Nutrition for Diabetes Mellitus

Question 1

what is diabetes mellitus?

Answer 1

• group of conditions that’s determined by a complete lack of insulin secretion by beta cells or by effects of cell insulin receptors

Question 2

what are the 3 categories of diabetes mellitus

Answer 2

• prediabetes & insulin resistance
• T 1 D (TIDM)
• T2D (T2DM)

Question 3

define prediabetes?

Answer 3

• blood glucose levels higher than normal but not high enough for a diagnosis of diabetes

Question 4

define insulin resistance?

Answer 4

• muscle, fat, and liver cells not responding to insulin and can’t easily absorb glucose from the blood stream

Question 5

what does A1C look like for normal pt, prediabetes PT, and diabetes PT?

Answer 5

• normal = < 5.7 %
• prediabetes = 5.7 - 6.4%
• diabetes = higher than 6.5%

Question 6

what does fasting plasma glucose look like for normal pt, prediabetes PT, and diabetes PT?

Answer 6

• normal = < 100
• pre DT = 100 - 125
• DTM = higher than 126

Question 7

what are the macrovascular complications of DTM?

Answer 7

• coronary artery disease, peripheral vascular disease, cerebrovascular disease
• damage results in disability and premature death

Question 8

what are the microvascular complications of DTM?

Answer 8

• nephropathy (changes in the kidneys), retinopathy (eye disorders), neuropathy (changes in the nerves), impaired healing (leading to gangrene and amputation)

Question 9

what are the 3 P’s of T1 DM?

Answer 9

• Polydipsia (increased thirst)
  ✓ Polyuria (increased urination)
  ✓ Polyphagia (weight loss)

Question 10

what is T 1 DM caused by?

Answer 10

• destruction of pancreatic beta cells
• pancreas loses the ability to synthesize insulin
• autoimmune disorder
• happens in childhood & adolescence
• need insulin injections

Question 11

what are the symptoms of T 2 DM? & its cause?

Answer 11

• gradual onset of polyuria and
  polydipsia, frequent fatigue, frequent infections (especially of urinary tract)
• caused by insulin resistance or failure of cells to respond to insulin

Question 12

what’s the goal now DM treatment?

Answer 12

• maintain blood glucose level within normal range

Question 13

what DM patients need insulin?

Answer 13

• all T1DM
• some T2DM require insulin to optimize

Question 14

what are the different types of insulin?

Answer 14

• conventional/standard insulin therapy
  ▪ flexible/intensive insulin therapy
  ▪ continuous subcutaneous insulin infusion

Question 15

why is exercise beneficial to DM pt’s?

Answer 15

-Exercise lowers blood glucose levels, assists
in maintaining normal lipid levels, and increases circulation
- avoid exercise when blood glucose level is greater than 250

Question 16

how does exercise help T 1 DM?

Answer 16

• glucose control can be compromised if
  food and insulin are not adjusted.

Question 17

what are the consequences of exercise for T2DM PT’s?

Answer 17

• patients may be at risk for hypoglycemia
  when taking oral agents and exercising.

Question 18

what are the general guidelines for exercise in T1DM patients?

Answer 18

• Avoid exercise if glucose levels exceed 250 mg/dL with ketosis or exceed 300 mg/dL.
  ➢ Ingest added carbohydrate if glucose level is less than 100 mg/dL.
  ➢ Monitor blood glucose levels before and after exercise and learn to adjust food and insulin amounts.
  ➢ Consume added carbohydrate as needed to avoid hypoglycemia; keep carbohydrate-based foods available during and after exercise.

Question 19

what are oral glucose lowering meds?

Answer 19

• Used for T2DM when diet and physical activity do not control hyperglycemia
• ex: metformin, glipizide, glyburide

Question 20

how are diabetes managed?

Answer 20

• control of blood glucose levels in the cornerstone of diabetes management
• Reduced rates of retinopathy, nephropathy, and neuropathy

Question 21

diabetes management includes an A1C of:

Answer 21

• < 7.0%

Question 22

what is A1c?

Answer 22

• reflects blood glucose control for 100 to 120 days; goal < 7.0%

Question 22

what is the goal BG before meals? two hr after meals? & at bedtime?

Answer 22

• b4 meals = 70 to 30 mg/dl
• two hours after meals = 180 (30-to-50-point rise from pre mean glucose)
• bedtime = 90 to 150 mg/dL

Question 23

what is hypoglycemia? and what are its causes?

Answer 23

• low BS
• too much insulin, skipping meals, too much
  exercise without food replacement; occurs most commonly during insulin peak and at night during sleep

Question 23

what are the symptoms of hypoglycemia?

Answer 23

- occur when blood glucose level falls below 50 mg/dL or if there is a significant drop in blood glucose level - cool, clammy, confusion, huger

Question 23

what is ketosis?

Answer 23

- abnormal accumulation of ketones resulting from metabolism of fatty acids

Question 24

what are the consequences of DKA?

Answer 24

- hyperglycemia, osmotic diuresis, dehydration, lactic acidosis, lowered pH, rapid respirations (Kussmaul’s respirations), fruity or acetone breath odor; coma and death if untreated

Question 25

what are the precipitating factors of DKA?

Answer 25

- insufficient or interrupted insulin therapy, too much food, infection, other stresses

Question 26

what is the cause of Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)?

Answer 26

- insulin deficiency that results in severe hyperglycemia; attributable to stress (e.g., trauma, infection)

Question 27

define Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)?

Answer 27

- Enough insulin is present to prevent ketosis and acidosis, but not enough to prevent hyperglycemia

Question 28

what are the goals of nutrition therapy for DM pt's?

Answer 28

- maintain blood glucose level within normal range ➢ Prevent and treat chronic complications ➢ Improve health through healthy food choices and physical activity

Question 29

carb counting algorithm:

Answer 29

- Before meal BG target 80-130 mg/dl - Correction Factor: 1 U of short-acting insulin for every 50mg/dl over the target

Question 30

what are the different terms for sugar in food?

Answer 30

1. Dextrose 2. Fructose 3. Galactose 4. Glucose 5. Lactose 6. Maltose 7. Sucrose 8. Syrups (corn syrup, honey, molasses, maple syrup

Question 31

what are the 3 biggest nonnutritive sweeteners

Answer 31

1. Acesulfame-K 2. Aspartame 3. Saccharin

Question 32

what is a good summary for DM?

Answer 32

- s a group of conditions characterized by either a relative or complete lack of insulin secretions by the beta cells of the pancreas or defects of cell insulin receptors. The two primary categories of intolerance are 3ᵗʰE T1DM and T2DM. Maintenance of glucose homeostasis may require the use of insulin or other medicines, nutrition therapy, and exercise.

Question 33

what is the nursing role in nutrition therapy?

Answer 33

- Consider client’s age and the setting. - Assess client’s knowledge, understanding, and adherence to regimen. - Monitor glucose to check compliance. - Noncompliance may be explained by lack of knowledge versus lack of motivation. - Devise care plan. - Ensure that management goals are realistic

Question 34

what is gastroparesis?

Answer 34

- delayed gastric emptying associated with heartburn, nausea, abdominal pain, vomiting, early satiety, weight loss

Question 35

what is the nutrition management?

Answer 35

- Replace carbohydrates with tolerated foods ➢ Six small meals per day ➢ Constipation or diarrhea: increase fiber ➢ Dry mouth: increase fluids; add broth to moisten food ➢ Low-fat (40 g) soft or liquid diet: may help