Exercise and Nutrition Flashcards
What are some benefits of exercise related to diabetes
- improve glycemic control
- decrease insulin resistance
- limit neuropathy
- Lower A1C
What type of exercise causes a decrease in BG vs an increase? Why?
mild to moderate = dec BG
- due to inc glucose usage and inc insulin sensitivity (up to 48 hours)
intensive activity like sports or marathon = inc BG
- due to inc hepatic glucose production
What pre-exercise assessment for conditions do you look for that can predispose a patient to injury
- Neuropathy (anutonomic and peripheral)
- Retinopathy
- Coronary artery disease – Resting ECG and exercise stress test
- Peripheral arterial disease
What is the pre-exercise assessment for risk of hypoglycemia
If BG is less than 5.0 mmol/L = 10-20g CHO before activity
If type 1 diabetes, either prophylactic decrease insulin dose or inc CHO intake
- 10-15g additional CHO/hr for moderate intensity
- 30-60g additional CHO/hr for intensive exercise
What is the pre-exercise assessment for risk of hyperglycemia
if BG over 16.7 mmol/L = ensure adequate hydration and monitor for signs of dehydration
if BG over 16.7 & feels ill = test for ketones
- if elevated, avoid physical activity
Is exercise beneficial in type 1 diabetes and type 2?
Educate that exercise is really only beneficial for glycemic control in T2DM
For T1, it will help reduce other comorbidities (bones, muscle, cardio)
How much can nutrition therapy reduce A1C by?
1-2%
What other effects can nutrition therapy have?
- Glycemic lowering effect
- Blood pressure lowering effect
- Improvement in lipid profile
- Weight management
What should you look out for in nutrition for type 1 vs type 2 diabetes
Type 1: encourage matching of insulin to CHO intake
Type 2: Know alternative dietary patterns
What is the minimum carbs for brain to function
130g/day
What is the % total energy of the 3 main macronutrient CHO, Protein, Fat
CHO
- 45-60%
Protein
15-20% or 1-1.5g/kg
Fat: 20-35%
How much calories per gram is in each macronutrient?
CHO
Protein
Fat
CHO: 4cal/g
Protein: 4cal/g
Fat: 9cal/g
What is the handy portion guide control for the following:
Grains and starches/fruits/milk
Vegetables
Meat alternatives
Fat
Grains and starches/fruits/milk: fist
Vegetables: 2 hands, as much as possible
Meat & alternatives: palm of hand
Fat: size of the tip of your thumb
Mediterranean diet
A1C
CV benefit
Other advantages
Disadvantages
A1C dec
CV benefit: dec CVD
Other advantages:
- Dec retinopathy, BP, CRP
- Inc HDL
Disadvantages: none
Vegetarian diet
A1C
CV benefit
Other advantages
Disadvantages
A1C: dec
CV benefit: dec CHD (coronary heart disease)
Other advantages: Dec weight, LDL
Disadvantages: Dec vitamin B12 levels
DASH diet
A1C
CV benefit
Other advantages
Disadvantages
A1C: dec
CV benefit: dec CHD
Other advantages: dec weight, LDL, BP, CRP
Disadvantages: none
Portfolio diet
A1C
CV benefit
Other advantages
Disadvantages
A1C: none
CV benefit: dec CVD
Other advantages: Dec LDL, CRP, BP
Disadvantages: none
How would you read a nutritional label
- Always convert to G
- Subtract Fibre from CHO
- DV 15%+ = a lot
- DV < 5% = a little
How much G of fibre should you have in a day?
30-50g dietary fibre
at least 1/3 from viscous soluble fibre
- delay gastric empty, dec PPG, dec LDL
- oats, barley, psyllium, beans, chickpeas, peas, apples/berries/citrus fruit
Define low glycemic index carbs
Foods that spike the blood sugar less and maintain satiety for longer
What kind of fats should diabetics use?
Choose healthy fats AVOID trans-fatty acids
Decrease saturated fatty acids to <9% of energy intake
**replace with POLYunsaturated fatty acids
eg. nuts, canola oil, soybean oil, flaxseed
MONOunsaturated extra virgin olive oil, avocados, whole grains, or low Gi-carbohydrates
What is the benefit of weight loss
Improved insulin sensitivity
glycemic control
blood pressure control
lipid levels
What is the recommendation for alcohol in people with diabetes and without for men and women
Same
Women: 2 standard drinks per day or <10 per week
Men: 3 standard drinks per day or <15 per week
What effect does alcohol have on patients using insulin?
Alcohol may DELAY hypoglycemia up to 24 hours when consumed 2-3 hours after an evening meal
- hypo can occur the next morning
- inhibits gluconeogenesis
