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SMP - MNE Exam 1 > Nutrition Modules 5 & 6: Diabetes > Flashcards

Nutrition Modules 5 & 6: Diabetes Flashcards

1
Q

Where is amylase found? What is its function?

A

Saliva and small intestine (pancreas secretion)

Breaks down 1,4-glycosidic bonds to give glucose and maltose

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2
Q

What are the 3 brush-border enzymes?

A
  1. Maltase
  2. Sucrase
  3. Lactase
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3
Q

What are the 3 monosaccharides absorbed by the small intestine? Through which transport mechanism?

A
  1. Glucose: active transport
  2. Galactose: active transport
  3. Fructose: facilitated diffusion
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4
Q

Where are monosaccharides transported once absorbed by the small intestine? How? Why?

A 
The liver via the portal vein to
3 pathways:
1. Glycolysis
2. PPP
3. Glycogen synthesis
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5
Q

What quantity of carbs can be absorbed by the small intestine in an hour?

A

1g/kg

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6
Q

Which cells in the small intestine absorb monosaccharides?

A

Enterocytes

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7
Q

What are dietary fibers?

A

Plant polysaccharides that cannot be absorbed by small intestine

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8
Q

What are the 2 types of glucose protein carriers for entry into cells?

A
  1. Energy dependent Na+/Glc co-transporters

3. GLUTs

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9
Q

Which GLUT is most widely expressed?

A

GLUT 1

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10
Q

GLUT 1

  1. Location?
  2. Function?
  3. Characteristics?
A
  1. Erythrocytes and barrier tissues
  2. Basal glucose transport: absorption
  3. High affinity
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11
Q

GLUT 2

  1. Location?
  2. Function?
  3. Characteristics?
A
  1. Liver, pancreatic B-cells, small intestine, kidney
  2. Transports all 3 monosaccharides and serves as the “glucose sensor”
  3. Low affinity, high capacity
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12
Q

GLUT 3

  1. Location?
  2. Function?
  3. Characteristics?
A
  1. Testes and brain
  2. Primary Glc transporter in neurons
  3. High affinity for Glc and Gal
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13
Q

GLUT 4

  1. Location?
  2. Function?
  3. Characteristics?
A
  1. Adipose tissue, skeletal muscle, heart
  2. Glucose uptake
  3. High affinity when insulin present
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14
Q

GLUT 5

  1. Location?
  2. Function?
  3. Characteristics?
A
  1. Small intestine
  2. Fructose transporter
  3. High affinity for fructose
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15
Q

What are the 4 monosaccharide transporters of the small intestine?

A
  1. Energy dependent Na+/Glc co-transporters
  2. GLUT 1
  3. GLUT 2
  4. GLUT 5
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16
Q

When is the PPP stimulated?

A

When glucose is high

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17
Q

In which 4 organs/cells does the PPP happen?

A
  1. RBCs
  2. Liver
  3. Adipose tissue
  4. Adrenal glands
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18
Q

What are the 3 types of precursors for gluconeogenesis?

A
  1. Glycerol
  2. Lactate
  3. Some AAs
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19
Q

In which 2 organs does gluconeogenesis occur?

A
  1. Liver

2. Kidneys

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20
Q

What is the Cori cycle?

A

Gluconeogenesis in liver using the lactate produced in muscle because of anaerobic glycolysis

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21
Q

What % of glucose is recycled through the Cori cycle?

A

20%

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22
Q

Describe glycogen synthesis.

A
  1. G6P converted to G1P

2. G1P activated by UTP and added to existing glycogen by glycogen synthase

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23
Q

How is glycogen synthase activated?

A

High G6P

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24
Q

How does glucagon stimulate glycogen breakdown? In which tissues?

A
  1. Activates glycogen phosphorylase in muscles, liver, and kidney by phosphorylating it
  2. Inhibits glycogen synthase by phosphorylating it
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25
Q

What are the 3 short-term complications of DM?

A
  1. Ketoacidosis
  2. Hyperosmolarity
  3. Lactacidosis
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26
Q

What are the 3 long-term complications of DM?

A
  1. Microvascular: diabetic retinopathy, nephropathy
  2. Macrovascular: peripheral, cerebrovascular, CVD
  3. Neuropathological
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27
Q

How is DM diagnosed?

A

1 of the following:

  1. Random plasma glucose > 200 mg/dL + DM symptoms
  2. FPG > 126 mg/dL*
  3. PG > 200 mg/dL 2 hrs after 75g glucose load*
  4. Hb A1C > 6.5%
  • need to be repeated the next day
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28
Q

What % of DM cases are T1?

A

5-10%

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29
Q

What % of DM cases are T2?

A

90-95%

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30
Q

T1D peak onset?

A

11-12 yo

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31
Q

T2D peak onset?

A

50-60 yo

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32
Q

State of beta cells in T2D patients at diagnosis?

A

Intact

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33
Q

What 5 metabolic processes does insulin stimulate?

