DM MNT Flashcards by Sydney Perry

The goal of MNT is to assist persons in
making __________ behavior changes to
improve overall DM management and health
status

self-directed

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Goals for MNT for adults with DM

Promote & support healthful eating patterns,
emphasizing a variety of nutrient-dense foods in
appropriate portion sizes, in order to improve
overall health and specifically to:
*achieve & maintain ________ goals
*attain individualized _____________ goals
*delay or prevent _________ of DM

body weight
glycemic, BP, & lipid
complications

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glycemic targets for adults with DM

preprandial capillary plasma glucose
peak postprandial capillary plasma glucose
A1C

80-130
<180
<7%

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Action of insulin is _________- promotes the
______ of nutrients and prevents the
_______ of nutrients

anabolic
storage
breakdown

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CHO
insulin facilitates

Entry of glucose into the cells
Glycogen synthesis in the liver & muscles
Increases triglyceride stores

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CHO
without insulin

Hyperglycemia occurs
Liver & muscle glycogenolysis occurs
Glucose production by the liver increases

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Protein
with insulin

Incorporation of amino acids into tissue
protein

Decreases gluconeogenesis

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protein
without insulin

Gluconeogenesis occurs and proteolysis
occurs in muscles

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fat
with insulin

*Lipogenesis by activating lipoprotein lipase
*Inhibits lipolysis

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fat
without insulin

*Lipolysis & fatty acid release occurs rapidly
- Leads to an excessive production of ketones

*Serum TG increases secondary to a decrease in
cellular uptake

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For all patients with overweight or obesity, behavioral modification to achieve & maintain a minimum weight loss of _______% is recommended
* Associated with improved glycemic control, lipid levels, and BP

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DRI Acceptable Macronutrient Ranges:

45-65% CHO
20-35% fat
10-35% protein

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For those with diabetic kidney disease:
*Provide _____ g/kg (if not on dialysis)
* For individuals in dialysis, provide _____ g/kg
*Higher levels (>____% of daily kcal from protein or >____ g/kg) associated with more rapid kidney function loss

0.8
1.0-1.2
20%
1.3

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Reducing overall _____ intake has demonstrated the most evidence for improving glycemia
* Emphasize nutrient-dense CHO sources that are
high in fiber and minimally processed.
* Eating plans should emphasize nonstarchy vegetables, fruits, and whole grains, as well as dairy products, with minimal added sugars

CHO

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starchiest veggies

potatoes
corn
peas

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Both the amount of CHO and the type of CHO affect BG levels but the ________ of CHO will have more of an effect on BG levels than the______ of CHO
*Substituting low glycemic index/load foods for
higher glycemic index/load foods may or may
not have a significant effect on glycemic
control - the research is inconclusive

TOTAL amount
source

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________-containing foods can be substituted for
isocaloric amounts of other CHO in the meal
plan, or if added to the meal plan, covered with
insulin
* However, consumption should be minimized to
avoid displacing healthier, more nutrient-dense
foods
*People with DM and those at risk should
replace sugar-sweetened beverages (including
juice) with water to control glycemia and
weight and reduce the risk of CVD & fatty liver

Sucrose

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___________ have the potential to reduce overall caloric &
CHO intake if substituted for other sweeteners
*Generally recognized as safe (GRAS) when consumed within the daily intake levels established by the FDA

*Overall, people are encouraged to decrease
both sweetened and nonnutritive-sweetened
beverages and replace with water

sugar substitutes

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Determined by the FDA
*The amount of a food additive that can be safely consumed on a daily basis over a person’s lifetime without any adverse effects.
*Determination generally includes a ____-fold
safety factor

ADI is ______

100

50 mg/kg

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Saccharin (__________)
Aspartame (_________)
Sucralose (_______)
Acesulfame K (____________)
Stevia (________)

Sweet’N Low
NutraSweet
Splenda
Sweet One & Sunett
Truvia

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________ is unknown if safe during pregnancy
people with PKU cannot consume ____________

saccharin
aspartame

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Sugar alcohols examples

erythritol
sorbitol
xylitol

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Sugar alcohols are ________________ by the body
*_______ kcal/g
*Intestinal side effects can limit usefulness=> gas, bloating, diarrhea

partially absorbed
1.5- 2.5

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Evidence is limited that fiber has a beneficial
effect on glycemic control
* Some research suggests that soluble fiber may__________ & lessen postprandial rise in glucose
* However, improved glycemic control required fiber
intakes of >_____ grams/d
*Soluble fiber can reduce ___________
*People with DM should consume at least the DRI for fiber

slow CHO absorption
50
LDL-cholesterol

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* Type of fat consumed is ______ important than total amount when considering CVD risk * Reduce SFA and replace with __________ * Increased consumption of foods containing ________ fatty acids is recommended to prevent or treat CVD However, evidence does not support use of _____________ * Consider use of a ______________ eating pattern

more PUFA & MUFA omega-3 supplements Mediterranean-style

Reduce sodium intake to <_______ mg/d *For individuals with both DM & HTN=> further reduction may be indicated

