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6-Clinical Nutrition 1 > Diabetes - Diet Approach > Flashcards

Diabetes - Diet Approach Flashcards

1
Q

What are the Goals of Diet Therapy in diabetes?

A

¢ maintenance of a healthy body weight

¢ the best possible metabolic control

  • Glycemic control: near-normal or targets
  • Lipid profile: primary target LDL-C ≤2.0 mmol/L
  • Blood pressure <130/80

¢ To delay or prevent complications associated with diabetes
¢ To provide specific guidelines for different stages in the lifecycle
¢ To promote self-care by providing the necessary knowledge, skills, resources and support
¢ To encourage overall health by practical instructions in optimal nutrition

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2
Q

What is the Nutrition Checklist provided by CDA?

A
  • REFER for nutrition counseling by a registered dietitian
  • FOLLOW Eating Well with Canada’s Food Guide
  • INDIVIDUALIZE dietary advice based on
    preferences and treatment goals
  • CHOOSE low glycemic index carbohydrate food sources
  • KNOW alternative dietary patterns for type 2 diabetes
    2013
  • ENCOURAGE matching of insulin to carbohydrate in type 1 diabetes
  • ENCOURAGE nutritionally balanced, calorie- reduced diet in overweight or obese patients
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3
Q

What are the recommendations for patients with BMI ≥25 kg/m2?

A

Nutritionally balanced, calorie-reduced diet should be followed to achieve and maintain a lower, healthier (and realistic) body weight

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4
Q

What are the benefits of weight loss?

A

Weight loss of 5-10% of initial body weight –> Improves:

  • insulin sensitivity
  • glycemic control
  • blood pressure control,
  • lipid levels
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5
Q

What is the order of Nutritional management of hyperglycemia in type 2 diabetes provided by CDA?

A

Clinical assessment
Lifestyle intervention by Registered Dietitian
-
Initiate intensive lifestyle intervention or energy restriction + increased physical activity to achieve/maintain a healthy body weight
-
Provide counselling on a diet best suited to the individual based on preferences, abilities, and treatment goals using the advantages/disadvantages listed below
-
If not at target
-
Continue lifestyle intervention and add pharmacotherapy
Timely adjustments to lifestyle intervention and/or pharmacotherapy should be made to attain target A1C within 2 to 3 months for lifestyle intervention alone or 3-6 months for any combination with pharmacotherapy

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6
Q

What is the target CHO for diabetic patients?

A

Carbohydrates : 45-60%

  • Minimum intake of 130 g/d
  • <45% may not provide enough vitamins & minerals
  • Higher range should include low GI index and high fiber intake
  • <10% of added sugar (sucrose)
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7
Q

What is glycemic index?

A

Scale 0-100 compared to glucose standard

  • Area under the curve (AUC) in blood glucose response of a given food compared to standard (glucose or white bread) for the same content in g CHO.
    Ex: 200 g cooked pasta (50 g CHO) vs. 50 g glucose or 100 g white bread (50 g CHO).
    GI= AUC pasta / AUC glucose or white bread X 100= 46
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8
Q

What is glycemic load?

A

Accounts for available CHO in portion

GL= g CHO in normal serving x GI/100
GL pasta= 50 g X 46 /100 = 23

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9
Q

What are the ranges of glycemic index?

A

Low: ≤ 55
Medium: 56-69
High: ≥ 70

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10
Q

What are the ranges of glycemic load?

A

Low: ≤ 10
Medium: 11-19
High: ≥ 20

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11
Q

What are the dietary factors affecting the glycemic response?

A 
¢ Dietary fibers
¢ Food form
¢ Cooking and processing
¢ Digestibility
¢ Other nutrients present (protein and fat) 
¢ Interprandial differences
¢ Fast/ slow eater
¢ Glucose tolerance effect
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12
Q

What is the benefit of replacing high GI foods with low GI foods?

A
  • better glycemic control
  • increased HDL-C
  • decreased CRP (reducing inflammation), hypoglycemia in T1DM, and medications

Recommended but teaching should be based on patient’s interest and ability.

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13
Q

What are the recommendations for dietary fiber intake in diabetes?

A

¢ Soluble fiber slows gastric emptying and glucose absorption
¢ Higher total intake recommended in DM: 25-50 g/d or 15-25 g/1000 kcal

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14
Q

What are the recommendations for added sucrose intake in diabetes?

A

<10% of total energy is acceptable

>10% increases BG and TG in some

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15
Q

What are the recommendations for added fructose intake in diabetes?

A
  • in place of sucrose may help lower A1C and unlikely
    harmful
  • > 10% increase TG in T2DM
  • When excess energy: adverse metabolic profile
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16
Q

What are the recommendations for natural fructose intake in diabetes?

A

from fruits = no harm

Caution with high GI fruits: pineapple, mango, papaya, melons

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17
Q

What is the target fat for diabetic patients?

A

Fat: 20-35% of energy

Due to high risk of CVD:

  • Saturated <7% of E
  • Avoid trans fatty acids
  • MUFAs up to 20%
  • PUFAs up to 10%
18
Q

What are the recommendations for Omega 3 fatty acids for diabetic people?

A

¢ No effect on blood glucose but decrease TG and platelet aggregation
¢ Higher intake of fish –> reduction in CVD in women with DM –> Recommendation: 2-3 servings fish/week
¢ Supplements: conflicting data –> Not recommended (except for severe hyperTG)

19
Q

What is the target protein for diabetic patients?

