Medical Nutrition Therapy - E. Endocrine & Metabolic Disorders (p. 15-20)

Question 1

Type 1 DM is insulin _______.

Answer 1

Insulin dependent. Depends on exogenous insulin.

Question 2

Type 2 DM is insulin ________.

Answer 2

Resistance May need insulin.

Question 3

*Normal Blood Glucose level:

Answer 3

*Casual: 70-100 mg/dL *2 hr post-prandial:

Question 4

Indicative of Diabetes- *Fasting Plasma Glucose (FPG):

Answer 4

*FPG: >126 mg/dL

Question 5

Indicative of Diabetes- *Glucose tolerance test (GTT):

Answer 5

*GTT: >200 mg/dL

Question 6

Indicative of Diabetes- *Symptoms of DM + casual glucose >__ mg/dL

Answer 6

*Symptoms of DM + casual glucose >200 mg/dL

Question 7

Indicative of Diabetes- *HgA1C:

Answer 7

*HgA1C: >6.5%

Question 8

In the GTT, a patient without diabetes will present with a _______ curve.

Answer 8

*SLOPED

Question 9

In the GTT, a diabetic patient will present with a _________ curve.

Answer 9

*ROUNDED

Question 10

Glycosylated Hemoglobin (HGA1C) measures the % of ______ that is carrying ______. It is a measure of long-term blood glucose control over 2-3 months.

Answer 10

HGBA1C measures the % of hemoglobin that is carrying insulin.

Question 11

Normal HGBA1C: Goal for diabetics:

Answer 11

Normal HGBA1C:

Question 12

The goal for all diabetics is to maintain normal blood glucose. Pre-prandial: __-___ Post-prandial:

Answer 12

Pre-prandial: 70-130 Post-prandial:

Question 13

For Type 1 DM, ________ CHO is recommended if doing fixed daily doses of ____. Integrate insulin therapy with usual eating habits. Monitor _______ and adjust ______ doses for amount of food eaten. For exercise, reduction in insulin dosage may be the best choice.

Answer 13

Consistent CHO if doing fixed doses of insulin Monitor glucose and adjust insulin doses for food eaten.

Question 14

Risk factors for gestational diabetes include: 1. 2.

Answer 14

BMI >30 History of GDM

Question 15

GDM usually develops (and is tested for) at 24-28 weeks gestation by a _____ _____ _____. Blood glucose will most likely return to normal following delivery, but with an increased risk for developing ____ ____ _____, which women will need to be tested for regularly.

Answer 15

Glucose tolerance test Increased risk for developing Type 2 DM.

Question 16

GDM increases risk of ______ ______ (large for gestational age) and fetal _________ at birth.

Answer 16

GDM increases risk for fetal macrosemia (large baby) and fetal hypoglycemia at birth.

Question 17

The ______ _____ compares the blood glucose response of a food to a standard load of glucose. Glucose = 100. Foods with ____ index produce greater satiety.

Answer 17

Glycemic index Foods with low index produce greater satiety.

Question 18

Carbohydrate counting 1 CHO serving = __ g CHO

Answer 18

15 g

Question 19

Rapid-Acting insulin Onset: Duration:

Answer 19

Rapid-Acting insulin Onset: 5-15 min Duration: 4 hrs

Question 20

Short-Acting Insulin Onset: Duration:

Answer 20

Short-Acting Insulin Onset: 30-45 min Duration: 3-6 hrs

Question 21

Intermediate-Acting Insulin Onset: Duration:

Answer 21

Intermediate-Acting Insulin Onset: 2-4 hrs Duration: 10-16 hrs

Question 22

Long-Acting Insulin Onset: Duration:

Answer 22

Long-Acting Insulin Onset: 2-4 hrs Duration: 20-24 hrs

Question 23

This oral glucose-lowering medication PROMOTES INSULIN SECRETION.

Answer 23

GLUCOTROL

Question 24

This oral glucose-lowering medication ENHANCES INSULIN ACTION. Also suppresses hepatic glucose production.

