56 terms

Nutrition and Diabetes Mellitus


Terms in this set (...)

-24 million in US
-54 million have pre diabetes (100-126 fasting)
-92% of T2 could avoid it through lifestyle changes
-80% T2 overweight/obese
-1/3 of babies born today are expected to have it
-6th leading cause of death (but bc it causes CVD)
-lose 15 years life expectancy
DM is a metabolic disorder characterized by
-elevated blood glucose
-disordered insulin metabolism
1. may have:
-impaired insulin secretion
-cells that do not respond to insulin normally
2. results in -hyperglycemia
Classic symptoms
Other symptoms
Blurred vision
Increased infections (bc high blood glucose is food for bacteria, and bad circulation)
Loss of weight
Constant fatigue
T1 Diabetes
5-10% of cases
-autoimmune destruction of beta cells
-may be inherited or environmental
-insulin therapy needed always
-usually occurs in childhood or adolescence
-ketosis may be the first sign
T2 Diabetes
90-95% of cases
-often asymptomatic
-some insulin is produced
-insulin resistance & relative insulin deficiency
-beta cells get exhausted
-prevalence is increasing in children
T2 risk increased with
Decreased physical activity
T2 Two most significant factors
Acute complications
-disturbances in energy metabolism
-fluid & electrolyte imbalances
-hyper & hypoglycemia
Hyperglycemia from
-low insulin
-not following diet
Hypoglycemia from
can be from too much insulin
-can also be from not eating
Ketoacidosis: hyper or hypo?
T1 Ketoacidosis
(hyperglycemic part)
1. ketosis
-acetone breath
2. acidosis
3. hyperglycemia
4. causes:
-missed insulin, illness, alcohol abuse, physiological stressors
T1 Hypoglycemia
-inappropriate management
-excessive insulin or antidiabetic drugs
-prolonged exercise
-skipped/delayed meals
-alcohol without food
-you always want to assume its hypoglycemia if you don't know which and give them sugar
T2 Hyperosmolar hyperglycemic state
-fluid losses
-blood volume depletion
-electrolyte imbalances
>600-2000 mg/dL
Chronic complications:
blood vessels
AGE's (advanced glucose end products) can damage blood vessels
1. Macrovascular (large blood vessels)
-accelerated atherosclerosis (coronary artery disease)
-impaired circulation, foot ulcers (peripheral vascular disease)
-cerebrovascular accidents
2. Microvascular (small blood vessels)
-neuropathy-pain & burning, numbness & tingling
Chronic complications:
nerve damage, autonomic ns
-loss of visceral sensation
-delayed stomach emptying (gastroperesis)
-sexual dysfunction
(nerve damage can affect entire body)
-50% have some type
T1 treatment
Insulin therapy
-but they should also eat healthy and exercise
T2 treatment
-diet therapy
-oral medications or insulin
Both require
lifelong treatment
-type 2 may be able to reverse it
Treatment goals
-desirable blood glucose levels
-healthy blood lipid concentrations
-control blood pressure
-manage weight
Conventional therapy for T1
-prick/get insulin 1-2 times a day
-one or two insulin injections a day, no daily adjustments
-need a consistent diet
-more rapid progression of retinopathy, nephropathy, and neuropathy
Intensive therapy for T1
-blood glucose is monitored at least 3 times a day
-3+ daily insulin injections or use of insulin pump (dosage adjusted according to results of blood glucose and expected carb intake (bolus given with pump=when you are about to eat)
-delayed progression of retinopathy, nephropathy and neuropathy
Evaluating treatment
1. self-monitored glucose testing
-type 1: 3 or more times/day
2. long-term
-glycosylated hemoglobin (HbA1c)
-measures glycemic control in past 2-3 months (normal less than or equal to 6.5 mg/dL)
3. routine blood pressure checks
4. lipid screening
5. urinary protein screening
6. ketone testing
Body weight concerns T1
-newly diagnosed are thin
-usually gain weight with insulin therapy
Body weight concerns T2
-newly diagnosed usually overweight
-worsens insulin resistance
-weight loss
Nutrient recommendations
1. carbohydrates: -50% total calories
-high fiber, whole grain
2. fiber
-same as general population
-more fiber = less hyperglycemic index so you can actually subtract fiber from carb)
3. sugar
-minimize foods & drink with added sugars
4. fat
