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Clinical Nutrition > Diabetes 2 > Flashcards

Diabetes 2 Flashcards

1
Q

Types of Insulin Therapy

A
  • 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
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2
Q

Children and Adult Insulin

A

children - insulin levels adjusted with diet / growth and development

adults - diet/insulin need is more stable

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3
Q

Insulin type/action

- rapid acting (clear)

A

duration: 4-5 hours
peak: 1-1.5 hours
- eat same time as injection (no more than 30 minutes before)

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4
Q

Insulin type/action

- short acting

A

duration: 6.5 hours
peak: 2-3 hours

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5
Q

Insulin type/action

- intermediate-acting (cloudy)

A

duration: 12-18 hours
peak: 5-8 hours

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6
Q

Insulin type/action

- long acting

A

duration: 24 hours
no peak
- enough to keep liver from making glucose
- keeps basil level of insulin in blood at all time

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7
Q

timing of insulin injections

A
  • should give insulin prior to meals

- if eating low GI foods you may be able to eat at the same time

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8
Q

AMDR variation for diabetes

A

20-25 % fat
50-55% CHO
20% Pro

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9
Q

4 medications for T2D (really important to know this)

A
  • metformin
  • Troglitazone
  • Acarbose
  • Sulfonylureas
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10
Q

actions of Metformin & Troglitazone (important)

A
  • decrease hepatic glucose output

- increase peripheral glucose uptake

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11
Q

action of Sulfonylureas (important)

A
  • increased insulin secretion
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12
Q

action of acarbose (important)

A
  • decreased glucose absorption (acts similar to fibre to lower postprandial rise)
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13
Q

three types of therapy often combined for T2D (previous slide has #3 different)

A
  1. Diet
  2. Oral Hypoglycemics ~ increase insulin production, secretion and sensitivity, decrease hepatic glucose production, delay absorption of glucose
  3. 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
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14
Q

when to initiate antihypoglycemic agents, insulin, and diet

A
  • 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
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15
Q

self-monitorying

A

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

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16
Q

Hemoglobin A1C

A
  • 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
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17
Q

problems when BG is not monitored

A

1) insulin reaction ~ hypoglycemia

2) ketoacidosis

18
Q

Insulin Reaction

A

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
19
Q

treatment for Insulin reaction - hypoglycemia

A
  • IV glucose in extreme cases
  • glucose tablets
  • glucagon injections ~ better choice is juice or simple sugars
  • candy/dextrose tablet
  • fluid will absorb the fastest *
20
Q

ketoacidosis

A

hyperglycemia *

  • red, flushed appearance, fruity acetone smell on breath, dehydration, dry skin
  • due to infection/illness, not enough insulin or missing shot, over-eating
21
Q

treatment for ketoacidosis - hyperglycemia

A
  • insulin; small amount initially
  • rest
  • monitor fluids and electrolytes
  • not as common in T2D
  • exercise will only help if there is insulin present
22
Q

Etiology of T2D

A
  • 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
23
Q

diagnostic criteria: biochemical

Type 2 Diabetes

A

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

24
Q

Diagnostic criteria: clinical

Type 2 Diabetes

A
  • 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 *
25
Q 
Acanthosis Nigricans (AN)
Type 2
A
  • 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
26
Q

AN varies with ethnicity

A
  • obesity ~ hispanics
  • obesity ~ native americans
  • obesity and AN ~ american indian
  • AN ~ native americans
  • caucasians low AN prevalence
27
Q

some lifestyle facors of Type 2 Diabetes

A
  • obesity
  • high fat intake
  • binge eating
  • inactivity
  • low fibre intake
  • ethnicity
  • genetic family hx
  • low birth weight
  • treatment with growth hormone
28
Q

Factors influencing GI rating

A
  • type of starch
  • cooking
  • food processing
  • fat content
  • acid content
29
Q

amylose has a _____ GI rating

amylopectin has a ______ GI rating

A
  • 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)
30
Q

Effects of cooking on GI rating

A
  • 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

31
Q

Effects of processing on GI rating

A
  • 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
32
Q

Effects of Fat on GI rating

A
  • 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
33
Q

Effects of Acids on GI rating

A
  • acids present in foods slow down your body digesting that food
  • slower rise in blood glucose
34
Q

other factors that influence GI repsonse

A
  • speed of stomach emptying (fat and protein) = mixed meals

- fat and protein slow the rate of stomach emptying, foods digest at a slower rate

35
Q

eating foods with a low GI may help to..

A
  • control BG levels
  • control cholesterol levels
  • control appetite
  • decrease risk of heart disease
  • decrease risk of type 2 diabetes
36
Q 
GI rating for...
All bran
Bran buds with psyllium
oatmeal
oat bran
A 
all bran (42)
Bran buds (42)
oatmeal (42-66)
oat bran (50)
37
Q 
GI rating for...
cornflakes
branflakes
rice krispies
cheerios
A

cornflakes (84)
branflakes (74)
rice krispies (82)
cheerios (74)

38
Q 
Lower GI ideas...
cooked pasta
whole grain pumpernickel
rice
grains
A 
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)
39
Q

Higher GI ideas…
canned or overcooked spaghetti
white bread
instant and short grain rice

A 
canned spaghetti (71-77)
white  bread (71-77)
instant rice (87)
short grain rice (72)
40
Q 
Lower GI ideas...
popcorn
boiled new potatoes
pear
plum
peach
milk
yogurt
A 
popcorn (55)
boiled new potato (56)
pear (38)
plums (39)
peach (42)
milk (42)
yogurt (30-40)
41
Q 
Higher GI ideas...
pretzels
soda crackers
french fries
baked potato
watermelon
A 
pretzel (89)
soda crackers (74)
french fires (75)
baked potato (93)
watermelon (72)

Clinical Nutrition (14 decks)

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