Diabetes 2 Flashcards
Types of Insulin Therapy
- single vs multiple injection
- short or long acting insulin
- constant infusion with a pump to maintain a basal level with bolus pulsing
- consider timing of meals and PA level
Children and Adult Insulin
children - insulin levels adjusted with diet / growth and development
adults - diet/insulin need is more stable
Insulin type/action
- rapid acting (clear)
duration: 4-5 hours
peak: 1-1.5 hours
- eat same time as injection (no more than 30 minutes before)
Insulin type/action
- short acting
duration: 6.5 hours
peak: 2-3 hours
Insulin type/action
- intermediate-acting (cloudy)
duration: 12-18 hours
peak: 5-8 hours
Insulin type/action
- long acting
duration: 24 hours
no peak
- enough to keep liver from making glucose
- keeps basil level of insulin in blood at all time
timing of insulin injections
- should give insulin prior to meals
- if eating low GI foods you may be able to eat at the same time
AMDR variation for diabetes
20-25 % fat
50-55% CHO
20% Pro
4 medications for T2D (really important to know this)
- metformin
- Troglitazone
- Acarbose
- Sulfonylureas
actions of Metformin & Troglitazone (important)
- decrease hepatic glucose output
- increase peripheral glucose uptake
action of Sulfonylureas (important)
- increased insulin secretion
action of acarbose (important)
- decreased glucose absorption (acts similar to fibre to lower postprandial rise)
three types of therapy often combined for T2D (previous slide has #3 different)
- Diet
- Oral Hypoglycemics ~ increase insulin production, secretion and sensitivity, decrease hepatic glucose production, delay absorption of glucose
- exogenous insulin ~ insulin injections, avoid for as long as possible, hard to stop using it
- disease may change and insulin needs to change as well ~ genetics, older people are less sensitive to insulin, diet helps some but not others
when to initiate antihypoglycemic agents, insulin, and diet
- antihypoglycemic agents if glycemic target is not reached within 2-3 months of lifestyle intervention
- diet, lifestyle and medication needed if A1C >9% ..since <6% is preferable (same as 0.06 mmol/l
self-monitorying
T1D - measure BG at least 3 times a day (done in a sanitary manor which can be inconvenient
T2D - can be variable; at least once a day at the same time
Hemoglobin A1C
- glycosylated Hb
- cells have glucose attached
- happens over time
- long term glucose control
- past three moths goal: <0.07
(normally ~ 0.05) - anyone over 80 years ~ 8% is acceptable
problems when BG is not monitored
1) insulin reaction ~ hypoglycemia
2) ketoacidosis
Insulin Reaction
Hypoglycemia
- pale skin, confused, weak and shakey, cold and sweaty
- due to too much insulin for that time, too much exercise/metabolic stress, or not enough food (eat during insulin peak but forget to have snacks)
- most common in Type 1
treatment for Insulin reaction - hypoglycemia
- IV glucose in extreme cases
- glucose tablets
- glucagon injections ~ better choice is juice or simple sugars
- candy/dextrose tablet
- fluid will absorb the fastest *
ketoacidosis
hyperglycemia *
- red, flushed appearance, fruity acetone smell on breath, dehydration, dry skin
- due to infection/illness, not enough insulin or missing shot, over-eating
treatment for ketoacidosis - hyperglycemia
- insulin; small amount initially
- rest
- monitor fluids and electrolytes
- not as common in T2D
- exercise will only help if there is insulin present
Etiology of T2D
- insulin resistance ~ not utilized effectively or relative insulin insufficiency (can’t bind to receptors)
- insulin secretory defect
- increase in aboriginal children and ethnic groups
- more common in females; childhood obesity
diagnostic criteria: biochemical
Type 2 Diabetes
fasting BG >7.0 mmol/L
random BG >11 mmol/L
serum insulin - highly variable (a low level doesn’t rule out Type 2)
- islet cell antibodies - highly variable
Diagnostic criteria: clinical
Type 2 Diabetes
- ethnicity, age and gender
- obesity BMI >85th percentile
- acanthosis Nigricans (darker skin)
- may have polyuria, nocturia
- family hx, maternal gestational
- may encounter ketoacidosis under stressful conditions *
Acanthosis Nigricans (AN) Type 2
- dark colour related to hyperkeratosis
- hyperplasia of dermis and epidermis
- associated with hyperinsulinemia and insulin resistance
- associated with obesity
- located on the neck, axillae, antecub, skinfolds, thighs
AN varies with ethnicity
- obesity ~ hispanics
- obesity ~ native americans
- obesity and AN ~ american indian
- AN ~ native americans
- caucasians low AN prevalence
some lifestyle facors of Type 2 Diabetes
- obesity
- high fat intake
- binge eating
- inactivity
- low fibre intake
- ethnicity
- genetic family hx
- low birth weight
- treatment with growth hormone
Factors influencing GI rating
- type of starch
- cooking
- food processing
- fat content
- acid content
amylose has a _____ GI rating
amylopectin has a ______ GI rating
- amylose has a low GI rating (molecules form tight clumps, harder to digest)
- amylopectin has a high GI rating (easier to digest, molecules are open)
Effects of cooking on GI rating
- cooking increases the GI rating
- swells starch molecules and softens foods making it faster to digest
boiled spaghetti for 5 min GI=34
boiled spaghetti for 15 min GI = 40
Effects of processing on GI rating
- highly processed foods are digested faster and have a higher GI rating
cornflakes GI = 86
Porridge GI = 49 - unprocessed grains have GI rating lower because digestion takes longer
pumpernickel GI = 46
white bread GI = 73
Effects of Fat on GI rating
- foods with higher fat content have lower GI rating
- fat changes how body digests foods
- low GI foods are not always the healthiest
potato chips GI = 75
Baked potato GI = 93
Effects of Acids on GI rating
- acids present in foods slow down your body digesting that food
- slower rise in blood glucose
other factors that influence GI repsonse
- speed of stomach emptying (fat and protein) = mixed meals
- fat and protein slow the rate of stomach emptying, foods digest at a slower rate
eating foods with a low GI may help to..
- control BG levels
- control cholesterol levels
- control appetite
- decrease risk of heart disease
- decrease risk of type 2 diabetes
GI rating for... All bran Bran buds with psyllium oatmeal oat bran
all bran (42) Bran buds (42) oatmeal (42-66) oat bran (50)
GI rating for... cornflakes branflakes rice krispies cheerios
cornflakes (84)
branflakes (74)
rice krispies (82)
cheerios (74)
Lower GI ideas... cooked pasta whole grain pumpernickel rice grains
cooked pasta (32-64) whole grain pumpernickel (46) basmati, brown, long grain, parboiled rice (48-56) barley (25) bulgar (48) buckwheat (54) chana dal (8)
Higher GI ideas…
canned or overcooked spaghetti
white bread
instant and short grain rice
canned spaghetti (71-77) white bread (71-77) instant rice (87) short grain rice (72)
Lower GI ideas... popcorn boiled new potatoes pear plum peach milk yogurt
popcorn (55) boiled new potato (56) pear (38) plums (39) peach (42) milk (42) yogurt (30-40)
Higher GI ideas... pretzels soda crackers french fries baked potato watermelon
pretzel (89) soda crackers (74) french fires (75) baked potato (93) watermelon (72)
