Diabetes Management Quiz

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Questions and Answers

Which type of neuropathy affects the nerves of the hands and feet?

Peripheral neuropathy (correct)

Autonomic neuropathy

Sensory neuropathy

Central neuropathy

What is the primary concern regarding the consumption of sucrose in individuals with diabetes?

It directly affects blood glucose levels.

It can be completely eliminated from the diet.

It is more beneficial than fructose.

It may increase calorie intake and reduce healthy food intake. (correct)

What is the recommended percentage of total caloric intake for protein in well-controlled diabetes?

5% to 10%

20% to 25%

15% to 20% (correct)

30% to 35%

Which of the following types of fatty acids should be minimized or eliminated in the diets of people with diabetes?

Trans fatty acids Signup and view all the answers

Which complication is categorized under microvascular issues associated with diabetes?

Retinopathy Signup and view all the answers

What is a primary characteristic of diabetes mellitus?

High blood glucose concentrations Signup and view all the answers

What percentage of the US population was diagnosed with diabetes in 2020?

10% Signup and view all the answers

Which of the following conditions can be indicative of a higher risk for developing diabetes?

Having a first-degree relative with diabetes Signup and view all the answers

What diagnostic criteria can confirm diabetes mellitus?

Symptoms + casual glucose > 200 mg/dl Signup and view all the answers

What is a common result of high blood glucose levels over time?

Increased risk of damage to organs Signup and view all the answers

What condition is often found in individuals with type 2 diabetes?

Overproduction of insulin Signup and view all the answers

What is the estimated direct and indirect cost of diabetes in the U.S. as reported in 2017?

$327 billion Signup and view all the answers

Which of the following is NOT a criterion for diagnosing diabetes mellitus?

FPG < 110 mg/dl Signup and view all the answers

What is the calorie content of a serving of whole milk?

150 Signup and view all the answers

What type of food group has the lowest calorie count according to the data?

Vegetables Signup and view all the answers

How much protein is found in a serving of skim or 1% milk?

8 grams Signup and view all the answers

Which type of carbohydrate group has the highest calorie count?

Starch Signup and view all the answers

What is the carbohydrate content in a serving of fruit?

15 grams Signup and view all the answers

Which meat category has a higher fat content per serving?

High fat meat Signup and view all the answers

What is the total calorie count for a serving of a typical starch?

80 Signup and view all the answers

What is the protein content range for high fat meat?

7 grams Signup and view all the answers

What is the primary purpose of carbohydrate counting?

To provide flexibility in food choices Signup and view all the answers

For a meal plan totaling 2400 calories, how many grams of fat are allocated?

67 g Signup and view all the answers

Which of the following is a macronutrient percent breakdown for a meal plan that totals 2000 kcal?

50% CHO, 20% Pro, 30% Fat Signup and view all the answers

Which guideline is followed when creating a meal plan using Exchanges?

Balancing macronutrient distribution Signup and view all the answers

What is the total daily carbohydrate allowance in grams for a meal plan totaling 2400 calories with 50% carbohydrates?

600 g Signup and view all the answers

What role does fat play in glucose control according to the principles of carbohydrate counting?

Fat contributes minimally to glucose levels Signup and view all the answers

To achieve 2000 calories using a macronutrient breakdown of 50% CHO, what would the daily calorie intake from carbohydrates be?

1000 kcal Signup and view all the answers

What is the primary focus of CHO Counting Level 1?

Consistently consuming carbohydrates at meals and snacks Signup and view all the answers

Which exchange group is used to provide a source of protein in the sample meal plan?

Meat group Signup and view all the answers

Which skill is NOT required for CHO Counting Level 2?

Cooking techniques Signup and view all the answers

What is the main prerequisite for progressing to CHO Counting Level 3?

Mastery of Level 1 and 2 Signup and view all the answers

What does the insulin to carbohydrate (I:C) ratio depend on?

Matching fast-acting carbohydrates to fast-acting insulin Signup and view all the answers

Which of the following methods is NOT used in CHO Counting Level 3?

