Spotlight A; Nutrition and Diabetes Flashcards
a projected [..] million people in the world will be living with diabetes by the year 2045
629
there is a pandemic of type [..] diabetes. its complications are insidious, and it is impacting the worlds youth, including children as young as [..] years of age
2
10
diabetes is characterized by the body’s inability to properly regulate blood glucose ([..]) concentrations, a main source of energy
sugar
energy
type 1 diabetes occurs when the [..] does not produce of the hormone [..]. required for the blood glucose control
pancreas
insulin
type 2 diabetes occurs when specific tissues become [..] to the effects of [..]
resistant
insulin
the result of either type of diabetes (1&2) is an [..] of glucose in the blood, causing vascular (blood vessel) [..] that can lead to serious and often fatal complications
overload
damage
since 1980 the percentage of individuals with diabetes has more than [..] in the wolds adult population, increasing from 4.7% to 9.6%
doubled
about 90% of people with diabetes are estimated to have top[..] diabetes
2
[..] is the main driver of type 2 diabetes
obesity
[..] predisposition is also a contributes to diabetes, as well as lifestyle choices such as inactivity and an unhealthy diet
genetic
diabetes mellitus, more commonly known simply as [..], is a group of disease that affect how the body uses blood [..], and if left untreated they can result in life threatening complications
diabetes
glucose
the hormone insulin plays a key role in blood glucose regulation by stimulating [..] and [..] muscle and [..] (fat) tissue to take up glucose from the blood. insulin also […] the release of glucose from the liver to the blood
cardiac, skeletal
adipose
suppresses
in diabetes, insulin is [..] or the cells of the body are [..] to its action
lacking
resistant
in type 1 diabetes, the pancreatic cells that secrete insulin are [..] by the body’s immune system, leading to a major [..] of insulin that typically progresses until its completely absent. it is an [..] disease.
destroyed
deficiency
autoimmune; the body’s immune system attack or destroy its own cells
is type 1 diabetes preventable
no,
its an autoimmune disease
when the pancreas becomes unable to [..] insulin, muscle and adipose tissues cannot take up glucose appropriately, and the blood glucose levels skyrocket - a condition known as hyperglycemia. in addition, the lack of insulin allows the liver to release excessive amounts of [..] into blood. when they rise too high, glucose enters [..] faster than the kidneys can transport it [..] into the blood, with the excess glucose “spilling over” into urine to be excreted from the body. this loss of glucose in urine deprives the body of a significant portion of the calories consumed throughout the day .
produce
glucose, urine , back
calories
the presence of elevated levels of glucose (type 2 diabetes), in urine also draws additional water into the urine to [..] the concentration of glucose, causing increased urine [..] and rapid rates of water [..].
dilute
volume
loss
the word diabetes comes from a Greek word meaning “to siphon, or to pass through”, because of the excessive [..] and fluid [..], whereas the word mellitus is derived from a latin word meaning “sweet” or “honeyed”, an apt description of the high sugar content in the urine of a person with uncontrolled diabetes
urination
fluid
in type 1 diabetes, the extremely low level of insulin not only allows [..] glucose production by the liver but also allows for the release of excessive amounts of [..] acids from adipose tissue. the liver converts some [..] acids into substances called ketone bodies that can used as a source of [..] by most cells in the body, including the brain. although ketone body synthesis is a normal process that occurs when insulin is low (such as during a fast), the near (or complete) lack of insulin in type 1 diabetes causes this process to become unregulated and to [..] dramatically.
excessive
fatty x 2, energy
accelerate
if diabetes is left untreated (type 1), the ketone bodies build up and reach dangerous levels in the blood, increasing its [..] and causing a condition called ketoacidosis, which can lead to coma and death
acidity
some of the increase in type 1 diabetes is due to the [..] population who now live longer, but most of the dramatic rise in type 2 diabetes is due to an increase in the prevalence of [..] and decreased [..] activity in our population - and not just in adults (under 20 years is increasing as well)
aging
obesity, physical
type 1 diabetes is typically diagnosed in [..] and [..] adults, and type 2 is most frequently seen in [..]
children, young
adults
unlike type 1, in which insulin producing pancreatic cells are destroyed and little or no insulin is made, type 2 diabetes occurs when cells are less [..] to the effects of insulin even if the pancreas is able to produce normal
destroyed
sensitive
obesity is by far the most significant risk factor for the type 2 disease: 80-90% of people with type 2 diabetes are overweight or obese. in addition to having excess body fat, physical inactivity is another fact that significantly affects the risk of developing type 2 diabetes
type 2 diabetes is higher among African americas, hispanics, and latinos, American Indians, asian Americans, and Pacific Islanders than among caucasians
the percentage of individuals in the [..] who have diabetes is even higher than that seen worldwide
US
in the US the percentage of individuals under the age of 20 years that have type [..] diabetes is about double that of those with type [..] diabetes, almost 6000 individuals in this age group are diagnosed with type 2 diabetes each year. until recently, type 2 diabetes was considered a disease of the [..] aged and [..]
