DM MNT Flashcards
The goal of MNT is to assist persons in
making __________ behavior changes to
improve overall DM management and health
status
self-directed
Goals for MNT for adults with DM
Promote & support healthful eating patterns,
emphasizing a variety of nutrient-dense foods in
appropriate portion sizes, in order to improve
overall health and specifically to:
*achieve & maintain ________ goals
*attain individualized _____________ goals
*delay or prevent _________ of DM
body weight
glycemic, BP, & lipid
complications
glycemic targets for adults with DM
preprandial capillary plasma glucose
peak postprandial capillary plasma glucose
A1C
80-130
<180
<7%
Action of insulin is _________- promotes the
______ of nutrients and prevents the
_______ of nutrients
anabolic
storage
breakdown
CHO
insulin facilitates
Entry of glucose into the cells
Glycogen synthesis in the liver & muscles
Increases triglyceride stores
CHO
without insulin
Hyperglycemia occurs
Liver & muscle glycogenolysis occurs
Glucose production by the liver increases
Protein
with insulin
Incorporation of amino acids into tissue
protein
Decreases gluconeogenesis
protein
without insulin
Gluconeogenesis occurs and proteolysis
occurs in muscles
fat
with insulin
*Lipogenesis by activating lipoprotein lipase
*Inhibits lipolysis
fat
without insulin
*Lipolysis & fatty acid release occurs rapidly
- Leads to an excessive production of ketones
*Serum TG increases secondary to a decrease in
cellular uptake
For all patients with overweight or obesity, behavioral modification to achieve & maintain a minimum weight loss of _______% is recommended
* Associated with improved glycemic control, lipid levels, and BP
5%
DRI Acceptable Macronutrient Ranges:
45-65% CHO
20-35% fat
10-35% protein
For those with diabetic kidney disease:
*Provide _____ g/kg (if not on dialysis)
* For individuals in dialysis, provide _____ g/kg
*Higher levels (>____% of daily kcal from protein or >____ g/kg) associated with more rapid kidney function loss
0.8
1.0-1.2
20%
1.3
Reducing overall _____ intake has demonstrated the most evidence for improving glycemia
* Emphasize nutrient-dense CHO sources that are
high in fiber and minimally processed.
* Eating plans should emphasize nonstarchy vegetables, fruits, and whole grains, as well as dairy products, with minimal added sugars
CHO
starchiest veggies
potatoes
corn
peas
Both the amount of CHO and the type of CHO affect BG levels but the ________ of CHO will have more of an effect on BG levels than the______ of CHO
*Substituting low glycemic index/load foods for
higher glycemic index/load foods may or may
not have a significant effect on glycemic
control - the research is inconclusive
TOTAL amount
source
________-containing foods can be substituted for
isocaloric amounts of other CHO in the meal
plan, or if added to the meal plan, covered with
insulin
* However, consumption should be minimized to
avoid displacing healthier, more nutrient-dense
foods
*People with DM and those at risk should
replace sugar-sweetened beverages (including
juice) with water to control glycemia and
weight and reduce the risk of CVD & fatty liver
Sucrose
___________ have the potential to reduce overall caloric &
CHO intake if substituted for other sweeteners
*Generally recognized as safe (GRAS) when consumed within the daily intake levels established by the FDA
*Overall, people are encouraged to decrease
both sweetened and nonnutritive-sweetened
beverages and replace with water
sugar substitutes
Determined by the FDA
*The amount of a food additive that can be safely consumed on a daily basis over a person’s lifetime without any adverse effects.
