Diabetes 4 Flashcards
Some useful principles in nutritional care:
socioeconomic
group setting
how should the diet differentiate from noraml
how should we individualize treatment
1) Individual counseling for people of lower socioeconomic status
2) Group education:
- Problem-solving, hands-on activities, role-playing, group discussions (shown to be better in groupd because they can share experiences)
- Culturally sensitive education. (lots of aboriginals and immigrants)
3) In general, how different should the diet of someone with diabetes be from the general public?
- it should not be very different
4) Individualized with respect to what factors?
- 1. Preferences- diet (tastes)
- 2. Current diet
- 3. Lifestyle – activity level, job, family (who cooks, where do they eat)
- 4. Cultural preferences
- 5. Socioeconomic status (finances)
- 6. Readiness for change
- 7. Other treatment for diabetes: are they on insulin? Do they have type 2? Which drugs are they on
5) Eating pattern and physical activity are formulated first, and then medications and/or insulin are adjusted to fit with this pattern.
people with type 1 and type 2 diabetes need to monitor their cho intake and insulin- but why are they differetn?
type 1
- definetly taking insulin and therefore:
- insulin doses have to match carb intake and physical activity
- what will happen if there is cho intake coming in, but not much insulin present to act?: BG is going to get too high.
- what will happen if insulin action is peaking, but little cho intake?: BG is going to go down and at risk for hypoglycemia.Therefore, these clients will be CHO counting. - Type of insulin regimen makes a difference:
a. Major goal is to coordinate peak actions of administered insulin with meals and snacks (cho).
b. To balance the insulin, the aim is to have consistent timing of meals and snack from day to day…. As well as consistent amounts of cho in meals/snacks from day to day.
– i.e. the mealplan needs to be more fixed
– 3 meals and 3 snacks (in between) may well be the safest to prevent hypoglycemia.
– however, the need for snacks still needs to be evaluated individually as
–not all clients are willing
-What are the risk?: weight gainIf on intensive insulin regiment (many injections or pump):- how do you think the above could be altered if the client is taking multiple injections of rapid-acting insulin (or is on a pump)? - the diet can be less fixed - they can use their multiple insulin injections (or pump) to alter their insulin to match a change in CHO.
people with type 1 and type 2 diabetes need to monitor their cho intake and insulin- but why are they differetn?
type 2
If not on insulin, major concerns are:
- Attention to food portions (CHO, PRO,FAT, and Kcals) and weight management + physical activity to improve glycemic control.
- Being consistent with the cho and spreading it out over the day will help to prevent large glycemic excursion ( to prevent a large increase in BG)following meals- take smaller amount more amount to prevent huge demands on the pancreas.
Therefore, these clients may be using an exchange system, such as Beyond the Basics (or a simplidied version of this).
If on insulin (or sulfonylureas, meglitinides)
- Then more attention to consistency in amont and timing of CHO, as for Type 1.
If overweight, how much weight loss can make a difference to glycemic control?
- 5-10%- improved insulin sensitivity , glycemic control, blood pressure control, lipid levels.
- If you had a new patient come to you with any type of diabetes, and you wanted to begin nutritional counselling, how would you estimate their energy requirements?
- How would you adjust this for an overweight client who aims to lose weight?
- If you had a new patient come to you with any type of diabetes, and you wanted to begin nutritional counselling, how would you estimate their energy requirements?
- do a really good dietary history and base it off their usual energy intake. if they come in and losing weight and really hungry- use this as their energy requirement because cutting back will be too little- it takes a while to normalize BG.-How would you adjust this for an overweight client who aims to lose weight?
- rule of thumb: subtract 500kcals/day
aim for 1-2lbs wtloss/week
-How would you adjust this for an overweight client who aims to lose weight? for adults and children
Adult?
Body weight
Child? Body weight and height
What is the minimum % of energy recommended to come from cho?
Can a lower cho-containing diet (< 45% of energy) have benefits for glycemic control, and if so, why is this approach not generally recommended i.e. what are disadvantages)?
45-60%
t CHO-restricted diets (mean CHO from 4% to 45% of total energy per day) improved A1C and triglycerides (TG), but not total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) or body weight compared with higher-CHO diets over. Not sustainable and miss of of vitamins and minerals.
Define glycemic index?
What are factors that determine the glycemic index i.e. affect cho absorption rate from the small intestine and the blood glucose response?
- How high the BG concentration increased after eating a food. Scale ranks CHO rich foods by how much they increase BG concentration compared to white bread or glucose.
- Fiber content
- How its cooked or processed
- Food form (what else is in the food)
- Injested Particle size
- Starch structure
- And others
What are the benefits of replacing high glycemic index foods with low glycemic index foods (within the same food category) for Type 1 diabetes and Type 2 diabetes?
- Decreased CVD risk
- Improved HbA1C
- Reduce the number of hypoglycemic events
Why aren’t all clients equally educated in detail about glycemic index?
Why aren’t all clients equally educated in detail about glycemic index?
- Don’t have access to RD, not willing to change, too overwhelming so only focus on CHO counting
What amount of soluble fibre intake is recommended? How does this compare with that for the general population?
What are the benefits of a high fibre diet?
- Higher fiber intake:25-50g/day )
slows gastric emptying and delays the absorption of glucose in the small intestine, thereby improving postprandial BG control (45). In addition, cohort studies demonstrate that diets high in dietary fibre, especially cereal fibre, are associated with a decreased risk of cardiovascular disease
Why have we traditionally limited sugar?
Why have we traditionally limited sugar? Faster absorption and sharper rise in BG (glycemic index)
Added sucrose intake of up to 10% of total daily energy (e.g. 50 to 65 g/day in a 2000 to 2600 kcal/day diet) is acceptable, as there is no evidence that sucrose intake up to this level has any deleterious effect on glycemic control or lipid profile in people with type 1 or type 2 diabetes
Fructose-What advice is provided?
> 60 g/day or >10% of total daily energy, fructose may have a small TG-raising effect in people with type 2 diabetes (60). As a source of excess energy, fructose has also been shown to contribute to weight gain and an adverse metabolic profile in people without diabetes
Fat
What are recommendations for fat? How do fat recommendations compare with those for the general public?
Fat
What are recommendations for fat? How do fat recommendations compare with those for the general public?
Current recommendations for the general population to consume fats in the range of 20% to 35% of energy intake apply equally to people with diabetes (47). As the risk of coronary artery disease (CAD) in people with diabetes is 2 to 3 times that of those without diabetes, saturated fats (SFAs) should be restricted to less than 7%
In general, how do protein requirements compare with those for the general population?-
15-20%
In general, how do protein requirements compare with those for the general population?- should stay the same What if your client has diabetes and the related complications, chronic kidney disease?- should not exceed more than 0.8g/kg
