Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Nutrition 3 > Diabetes Nutrition Therapy > Flashcards

Diabetes Nutrition Therapy Flashcards

1
Q

Discuss the nutrition therapy from the 1920’s until today

A
  • 1920s: Carb restriction (max 100 g/day), fasting
  • Mid 20th century: Isocaloric diet w/ moderate fat consumption
  • Now: Encourage MUFA & CHO (60-70% of E) and INDIVIDUALIZE the diet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a key concept with diabetic nutrition therapy?

A

It is a “common sense” diet, however it must be individualized to the patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

% CHO? kcal/day?

A
  • 45-60%

- 225-300

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

% Pro? kcal/day?

A

15-20%

-75-100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

% Fat? kcal/day?

A

-20-35%
-44-78
<9% SFA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Protein recommendation?

A

1-1.5 g/kg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a key CHO recommendation?

A

We must teach how to count net carbs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Net carbs?

A

Total carbohydrate - (fibres + sugar alcohols)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are key concepts to address w/ label reading?

A
  • Serving size
  • Calories
  • Fat
  • Sodium
  • Net carbs
  • *NOT just CHOS**
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How can we chose healthy carbohydrates?

A
  • Increase fibre
  • increase pulses
  • Increase whole grains
  • Increase fruit and veg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Fibre recommendation?

A
  • Increase to 30-50 g/day

- 1/3 of fibre (10-20g) should be from viscous soluble fibre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Low GI CHO?

A
  • Pumpernickel
  • Oat Bran
  • Pasta/noodles
  • Sweet potato
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Medium GI CHO?

A
  • Rye
  • Oatmeal
  • Brown/basmati rice
  • White potato
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

High GI CHO?

A
  • White bread
  • Corn-flakes
  • Short-grain rice
  • French fries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are 3 healthy dietary patterns that may be recommended for diabetes?

A
  • Mediterranean
  • Vegetarian
  • DASH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Overarching diet recommendation for those with a BMI >/= 25?

A

Nutritionally balanced, caloric-reduced diet should be followed to achieve and maintain a lower, healthier body weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the significance of a 5-10% weight loss of initial body weight?

A

Improved insulin sensitivity, glycemic control, blood pressure control, lipid levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

First three steps in the nutritional management of hyperglycemia in type II diabetes?

A

1) Clinical assessment
2) Intensive healthy behaviour interventions or energy restriction/increased PA to achieve/maintain HBW
3) Provide counselling on a diet best suited to ind. needs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What happens if HBW target is not met after initial assessment by dietitian?

A
  • Continue healthy interventions and add pharmacotherapy
  • Adjustments should be made with healthy behaviours and/or meds to attain A1C within 2-3 months, or 3-6 months for any combination with meds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is one impact of increasing fibre in the diet?

A

May have undesirable GI side-effects, must increase water intake
-Suggest introducing fibres slowly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

There are many dietary patterns which may have beneficial effects for diabetes, what is one overarching principle?

A

That these people have a chronic disease, and they need to adhere to this diet for life –> Pick a sustainable choice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Targeted strategies for pre-diabetes?

A
  • Weight loss or maintenance*
  • Portion control(
  • Guidance to include low GI CHO, reduce refined CHO
  • PA
  • *Consistent with all stages of diabetes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Targeted strategies for early T2DM?

A
  • Introduce high-fibre
  • CHO distribution
  • Healthy dietary pattern of choice
  • PA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Targeted strategies for those not on insulin?

A
  • CHO distribution
  • Low GI CHO
  • High Fibre
  • PA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Targeted strategies for those on basal insulin only?

A
  • CHO consistency
  • Low GI CHO
  • High Fibre
  • PA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Targeted strategies ofr basal-bolus therapy?

A
  • CHO consistently initially then learn CHO counting
  • Low GI CHO
  • High fibre
  • PA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

(T/F) Adults with diabetes may substitute added sugars with other CHOs as part of mixed meals up to a maximum of 10% of total daily energy intake

A

T, as long as there is adequate control of BG, lipids and body weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Why should low GI foods be selected?

A
  • Optimize glycemic control
  • Improve LDL-C
  • Decrease CVD risk
29
Q

Implications of mediterranean diet?

A

-Reduce major CV events and improve glycemic control

30
Q

Vegan and vegetarian diet implications?

A

-Improve glycemic control
-Body weight
-Blood lipids (LDL)
and reduced MI

31
Q

DASH implications?

A
  • Improve glycemic control

- LDL-c and reduce major CV events

32
Q

Dietary pulses implications?

A

-Improve glycemic control, systolic BP and body weight

33
Q

Fruit and vegetable implications?

A

-Improve glycemic control, reduce CVD mortality

34
Q

Nut implications?

A

Improve glycemic control and LDL-C

35
Q

People with diabetes using what kinds of medications should be educated about the risk of hypoglycaemia from using alcohol?

A

Those on insulin or insulin-secretagogues

36
Q

What are the two types of CHO counting?

A

Basic and Advanced

37
Q

When should advanced be used?

A

When the patient is on insulin

38
Q

Discuss basic CHO counting

A

Encourages the inclusion of consistent amounts of CHO at meals and snacks

39
Q

Discuss advanced CHO counting

A

-Teaches patient who are on MDI or insulin pump how to match insulin to CHO

40
Q

What must we do before we begin CHO counting?

A

Determine the person’s base knowledge (healthy eating, perceived notions, basic nutrition concepts, understanding medication)

41
Q

Which concepts should be taught during CHO counting?