2300

Effect of alcohol on BG levels depends on the amount of ingested as well as food intake *Blocks _________ and can cause _________ if not consumed with food * Especially if taking insulin or insulin secretagogues *If alcohol is consumed, do so in moderation: *<1 drink/day for women; <2 drinks for men

gluconeogenesis hypoglycemia

1 drink = ___ oz beer ___ oz of wine ___ oz of distilled spirits

12 5 1.5

1.5 oz distilled spirits 5 oz dry, red, or white wine 12 oz beer

100 kcal, 0 CHO choices 100-125 kcal, 0 CHO choices regular 150 kcal, 1 CHO choice light 100 kcal, 0.5 choice

Many vitamin and minerals act as cofactors in the metabolism of macronutrients * No clear evidence of benefit from supplementation of vitamins, minerals, or herbal supplements in DM for those ____________ * Routine supplementation with ________ is not advised due to lack of evidence of efficacy and concern related to long-term safety * It is recommended that people taking metformin have an annual assessment of _________ status

without deficiencies antioxidants vitamin B 12

A variety of eating patterns can be considered for the management of type 2 DM and to prevent diabetes in individuals with prediabetes *Focus on the key factors that are common among the patterns: * emphasize _____________ * minimize _________________ * choose ___________ over highly processed foods

non-starchy vegetables added sugars & refined grains whole foods

collect lab data including ___________________________________

A1C FPG fasting lipid profile urinary albumin (DKD) Cr BUN

Factors that may increase BG levels

trauma and stress (physical or mental) corticosteroids or diuretics various diseases - Cushing syndrome excessive kcal or CHO intake

Factors that decrease BG levels

insulin or insulin secretagogues physical activity poor intake ETOH consumption extensive liver disease

2 phases of self management education

initial education in depth continuing education

initial education of self management included ________ some examples ?

information needed at time of diagnosis - called survival skills importance of eating at regular times signs and symptoms of high and low BG treatment of hypoglycemia sick day management

in depth continuing education for self management includes ___________________ examples?

management skills needed to make decisions to achieve goals and foster self care CHO counting or meal planning label reading exercise guidelines

initial education should be ______ encounters during the _________ follow up should be ____ encounter _______ to _______

3-6 1st 6 months at least 1 annually reinforce lifestyle changes and to evaluate outcomes that impact the need for changes in MNT or medications

For meal planning, emphasize goal of achieving __________ by ____________________ use _____ monitoring, ______ records, and _______ records

glycemic targets balancing food, medications and exercise BG food excercise

If using a flexible insulin therapy program=> _________ approach to optimize mealtime insulin dosing If fixed insulin doses=> consistent pattern of _______ with respect to time and amount synchronized with insulin

CHO counting CHO intake

Caloric restriction to promote weight loss (if overweight or obese) If using MNT alone or non-insulin secretagogue meds=> monitor ________ healthful eating pattern If on fixed insulin doses or insulin secretagogues=> _________________; healthful eating pattern

CHO intake Consistent CHO intake and mealtimes

Several approaches are available including: *_____ counting *_________ for Diabetes *For those with health literacy concerns=> _______ method, portion control and healthy eating tips

CHO Food lists MyPlate

Evidence has shown that _____ and _______ are the main factors affecting post-prandial blood glucose Emphasis is placed on total amount of CHO to be consumed - Used to determine pre-meal insulin doses

CHO intake available insulin

CHO counting Advantages: - Offers greater_______ in food choices - Allows for better control of_____ Disadvantage: - By itself, it doesn’t teach __________ - Requires more _________________

flexibility BG healthy eating habits self-monitoring & decision making

Determine patient/client’s total daily calorie needs - Distribute amongst macronutrients - will be dependent on individual patient goals - Determine total _________ needed per day

grams of CHO

Convert the number of grams of CHO recommended per day into the ____________ - Distribute grams of CHO _______ for meals

number of carbohydrate choices equally

The amount of ________ needed to “cover” a given amount of carbohydrates - Gives the patient an idea of what size ________ should be given when eating carbohydrates

insulin insulin bolus

Insulin to CHO ratios are unique, individualized ratios - Ratios can vary significantly from person to person - The ratio should be calculated by a _________ using the person’s food records, doses of insulin, & log of post-prandial BG levels - Most adults with type 1 DM will need approximately __________ for each ________ of CHO consumed