*Determination generally includes a ____-fold
safety factor
ADI is ______
100
50 mg/kg
Saccharin (__________)
Aspartame (_________)
Sucralose (_______)
Acesulfame K (____________)
Stevia (________)
Sweet’N Low
NutraSweet
Splenda
Sweet One & Sunett
Truvia
________ is unknown if safe during pregnancy
people with PKU cannot consume ____________
saccharin
aspartame
Sugar alcohols examples
erythritol
sorbitol
xylitol
Sugar alcohols are ________________ by the body
*_______ kcal/g
*Intestinal side effects can limit usefulness=> gas, bloating, diarrhea
partially absorbed
1.5- 2.5
Evidence is limited that fiber has a beneficial
effect on glycemic control
* Some research suggests that soluble fiber may__________ & lessen postprandial rise in glucose
* However, improved glycemic control required fiber
intakes of >_____ grams/d
*Soluble fiber can reduce ___________
*People with DM should consume at least the DRI for fiber
slow CHO absorption
50
LDL-cholesterol
- Type of fat consumed is ______ important than total
amount when considering CVD risk - Reduce SFA and replace with __________
- Increased consumption of foods containing ________
fatty acids is recommended to prevent or treat CVD
However, evidence does not support use of _____________ - Consider use of a ______________ eating pattern
more
PUFA & MUFA
omega-3
supplements
Mediterranean-style
Reduce sodium intake to <_______ mg/d
*For individuals with both DM & HTN=> further
reduction may be indicated
2300
Effect of alcohol on BG levels depends on the amount of ingested as well as food intake
*Blocks _________ and can cause _________ if not consumed with food
* Especially if taking insulin or insulin secretagogues
*If alcohol is consumed, do so in moderation:
*<1 drink/day for women; <2 drinks for men
gluconeogenesis
hypoglycemia
1 drink =
___ oz beer
___ oz of wine
___ oz of distilled spirits
12
5
1.5
1.5 oz distilled spirits
5 oz dry, red, or white wine
12 oz beer
100 kcal, 0 CHO choices
100-125 kcal, 0 CHO choices
regular 150 kcal, 1 CHO choice
light 100 kcal, 0.5 choice
Many vitamin and minerals act as cofactors in the metabolism of macronutrients
* No clear evidence of benefit from supplementation of vitamins, minerals, or herbal supplements in DM for those ____________
* Routine supplementation with ________ is not advised due to lack of evidence of efficacy and concern related to long-term safety
* It is recommended that people taking metformin have an annual assessment of _________ status
without deficiencies
antioxidants
vitamin B 12
A variety of eating patterns can be considered for the management of type 2 DM and to prevent diabetes in individuals with prediabetes
*Focus on the key factors that are common
among the patterns:
* emphasize _____________
* minimize _________________
* choose ___________ over highly processed foods
non-starchy vegetables
added sugars & refined grains
whole foods
collect lab data including ___________________________________
A1C
FPG
fasting lipid profile
urinary albumin (DKD)
Cr
BUN
Factors that may increase BG levels
trauma and stress (physical or mental)
corticosteroids or diuretics
various diseases - Cushing syndrome
excessive kcal or CHO intake
Factors that decrease BG levels
insulin or insulin secretagogues
physical activity
poor intake
ETOH consumption
extensive liver disease
2 phases of self management education
initial education
in depth continuing education
initial education of self management included ________
some examples ?
information needed at time of diagnosis
- called survival skills
importance of eating at regular times
signs and symptoms of high and low BG
treatment of hypoglycemia
sick day management
in depth continuing education for self management includes ___________________
examples?
management skills needed to make decisions to achieve goals and foster self care
CHO counting or meal planning
label reading
exercise guidelines
initial education should be ______ encounters during the _________
follow up should be ____ encounter _______ to _______
3-6
1st 6 months
at least 1
annually
reinforce lifestyle changes and to evaluate outcomes that impact the need for changes in MNT or medications
For meal planning, emphasize goal of achieving __________ by ____________________
use _____ monitoring, ______ records, and _______ records
glycemic targets
balancing food, medications and exercise
BG
food
excercise
If using a flexible insulin therapy program=>
_________ approach to optimize mealtime insulin dosing
If fixed insulin doses=> consistent pattern of _______ with respect to time and amount synchronized with insulin
CHO counting
CHO intake
Caloric restriction to promote weight loss (if
overweight or obese)
If using MNT alone or non-insulin secretagogue meds=> monitor ________ healthful eating pattern
If on fixed insulin doses or insulin secretagogues=> _________________; healthful eating pattern
CHO intake
Consistent CHO intake and mealtimes
Several approaches are available including:
*_____ counting
*_________ for Diabetes
*For those with health literacy concerns=>
_______ method, portion control and healthy eating tips
CHO
Food lists
MyPlate
Evidence has shown that _____ and _______ are the main factors affecting post-prandial blood glucose
Emphasis is placed on total amount of CHO to
be consumed
- Used to determine pre-meal insulin doses
CHO intake
available insulin
CHO counting Advantages:
- Offers greater_______ in food choices
- Allows for better control of_____