A
  1. Glucose uptake
  2. FA/TAG synthesis
  3. Glycogen synthesis
  4. AA uptake/protein synthesis
  5. Glycolysis
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34
Q

What 4 metabolic processes does insulin inhibit?

A
  1. Glycogen breakdown
  2. Lipolysis
  3. Proteolysis
  4. Gluconeogenesis
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35
Q

Describe the glucose uptake mechanism by GLUT 4 (3 steps)

A
  1. Insulin/GLUT 4 dimerization
  2. Autophosphorylation of receptor tyrosine kinase
  3. Signaling cascase promoting glucose entry via GLUT 4 fusion with plasma membrane
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36
Q

Describe how chromium contributes to glucose uptake.

A

Chromium enhances the activity of tyrosine kinase by binding chromodulin, which then binds to the receptor => it enhances glucose uptake

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37
Q

What is the result of chromium deficiency?

A

Insulin resistance

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38
Q

Can increase chromium intake help T2D patients?

A

NOPE

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39
Q

What 4 metabolic processes does glucagon stimulate?

A
  1. Glycogen breakdown
  2. Gluconeogenesis
  3. Ketogenesis
  4. Lipolysis
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40
Q

What 2 metabolic processes does glucagon inhibit?

A
  1. Glycolysis

2. Glycogen synthesis

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41
Q

What kind of receptors does glucagon bind?

42
Q

What 3 metabolic processes are stimulated by epinephrine?

A
  1. Glycogenolysis
  2. Gluconeogenesis
  3. Lipolysis
43
Q

How long after eating does the fasting state occur?

A

3-4 hours after

44
Q

What are the 3 ways in which cortisol increases blood glucose levels?

A
  1. Activates PEPCK to promote gluconeogenesis
  2. Proteolysis to maintain gluconeogenesis from protein
  3. Stimulates lipolysis
45
Q

How does insulin stimulate glycogen synthesis?

A
  1. Activates glycogen synthase by dephosphoralating it

2. Inhibits glycogen phosphorylase by dephosphoralating it

46
Q

Does glucagon affect muscles?

47
Q

What are the 9 populations at risk of T2D?

A
  1. BMI >=25
  2. First-degree relatives with DM (DIRECT FAMILY)
  3. Birthed baby > 9 lbs
  4. History of gestational diabetes
  5. Minorities
  6. Hypertension
  7. Physically inactive
  8. Low HDL or high TAG
  9. Impaired glucose tolerance
48
Q

How often should high risk patients be tested?

A

Every 3 years

49
Q

When should ALL patients be tested?

A

After 45 yo

50
Q

Describe the obesity cycle of insulin resistance leading to T2D.

A

Obesity => high FAs => gluconeogenesis => hyperglycemia => increased insulin secretion => further weight gain => insulin can’t secrete enough insulin => T2D

51
Q

How can gestational diabetes affect the fetus? 2 options

A
  1. Macrosomia

2. Restricted fetal growth

52
Q

What % of pregnancies are affected by gestational diabetes?

53
Q

What are the 4 risk factors for gestational diabetes?

A
  1. Obesity
  2. Family history of DM or GDM
  3. Glycosuria
  4. Previous pregnancies with large babies
54
Q

What is gestational diabetes due to?

A

Placental hormones interfere with maternal responsiveness to insulin

55
Q

When is gestational diabetes diagnosed?

A

After the 1st trimester (24-28 weeks) at the first prenatal visit

56
Q

What are the 3 parts of treatment for GDM?

A
  1. Diet: caloric targets (less than 45% carbs), and dietician counseling
  2. Exercise
  3. Insulin therapy if nutrition fails to maintain blood glucose OR if fetus is abnormally large (macrosomia)
57
Q

How does exercise help diabetes patients? 2 parts

A
  1. Increase muscle contractions = glucose uptake activation = insulin sensitivity increases = increase glucose uptake
  2. Increase in catecholamines and glucagon increase gluconeogenesis and lipolysis (weight loss and better lipid profiles)
58
Q

What kinds of questions should be avoided when assessing nutritional status of patients?

A

Leading questions (eg: what do you eat for breakfast, which assumes they eat breakfast) and questions about what was eaten the day before (focus on USUAL intake)

59
Q

What is the downside of fat-free foods?

A

High in sugar

60
Q

How should the 2h post-prandial glucose level be compared to the fasting glucose level?

61
Q

What % weight loss is sufficient to control diabetes in T2D patients?

A

5-10% GRADUAL weight loss

62
Q

What helps maintain glucose homeostatis?

A

Energy balance:

Eintake = Erequirement

63
Q

What is the normal fasting BG?

A

70-99 mg/dL

64
Q

What is the normal 2h postprandial BG?

A

Below 140 mg/dL

65
Q

How do fats and proteins ingested with carbs affect absorption?

A

They increase insulin so delay absorption

66
Q

How long after eating do glucose levels peak?

