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71 Cards in this Set
- Front
- Back
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Normal blood glucose fasting levels?
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3.3-3.5mmol/l
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how does active insulin reach the blood?
What kind of hormone is insulin? What does that mean? |
portal vein
Anabolic - build things up/ storage |
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Does insulin stimulate glucose synthesis? What then (2)?
Where else does the latter conversion happen? |
No - glycogen or fatty acids.
Glucose -> fatty acids in the liver. |
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What system does glucagon activate to increase blood glucose?
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cAMP 2nd messenger system.
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What happens to blood glucose several hours after a meal? What is the response?
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Decreases below fasting levels, so initiate glucagon.
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What is the shared characteristic of diabetes mellitus?
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hyperglycemia.
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What is the leading cause of blindness, lower leg amps, and renal failure?
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T2D
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In order to run an oral glucose tolerance test, what are the two pre-test requirements?
When is the test completed ? |
3 days of:
1) normal PA 2) at least 150g CHO daily After an overnight fast . |
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After a OGTT, what range of fasting glucose = impaired fasting glucose & impaired glucose tolerance?
How about after a meal. |
impaired fasting glucose (prediabetes) = 5.5-7
post meal = 7.8-11 impaired glucose tolerance =more than 7 post meal = greater than 11. |
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T1D etiology
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cell mediated autoimmune destruction of B cells in the pancreas.
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What is LADA?
What is the clinical indicator? |
latent autoimmune diabetes of adults.
T2D initial diagnosis but really T1D. Islet failure not insulin resistance found via raised antibodies against islets of Langerhans. |
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What is often the first sign of T1D?
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ketoacidosis.
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What is T1D pathophysiology?
Why does this lead to dehydration? Why does T1D lead to ketone production? |
absolute insulin deficiency due to beta cell destruction - body can't use glucose for energy.
hyperglycemia = glycosuria = increased urination Increased demand on lipolysis. |
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What is the most common cause of premature death with diabetic individuals? Example?
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cardiovascular disease - atherosclerosis.
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How does diabetes cause vascular disease?
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make more pron to endothelial damage.
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What is the single leading cause of chronic kidney disease?
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nephropathy - changes in glomerular blood vessels = decreased filtering ability.
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What is retinopathy? When can it be caused?
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eye damage linked to hyperglycemic damage to its blood vessels - diabetes.
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What are the diabetic effects on the nervous system (3)?
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1) impaired sensation in hands or feets (diabetic ulcers).
2) gastroparesis - delayed gastric emptying - results from damaged vagus nerve. 3) carpel tunnel |
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What is the ratio you must consider with insulin therapy?
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insulin: glucose.
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How is insulin types classified (3)?
What kind insulin is involved with subcutaneous infusion? What kind with intensive insulin therapy? What is intensive therapy? |
expected onset, peak time, and duration of action.
rapid or short acting intermediate or short acting - multiple injections |
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What are the three targets of T1D nutritional goals?
What is a common technique? how is this based? How are fats and vitamins/ minerals prescribed? |
1) blood glucose
2) lipoproteins 3) BP CHO counting - 15g CHO = 1 CHO choice. Based on entire population. |
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What is hemoglobin A1C?
High blood glucose = ? What can you measure? |
measures amount of glucose bound to hemoglobin.
high blood glucose = more glycated hb average blood glucose for 2-3 months |
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How many times should you self monitor glucose per day?
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3 times.
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Where and how often is continuous glucose monitoring?
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under the skin - every 5 mins.
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When is hypoglycemia a risk with exercise (2)?
Can you go hyperglycemic with exercise too? |
exercise greater than 1 hr and within 24hr window of strenuous activity
Yes |
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What is the effect of alcohol on blood glucose?
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alcohol can inhibit liver ability to release glucose - therefore hypoglycemia.
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Is T2D genetic?
How is alcohol related to T2D etiology? |
YES - clearly inherited.
U-shaped association - moderate consumption = low risk. |
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What population is at the greatest risk of Canada diabetes?
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Aboriginals.
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How does the pancreas respond to T2D initially?
Eventually?? |
Increases more insulin release
inability to produce insulin. |
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What was found to better reduce risk of T2D, diet or exercise?
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exercise you nutrition betches.
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How does fat play into T2D?
What type of fat increases insulin sensitivity? |
insulin resistance INDEPENDENT of obesity
unsaturated. |
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What evidence exists and does not exist for fat and T2D risk?
