Spotlight A; Nutrition and Diabetes

Question 1

a projected [..] million people in the world will be living with diabetes by the year 2045

Answer 1

629

Question 2

there is a pandemic of type [..] diabetes. its complications are insidious, and it is impacting the worlds youth, including children as young as [..] years of age

Answer 2

2
10

Question 3

diabetes is characterized by the body’s inability to properly regulate blood glucose ([..]) concentrations, a main source of energy

Answer 3

sugar
energy

Question 4

type 1 diabetes occurs when the [..] does not produce of the hormone [..]. required for the blood glucose control

Answer 4

pancreas
insulin

Question 5

type 2 diabetes occurs when specific tissues become [..] to the effects of [..]

Answer 5

resistant
insulin

Question 6

the result of either type of diabetes (1&2) is an [..] of glucose in the blood, causing vascular (blood vessel) [..] that can lead to serious and often fatal complications

Answer 6

overload
damage

Question 7

since 1980 the percentage of individuals with diabetes has more than [..] in the wolds adult population, increasing from 4.7% to 9.6%

Answer 7

doubled

Question 8

about 90% of people with diabetes are estimated to have top[..] diabetes

Answer 8

2

Question 9

[..] is the main driver of type 2 diabetes

Answer 9

obesity

Question 10

[..] predisposition is also a contributes to diabetes, as well as lifestyle choices such as inactivity and an unhealthy diet

Answer 10

genetic

Question 11

diabetes mellitus, more commonly known simply as [..], is a group of disease that affect how the body uses blood [..], and if left untreated they can result in life threatening complications

Answer 11

diabetes
glucose

Question 12

the hormone insulin plays a key role in blood glucose regulation by stimulating [..] and [..] muscle and [..] (fat) tissue to take up glucose from the blood. insulin also […] the release of glucose from the liver to the blood

Answer 12

cardiac, skeletal
adipose
suppresses

Question 13

in diabetes, insulin is [..] or the cells of the body are [..] to its action

Answer 13

lacking
resistant

Question 14

in type 1 diabetes, the pancreatic cells that secrete insulin are [..] by the body’s immune system, leading to a major [..] of insulin that typically progresses until its completely absent. it is an [..] disease.

Answer 14

destroyed
deficiency
autoimmune; the body’s immune system attack or destroy its own cells

Question 15

is type 1 diabetes preventable

Answer 15

no,
its an autoimmune disease

Question 16

when the pancreas becomes unable to [..] insulin, muscle and adipose tissues cannot take up glucose appropriately, and the blood glucose levels skyrocket - a condition known as hyperglycemia. in addition, the lack of insulin allows the liver to release excessive amounts of [..] into blood. when they rise too high, glucose enters [..] faster than the kidneys can transport it [..] into the blood, with the excess glucose “spilling over” into urine to be excreted from the body. this loss of glucose in urine deprives the body of a significant portion of the calories consumed throughout the day .

Answer 16

produce
glucose, urine , back
calories

Question 17

the presence of elevated levels of glucose (type 2 diabetes), in urine also draws additional water into the urine to [..] the concentration of glucose, causing increased urine [..] and rapid rates of water [..].

Answer 17

dilute
volume
loss

Question 18

the word diabetes comes from a Greek word meaning “to siphon, or to pass through”, because of the excessive [..] and fluid [..], whereas the word mellitus is derived from a latin word meaning “sweet” or “honeyed”, an apt description of the high sugar content in the urine of a person with uncontrolled diabetes

Answer 18

urination
fluid

Question 19

in type 1 diabetes, the extremely low level of insulin not only allows [..] glucose production by the liver but also allows for the release of excessive amounts of [..] acids from adipose tissue. the liver converts some [..] acids into substances called ketone bodies that can used as a source of [..] by most cells in the body, including the brain. although ketone body synthesis is a normal process that occurs when insulin is low (such as during a fast), the near (or complete) lack of insulin in type 1 diabetes causes this process to become unregulated and to [..] dramatically.

