MNT Diabetes

MNT: Diabetes

By Caroline Geist

2: prediabetes with archie

1: insulin with betty

ok heres the tea

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3: gestational with jughead

4: type 1 with veronica

5: type 2 with cheryl

lets gooooooo!

Insulin Resistance

Part 1: Betty

Part 1: Betty: Insulin Resistance

who's going to ace this part???!!!

​

Open Ended

What are 3 ways insulin lowers blood glucose?

​Insulin:

1. Helps glucose enter muscle, fat, and liver cells.

2. Stimulates the liver and muscles to store excess glucose.

3. Reduces blood glucose production in the liver.

Part 1: Betty: Insulin Resistance

Multiple Choice

Having dark, velvety patches on the skin that indicates insulin resistance is called:

• THE SERIAL KILLER GENE

• Aconthosis Nigricans

• Acerosis Nagthicans

• Atherosclerosis

Multiple Select

Insulin resistance increases risk of:

• Type I diabetes

• Type II Diabetes

• prediabetes

Multiple Choice

What is the most effective way to increase insulin sensitivity?

• Lose weight

• Low-carb diet

• Increase physical activity

oh no! Betty, a diabetic, has collapsed!

Multiple Choice

Betty's blood glucose is 60 mg/dL. She is:

• A SERIAL KILLER

• hyperglycemic

• normal

• hypoglycemic

Hypoglycemia: >70 mg/dL

​

Part 1: Betty: Insulin Resistance

Open Ended

You figure out she is in a mild hypoglycemic state. What will you do to help her?

-give 15-20 g carbs

-​simple, easily digestible carbs

-retest in 10-20 minutes; retreat if <70​ mg/dL

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Mild hypoglycemic treatment:

​

Severe hypoglycemic treatment:

​

-give 15-20 g carbs

-may have to give ​

-​simple, easily digestible carbs

-retest in 10-20 minutes; retreat if <70​ mg/dL

Multiple Choice

As Betty recovers, Jughead falls into a severe hypoglycemic coma. What should you do?

• Give him a Snickers bar

• Give him some fruit

• Put honey in his cheek

• Shake him to wake him up

Now you know all about insulin!

​

Part 1: Betty: Insulin Resistance

Prediabetes

Part 2: Archie

Multiple Select

Most people with prediabetes develop Type 2 within 10 years. What lifestyle changes decrease this risk?

• Losing 5-7% of body weight

• Using insulin pumps

• High carb diet

• Increasing physical activity

Open Ended

List as many prediabetes risk factors as you can think of.

-overweight/obese

-45+ years old

​-parent/sibling with T2

-low physical activity

-having Gestational Diabetes

-Giving birth to a 9+ lb baby​

​-Race, ethnicity​

Part 2: Archie: Prediabetes

Risk factors for Prediabetes​:

Open Ended

What is the pathophysiology behind prediabetes?

The pathophysiology of prediabetes:

Beta cells are no longer produce in​sulin in sufficient amounts, and continue to degrade, leading to type 2 diabetes.

Part 2: Archie: Prediabetes

Multiple Choice

What is commonly prescribed with the goal of slowing the development of prediabetes?

• Statins

• Insulin

• Mastins

• Metformin

Open Ended

What are the nutrition intervention goals of prediabetes?

MNT goals of prediabetes:

• Reduce risk of Type 2

• Reduce energy intake if indicated

• Weight loss may be needed (5-7%)

• Increase physical activity

• Healthy food choices

• ​Maintain optimal metabolic factors

• (A1c, FG, PPG, Blood pressure, LDL, HDL, Triglycerides, etc.​)

Part 2: Archie: Prediabetes

you might think this is hard... but clearly you've never known the epic highs and lows of high school football.

Break time!

Gestational diabetes

jughead

Multiple Choice

Surprise! Jughead is pregnant. When should he be screened for gestational diabetes?

• 11-15 weeks

• 24-28 weeks

• Immediately

• At any point

Open Ended

Why should Jughead be screened at this time?

This is when insulin-antagonist hormone levels and insulin resistance are highest.​

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GD screening

Open Ended

Describe one of the ways Jughead may be tested.

-one-time OGTT

(3-hour, 75 g)​

(best with high risk groups)

-GCT followed by OGTT if indicated​

-GCT: 1-hour, 50 g

-if >140, OGTT indicated​

​

​

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GM Testing

Multiple Choice

Jughead takes the one-time, 2-hour OGTT test. He has a glucose level of 170 mg/dL. Does he have GD?

