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Clinical Nutrition 1 > Dietary Management in Diabetes > Flashcards

Dietary Management in Diabetes Flashcards

1
Q

List some goals of diet therapy

A
  • Encourage the attainment or maintenance of a healthy body weight
  • To achieve the best possible metabolic control without seriously compromising quality of life
  • Delay or prevent complications
  • Provide specific guidelines for different stages in lifecycle
  • promote self-care
  • encourage overall health by providing nutrition instruction
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2
Q

What goal of diet therapy is very important?

A

Promoting self-care by providing the necessary knowledge, skills resources and support - as the patient must be able to care fo their own condition

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3
Q

In order to achieve the best possible metabolic control without seriously compromising quality of life, which targets are we focusing on?

A
  • Glucose
  • Lipid profile (LDL <2 mmol/L)
  • BP <130/80
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4
Q

What are the first 4 points of the nutrition checklist? (RFIC)

A
  • Refer to nutrition counselling by an RD
  • Follow Eating Well with CFG
  • Individualize dietary advice based on preferences and treatment goals
  • Choose low GI CHO foods
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5
Q

What are the next 3 points of the nutrition checklist? (KEE)

A
  • Know alternative dietary patters for T2DM
  • Encourage matching of insulin to CHO for T1DM
  • Encourage nutritionally balances, calorie-reduced diet in patients overweight or obesity
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6
Q

What is a clinical assessment?

A
  • Healthy behaviour interventions by an RD

- Always the first step in management of hyperglycemia in T2DM

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7
Q

In management of hypergylcemia in T2DM, after consult with RD we will usually inititiate intensive healthy behaviour interventions/energy restriction and increased PA to achieve HBW. What happens next?

A

Provide counselling on a diet best suited to individual needs, preferences and treatment goals based on advantages and disadvantages

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8
Q

If after diet counselling, patient is still not at target, what is the protocol?

A

Continue healthy behaviour interventions and add pharmacotherapy

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9
Q

When should timely adjustments to healthy behaviour interventions be made to attain A1C?

A

2-3 months for healthy behaviour alone

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10
Q

When should timely adjustments to healthy behaviour AND pharmacotherapy interventions be made to attain A1C?

A

3 to 6 months when healthy behaviour is combined with pharmacotherapy

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11
Q

When should a 5-10% weight loss of initial body weight be recommended? Why?

A

BMI >/= 25

We know that modest weight loss can greatly improve insulin sensitivity, and 5-10% is an achievable target

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12
Q

What are the other benefits to a 5-10% moderate weight loss?

A
  • Improved insulin sensitivity
  • Glycemic control
  • Blood pressure control
  • Lipid levels
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13
Q

What is the SINGLE action that will help insulin and glycemic control the most?

A

Moderate weight loss of 5-10%

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14
Q

Target CHO diabetes?

A

45-60%

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15
Q

Target protein diabetes?

A

15-20%

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16
Q

Target fat diabetes?

A

20-35%

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17
Q

Minimum intake of ____ of CHO is recommended to sustain brain and glucose dependent organs

A

130 g/day

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18
Q

Explain the rationale of providing a >45% intake of CHO with diabetes

A

This amount of CHO, when complex, will prevent the high intake of saturated fat which will lead to a higher risk of CVD

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19
Q

What kinds of CHOs should be recommended?

A
  • Low GI
  • High fibre
  • Complex
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20
Q

____of added sugar (sucrose) is recommended

A

<10%

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21
Q

What is important to consider when evaluating the response of the blood glucose curve?

A

The area unde the curve

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22
Q

What is the glycemic index?

A

Area under the curve (AUC) in blood glucose response of a given food compare to a standard of the same content of CHO (g) - based on a scale of 0-100

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23
Q

How is GI calculated?

A

AUC food / AUC standard x 100

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24
Q

What is the glucose load?

A

Accounts for available CHO in a portion

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25
Q

Pasta has a high glycemic load, does this mean that is automatically has a high GI?

A

NO - recall that GI is based on the blood glucose response it elicits, and NOT the amount of CHO per portion

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26
Q

What is important when making recommnedations about GI and GL?

A
  • Must explain in lay terms

- Must give recommendations for similar food groups

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27
Q

Watermelon has a high/low GI and a high/low GL

A

High GI
Low GL
-Watermelon is 98% water, but due to “simple sugars” within the melon will cause a spike in blood glucose

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28
Q

Low GI?

A

= 55

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29
Q

Medium GI?

A

56-69

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30
Q

High GI?

A

> /= 70

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31
Q

Low GL?

A

= 10

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32
Q

Medium GL?

A

11-19

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33
Q

High GL?

A

> /= 20

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34
Q

What else should be considered about Gl and GL accuracy?

