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Medical Nutrition Therapy > DM MNT > Flashcards

DM MNT Flashcards

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USMLE® Step 1 flashcards
1
Q

The goal of MNT is to assist persons in
making __________ behavior changes to
improve overall DM management and health
status

A

self-directed

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2
Q

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

A

body weight
glycemic, BP, & lipid
complications

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3
Q

glycemic targets for adults with DM

preprandial capillary plasma glucose
peak postprandial capillary plasma glucose
A1C

A

80-130
<180
<7%

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4
Q

Action of insulin is _________- promotes the
______ of nutrients and prevents the
_______ of nutrients

A

anabolic
storage
breakdown

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5
Q

CHO
insulin facilitates

A

Entry of glucose into the cells
Glycogen synthesis in the liver & muscles
Increases triglyceride stores

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6
Q

CHO
without insulin

A

Hyperglycemia occurs
Liver & muscle glycogenolysis occurs
Glucose production by the liver increases

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7
Q

Protein
with insulin

A

Incorporation of amino acids into tissue
protein

Decreases gluconeogenesis

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8
Q

protein
without insulin

A

Gluconeogenesis occurs and proteolysis
occurs in muscles

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9
Q

fat
with insulin

A

*Lipogenesis by activating lipoprotein lipase
*Inhibits lipolysis

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10
Q

fat
without insulin

A

*Lipolysis & fatty acid release occurs rapidly
- Leads to an excessive production of ketones

*Serum TG increases secondary to a decrease in
cellular uptake

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11
Q

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

A

5%

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12
Q

DRI Acceptable Macronutrient Ranges:

A

45-65% CHO
20-35% fat
10-35% protein

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13
Q

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

A

0.8
1.0-1.2
20%
1.3

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14
Q

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

A

CHO

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15
Q

starchiest veggies

A

potatoes
corn
peas

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16
Q

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

A

TOTAL amount
source

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17
Q

________-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

A

Sucrose

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18
Q

___________ 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

A

sugar substitutes

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19
Q

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 ______

A

100

50 mg/kg

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20
Q

Saccharin (__________)
Aspartame (_________)
Sucralose (_______)
Acesulfame K (____________)
Stevia (________)

A

Sweet’N Low
NutraSweet
Splenda
Sweet One & Sunett
Truvia

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21
Q

________ is unknown if safe during pregnancy
people with PKU cannot consume ____________

A

saccharin
aspartame

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22
Q

Sugar alcohols examples

A

erythritol
sorbitol
xylitol

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23
Q

Sugar alcohols are ________________ by the body
*_______ kcal/g
*Intestinal side effects can limit usefulness=> gas, bloating, diarrhea

A

partially absorbed
1.5- 2.5

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24
Q

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

A

slow CHO absorption
50
LDL-cholesterol

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25
Q
  • 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
A

more
PUFA & MUFA
omega-3
supplements
Mediterranean-style

26
Q

Reduce sodium intake to <_______ mg/d

*For individuals with both DM & HTN=> further
reduction may be indicated

A

2300

27
Q

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

A

gluconeogenesis
hypoglycemia

28
Q

1 drink =
___ oz beer
___ oz of wine
___ oz of distilled spirits

A

12
5
1.5

29
Q

1.5 oz distilled spirits
5 oz dry, red, or white wine
12 oz beer

A

100 kcal, 0 CHO choices

100-125 kcal, 0 CHO choices

regular 150 kcal, 1 CHO choice
light 100 kcal, 0.5 choice

30
Q

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

A

without deficiencies
antioxidants
vitamin B 12

31
Q

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

A

non-starchy vegetables
added sugars & refined grains
whole foods

32
Q

collect lab data including ___________________________________

A

A1C
FPG
fasting lipid profile
urinary albumin (DKD)
Cr
BUN

33
Q

Factors that may increase BG levels

A

trauma and stress (physical or mental)
corticosteroids or diuretics
various diseases - Cushing syndrome
excessive kcal or CHO intake

34
Q

Factors that decrease BG levels

A

insulin or insulin secretagogues
physical activity
poor intake
ETOH consumption
extensive liver disease

35
Q

2 phases of self management education

A

initial education
in depth continuing education

36
Q

initial education of self management included ________
some examples ?

A

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

37
Q

in depth continuing education for self management includes ___________________

examples?

A

management skills needed to make decisions to achieve goals and foster self care

CHO counting or meal planning
label reading
exercise guidelines

38
Q

initial education should be ______ encounters during the _________

follow up should be ____ encounter _______ to _______

A

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

39
Q

For meal planning, emphasize goal of achieving __________ by ____________________

use _____ monitoring, ______ records, and _______ records

A

glycemic targets
balancing food, medications and exercise

BG
food
excercise

40
Q

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

A

CHO counting

CHO intake

41
Q

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

A

CHO intake

Consistent CHO intake and mealtimes

42
Q

Several approaches are available including:
*_____ counting
*_________ for Diabetes
*For those with health literacy concerns=>
_______ method, portion control and healthy eating tips

A

CHO
Food lists
MyPlate

43
Q

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

A

CHO intake
available insulin

44
Q

CHO counting Advantages:
- Offers greater_______ in food choices
- Allows for better control of_____

Disadvantage:
- By itself, it doesn’t teach __________
- Requires more _________________

A

flexibility
BG

healthy eating habits
self-monitoring & decision making

45
Q

Determine patient/client’s total daily calorie needs
- Distribute amongst macronutrients
- will be dependent on individual patient goals
- Determine total _________ needed per day

A

grams of CHO

46
Q

Convert the number of grams of CHO recommended per day into the ____________
- Distribute grams of CHO _______ for meals

A

number of carbohydrate choices
equally

47
Q

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

A

insulin
insulin
bolus

48
Q

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

A

Certified Diabetes Care & Education Specialist (CDCES)
1 unit of rapid-acting insulin
10-15 grams

49
Q

simple/basic method. of calculating insulin to CHO ratio

Example : 50 units of insulin per day

A

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

50
Q

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

A

blood glucose
food sources
15
CHO

51
Q

Advanced CHO Counting education:
- Importance of _________ (food & BG diaries)
- Concept of matching insulin to carbohydrate intake is introduced
- Using individualized insulin-to-CHO ratios

A

record keeping

52
Q

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

A

“exchange”
servings

53
Q

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 _______

A

nutritional requirements
meal plan
sample menu
participation

54
Q

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 _________

A

healthy eating habits
portion control
flexible
BG levels

55
Q

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

A

CDCES
1000

56
Q

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

A

30 min

57
Q

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

A

150
3
2

58
Q

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

A

BG and insulin levels

insulin sensitivity

59
Q

_________ 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 ____________

A

Hypoglycemia
vitreous hemorrhage or retinal detachment

60
Q

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

A

15
1 hour
30
100

Medical Nutrition Therapy (12 decks)

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