Required Readings - Final Flashcards
(211 cards)
1
Q
What contributes to systemic glucotoxicity?
A
Increased hepatic glucose output, which leads to further complications of chronic disease
2
Q
What contributes to fatty liver disease?
A
Increased glucose and fatty acid uptake (increased conversion to TGs and VLDLs)
3
Q
What does increased pancreatic islet mass followed by exhaustion lead to?
A
Pre-diabetes, followed by overt diabetes
4
Q
In metabolic syndrome, what are some examples abnormal GI activity?
A
- Increased dietary fat and sugar absorption
- Increased gut motility
5
Q
What contributes to increase fat storage and fat tissue hypertrophy in visceral adipose tissues?
A
- Decreased glucose uptake
- Increased lipid uptake
- Increased lipolysis
6
Q
What does increased fat storage and fat tissue hypertrophy in adipose tissue lead to?
A
Systemic low-grade inflammation
7
Q
What leads to systemic lipotoxicity, and will lead to complications of chronic diabetes?
A
Increased lipolysis in visceral adipose tissues
8
Q
How is satiety altered in metabolic syndrome?
A
-Abnormal hedonic and homeostatic response
9
Q
What contributes to abnormal satiety?
A
CCk, Ghrelin, PPY, increase in ECs
10
Q
What contributes to abnormal nutrient sensing?
A
- Increased insulin
- Increased dietary nutrients, CCK
11
Q
(T/F) Both insulin and glucagon increase in MetS
A
T
Insulin (resistance)
Glucagon increases because cells “starved”
12
Q
What does incretin control?
A
GLP-1 and GIP
13
Q
What are the actions of incretin? (4)
A
- Stimulate insulin release-Inhibits glucagon release
- Increases insulin sensitivity
- Effects on gut-motility
14
Q
In MetS, incretin increases/decreases?
A
Decreases
15
Q
Which gut hormone increases?
A
EC
16
Q
Which gut hormone decreases?
A
GLP-1 (under the influence of incretin)
17
Q
Which adipose tissue hormone increases?
A
Leptin, but with resistance
Adiponectin
18
Q
What are the effects of increased leptin resistance?
A
-Decreased satiety and decreased energy expenditure.
19
Q
What are the effects of decreased adiponectin?
A
- Increased gluconeogenesis
- Decreased glucose uptake
- Decreased insulin sensitivity
- Increased body-weight
- Decreased endothelial function
20
Q
What are the abnormal muscle functions in MetS?
A
Decreased glucose uptake while fatty-acid uptake increases
21
Q
Risk factors that should be assessed for T2DM annually?(CP-FHH)
A
- CVD risk factor
- Presence of end-organ damage associated with diabetes
- Family history
- History of GDM/pre-diabetes
- High risk populations
22
Q
No risk factors present in <40 y/o pt or low-moderate risk?
A
No screening, continue to assess risk factors
23
Q
No risk factors, but >40 y/o or high risk?
A
Screen every 3 years
24
Q
Presence of risk factors OR very high risk?
A
Screen every 6-12 months?
25
High risk?
33% of developing T2DM within 10 years
26
Very high risk?
50% of developing T2DM within 10 years
27
How to screen?
FPG or AIC
28
FBG 6.1-6.9?
IFG
29
FBP >/= 7.0?
Diabetes
30
A1C 6.0-6.4 %
Prediabetes
31
A1C >/= 6.5%?
Diabetes
32
Meds for patient with CVD and diabetes?
Statin + ACEi/ARB + ASA
33
Patient with CVD and diabetes started on meds, but NOT at glycemic targets?
Add Liraglutide, Emaglifloinor Canafliglozin (ONLY for T2DM)
34
Patient has NO CVD, but has microvascular disease. What meds?
Statin + ACEi/ARB
35
Patient has NO CVD or microvascular disease BUT >55 with additional CV risk factors. What meds?
Statin + ACEi/ARV
36
When is ONLY a statin prescribed in T2DM for cardiovascular protection?
- Age >/= 40
- Age>/= 30 and diabetes >15 years
- Warranted for statin therapy based on Canadian CVD Lipid guidelines
37
____ should be used as a secondary prevention in cardiovascular disease prevention in diabetics.
ASA
38
How can we keep patients safe when they are at risk of HypoG? (RAPR)
- Recognize
- Act/Treat
- Prevent
- Reduce Driving Risk
39
How can we reduce driving risk?
