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What is purpose of urine albumin-to-creatinine ration (UACR)

Detect early kidney disease in those with diabetes or other risk factors such as HTN


What is normal UACR range

0-30 mg/g albumin excretion/day


What is abnormal UACR

> 30 mg/g albumin excretion/day


Purpose of A1C

- Screen or dx diabetes or prediabetes in an adult
- Monitor response to therapy


A1C results for:
- Non-DM
- Pre-DM
- DM

- Non-diabetic <5.7%
- Prediabetes 5.7-6.4%
- Diabetes >6.5%


Purpose of the oral glucose tolerance test

- Screen for or diagnose DM or preDM
- Screen for gestational DM during pregnancy


What is being tested by a c-peptide test

- When insulin’s precursor molecule, proinsulin, is cleaved to make insulin, C-peptide is formed as a byproduct
- Insulin and c-peptide as secreted in equimolar amounts and released into circulation via the portal vein


Explain the results of a c-peptide test

- Elevated levels of c-protein indicate insulin resistance
- Levels in the normal range in the face of hyperglycemia indicate a dysfunctional insulin release that cannot keep blood glucose in physiologic range
- Expect to see levels at the low end of normal or less than normal in early Type 1 DM


3 ketone bodies

- acetone
- acetoacetate
- beta-hydroxybutyrate


Why are ketones produced?

- Ketones are produced by the body as an alternative to glucose
- When the body has too little insulin, cells cannot take in enough glucose from the blood. To compensate, the body will break down fat to produce ketones (ketosis)


Under what conditions should ketones be ordered or a patient advised to check ketones

1. Screen for, detect, and monitor DKA
• Beta-hydroxybutyrate is the predominant ketone in severe DKA
• Pts with DM are at higher risk for DKA when pregnant or sick
2. Order when glucose levels remain above 250-300 mg/dL (can be done at home with a urine strip)
3. In pt without DM to detect ketoacidosis dt a non-DM cause such as excessive ingestion of alcohol


What must be monitored when taking metformin long-term



What is the usual reference range for serum potassium

3.5-5.1 mEq/L


What is normal fasting serum glucose

70-99 mg/dL


What is a fasting blood glucose

- no caloric intake in the past 8 hours

*not sure if this is what she wanted but it is the only thing that I could get out of the packet...


Regarding blood glucose, what is considered
- normal
- hyperglycemia
- hypoglycemia

- hypoglycemia <70 mg/dL
- normal 70-99 mg/dL
- hyperglycemia >99 mg/dL


physical activity guidelines for adults for overall cardiovascular health

-At least 30 mins of moderate-intensity aerobic activity at least 5 days/week for a total of 150 min
-At least 25 mins of vigorous aerobic activity at least 3 days/week for a total of 75 mins; or a combo of moderate- and vigorous-intensity aerobic activity
Moderate- to high-intensity muscle-strengthening activity at least 2 days/week for additional health benefits


physical activity guidelines for adults for lowering BP and cholesterol

An average 40 minutes of moderate- to vigorous-intensity aerobic activity 3 or 4 times per week


physical activity guidelines just for older adults

-same as for adults
-If they can't do 150 mins of moderate-intensity aerobic activity a week b/c of chronic conditions, they should be as physically active as their abilities and conditions allow
-they should do exercises that maintain or improve balance if they are at risk of falling
-they should determine their level of effort for physical activity relative to their level of fitness
-they should understand whether and how their conditions affect their ability to do regular physical activity safely


benefits of exercise in children and adolescents

It not only makes them healthier and fit now, but it lowers their risk of chronic diseases and improves their chances of becoming healthy adults.


guidelines for physical activity for adolescents and children (ages 6-17)

-60 minutes or more of physical activity each day, including:
-aerobic activity
-muscle strengthening
-bone strengthening


what type of physical activity should the majority be for adolescents and children?

-aerobic activity
-Most of the 60 or more mins/day should be either moderate- or vigorous-intensity aerobic physical activity (such as running, dancing, or biking), and include vigorous-intensity physical activity at least 3 days a week


muscle strengthening for children/adolescents

As part of the 60 or more minutes of daily physical activity, include muscle-strengthening physical activity (such as climbing trees, using playground equipment, or lifting weights) on at least 3 days of the week


bone-strengthening for children/adolescents

As part of the 60 or more minutes of daily physical activity, include bone-strengthening physical activity (such as running or jumping rope) on at least 3 days of the week


How many minutes of exercise should pt with DM do per week?

at least 150 minutes/week


How much weight loss in addition to 150 min per week is recommended to prevent or delay DM in those at high risk?

