Untitled Quiz

Addison's Disease

• Addison's disease, also called adrenal insufficiency, is a rare disorder
• It occurs when the body does not produce enough cortisol and often too little aldosterone
• It can affect any age group and both sexes
• It's a life-threatening condition
• Discovered in 1855 by Dr Thomas Addison

Addison's Disease - Aetiology

• Autoimmune attack on adrenal glands
• Tuberculosis (most common worldwide, but commonly found in developing countries)
• Infections (e.g., AIDS, fungal)
• Adrenal hemorrhage (e.g., caused by sepsis, meningitis)
• Metastatic spread to the adrenals
• Amyloidosis
• Adrenalectomy
• Genetic/congenital defects

Addison's Disease - Pathophysiology

• Hyponatremia due to low cortisol, increasing vasopressin secretion/action, impacting free water excretion
• Low aldosterone causing hyperkalemia
• High adrenocorticotropic hormone (ACTH) due to low cortisol
• Low glucose (cortisol stimulates glycogenolysis (via increased glucagon release) and gluconeogenesis (via protein catabolism to generate gluconeogenic amino acids); low cortisol increases insulin sensitivity)

Addison's Disease - Nutrition

• Higher sodium intake
• If on high-dose corticosteroids, increased vitamin D and calcium (high-dose corticosteroids are linked to higher risk of osteoporosis)
• Lowering potassium intake (if warranted)
• Comfort food (high simple) sugar reported

Hypoglycemia

• Hypoglycemia can be diabetic or non-diabetic

Hypoglycemia - Aetiology and Pathophysiology

• Failure of counter-regulatory mechanisms is the initial deficit in hypoglycemia decreases in insulin production
• Hepatic glycogenolysis, low insulin levels are necessary
• Plasma glucose levels decline, beta cell secretion of insulin decreases ,leading to increased hepatic/renal gluconeogenesis and hepatic glycogenolysis.
• Glycogenolysis maintains serum glucose levels over 8-12 hours, until glycogen stores are depleted and hepatic gluconeogenesis contributes to maintaining euglycemia when required
• Pancreatic alpha-cell secretion of glucagon is the next line of defense against hypoglycemia; if inadequate, adrenomedullary measures are required

Hypoglycemia - Aetiology non-diabetic

• Reactive hypoglycemia
• Fasting hypoglycemia
• Having pre-diabetes or being at risk for diabetes
• Stomach surgery
• Rare enzyme deficiencies
• Medications (e.g., salicylates, sulfa drugs, quinine, pentamidine)
• Alcohol (especially with binge drinking)
• Serious illnesses (e.g., liver, heart, or kidney problems)
• Hormone imbalances (e.g., cortisol, growth hormone, glucagon, or epinephrine)
• Tumors (e.g., pancreas, IGF-II)
• Not getting enough to eat

Hypoglycemia - Pathophysiology non-diabetic

• Irregular or fast heartbeat
• Fatigue
• Pale skin
• Shakiness
• Anxiety
• Sweating
• Hunger
• Irritability
• Tingling or numbness of lips, tongue, or cheeks
• Confusion
• Abnormal behavior
• Visual disturbances (e.g., blurry vision)
• Seizures
• Loss of consciousness

Hypoglycemia - Nutrition non-diabetic

• Immediate treatment of low blood glucose: Eat or drink 15 grams carbohydrate (e.g., juice, glucose tablets, hard candy)
• Eat small meals/snacks throughout the day (every 3 hours)
• Include variety of foods, including protein, dairy, and high-fiber foods (e.g., whole-grain bread, fruit, vegetables)
• Limit high-sugar foods

Hypoglycemia - Aetiology diabetic

• Taking too much insulin or diabetes medication
• Not eating enough
• Postponing or skipping a meal/snack
• Increasing exercise/activity without eating more or adjusting medications
• Drinking alcohol

Hypoglycemia - Pathophysiology diabetic

• Symptoms similar to non-diabetic hypoglycemia (irregular or fast heartbeat, etc.)

Hypoglycemia - Nutrition diabetic

• Don't skip or delay meals/snacks
• Be consistent with insulin/oral diabetes medication amounts and timing
• Adjust medication or eat additional snacks with increased physical activity; adjustment is based on blood sugar test results, activity type/length, medications
• Eat a meal/snack with alcohol if choosing to drink; alcohol can cause delayed hypoglycemia

Special Diets (General)

• Used to treat or prevent conditions
• Modifications to diet include changes to texture, nutrient level, meal frequency, timing, and/or exclusions
• Examples include renal, heart health, malabsorption, and iron-deficiency anemia diets

Special Diets - Renal

• Excretion-diet for chronic kidney disease
• Used for patients with chronic kidney disease
• Restrict protein, fluid, sodium, potassium, and phosphorus
• Restrictions become more strict as the disease progresses (stage 1-4)
• Dialysis may be required at stage 5
• Higher- and lower-phosphorus foods (examples listed elsewhere in the notes)
• High- and low-potassium foods (examples listed elsewhere in the notes)
• Higher- and lower-sodium foods (examples listed elsewhere in the notes)
• High-protein foods and low-protein foods (examples listed elsewhere in the notes)
• Spironolactone (aldolactone) can be used to lower blood pressure in CKD patients but is a potassium-sparing drug

Special Diets - Heart Health

• Aims to manage metabolic syndrome (TLC diet mainly) by targeting total fat, saturated, polyunsaturated, & monounsaturated fats, trans fat amounts & types of carbohydrate
• Also targets cholesterol, sodium (examples listed elsewhere in the notes)

Special Diets - Malabsorption Syndrome

• Poor nutrient absorption (occurs due to impaired digestion (e.g. lactase activity reduction) or impaired absorption (e.g. celiac disease))
• Eating small, frequent meals (5-6 per day) can benefit absorption; can reduce diarrhea and gas
• Limit high-fat foods (butter, margarine, mayonnaise, gravies, fried foods, rich desserts, bacon, hot dogs, chipped ham)
• Limit high-fiber foods (wheat bran, nuts, raw fruits/vegetables with skin or seeds)
• Vitamin/mineral supplements may be necessary to prevent deficiencies
• Liquids are better absorbed separately from food

Special Diets - Iron Deficiency Anemia

• Low iron in the body
• Iron deficiency anemia results in poor hemoglobin formation, decreased oxygen transport, and reduced oxidative metabolism, resulting in tiredness
• Ingestion-iron deficiency anemia can occur due to iron-deficient diet or other reasons (e.g., poor digestion, poor absorption, consumption of grains with phytates over-consumption), blood loss issues, or pregnancy)
• Foods should contain heme iron (red meat, pork, poultry, liver, seafood, beans, dark leafy green vegetables, dried fruit, iron-fortified cereals, breads, and pastas)
• Iron supplements may be necessary