Answer 19

excessive
fatty x 2, energy
accelerate

Question 20

if diabetes is left untreated (type 1), the ketone bodies build up and reach dangerous levels in the blood, increasing its [..] and causing a condition called ketoacidosis, which can lead to coma and death

Answer 20

acidity

Question 21

some of the increase in type 1 diabetes is due to the [..] population who now live longer, but most of the dramatic rise in type 2 diabetes is due to an increase in the prevalence of [..] and decreased [..] activity in our population - and not just in adults (under 20 years is increasing as well)

Answer 21

aging
obesity, physical

Question 22

type 1 diabetes is typically diagnosed in [..] and [..] adults, and type 2 is most frequently seen in [..]

Answer 22

children, young
adults

Question 23

unlike type 1, in which insulin producing pancreatic cells are destroyed and little or no insulin is made, type 2 diabetes occurs when cells are less [..] to the effects of insulin even if the pancreas is able to produce normal

Answer 23

destroyed
sensitive

Question 24

obesity is by far the most significant risk factor for the type 2 disease: 80-90% of people with type 2 diabetes are overweight or obese. in addition to having excess body fat, physical inactivity is another fact that significantly affects the risk of developing type 2 diabetes

Question 25

type 2 diabetes is higher among African americas, hispanics, and latinos, American Indians, asian Americans, and Pacific Islanders than among caucasians

Question 26

the percentage of individuals in the [..] who have diabetes is even higher than that seen worldwide

Answer 26

US

Question 27

in the US the percentage of individuals under the age of 20 years that have type [..] diabetes is about double that of those with type [..] diabetes, almost 6000 individuals in this age group are diagnosed with type 2 diabetes each year. until recently, type 2 diabetes was considered a disease of the [..] aged and [..]

Answer 27

1, 2 middle , elderly

Question 28

the term epigenetic refers to the heritable chemical changes to genes that do not affect the [..] sequence but do alter gene [..]. these changes are triggered by [..] factors that alter the characteristics of the developing organism. since offspring can be affected by one or more of these environmental factors if either parent was exposed to them before the time of conception or if the mother was exposed to the during pregnancy. the net effect on the offspring can be immediately apparent at birth or in childhood, but it can be delayed, with increased risk of chronic diseases such as diabetes later in adulthood

Answer 28

DNA, function environmental

Question 28

maternal health and nutritional status may influence diabetes risk in the generation.

Answer 28

yes and because type 2 diabetes itself can act as an epigenetic factor, these cause and effect trends can be multigenerational

Question 29

causes; type 2 diabetes begins with the development of insulin [..]. most often this occurs because excess adipose tissue produces hormone like substances that circulate throughout the body and [..] with the signal that insulin sends into cells to stimulate glucose transporters to increase their [..] of glucose from the blood and into cells. as a result, muscle and fat cells respond poorly to insulin and take up glucose from the blood [..]. the body then needs higher levels of insulin to [..] blood glucose concentrations to appropriate levels. specific cells in the pancreas then produce more of the hormone to meet this demand. in some insulin resistant individuals, the pancreas can no longer keep up with the [..] demand for insulin, consequently, the concentration of glucose in the blood increases. insulin resistance also interferes with insulins ability to [..] the liver to stop glucose production, and the livers continued production of glucose also contributes to the increase in blood glucose levels.

Answer 29

resistance, interfere, uptake (absorption), insufficiently (poorly) reduce, increased, signal

Question 30

without intervention and lifestyle changes, many people who have insulin resistance go on to develop type [..] diabetes. however, they may first develop pre diabetes, a condition in which blood glucose moderately elevated above levels that are considered normal or desirable.

Answer 30

2

Question 31

after fasting for eight hours, the normal blood glucose is between [..] mg and [..] mg per 100 ml blood, but the blood glucose levels of someone with pre diabetes would measure [..] mg to [..] mg per 100 ml blood (fasting blood glucose *above* [..] mg would indicate diabetes

Answer 31

70, 100 100, 125 125

Question 32

to confirm the diagnosis of pre diabetes, glucose would be ingested as part of an oral glucose tolerance test (OGTT) and the same person would have elevated blood glucose levels in the 140-199 per 100 ml range - just under the 200 mg/100 ml diagnostic level for diabetes.

