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Diabetes Flashcards

1
Q

What are the risks associated with Gestational diabetes

A

Risk remains elevated for mom later in life that she will get T2D again

Increases risk for large size delivery for infant, bigger heads and differences in the way the liver functions at birth

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2
Q

What are the risk factors for Metabolic Syndrome?

A

Fasting Blood glucose ≥ 6.1 mmol/L
Blood pressure ≥ 130/85 mmHg
Triglyceride ≥ 1.7 mmol/L
HDL: Men < 1.0 mmol/L women < 1.3 mmol/L

Abdominal Obesity - waist circumference
men > 102 cm
Women > 88cm

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3
Q

What is polyphagia?

A

The body feels as though it is starving because lack of insulin function prevents transfer of glucose from the blood - strong desire to over eat

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4
Q

What is polyuria?

A

Hyperglycemia above the renal threshold of ~13.5 mmol/L causes glucose to be lost in the urine. Increased glucose in the urine leads to an increased urine production

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5
Q

What is polydypsia?

A

Increased urine production leads to water loss which leads to increased thirst

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6
Q

Why would diabetic patients experience weight loss?

A

their inability to utilize blood glucose leads to catabolism to provide energy

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7
Q

Why would diabetic patients experience fatigue?

A

The stress of starvation and inability to utilize blood glucose for energy

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8
Q

Why would diabetic patients experience poor wound healing and increased infections?

A

Hyperglycemia provides the ideal media for bacteria

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9
Q

Why would diabetic patients experience blurred vision?

A

Lens change due to hyperglycemia

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10
Q

Why would diabetic patients experience tingling/numbness in the extremities?

A

Neuropathy of diabetes - may happen if extended period prior to diagnosis

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11
Q

Why would diabetic patients develop ketoacidosis?

A

The body cannot utilize sugar for fuel so the liver starts to break down fats instead. Ketone bodies are a byproduct of this process, which leads to their breath smelling of acetone. High levels of ketones in the blood can impact pH and can be life threatening - although DKA is more common in type 1 diabetes.

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12
Q

Why might ketoacidosis cause labored respiration?

A

If the blood pH decreases, there is an increase in CO2 production
Respiratory rate increases to decrease CO2 production

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13
Q

What is Ketonemia?

A

presence of ketones in the blood

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14
Q

What is ketnuria?

A

ketones in the urine

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15
Q

What is Lipemia?

A

Increased lipids in the blood, specifically Non Esterified Fatty acids which are metabolized for energy - producing ketone bodies

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16
Q

What is the diagnostic criteria for Diabetes?

A

Hemoglobin A1c ≥ 6.5%
Fasting Blood Glucose ≥ 7.0 mmol/L
Random Glucose ≥ 11.1 mmol/L
2 hour post prandial OGTT ≥ 11.1 mmol/L
diagnosis requires a second positive lab test on a subsequent day (T2D only)

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17
Q

What leads to a diabetic coma?

A

Result of ketoacidosis and dehydration caused by hyperglycemia which leads to decreased circulation and decreased oxygen to the brain

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18
Q

What does HBA1c tell us?

A

Indicator of long term glucose control over 3 months
Normal is 4-5%
Desirable to be below 7% as having a level above 7% is associated with increased risk

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19
Q

How often should people with Diabetes monitor their blood?

A

Type 1 - at least 3x per day
Type 2 - can be variable but at least once per day is recommended

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20
Q

What are the recommended targets for glycemic control?

A

to reach an HbA1C level of <7%:

fasting plasma glucose target of 4-7 mmol/L
2 hr post prandial glucose target of 5-10 mmol/L

Further lowering of 5-8 mmol/L might be considered if the above does not reach the target

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21
Q

What are the complications of Diabetes?

A

Microvascular:
Retinopathy - damage to the retina
Nephropathy - kidney disease
Neuropathy - nerve damage

Macrovascular:
Coronary Artery Disease
Cerebrovascular Disease
Peripheral Vascular Disease

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22
Q

What are risk factors that can contribute to complications of Diabetes?

A
  • Smoking - not causative but nicotine makes arteries more stiff and oxidative stress impacts organs
  • Hypertension - not causative but clustered together
  • Elevated serum lipids - not causative
  • Duration of the disease
  • Genetic predisposition
  • Blood glucose control
23
Q

What are the Main symptoms of Diabetes?

A

Polydipsia
Polyphagia
Blurred Vision
Polyuria/Glycosuria

In Type 1 Diabetes patients:
Weight loss
Lethargy, stupor
Breath smells of acetone
Hyperventilation
Nausea
Vomiting

24
Q

What are the key messages for diabetic patients regarding fibre?

A

Aim for 30-50g per day
10-20g as viscous soluble fibre as viscous soluble fibre can decrease A1c, fasting BG, and decrease LDL

25
Q

What is the balanced food plate for diabetics?

A

Fill 1/2 plate with non starchy veg and fruit
Fill 1/4 with protein foods
Fill 1/4 with whole grains and starchy vegetables

26
Q

Compare the Plate/hand method to carb counting

A

Plate is an easier concept and doesn’t require math, but it can be challenging to apply to some meals/cultures and is less flexible

Carb counting can allow for some flexibility and a better understanding about how food impacts blood glucose response

27
Q

What are best practices regarding WHEN to eat?

A

Space eating out over the day
Eating earlier in the day is beneficial for glycemic management
Individualize snack recommendations
fasting may be done safely using a coordinated approach

28
Q

What considerations should be made regarding when to eat?

