diabetes mellitus and nutrition

Question 1

diabetes is the _th leading cause ofdeath in the US

Answer 1

7th

Question 2

Distinguish between the following and their cause

1. T1DM
2. T2DM
3. gestational diabetes
4. impaired glucose tolerance
5. others

Answer 2

1. T1DM
   
   1. 5-10% of cases
   2. insulin-dependent
   3. cause
      
      1. autoimmune destruction of pancreatic cells
      2. can occur at any age
2. T2DM
   
   1. 90-95% of DM cases
   2. non-insulin dependent/ insulin resistant
   3. prevelant in elder and larger
   4. treated with diet and exercise
3. gestational diabetes
   
   1. occurs during pregnanacy
   2. temporary form of DM
   3. follow a careful diet
      
      1. blood glucose, blood pressure and urinary protein
4. impaired glucose tolerance
   
   1. DM that appears with combination of other factors
      
      1. hypercholesterolemia
      2. obesity
      3. hypertension
   2. risk of becoming T2DM
5. drug/toxin
   
   1. genetic defect
   2. pancreatic conditions or disease
   3. endocrinopatthies
      
      1. imbalance with other hormones in the body
   4. second-generation antipsychotics
      
      1. metabolic adverse effects are glucose dysregulation
         
         1. increased risk of diabetes
   5. corticosteroids
      
      1. decrease glucose utilization
      2. increase hepatic gluconeogenesis
         
         1. overall increase blood glucose

Question 3

What are the screening tools for diabetes?

Answer 3

1. signs
   
   1. polydipsia
   2. polyuria
   3. polyphagia(hunger)
   4. unusual weight loss (TYPE 1)
   5. unusual weight gain (TYPE 2)
2. lab
   
   1. glycosuria
   2. hyperglycemia
   3. abnormal glucose tolerance test

Question 4

Which type of DM is ketoacidosis seen in?

Answer 4

Usually in type 1.

Question 5

what are normal glucose blood levels?

Answer 5

70-110

Question 6

what are the sources of blood glucose?

Answer 6

dietary intake

glycogen from liver

Question 7

what are the uses of blood glucose in the muscle?

Answer 7

1. synthesis of glycogen
2. synthesis of triglycerides
   
   1. VLDL

Question 8

diagram the glucose metabolism

Answer 8

Question 9

What are the stimulatory and inhibitory actions of insulin?

Answer 9

1. stimulatory
   
   1. lipogeneisis
   2. glucose transit into cell
      
      1. muscle and adipose
2. inhibitory
   
   1. lipogenisis
   2. proteolysis
3. also
   
   1. promotes the dietary uptake of amino acids
   2. influences burning of glucose for energy (glycolysis)

Question 10

what does the liver use insulin for?

Answer 10

1. NOT GLUCOSE UPTAKE
2. needed for activity
   
   1. Glycolysis for acetyl CoA synthesis
   2. glycogen synthesis

Question 11

What are the functions of glucagon?

Answer 11

1. break down stoerd glycogen
2. gluconeogenesis from non-carbohydrate stores
3. glycogenolysis

raises blood glucose during rest

Question 12

why is the degradation of fat necessary during gluconeogenesis?

Answer 12

gluconeogenesis is expensive and fats contain alot of energy.

Question 13

explain the metabolism in uncontrolled DM

Answer 13

1. condition
   
   1. insulin insufficieny
2. macrnutrients
   
   1. glucose
      
      1. w/o insulin cells are starved for glucose
      2. causing
         
         1. release of glucagon
            
            1. gluconeogenesis
            2. ​lipolysis
         2. more glucose in the bloodstream
   2. fat
      
      1. w/o insulin LPL synthesis decreases
         
         1. insulin stimulates the synthesis of LPL,
         2. result in
            
            1. uptake of fatty acids
            2. accumulation of
               
               1. _​chylomicrons_
               2. VLDLs
      2. triglyceride breakdown INCREASES
         
         1. intermediate fats are broken down into ketones, and accumulate in the blood stream.
            
