MNT 2 - Exam #2 (Part 1) Flashcards Preview

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1

What is the prevalence of DM i the United States?

-25.8 million Americans have Diabetes;
-8.3% of population ;
-Type 1 = 5% of all patients with DM;
-Type 2 = 90-95%;
-GDM: (Gestational Diabetes);
-Occurs in 2-10% of pregnancies;
-Have 35-60% chance of developing type 2;
-7 million undiagnosed;
-Risk for death – DOUBLE → vs. no Diabetes

2

What is the average cost of DM?

Average. Cost – nearly double due to cost of treatment complications

3

Who is at risk for developing for DM?

-Age: > 45l
- > 120% IBW; BMI > 25 (especially those with abdominal obesity);
-Have 1st degree relative with dm;
-High risk ethnic group (African-American, Native American, Asian, Pacific Islander..);
-Delivered a baby > 9 lb or dx of GDM;
-HTN (> 140/90 mm Hg);
-HDL < 35 or TG > 250 mg/dl;
-IGT or IFG on previous testing ;
-Habitual physical inactivity

4

How is DM a diverse group of disorders?

-Differ in origin and severity;
-All share hyperglycemia /glucose intolerance from:
1. defect in insulin production
2. defect in insulin action
3. OR both

5

What are the 3 types of DM?

-Type 1 DM → Beta cells are destroyed and NO insulin production
-Type 2 DM → Insulin resistance; Cell do NOT RESPOND to insulin and thus glucose builds up and is not taken into cells
-Gestational DM (GDM)
→ IGT and IFG (pre diabetes) = increased risk of DM

6

What drugs are known to cause DM?

-Diabetes due to other causes (drugs, diseases);
-Corticosteroids put people at a high-risk for development of DM

7

What are the criteria for Diagnosis of DM?

1. Symptoms of DM plus casual blood glucose of > 200 mg/dL
OR
2. Fasting plasma glucose > 126 mg/dL
OR
3. 2-hour post-load glucose > 200 mg/dL during an OGTT
OR
4. HgbA1c > 6.5

8

What are the diagnostic criteria for IFG and IGT?

-IGT – Impaired Glucose Tolerance
-IFG – Impaired Fasting Glucose

— IFG = FPG > 110 and < 126 mg/dL
— IGT = 2 hPG > 140 and < 200 mg/dL

9

Who are the members of the medical treatment teams for patients with DM?

-Physicians, Nurse Practitioners, PA’s;
-RD/ DTR;
-CDE (Nurse &/or RD);
-Pharmacists;
-Mental Health Professionals;
-Other “allied health professionals”

10

What is the key to treatment with DM and preventing complications?

Diabetes Care, the EARLIER, the BETTER = Early Screening → Early Diagnosis → Early Care → Delay/Prevent Complications

11

What is included in the Lifetime Management of DM?

Includes “4 M’s”:
-MNT
-Physical activity
-Blood glucose monitoring
-Medications
-Self-management education (DSME)

12

What are the goals of MNT for DM?

**An overall good and healthful diet it applicable to DM and CVD and Renal Disease! All are one in the same with small variations;
1. Achieve and maintain optimal BG (blood glucose), BP (blood pressure), and lipid levels
2. Improve overall health (diet and exercise)
3. Address individual energy and nutrients needs while considering personal/cultural preferences, lifestyle, and patient’s readiness to change → Plan should be practical!
4. Prevent or delay, and treat long-term complications of DM:

13

What is included in the Education on Complication of DM?

1. Long term = Myopathy, Neuropathy, Retinopathy, Nephropathy, CVD
— Retinopathy is one of the most prevalent FIRST signs
2. Acute = Hyper- and Hypoglycemia

14

What does the AND says about Macronutrient recommendation for DM?

-“RD’s should encourage consumption of macronutrients based on the DRI’s for healthy eating as research does not support any ideal percentage of energy from macronutrients for persons with diabetes.” JADA. 2010:119:1852-1899.;
-No ONE diabetic diet → There is a lot of variation depending upon the patient ;
-Focus is NOT on the TYPE of CHO, but on the distribution and timing of the CHOs throughout the day

15

What are the recommendations for CHO?

-Total CHO vs Source of CHO
-Sucrose vs other CHO’s
-Dietary fiber: per dietary guidelines
-Emphasis on balanced diet
-Non-nutritive sweeteners are safe → Do produce a lower postprandial response and have lower energy values

16

What are the recommendations of Protein?

