Management of Diabetes & Other Non-Communicable Diseases Flashcards
What are the differences between T1DM and T2DM in symptoms?
T1DM: polyuria, polydipsia, polyphagia
T2DM: may or may not have symptoms; nocturia, eye damage, polydipsia
What 3 things create the “perfect storm” for T2DM?
- obesity
- sedentary lifestyle
- aging population
What group is at highest risk for T2DM
Aboriginals
Why are immigrants at high risk of T2DM?
- adopt westernized lifestyle
What three basic metabolic defects characterize the disease?
- insulin resistance
- an insulin secretory defect that is not autoimmune-mediated
- an increase in glucose production by the liver
- any combo of these; not a homogenous disorder
- incretin pathway may also be involved
What is gestational diabetes?
Glucose intolerance with onset or first recognition during pregnancy; increases risk of T2DM
What is pre-diabetes?
Term for impaired fasting glucose and impaired glucose tolerance place individuals at risk for developing diabetes
What happens through the course of diabetes development?
- insulin resistance and insulin level rises in pre-diabetes
- insulin level then drops in diabetes
- incretin and beta cell function continue to decline
Diabetes can be reversed in the…
First 3 years of diagnosis
How is diabetes managed via lifestyle modification?
- healthy eating
- increasing exercise
- smoking cessation
- stress management
What is problematic with CFG?
- blanket statement for all of Canada
- not individualized
- doesn’t consider other cultural foods
What are the 6 recommendations for nutritional management of diabetes?
- Nutrition counselling by a Registered Dietitian
- Encouraged to follow CFG (aim for balance, timing, and spacing of meals)
- Choose low glycemic index carbohydrates
- Sucrose and sucrose-containing foods can be substituted for other carbohydrates (max. of 10% of total daily energy)
- Consume < 7% of total daily energy from saturated fats and should limit intake of trans fatty acids
- Other dietary patterns –Mediterranean & Vegan
What is mediterranean diet pattern?
- more nuts, fruits, veg, less animal protein, whole grains, fish, yogurt, legumes, alcohol in moderation
- cardioprotective
How should a dinner plate be divided by food group?
- half should be vegetables
- quarter is starch
- quarter is protein
Non-oil seed pulses such as chickpeas and beans have…
A glycemic benefit
What are recommendations for exercise management of diabetes?
- 150 minutes of aerobic exercise per week, spread over 3 days
- resistance exercise at least 2 times per week (with supervision)
- people with possible CVD or microvascular complications should be assessed if undertaking exercise greater than brisk walking
- limit sitting for prolonged periods
Why is smoking cessation important for diabetes?
- independent risk factor for all-cause mortality
- increases risk of MI, stroke, and progression to end-stage CKD
- should offer resources to quit
Why is stress management important for diabetes and how is it assessed?
- stress is a precursor to T2DM and increases hyperglycaemia
- should be screened routinely for subclinical psychological distress (depressive and anxious symptoms) and psychiatric disorders
- interview or standardized questionnaires
- should offer stress management strategies, coping skills training, behavioural therapy, family therapy, case management and/or pharmacotherapy if required
How is diabetes prevented?
- structured lifestyle modification including moderate weight loss (5%), regular physical activity, dietary modification
- needs to be intensive, clients met with once a week
- effective at reducing risk in some
People with T2DM often live with…
Multiple chronic conditions due to lifestyle choices
What denotes pre-diabetes?
Anyone with impaired fasting glucose (6.1-6.9 mmol/L) or impaired glucose tolerance (7.8-11 mmol/L)
What are the criteria for metabolic syndrome?
Any 3 of:
- Prediabetes/diabetes
- BP > 130/85 mm/Hg
- TG > 1.7 mmol/L
- HDL < 1.0 mmol/L (men); 1.3 (women)
- Abdominal obesity > 102 cm (men); 88 (women)
When are people often diagnosed with T2DM>
- post MI because high glucose levels are seen
What factors increase risk for non-communicable disease?
- tobacco use
- unhealthy diet
- physical activity
- harmful use of alcohol
- stress
How are NCDs prevented?
- lifestyle!
- healthy eating: sodium restriction, high fibre
- physical activity: weight loss, cardio/ weight training
- smoking cessation
- stress management
- alcohol moderation
How are genetic implicated in diabetes research?
- studying genome provides organism’s hereditary information
- genome wide association studies (GWAS) being led to determine CV and metabolic phenotypes in humans
How is environment implicated in diabetes research?
- built environment: studying our environment geographically, such as urbanization, walkability, bike friendly cities, etc.
- chemical environment: studying the chemicals that are disrupting our endocrine system (mimic estrogens) known as obesogens
What are obesogens?
- chemicals that cause DNA to be expressed differently (not mutated)
- occurs as early as in utero
- ex, nicotine, DEHP, tributyltin
