Diabetes 2

Question 1

Types of Insulin Therapy

Answer 1

• single vs multiple injection
• short or long acting insulin
• constant infusion with a pump to maintain a basal level with bolus pulsing
• consider timing of meals and PA level

Question 2

Children and Adult Insulin

Answer 2

children - insulin levels adjusted with diet / growth and development

adults - diet/insulin need is more stable

Question 3

Insulin type/action

- rapid acting (clear)

Answer 3

duration: 4-5 hours
peak: 1-1.5 hours
- eat same time as injection (no more than 30 minutes before)

Question 4

Insulin type/action

- short acting

Answer 4

duration: 6.5 hours
peak: 2-3 hours

Question 5

Insulin type/action

- intermediate-acting (cloudy)

Answer 5

duration: 12-18 hours
peak: 5-8 hours

Question 6

Insulin type/action

- long acting

Answer 6

duration: 24 hours
no peak
- enough to keep liver from making glucose
- keeps basil level of insulin in blood at all time

Question 7

timing of insulin injections

Answer 7

• should give insulin prior to meals

- if eating low GI foods you may be able to eat at the same time

Question 8

AMDR variation for diabetes

Answer 8

20-25 % fat
50-55% CHO
20% Pro

Question 9

4 medications for T2D (really important to know this)

Answer 9

• metformin
• Troglitazone
• Acarbose
• Sulfonylureas

Question 10

actions of Metformin & Troglitazone (important)

Answer 10

• decrease hepatic glucose output

- increase peripheral glucose uptake

Question 11

action of Sulfonylureas (important)

Answer 11

• increased insulin secretion

Question 12

action of acarbose (important)

Answer 12

• decreased glucose absorption (acts similar to fibre to lower postprandial rise)

Question 13

three types of therapy often combined for T2D (previous slide has #3 different)

Answer 13

1. Diet
2. Oral Hypoglycemics ~ increase insulin production, secretion and sensitivity, decrease hepatic glucose production, delay absorption of glucose
3. exogenous insulin ~ insulin injections, avoid for as long as possible, hard to stop using it
   - disease may change and insulin needs to change as well ~ genetics, older people are less sensitive to insulin, diet helps some but not others

Question 14

when to initiate antihypoglycemic agents, insulin, and diet

Answer 14

• antihypoglycemic agents if glycemic target is not reached within 2-3 months of lifestyle intervention
• diet, lifestyle and medication needed if A1C >9% ..since <6% is preferable (same as 0.06 mmol/l

Question 15

self-monitorying

Answer 15

T1D - measure BG at least 3 times a day (done in a sanitary manor which can be inconvenient

T2D - can be variable; at least once a day at the same time

Question 16

Hemoglobin A1C

Answer 16

• glycosylated Hb
• cells have glucose attached
• happens over time
• long term glucose control
• past three moths goal: <0.07
  (normally ~ 0.05)
• anyone over 80 years ~ 8% is acceptable

Question 17

problems when BG is not monitored

Answer 17

1) insulin reaction ~ hypoglycemia

2) ketoacidosis

Question 18

Insulin Reaction

Answer 18

Hypoglycemia

• pale skin, confused, weak and shakey, cold and sweaty
• due to too much insulin for that time, too much exercise/metabolic stress, or not enough food (eat during insulin peak but forget to have snacks)
• most common in Type 1

Question 19

treatment for Insulin reaction - hypoglycemia

Answer 19

• IV glucose in extreme cases
• glucose tablets
• glucagon injections ~ better choice is juice or simple sugars
• candy/dextrose tablet
• fluid will absorb the fastest *

Question 20

ketoacidosis

Answer 20

hyperglycemia *

• red, flushed appearance, fruity acetone smell on breath, dehydration, dry skin
• due to infection/illness, not enough insulin or missing shot, over-eating

Question 21

treatment for ketoacidosis - hyperglycemia

Answer 21

• insulin; small amount initially
• rest
• monitor fluids and electrolytes
• not as common in T2D
• exercise will only help if there is insulin present

Question 22

Etiology of T2D

Answer 22

• insulin resistance ~ not utilized effectively or relative insulin insufficiency (can’t bind to receptors)
• insulin secretory defect
• increase in aboriginal children and ethnic groups
• more common in females; childhood obesity