-Usual protein intake of approximately 15-20% energy can be maintained
-Exceptions for CHANGE =
•Individuals with excessive protein choices that are high in saturated fat content
•Individuals with protein intake < RDI’s
•Patients with diabetic nephropathy

17

What are the recommendations for fat?

-Cardio-protective nutrition interventions;
-If LDL level is > 100, use TLC
1. DM = risk equivalent=previous CVD/no DM
2. <7% saturated fat and 200 mg/d cholesterol
3. Limit intake of trans- fatty acids

18

What are the recommendations for Micronutrients?

-NO CLEAR evidence of benefit from vitamin or mineral supplementation
-EXCEPTIONS:
- Folate (prevent of birth defects) → Follow standard recommendations;
-Calcium (prevent bone disease) → Follow standard recommendations;
-Routine supplementation with antioxidants is NOT advised;
-Due to the uncertainties related to long-term safety

19

What are the Acute Complications or “Sick Days” with DM?

-Hypoglycemia
-Hyperglycemia
-DKA
-HHNS → Hyperosmolar Hyperglycemic Non-Ketotic Syndrome

20

What is Hypoglycemia?

Signs and symptoms = Initial S/S
— Neuroglycopenic S/S (inadequate glu to brain: confusion, irrational bx, seizure, coma);
— Test BG if possible/ if not – treat → CHECK

21

What is the treatment for Hypoglycemia?

— Treatment: → TREAT = initial 15-20 g of glucose
— Best thing is glucose tablets → Straight dextrose (w/o any extra calories)
— Re check in 15 minutes/ re treat if necessary → RE-CHECK
— Glucose levels will begin to fall after ~ 60 minutes of the glucose consumption
— Reevaluate/ additional tx if needed / consider a snack with CHO & protein
— IF next meal is more than about an hour away recommended a snack

22

What are ways to prevent and some of the causes?

Prevention/ causes?
-Too much meds
- Skipping or delayed meals → Recommend packing snacks or meals if busy!

23

What is Hyperglycemia?

ELEVATED blood glucose
- Increase thirst – Polydipsia
- Frequent urination – POLYURIA
→ Increased fluid loss
- Weight Loss → Particularly with Type 1
- Blurry Vision
- Delayed wound healing
- Irritability and hunger
- Fatigue

24

What are the causes of Hyperglycemia?

1. Excessive food/ CHO intake
2. Over-treatment of hypoglycemia
-Wrong timing of DM medications
— Insulin must be injected so that it peaks at the SAME time the blood glucose peaks from the meal that is consumed
— Some are taken at meals, some at bedtime → All depends on patient and medication
3. Illness → Sometimes meds have to be increased during illness due to increased stress and elevated blood glucose during sickness
-Stress → Raises blood glucose
4. Gastroparesis/other affecting digestion or absorption
5. Physical Activity
6. Other medications

25

What are the treatments and prevention methods of HYPERglycemia?

-Insulin Injections
-Oral-medications → Can take up to 3 different oral meds
-Diet
-Exercise
-Stress Management
-Treating subsequent illnesses

26

What are Acute Illness/Sick day management?

-Medications = continued/ may be increase;
-Monitor BG(before meals and snacks);
-Monitor Ketones (especially for T1DM);
-Adequate fluids;
-Adequate CHO;
-Watch for DKA;

27

Adequate CHO for Sick Day Management

-Prevent starvation ketosis!
-Adults= 150-200 g/CHO daily Or 45-50gm CHO every 3-4 hrs. Or 10-15gm CHO every 1-2 hrs. (may use liquids/ provide list of easy to tolerate CHO food/ beverages)
— 4oz. Regular Ginger-Ale
— 4oz. Apple Juice

28

What are the symptoms of DKA?

-Moderate to large amount of urine ketones, severe N/V diarrhea/ abdominal pain, rapid breathing, fruity breath;
-Kussmal Respirations = Rapid Breathing

29

What are the differences in HHS and DKA?

**DKA and HHNS are the most ACUTE and short-term complications of DM;
-Blood glucose does NOT get as high with DKA, as HHNS → BOTH are caused by HIGH glucose (lack of insulin causing alternate pathway of ketone formation)

30

What are the long term MICRO and MACROVASCULAR complications of DM?

1. Microvascular complications → “opathies”
— Nephropathy
— Retinopathy
— Neuropathy (Peripheral and Autonomic)
2. Macrovascular complications → CVD