Lecture 7 - Part 2

Question 1

What are the blood lipid profile targets?

Answer 1

LDL-c < 2.0 mmol/L
or at least 50% decrease LDL-c from baseline

non-HDL-c < 2.6mmol/L

TG < 1.5 mmol/L

ApoB < 0.80 g/L

Question 2

People who have DM what are they at an increased risk for?

Answer 2

Coronary Artery Disease

Question 3

What should the ideal BP be for people with DM?

Answer 3

less than 130/80mmHg

Question 4

nutritionally what recommendations should people with DM follow?

Answer 4

• Follow Eating Well with Canada’s Food Guide (all foods fit)

• Ensure adequate intake of all nutrients to meet
needs

• Regular timing of meals and snacks

Question 5

What are the “just the basics”

Answer 5

1. Eat 3 meals/day at regular times & space meals no more than 6 hours apart
2. Limit sugars & sweets
3. Limit high-fat foods
4. Eat more high-fibre foods
5. Drink water
6. Add physical activity to your life

Question 6

What should people with DM do when consuming Carbs?

Answer 6

Total CHO: 45-60% of energy

▪ Individualize

▪ Low-glycemic-index foods
→ Low glycemic (meal) load

▪ Sucrose (added sugars): should be = or less than 10% of energy

▪ Available CHO

Question 7

What are available carbs?

Answer 7

= Total CHO (g) – dietary fibre (g) – sugar alcohol sweeteners (g)

Question 8

What is the Glycemix index?

Answer 8

Blood glucose response 2-3 hrs after 50g CHO of a particular food is eaten relative to a standard

Question 9

What do low GI foods have more of?

Answer 9

Low GI foods (GI score 55) → have more often:

▪ Fructose, lactose
▪ Legumes, yam, sweet potato, apple
▪ Pumpernickel, oatmeal, barley, bran, pasta

Question 10

What do high GI foods have more of?

Answer 10

• High GI foods (GI score 70) → have less often:

▪ Glucose, maltose
▪ White bread / bagel, Rice Krispies
▪ French fries, soda crackers

Question 11

What diets are good for DM?

Answer 11

Mediterranean
Vegan/Veg
Dietary Approachess to stop Hypertension (DASH)
More pulses
More Fruit and veg and nuts

Question 12

What is the handy portion guide for carbs?

Answer 12

2 fists
For most women this equals 45-60 grams For most men this equals 60-75 grams
– Recommend 1-2 fists/meal

• Larger amounts can be eaten by those who are more active or are leaner/ more muscular
• Vegetables (non-starchy) as much as you can hold

Question 13

What is the handy portion guide for protein?

Answer 13

size of the palm of the hand, thickness of little finger

Question 14

What is the handy portion guide for fat?

Answer 14

Tip of thumb

Question 15

What are the different levels of carb counting?

Answer 15

1.Basic:
– Consistent CHO amount per meal or snack
– CHO content per food portion
– Carb ranged for meals and snacks

2. Intermediary:
   – Adjustments in activity / food intake / meds
3. Advanced:
   – Use of individual CHO / insulin ratios
   • Carb to insulin ration determination for patient. But they are able to determine how many carbs they eat and how mcuh insulin they would require
   • Good for flexability in the foods and amount they can eat

Question 16

What is beyond the basics?

Answer 16

• Tool for learning CHO counting
• Use of Food Choice Values (food exchange groups)
• Determination of CHO content of foods
• Values on poster = average of available carbohydrates
• Carbohydrate counting

Question 17

What are the advantages of carb counting?

Answer 17

▪ Matching of food & insulin/medication ▪ Flexible food choices
▪ increase blood glucose control

Question 18

What are the steps for calculcating a meal plan using echanges/carb choices from Beyond the basics?

Answer 18

1. Assess usual food intake
2. Categorize food intake into BTB food choices
3. Determine energy needs
4. Translate energy needs into CDA food choices
5. Adjust choices with goals of % energy from macronutrients
6. Distribute choices among meals/snacks

Question 19

How much of the diet should be protein and fat?

Answer 19

Protein: 15-20%
-not too high of intake to avoid renal disease

Fat: 20-35%

Question 20

Why is it important to have protein with every meal?

Answer 20

Helps with glycemic control and satiation

-digest carbs slower and fuller longer

Question 21

What should you eat when you have hypertriglyceridemia?

Answer 21

Low sucrose and carbs

Question 22

Can you drink alcohol when you have DM?

Answer 22

Occasionally, in moderation, if glycemia well-controlled

• Consume with food to  risk of hypoglycemia (on insulin
Intake
or insulin secretogogues)

• ≤2 standard drinks per day and <10 drinks per week for women
• ≤3 standard drinks per day or <15 drinks per week for men

Question 23

What is 1 standard drink equivalent to?

Answer 23

11⁄2 oz (43 mL) spirits (40% ethanol) 
12 oz (341 mL) beer (5% ethanol)
5 oz (142 mL) wine (12% ethanol)

Question 24

do sugar alcohols impact blood glucose?

Answer 24

▪ Mannitol, sorbitol, etc
▪ No major effect on blood glucose
▪ < 10g/d
▪ Possible GI side effects (especially with Metformin)

Question 25

What are the characteristics of aspartame ?

Answer 25

▪ Acceptable Daily Intake = 40 mg/kg /d ▪ Not if PKU (contains PHE) - • Phenylketone uria, cant have anythign with phenylalanine ▪ May lose its sweetness during heating/baking Phenealanin and aspartic acid put together, found in higher amounts in other foods. Just really sweet when put together

Question 26

What are other sweetners?

Answer 26

* Sucralose(Splenda®) – Goodforbaking * Acesulfame potassium(Ace-K®) * Saccharin(Hermestas®) * Cyclamate (Sucaryl®,SugarTwin®,Sweet’n’Low®) – Safe in pregnancy* (Be cautious of exceeding ADI) * Steviol glycosides(Stevia,Truvia)

Question 27

Who is at the heist risk of DM2?

Answer 27

Indigenous peoples - need to focus on building a therapeutic relationship - acknowledge the legacy of colonization and its ongoing adverse effects on indigenous health

Question 28

What should we look at in elderly with DM?

Answer 28

▪ Assess for level of functional dependency (frailty) ▪ Individualize glycemic targets based on A1C ≤8.5% ▪ Avoid hypoglycemia in cognitive impairment ▪ Caution with sulfonylureas or thiazolidinediones (TZDs) ▪ Dpp-4 inhibitors should be used over sulfonylureas ▪ Basal analogues instead of nph or human 30/70 insulin ▪ Recommend regular diets instead of “diabetic diets

Question 29

What are the key messages about physical activity?

Answer 29

Physical activity can improve glucose control and facilitate weight loss, but has multiple other health benefits Avoid prolonged sitting Aim for min 150 minutes/week of aerobic exercise Using a step monitor In addition to aerobic exercise, include at least 2 sessions per week of strength training If these recommended levels of activity can’t be achieved, smaller amounts of activity still has some health benefits.