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