Nutrition + Psychosocial Aspects of Diabetes Flashcards
What happens if an individual has a high-risk score?
Offered a blood glucose test to determine their risk of developing T2DM or diagnose existing diabetes
How is risk managed for individuals at different risk levels?
(1) Low risk → Brief advice on lifestyle changes
(2) Moderate risk → Brief intervention on lifestyle changes
(3) High risk → Intensive intervention (increase activity, weight loss, dietary improvements)
(4) Diagnosed T2DM → Enter diabetes management pathway
What are the components of diabetes management?
Type 1 → Diet + Insulin
Type 2 & Gestational → Lifestyle changes ± Medication
What is the recommended calorie deficit for weight loss?
600 kcal deficit
What percentage of T2DM patients are overweight? + What weight loss percentage improves glycaemic control and CVD risk?
(1) 80-90%
(2) ≥5%
How much physical activity is recommended?
≥150 mins/week (moderate to vigorous) over ≥3 days, including aerobic & resistance training
‘A structured education program for carb counting in T1DM’ What programme is this describing?
DAFNE
What is the target blood glucose range before exercise?
7-15 mmol/L
What should be done to prevent exercise-induced hypoglycaemia?
Adjust insulin or consume 1g CHO/kg/hour of exercise
Why is alcohol-related hypoglycaemia dangerous?
It can mimic drunkenness, leading to delayed or missed treatment. Those using insulin or sulfonylureas are at higher risk
How are mood and psychotic disorders linked to diabetes?
Has a bidirectional relationship
What percentage of patients experience distress at diagnosis?
85.2%
What percentage of patients report poor wellbeing years after diagnosis?
41%
How many patients receive psychological treatment for diabetes distress?
Only 10%
What is the most common mental health issue in diabetes?
Diabetes distress, not depression
What percentage of children with early-onset diabetes show neuropsychological deficits?
24%
Which tools can help evaluate diabetes distress?
PHQ-9 (depression screening)
Diabetes Distress Scale
How does Orlistat work and who is eligible for Orlistat treatment?
It is a lipase inhibitor that blocks the absorption of dietary fat
BMI ≥30 kg/m²
BMI ≥28 kg/m² with co-morbid conditions
What are the weight loss targets for continued Orlistat therapy?
≥5% weight loss in the first 3 months
≥10% weight loss in the first 6 months
How long can Orlistat be prescribed for?
Recommended maximum of 2 years
Safety evidence available for up to 4 years
A 39-year-old female presents to the GP enquiring about possible strategies to help her lose weight. She is a non-smoker and drinks alcohol only occasionally, however, she lives a very sedentary lifestyle and mainly cooks ready meals. She has type 2 diabetes mellitus, despite multiple interventions, her blood sugars remain above normal and she has presented to hospital three times over the past year as a result of this. Her height is 152 cm and weight is 92 kg. Her BMI is 39.2
Why is bariatric surgery the most suitable intervention?
BMI above 35 and type 2 diabetes
Diabetes is poorly controlled
Has tried multiple interventions
A 38-year-old lady presents to the GP for a follow-up appointment. She was recently started on liraglutide injections one month ago, however she has experienced severe nausea and vomiting throughout the past few weeks and would like to stop the injections. The GP decides to commence a different class of weight loss drug.
What is the mechanism of action of the likely new medication?
Drug prescribed is orlistat
= Pancreatic lipase inhibitor
A 45-year-old female presents with difficulty losing weight. She has a history of dyslipidaemia and obesity. At her last appointment, her weight was 90kg and her BMI 36.1 (height 158cm)
Despite attempting to increase her physical activity and modify her diet, she has been unable to lose weight and was commenced on liraglutide 12 weeks ago at her last appointment.
At today’s appointment she weighs 87kg.
Explain why the best advice moving forward is to discontinue liraglutide
This patient has lost 3kg
(3.3% of her initial body weight)
This is below the recommended 5% weight loss threshold after 12 weeks of treatment.
Therefore unlikely to provide significant further benefit
Liraglutide is recommended as an adjunct to diet and exercise for weight management in individuals with what?
(1) BMI ≥35
(2) BMI ≥30 with weight-related comorbidities such as type 2 diabetes or hypertension
