Ch. 20 - Diabetes Mellitus & Nutrition
Cause of Type 1 Diabetes
autoimmune destruction of pancreatic beta cells that produce insulin - resulting in NO insulin production
Two types of carb counting
basic and advanced
Gives a person a daily carb allowance and divides them into equal patterns of meals and snacks
basic carb counting
Although insulin resistance is the main issue in Type 2 diabetes, why is there also a relative insulin deficiency?
beta cells get worn out
Carb-containing food groups include _____ and _____, ____ veggies, _____-_____ veggies, _____, _____ products, and _____ and ______.
bread, grains, starchy, non-starchy, fruits, milk, sweets, desserts
Fasting-plasma glucose for diabetics
126+ mg/dL
Protein intake for diabetics should be ____-____% of daily kcals. It is a ______ intake in order to not put additional _____ on the _____.
15, 20, moderate, stress, kidneys
What should a diabetics PP blood glucose be lower than?
180 mg/dL
In a glucose tolerance test, a patient's glucose is checked ____ hours after administration of _____ grams of glucose load.
2, 75
Reading of Glucose Tolerance Test to indicate diabetes
200 mg/dL
Give the cut off for non-fasting plasma glucose to be diagnosed with diabetes?
200+ mg/dL AND classic symptoms
When blood glucose exceeds ______ mg/dL, ____ spills into the _____ and draws _____ from the blood, causing both ______, _______, and ______.
200, glucose, urine, water, polyuria, polydipsia, dehydration
Self-monitored glucose testing should be done with Type 1 diabetes _____ or more times a day.
3
How many of the 5 risk factors of metabolic syndrome indicate that you have it? What are the 5 risk factors?
3/5 - insulin resistance, central obesity, hypertriglyceridemia, reduced HDLs, and hypertension
With non-starchy veggies, only ____ g of carbs per serving, meaning that ____ servings is equal to a carb _____.
5, 3, portion
Carbs should be _____% of total kcals and each carb portion is equal to _____g.
50, 15
Carbohydrates should make up _____% of total kcals in diabetics. The diet should be high in _____ and _____ _____ to slow ____ and decrease _____ response.
50, fiber, whole grains, digestion, glycemic
What should Hgb A1c be under for diabetics with treatment?
7
What should fasting blood glucose be for diabetics on treatment?
80-130 mg/dL
reactive molecules that form when glucose and proteins come together in the blood and end up damaging cells
AGEs
What is the main problem with Type 2 diabetes?
Insulin resistance - cells do not respond normally to insulin being released
______ is the key to opening up _____ to allow _____ to enter and be used for _______.
Insulin, cells, glucose, energy
Three or more daily injections of insulin OR the use of an insulin pump while monitoring blood glucose frequently throughout the entire day
Intensive therapy
What may be the first sign of Type 1 Diabetes?
Ketoacidosis
Blood glucose taken 1-2 hours after eating
Postprandial blood glucose
What two things does Metabolic Syndrome increase the risk for?
Type 2 diabetes and CVD
Hyperglycemia in the early morning due to secretion oh the Growth Hormone - insulin must be adjusted
dawn phenomenon
metabolic disorder characterized by hyperglycemia and disordered insulin metabolism
diabetes mellitus
Treatment for Type 2 Diabetes includes ____ therapy with an emphasis on ____ loss, _____, and _____ meds or _____.
diet, weight, exercise, anti-diabetic, insulin
Acute Complications of diabetes include disturbances in _____ metabolism, ____ and ____ imbalances due to ______.
energy, fluid, electrolyte, hyperglycemia
Meal-planning strategy that is more complex and difficult to learn and manage as compared to Carbohydrate Counting
exchange lists
Sorts foods according to their proportions of carbs, fats, and portions in which each food has similar macronutrient and energy content
exchange lists
_____ lists controls _____ more closely than ______ _____.
exchange, calories, carb counting
Risk factors for gestational diabetes includes having a _____ history of diabetes, _____, and previous delivery of baby weighing over ____ pounds.
family, obesity, 9
Characteristics of ketoacidosis are ______ or _____ smelling breath, ______ due to excess _____ building up in the blood, _______ as compensation for acidosis, and _______ causing ______ and ______.
