DM - Exam 2

Question 1

What constitutes DM?

Answer 1

Hemoglobin A1c - 6.5% or greater

Fasting Plasma Glucose - 126 mg/dL or greater

2-hour OGTT - 200 mg/dL or greater (need to ingest 75mg of glucose)

Random Plasma Glucose - 200 mg/dL or greater

need at least 2 readings on 2 different occassions

Question 2

_____ related to destruction of pancreatic β-cells and loss of insulin production. What is it due to? What is the tx?

Answer 2

T1DM

due to an autoimmune process

must be treated with insulin

Question 3

_____ is related to insulin resistance with potential eventual loss of β-cell function. What is it dependent on?

Answer 3

T2DM

diet and lifestyle

Question 4

_____ chronic insulin resistance and insulin insufficiency in the brain may play a role in the pathogenesis of Alzheimer’s patients

Answer 4

Alzheimer’s Disease and type 3 DM

Question 5

What is prediabetes defined as?

Answer 5

Impaired Fasting Glucose - 100-125 mg/dL

Impaired Glucose Tolerance - 140-199 mg/dL on 2-hr OGTT

Elevated HbA1c - 5.7-6.4%

Question 6

What are some healthy recommendations for DM?

Answer 6

high in fiber, moderate to low carbohydrate consumption, plant-based foods, Mediterranean style

regular physical activity

sleep!

no tobacco!

Weight loss!

Question 7

What are the recommended amounts of carbs for DM? What kind?

Answer 7

30grams

whole grain, fruits, veggies

carbs should be minimally processed and plant based

Question 8

Replacing carbs with ____ was found to help glycemic control in DM.

Answer 8

MUFAs

Question 9

What are the protein requirements for pt with DM? Excess proteins can be harmful in patients with ____. What kind of proteins are preferred?

Answer 9

0.8 g/kg/day

CKD

plant proteins are preferred

Question 10

What are the Pros for keto diet and DM? Cons? Is there any difference at the 1 year mark?

Answer 10

Pro: Often have faster early weight loss, significant early improvements in blood glucose levels

cons: “Keto flu,” long-term cost and compliance issues

Studies have shown no major differences in glycemic control at the 1 year mark

Question 11

What is the best diet for DM?

Answer 11

the best diet is the one your patient can adhere to!!!

Mounting evidence that eating healthy foods in general, rather than worrying about specific percentages of macros, is the best approach

Question 12

What are 3 helpful suggestions for DM diets?

Answer 12

The Plate Method

Diabetic Recipes

Diet Exchange Lists

Question 13

When are diet exchange lists especially helpful for DM?

Answer 13

especially helpful for patients counting carbohydrates/reliant on insulin

Question 14

in general- 1 unit of rapid-acting insulin = ____ carbs

Answer 14

12-15 carbs

Question 15

?????: Helps promote slightly lower carb intake

Answer 15

Low Glycemic Index/Glycemic Load Food Choices

Question 16

What are some important points to consider regarding nuts and DM. What do nuts NOT do?

Answer 16

reduced CVD risk

benefit in preventing DM

recommended as a favorable addition to diet (careful of the overall caloric intake)

have NOT been shown to improve glycemic control directly in patients who already have DM diagnosis

Question 17

Ethanol can interfere with _____. When consumed without food increased risk of ______. Excessive ethanol intake can contribute to _____ and overall worse _______.

Answer 17

hepatic gluconeogenesis

hypoglycemia

elevated TG

glucose control

Question 18

Who at the highest risk of hypoglycemia due to alcohol intake for a DM pt?

Answer 18

DM pts taking insulin or drugs that stimulate insulin release

aka need to eat something if DM pts are going to drink

Question 19

Caffeine technically shown to cause higher _____ and insulin levels
and decreased _____ in T2DM patients

Answer 19

plasma glucose

insulin sensitivity

Question 20

______ insulin cofactor that may help stimulate expression of insulin receptors and activate those receptors, resulting in better clearance of glucose from the blood. What pt population does it have the most benefit?