Educate patients to drive safely with diabetes by:
- Prepare w/ fast acting sugar nearby
- Be ware of BG every 4 hours during long drives
- Stop driving and treat symptoms
- After treating, wait until BG > 5 mmol/L to start driving again
40
Brain function may not be fully restored until ___ after hypoG is resolved
40 mins
41
How can we keep patients safe when they are at risk of dehydration (V/D)?
- Rehydrate appropriately, avoid caffeine (Water, broth, diet drinks, sugar free beverages Ok)
- Hold SADMANS and restart when able to drink/eat normally
42
What are SADMANS meds that should be stopped then resumed when pt can eat/drink normally?
- Sulfonylureas/Secretagogues
- ACEi
- Diuretics
- Metformin
- ARB
- NSAIDs
- SGLT2 inhibitors
43
Discuss consideration for women with T1DM and T2DM who wish to conceive
- A1C <7% --> Aim for <6.5%
- Stop certain meds
- Start folic acid supplementation
- Screen for complications
- Aim for healthy BMI
- Ensure vaccinations have occured
- Refer to diabetes clinic
44
Which meds should be stopped prior to conception?
- Non-insulin antiHG meds EXCEPT for metformin/glyburide
- Sating
- ACEi/ARB
45
What may be used until the detection of pregnancy if nephropathy exists?
ACEi or ARB
46
What meds may need to be begun prior to conception?
- Insulin if target A1C not achieved on metformin/glyburide
| - Other antiHTN agents safe for pregnancy if HTN control needed
47
3 quick questions to help patients to meet their goals?
1) Ask them to rate the IMPORTANCE of their goals (high, medium low)
2) Ask them to rate the CONFIDENCE of achieving their goals
3) Ask to set a SMART goal before next meeting
48
What are some suggestions of goals?
-Eat healthy
-Check feet
-Manage stress
-Be more active
(Practical/simple recommendations)
49
Goal of CANRISK?
To determine risk of having pre-diabetes or T2DM (NOT Type 1)
50
CANRISK age?
For adults aged 40-74 years
51
Key CANRISK questions? (WAGE-H-BPFDE)
```
Waist C
Age
Gender
Ethnicity
HTN
BMI
PA
Family history
Diet (Fruits & Veg)
Education
```
52
CANRISK<21?
Low risk
53
CANRISK 21-32?
Mod risk
54
CANRISK >33 ?
High risk
55
How does MetS contribute a financial and social burden?
MetS is a leading cause of blindness, amputation and kidney failure
56
Main underlying cause of MetS?
Insulin resistance an central obesity
57
How does the IDF based the definition of MetS?
The need for early diagnosis and treatment
58
Official IDF definition of MetS?
Central obesity (WC) plus and two out of four factors
59
What are the 2/4 factors that must be present for Mets?
-Raised TGs
-Reduced HDL
-High BP
-High FBG
OR treatment of any of these abnormalities (i.e. even if they are on medications and normal levels, still considered MetS)
60
Important to consider about central obesity?
WC must be ethnicity specific
61
HIGHEST WC for MetS?
USA (102 cm Men and 88 Women)
62
LOWEST WC for Met S?
South asians, chinese and japanese (90 cm Men and 80 cm women)
63
Examples of additional metabolic measurements for research in MetS?
- abnormal BF distribution
- Pro-inflammatory state
- Prothrombotic state
- Hormonal factors
64
Primary intervention of MetS from IDF?
- Moderate kcal restriction to achieve 5-10% weight-loss in 1st year
- Moderate increase in PA
- Changes in dietary consumption
65
Secondary intervention of MetS from IDF?
Drug therapy (when lifestyle not enough and who are at high risk for CVD)
66
What is the pathogenesis of MetS?
Primary underlying cause is insulin resistance and central obesity
67
Is MetS a valid indicator of CVD?
Not an absolute risk factor, but those with MetS increase risk of major CVD events x2.
68
People with diabetes and Mets S have a much _____ than those with T2DM alone
Higher CVD risk
69
Is the risk of CVD greater in MetS than the sum of its parts?
