Diabetes Pt 3 - Treatments Flashcards
Nutrition, exercise, glucose monitoring, transplantation
DM Nutritional Therapy
- Counseling
- Education
- Ongoing monitoring
- Interdisciplinary team w/RDN as lead
Nutritional Therapy Goals
ADA healthy food choices for improved metabolic control
- Maintain BG lvls to as near normal as safely possible to prevent or reduce risk for complications of DM
- Normal lipid profiles & BP that reduce risk for CVD
- Prevent or slow complications
- Individual needs; personal, cultural preferences
- Maintain pleasure of eating by allowing as many food choices as possible
Nutritional Therapy: Type 1
- Meal plan is based on individual’s usual food intake & is balanced w/insulin & exercise patterns
- Day-to-day consistency important for pts using conventional, fixed insulin regimens
- More flexibility w/rapid-acting insulin, multiple daily injections, & insulin pump
Nutritional Therapy: Type 2
- Emphasis on achieving glucose, lipid, & BP goals
- Wt loss
- Nutritionally adequate meal plan w/↓ fat & CHO
- Spacing meals
- Regular exercise
Food composition
- Nutrient balance of diabetic diet is essential
- Nutritional energy intake should be balanced w/energy output
- Individualized
Carbohydrates (sugars, starches, fiber)
- Minimum of ___g/day
- Fruits, vegetables, whole grains, legumes, low-fat milk
- Monitor w/CHO counting, exchanges, or experience-based estimation
- Use glycemic index
- Sucrose-containing food substituted for other CHOs
- Fiber intake should be 25-30 g/day
130
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Term used to describe rise in BG lvls after carb-containing food is consumed
High ___ foods inc glucose lvls faster
glycemic index
Fats
- Provides energy, carries fat-soluble vitamins, & provides essential fatty acids
- Limit saturated fat to less than 7% of total calories
- Limit cholesterol to less than 200 mg/day
- Minimize trans fat
- 2 or more servings of fish per week to provide polyunsaturated fatty acids
Protein
- Should make up 15-20% of total calories
- High-protein diets not recommended (for wt loss)
Fiber
- 25-30 g/day
Nutritive & nonnutritive sweeteners
- e.g., saccharine, aspartame, sucralose, neotame, & acesulfame-potassium
> in moderation
Alcohol
- Inhibits gluconeogenesis (breakdown of glycogen to glucose) by the liver; can cause severe hypoglycemia in pts taking insulin or oral hypoglycemic rx’s that inc insulin secretion
- Limit to moderate amt
- Consume w/food to reduce risk of nocturnal hypoglycemia if using insulin or insulin secretagogues
- Consume w/CHO to reduce hypoglycemia, but then watch for hyperglycemia from CHOs
One alcoholic beverage = 12 oz of beer, 5 oz of wine, & 1.5 oz distilled alcohol
Diet teaching
- Dietitian initially provides instruction
Carbohydrate counting
- serving size is 15g of CHO
- typically 45-60 g per meal
- insulin dose based on # of CHOs consumed
- patient teaching essential
Exchange lists
- starches, fruits, milk, meat, sweets, fats, free foods
USDA MyPlate method
- helps pt visualize the amts of nonstarchy vegetable (1/2), starch (1/4), & protein (1/4) that should fill a 9-inch plate
Consistent CHO diet
Diabetes: Exercise
Type/amount
- Minimum 150 minutes/wk aerobic
- Resistance training 3x/wk
Benefits
- ↓ insulin resistance & BG
- Wt loss
- ↓ TG’s & LDL, ↑ HDL
- Improve BP & circulation
- Start slowly after medical clearance
- Monitor BG
- Glucose-lowering effect up to 48 hrs after exercise
- Exercise 1 hr after meal
- Snack to prevent hypoglycemia
- Do not exercise if BG lvl exceeds 300 mg/dL & if ketones are present in urine
Self-Monitoring of Blood Glucose (SMBG)
- Enables decisions re: diet, exercise, & rx
- Accurate record of glucose fluctuations
- Helps identify hyperglycemia & hypoglycemia
- Helps maintain glycemic goals
- A must for insulin users
- Frequency of testing varies
- Alternative blood sampling sites (e.g., forearm, palm)
- Data uploaded to computer
Continuous glucose monitoring (CGM)
* Displays glucose values w/updating every 1-5 min
* Helps identify trends & track patterns
* Alerts to hypoglycemia or hyperglycemia
Patient teaching
- How to use, calibrate
* Control sol’n should be used when a glucometer is first used, when a new bottle of strips are used, or if there’s a reason to believe that the readings are not correct
When to test
- Before meals
- 2 hrs after meals
- When hypoglycemia is suspected
- During illness
- Before, during, & after exercise
Pancreas Transplantation
- For type 1 DM w/kidney transplant (those w/ESRD)
- Eliminates need for exogenous insulin, SMBG, dietary restrictions
- Can also eliminate acute complications
- Long-term complications may persist
- Only partially successful in reversing the long-term & neurologic complications of DM
- Lifelong immunosuppression
- Islet cell transplantation - experimental
Pancreas Transplantation Criteria
- A h/o frequent, acute, & severe metabolic complications (e.g., hypoglycemia, hyperglycemia, ketoacidosis) necessitating medical attention
- Clinical & emotional problems w/exogenous insulin therapy that are so severe as to be incapacitating; and
- Consistent failure of insulin-based management to prevent acute complications
