Nutrition & exercise Flashcards
1
Q
Beans
A
1/2 cup= 15 g
2
Q
Rice
A
1/3 cup= 15 g
3
Q
Small tortilla
A
1 6 inch
4
Q
Saltines
A
5-6
5
Q
Bread
A
1 slice
6
Q
Corn
A
1/2 cup or 1 small ear
7
Q
Cooked pasta
A
1/3 cup
8
Q
Cold cereal
A
3/4 cup
9
Q
Small baked potato
A
1
10
Q
English muffin
A
1/2
11
Q
Bagel
A
1/4 or 1 ounce
12
Q
1 starch exchange
A
80 kcal 15 g CHO
13
Q
Fruit exchange
A
60 kcal 15 g CHO
14
Q
Grapes
A
17
15
Q
Fruit juice
A
4 ounce
16
Q
Prune juice
A
1/3 cup
17
Q
Fruit juice blend
A
1/3 cup
18
Q
Banana
A
1/2
19
Q
Unsweetened applesauce
A
1/2 cup
20
Q
Melon
A
1 cup
21
Q
Dried fruit
A
1/4 cup
22
Q
Raisins
A
2 tbsp
23
Q
Strawberries
A
1.25 cup
24
Q
Non starchy veggie
A
3 cups raw or 1.5 cup cooked= 15 grams
25
Milk exchange
90-150 calories. 12-15 grams
26
Diet hot chocolate
1 packet
27
Buttermilk
8 ounces
28
Plain yoghurt
6 ounces
29
Lite fruit yogurt
6 ounces
30
Cow milk
12 g In 8 ounce
31
Nondairy milk alternative
8 ounce
32
Brownie
1 ounce square
33
Cookies
2 small
34
Diet pudding
1/2 cup
35
Regular pudding
1/4 cup
36
Regular jello
1/2 cup
37
Light Syrup
2 tbsp
38
Regular syrup, jelly, jam, sugar, honey, agave
1 tbsp
39
Sorbet
1/4 cup
40
Sherbet
1/2 cup
41
Ice cream. Frozen yogurt
1/2 cup
42
PA recommendations for kids
60 minute/day moderate or vigorous aerobic ; muscle and bone strengthening 3 days/week moderate-vigorous
43
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
44
Benefits of PA
improve BG
reduce CV risk factors
helps WL
improve overall well being
45
moderate to high volumes of aerobic activity are associated w/
sig. lower CV and overall mortality risk for T1 and T2
46
What medical conditions may be contraindicated for exercise?
```
uncontrolled HTN
untreated proliferative retinopathy
autonomic neuropathy
peripheral neuropathy
foot ulcers
charcot foot
```
47
if pt on insulin or insulin secretagogue wants to exericse, and their BG is <90
CHO containing snack before
48
Who is less likely to suffer from post exercise hypo?
T2 on oral meds only
49
how long does insulin sensitivity after exercise last?
several hours
50
Vigorous PA may actually _____ BG levels especially if pre-exercise levels are ____
raise due to flight or fight response; elevated
51
When to check BG in terms of exercise?
Before, after, and potentially during
52
Retinopathy
Proliferative retinopathy or severe nonproliferative pts may experience hemorrhage or retinal detachment with vigorous activity; consult opthamologist
53
peripheral neuropathy
asses b4 starting regimen to ensure the neuropathy does not impact kinesthetic or propioceptive sensation esp if neuropathy is severe
54
neuropathy concerns
decreased pain sensation, higher pain threshold, increase risk of skin breakdown, infection, joint destruction
55
In whom in tobacco use higher
- adults w/ chronic conditions
| - adolescents/YA w/ DM
56
Why is smoking bad?
```
increased risk of CVD
premature death
microvascular complications
worse glycemic control
may contribute to T2 dx
```
57
How to help pt quit smoking
Refer to pharmacologic tx counseling, which is more effective than either alone
58
Screen older adults >/=65 for
cognitive impairment, depression
59
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
```
60
SDOH
loss of employment
birth of child
family stressors
61
Refer to MH specialist
- positive screening for overall stress, work/life balance
- DM distress
- DM management difficulties
- depression
- anxiety
- disordered eating
- cognitive dysfunction
62
How common is DM distress
45%; but only 25% were asked about it
63
Why is DM distress bad
impacts medication taking
| linked to higher A1c, lower self-efficacy, poorer diet/PA
64
How to reduce DM distress
- refer to DSMES
| - address culprit of stress
65
Other MH issues that affect DM self-care
depression
anxiety
disordered eating
cognitive abilities
66
What can be done for those w/ hypo-unawareness
BG awareness training to re-establish s/s and reduce fear of s/s
67
Hx of depression, current depression, antidepressant meds
risk for developing T2DM
68
prevalence of depressive symptoms
- 1/4 with T1D and T2D
| - higher in women
69
when to screen for ED behaviors
unexplained hyper and weight loss
70
Why would someone with T1 skip insulin?