Question 33

according to the American diabetes association, an estimated [..]% of Americans older than 18 have pre diabetes and fewer than [..]% have been told they have it. almost half ([..]) of adults aged 65 years or older have pre diabetes, which increases the risk of not only type 2 diabetes but also heart disease, stroke, and other conditions associated with elevated blood glucose levels (lifestyle strategies can normalize blood glucose levels and prevent or delay the onset or the consequence of type 2 diabetes)

Answer 33

34.5%, 16% 46.6%

Question 34

doctors can diagnose pre diabetes and diabetes based on blood glucose concentrations after a patient has fasted for 8 hours or 2 hours after ingesting 75 grams of glucose (this last test is called an oral glucose tolerance test, or OGTT)

Question 35

symptoms of diabetes are constantly feeling [..] (as the kidneys excrete the extra glucose through urine), experiencing [..] vision (as extra glucose enters the eye), and [..] weight (due to low insulin levels and muscle cells relying on burning fat for energy)

Answer 35

thirsty blurred losing

Question 36

over time, high levels of blood glucose can damage [..] and [..], creating long term problems in the [..], [..] vessels, [..], [..], and [..]. the excess glucose causes blood vessel to [..] and lose some of elasticity, making these people more prone to heart attacks and stroke.

Answer 36

cells and organs heart, blood, kidneys, eyes, nerves thicken

Question 37

even today, with the vast improvements in treatment, diabetes is the number one cause of adult [..] and is responsible for more than 60% of lower limb [..] that don't result from trauma

Answer 37

blindness amputations

Question 38

complications of diabetes; - diabetes [..] risk of stroke - those with diabetes are more likely to die of [..] or [..] - diabetes is the leading cause of kidney [..] - diabetes can cause erectile [..] - poorly controlled diabetes during pregnancy increases the risk of [..] for mother and baby - diabetes damages small [..] vessels - impaired [..] and [..] hyperglycemia damages the tiny blood vessels or capillaries that are abundant in tissues such as the retina of the eye - gum [..] and tooth [..] - increases risk of death from heart disease; number one killer of individuals with heart disease - damages nerves through the body, causing [..] and [..] - damages to nerves and blood vessels can cause lack of feeling in the extremities, poor [..] of wounds, and eventual [..]

Answer 38

increases , pneumonia or influenza failure , dysfunction, complications blood , vision and blindness disease and loss , numbness and pain, feeling , healing, amputations

Question 39

the risk of complications is even higher when diabetes develops during [..] and [..]

Answer 39

childhood adolescence`

Question 40

diabetes complications; complications are substantial in both groups but higher in those with type [..] diabetes

Answer 40

2

Question 41

the risk associated with the early onset and longer duration of type 2 diabetes is compounded by the fact that complications, often present at diagnosis, can progress more [..] when the disease occurs in people middle aged and beyond

Answer 41

rapidly

Question 42

early onset type 2 diabetes is a serious life altering event, potentially leading to difficult to manage health complications, drastically impacting not only the quality of life of those in their prime but also their overall life expectancy .

Question 43

researchers estimate that the development of type 2 diabetes in people between the ages of [..] to [..] years imparts a lifetime risk of blindness and reduces their lifespan by [..] years

Answer 43

15 to 24 15

Question 44

pregnant women can develop a form of diabetes known as gestational diabetes. (risk has been increasing steadily)

Question 45

approximately [..]% of expectant mothers will experience high blood glucose levels for the first time during pregnancy and this can affect their pregnancy, increasing the rate of complications or causing the fetus (the baby in the womb) to grow too [..].

Answer 45

18% large

Question 46

[..] women are at higher risk of pregnancy complications, so they are often screened early in their pregnancies . extra [..] can reduce the risk , and high [..] and a low glycemic index diet can help blood glucose at health levels

Answer 46

obese exercise fiber

Question 47

for many women, gestational diabetes goes away once they give birth, but they will remain at a much higher risk of developing type [..] diabetes later in life. as a consequence, increase in the prevalence of gestational diabetes that contributes to the global diabetes pandemic

Answer 47

2

Question 48

gestational diabetes; 1. hormones produced during pregnancy cause some women to develop insulin [..], which in turn causes gestational diabetes 2. causes glucose in the mother blood to increase and cross the [..]. the developing fetus is then exposed to the excess glucose 3. in response to high glucose, the fetus produces excess [..] 4. the extra fuel and high insulin concentrations cause the fetus to grow [..] and accumulate body [..]