Question 23

diagnostic criteria: biochemical

Type 2 Diabetes

Answer 23

fasting BG >7.0 mmol/L
random BG >11 mmol/L
serum insulin - highly variable (a low level doesn’t rule out Type 2)
- islet cell antibodies - highly variable

Question 24

Diagnostic criteria: clinical

Type 2 Diabetes

Answer 24

• ethnicity, age and gender
• obesity BMI >85th percentile
• acanthosis Nigricans (darker skin)
• may have polyuria, nocturia
• family hx, maternal gestational
• may encounter ketoacidosis under stressful conditions *

Question 25

``` Acanthosis Nigricans (AN) Type 2 ```

Answer 25

- dark colour related to hyperkeratosis - hyperplasia of dermis and epidermis - associated with hyperinsulinemia and insulin resistance - associated with obesity - located on the neck, axillae, antecub, skinfolds, thighs

Question 26

AN varies with ethnicity

Answer 26

- obesity ~ hispanics - obesity ~ native americans - obesity and AN ~ american indian - AN ~ native americans - caucasians low AN prevalence

Question 27

some lifestyle facors of Type 2 Diabetes

Answer 27

- obesity - high fat intake - binge eating - inactivity - low fibre intake - ethnicity - genetic family hx - low birth weight - treatment with growth hormone

Question 28

Factors influencing GI rating

Answer 28

- type of starch - cooking - food processing - fat content - acid content

Question 29

amylose has a _____ GI rating | amylopectin has a ______ GI rating

Answer 29

- amylose has a low GI rating (molecules form tight clumps, harder to digest) - amylopectin has a high GI rating (easier to digest, molecules are open)

Question 30

Effects of cooking on GI rating

Answer 30

- cooking increases the GI rating - swells starch molecules and softens foods making it faster to digest boiled spaghetti for 5 min GI=34 boiled spaghetti for 15 min GI = 40

Question 31

Effects of processing on GI rating

Answer 31

- highly processed foods are digested faster and have a higher GI rating cornflakes GI = 86 Porridge GI = 49 - unprocessed grains have GI rating lower because digestion takes longer pumpernickel GI = 46 white bread GI = 73

Question 32

Effects of Fat on GI rating

Answer 32

- foods with higher fat content have lower GI rating - fat changes how body digests foods - low GI foods are not always the healthiest potato chips GI = 75 Baked potato GI = 93

Question 33

Effects of Acids on GI rating

Answer 33

- acids present in foods slow down your body digesting that food - slower rise in blood glucose

Question 34

other factors that influence GI repsonse

Answer 34

- speed of stomach emptying (fat and protein) = mixed meals | - fat and protein slow the rate of stomach emptying, foods digest at a slower rate

Question 35

eating foods with a low GI may help to..

Answer 35

- control BG levels - control cholesterol levels - control appetite - decrease risk of heart disease - decrease risk of type 2 diabetes

Question 36

``` GI rating for... All bran Bran buds with psyllium oatmeal oat bran ```

Answer 36

``` all bran (42) Bran buds (42) oatmeal (42-66) oat bran (50) ```

Question 37

``` GI rating for... cornflakes branflakes rice krispies cheerios ```

Answer 37

cornflakes (84) branflakes (74) rice krispies (82) cheerios (74)

Question 38

``` Lower GI ideas... cooked pasta whole grain pumpernickel rice grains ```

Answer 38

``` cooked pasta (32-64) whole grain pumpernickel (46) basmati, brown, long grain, parboiled rice (48-56) barley (25) bulgar (48) buckwheat (54) chana dal (8) ```

Question 39

Higher GI ideas... canned or overcooked spaghetti white bread instant and short grain rice

Answer 39

``` canned spaghetti (71-77) white bread (71-77) instant rice (87) short grain rice (72) ```

Question 40

``` Lower GI ideas... popcorn boiled new potatoes pear plum peach milk yogurt ```

Answer 40

``` popcorn (55) boiled new potato (56) pear (38) plums (39) peach (42) milk (42) yogurt (30-40) ```

Question 41

``` Higher GI ideas... pretzels soda crackers french fries baked potato watermelon ```

Answer 41

``` pretzel (89) soda crackers (74) french fires (75) baked potato (93) watermelon (72) ```