Nutrition of Diabetes Flashcards
what are the risk factors for T2 diabetes
genetics- ethnicity, family history
increasing age
obesity
deprivation
is lifestyle good at managing T2DM
yes can be more effective than medication
what ethnicity are high risk groups for T2DM
25-39 year old from south asian, chinese, african-caribbean, black african + other black and minority ethnic groups
what factors are used to calculate the 10 year risk of developing T2DM
age, family history, BMI, waist circumference, gender, blood pressure, ethnicity, diet, exercise, hyperglycaemia
what are the acute symptoms of T2DM
hyperosmolar hyperglycaemic state
what are the acute symptoms of T1DM
DKA, hypos, weight loss, polydypsia, polyuria
what are the components of management for T1DM
diet and insulin
BM measuring
what are the components of treatment for T2DM
lifestyle
lifestyle + medication
what is MNT
medical nutrition therapy
what is the goals of MNT
self management in T2DM- BG control, healthy body weight, BP, lipid profile
long term reduce complications
what needs to be taken into account in MNT
QOL- social eating, pleasure, religious
what are the nutritional considerations for T1DM
consistency and timing of meals
timing of insulin
monitoring BG
CARBS- main concern for glycaemic control
what are the nutritional considerations for T2DM
weight loss
lifestyle changes
smaller meals and snacks
monitoring BG
what percentage of weight loss should you aim for in a patient
8%
what should be the main glycaemic control in T2DM
weight management- reducing adiposity improves insulin sensitivity and beta cell function
(low GI diet not recommended for BG control)
what food should be eaten in T2DM
focus should be on total energy intake rather than the food groups
reduce: sugars and energy dense food, fast foods, GI of carbs, alcohol
increase: fibre, activity, self weighing
low fat, mediterranean, high protein
how much of a calorie deficit should you have
-600 kcals
how should carbs be eaten in T1DM
more flexibility in short and long acting insulin
insulin analogues allow carb counting flexible diets
insulin can be adjusted in response to carb intake
if on fixed insulin then have similar carb intake day to tday
what is DAFNE suitable for
type 1 DM using basal bolus insulin (multiple daily injections)
what are the pros of DANFE
consistency less important, enjoy greater variety of foods promotes self management
what are cons of DAFNE
requires patient information and support, BG monitoring
what are the calorie counting steps
Identify which foods contain carbohydrate
Calculate or estimate the carbohydrate content of the meal
Calculate insulin dose needed to ‘cover’ carbohydrate eaten (insulin to CHO ratio, ICR)
Carbohydrate portions (CPs ) may be used 1 CP =10g
what is hypos a concern in
T2DM and T1 with meds
what is the treatment for hypos
15-20 g of rapidly absorbed carbs
what are the usual causes of hypos
Missed / delayed meal Not enough CHO at last meal Increased physical activity Too much insulin Alcohol (esp. on empty stomach) Tight control (little reserves for unexpected events)
how can you reduce the risk of hypos
Carry an emergency supply of CHO + diabetic ID
Check BG frequently (esp. before bed)
Never consume alcohol on an empty stomach
Be aware that stress / illness / exercise affects BG levels
how is exercise linked to hypos
Can occur 12-24h after exercise
>60 mins moderate intensity
Exercise during peak insulin activity
Afternoon exercise (nocturnal hypo)
how do you prevent exercise hypos
adjust insulin/ CHO
how is exercise linked to hyperglcaemia
Anaerobic activity, competition or insufficient insulin
Avoid exercise if BG >14 mmol/L or ketones present (additional fast acting insulin may be required)
low glucose causes low secretion of glucagon- causes hypers
what are the risks in diabetes of alcohol
calories
increased risk of cancer, hypertension, liver disease
hypos- esp if no ffod, increased activity of insulin- more prone if using an SU
confusion hypo symtpoms
what are the types of sweetener and what effects do they have on diabetes
Nutritive e.g. xylotol reduced CHO – adjust insulin dose
Non-nutritive e.g. aspartame - no effect on BG
how does GI affect BG
GI is positively associated with HbA1c
what is the importance of micronutrients in diabetes
consume vitamins and minerals from natural food sources, usually no need for supplements (exception with folic acid pre conception)