Studies are contradictory
70
How were the WC for men and women in the US determined?
ATP III (Adult Treatment Panel)
71
(T/F) As a general rule, alcohol should be avoided in diabetes
False
72
What is important prior to drinking alcohol?
That patients diabetes in under control, knowledgeable of preventing low blood sugar ad free from health problems that could where alcohol may aggravate diseases.
73
Mod alcohol women?
<2 SD/day and <10/week
74
Mod alcohol men?
<3 SD/day and <15/week
75
SD beer?
341ml/12 oz
76
SD spirits?
43ml/1.5oz
77
SD wine?
142 ml/5 oz
78
(T/F) in CHO counting,CHO's MUST be counted for within the alcoholic drinks, and insulin should be adjusted
False
79
What may delay hypoG?
When alcohol is consumed with, or 2-3 hours after an evening meal
80
In delayed hypoG, when does it arise?
Next morning, or 24 hours after consumptions
81
(T/F) Only T1DM must be cautious of alcohol, as they must CHO count
False, T2DM who are using insulin or insulin secretagogues
82
Risks of alcohol?
- Increase Bp and TGs
- Damage to liver/nerves
- Inflammation of pancreas
- Dehydrate body --> very dangerous if high blood sugar
83
Recommendations before drinking alcohol?
1) Always have treatment for low BG with you
2) Have someone know your signs and symptoms of hyperG
3) Wear diabetes ID
84
What is the danger of glucagon when alcohol is in the body?
Glucagon will NOT work. Ambulances should be called if a diabetic passes out.
85
Practical recommendation while drinking alcohol?
Eat CHO rich foods
Drink slowly
Avoid coolers, dilute alcoholic drinks with sugar-free beverages
86
Practical recommendation after drinking alcohol?
- Tell responsible person that you have been drinking and have them look for low blood sugar symptoms
- Set alarm for early morning/middle of night to monitor blood glucose
- Do not miss medications
87
(T/F) Diabetics have the same alcohol intake recommendations as healthy individuals
True
88
Delayed low blood sugar can occur anytime up to ___ after consuming alcohol
24 hours
89
When are diabetics at risk for dehydration?
- Vomiting
- Diarrhea
- Fever
- Excessive exposure to heat/humidity without drinking enough
90
Practical recommendations to drink more fluids in deydration or illness?
- Consider electrolyte replacement solutions, clear soups, broth, water, diet soda, watered down apple juice
- Limit caffeine
91
Practical recommendations to avoid risk of hypoG in dehydration or illness??
If usual foods cannot be eaten, try having 1 cup milk, 1/2 cup applesauce, 1/2 cup ice-cream
- each contain 15 g CHO
- Avoid dairy option of vomiting/diarrhea
92
Other recommendations in dehydration or illness?
-Check blood glucose more frequently if on insulin
93
When should certain diabetes meds be temporarily stopped?
If eating less than normal and symptoms>24 hours
94
What medications should be stopped if eating less than 24 hours and dehydrates or at the risk of dehydration?
- BP/Heart Meds (ACE and ARBs)
- All water pills
- Metformin, SGLT2 inhibitors
- Anti-inflammatory drugs, including ibuprofen
95
Examples of symptoms of hypoglycemia (from least -->most severe?)?
-Sweating, hunger, disturbed sleep, vision changes
96
Practical recommendations of fast acting sugar (15-15 rule?
- 15 g of glucose tablets
- 1 TBSP honey
- 2/3 juice
- 6 LifeSavers
97
After 15mins, blood glucose > 4 and meal within the hour?
Good to go
98
After 15 mins, blood glucose > 4 but meal is longer than 1 hour away?
Eat one starch (i.e 7 crackers) and one protein (i.e. 2 TBSP PB)
99
After 15 mins, glucose <4?
Consume 15 g fast-acting glucose
100
value of one starch CHO exchange?
15 g
101
value of one milk/alternatives CHO exchange?
12-15
102
value of fat and protein CHO exchange?
0
103
How many CHOs needed per meal?
45-75 g
104
How many CHOs per snack, if needed?
15-30 g
105
Visual representation of 5 g of sugar?
1 sugar cube
106
Practical recommendations to control blood sugar and weight?
