Management of Diabetes & Other Non-Communicable Diseases

Question 1

What are the differences between T1DM and T2DM in symptoms?

Answer 1

T1DM: polyuria, polydipsia, polyphagia
T2DM: may or may not have symptoms; nocturia, eye damage, polydipsia

Question 2

What 3 things create the “perfect storm” for T2DM?

Answer 2

• obesity
• sedentary lifestyle
• aging population

Question 3

What group is at highest risk for T2DM

Answer 3

Aboriginals

Question 4

Why are immigrants at high risk of T2DM?

Answer 4

• adopt westernized lifestyle

Question 5

What three basic metabolic defects characterize the disease?

Answer 5

• insulin resistance
• an insulin secretory defect that is not autoimmune-mediated
• an increase in glucose production by the liver
• any combo of these; not a homogenous disorder
• incretin pathway may also be involved

Question 6

What is gestational diabetes?

Answer 6

Glucose intolerance with onset or first recognition during pregnancy; increases risk of T2DM

Question 7

What is pre-diabetes?

Answer 7

Term for impaired fasting glucose and impaired glucose tolerance place individuals at risk for developing diabetes

Question 8

What happens through the course of diabetes development?

Answer 8

• insulin resistance and insulin level rises in pre-diabetes
• insulin level then drops in diabetes
• incretin and beta cell function continue to decline

Question 9

Diabetes can be reversed in the…

Answer 9

First 3 years of diagnosis

Question 10

How is diabetes managed via lifestyle modification?

Answer 10

• healthy eating
• increasing exercise
• smoking cessation
• stress management

Question 11

What is problematic with CFG?

Answer 11

• blanket statement for all of Canada
• not individualized
• doesn’t consider other cultural foods

Question 12

What are the 6 recommendations for nutritional management of diabetes?

Answer 12

1. Nutrition counselling by a Registered Dietitian
2. Encouraged to follow CFG (aim for balance, timing, and spacing of meals)
3. Choose low glycemic index carbohydrates
4. Sucrose and sucrose-containing foods can be substituted for other carbohydrates (max. of 10% of total daily energy)
5. Consume < 7% of total daily energy from saturated fats and should limit intake of trans fatty acids
6. Other dietary patterns –Mediterranean & Vegan

Question 13

What is mediterranean diet pattern?

Answer 13

• more nuts, fruits, veg, less animal protein, whole grains, fish, yogurt, legumes, alcohol in moderation
• cardioprotective

Question 14

How should a dinner plate be divided by food group?

Answer 14

• half should be vegetables
• quarter is starch
• quarter is protein

Question 15

Non-oil seed pulses such as chickpeas and beans have…

Answer 15

A glycemic benefit

Question 16

What are recommendations for exercise management of diabetes?

Answer 16

• 150 minutes of aerobic exercise per week, spread over 3 days
• resistance exercise at least 2 times per week (with supervision)
• people with possible CVD or microvascular complications should be assessed if undertaking exercise greater than brisk walking
• limit sitting for prolonged periods

Question 17

Why is smoking cessation important for diabetes?

Answer 17

• independent risk factor for all-cause mortality
• increases risk of MI, stroke, and progression to end-stage CKD
• should offer resources to quit

Question 18

Why is stress management important for diabetes and how is it assessed?

Answer 18

• stress is a precursor to T2DM and increases hyperglycaemia
• should be screened routinely for subclinical psychological distress (depressive and anxious symptoms) and psychiatric disorders
• interview or standardized questionnaires
• should offer stress management strategies, coping skills training, behavioural therapy, family therapy, case management and/or pharmacotherapy if required

Question 19

How is diabetes prevented?

Answer 19

• structured lifestyle modification including moderate weight loss (5%), regular physical activity, dietary modification
• needs to be intensive, clients met with once a week
• effective at reducing risk in some

Question 20

People with T2DM often live with…

Answer 20

Multiple chronic conditions due to lifestyle choices

Question 21

What denotes pre-diabetes?

Answer 21

Anyone with impaired fasting glucose (6.1-6.9 mmol/L) or impaired glucose tolerance (7.8-11 mmol/L)

Question 22

What are the criteria for metabolic syndrome?

Answer 22

Any 3 of:

• Prediabetes/diabetes
• BP > 130/85 mm/Hg
• TG > 1.7 mmol/L
• HDL < 1.0 mmol/L (men); 1.3 (women)
• Abdominal obesity > 102 cm (men); 88 (women)

Question 23

When are people often diagnosed with T2DM>

Answer 23

• post MI because high glucose levels are seen

Question 24

What factors increase risk for non-communicable disease?

Answer 24

• tobacco use
• unhealthy diet
• physical activity
• harmful use of alcohol
• stress

Question 25

How are NCDs prevented?

Answer 25

• lifestyle!
• healthy eating: sodium restriction, high fibre
• physical activity: weight loss, cardio/ weight training
• smoking cessation
• stress management
• alcohol moderation

Question 26

How are genetic implicated in diabetes research?

Answer 26

• studying genome provides organism’s hereditary information

- genome wide association studies (GWAS) being led to determine CV and metabolic phenotypes in humans

Question 27

How is environment implicated in diabetes research?

Answer 27

• built environment: studying our environment geographically, such as urbanization, walkability, bike friendly cities, etc.
• chemical environment: studying the chemicals that are disrupting our endocrine system (mimic estrogens) known as obesogens

Question 28

What are obesogens?

Answer 28

• chemicals that cause DNA to be expressed differently (not mutated)
• occurs as early as in utero
• ex, nicotine, DEHP, tributyltin