Nutrition of Diabetes

Question 1

What are the risk factors for diabetes?

Answer 1

Genetic predisposition: ethnicity, family history
Increasing age
Obesity: sedentary lifestyles, energy dense diets
Deprivation

Question 2

What is more effective at prevention of type 2 diabetes; metofrmin or lifestyle?

Answer 2

Lifetsyle - achieve/ maintain >7% weight loss via diet + >150 mins/ week moderate intensity activity

Question 3

What is included in the 10 year risk of T2DM?

Answer 3

Age
Family history
BMI
Waist circumference
BP
Ethnicity
Diet, exercise, hyperglycaemia

Question 4

What is the aim of treatment in diabetes?

Answer 4

Relieve acute symptoms
Avoid extremes of hypo and ketoacidosis
Reduce risk of micro and macrovasular complications (normal glucose, BP and weight loss)
Maintain QOL

Question 5

What are the long term macrovascular complications of diabetes?

Answer 5

TIA
Stroke
Angina
MI
Heart failure
PVD

Question 6

What are the microvascular complications of diabetes?

Answer 6

Diabetic retinopathy (non-proliferative, proliferative, macular oedema)
Microalbuminaemia, macroalbuminaemia, renal disease
ED
Autonomic neuropathy
Peripheral neuropathy
Osteomyelitis
Amputation

Question 7

What is the main nutritional considerations in T1DM?

Answer 7

Consistency and timing of meals and CHO
Timing of insulin
Monitoring blood glucose regularly

Question 8

What are the main nutritional considerations in T2DM?

Answer 8

Weight loss
Smaller meals and snacks
Physical activity
Monitoring blood glucose and medication if on insulin

Question 9

What is recommended for weight loss in T2DM?

Answer 9

Sustained weight los of 5% in overweight people by reducing calorie intake and increasing energy expenditure

Question 10

Why does losing weight help with T2DM?

Answer 10

Reducing adiposity improves insulin sensitivity and beta cell function

Question 11

What can be done to help with metabolic syndrome in terms of nutrition?

Answer 11

Decreased salt to decrease BP

Decreased saturated fat intake to decrease triglycerides and increase HDL cholesterol

Question 12

What should be reduced in nutritional advice in T2DM?

Answer 12

Energy dense food and drink
Fast food
GI of carbs
Alcohol
Sedentary behaviour

Question 13

What is included in a diet prescription?

Answer 13

-600kcal

Question 14

What should be encouraged in nutritional advice?

Answer 14

Low energy density food and drinks
Mod to vig activity: regular, tailored, provide support
If diabetic with complications - medical review
Self-weighing

Question 15

How much exercise should be done to help with glycaemic control?

Answer 15

Aim for 150 mins per week of moderate to vigorous PA over at least 3 days per week

Question 16

What is carb counting?

Answer 16

Identify which foods contain CHO
Calculate or estimate the CHO content
Calculate insulin dose to cover CHO eaten
Carbohydrate portion may be used 1CP = 10g CHO

Question 17

When is DAFNE used?

Answer 17

Typ1 using basal bolus insulin (MDI or CSII)

Question 18

What are the pros to DAFNE?

Answer 18

Consistency less important
Can enjoy a wide variety of foods
Learn to predict BG response
Promotes self-management

Question 19

What are the cons to DAFNE?

Answer 19

Complex so requires education
Regular BG monitoring
Focus on CHP may compromise other aspects of diet

Question 20

How can early hypoglycaemia be corrected?

Answer 20

15/20g of rapidly absorbed CHO - 4-5 glucotabs, 170-225 ml of lucozade, 150-200ml of fruit juice

Question 21

What are the common cuases for hypoglycaemia?

Answer 21

Missed/ delayed meal
Not enough CHO at meal
Increased physical activity 
Too much insulin 
Alcohol on an empty stomach 
Tight control

Question 22

What are some ways to reduce the risk of hypo?

Answer 22

Carry an emergency supply of CHO + diabetic ID
Check BH frequently - esp before bed
Never consume alcohol on an emtpy stomach
Be aware that stress/ illness/ exercise affect BG levels

Question 23

When can a hypo occur after exercise?

Answer 23

12-24 hours after exercise
if more than 60 mins of moderate intensity
Exercise during peak insulin levels
Afternoon exercise can lead to nocturnal hypo

Question 24

What can cause hyperglycaemia in exercise?

Answer 24

Anaerobic activity, competition or insufficient insulin

Aovid exercise if BG >14 mmol/L or ketones present

Question 25

What is the glycaemic index?

Answer 25

The rank of rate at which food makes BG rise