DM - Exam 2 Flashcards
What constitutes DM?
Hemoglobin A1c - 6.5% or greater
Fasting Plasma Glucose - 126 mg/dL or greater
2-hour OGTT - 200 mg/dL or greater (need to ingest 75mg of glucose)
Random Plasma Glucose - 200 mg/dL or greater
need at least 2 readings on 2 different occassions
_____ related to destruction of pancreatic β-cells and loss of insulin production. What is it due to? What is the tx?
T1DM
due to an autoimmune process
must be treated with insulin
_____ is related to insulin resistance with potential eventual loss of β-cell function. What is it dependent on?
T2DM
diet and lifestyle
_____ chronic insulin resistance and insulin insufficiency in the brain may play a role in the pathogenesis of Alzheimer’s patients
Alzheimer’s Disease and type 3 DM
What is prediabetes defined as?
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 are some healthy recommendations for DM?
high in fiber, moderate to low carbohydrate consumption, plant-based foods, Mediterranean style
regular physical activity
sleep!
no tobacco!
Weight loss!
What are the recommended amounts of carbs for DM? What kind?
30grams
whole grain, fruits, veggies
carbs should be minimally processed and plant based
Replacing carbs with ____ was found to help glycemic control in DM.
MUFAs
What are the protein requirements for pt with DM? Excess proteins can be harmful in patients with ____. What kind of proteins are preferred?
0.8 g/kg/day
CKD
plant proteins are preferred
What are the Pros for keto diet and DM? Cons? Is there any difference at the 1 year mark?
Pro: Often have faster early weight loss, significant early improvements in blood glucose levels
cons: “Keto flu,” long-term cost and compliance issues
Studies have shown no major differences in glycemic control at the 1 year mark
What is the best diet for DM?
the best diet is the one your patient can adhere to!!!
Mounting evidence that eating healthy foods in general, rather than worrying about specific percentages of macros, is the best approach
What are 3 helpful suggestions for DM diets?
The Plate Method
Diabetic Recipes
Diet Exchange Lists
When are diet exchange lists especially helpful for DM?
especially helpful for patients counting carbohydrates/reliant on insulin
in general- 1 unit of rapid-acting insulin = ____ carbs
12-15 carbs
?????: Helps promote slightly lower carb intake
Low Glycemic Index/Glycemic Load Food Choices
What are some important points to consider regarding nuts and DM. What do nuts NOT do?
reduced CVD risk
benefit in preventing DM
recommended as a favorable addition to diet (careful of the overall caloric intake)
have NOT been shown to improve glycemic control directly in patients who already have DM diagnosis
Ethanol can interfere with _____. When consumed without food increased risk of ______. Excessive ethanol intake can contribute to _____ and overall worse _______.
hepatic gluconeogenesis
hypoglycemia
elevated TG
glucose control
Who at the highest risk of hypoglycemia due to alcohol intake for a DM pt?
DM pts taking insulin or drugs that stimulate insulin release
aka need to eat something if DM pts are going to drink
Caffeine technically shown to cause higher _____ and insulin levels
and decreased _____ in T2DM patients
plasma glucose
insulin sensitivity
______ insulin cofactor that may help stimulate expression of insulin receptors and activate those receptors, resulting in better clearance of glucose from the blood. What pt population does it have the most benefit?
Chromium
mixed data, greater benefit in poorly controlled pts
no benefit for pts who have normal glucose and are at risk for developing DM
____ is an insulin cofactor with a very narrow therapeutic window with lots of GI SE!!
Vanadium
_____ is commonly used to treat elevated TG. Does it have an impact on glycemic control?
Fish Oil
no major impact on glycemic control, NOT recommended for prevention or treatment of DM
just to treat hyperTG
Popularly reported that ____ chocolate may improve glycemic control and insulin sensitivity due to _____ and ______. What is the recommendation?
dark
cacao and its bioflavinoid antioxidants
Recommended to consume small amounts, in moderation, but healthier than other forms of chocolate
What is important to know about cinnamon and DM?
Supplementation probably would be minimally harmful, but not likely to help, and not enough evidence to replace medical treatment aka do not actively discourage
One study did show a possible benefit in prediabetic patients but NOT helpful in T1DM or T2DM
What is white sugar composed of? What is brown sugar composed of? Which has more calories by volume? by weight?
purified, refined sucrose
glucose + fructose
_______
Brown: sucrose and have molasses added back in
volume: brown sugar has more calories
weight: white sugar has more calories
_____ does not require insulin to be processed. ______ absorbs it and turns it into fat (TG). Name some sources
Fructose
liver
Fructose - “fruit sugar” - monosaccharide
sucrose, honey, fruit, corn
______ is widely used in the US as a sweetener due to low cost. Why is it a problem?
High-Fructose Corn Syrup
Problem with HFCS is likely not the fructose itself, but the amount of unnecessary added sugar it adds to our diet as a whole
Will natural caloric sweeteners increase blood sugar? Do they have a higher or lower glycemic index than sucrose? What else do they contain?
these are still simple sugars and will still cause a spike in blood glucose levels!
lower glycemic index/glycemic load than sucrose
nutrients like vitamins, minerals and antioxidants
What are some sweeteners that have a lower glycemic index than sucrose (white/brown sugar)?
______ generally provide less calories per gram and cause a minimal change (or no change) in blood glucose. What are some examples
Sugar Alcohols
xylitol, erythritol, sorbitol, mannitol, isomalt, maltitol, lactitol
Sugar alcohols have high levels of ingestion linked to ______.
____ and ____ specifically have an FDA-mandated warning that excess consumption can lead to laxative effects.
gastrointestinal symptoms
sorbitol and mannitol
What is the concern over negative GI symptoms and poyols? What else are they associated with? Which one specifically?
Concern over negative effects on gut microbiome
May be associated with higher risk of CV events (MI, CVA, DVT)
Erythritol - high levels of consumption associated with increased thrombosis
Non-Nutritive Sweeteners (NNS) are generally _____ than sucrose. Are they good for us?
Generally higher-intensity (sweeter) than sucrose
Generally allowed to be consumed as part of a general pattern of healthful lifestyle changes: less harmful than caloric sweeteners, good for those who need to limit sugary foods/drinks
NOT encouraged for weight loss or other chronic dz management
Are non-nutritive sweeteners bad for us?
Generally not associated with cancer, brain tumors, or neurologic disease in studies
but are NOT associated with lower weight, better glycemic control, lower risk of obesity/heart disease in most studies
they just displace calories/sugar not lower caloric/sugar content
Give some examples of non-nutritive sweeteners. Consider looking at other noteworthy facts?