• Yes

• No

​Fasting >92 mg/dL

One-step: 75 g load​

1h >180 mg/dL

2h >153 mg/dL​

​2-Step:

1. 50 g load

>140 indicates 2nd test

2. 100 g load

2h >140 mg/dL

​

​

​

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GM Diagnosis

Open Ended

As Jughead's dietitian, what would your MNT goals be?

• Adequate energy intake

  -modest energy restriction if wt loss is

  indicated

• Recommend PA

• ​Check blood sugar regularly

​

​

​

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GM MNT

Multiple Choice

True/False: Once Jughead delivers his baby, Bughead, he has a 80% chance of having Type 2 Diabetes immediately afterward.

• True.

• False.

hi, i'm jughead, and i have gestational diabetes. i know, i'm weird. i'm a weirdo.

Type 1 diabetes

veronica

Multiple Choice

Type 1 Diabetes accounts for what % of overall diabetes diagnoses?

• 1-2%

• 2-5%

• 5-10%

• 10-20%

Multiple Choice

What is the peak incidence of Type 1 Diabetes diagnoses?

• infancy

• childhood

• puberty

• young adulthood

Open Ended

Describe the difference between immune-mediated and idiopathic diabetes.

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Immune-mediated​

idiopathic diabetes:​

-autoimmune

​-destruction of beta-cells

-associated with celiac, thyroid disease​

-no known etiology

-minority of T1​

Open Ended

What is the "honeymoon stage" in type 1 diabetes?

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Type 1 Diabetes: The Honeymoon Stage

• ​Occurs over (roughly) one year around diagnosis

• Exogenous insulin ​needs are decreased and blood glucose is easily managed

• Exogenous insulin is inevitable

Open Ended

List as many symptoms of type 1 diabetes as you can think of:

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Type 1 Diabetes: The Symptoms

• ​Drastic weight loss

• Hyperglycemia

• ​Polyuria

• Polydipsia

• Polyphagia

• Dehydration

• Acetone/fruity scented breath

-due to ketoacidosis​

Multiple Select

Type 1 is managed through (select all that apply)

• Daily blood glucose monitoring

• Syncing insulin with food intake

• Weight loss

• Insulin pumps

Multiple Choice

True/False: Veronica should focus equally on micronutrients and macronutrients.

• True.

• False.

Multiple Choice

After tracking her macros, Veronica finds that carbs are 40% of her kcal, protein is 25%, and fat is 35%. Is she within a healthy parameter for Type 1?

• Yes

• No

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Type 1 Diabetes: Macros

• ​Carbs: 40%

• Protein: 20-30%

• Fat: 30-35%

  ​

Type 2 diabetes

Cheryl

Saving the best for last...

Open Ended

List and define the 3 P's.

Open Ended

Tori notices Cheryl is exhibiting symptoms of T2D. What are some of the symptoms she might be noticing?

-polyphagia

-polyuria

-polydipsia

-always tired

-slow wound healing

-blurry vision

-tingling in hands and feet​

-sexual problems​

​

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Type 2 diabetes symptoms​

Open Ended

Cheryl experienced excessive urinating before she was diagnosed with Type 2 Diabetes. Why?

-the kidney has a blood sugar threshold of 180 mg/dL​

-above this, it begins spilling glucose into the urine, increasing urine output.

Polyuria pathophysiology

​

Multiple Select

Who should be screened for T2DM? select all that apply.

• Someone whose sister had GD

• Overweight adults

• Someone with PCOS

• Someone with hypertension

• overweight/obese​

• 45+ years old​

• first degree familial diabetes

• Low​ PA

• Having GDM

• Race/ethnicity

• Prediabetes

• PCOS

Type 2 Diabetes | Cheryl

T2DM Risk factors

​

Multiple Select

Because his twin has Type 2 Diabetes, Jason Blossom is at a higher risk. What can he do to reduce this risk? (Select all that apply)

• Increase physical activity

• Give insulin

• Eat low carb diet

• Eat low fat diet

• Mechanism: Slows down glucose production in the liver

• Makes cells more sensitive to insulin

• Fairly inexpensive

• Contraindications

  -Kidney/liver/heart issues

  -Acute illness

Type 2 Diabetes | Cheryl

Metformin

​

Discuss basic carb counting, advanced carb counting, and exchange lists. What are they, and what are their indications?​ Pros and cons of each?

Type 2 Diabetes | Cheryl

Let's Talk!

​

the end

Multiple Select

bonus question: Dr Amaya loves it when you say "diabetes"

• no

• no

• no

• no