Nutrition and diabetes Flashcards

(37 cards)

1
Q

How many people in the world have diabetes?

A

347 million

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2
Q

Which groups are at high risk of diabetes?

A

Family history- genetic and environmental factors play a role. Tends to cluster in families
Ethnicity- 6x more common in south Asians, 3x more common in Africa/Afro-Caribbean people
Obesity- 80-85% of overall risk of developing T2D

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3
Q

What did the finnish diabetes prevention study show?

A
Lifestyle adaptations (reducing weight, total fat, saturated fat, increased fibre and exercise) enabled people to lose more weight than the controls. Glycaemia and lipaemia were also more improved
Lifestyle changes are more effective than medication
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4
Q

What is the most important predictor of risk reduction for type 2 diabetes?

A

Weight loss

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5
Q

What protects from diabetes?

A

Decreased intake of sat fat and increase intake intake of monounsaturated fat
Eat low GI food
Eat dietary fibre and wholegrains

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6
Q

What reduces risk of diabetes?

A

Low fat dairy foods
Green leafy veg
Coffee
Moderate intakes of alcohol

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7
Q

What increases risk of diabetes?

A

Red meats
Processed meats
Fried potatoes

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8
Q

What are the NICE guidelines on managing type 2 diabetes?

A

Offer education
Dietary advice- high fibre, low GI carbs e.g. fruit, veg, wholegrains and pulses, low fat dairy, oily fish, control saturated fat intake and trans fatty acids
Personalised diabetes plan with lifestyle modifications
Target initial body weight loss of 5-10%
Avoid diabetic products
Not just about reducing sugar

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9
Q

What is the primary strategy for dietary management of glycaemic control in type 2 diabetes?

A

Weight loss

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10
Q

What is the most important factor in glycaemic control?

A

Total energy intake- total CHO is strong predictor of glycaemic response

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11
Q

What treatment options are there for obesity?

A
Prevention is best
Reduced calorie diet and exercise
Therapeutic agents- orlistat
Surgery can cure T2D
Combination of above
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12
Q

What are 10 ways to eat well with diabetes?

A
Regular meals
Starchy carbohydrates in diet
Cut down on fat particularly saturated
Eat more fruit and veg
Reduce salt in your diet to 6g or less a day
Include more lentils, bean and pulses
Aim for at least two portions of oily fish a week
Limit sugary foods
Avoid diabetic foods or drinks
Limit alcohol intake
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13
Q

What is the glycaemic index?

A

A ranking of carbs on a scale of 1 to 100 according to how much they increase blood sugar levels after you have eaten them

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14
Q

What does a high GI mean?

A

Rapidly digested and absorbed

Sharp increase in blood glucose

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15
Q

What does a low GI mean?

A

Slowly digested and absorbed

Gradual rise in blood glucose levels

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16
Q

What is the GI of protein and fat?

A

Don’t have one as they don’t break down into glucose

17
Q

How is GI determined?

A

50g of test food is compared to 50g of glucose which has GI 100 in 10 people. Effect on blood glucose is measured in these people over next two hours. For each person, area under two hour blood glucose response is measured i.e. glucose AUC. A GI of test food is calculated for each person- AUC of test food/AUC reference x 100. GI value is average GI of 10 people

18
Q

What foods have high GI?

A
White and wholemeal bread
Cereals
Rice
Beans
Watermelon
Sugary drinks
19
Q

What foods have medium GI?

A

New potatoes
Biscuits
Rice
Fruit

20
Q

What foods have low GI?

A
Pasta
Beans
Tortillas
Oats
Seeded bread
21
Q

Which diabetic medications increase weight gain?

A

Sluphonylureas
Thiazolidinediones/glitazones
Insulin

22
Q

Which diabetic medications cause no effect on weight?

A

Biguanides (metformin)
Prandial glucose regulators
Alpha glucosidase inhibitors
DPP4 inhibitors

23
Q

What diabetic medications cause loss of weight?

A

Incretin mimetics

24
Q

How is type 1 diabetes managed?

A

Insulin (each type defined by its onset, peak and duration of action)

25
What are the aims of type 1 diabetes management?
Aim to coordinate lifestyle and insulin therapy with focus on flexibility, good glycaemic control, CVD risk reducrtion Assessing CHO intake and matching it with insulin dose- CHO counting required and considers effects of exercise, alcohol, GI and illness on blood glucose levels Encouraging nutrition- healthy eating and weight management
26
What is DAFNE?
Dose adjustment for normal eating. Help people to judge how much CHO is in different foods, because there can be errors in estimations
27
What foods contain carbs?
``` Cereal derived starch products Vegetable starch Fructose: fruit, fruit juice Lactose foods- milk, yoghurt etc Sucrose- chocolate and confectionary ```
28
Which diets don't contain carbohydrate?
``` Meat, fish, chicken, eggs and nuts Cheese Most veg Diet drinks, sugar free drinks Alcohol ```
29
Why do you count carbs in type 1 diabetes?
Insulin is required to utilise glucose Glucose comes from CHO Insulin and glucose must be well matched otherwise there will be hypo or hyperglycaemia So either: Match insulin to CHO intake or maintain a consistent CHO intake Qualitative benefits- improved QoL, food freedom, general well being Quantitative benefits- less hypos, improved glycaemic control
30
What are the pros and cons of counting carbs?
Pros: Food freedom Improved QOL Improved glycaemic control ``` Cons: Blood testing Reading labels Weighing foods Keeping records Weight gain ```
31
What are the aims of nutritional management in type 1 and type 2?
Good glycaemic control Minimise risk of long term microvascular and macrovascular ocmplications CVD risk reduction- weight, BP and lipid management Enjoyment of food and QoL Facilitation of health behaviour changes and self management Structured education is recommended for both
32
What is ICICLE?
Imperial College Insulin Carbohydrate Lifestyle Education
33
What is BERTIE?
Bournemouth type 1 intensive education programme
34
What are the disadvantages of low carb diets?
Nutritional adequacy, constipation and headaches
35
Who should be referred to a dietician?
All patients newly diagnosed with diabetes Patients with diabetes starting on insulin Patients with diabetes in pregnancy Patients with diabetes who have never seen a dietician Patients with a high nutritional screening tool score in hospital
36
What dietary advice would you give a young person newly diagnosed with type 1 diabetes?
Adjust insulin around what you are eating, education about carbs
37
What dietary advice would be given to an obese middle aged man diagnosed with type 2 diabetes?
Exercise, cut out high fat and sugar, follow a lower calorie diet