1, 2
middle , elderly
the term epigenetic refers to the heritable chemical changes to genes that do not affect the [..] sequence but do alter gene [..]. these changes are triggered by [..] factors that alter the characteristics of the developing organism. since offspring can be affected by one or more of these environmental factors if either parent was exposed to them before the time of conception or if the mother was exposed to the during pregnancy. the net effect on the offspring can be immediately apparent at birth or in childhood, but it can be delayed, with increased risk of chronic diseases such as diabetes later in adulthood
DNA, function
environmental
maternal health and nutritional status may influence diabetes risk in the generation.
yes
and because type 2 diabetes itself can act as an epigenetic factor, these cause and effect trends can be multigenerational
causes; type 2 diabetes begins with the development of insulin [..]. most often this occurs because excess adipose tissue produces hormone like substances that circulate throughout the body and [..] with the signal that insulin sends into cells to stimulate glucose transporters to increase their [..] of glucose from the blood and into cells. as a result, muscle and fat cells respond poorly to insulin and take up glucose from the blood [..]. the body then needs higher levels of insulin to [..] blood glucose concentrations to appropriate levels. specific cells in the pancreas then produce more of the hormone to meet this demand. in some insulin resistant individuals, the pancreas can no longer keep up with the [..] demand for insulin, consequently, the concentration of glucose in the blood increases. insulin resistance also interferes with insulins ability to [..] the liver to stop glucose production, and the livers continued production of glucose also contributes to the increase in blood glucose levels.
resistance, interfere, uptake (absorption), insufficiently (poorly)
reduce, increased, signal
without intervention and lifestyle changes, many people who have insulin resistance go on to develop type [..] diabetes. however, they may first develop pre diabetes, a condition in which blood glucose moderately elevated above levels that are considered normal or desirable.
2
after fasting for eight hours, the normal blood glucose is between [..] mg and [..] mg per 100 ml blood, but the blood glucose levels of someone with pre diabetes would measure [..] mg to [..] mg per 100 ml blood (fasting blood glucose above [..] mg would indicate diabetes
70, 100
100, 125
125
to confirm the diagnosis of pre diabetes, glucose would be ingested as part of an oral glucose tolerance test (OGTT) and the same person would have elevated blood glucose levels in the 140-199 per 100 ml range - just under the 200 mg/100 ml diagnostic level for diabetes.
according to the American diabetes association, an estimated [..]% of Americans older than 18 have pre diabetes and fewer than [..]% have been told they have it. almost half ([..]) of adults aged 65 years or older have pre diabetes, which increases the risk of not only type 2 diabetes but also heart disease, stroke, and other conditions associated with elevated blood glucose levels (lifestyle strategies can normalize blood glucose levels and prevent or delay the onset or the consequence of type 2 diabetes)
34.5%, 16%
46.6%
doctors can diagnose pre diabetes and diabetes based on blood glucose concentrations after a patient has fasted for 8 hours or 2 hours after ingesting 75 grams of glucose (this last test is called an oral glucose tolerance test, or OGTT)
symptoms of diabetes are constantly feeling [..] (as the kidneys excrete the extra glucose through urine), experiencing [..] vision (as extra glucose enters the eye), and [..] weight (due to low insulin levels and muscle cells relying on burning fat for energy)
thirsty
blurred
losing
over time, high levels of blood glucose can damage [..] and [..], creating long term problems in the [..], [..] vessels, [..], [..], and [..]. the excess glucose causes blood vessel to [..] and lose some of elasticity, making these people more prone to heart attacks and stroke.
cells and organs
heart, blood, kidneys, eyes, nerves
thicken
even today, with the vast improvements in treatment, diabetes is the number one cause of adult [..] and is responsible for more than 60% of lower limb [..] that don’t result from trauma
blindness
amputations
complications of diabetes;
- diabetes [..] risk of stroke
- those with diabetes are more likely to die of [..] or [..]
- diabetes is the leading cause of kidney [..]
- diabetes can cause erectile [..]
- poorly controlled diabetes during pregnancy increases the risk of [..] for mother and baby
- diabetes damages small [..] vessels
- impaired [..] and [..] hyperglycemia damages the tiny blood vessels or capillaries that are abundant in tissues such as the retina of the eye
- gum [..] and tooth [..]
- increases risk of death from heart disease; number one killer of individuals with heart disease
- damages nerves through the body, causing [..] and [..]
