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FNH 477 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is diabetes?

A

Metabolic disorder characterized by the presence of hyperglycemia due to defective insulin secretion, defective insulin action, or both

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2
Q

What is type 1 diabetes?

A

Autoimmune disease leading to destruction of beta-cells of pancreas, impairs insulin secretion (no, or very little, insulin is produced)

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3
Q

What is type 2 diabetes?

A

Insulin resistance/insensitivity - cells do not respond to insulin, may lead to impaired insulin secretion

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4
Q

What is the age at onset (most commonly) for type 1 diabetes?

A

< 30 years

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5
Q

What is the age at onset (most commonly) for type 2 diabetes?

A

> 30 years

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6
Q

Type 1 diabetes is associated with obesity.
True or False?

A

False.
Type 2 diabetes is associated with obesity

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7
Q

Type 2 diabetes is associated with obesity.
True or False?

A

True.

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8
Q

In type 1 diabetes, there is a propensity to ketoacidosis, requiring insulin to control.
True or False?

A

True.

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9
Q

In type 2 diabetes, there is a propensity to ketoacidosis, requiring insulin to control.
True or False?

A

False.
In type 1 diabetes, there is a propensity to ketoacidosis, requiring insulin to control.

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10
Q

Endogenous insulin secretion is extremely low in type I diabetes.
True or False?

A

True.

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11
Q

Endogenous insulin secretion is extremely low in type 2 diabetes.
True or False?

A

False.
Endogenous insulin secretion is significant but variable in type 2 diabetes.

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12
Q

Endogenous insulin secretion is significant but variable in type 2 diabetes.
True or False?

A

True

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13
Q

Endogenous insulin secretion is significant but variable in type I diabetes.
True or False?

A

False.
Endogenous insulin secretion is extremely low in type 1 diabetes.

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14
Q

The cell response to insulin in type I diabetes is normal.
True or False?

A

True.

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15
Q

The cell response to insulin in type II diabetes is resistant.
True or False?

A

True.

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16
Q

The cell response to insulin in type I diabetes is resistant.
True or False?

A

False.
The cell response to insulin in type I diabetes is normal.

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17
Q

The cell response to insulin in type II diabetes is normal.
True or False?

A

False.
The cell response to insulin in type II diabetes is resistant.

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18
Q

What occurs with impaired insulin response?

A

Increased blood glucose

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19
Q

Describe the metabolic consequences of type 1 diabetes.

A
  • No glucose enters cells
  • Cells break down protein and fat (ketones produced; diabetic ketoacidosis)
  • Weight loss
  • Excessive eating
  • Hunger (polyphagia)
  • Hyperglycemia (glucosuria; water moves into blood compartment (osmotic pressure); polyuria; dehydration; polydypsia)
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20
Q

Describe the metabolic consequences of type 2 diabetes.

A
  • Glucose enters cells slowly, if at all
  • Hunger (polyphagia)
  • Weight gain
  • Hyperglycemia (glucosuria; water moves into blood compartment (osmotic pressure); polyuria; dehydration; polydypsia)
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21
Q

How is pre-diabetes diagnosed?

A
  • Fasting plasma glucose = 6.1-6.9 mmol/L
  • 2h 75-g OGTT (oral glucose tolerance test) = 7.8-11 mmol/L
  • A1C (glycated hemoglobin) = 6.0-6.4%
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22
Q

How is diabetes diagnosed?

A
  • Fasting plasma glucose = ≥ 7 mmol/L
  • 2h 75-g OGTT (oral glucose tolerance test) = ≥ 11.1 mmol/L
  • A1C (glycated hemoglobin) = ≥ 6.5%
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23
Q

What is the main factor of diabetes?

A

Obesity

24
Q

What is characteristic of diabetic ketoacidosis? [4]

A
  • Type I diabetes
  • Acetone breath
  • Ketonemia
  • Ketonuria
25
Q
A

Answer: C
Her BMI = 17.9; she is underweight; however, since she is young, she doesn’t have increased mortality.
Generally, underweight BMI only confers increased mortality for older individuals.

26
Q
A

Answer: B

BMI for age; recall WHO charts

27
Q

Describe the burden of diabetes in Canada. [3]

A
  • Only from 1998/99 to 2008/09, the prevalence of diagnosed diabetes among Canadians increased by 70%
  • Rates continue to grow
  • 33% of Canadians live with diabetes or pre-diabetes
28
Q

What are the three tests used to diagnose diabetes?

A
  • Fasting plasma glucose
  • 2h 75-g oral glucose tolerance test
  • A1C (glycated hemoglobin)
29
Q

What are some possible diabetes complications? [7]

A
  • Chronic kidney disease
  • Eye disease (retinopathy) leading to blindness
  • Foot problems
  • Lower limb (leg, foot, toe, etc.) amputation
  • Heart attack
  • Stroke
  • Nerve damage
30
Q

What are risk factors for type 2 diabetes? [6]

A
  • Pre-diabetes
  • Age
  • Obesity
  • Physical inactivity
  • Certain ethnicities
  • Family history of diabetes (or gestational diabetes)
31
Q

.

A

Answer: B

32
Q

How can risk of developing type 2 diabetes be reduced? [4]

A
  • Weight management (lose weight if overweight/obese)
  • Physical activity
  • Healthy diet
  • Quality not quantity of fats and carbohydrates
    • Plant-based fats better than animal fats (unsaturated > saturated)
    • Lower glycemic index and glycemic load foods
33
Q

What are the main causes of avoidable mortality across the OECD? [5]

A
  • Circulatory system diseases, 36%
  • Cancers, 27%
  • Others, 20%
  • Diabetes and other endocrine diseases, 8%
  • Respiratory system, 9%
34
Q
A

Answer: D

35
Q

What is glycemic index?