fruity, acetone, acidosis, ketones, hyperventilation, hyperglycemia, polyuria, polydipsia
Hyperglycemia in the third trimester
gestational diabetes
When glucose cannot get into cells, the hormone _____ causes the breakdown of _____ tissues and muscle _______ CAUSING the production of ______.
glucagon, adipose, portion, ketones
Most common glucose-supply that type 1 diabetics carry with them just in case of hypoglycemia?
glucose tablets
a ranking of carb foods based on their effects on blood glucose levels after ingestion
glycemic index (GI)
Characteristics of HHS: _______ between _____-_____ mg/dL, _____ losses leading to _____, and ______ imbalances.
hyperglycemia, 600, 2000, fluid, dehydration, electrolyte
The most common complication with insulin therapy
hypoglycemia
______ can increase the risk of _____ in Type 1 Diabetics. _____ blood glucose testing should be done, a regular CHO intake of _____-_____g every ____-____ hours should be followed, and increase _____ intake to avoid ____.
illness, DKA, frequent, 45, 50, 3, 4, fluid, dehydration
When hypoglycemia is observed, the person needs _____ intake of ______. Then, their blood glucose is testing _____-_____ minutes afterward. If it has not returned to normal, a second dose of ____-____ grams of CHO may be needed.
immediate, glucose, 10, 20, 15, 20
Why are routine blood pressure and lipid screenings done for diabetics?
increased risk of CVD
What can cause weight gain?
insulin
Use a insulin to carb ratio to determine how much insulin to administer
insulin pump
Two central features of metabolic syndrome
insulin resistance and central obesity
Type of therapy always needed for Type 1 Diabetes
insulin therapy
Hypoglycemia can be caused by excessive _____ or ______ drugs, prolonged ______, skipped/delayed ______, and drinking _____ without ______.
insulin, anti-diabetic, exercise, meals, alcohol, food
Treatment for Type 1 diabetes includes _____ therapy, increased ______, and ______ _____ diet.
insulin, exercise, carb counting
_____ demand increases as body _____ increases and tissues are less able to _____ to _____, causing ______ of Type 2 Diabetes.
insulin, fat, respond, insulin, hyperglycemia
_____ must sometimes be adjusted due to fasting ______ caused by either _____ insulin _____ or the _____ _____.
insulin, hyperglycemia, insufficient, overnight, dawn phenomenon
Causes of ketoacidosis: missed _____ dose, _____, _____ abuse, and physiological _____.
insulin, illness, alcohol, stressors
Antidiabetic drugs can work by: - improving ____ secretion - reducing the _____ _____ production - improve _____ ______ by cells - delay _____ absorption
insulin, livers glucose, glucose uptake, CHO
Traditional insulin therapy administers _______ or _____-acting insulin to cover most of the day, and then ____ or _____- acting insulin at mealtimes.
intermediate, long, short, rapid
Central feature for managing type 2 diabetes
physical activity
Meal-Planning strategy that encourages eating a balanced plate with appropriate portions to promote weight loss and glucose control for Type 2 diabetics
plate method
Three P's of diabetes (s/sx)
polyuria, polydipsia, polyphagia
What is the main treatment goal for diabetes?
reach desired level of blood glucose to avoid complications
When and by how many grams should carbohydrates be reduced in patients with gestational diabetes?
reduce to 30 g (2 servings) in the morning at breakfast
The dose of insulin may need to be ______ when _____ to avoid _____.
reduced, exercising, hypoglycemia
Pregnancy increases insulin _____ and the ____ for insulin itself, making _____ control much more difficult.
resistance, need, glycemic
To treat gestational diabetes, mothers may need to _____ carb intake to ____-____% total kcals, _____ intake throughout the day, engage in regular ____ activity, and administration of _____.
restrict, 40, 50, space, aerobic, insulin
Two types of chronic complications of diabetes that effects the microvasculature
retinopathy and nephropathy
Fat intake for diabetics are ______ as general population unless have elevated _____ levels.
same, LDL
Physical activity: - improve insulin _____ - improves ____ levels - lowers ____ ____ - promotes ____ ____
sensitivity, lipid, blood pressure, weight loss
Insulin pumps administer ____-acting insulin and is given _______ throughout the day.
short, continuously
Macronutrient ranges for diabetes are:
similar to general population
Allowed in a diet for diabetics, but should minimize due to empty calories
sugar
Why is hypoglycemia a less common complication for type 2 diabetes as compared to type 1?
