Nutritional Aspects of Diabetes Flashcards
What are the aims of lifestyle interventions?
Achieve and maintain >= 7% weight loss via diet plus >= 150 mins/week moderate intensity exercise
What are the first two steps of diabetic treatment?
Identifying risk and risk management
How can risk be identified?
Computer based tools to use on practice data = Cambridge diabetes score, Leicester practice score
Questionnaires (if took not available) = FINDRISK
What does the Diabetes UK self assessment risk score assess?
10 year risk of type 2 diabetes = family history, age, gender, ethnicity, BMI, waist circumference, blood pressure
What is the risk management for a patient with low risk?
Brief advice on benefits of healthy lifestyle and modifying risk factors
What is the risk management for a patient with moderate risk?
Brief intervention on benefits of healthy lifestyle and modifying risk factors
What is the risk management for a high risk patient?
Intensive intervention to increase physical activity, achieve and maintain weight loss, increase fibre and reduce fats/saturated fats
What are the aims of diabetes management?
Relief acute symptoms
Avoid extremes of hypo and ketoacidosis
Reduce risk of macro/microvascular complications, maintain quality of life
How can the risk of macro and microvascular complications be reduced?
Maintain near normal control of blood glucose, blood pressure control, weight loss
What are the components for diabetes management?
Type 1 = diet and insulin
Type 2 = lifestyle alone, lifestyle and medication, strong association with obesity
What are the features of weight management?
Prioritise sustained weight loss of >= 5% in overweight people by reducing calorie intake and increasing energy expenditure
Why does weight loss help improve diabetes?
Reducing adiposity improves insulin sensitivity and beta cell function
What is the SIGN advice of n behaviour change for weight loss?
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
What should the choice of diet in a type 2 diabetic be based on?
Overall nutritional quality of diet
Patient preference and acceptability of diet
Evidence for potential clinical benefits and any risk of harm
What kind of diets are recommended in type 2 diabetics?
Cardio-protective
Mediterranean diet or equivalent healthy eating pattern
How effective are low carb diets in type 2 diabetics?
Effective in managing weight and improving glycaemic control in the short term
What kinds of exercise improve glycaemic control in type 2 diabetics?
Aerobic and resistance PA
How should carbohydrate intake be tailored to insulin medication in type 1 diabetics?
Early insulin = regulated carbohydrate
Short/long acting insulin = more flexibility
Multiple daily injections = carb counting
Continuous SC insulin infusion = flexible diet
What are some features of dose adjustments for normal eating (DAFNE)?
Suitable for type 1 diabetics using basal-bolts insulin, regular BG monitoring allows dose to be adjusted to CHO intake, activity levels and BG
What are the steps to carb counting?
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)
What are some other factors that need to be considered when carb counting?
Other factors that may influence blood glucose response, pre-meal blood glucose, activity levels
What is the glycaemic index?
Rank of rate at which food makes blood glucose rise = insufficient evidence to recommend
What are the usual causes of hypoglycaemia?
Missed/delayed meal, not enough CHO at last meal, increased physical activity, too much insulin, alcohol, tight control
What are ways to reduce risk of hypoglycaemia?
Carry emergency supply of CHO and diabetic ID, check BG frequently, never drink alcohol on an empty stomach
How should hypoglycaemia be treated?
Early stages easily corrected by 15-20g rapidly absorbed carbohydrates
Who are at particular risk of hypoglycaemia?
Type 1 diabetics and type 2 diabetics on steroids insulin
What are some ways to correct early hypoglycaemia?
4-5 glucotabs, 150ml sugary drink, 150-200ml fruit juice
How can exercise cause hypoglycaemia?
Can occur 12-24hrs after exercise = >60 mins moderate intensity, exercise during peak insulin activity, afternoon exercise
How can hypoglycaemia following exercise be prevented?
Adjust insulin or CHO intake = 1g of CHO/kg/hr of exercise
How w may hyperglycaemia arise during exercise, and how may it be avoided?
Anaerobic activity, competition or insufficient insulin
Avoid exercising if BG > 14mmol/L or ketones present
What are the risks associated with alcohol?
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
