Diet and DM Flashcards
what constitutes DM?
- Hemoglobin A1c - >6.5%
- Fasting Plasma Glucose - >126 mg/dL
- Fasting - no caloric intake for 8+ hours - 2-hour OGTT - >200 mg/dL
- Requires 75-g oral glucose load - Random Plasma Glucose - >200 mg/dL
- If in the presence of a hyperglycemic crisis
which DM
- Related to destruction of β-cells and loss of insulin production
- Generally thought to be due to an autoimmune process
- Patients must be treated with insulin
Type 1 Diabetes Mellitus - aka T1DM
which DM
- Related to insulin resistance with potential eventual loss of β-cell function
- Multifactorial
- More heavily dependent on diet and lifestyle
- Patients may be treated with insulin
Type 2 Diabetes Mellitus - aka T2DM
which DM is MC in the US?
T2DM - 90%
which DM
- NOT true diabetes
- Chronic insulin resistance and insulin insufficiency in the brain may play a role in the pathogenesis
Alzheimer’s disease
- Managing blood glucose levels appropriately may aid in AD treatment
what is the criteria for prediabetes aka hyperglycemia?
- Impaired Fasting Glucose - 100-125 mg/dL
- Impaired Glucose Tolerance - 140-199 mg/dL on 2-hr OGTT
- Elevated HbA1c - 5.7-6.4%
what is the onset of DM during pregnancy that resolves after birth
Gestational DM
goals for DM management
- Maintain a normal or near-normal serum glucose level
- Prevent or reverse lipid abnormalities
- Prevent or delay complications of prolonged hyperglycemia
DM complications
- Endocrine: self-perpetuating cycle
- CV: microvascular damage, enhanced atherosclerosis, higher risk of amputations, CAD, higher risk of MI and CVA
- Eye: diabetic retinopathy, blurry vision, cataracts
- Neuro: increased dementia risk, peripheral sensorimotor neuropathy, autonomic neuropathy
- Renal: diabetic nephropathy
- Reproductive: sexual dysfunction
- Immune: impaired immune function
- Skin: poor peripheral circulation, poor wound healing
management for DM
- Glycemic Control - Essential to help delay or prevent complications
- Effective regardless of diabetes type
- Type 1 DM - must still receive insulin, but can benefit from lifestyle modifications
- Type 2 DM - lifestyle modifications are key; may be able to treat solely with lifestyle modifications - Other General Interventions
- Healthy eating pattern - high in fiber, moderate to low carbohydrate consumption, plant-based foods, Mediterranean style
- Regular physical activity
- Good amount and quality of sleep daily
- Avoidance of tobacco
- Weight loss (even 5-10%) - esp truncoabdominal
what surgery can have dramatic effects on glycemic control
Bariatric surgery
what macros are best for DM?
- No set macro amount versus that of a “typical” diet!
- Carbs/High Fiber - about 30 g/day
- Whole grain products, fruits (especially berries), veggies (especially raw)
- Carbohydrates should ideally be minimally processed, plant-based if possible - Fats - monounsaturated fats and polyunsaturated fats
- Saturated and trans fats associated with worse DM outcomes
- Replacing carbs with MUFAs was found to help glycemic control - Protein - 0.8 g/kg/day
- help replace saturated fats and refined carbs
- Higher intake is not necessarily recommended - may help with satiety
- Excess protein can be harmful in patients with CKD
- Plant protein > animal protein
what is the General theory/popular perception about carbs
excessive carbohydrate consumption is obesogenic and leads to postprandial hyperinsulinemia and subsequent hyperglycemia and frank diabetes mellitus
- However…randomized controlled trials have not supported that carbohydrates are inherently any less healthy than proteins/fats
pros vs cons of keto diet for DM pts
- Pros: faster early wt loss, early improvements in blood glucose levels
- often encouraged by noticeable early results
- Carbohydrates have a more immediate impact on blood glucose - Cons: “Keto flu,” long-term cost and compliance issues
Bottom line: no major differences in glycemic control at the 1 year mark
general diet principles of DM
- the best diet is the one your patient can adhere to!
- eating healthy foods in general, rather than worrying about specific percentages of macros, is the best approach
- Better intake of vitamins, minerals, and fiber
- Promotes healthier gut microbiome
- More sustainable in the long-term
- Helps with multiple conditions, not just DM
4 ways to diet for DM
- The Plate Method - easy for patients to remember and visualize when preparing meals
- Diabetic Recipes - can limit the work of patients deciding on healthy choices/ingredients on their own
- Diet Exchange Lists - especially helpful for patients counting carbohydrates/reliant on insulin
- In general - 1 unit of rapid-acting insulin = 12-15 g carbs - Low Glycemic Index/Glycemic Load Food Choices - Helps promote slightly lower carb intake
what are the specific food recommendations/considerations for DM?
