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NUTR600 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Hyperinsulinemia

A

Abnormally high levels of insulin. This is typically caused by the body’s response to insulin resistance and trying to correct that hyperglycaemia.

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2
Q

Metabolic Syndrome

A

Collective of risk factors that increase the risk of stroke, heart disease and type 2 diabetes.
- To be diagnosed you need to have at least 3/5 risk factors which include
○ High waist circumference
○ Hypertension
○ Elevated triglycerides
○ Low HDL cholesterol
○ Elevated fasting glucose

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3
Q

Pre diabetes

A

Before type 2 diabetes is diagnosed, where blood glucose levels are higher than normal, but not high enough to be classified as type 2.

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4
Q

Non modifiable risk factors for T2D

A
  • Gender
  • Ethnicity
  • Increasing age
  • Family history
  • Hormonal disorders (PCOS)
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5
Q

Type 2 diabetes symptoms

A
  • Extreme fatigue or irritability
  • Polydipsia or polyphagia
  • Polyuria
  • Frequent infections
  • Poor wound healing
  • Tingling or numbness in hands/ feet
  • Blurred vision or dizziness
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5
Q

Type 2 diabetes symptoms

A
  • Extreme fatigue or irritability
  • Polydipsia or polyphagia
  • Polyuria
  • Frequent infections
  • Poor wound healing
  • Tingling or numbness in hands/ feet
  • Blurred vision or dizziness
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6
Q

Extreme Fatigue/ Irritability

A

Note that people that are experiencing fatigue may not be able to answer all the questions or we may not be able to get as in-depth answers as we would like.

May also become irritable after a short amount of time. Get the key information first and then gauge how people are feeling.

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7
Q

Increased hunger and thirst

A

Not only check how appetite is but also have they experienced changes and if so, how long has this been going on for, how much are we talking (on a scale 1-10), and then consider if this is linked to other factors including weight changes and the time frames for this

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8
Q

Poor Wound Healing

A

Even if they are small ones, and how long have they had them for. Particularly on the feet as these can take a long time to heal and can lead to much more serious complications. Are they meeting the RDI for vitamin A, Zinc and vitamin C.

- Do they need adjusted nutrition requirements 
- Do they need a wound healing supplement?
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9
Q

Blurred vision

A

Consider education material - if they can actually read these
- Note some people may be too embarrassed to say something upfront
- Important to check before giving out things
- How is your eyesite?
- Would you prefer I talk you through the information
- This also gives people a chance to let you know how they prefer to receive information
○ Documents with large text, allow people to grab their glasses, prefer pictures, using teach back approach

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10
Q

Dizziness

A

Usually in hospital cases

- Make sure they stay lying down - they don’t need to be sitting up to answer our questions

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11
Q

Diagnosis of diabetes

A
  1. Fasting and random blood glucose level (FBG ≥ 7.0 mmol/L or RBG ≥ 11.1 mmol/L) confirmed by a second abnormal FBG on a separate day.
    1. Oral glucose tolerance test
    2. HbA1C ≥ 6.5% on 2 separate occasions (percentage of glycated haemoglobin present in the blood for 2-3 months)
      a. Also used to measure overall diabetes control
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12
Q

Complications of type 2 diabetes

A
  • Retinopathy and blindness
  • Heart and disease or stroke
  • Nephropathy
  • Hypertension
  • Diabetic foot - Ulceration and amputation
  • Cerebrovascular disease
  • Severe periodontal disease
  • Complications/ birth defects
  • Neuropathy
  • Loss of sensitivity
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13
Q

Reversal of type 2 diabetes

A

There is currently no ‘cure’ (not permanent), but people can have ‘complete remission’ or ‘partial remission’ when treated early and effectively

- This is indicated by fasted glucose returning to normal range 
- Medications are no longer required 
- Generally success occurs through early diet and lifestyle intervention and/or weight loss of at least 10% body weight (gastric bypass surgery primary example).
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14
Q

When does gestational diabetes usually occur?