- damages to nerves and blood vessels can cause lack of feeling in the extremities, poor [..] of wounds, and eventual [..]
increases , pneumonia or influenza
failure , dysfunction, complications
blood , vision and blindness
disease and loss , numbness and pain,
feeling , healing, amputations
the risk of complications is even higher when diabetes develops during [..] and [..]
childhood
adolescence`
diabetes complications; complications are substantial in both groups but higher in those with type [..] diabetes
2
the risk associated with the early onset and longer duration of type 2 diabetes is compounded by the fact that complications, often present at diagnosis, can progress more [..] when the disease occurs in people middle aged and beyond
rapidly
early onset type 2 diabetes is a serious life altering event, potentially leading to difficult to manage health complications, drastically impacting not only the quality of life of those in their prime but also their overall life expectancy .
researchers estimate that the development of type 2 diabetes in people between the ages of [..] to [..] years imparts a lifetime risk of blindness and reduces their lifespan by [..] years
15 to 24
15
pregnant women can develop a form of diabetes known as gestational diabetes. (risk has been increasing steadily)
approximately [..]% of expectant mothers will experience high blood glucose levels for the first time during pregnancy and this can affect their pregnancy, increasing the rate of complications or causing the fetus (the baby in the womb) to grow too [..].
18%
large
[..] women are at higher risk of pregnancy complications, so they are often screened early in their pregnancies . extra [..] can reduce the risk , and high [..] and a low glycemic index diet can help blood glucose at health levels
obese
exercise
fiber
for many women, gestational diabetes goes away once they give birth, but they will remain at a much higher risk of developing type [..] diabetes later in life. as a consequence, increase in the prevalence of gestational diabetes that contributes to the global diabetes pandemic
2
gestational diabetes;
1. hormones produced during pregnancy cause some women to develop insulin [..], which in turn causes gestational diabetes
2. causes glucose in the mother blood to increase and cross the [..]. the developing fetus is then exposed to the excess glucose
3. in response to high glucose, the fetus produces excess [..]
4. the extra fuel and high insulin concentrations cause the fetus to grow [..] and accumulate body [..]
resistance
placenta
insulin
larger, fat
gestational diabetes risk factors;
- [..] prior to pregnancy
- older than [..] years
- [..]
- family history of type [..] diabetes
- non [..] race
obese
25
pre diabetic
2
white
gestational diabetes consequences
for the mother:
- higher incidence of [..] section
- high blood [..] during pregnancy
- increased risk of develop [..] in 10-20 years
for the baby;
- risk of [..] injury during birth
- higher risk of [..] problems
- increased risk of becoming an [..] child
- increased risk of developing [..] as an adult
cesarean, pressure, diabetes
shoulder, breathing, obese, diabetes
people with type 1 diabetes must receive injections of [..] to manage their blood glucose levels. the person must give themselves injections several times per day or wears a medical device known as an insulin pump
insulininsulin
most insulin pumps are programmed manually to [..] deliver fixed amounts of insulin throughout the day, and they can be instructed to deliver [..] insulin following a meal or snack.
automatically
additional
the FDA recently approved the first artificial pancreas device system, this system includes a glucose sensor that is inserted through the skin and continuously monitors blood glucose levels . glucose values are sent wirelessly to the insulin pump that can then automatically adjust the insulin dose to maintain appropriate blood glucose levels.
regular monitoring of blood glucose levels with a glucose meter gives a person with type 1 diabetes a way to track the [..] of his or her food choices and activity level so that he or she can adjust insulin [..] accordingly to maintain desirable blood glucose level. although they must monitor their blood glucose levels, persons with type 2 diabetes generally do not require insulin injections , and their diabetes can often be [..] (or even prevented or reserved) by lifestyle modifications (including diet and physical activity) that [..] insulin resistance and promote a health body weight
impact
injections
managed, reduce
Different foods have different effects on blood glucose, even when those foods contain the [..] amount of starch and sugars. Specifically, how the body processes particular carbohydrates dictates how much and at what rate glucose will be released into the bloodstream and, therefore, how much insulin is released.
same
e.g. the complex carbohydrates or starches in foods can be partially “trapped” within the physical structure of grains or in the interlay portion of larger food particles. these physical structures can make it difficult for digestive enzymes to gain access to the starch, slowing digestion and the subsequent appearance of glucose in blood. such, which remain undigested when they enter the large intestine, are called resistant starches
diets high in resistant starch may [..] insulin sensitivity and make people feel [..] for longer periods. e.g. foods high in resistant starches include beans, underripe bananas, whole grain kernels, and pasta
starches in some foods, boiled potatoes and many breakfast cereals - are digested so quickly that blood glucose rises nearly as rapidly as what is seen after consuming an equal amount of pure glucose
improve
full
Surprisingly, sucrose, fructose, and lactose and foods that contain these sugars (such as candies, fruit, and dairy foods) often produce a [..] dramatic rise in blood glucose than do starchy foods. This is because fructose and galactose (a monosaccharide in lactose) have no [..] impact on blood glucose levels until they are converted to glucose in the liver.
