Nutrition of Diabetes

Question 1

what are the risk factors for T2 diabetes

Answer 1

genetics- ethnicity, family history
increasing age
obesity
deprivation

Question 2

is lifestyle good at managing T2DM

Answer 2

yes can be more effective than medication

Question 3

what ethnicity are high risk groups for T2DM

Answer 3

25-39 year old from south asian, chinese, african-caribbean, black african + other black and minority ethnic groups

Question 4

what factors are used to calculate the 10 year risk of developing T2DM

Answer 4

age, family history, BMI, waist circumference, gender, blood pressure, ethnicity, diet, exercise, hyperglycaemia

Question 5

what are the acute symptoms of T2DM

Answer 5

hyperosmolar hyperglycaemic state

Question 6

what are the acute symptoms of T1DM

Answer 6

DKA, hypos, weight loss, polydypsia, polyuria

Question 7

what are the components of management for T1DM

Answer 7

diet and insulin

BM measuring

Question 8

what are the components of treatment for T2DM

Answer 8

lifestyle

lifestyle + medication

Question 9

what is MNT

Answer 9

medical nutrition therapy

Question 10

what is the goals of MNT

Answer 10

self management in T2DM- BG control, healthy body weight, BP, lipid profile

long term reduce complications

Question 11

what needs to be taken into account in MNT

Answer 11

QOL- social eating, pleasure, religious

Question 12

what are the nutritional considerations for T1DM

Answer 12

consistency and timing of meals
timing of insulin
monitoring BG

CARBS- main concern for glycaemic control

Question 13

what are the nutritional considerations for T2DM

Answer 13

weight loss
lifestyle changes
smaller meals and snacks
monitoring BG

Question 14

what percentage of weight loss should you aim for in a patient

Answer 14

8%

Question 15

what should be the main glycaemic control in T2DM

Answer 15

weight management- reducing adiposity improves insulin sensitivity and beta cell function
(low GI diet not recommended for BG control)

Question 16

what food should be eaten in T2DM

Answer 16

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

Question 17

how much of a calorie deficit should you have

Answer 17

-600 kcals

Question 18

how should carbs be eaten in T1DM

Answer 18

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

Question 19

what is DAFNE suitable for

Answer 19

type 1 DM using basal bolus insulin (multiple daily injections)

Question 20

what are the pros of DANFE

Answer 20

consistency less important, enjoy greater variety of foods promotes self management

Question 21

what are cons of DAFNE

Answer 21

requires patient information and support, BG monitoring

Question 22

what are the calorie counting steps

Answer 22

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

Question 23

what is hypos a concern in

Answer 23

T2DM and T1 with meds

Question 24

what is the treatment for hypos

Answer 24

15-20 g of rapidly absorbed carbs

Question 25

what are the usual causes of hypos

Answer 25

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)

Question 26

how can you reduce the risk of hypos

Answer 26

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

Question 27

how is exercise linked to hypos

Answer 27

Can occur 12-24h after exercise
>60 mins moderate intensity
Exercise during peak insulin activity
Afternoon exercise (nocturnal hypo)

Question 28

how do you prevent exercise hypos

Answer 28

adjust insulin/ CHO

Question 29

how is exercise linked to hyperglcaemia

Answer 29

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

Question 30

what are the risks in diabetes of alcohol

Answer 30

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

Question 31

what are the types of sweetener and what effects do they have on diabetes

Answer 31

Nutritive e.g. xylotol reduced CHO – adjust insulin dose

Non-nutritive e.g. aspartame - no effect on BG

Question 32

how does GI affect BG

Answer 32

GI is positively associated with HbA1c

Question 33

what is the importance of micronutrients in diabetes

Answer 33

consume vitamins and minerals from natural food sources, usually no need for supplements (exception with folic acid pre conception)