Using body mass index (BMI) Signup and view all the answers

What common side effect is associated with the medication Metformin?

Nausea and diarrhea Signup and view all the answers

Which class of medication is primarily responsible for increasing insulin secretion from the pancreas?

Sulfonylureas Signup and view all the answers

Which medication is used as an insulin sensitizer?

Pioglitazone Signup and view all the answers

Which side effect is particularly associated with DPP-4 inhibitors?

Nausea and vomiting Signup and view all the answers

How do SGLT2 inhibitors work to lower blood glucose levels?

By decreasing glucose reabsorption in the kidney Signup and view all the answers

What is one of the primary actions of Liraglutide in managing Type 2 Diabetes Mellitus?

Enhance insulin production Signup and view all the answers

Which of the following is a potential side effect of using Amylin (Pramlintide)?

Nausea Signup and view all the answers

What hormone does Dulaglutide mimic to aid in glucose regulation?

GLP-1 Signup and view all the answers

What is a recommended carbohydrate addition for an individual exercising when using insulin?

15 g for every 30 to 60 minutes Signup and view all the answers

Which of the following increases the risk of hypoglycemia for individuals on insulin?

Regular insulin secretagogues Signup and view all the answers

What should be monitored frequently before, during, and after exercise for individuals using insulin?

Blood glucose levels Signup and view all the answers

What is one of the main benefits associated with exercise for individuals with diabetes?

Improves glucose levels for approximately 48 hours Signup and view all the answers

What is a common consequence of hyperglycemia during exercise?

Increased counterregulatory hormones Signup and view all the answers

Study Notes

MNT for Diabetes

MNT is the process of managing diabetes through nutrition.
The American Diabetes Association (ADA) provides guidelines for diabetes management.
The presentation, titled "MNT for Diabetes," is part of FNES 366.

Overview

Background includes definitions, pathophysiology, and medical diagnosis.
Complications covered are acute and chronic.
Management encompasses nutrition, medications, exercise, monitoring, and education.
The Nutrition Care Process is also discussed.

Background

Diabetes is defined as a metabolic disease characterized by high blood glucose concentrations.
High BG leads to damage to various organs, such as the eyes, kidneys, nerves, heart, and blood vessels.
Prevalence of diabetes in the USA in 2020: 34 million people (10% of the population).
Prevalence of prediabetes in the USA in 2020: 88 million people (35% of the population).
Direct and indirect costs of diabetes in 2017 were $327 billion.
Prevalence of diagnosed diabetes among US adults in 2015 shows varying rates across different states, with data gaps in some.
Prevalence of obesity and diabetes among US adults increased over time.

Pathophysiology

Diabetes involves abnormal metabolism of carbohydrates, proteins, and fats.
This abnormality leads to hyperglycemia.
The body may not produce enough insulin or may not respond properly to it.
Classic symptoms of hyperglycemia are the 3 Ps: polyuria, polydipsia, and polyphagia.

Factors Contributing to High Blood Glucose

Unhealthy lifestyle, including excess calories and physical inactivity, contributes to high blood glucose.
Genetic predisposition plays a role in the development of diabetes.
Visceral obesity is a significant risk factor.
Insulin secretion and sensitivity, as well as kidney glucose reabsorption, affect blood glucose.

Insulin and Amylin

Insulin is an anti-catabolic and anabolic hormone, produced by beta cells of the pancreas.
It helps use and store body fuels, lowering blood glucose by facilitating glucose transport into cells.
Amylin is co-secreted with insulin; it suppresses glucagon secretion.

Counterregulatory Hormones

These hormones—glucagon, growth hormone, cortisol, epinephrine, and norepinephrine—oppose the effects of insulin, increasing blood glucose.

Normal Glucose

Normal blood glucose levels are 70-100 mg/dL.
Pre-prandial blood glucose goal: 80-130 mg/dL.
1-2-hour postprandial glucose goal: <180 mg/dL.
Hemoglobin A1c goal: <7.0%.

