Diabetes & CVD Flashcards
Nutrition interventions plays a key role in prevention and treatment of what?
- coronary heart disease
- HTN
- metabolic syndrome
T/F nutrition intervention can be cost saving and have improved clinical outcomes
True
T/F there is a generalized MNT recommended for everyone with T1D & T2D
False!
Individualized best!!
No one size fits all
Variables to consider in diabetic MNT
- individual nutrition needs
- personal and cultural preferences
- health literacy and numeracy
- access to healthy food choices
- willingness to change
- barriers to change
Nutrition goals for adult diabetes
- promote and support healthy eating patterns
- attain individualized glycemic, BP and lipid goals
- achieve and maintain BW goals
- delay and prevent diabetes complications
- address individual nutrition needs
- maintain pleasure of eating
- provide practical tools for day to day meal planning
What labs should you attain for adults in diabetes in nutrition goals
glycemic
BP
Lipid goals
T/F modest weight loss may provide clinical benefits in some individuals with diabetes, especially those early in disease process
True
T/F for overweight and obese individuals increasing energy intake while maintaining a healthy eating pattern is recommended for weight loss
False!!
Reducing energy intake
What are some lifestyle intervention programs for adult diabetes?
Nutrition
Physical activity
Behavior change
T/f in MNT for diabetes there is no ideal % of calories from carbs, protein and fat
True
- should be individualized
What are general individualized metabolic goals for adult diabetes? (PCF)
Protein: 10-35%
Carbs: 35-65%
Fat: 20-35%
_______ intake has direct effect on post meal glucose levels
Carbohydrates
T/F evidence is inconclusive for an ideal amount of CHO intake for those with diabetes
True
Knowledge and skills needed for those with diabetes
- effect of CHO foods on blood glucose
- sources of CHO
- recognizing CHO servings or grams
1 CHO serving = _____ gm CHO
15
Ways to recognizing CHO servings or grams
- nutrition facts label
- measuring portions
- CHO counting resources
- insulin to CHO ratio
- heart healthy food choices if applicable
What are the most important factors influencing glycemic response after eating?
- amount of CHO from foods
- available insulin
What else can affect blood sugar, especially fasting blood sugar?
Liver production of glucose
Monitoring _____ intake is crucial for achieving glycemic control
CHO
What are some healthier CHO food choices?
- veggies
- fruit
- whole grains
- legumes
- dairy
Carbohydrates goals for diabetes
- healthier CHO choices
- limit less healthy CHO
- substitute low glycemic load foods for higher glycemic foods may modestly improve glycemic control
_____% of grains should come from whole grains?
50%
T/F people with diabetes and those at risk do not need to avoid intake of sugar sweetened beverages
False!
Should avoid
Why should those with diabetes or those at risk avoid sugar sweetened beverages?
- reduce risk for weight gain
- reduce risk of worsening cardio metabolic risk profile
T/F use of non-nutritive sweeteners is not acceptable in those with diabetes
False!
Is acceptable within defined acceptable daily intake levels
What is there a potential for when using non-nutritive sweeteners?
Potential to reduce overall calorie and CHO intake if substituted for caloric sweetener
Without compensation of additional calories from other foods
2 ways to treat diabetes with carbohydrates
- insulin to carb ratio
- fixed daily insulin doses (with meals)
Insulin to carb ratio
- Education program using CHO counting can result in improved glycemic control
Improves ability to match insulin to CHO intake - allows for more flexibility based on lifestyle, meal schedule, food choices and activity
- utilized with rapid acting insulin
- based on amounts of CHo eating and units of insulin used to meet target BG goals
Fixed daily insulin doses (with meals)
Consistent CHO intake with respect to time and amount can result in improve glycemic control
T/F individuals with T2D identified to have health and numeracy literacy concerns may better suited for simple diabetes meal planning approach
True
T/F fat quantity is more important than quality
False!
