Diabetes – Medical Nutrition Therapy – Flashcards

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Diabetes
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Metabolic disorder characterized by High Blood Glucose levels and disordered insulin metabolism.
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Absence of insulin, insufficient insulin, resistance to insulin
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3 Characteristics of Diabetes
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Insulin
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pancreatic hormone that unlocks the cell door that lets the sugar inside, where it is burned for energy
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Builds up in the blood
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Happens to glucose without insulin
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Type 1 (juvenile onset / IDDM)
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Type of diabetes that usually begins in childhood / early adolescence. 5-10% of diabetics. It is Genetic and Autoimmune. It usually requires insulin and frequent blood glucose monitoring.
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Type 2 (adult onset / NIDDM)
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Type of Diabetes that is insulin resistant or insulin deficient. It is frequently seen in overweight individuals. 90-95% of diabetics. Sometimes doesn't require insulin just medication. Risks: Obesity, age, physical inactivity, genetics. It can go undiagnosed and can damaged vital organs.
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Polyuria
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sign of diabetes, frequently urinating
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Polydipsia
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sign of diabetes, feeling of thirst
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Ketoacidosis
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acidosis due to excessive production of ketone bodies. Inadequate CHO metabolism shifts to fat and protein.
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Ketosis
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alteration of acid based balance.
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Insulin resistance
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form of type 2 diabetes, cells no longer respond to insulin
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Hyperinsulinemia
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Form of type 2 diabetes where pancreas responds with increased insulin
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insulin resistance and insulin deficiency
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form of type 2 diabetes where pancreas exhausts causes impaired insulin
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Polyphagia
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Signs of diabetes, too much hunger
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Family History (genetic), Autoimmune, Environmental, Age >45, Overweight, women w/ birth >9lbs, Hypertension, Hyperlipidemia
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Factors Affecting Risk in having Diabetes
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African American, Latino, Native American, Asian America, Pacific Islander
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High Risk Ethnic Groups in developing diabetes
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Type 1, Type 2, Prediabetes, Gestational
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Types of diabetes Mellitus
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Autoimmune (immune system destroys beta calls of pancreas) Idiopathic
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Types of Type 1
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Polyuria Polydipsia weight loss fatigue weakness ketoacidosis
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Signs and symptoms of Type 1
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Insulin and Glucose Monitoring
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Ways to control Type 1
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Diet Medicine Exercise insulin
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Ways to control type 2
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Obesity Age genetics Physical Inactivity
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Risks factors in type 2
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Type 2 Diabetes in Children
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Both parents are diabetic, sedentary lifestyle, childhood obesity, often asymptomatic and needs to routinely screen for high risk.
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Placenta
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It makes the pregnant woman cells insulin resistan
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Macrosomia
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term for newborn with an excessive birthweight, causes by extra glucose transfer to baby
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Several small meals per day (6 meals) Moderate CHO (40% of Kcal) Avoid juice and added sugar Blood Glucose much stricter
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Nutrition plan for GDM
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Renal Threshold
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Symptoms of diabetes where blood glucose is >200mg/dl, glycosuria and edema
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Renal Threshold Polyuria polydipsia polyphagia blurred vission infections fatigue weight loss
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Symptoms of diabetes
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1. Infections 2. fatigue 3. weight loss
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1.symptoms of diabetes resulted to poor blood circulation 2. symptoms of diabetes resulted to altered metabolism of sugar 3. symptoms of diabetes resulted to losing sugar in urine, cell starving
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Blood Glucose Level (Primary) Oral Glucose Tolerance Test Glycated Hemoglobin
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Ways of Diagnosing Diabetes
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1. 126 or higher 2. >200 mg/dl 3. >200 4. 6.5% or higher
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Diagnosis: Diabetes 1. Fasting plasma glucose level: 2. Random PG level: 3. Oral Glucose Tolerance test 4. Glycated Hemoglobin (Hgb AIC)
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1. 100-125 mg/dl 2. 140-199 mg/dl 3. 5.7 - 6.4 %
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Diagnosis: Prediabetes 1. Fasting PG level 2. Random 2hr PG 3. AIC
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1. <100 mg/dl 2. 140 mg/dl
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Normal Blood glucose level 1. fasting 2. random
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Prediabetes
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Type of diabetes where levels of BG are between normal and diabetes. Confirmed by repeat testing (multiple testing in 3 months). High risk of developing diabetes. Lifestyle changes are imperative.
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DKA - Diabetic KetoAcidosis hyperosmolar hyperglycemic syndrome Hypoglycemia
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Acute Complication of diabetes
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DKA - Diabetic Ketoacidosis
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acute complication of DM which is a severe lack of insulin, develops quickly. Ketosis, acidosis, hyperglycemia
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rehydrate insulin electrolyte balance
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Treatments for DKA
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hyperosmolar hyperglycemic syndrome
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acute complication of DM that is severe hyperglycemia and dehydration in absence of ketosis. Develops slowly. Occur in older adults and can result to coma and seizure
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Hydration and insulin drip
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Treatment for hyperosmolar hyperglycemic syndrome
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Damages the cells and tissues
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What damages prolonged hyperglycemia?