Answer 24

GLUCOPAHGE (metformin)

Question 25

**The increase in early morning blood glucose due to increased hepatic production after overnight fast. Usually happens between 2 and 8 AM

Answer 25

Dawn phenomenon

Question 26

A complication of uncontrolled diabetes - hyperglycemia due to lack of insulin (insulin deficiency).

Answer 26

Ketoacidosis

Question 27

**Symptoms of DKA include: -Polyuria (leading to ______) -Increased _______ (respiratory compensation-inc respiration to inc CO2 excretion) -Fruity odor on breath (_________)

Answer 27

Symptoms of DKA include: Polyuria (leading to dehydration) -Increased pulse (respiratory compensation-inc respiration to inc CO2 excretion) -Fruity odor on breath (ketones)

Question 28

**Treatment of DKA includes:

Answer 28

Insulin therapy, rehydration (electrolyte replacement)

Question 29

Abnormally low blood glucose due to excess insulin or lack of food. (in DM) Symptoms include slow pulse, clammy skin, hunger, weak)

Answer 29

Acute Hypoglycemia

Question 30

**Treatment of HYPOGLYCEMIA begins with __ g CHO from glucose tablets, ______, ______. Wait 15 minutes, and check again. If still

Answer 30

Treatment of hypoglycemia begins with 15 g CHO from glucose tablets, fruit juice, sugar. Wait 15 minutes, and check again. If still

Question 31

The 3 LONG-TERM effects of uncontrolled diabetes include:

Answer 31

Neuropathy (peripheral and autonomic ie. gastroparesis) Retinopathy (leads to blindess) Nephropathy (leads to decreased kidney function)

Question 32

Condition caused by overstimulation of the pancreas or increased insulin sensitivity. BG falls below normal (

Answer 32

Postprandial or Reactive hypoglycemia

Question 33

**The goal in postprandial or reactive hypoglycemia is to prevent marked ____ in BG that would stimulate more ______.

Answer 33

The goal in postprandial or reactive hypoglycemia is to prevent marked RISE in BG that would stimulate more INSULIN.

Question 34

**Postprandial/Reactive hypoglycemia diet therapy: Avoid ____ sugars _____, _____ meals Consistent ___ intake

Answer 34

Postprandial/Reactive hypoglycemia diet therapy: Avoid simple sugars Small, frequent meals Consistent CHO intake

Question 35

Adrenal cortex insufficiency, or ________ disease, is characterized by a deficiency of _______ ______.

Answer 35

Addison’s disease Adrenal hormone deficiency

Question 36

Adrenal hormones include: __________ (stimulates gluconeogenesis, inhibits insulin, SO INC BG - in its absence, BG is DEC) __________ (increases reabsorption of fluid and ions by the kidney - in its absence, increased losses) __________ (influences body composition)

Answer 36

CORTISOL: (stimulates gluconeogenesis, inhibits insulin, SO INC BG - in its absence, BG is DEC) ALDOSTERONE: (increases reabsorption of fluid and ions by the kidney - in its absence, increased losses) ANDROGEN: (influences body composition)

Question 37

Symptoms of adrenal cortex insufficiency (Addison’s disease), due to absence of adrenal hormones include:

Answer 37

Hypoglycemia Sodium loss, dehydration Tissue wasting, weight loss

Question 38

The primary therapy for Addison’s disease is:

Answer 38

Hormone replacement

Question 39

Condition characterized by EXCESS secretion of thyroid hormone. T3 and T4 are ELEVATED. Increased BMR–>weight loss.

Answer 39

HYPERthyroidism

Question 40

Condition characterized by DEFICIENCY of thyroid hormone. T3 low/normal ; T4 is LOW. Decreased BMR–>weight gain.

Answer 40

HYPOthyroidism

Question 41

Enlargement of the thyroid gland due to insufficient thyroid hormone.

Answer 41

Goiter

Question 42

Type of goiter (enlargement of the thyroid gland) due to inadequate iodine intake. IODINE is essential for the production of THYROID HORMONE.