Skipping causes glycosuria --> weight loss
71
T1 with ED have
high rates of DM distress and fear of hypoglycemia
72
ED associated w/ T2DM
Binge eating disorder
| May omit insulin
73
Those taking atypical antipsychotics should be screened how often for pre-DM/DM
annually
74
Monitor what carefully in pts on second generation antipsychotics
weight, BG, lipids
75
Examples of DM advocacy include
cost barriers- insulin, other meds, DSMES
insulin access/affordability
employment
driving
schools/childcare/correctional setting care
76
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
77
Meeting with a RD reduces A1c how much in T1DM?
1-1.9%
78
Meeting with RD reduces A1c how much in T2dM?
0.3-2%
79
When should encounter with RD start?
At diagnosis or within 3-6 months of dx
80
How many annual f/u with RD is recommended?
at least 1
81
How many encounters with RD are recommended?
3-4, 45-90 minute sessions
82
How much DSMES is covered?
1 hour individual assessment (G108)
9 hour group (1x during lifetime) (G109)
2 hours annually
83
How much MNT is covered?
First calendar year- 180 minutes
| annually- 120 minutes
84
Can DSMES and MNT be billed on same day?
No, won't be covered
85
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
86
IF someone is on flexible insulin regimen, what to educate on?
CHO counting, effect of fat/protein
87
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
88
Sodium recommendations
2,300 mg/day
| NOT less than 1,500 mg/d even if HTN
89
Cholesterol recommendations
<300 mg/day
90
Saturated fat recommendations
<10% kcal
91
Fiber recommendations
25-38 g/day
92
Trans fat recommendations
avoid
93
5% WL in those with DM -->
Reduced TG, reduced need for meds,
| improved glycemic control
94
If possible avoid these DM meds that cause wt gain
Insulin, sulfonylurea, TZD
95
When is low CHO diet contraindicated?
- pregnancy or lacatation
- ED's
- children
- SGLT2-i takers
- renal dz
96
CHO consumption causes BG levels to peak in how many hours?
1-2 hours
97
Why is MUFA beneficial?
Raises HDL; lowers total and LDL cholesterol
98
Why is PUFA beneficial?
lowers total cholesterol and LDL
99
HFCS may adversely affect
lipids
100
Why is trans fat harmful?
- lowers HDL
- raises LDL
- may contribute to t2DM
- may cause wt gain and abdominal fat
101
What is protein recommendation in CKD?
0.8 g/kg
102
How common is celiac dz in T1D
10%
103
How common is gastroparesis?
20-30% in longstanding DM
104
What is gastroparesis?
Delayed gastric emptying d/t nerve damage
| s/s- early satiety, fullness, n/v, postprandial hypo
105
treatment for gastroparesis
small, low fiber, low-fat meals
take insulin with meal or after meal
reglan, erythromycin
106
what are s/s of diabulimia?
unexplained WL, unexplained HYPER
records that don't match A1c
no finger prick marks
unfilled rx for insulin
107
```
how many kcals/g
fat
alcohol
CHO
protein
```
fat- 9
alcohol-7
CHO and PRO- 4
108
how many g CHO in 8 ounce cow milk
12
109
how many steps/day recommended
7,500-10,000
110
how many steps is 1 mile
2,000
111
how many kcals to burn 1 lb
3,500
112
servings of alcohol
5 ounce wine
12 ounce beer
1.5 ounce distilled spirits
113
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
114
An 8 week walking program reduced A1c by how much in T2DM?
0.6% w/o weight loss
115
Those w/ T1D are at increased risk of hypo for how many hours after exercise?
4-15
| esp at night
116
WHy are people at risk for hypo after drinking alcohol?
glycogenolysis in liver is not happening bc liver is busy detoxifying the alcohol
117
T1D exercise recommendations
BG <90
BG 90-150
<90- 15-30 g CHO
| 90-150 may need 15 g
118
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
119
Hormonal response to exercise in T2DM
- decreased secretion of endogenous insulin
- increase insulin sensitivity
- increase glucose disposal
120
Hormonal response to exercise in T1DM
- exogenous insulin remains high
- increased absorption of insulin
- increased insulin sensitivity
121
Why should PWD w/ ketones NOT exercise?
- can worsen hyperglycemia and ketosis
122
When to check for ketones before exercise?
T1D BG >240
| T2D BG>300
123
how much popcorn is 15 g CHO
3 cups
124
How much berries is 15 g CHO?
1 cup razzies
125
how much rice milk sweetened has 15 g CHO?
4 ounces
126
how much winter squash has 15 g CHO
1 cup
127
how much pita bread is 15 g CHO?
1/2 6 inch
128
cooked oatmeal is how much CHO?
1/2 cup cooked =15 g
129
how much muffin is 15 g CHO
1/4
130
how much canned fruit w/o added sugar has 15 g CHO
1/2 cup
