Nutrition and diabetes Flashcards
How many people in the world have diabetes?
347 million
Which groups are at high risk of diabetes?
Family history- genetic and environmental factors play a role. Tends to cluster in families
Ethnicity- 6x more common in south Asians, 3x more common in Africa/Afro-Caribbean people
Obesity- 80-85% of overall risk of developing T2D
What did the finnish diabetes prevention study show?
Lifestyle adaptations (reducing weight, total fat, saturated fat, increased fibre and exercise) enabled people to lose more weight than the controls. Glycaemia and lipaemia were also more improved Lifestyle changes are more effective than medication
What is the most important predictor of risk reduction for type 2 diabetes?
Weight loss
What protects from diabetes?
Decreased intake of sat fat and increase intake intake of monounsaturated fat
Eat low GI food
Eat dietary fibre and wholegrains
What reduces risk of diabetes?
Low fat dairy foods
Green leafy veg
Coffee
Moderate intakes of alcohol
What increases risk of diabetes?
Red meats
Processed meats
Fried potatoes
What are the NICE guidelines on managing type 2 diabetes?
Offer education
Dietary advice- high fibre, low GI carbs e.g. fruit, veg, wholegrains and pulses, low fat dairy, oily fish, control saturated fat intake and trans fatty acids
Personalised diabetes plan with lifestyle modifications
Target initial body weight loss of 5-10%
Avoid diabetic products
Not just about reducing sugar
What is the primary strategy for dietary management of glycaemic control in type 2 diabetes?
Weight loss
What is the most important factor in glycaemic control?
Total energy intake- total CHO is strong predictor of glycaemic response
What treatment options are there for obesity?
Prevention is best Reduced calorie diet and exercise Therapeutic agents- orlistat Surgery can cure T2D Combination of above
What are 10 ways to eat well with diabetes?
Regular meals Starchy carbohydrates in diet Cut down on fat particularly saturated Eat more fruit and veg Reduce salt in your diet to 6g or less a day Include more lentils, bean and pulses Aim for at least two portions of oily fish a week Limit sugary foods Avoid diabetic foods or drinks Limit alcohol intake
What is the glycaemic index?
A ranking of carbs on a scale of 1 to 100 according to how much they increase blood sugar levels after you have eaten them
What does a high GI mean?
Rapidly digested and absorbed
Sharp increase in blood glucose
What does a low GI mean?
Slowly digested and absorbed
Gradual rise in blood glucose levels
What is the GI of protein and fat?
Don’t have one as they don’t break down into glucose
How is GI determined?
50g of test food is compared to 50g of glucose which has GI 100 in 10 people. Effect on blood glucose is measured in these people over next two hours. For each person, area under two hour blood glucose response is measured i.e. glucose AUC. A GI of test food is calculated for each person- AUC of test food/AUC reference x 100. GI value is average GI of 10 people
What foods have high GI?
White and wholemeal bread Cereals Rice Beans Watermelon Sugary drinks
What foods have medium GI?
New potatoes
Biscuits
Rice
Fruit
What foods have low GI?
Pasta Beans Tortillas Oats Seeded bread
Which diabetic medications increase weight gain?
Sluphonylureas
Thiazolidinediones/glitazones
Insulin
Which diabetic medications cause no effect on weight?
Biguanides (metformin)
Prandial glucose regulators
Alpha glucosidase inhibitors
DPP4 inhibitors
What diabetic medications cause loss of weight?
Incretin mimetics
How is type 1 diabetes managed?
Insulin (each type defined by its onset, peak and duration of action)
What are the aims of type 1 diabetes management?
Aim to coordinate lifestyle and insulin therapy with focus on flexibility, good glycaemic control, CVD risk reducrtion
Assessing CHO intake and matching it with insulin dose- CHO counting required and considers effects of exercise, alcohol, GI and illness on blood glucose levels
Encouraging nutrition- healthy eating and weight management
What is DAFNE?
Dose adjustment for normal eating. Help people to judge how much CHO is in different foods, because there can be errors in estimations
What foods contain carbs?
Cereal derived starch products Vegetable starch Fructose: fruit, fruit juice Lactose foods- milk, yoghurt etc Sucrose- chocolate and confectionary
Which diets don’t contain carbohydrate?
Meat, fish, chicken, eggs and nuts Cheese Most veg Diet drinks, sugar free drinks Alcohol
Why do you count carbs in type 1 diabetes?
Insulin is required to utilise glucose
Glucose comes from CHO
Insulin and glucose must be well matched otherwise there will be hypo or hyperglycaemia
So either:
Match insulin to CHO intake or maintain a consistent CHO intake
Qualitative benefits- improved QoL, food freedom, general well being
Quantitative benefits- less hypos, improved glycaemic control
What are the pros and cons of counting carbs?
Pros:
Food freedom
Improved QOL
Improved glycaemic control
Cons: Blood testing Reading labels Weighing foods Keeping records Weight gain
What are the aims of nutritional management in type 1 and type 2?
Good glycaemic control
Minimise risk of long term microvascular and macrovascular ocmplications
CVD risk reduction- weight, BP and lipid management
Enjoyment of food and QoL
Facilitation of health behaviour changes and self management
Structured education is recommended for both
What is ICICLE?
Imperial College Insulin Carbohydrate Lifestyle Education
What is BERTIE?
Bournemouth type 1 intensive education programme
What are the disadvantages of low carb diets?
Nutritional adequacy, constipation and headaches
Who should be referred to a dietician?
All patients newly diagnosed with diabetes
Patients with diabetes starting on insulin
Patients with diabetes in pregnancy
Patients with diabetes who have never seen a dietician
Patients with a high nutritional screening tool score in hospital
What dietary advice would you give a young person newly diagnosed with type 1 diabetes?
Adjust insulin around what you are eating, education about carbs
What dietary advice would be given to an obese middle aged man diagnosed with type 2 diabetes?
Exercise, cut out high fat and sugar, follow a lower calorie diet
