Thomas: Carb Counting & Lifestyle Changes for Diabetics

Question 1

Diabetes is the (blank) leading cause of death in the US, and (blank) million Americans have diabetes

Answer 1

7th; 26 million

Question 2

People who receive diabetes education have these benefits

Answer 2

they use primary care & preventive services, are more proactive in their care
control their glucose, blood pressure & LDL cholesterol
take medications as prescribed
have lower health costs

Question 3

T/F: Most people with diabetes receive diabetes education

Answer 3

False! 56% of these patients have not received diabetes education

Question 4

Why is diabetes education underutilized? What happens on the side of the patient? On the side of the provider?

Answer 4

patients with diabetes don’t follow through on referral, are emotional/shocked at their diagnosis, end up relying on family/friends, & think they know enough & can handle it on their own

providers know the importance of education, but don’t necessarily prescribe, also sometimes forget to follow up with pts to encourage attendance

Question 5

In what ways do diabetes educators help physicians?

Answer 5

help patients improve outcomes
help delay onset of diabetes
track & monitor patients' progress
increase efficiency
meet pay-for-performance goals

Question 6

In what ways do diabetes educators help patients?

Answer 6

help patients develop self-management skills
achieve better metabolic control
improve lipid levels
reduce blood pressure

Question 7

Diabetes educators can be from any of these health care realms..

Answer 7

RN
registered dietitian
pharmacist

Question 8

List some ways in which diabetes educators teach about self-care behaviors

Answer 8

healthy eating
being active
taking meds
problem-solving
reducing risks
healthy coping
monitoring

Question 9

Diabetes educators teach (blank) information, teach patients how to use (blank), and how to adopt healthy (blank)

Answer 9

basic;
devices;
eating & physical activity habits

Question 10

What is a diabetic diet?

Answer 10

no single diet

the best diet is one that is individualized based on the patient’s goals & assessment

Question 11

Medical management of type 2 diabetes includes (blank) modification

Answer 11

lifestyle

Question 12

In the Diabetes Prevention Program study, which intervention reduced incidence of diabetes most impressively - placebo, metformin, or lifestyle changes?

Answer 12

lifestyle changes!

Question 13

Lifestyle change is imperative in diabetes management. What ways can you incorporate lifestyle changes?

Answer 13

120 min/week moderate exercise
decrease total kcal intake by 450kcal/day
5% weight loss or 8.8 lbs over 3yrs

Question 14

The recommendation is to reinforce lifestyle changes (blank)

Answer 14

at every visit!!!

Question 15

What are the macro recommendations for carbs, protein & fat for diabetes patients?

Answer 15

45-65% carbs
15-20% protein
25-35% fat

Question 16

These affect blood glucose (BG) more directly than protein and fat
The amount and type both influence the BG level

Answer 16

carbohydrates

Question 17

So how can you achieve glycemic control with carbohydrate intake?

Answer 17

monitor total grams of carbs
spread out total amount of carbs throughout the day - be consistent
food & meal planning approach
choose a variety of foods & keep carb amount consistent so that postprandial glucose levels remain consistent

Question 18

1 serving of CHO food contains (blank)g of CHOs

Answer 18

15g

Question 19

How many grams of CHOs do these contain?

1 ounce slice of bread
3 cups of popcorn
½ cup of oatmeal
8 oz of milk
4 oz of orange juice
½ small banana
2 tablespoons of raisins
½ cup of beans or corn
1/3 cup of cooked pasta or rice

Answer 19

15g CHO

Question 20

CHO counting is individualized - but to start, women should aim for (blank) CHO servings per meal, and men more like (blank) CHO servings per meal

Answer 20

3-4;

4-5

Question 21

What are the desirable blood sugar levels before feeding? After feeding? What is an optimal A1c?

Answer 21

70-130mg/dL
less than 180mg/dL
A1c less than 7%

Question 22

Has been shown to have a minimal influence on glycemic response with an acute effect on insulin secretion, including postprandial blood sugars

Answer 22

protein

Question 23

How much of a diabetic’s diet should be made up of protein?

Answer 23

15-20% of daily energy

Question 24

In patients with diabetic nephropathy, how should protein be restricted? What about in chronic kidney disease?

Answer 24

no more than 1g/kg/day

in CKD, somewhere between 0.7-1.0g/kg/day

Question 25

(blank) acutely increases glucose concentrations and insulin requirements in patients with Type 1 DM

Answer 25

dietary fat

• *high fat dinners were should to require more insulin than low fat dinners
• *despite insulin admin, high fat dinners increased blood sugars more

Question 26

Adults with type 1 diabetes require more (blank) coverage for higher-fat meals than for lower-fat meals with identical carbohydrate content.

Dietary (blank) intake is an important nutritional consideration in individuals with type 1 diabetes striving for tight glycemic control.

Answer 26

insulin; fat

Question 27

How much fiber is recommended daily? Is more fiber better for controlling blood sugar levels in diabetic patients?

Answer 27

14g for every 1000 kcal (28g for 2000 cal diet); more fiber is not better in regards to blood sugar

Question 28

How much soluble fiber is recommended daily? What are some sources of soluble fiber?

Answer 28

7-13 g per day;

oats, apples, oranges, pears, strawberries, nuts, bloobs, celery, carrots, cucumbers

Question 29

The average American consumed 2700 cal per day. That means the avg American is consuming more (blank)

Answer 29

carbs =(

and only 7% of Americans are eating 3 servings of whole grains on a daily basis

Question 30

What are the top 5 sources of calories in US diets?

Answer 30

grain-based deeeeserts
yeast breads
chicken
soda, energy & sports drinks
pizza

Question 31

How much cardio exercise should the ‘betes patients be getting? What about resistance training?

Answer 31

3-7 days per week of walking, swimming or jogging;
2-3 days per week with free weights, res bands
practice balance/flexibility daily

Question 32

Before a workout, what should these patients eat?

Answer 32

slow absorbed CHO with protein & fat

**not glucose tabs! try sports bars, whole fruits, yogurt, snack bars

Question 33

After a workout, what should these patients eat?

Answer 33

white milk, chocolate milk, yogurt