A

¢ Protein: 15-20% (1.0-1.5 g/kg/day)
¢ Maintain 1.0-1.5 g/kg/d during weight-reduction
¢ Concern with chronic kidney disease (CKD)
- No more than 0.8 g/kd/d

20
Q

What are the advantages and disadvantages of Hi-CHO (low-glycemic index [GI]) in diet?

A

Advantages:
decreased A1C, CRP, hypoglycemia
increased HDL-C

Disadvantages:
none

21
Q

What are the advantages and disadvantages of Hi-CHO (high fibre) in diet?

A

Advantages:
decreased A1C, TC, LDL-C

Disadvantages:
decreased HDL-C

22
Q

What are the advantages and disadvantages of Hi-MUFA in diet?

A

Advantages:
decreased A1C, TG

Disadvantages
none

23
Q

What are the advantages and disadvantages of Lo-CHO diet?

A

Advantages:
decreased TG

Disadvantages:
decreased micronutrients
increased renal load

**no change in A1C

24
Q

What are the advantages and disadvantages of Hi-protein diet?

A

Advantages:
decreased A1C, BP, TG
preserve lean mass

Disadvantages:
decreased micronutrients
increased renal load

25
Q

What are the advantages and disadvantages of Long chain omega 3 fatty acids diet?

A

Advantages:
decreased TG

Disadvantages:
Methyl-Hg exposure, environmental impact

**no change in A1C

26
Q

What are the considerations of non-nutritive sweeteners?

A

¢ May help in glucose control
¢ Acceptable daily intake: Table 2 in CDA Guidelines Nutrition
¢ Sugar alcohols (sorbitol, xylitol, maltitol,…)
- No acceptable daily intake determined
- GI symptoms limit intake
- Not counted in CHO counting
¢ Recent study shows impact of saccharin, sucralose and aspartame on glucose tolerance through alteration of gut microbiome

27
Q

What are the recommendations for alcohol in diabetes?

A

¢ Limit to ≤2 drinks/d in women, ≤3 in men
¢ Moderate intake with meals has little effect on BG
¢ Moderate daily intake: lower risk of fatal CHD in T2DM
¢ Risks: alcohol may mask symptoms of hypoglycemia and increase ketones
¢ T1DM: moderate alcohol intake with meal or 2-3 hours later –> delayed hypoglycemia

28
Q

What are the benefits of alcohol in T1DM?

A

moderate alcohol intake with meal or 2-3 hours later –> delayed hypoglycemia

29
Q

What are the risks of alcohol in diabetes?

A

alcohol may mask symptoms of hypoglycemia and increase ketones

30
Q

What are some special concerns with insulin Tx?

A

¢ Regularity in meal spacing and CHO content may help glycemic control
¢ Snacks may be useful to avoid hypoglycemia: balance against potential for weight gain
¢ Bed-time snacks containing protein may help avoiding nocturnal hypoglycemia

31
Q

What are the extra precautions when a diabetes person is sick?

A

¢ Take DM medications as prescribed
¢ SMBG often: ≥ 4/d
¢ Episodes of N/V: replace usual CHO with liquid or semi-liquid containing CHO (fruit juice, yogurt, Gatorate, soft drinks, Jello, …)
¢ Hydrate: 250-370 mL per hour
¢ Consult MD if: cannot tolerate liquids, glycemia >20 mmol/L, To >38.5o C for 48 h, ketonuria, persistent diarrhea, general deterioration

32
Q

What are in hospital glycemic targets and therapy choices for non-critically ill?

A

Fasting 5-8
Random <10

Pre-hospital regimen OR basal-bolus- correction

33
Q

What are in hospital glycemic targets and therapy choices for critically ill?

A

8-10

IV insulin infusion

34
Q

What are in hospital glycemic targets and therapy choices for CABG intraop?

A

5.5-10

IV insulin infusion

35
Q

What are in hospital glycemic targets and therapy choices for Other periop?

A

5-10

As appropriate

36
Q

Compare Type 1 and Type 2

  • decrease calories
  • Improve insulin action (sensitivity)
  • Increase frequency of feedings
  • Consistent intake of kcal, CHO, pro, fat
A

Type 1
- decrease calories: NO
- Improve insulin action (sensitivity) –> Seldom important:
β-cells are inactive and no IR
- Increase frequency of feedings –> Yes (conventional Tx) No (intensive Tx)
- Consistent intake of kcal, CHO, pro, fat –> Important (conventional Tx) Not critical (intensive Tx)

Type 2

  • decrease calories: YES
  • Improve insulin action (sensitivity) –> very important
  • Increase frequency of feedings –> not usually
  • Consistent intake of kcal, CHO, pro, fat –> Better but not critical
37
Q

How important is consistent ratio of CHO, pro, fat/meal in T1DM and in T2DM?

A

T1DM

  • Very important (conventional Tx)
  • Not critical (intensive Tx)

T2DM
- not crucial

38
Q

How important is consistent timing of meals in T1DM and in T2DM?

A

T1DM
- important (conventional Tx)

T2DM
- not crucial

39
Q

How important is extra food for unusual exercise in T1DM and in T2DM?

A

T1DM

  • Yes (conventional Tx)
  • Variable (intensive Tx)

T2DM
- Not usually

40
Q

How important is during illness, provide CHO (with meds and close monitoring) in T1DM and in T2DM?

A

T1DM
- To prevent ketosis (insulin needs may be higher than usual)

T2DM
- To prevent HHS

41
Q

How important is use of food to treat, prevent hypoglycemia in T1DM and in T2DM?

A

T1DM
- important

T2DM
- Less important (yes, to treat)

42
Q

Why is consuming plant protein better than animal protein in diabetes?

A

decreased albuminuria, LDC-C, TG, CRP

6-Clinical Nutrition 1 (21 decks)

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