MNT Diabetes FINAL REVIEW 366 PDF

## MNT DIABETES ### What is diabetes? Diabetes is a metabolic disease characterized by high blood glucose (BG) concentrations and can cause damage to organs such as the eyes, kidneys, nerves, heart, and blood vessels. ### Prevalence of diabetes - 34 million people in the USA (10% of the populat...

## MNT DIABETES ### What is diabetes? Diabetes is a metabolic disease characterized by high blood glucose (BG) concentrations and can cause damage to organs such as the eyes, kidneys, nerves, heart, and blood vessels. ### Prevalence of diabetes - 34 million people in the USA (10% of the population) had diabetes in 2020. - 88 million (35%) had prediabetes in 2020. - The total cost of diabetes was $327 billion in 2017. ### Pathophysiology of diabetes Diabetes involves abnormal metabolism of carbohydrates, proteins, and fats, leading to hyperglycemia due to either insufficient production or improper response to insulin. ### Key factors contributing to high blood glucose - Insulin dysfunction - Amylin deficiency - Action of counterregulatory hormones - Glucagon - Cortisol - Epinephrine ### Normal blood glucose levels and ADA guidelines Normal blood glucose is 70-100 mg/dl. ADA guidelines suggest: - Pre-prandial glucose of 80-130 mg/dl - Post-prandial glucose of <180 mg/dl - A1c <7% ### Categories of glucose intolerance - Type 1 Diabetes (T1DM) - Type 2 Diabetes (T2DM) - Gestational Diabetes (GDM) - Prediabetes (IFG and IGT) - Other types caused by surgery, drugs, or malnutrition ### Characteristics of Type 1 Diabetes - Complete lack of insulin production - Requires insulin for survival - Often presents during the pre-teen years - Causes include genetic and autoimmune factors. ### Characteristics of Type 2 Diabetes - Reduced insulin action and/or secretion - Affects 90-95% of diabetics, - Often associated with obesity and genetic factors. - Around 40% may require insulin for glucose control ### Screenings for T2DM - People >45 years should be screened every 3 years - Younger individuals should be screened if they have risk factors: - Obesity - Sedentary lifestyle - High-risk ethnicity - Hypertension - History of GDM ### Diagnosis of diabetes Requires two of the following: - Symptoms with random glucose >200 mg/dl - Fasting glucose >126 mg/dl - 2-hour glucose >200 mg/dl after a 75g load (OGTT) - A1c >6.5% ### Gestational Diabetes Mellitus (GDM) Glucose intolerance diagnosed during pregnancy, usually occurring in the second or third trimester. - After delivery, 90% of cases normalize - 5-10% remain Type 2 diabetics - 35-60% develop T2DM within 5-10 years ### Diagnosis of GDM - 50g glucose non-fasting screen - If glucose is >140 mg/dl at 1 hour, a 3-hour 100g OGTT is performed. - Diagnosis is confirmed if any values exceed the following: - Fasting 92 - 1 hour 180 - 2 hours 153 mg/dl ### Prediabetes - Impaired fasting glucose (IFG: 100-125 mg/dl) - Impaired glucose tolerance (IGT: 140-199 mg/dl after 2 hours) - A1c of 5.7%-6.4% ### Metabolic Syndrome - Cluster of conditions increasing the risk for CVD and insulin resistance - Diagnosis requires three of the following criteria: - Abdominal obesity - Triglycerides >150 mg/dl - HDL <40 mg/dl (men) or <50 mg/dl (women) - BP >130/85 - Fasting glucose >100 mg/dl ### Acute Complications of diabetes - Diabetic ketoacidosis (DKA) - Hyperglycemic hyperosmolar state (HHS) - Hypoglycemia - Somogyi effect, - Dawn phenomenon ### Diabetic ketoacidosis (DKA) - Occurs due to insulin deficiency, leading to fat breakdown and ketone production. - Symptoms include: - Hyperglycemia >250 mg/dl - Ketonuria - Dehydration - Acetone breath - Kussmaul breathing (deep rapid breathing) ### Hyperglycemic hyperosmolar state (HHS) - Occurs primarily in elderly T2DM patients - Involves extreme hyperglycemia (>400 mg/dl), severe dehydration, and absence of ketones. ### "Rule of 15" for hypoglycemia management - Treat hypoglycemia (BG <70 mg/dl) by consuming 15g of fast-acting carbohydrate, waiting 15 minutes  - Recheck BG.  - Repeat if necessary and follow up with a meal. ### Chronic Complications of diabetes - Microvascular damage - Retinopathy - Nephropathy - Neuropathy - Macrovascular issues - CHD - Cerebrovascular disease - PVD ### Treatment Goals for diabetes management - Maintaining A1c <7% - Pre-prandial glucose of 80-130 mg/dl - Post-prandial glucose <180 mg/dl - Preventing complications - Promoting overall health ### Energy requirements for youth with diabetes - Based on food and nutrition assessments, validated using Dietary Reference Intakes (DRIs), - Adjusted for age, activity level, and growth needs. ### Key components of diabetes management - Nutrition - Medications - Exercise - Monitoring - Education. ### Goals of Medical Nutrition Therapy (MNT) for diabetes - Achieving near-normal BG levels - Optimal lipid levels - Appropriate caloric intake for weight and growth - Preventing complications: - Promoting overall health ### MNT for Type 1 diabetes - Insulin regimens with regular eating habits - Physical activity. - Balanced CHO intake to avoid weight gain. ### MNT for Type 2 diabetes - Lifestyle interventions - Improved diet and increased physical activity. - Control glucose, lipids, and BP. - Medications if needed. ### Strategies for weight management in diabetes - Gradual weight loss - Regular eating - Choosing lower-fat foods - Incorporating physical activity ### Why are low-carbohydrate diets not recommended for diabetes? - Sugars do not increase glycemia more than isocaloric starches. - Portion control and consistent CHO intake are emphasized. ### Recommended fiber intake for people with diabetes - 25-38 g/day, - Similar to the general population - Focus on fiber-rich foods providing more than 5 g/serving. ### Sweeteners in a diabetes meal plan - Sucrose can replace other CHO sources or be covered by insulin. - Nonnutritive sweeteners like saccharin and aspartame are generally safe, - But excess sugar alcohols may cause digestive issues. ### Protein intake and blood glucose levels - Protein intake does not affect blood glucose levels in well-controlled diabetes - Should constitute 15-20% of total caloric intake. ### Dietary fat recommendations for people with diabetes - Total fat should be 25-35% of total calories - Reduced saturated fats - Minimal trans fats - Emphasis on polyunsaturated fats, especially omega-3 fatty acids. ### Guidelines for alcohol consumption - Moderation (1 drink/day for women, 2 for men) - Alcohol should be consumed with food to minimize glucose fluctuations. - Excessive intake may cause hyperglycemia or hypoglycemia. ### Micronutrient supplements - No clear evidence supporting supplements for diabetes - Though chromium, cinnamon, and alpha-lipoic acid show some promise. - Consider individual needs and medication interactions ### ADA/AND Exchange Lists - Categorize foods based on their macronutrient content - Help manage portion control and nutrient intake - Aid in meal planning for diabetes. ### Carbohydrate counting for diabetes - Consistent CHO intake at meals/snacks, - Focusing on total CHO amounts - Involves self-monitoring and is adaptable to all diabetes types. ### "Rule of 15" in exercise - Add 15g of CHO for every 30-60 minutes of moderate activity - CHO adjustments depend on glucose levels and activity intensity ### Insulin guidelines for exercise - Reduce rapid-acting insulin by 1-2 units for moderate-to-strenuous activity over 45-60 minutes - Total daily insulin may need a 15-20% reduction for prolonged vigorous exercise ### Recommended exercise prescription - Engage in at least 150 minutes/week of moderate aerobic activity - Or 90 minutes of vigorous activity spread over at least three days - Resistance training 3 times a week. ### Importance of self-monitoring blood glucose (SMBG) - Adjust insulin doses and dietary intake - Detect glucose patterns - Improve overall diabetes management. ### Treatment Goals for Medical Nutrition Therapy (MNT) in youth with Type 1 diabetes - Normal growth and development - Maintaining blood glucose levels within target