Diabetes Flashcards
Diabetes definition
Diabetes Mellitus (DM): Insulin insufficiency or resistance.
T2DM Diagnosis
HbA1c: ≥ 6.5%.
Fasting Glucose (FGL): ≥ 7 mmol/L (8 hours fasted).
OGTT (2hr post-load): ≥ 11 mmol/L.
Random BGL: ≥ 11.1 mmol/L + DM symptoms (e.g., thirst, polyuria, fatigue).
Pre-Diabetes:
FGL: 6.1 - 6.9 mmol/L.
HbA1c: 6.0 - 6.4%.
DM Risk Factors
Modifiable:
Excess Calories: Leads to obesity, central adiposity, and insulin resistance.
Saturated Fats: Contribute to obesity and insulin resistance.
Low PAL: Associated with higher risk; exercise improves insulin sensitivity and weight management.
Non-Modifiable:
Age: Reduced muscle mass and hormonal changes decrease insulin sensitivity.
Ethnicity: Higher predisposition in Aboriginal, Indian, and Chinese populations (>35 years).
History of GDM: Post-pregnancy monitoring and healthy lifestyle essential.
Overweight and High BP: >55 years or >45 with additional risk factors.
DM Management Goals
Blood Glucose Levels (BGL):
FGL: 6 - 8 mmol/L.
Post-Prandial (2hrs): 8 - 10 mmol/L.
HbA1c: <7% (target); >8% indicates poor control.
OGTT: <11 mmol/L.
Random BGL: <11 mmol/L.
Blood Pressure (BP): <130/80 mmHg.
Lipids (High Risk):
LDL-C: <1.8 mmol/L.
TC: <4 mmol/L.
HDL-C: >2 mmol/L.
TG: <2 mmol/L.
Weight Management:
5-10% weight loss over 6 months.
Aggressive targets for BMI >35.
Key DM Nutrition Strategies
Reduce calorie and saturated fat intake.
Increase PAL.
Manage CHO intake (e.g., low GI).
Address smoking and alcohol use.
Follow Na dietary targets for BP and overall health.
HbA1c
Indicator: Average BGL over ~2-3 months.
Mechanism: Glucose binds to hemoglobin → HbA1c reflects glucose exposure during RBC lifespan.
Dietary Management of T2DM (GI)
Glycemic Index (GI): Rates CHO foods based on their effect on BGL.
Low GI (0-55): Legumes, non-starchy veg, whole grains, nuts, most fruits.
Medium GI (56-69): Whole wheat products, basmati rice, sweet potato, pineapple.
High GI (>70): White bread/rice, sugary cereals, baked potatoes, watermelon.
Glycemic Load (GL): Considers GI and CHO quantity for better BGL predictions.
Low GL: 1-10.
Medium GL: 11-19.
High GL: >20.
Formula: GL = (GI x g of CHO) / 100.
What is Glycaemic Index?
Measures the postprandial blood glucose response to 50g of digestible carbohydrate compared to a reference food (glucose or white bread, GI = 100).
Low GI foods:
(<55): Soy products, beans, fruit, milk, oats, lentils, yogurt, bulgur wheat, quinoa, grainy bread, crackers, popcorn, special K, baked beans, chocolate, most fruits.
Medium GI foods:
(55–70): Orange juice, honey, basmati rice, wholemeal bread, full-fat ice cream, pineapple, raisins, new potatoes, Fanta, beer, honey, sweet potatoes, shredded wheat, peaches in syrup
High GI foods:
(>70): White bread, short-grain rice, baked potatoes, watermelon, pretzels, jasmine rice, GF bread, cornflakes, Rice bubbles, sugar, instant mashed potatoes, cornflakes, pretzels, puffed rice cakes, white bread
Glycaemic load formula:
GI × grams of carbs in a serving ÷ 100.
Examples:
Pasta (GI 43, carbs 44g): GL = 43 × 44 ÷ 100 = 19g.
Small baked potato (GI 80, carbs 15g): GL = 80 × 15 ÷ 100 = 12g.
Apple (GI 40, carbs 15g): GL = 40 × 15 ÷ 100 = 6g.
Factors influencing lower GI:
Fat, protein, and soluble fibre slow digestion.
Foods with fructose and lactose.
Fatty and acidic foods slow gastric emptying.
Phytates in whole grains slow digestion and inhibit amylase.
Factors influencing higher GI:
Cooking and processing break down cell walls, increasing GI (e.g., rice bubbles have higher GI than sugar).
Texture and viscosity, e.g., ripe banana (GI 55) vs unripe banana (GI 30).
GI Key Takeaways:
Low GI foods provide better blood glucose control.
High GI foods cause quicker spikes in blood glucose.
GI alone doesn’t account for portion size; GL is a better measure of real-life BG impact.
Diabetes HbA1c Diagnostic Criteria:
Diabetes: ≥6.5% (48 mmol/mol)
Pre-Diabetes: 5.7–6.4% (39–47 mmol/mol)
