Level 1 - Nutrition & Exercise (Class 2) Flashcards
DiabetesEd
When are the 5 critical times to provide and modify DSMES?
- At diagnosis
- When not meeting treatment goals.
- Annually (PWD should be coming even when they are doing well).
- When complicating factors develop (medical, physical, psychosocial).
- When transitions in life and care occur.
What the benefits of DSMES? (10 total)
- Improved knowledge
- Lower weight
- Improved QOL
- Reduced mortality
- Positive coping
- Reduced cost
- Only 5-7% of Medicare/insured receive DSMES
- Increased PCP, preventative services
- Less frequent use of acute care and inpatient admission
- More likely to follow best practice recommendations (especially those on Medicare)
What are the objectives of DSMES?
- Support informed decision making
- Promote skill mastery needed for optional self-care
- Consider treatment burden
- Incorporate needs, goals, and life experiences of the individual
- Supports informed decision making, self-care behavior, problem-solving, and active collaboration
How much of socioeconomic factors play in health?
About 40% and DSMES has the ultimate goal of health equity across all populations
What are the two questions that make up the food insecurity screening?
“Within the past 12 months, you worried whether our food would run out before we got money to buy more.”
“Within the past 12 months, the food we bought just didn’t last, and we didn’t have enough money to get more.”
(TRUE or FALSE)
“People eat food, not nutrients, nutrient recommendations needs to be applied to WHAT people eat.”
TRUE
The Standards of Care has been moving away from providing macronutrient recommendations, rather providing eating patterns and nutritional information
What does Medicare cover for MNT?
Initial benefit: 3 hours within the first calendar year (of REFERRAL, not diagnosis)
Annually: 2 hours for follow-up
Additional hours are per provider recommendation
(TRUE or FALSE)
20% of people with diabetes are referred for MNT.
FALSE
ONLY 10%
(TRUE or FALSE)
MNT provided by RDNs can reduce A1c by up to 2%.
TRUE
What are the 4 goals of MNT?
- Support healthful eating patterns
- Maintain pleasure of eating.
- Individualize nutrition case based on:
-personal and cultural preferences
-health literacy
-access to healthful foods
-willingness and ability to make changes
-barriers to change - Provide practical tools for day-to-day healthy meal planning.
(TRUE or FALSE)
The ADA states that there is no ideal percentage of calories from protein, carbs, and fat for PWD.
TRUE
We want to consider personal preferences
We can provide macronutrient distribution based on individualized assessment
What percentage of people develop a vitamin B12 deficiency on metformin?
6-20%
Symptoms are similar to those of neuropathy
What are the fat recommendations for PWD?
The same as the general population:
- Less than 10% saturated fat
- Avoid trans fat
- Less than 300 mg cholesterol daily
- Mediterranean diet reduces CVD events
What is the general fiber recommendation?
For every 1000 calories, aim for 14 grams of fiber
Lowers all cause mortality and reduced risk of T2DM
AR has type 2 diabetes, is on metformin 1000 mg BID, has a BMI of 29.3 and GFR of 62. Most recent A1c is 8.3%. AR wants to lose weight and tells you they are on a low-carb diet. What is the best response?
A. That approach can harm the kidneys.
B. How is that working for you?
C. We recommend 50% of your intake comes from carbs.
D. This meal plan approach is not recommended.
B.
(TRUE or FALSE)
Reducing overall carb intake has demonstrated the most evidence for improved glycemia.
TRUE
Emphasize non-starchy veggies, fruits, whole grains, dairy products, with minimal added sugar
How is a low-carb diet usually defined?
Less than 25% of calories are coming from carbs.
Research showed an improvement in A1c in 6 months, but with diminished results at 12 months.
Who is not appropriate for low-carb diets?
-Pregnant women; or lactating
-Children
-Those with disordered eating or at risk
-Those with renal disease
-Use caution if they are on SGLT-2 inhibitor due to the potential risk for ketoacidosis
For people newly diagnosed with T2DM with an elevated BMI and waist circumference, which best reflects the ADA Standard of Care recommendation?
A. Avoid all desserts and processed foods.
B. >5% weight loss from current body weight may be beneficial
C. Eat less than 7% saturated fats
D. Consume about 30-45 grams of carb at each meal.
B.
What percentage of body weight loss will prevent progression from prediabetes to T2DM?
Greater than 7%
Goal: 7-10% of original body weight
What percentage of body weight loss will improve glucose levels and intermediate CVD risk, in those with T2DM?
3-7%
> 10% loss may lead to remission of T2DM, CVD, and reduced mortality
List some successful weight loss strategies.
1) Weekly self-weighing/tracking
2) Structured programs
3) Eat breakfast
4) Decrease portion size
5) Increase exercise
6) Use meal replacements
7) Eat healthy foods
8) Drink water
9) Adequate sleep
10) GLP and GIP/GLP medications
11) Consider bariatric surgery
Intermittent fasting (no matter which of the 3 methods) has been showed to reduce in how much body weight in a short duration of 8-12 weeks?
3-8%
No significant differences in weight loss when compared with continuous calorie restriction
Longer research studies are needed.
(TRUE or FALSE)
In T1DM, they may need additional or a change in insulin amount for high fat / high protein meals.
TRUE
Based on the exchange list: which of the following food choices equals about 15 grams of carbs? (Multiple correct answers).