A

An hour after

67
Q

What are the 3 main factors that influence the glycemic response?

A
  1. Individual variation
  2. Carb source
  3. Meal size/composition
68
Q

What 6 carbs will lower the glycemic response?

A
  1. Whole grains
  2. Carbs with a high amylose/amylopectin ratio
  3. Less cooked carbs
  4. Less processed carbs
  5. Reduced ripeness
  6. Viscous fibers: gum, pectin
69
Q

What kinds of foods will increase the glycemic response?

A

Insoluble (incompletely fermented) fibers: cellulose (wheat, vegetable skin), hemicellulose (corn kernel skin, brown rice), lignin (broccoli stems, seeds, nuts)

70
Q

What is the glycemic index of a food?

A

Compares its quality to a reference 50g of sugar or white bread

71
Q

What are 3 limitations of glycemic index?

A
  1. Does not account for food condition (eg: ripeness)
  2. Ignores other foods ingested
  3. Fibers could be influencing results
72
Q

Are complex carbs absorbed at the same rate as simple carbs?

73
Q

How should DM patients ingest carbs?

A

Small amounts throughout the day

74
Q

What are 4 symptoms of hypoglycemia I did not know about?

A
  1. Sweating
  2. Blurry vision
  3. Poor coordination
  4. Seizures
75
Q

What are 3 potential causes of hypoglycemia?

A
  1. Inadequate food intake
  2. Medications
  3. Excessive exercise
76
Q

What is ketoacidosis caused by in DM patients?

A

Hyperglycemia but no insulin to trigger glucose uptake so ketone bodies are produced (same mechanism as starvation)

77
Q

What do Hb A1C levels represent? How?

A

Average blood glucose over 2-3 months because glucose binds to Hb in RBCs in proportion to ambiant glucose and HbA1C (glycated RBC) remains in blood for the lifespan of the RBC

78
Q

What is the KEY strategy to achieve glycemic control?

A

Monitor carb intake

79
Q

What are the 2 types of symptoms associated with hyperglycemia?

A
  1. Hyperosmolar symptoms

2. Impaired glucose uptake symptoms

80
Q

What are the 4 hyperosmolar symptoms of hyperglycemia?

A
  1. Polydipsia: excessive thirst
  2. Polyuria: excessive peeing
  3. Norturia: awakening to peeing
  4. Sudden unexplained weight loss
81
Q

What are the 5 symptoms of hyperglycemia due to impaired glucose uptake?

A
  1. Polyphagia
  2. Poor wound healing
  3. Chronic/recurrent skin infections
  4. Confusion
  5. Neurological symptoms
82
Q

What did the Diabetes Control and Complications Trial (DCCT) prove? With what patients?

A

Intensive management of T1D prevents complications:

  1. Test blood glucose 4x/day
  2. Insulin pump or injection 4x/day
  3. Adjust insulin
  4. Diet + exercise plan
  5. See docs/monthly
83
Q

What are the 3 goals of DM individualized nutrition therapy?

A
  1. Improve lipid profile
  2. Achieve/maintain ideal body weight
  3. Adapt to culture and lifestyle preferences
84
Q

Foods rich in what 3 things should be avoided by DM patients?

A
  1. Saturated FAs
  2. Trans FAs
  3. Cholesterol
85
Q

What information is needed to calculate the daily carb requirement?

A
  1. Weight
  2. Height
  3. Age
  4. Physical activity
86
Q

How many grams of carbs in 1 carb serving?

87
Q

What are the 7 foods that have 0 carbs?

A
  1. Meat
  2. Poultry
  3. Fish
  4. Eggs
  5. Nuts
  6. Cheese
  7. Salad greens (they have a little but not counted)
88
Q

How does alcohol affect metabolism?

A

It inhibits gluconeogenesis by the liver

89
Q

What are the 2 home glucose monitoring methods?

A
  1. Finger stick

2. Urine ketones

90
Q

How many calories should a DM patient burn each day exercising?

A

200-300 kcal

91
Q

What is the target fasting BG for DM patients?

A

90-130 mg/dL

92
Q

What is the target random BG for DM patients?

A

Below 180 mg/dL

93
Q

What is the target HbA1C for DM patients?

94
Q

What is the target HDL for DM patients?

A

> 50 mg/dL

95
Q

What is the target LDL for DM patients?

A

Below 100 mg/dL

96
Q

What is the target TAG for DM patients?

A

Below 150 mg/dL

97
Q

What is the main measurable target for DM patients?

98
Q

How often should HbA1C levels be tested?

A

2-4 times/year

99
Q

What are the 5 glucose management tools?

A
  1. Individualized meal plan
  2. Self-monitoring blood glucose
  3. Medical monitoring blood glucose
  4. Medication as needed
  5. Physical activity
100
Q

What are the basal/eating/total a day secretions of insulin by units?

A

Basal: 1/hr
Eating: 4-6/hr
Total a day: 40 units

SMP - MNE Exam 1 (25 decks)

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