-30 mins of moderate PA most days of the week
-Eat 3 balanced meals each day
Eat meals and snacks at regular hours
-Opt for high fibre foods
-Limit intake of high trans/sat fats, high salt, season with herbs
107
Spacing of meals for diabetics?
4-6 hour interval
108
Spacing of snack for diabetics?
2-3 hours after meals
109
Practical recommendations for diabetics when eating out?
- Mostly cook from home
- Choose ones similar to the balanced plate method
- measure blood sugar more often when eating out
110
How to calculate meal pattern targets?
Start with CHO, then protein, then fat
111
Divide total allowance of CHO g by ____ to determine number of starches
15
112
Subtotal protein g and subtract from total, then divide remaining by ____ to determine number of meat and alternative
-8
113
Subtotal fat g and subtract from total, then divide remaining by ____ to determine number of fats available
-5
114
What increases the risk of breast cancer?
- First period before 12
- Not having children, or having first child after age 30
- Late age at menopause
- FMhx of breast cancer
115
Dietary factors increasing risk of breast cancer?
- Increase body weight
| - Alcohol (even low amounts)
116
(T/F) Lowering fat intake has an effect of breast cancer risk
False
117
Bottom line recommendations on breast cancer
- Regular, intentional PA
- Reduce weight gain, limit kcals
- -Avoid/limit alcohol intake
118
Bottom line recommendations on colorectal cancer
- Increase intensity and amount of PA
- Limit red and processed meats
- Meet calcium and Vit D DRIs
- Eat more F&V
- Avoid obesity, avoid excess alcohol
119
Why does obesity increase risk of endometrial cancer?
Increase in estrogen levels
120
Bottom line recommendations on endometrial cancer?
Stay at a healthy weight, regular PA
121
Best known modifiable risk factors of kidney cancer?
- Obesity
| - Tobacco smoking
122
(T/F) There is clear evidence regarding diet an kidney cancer
False, main recommendations are to stay at healthy weight and avoid tobacco
123
Diet and lung cancer?
-High fruit/veg may reduce lung cancer BUT high doses of vitamin A or b-carotene INCREASE lung cancer amongst smokers
124
Bottomline recommendations on lung cancer
- Avoid tobacco use, second hand smoke
| - Avoid radon exposure
125
___ raised the risk of cancer in the lower esophagus and at the junction between the stomach and esophagus due to ____
Obesity
| Increased acid reflux
126
What kind of beverage may increase risk of mouth and esophagus cancers?
Hot beverages due to damage from heat
127
Bottomline recommendations on lung cancer
- Avoid all forms of tobacco
- Restrict alcohol intake
- Avoid obesity
- Eat at least 2 1/2 cups of veg/day
128
There are no clearly proven nutritional risk factors for _____
Ovarian cancer
| No strong recommendations can be made
129
What increases the risk of pancreatic cancer?q
-Tobacco, T2DM, pre-diabetes
130
Bottomline recommendations on pancreatic cancer
- Stay at healthy weight
| - PA
131
Bottomline recommendations on prostate cancer
- Eat a wide range of V&F each day
- PA
- Healthy weight
- -> Sensible to limit calcium supplement and calcium in diet, but no official recommendations
132
Why has cancer in the cardia (first part of the stomach) risen in the past years?
Increased gastric reflux, which is linked to obesity
133
Bottomline recommendations on stomach cancer
- Eat at least 2 1/2 servings of V/F/day
- Reduce intake of meat, salt and foods preserved with salt
- PA
- Healthy weight
134
ACS guidelines for weight and PA?
- Be as lean and possible throughout life without being underweight
- Avoid excess weight gain at all ages
- If obese or overweight, lose a small amount of weight to begin with
- Get regular PA, limit high kcal foods and drinks
135
Which cancers are clearly linked to body weight? (PECK-BE)
- Pancreas
- Endometrium
- Colon
- Kidney
- Breast
- Esophagus
136
Adults should get ____ mins off moderate intensity or __ minutes of vigorous intensity PA each week, spread out throughout the week
150
| 75
137
Differentiate between usual and intentional activities
- Usual are those done within usual routine
| - Intentional are those that are planned, and are done at leisure or adding more purposeful activity
138
Light intensity activity examples
-housework, shopping, gardening
139
Moderate intensity activities?