less
immediate
Diets high in fiber, especially [..] fiber, also seem to help control blood glucose levels. One study found that people who consumed [..] grams of fiber per day with at least half as soluble fiber were able to control their blood glucose better than those who ate less fiber
soluble
50
Because food sources of carbohydrates have [..] effects on blood glucose levels, blood glucose control may be improved when people pay attention to a measure known as the glycemic index (GI) that ranks foods by how quickly and to what degree they raise blood glucose levels. The amount of available [..] (starch and sugars) present in the food is compared with the equivalent amount of [..], which has a GI of 100. Foods with a [..] GI raise blood glucose quickly and cause considerable spikes in blood glucose levels, whereas foods with a [..] GI cause a smaller and more gradual increase. Low GI diets may help individuals with diabetes better control blood glucose levels, and for those who don’t have the disease, a low GI diet reduces the risk of developing type 2 diabetes.
different
carbohydrate, glucose
high, low
Although glycemic index can be a helpful measure to consider, it has some limitations. Most significantly, there is wide variation among individuals in the measured glycemic [..] to the same foods. In addition, we rarely eat carbohydrate-containing foods in consistently the [..] amounts (smaller or larger amounts would alter the GI) or eat these foods by themselves. And even carbs with high GIs have less effect on blood glucose when consumed as part of a meal or snack with protein, fat, or fiber, which all delay gastric emptying. Even factors such as the [..] of a fruit or how a carbohydrate is processed can alter its GI.
response
same
ripeness
The GI of a food often does not reflect the amount of [..] contained in the servings of food that we typically consume. Foods with a low to moderate GI can still cause a dramatic [..] in blood glucose levels if consumed in large amounts.
carbohydrates
rise
consumers can also consult the glycemic load (GL), which calculates the effect of the actual serving size of food on blood glucose (by multiplying the GI by a food’s grams of carbohydrates, divided by 100). The GL, therefore, is a more useful assessment than the GI of a food’s effect on blood glucose
more useful than the GI
Some research suggests that diets emphasizing [..]-GI and [..]-GL foods in the overall diet may help manage diabetes, control body weight, and improve other health conditions. In addition, low-GI foods are often rich in [..] and other nutrients, which have clear benefits for health.
low
low
fiber
carbohydrate counting , or “carb counting”, is a meal planning technique that can help manage blood glucose levels. If part of the person’s diabetes management is to keep blood glucose levels in a desirable range, they can determine the total amount of carbohydrates (in grams) to include each day according to their energy needs and activity level.
yes
those with diabetes must keep track of their [..] intake, limiting saturated fat to less than [..]% of their total calories and eating as little [..] fat as possible
fat
7%
trans
some fats are heart healthy, though, and doctors will often tell people with diabetes to eat two or more weekly servings of [..], which provide [..] polyunsaturated fatty acids
fish
omega 3
physical activity also helps improve insulin [..], lower blood glucose levels, and keep weight [..] over the long term. exercise alone may not be enough, but exercise in addition to weight control and a varied and balanced diet provide the foundation for managing and preventing type [..] diabetes. when those lifestyle changes aren’t enough, [..] medications are available to lower blood glucose levels of individuals with type of 2 diabetes, and some people may require insulin [..] to get their glucose under control
sensitivity, lower, off
2, oral , injections
it is possible to overmedicate patients with diabetes
true
when the overmedication occurs, the patient can develop hypoglycemia, in which their blood glucose levels drop too low
yes
hypoglycemia is diagnosed at [..] 70 mg/100 ml blood , causing symptoms ranging from irritability, headache, hunger, weakness or fatigue, sweating, and rapid heartbeat
<
There are different types of hypoglycemia— fasting hypoglycemia, for instance, occurs when people have not [..], have drunk too much [..], or have underlying [..] conditions or [..] (for example, pancreatic tumors).
eaten, alcohol, hormonal , tumors
People with reactive hypoglycemia, in contrast, experience symptoms when they eat [..] amounts of carbohydrates, causing a huge [..] of insulin and rapid [..] in blood glucose. in response, the [..] glands release epinephrine—also known as adrenaline—which, like glucagon, functions to [..] blood glucose by stimulating glucose synthesis in the liver.
large
release
drop, adrenal, raise
The best way to manage or prevent reactive hypoglycemia is not to eat too many carb-heavy meals or snacks; include some [..] along with [..]; and emphasize foods that contain fiber, particularly [..] fiber.
protein along with carbohydrates
soluble
We need “community programs, emphasizing early diagnosis, healthy lifestyle, more attention to maternal and child health, and better urban planning to provide opportunity for walking, jogging, and other outdoor activities.”
to end the type 2 diabetes global pandemic, what is needed most is education. will understand how they can prevent themselves from developing type 2 diabetes and what may happen if they do not
yes