ranges - Preventing cardiovascular complications with an individualized meal and insulin plan. ### Key aspects of MNT for Type 2 diabetes in youth - Halt excessive weight gain - Achieve blood glucose and A1C goals - Address comorbidities like hypertension and dyslipidemia - Promote behavior modification - Metformin and insulin may be used. ### MNT for preexisting diabetes managed during pregnancy - Involves preconception counseling - Adjusting meal plans for hormonal changes - Increasing insulin requirements in later trimesters - Ensuring adequate caloric intake without hypoglycemia or ketosis ### MNT for Gestational Diabetes Mellitus (GDM) - Carbohydrate-controlled meal plan - Maintaining normoglycemia - Avoiding ketones - Individualizing the plan to adjust throughout pregnancy - Insulin may be used if needed. ### MNT for older adults with diabetes - Similar recommendations to younger populations - Concerns: - Malnutrition - Hyperglycemia - Dehydration leading to hyperglycemic hyperosmolar state (HHS) ### Effective strategies for diabetes prevention - Moderate weight loss (5-7%% body weight) - Regular physical activity - Low-fat diet - Structured programs with regular follow-up ### Classifications of oral glucose-lowering medications - Biguanides (e.g., metformin) - Insulin secretagogues - Sulfonylureas - Meglitinides - Insulin sensitizers (TZDs) - Alpha-glucosidase inhibitors - DPP-4 inhibitors - SGLT2 inhibitors ### Biguanides (e.g., metformin) - Reduce hepatic glucose production - Side effects: - Nausea - Vomiting - Diarrhea - Gas ### Action of biguanides - Inhibiting gluconeogenesis - Enhancing insulin sensitivity ### GLP-1 receptor agonists (e.g., Byetta) - Enhance insulin secretion - Suppress glucagon - Reduce food intake for T2DM ### Amylin mimetics (e.g., Symlin) - Regulate blood glucose by - Slowing gastric emptying - Suppressing glucagon - Inducing satiety for T1 and T2DM ### Mechanisms of GLP-1 and GIP incretins in diabetes - Stimulate insulin secretion - Inhibit glucagon release in response to meals - Improve glucose levels - DPP-4 inhibitors prevent the breakdown of these incretins, enhancing their effects. ### Types of insulin based on action time - Rapid-acting - Onset <15 minutes - Duration 3-4 hours - Short-acting - Onset 0.5-1 hour - Duration 3-6 hours - Intermediate - Onset 2-4 hours - Duration 10-16 hours - Long-acting - Onset 1-4 hours - Duration up to 24 hours ### Diabetic ketoacidosis (DKA) vs. hyperglycemic hyperosmolar state (HHS) - **DKA:** - Occurs in T1DM - Due to lack of insulin, leading to fat breakdown and ketone production. - **HHS:** - Occurs in T2DM - Characterized by extreme hyperglycemia (>400 mg/dl) and dehydration, without ketones. ### Purpose of self-monitoring blood glucose (SMBG) - Helps individuals adjust insulin doses, meal plans, and physical activity - To maintain optimal glucose control. ### Role of exercise in diabetes prevention and management - Improves glucose utilization - Reduces insulin resistance - Promotes weight management - Decreases cardiovascular risks - Guidelines suggest 150 minutes of moderate activity weekly. ### Potential risks of alcohol consumption - Excessive alcohol - May cause hyperglycemia - Increases the risk of hypoglycemia when combining alcohol with insulin or secretagogues. ### Side effects of sulfonylureas and biguanides - **Sulfonylureas:** May cause hypoglycemia - **Biguanides (e.g., metformin):** - Can lead to gastrointestinal issues such as nausea, vomiting, diarrhea, and gas. ### Dietary fat intake recommendations for diabetes - Total fat: 25-35% of calories - Minimize saturated fats and trans fats - Include omega-3 fatty acids and polyunsaturated fats for cardiovascular protection ### Recommended fiber intake for diabetes - Same as for the general population: 25-38 g/day - Emphasis on fiber-rich foods providing more than 5 g/serving. ### Alcohol consumption and diabetes medications - May cause hypoglycemia when combined with insulin or insulin secretagogues - Excessive alcohol intake can