Nutrition & exercise Flashcards
Beans
1/2 cup= 15 g
Rice
1/3 cup= 15 g
Small tortilla
1 6 inch
Saltines
5-6
Bread
1 slice
Corn
1/2 cup or 1 small ear
Cooked pasta
1/3 cup
Cold cereal
3/4 cup
Small baked potato
1
English muffin
1/2
Bagel
1/4 or 1 ounce
1 starch exchange
80 kcal 15 g CHO
Fruit exchange
60 kcal 15 g CHO
Grapes
17
Fruit juice
4 ounce
Prune juice
1/3 cup
Fruit juice blend
1/3 cup
Banana
1/2
Unsweetened applesauce
1/2 cup
Melon
1 cup
Dried fruit
1/4 cup
Raisins
2 tbsp
Strawberries
1.25 cup
Non starchy veggie
3 cups raw or 1.5 cup cooked= 15 grams
Milk exchange
90-150 calories. 12-15 grams
Diet hot chocolate
1 packet
Buttermilk
8 ounces
Plain yoghurt
6 ounces
Lite fruit yogurt
6 ounces
Cow milk
12 g In 8 ounce
Nondairy milk alternative
8 ounce
Brownie
1 ounce square
Cookies
2 small
Diet pudding
1/2 cup
Regular pudding
1/4 cup
Regular jello
1/2 cup
Light Syrup
2 tbsp
Regular syrup, jelly, jam, sugar, honey, agave
1 tbsp
Sorbet
1/4 cup
Sherbet
1/2 cup
Ice cream. Frozen yogurt
1/2 cup
PA recommendations for kids
60 minute/day moderate or vigorous aerobic ; muscle and bone strengthening 3 days/week moderate-vigorous
PA recommendations for adults
at least 150 minutes/week moderate/vigorous PA; spread over at least 3 days/week, no more than 2 consecutive days w/o exercise
- resistance and strength- 2-3x/week, moderate to vigorous, non-consecutive days
- older adults- flexibility and balance 2-3 days/week
Benefits of PA
improve BG
reduce CV risk factors
helps WL
improve overall well being
moderate to high volumes of aerobic activity are associated w/
sig. lower CV and overall mortality risk for T1 and T2
What medical conditions may be contraindicated for exercise?
uncontrolled HTN untreated proliferative retinopathy autonomic neuropathy peripheral neuropathy foot ulcers charcot foot
if pt on insulin or insulin secretagogue wants to exericse, and their BG is <90
CHO containing snack before
Who is less likely to suffer from post exercise hypo?
T2 on oral meds only
how long does insulin sensitivity after exercise last?
several hours
Vigorous PA may actually _____ BG levels especially if pre-exercise levels are ____
raise due to flight or fight response; elevated
When to check BG in terms of exercise?
Before, after, and potentially during
Retinopathy
Proliferative retinopathy or severe nonproliferative pts may experience hemorrhage or retinal detachment with vigorous activity; consult opthamologist
peripheral neuropathy
asses b4 starting regimen to ensure the neuropathy does not impact kinesthetic or propioceptive sensation esp if neuropathy is severe
neuropathy concerns
decreased pain sensation, higher pain threshold, increase risk of skin breakdown, infection, joint destruction
In whom in tobacco use higher
- adults w/ chronic conditions
- adolescents/YA w/ DM
Why is smoking bad?
increased risk of CVD premature death microvascular complications worse glycemic control may contribute to T2 dx
How to help pt quit smoking
Refer to pharmacologic tx counseling, which is more effective than either alone
Screen older adults >/=65 for
cognitive impairment, depression
When should MH be assessed
@ dx regular scheduled appts hospitalization new onset complications transition in care unable to reach A1c goal QOL changes SM difficulties
SDOH
loss of employment
birth of child
family stressors
Refer to MH specialist
- positive screening for overall stress, work/life balance
- DM distress
- DM management difficulties
- depression
- anxiety
- disordered eating
- cognitive dysfunction
How common is DM distress
45%; but only 25% were asked about it
Why is DM distress bad
impacts medication taking
linked to higher A1c, lower self-efficacy, poorer diet/PA
How to reduce DM distress
- refer to DSMES
- address culprit of stress
Other MH issues that affect DM self-care
depression
anxiety
disordered eating
cognitive abilities
What can be done for those w/ hypo-unawareness
BG awareness training to re-establish s/s and reduce fear of s/s
Hx of depression, current depression, antidepressant meds
risk for developing T2DM
prevalence of depressive symptoms
- 1/4 with T1D and T2D
- higher in women
when to screen for ED behaviors
unexplained hyper and weight loss
Why would someone with T1 skip insulin?
Skipping causes glycosuria –> weight loss
T1 with ED have
high rates of DM distress and fear of hypoglycemia
ED associated w/ T2DM
Binge eating disorder
May omit insulin
Those taking atypical antipsychotics should be screened how often for pre-DM/DM
annually
Monitor what carefully in pts on second generation antipsychotics
weight, BG, lipids
Examples of DM advocacy include
cost barriers- insulin, other meds, DSMES
insulin access/affordability
employment
driving
schools/childcare/correctional setting care
What are the goals of MNT?
