flakes, rice krispies
- short grain rice
- baked potato, french fries, rice cakes, soda crackers
women and men CHO choice recommendations
15 g CHO
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
Protein choice recommendations
contains 7 g protein and 3 g fat
women - 5-7 choices per day
men - 6-9 choices per day
(some may contain fat)
Fat choice recommendations
one fat choice = 5 g of fat
women - 5-6 choices per day
men - 5-8 choices per day
Protein choices with CHO
- hummus
- legumes: kidney beans, lentils
snacks
- needed if meals are more than 4 hours apart
- CHO containing snacks
- night time snack can include a protein
Islet Cell Transplantation - for pt with severe type 1 diabetes
- hemoglobin A1c - represents longer term glycemic control
metabolic syndrome (diabetes can be part of this syndrome)
- 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
Ultimate Goal of Diabetes is Blood Glucose Control
- meal planning/food choices ~ nutrition care and medical nutrition therapy
- physical therapy (exercise)
- medication
- monitoring (self, medical professional)
- education
Three types of Diabetes therapy
- diet
- 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
- exercise
Goals of Medical Nutrition Therapy (Nutrition Care)
- 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
Guidlines for T1, T2 Diabetes
- 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
Three types of Diabetes therapy
- diet
- 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
- exercise
Goals of Medical Nutrition Therapy (Nutrition Care)
- 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
Guidlines for T1, T2 Diabetes
- 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
Risk Factors for Severe Hypoglycemia
- 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
The Edmonton Protocol for Islet Cell Transplants
- 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
transplant not required for Type 2
- 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