A

That these foods are not usually consumed in isolation, and when combined with other foods may alter the glycemic response

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35
Q

What are some dietary factors that affect the glycemic response?

A
  • Dietary fibres
  • Food form
  • Cooking and processing
  • Digestibility
  • Nutrients such as fat/protein present
  • Inter-prandial differences
  • Fast/slow eater
  • Individual glucose tolerance
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36
Q

How can food forms affect glycemic response?

A

Smaller forms of the same foods may be digested faster

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37
Q

How can cooking and processing affect glycemic response?

A

Overly cooked foods, such as pasta, will have a higher GI than if cooked al-dente

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38
Q

How can inter-prandial differences affect glycemic response?

A

Time between meals can affect how we respond to different foods

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39
Q

Glycemic indexes are determined in ___

A

healthy individuals with normal glucose tolerance

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40
Q

Examples of Low GI breads, grains and cereals?

A

100% stone-ground whole wheat, pasta, all bran

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41
Q

Examples of other low GI foods?

A

Sweet potato, yam, legumes

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42
Q

Medium GI breads, grains and cereals?

A

Whole wheat, rye, pita, oatmeal, couscous, basmati rice

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43
Q

Other Medium GI foods?

A

White potato, sweet corn, stoned wheat thins, popcorn, bean/pea soups

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44
Q

High GI breads, cereals, grains?

A

White brea, bran flakes, short-grain rice

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45
Q

Other High GI foods?

A

Russet potato, pretzels, rice cake

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46
Q

What have studies shown regarding replacing high GI with low GI?

A
  • Improvement in glycemic control in diabetes

- Suggested of increased HDL, decrease CRP

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47
Q

Disadvantage of high GI foods?

A

Some studies showed hypoglycaemic events with T1DM combined with meds

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48
Q

____ total intake of fibres recommended in DM

A

HIGHER

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49
Q

g/d fibre diabetes?

A

30-50 g/day

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50
Q

g/1000 kcal fibre diabetes?

A

15-15 g/1000 ckal

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51
Q

How does fibre improve glycemic control in diabetes?

A

Evidence in SOLUBLE fibres, which will slow gastric emptying and glucose absorption as it forms a gel

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52
Q

___ of total fibre intake should be soluble, viscous fibre

A

1/3

~10-20 g/day

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53
Q

Explain to a patients why it is still OK to consume sugars as a diabetic

A

We want to minimize intake of aded sugar to minimize spiking blood sugar, but this does NOT mean that we need to eliminate CHOs, in fact, 45-60% of low GI, high fibre CHO are recommended to improve blood sugar control and reduce CVD risk

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54
Q

Bottom line recommendation on CHOs and diabetes

A

Focus on minimal added sugars, and high quality, high soluble fibre complex carbohydrates

55
Q

Sucrose recommendation?

A

<10% total energy

56
Q

Added fructose?

A

In place of sucrose may help lowerA1c, likely unharmful BUT may increase TGs

57
Q

Does intake of HFCS worsen cardiometabolic outcomes compared to sucrose? What is the exception?

A
  • No

- sugar-sweetened beverages

58
Q

Risk with sugar-sweetened beverages?

A

High intake associate with HTN and increased ris of CHD, could have huge impact if these are cut out

59
Q

(T/F) High GI fruits, such as pineapple mango, papaya and melons should be consumed in unlimited amounts in diabetics, as their fibre will decrease glycemic response

A

False, high GI and should be consumed with caution and in smaller portion sizes

60
Q

(T/F) High GI fruits, such as pineapple mango, papaya and melons are harmful due to high fructose content

A

False, could never consume enough fructose from whole fruits to cause harm

61
Q

Could replacing sucrose with honey and maple syrup be beneficial?

A

On a weight-weight comparison, contain less sucrose, however contains fructose and glucose therefore not the best substitution

62
Q

Considerations about low-CHO diets and diabetes?

A
  • Low CHO means a larger amount of lipids, and recall that diabetics are at the highest risk of heart disease
  • T1 and T2 DM on Insulin Tx are more prone to ketosis, and severe concern of acidosis
63
Q

What may compound the risks of keto-acidosis in diabetic patients?

A
  • Insulin therapy or SGLT2 inhibiters

- Low-CHO diets

64
Q

key concept of developing an adverse metabolic profile?

A

Excess energy

65
Q

Low CHO diet range?

A

4-45%

66
Q

(T/F) Low CHO diets have shown consistent improvements in A1C, blood lipid profile and maintenance of weight-loss in the long-term

A

False

67
Q

What is a concern with low CHO diet and treatment of hypoglycemia in diabetes?

A

There will be a a blunted response of glucagon injection

68
Q

Role of glucagon?

