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NUTRITION CARE > DIABETES > Flashcards

DIABETES Flashcards

1
Q

diabetes is mainly caused by _____

A

hyperglycemia

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2
Q

3 causes of hyperglycemia (insulin related)

A
  1. impairment of insulin secretion
  2. defective insulin action (producing insulin but its not working)
  3. both
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3
Q

common complications related to diabetes

A
  • loss of sensation
  • poor blood circulation
  • poor wound healing
  • heart disease
  • leads to blindess
  • kidney diseases
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4
Q

epidemiology of diabetes

A

5-10% of canadians have type 1 - most onset <25 years
90-95% of canadians have type 2 - most onset > 24
Prevalence increases with age
Higher prevalence in males than females

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5
Q

where are alpha and beta cells secreted from and what do they secrete

A

from the pancreas

  • beta = insulin
  • alpha = glucagon
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6
Q

what is c-peptide

A
  • Insulin secreted as a pre hormone that needs to be activated (connected by c-peptide)
  • When insulin is activated - c-peptide is released (1:1 ratio)
  • Useful to differentiate between the two types of diabetes
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7
Q

how to differentiate T1DM and T2DM with c-peptide

A
  • Type 1: does not produce insulin - low/no c-peptide
  • Type 2: usually have high secretion of insulin - high c-peptide levels
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8
Q

what is normal blood glucose levels

A

3.9-6.1 mmol/L

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9
Q

explain what happens to blood glucose levels and organs that are relevant after eating a meal

A
  • After a meal, increase levels of blood glucose which will trigger insulin secretion from the pancreas and this will trigger the uptake of glucose in our tissues and muscles
  • Return blood glucose back to normal
  • Increase of insulin will also increase glycogenesis (synthesis of glycogen) and decreasing gluconeogenesis (synthesis of glucose from precursors that are not carbs)
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10
Q

which organs have glycogen and which one contributes to the maintenance of blood glucose levels

A

liver and muscles
- liver contributes to maintenance of blood glucose levels

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10
Q

explain what happens to blood glucose levels and organs that are relevant when fasting

A
  • If normal blood glucose levels are dropping (fasting or overnight), trigger secretion from alpha pancreatic cells to secrete glucagon
  • Inhibit glycogenesis (synthesis of glycogen) and increase gluconeogenesis (making carbs from non carb precursors)
  • Sends glucose to our blood
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11
Q

describe the molecular process of insulin

A

insulin binds to insulin receptor - triggers a chain of reactions
- finishes with translocation of GLUT4 to the membrane which lets glucose enter
- insulin itself DOES NOT directly uptake glucose into cells

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11
Q

describe T1DM

A
  • autoimmune response that destroys beta cells and then this impacts the ability to synthesize insulin
  • autoimmune destruction of beta cells - caused by genetic + environmental + immune regulation
  • patients will not produce insulin
  • 90-95% of beta cells are destructed - some insulin produced but not nearly enough
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12
Q

describe T2DM

A
  • combination of abnormal insulin secretion + insulin resistance
  • individuals with T2DM produce insulin but their tissues are insulin resistant –> increases the need for insulin –> pancreas increases production –> over time, the pancreas is not able to maintain such high production levels
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13
Q

primary factors that “cause” T2DM

A
  • obesity - central adiposity increases the degree of insulin resistance
  • poor nutrition
  • physical inactivity (activity seems to enhance whole-body insulin sensitivity
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14
Q

what is A1C

A

glycated hemoglobin - 3 month average
- expect high levels of A1C for those who have poor glycemic control

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15
Q

what is fasting glucose

A

blood sugar levels after fasting (8+ hours

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16
Q

what is random glucose

A

blood sugar levels anytime, no fasting

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17
Q

what is the A1C level to diagnose adults

A

A1C > or equal to 6.5

18
Q

how are hyperglycemia and hydration/hunger related

A
  • threshold until the kidneys cannot filter glucose anymore so you start losing glucose in the urine (glucoseurea)
  • glucose is an osmotic active - draws water - leads to an increase of water in urine and this will increase urinary output (polyuria)
  • decrease uptake of glucose by cels will lead to intracellular glucose deficiency that leads to polyphagia (hunger)
19
Q

what are the three criteria of hypoglycemia and what mmol/L is the range

A
  1. development of neurogenic or neuroglycopenic symptoms
  2. low blood glucose (<4 mmol/L)
  3. symptoms respond to the administration of carbohydrate
20
Q

what are some causes of hypoglycemia

A
  • more physical activity than usual
  • not eating on time
  • eating less than planned
  • taking too much medication
  • alcohol (inhibits gluconeogenesis and inhibits glycogenolysis)
21
Q

what is the treatment for mild-to-moderate hypoglycemia

A
  1. recognize symptoms
  2. confirm if possible (blood glucose < 4mmol/L)
  3. treat with “fast acting sugar” (15g)
  4. retest in 15 min to ensure BG >4mmol/L and retreat if needed
  5. eat snack/meal at usual time of day
22
Q

what is the treatment for severe hypoglycemia (conscious person)