they typically are not insulin-dependent
What patients is advanced carb counting used for?
those with insulin pumps (type 1)
Hyperglycemia from diabetes causes damage to WHAT three things?
tissues, nerves, and blood vessels
Why does blood sugar need to be checked before and after physical activity?
to avoid hypoglycemia
Hypoglycemia is a more common complication for?
type 1 diabetics
Who needs medical evaluation before starting an exercise program?
type 2 diabetics
What is the deal with diabetics and alcohol consumption?
use with food
Blurred _____ and increased risk of _______ are also common symptoms of diabetes.
vision, infection
Two s/sx from polyphagia
weight loss and fatigue
The changes that are needed to manage diabetes and decrease the risks of complications include ______ management, increased ______, and a ______ food intake.
weight, exercise, balanced
Three main ways to diagnose diabetes
1. non-fasting plasma glucose and classic s/sx 2. fasting-plasma glucose 3. glucose tolerance test
Acute Complication of Type 2 Diabetes that happens over a longer period of time
Hyperosmolar hyperglycemia (HHS)
One or two daily injections of insulin & only monitoring blood glucose once a day
Conventional therapy
Main acute complication of Type 1 Diabetes that is usually how it is diagnosed
DKA
a long-term evaluation of diabetes treatment that measures glycemic control in the past 2-3 months, which is the typically RBC lifespan
Hemoglobin A1C
Can eat any exact number of carb grams and their insulin can be adjusted accordingly
advanced carb counting
What does AGE's stand for?
advanced glycation end products
Advantages and Disadvantages of Conventional Insulin Therapy
advantages: less risk of hypoglycemia and weight gain disadvantages: increased risk of chronic complications
Advantages and disadvantages of intensive insulin therapy
advantages: more tightly controlled blood glucose, less risk of complications disadvantages: increased risk of weight gain and hypoglycemia
Four risks that increase likelihood of Type 2 Diabetes
age, obesity, decreased physical activity, and genetics (small)
Type 2 diabetes is often ______ for a long time.
asymptomatic
When hyperglycemia causes damage to the large blood vessels (macrovascular), it can lead to accelerated ______, increasing the risk for ______, impaired circulation to the _______, called _____, and as a result, _____ _____.
atherosclerosis, CVD, limbs, PVD, foot ulcers
Diet to match carbs with insulin administered
carbohydrate counting
Evaluating treatment of diabetes may include _____ testing and urinary _____ screening for early signs of _____.
ketone, protein, nephropathy
Type 1 diabetes is ____ common, accounting for ____-____% of cases. It can be ______ or caused by ______ factors.
less, 5, 10, inherited, environmental
The treatment for Metabolic syndrome includes ____ changes such as _____ loss, and ____ changes, such as limiting _____ and _____ ____ intake.
lifestyle, weight, dietary, sugar, refined carb
Other goals of treatment for diabetes: - maintain a good blood _____ concentration as well as a healthy _____ _____ to reduce the risk of ______ - manage ______
lipid, blood pressure, CVD, weight
Uncontrolled diabetes in the second and third trimester increasing the risk of delivery babies with ______.
macrosomia
HBW baby due to uncontrolled diabetes that increases risk of complications and C-sections
macrososmia
Chronic complications of diabetes include _______, ______, and ______.
microvascular, microvascular, neuropathy
Uncontrolled diabetes in the 1st trimester increases the risk for _____, _____ defects, and fetal _____.
miscarriages, birth, deaths
Explain why polyphagia occurs with diabetes and in WHOM is it more common?
more common in Type 1 diabetics because they lack total insulin, therefore none of the glucose can get into cells and be used for energy. It is essentially stuck in the blood.
Type 2 diabetes is _____ common, accounting for ____-____% of cases. It typically occurs in ______ older adults who are ______, but there has been an increasing prevalence in ______ due to ______.
more, 90, 95, sedentary, overweight, children, obesity
nerve damage that occurs in about HALF of all diabetics
neuropathy
Neuropathy causes _____ and _____ in the _____ and _____, a loss of _____, delayed _____ _____ causing ______, and _____ dysfunction.
numbness, tingling, hands, feet, sensation, stomach emptying, constipation, sexual