A

Lifestyle
weight management and metabolic goals
Culture, religious practices, health beliefs regarding fasting
Physical activity
Diabetes medications

29
Q

When are snacks helpful to blood sugar?

A

Meals are more than 4-6 hours apart
When an individual is more active than usual and is at risk of hypoglycemia
When an individual has better fasting/morning blood sugars as a result of including an evening snack
If they experience better portion control at meals as a result of a midday snack

Bedtime snacks: may or may not be needed and depends on previously mentioned factors - for people with insulin treated diabetes, a bedtime snack with carb and protein can help prevent hypoglycemia when blood glucose is less than 7.0 mmol/L

30
Q

How does weight loss impact T2D?

A

5-10% of initial weight loss can improve insulin sensitivity, glycemic management, blood pressure and dyslipidemia
15% or more loss can send T2D into remission

31
Q

What are the four main types of T2D pharmacotherapies?

A

1st line of therapies - metformin, SGLY-2 inhibitors (end in flozin) and DPP-4 inhibitors (end in liptin)

Second group - GLP-1 receptor agonists (semaglutide - end in tide)

Third group - Sulfonylureas and meglitinides - becoming less comon –> these have a hypoglycemia risk

Thiazolinidone and a-glucosidase inhibitors - less common

32
Q

Where does metformin (biguanide) target and what are its actions?

A

Targets liver, muscle/fat cells
Increases insulin sensitivity, decreases liver glucose and increases glucose uptake

33
Q

Where do SGLT2-inhibtors target and what are its actions?

A

Sodium glucose cotransport 2 inhibitor
targets SGLT-2 in the kidney and increases excretion of glucose

34
Q

What does DPP4 -inhibitor target and what are its actions?

A

Targets DPP-4 enzyme that impacts gut hormone and increases incretin effect

35
Q

Where does GLP-1 target and what are its actions?

A

Targets: gut, pancreas (alpha and beta cells), brain
Actions: decreases gastric emptying, decreases glucagon, increases insulin secretion and satiety
very effective for weight reduction

36
Q

What are the side effects of GLP1-RA and how can they be managed?

A

Side effects:
Nausea, vomiting, constipation, diarrhea, GERD

Dietary modifications:
eat smaller meals
mindfulness to stop when full
avoid eating when not hungry
avoid fatty, spicy foods
may need to reduce fibre temporarily

37
Q

Where do secretagogues target and what are their actions?

A

Target pancreas, increase insulin secretion

38
Q

Where do a-glucosidase inhibitors target and what are their actions?

A

target small intestine, decrease carbohydrate absorption

39
Q

Where do Thiazolidinediones (TZD) target and what are their actions?

A

target muscle/fat cells, increase insulin sensitivity

40
Q

Briefly outline the guidelines for CHO Choices - i.e. how many choices/what food groups should the patient aim to eat from?

A

Aim for 7 or more sweet vegetables and fruit
Aim for 6 servings of grain
Aim for 2-3 milk and alternatives
limit sweet foods, snacks and “other” foods

41
Q

How many grams of Carbohydrate does 1 CHO choice contain?
How many grams of protein and fat?

A

12-18g - average of 15g/serving
MUST be less than 5g of fat
MUST be less than 6g of protein

42
Q

Describe dairy according to AHS choices

A

4-6g/serving
15g CHO
1% = 1g fat
2% = 2g fat

43
Q

How much CHO do free veggies contain?

A

<4g

44
Q

Describe fat choices according to AHS choices

A

One choice = 5g of fat

45
Q

Describe protein choices according to AHS choices.
Describe high fat protein choices.

A

One choice = 7g protein AND 3g of fat
High fat protein choice = 8g fat
may not contain more than 7g protein

46
Q

Describe legumes according to choices

A

1 protein + 1 CHO
7g protein, 3g fat, 15g CHO

47
Q

What are the CHO choices recommendations for women?

A

Meals: 3-4 choices CHO
Snacks: 1-2 choices CHO

Over the day total:
CHO: 13-18 choices
Protein: 5-7
Fat 5-6

48
Q

What are the CHO choices recommendations for men?

A

Meals: 4-5 choices CHO
Snacks: 1-3 choices CHO

Over the day total:
CHO: 15-24
Protein: 6-9
Fat: 5-8

49
Q

What is the Somogyi Effect?

A

Low blood sugar overnight = glucagon and catecholamine secretion
Results in increased rates of gluconeogenesis resulting in higher blood sugars - increase in over all blood sugars

Often occurs in patients taking longer lasting insulin, can be prevented by consuming a late night snack

50
Q

What is an insulin reaction?

A

More common in Type 1 Diabetes
Hypoglycemia resulting from either too much insulin, too much exercise/stress or not enough food

51
Q

What are the symptoms of insulin reaction?

A

Pale skin
Confused
Weak, shaky
Cold sweat
Possibly irritable

52
Q

What are the treatments for Insulin Reaction?

A

IV Glucose (extreme cases)
Glucose tablets
Glucagon injections
Juice/cola
Candy/dextrose tablets

53
Q

What are the key features of Ketoacidosis?

A

Red, flushed appearance
Fruity smell on breath (from ketones)
Dehydration
Dry Skin
Hyperglycemic

54
Q

How is ketoacidosis treated?

A

Insulin
Rest
Monitor fluids and electrolytes

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