Diabetes and Nutrition Flashcards
What is diabetes mellitus?
A group of disorders comprising abnormalities (fat, protein, carbohydrates), characterized by hypergylcemia ,resulting from insulin deficiency or resistance
Type I- Insulin Dependent (IDDM) is about 10% of all adult cases, what are some features of Type I?
Weight Loss
Polyuria
Polydypsia
Ketosis (keto-acidotic coma)
Type I DM is the most common type of diabetes found is what age group?
Childhood
Type 2- Non-Insulin Dependent (NIDDM), what are the symptoms?
Often asymptomatic Overweight Infections -- urinary tract, vula Thirst Rarely coma
What is the demographic for Type II diabetes?
Usually appears at age greater than or equal to 40 in caucasians and at a younger age greater than or equal 20 in those ethnic groups at greater risk
Gestational Diabetes (GDM) affects 2% to 10% of pregnancies in previously non-diabetic pregnant women, usually during the 2nd or 3rd trimester. What are the symptoms?
May be asymptomatic apart from hyperglycemia but symptoms if present like type 2 diabetes
Gestational Diabetes (GDM) usually goes away after giving birth but what may develop immediately or 10-20 years later?
Type 2 may develop
- -immediately in 5% to 10% of women
- -in 35% to 60% in the next 10-20 years
What are the risk factors for gestational diabetes and the development of type 2 diabetes?
Overweight or obese
Have has gestational diabetes before
Had a very large baby in a previous pregnancy (10lb or over)
Have a family history of diabetes
Black, hispanic/latino, American Indian, South Asian or Middle Eastern Background
Diabetes can lead to serious complications, such as ?
Blindness Kidney Damage Cardiovascular disease Lower-limb Amputations Dementia
People with diabetes can lower the occurrence of these and other diabetes complications by controlling what?
Blood glucose
Blood pressure
Blood lipids
How many people in the US population have diabetes?
- 1 million
(9. 3%)
- -21.0 million diagnosed
- 8.1 million undiagnosed
Incidence of diabetes varies markedly between ethnic/minority groups. What groups are at most risk?
- Pima Indians (24.0%)
- Non-Hispanic Black (13.2%)
- Asian Indians (13.0%)
Type I diabetes in mainly a T cell mediated autoimmune disease. What factors lead to Type I diabetes?
- Genetic factors (HLA linked) account for 40% risk
- Environmental Factors (60% risk) including viruses (rubella, enterovirus, coxsackievirus, cytomegalovirus)
- -too clean environment leading to a deficiency in immunoregulation - Dietary Factors (cows milk, gluten before 3 months, vit D intake)
- -breast feeding protects
What are the theories for the relationship between type I diabetes and cows milk consumption in infants?
- Immature gut mucosa allows antigenic proteins to cross
- -beta casein, beta lactoglobulin, and albumin - Bovine Insulin in milk triggers antibodies to insulin
- -breast feeding is protective
Type 2 and GDM have a strong environmental etiology. What is the pathogenesis for these types of diabetes?
- Insulin Secretory Defect (esp with genetic transmission): low birth weight, fetal origins theory, chronic hyperglycemia and high GI/GL foods
- Peripheral Insulin Resistance (impaired insulin mediated glucose uptake in muscle): genetic and environmental factors
- –an obesogenic environment is a major causal facto
What are the risk factors for type 2 diabetes?
Age Family History Ethnic Group Social Class Fetal Nutrition and Early growth pattern Diet Inadequate physical activity Central obesity Metabolic Syndrome
Prevalence of all types of diabetes has ______ markedly.
Increased
What percent of type 2 diabetics are either overweight or obese?
70-80%
For each 1kg increase in weight in the population, risk of diabetes increases by what percent?
4.5%
Patients with _______ _______ have higher insulin levels and are insulin resistant than patients with similar weight but with peripheral obesity.
Central adiposity (waist greater than 1.02m in med and greater than 0.88m in women)
Central obesity leads to insulin resistance and the metabolic syndrome a precursor of what disease?
type 2 diabetes (glucose intolerance)
atherosclerotic vascular disease
increased risk of death (hypertension and dyslipidemia)
What percentage of the adult US population have the metabolic syndrome?
20-35%
Central adiposity is a key determinant of CHD risk in men and women. What is the raw data in support of this?
CHD risk: men vs women
3: 2
- -men have more central adiposity whereas women have fat more in hip location
The main cause of the metabolic syndrome is?
Intra-abdominal (visceral obesity)
Why does central obesity lead to insulin resistance?
- Adipocytes located centrally are larger and more resistant to insulin than peripherally
- Hyperinsulinemia directly related to waist circumference
- Drains directly to liver via portal system
- More NEFA produced than from gluteal-femoral fat: NEFA delivery to muscle causes IR
- More inflammatory cytokines than from gluteal femoral fat
What is treatment for type I diabetes?
Type I: diet/lifestyle + insulin
What is the treatment for type 2 and GDM?
Diet/Lifestyle
plus or minus oral hypoglycemia drugs and insulin
In regards to treatment what is the current US statistics for all diagnosed adults (type 1 or type 2)
23% no insulin or oral medication
49% take oral medication only
16% take insulin only
12% take both insulin and oral medication
What are the current recommendations for lifestyle changes/dietary principles for diabetes treatment and prevention?
- Weight Control
- Modest Energy deficit within a healthy diet (whore fruit, whole grain, healthy fats, regular meals, Vit D, avoid excess salt, mod alcohol intake)
- Complicated diets dont work
Patients with diabetes should avoid trans-fat and reduce saturated fat, why?
Saturated Fat is a causal factor in insulin resistance
Substitution with either PUFA or MUFA reduces insulin resistance and changes abdominal fat distribution
What is the recommendations for fishoil supplementation in diabetics ?
Although in type 2 diabetes fish oils may lead to a small impairment in diabetic control, significant benefits in terms of serum lipids, coagulation and blood pressure may outweigh these potentially negative effects.
Why do Omega 3 fatty acids have anti-inflammatory effects?
Omega 3 Fatty Acids activate a macrophage receptor in intraperitoneal macrophages, resulting in anti-inflammatory effects and improved system insulin sensitivity
What types of exercise improves insulin action, and can assist in the management of BG levels, lipids, BP, CV risk and mortality?
Both aerobic and resistance training
How often should exercise be done a week in order to have an impact of health?
At least five a week
One hour of moderate intensity exercise equals how many kcals lost?
250-300kcals
For prediabetics (impaired glucose/fasting glucose) what can help glucose levels return to normal?
Dietary Change
Weight Loss
Increased physical activity
Lifestyle (diet and exercise) is an important part of the management of what?
Diabetes and prevention of type II
what is metabolic syndrome
a clustering of disorders, at least 3, that results from failure of the normal actions of insulin
- central adiposity in the middle with
- glucose intolerance
- hypertension
- dylipidemia (increased TAG and decreased HDL)