Categories of Glucose Intolerance

Type 1 (T1DM)
Type 2 (T2DM)
Gestational diabetes (GDM)
Prediabetes (IFG and IGT)
Other types
Other types from surgery, drugs, or malnutrition.

Type 1 and Type 2 Diabetes

Type 1 diabetes: No insulin produced, requiring insulin for survival. Includes genetic, autoimmune, idiopathic causes and a honeymoon phase.
Type 2 diabetes: Insulin action or secretion decrease, but insulin levels can be normal. ~90–95% of diabetes cases.

Type 2 Diabetes Defects

Abnormal insulin secretion by the beta cells.
Reduced insulin uptake by cells' insulin receptors.
Increased release of glucose by the liver, especially in the AM.
Increased glucagon secretion.

Who Should Be Screened for T2DM

People over 45 years, and younger individuals with certain risk factors.

Diagnosis of DM

Two of the criteria below confirm diabetes:
Symptoms + casual glucose >200 mg/dL;
Fasting plasma glucose (FPG) >126 mg/dL;
2-hour postprandial glucose (2h PG) >200 mg/dL after a 75 g glucose load (oral glucose tolerance test - OGTT);
Hemoglobin A1c (A1c) ≥6.5%

Prediabetes

Impaired fasting glucose (IFG): FPG 100 mg/dL – 125 mg/dL.
Impaired glucose tolerance (IGT): 2-hr plasma glucose 140 mg/dL–199 mg/dL.
Hemoglobin A1c (A1c): 5.7%–6.4%. Prediabetes is a risk factor for future type 2 diabetes and cardiovascular disease (CVD).

Gestational Diabetes (GDM)

Glucose intolerance during pregnancy affects about 7% of pregnant women.
GDM often leads to type 2 diabetes later in life.
Screening occurs between week 24 and 28 of pregnancy and in high-risk women during the first visit.
Diabetes diagnosis criteria of GDM are 50 g glucose 1 hr test >140 ; then 3-hour 100 g OGTT with diagnosis if 2-hour >140. OGTT is conducted by taking a fasting glucose, then administering 75 g glucose load and diagnosing GDM if any values are greater than or equal to the following: Fasting: 92 , 1 hr: 180, 2 hr: 153.
After delivery, 5–10% of women with GDM may have persistent type 2 diabetes and 35–60% may develop type 2 diabetes in 5–10 years.

Metabolic Syndrome

Grouping of risk factors associated with insulin resistance and an increased risk for CVD.
Three of five criteria are needed to diagnose metabolic syndrome.
Abdominal obesity (waist circumference).
Triglycerides >150 mg/dL or on medication.
HDL <40 mg/dL (in men) or <50 mg/dL (in women) or on medication.
Blood pressure (BP) ≥130/85 or on medication.
Fasting glucose ≥100 mg/dL or on medication.

Complications: Acute

Hyperglycemia (BG > 250 mg/dL):
Diabetic Ketoacidosis (DKA).
Hyperglycemic Hyperosmolar State (HHS).
Somogyi Effect.
Dawn Phenomenon.
Hypoglycemia (BG < 70 mg/dL)

Complications: Chronic

Neuropathy (peripheral and autonomic).
Microvascular complications (retinopathy and nephropathy).
Macrovascular complications (CHD, cerebrovascular disease, and PVD).

Treatment Goals

Hemoglobin A1c <7%.
Glucose levels (pre-prandial 80-130 mg/dL and post-prandial <180 mg/dL).

Energy Requirements for Youth

Base energy requirements on food and nutrition assessment.
Validate energy needs, referring to DRIs.
Use Krause Table 17-2 and 17-3.

Management

Nutrition, medications, exercise, monitoring, and patient education are key elements of diabetes management.

Nutrition

Current guidelines from the AND and ADA are used.

Goals of MNT for Diabetes

Near normal blood glucose levels.
Optimal serum lipid levels.
Achieving adequate calories for specific needs (e.g., growth, pregnancy).
Recovery from catabolic illnesses.
Prevention and treatment of diabetes complications.
Overall health and wellness.

