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Therapeutics IV: Exam #3 - Nutrional Considerations & CAM
n/a
20
Health Care
Graduate
11/02/2010

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Cards

Term
Medical Nutrition Therapy (MNT)
Definition
used to evaluate a pt's food intake, metabolic status, lifestyle, & readiness for change;
personalized dietary instruction & goal setting;
should include:
- amount & type of CHOs consumed;
- timing of meals & snacks;
provided by registered dietitians
Term
MNT
Definition
primary prevention for pts w/ obesity & pre-diabetes;
2ndary prevention to help prevent complications in pts w/ already established DM;
tertiary prevention to prevent morbidity & mortality in pts w/ DM-related complications
Term
Protein
Definition
meat, dairy products, eggs, legumes;
Role: to form & help repair body tissues;
1 g = 4 cal;
Causes acute increase in insulin response but does not increase circulating glucose;
Recommended:
- Normal Renal Fc: 15-20% of total cals/day;
- CKD: 0.8-1 g/kg/day
Term
Fat
Definition
found in oils, margarine, nuts, animal products;
Role: provides essential fatty acids & to carry fat-soluble vitamins;
1 g = 9 cal;
Recommended:
- Saturated <7% of total cals/day;
- minimize intake of trans;
- cholesterol intake <200 mg/day
Term
Carbohydrates
Definition
found in breads, pasta, rice, cereal, starchy veggies, fruit, dairy products, sweets;
Most direct impact on glucose levels;
1 g = 4 cal;
sugars, starches, fibers
Term
Exchanges
Definition
method used for many years;
taught what quantity of CHO-containing food amounted to 10 g, 12g, or 15 g of CHO;
Fruits, starch, carbs = 15 g
milk = 12 g
vegetable = 5 g
meat or fat = 0 g
Term
Carb Counting
Definition
involves keeping total CHO intake at each meal consistent from day to day;
helps pts dependent on insulin tailor mealtime insulin doses to cover CHOs consumed;
helps pts not dependen on insulin control glucose levels;
flexibility to enjoy favorite sweets on occasion;
only works if ACCURATE portions sizes are estimated
Term
Examples of foods w/ 15 g CHO
Definition
small piece of fresh fruit, 1/2 cup oatmeal, 1/3 cup pasta or rice, 4-6 crackers, 1 slice of bread, 1 6-inch tortilla, 1/4 serving of medium french fries
Term
Plate Method
Definition
plate divided into section:
- 1/2 fruits & veggies, 1/4 lean meat/protein, 1/4 grains/starches;
- uses 9 inch plate --> leave space around outside of plate
Term
Glycemic Index
Definition
measures CHO-counting food raises BG; foods ranked on scale of 0-100% when compared to BG response of 50 g glucose (100%);
high # raises glucose more than a food with medium or low #;
if eating food with a high #, combine it with a food with a low #;
fat & fiber lower #;
more ripe --> higher #;
processing --> higher #
Term
Prioritizing Nutrition Messages
Definition
emphasize blood glucose, lipids, & BP control;
Focus on CHO foods, portions, & # of servings per meal;
Encourage physical activity;
Use food records w/ BG monitoring data;
Term
Insulin Sensitizers
Definition
chromium, cinnamon
Term
hypoglycemic agents
Definition
bitter melon, Fenugreek, Gymnema sylvestre
Term
inhibits CHO absorption
Definition
Fenugreek
Term
Chromium
Definition
essential trace element;
Adult RDA = 50-200 mcg;
Deficiency --> impaired glucose tolerance, glycosuria, insulin resistance;
Evidence: decreased BG levels, insulin levels, A1c;
Recommend ONLY if pts w/ documented deficiency;
If pts w/ Type 2 DM want to try, use 100-500 mcg BID for 3 months, D/C if no response after 3 months;
ADRs: hypoglycemia, weight loss
Term
cinnamon (Cinnamomum cassia)
Definition
culinary spice;
May have modest effect on FPG, no difference in A1c;
Dose: 1-6 g/day;
ADRs: skin & mucuos membrane irritation/sensitivity;
Drug Interactoins: secretagogues, anticoagulant/antiplatelet meds;
C/I: allergies, liver problems, pregnant women
If pt wants to try, use specific kind
Term
Bitter melon
Definition
vegetable eaten in Asia, Africa, & Latin America;
Evidence: poorly designed trials show decrease in glucose levels & A1c;
ADRs: hypoglycemia, LFTs, HA;
Avoid if: allergic, pregnant/breast-feeding, G6DH defiency;
DON'T RECOMMEND
Term
Gymnema sylvestre
Definition
plant native to India known as "sugar destroyer";
Evidence: statistically significant decrease in FPG & A1c using 200-800 mg/day;
ADRs: hypoglycemia;
Don't recommend for widespread use until more evidence accumulates
Term
Fenugreek (Trigonella foenum graecum)
Definition
herb, spice, flavoring agent, good source of fiber;
Evidence: may lower FPG & PPG using 2.5-15 g/day;
ADRs: GI discomfort (diarrhea, flatulence);
Drug Interactions: insulin, secretagogues, antiplatelets & anticoagulants, diuretics, laxatives;
Avoid if: allergic to beans, pregnant women;
Bottom line: further studies needed, if taking separate from other meds by >2 hrs
Term
Role of Pharmacist
Definition
encourage pts to inform ALL HCPs of any CAM use;
reinforce to pts the risks & benefits of specific products;
provide information about safety & efficacy of products;
advise pts to monitor BG levels closely when taking any type of CAM product
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