A

Usually occurs in 24th to 28th week of pregnancy

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15
Q

Macrosomia

A

Baby larger than 4 kg due to large amounts of available glucose

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16
Q

Primary Goal of dietary management of type 2 diabetes

A
  • Improving glycemic control
  • Weight management for those who are overweight or obese
  • Ensure people are getting a nutrient rich diet
17
Q

Initial Strategies for Type 2 diabetes

A
  1. Spacing meals and spreading carbs throughout the day
    • Eating breakfast
    • Including mid meal snacks where indicated
    • Avoiding skipping meals
      2. Swapping high GI for low GI alternatives
      3. Increasing fibre
    • Using fruit or veg for snacks
    • Including veg with at least 2 main meals
      4. Encouraging healthier take-away options
      5. Strongly recommending limiting alcohol (avoid in pregnancy)
    • Avoid high sugar options and mixers
    • Space with water and non-alcoholic drinks
      Ensuring food with alcohol
18
Q

Education for type 2 diabetes

A

Priority:

  1. Diabetes and carbs
  2. Healthy meal and snack examples
  3. Portions and timing
  4. Healthier take - away choices
  5. Glycaemic index

Optional

  1. Label reading
  2. Fats
  3. Salt
  4. Alcohol
  5. Mindful eating
19
Q

Dietary Management in Acute Setting (type 2 diabetes)

A
  • Assess nutrition intake
  • Interpret biochem
  • Screen for nutrition impact syndromes
  • Interpret BGLs
  • Investigate weight
  • Wound management
  • Manage acute issues
  • Commence education if new T2D
20
Q

Different types of sweeteners

A

Non-nutritive: chemical additives that are sweeter than sugar but contain zero kilojoules/ calories (don’t directly impact blood glucose)
Nutritive: Contain less energy than sugar but are not sugar free

21
Q

Different classifications of low carb diets

A 
Moderate Carb (130-225g/day or 26-45% total energy intake per/day)
Low Carb (<130/d or < 26% total energy intake/day)
Very low carb (<50g/d or < 14% total energy intake/ day)
22
Q

Exercise suggestions

A

Important part of healthy lifetsyle - 150min/wk minimum

- Helps with insulin sensitivity/ resistance 
- Helps with weight management 
- Can have mental health benefits

Check BSL (ideal range is 6-14 mmol/L)

- May need to adjust CHO intake 
- Important to check after exercise (delayed hypoglycaemia) 
- BSL's can sometimes be elevated or unpredictable (particularly in sport where adrenaline is released)
23
Q

Metformin

A

First line insulin treatment

  • Decreases output of glucose from the liver
  • Decreases absorption of glucose by the GIT
  • Increases skeletal uptake of glucose

All of this is thought to occur via its action on AMPK (enzymes that plays an important role in cellular energy management)

24
Q

Explaining type 1 diabetes

A

Explain role of Dietitian
•Relationship between diet and diabetes
•Explain reason for long term healthy eating
•Explain reason for focus of consistent carbohydrate at meal during honeymoon period
•Discuss label reading to identify CHO amount and overall nutritional quality
•Discuss alcohol
•Discuss hypo management
•Discuss exercise
•Not all topics need to be covered in the 1 session
•Prioritise what will keep the person safe

25
Q

Fat effect on sugar levels

A

• Fat can reduce early glucose response and delay peak glucose levels -> late postprandial hyperglycaemia – may need to split dose of bolus insulin to cover the delayed response eg when eating pizza (have half before pizza and then the other half 2 hours later)

26
Q

How to encourage your pts to count carbohydrates

A
  1. Keep a diary of commonly eaten foods and develop own ready reckoner
    1. Focus on one meal period at a time
    2. Weigh and measure the amount of foods eaten Use same bowl/plate at home
    3. Use measuring cups, spoons and kitchen scales Recalibrate from time to time
    4. Look up the amount of carbohydrates in the food by reading NIP or using apps and websites
      eg Website: Calorie King (Australia),
27
Q

Carbohydrate exchanges

A

CHO portions can be broken down into 15 g exchanges
Useful for people who have:
• Set meal time routine
• People on mixed insulin eg protaphane bd
Generally used for type 2 diabetes

28
Q

Different levels of carb counting

A

Basic - introduces the concept of carbohydrate counting, focuses on consistency, involves identifying carbohydrates in the pts diet
Intermediate - relationship between food, insulin, physical activity and glucose levels, how to interpret and take action on blood glucose patterns
Advanced - teaches pts how to match their rapid acting insulin using an insulin to carb ratio
Aim of all levels:

