Nutrition of Diabetes

Question 1

how effective are lifestyle changes at preventing T2DM compared to medication

Answer 1

lower calorie/healthier diet and increased exercise is just as if not more effective than taking medication

Question 2

what patients should be screened for risk of developing T2DM

Answer 2

those >40y/o(except pregnant), those aged 25-39y/o South Asian, Chinese, African Caribbean, Black African, etc., those with conditions that increase risk of T2DM

Question 3

what degree of weight loss reduction should be recommended to patients at high risk of developing T2DM

Answer 3

weight loss of 5-7% of body weight significantly reduces risk

Question 4

what dietary advice should be given to those at high risk of T2DM trying to lose weight

Answer 4

decrease high energy/calorie food/meals, a diet high in fibre, reduce total fat/saturated fat in diet

Question 5

what are the recommended weekly levels of exercise and activity advice for patients

Answer 5

at least 150mins moderate exercise a week, OR 75mins vigorous exercise a week, also decrease sedentary time, improve strength + balance twice a week

Question 6

what is the difference between moderate and vigorous physical activity

Answer 6

moderate = increased breathing, able to talk(eg swim, walk, cycle)
vigorous = breathing fast, difficulty talking(eg run, sports)

Question 7

what types of diabetes are nutrition and lifestyle advice important to help with management

Answer 7

all types of diabetes

Question 8

what is the aim of diet and lifestyle management in the majority(80-90%) of people with T2DM

Answer 8

main issue is overweight and obesity

sustained weight loss of >/= 5%, by reducing calorie intake and increasing energy expenditure

Question 9

what is a general daily calorie deficit that can be used for diabetes patients losing weight

Answer 9

-600kcal a day

although this should be tailored to patients lifestyle and realistic to there situation

Question 10

in general what foods/drinks/behaviours should be reduced in those trying to lose weight

Answer 10

energy dense foods/drinks, fast foods, alcohol, sedentary behaviour
(although should be tailored to individual for best results)

Question 11

in general what food/drink/behaviours should be encouraged in those trying to lose weight

Answer 11

low energy dense food/drinks, increased physical activity, self-weighing

Question 12

what are some challenges to weight loss and maintenance

Answer 12

medication can induce weight gain, unrealistic aims can lead to frustration and non-compliance

Question 13

what nutrition advice is given to those with T1DM taking multiple daily injections or on insulin pumps
(ie those using basal bolus insulin)

Answer 13

adjust insulin to carbohydrate intake(‘carb counting’ or ‘insulin dose adjustment’), offer education and support

Question 14

what nutrition advice is given to those with T1DM on fixed mixed insulin regimes

Answer 14

aim for consistent quantities of carbohydrates on a day-to-day basis

Question 15

describe what DAFNE is

Answer 15

Dose Adjustment For Normal Eating, is an advanced carb counting course to help those with T1DM manage their nutrition

Question 16

what are the pros of carb counting/insulin dose adjustment

Answer 16

consistency less important, can enjoy wider variety of food, promotes self-management

Question 17

what are the cons of carb counting/insulin dose adjustment

Answer 17

complex so requires education + support, regular BG monitoring, focus on this may compromise other aspects of diet

Question 18

what are the different steps of carbohydrate counting/insulin dose adjustment

Answer 18

identify which foods contain carbs, calculate/estimate carb content of meal, calculate insulin dose required to ‘cover’ carbs eaten
(eg 1 insulin unit:10g carbs, different for each patient)

Question 19

what is the glycaemic index(GI) of a food

Answer 19

it is a rank of the rate at which food makes blood glucose rise

Question 20

what are the usual causes of hypoglycaemia in those with T1DM

Answer 20

missed/delayed meals, not enough carbs at last meal, increased exercise, too much insulin, alcohol

Question 21

what are some ways to reduce the risk of hypoglycaemia in those with T1DM

Answer 21

carry emergency supply of carbs, check BG regularly, never consume alcohol on empty stomach, be aware stress/exercise/illness affect BG levels