Medical Nutrition Therapy - E. Endocrine & Metabolic Disorders (p. 15-20) Flashcards
Type 1 DM is insulin _______.
Insulin dependent. Depends on exogenous insulin.
Type 2 DM is insulin ________.
Resistance May need insulin.
*Normal Blood Glucose level:
*Casual: 70-100 mg/dL *2 hr post-prandial:
Indicative of Diabetes- *Fasting Plasma Glucose (FPG):
*FPG: >126 mg/dL
Indicative of Diabetes- *Glucose tolerance test (GTT):
*GTT: >200 mg/dL
Indicative of Diabetes- *Symptoms of DM + casual glucose >__ mg/dL
*Symptoms of DM + casual glucose >200 mg/dL
Indicative of Diabetes- *HgA1C:
*HgA1C: >6.5%
In the GTT, a patient without diabetes will present with a _______ curve.
*SLOPED
In the GTT, a diabetic patient will present with a _________ curve.
*ROUNDED
Glycosylated Hemoglobin (HGA1C) measures the % of ______ that is carrying ______. It is a measure of long-term blood glucose control over 2-3 months.
HGBA1C measures the % of hemoglobin that is carrying insulin.
Normal HGBA1C: Goal for diabetics:
Normal HGBA1C:
The goal for all diabetics is to maintain normal blood glucose. Pre-prandial: __-___ Post-prandial:
Pre-prandial: 70-130 Post-prandial:
For Type 1 DM, ________ CHO is recommended if doing fixed daily doses of ____. Integrate insulin therapy with usual eating habits. Monitor _______ and adjust ______ doses for amount of food eaten. For exercise, reduction in insulin dosage may be the best choice.
Consistent CHO if doing fixed doses of insulin Monitor glucose and adjust insulin doses for food eaten.
Risk factors for gestational diabetes include: 1. 2.
BMI >30 History of GDM
GDM usually develops (and is tested for) at 24-28 weeks gestation by a _____ _____ _____. Blood glucose will most likely return to normal following delivery, but with an increased risk for developing ____ ____ _____, which women will need to be tested for regularly.
Glucose tolerance test Increased risk for developing Type 2 DM.
GDM increases risk of ______ ______ (large for gestational age) and fetal _________ at birth.
GDM increases risk for fetal macrosemia (large baby) and fetal hypoglycemia at birth.
The ______ _____ compares the blood glucose response of a food to a standard load of glucose. Glucose = 100. Foods with ____ index produce greater satiety.
Glycemic index Foods with low index produce greater satiety.
Carbohydrate counting 1 CHO serving = __ g CHO
15 g
Rapid-Acting insulin Onset: Duration:
Rapid-Acting insulin Onset: 5-15 min Duration: 4 hrs
Short-Acting Insulin Onset: Duration:
Short-Acting Insulin Onset: 30-45 min Duration: 3-6 hrs
Intermediate-Acting Insulin Onset: Duration:
Intermediate-Acting Insulin Onset: 2-4 hrs Duration: 10-16 hrs
Long-Acting Insulin Onset: Duration:
Long-Acting Insulin Onset: 2-4 hrs Duration: 20-24 hrs
This oral glucose-lowering medication PROMOTES INSULIN SECRETION.
GLUCOTROL
This oral glucose-lowering medication ENHANCES INSULIN ACTION. Also suppresses hepatic glucose production.
GLUCOPAHGE (metformin)
**The increase in early morning blood glucose due to increased hepatic production after overnight fast. Usually happens between 2 and 8 AM
Dawn phenomenon
A complication of uncontrolled diabetes - hyperglycemia due to lack of insulin (insulin deficiency).
Ketoacidosis
**Symptoms of DKA include: -Polyuria (leading to ______) -Increased _______ (respiratory compensation-inc respiration to inc CO2 excretion) -Fruity odor on breath (_________)
Symptoms of DKA include: Polyuria (leading to dehydration) -Increased pulse (respiratory compensation-inc respiration to inc CO2 excretion) -Fruity odor on breath (ketones)
**Treatment of DKA includes:
Insulin therapy, rehydration (electrolyte replacement)
Abnormally low blood glucose due to excess insulin or lack of food. (in DM) Symptoms include slow pulse, clammy skin, hunger, weak)
Acute Hypoglycemia
**Treatment of HYPOGLYCEMIA begins with __ g CHO from glucose tablets, ______, ______. Wait 15 minutes, and check again. If still
Treatment of hypoglycemia begins with 15 g CHO from glucose tablets, fruit juice, sugar. Wait 15 minutes, and check again. If still
The 3 LONG-TERM effects of uncontrolled diabetes include:
Neuropathy (peripheral and autonomic ie. gastroparesis) Retinopathy (leads to blindess) Nephropathy (leads to decreased kidney function)
Condition caused by overstimulation of the pancreas or increased insulin sensitivity. BG falls below normal (
Postprandial or Reactive hypoglycemia
**The goal in postprandial or reactive hypoglycemia is to prevent marked ____ in BG that would stimulate more ______.
The goal in postprandial or reactive hypoglycemia is to prevent marked RISE in BG that would stimulate more INSULIN.
