Non-pharmacologic Treatment Flashcards
The cornerstone of diabetes care that can effectively lower BG is…
Diet
Can be 1st line treatment for T2DM
Nutritional education is vital to understand the relationship between…
Carbohydrates, insulin, and blood glucose,
Also consider effects of weight, BP, and lipids
Diet should be individualized, based on…
Patient goals and preferences
Be mindful of cultural importance of food
If weight loss is a goal, this amount of weight loss may provide health benefits…
5-10%
Carbohydrates are available as the following…
Starches, sugars, and fibre
Carb counting can be used to allow for insulin doses to be…
Adjusted according to meal content
Generally, people should consume ____ of their total energy from carbohydrates
45-60%
Glycemic index is used to assess the quality of carbohydrate foods, based on…
Their ability to increase BG
Glycemic index can be used to distinguish foods based on…
Foods to choose more often (low GI) and foods to choose less often (high GI)
1 serving of carbohydrates is usually classified as…
15g
Soluble fibre works in the body by…
Slowing gastric emptying and delaying sugar absorption in the small intestine
When carb counting, fiber should be ____ since it cannot be ____
Subtracted from total carbs, since it cannot be digested
When a patient is considering fasting (Ramadan), it is important to encourage consultation with…
Dietitians +/- diabetes educators, 2 months before
For fasting, T1DM patients should be…
Advised against fasting
For fasting, medications should be chosen and adjusted based on…
Lowest risk of hypoglycemia, adjusted to try and minimize risk of low BG
Alcohol use in PWD can decrease ____ which can result in ____
Hepatic production of glucose, which can result in masking symptoms of hypoglycemia
In people with T1DM, or those with T2DM on insulin/sulfonylureas, alcohol can cause delayed hypoglycemia which means that…
Hypoglycemia can occur at blood alcohol levels of mild intoxication + persist for up to 24 hours following the last drink
New alcohol recommendations state that…
No amount of alcohol is safe, and it is a continuum of risk
Health benefits of physical activity, beyond weight loss + glycemic control include…
Increased cardio/respiratory fitness
Decreased insulin resistance
Improved lipids + BP (reduced risk of CVD, stroke, onset of mcirovascular issues)
Psychological aspect important
Physical activity has been correlated with A1C with…
Improvements in T2DM patients and kids with T1
Less clear evidence for A1C of adults with T1
Exercise recommendations for people with diabetes are…
> 150 minutes of moderate to vigorous intensity aerobic exercise/week
Spread over 3+ days, no more than 2 consecutive days of no activity
IT IS OK TO START SLOW
Before starting exercise, it is important to assess for conditions that can predispose to injury such as…
Neuropathy, CAD, previous MI/TIA… etc.
Low-moderate intensity exercise (aerobic) affects BG by…
Decreasing BG during + after exercise due to increased insulin sensitivity
Using glucose as fuel
30 minutes of exercise can improve insulin sensitivity for the next 48 hours
Very intense exercise (anaerobic) affects BG by…
Increasing BG during + after exercise due to increased glucose production (increased secretion of stress hormones)
It is important for PWD to monitor for signs of low/high BG and continue to self monitor glucose levels, because…
Particular for those on insulin
Rapid changes in BG can occur during and after exercise
Exercising for T1DM has a special focus on…
Minimizing risk of hypoglycemia
Some non-insulin strategies to minimize risk of hypoglycemia during exercise includes…
Consuming extra carbs before/during/after exercise, carry a fast acting glucose source
Perform max intensity exercise before aerobic exercise
Ways that insulin can be adjusted during exercise to minimize hypoglycemia risk includes…
Injecting insulin at a non-exercise site
Reducing dose of bolus insulin that is most active at time of exercise (25-75%)
Reducing basal insulin overnight by 20%
Careful with exercise late in the evening - overnight lows
Exercise should be avoided if BG is below…
4 mmol/L
In T2DM, exercise is okay to initiate if BG is high, as long as…
There are no signs of dehydration and the patient feels fine
In T1DM, exercise is okay to initiate if BG is high, as long as…
No ketones are present, patient feels fine
BG is below 16.7 mmol/L