A
  1. Treat with oral fast-acting sugar
  2. Test after 15 min, if BG < 4mmol/L give them another 15g
  3. Once the hypoglycemia has been reversed, usual meal or snack that is due at that time
23
Q

what is the treatment for severe hypoglycemia (unconscious person)

A
  1. With no intravenous access: 1mg glucagon given subcutaneously or intramuscularly
  2. Call 911
  3. With intravenous access: 10-25g of glucose should be given intravenously over 1-3 min
24
Q

what is diabetes ketoacidosis and which DM is it more common in?

A

type 1

  • When increase lypolysis (breakdown of fat) happens with no insulin present, this produces ketones that may lead to diabetes ketoacidosis
  • Type 1 - no insulin present - increase lipolysis which will lead to formation of ketone bodies
  • Formation of ketone bodies will decrease blood pH leading to acidosis
  • With the presence of minimal insulin - this does not produce ketones - therefore diabetes ketoacidosis is not as prevalent in type 2 diabetes unless you are in the very late stages
25
Q

what is hyperglycemic hyperosmolar syndrome and which DM is it more common in?

A

In type 2, hyperglycemia will lead to increase urinary output that will lead to electrolyte imbalance, dehydration, osmotic diuresis and this will lead to this syndrome

26
Q

what is the treatment for hyperglycemic emergencies

A
  • insulin, IV fluids, electrolyte replacement, sodium bicarbonate
27
Q

what is the dawn phenomenon and what is the treatment

A
  • Abnormal early morning increase in blood sugar (between 4-8am)
  • More common in type I DM than type 2
  • Mechanism: increase in hepatic glucose production, which may be secondary to the midnight surge of growth hormone

treatment:
- adjust insulin dosages
- adjustment of bedtime snack

28
Q

what is somogyi effect and what is the treatment

A
  • Early morning hyperglycemia occurs due to a rebound effect from late-night hypoglycemia
  • Mechanism: counterregulatory hormones stimulate gluconeogenesis

treatment:
- adjust insulin levels
- adjust bedtime snack

29
Q

how do you differentiate between dawn phenomenon and somogyi effect?

A
  • wake up between 2-4am and monitor BGL
  • if blood sugar is low, somogyi effect
  • if blood sugar is normal, dawn
30
Q

what is gastroparesis and how is it related with diabetes

A
  • delayed gastric emptying in the absence of mechanical obstruction
  • affects 30-50% of patients with diabetes
  • increases risk of hypoglycemia
31
Q

what is the biggest thing we are trying to optimize with diabetes management

A

optimize glycemic control

32
Q

what are the A1C targets for most adults

A

7% or less

33
Q

what are the A1C goals for individuals with type 2 diabetes (and no risk of hypoglycemia)

A

<6.5%

34
Q

what are the A1C targets for those who have recurrent severe hypoglycemia, limited life expectancy, or frail elderly?

A

7.1-8.5%

35
Q

what is the range preprandial (fasting) for most individuals?

A

4-7mmol/L

36
Q

what is the range postprandial for most individuals?

A

5-10mmol/L

37
Q

when and what medication to give individual with type 1 diabetes?

A

insulin right away

38
Q

what intervention when patient has A1C 1.5% above the target

A

start with lifestyle changes (nutrition therapy, weight management, and physical activity)

39
Q

what intervention when patient has A1C over 1.5% of target?

A

start metformin

  • if patient is diagnosed with symptomatic hyperglycemic and diabetes ketoacidosis - treat with metformin and insulin
40
Q

what are some nutritional recommendations for individuals with diabetes?

A
  • meals do not have to be drastically different than what we usually have
  • combining dietary modification + increased physical activity
  • T2DM: regular timing and spacing of meals
  • CHO - low glycemic index foods
  • 30-50g of dietary fiber (10-20g soluble fiber)
  • snacking: include protein to slow digestion
41
Q

nutritional recommendations for individuals with diabetes consuming alcohol

A
  • risk of hypoglycemia because gluconeogenesis is inhibited
  • always consume with food
  • avoid sweet alcohol, try sugar free
42
Q

how many g of carbs should individuals with diabetes aim to have at each meal? snack?

A

meal: 30-60g
snack: 15g

43
Q

after a meal, blood glucose levels should not rise more than ____ mmol/L

A

3.0

44
Q

how to calculate “carb counting”

A
  • grams of CHO minus g of fiber

NUTRITION CARE (17 decks)

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