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(C) Nutrition > Lecture 7: Intro to DM > Flashcards

Lecture 7: Intro to DM Flashcards

1
Q

What tests are used to test for DM?

A

HbA1c > 6.5%
Fasting BG > 126

2-hour Oral glucose tolerance test (OGTT) > 200

Random plasma glucose > 200 (if htn crisis)

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2
Q

How common is T1DM?

A

10% of all US adults.

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3
Q

What is the pathophysiology of T1DM?

A

Destruction of beta cells = no insulin production.

Often caused by autoimmune disease.

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4
Q

What is the pathophysiology of T2DM?

A

Insulin resistance.

Multifactorial, more dependent on diet and lifestyle.

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5
Q

What is the treatment of T1DM and T2DM?

A

T1DM must get insulin.

T2DM may get insulin.

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6
Q

How common is T2DM?

A

90% of adult DM Dx.

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7
Q

What is T3DM?

A

Alzheimer’s

Not actually diabetes

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8
Q

Why is Alzheimer’s related to DM?

A

Chronic insulin resistance and insulin insufficiency may play a role.

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9
Q

What counts as prediabetes?

A

Impaired fasting BG of 100-125
Impaired glucose tolerance of 140-199
Elevated HbA1c 5.7-6.4%

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10
Q

What is gestational DM?

A

DM that occurs during pregnancy that resolves after birth.

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11
Q

What are the general goals of DM and pre-DM management?

A

Maintain a normal or near-normal serum glucose level.

Prevent or reverse LIPID abnormalities

Prevent or delay complications.

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12
Q

What is glycemic control?

A

Controlling BG regardless of DM type.

T1 still need insulin, but can benefit from lifestyle modifications.

T2 can potentially be treated from just lifestyle modifications.

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13
Q

What are some general interventions one can make for DM management?

A

Healthy eating pattern, focusing on high fiber, medi style, low carbs, more plant-based.

Weight loss (Esp truncoabdominal fat loss)
Bariatric surgery (can boost glycemic control)

Avoid tobacco (worsens insulin resistance)

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14
Q

How little weight loss can start having benefits for DM?

A

5-10%

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15
Q

What is the macro distribution for DM?

A

No actual set.

Recommended:
Carbs/high fiber: 30g/day
Fats: focused on MUFA and PUFA
Protein: 0.8g/kg/day

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16
Q

What fats are associated with worse DM outcomes?

A

Saturated and trans fats

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17
Q

In what kind of patient is excess protein dangerous?

A

CKD (stages 3-4)

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18
Q

What protein type is recommended for DM pts?

A

Plant based

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19
Q

What is the general consensus about macros?

A

Excess carbs = obesity.

No RCTs have supported that statement. Carbs are not less healthy than fats/proteins.

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20
Q

Is a Keto diet good for DM? What are the pros and cons?

A

Pros:
Fast initial weight loss
Early improvements in BG

Cons:
Keto flu
Long-term compliance

Overall: no major differences in glycemic control after 1 year.

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21
Q

What is the best diet for a DM pt?

A

The one they are compliant with and adhere to.

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22
Q

What is more important between eating healthy foods and eating macros?

A

Eating healthy foods is best since it sustains better gut flora and is more sustainable.

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23
Q

What resources are available for DM pts to make diets?

A

Plate methods
Diabetic recipes
Diet exchange lists

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24
Q

When are diet exchange lists especially useful?

A

Pts counting carbs/reliant on insulin.

1 unit of rapid-acting insulin = 12-15g of carbs.

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25
Q

What is considered high glycemic index (GI) and low GI?

A

High GI is 70+

Low GI is 55-

26
Q

What does it mean when something has a high GI?

A

It causes a rapid rise in BG followed by a rapid drop in BG.

27
Q

What is the difference between glycemic index and glycemic load?

A

GI is the quality of a carb.

GL is the quality of a carb relative to how much you normally eat.

EX: Watermelon has high GI but low GL since you don’t actually eat a lot of it at once.

28
Q

What are the benefits of nuts?

A

Low carb, high MUFA, high PUFA.
Filling.

Associated with lower CVD risk.
Associated with preventing DM.

29
Q

What have nuts not been shown to do?

A

Improving glycemic control in existing DM pts.

30
Q

Are nuts recommended for pts with DM or at risk?

A

Yes.