5-7% weight loss


What is required to maintain blood glucose within an acceptable range during exercise for patients with type 1 DM

- additional CHO intake
- insulin reduction


If want to start exercise and bg is 90-150 mg/dL, what should pt do (regarding CHO intake)

carbs should be consumed


If want to start exercise and bg is 150-250 mg/dL, what should pt do (regarding CHO intake)

start pumping iron, no additional intake needed


At what bs level should ketones be tested?

bg > 250 mg/dL


At what bg level should exercise be delayed? Why

- if bg >250 mg/dL
- exercise may increase bg level


What are the exercise recommendations for kids with type 1 or type 2 DM?

- 60 min/day or more of moderate or vigorous intensity aerobic activity
- Vigorous, muscle-strengthening, and bone-strengthening activities at least 3 days/week


What is the resistance training recommendation for adults with DM

2-3 sessions/week


what are the four critical times in the management of a person with diabetes when DSME referral should be made?

-At diagnosis
-Annually for assessment of education, nutrition, and emotional needs
-When new complicating factors (health conditions, physical limitations, emotional factors, or basic living needs) arise that influence self-management
-When transitions in care occur


Who is the person central to the management of the person with diabetes?

the patient him/herself


In terms of meal planning, emphasis is on what?

a variety of nutrient dense foods in appropriate portion sizes


Define nutrient dense

Food that is high in nutrients but relatively low in calories. Nutrient-dense foods contain vitamins, minerals, complex carbohydrates, lean protein, and healthy fats


examples of nutrient dense

Examples of nutrient-dense foods include fruits and vegetables, whole grains, low-fat or fat-free milk products, seafood, lean meats, eggs, peas, beans, and nuts


Describe the purpose of using a diabetes plate method

The diabetes plate method is commonly used for providing basic meal planning guidance as it provides a visual guide showing how to control calories (by featuring a smaller plate) and carbohydrates (by limiting them to what fits in one-quarter of the plate) and puts an emphasis on low-carbohydrate (or nonstarchy) vegetable


Identify the daily energy deficit needed for weight loss

Weight loss can be attained with lifestyle programs that achieve a 500–750 kcal/day energy deficit


Identify the total kcal/day for men and women for weight loss

provide ∼1,200–1,500 kcal/day for women and 1,500–1,800 kcal/day for men, adjusted for the individual’s baseline body weight


Identify the percent weight loss needed for optimal impact on glycemic control

For many obese individuals with type 2 diabetes, weight loss >5% is needed to produce beneficial outcomes in glycemic control, lipids, and blood pressure, and sustained weight loss of ≥7% is optimal


Identify the caloric density of carbohydrates, fat, and protein.

-1 gram of carbohydrate = 4 kcal
-1 gm of protein = 4 kcal
-1 gram of fat = 9 kcal


Given a patient’s insulin to carb ratio and the amount of carbohydrates in the meal, determine the units of bolus insulin to be administered

-Initially, the patient may be instructed to administer 1 unit of a bolus insulin for every 15 gm of carbohydrate in the meal

*For example, one cup of cheerios contains 22 gm of carbohydrate, a 3/4 cup of milk contains 9 gm of carbohydrate, 6 oz. of orange juice contains 15 gm of carbohydrate. The total amount of carbohydrate is 46 gm. If a 1:15 insulin:carb ratio is used, then the amount of bolus insulin given before the meal is 3 units.


Identify the recommended daily dietary restriction of saturated fat

Limit saturated fats to <10% of total calories (raises LDL)


identify the recommended daily dietary restriction of sodium for most adults

Healthy eating patterns limit sodium to less than 2,300 mg per day for adults and children ages 14 years and older


identify the guidelines for daily alcohol consumption for men and women

-for women, no more than one drink per day
-for men, no more than two drinks per day is recommended

*(one drink is equal to a 12-oz beer, 5-oz glass of wine, or 1.5-oz distilled spirits)


Be able to be given a food product and the amount of carb, fat and/or protein and . .

determine the calories.