A

Stimulate glycogenolysis and gluconeogenesis in the liver to re-establish blood glucose

69
Q

Explain the dangerous situation that may arise if a diabetic is following a low CHO diet and experiences a hypoglycaemic episode

A

If low intake of CHO, glycogen will be depleted, which means that there will be no glycogen reserves to undergo hydrolysis and re-establish blood glucose after injection of glucagon (blunted response)

70
Q

What is an advantage of low CHO intake?

A

Less CHOs consumes, less insulin injected

71
Q

Fat recommendation diabetes?

A

20-35% of energy

72
Q

Diabetes recommendations due to high risk of CVD?

A
  • Avoid trans fat
  • Sat fat <9%E
  • Limit animla sar fat
73
Q

AI linoleic women and men?

A

12 g

17 g

74
Q

AI linolenic acid women and men?

A
  1. 1 g

1. 6 g

75
Q

How should sat and trans fats be replaces?

A

-PUFAs, MUFAs, whole grains or low-GI CHOs

76
Q

(T/F) Omega-3 supplements are never recommended, including in severe TG

A

False, may be recommended for severe HyperTg

77
Q

Omega-3 supplementation potential effect?

A

-Decrease TG, platelet aggregation

78
Q

Higher intake of fish associated with what? Recommendation?

A
  • Red. CAD and kidney disease in T2DM, less albuminemia in T1DM
  • 2-3 servings of fish/week
79
Q

Protein recommendation diabetes?

A
  • 15-20% (1.0-1.5 g/kg/day)

- Replacement of animal with plant protein sources

80
Q

Effect of replacing animal with plant protein?

A

Improved A1c, fasting BG, insulin

81
Q

Concern of CKD and protein?

A
  • No more than 0.8 g/kg/da
  • monitor protein status to avoid malnutrition
  • CAUTION with plant protein (increase in K+)
82
Q

Is increasing plant protein recommended in CKD?

A

NO - as it increased K+ and must consume more volume to get same protein amount, and also we have a limited “budget” for protein, may be better to consume animal proteins

83
Q

Effects of replacing MUFA with CHO?

A
  • benefits
  • Improved fasting BG, systolic BP, Tg and HDL-C
  • No effect an A1C
84
Q

What are the 3 key cardiometabolic benefits related to macronutrient substitutions in diabetes?

A

1) High CHO with MUFA
2) Fat with low-GI CHO
3) High GI CHO w/ High protein (weight-loss)

85
Q

Which dietary patterned may be recommended in diabetes?

A
  • Mediterranean diet
  • Vegetarian diet
  • DASH diet
  • Portfoliodiet
  • Nordic diet
86
Q

What is the MOST important consideration when evaluating the benefit of a certain diet in diabetes?

A

Glycemic control, indicate by A1C

87
Q

What may help in glycemic control?

A

Non nutritive sweetners

88
Q

Are non-nutritive sweeteners included in CHO counting? is there an acceptable daily intake?

A

No

89
Q

What may limit intake of non-nutritive sweeteners?

A

GI disturbances

90
Q

(T/F) Sorbitol, xylitol and Maltitol are artificial sweeteners

A

False, are sugar alcohols (non-nutritive sweetners)

91
Q

No adverse effect of non-nutritive sweeteners with consumption of ___ g/day

A

10

92
Q

Alcohol recommendation diabetes?

A

= 2 drinks/day or 10/week (women)

= 3 drinks/day or 15/week for men

93
Q

Does moderate intake of alcohol impact BG?

A

Little effect

94
Q

Light to moderate intake on BG?

A

Inverse association with A1C, lower risk of fatal CHD in T2DM

95
Q

What is a major risk of alcohol intake?

A

MASKS the symptoms of hypoglycemia and increases ketones

96
Q

What may delay hypoglycemia?

A

Moderate alcohol intake with a meal or intake 2-3 hours later

97
Q

What is a cultural consideration for diabetic patients

A

fasting and ramadan, risk of hypoglycemia if insulin Tx

98
Q

What are some key, special concerns for patients on insulin Tx?

A
  • Regularity in meal-spacing and CHO content
  • Snacks to avoid hypoglycemia
  • Bedtime snacks of CHO and protein –> Avoid nocturnal hypoglycemia
99
Q

Targeted strategies for pre-diabetes?

A

-Weight loss/maintenance
-Portion control
Low GI, reduce refined CHO
-PA

100
Q

Targeted strategies for early type 2 DM

A
  • Same as pre-diabetes, plus:

- CHO distribution, high fibre and dietary pattern of choice

101
Q

Targeted strategies for DM not on insulin?

A

Same as early type-2 DM

102
Q

Targeted strategies when on basal insulin only?