MNT for Type 1 Diabetes

Integrate insulin regimen into daily routines (food, exercise).
Use multiple injections (3+ per day) or insulin pumps.
Half insulin for basal; half for before meals.
Regulate total energy and carbohydrate intake to avoid weight gain.

MNT for Type 2 Diabetes

Lifestyle interventions to improve blood glucose, lipids, and blood pressure.
Consider medications as added interventions.
Improve food choices and physical activity to promote weight control.
Teach meal planning techniques, focusing on carbohydrate sources, serving sizes, and limiting fats.
Individualize macronutrient distribution based on the patient's needs.
Monitor blood sugar levels frequently (SMBG).

Weight Management

Make long-term adjustments to eating and lifestyle habits.
Consume food regularly and incorporate regular physical activity.
Gradual weight loss is preferable.
Lower-fat foods are often recommended.
Low-carbohydrate diets are discouraged.
Carbohydrate intake is more important than type.
Variable glycemic effects exist among different foods.
Carbohydrate counting is recommended (15 g carbohydrate = 1 CHO serving).
Use of exchange lists is a common method.

Fiber

Recommended daily fiber intake is 25-38 g.
Diverse sources of fiber-rich foods are desired.

Sweeteners

Sucrose should be replaced by other carbohydrates or covered by insulin/glucose-lowering meds.
Fructose doesn't offer an advantage over sucrose.
Reduced-calorie sweeteners (some alcohols) and non-nutritive sweeteners are used/discussed (e.g., saccharin, aspartame, etc.).
Consider the Acceptable Daily Intake (ADI) and Generally Recognized as Safe (GRAS) status of different sweeteners.

Protein

Protein does not significantly affect blood glucose levels in well-controlled diabetes.
Usual protein intake (15–20% of kcals) is recommended.

Dietary Fat

Maintain fat intake similar to the general population.
Total fat: 25–35% of total calories.
Reduce saturated fats and increase polyunsaturated fatty acids (PUFAs), monounsaturated fatty acids (MUFAs), and omega-3 fatty acids.
Minimize or eliminate trans fats.
Consider adding plant sterols/stanols to inhibit cholesterol absorption.

Alcohol

Avoid alcohol if a history of abuse, pregnancy, or medical issues are present.
Moderate alcohol consumption with meals is typically manageable.
Frequent alcohol consumption (>3 drinks/day) can increase blood glucose.
Alcohol can potentially lead to hypoglycemia in individuals taking insulin or insulin secretagogues.

Micronutrients

No strong evidence supporting the use of supplements for diabetes management.
Some preliminary research suggests chromium might be beneficial in high-risk subgroups, but interactions with medications need to be carefully observed.

Tools for Nutrition Intervention

Plate method.
Exchange lists.
CHO counting.
Tracking tools/apps.

ADA/AND Exchange Lists

System to guide healthy eating for diabetes management.
Categorizes foods according to calorie, carbohydrate, protein, and fat content.
Portion sizes vary depending on the food group.
Important for patient's ability to practice portion control.

Exchange Lists

Useful for variety, flexibility, and portion control for meal planning.
Initial recommendation for measuring and weighing food is advised.

ADA Exchange Lists: Examples

Includes examples of different food groups and their corresponding exchange values.
Provides illustrations of portion sizes and how to maintain calorie balance based on selected foods.

CHO Counting

This approach emphasizes total carbohydrate and not specific types of carbohydrate.
Emphasizes consistency in carbohydrate consumption in each meal.
Level 1, Level 2, Level 3: incremental levels of CHO counting skill building (increasingly complex).

Insulin Delivery

Insulin can be delivered by injections (multiple daily injections - MDI) or insulin pumps, each having different methods and time considerations.
Insulin is measured in units.
Subcutaneous Insulin injection: rapid or short-acting regular insulin has a peak action time of 2–4 hours and long term insulin has different effects on the body.