Identify the three macronutrients and their building blocks

-Carbohydrates—glucose and other sugars
-Protein—amino acids
-Fats—free fatty acids


Define monosaccharides

Made up of chains of simple sugars (monosaccharides; one sugar unit)

Examples: glucose, fructose, galactose


Define disaccharides

-Two monosaccharides combined to form a new sugar, a disaccharide:
*Glucose + fructose = sucrose
*Galactose + glucose = Lactose
*Glucose + glucose = maltose


Define polysaccharides or starch

-Made up of more than 10 monosaccharide units
-Starches = polysaccharides (many sugar units of glucose)
-Starches are the way plants store energy
-Common sources are corn, potatoes, rice, green peas, and wheat
-Cellulose and glycogen are polysaccharides

-Storage polysaccharides: glycogen (glucose) and starch (glucose polymer)
-Structural polysaccharides: cellulose (glucose) and chitin (N-acetylglucosamine)


Given a list of foods, identify the ones that are carbohydrates

-Dairy: milk, yogurt, and ice cream
-Fruit: whole fruit and fruit juice
-Grains: bread, rice, crackers, and cereal
-Legumes: beans and other plant-based proteins
-Starchy Vegetables: potatoes and corn
-Sugary Sweets: soda, candy, cookies, and other desserts


Identify the organs that store glucose

-Liver: stored as glycogen
-Muscle: stored as glycogen, used for quick energy needs
-Adipose tissue: unlimited

*Liver and muscle glycogen stores are limited and can be quickly consumed if demand is great.
*Insulin promotes the conversion of glucose into fat.


Identify the purpose of glycogen

-In the presence of Insulin, extra glucose is taken up by the liver and stored as glycogen.
-Muscles can also store glucose as glycogen and use it for quick energy needs.


Identify the relative impact of carbohydrates, protein, and fats on blood glucose over time

Percentage of nutrients changes to blood glucose:
-Carbohydrate: up to 100%
-Protein: 50%
-Fat: < 10%


Given a serving of fruit, starchy vegetable, pasta, bread and fruit juice, identify the amount of carbohydrate in the serving

-1 g carbohydrate = 4 calories, so divide daily calories from carbohydrates by 4 to get the number of grams.

*Example: a person eats 2,000 total calories per day and gets 50% of calories from carbohydrates, calculate that amount as follows:

0.5 x 2000 calories = 1000 calories

1000 ÷ 4 = 250 grams of carbohydrate

250 grams of carbohydrate = 250 gm / 15 gm/ serving = 16 to 17 carb servings /day


Identify the percent of macronutrients in a normal healthy diet

-Carbohydrate: 45- 65% of total calories
-Protein: Intake for an adult should be about 0.8 gm/kg of body weight or about 20% of caloric intake.
-Fats: < 30% of total calories; Limit saturated fats to < 10% of total calories (raises LDL); Increase amount of monounsaturated fats (increases HDL) and polyunsaturated fats


State the effect of insulin on carbohydrates

-in presence of insulin, glucose is taken up by cells for immediate use.
-in the presence of Insulin, extra glucose is taken up by the liver and stored as glycogen.
-Muscles can also store glucose as glycogen and use it for quick energy needs.
-Liver and muscle glycogen stores are limited and can be quickly consumed if demand is great.
-Adipose tissue is unlimited and can store glucose for future use.
-Insulin promotes the conversion of glucose into fat.


State the effect of insulin on proteins

-Amino acids can also stimulate the pancreas to secrete insulin.
-Insulin stimulates the uptake of glucose and amino acids by the muscle cells. It promotes protein synthesis by increasing amino acid transport and stimulating ribosomal protein synthesis.
-Insulin also promotes glycogen synthesis to replace glycogen storage used during muscle activity.
-Insulin accomplishes this by increasing glucose uptake, enhancing glycogen synthase activity, and inhibiting glycogen phosphorylase.
-Muscle stores about 500 to 600 grams of glycogen.
-Muscle lacks the enzyme glucose-6-phosphatase, so it does not contribute to blood glucose.


State the effect of insulin on fats

-Most fats are used for energy or stored for later use with the help of insulin.
-When other fuels are in short supply, such as during a prolonged fast, the level of insulin in the blood falls.
-The reduced level of circulating insulin promotes the removal of fat from the storage depots and helps its entry into the circulation.
-It may then be used by muscle and other organs.
-Insulin stimulates glucose and fatty acid uptake leading to lipogenesis (triglyceride production and storage) and inhibits lipolysis.
-Insulin accomplishes these effects by inducing production of lipoprotein lipase in adipose tissue, increasing glucose uptake to produce alpha-glycerol phosphate, and inhibition of intracellular lipase to decrease lipolysis.