A

Same, but CHO consistency (since on insulin)

103
Q

Targeted strategies on basal-bolus insulin?

A

Same, but CHO consistency initially then learn CHO counting (more flexibility)

104
Q

Considerations during illness?

A

Take DM medications as perscribes, and SMBG often

105
Q

Illness and episode’s of N/V?

A

Replace usual CHO w liquid or semi-liquid containing CHO (fruit juice, jello, gatorade)

106
Q

Hydration during illness?

A

250-370 ml/hr

107
Q

When should a patient consult MD in illness?

A
  • Cannot tolerate illness
  • Glycemia >20 mmol/l
  • > 38.5 C for 48 hr
  • Ketonuria
  • Persistant diarrhea, general deterioration
108
Q

In hospital glycemic targets in non-critically ill?

A

Fasting: 5-8
Random: <10

109
Q

Therapy of choice in non-critically ill?

A

Pre-hospital regimen or basal-bolus correction

110
Q

In hospital glycemic targets in critically ill?

A

8-10

111
Q

Therapy of choice in critically ill?

A

IV insulin infusion

112
Q

In hospital glycemic target of CABG intra-op?

A

5.5-10

113
Q

Therapy of choice in CABG intra-op?

A

IV insulin infusion

114
Q

In hospital glycemic target for other peri-op?

A

5-10

115
Q

Therapy of choice in other peri-op?

A

As appropriate

116
Q

No ____ are proven to treat diabetes, and may be harmful

A

No natural health products

117
Q

Compare & contrast decreasing kcal in T1Dm and T2DM

A

T1: No
T2: yes

118
Q

Compare & contrast importance of improving insulin action in T1Dm and T2DM

A

T1: Impossible, not important
T2: Very urgent

119
Q

Compare & contrast the increase frequency of feedings in T1Dm and T2DM

A

T1: Yes for conventional Tx, but no fo intensive Tx
T2: Not usually

120
Q

Compare & contrast the importance of consistent intake of kcal and macronutrients kcal in T1Dm and T2DM

A

T1: Important (conventional Tx), not critical (intensive Tx)
T2: Better, but not critical

121
Q

Compare & contrast the consistent ratio of CHO, pro and fat/meal in T1Dm and T2DM

A

T1: Very important (conventional Tx), not critical (intensive Tx)
T2: Not crucial

122
Q

Compare & contrast consistent timing of meals in T1Dm and T2DM

A

T1: important
T2: Not crucial

123
Q

Compare & contrast significance of extra food for unusual exercise in T1DM and T2DM

A

T1: Yes (conventional Tx) variable (intensive Tx)
T2: Not usually

124
Q

Compare & contrast recommendation on providing CHO with meals during illness in T1Dm and T2DM

A

T1: To prevent ketosis
T2: To prevent HHS

125
Q

Compare & contrast the use of food to treat, and prevent hypoglycemia in T1Dm and T2DM

A

T1: Important
T2: Less important, but could be used to treat

126
Q

Discuss important consideration when on conventional Tx (T1DM)

A
  • Increase frequency of feedings
  • Consistent intake and ratio of kcal, CHO, pro and fat
  • Account for extra food for unusual exercise
127
Q

Key recommendations (1/7)

A
  • Nutrition counselling by RD to lower A1C and red. hospitalization rates
  • Deliver education in small groups or one-on-one
128
Q

Key recommendations (2/7)

A
  • Follow CFF
  • if overweight/obese, follow a nutritionally/balanced, calorie reduced diet
  • Dietary modification and increased PA
129
Q

Key recommendations (3/7)

A
  • 45-60% CHO, 15-20% pro, 20-35% fat

- Regularity in timing and spacing of meals

130
Q

Key recommendations (4/7)

A

-Avoid TFA, <9% E from SFA, –> replace with MUFA, PUFA, whole grains and low GI CHO

131
Q

Key recommendations (5/7)

A

-Substitute added sugars with other CHOs as part of mixed meals to a max of 10% total energy intake

132
Q

Key recommendations (6/7)

A
  • 30-50 g/day fibre, where 10-20g/day from soluble
  • Low GI CHOs
  • Med, veg, DASH, legumes, F&V and nuts recommended
133
Q

Key recommendations (7/7)

A
  • T1DM match insulin to CHO, or maintain consistency

- Insulin Tx should be education on risk of hypoglycemia alcohol

134
Q

Key messages ? (4)

A
  • Replace high GI with low GI in mixed meals
  • Consistency/spacing of CHO intake
  • Intensive healthy behaviour interactions
  • Choose the dietary pattern that best aligns with their values, preferences and treatment goals

Clinical Nutrition 1 (30 decks)

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