Nutrition Care for T2D (Guest Lecture) (Diabetes Week 9) Flashcards

1
Q

What are important lifestyle interventions for people with T2D?

A
  • Nutrition
  • physical activity
  • stress management
  • self-management and support
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2
Q

How much can nutrition therapy reduce A1c in people with T2D?

A

0.5-2%

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3
Q

Goals of nutrition care in diabetes

A

To support eating patterns that improve overall
health and
* Delay or reduce the risk of complications
* Achieve individualized glycemic, blood pressure and lipid goals
* Achieve and/or maintain individualized body weight goals

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4
Q

What individual patient factors need to be considered?

A
  • Individual personal and cultural preferences
  • Health literacy and numeracy
  • Access to healthful foods
  • Readiness for and barriers to behaviour change
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5
Q

Nutrition Education

A

Focus on survival and basic as main things for people just diagnosed to walk away with

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6
Q

what are some common approaches to nutrition for individuals with diabetes

A

There are many ways to eat to manage diabetes and have moved away from being prescriptive to focus more on dietary patterns
* mediterranean
* low GI
* DASH
* portfolio
* low carb
* intermittant fasting

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7
Q

Healthy dietary patterns

A
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8
Q

Suggested food substitutions

A
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9
Q

Key message about fibre

A

Focus on fibre
* Aim for 30 to 50 g per day
* 10 to 20 g as viscous soluble fibre
* Viscous soluble fibre can: ↓ A1c, ↓ fasting blood glucose, Improve lipid profile (↓ LDL-C)

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10
Q

hydration with fibre

A

important to help move things along and prevent GI disturbances

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11
Q

Evidence-based tips regarding nutrition

A
  • Replace refined, sugar-sweetened, high sodium and/or high fat processed foods with: 30-60 g (1⁄4 to 1⁄2 cup) unsalted nuts most days, whole vegetables and fruit
  • Consume lower carb veg and/ or protein first at a meal as a strategy to improve manage glycemic response.
  • Choose whole grains high in beta-glucan (e.g. oats and barley) to improve lipid profile and glycemic management.
  • Replace sugar-sweetened beverages and foods with dairy products with similar or reduced energy content (this can make huge impact)
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12
Q

How much to eat?

A
  • The Balanced Plate and Handy Guide method
  • Carbohydrate Counting
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13
Q

The balanced food plate

A
  • specifically states non-starchy fruits and vegetables
  • Starchy vegetables included with whole grains
  • Using hands is also a good tool
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14
Q

Carbohydrate Counting

A

Usually healthy plate and portion guide is best for beginners

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15
Q

Carbohydrate counting education

A
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16
Q

Best practice for when to eat

A
  • Space eating times over the day (every 4-6 hours)
  • Breakfast/eating earlier in the day is beneficial for glycemic management
  • Individualize snack recommendations (may not need)
  • Fasting may be done safely using a coordinated approach
17
Q

What might you consider if counselling about spacing and timing of eating?

A
  • Lifestyle and quality of life
  • Weight management and metabolic goals
  • Culture, religious practices, and health beliefs regarding fasting
  • Physical activity
  • Diabetes medications (pharmacotherapy)
18
Q

Tips for snacking

A
19
Q

Prevalance of obesity with T2D

A

> 80% of individuals with T2D also live with obesity

20
Q

What can weight loss improve?

A

5 to 10% of initial weight loss can improve:
* insulin sensitivity & glycemic management
* blood pressure & dyslipidemia

≥ 15% of initial body weight
* Remission of T2D

Intensive lifestyle intervention programs typically include a very-low energy diet with meal replacements for at least the first 12 months.

21
Q

How do the different systems contribute to hyperglycemia

A
22
Q

What are considerations beyond glycemic management regarding T2D pharmacotherapy?

A
  • cardiovascular protection
  • weight impact
  • hypoglycemia risk
  • cost
  • side effects
23
Q

What are the common medications for T2D?

A
24
Q

Sites of action for diabetic medications

A
25
Q

Describe metformin

A

Biguanide

Targets:
* liver
* muscle/fat cells

Actions:
* ↑ insulin sensitivity
* ↓liver glucose
* ↑glucose uptake

26
Q

Describe SGLT-2 inhibitor

A

Sodium glucose cotransport 2 inhibitor (-flozin)

Targets:
* SGLT-2 in the kidney

Actions:
* ↑ kidney excretion of glucose

27
Q

Describe DPP-4 inhibitors

A

-liptin

Targets:
* DPP-4 enzyme that impacts gut hormone

Actions:
* ↑ incretin effect

28
Q

Describe GLP-1 RA

A

Glucagon-like-peptide-1 receptor agonist (-tide)

Targets:
* gut
* pancreas (alpha, beta cells)
* brain

Actions:
* ↓gastric emptying
* ↓glucagon
* ↑insulin secretion
* ↑satiety

Most effective for weight reduction

29
Q

Side effects of GLP-1 RA

A

Side effects are often short term:
* Nausea
* vomiting
* constipation
* diarrhea
* GERD

30
Q

Dietary modifications to manage side effects of GLP-1 RA

A
  • Eat smaller meals
  • Mindfulness to stop eating when full
  • Avoid eating when not hungry
  • Avoid fatty foods
  • Avoid spicy foods
  • May need to reduce fibre intake temporarily
31
Q

Describe Secretagogues

A

(-ide)
* Targets: pancreas
* Actions: ↑ insulin secretion

32
Q

Describe Alpha-glucosidase inhibitor

A

(acarbose)
* Targets: small intestine
* Actions: ↓ carbohydrate absorption

33
Q

Describe Thiazolidinediones (TZDs)

A

(-azone)
* Targets: muscle/fat cells
* Actions: ↑ insulin sensitivity

34
Q

Tips for nutrition care when taking T2D pharmacotherapy

A
  • Identify what medications are for glycemic management (know the classes).
  • Identify those that pose a risk for hypoglycemia and weight gain.
  • Identify those that can cause GI problems.