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FN 125 LE3 > PRE-DIABETES & T2DM > Flashcards

PRE-DIABETES & T2DM Flashcards

1
Q

Group of diseases characterized by prolonged hyperglycemia

A

Diabetes Mellitus

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2
Q

Defects that cause DM

A
  • insulin secretion
  • insulin action
  • both secretion and action
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3
Q

T or F: DM contributes to increase in Morbidity and mortality

A

TRUE

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4
Q

How to reduce effect of DM

A

Early diagnosis and treatment

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5
Q

Cells that release insulin

A

Pancreatic beta cells from islets of langerhans

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6
Q

Cells that release glucagon

A

Pancreatic alpha cells from islets of langerhans

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7
Q

Categories of glucose intolerance

A
  • pre-diabetes
  • T1DM
  • T2DM
  • GDM
  • Other types
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8
Q

Impairment of pre-diabetes

A
  • impaired fasting glucose
  • impaired glucose tolerance
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9
Q

one step before diabetes

A

pre-diabetes

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10
Q

what conditions are you susceptible to if pre-diabetic

A
  • diabetes mellitus
  • cardiovascular diseases
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11
Q

How many test should you be positive to be considered pre-diabetic

A

1 test

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12
Q

tests to diagnose pre-diabetes

A
  • impaired fasting glucose
  • impaired glucose tolerance
  • hemoglobin A1C (HbAIC)
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13
Q

How many hours do you need to fast for Impaired fasting glucose

A

8 hrs

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14
Q

primary intervention for pre-diabetes

A

lifestyle modification

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15
Q

minimum weight loss required for pre-diabetes

A

5%

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16
Q

based on clinical trials, what are the primary interventions for pre-diabetes

A
  • weight loss 5% - 10%
  • physical activity of at least 150 min/week of moderate activity
  • ongoing counseling and support
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17
Q

What drug has the strongest evidence for DM prevention

A

metformin

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18
Q

T or F: Drugs/Medications are most effective way in managing diabetes or preventing diabetes

A

False, lifestyle modifications are more recommended

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19
Q

Benefits of physical activity

A
  • improves blood glucose control in T2DM
  • improve insulin sensitivity independent of weight loss
  • reduce CVD risk factors
  • contribute to overall well-being
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20
Q

Recommendations for physical activity for pre-diabetes

A
  • moderate-intensity aerobic PA minimum of 30 mins, 5 days per week (150 min/week) OR vigorous-intensity aerobic PA minimum of 20 minutes, 3 days per week (90 min/week)
  • muscle-strengthening activities involving major muscle groups 2 days per week
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21
Q

Diagnostic criteria of Pre-diabetes for each test

A
  • IFG: 100-125 mg/dL
  • IGT: 140-199 mg/dL
  • HbAIC: 5.7-6.4%
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22
Q

Factors taken into account when meal planning

A
  • health status
  • Food preferences
  • Food security
  • Housing situation
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23
Q

How to maintain the pleasure of eating for pre-diabetic patients

A

provide nonjudgmental messages about food choices

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24
Q

Recommended healthy lifestyle habits

A
  • develop healthy eating pattern
  • regular physical activity
  • achieve and maintain body weight goals
  • moderate alcohol intake and being a nonsmoker
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24
Q

Benefit of healthy lifestyle habits

A

reduce risk of T2DM in women (84%) and men (72%)

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25
Q

What type of diet/eating pattern is recommended for pre-diabetes

A

Mediterranean-style

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25
Q

How much fish and wine is recommended

A

moderate amounts

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25
Q

What is included in Mediterranean-style diet

A

high levels of MUFA such as olive oil, high intake of plant-based food such as vegetables, legumes, fruits, and nuts

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26
Q

T or F: It is recommended to eat more red meat and whole-fat dairy products

A

False

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27
Q

recommended fiber intake for pre-diabetes

A

14 g/1000 kcal

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28
Q

Benefits of increased fiber intake

A
  • improve insulin sensitivity
  • improve insulin secretion to overcome insulin resistance
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29
Q

