Thomas: Carb Counting & Lifestyle Changes for Diabetics Flashcards
Diabetes is the (blank) leading cause of death in the US, and (blank) million Americans have diabetes
7th; 26 million
People who receive diabetes education have these benefits
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
T/F: Most people with diabetes receive diabetes education
False! 56% of these patients have not received diabetes education
Why is diabetes education underutilized? What happens on the side of the patient? On the side of the provider?
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
In what ways do diabetes educators help physicians?
help patients improve outcomes help delay onset of diabetes track & monitor patients' progress increase efficiency meet pay-for-performance goals
In what ways do diabetes educators help patients?
help patients develop self-management skills
achieve better metabolic control
improve lipid levels
reduce blood pressure
Diabetes educators can be from any of these health care realms..
RN
registered dietitian
pharmacist
List some ways in which diabetes educators teach about self-care behaviors
healthy eating being active taking meds problem-solving reducing risks healthy coping monitoring
Diabetes educators teach (blank) information, teach patients how to use (blank), and how to adopt healthy (blank)
basic;
devices;
eating & physical activity habits
What is a diabetic diet?
no single diet
the best diet is one that is individualized based on the patient’s goals & assessment
Medical management of type 2 diabetes includes (blank) modification
lifestyle
In the Diabetes Prevention Program study, which intervention reduced incidence of diabetes most impressively - placebo, metformin, or lifestyle changes?
lifestyle changes!
Lifestyle change is imperative in diabetes management. What ways can you incorporate lifestyle changes?
120 min/week moderate exercise
decrease total kcal intake by 450kcal/day
5% weight loss or 8.8 lbs over 3yrs
The recommendation is to reinforce lifestyle changes (blank)
at every visit!!!
What are the macro recommendations for carbs, protein & fat for diabetes patients?
45-65% carbs
15-20% protein
25-35% fat
These affect blood glucose (BG) more directly than protein and fat
The amount and type both influence the BG level
carbohydrates
So how can you achieve glycemic control with carbohydrate intake?
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
1 serving of CHO food contains (blank)g of CHOs
15g
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
15g CHO
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
3-4;
4-5
What are the desirable blood sugar levels before feeding? After feeding? What is an optimal A1c?
70-130mg/dL
less than 180mg/dL
A1c less than 7%
Has been shown to have a minimal influence on glycemic response with an acute effect on insulin secretion, including postprandial blood sugars
protein
How much of a diabetic’s diet should be made up of protein?
15-20% of daily energy
In patients with diabetic nephropathy, how should protein be restricted? What about in chronic kidney disease?
no more than 1g/kg/day
in CKD, somewhere between 0.7-1.0g/kg/day
(blank) acutely increases glucose concentrations and insulin requirements in patients with Type 1 DM
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
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.
insulin; fat
How much fiber is recommended daily? Is more fiber better for controlling blood sugar levels in diabetic patients?
14g for every 1000 kcal (28g for 2000 cal diet); more fiber is not better in regards to blood sugar
How much soluble fiber is recommended daily? What are some sources of soluble fiber?
7-13 g per day;
oats, apples, oranges, pears, strawberries, nuts, bloobs, celery, carrots, cucumbers
The average American consumed 2700 cal per day. That means the avg American is consuming more (blank)
carbs =(
and only 7% of Americans are eating 3 servings of whole grains on a daily basis
What are the top 5 sources of calories in US diets?
grain-based deeeeserts yeast breads chicken soda, energy & sports drinks pizza
How much cardio exercise should the ‘betes patients be getting? What about resistance training?
3-7 days per week of walking, swimming or jogging;
2-3 days per week with free weights, res bands
practice balance/flexibility daily
Before a workout, what should these patients eat?
slow absorbed CHO with protein & fat
**not glucose tabs! try sports bars, whole fruits, yogurt, snack bars
After a workout, what should these patients eat?
white milk, chocolate milk, yogurt