contribute to hyperglycemia and other metabolic disturbances. ### ADA/AND Exchange Lists - Provide a systematic way to manage nutrient intake - Allowing for variety, portion control, and flexibility in meal planning for diabetes. ### Plate method in diabetes nutrition - Meal planning tool - Divides a plate into sections: - Non-starchy vegetables - Lean proteins - Carbohydrates - Simplifying portion control and encouraging balanced meals. ### Carbohydrate counting - Flexibility in food choices - Improves glucose control - Emphasizes total carbohydrate intake over type - Adjustments based on self-monitoring records. ### Levels of carbohydrate counting - **Level 1** - Focuses on consistent carbohydrate intake at meals/snacks - Use records to monitor intake. - **Level 2** - Emphasizes the relationship between food, activity, and blood glucose levels. - Requires pattern management and use of a diabetes diary. - **Level 3** - Utilizes insulin-to-carbohydrate ratios for precise insulin adjustments. - Requires advanced skills in managing food intake, activity, and glucose patterns. ### Methods of carbohydrate counting at Level 3 - **Method 1:** Calculating insulin needs based on grams of carbs consumed. - **Method 2:** Determining insulin doses based on portions of food, where one choice equals 15g of carbs. ### MNT in gestational diabetes - Carbohydrate-controlled meal plans to maintain normoglycemia. - Adjust caloric intake throughout pregnancy. - Screen for GDM between 24-28 weeks of gestation, with insulin introduced as necessary. ### Adjunctive injectable agents for diabetes management - **GLP-1 Receptor Agonists (e.g., Byetta):** - Enhance insulin secretion - Suppress glucagon - Reduce food intake for T2DM - **Amylin mimetics (e.g., Symlin):** - Regulate blood glucose by: - Slowing gastric emptying - Suppressing glucagon - Inducing satiety for T1 and T2DM ### Mechanisms of GLP-1 and GIP incretins in diabetes - Stimulate insulin secretion - Inhibit glucagon release in response to meals - Improve glucose levels - DPP-4 inhibitors prevent the breakdown of these incretins, enhancing their effects. ### Types of insulin based on action time - **Rapid-acting:** - Onset <15 minutes - Duration 3-4 hours - **Short-acting:** - Onset 0.5-1 hour - Duration 3-6 hours - **Intermediate:** - Onset 2-4 hours - Duration 10-16 hours - **Long-acting:** - Onset 1-4 hours - Duration up to 24 hours ### Diabetic ketoacidosis (DKA) vs. hyperglycemic hyperosmolar state (HHS) - **DKA:** - Occurs in T1DM - Due to lack of insulin, leading to fat breakdown and ketone production. - **HHS:** - Occurs in T2DM - Characterized by extreme hyperglycemia (>400 mg/dl) and dehydration, without ketones. ### Purpose of self-monitoring blood glucose (SMBG) - Helps individuals adjust insulin doses, meal plans, and physical activity - To maintain optimal glucose control. ### Role of exercise in diabetes prevention and management - Improves glucose utilization - Reduces insulin resistance - Promotes weight management - Decreases cardiovascular risks - Guidelines suggest 150 minutes of moderate activity weekly. ### Potential risks of alcohol consumption - Excessive alcohol - May cause hyperglycemia - Increases the risk of hypoglycemia when combining alcohol with insulin or secretagogues. ### Side effects of sulfonylureas and biguanides - **Sulfonylureas:** May cause hypoglycemia - **Biguanides (e.g., metformin):** - Can lead to gastrointestinal issues such as nausea, vomiting, diarrhea, and gas. ### Dietary fat intake recommendations for diabetes - Total fat: 25-35% of calories - Minimize saturated fats and trans fats - Include omega-3 fatty acids and polyunsaturated fats for cardiovascular protection ### Recommended fiber intake for diabetes - Same as for the general population: 25-38 g/day - Emphasis on fiber-rich foods providing more than 5 g/serving. ### Alcohol consumption and diabetes medications - May cause hypoglycemia when combined with insulin or insulin secretagogues - Excessive alcohol intake can contribute