Diabetes Mellitus

Question 1

diabetes mellitus

Answer 1

metabolic disorder
characterized by:
- elevated blood glucose concentrations
- disordered insulin metabolism
hyperglycemia:
- a marked elevation in blood glucose levels
- normal fasting plasma glucose levels are less than 100 mg/dL

Question 2

type 1

Answer 2

5-10% of cases
usually develops during childhood/adolescence
autoimmune destruction of pancreatic beta cells
causes little to no insulin production by the pancreas
patient usually needs exogenous (subq) insulin

Question 3

type 2

Answer 3

most prevalant form (90-95% of cases)
age of onset ofen >40 years
characterized by insulin resistance and eventual insulin deficiency
obesity, aging, inactivity, race, and genetics are associated risk factors

Question 4

signs/symptoms of diabetes

Answer 4

polyuria
polydipsia
polyphagia
unexplained weight loss
blurred vision
constant fatigue
increased infections

Question 5

acute complications of diabetes

Answer 5

hypoglycemia:

• low blood glucose (below 70 mg/dL)
• caused by excessive insulin, prolonged exercise, skipped meals,, inadequate intake, or drinking alcohol without eating

diabetic ketoacidosis:

• severe lack of insulin (more often seen in type 1)
• glucagon kicks in and high numbers of ketone bodies are produced (ketosis)
• blood pH becomes more acidic
• often requires hospital management

Question 6

chronic complications of diabetes

Answer 6

• atherosclerosis (CVD is the leading cause of death in people with diabetes)
• blood clots (thrombosis)
• peripheral vascular disease
• diabetes retinopathy (leading cause of blindness in US)
• diabetic nephropathy
• diabetic neuropathy
• poor wound healtin
• increased risk for infection

Question 7

diabetes triangle

Answer 7

meal planning (on top), medications, physical exercise

Question 8

common medications

Answer 8

Metformin
Glyburide
Insulin (via pump that injects how much is needed at the time)

Question 9

exercise

Answer 9

adults:
- at least 150 minutes of moderate intensity aerobic activity per week
children:
- at least 60 minutes per day
exercise improves glycemic control in addition to providing cardiovascular benefits and weight management

Question 10

goals for glycemic control (adults with diabetes)

Answer 10

before meals: 80-130 mg/dL
1-2 hours after the start of a meal: <180 mg/dL
HbA1c: <7.0%

Question 11

HbA1c

Answer 11

a blood test that reflects glycemic control over the preceding 2-3 months
often the goal is <7.0%

Question 12

HbA1c levels

Answer 12

6% HbA1c: 126 mg/dL
7% HbA1c: 154 mg/dL
8% HbA1c: 183 mg/dL
9% HbA1c: 212 mg/dL

Question 13

dietary recommendations

Answer 13

a registered dietitian or certified diabetes education can help
carbohydrates influence blood glucose the most
- ideally should be fruits, veggies, whole grains, legumes, milk products
choose foods with low glycemic index (GI)
- high fiber, minimally processed foods
sugar:
- in moderation
focus on fiber rich foods
focus on poly and monounsaturated fats
minimize saturated and trans fat
- sat fat should be less than 7% of total calories
limit cholesterol intake to 300mg/day
protein similar to gen population
- 15-20% of daily kcal
alcohol use guidelines similar to gen population
- men: average 2 drinks/day
- women: average 1 drink/day
- consume food when ingesting alcohol

Question 14

measuring carb intake

Answer 14

carb counting
- 15 g carbs = 1 carb portion
- carbohydrates generally provide 45-65% of daily calories
15g of carbs:
- 1 small piece of fruit
- 1 slice of bread
- 1/2 cup oatmeal
- 1/3 cup pasta or rice
- 1/2 english muffin or hamburger bun
- 1/2 cup of black beans or starchy veggie
- 1/4 baked potato
- 2/3 cup of fat free yogurt
- 2 small cookies
- 2 inch square brownie or cake without frosting
- 1 tbsp syrup, jam, jelly, sugar, honey

Question 15

carb counting

Answer 15

look at serving size

look at grams of total carbs