PRE-DIABETES & T2DM Flashcards
1
Q
Group of diseases characterized by prolonged hyperglycemia
A
Diabetes Mellitus
2
Q
Defects that cause DM
A
- insulin secretion
- insulin action
- both secretion and action
3
Q
T or F: DM contributes to increase in Morbidity and mortality
A
TRUE
4
Q
How to reduce effect of DM
A
Early diagnosis and treatment
5
Q
Cells that release insulin
A
Pancreatic beta cells from islets of langerhans
6
Q
Cells that release glucagon
A
Pancreatic alpha cells from islets of langerhans
7
Q
Categories of glucose intolerance
A
- pre-diabetes
- T1DM
- T2DM
- GDM
- Other types
8
Q
Impairment of pre-diabetes
A
- impaired fasting glucose
- impaired glucose tolerance
9
Q
one step before diabetes
A
pre-diabetes
10
Q
what conditions are you susceptible to if pre-diabetic
A
- diabetes mellitus
- cardiovascular diseases
11
Q
How many test should you be positive to be considered pre-diabetic
A
1 test
12
Q
tests to diagnose pre-diabetes
A
- impaired fasting glucose
- impaired glucose tolerance
- hemoglobin A1C (HbAIC)
13
Q
How many hours do you need to fast for Impaired fasting glucose
A
8 hrs
14
Q
primary intervention for pre-diabetes
A
lifestyle modification
15
Q
minimum weight loss required for pre-diabetes
A
5%
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
17
Q
What drug has the strongest evidence for DM prevention
A
metformin
18
Q
T or F: Drugs/Medications are most effective way in managing diabetes or preventing diabetes
A
False, lifestyle modifications are more recommended
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
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
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%
22
Q
Factors taken into account when meal planning
A
- health status
- Food preferences
- Food security
- Housing situation
23
Q
How to maintain the pleasure of eating for pre-diabetic patients
A
provide nonjudgmental messages about food choices
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
24
Benefit of healthy lifestyle habits
reduce risk of T2DM in women (84%) and men (72%)
25
What type of diet/eating pattern is recommended for pre-diabetes
Mediterranean-style
25
How much fish and wine is recommended
moderate amounts
25
What is included in Mediterranean-style diet
high levels of MUFA such as olive oil, high intake of plant-based food such as vegetables, legumes, fruits, and nuts
26
T or F: It is recommended to eat more red meat and whole-fat dairy products
False
27
recommended fiber intake for pre-diabetes
14 g/1000 kcal
28
Benefits of increased fiber intake
- improve insulin sensitivity
- improve insulin secretion to overcome insulin resistance
29
Recommended amount of alcohol for consumption
1-3 drinks/day or 15-45 g
30
What types of SSBs should be limited
- soft drinks
- fruit drinks
- energy and vitamin water-type drinks
31
what type of fat is associated with increased markers of insulin resistance and risk of T2DM
SFA and Trans fats
32
What effect does increased consumption of unsaturated fatty acids have
inverse risk of diabetes
33
T2DM accounts for ___% of all diagnosed cases of DM
90-95%
34
T or F: T2DM is likely to be present long before it is diagnosed
True
35
Primary metabolic abnormality in T2DM
Hyperglycemia
36
What does it mean if symptoms of T2DM show
body cannot handle hyperglycemia anymore
37
what kind of complications will develop from hyperglycemia
microvascular and macrovascular complications
38
what physical sign is often associated with hyperglycemia
non-healing wounds
39
usual bmi profule of T2DM patients
obese: bmi greater than or equal to 30 kg/m^2
40
what are small plasma proteins produced by adipose tissue that can contribute to insulin resistance
adipokine
41
what are 2 adipokines that promote insulin resistance
TNF alpha (TNF-a) and Interleukin 6 (IL-6)
42
fatty acids promote lipid overflow and are stored in what tissues/organs
skeletal muscle, liver, pancreas
43
Risk factors of T2DM
- family history of diabetes
- older age
- physical inactivity
- prior history of gestational diabetes, prediabetes, hypertension, or dyslipidemia
44
pathophysiology: T2DM is a combination of ___
insulin resistance and B-cell failure
45
upon diagnosis of T2DM, there is already a ____% reduction in B-cell function
24-65%
46
Target tissues of insulin resistance
muscle, liver, and adipose cells
47
what is it called when the pancreas is unable to continue producing adequate insulin
pancreatic decompensation
48
what causes lipotoxicity
- lipolysis and elevation of circulating FFAs
- excess intraabdominal obesity causing increased influx of FFAs to the liver
49
effect of lipotoxicity
- decrease insulin sensitivity at the cellular level, impairs pancreatic insulin secretion, & disrupts hepatic glucose production
50
how is hyperglycemia first exhibited
elevation of postprandial blood glucose caused by insulin resistance at cellular level