Additions as a diet is mainly to prevent CVD risk.
Must be careful because nuts are nutrient and calorie dense.

31
Q

How does ETOH affect DM?

A

Interferes with hepatic gluconeogenesis.

Drinking ETOH without food increases the risk of hypoglycemia.

It is especially dangerous with DM pts taking insulin or drugs that stimulate insulin release.

32
Q

What is excessive ETOH intake associated with?

A

Elevated TG
Worse BG control.

33
Q

What is the recommendation in regards to ETOH for DM pts?

A

Consume in moderation WITH FOOD or abstain.

34
Q

How does caffeine relate to DM?

A

Protective effect (potentially…)

Caffeine has been shown to cause higher BG and insulin levels and decreased insulin sensitivity in T2DM pts.

Long-term abstinence may lower HbA1c.

35
Q

What is the recommendation for caffeine with DM?

A

Recommended to consume in moderation or to abstain.

Be mindful of additives.

36
Q

What does chromium do with DM?

A

Insulin cofactor that MAYBE helps stimulate insulin receptors so we clear out our BG.

No benefit in normal pts.

Most benefit potentially in poorly controlled T2DM.

Supplementation is safe.

37
Q

What does Vanadium do with DM?

A

Insulin cofactor with narrow TI.

GI upset in all studies.

Not really recommended.

38
Q

What is fish oil normally used for?

A

Treating elevated TGs.

39
Q

What does fish oil do with DM?

A

Can lower TG but no effect on glycemic control.
Modest elevation of LDL.

40
Q

What is the recommendation for taking fish oil for DM?

A

Not recommended for prevention or treatment.

Only recommended for management of TGs.

41
Q

What does chocolate do with DM?

A

Cacao and bioflavinoids are antioxidants.
No guideline or clear benefits.

42
Q

What is the recommendation for taking chocolate for DM?

A

Recommended to consume in small amounts, still healthier than other forms of chocolate.

43
Q

What does cinnamon do with DM?

A

Reported to lower BG.

No confirmed benefit.

44
Q

What is the recommendation for taking cinnamon for DM?

A

Supplementation probably minimally harmful, but not likely to help and not replacement for medical treatment.

45
Q

What is the difference between white sugar and brown sugar?

A

White sugar is purified and refined sucrose.
(Glucose + fructose)

Brown sugar is less refined. It contains the molasses from grinding down sugar cane.

MORE calories per volume but less calories by weight.
Minimal amts of calcium, iron, and potassium. (from the sugar cane)

Minimal nutritional differences!

46
Q

What is unique about fructose?

A

Does not require insulin.

Our liver takes it and turns it into TGs.

47
Q

Where is fructose found?

A

Fruit sugar, aka sucrose, honey, fruit, and corn.

48
Q

What is high-fructose corn syrup?

A

Sweetener due to low cost.

Adds a lot of sugar to diets.

49
Q

What is the con of high-fructose corn syrup?

A

It gets added to everything.

Not solely because it has fructose.

50
Q

What is the recommendation for natural caloric sweeteners for DM pts?

A

Use is acceptable but limited.

Still has sugar in it.

51
Q

What are natural caloric sweeteners?

A

Honey
Monkfruit
Maple syrup
Agave

52
Q

What are polyols?

A

Sugar alcohols, used as low-calorie sweeteners.

53
Q

What are the polyols?

A

Xylitol
Erythritol
Sorbitol
Mannitol
Isomalt
Lactitol

54
Q

What are the risks of the polyols/sugar alcohols?

A

GI symptoms in excess ingestion.
Higher risk of CV events.

55
Q

What polyols cause FDA-mandated warnings of laxative effects in excess?

A

Sorbitol and mannitol

56
Q

What polyol is associated with increased thromboses?

A

Erythritol

57
Q

What are non-nutritive sweeteners?

A

Artificial sweeteners with a higher-intensity than sucrose.
Must be approved by FDA.

58
Q

What is the consensus on NNS?

A

Beneficial for DM pts that are having trouble limiting their sugary food/drink intake.
Generally seen as less harmful.

59
Q

What is the concern with long-term NNS use?

A

Displacement of calories/sugar may cause a person to still love sugary foods and encourage their preference for sweet foods.

May kill gut flora
Patients might make up the calories anyways.

60
Q

What is the sweetest sweetener in existence?

A

Advantame

(C) Nutrition (12 decks)

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