Certified Diabetes Care & Education Specialist (CDCES) 1 unit of rapid-acting insulin 10-15 grams

simple/basic method. of calculating insulin to CHO ratio Example : 50 units of insulin per day

divide 500 by the total daily dose of insulin that the individual takes 500/50 = 10 - 1 unit of rapid acting insulin will cover 10 grams of carbohydrates - 1:10

Basic CHO Counting education: - Effect of CHO on _______ - Primary________ of CHO - 1 CHO Choice = _____ g of CHO - Portion sizes - Label reading - Amount of total ___ that should be eaten daily

blood glucose food sources 15 CHO

Advanced CHO Counting education: - Importance of _________ (food & BG diaries) - Concept of matching insulin to carbohydrate intake is introduced - Using individualized insulin-to-CHO ratios

record keeping

Food Lists Developed by the American Diabetes Association & the Academy of Nutrition & Dietetics - Formerly referred to as ________ lists - The term “choice” is used to describe a certain quantity of food within a group of similar foods - Used to calculate a meal plan=> the number of ______ of food groups to be consumed at each meal

"exchange" servings

For individualized meal plans... First, complete a full nutrition assessment - Obtain information on the individual’s usual eating habits, lifestyle, food preferences, exercise habits - Calculate patient’s _____________ - Design a preliminary ________ & _______ with consistent CHO intake and timing of meals - Encourage patient/client _______

nutritional requirements meal plan sample menu participation

Advantages of Food Lists: - Beneficial in teaching __________ - Can teach __________ and calorie restriction to promote weight loss Disadvantages: - Not as ________ as CHO counting - Not tailored to actual _________

healthy eating habits portion control flexible BG levels

A _______ is a health professional who possesses comprehensive knowledge of and experience in diabetes prevention, prediabetes, and diabetes management - The certification exam is provided by the Certification Board for Diabetes Care and education ____ hours woking with diabetes patients and then take exam

CDCES 1000

Physical activity (PA) should be an integral part of the treatment plan for persons with diabetes * Benefits: Exercise helps improve insulin sensitivity, reduce CVD risk factors, assists with weight management, and can improve mood & well-being * All adults, and particularly those with type 2 DM, should decrease the amount of time spent in sedentary behavior. Prolonged sitting should be interrupted every _____ for BG benefits. * Individuals should speak with their MD prior to beginning an exercise program

30 min

Most adults with type 1 & type 2 DM should engage in >______ min of moderate-to-vigorous intensity aerobic activity per week, spread over at least ___ days/wk, with no more than ___ consecutive days without activity *Shorter durations (minimum 75 min/wk) of vigorous intensity or interval training may be sufficient for younger and more physically fit individuals *Adults with type 1 & type 2 DM should engage in 2–3 sessions/wk of resistance exercise on nonconsecutive days

150 3 2

Type 1 DM=> glycemic response varies depending on overall diabetes control, _________ at the start of exercise; timing, intensity, & duration of the exercise; and previous food intake Type 2 DM=> BG control can improve with PA due to increased ________ resulting in increased peripheral use of glucose not only during but also after the activity

BG and insulin levels insulin sensitivity

_________ is a potential problem for people taking insulin or insulin secretagogues in exercise - Occurs due to insulin-enhanced glucose uptake by the exercising muscle - For individuals with diabetic retinopathy=> vigorous-intensity aerobic or resistance exercise may be contraindicated because of the risk of triggering ______________ or ____________

Hypoglycemia vitreous hemorrhage or retinal detachment

For moderate-intensity exercise => consume an additional ______ g of CHO for ______ of exercise - For more strenuous exercise such as 1-2 hours of basketball, football, soccer, or strenuous bicycling=> ____ g CHO may be needed - Monitor BG before, during, & after exercise - Moderate exercise of <30 min generally does not require any additional CHO or insulin adjustment, unless BG <_______ mg/dL, in which case a small snack may be needed

15 1 hour 30 100

DM MNT Flashcards

(60 cards)