A

The increase in blood glucose during 2-hour period after consumption of a certain amount of CHO compared with equal CHO from reference food

36
Q

Describe diabetes prevalence in Canada.

A
  • Above average
  • Diabetes Canada estimates the prevalence is even higher
37
Q

What is glycemic load?

A
  • Considers quantity and quality of CHO in a food
  • GI x grams of CHO in 1 serving
38
Q

Describe a response to a high-glycemic index food.

A

Eating a high glycemic index food can cause a rapid increase in blood glucose levels. In response to this increase, the pancreas secretes insulin to help regulate blood sugar levels. Insulin signals cells to take up glucose from the blood, which can cause blood sugar levels to fall. In some cases, the body may overcompensate and release too much insulin, causing blood sugar levels to fall below normal.

39
Q

Describe a response to a low-glycemic index food.

A
40
Q

Compare the glycemic index of boiled potatoes, hot versus after they have cooled down.

A
  • This phenomena occurs because the cooled boiled potato has more dietary fibre (resistant starches).
41
Q

Which type of diabetes is more common in Canada?

A

Type II

42
Q

Compare the glycemic index of whole meal versus durum wheat spaghetti.

A
  • There is more fibre in whole meal spaghetti, hence the lower GI.
43
Q

Describe the glycemic reseponse of eating lentils.

A
  • Glycemic Index: Ratio of blood glucose
    response to a given food in comparison to a
    standard. [lentils = 30]
  • Glycemic Load: Glycemic index multiplied
    times the grams of carbohydrate in 1 serving.[lentils = 12]
44
Q

According to these meta-analyses results, intakes of which nutrients are associated with reduced risk for type 2 diabetes?

A

Cereal fibre
Magnesium
Vitamin D

45
Q

Which components of DASH/MD is not likely to reduce risk of type 2 diabetes, considering these meta-analyses results?

A

Fish/seafood

46
Q

How does animal protein affect risk of type 2 diabetes?

A

Increases risk

47
Q

How does animal protein affect risk of type 2 diabetes?

A

Increases risk

48
Q

Discuss the relevance of heme iron in type 2 diabetes risk.

A
  • May be a marker for consumption of animal meats
  • Animal meats/processed meats
    • animal fats (saturated)
    • N-nitroso compounds
    • AGE: advanced glycation end products
  • Direct effects of heme iron?
49
Q

Discuss the relevance of vitamin D in diabetes risk.

A
  • Blood levels of vitamin D measured
    • From food and skin synthesis
    • Potential confounders: time spent outdoors (i.e., active lifestyles)
    • Potential mechanisms:
      • Direct effects on insulin signalling via vitamin D receptor
      • Effects of vitamin D on calcium homeostasis
      • Anti-inflammatory effects of vitamin D
50
Q

Discuss the relevance of magnesium in diabetes risk.

A
  • Direct effects of Mg on insulin action (tyrosine kinase activity of insulin receptor)
  • Interaction with other nutrients (i.e., calcium)
51
Q

What is the role of tyrosine kinase?

A
  • Insulin binds to receptor proteins
  • Receptor is phosphorylated; tyrosine kinase is now active
  • Phosphorylation of signal molecules; cascade of effects; glucose uptake and anabolic reactions
52
Q

What are recommended dietary patterns for diabetes prevention and management?

A
  • Typically rich in whole grains, fruits and vegetables, nuts, and legumes; moderate in alcohol consumption; and lower in refined grains, red or processed meats, and sugar sweetened beverages.
  • Consistent with dietary patterns such as: MD, DASH, Prudent
53
Q

Based on this data, would you recommend that individuals consume coffee to prevent type 2 diabetes?

A

Not necessarily.

54
Q

Describe management of type 2 diabetes.

A
  • Timing and distribution of meals (consistent CHO spaced throughout the day)
  • Weight control (weight loss helps to reverse insulin resistance)
  • Alcohol (moderate amounts with attention to calories, simple sugars etc., may interact with some oral hypoglycemic drugs)
  • Physical activity (improves blood glucose; increases insulin sensitivity; contributes to weight loss; improves blood pressure)
55
Q

Why is dietary management of diabetes difficult to implement?

A
  • Areas of consensus in formulating evidence based on dietary guidelines (weight management; energy balance; dietary patterns; foods to avoid)
  • Areas of uncertainty (optimal macronutrient composition; fish, dairy, oils; weight loss helps to reverse insulin resistance)
  • Further research is needed to resolve areas of uncertainty and controversy.
56
Q

Describe diet and exercise in the prevention and treatment of type 2 diabetes mellitus. [5]

A
  • Studies show that weight loss can produce remission of type 2 diabetes mellitus (T2DM) in a dose-dependent manner
  • In patients with T2DM and obesity, weight loss of ~15 kg, achieved by an intensive management programme involving calorie restriction, can lead to remission of T2DM in ~80% of individuals
  • Carbohydrate restriction might help maintain weight loss and maximize metabolic benefits
  • When combined with calorie restriction and weight loss, increases in physical activity and fitness are an important contributor to T2DM
    remission
  • Preliminary work suggests that pretreatment glycaemic status could be used to stratify patients in order to optimize dietary recommendations

FNH 477 (11 decks)

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