- Nuts - favorable additions to diet in patients with DM or at risk
- associated with reduced CVD risk mostly
- some benefit in preventing DM
- has not been shown to improve glycemic control directly in patients who already have DM diagnosis - Ethanol - consume in moderation, with food, or to abstain
- interferes with hepatic gluconeogenesis
- can contribute to elevated TG and overall worse glucose control - Caffeine - consume in moderation, or to abstain
- higher plasma glucose and insulin levels and decreased insulin sensitivity in T2DM patients
- Long-term abstinence from caffeine noted to help lower HbA1c in one study - minerals - chromium and vanadium
- fish oil - Recommended to use as directed by a provider, specifically for the management of hypertriglyceridemia
- Not recommended for prevention or treatment of DM - chocolate - consume small amounts, in moderation, but healthier than other forms of chocolate (dark chocolate)
- Cinnamon - Supplementation minimally harmful, but not likely to help
who is at highest risk with hepatic gluconeogenesis when ethanol is consumed?
DM pts taking insulin or drugs that stimulate insulin release
what mineral is an insulin cofactor that may help stimulate expression of insulin receptors and activate those receptors, resulting in better clearance of glucose from the blood
Chromium
Chromium has greater benefits for who?
poorly controlled pts > normal glucose who are at risk for DM
dosing for chromium
Supplementation of up to 8 µg/kg/day - safe and may be beneficial
which mineral is an insulin cofactor with a very narrow therapeutic window
Vanadium
what is a MC SE of Vanadium
GI
what two factors makes dark chocolate supposedly improve glycemic control and insulin sensitivity
cacao
bioflavinoid antioxidants
Most common sweetener purchased over-the-counter by patients
purified, refined sucrose
Disaccharide made of glucose + fructose
Sugar (White Sugar)
sugar that is less refined and so still contains some molasses from sugar cane
Slightly more calories by volume, less calories by weight than white sugar
brown sugar
what minerals does brown sugar lack compared to white sugar
calcium, iron, and potassium
“fruit sugar” - monosaccharide
Found in many foods including sucrose, honey, fruit, corn
Fructose
fructose does not require ___ to be processed
insulin
Liver absorbs fructose and turns it into ?
fat (triglyceride)
produced from refinement of corn
Widely used in the US as a sweetener due to low cost
High-Fructose Corn Syrup
what is the problem with HFCS
likely not the fructose itself, but the amount of unnecessary added sugar it adds to our diet as a whole
May contain more nutrients like vitamins, minerals and antioxidants
May have lower glycemic index/glycemic load than sucrose
Natural Caloric Sweeteners
still simple sugars and will still cause a spike in blood glucose levels!
generally provide less calories per gram and cause a minimal change (or no change) in blood glucose
Used as sweeteners and as bulking agents
Sugar Alcohols
sugar alcohols are commonly found in what type of food products?
sugar-free, low-carb, low-sugar, diet, or keto-friendly
high levels of polyols are linked to what?
- gastrointestinal symptoms
- abd gas, bloating, diarrhea
- Sorbitol and mannitol - FDA-mandated warning, can lead to laxative effects
- May cause digestive dysmotility in IBS patients - higher risk of CV events (MI, CVA, DVT)
Generally higher-intensity (sweeter) than sucrose
Increasing use in the US, both directly and as additives to food/drinks
Must undergo review and approval by the FDA
Non-Nutritive Sweeteners (NNS)
how are Non-Nutritive Sweeteners (NNS) good vs bad for you so far?
good:
1. allowed to be consumed as part of a general pattern of healthful lifestyle changes
- less harmful than caloric sweeteners
- May be benefit in DM who need to limit sugary foods/drinks
2. not associated with cancer, brain tumors, or neuro disease
bad:
1. Not associated with lower wt, better glycemic control, lower risk of obesity/heart disease in most studies
2. displaces calories/sugar, not lower caloric/sugar content
- May encourage preference for sweet-tasting food products
- May alter gut microbiome
- May make patients feel like they can eat more unhealthy foods to “make up” for absence of calories in a diet beverage
which NNS is the sweetest and least?
- advantame
- monk fruit extract
