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FN 125 LE2 > Diabetes > Flashcards

Diabetes Flashcards

(134 cards)

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1
Q

Weight is ____ proportional to insulin resistance

A

Directly

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2
Q

What type of fat promotes insulin resistance

A

Visceral fat

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3
Q

Excess macronutrients causes ____ fatty acids

A

increased

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4
Q

What general methods are done/prescribed for weight management (DBW)

A
  • +/- 500 kcal
  • DBW x PA (Krause)
  • BMI method
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5
Q

Formula to get ideal weight using BMI

A

sqrt of BMI x height (m) = weight (kg)

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6
Q

Hormone responsible for lowering blood glucose

A

insulin

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7
Q

Hormone responsible for increasing blood glucose

A

Glucagon

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8
Q

Difference between type 1 and type 2 DM

A

Type 1: no insulin at all
Type 2: low production of insulin/insulin resistance

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9
Q

3 Ps of DM

A
  • Polyuria
  • Polydipsia
  • Polyphagia
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10
Q

Excessive urination

A

Polyuria

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11
Q

Excessive thirst

A

Polydipsia

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12
Q

Excessive hunger

A

Polyphagia

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13
Q

Why is excessive hunger a sign of diabetes

A

The brain signals the need for higher glucose uptake since cells cannot take in glucose due to insulin insensitivity

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14
Q

Etymology of diabetes mellitus

A

Diabetes = excessive passage of urine
Mellitus = sweet taste or honey-like
Diabetes Mellitus = excessive passage of urine with a sweet taste

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15
Q

What 2 process are responsible for glucose formation

A
  • glycogenolysis
  • gluconeogenesis
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16
Q

What are other effects of high blood sugar

A
  • muscle wasting
  • dehydration
  • increase ketones
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17
Q

What happens if there is a high deposition of sugar in blood vessels

A

Damage lining of blood vessels causing inflammation

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18
Q

What condition is associated with blockage in blood vessels from high blood sugar

A

Atherosclerosis

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19
Q

Functions of insulin (7)

A
  1. Facilitates transport of glucose through insulin receptors in cell membrane
  2. Enhance conversion of glucose or glycogen and its storage in liver
  3. Stimulate lipogenesis
  4. Inhibit lipolysis and protein breakdown
  5. Promote amino acid uptake by Skeletal muscle and increase protein synthesis
  6. Influence glucose oxidation (glycolysis pathway - enzyme glucokinase)
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20
Q

What cells are insulin sensitive

A
  • adipose
  • muscle
  • monocytes
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21
Q

True or False: Insulin receptors increase with weight gain and physical activity

A

False: weight loss

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22
Q

Screening tests for DM (5)

A
  • urine test
  • random blood sugar
  • fasting plasma glucose test
  • oral glucose tolerance test
  • glycosylated hemoglobin (A1C) level
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23
Q

What test is done by measuring glucose & ketones by dipping indicator paper strips or reagent strips in urine

