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nutrition > Diet and DM > Flashcards

Diet and DM Flashcards

1
Q

what constitutes DM?

A
  1. Hemoglobin A1c - >6.5%
  2. Fasting Plasma Glucose - >126 mg/dL
    - Fasting - no caloric intake for 8+ hours
  3. 2-hour OGTT - >200 mg/dL
    - Requires 75-g oral glucose load
  4. Random Plasma Glucose - >200 mg/dL
    - If in the presence of a hyperglycemic crisis
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2
Q

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

A

Type 1 Diabetes Mellitus - aka T1DM

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3
Q

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

A

Type 2 Diabetes Mellitus - aka T2DM

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4
Q

which DM is MC in the US?

A

T2DM - 90%

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5
Q

which DM
- NOT true diabetes
- Chronic insulin resistance and insulin insufficiency in the brain may play a role in the pathogenesis

A

Alzheimer’s disease
- Managing blood glucose levels appropriately may aid in AD treatment

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6
Q

what is the criteria for prediabetes aka hyperglycemia?

A
  1. Impaired Fasting Glucose - 100-125 mg/dL
  2. Impaired Glucose Tolerance - 140-199 mg/dL on 2-hr OGTT
  3. Elevated HbA1c - 5.7-6.4%
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7
Q

what is the onset of DM during pregnancy that resolves after birth

A

Gestational DM

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8
Q

goals for DM management

A
  1. Maintain a normal or near-normal serum glucose level
  2. Prevent or reverse lipid abnormalities
  3. Prevent or delay complications of prolonged hyperglycemia
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9
Q

DM complications

A
  1. Endocrine: self-perpetuating cycle
  2. CV: microvascular damage, enhanced atherosclerosis, higher risk of amputations, CAD, higher risk of MI and CVA
  3. Eye: diabetic retinopathy, blurry vision, cataracts
  4. Neuro: increased dementia risk, peripheral sensorimotor neuropathy, autonomic neuropathy
  5. Renal: diabetic nephropathy
  6. Reproductive: sexual dysfunction
  7. Immune: impaired immune function
  8. Skin: poor peripheral circulation, poor wound healing
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10
Q

management for DM

A
  1. 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
  2. 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
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11
Q

what surgery can have dramatic effects on glycemic control

A

Bariatric surgery

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12
Q

what macros are best for DM?

A
  1. No set macro amount versus that of a “typical” diet!
  2. 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
  3. 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
  4. 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
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13
Q

what is the General theory/popular perception about carbs

A

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

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14
Q

pros vs cons of keto diet for DM pts

A
  1. 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
  2. Cons: “Keto flu,” long-term cost and compliance issues

Bottom line: no major differences in glycemic control at the 1 year mark

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15
Q

general diet principles of DM

A
  1. the best diet is the one your patient can adhere to!
  2. 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
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16
Q

4 ways to diet for DM

A
  1. The Plate Method - easy for patients to remember and visualize when preparing meals
  2. Diabetic Recipes - can limit the work of patients deciding on healthy choices/ingredients on their own
  3. Diet Exchange Lists - especially helpful for patients counting carbohydrates/reliant on insulin
    - In general - 1 unit of rapid-acting insulin = 12-15 g carbs
  4. Low Glycemic Index/Glycemic Load Food Choices - Helps promote slightly lower carb intake
17
Q

what are the specific food recommendations/considerations for DM?

A
  1. 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
  2. Ethanol - consume in moderation, with food, or to abstain
    - interferes with hepatic gluconeogenesis
    - can contribute to elevated TG and overall worse glucose control
  3. 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
  4. minerals - chromium and vanadium
  5. fish oil - Recommended to use as directed by a provider, specifically for the management of hypertriglyceridemia
    - Not recommended for prevention or treatment of DM
  6. chocolate - consume small amounts, in moderation, but healthier than other forms of chocolate (dark chocolate)
  7. Cinnamon - Supplementation minimally harmful, but not likely to help
18
Q

who is at highest risk with hepatic gluconeogenesis when ethanol is consumed?

A

DM pts taking insulin or drugs that stimulate insulin release

19
Q

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

A

Chromium

20
Q

Chromium has greater benefits for who?

A

poorly controlled pts > normal glucose who are at risk for DM

21
Q

dosing for chromium

A

Supplementation of up to 8 µg/kg/day - safe and may be beneficial

22
Q

which mineral is an insulin cofactor with a very narrow therapeutic window

A

Vanadium

23
Q

what is a MC SE of Vanadium

A

GI

24
Q

what two factors makes dark chocolate supposedly improve glycemic control and insulin sensitivity

A

cacao
bioflavinoid antioxidants

25
Q

Most common sweetener purchased over-the-counter by patients
purified, refined sucrose
Disaccharide made of glucose + fructose

A

Sugar (White Sugar)

26
Q

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

A

brown sugar

27
Q

what minerals does brown sugar lack compared to white sugar

A

calcium, iron, and potassium

28
Q

“fruit sugar” - monosaccharide
Found in many foods including sucrose, honey, fruit, corn

A

Fructose

29
Q

fructose does not require ___ to be processed

A

insulin

30
Q

Liver absorbs fructose and turns it into ?

A

fat (triglyceride)

31
Q

produced from refinement of corn
Widely used in the US as a sweetener due to low cost

A

High-Fructose Corn Syrup

32
Q

what is the problem with HFCS

A

likely not the fructose itself, but the amount of unnecessary added sugar it adds to our diet as a whole

33
Q

May contain more nutrients like vitamins, minerals and antioxidants
May have lower glycemic index/glycemic load than sucrose

A

Natural Caloric Sweeteners
still simple sugars and will still cause a spike in blood glucose levels!

34
Q

generally provide less calories per gram and cause a minimal change (or no change) in blood glucose
Used as sweeteners and as bulking agents

A

Sugar Alcohols

35
Q

sugar alcohols are commonly found in what type of food products?

A

sugar-free, low-carb, low-sugar, diet, or keto-friendly

36
Q

high levels of polyols are linked to what?

A
  1. gastrointestinal symptoms
    - abd gas, bloating, diarrhea
    - Sorbitol and mannitol - FDA-mandated warning, can lead to laxative effects
    - May cause digestive dysmotility in IBS patients
  2. higher risk of CV events (MI, CVA, DVT)
37
Q

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

A

Non-Nutritive Sweeteners (NNS)

38
Q

how are Non-Nutritive Sweeteners (NNS) good vs bad for you so far?

A

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

39
Q

which NNS is the sweetest and least?

A
  1. advantame
  2. monk fruit extract

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