29
Q

Flexible Insulin Therapy

A

Multiple Daily Injections or Insulin Pump – educate on CHO counting to determine mealtime insulin dosing

30
Q

Fixed Insulin Therapy

A

Twice Daily Insulin –educate on consistent CHO intake (both amount & timing) - keep carbohydrate intake consistent (good for beginners, don’t need to focus on carbohydrate counting)

31
Q

How to treat a hypo

A
  1. Have a high sugar food e.g. 5 jelly beans
    • Wait 10-15 mins and re-check blood glucose
      ○ If its < 4.0mmol/L, repeat treatment above
      ○ If blood is glucose is > 4.0mmol/L choose a low GI carbohydrate snack. E.g. wholegrain bread, apple, weetbix
      ○ OR follow up with regular meal and include one of those carbohydrate sources
32
Q

What causes a hypo

A
  • Not enough carbohydrate in meal or snack times
    • Too much insulin or diabetes tablets (e.g. Amaryl or Diamicron)
    • Too much alcohol or alcohol consumed without food
    • Physical activity without enough carbohydrate foods
    • Not reducing your insulin dose before physical activity
33
Q

Bolus Insulin

A
  • Rapid acting insulins that are injected with meals
    • It is delivered to correct elevated glucose level or to manage glucose levels when carbohydrates are eaten
    • Rapid acting insulin works very quickly
    • Should be given immediately before your main meals

It is important to match insulin doses to food intake rather than matching food to insulin

34
Q

Basal Insulin

A
  • Injected one or twice a day and are long acting insulins
    • Provides a constant slow release of insulin for up to 24 hours
    • E.g. Levemir, Lantus, Toujeo
35
Q

Types of insulin therapy

A

Rapid Acting - works from 1-20 mins (lasts 3-5 hours)
Short Acting - works within 1/2 hour (lasts 6-8 hours) - ActRapid
Intermediate - works within 1.5 hours (16-24hrs), Protofane
Long acting (18-24hrs)
Mixed (short and long)
Insulin pump therapy or CSII (continuous Subcutaneous Insulin Fusion)

36
Q

How does insulin vary

A
  • How quickly they work (the onset time)
    • How long they take to achieve maximum impact (time until they peak)
    • Low long they last before the effect wears off
37
Q

HBA1C

A

HBA1C - Blood test (via a finger prick) - indicated diabetes management over time

- Refers to the glucose and Hb joined together, so the Hb is glycated. Hb is the protein in red blood cells that carries oxygen throughout the body. The amount of HbA1C formed is directly related to the amount that is in the blood. Red blood cells live up to 4 months, therefore a good indicator of how much sugar is in the blood over the previous few months. 
- People with diabetes are advised to have this test done every 3-6 months
38
Q

Management - self monitoring

A
  1. Blood glucose monitor - finger prick
    1. Continuous Glucose Monitoring - small wearable device that measures glucose levels 24 hourly
      a. Alarms user if BGLs are getting too low or too high, and whether BGL is trending up or down or remaining stable
      b. Can work in conjunction with compatible insulin pump or some can send information to a CGM receiver or smartphone
    2. Flash glucose monitoring - like a CGM device, except that you can scan the sensor with a reader, smartphone or smart device to get your reading. But does not connect to an insulin pump
39
Q

Honeymoon Period

A

Brief or partial remission stage - regain Beta cell activity temporarily

- Initiation of insulin therapy - pancreas experiences less pressure to produce insulin 
- Remaining beta cells produce enough insulin to decrease need for exogenous insulin

After a period of time the remaining cells are destroyed and the pancreas stops producing insulin - leading to increased insulin requirements

Diabetes team needs to keep adjusting or titrating insulin requirements to prevent any hypoglycaemic episodes.

40
Q

Diabetic Ketoacidosis

A
  • Can lead to diabetic coma or death
    • It is the build up of acid in the blood
    • Ketones are produced by the body when there is not enough insulin to use glucose
      Ketones are a chemical the body creates when it starts to breakdown fat as an energy source

NUTR600 (3 decks)

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