51
after elevation of postprandial blood glucose, what is the following sign of hyperglycemia
elevation of fasting glucose concentrations
52
as insulin secretion decreases, hepatic glucose production ____
increases
53
what is the cause of elevated fasting blood glucose
liver signals glycogenolysis to compensate for the lack of glucose in cells as a result of insulin insensitivity
54
what function of the pancreas increases hepatic glucose production
pancreatic alpha cells produce glucagon to signal glycogenolysis and gluconeogenesis
55
what causes redox stress in the islets of langerhans
glucotoxicity
56
3 classical symptoms of T2DM
- polydipsia
- polyuria
- polyphagia
57
T or F: T2DM patients are prone to diabetic ketoacidosis
False, T1DM are more prone to DKA
58
when does DKA happen in T2DM patients
under severe stress
59
What risk factors, when combined with obesity, indicate the need for diabetes screening in adults
- 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
what other factos should be considered for screening in adults
- patients with prediabetes (yearly)
- women diagnosed with GDM
- 45 years old
- HIV
61
What risk factors, when combined with obesity/overweight, indicate the need for diabetes screening in children/adolescents
- 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
diagnostic criteria for T2DM
- 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
diagnostic criteria to differentiate T1DM from T2DM
T1DM = low C-peptide
T2DM = high C-peptide
64
how does HbAIC work?
blood sugar attaches to hemoglobin
65
How long does HbA1c represent average blood glucose levels
approx 3 months
66
components of medical management in T2DM
- MNT
- physical activity
- blood glucose monitoring
- medications
- self-management education and support
67
what is the progression of pharmacological management in T2DM patients
oral hyperglycemic agents first then injectable insulin
68
target improvement goals of MNT for T2DM
- improve AIC, blood pressure, and cholesterol levels
- achieve and maintain body weight goals
- delay or prevent progression of diabetes
69
how many MNT encounters during the first 6 months
3-6
70
minimum annual MNT follow up encounter
1
71
ideal macronutrient distribution
no ideal percentage
72
key strategy to achieve glycemic targets
assessment of current diet intake followed by individualized guidance on self-monitoring carbohydrate intake
73
recommended fiber intake for T2DM
14 g/1000 kcal
74
key factors commonly focused on for eating pattern
- emphasize non-starchy vegetable
- minimize added sugar and refined grains
- whole foods over processed foods
75
eating pattern recommendation with the most evidence in improving glycemia
reduce overall CHO intake
76
what is a viable approach for adults with T2DM not meeting glycemic targets
low or very low CHO eating plans
77
MNT recommendation to lose weight
energy deficit individualized eating plan with enhanced physical activity
78
simple an effective approach to glycemia & weight management for patients not taking insulin and limited health literacy
emphasize appropriate portion size & healthy eating
79
minimum weight loss required for T2DM
5%
80
weight loss to achieve optimal outcome
greater than or equal to 15%
81
weight loss in prediabetes to prevent progression to T2DM
7-10%
82
T or F: medication-assisted weight loss can be considered for people at risk for T2DM to achieve 7-10% weight loss
True
83
type of intervention for prediabetes at a healthy weight
lifestyle intervention (aerobic and resistance exercise w/ healthy eating plan)
84
what should SSBs be replaced with
water
85
what should be done if sugar substitutes are used to reduce overall calorie and CHO intake
counseling to avoid compensating from other food sources
86
T or F: Routine use of vitamins and mineral supplements are recommended
false
87
what vitamin should be assessed if patient is taking metformin
B12
88
recommendation for adults with fixed daily insulin doses
consistent CHO intake with respect to time and amount while considering insulin action time
89
what to consider when consuming mixed meal with CHO and high in fat
- 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
what to replace saturated fats with?
unsaturated fat
91
what to replace foods high in CHO
foods low in CHO and high in fat (high unsaturated fat)
92
recommended amount of sodium
<2,300 mg/day
93
servings of fatty fish per week
at least 2
94
lowering protein does not alter the?
- glycemic measures
- CVD risk
- GFR decline
but can increase risk of malnutrition
95
MNT for prevention and management of gastroparesis
- selection of small-particle size foods
- correcting hyperglycemia
- use of CGM and/or insulin pump therapy
96
recommendations for glycemic control for T2DM
- AIC = <7%
- preprandial capillary plasma glucose = 80-130 mg/dL
- <180 mg/dL
