Nutritional Aspects of Diabetes

Question 1

What are the aims of lifestyle interventions?

Answer 1

Achieve and maintain >= 7% weight loss via diet plus >= 150 mins/week moderate intensity exercise

Question 2

What are the first two steps of diabetic treatment?

Answer 2

Identifying risk and risk management

Question 3

How can risk be identified?

Answer 3

Computer based tools to use on practice data = Cambridge diabetes score, Leicester practice score
Questionnaires (if took not available) = FINDRISK

Question 4

What does the Diabetes UK self assessment risk score assess?

Answer 4

10 year risk of type 2 diabetes = family history, age, gender, ethnicity, BMI, waist circumference, blood pressure

Question 5

What is the risk management for a patient with low risk?

Answer 5

Brief advice on benefits of healthy lifestyle and modifying risk factors

Question 6

What is the risk management for a patient with moderate risk?

Answer 6

Brief intervention on benefits of healthy lifestyle and modifying risk factors

Question 7

What is the risk management for a high risk patient?

Answer 7

Intensive intervention to increase physical activity, achieve and maintain weight loss, increase fibre and reduce fats/saturated fats

Question 8

What are the aims of diabetes management?

Answer 8

Relief acute symptoms
Avoid extremes of hypo and ketoacidosis
Reduce risk of macro/microvascular complications, maintain quality of life

Question 9

How can the risk of macro and microvascular complications be reduced?

Answer 9

Maintain near normal control of blood glucose, blood pressure control, weight loss

Question 10

What are the components for diabetes management?

Answer 10

Type 1 = diet and insulin

Type 2 = lifestyle alone, lifestyle and medication, strong association with obesity

Question 11

What are the features of weight management?

Answer 11

Prioritise sustained weight loss of >= 5% in overweight people by reducing calorie intake and increasing energy expenditure

Question 12

Why does weight loss help improve diabetes?

Answer 12

Reducing adiposity improves insulin sensitivity and beta cell function

Question 13

What is the SIGN advice of n behaviour change for weight loss?

Answer 13

Reduce energy dense food/drink, fast foods, alcohol and sedentary behaviour
600kcal deficit tailored diet
Encourage low energy density food/drink, moderate-vigorous activity and self weighing

Question 14

What should the choice of diet in a type 2 diabetic be based on?

Answer 14

Overall nutritional quality of diet
Patient preference and acceptability of diet
Evidence for potential clinical benefits and any risk of harm

Question 15

What kind of diets are recommended in type 2 diabetics?

Answer 15

Cardio-protective

Mediterranean diet or equivalent healthy eating pattern

Question 16

How effective are low carb diets in type 2 diabetics?

Answer 16

Effective in managing weight and improving glycaemic control in the short term

Question 17

What kinds of exercise improve glycaemic control in type 2 diabetics?

Answer 17

Aerobic and resistance PA

Question 18

How should carbohydrate intake be tailored to insulin medication in type 1 diabetics?

Answer 18

Early insulin = regulated carbohydrate
Short/long acting insulin = more flexibility
Multiple daily injections = carb counting
Continuous SC insulin infusion = flexible diet

Question 19

What are some features of dose adjustments for normal eating (DAFNE)?

Answer 19

Suitable for type 1 diabetics using basal-bolts insulin, regular BG monitoring allows dose to be adjusted to CHO intake, activity levels and BG

Question 20

What are the steps to carb counting?

Answer 20

Identify which foods contain carbs
Calculate or estimate the CHO content of the meal
Calculate insulin dose needed to cover CHO eaten (insulin to CHO ratio 1:10)

Question 21

What are some other factors that need to be considered when carb counting?

Answer 21

Other factors that may influence blood glucose response, pre-meal blood glucose, activity levels

Question 22

What is the glycaemic index?

Answer 22

Rank of rate at which food makes blood glucose rise = insufficient evidence to recommend

Question 23

What are the usual causes of hypoglycaemia?

Answer 23

Missed/delayed meal, not enough CHO at last meal, increased physical activity, too much insulin, alcohol, tight control

Question 24

What are ways to reduce risk of hypoglycaemia?

Answer 24

Carry emergency supply of CHO and diabetic ID, check BG frequently, never drink alcohol on an empty stomach

Question 25

How should hypoglycaemia be treated?

Answer 25

Early stages easily corrected by 15-20g rapidly absorbed carbohydrates

Question 26

Who are at particular risk of hypoglycaemia?

Answer 26

Type 1 diabetics and type 2 diabetics on steroids insulin

Question 27

What are some ways to correct early hypoglycaemia?

Answer 27

4-5 glucotabs, 150ml sugary drink, 150-200ml fruit juice

Question 28

How can exercise cause hypoglycaemia?

Answer 28

Can occur 12-24hrs after exercise = >60 mins moderate intensity, exercise during peak insulin activity, afternoon exercise

Question 29

How can hypoglycaemia following exercise be prevented?

Answer 29

Adjust insulin or CHO intake = 1g of CHO/kg/hr of exercise

Question 30

How w may hyperglycaemia arise during exercise, and how may it be avoided?

Answer 30

Anaerobic activity, competition or insufficient insulin

Avoid exercising if BG > 14mmol/L or ketones present

Question 31

What are the risks associated with alcohol?

Answer 31

Hidden calories, increases risk of cancers, hypertension and liver disease, hypoglycaemia (especially on empty stomach), may mix up hypo symptoms with symptoms patient of intoxication