-same as general population unless have increased LDLs
-want heart healthy fat
5. protein
15-20% of calories
-not high protein to help avoid nephropathy
6. alcohol
-use with food
7. micronutrients
-same as general population
Meal-planning strategies:
Carb counting
-simpler & more flexible than other methods
-person given a daily carbohydrate allowance
-divided into pattern of meals & snacks
Meal-planning strategies:
Exchange lists
-more complex & difficult to learn
-sorts foods according to their proportions of CHO, fat, & protein
-each food has similar macronutrient & energy content
Insulin therapy
-for people that can't produce enough insulin
-type 1 diabetes
-some persons with type 2
-insulin formula can change with age, health, ect
Insulin delivery
-injection with syringes
-injection ports
-insulin pumps
T1 insulin regimen
-multiple daily injections
-several types of insulin
-insulin pump
T2 insulin regimen
-30% of persons need insulin
-insulin alone
-insulin with oral agents
Insulin therapy & hypoglycemia
-most common complication
-need immediate intake of glucose or CHO food
-15 to 20 grams
-relieves in 10-20 minutes
15 grams CHO
2-3 glucose tablets
4 tsp table sugar
1 tbs honey
15 small jellybeans
½ cup unsweetened grape juice
½ cup canned orange juice
-rapid onset
-more noticeable
-sweating, fainting, HA, personality changes
-take tablets/food with sugar
-slow onset
-sugar/ketones in urine
-deep breathing (hyperpnea)
-call doctor
-fluids without sugar
Oral anti diabetic management modes of action
modes of action:
-improves insulin secretion
-reduces liver glucose production
-improves glucose use by tissues
-delays CHO absorption
Physical activity
-central feature of management for type 2
-improves insulin sensitivity
-improves lipid levels
-lowers blood pressure
-promotes weight loss
Physical activity & insulin therapy
-doses need to be reduced
-check blood sugar before & after
(Need to know activity guidelines in book)
Type 2 and Physical activity
medical evaluation needed before starting
Sick-day management
1. type 1 diabetes
-illness increases ketoacidosis risk
2. recommendations
-frequent blood glucose testing
-regular CHO intake
-fluids to avoid dehydration
(Need to know sick day guidelines in book)
Diabetes Management & Pregnancy
-pregnancy increases insulin resistance & need for insulin
-glycemic control more difficult
Uncontrolled diabetes
Birth defects
Fetal deaths
T2 and pregnancy
Deliver large babies
May need C-section
T1 and T2 with pregnancy
need glycemic control 3 months before conception
-at conception & during 1st trimester to reduce risks of birth defects
-2nd & 3rd trimesters to minimize risks of large babies & infant mortality
Gestational diabetes risk factors
-family history of diabetes
-certain ethnic groups
-delivered babies with macrosomia
Gestational diabetes
-may need to restrict carbohydrates to 40-50% total calories
-space carbohydrates throughout the day
-regular aerobic activity
-may need insulin
-increased risk for T2 later in life
Blood Glucose Goals During Pregnancy
Fasting = < 95 mg/dl
1 hr post-prandial = < 140 mg/dl
2 hr post-prandial = < 120 mg/dl
Metabolic Syndrome
1. insulin resistance is a central feature
2. increases risk of CVD
3. three of the following:
-insulin resistance
-obesity (esp. upper body)
-reduced HDLs
4. risk increases with age
5. main cause
-central abdominal fat
Metabolic syndrome treatment
-weight loss, dietary & lifestyle changes
-reduce sugar & refined grains
Postexercise hypoglycemia can occur for up to________ hrs. after strenous exercise lasting longer than 1 hr.
Acanthosis nigricans
Other Clinical signs of risk for T2DM:
-hyperpigmentation and thickening of the skin into velvety irregular folds and flexural areas
Reflects chronic hyperinsulinemia
Polycystic ovarian syndrome
Other Clinical signs of risk for T2DM:
Associated with insulin resistance and obesity
Other Clinical signs of risk for T2DM:
Occurs in 20% to 30% of patients with T2DM
Girls appear more susceptible than boys to T2DM
Female-to-male ratio of 1.7:1 regardless of race
Nutrition therapy and _______________ first-line treatments
Most children with T2DM require drug therapy (oral hypoglycemics)