to hyperglycemia and other metabolic disturbances. ### ADA/AND Exchange Lists - Provide a systematic way to manage nutrient intake - Allowing for variety, portion control, and flexibility in meal planning for diabetes. ### Plate method in diabetes nutrition - Meal planning tool - Divides a plate into sections: - Non-starchy vegetables - Lean proteins - Carbohydrates - Simplifying portion control and encouraging balanced meals. ### Carbohydrate counting - Flexibility in food choices - Improves glucose control - Emphasizes total carbohydrate intake over type - Adjustments based on self-monitoring records. ### Levels of carbohydrate counting - **Level 1** - Focuses on consistent carbohydrate intake at meals/snacks - Use records to monitor intake. - **Level 2** - Emphasizes the relationship between food, activity, and blood glucose levels. - Requires pattern management and use of a diabetes diary. - **Level 3** - Utilizes insulin-to-carbohydrate ratios for precise insulin adjustments. - Requires advanced skills in managing food intake, activity, and glucose patterns. ### Methods of carbohydrate counting at Level 3 - **Method 1:** Calculating insulin needs based on grams of carbs consumed. - **Method 2:** Determining insulin doses based on portions of food, where one choice equals 15g of carbs. ### MNT in gestational diabetes - Carbohydrate-controlled meal plans to maintain normoglycemia. - Adjust caloric intake throughout pregnancy. - Screen for GDM between 24-28 weeks of gestation, with insulin introduced as necessary. ### Adjunctive injectable agents for diabetes management - **GLP-1 Receptor Agonists (e.g., Byetta):** - Enhance insulin secretion - Suppress glucagon - Reduce food intake for T2DM - **Amylin mimetics (e.g., Symlin):** - Regulate blood glucose by: - Slowing gastric emptying - Suppressing glucagon - Inducing satiety for T1 and T2DM ### Mechanisms of GLP-1 and GIP incretins in diabetes - Stimulate insulin secretion - Inhibit glucagon release in response to meals - Improve glucose levels - DPP-4 inhibitors prevent the breakdown of these incretins, enhancing their effects. ### Types of insulin based on action time - **Rapid-acting:** - Onset <15 minutes - Duration 3-4 hours - **Short-acting:** - Onset 0.5-1 hour - Duration 3-6 hours - **Intermediate:** - Onset 2-4 hours - Duration 10-16 hours - **Long-acting:** - Onset 1-4 hours - Duration up to 24 hours ### Diabetic ketoacidosis (DKA) vs. hyperglycemic hyperosmolar state (HHS) - **DKA:** - Occurs in T1DM - Due to lack of insulin, leading to fat breakdown and ketone production. - **HHS:** - Occurs in T2DM - Characterized by extreme hyperglycemia (>400 mg/dl) and dehydration, without ketones. ### Purpose of self-monitoring blood glucose (SMBG) - Helps individuals adjust insulin doses, meal plans, and physical activity - To maintain optimal glucose control. ### Role of exercise in diabetes prevention and management - Improves glucose utilization - Reduces insulin resistance - Promotes weight management - Decreases cardiovascular risks - Guidelines suggest 150 minutes of moderate activity weekly. ### Potential risks of alcohol consumption - Excessive alcohol - May cause hyperglycemia - Increases the risk of hypoglycemia when combining alcohol with insulin or secretagogues. ### Side effects of sulfonylureas and biguanides - **Sulfonylureas:** May cause hypoglycemia - **Biguanides (e.g., metformin):** - Can lead to gastrointestinal issues such as nausea, vomiting, diarrhea, and gas. ### Dietary fat intake recommendations for diabetes - Total fat: 25-35% of calories - Minimize saturated fats and trans fats - Include omega-3 fatty acids and polyunsaturated fats for cardiovascular protection ### Recommended fiber intake for diabetes - Same as for the general population: 25-38 g/day - Emphasis on fiber-rich foods providing more than 5 g/serving. ### Alcohol consumption and diabetes medications - May cause hypoglycemia when combined with insulin or insulin secretagogues - Excessive alcohol intake can contribute to hyperglycemia