What is a major finding? Specific fat type and women risk of t2D? |
NO long-term RCT
Yes epidemiological studies. saturated fat intake independently predicted insulin resistance. Trans-fats |
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What has intervention studies with fat and diabetes?
potential mechanism? |
SFA free diet improved insulin sensitivity.
fat quality affects membrane FA composition which alters insulin receptor binding/ affinity |
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What is glycemic index?
What food is it compared to? Why is this important? |
ability to raise blood glucose levels.
white bread. GI associated to increased t2d risk |
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What does medical therapy for T2D encompass?
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PA, nutrition, and medication.
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What are four functions of T2D drugs?
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1) decreases insulin resistance
2) stimulate insulin secretion in glucose presence. 3) decreases hepatic glucose production and increases insulin uptake in muscle (metformin) 4) delays intestinal absorption of glucose |
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Weight loss and blood glucose
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moderate weight loss improves glycemic control and reduces CVD risk
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Are low CHO diets recommended for T2D?
why (2)? |
No
Increased protein may be a risk factor for nephropathy Increased fat = bad . |
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What screening technique used for gestational diabetes?
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OGTT
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What is etiology for gestational diabetes?
Result. Fetus result |
metabolic alterations to meet maternal and fetal demands - can lead to islet cell dysfunction
result = insulin secretion cannot meet increased insulin needs. fetus = fetus exposed to hyperglycemia and they produce too much insulin - fetal hyperinsulinemia. |
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What is plan a and b for gestational diabetes?
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a = nutrition therapy
b = insulin therapy |
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what is the increased protein requirement in 2nd and 3rd trimester?
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1.1g/kg.
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Is hypertension symptomatic?
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no
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pre vs. stage 1 vs. stage 2 hypertension SP&DBP
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pre = 120-139/ 80-89
stage 1 = 140-159/ 90-99 stage 2 = greater than 160/ greater than 100 |
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2 types of hypertension
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primary = idiopathic
secondary = occurs as a result of another problem |
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vasopressin and hypertension
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works like angiotensin II
hypertensive people have more vasopressin from hypothalamus. |
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What is the maximal BP for medical reduction goal?
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140/80
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What is the dose-response daily alcohol drink with hypertension risk?
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above 2 per day for men and 1 for women.
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What is the DASH diet?
How are K+, Ca++, Mg+ +related to BP? |
dietary approaches to stop hypertension.
reduce sodium K+, Ca++, Mg+ +reduce BP |
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What does salt sensitivity mean?
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individuals respond differently to changing salt in diet and blood pressure responses.
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how are lipids transported in the blood?
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lipoproteins
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what is dyslpidemia?
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high ldl and low hdl
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what is the role of HDLs?
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reverse lipid transport - tissue to liver.
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What is the single strongest indicator of CVD risk and involved in athersclerotic process?
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LDL
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What process of LDL initiates plaque build up?
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oxidation
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What are the two phases in atherosclerosis pathophysiology?
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1) fatty streaks - LDL reacts with ROS and oxidized LDL call upon monocytes. Monocytes plus macrophages = foam cells.
2) fibrous plaque - smooth muscle migrates into fatty streak and secretes fibrous proteins - narrow arteries. |
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What do statins do?
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lower blood cholesterol
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What is the belief of nutritional therapy for atherosclerosis?
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interferes with plaque formation by inhibiting inflammatory response that causes the changes within the blood vessels.
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Should you reduce total dietary fat with atherosclerosis?
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NO. You should switch to reducing SFA and trans
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SFA maximal of total kcal?
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7%
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How are trans fats formed?
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hydrogenation of unsaturated fats.
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what do monounsat fat - omega 3 FA (linolenic acid) and polyunsat fat do to cholesterols?
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LDL nothing to HDL.
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What predicts serum cholesterol?
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fat predicts serum cholesterol.
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Coconut oil SFA case
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SFA = lauric acid - raises HDL.
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How does fibre affect cholesterols (2) ?
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fibre reduces LDL and serum cholesterol
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How does fibre reduce risk of CVD?
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slows gastric emptying and maintains satiety.
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Can plant sterol slower LDL
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YES F*&( this course
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What is the nutrition therapy for immediately after a myocardial infarction?
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progression from liquids to solids.
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What is the main etiology of heart failure?
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impaired left ventricular myocardial function
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how does the heart respond to hypertrophy left ventricle with heart failure? how does this play into the disease?
How is the left ventricle re-modeled? How does this affect contractility? |
increases SNA and RAS and increases symptoms.
dilated - decreases contractility. |
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What is essential in medical therapy for heart failure?
Therefore, what is a nutritional therapy technique (2) ? |
control of BP
reduce sodium and fluid (reduce blood volume = reduce blood pressure). |