Recommended amount of alcohol for consumption

A

1-3 drinks/day or 15-45 g

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30
Q

What types of SSBs should be limited

A
  • soft drinks
  • fruit drinks
  • energy and vitamin water-type drinks
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31
Q

what type of fat is associated with increased markers of insulin resistance and risk of T2DM

A

SFA and Trans fats

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32
Q

What effect does increased consumption of unsaturated fatty acids have

A

inverse risk of diabetes

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33
Q

T2DM accounts for ___% of all diagnosed cases of DM

A

90-95%

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34
Q

T or F: T2DM is likely to be present long before it is diagnosed

A

True

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35
Q

Primary metabolic abnormality in T2DM

A

Hyperglycemia

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36
Q

What does it mean if symptoms of T2DM show

A

body cannot handle hyperglycemia anymore

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37
Q

what kind of complications will develop from hyperglycemia

A

microvascular and macrovascular complications

38
Q

what physical sign is often associated with hyperglycemia

A

non-healing wounds

39
Q

usual bmi profule of T2DM patients

A

obese: bmi greater than or equal to 30 kg/m^2

40
Q

what are small plasma proteins produced by adipose tissue that can contribute to insulin resistance

41
Q

what are 2 adipokines that promote insulin resistance

A

TNF alpha (TNF-a) and Interleukin 6 (IL-6)

42
Q

fatty acids promote lipid overflow and are stored in what tissues/organs

A

skeletal muscle, liver, pancreas

43
Q

Risk factors of T2DM

A
  • family history of diabetes
  • older age
  • physical inactivity
  • prior history of gestational diabetes, prediabetes, hypertension, or dyslipidemia
44
Q

pathophysiology: T2DM is a combination of ___

A

insulin resistance and B-cell failure

45
Q

upon diagnosis of T2DM, there is already a ____% reduction in B-cell function

46
Q

Target tissues of insulin resistance

A

muscle, liver, and adipose cells

47
Q

what is it called when the pancreas is unable to continue producing adequate insulin

A

pancreatic decompensation

48
Q

what causes lipotoxicity

A
  • lipolysis and elevation of circulating FFAs
  • excess intraabdominal obesity causing increased influx of FFAs to the liver
49
Q

effect of lipotoxicity

A
  • decrease insulin sensitivity at the cellular level, impairs pancreatic insulin secretion, & disrupts hepatic glucose production
50
Q

how is hyperglycemia first exhibited

A

elevation of postprandial blood glucose caused by insulin resistance at cellular level

51
Q

after elevation of postprandial blood glucose, what is the following sign of hyperglycemia

A

elevation of fasting glucose concentrations

52
Q

as insulin secretion decreases, hepatic glucose production ____

53
Q

what is the cause of elevated fasting blood glucose

A

liver signals glycogenolysis to compensate for the lack of glucose in cells as a result of insulin insensitivity

54
Q

what function of the pancreas increases hepatic glucose production

A

pancreatic alpha cells produce glucagon to signal glycogenolysis and gluconeogenesis

55
Q

what causes redox stress in the islets of langerhans

A

glucotoxicity

56
Q

3 classical symptoms of T2DM

A
  • polydipsia
  • polyuria
  • polyphagia
57
Q

T or F: T2DM patients are prone to diabetic ketoacidosis

A

False, T1DM are more prone to DKA

58
Q

when does DKA happen in T2DM patients

A

under severe stress

59
Q

What risk factors, when combined with obesity, indicate the need for diabetes screening in adults

A
  • 1st degree relative with diabetes
  • high risk race/ethnicity (African American, Latino, Native American, Asian American, Pacific Islander)
  • History of CVD
  • Hypertension
  • HDL-cholesterol lvl >35 mg/dL or TAG lvl >250 mg/dL
  • women w/ PCOS
  • physical inactivity
  • other clinical conditions associated with insulin resistance
60
Q

what other factos should be considered for screening in adults

A
  • patients with prediabetes (yearly)
  • women diagnosed with GDM
  • 45 years old
  • HIV
61
Q

What risk factors, when combined with obesity/overweight, indicate the need for diabetes screening in children/adolescents

A
  • maternal history of diabetes/GDM
  • family history of T2DM in 1st or 2nd degree relative
  • race/ethnicity
  • signs of insulin resistance (acanthosis nigricans, hpn, dylipidemia, small-for- gestational age birth weight
62
Q

diagnostic criteria for T2DM

A
  • HbAIC = greater than or equal to 6.5%
  • fasting plasma glucose = greater than or equal to 126 ml/dL
  • 2 hr post-challenge glucose = greater than or equal to 200 mg/dL
  • random plasma glucose = greater than or equal to 200 mg/dL
63
Q

diagnostic criteria to differentiate T1DM from T2DM

A

T1DM = low C-peptide
T2DM = high C-peptide

64
Q

how does HbAIC work?