A

Urine test

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24
Q

Percentage in urine test that indicates diabetes

A

0-0.25%

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25
What test is done where blood is drawn but fasting is not necessary
Random blood sugar
26
What result from random blood sugar indicate DM
Greater than or equal to 200 mg/dl
27
What test is done after an overnight fast for at least 8 hrs
Fasting plasma glucose test
28
What test is done after an overnight fast for at least 8 hrs
Fasting plasma glucose test
29
Normal levels for fasting plasma glucose test
70-100 mg/dl
30
Safe levels for fasting plasma glucose test
90-100 mg/dl
31
What result of FBG may indicate DM
Greater than or equal to 126 mg/dl
32
Test that evaluate a person's ability to tolerate a glucose load after fasting
Oral glucose tolerance test
33
Common protocol for OGTT
- ingestion of 75 g glucose load - measurement of plasma glucose after 2 hrs interval
34
Results of OGTT that indicates diabetes
200 mg/dl or 11 mmol/L
35
Results of OGTT that indicates diabetes
200 mg/dl or 11 mmol/L
36
Upper normal limit for OGTT
140 mg/dl (7.8 mmol/L)
37
What is the interpretation if OGTT results is between 140 and 200
Impaired glucose tolerance
38
Provides average blood glucose levels over the past 2-3 months
HbA1C
39
How does glycosylation of rbc occur
Glucose molecules attach themselves to the hemoglobin
40
Ideal percentage of glycosylated hemoglobin
Less than 7%
41
4 stages of DM
1. Prediabetes 2. Subclinical diabetes 3. Latent diabetes 4. Over diabetes
42
Meaning of IGT
impaired glucose tolerance: takes time for bg to be normal
43
Period from conception until development of IGT
Prediabetes
44
FBS and OGTT are normal
subclinical diabetes
45
abnormal OGTT, no symptoms
latent diabetes
46
Abnormal OGTT w/ symptoms as polydipsia, polyphagia, fasting hyperglycemia, glycosuria
Over diabetes
47
Precursor of diabetic coma
ketoacidosis
48
What medicine used for diabetes is used for weight loss
metformin
49
Cause of gallstones
High cholesterol deposits
50
pre-diabetic stage
impaired glucose homeostasis
51
How is impaired glucose homeostasis detected
- impaired fasting glucose level (above normal but lower than diabetic values) - detected primarily through OGTT
52
Risk factors of impaired glucose homeostasis
- familial disposition - race - obesity - age (>45 years old) - birth to large babies (greater than or equal to 9 lbs) - women who developed GDM
53
Any degree of glucose intolerance during pregnancy
Gestational DM
54
How many percent are normoglycemic after delivery
90%
55
Risks factors of GDM
- Occurence of GDM in previous pregnancy - Delivery of previous macrosomic infant - family history - maternal obesity (> 120% of DBW)
56
Pathophysiology of GDM
- Placental & ovarian hormones decreases insulin sensitivity - lack of pancreatic reserves
57
Screening OGTT results for OGTT
- fasting: ≥ 95 mg/dl - 1 hr: ≥ 180 mg/dl - 2 hr: ≥ 155 mg/dl - 3 hr: 140 mg/dl
58
Nutritional goals of IGT and GDM
- to provide adequate energy - to prevent weight gain - to achieve and maintain normoglycemia - to prevent ketone body formation
59
Is a normal blood sugar should be the goal
Not necessarily but blood sugar should not fluctuate
60
Dietary & non-dietary strategies
- individualization of meal plans - monitoring of plasma glucose, appetite, and weight - insulin therapy (if medically advised) - CHO: maximum of 50% of total kcal - CHO properly spaced throughout the day - be physically active
61
Specifc goal for nutrition therapy of DM
- achieve physiologic blood glucose levels - attain and maintain desirable body weight - maintain desirable plasma lipid levels - reduce likelihood of specific diabetic complications - retard development of atherosclerosis
62
General goal for nutrition therapy of DM
- Consume health-promoting selection of nutrients - maintain energy needs in timely manner - address special requirements (e.g pregnancy) - Tailor for therapeutic needs (e.g., renal disease)
63
Characteristics of T1DM
Person does not secrete enough insulin to control blood glucose level
64
Other terms for T1DM
