Diet and diabetes

Question 1

the goals of medical nutrition therapy in diabetics are dependent upon what two factors?

Answer 1

• type of diabetes

- age

Question 2

what are the goals of medical nutrition therapy in diabetics?

Answer 2

1. healthful eating pattern to improver overall health
2. attain individualized glycemic, BP, lipid goals
3. achieve and maintain body weight goals
4. delay or prevent diabetic complications

Question 3

what is the goal HbQA1c level?

Answer 3

below 7%

Question 4

what is the goal BP in diabetic patients?

Answer 4

under 140/80

Question 5

what is the goal LDL cholesterol for diabetic patients? HDL for men and women?

Answer 5

• LDL: under 100 mg/dL
• HDL men: over 40 mg/dL
• HDL women: over 50 mg/dL

Question 6

how are MNT goals for diabetics achieved?

Answer 6

regulation of carbohydrates consumed

Question 7

what is the most important nutrient to consider in the treatment of diabetes? why?

Answer 7

carbohydrates - they have the greatest postporandial effect on glucose levels

Question 8

what are the approaches to regulating carbohydrate intake?

Answer 8

• carb counting

Question 9

what are the key concepts of level 1 (basic) carb counting?

Answer 9

• awareness of which foods contain CHO
• portion sizes
• avoidance of sweets
• CHO consistency

Question 10

what are the key concepts of level 2 (intermediate) carb counting?

Answer 10

• understand how blood glucose is affected and managed by food, medication, and physical activity
• pattern management
• reducing body weight

Question 11

what are the key concepts of level 3 (advanced) carb counting?

Answer 11

• teaching how to calculate CHO to insulin ratios when using multiple daily injection or insulin pump

Question 12

what is the starting goal for number of carbs to have per meal?

Answer 12

45-60 g

Question 13

what is measured by the glycemic index?

Answer 13

GI measures the QUALITY of a CHO by determining how high it raises blood glucose

Question 14

how are high GI foods treated by the GI tract? what is the result?

Answer 14

• rapidly digested and absorbed

- will result in large fluctuations in glucose levels

Question 15

how do fats and fibers affect the GI of a food?

Answer 15

fats and fibers tend to lower the GI

Question 16

how does eating foods with high GI with protein, fats, and other low GI carbs affect the GI of that food?

Answer 16

lowers the GI

Question 17

limitations of GI

Answer 17

• affected by combination of other foods
• variation in GI reports for the same food
• does not factor in calories (risk of overconsumption)
• individual glucose responses to different types of carbs
• lower GI carb does not always mean better carb
• GI changes with food preparation

Question 18

what is the glycemic load? what does it tell you?

Answer 18

QUALITY (GI) of carbs + QUANTITY of carbs

provides a way to determine blood glucose values of different types and amounts of carbs

Question 19

are high protein diets beneficial to diabetic patients without renal disease?

Answer 19

no - no difference when compared to normal healthy eating guidelines

Question 20

what are the protein recommendations for diabetic patients with renal disease?

Answer 20

• no evidence of benefit of reduced protein in diet

- sensible to avoid high protein diet

Question 21

what are the fat recommendations for diabetic patients?

Answer 21

same as general population - 20-35% of energy from fat

Question 22

what was the primary goal of the diabetes prevention program (DPP)?

Answer 22

determine if modest weight loss through dietary changes and physical activity OR treatment with the oral diabetes drug metformin could prevent or delay the onset of type II diabetes

Question 23

what were the inclusion criteria for the DPP?

Answer 23

• overweight

- diagnosed with prediabetes

Question 24

what were the treatment groups in the DPP?

Answer 24

• lifestyle intervention group
• drug treated group #1 - metformin
• drug treated group #2 - troglitazone
• control group (placebo 2x/day)

Question 25

what were the outcomes of the DPP for pre-diabetics?

Answer 25

• pre-diabetics can delay or avoid developing type II diabetes with regular exercise and utilizing a diet low in calories and fat

Question 26

what were the outcomes of the DPP for the diet and exercise group?

Answer 26

effect was seen in all participating minority and gender groups

Question 27

how did diet and exercise compare with metformin in the DPP study?

Answer 27

the incidence of diabetes was reduced by 58% with the lifestyle intervention and by 31% with metformin as compared with placebo