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Macrovascular: Large Blood Vessel Microvascular: Small Blood Vessel Neuropathy: Nervous system
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Chronic Complications of DM
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PVD (peripheral vascular disease)
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Macrovascular Chronic Complication of DM due to Poor circulation of blood causes ulcers, gangrene and amputation. Mass of body tissue dies due to reduced blood supply)
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Atherosclerosis
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it is a macrovascular Chronic Complication of DM that is the leading cause of death in people with DM characterized by thickening of artery wall as a result of the accumulation of fatty materials such as cholesterol and triglycerides.
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Retinopathy
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A microvascular chronic complication of DM characterized by impaired capillaries to retina
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Nephropathy
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A microvascular chronic complication that result to kidney failure due to too much work of the kidney for filtering the sugar in the blood. Treatment: Dialysis or Transplant
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Neuropathy
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Chronic complication of DM that causes the nerve ending in nervous system is not working due to high blood glucose can injure the walls of tiny blood vessels that nourish the nerves. Contribute to ulcers (wounds) due to loss of feeling.
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gastroparesis
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A neuropathy complication of DM that reduces the ability of stomach to empty its content caused by disruption of nerve signals to stomach
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Healthy Eating Exercise / physical activity medicines
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Management of Diabetes
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Maintain Blood Sugar in ideal range Prevent and treat chronic complications (50-75% reduced in complication) Healthy Blood glucose, Blood Lipids, Blood Pressure and Healthy Weight
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Goal of MNT for Diabetes
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Bariatric Surgery (gastric bypass surgery)
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Surgery treatment in DM where the stomach is reduced in size.
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Blood Glucose Monitoring
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Primary responsibility in treating DM. Done 3x a day in type 1 and varies in type 2. Allows for adjustment in Meds, Meals and Activity.
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Carbohydrate
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Major nutrient that affect Blood sugar
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Fiber Protein Fat Alcohol Micronutrients (same as healthy person)
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Focus intake of these on DM
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Fiber
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a cho that promotes sateity, delayed gastric emptying and cholesterol lowering
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20-35% Normalize lipid profile
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Goal in fat intake in DM
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20-35% not much protein because of kidney function (little impact on glycemic levels)
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Goal on Protein intake in DM
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Women - 1 drink/day Men - 2 drinks/days
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Goal on Alcohol intake in DM
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12 oz beer 5 oz wine 1.5 oz distilled spirits 15 g of alcohol
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one drink =
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Alcohol
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too much of this can interfere with liver production of glucose thus causes hypoglycemia. Does not require insulin.
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Exchange Lists
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sorting of food according proportions of CHO, FAT, PROTEIN so that each item in a group has similar macro nutrient and energy content
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carbohydrate counting
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a method of meal planning for people with diabetes based on counting the number of grams of carbohydrate in food. Emphasize control on carb intake and portion.
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flexibility and variety measuring and counting
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Pros of Carb counting cons of carb counting
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Step1 determine nutrient and energy needs (carb allowance) Step 2 divide into meal and snack pattern
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Steps in carb Counting
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15 g 12 g 5 g
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1 CHO, 1 fruit = 1 milk = 1 vegetable =
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Hypoglycemia
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abnormally low concentration of blood glucose in diabetes.
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70 mg/dl
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Hypoglycemia is treated at what glucose level
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Excessive insulin or oral meds prolonged exercises skipped meals/ delayed intake of meals alcohol intake w/o food
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Causes of Hypoglycemia (inappropriate Mngt)
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Adjust the diet
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what to do when you exercise for long when DM
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Headache Dizziness sweating Irritability shaking weakness Hunger pains Confusion (big thing)
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symptoms of hypoglycemia
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Acute Hypoglycemia chronic hypoglycemia
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types of hypoglycemia
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gastric surgery may cause exagerated insulin reactions serious medical disorders increased insulin sensitivity with weight loss prolonged weight loss
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Causes of Acute Hypoglycemia
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Treat Blood glucose <70mg/dl eat a rapid acting source of glucose avoid high fat food follow the 15 rule
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Treatment of Acute hypoglycemia
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eat 15 g CHO, check blood glucose in 15 min later
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what is 15 rule?
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pancreatic tumors - produces too much insulin endocrine disorders
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causes of chronic Fasting hypoglycemia
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Post Prandial hypoglycemia
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Hypoglycemia 4 hrs afer eating high CHO meal in non diabetes diagnosed with glucose tolerance test GI surgeries can be a cause
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Tumor removal from pancreas medication therapy nutrition therapy
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Treatment of Chronic Hypoglycemia
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