Answer 48

resistance placenta insulin larger, fat

Question 49

gestational diabetes risk factors; - [..] prior to pregnancy - older than [..] years - [..] - family history of type [..] diabetes - non [..] race

Answer 49

obese 25 pre diabetic 2 white

Question 50

gestational diabetes consequences for the mother: - higher incidence of [..] section - high blood [..] during pregnancy - increased risk of develop [..] in 10-20 years for the baby; - risk of [..] injury during birth - higher risk of [..] problems - increased risk of becoming an [..] child - increased risk of developing [..] as an adult

Answer 50

cesarean, pressure, diabetes shoulder, breathing, obese, diabetes

Question 51

people with type 1 diabetes must receive injections of [..] to manage their blood glucose levels. the person must give themselves injections several times per day or wears a medical device known as an insulin pump

Answer 51

insulininsulin

Question 52

most insulin pumps are programmed manually to [..] deliver fixed amounts of insulin throughout the day, and they can be instructed to deliver [..] insulin following a meal or snack.

Answer 52

automatically additional

Question 53

the FDA recently approved the first artificial pancreas device system, this system includes a glucose sensor that is inserted through the skin and continuously monitors blood glucose levels . glucose values are sent wirelessly to the insulin pump that can then automatically adjust the insulin dose to maintain appropriate blood glucose levels.

Question 54

regular monitoring of blood glucose levels with a glucose meter gives a person with type 1 diabetes a way to track the [..] of his or her food choices and activity level so that he or she can adjust insulin [..] accordingly to maintain desirable blood glucose level. although they must monitor their blood glucose levels, persons with type 2 diabetes generally do not require insulin injections , and their diabetes can often be [..] (or even prevented or reserved) by lifestyle modifications (including diet and physical activity) that [..] insulin resistance and promote a health body weight

Answer 54

impact injections managed, reduce

Question 55

Different foods have different effects on blood glucose, even when those foods contain the [..] amount of starch and sugars. Specifically, how the body processes particular carbohydrates dictates how much and at what rate glucose will be released into the bloodstream and, therefore, how much insulin is released.

Answer 55

same e.g. the complex carbohydrates or starches in foods can be partially "trapped" within the physical structure of grains or in the interlay portion of larger food particles. these physical structures can make it difficult for digestive enzymes to gain access to the starch, slowing digestion and the subsequent appearance of glucose in blood. such, which remain undigested when they enter the large intestine, are called resistant starches

Question 56

diets high in resistant starch may [..] insulin sensitivity and make people feel [..] for longer periods. e.g. foods high in resistant starches include beans, underripe bananas, whole grain kernels, and pasta starches in some foods, boiled potatoes and many breakfast cereals - are digested so quickly that blood glucose rises nearly as rapidly as what is seen after consuming an equal amount of pure glucose

Answer 56

improve full

Question 57

Surprisingly, sucrose, fructose, and lactose and foods that contain these sugars (such as candies, fruit, and dairy foods) often produce a [..] dramatic rise in blood glucose than do starchy foods. This is because fructose and galactose (a monosaccharide in lactose) have no [..] impact on blood glucose levels until they are converted to glucose in the liver.

Answer 57

less immediate

Question 58

Diets high in fiber, especially [..] fiber, also seem to help control blood glucose levels. One study found that people who consumed [..] grams of fiber per day with at least half as soluble fiber were able to control their blood glucose better than those who ate less fiber

Answer 58

soluble 50

Question 59

Because food sources of carbohydrates have [..] effects on blood glucose levels, blood glucose control may be improved when people pay attention to a measure known as the glycemic index (GI) that ranks foods by how quickly and to what degree they raise blood glucose levels. The amount of available [..] (starch and sugars) present in the food is compared with the equivalent amount of [..], which has a GI of 100. Foods with a [..] GI raise blood glucose quickly and cause considerable spikes in blood glucose levels, whereas foods with a [..] GI cause a smaller and more gradual increase. Low GI diets may help individuals with diabetes better control blood glucose levels, and for those who don’t have the disease, a low GI diet reduces the risk of developing type 2 diabetes.

