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Clinical Nutrition 1 > Diabetes and Metabolic Syndrome > Flashcards

Diabetes and Metabolic Syndrome Flashcards

1
Q

What is the definition of Diabetes mettilus?

A
  • Metabolic disorder characteristic by elevated blood glucose concentration and
  • disturbance of CHO, lipid and protein metabolism due to
  • defective insulin secretion and/or action
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2
Q

Type II diabetes is usually not prone to ketosis. In the rare cases where it is (5% of cases) what is the treatment?
What is the treatment when it is not ketosis prone (ketosis resitant).

A

Ketosis prone (5%): Insulin Rx

Ketosis Resistant (85-90%): Diet, Oral medication, insulin Rx

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3
Q

What is gestational diabetes?

A

Diagnosed during pregnancy (and resolved at delivery).

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4
Q

T or F.

Prediabetes state is not reversible.

A

Prediabetes is reversible.

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5
Q

In terms of symptoms for type I diabetes, what are some initial observations? (4)

A 
Increased thirst (polydipsia)
Increased urination (polyuria)
Increased hunger (polyphagia) 
Wt loss
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6
Q

Give at least 4 roles of insulin action.

A
  1. Increase glu uptake by the cells and storage
  2. Decrease endogenous glu production (done by decreasing glycogenolysis and gluconeogenesis)
  3. Increase lipogenesis
  4. Decrease lipolysis
  5. Decrease proteolysis
  6. Increase protein synthesis
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7
Q

What does the “super fasted state” refer to?

A

The exacerbation of the effects of a normal fasted state due to lack of insulin action.

  • High a.a. breakdown
  • High glucose production
  • High ketone production
  • Excretion of ketone in the urine
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8
Q

Name 3 factors contributing to hyperglycemia.

A
  1. Increased hepatic (liver) output
  2. Decrease uptake by the cells.
  3. Decrease a.a uptake + increase protein degradation = excess a.a. in blood = increase gluconeogenesis
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9
Q

Explain what leads to

  1. Polyuria
  2. Polydipsia
  3. Polyphagia
A

Hyperglycemia –> glucosuria –> osmotic diuresis –> POLYURIA –> dehydration –> POLYDIPSIA.

Decreased glucose uptake by the cells –> intracellular glu deficiency –> POLYPHAGIA

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10
Q

Why did the treatment for Type I DM used to be starving the patient ?

A

When we eat protein, we are protecting the muscle. BUT, Type I has no insuline to stimulate protein synthesis. So a.a. serve for gluconeogenesis, which increases hypergylcemia, while muscle wasting still remains.

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11
Q

What can cause insulin resistance in Type II diabetes ?

A

Obesity (due to lack of exercise, excess food intake and some genetic predisposition), inflammation, and genetic predispositons to insulin resistance.

Also maybe compensatory hyperinsulinemia.

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12
Q

Describe the causes of Type II diabetes (the process).

A

Insuline resistance –> less uptake of glucose by cells –> more circulating glucose –> hyperglycemia.

Hyperglycemia signals the pancreas (B cells) to produce more insuline (hyperinsulinemia), which eventually leads to B cells decompensation and eventually failiure.

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13
Q

Name 5 risk factors for T2DM.

A 
Age and sex 
Obesity 
Lack of exercise
Ethnicity
Family history 
History of GDM
Prediabetes 
Child of mother with poorly controled diabetes during pregnancy
Low (<2.5kg) and high (>4kg) birth weight
Polycistic ovary syndrome (PCOS)
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14
Q

Describe in 4 steps the insulin-induced glucose uptake.

A
  1. Insulin binds to receptor on cell surface.
  2. Binding of insulin to its receptor
  3. Triggers a phosphorylation cascade (insulin signaling) –> GLUT4 moves from the cytoplasm to the cell membrane
  4. Glucose transporter move extracellular glucose inside the cell.
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15
Q 
T or F
Early diabetes (before B cell failure) is not reversible.
A

False, this is still reversible by diet, wt loss and exercise, up until there is B cell failure.

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16
Q

Name the two cellular mechanism of insulin resistance. Which one is the most common?

A
  1. Receptor defect; decreased number and affinity

2. Post-receptor second messenger signaling (most cases)

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17
Q

Give 2 characteristics of prediabetes.

A

Impaired fasting glucose and impaired glucose metabolism

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18
Q

T or F

Type 2 DM is easily stabilized.

A

True.

TIDM is very unstable.

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19
Q

Which type of diabetes is associated with marked family history? (Type I or II)

A

Type II

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20
Q

Which type of diabetes is characterized with a sudden and rapid onset? (Type I or II)

A

Type I

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21
Q

Which of type of diabetes do these symptoms belong to? (I or II)
Fatigue, vision change, recent wt loss, not very evident.

A

Type II

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22
Q

With which type of diabetes are oral anti-hyperglycemic agents effective?

A

Type II

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23
Q

What is the definition of metabolic syndrome?

A

A cluster of closely related metabolic dissorders increasing the risk of developpement of T2DM and CVD.

24
Q

How many criteria needed to diagnose MEtS and which ones are those ?