Quality > quantity
Large intake of ____ can affect insulin response and may slow decline in blood glucose after meal
Fat
T/F recommendations for saturated fat, cholesterol and trans fat intake in diabetic is the same as general population
True
What type of eating pattern may benefit glycemic control and CVD risk factors?
Mediterranean
Increased intake of monosat FA
Effective alternative to lower fat, higher carb eating pattern
What type of fats is recommended to prevent or treat CVD
Long chain omega 3 FA
Nuts/seeds
T/F ingested protein may increase insulin response without increasing plasma glucose concentrations
True
T/f avoid use of CHO food source low in protein for treating or preventing hypoglycemia
False!
CHO high in protein
T/F for people with diabetes and diabetic kidney disease, reducing the amount of dietary protein below usual intake is NOT recommended
True!
Not recommended because it does not alter glycemia measures, CVD risk or course of GFR decline
T/F there is evidence of benefit from vitamin or mineral supplementation in people with diabetes who do not have underlying deficiencies
False!
No clear evidence
Alcohol and diabetes
Consumed in moderation
1/day for women
2/day for men
Alcohol consumption may put people at risk for __________, especially if they are using insulin
Delayed hypoglycemia
T/f increased blood glucose monitoring after consuming alcohol is recommended
True
What your patients need to know about nutrition and diabetes
- understand components of healthy eating
- how to apply current meal/snack plan to their medication plan
- importance of monitoring CHO intake
T1D & T2D focus of interventions
- integrate insulin into nutritional and physical activity patterns
- adjust meal/snack insulin doses based on CHO content when using rapid acting insulin
- use consistent CHO with fixed meal doses
- planned exercise requires adjusting insulin or additional CHO intake
Lifestyle modifications for T2D
- reduce intake of energy, saturated and trans fat, sodium
- total calorie recommendations based on weight loss goals
- recommend CHO intake based on calorie needs, review pre and post meal blood sugars, lipid and preferences
- increase physical activity
Using a food label in diabetes
- pay attention to serving size and servings/container
- look at total grams of carbs
1 serving = _____ gm of carbs
15gm
Information to obtain when establishing insulin to carb ratios
- meal CHO intake/food log
- blood glucose log
- total daily dose of insulin (50% of total dose should be bolus)
- evaluation of BG2 hours after meals
Who can use insulin to carb ratios?
T1D or T2D
Patient needs to have ability to accurately count CHO servings
Also used in hospital setting
Hypoglycemia
<70mg/dL
- use fast acting CHO
Hyperglycemia
- increase fluids
- maintain CHO servings
- may need additional short/rapid acting insulin
- frequent BG monitoring
Therapeutic lifestyle changes overview for CVD
- promote targeted changes in individuals lifestyle to produce significant reduction in patient’s risk
- track outcome measurements
- includes diet, physical activity, weight management
TLC diet guidelines for CVD
- <7% total calorie sat fat
- 25-35% total calorie fat
- <200mg of dietary cholesterol/day
- limit sodium 2400mg/day
- consume enough calories to achieve or maintain healthy weight
The ADA recommend ______ mg of sodium for general public with further restrictions for those with diabetes & HTN
2300mg
Dietary changes to lower cholesterol
- increase fiber
- add sources of plant stanols/sterols
- decrease sat fat
- replace sat fat with MUFA or PUFA
- limit high cholesterol
Dietary changes to raise HDL
- use MUFA in place of PUFA
- weight loss
- limit trans fat intake
MNT for HTN
- reduce sodium levels
- generous amounts of K and Ca (fruits/veggies)
- abstinence or moderation of alcohol
- weight control
Recommended sodium level in HTN
1500-2400mg/day
____ drinks/day can increase BP
3
____ weight loss = ____ HG drop in systolic BP
20lbs
6.3mm
Dietary approaches to stop HTN (DASH)
- grains 7-8
- veggies/fruits 4-5
- low fat dairy 2-3
- meats, poultry, fish <2
- nuts/seeds 4-5
- fats/oils 2-3
- sweets 5/week