A. 1/2 bagel, 4 oz
B. 1 1/4 cup strawberries
C. 1 cup of milk
D. 1/2 cup cooked rice
E. 1 oz trail mix with fruit
B & E
A. 1/2 bagel, 4 oz (30 G)
B. 1 1/4 cup strawberries
C. 1 cup of milk (12 G)
D. 1/2 cup cooked rice (30 G)
E. 1 oz trail mix with fruit
(TRUE or FALSE)
Estimating carb intakes for meals and snacks is part of the ADA Standard.
FALSE
What is the average intake of added sugar per day?
15 to 19 teaspoons
What is the WHO, Dietary Guidelines for America (DGA) and AHA goals for intake of added sugar?
Less than 5 to 10 teaspoons/day
What is the best beverage to encourage?
Water
Sugary and processed foods can displace healthier, more nutrient-dense food choices
What is the stance on non-nutritive sweeteners?
Can be beneficial in reducing overall calorie/carb intake if substituting for sugary beverages
But, overall people are encourage to decrease both sweetened and non-nutritive sweetened beverages
Encourage WATER
A person with diabetes presents with unexplained weight loss, what are the possible causes?
A. Taking less insulin than needed.
B. Disordered eating
C. Finances
D. Poor dentition
E. All of the above
E.
(TRUE or FALSE)
People with diabetes and diagnosable eating disorders have high rates of other psychiatric disorders.
TRUE
What is the most common disordered eating behavior of T1DM?
Not using insulin causing glycosuria to lose weight
What is the most common disordered eating behavior of T2DM?
Bingeing episodes with an accompanying sense of loss of control
If on insulin, intentional omission is also frequently reported
What is diabulimia?
Anyone with insulin-dependent diabetes who omits/restricts insulin as means of weight loss
Tends to start in adolescence, more likely to occur in women than men.
What are the signs of diabulimia?
1) Unexplained hyperglycemia or elevated A1c
2) Weight loss
3) Lack of marks from fingerpriks
4) Lack of prescription refills for meds
5) Records that don’t match A1c
6) Classic ED signs
For treatment: Refer to mental health specialist and team
Which of the following is true about alcohol and diabetes based on ADA Standards?
A. Only white wine decreases blood sugar.
B. Men can have up to 2 drinks and women can have up to 1 drink a day
C. Alcohol increases risk of hyperglycemia.
D. 6 ounces of wine is considered one serving.
B.
5 oz wine = 1 serving
What are the risks of drinking alcohol in diabetes?
1) Hypoglycemia
2) Weight gain
3) Hyperglycemia
4) May worsen neuropathy
About what percentage of people are meeting the exercise goals?
Only 50%
Which of the following are accurate exercise recommendations for people with diabetes?
A. Exercise must be done daily for 30 minutes at a time to be effective
B. Must get stress test before starting am exercise program.
C. Try not to miss more than 2 consecutive days of exercise.
D. C & D
E.
What are the exercise standards for adults?
150 minutes per week of moderate to vigorous intensity
Strength training 2-3x/week
Get up and move every 30 minutes (reduce sedentary time)
Flexibility and balance training for older adults, 2-3x/week (yoga or tai chi) has been shown to reduce falls by 30%
What are the exercise standards for kids?
At least 60 minutes of moderate/vigorous exercise PER DAY
Including bone/muscle strengthening 3x/week
List the ways in which exercise is beneficial.
Exercise alone does not cause weight loss, but it does:
1) Help with weight maintenance
2) Decreases visceral fat
3) Lowers A1c regardless of weight loss
4) Decreases CVD risk
5) Decreases overall mortality risk
Based on race, how are doing with meeting the exercise goals?
People with T2DM who achieved 150 minutes/week:
65% Hispanic
44% White
43% African American
How long after exercise does glucose uptake remain elevated?
24-48 hours depending on exercise duration
It increases up to 5x via both insulin dependent (GLUT-4) and non-insulin dependent channels
What conditions does exercise decrease?
1) Sleep apnea
2) Diabetic kidney disease (retinopathy)
3) Depression
4) Sexual dysfunction
5) Urinary incontinence
6) Knee pain
7) Needs for medications
8) Health care costs
30 minutes of walking can lower glucose levels by how much?
About 30 mg/dL
Estimate: 1 mg/dL with each minute of exercise
What is “Passeggiata?”
Take an after-meal stroll
Benefits:
1) Decrease A1c by 0.7%
2) 48% loss in visceral fat (no change in body weight)
What are some exercise precautions for people with diabetes on insulin?
A. Carry some form of ID on you at all times.
B. Have a snack if BG less than 90 mg/dL.
C. Look for signs of hypo for up to 24 hours after exercise.
D. Carry a snack with you during exercise.
E. All of the above.
E
What symptoms should be discussed with a provider before, or after starting exercise?
1) Chest pain, SOB, reduced exercise tolerance
2) Leg cramps that go away with rest
3) Head, shoulder, neck, and/or back pain
4) Any unexplained pain above the belt line, should be considered cardiac in origin until proven otherwise * (can feel similar to GERD).
How do we prevent hypoglycemia for insulin/secretagogues?
1) Check glucose BEFORE
2) Adjust CHO/insulin prior to planned activity, (if BG < 90, eat 15-30g CHO).
3) Carry carb snack/glucagon kit
4) Extra carb in post-exercise period
5) Caution with alcohol post-exercise
How much additional carb may people need during exercise?
An additional 1.0 to 1.5 g/kg CHO for the duration of the activity
What are 5 behavior change strategies?
1) Prompt focus on past success
2) Barrier ID/problem-solving
3) Use of follow-up prompts
4) Provision of information on where and when to perform the behavior
5) Prompt review of behavioral goals.