A 
3 !! 
1. Central obesity (waist circum) 
2. and 3. (2 of these) 
Plasma TG above 1.7 mmol/L
Plasma HDL (men) below 1.0 mmol/L and (women) below 1.3 mmol/L
BP above 130/85 mmhg
Fasting BG above 5.6 mmol/L
25
Q

Name at least 3 goals of diet therapy for diabetes.

A
  • Maintain/attain healthy body weight
  • Metabolic control: glycemic control, lipid profile (LDL below or equal to 2 mmol/L), BP (below 130/80)
  • delay or prevent complications associated with diabetes
  • promote self-care (with knowledge, tools, etc)
  • encourage overall health
26
Q

If an apple has a GI or 40 and contains 10 of CHO, what is its GL?

A

GL = 40 x 10 / 100 = 4

27
Q

What is the range of CHO for patients with diabetes. (AMDR)

A

45-60% of total calories (compared to 45-65 in normal individuals)

28
Q

Whats is the recommendation for added sugars?

A

Below 10%

29
Q

What is the equation for GI?

A

GI= AUC food/AUC glucose or standard x 100

30
Q

What is the equation for GL?

A

GL= g CHO in one serving x GL / 100

31
Q

Why is it important to provide a minimum of 130g/day of CHO in diabetic patients?

A
  1. Minimum to prevent ketoacidosis

2. Bellow that could not get enough of vitamines and minerals

32
Q

Name at least 5 factors affecting the glycemic response.

A
  1. Dietary fibers
  2. Food form
  3. Cooking and processing
  4. Digestibility
  5. Other nutrients present (protein and fat)
  6. Fast/slow eater
  7. Glucose tolerance effect
33
Q

What is the range for low, medium and high GI?

A

Low: 0-55
Med: 56-69
High: 70-100

34
Q

What is the range for low, medium and high GL?

A

Low: 0-10
Med: 11-19
High: 20-higher

35
Q

What is the recommended dietary fiber in DM patients ?

A

25-50g/day (compared to 25-30 for normal)
OR
15-25g/1000kcal

36
Q

Which type of fiber is important in DM patient and what does it do in terms of controling GI?

A

Soluble fiber.

  1. Slows down gastric
  2. Slows down glucose absoption
37
Q

What GI range do these foods belong to:

  1. Oatmeal
  2. Sweat potato
  3. Whole wheat bread
  4. Brown rice
  5. Bagel
A
  1. oatmeal –> medium (51-69)
  2. Sweat potato –> low (50 and bellow)
  3. Whole wheat read –> med
  4. Brown rice –> med
  5. Bagel –> high (70 and higher)
38
Q

What are the recommendations for added fructose in diabetic patients?

A

In place of sucrose, may help lowetr A1C and is unlikely harmful.
But above 10%, increases TG in T2DM. so never take in excess.

39
Q

What is the range of fat for patients with diabetes? (AMDR)

What proportion of MUFAs, PUFAs, saturated and trans fats.

A

20-35% (compared to 10-35% in normal)

MUFAs: up to 20%
PUFAs: up to 10%
Sat: below 7% of energy
Trans: avoid (so 0)

40
Q

T or F

Omega 3 has en effect on BG.

A

False.

41
Q

What are the effects of Omega-3 (how do they help decrease CVD risk) ?

A
  1. decrease TG

2. decrease platelet aggregation

42
Q

What is the range of protein for patients with diabetes? (AMDR)

A

10-20% (or 1-1.5g/kg/day)

43
Q

Why is alcohol limited in 2 drinks/day in patients with diabetes?

A

Alcohol can mask the symptoms of hypoglecemia and increase ketones.

Moderate alcohol intake with meal causes delayed hypoglycemia (2-3 hours later)

44
Q

How could you avoid nocturnal hypoglycemia?

A

Take a bed-time snack that contains protein.

45
Q

How often should patients self monitor blood glucose per day?

A

More or equal to 4/d.

46
Q

What is the frequency of hydration for patients with DM?

A

Hydration: 250-370mL/h

47
Q

What do you do when an episode of vaumiting or nausea occurs in patients with DM?

A

Replace usual CHO with liquid or semi-liquide containing CHO (fruit juice, yogurt, soft drink, jello, gatorade)

48
Q

Typically what type of diabetes would you give extra food to in case of exercise?

a) TIDM
b) T2DM
c) Always both

A

a) TIDM

49
Q

In what type of diabetes is it very important to try to improve insulin action (sensitivity)?

A

T2DM

Only seldom important in TIDM.

50
Q

T or F

Milk, cheese and fruits all contain servings of CHO.

A

F, not cheese.

51
Q

How many servings of CHO is meat and alternatives ?

A

0!! (except for legumes)

52
Q

What should the blood sugar levels of diabetic patients be? (before and after a meal)

A

Before meal: 4-7mmol/L

After meal: 5-10mmol/L

53
Q

What are the recommended amounts of CHO needed per meal and per snack? (in g)

A

45-75g CHO/meal

15-30g CHO/snack

54
Q

In the Meal Planning booklet, under what category are nuts and seeds?

A

Fats

55
Q

In the Meal Planning booklet, give two possible ways of calculating legumes.

A
  1. In starches, then add 1 meat exchange and 2 fats

2. In meats: add 1 starch

Clinical Nutrition 1 (1 decks)

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