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Year 2 Clinical > Nutritional Aspects of Diabetes Mellitus > Flashcards

Nutritional Aspects of Diabetes Mellitus Flashcards

1
Q

Who should be seen by a dietitian?

A

All people with newly diagnosed diabetes should be assessed by a dietitian

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2
Q

Preventable diabetes?

A

T2DM

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3
Q

Risk factors for diabetes?

A

Increasing age

Genetic predisposition:

  • Ethnicity
  • FH

Obesity:

  • Sedentary lifestyle
  • Energy-dense diet Deprivation
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4
Q

Evidence that lifestyle changes can control diabetes?

A

Lifestyle modification is at least as effective as medication at decreasing risk

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5
Q

NICE guideline for diabetes control?

A
  1. Identify risk (using computer-based tools, like Qdiabetes score)
  2. Risk management
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6
Q

What does the diabetes UK risk score (self-assessment) calculate?

A
  • Age
  • FH
  • BMI
  • Waist cirumference (+gender)
  • BP
  • +/- ethnicity
  • +/- diet, exercise, hyperglycaemia
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7
Q

Risk management at different levels?

A
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8
Q

Aims of treatment of diabetes?

A

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
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9
Q

Short terms risks of T1DM and T2DM?

A

T1DM - hypoglycaemia, DKA

T2DM - HHS

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10
Q

Long-term risks of diabetes?

A

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
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11
Q

Mx of T1DM?

A

Diet + insulin

Advise smoking cessation

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12
Q

Mx of T2DM?

A

Lifestyle alone

Lifestyle + medication

Advice smoking cessation

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13
Q

Goals of medical nutrition therapy?

A

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

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14
Q

What is macronutrient distribution based upon?

A

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

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15
Q

Main nutritional considerations in T1DM?

A

Consistency and timing of meals and CHO

Timing of insulin

Monitoring BG regularly

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16
Q

Main nutritional consideration in T2DM?

A

Weight loss

Smaller meals and snacks

Physical activity

Monitoring BG and medication, if on insulin

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17
Q

Achieving glycaemic control in T2DM?

A

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

18
Q

Methods of control metabolic syndrome in T2DM?

A

Decrease salt intake to reduce BP (not all patients are salt-sensitive)

Decrease saturated fat intake to reduce triglycerides and increase HDL

19
Q

Diet in T2DM?

A

Focus on total energy intake rather than on source of energy for optimal glycaemic control

20
Q

Guidelines for weight loss?

A

Benefits of weight loss occur even when relatively little weight is lost, e.g: 10% is acceptable

21
Q

Advice for behaviour change?

A

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
22
Q

What is the most important factor for weight loss?

A

Energy reduction

23
Q

Glycaemic control in T1DM?

A

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

24
Q

Carbohydrate counting steps?

A
  1. Identify which foods contain carbs
  2. Calculate/estimate carb content of the meal
  3. Calculate insulin dose needed to cover carbs (insulin : CHO ratio, ICR)

Carb portions (CPs) may be used with 1 CP = 10g CHO

25
Q

Consideration with carb counting steps?

A
  • Other factors that may influence blood glucose response, i.e. Glycaemic Index
  • Pre-meal blood glucose
  • Activity levels
26
Q

Types of carb counting?

A

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

27
Q

Advantages of advanced carb counting?

A
  • Consistency less important
  • Can enjoy a wider variety of foods
  • Learn to predict BG response in a variety of situations
  • Promotes self-management
28
Q

Disadvantages of advanced carb counting?

A
  • Complex so requires dietetic education and support
  • Regular BG monitoring
  • Focus on CHO may compromise other aspects of diet
29
Q

Treatment of hypoglycaemia?

A

15-20g rapidly absorbed carbohydrate:

• Glucose tablets or sugary/glucose drink, e.g: 4-5 glucotabs, 90ml-120ml Lucozade, 150-200ml fruit juice

30
Q

Usual causes of hypoglycaemia?

A
  • 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)
31
Q

Reducing risk of hypoglycaemia?

A
  • 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
32
Q

Exercise and hypoglycaemia?

A

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)
33
Q

Exercise and hyperglycaemia?

A

Anaerobic activity, competition or insufficient insulin

• Avoid exercise if BG >14 mmol/L or ketones present (additional fast-acting insulin may be required)

34
Q

Problems with alcohol?

A

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

35
Q

Effect of sucrose on glycaemic control?

A

No different effect to other types of CHO

36
Q

Effect of high dietary fibre on glycaemic control?

A

Effects unclear

37
Q

Effect of sweeteners on glycaemic control?

A
  • 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)

38
Q

What is the glycaemic index (GI)?

A

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

39
Q

What is the most important dietary factor in T1DM?

A

Total CHO is most important

40
Q

Micronutrients in diabetes?

A

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

Year 2 Clinical (119 decks)

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