- Insulin-dependent DM - Juvenile diabetes - Juvenile-onset diabetes - ketosis-prone diabetes
65
2 types of T1DM
- idiopathic T1DM - Immune-mediated DM
66
Forms of the disease that have no known etiology (mostly Asian and African origin)
Idiopathic T1DM
67
Results from autoimmune destruction of beta cells of pancreas
Immune-mediated DM
68
Etiology of T1DM
1. Increase human leukocyte Antigen (HLA)-B8 and HLA-B15 2. Formation of islet cell antibodies 3. Attack of beta cells in the pancreas 4. Hyperglycemia 5. T1DM
69
MNT goals for T1DM
- maintain blood glucose levels within a desirable range to prevent or reduce risk of complications - supply adequate calories for weight maintenance
70
Nutrient Recommendations for DM
- CHO = 50-60%; complex type; low GI vs High GI - CHON = 20% - Fats = max 30% (1/3 SFA + 2/3 PUFA; Cholesterol < 300 mg/day; if LDL is high, 7% kcal from SFA & 200 mg/day cholesterol) - Increase dietary fiber
71
Dietary Strategies for DM
- timing of meals - CHO counting
72
What is needed to do for timing of meals as dietary strategy
- eat regular meals that are evenly spaced - 3 meals + 3 snacks
73
What is needed to do for CHO counting as dietary strategy
- counting the grams of CHO provided by foods - Counting CHO portions, expressed in terms of servings
74
Goal of Insulin Therapy
To mimic natural insulin secretion to meet metabolic needs
75
Differences of forms of insulin
- onset activity - timing of peak activity - duration of effects
76
What is needed to be considered for Insulin Therapy
A diabetic's diet must be planned so that there is a distribution of CHO and kcal to coincide with the type of insulin used
77
Characteristics of Rapid Acting Insulin
Preparations: Lispro Apart Onset of Action: 15 min Peak Activity: 30 min- 2 hr Duration of Action: 3-5 hr
78
Characteristics of Short Acting Insulin
Preparations: Regular Onset of Action: 30 min Peak Activity: 2 - 4 hr Duration of Action: 5-8 hr
79
Characteristics of Intermediate Acting Insulin
Preparations: Lente NPH Onset of Action: 1-3 hr Peak Activity: 5 - 10 hr Duration of Action: 18-24 hr
80
Characteristics of Long Acting Insulin
Preparations: Ultralente Onset of Action: 4-6 hr Peak Activity: 8 - 12 hr Duration of Action: >30 hr
81
Characteristics of Insulin Mixtures
Preparations: NPH/regular (70:30); NPH/regular (50:50) Onset of Action: Variable; depends on formulation Peak Activity: Variable; depends on formulation Duration of Action: Variable; depends on formulation
82
descending order of Glucose infusion rate of different types of insulin
Insulin lispro aspart, glulisine > Regular > NPH > Insulin detemir > Insulin glargine
83
___% of total daily insulin replace insulin overnight
40-50%
84
50-60% Total daily insulin does for carbohydrate coverage (food) and high blood sugar correction
Bolus insulin replacement
85
Insulin to CHO ration
9g CHO : 1 unit of insulin
86
Formula for calculating CHO coverage insulin dose
CHO insulin does = total g of CHO in meal/ g of CHO disposed by 1 unit of insulin
87
Blood sugar correction - 1 unit will drop blood sugar 50 pts - high blood sugar correction factor: 50 - Pre-meal blood sugar target: 120 mg/dl - Actual blood sugar before lunch is 220 mg/dl
220 - 120 mg/dl = 100 mg/dl Correction dose = difference between actual and target blood glucose (100mg/dl)/correction factor (50) = 2 units of rapid acting insulin
88
Formula for Total Meal Insulin Dose
Total Meal Insulin Dose = CHO insulin dose + High blood sugar correction dose
89
Time between peak activity two types of insulin
Point of intersection
90
Ratio of CHO to insulin unit (point of intersection)
1 unit : 10-15 g CHO
91
2 primary defects of T2DM
- insulin resistance (diminished tissue sensitivity to insulin) - impaired beta cell function (delayed or inadequate insulin release)
92
Other names for T2DM
- non-insulin dependent diabetes mellitus - adult-onset diabetes mellitus
93
Risks to T2DM
- heredity - poor diet - aging - obesity - lack of physical activity
94
Etiology of T2DM
1. overeating 2. increased blood glucose level 3. increased production of insulin 4. hyperinsulinemia 5. chronic demand for insulin exhausts B-cells 6. insulin production falters