Exercise

Exercise increases glucose utilization by muscles.
Exercise guidelines need to adjust for insulin regimen.
Frequent blood glucose monitoring can help determine if adjustments to the insulin or carbohydrate intake are required.

Exercise & Carbohydrate with Insulin or Insulin Secretagogues

Carbohydrate intake should be adjusted based on the intensity and duration of exercise.
If pre-exercise blood glucose level is <100 mg/dL, carbohydrate intake may be required before exercise.
Additional carbohydrate intake after exercise is not typically required if insulin or secretagogues are administered as part of treatment.

Insulin Guidelines for Exercise

Moderate-strenuous exercise ( ≥ 45-60 min): decreased rapid/short-acting insulin doses (1-2 U).
Prolonged vigorous exercise: may need a daily insulin dose reduction of 15-20%.

Exercise Prescription

At least 150 minutes of moderate-intensity or 90 minutes of vigorous aerobic exercise are recommended and to be performed at least 3 days/week with no more than 2 consecutive days without activity.
Resistance exercise 3 times weekly is also beneficial.

Monitoring

Self-monitoring of blood glucose (SMBG):
Continuous ambulatory blood glucose monitoring (CAGM).
Urine/blood ketones are also commonly monitored based on circumstance.

Education: DSME

Comprehensive DSME (Diabetes Self-Management Education) programs for patients/individuals.
Survival skills and outpatient support.
Patient-led self-care.
Team approach is common

Nutrition Care Process

System to guide diabetes patient care from assessment to evaluation (includes different phases).
Includes initial assessment, patient diagnostics, interventions to improve/change patient diet/lifestyle, nutrition education, and long-term monitoring and adjustments.

MNT for Type 1 Diabetes in Youth

Proper growth and development are important.
Nutritional prescriptions are individually adjusted based on assessments and patient/individual needs.
Use of food and nutrition history.
Adjust the plan according to the individual patient's age, exercise, and growth rate, and individualize the food plan according to their specific insulin regimen.
Realistic blood glucose goals.
Reduce risk of cardiovascular disease.
Meal planning is important and should be personalized.

MNT for Type 2 Diabetes in Youth

Childhood obesity frequently accompanies the development of type 2 diabetes.
Cessation of excessive weight gain is recommended as well as promote normal growth and development, while achieving blood glucose and A1c goals.
The treatment plan should target comorbidities like hypertension and dyslipidemia.
Implement behavioral modifications and weight-loss strategies.
Medications like metformin or insulin may be needed.

MNT for Preexisting Diabetes and Pregnancy

Preconception counseling is essential in the planning stage before pregnancy.
Significant hormonal shifts during the first trimester often result in unpredictable blood glucose levels; adjust meal plans as needed.
Increased insulin requirements typically occur in the second and third trimesters of pregnancy.
Nutritional meal plans should meet the increased calorie needs during pregnancy.
Prevent hypoglycemia and ketoacidosis

MNT for GDM

Screening and testing are important.
Carbohydrate-controlled meal plans are used, focusing on adequate energy without ketoacidosis.
The plan should be individualized and adjusted throughout pregnancy.
Insulin use is often necessary.
Carbohydrate distribution and exercise are important aspects of management.

MNT for Older Adults

Prevalence of diabetes and impaired glucose tolerance (IGT) increases with age.
Similar management principles as younger populations apply.
Concerns regarding malnutrition are present.
Prevent hyperglycemia and dehydration, targeting the hyperglycemic hyperosmolar state (HHS).

Diabetes Prevention

Recommendations for weight loss, routine physical activity, and low-fat diets are considered important measures for diabetes prevention.
Participation in structured programs with regular contact provides support.

Diabetes Resources for Professionals

Online resources from the American Diabetes Association (ADA) for professionals are available.

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Description

Test your knowledge on diabetes management with this comprehensive quiz. Covering various aspects such as neuropathy, dietary concerns, and diagnostic criteria, the questions will challenge your understanding of diabetes. This quiz is perfect for students and healthcare professionals alike.