Nutrition and Diabetes Quiz

Pancreas Overview

• The pancreas is located in the abdomen, behind the stomach.
• It plays a crucial role in the digestive system and the regulation of blood sugar.

Insulin Function

• Insulin is produced by beta cells in the islets of Langerhans within the pancreas.

• It lowers blood glucose levels by facilitating the uptake of glucose into cells (primarily muscle, fat, and liver cells).

• This uptake allows cells to use glucose for energy or store it as glycogen.

• Insulin also promotes glycogen storage in the liver and inhibits glucose production (gluconeogenesis) when blood sugar is high.

• Insulin is needed to help transport glucose across the cell membrane to the cytoplasm of the cell.

• Insulin is an anabolic or storage hormone, which stimulates the storage of fat by stimulating fat cells (adipocytes), inhibits the breakdown of fat, and plays a role in protein metabolism by promoting amino acid uptake into cells for protein synthesis and muscle building.

• Insulin also helps regulate potassium levels in the blood.

• Daily insulin secretion in adults is approximately 40-50 units, or 0.6 units per kilogram of body weight.

• Normal blood glucose range is approximately 70-120 mg/dL (3.9-6.66 mmol/L).

Diabetes Mellitus

• Diabetes mellitus is a chronic multi-system disease characterized by disordered metabolism and inappropriately high blood glucose (hyperglycemia). This is caused by either low levels of insulin or impaired insulin utilization.
• A diagnosis of diabetes is suggested when fasting whole blood glucose level is 5.7 mmol/L or more, or when random blood glucose, taken 2 hours after a meal or 75g glucose load (1.75g/kg body weight in children), is 7.8 mmol/L or more.
• There are different types of diabetes: type 1 (insulin-dependent/juvenile onset), type 2 (non-insulin-dependent/maturity onset), gestational diabetes, diabetes secondary to other medical conditions or syndromes, and other specific types like monogenic diabetes syndromes and diseases of the exocrine pancreas (e.g., cystic fibrosis).

Type 1 Diabetes Mellitus (IDDM)

• Characterized by the destruction of pancreatic beta cells.
• Genetic, immunologic, and possibly environmental factors are involved in beta cell destruction.
• Usually occurs in younger people (before age 30).
• Insufficient or absent insulin production.

Type 2 Diabetes Mellitus (NIDDM)

• Occurs typically after age 30.

• Two main causes are insulin resistance, and impaired insulin production.

• Obesity, especially abdominal and visceral adiposity, is a significant risk factor.

• The pancreas typically continues to produce some insulin, but it's either insufficient for the body's needs or used poorly by the tissues.

• Often treated with diet, exercise, and oral medications.

Gestational Diabetes Mellitus

• This type of diabetes occurs during pregnancy, usually in the last trimester.
• Pregnancy leads to weight gain and increased levels of estrogen and placental hormones, which are antagonistic to insulin utilization.
• Babies born in these pregnancies are often large and overweight, sometimes accompanied by maternal polyhydramnios.
• Blood glucose returns to normal after delivery.

Diagnostic Investigations

• Random Plasma Glucose Test, Fasting Plasma Glucose (FPG) Test, Oral Glucose Tolerance Test (OGTT), Glycated Hemoglobin (HbA1c) Test, C-Peptide Test, Insulin Autoantibodies (IAA) Test, Lipid Profile, Urine Tests (ketones, microalbuminuria), Continuous Glucose Monitoring (CGM), Fructosamine Test, and Genetic Testing.

Pathophysiology

• In diabetes, if insulin levels are low or insensitive, glucose absorption by the body cells is hampered, leading to elevated blood glucose levels (hyperglycemia).
• Classic symptoms are polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased appetite).
• Other symptoms include fatigue, weakness, sudden vision changes, tingling or numbness in hands or feet, dry skin, poor skin turgor, recurrent infections, weight loss, nausea/vomiting, abdominal pains, poor vision, pruritus vulvae, paresthesia, aching and cramps in the legs, lowered resistance to infection, ketoacidosis, fruity smell of breath, impotence in men, skin lesions/slow-to-heal wounds, foot gangrene, and pedal edema.

Clinical Manifestations

• The symptoms of diabetes include increased urination (polyuria), increased thirst (polydipsia), increased appetite (polyphagia), fatigue and weakness, sudden vision changes, tingling or numbness in hands or feet, dry skin, poor skin turgor, recurrent infections, weight loss, nausea/vomiting, abdominal pain, poor vision, genital itching, tingling in hands/feet, aches/cramps in legs, reduced resistance to infections like skin boils, ketoacidosis, fruity breath, impotence, skin lesions, foot gangrene, and swelling in the feet (pedal edema).

Treatment Objectives

• Relieve symptoms
• Prevent acute hyperglycemic complications (e.g., ketoacidosis and hyperosmolar state).
• Prevent treatment-related hypoglycemia.
• Achieve fasting blood glucose between 4-7 mmol/L (less intensive targets in elderly).
• Achieve 2-hour post-meal blood glucose between 5-9 mmol/L (less intensive targets in elderly).
• Maintain glycated hemoglobin (A1c) below 7% (less intensive targets in elderly).
• Ensure weight reduction in overweight and obese individuals.
• Prevent chronic complications of diabetes like hypertension.

Management

• Nutritional measures (diet, carbohydrate control, reduced refined sugars and alcohol, increased fiber, appropriate portions based on individual needs).
• Exercise (daily, consistent, appropriate for fitness level, blood glucose monitoring before exercising, providing extra carbs/calories before or after).
• Monitoring (self-monitoring of blood glucose, checking before meals and 2 hours after, consistent frequency depending on diabetes type/insulin use).
• Pharmacologic treatment (medications like sulfonylureas, biguanides, thiazolidinediones, insulin depending on specific diabetes type).
• Education (regarding diabetes pathophysiology, treatment modalities, acute complications). (Foot care, eye care, general hygiene, risk factor management, insulin administration).

Foot Care

• Daily foot inspection.
• Avoiding barefoot walking.
• Wearing appropriate, properly-fitting shoes.
• Checking for injuries and infections.
• Keeping feet clean and dry, with mild soap only.
• Avoiding soaking the feet.
• Treatment of corns/calluses under medical guidance.
• Prompt treatment during infections.
• Seeking professional advice for foot problems including podiatrist checkups.

Incidence, Aetiology and Risk Factors

• Type 1 diabetes is sudden in onset and occurs before age 30 (around 5-10% of cases).
• Type 2 diabetes typically develops after 30 years of age (around 90-95% of cases).
• Gestational diabetes occurs in 2% of pregnancies.
• Aetiology includes autoimmune disorders, idiopathic factors, genetic predisposition, excessive calorie intake, and lack of physical activity.
• Risk factors include family history of diabetes, obesity, race/ethnicity, age over 45, previously unidentified impaired fasting glucose/impaired glucose tolerance.

Test your knowledge on nutrition guidelines and diabetes management in this comprehensive quiz. Covering various dietary recommendations and exercise advice, this quiz will help reinforce your understanding of essential concepts related to diabetes. Perfect for healthcare students and professionals.