Medical Nutrition Therapy in Diabetes Mellitus Flashcards Preview

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Flashcards in Medical Nutrition Therapy in Diabetes Mellitus Deck (32):
1

What is diabetes self-management?

recognizing that people are responsible for the day-to-day decision that influence their disease, supporting behaviors that promote effective self-management

effective management requires proper use of multiple technologies, complex treatment strategies and problem-solving skills

important to deliver education and training at to patients that are prepared and competent

2

What are the 5 steps in diabetes self management?

assessment, goal setting, planning, implementation and evaluation

3

Lifestyle optimization requires DSME/T in these self-care behaviors.

healthy eating
being active
monitoring (blood glucose)
taking medication
problem solving
healthy coping
reducing risks

4

Define medical nutrition therapy.

MNT is healthy eating education performed by a registered dietitian

5

Lifestyle optimization requires DSME/T in these self-care behaviors.

healthy eating
being active
monitoring (blood glucose)
taking medication
problem solving
healthy coping
reducing risks

note diabetes self management training usually occurs in group setting (up to 10h in the first year and additional 2 hrs in subsequent years)

6

Define medical nutrition therapy.

MNT is healthy eating education performed by a registered dietitian (focusing on assessment, goals, intervention and evaluation)

MNT is most effected at the time of diagnosis, 1% decrease in newly diagnosed DM1 and 2% in DM3; blood lipid concentrations and blood pressure decreases also observed

7

How do patients get access to MNT consoling?

consists of a series of 3-4 encounters with a RD for 45-90 min beginning with a referral at diagnosis (completed within 3-6mo

at least 1 followup encounter is recommended annually to reinforce lifestyle changes and evaluate/monitor outomes

payment: a glucose of >125 on 2 tests permits 3 h in first year, 2h follow-up in subsequent years (requires MD referral each calendar year

8

Name 4 behaviors associated with improved glycemic control by the DCCT.

adherence to a meal plan
consistent snacking behaviors
appropriate treatment of hypoglycemia
prompt response to hyperglycemia

9

Name 4 behaviors associated with improved glycemic control by the DCCT.

adherence to a meal plan
consistent snacking behaviors
appropriate treatment of hypoglycemia
prompt response to hyperglycemia

10

What are the tenets of healthy eating?

promotes energy balance,
limits saturated and transfat intake,
encourages consistent carbohydrate intake,
controls sodium intake and
meets dietary reference for intake of micronutrients

11

What are the tenets of healthy eating?

promotes energy balance,
limits saturated and transfat intake,
encourages consistent carbohydrate intake,
controls sodium intake and
meets dietary reference for intake of micronutrients

12

What degree of modest weight loss has been shown to prevent the progression from pre-diabetes to type 2 diabetes?

losses of 5-10%, reductions in visceral and subcutaneous adipose tissue,

** leads to fewer free fatty acids interfering with hepatic glucose production and production of fewer pro-inflammatory chemicals

13

What is important to consider about the quality of carbohydrates consumed by diabetics?

simple carbs usually cause more rapid blood sugar increase
unrefined carbs usually contain more nutrients

recommended 50% calories (same as all people) for diabetics, carbs do not need to be eliminated or severely limited

14

What does glycemic index tell you about a food?

glycemic index is the effect on raising blood sugar that is measured for a given carb dose after a 12h fast

high glycemic index foods are 70 or greater, low 55 or less

15

What is important to consider about the quality of carbohydrates consumed by diabetics?

simple carbs usually cause more rapid blood sugar increase
unrefined carbs usually contain more nutrients

recommended 50% calories (same as all people) for diabetics, carbs do not need to be eliminated or severely limited

44-50g of fiber daily is shown to improve glycemia, soluble fiber has a stronger influence on glycemic control (increases viscosity, slows digestion)

natural and added sugars are safe but should be monitored (less than 24g for women and less than 36 for men)

16

What does glycemic index tell you about a food?

glycemic index is the effect on raising blood sugar that is measured for a given carb dose after a 12h fast

high glycemic index foods are 70 or greater, low 55 or less
*mixing foods can significantly change the GI of singular foods

17

How does fructose effect TG?

fructose is a natural sugar metabolized by the liver and large amounts can increase TG and insulin resistence
(AHA recommends consuming water as the primary beverage)

18

How does fructose effect TG?

fructose is a natural sugar metabolized by the liver and large amounts can increase TG and insulin resistence
(AHA recommends consuming water as the primary beverage)

19

Do sugar alcohols have calories?

yes, an average of 2 calories, they produce lower post prandial glucose response and potentially a laxative effect

20

What are resistant starches?

carbohydrates with high amylose content (starch is enclose din plant cell structure increasing the time required to digest and absorb the carbohydrate

21

What are resistant starches?

carbohydrates with high amylose content (starch is enclose din plant cell structure increasing the time required to digest and absorb the carbohydrate (i.e. chicory root extract)

22

What is the recommended protein intake and how does it effect blood glucose?

small portions of high protein foods are suggested and have little effect on blood sugar, only need to cover protein in a hight protein diet

23

What is the recommended protein intake and how does it effect blood glucose?

small portions of high protein foods are suggested and have little effect on blood sugar, only need to cover protein in a hight protein diet (

24

What are the recommendations about amount and types of fat diabetics should consume?

total fat 30-35% of calories with polyunsaturated fat

25

How does alcohol effect blood sugar?

it's calories do not raise blood pressure and alcohol should be consumed with food to prevent hypoglycemia

2 drinks/d men or 1 drink/d for women

26

What are the serving recommendations made by My Plate approach to portion control?

grains 1-2 servings a meal
vegetables 1+ serving per meal
fruits 0-1 servings per meal
meats and beans 1-2 servings per meal
dairy 0-1 servings per meal

27

What are the serving recommendations made by My Plate approach to portion control?

grains 1-2 servings a meal
vegetables 1+ serving per meal
fruits 0-1 servings per meal
meats and beans 1-2 servings per meal
dairy 0-1 servings per meal

28

What are MNT strategies for managing insulin?

estimate energy needs by carb counting (based on personal CHO/insulin ratio)*
eat at consistent times with fixed amount of CHO

individualized education for self-management behaviors that utilize the latest technology for matching CHO to insulin is preferred

* in meds you match the insulin to the CHO intake

29

Give examples of glucose sources that could be used to address hypoglycemia and their relative amounts.

3 glucose tabs, ½ can regular pop, 4 oz juice for patients with blood glucose

30

What are specific dietary recommendations for diabetics with gastroparesis?

low residue diet is recommended, they may be wide swings in sugars, nausea, anorexia

31

What are the exercise recommendations for diabetics?

150 minutes of moderate intensity exercise per week,

32

What are the exercise recommendations for diabetics?

150 minutes of moderate intensity exercise per week,
2-3d resistance exercise; flexibility exercise 2-3 days a week (ROM) and neurmotor exercise 2-3 d/week

*monitory glucose before and after (type 1) and don't exercise if glucose >250 + ketones or >300