Answer 42

Endemic goiter

Question 43

Disorder of PURINE metabolism, leading to increased serum URIC ACID. Uric acid deposits in joints–>pain, swelling

Answer 43

GOUT

Question 44

Gout diet therapy: Avoid high ____ foods (organ meats, sweetbreads, anchovies, sardines, herring, mackerel, scallops, beer) However, low _____ diet may not be effective because the body produces it.

Answer 44

Purine (organ meats, sweetbreads, anchovies, sardines, herring, mackerel, scallops, beer)

Question 45

An inborn error of metabolism characterized by missing the enzyme that would have converted GALACTOSE–>GLUCOSE.

Answer 45

Galactosemia

Question 46

Galactosemia is treated solely by ____.

Answer 46

DIET. Galactose and Lactose free No organ meats, milk/milk product

Question 47

_____ cycle defects: Inborn error of metabolism characterized by the inability to synthesize urea from ammonia –> ammonia accumulation.

Answer 47

Urea cycle defects Symptoms: vomiting, anorexia, lethargy, seizures, coma

Question 48

Diet therapy for urea cycle defects: ___________ restriction BASED ON TOLERANCE. (Restriction to reduce ammonia buildup)

Answer 48

Protein restriction based on tolerance

Question 49

Inborn error of metabolism characterized by missing the enzyme PHENYLALANINE HYDROXYLASE, which converts PHENYLALANINE –> TYROSINE. Phenylalanine accumulates.

Answer 49

Phenylketonuria (PKU)

Question 50

Diet therapy for PKU: Restrict __________. Supplement _______.

Answer 50

Restrict PHENYLALANINE. Supplement TYROSINE.

Question 51

Sources of ___________: Dairy Eggs Meat, poultry, fish Nuts Beans **ASPARTAME (ie. Equal-very high in PHE)

Answer 51

Phenylalanine

Question 52

Children with PKU have a higher incidence of ________ _______ due to HIGH CHO, LOW PTN intake.

Answer 52

Dental caries

Question 53

Inborn error of metabolism where there is a deficiency of GLUCOSE-6-PHOSPHATASE in the liver, so the liver cannot convert GLYCOGEN–>GLUCOSE. Impairs glycogenolysis–>Hypoglycemia

Answer 53

Glycogen storage disease

Question 54

Diet therapy for glycogen storage disease: Provide consistent supply of _____ _____ with CORNSTARCH (exerts a lower and delayed BG peak). High ___, Low Fat

Answer 54

Diet therapy for glycogen storage disease: Provide consistent supply of EXOGENOUS GLUCOSE with regular intervals of CORNSTARCH (exerts a lower and delayed BG peak). High CHO, Low Fat

Question 55

Inherited disorder of amino acid metabolism.

Answer 55

Homocystinurias

Question 56

Homocystinuria is characterized by severe elevations in ________ and ________, and excess excretion of _________ in urine.

Answer 56

Homoecystinuria is characterized by severe elevations in METHIONINE and HOMOECYSTEINE, and excess excretion of HOMOCYSTEINE in urine.

Question 57

Homocystinuria associated with low levels of vitamin __, vitamin __ and _____. **Treatment is to provide HIGH levels of these 3 nutrients. If they don’t respond - low protein, low methionine diet

Answer 57

Homocystinuria associated with low levels of B6, B12 and FOLATE. **Treatment is to provide HIGH levels of these 3 nutrients. If they don’t respond - low protein, low methionine diet

Question 58

Inborn error of metabolism of the BCAAs (leucine, isoleucine, and valine). Poor sucking reflex, anorexia, FTT, sweet burnt maple syrup odor of sweat and urine

Answer 58

Maple Syrup Urine Disease (MSUD)

Question 59

Diet therapy for MSUD: Restrict _____ Provide adequate energy from ___ and ___ to spare ___.

Answer 59

Diet therapy for MSUD: Restrict BCAA Provide adequate energy from CHO and FAT to spare AA (PTN).