and other metabolic disturbances. ### ADA/AND Exchange Lists - Provide a systematic way to manage nutrient intake - Allowing for variety, portion control, and flexibility in meal planning for diabetes. ### Plate method in diabetes nutrition - Meal planning tool - Divides a plate into sections: - Non-starchy vegetables - Lean proteins - Carbohydrates - Simplifying portion control and encouraging balanced meals. ### Carbohydrate counting - Flexibility in food choices - Improves glucose control - Emphasizes total carbohydrate intake over type - Adjustments based on self-monitoring records. ### Levels of carbohydrate counting - **Level 1** - Focuses on consistent carbohydrate intake at meals/snacks - Use records to monitor intake. - **Level 2** - Emphasizes the relationship between food, activity, and blood glucose levels. - Requires pattern management and use of a diabetes diary. - **Level 3** - Utilizes insulin-to-carbohydrate ratios for precise insulin adjustments. - Requires advanced skills in managing food intake, activity, and glucose patterns. ### Methods of carbohydrate counting at Level 3 - **Method 1:** Calculating insulin needs based on grams of carbs consumed. - **Method 2:** Determining insulin doses based on portions of food, where one choice equals 15g of carbs. ### MNT in gestational diabetes - Carbohydrate-controlled meal plans to maintain normoglycemia. - Adjust caloric intake throughout pregnancy. - Screen for GDM between 24-28 weeks of gestation, with insulin introduced as necessary. ### Adjunctive injectable agents for diabetes management - **GLP-1 Receptor Agonists (e.g., Byetta):** - Enhance insulin secretion - Suppress glucagon - Reduce food intake for T2DM - **Amylin mimetics (e.g., Symlin):** - Regulate blood glucose by: - Slowing gastric emptying - Suppressing glucagon - Inducing satiety for T1 and T2DM ### Mechanisms of GLP-1 and GIP incretins in diabetes - Stimulate insulin secretion - Inhibit glucagon release in response to meals - Improve glucose levels - DPP-4 inhibitors prevent the breakdown of these incretins, enhancing their effects. ### Types of insulin based on action time - **Rapid-acting:** - Onset <15 minutes - Duration 3-4 hours - **Short-acting:** - Onset 0.5-1 hour - Duration 3-6 hours - **Intermediate:** - Onset 2-4 hours - Duration 10-16 hours - **Long-acting:** - Onset 1-4 hours - Duration up to 24 hours ### Diabetic ketoacidosis (DKA) vs. hyperglycemic hyperosmolar state (HHS) - **DKA:** - Occurs in T1DM - Due to lack of insulin, leading to fat breakdown and ketone production. - **HHS:** - Occurs in T2DM - Characterized by extreme hyperglycemia (>400 mg/dl) and dehydration, without ketones. ### Purpose of self-monitoring blood glucose (SMBG) - Helps individuals adjust insulin doses, meal plans, and physical activity - To maintain optimal glucose control. ### Role of exercise in diabetes prevention and management - Improves glucose utilization - Reduces insulin resistance - Promotes weight management - Decreases cardiovascular risks - Guidelines suggest 150 minutes of moderate activity weekly. ### Potential risks of alcohol consumption - Excessive alcohol - May cause hyperglycemia - Increases the risk of hypoglycemia when combining alcohol with insulin or secretagogues. ### Side effects of sulfonylureas and biguanides - **Sulfonylureas:** May cause hypoglycemia - **Biguanides (e.g., metformin):** - Can lead to gastrointestinal issues such as nausea, vomiting, diarrhea, and gas. ### Dietary fat intake recommendations for diabetes - Total fat: 25-35% of calories - Minimize saturated fats and trans fats - Include omega-3 fatty acids and polyunsaturated fats for cardiovascular protection ### Recommended fiber intake for diabetes - Same as for the general population: 25-38 g/day - Emphasis on fiber-rich foods providing more than 5 g/serving. ### Alcohol consumption and diabetes medications - May cause hypoglycemia when combined with insulin or insulin secretagogues - Excessive alcohol intake can contribute to hyperglycemia and other