A
  • Rationale for counting carbs
  • Identify foods that contain carbs
  • Understand that many foods containing carbs are healthy, and these do not have to be overtly limited
  • Determine how much to eat per day
42
Q

How many carb servings per meal? How many g/serving?

A
  • 3-5 servings per meal

- 15 g per serving

43
Q

What would be an appropriate response to someone who believes cutting all carbs (i.e. ket/LCHF diets) will solve their diabetes?

A
  • It’s difficult to adhere to a low-carb diet
  • The glucose that we are consuming is NOT the only impact on our blood sugar, the endogenous production remains
  • Insulin is important for growth, protein synthesis and satiety
  • Caution with those w/ eating disorders who withhold insulin
44
Q

Key concepts to teach with advanced CHO counting?

A
  • The onset, action, peak and duration of insulin action
  • Difference between basal and bolus insulin
  • Insulin carb ratio
  • Correction bolus
  • Adjusting for dietary fibre intake and foods that contain polyols (sugar alcohols)
45
Q

How do we account for sugar alcohols in net carbs

A

Subtract 1/2 of them

46
Q

Discuss sugar alcohols

A
  • Only about 50% are absorbed, less kcals
  • There may be GI side-effects when more than 10 g/day is consumed
  • Sometimes not listed on nutrition facts, difficult to account for
  • Often found in processed foods, special diabetic foods which are not necessarily what we want patients eating
47
Q

Where are hidden carbs?

A
  • Breading on meat
  • Cornstarch mixed in dishes and soups
  • Pasta sauce
  • Croutons in salads
  • Salad dressing
  • Ketchup
48
Q

What do studies show about patients and their ability to carb count after being counselled by a dietitian?

A

Almost as accurate as a computer program as estimating

49
Q

What do studies show about patients ability to carb count, when they are not offered a revision by a dietitian?

A

Up to 20% error of CHO counting within the meal

50
Q

What are the basics of diabetes meal planning?

A
  • Timing
  • CHO distribution
  • Protein distribution
  • Balanced meals
  • Type of carb
  • Type of fat
  • Limit/avoid concentrated simple suagr
  • Control portion size
51
Q

What should be critiques during the 24 hour recall?

A
  • The basics of diabetes meal planning
  • Ensure meals are 4-6 hours apart
  • Low glycemic?
  • 3-5 CHO servings at 15 g each, at each meal?
  • Before going to sleep, did they include a snack that included a protein source?
52
Q

How should we plan meals for the day?

A
  • Distribute CHO servings evenly
  • All meals should have a protein source
  • Breakfast may be lower CHO is higher blood glucose in AM
  • Consider snacks, especially if aerobic exercise (may lower blood glucose)
53
Q

Snacks should be minimum ___

A

3 hours from a meal

54
Q

Meals can be _____ without a snack, or further apart with a snack

A

4-5

55
Q

Portion guide for fruits, grains and starches?

A

Fist

56
Q

Portion guide for vegetables?

A

As much as you can hold in both hands

57
Q

Portion guide for meat and alternatives?

A

Palm of hand and thickness of little finger

58
Q

Portion guide for fats?

A

Size of tip of your thumb

59
Q

Examples of low-calorie sweeteners (LCS)?

A
  • Sucralose
  • Saccharin
  • Aspartame
  • Rebaudioside A
  • Acesulfame-K
60
Q

Which LCS is the sweetest?

A
  • Sucralose (Splenda)

- 600x as sweet as sucrose

61
Q

What did numerous toxicology and clinical studies demonstrate about LCS?

A

That they are generally safe and well-tolerated

62
Q

What are some proposed mechanisms that LCS may lead to weight gains and chronic disease?

A
  • Sweet-tase receptor mediated changes in gut hormones
  • Altered nutrient absorption via changing gut microbiota
  • Impaired predictive relationship between sweet taste and calories
  • Change in taste preferences and dietary patterns
63
Q

What are some benefits of artificial sweeteners?

A
  • More variety in food
  • Does not raise blood glucose
  • Does not contain calories
  • Can help avoid dental caries, while still enhancing
64
Q

How does artificial sweeteners allow for more variety in food?

A

-Enables people who are CHO, sugar or kcal conscious to take in a wide range of foods that they would either not be allowed to eat or could only eat in such tiny amounts that they were not satisfying

65
Q

What are some health concerns of artificial sweetners?

A
  • Can be associated with cancer (cellular damage)
  • Can cause bloating
  • Can be associated w/ hyperTG an GI symptoms
  • May be associated with increased incidence of T2DM
  • Can be associate with increased weight and obesity
  • Provide no nutritional value
66
Q

When does a snack need to be administered?

A
  • Bedtime snack (if time between supper and bed is >3 hours)
  • If patient has a gap of 5 hours (on insulin) or 6 hours (without insulin) between meals, then a snack should be planned?
67
Q

What should be included with the bed time snack? Why?

A
  • Protein to slow digestion

- May reduce chance of having low blood sugar during the night and/or may improve morning blood sugars

68
Q

When else should snacks be administered?

A
  • When patients notice a recurring time of the day where BG low
  • Starting new exercise, exercising for longer than normal, has fairly low blood sugar prior to starting intensive exercise
  • Whenever a delay to next meal is possible (stuck in traffic, waiting at airport for flight)
69
Q

What are appropriate snacks?

A
  • Healthy source of CHO (high in fibre, avoid juice)
  • Lean protein
  • Whole grain toast + PB
  • Whole grain crackers + cheese
  • Oatmeal + nuts/raisins + milk

Clinical Nutrition 3 (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions