Diet and Chronic Disease: Diabetes Mellitus

Question 1

what are characteristics of diabetes mellitus?

Answer 1

relative or absolute insulin deficiency; hyperglycemia; glucosuria; polyuria

Question 2

what are associated risks of diabetes mellitus?

Answer 2

retinopathy; nephropathy; neuropathy; atherosclerotic coronary and peripheral vascular disease

Question 3

what are other names for type I diabetes?

Answer 3

insulin dependent diabetes mellitus (IDDM) and juvenile onset (old)

Question 4

what are other names for type II diabetes?

Answer 4

non-insulin dependent diabetes mellitus (NIDDM) and adult onset (old)

Question 5

what age of onset is most commonly associated with type I?

Answer 5

less than 30 years old

Question 6

what age of onset is most commonly associated with type II?

Answer 6

greater than 30 years old

Question 7

which type of diabetes is associated with obesity?

Answer 7

type II

Question 8

which type of diabetes has propensity to ketoacidosis and requires insulin to control?

Answer 8

type I

Question 9

whats the level of endogenous insulin secreted in type I?

Answer 9

extremely low

Question 10

whats the level of endogenous insulin secreted in type II?

Answer 10

significant but variable

Question 11

what is the cell response to insulin in type I?

Answer 11

normal

Question 12

what is the cell response to insulin in type II?

Answer 12

resistant

Question 13

what does hyperglycemia result in?

Answer 13

glucose being bound to hemoglobin

Question 14

what is glycosylated hemoglobin (A!C) an indicator of?

Answer 14

average blood glucose levels over the last 3 months (lifespan of RBC)

Question 15

what is a normal level of an A1C?

Answer 15

<7%

Question 16

what is the best way to assess and manage blood glucose control?

Answer 16

fasting blood glucose; glucose tolerance test; A1C; but we really want to know how well glucose is metabolized and that means lipids and proteins would be involved; Metabolomics

Question 17

what is metabolomics?

Answer 17

simultaneously measure the impact of changes in metabolism of “everything” to get at the impact of changes of diet on glucose metabolism… or metabolism of everything

Question 18

what are signs of diabetic ketoacidosis?

Answer 18

acetone breath, ketonemia, ketonuria

Question 19

how can you control type I with diet?

Answer 19

carbohydrate counting, low glycemic index foods/high dietary fiber, attention to lipid levels

Question 20

how can you control type II with diet?

Answer 20

weight loss/ exercise

Question 21

what drugs are used to treat DM?

Answer 21

insulin injection; reduce glucose absorption (alpha-glucosidase inhibitors); suppress glucose synthesis by the liver (biguanides); help pancreas continue to make insulin (DPP-4 inhibitors); increase beta-cell growth/reduce appetite (glucagon-like peptides); stimulate insulin secretion (sulfonylureas or meglitinide); increase insulin sensitivity of peripheral tissues (thiazolidinediones); reduce glucose reabsorption by kidney (SGLT2 inhibitor)

Question 22

What are dietary treatment of IDDM?

Answer 22

energy (maintain healthy body weight); carbohydrate (need carbs to maintain blood glucose levels; constant amount at regular intervals; complex carbs); protein (adequate but not excessive protein help in preventing kidney disease); fat (follow dietary guidelines; elevated LDL may need additional restrictions); alcohol (moderate amounts with attention to calories, simple sugars, etc.)

Question 23

what is the dietary treatment of NIDDM?

Answer 23

timing and distribution of meals (consistent carbohydrates spaced throughout the day); weight control (weight loss helps to reverse insulin resistance); alcohol (similar to IDDM but may interact with some oral hypoglycemic drugs); physical activity (improves blood glucose; contributes to weight loss; improves blood pressure)

Question 24

what is glycemic index?

Answer 24

ratio of blood glucose response to a given food in comparison to a standard

Question 25

what is glycemic load?

Answer 25

glycemic index multiplied times the grams of carbohydrate in 1 serving

Question 26

what is gestational diabetes?

Answer 26

blood insulin levels increase during pregnancy to cause storage of energy nutrients; later in pregnancy cells become more insulin resistant to shift from storage to utilization by fetus; this stress on glucose regulation causes anyone with impaired systems to have problems

Question 27

what is diet therapy for gestational diabetes?

Answer 27

support demands of pregnancy while maintaining normal glucose levels; lower levels of carbohydrates in meals to prevent higher levels of glucose after meals; this means smaller, more frequent meals

Question 28

what happens after gestational diabetes pregnancy?

Answer 28

usually glucose tolerance returns to normal; greater risk of developing NIDDM with much greater impact of overweight; therefore, maintain healthy body weight and monitor glucose levels regularly

Question 29

what are the types of hypoglycemia?

Answer 29

reactive (postprandial) and fasting

Question 30

what are symptoms of hypoglycemia?

Answer 30

shaky/jittery/dizzy; sweaty; hungry; headache; weakness; slow thought processes

Question 31

what is the diagnosis for hypoglycemia?

Answer 31

hypoglycemia + symptoms

Question 32

what is hypoglycemia most often associated with?

Answer 32

diabetes (error in insulin injection; insufficient CHO consumption; skipping or delaying meals; increased physical activity; alcohol without food; being ill)