**Postprandial/Reactive hypoglycemia diet therapy: Avoid ____ sugars _____, _____ meals Consistent ___ intake
Postprandial/Reactive hypoglycemia diet therapy: Avoid simple sugars Small, frequent meals Consistent CHO intake
Adrenal cortex insufficiency, or ________ disease, is characterized by a deficiency of _______ ______.
Addison’s disease Adrenal hormone deficiency
Adrenal hormones include: __________ (stimulates gluconeogenesis, inhibits insulin, SO INC BG - in its absence, BG is DEC) __________ (increases reabsorption of fluid and ions by the kidney - in its absence, increased losses) __________ (influences body composition)
CORTISOL: (stimulates gluconeogenesis, inhibits insulin, SO INC BG - in its absence, BG is DEC) ALDOSTERONE: (increases reabsorption of fluid and ions by the kidney - in its absence, increased losses) ANDROGEN: (influences body composition)
Symptoms of adrenal cortex insufficiency (Addison’s disease), due to absence of adrenal hormones include:
Hypoglycemia Sodium loss, dehydration Tissue wasting, weight loss
The primary therapy for Addison’s disease is:
Hormone replacement
Condition characterized by EXCESS secretion of thyroid hormone. T3 and T4 are ELEVATED. Increased BMR–>weight loss.
HYPERthyroidism
Condition characterized by DEFICIENCY of thyroid hormone. T3 low/normal ; T4 is LOW. Decreased BMR–>weight gain.
HYPOthyroidism
Enlargement of the thyroid gland due to insufficient thyroid hormone.
Goiter
Type of goiter (enlargement of the thyroid gland) due to inadequate iodine intake. IODINE is essential for the production of THYROID HORMONE.
Endemic goiter
Disorder of PURINE metabolism, leading to increased serum URIC ACID. Uric acid deposits in joints–>pain, swelling
GOUT
Gout diet therapy: Avoid high ____ foods (organ meats, sweetbreads, anchovies, sardines, herring, mackerel, scallops, beer) However, low _____ diet may not be effective because the body produces it.
Purine (organ meats, sweetbreads, anchovies, sardines, herring, mackerel, scallops, beer)
An inborn error of metabolism characterized by missing the enzyme that would have converted GALACTOSE–>GLUCOSE.
Galactosemia
Galactosemia is treated solely by ____.
DIET. Galactose and Lactose free No organ meats, milk/milk product
_____ cycle defects: Inborn error of metabolism characterized by the inability to synthesize urea from ammonia –> ammonia accumulation.
Urea cycle defects Symptoms: vomiting, anorexia, lethargy, seizures, coma
Diet therapy for urea cycle defects: ___________ restriction BASED ON TOLERANCE. (Restriction to reduce ammonia buildup)
Protein restriction based on tolerance
Inborn error of metabolism characterized by missing the enzyme PHENYLALANINE HYDROXYLASE, which converts PHENYLALANINE –> TYROSINE. Phenylalanine accumulates.
Phenylketonuria (PKU)
Diet therapy for PKU: Restrict __________. Supplement _______.
Restrict PHENYLALANINE. Supplement TYROSINE.
Sources of ___________: Dairy Eggs Meat, poultry, fish Nuts Beans **ASPARTAME (ie. Equal-very high in PHE)
Phenylalanine
Children with PKU have a higher incidence of ________ _______ due to HIGH CHO, LOW PTN intake.
Dental caries
Inborn error of metabolism where there is a deficiency of GLUCOSE-6-PHOSPHATASE in the liver, so the liver cannot convert GLYCOGEN–>GLUCOSE. Impairs glycogenolysis–>Hypoglycemia
Glycogen storage disease
Diet therapy for glycogen storage disease: Provide consistent supply of _____ _____ with CORNSTARCH (exerts a lower and delayed BG peak). High ___, Low Fat
Diet therapy for glycogen storage disease: Provide consistent supply of EXOGENOUS GLUCOSE with regular intervals of CORNSTARCH (exerts a lower and delayed BG peak). High CHO, Low Fat
Inherited disorder of amino acid metabolism.
Homocystinurias
Homocystinuria is characterized by severe elevations in ________ and ________, and excess excretion of _________ in urine.
Homoecystinuria is characterized by severe elevations in METHIONINE and HOMOECYSTEINE, and excess excretion of HOMOCYSTEINE in urine.
Homocystinuria associated with low levels of vitamin __, vitamin __ and _____. **Treatment is to provide HIGH levels of these 3 nutrients. If they don’t respond - low protein, low methionine diet
Homocystinuria associated with low levels of B6, B12 and FOLATE. **Treatment is to provide HIGH levels of these 3 nutrients. If they don’t respond - low protein, low methionine diet
Inborn error of metabolism of the BCAAs (leucine, isoleucine, and valine). Poor sucking reflex, anorexia, FTT, sweet burnt maple syrup odor of sweat and urine
Maple Syrup Urine Disease (MSUD)
Diet therapy for MSUD: Restrict _____ Provide adequate energy from ___ and ___ to spare ___.
Diet therapy for MSUD: Restrict BCAA Provide adequate energy from CHO and FAT to spare AA (PTN).