metabolic disturbances. ### ADA/AND Exchange Lists - Provide a systematic way to manage nutrient intake - Allowing for variety, portion control, and flexibility in meal planning for diabetes. ### Plate method in diabetes nutrition - Meal planning tool - Divides a plate into sections: - Non-starchy vegetables - Lean proteins - Carbohydrates - Simplifying portion control and encouraging balanced meals. ### Carbohydrate counting - Flexibility in food choices - Improves glucose control - Emphasizes total carbohydrate intake over type - Adjustments based on self-monitoring records. ### Levels of carbohydrate counting - **Level 1** - Focuses on consistent carbohydrate intake at meals/snacks - Use records to monitor intake. - **Level 2** - Emphasizes the relationship between food, activity, and blood glucose levels. - Requires pattern management and use of a diabetes diary. - **Level 3** - Utilizes insulin-to-carbohydrate ratios for precise insulin adjustments. - Requires advanced skills in managing food intake, activity, and glucose patterns. ### Methods of carbohydrate counting at Level 3 - **Method 1:** Calculating insulin needs based on grams of carbs consumed. - **Method 2:** Determining insulin doses based on portions of food, where one choice equals 15g of carbs. ### MNT in gestational diabetes - Carbohydrate-controlled meal plans to maintain normoglycemia. - Adjust caloric intake throughout pregnancy. - Screen for GDM between 24-28 weeks of gestation, with insulin introduced as necessary. ### Adjunctive injectable agents for diabetes management - **GLP-1 Receptor Agonists (e.g., Byetta):** - Enhance insulin secretion - Suppress glucagon - Reduce food intake for T2DM - **Amylin mimetics (e.g., Symlin):** - Regulate blood glucose by: - Slowing gastric emptying - Suppressing glucagon - Inducing satiety for T1 and T2DM ### Mechanisms of GLP-1 and GIP incretins in diabetes - Stimulate insulin secretion - Inhibit glucagon release in response to meals - Improve glucose levels - DPP-4 inhibitors prevent the breakdown of these incretins, enhancing their effects. ### Types of insulin based on action time - **Rapid-acting:** - Onset <15 minutes - Duration 3-4 hours - **Short-acting:** - Onset 0.5-1 hour - Duration 3-6 hours - **Intermediate:** - Onset 2-4 hours - Duration 10-16 hours - **Long-acting:** - Onset 1-4 hours - Duration up to 24 hours ### Diabetic ketoacidosis (DKA) vs. hyperglycemic hyperosmolar state (HHS) - **DKA:** - Occurs in T1DM - Due to lack of insulin, leading to fat breakdown and ketone production. - **HHS:** - Occurs in T2DM - Characterized by extreme hyperglycemia (>400 mg/dl) and dehydration, without ketones. ### Purpose of self-monitoring blood glucose (SMBG) - Helps individuals adjust insulin doses, meal plans, and physical activity - To maintain optimal glucose control. ### Role of exercise in diabetes prevention and management - Improves glucose utilization - Reduces insulin resistance - Promotes weight management - Decreases cardiovascular risks - Guidelines suggest 150 minutes of moderate activity weekly. ### Potential risks of alcohol consumption - Excessive alcohol - May cause hyperglycemia - Increases the risk of hypoglycemia when combining alcohol with insulin or secretagogues. ### Side effects of sulfonylureas and biguanides - **Sulfonylureas:** May cause hypoglycemia - **Biguanides (e.g., metformin):** - Can lead to gastrointestinal issues such as nausea, vomiting, diarrhea, and gas. ### Dietary fat intake recommendations for diabetes - Total fat: 25-35% of calories - Minimize saturated fats and trans fats - Include omega-3 fatty acids and polyunsaturated fats for cardiovascular protection ### Recommended fiber intake for diabetes - Same as for the general population: 25-38 g/day - Emphasis on fiber-rich foods providing more than 5 g/serving. ### Alcohol consumption and diabetes medications - May cause hypoglycemia when combined with insulin or insulin secretagogues - Excessive alcohol intake can contribute to hyperglycemia and other metabolic