95
Should you give insulin if GDM is present
If severe enough, insulin may be given since some oral medications are contraindicated or the mother is undergoing insulin therapy even before pregnancy
96
Etiology of T2DM from Obesity
1. obesity 2. enlarged fat cells 3. increased abdominal fat 4. insulin resistance: set amount of insulin produces a subnormal effect
97
MNT goals and strategies for T2DM
- Achieve and maintain DBW - Energy restricted diet - diet should allow weight reduction of 1-2 lbs/week
98
Exercise goals and strategies
- glycemic control and weight loss - lowers blood glucose and fattu acid levels; raises HDL levels - Aerobics & strength training; mild or moderate exercise is prescribed at first
99
Mode of action of medications that end with -ide
stimulate insulin secretion by pancreas
100
Possible side effects of medicine for insulin secretion
- hypoglycemia - weight gain - GI side effects - cramps - allergic skin reactions
101
Mode of action of metformin
Inhibits liver glucose production
102
Possible side effects of metformin
- anorexia - metallic taste - GI side effects - cramps
103
Mode of action of medicine that ends with -zone
increase insulin sensitivity
104
Possible side effects of medicine that ends with -zone
- fluid retention - edema - weight gain - anemia
105
Mode of action of medicine like acarbose and miglitol
delays glucose absorption
106
Possible side effects of medicine
GI side effects
107
Cause of diabetic ketoacidosis
severe lack of insulin
108
Characteristics of diabetic ketoacidosis
- ketosis: acetone breath - acidosis: hyperventilation - hyperglycemia: polyuria
109
Blood glucose level of diabetic ketoacidosis
>250 mg/dl
110
Blood pH of diabetic ketoacidosis
<7.3
111
Other symptoms of diabetic ketoacidosis
weakness, nausea, vomiting, and affected mental state
112
T or F: Diabetic ketoacidosis is more common in T1DM
True
113
Events leading to DKA
1. increase ketones 2. acidic plasma 3. destruction of enzymes 4. coma 5. death
114
Events leading to hyperglycemia
1. Hyperglycemia 2. Polyuria 3. Dehydrated cells 4. shock 5. coma 6. death
115
Condition of sever hyperglycemia that usually develops in the absence of significant ketosis
hyperosmolar hyperglycemic state
116
T or F: hyperosmolar hyperglycemic state is more common in T2DM
True
117
Blood glucose level of hyperosmolar hyperglycemic state
> 600 mg/dl
118
Low blood glucose
hypoglycemia
119
T or F: Hypoglycemia is a result of appropriate management of diabetes
False: inappropriate
120
Symptoms of hypoglycemia
Hunger, sweating, shakiness, heart palpitations, slurred speech and mental confusion
121
Prolonged hypoglycemia may cause ___
brain damage
122
Which type of diabetes is hypoglycemia is commonly observed
T1DM
123
Disorders that affect the large blood vessels
Macrovascular diseases
124
Caused by accumulation of advanced glycation end product (AGEs) that accelerates atherosclerosis
macrovascular disease
125
example of AGEs (advanced glycation end products)
glucose/glucose fragments + CHON
126
Disorders that affect arterioles and capillaries
microvascular diseases
127
3 microvascular diseases
- diabetic retinopathy - diabetic nephropathy - diabetic neuropathy
128
Early background lesions in capillaries of the eye
retinopathy
129
Lesions in capillaries of the eyes result from
1. microaneurysms, minute sacs formed on the capillary membrane at points of membrane weakness caused by insufficient numbers of endothelial cells 2. hard exudates from capillary leakage
130
T or F: Diabetics are vulnerable to nerve damage and diminish transmission of nerve impulses that affect muscle function & sensory perception
true
131
what types of sugar do schwann cells convert glucose using enzymes aldose reductase and sorbitol dehydrogenase into?
sorbitol and fructose
132
T or F: sorbitol & glucose diffuse poorly across cell membranes and are osmotically active
True
133
earliest clinical sign of microalnuinuria
nephropathy
134
Basement membrane of glomerulus thickens and diffuse tissue involvement follows
nephropathy

FN 125 LE2 (8 decks)

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