MNT 2 - Exam #3 (Part 1) Flashcards Preview

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What is the prevalence of T1DM?

-5-10% of all DM cases
-About 5% of these cases are idiopathic


What are the causes of T1DM?

-Immune mediated versus idiopathic;
-About 5% of these cases are idiopathic
-Rate of beta cell destruction variable;
-"honeymoon period”still maintains insulin production;
-Causes → NOT clearly understood;
-Multiple genetic predispositions;
-Environmental factors (coxsackie virus, cow’s milk protein, rubella = possible triggers)


What is the pathophysiology of T1DM?

-Absolute deficiency of insulin = beta cells are totally destroyed and they make none;
-Elevated plasma glucose
-Cells cannot use glucose for energy


What are the clinical manifestations of T1DM?

S/S”s of body’s efforts to compensate:
1. Glycosuria – glucose in the urine
2. Polyuria – excessive urination
3. Polydipsia – increased thirst
4. Polyphagia – increased hunger


How is an Oral Glucose Tolerance Test (OGTT) used with T1DM diagnosis?

-Oral glucose tolerance test (OGTT)- to dx IGT, IFG, GDM


What are the diabetes related Autoantibodies?

-Glutamic acid decarboxylase autoantibodies (GADA);
-Islet cell autoantibodies (ICA);
-Insulin autoantibodies (IAA);


What are Glutamic Acid Decarboxylase Autoantibodies (GADA)?

1. Test measures specific islet cell antigens
2. Most sensitive marker for T1DM risk


What are Islet Cell Autoantibodies (ICA)?

-Also indicator or T1DM risk;
-Will not be as accurate an indicator as the T1 progresses as the antibodies are lost ;
-Prevalence of ICA decreases as T1DM continues


What are the Insulin Autoantibodies (IAA)?

-Evidence of ongoing Beta-cell destruction
-Not accurate if patient injecting insulin


What are the C-peptides?

-Released as insulin’s 2 polypeptide chains separate
-So c-peptide can be used to measure insulin production


What are the goals of MNT for T1DM?

1. Achieve and maintain optimal BG, BP, and lipid levels
2. Improve overall health (diet and exercise)
3. Address individual energy and nutrients needs while considering personal/cultural preferences, lifestyle, and pt’s readiness to change
4. Prevent or delay, and treat long-term complications of DM


What is the focus of education with T1 Diabetics?

-T1 starts earlier in life so there is a longer lifespan for risk of complications
-Acute complications and sick day management education is key


What the main MNT approaches for T1DM?

-Integrate insulin therapy with an individual’s food and physical activity
-Base food plan on assessment of appetite, preferred foods, usual eating and exercise


What are the methods of insulin therapy?

1. Flexible or intensive insulin therapy: (CSII or MDII) → Continuous Subcutaneous Insulin Injections; Multiple daily insulin injections
— Determine and adjust pre-meal insulin doses based on the total amount of CHO in the meal
— Test BG 30 minutes prior to a meal and adjust insulin accordingly
— Use a carbohydrate-to-insulin ratio

2. Fixed daily insulin dose
— Emphasize consistency in day-to-day meal CHO content


What are the macronutrient needs with T1DM?

-PRO — RDA: .8-1.0 g/kg;

-Kcals =
1. Sedentary: 25 kcal/kg
2. Normal: 30 kcal/kg
3. Undernourished or active: 45-50 kcal/kg

-Determine fat and CHO intake based on lipids and weight levels


What are the assessment consideration for T1DM?

-Relevant medical history
-Present health status
-Diabetes knowledge and skills
-Cultural influences
-Health beliefs/attitudes
-Support systems
-Readiness to change
-Barriers to learning
-Socioeconomic factors
-Client goals
-Level of glycemic control
-Insulin regimen
-Usual schedule
-Usual food intake = Meal times, composition, and macronutrient content)


What are the T1DM insulin medical treatments?

1. Syringes or pens
- Syringes disposable
- Pens refillable 150-300 U insulin
2. Insulin pumps
- Battery powered size of pager
- Duplicates endogenous insulin best


What are the T1DM goals fro preprandial glucose?

Normal = <100mg/dL
GOAL = 70-130 mg/dL;


What are the T1DM goals fro postprandial glucose?

Normal = < 140mg/dL;
GOAL = <180mg/dL


What are the T1Dm goals for AIC?

Normal = 4-6;
GOAL = <7


What is the care plan documentation for T1DM?

-Physician referral for MNT
-Patient name (ID information)
-Date of visit/ time spent
-Reason for visit
-Current & past Dx
-Pertinent test/lab results
-Current medications
-Others present during visit


Nutrition Assessment for T1DM

- nutrition hx, medical hx, social hx
- assessed needs for macronutrients/ micronutrients
- labs/biochemical;
- nutrition focused physical;
- for follow up: achievement of goals (behavioral and clinical);


Nutrition Diagnosis and Intervention for T1DM

-Nutrition Diagnosis (PES)
-Nutrition Interventions
— Nutrition RX always first
— Food and meal planning
— Short and long term goals (clinical/ behavioral)
— Educational topics covered/ materials provided


Monitoring and Evaluation for T1DM

-Impression of patient acceptance and understanding
-Anticipated compliance
-Additional skills or information needed
-Recommendations and plans for ongoing care


Evaluation for T1DM

1. Weight/Height (q visit)
2. HgbA1c (Initially, 4-6 wks after changes, then 3-4 times a year)
3. Lipid profile (initially, 6 months after lifestyle changes, then annually)
4. Blood pressure (follow up visit)
5. Self Monitoring (follow up visit) = Food record, BG and medication records (changes in meds?), Activity/exercise patterns
6. Specific behavior changes per plan (q visit) Schedule changes (follow up visit)


What are the goals for Gestational DM?

- PRE-prandial
- When insulin is used, post prandial SMBG is preferred as these values directly R/T rates of macrosomia, neonatal hypoglycemia and C-section.


What is Diabetic Ketoacidosis (DKA)?

-Inadequate insulin = gluconeogenesis
-Lipolysis stimulated by counter regulatory hormonesà ketones
-Metabolic acidosis
-Osmotic diuresis occurs = Dehydration and electrolyte imbalances


DKA affects….



Labs for DKA...



Treatment and Prevention for DKA...