disturbances. ### ADA/AND Exchange Lists - Provide a systematic way to manage nutrient intake - Allowing for variety, portion control, and flexibility in meal planning for diabetes. ### Plate method in diabetes nutrition - Meal planning tool - Divides a plate into sections: - Non-starchy vegetables - Lean proteins - Carbohydrates - Simplifying portion control and encouraging balanced meals. ### Carbohydrate counting - Flexibility in food choices - Improves glucose control - Emphasizes total carbohydrate intake over type - Adjustments based on self-monitoring records. ### Levels of carbohydrate counting - **Level 1** - Focuses on consistent carbohydrate intake at meals/snacks - Use records to monitor intake. - **Level 2** - Emphasizes the relationship between food, activity, and blood glucose levels. - Requires pattern management and use of a diabetes diary. - **Level 3** - Utilizes insulin-to-carbohydrate ratios for precise insulin adjustments. - Requires advanced skills in managing food intake, activity, and glucose patterns. ### Methods of carbohydrate counting at Level 3 - **Method 1:** Calculating insulin needs based on grams of carbs consumed. - **Method 2:** Determining insulin doses based on portions of food, where one choice equals 15g of carbs. ### MNT in gestational diabetes - Carbohydrate-controlled meal plans to maintain normoglycemia. - Adjust caloric intake throughout pregnancy. - Screen for GDM between 24-28 weeks of gestation, with insulin introduced as necessary. ### Adjunctive injectable agents for diabetes management - **GLP-1 Receptor Agonists (e.g., Byetta):** - Enhance insulin secretion - Suppress glucagon - Reduce food intake for T2DM - **Amylin mimetics (e.g., Symlin):** - Regulate blood glucose by: - Slowing gastric emptying - Suppressing glucagon - Inducing satiety for T1 and T2DM ### Mechanisms of GLP-1 and GIP incretins in diabetes - Stimulate insulin secretion - Inhibit glucagon release in response to meals - Improve glucose levels - DPP-4 inhibitors prevent the breakdown of these incretins, enhancing their effects. ### Types of insulin based on action time - **Rapid-acting:** - Onset <15 minutes - Duration 3-4 hours - **Short-acting:** - Onset 0.5-1 hour - Duration 3-6 hours - **Intermediate:** - Onset 2-4 hours - Duration 10-16 hours - **Long-acting:** - Onset 1-4 hours - Duration up to 24 hours ### Diabetic ketoacidosis (DKA) vs. hyperglycemic hyperosmolar state (HHS) - **DKA:** - Occurs in T1DM - Due to lack of insulin, leading to fat breakdown and ketone production. - **HHS:** - Occurs in T2DM - Characterized by extreme hyperglycemia (>400 mg/dl) and dehydration, without ketones. ### Purpose of self-monitoring blood glucose (SMBG) - Helps individuals adjust insulin doses, meal plans, and physical activity - To maintain optimal glucose control. ### Role of exercise in diabetes prevention and management - Improves glucose utilization - Reduces insulin resistance - Promotes weight management - Decreases cardiovascular risks - Guidelines suggest 150 minutes of moderate activity weekly. ### Potential risks of alcohol consumption - Excessive alcohol - May cause hyperglycemia - Increases the risk of hypoglycemia when combining alcohol with insulin or secretagogues. ### Side effects of sulfonylureas and biguanides - **Sulfonylureas:** May cause hypoglycemia - **Biguanides (e.g., metformin):** - Can lead to gastrointestinal issues such as nausea, vomiting, diarrhea, and gas. ### Dietary fat intake recommendations for diabetes - Total fat: 25-35% of calories - Minimize saturated fats and trans fats - Include omega-3 fatty acids and polyunsaturated fats for cardiovascular protection ### Recommended fiber intake for diabetes - Same as for the general population: 25-38 g/day - Emphasis on fiber-rich foods providing more than 5 g/serving. ### Alcohol consumption and diabetes medications - May cause hypoglycemia when combined with insulin or insulin secretagogues - Excessive alcohol intake can contribute to hyperglycemia and other metabolic disturbances