A

blood sugar attaches to hemoglobin

65
Q

How long does HbA1c represent average blood glucose levels

A

approx 3 months

66
Q

components of medical management in T2DM

A
  • MNT
  • physical activity
  • blood glucose monitoring
  • medications
  • self-management education and support
67
Q

what is the progression of pharmacological management in T2DM patients

A

oral hyperglycemic agents first then injectable insulin

68
Q

target improvement goals of MNT for T2DM

A
  • improve AIC, blood pressure, and cholesterol levels
  • achieve and maintain body weight goals
  • delay or prevent progression of diabetes
69
Q

how many MNT encounters during the first 6 months

70
Q

minimum annual MNT follow up encounter

71
Q

ideal macronutrient distribution

A

no ideal percentage

72
Q

key strategy to achieve glycemic targets

A

assessment of current diet intake followed by individualized guidance on self-monitoring carbohydrate intake

73
Q

recommended fiber intake for T2DM

A

14 g/1000 kcal

74
Q

key factors commonly focused on for eating pattern

A
  • emphasize non-starchy vegetable
  • minimize added sugar and refined grains
  • whole foods over processed foods
75
Q

eating pattern recommendation with the most evidence in improving glycemia

A

reduce overall CHO intake

76
Q

what is a viable approach for adults with T2DM not meeting glycemic targets

A

low or very low CHO eating plans

77
Q

MNT recommendation to lose weight

A

energy deficit individualized eating plan with enhanced physical activity

78
Q

simple an effective approach to glycemia & weight management for patients not taking insulin and limited health literacy

A

emphasize appropriate portion size & healthy eating

79
Q

minimum weight loss required for T2DM

80
Q

weight loss to achieve optimal outcome

A

greater than or equal to 15%

81
Q

weight loss in prediabetes to prevent progression to T2DM

82
Q

T or F: medication-assisted weight loss can be considered for people at risk for T2DM to achieve 7-10% weight loss

83
Q

type of intervention for prediabetes at a healthy weight

A

lifestyle intervention (aerobic and resistance exercise w/ healthy eating plan)

84
Q

what should SSBs be replaced with

85
Q

what should be done if sugar substitutes are used to reduce overall calorie and CHO intake

A

counseling to avoid compensating from other food sources

86
Q

T or F: Routine use of vitamins and mineral supplements are recommended

87
Q

what vitamin should be assessed if patient is taking metformin

88
Q

recommendation for adults with fixed daily insulin doses

A

consistent CHO intake with respect to time and amount while considering insulin action time

89
Q

what to consider when consuming mixed meal with CHO and high in fat

A
  • insulin dosing should not be based solely on CHO counting
  • increase mealtime insulin as suggested
  • continuous glucose monitoring or self-monitoring of blood glucose to guide administration of additional insulin
90
Q

what to replace saturated fats with?

A

unsaturated fat

91
Q

what to replace foods high in CHO

A

foods low in CHO and high in fat (high unsaturated fat)

92
Q

recommended amount of sodium

A

<2,300 mg/day

93
Q

servings of fatty fish per week

A

at least 2

94
Q

lowering protein does not alter the?

A
  • glycemic measures
  • CVD risk
  • GFR decline
    but can increase risk of malnutrition
95
Q

MNT for prevention and management of gastroparesis

A
  • selection of small-particle size foods
  • correcting hyperglycemia
  • use of CGM and/or insulin pump therapy
96
Q

recommendations for glycemic control for T2DM

A
  • AIC = <7%
  • preprandial capillary plasma glucose = 80-130 mg/dL
  • <180 mg/dL

FN 125 LE3 (5 decks)

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