            1. leads to ketoacidosis (T1DM)
   3. protein
      
      1. w/o insulin proteins are broken down to secure energy
         
         1. loss of protein leads to weight loss, muscle waisting, urinary nitrogen loss

Question 14

how is heart disease related to diabetes?

Answer 14

insulin is necesarry for the synthesis of LPL.

With the decrease in insulin circulation, the patient experiences an accumulation of chylomicrons** and **VLDL

Question 15

describe the clinical feature of dylipidemia

Answer 15

elevated triglycerides

decreased HDL cholesterol

Question 16

what is hypertension considered?

Answer 16

a comorbid condition, two conditions at once.

Question 17

long term complications of diabetes lead two -emia’s and damage to what organ?

Answer 17

1. hyperglycemia
2. hyperlipidemia

these both cause microvascular and macrovascular trauma. Acut pancreatitis is the result from damage to acinar cells and microvasculature. this condition is compounded by the release of pancreatic enzymes in the enviornment. with a decrease in pH, due to CO increase, the trypsinogen is converted to active form trypsin and causes more damage.

Question 18

what is the general management of diabetes

Answer 18

1. early detection
2. prevention of complications
3. glucose tolerance test
4. goals
   
   1. mantaining optimal nutrition
   2. avoiding symptoms
   3. preventing comlications
5. self care skills
   
   1. basic elements
   2. healthy diet
   3. physical activity
      
      1. generates GLUT4 channlels in muscle w/o insulin
   4. adequate dosage and timely intake of hypoglycemic agents (only T2DM)
   5. titrate insulin dosage

Question 19

describe the order of macronutrients in order for diabetic persons

Answer 19

1. carbohydrates
2. proteins
3. fats

paying attention to the glycemic index of foods

Question 20

wat is FITT?

Answer 20

frequency, intensity, time and type

Question 21

what can stop the efficiency of insulin?

Answer 21

1. stress
   
   1. increase of corisol
2. epinephrine
   
   1. antagonist to insulin

Question 22

differentiate between the diseases associated with

1. hyperglycemia
2. lyperlipidemia

Answer 22

1. hyperglycemia
   
   1. sugar is taken up and turned into sorbitol
      
      1. swelling of cells
      2. retinopathy
      3. nephropathy
      4. neuropathy
2. hyperlipidemia
   
   1. increasing lipids in blood
      
      1. heart disease
         
         1. dylipidemia
         2. hypertension
   2. based on what is in the blood stream
      
      1. VLDL may lead to clogging in macro and microvasculature
      2. hyperlipidemia pancreatis

Question 23

What does the liver do with excess lipid?

Answer 23

repackage them and send them out as VLDL

Question 24

what role does isulin play other than glucose absorption?

Answer 24

fat and protein mettabolism

Question 25

What has a strong genetic link to disease?

Answer 25

T2DM

Question 26

Jerrys blood glucose is above fasting levels but not high enough for diabetes, what is his disease?

Answer 26

impaired glucose tolerance

1. risk factor for T2DM
2. presence underlying conditions
   
   1. hypercholesterolemia
   2. obesity
   3. hypertension

Question 27

metabolism of what two macronutrientts is related to diabetes?

Answer 27

metabolism of carbohydrates and fat

it actually involves all three, but C and F have the largest contributions

Question 28

what are the specia lobjective during pregnacny for diabetes?

Answer 28

1. tetam of speialists
2. carful monitoring
3. incresed physiological demands
4. normal pregnancy must resist diabetets manifestation

Question 29

what is the medical nutrtion advice for pre-diabetics vs diabetics?

Answer 29

IGT

1. promote healthy food choices
2. increase PA
3. loose weight

diabetics

1. mainttain blood glucose
2. monitor lipid profile
   
   1. avoid high TG
3. monitor blood pressure
4. slow chronic complications
5. maintain the pleasure of eating

Question 30

what should total energy balance for diabetics be for weight loss?

Answer 30

avoid negative energy balance for weight loss

fresh fruits have lower glycemic index than dried fruits.

more carbs and proteins, than fats

Question 31

how can illness affect a diabetic

Answer 31

raising the stress levels may counter insulin affects. should increase protein and monitor glucose levels closely