Answer 20

Chromium

mixed data, greater benefit in poorly controlled pts
no benefit for pts who have normal glucose and are at risk for developing DM

Question 21

____ is an insulin cofactor with a very narrow therapeutic window with lots of GI SE!!

Answer 21

Vanadium

Question 22

_____ is commonly used to treat elevated TG. Does it have an impact on glycemic control?

Answer 22

Fish Oil

no major impact on glycemic control, NOT recommended for prevention or treatment of DM

just to treat hyperTG

Question 23

Popularly reported that ____ chocolate may improve glycemic control and insulin sensitivity due to _____ and ______. What is the recommendation?

Answer 23

dark

cacao and its bioflavinoid antioxidants

Recommended to consume small amounts, in moderation, but healthier than other forms of chocolate

Question 24

What is important to know about cinnamon and DM?

Answer 24

Supplementation probably would be minimally harmful, but not likely to help, and not enough evidence to replace medical treatment aka do not actively discourage

One study did show a possible benefit in prediabetic patients but NOT helpful in T1DM or T2DM

Question 25

What is white sugar composed of? What is brown sugar composed of? Which has more calories by volume? by weight?

Answer 25

purified, refined sucrose glucose + fructose _______ Brown: sucrose and have molasses added back in volume: brown sugar has more calories weight: white sugar has more calories

Question 26

_____ does not require insulin to be processed. ______ absorbs it and turns it into fat (TG). Name some sources

Answer 26

Fructose liver Fructose - “fruit sugar” - monosaccharide sucrose, honey, fruit, corn

Question 27

______ is widely used in the US as a sweetener due to low cost. Why is it a problem?

Answer 27

High-Fructose Corn Syrup Problem with HFCS is likely not the fructose itself, but the amount of unnecessary added sugar it adds to our diet as a whole

Question 28

Will natural caloric sweeteners increase blood sugar? Do they have a higher or lower glycemic index than sucrose? What else do they contain?

Answer 28

these are still simple sugars and will still cause a spike in blood glucose levels! lower glycemic index/glycemic load than sucrose nutrients like vitamins, minerals and antioxidants

Question 29

What are some sweeteners that have a lower glycemic index than sucrose (white/brown sugar)?

Answer 29

Question 30

______ generally provide less calories per gram and cause a minimal change (or no change) in blood glucose. What are some examples

Answer 30

Sugar Alcohols xylitol, erythritol, sorbitol, mannitol, isomalt, maltitol, lactitol

Question 31

Sugar alcohols have high levels of ingestion linked to ______. ____ and ____ specifically have an FDA-mandated warning that excess consumption can lead to laxative effects.

Answer 31

gastrointestinal symptoms sorbitol and mannitol

Question 32

What is the concern over negative GI symptoms and poyols? What else are they associated with? Which one specifically?

Answer 32

Concern over negative effects on gut microbiome May be associated with higher risk of CV events (MI, CVA, DVT) Erythritol - high levels of consumption associated with increased thrombosis

Question 33

Non-Nutritive Sweeteners (NNS) are generally _____ than sucrose. Are they good for us?

Answer 33

Generally higher-intensity (sweeter) than sucrose Generally allowed to be consumed as part of a general pattern of healthful lifestyle changes: less harmful than caloric sweeteners, good for those who need to limit sugary foods/drinks NOT encouraged for weight loss or other chronic dz management

Question 34

Are non-nutritive sweeteners bad for us?

Answer 34

Generally not associated with cancer, brain tumors, or neurologic disease in studies but are NOT associated with lower weight, better glycemic control, lower risk of obesity/heart disease in most studies they just displace calories/sugar not lower caloric/sugar content

Question 35

Give some examples of non-nutritive sweeteners. Consider looking at other noteworthy facts?

Answer 35