- attain BP, BG, lipid goals
- attain and maintain BW goals
- delay/prevent complication
- encourage nutrient dense foods
- help with meal planning
- maintain pleasure of eating
- appropriate portions
Meeting with a RD reduces A1c how much in T1DM?
1-1.9%
Meeting with RD reduces A1c how much in T2dM?
0.3-2%
When should encounter with RD start?
At diagnosis or within 3-6 months of dx
How many annual f/u with RD is recommended?
at least 1
How many encounters with RD are recommended?
3-4, 45-90 minute sessions
How much DSMES is covered?
1 hour individual assessment (G108)
9 hour group (1x during lifetime) (G109)
2 hours annually
How much MNT is covered?
First calendar year- 180 minutes
annually- 120 minutes
Can DSMES and MNT be billed on same day?
No, won’t be covered
IF someone is on fixed insulin regimen, what to educate on?
consistent CHO, timing and amount of CHO to improve BG and risk of hypo
IF someone is on flexible insulin regimen, what to educate on?
CHO counting, effect of fat/protein
Specific nutrition recommendations:
-Emphasize non starchy vegetables
-Minimize added sugars and refined
grains
-Choose whole foods over highly
processed foods to the extent
possible
- Healthful approaches include:
* Mediterranean-style
*low-carb
*plant based or vegetarian
* Plate method good getting started
approach
Sodium recommendations
2,300 mg/day
NOT less than 1,500 mg/d even if HTN
Cholesterol recommendations
<300 mg/day
Saturated fat recommendations
<10% kcal
Fiber recommendations
25-38 g/day
Trans fat recommendations
avoid
5% WL in those with DM –>
Reduced TG, reduced need for meds,
improved glycemic control
If possible avoid these DM meds that cause wt gain
Insulin, sulfonylurea, TZD
When is low CHO diet contraindicated?
- pregnancy or lacatation
- ED’s
- children
- SGLT2-i takers
- renal dz
CHO consumption causes BG levels to peak in how many hours?
1-2 hours
Why is MUFA beneficial?
Raises HDL; lowers total and LDL cholesterol
Why is PUFA beneficial?
lowers total cholesterol and LDL
HFCS may adversely affect
lipids
Why is trans fat harmful?
- lowers HDL
- raises LDL
- may contribute to t2DM
- may cause wt gain and abdominal fat
What is protein recommendation in CKD?
0.8 g/kg
How common is celiac dz in T1D
10%
How common is gastroparesis?
20-30% in longstanding DM
What is gastroparesis?
Delayed gastric emptying d/t nerve damage
s/s- early satiety, fullness, n/v, postprandial hypo
treatment for gastroparesis
small, low fiber, low-fat meals
take insulin with meal or after meal
reglan, erythromycin
what are s/s of diabulimia?
unexplained WL, unexplained HYPER
records that don’t match A1c
no finger prick marks
unfilled rx for insulin
how many kcals/g fat alcohol CHO protein
fat- 9
alcohol-7
CHO and PRO- 4
how many g CHO in 8 ounce cow milk
12
how many steps/day recommended
7,500-10,000
how many steps is 1 mile
2,000
how many kcals to burn 1 lb
3,500
servings of alcohol
5 ounce wine
12 ounce beer
1.5 ounce distilled spirits
Why is exercise helpful for lowering BG?
Increase muscle uptake of GLU by 5x, for 24-48 hours
includes fat, liver, muscle cells for increased insulin sensitivity
Reduce BP, lipids, BG, A1C
An 8 week walking program reduced A1c by how much in T2DM?
0.6% w/o weight loss
Those w/ T1D are at increased risk of hypo for how many hours after exercise?
4-15
esp at night
WHy are people at risk for hypo after drinking alcohol?
glycogenolysis in liver is not happening bc liver is busy detoxifying the alcohol
T1D exercise recommendations
BG <90
BG 90-150
<90- 15-30 g CHO
90-150 may need 15 g
After exercise what should those with T1 D do?
- avoid alcohol
- may have a snack w/ extra CHO
- monitor BG frequently esp at night
- reduce insulin after exercise, some may reduce it before too
Hormonal response to exercise in T2DM
- decreased secretion of endogenous insulin
- increase insulin sensitivity
- increase glucose disposal
Hormonal response to exercise in T1DM
- exogenous insulin remains high
- increased absorption of insulin
- increased insulin sensitivity
Why should PWD w/ ketones NOT exercise?
- can worsen hyperglycemia and ketosis
When to check for ketones before exercise?
T1D BG >240
T2D BG>300
how much popcorn is 15 g CHO
3 cups
How much berries is 15 g CHO?
1 cup razzies
how much rice milk sweetened has 15 g CHO?
4 ounces
how much winter squash has 15 g CHO
1 cup
how much pita bread is 15 g CHO?
1/2 6 inch
cooked oatmeal is how much CHO?
1/2 cup cooked =15 g
how much muffin is 15 g CHO
1/4
how much canned fruit w/o added sugar has 15 g CHO
1/2 cup
