Medical Nutrition Therapy in Diabetes Mellitus Flashcards
What is diabetes self-management?
recognizing that people are responsible for the day-to-day decision that influence their disease, supporting behaviors that promote effective self-management
effective management requires proper use of multiple technologies, complex treatment strategies and problem-solving skills
important to deliver education and training at to patients that are prepared and competent
What are the 5 steps in diabetes self management?
assessment, goal setting, planning, implementation and evaluation
Lifestyle optimization requires DSME/T in these self-care behaviors.
healthy eating being active monitoring (blood glucose) taking medication problem solving healthy coping reducing risks
Define medical nutrition therapy.
MNT is healthy eating education performed by a registered dietitian
Lifestyle optimization requires DSME/T in these self-care behaviors.
healthy eating being active monitoring (blood glucose) taking medication problem solving healthy coping reducing risks
note diabetes self management training usually occurs in group setting (up to 10h in the first year and additional 2 hrs in subsequent years)
Define medical nutrition therapy.
MNT is healthy eating education performed by a registered dietitian (focusing on assessment, goals, intervention and evaluation)
MNT is most effected at the time of diagnosis, 1% decrease in newly diagnosed DM1 and 2% in DM3; blood lipid concentrations and blood pressure decreases also observed
How do patients get access to MNT consoling?
consists of a series of 3-4 encounters with a RD for 45-90 min beginning with a referral at diagnosis (completed within 3-6mo
at least 1 followup encounter is recommended annually to reinforce lifestyle changes and evaluate/monitor outomes
payment: a glucose of >125 on 2 tests permits 3 h in first year, 2h follow-up in subsequent years (requires MD referral each calendar year
Name 4 behaviors associated with improved glycemic control by the DCCT.
adherence to a meal plan
consistent snacking behaviors
appropriate treatment of hypoglycemia
prompt response to hyperglycemia
Name 4 behaviors associated with improved glycemic control by the DCCT.
adherence to a meal plan
consistent snacking behaviors
appropriate treatment of hypoglycemia
prompt response to hyperglycemia
What are the tenets of healthy eating?
promotes energy balance,
limits saturated and transfat intake,
encourages consistent carbohydrate intake,
controls sodium intake and
meets dietary reference for intake of micronutrients
What are the tenets of healthy eating?
promotes energy balance,
limits saturated and transfat intake,
encourages consistent carbohydrate intake,
controls sodium intake and
meets dietary reference for intake of micronutrients
What degree of modest weight loss has been shown to prevent the progression from pre-diabetes to type 2 diabetes?
losses of 5-10%, reductions in visceral and subcutaneous adipose tissue,
** leads to fewer free fatty acids interfering with hepatic glucose production and production of fewer pro-inflammatory chemicals
What is important to consider about the quality of carbohydrates consumed by diabetics?
simple carbs usually cause more rapid blood sugar increase
unrefined carbs usually contain more nutrients
recommended 50% calories (same as all people) for diabetics, carbs do not need to be eliminated or severely limited
What does glycemic index tell you about a food?
glycemic index is the effect on raising blood sugar that is measured for a given carb dose after a 12h fast
high glycemic index foods are 70 or greater, low 55 or less
What is important to consider about the quality of carbohydrates consumed by diabetics?
simple carbs usually cause more rapid blood sugar increase
unrefined carbs usually contain more nutrients
recommended 50% calories (same as all people) for diabetics, carbs do not need to be eliminated or severely limited
44-50g of fiber daily is shown to improve glycemia, soluble fiber has a stronger influence on glycemic control (increases viscosity, slows digestion)
natural and added sugars are safe but should be monitored (less than 24g for women and less than 36 for men)
What does glycemic index tell you about a food?
glycemic index is the effect on raising blood sugar that is measured for a given carb dose after a 12h fast
high glycemic index foods are 70 or greater, low 55 or less
*mixing foods can significantly change the GI of singular foods
How does fructose effect TG?
fructose is a natural sugar metabolized by the liver and large amounts can increase TG and insulin resistence
(AHA recommends consuming water as the primary beverage)
How does fructose effect TG?
fructose is a natural sugar metabolized by the liver and large amounts can increase TG and insulin resistence
(AHA recommends consuming water as the primary beverage)
Do sugar alcohols have calories?
yes, an average of 2 calories, they produce lower post prandial glucose response and potentially a laxative effect
What are resistant starches?
carbohydrates with high amylose content (starch is enclose din plant cell structure increasing the time required to digest and absorb the carbohydrate
What are resistant starches?
carbohydrates with high amylose content (starch is enclose din plant cell structure increasing the time required to digest and absorb the carbohydrate (i.e. chicory root extract)
What is the recommended protein intake and how does it effect blood glucose?
small portions of high protein foods are suggested and have little effect on blood sugar, only need to cover protein in a hight protein diet
What is the recommended protein intake and how does it effect blood glucose?
small portions of high protein foods are suggested and have little effect on blood sugar, only need to cover protein in a hight protein diet (
What are the recommendations about amount and types of fat diabetics should consume?
total fat 30-35% of calories with polyunsaturated fat
How does alcohol effect blood sugar?
it’s calories do not raise blood pressure and alcohol should be consumed with food to prevent hypoglycemia
2 drinks/d men or 1 drink/d for women
What are the serving recommendations made by My Plate approach to portion control?
grains 1-2 servings a meal vegetables 1+ serving per meal fruits 0-1 servings per meal meats and beans 1-2 servings per meal dairy 0-1 servings per meal
What are the serving recommendations made by My Plate approach to portion control?
grains 1-2 servings a meal vegetables 1+ serving per meal fruits 0-1 servings per meal meats and beans 1-2 servings per meal dairy 0-1 servings per meal
What are MNT strategies for managing insulin?
estimate energy needs by carb counting (based on personal CHO/insulin ratio)*
eat at consistent times with fixed amount of CHO
individualized education for self-management behaviors that utilize the latest technology for matching CHO to insulin is preferred
- in meds you match the insulin to the CHO intake
Give examples of glucose sources that could be used to address hypoglycemia and their relative amounts.
3 glucose tabs, ½ can regular pop, 4 oz juice for patients with blood glucose
What are specific dietary recommendations for diabetics with gastroparesis?
low residue diet is recommended, they may be wide swings in sugars, nausea, anorexia
What are the exercise recommendations for diabetics?
150 minutes of moderate intensity exercise per week,
What are the exercise recommendations for diabetics?
150 minutes of moderate intensity exercise per week,
2-3d resistance exercise; flexibility exercise 2-3 days a week (ROM) and neurmotor exercise 2-3 d/week
*monitory glucose before and after (type 1) and don’t exercise if glucose >250 + ketones or >300
