Exam 3 - Diabetes MNT

Question 1

Benefits and considerations for physical activity in regards to diabetes?

Answer 1

• Improved insulin sensitivity for those not insulin dependent
• Potential hypoglycemia - Test blood prior to exercise
• Potential hyperglycemia if intense - Counter-regulatory hormones
• Carbohydrate Guidelines:
  15 g CHO/30 - 60 min activity
  Not necessary if less than 30 min
  If <100 mg/dL prior

Question 2

Diet Goals for T1DM and T2DM

Answer 2

• Diet - Address individual needs (Growth/development, Pregnancy, Older adults, Cultural preferences)
• Promote and support healthful eating pattern
• Maintain pleasure of eating
• Provide practical day-day tools

Question 3

MNT goals for type 1 and 2 diabetes

Answer 3

• Individualize energy needs and nutrition care based on metabolic profile, treatment goals, and changes person is willing and able to make
• Glucose control
• Lipid/lipoprotein control
• Blood pressure control
• Help prevent or delay chronic complications

Question 4

Lipid and blood pressure goals

Answer 4

• Lipids: statin therapy if 40 years or older with elevated lipoprotein markers
• HDL cholesterol: > 40 men, > 50 women
• trglycerides < 150 mg/dl
• blood pressure individualized based on CVD risk

Question 5

Diabetes and carbohydrates

Answer 5

• Follow a DASH or Mediterranean Style Diet: Understand the types, Focus on minimal processed and refined carbs, Include Fiber, Consistency is key
• Insulin pre-meal or pump – time CHO intake to Insulin and focus on ration
• bottom end of CHO recommendation is 40% for low carb - Carbs are still important even with diabetes!!

Question 6

Diabetes and sweeteners

Answer 6

• Sugar ok if counted, never alone
• Fructose – large amounts increase TG
• Sugar alcohols - sometimes cause GI upset
• Non-nutritive sweeteners – new guidelines to encourage patients to drink water

Question 7

Diabetes and other macronutrients (protein, fat, alcohol)

Answer 7

• Protein:15-20% kcal, Lean
• Fat: Omega-3s, Focus on Monounsaturated
• Alcohol: With food, Can cause hypoglycemia, especially with sulfonylureas and meglitinides (Prandin), Limit or eliminate if pt has HTN and other CVD risk factors

Question 8

What is the best diet for a patient with diabetes?

Answer 8

• Always individualize
• Diet history to determine patterns, schedules
• Label reading, focus on complex carbs
• Feedback with SMBG

Question 9

MNT for Gestational Diabetes

Answer 9

• Initiate within one week of diagnosis
• Minimum of three visits
• Consume adequate calories to promote appropriate weight gain
• Minimum of 175 grams carb per day
• Total carb less than 45% of total energy
• Recommend BG monitoring and ketone testing
• Additional recs from RDs in practice: No fruit juice (concentrated form of glucose), no milk with breakfast (any milk), no fruit with breakfast, always pair CHO with fat & protein, spread meals out throughout day 3 meals and 3 snacks, eat every 3 hours, keep detailed food records, ketone testing every day, no sweets

GD is not a time for low carb diet, CHO is a huge energy source for baby