Equal effort to a brisk walk
140
Vigorous intensity?
Larger muscle groups, resulting is a faster heart rate, deeper and faster breathing and sweating
141
1 minute of vigorous activity can take the place of ___ of moderate activity
2 mins
142
Can garlic lower cancer risk?
Maybe, however allium compound supplements have little evidence
143
Do GMOs cause cancer?
No evidence indicating that they increase or decrease cancer - however no proof of safety as long-term impacts are unknown
144
Do organic foods lower cancer risk?
No evidence that organic foods are more effective in educing cancer risk or providing other health benefits than similar foods produced by conventional methods
145
Do pesticides and herbicides cause cancer?
No evidence that the residues in low doses cause cancer, however fruits and vegetables should be thoroughly washed
146
Do selenium supplements lower cancer risk? Are supplements recommended?
Maybe in animal studies, but no supplements recommended
147
Does sugar case cancer?
Higher sugar may cause weight-gain, leading to cancer
148
Will eating F and V lower cancer risk?
Yes
149
Bottom line recommendations from ACS?
- Achieve and maintain a HBW throughout life
- Be physically active
- Eat a healthy diet,, with an emphasis on plant foods
- If you drink alcohol limit intake
150
Alcohol for cancer prevention?
<1 drink/day females<2 drinks/day males
151
What is used in nutritional assessment in cancer?
PG-SGA
152
Common nutritional diagnosis with cancer?
- Involuntary weight loss
- Increased energy an protein needs
- Inadequate oral intake
- Malnutrition
- Altered GI function
- Impaired ability to prepare meals
153
What is the most common cause of nausea and vomiting in cancer patients?
Chemotherapy-induced vomiting (CINV)
154
Which cancer treatments are emetogenic?
- Cisplatin
- Methotrexate
- Doxorubicin
- Cyclophosphamide
- Pain medications, such as morphine and fentanyl
155
When should antiemetics be taken?
30-45 minutes prior to a meal, even if they do not feel nauseated
156
(T/F) Nausea is only induced by eating in cancer patients
False, could also be cooking odours
157
Recommended nutrition therapy for emesis?
Eat small, low fat meal the morning of the first treatment and avoid friend, greasy foods, favourite foods several days after the treatment.
158
When may a clear liquid diet be prescribed? What else should be recommended?
- First 24 hr after therapy
| - Electrolyte fortified beverages and non-acidic fruit drinks
159
Why should patients with emesis avoid favourite foods?
If it is vomited up, they are less likely to consume later
160
What else should be avoided in emesis?
Creamy nutritional drinks (ONS) as if they are vomited on, less likely to consume and they will be important later in nutritional therapy
161
What is the primary cause of early satiety?
Delayed gastric emptying
162
Nutrition therapy for pt with early satiety?
Eat small, frequent nutrient dense meals and caloric beverages
163
When should beverages be consumed for pt w/ early satiety?
BETWEEN meals, not w/ meals to avoid adding to satiety
164
What should be avoided in early satiety?
Consumption of raw veg, high fiber foods.
165
What is the action of prokinetics?
Will increase gastric emptying
166
Potential side effects of prokinetics?
Diarrhea
167
What is mucositis?
Irritation of the lining of the epithelial cells of the mucosal membranes within any point of the GI tract , causing pain
168
What is mucositis associated with?
Main source of cancer treatment-related pain, and afflicts 40-70% of patients receiving chemo or radiotherapy -
169
When does mucositis occur?
5-7 days after chemotherapy initiated, and may continue until the patient recovers from immunosuppresion
170
Main nutritional related concerns with mucositis?
SEVERE pain and burning when chewing/swallowing which could inhibit intake of any foods or fluids
171
What can mucositis lead to?
Dehydration, acute weight-loss
172
What does the NCI recommend to supplement with to prevent pain cause by mucositis?
Zinc
173
Mucositis may leave pt more prone to mouth sores - practical recommendations?
- Eat foods cold/room temp
- Choose soft foods/blended
- Drink plenty of liquids
- Suck on ice-chips, popsicles
174
Bottom line nutritional therapy for mucositis?
- Eat only soft, non-fibrous, non-acidic foods.
