Nutrition and diabetes

Question 1

How many people in the world have diabetes?

Answer 1

347 million

Question 2

Which groups are at high risk of diabetes?

Answer 2

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

Question 3

What did the finnish diabetes prevention study show?

Answer 3

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

Question 4

What is the most important predictor of risk reduction for type 2 diabetes?

Answer 4

Weight loss

Question 5

What protects from diabetes?

Answer 5

Decreased intake of sat fat and increase intake intake of monounsaturated fat
Eat low GI food
Eat dietary fibre and wholegrains

Question 6

What reduces risk of diabetes?

Answer 6

Low fat dairy foods
Green leafy veg
Coffee
Moderate intakes of alcohol

Question 7

What increases risk of diabetes?

Answer 7

Red meats
Processed meats
Fried potatoes

Question 8

What are the NICE guidelines on managing type 2 diabetes?

Answer 8

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

Question 9

What is the primary strategy for dietary management of glycaemic control in type 2 diabetes?

Answer 9

Weight loss

Question 10

What is the most important factor in glycaemic control?

Answer 10

Total energy intake- total CHO is strong predictor of glycaemic response

Question 11

What treatment options are there for obesity?

Answer 11

Prevention is best
Reduced calorie diet and exercise
Therapeutic agents- orlistat
Surgery can cure T2D
Combination of above

Question 12

What are 10 ways to eat well with diabetes?

Answer 12

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

Question 13

What is the glycaemic index?

Answer 13

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

Question 14

What does a high GI mean?

Answer 14

Rapidly digested and absorbed

Sharp increase in blood glucose

Question 15

What does a low GI mean?

Answer 15

Slowly digested and absorbed

Gradual rise in blood glucose levels

Question 16

What is the GI of protein and fat?

Answer 16

Don’t have one as they don’t break down into glucose

Question 17

How is GI determined?

Answer 17

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

Question 18

What foods have high GI?

Answer 18

White and wholemeal bread
Cereals
Rice
Beans
Watermelon
Sugary drinks

Question 19

What foods have medium GI?

Answer 19

New potatoes
Biscuits
Rice
Fruit

Question 20

What foods have low GI?

Answer 20

Pasta
Beans
Tortillas
Oats
Seeded bread

Question 21

Which diabetic medications increase weight gain?

Answer 21

Sluphonylureas
Thiazolidinediones/glitazones
Insulin

Question 22

Which diabetic medications cause no effect on weight?

Answer 22

Biguanides (metformin)
Prandial glucose regulators
Alpha glucosidase inhibitors
DPP4 inhibitors

Question 23

What diabetic medications cause loss of weight?

Answer 23

Incretin mimetics

Question 24

How is type 1 diabetes managed?

Answer 24

Insulin (each type defined by its onset, peak and duration of action)

Question 25

What are the aims of type 1 diabetes management?

Answer 25

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

Question 26

What is DAFNE?

Answer 26

Dose adjustment for normal eating. Help people to judge how much CHO is in different foods, because there can be errors in estimations

Question 27

What foods contain carbs?

Answer 27

Cereal derived starch products
Vegetable starch
Fructose: fruit, fruit juice
Lactose foods- milk, yoghurt etc
Sucrose- chocolate and confectionary

Question 28

Which diets don’t contain carbohydrate?

Answer 28

Meat, fish, chicken, eggs and nuts
Cheese
Most veg
Diet drinks, sugar free drinks
Alcohol

Question 29

Why do you count carbs in type 1 diabetes?

Answer 29

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

Question 30

What are the pros and cons of counting carbs?

Answer 30

Pros:
Food freedom
Improved QOL
Improved glycaemic control

Cons:
Blood testing
Reading labels
Weighing foods
Keeping records
Weight gain

Question 31

What are the aims of nutritional management in type 1 and type 2?

Answer 31

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

Question 32

What is ICICLE?

Answer 32

Imperial College Insulin Carbohydrate Lifestyle Education

Question 33

What is BERTIE?

Answer 33

Bournemouth type 1 intensive education programme

Question 34

What are the disadvantages of low carb diets?

Answer 34

Nutritional adequacy, constipation and headaches

Question 35

Who should be referred to a dietician?

Answer 35

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

Question 36

What dietary advice would you give a young person newly diagnosed with type 1 diabetes?

Answer 36

Adjust insulin around what you are eating, education about carbs

Question 37

What dietary advice would be given to an obese middle aged man diagnosed with type 2 diabetes?

Answer 37

Exercise, cut out high fat and sugar, follow a lower calorie diet