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Flashcards in Diabetes and Nutrition Deck (38)
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1

What is diabetes mellitus?

A group of disorders comprising abnormalities (fat, protein, carbohydrates), characterized by hypergylcemia ,resulting from insulin deficiency or resistance

2

Type I- Insulin Dependent (IDDM) is about 10% of all adult cases, what are some features of Type I?

Weight Loss
Polyuria
Polydypsia
Ketosis (keto-acidotic coma)

3

Type I DM is the most common type of diabetes found is what age group?

Childhood

4

Type 2- Non-Insulin Dependent (NIDDM), what are the symptoms?

Often asymptomatic
Overweight
Infections -- urinary tract, vula
Thirst
Rarely coma

5

What is the demographic for Type II diabetes?

Usually appears at age greater than or equal to 40 in caucasians and at a younger age greater than or equal 20 in those ethnic groups at greater risk

6

Gestational Diabetes (GDM) affects 2% to 10% of pregnancies in previously non-diabetic pregnant women, usually during the 2nd or 3rd trimester. What are the symptoms?

May be asymptomatic apart from hyperglycemia but symptoms if present like type 2 diabetes

7

Gestational Diabetes (GDM) usually goes away after giving birth but what may develop immediately or 10-20 years later?

Type 2 may develop
--immediately in 5% to 10% of women
--in 35% to 60% in the next 10-20 years

8

What are the risk factors for gestational diabetes and the development of type 2 diabetes?

Overweight or obese
Have has gestational diabetes before
Had a very large baby in a previous pregnancy (10lb or over)
Have a family history of diabetes
Black, hispanic/latino, American Indian, South Asian or Middle Eastern Background

9

Diabetes can lead to serious complications, such as ?

Blindness
Kidney Damage
Cardiovascular disease
Lower-limb Amputations
Dementia

10

People with diabetes can lower the occurrence of these and other diabetes complications by controlling what?

Blood glucose
Blood pressure
Blood lipids

11

How many people in the US population have diabetes?

29.1 million
(9.3%)
--21.0 million diagnosed
-8.1 million undiagnosed

12

Incidence of diabetes varies markedly between ethnic/minority groups. What groups are at most risk?

1. Pima Indians (24.0%)
2. Non-Hispanic Black (13.2%)
3. Asian Indians (13.0%)

13

Type I diabetes in mainly a T cell mediated autoimmune disease. What factors lead to Type I diabetes?

1. Genetic factors (HLA linked) account for 40% risk
2. Environmental Factors (60% risk) including viruses (rubella, enterovirus, coxsackievirus, cytomegalovirus)
--too clean environment leading to a deficiency in immunoregulation
3. Dietary Factors (cows milk, gluten before 3 months, vit D intake)
--breast feeding protects

14

What are the theories for the relationship between type I diabetes and cows milk consumption in infants?

1. Immature gut mucosa allows antigenic proteins to cross
--beta casein, beta lactoglobulin, and albumin
2. Bovine Insulin in milk triggers antibodies to insulin
--breast feeding is protective

15

Type 2 and GDM have a strong environmental etiology. What is the pathogenesis for these types of diabetes?

1. Insulin Secretory Defect (esp with genetic transmission): low birth weight, fetal origins theory, chronic hyperglycemia and high GI/GL foods
2. Peripheral Insulin Resistance (impaired insulin mediated glucose uptake in muscle): genetic and environmental factors
---an obesogenic environment is a major causal facto

16

What are the risk factors for type 2 diabetes?

Age
Family History
Ethnic Group
Social Class
Fetal Nutrition and Early growth pattern
Diet
Inadequate physical activity
Central obesity
Metabolic Syndrome

17

Prevalence of all types of diabetes has ______ markedly.

Increased

18

What percent of type 2 diabetics are either overweight or obese?

70-80%

19

For each 1kg increase in weight in the population, risk of diabetes increases by what percent?

4.5%

20

Patients with _______ _______ have higher insulin levels and are insulin resistant than patients with similar weight but with peripheral obesity.

Central adiposity (waist greater than 1.02m in med and greater than 0.88m in women)

21

Central obesity leads to insulin resistance and the metabolic syndrome a precursor of what disease?

type 2 diabetes (glucose intolerance)
atherosclerotic vascular disease
increased risk of death (hypertension and dyslipidemia)

22

What percentage of the adult US population have the metabolic syndrome?

20-35%

23

Central adiposity is a key determinant of CHD risk in men and women. What is the raw data in support of this?

CHD risk: men vs women
3:2
--men have more central adiposity whereas women have fat more in hip location

24

The main cause of the metabolic syndrome is?

Intra-abdominal (visceral obesity)

25

Why does central obesity lead to insulin resistance?

1. Adipocytes located centrally are larger and more resistant to insulin than peripherally
2. Hyperinsulinemia directly related to waist circumference
3. Drains directly to liver via portal system
4. More NEFA produced than from gluteal-femoral fat: NEFA delivery to muscle causes IR
5. More inflammatory cytokines than from gluteal femoral fat

26

What is treatment for type I diabetes?

Type I: diet/lifestyle + insulin

27

What is the treatment for type 2 and GDM?

Diet/Lifestyle
(plus or minus oral hypoglycemia drugs and insulin)

28

In regards to treatment what is the current US statistics for all diagnosed adults (type 1 or type 2)

23% no insulin or oral medication
49% take oral medication only
16% take insulin only
12% take both insulin and oral medication

29

What are the current recommendations for lifestyle changes/dietary principles for diabetes treatment and prevention?

1. Weight Control
2. Modest Energy deficit within a healthy diet (whore fruit, whole grain, healthy fats, regular meals, Vit D, avoid excess salt, mod alcohol intake)
3. Complicated diets dont work

30

Patients with diabetes should avoid trans-fat and reduce saturated fat, why?

Saturated Fat is a causal factor in insulin resistance
Substitution with either PUFA or MUFA reduces insulin resistance and changes abdominal fat distribution