- Avoid hot foods
- Liquids to prevent dehydration
- Non-acidic juices (nectars)
- High kcal/supplements (ONS - granted not vomiting)
175
What agent is likely to cause diarhea?
Antineoplastic agents
176
Bottom line nutritional therapy of diarrhea?
- Drink small amounts of fluids throughout the day, avoid fruit juice (fructose)
- Clear liquid nutritional beverages
- Increase soluble fiber BUT caution if low appetite
177
Effects of dysgeusia?
Alterations in taste which can have a profound effect on patients ability to ingest an adequate amount of nutrition.
178
What are key suspects of dysgeusia?
-Chemotherapeutic agents, such as cisplatin and radiation to head and neck area
179
What is aguesia?
no taste sensations
180
What does dysgeusia include?
- Heightening of certain foods (especially sweets)
- Aversions to foods liked in the past
- Metallic taste
181
Utensil/containers recommendations for patients with dygeusia?
- Use plastic utensils
| - Consume nutritional supplement in a glass (to avoid metal container)
182
Food often not tolerated in dysgeusia?
Meats (metallic) but concern for not enough protein
183
(T/F) We should recommend meat to pt with dysgeusia to avoid malnutriton
F - should recommend vegetarian sources
184
Recommendation fo patients with ageusia?
Use lots of spices, and highly flavoured foods
185
Issue with heightened sweet taste? Recommendation?
ONS are often too sweet could use non-sweet glucose supplement such as Polycose
186
What is dysphonia?
Difficulty speaking
187
What is dysomia?
Difficulty smelling
188
Xerostomia recommendations?
- Artificial saliva (less recommended)
| - Sugar free gum or candies to increase saliva flow (more recommended)
189
Prevalence of anorexia amongst cancer patients?
50%
190
Nutritional therapy for anorexia?
- Small, frequent meals
- Maximize food intake when appetite is normal
- Limit fluids w/ meals
- Eat favourite food and in pleasant, relaxing environments
- Eat in well ventilated room
- ONS that is appealing
191
Recommendations to increase appetite in anorexia?
- Wine before meals (check w/ physician)
| - Mild exercise (check w/ physician)
192
Pharm to increase appetite in anorexia?
Megestrol acetate and cotriciosteroids
| -Caution with corticosteroid side effects
193
(T/F) EN and PN should be used ROUTINELY adjunct to radiation/chemo
False
194
When should EN PN be used?
When pt is malnourished or anticipated to have low ingestion of food/fluids for long periods of time
195
(T/F) Antioxidant supplementation should not be taken with radiation therapy
True, as they may reduce the efficacy of treatment
196
When is nutrition support before surgery beneficial?
In moderately or severely malnourished patients if administered 7-14 days PO
197
What is prophylactic?
Anticipatory nutrition therapy
198
When may prophylactic nutritional therapy be used?
- 5% weight loss in 1 mo or 10% in 6 mo
- Ongoing dehydration or interruptions with feeding
- Severe aspiration
- High risk of long-term swallowing disorder after therapy
199
_____ enteral formulas may be beneficial in cancer patients undergoing major cancer operations
Immune-enhancing
200
When are alterations in swallowing seen?
Can occur long-after treatment, and especially in radiation
| -requires life-time monitoring
201
Pharmacological doses of ___ may benefit pat undergoing hematopoietic cell transplantation
parenteral glutamine
202
cancer kcal requirements obese?
21-25 kcal/kg
203
cancer kcal requirements non-ambulatory or sedentary adults?
25-30 kcal/kg
204
Cancer kcal requirements for hypermetabolic pt that need to gain weight?
30-35 kcal/kg
205
Cancer kcal requirements for hypermetabolic pt w/ malabsorption?
35 kcal/kg +
206
When are protein needs elevated in cancer?
- Severe diarrhea
| - Malabsortption
207
Normal cancer protein needs
0.8-1.0 g/kg/day
208
Non-stressed cancer pt protein needs?
1.0-1.5 g/kg/day
209
Fluid req cancer?
Calculate w/ same formula, but need to monitor for dehydration
210
Multivitamin supplementation cancer?
<150% of DRI may be beneficial for patient under going chemo/radiotherapy
211
What should be monitored in cancer?
- Weight
- Caloric and protein intakes
- Aspects of the PG-SFA
- Tolerance to diet
