Nutritional Aspects of Diabetes Mellitus Flashcards
Who should be seen by a dietitian?
All people with newly diagnosed diabetes should be assessed by a dietitian
Preventable diabetes?
T2DM
Risk factors for diabetes?
Increasing age
Genetic predisposition:
- Ethnicity
- FH
Obesity:
- Sedentary lifestyle
- Energy-dense diet Deprivation
Evidence that lifestyle changes can control diabetes?
Lifestyle modification is at least as effective as medication at decreasing risk
NICE guideline for diabetes control?
- Identify risk (using computer-based tools, like Qdiabetes score)
- Risk management
What does the diabetes UK risk score (self-assessment) calculate?
- Age
- FH
- BMI
- Waist cirumference (+gender)
- BP
- +/- ethnicity
- +/- diet, exercise, hyperglycaemia
Risk management at different levels?
Aims of treatment of diabetes?
Relief of acute symptoms
Avoid extremes, i.e: hypoglycaemia and DKA
Maintain quality of life
Reduce risk of micro/macrovascular complications:
- Main near normal control of BG levels
- BP control
- Weight loss in overweight/obese
Short terms risks of T1DM and T2DM?
T1DM - hypoglycaemia, DKA
T2DM - HHS
Long-term risks of diabetes?
Macrovascular disease:
- TIA and stroke
- Angina, MI cardiac failure
- PVD
Microvascular disease:
- Diabetic retinopathy
- Micro/macroalbuminuria and end-stage renal disease
- Autonomic neuropathy
- Peripheral neuropathy
- Osteomyelities
- Amputation
Mx of T1DM?
Diet + insulin
Advise smoking cessation
Mx of T2DM?
Lifestyle alone
Lifestyle + medication
Advice smoking cessation
Goals of medical nutrition therapy?
Self-management (affected by quality of life and flexibility):
• Short term - optimise BG and BP control, optimise lipid profile and maintain a healthy body weight
What is macronutrient distribution based upon?
No ideal % of calories from carbs, protein and fat for all diabetic
So, should be based upon individualized assessment of current eating patterns, preferences, and metabolic goals
Main nutritional considerations in T1DM?
Consistency and timing of meals and CHO
Timing of insulin
Monitoring BG regularly
Main nutritional consideration in T2DM?
Weight loss
Smaller meals and snacks
Physical activity
Monitoring BG and medication, if on insulin
Achieving glycaemic control in T2DM?
Weight Mx should be the primary nutritional strategy in managing glucose control in T2DM for people who are overweight/obese
Regular, moderate physical activity can reduce HbA1c independent of weight loss
Methods of control metabolic syndrome in T2DM?
Decrease salt intake to reduce BP (not all patients are salt-sensitive)
Decrease saturated fat intake to reduce triglycerides and increase HDL
Diet in T2DM?
Focus on total energy intake rather than on source of energy for optimal glycaemic control
Guidelines for weight loss?
Benefits of weight loss occur even when relatively little weight is lost, e.g: 10% is acceptable
Advice for behaviour change?
Reduce energy-dense food/drinks, fast foods, GI of carbs, alcohol and sedentary behaviour
Diet prescription (-600 kcal deficit but this is tailored)
Encourage:
- Low-energy density food/frinks
- Moderate-vigorous activity
- Self-weighing
What is the most important factor for weight loss?
Energy reduction
Glycaemic control in T1DM?
Carbs are the main nutrition consideration in T1DM
People using MDIs and CSII benefit from adjusting insulin to carb intake (offer eduction)
Consistent quantities of carbs on a day-to-day basis are beneficial for those people on fixed insulin regimens
Increased physical acitvity has health benefits but no evidence for improved glycaemic control in T1DM
Carbohydrate counting steps?
- Identify which foods contain carbs
- Calculate/estimate carb content of the meal
- Calculate insulin dose needed to cover carbs (insulin : CHO ratio, ICR)
Carb portions (CPs) may be used with 1 CP = 10g CHO
Consideration with carb counting steps?
- Other factors that may influence blood glucose response, i.e. Glycaemic Index
- Pre-meal blood glucose
- Activity levels
Types of carb counting?
Basic carb counting - suitable for all types
Advanced carb counting:
• Suitable for type 1 using basal bolus insulin, i.e: MDI, CSII; regular BG monitoring allows dose adjustment to CHO intake, activity levels and BG
Advantages of advanced carb counting?
- Consistency less important
- Can enjoy a wider variety of foods
- Learn to predict BG response in a variety of situations
- Promotes self-management
Disadvantages of advanced carb counting?
- Complex so requires dietetic education and support
- Regular BG monitoring
- Focus on CHO may compromise other aspects of diet
Treatment of hypoglycaemia?
15-20g rapidly absorbed carbohydrate:
• Glucose tablets or sugary/glucose drink, e.g: 4-5 glucotabs, 90ml-120ml Lucozade, 150-200ml fruit juice
Usual causes of hypoglycaemia?
- 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)
Reducing risk of hypoglycaemia?
- 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
Exercise and hypoglycaemia?
Can occur 12-24h after exercise
- >60 mins moderate intensity
- Exercise during peak insulin activity
- Afternoon exercise (nocturnal hypo)
- Prevent by adjusting insulin and /or CHO (1g CHO/kg body weight / hour exercise)
Exercise and hyperglycaemia?
Anaerobic activity, competition or insufficient insulin
• Avoid exercise if BG >14 mmol/L or ketones present (additional fast-acting insulin may be required)
Problems with alcohol?
Hidden calories Increased risk of some cancers, hypertension and liver disease
Hypoglycaemia can occur, esp. if no food, and this can be confused for drunken behaviour
Effect of sucrose on glycaemic control?
No different effect to other types of CHO
Effect of high dietary fibre on glycaemic control?
Effects unclear
Effect of sweeteners on glycaemic control?
- Nutritive e.g. xylotol reduced CHO – adjust insulin dose
- Non-nutritive e.g. aspartame - no effect on BG
No evidence of harm and most are unlikely to exceed Acceptable Daily Intake (ADI)
‘Diabetic foods’ NOT recommended (no benefit)
What is the glycaemic index (GI)?
Rank of rate at which food makes BG rise; it is +vely assoc. with HbA1c and a low GI diet can reduce HbA1c by 0.5%
Theory is that choosing foods based on GI can help control BG; in practice, there is variability and there is insufficient evidence to recommend
What is the most important dietary factor in T1DM?
Total CHO is most important
Micronutrients in diabetes?
No evidence of benefit unless there is an underlying deficiency; educate patients about importance of a diet with adequate vitamins/minerals and the potential toxicity of megadoses of supplements