Disadvantage:
- By itself, it doesn’t teach __________
- Requires more _________________
flexibility
BG
healthy eating habits
self-monitoring & decision making
Determine patient/client’s total daily calorie needs
- Distribute amongst macronutrients
- will be dependent on individual patient goals
- Determine total _________ needed per day
grams of CHO
Convert the number of grams of CHO recommended per day into the ____________
- Distribute grams of CHO _______ for meals
number of carbohydrate choices
equally
The amount of ________ needed to “cover” a given amount of carbohydrates
- Gives the patient an idea of what size ________ should be given when eating carbohydrates
insulin
insulin
bolus
Insulin to CHO ratios are unique, individualized ratios
- Ratios can vary significantly from person to person
- The ratio should be calculated by a _________ using the person’s food records, doses of insulin, & log of post-prandial BG levels
- Most adults with type 1 DM will need approximately __________ for each ________ of CHO consumed
Certified Diabetes Care & Education Specialist (CDCES)
1 unit of rapid-acting insulin
10-15 grams
simple/basic method. of calculating insulin to CHO ratio
Example : 50 units of insulin per day
divide 500 by the total daily dose of insulin that the individual takes
500/50 = 10
- 1 unit of rapid acting insulin will cover 10 grams of carbohydrates
- 1:10
Basic CHO Counting education:
- Effect of CHO on _______
- Primary________ of CHO
- 1 CHO Choice = _____ g of CHO
- Portion sizes
- Label reading
- Amount of total ___ that should be eaten daily
blood glucose
food sources
15
CHO
Advanced CHO Counting education:
- Importance of _________ (food & BG diaries)
- Concept of matching insulin to carbohydrate intake is introduced
- Using individualized insulin-to-CHO ratios
record keeping
Food Lists Developed by the American Diabetes Association & the Academy of Nutrition & Dietetics
- Formerly referred to as ________ lists
- The term “choice” is used to describe a certain
quantity of food within a group of similar foods
- Used to calculate a meal plan=> the number of
______ of food groups to be consumed at each
meal
“exchange”
servings
For individualized meal plans…
First, complete a full nutrition assessment
- Obtain information on the individual’s usual eating habits, lifestyle, food preferences, exercise habits
- Calculate patient’s _____________
- Design a preliminary ________ & _______ with consistent CHO intake and timing of meals
- Encourage patient/client _______
nutritional requirements
meal plan
sample menu
participation
Advantages of Food Lists:
- Beneficial in teaching __________
- Can teach __________ and calorie restriction to promote weight loss
Disadvantages:
- Not as ________ as CHO counting
- Not tailored to actual _________
healthy eating habits
portion control
flexible
BG levels
A _______ is a health professional who possesses comprehensive knowledge of and experience in diabetes prevention, prediabetes, and diabetes management
- The certification exam is provided by the Certification Board for Diabetes Care and education
____ hours woking with diabetes patients
and then take exam
CDCES
1000
Physical activity (PA) should be an integral part of the treatment plan for persons with diabetes
* Benefits: Exercise helps improve insulin sensitivity,
reduce CVD risk factors, assists with weight management, and can improve mood & well-being
* All adults, and particularly those with type 2 DM, should decrease the amount of time spent in sedentary behavior. Prolonged sitting should be interrupted every _____ for BG benefits.
* Individuals should speak with their MD prior to beginning an exercise program
30 min
Most adults with type 1 & type 2 DM should
engage in >______ min of moderate-to-vigorous intensity aerobic activity per week, spread over at least ___ days/wk, with no more than ___ consecutive days without activity
*Shorter durations (minimum 75 min/wk) of
vigorous intensity or interval training may be
sufficient for younger and more physically fit
individuals
*Adults with type 1 & type 2 DM should engage in
2–3 sessions/wk of resistance exercise on
nonconsecutive days
150
3
2
Type 1 DM=> glycemic response varies depending on overall diabetes control, _________ at the start of exercise; timing, intensity, & duration of the exercise; and previous food intake
Type 2 DM=> BG control can improve with PA due to increased ________ resulting in increased peripheral use of glucose not only during but also after the activity
BG and insulin levels
insulin sensitivity
_________ is a potential problem for people taking insulin or insulin secretagogues in exercise
- Occurs due to insulin-enhanced glucose uptake by the exercising muscle
- For individuals with diabetic retinopathy=> vigorous-intensity aerobic or resistance exercise may be contraindicated because of the risk of triggering ______________ or ____________
Hypoglycemia
vitreous hemorrhage or retinal detachment
For moderate-intensity exercise => consume an additional ______ g of CHO for ______ of exercise
- For more strenuous exercise such as 1-2 hours
of basketball, football, soccer, or strenuous
bicycling=> ____ g CHO may be needed
- Monitor BG before, during, & after exercise
- Moderate exercise of <30 min generally does not
require any additional CHO or insulin adjustment,
unless BG <_______ mg/dL, in which case a small snack
may be needed
15
1 hour
30
100
