nutrition: chapter 20 Flashcards
glucose
primary source of energy for the body
insulin
- produced by beta cells of the pancreas
- needed for glucose transport into cells
diabetes
- metabolic diseases characterized by hyperglycemia
people with diabetes either:
- produce very little to no insulin (insulin deficiency)
- ineffectively use insulin (insulin resistance)
- produce inadequate insulin amount (insulin insufficiency)
hyperglycemia
elevated blood sugar level
classifications
- type 1 diabetes
- type 2 diabetes
- gestational diabetes
- other types
- impaired glucose tolerance
symptoms
- polydipsia
- polyuria
- polyphagia
- unintentional weight loss (type 1)
- blurred vision, fatigue, dehydration, skin irritation or infection, general weakness, loss of strength
lab tests will show
- hyperglycemia
- abnormal glucose tolerance tests (done in pregnancy)
- elevated glycosylated hemoglobin A1c (3 month avg.)
- glucosuria
- proteinuria
- microalbuminuria
diabetic ketoacidosis (DKA)
stages of glucose metabolism
- initial interchange with glycogen (glycogenolysis) and reduction to a smaller central compound (glycolysis pathway)
- joining with the other two energy-yielding nutrients, fat and protein (pyruvate link)
- final common energy production (citric acid cycle and electron transport chain)
exogenous
originating from outside the body
sources of blood glucose
- dietary intake
- glycogen from liver and muscles
uses of blood glucose
- for immediate energy needs: glycolysis
- change to glycogen for storage: glycogenesis
- convert to fat for longer-term storage: lipogenesis
glucagon
- opposes insulin
- responds to hypoglycemia
- alpha cells
somatostatin
- acts as a referee for insulin and glucagon
- delta cells
abnormal metabolism in diabetes (glucose)
- cells are starved for glucose
- glucose concentrations increase in the blood
- hyperglycemia results
abnormal metabolism in diabetes (fat)
- lipolysis in the adipose tissue increases
- fatty acids are released in the blood
- elevated triglyceride levels result
- ketogenesis ensues in the liver
- ketones accumulate in the body
- diabetic ketoacidosis results
abnormal metabolism in diabetes (protein)
- protein tissues are broken down
- weight loss, muscle weakness, and urinary nitrogen loss result
long term complications
- retinopathy (eye damage)
- nephropathy (kidney damage)
- neuropathy (nerve damage)
- heart disease
- dyslipidemia
- hypertension
postprandial
after eating; normally 1-2 hours after a meal
Cushing’s syndrome
glucagonoma
- rare neuroendocrine tumor
- found in alpha cells of pancreas
- leads to overproduction of glucagon
- may cause diabetes, weight loss, high glucagon levels, and hypoaminoacidemia
pheochromocytoma
- tumor of the adrenal medulla or the sympathetic nervous system
- affected cells secrete excess epinephrine or norepinephrine
- causes headache, hypertension, and nausea
hypoglycemia
low blood glucose level
GLUT4
insulin-regulated protein that is responsible for glucose transport into cells
ketogenesis
production of ketones in the body (occurs in the liver)
ketones
acids that occur as intermediate products of fat metabolism
acetone
- major ketone compound
- results from fat breakdown for energy in individuals with unmanaged diabetes
albuminuria
high levels of albumin in the urine
estimated glomerular filtration rate (eGFR)
equation used to measure kidney function
cellulitis
- diffuse inflammation of soft or connective tissues from injury, bruises, or pressure sores that leads to infection
- poor care may result in ulceration and abscess or gangrene
glycemic control
management of blood glucose levels within individualized targets
insulin secretagogues
- oral medication
- stimulates beta cells to secrete insulin
- lowers overall blood glucose levels
- increases risk of hypoglycemia and weight gain
early detection and monitoring
- community screening programs
- annual physical examinations
- fasting blood glucose, HbA1c
basic goals of care
- exogenous insulin
- oral/ non-insulin injectable meds
- maintaining healthy eating patterns
- 150 minutes of moderate-intensity aerobic physical activity weekly
Diabetes Self-Management Education and Support (DSME/S)
- dietary and lifestyle management
- monitoring
- medications
- problem solving
- reducing risk
- psychosocial assessment and care
- resource awareness
MNT
prediabetes:
- healthy dietary pattern, physical activity, weight loss
diabetes:
- individualized nutrition therapy
nutrient balance
- starch and sugar
- glycemic index
- sugar substitutes and sweeteners
- protein
- fat
nutrient intake, physical activity, and medication timing
- daily schedule
- physical activity and glycemic management
- meds and meal timing
- carbohydrate counting
- healthy eating patterns (t2/prediabetes)
additional concerns
- “diabetic” foods
- alcohol
- hypoglycemia
- illness
- travel
- eating out
- stress
diabetes distress
psychological reaction to the intense emotional burden and negative impact of daily concerns when managing the serious and complex lifelong disease of diabetes