Answer 59

different carbohydrate, glucose high, low

Question 60

Although glycemic index can be a helpful measure to consider, it has some limitations. Most significantly, there is wide variation among individuals in the measured glycemic [..] to the same foods. In addition, we rarely eat carbohydrate-containing foods in consistently the [..] amounts (smaller or larger amounts would alter the GI) or eat these foods by themselves. And even carbs with high GIs have less effect on blood glucose when consumed as part of a meal or snack with protein, fat, or fiber, which all delay gastric emptying. Even factors such as the [..] of a fruit or how a carbohydrate is processed can alter its GI.

Answer 60

response same ripeness

Question 61

The GI of a food often does not reflect the amount of [..] contained in the servings of food that we typically consume. Foods with a low to moderate GI can still cause a dramatic [..] in blood glucose levels if consumed in large amounts.

Answer 61

carbohydrates rise

Question 62

consumers can also consult the glycemic load (GL), which calculates the effect of the actual serving size of food on blood glucose (by multiplying the GI by a food’s grams of carbohydrates, divided by 100). The GL, therefore, is a more useful assessment than the GI of a food’s effect on blood glucose

Answer 62

more useful than the GI

Question 63

Some research suggests that diets emphasizing [..]-GI and [..]-GL foods in the overall diet may help manage diabetes, control body weight, and improve other health conditions. In addition, low-GI foods are often rich in [..] and other nutrients, which have clear benefits for health.

Answer 63

low low fiber

Question 64

carbohydrate counting , or "carb counting", is a meal planning technique that can help manage blood glucose levels. If part of the person’s diabetes management is to keep blood glucose levels in a desirable range, they can determine the total amount of carbohydrates (in grams) to include each day according to their energy needs and activity level.

Answer 64

yes

Question 65

those with diabetes must keep track of their [..] intake, limiting saturated fat to less than [..]% of their total calories and eating as little [..] fat as possible

Answer 65

fat 7% trans

Question 66

some fats are heart healthy, though, and doctors will often tell people with diabetes to eat two or more weekly servings of [..], which provide [..] polyunsaturated fatty acids

Answer 66

fish omega 3

Question 67

physical activity also helps improve insulin [..], lower blood glucose levels, and keep weight [..] over the long term. exercise alone may not be enough, but exercise in addition to weight control and a varied and balanced diet provide the foundation for managing and preventing type [..] diabetes. when those lifestyle changes aren't enough, [..] medications are available to lower blood glucose levels of individuals with type of 2 diabetes, and some people may require insulin [..] to get their glucose under control

Answer 67

sensitivity, lower, off 2, oral , injections

Question 68

it is possible to overmedicate patients with diabetes

Answer 68

true

Question 69

when the overmedication occurs, the patient can develop hypoglycemia, in which their blood glucose levels drop too low

Answer 69

yes

Question 70

hypoglycemia is diagnosed at [..] 70 mg/100 ml blood , causing symptoms ranging from irritability, headache, hunger, weakness or fatigue, sweating, and rapid heartbeat

Answer 70

<

Question 71

There are different types of hypoglycemia— fasting hypoglycemia, for instance, occurs when people have not [..], have drunk too much [..], or have underlying [..] conditions or [..] (for example, pancreatic tumors).

Answer 71

eaten, alcohol, hormonal , tumors

Question 72

People with reactive hypoglycemia, in contrast, experience symptoms when they eat [..] amounts of carbohydrates, causing a huge [..] of insulin and rapid [..] in blood glucose. in response, the [..] glands release epinephrine—also known as adrenaline—which, like glucagon, functions to [..] blood glucose by stimulating glucose synthesis in the liver.

Answer 72

large release drop, adrenal, raise

Question 73

The best way to manage or prevent reactive hypoglycemia is not to eat too many carb-heavy meals or snacks; include some [..] along with [..]; and emphasize foods that contain fiber, particularly [..] fiber.

Answer 73

protein along with carbohydrates soluble

Question 74

We need “community programs, emphasizing early diagnosis, healthy lifestyle, more attention to maternal and child health, and better urban planning to provide opportunity for walking, jogging, and other outdoor activities.”

Question 75

to end the type 2 diabetes global pandemic, what is needed most is education. will understand how they can prevent themselves from developing type 2 diabetes and what may happen if they do not

Answer 75

yes