Chapter Review

BRING IT HOME

CHAPTER 5 BRING IT HOME

Focus on type 2 diabetes

Type 2 diabetes affects at least one in 10 U.S. adults 20 years or older—and at least one in four older than 65 years. To better understand your risk of developing type 2 diabetes, as well as strategies for prevention and treatment, visit the website for the American Diabetes Association at www.diabetes.org.

Question 5.8

1. Take the Type 2 Diabetes Risk Test found at www.diabetes.org/are-you-at-risk/ to address these questions:

  1. What was your score (on their scale from 1 to 10, with 10 representing those at highest risk)?

  2. List any risk factors identified under Your Risk Factors, as well as the points earned for each.

  3. Click on Next Steps to learn more about your risk factors and ways to reduce risk. List at least one way each of these contributes to risk and at least one strategy to help prevent type 2 diabetes.

Question 5.9

2. Go to www.diabetes.org/diabetes-basics/ to address these questions and learn more about the symptoms of and myths about type 2 diabetes.

  1. Click on Symptoms (www.diabetes.org/diabetes-basics/symptoms/) and list five common symptoms of diabetes.

  2. Click on Diabetes Myths (www.diabetes.org/diabetes-basics/myths/). Read over the diabetes myths, choose one, and briefly describe how the information provided clarifies the common misconception.

Question 5.10

3. Go to Diabetes Meal Plans and a Healthy Diet at http://www.diabetes.org/food-and-fitness/food/planning-meals/diabetes-meal-plans-and-a-healthy-diet.html and use the information provided to answer these questions:

  1. What is a diabetes meal plan?

  2. Briefly describe the “Create Your Plate” and “Carbohydrate Counting” meal planning tools.

Take It Further

  1. Share the Type 2 Diabetes Risk Test with a family member or friend.

  2. Take the Type 2 Diabetes Risk Test for an individual with the following profile: 44-year-old male with a family history of diabetes, high blood pressure, 5'10" tall, and 210 pounds. What is his score? Identify three lifestyle strategies to help lower this individual’s risk of developing type 2 diabetes.

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KEY IDEAS

KEY IDEAS

  • Diabetes mellitus, more commonly known as simply diabetes, is a disease that disrupts the body’s ability to adequately regulate glucose metabolism.

  • Insulin and glucagon are hormones secreted by the pancreas that regulate glucose metabolism and blood glucose levels.

  • Insulin enables cells in the skeletal muscle, cardiac muscle, and adipose tissue to take up glucose from the blood. Insulin also promotes the conversion of excess glucose to glycogen in the liver and muscle. Additionally, as glycogen storage is limited, insulin stimulates the conversion of glucose to fat in the liver and adipose tissue.

  • Glucagon is responsible for increasing glucose availability in the blood when blood glucose levels fall by signaling the liver to break down glycogen or synthesize new glucose molecules.

  • Type 1 diabetes is an autoimmune disease characterized by the destruction of insulin-producing cells in the pancreas and increased levels of blood glucose (hyperglycemia).

  • Type 2 diabetes is the most common form of diabetes and is characterized by insulin resistance and hyperglycemia.

  • Insulin resistance is a common condition in which cells lose their sensitivity to insulin and often precedes development of type 2 diabetes.

  • A diagnosis of diabetes is based on blood glucose concentrations of at least 126 mg per 100 ml of blood after an 8-hour fast, and an oral glucose tolerance test result of at least 200 mg per 100 ml 2 hours after the ingestion of 75 grams of glucose.

  • Individuals with prediabetes or glucose levels higher than normal (typically 100–125 mg/dl), but not high enough to be diagnosed with type 2 diabetes are more likely to develop some form of diabetes and are at higher risk of heart disease and stroke.

  • Diabetes affects many major organs, including the heart, blood vessels, nerves, eyes, and kidneys. Controlling blood glucose levels can help prevent these complications, which can be disabling or even life-threatening.

  • Gestational diabetes is a common form of diabetes that afflicts women during pregnancy, particularly women who are overweight or obese. Most women revert to normal blood glucose levels following delivery, but may be at increased risk of developing type 2 diabetes later in life.

  • Although type 2 diabetes is influenced by genetics, lifestyle modifications including a diet rich in whole grains, beans, and healthy fats, along with regular physical activity and maintenance of a healthy body weight, can reduce the risk of or potentially reverse the disease.

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  • Diets that emphasize foods with resistant starch (foods that are resistant to digestion because of their physical structure) may improve insulin sensitivity, satiety, and blood glucose control.

  • Food sources of carbohydrates can have different effects on blood glucose levels. The glycemic index (GI) is a ranking of how food affects blood glucose relative to the effect of an equivalent amount of carbohydrate. Although the clinical relevance of using GI is unclear, a more applicable measure may be the glycemic load (GL), which indicates the effect of typical portions on blood glucose.

  • Hypoglycemia, or low blood glucose levels, may result from overmedication in individuals with diabetes, in response to prolonged periods of not eating, to consuming excessive amounts of alcohol, or in rare cases, from abnormalities in the way the body produces and responds to insulin.

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NEED TO KNOW

NEED TO KNOW

Review Questions

Question 5.11

1. All of the following are true for the hormone insulin, EXCEPT that it:

  1. functions to lower blood glucose levels.

  2. enhances storage of excess glucose to fat in adipose tissue.

  3. enhances conversion of excess glucose into glycogen in liver and muscles.

  4. is required for release of glucose from glycogen stores.

  5. is secreted by cells in the pancreas.

1. d

Question 5.12

2. All of the following are true for the hormone glucagon, EXCEPT that it:

  1. triggers the synthesis of glycogen in the liver.

  2. signals the liver to release glucose into the blood.

  3. is secreted from the pancreas.

  4. works with insulin in regulating blood sugar levels.

  5. signals glucose production from amino acids.

2. a

Question 5.13

3. In type 1 diabetes, cells in the pancreas:

  1. are less responsive to effects of circulating insulin.

  2. secrete excessive amounts of insulin.

  3. secrete excessive amounts of glucagon.

  4. are destroyed by the body’s immune system.

  5. multiply to provide sufficient amounts of insulin.

3. d

Question 5.14

4. Type 2 diabetes:

  1. is characterized by an absence of insulin production by the pancreas.

  2. is characterized by insulin resistance and obesity.

  3. is caused by excessive intake of sugar or sucrose.

  4. occurs only during pregnancy and disappears after delivery.

  5. is an autoimmune disease.

4. b

Question 5.15

5. Ketone bodies in the blood:

  1. are synthesized from the breakdown of amino acids.

  2. stimulate the action of insulin in glucose uptake by the body’s cells.

  3. can be used as an energy source when glucose use is impaired.

  4. can increase the alkalinity of the blood to dangerous levels.

  5. are correlated with low blood insulin levels.

5. c

Question 5.16

6. All of the following are true with regard to insulin resistance, EXCEPT that it:

  1. develops in the latter stages of type 2 diabetes.

  2. can occur even when the pancreas produces normal amounts of insulin.

  3. is associated with excess adipose tissue and obesity.

  4. blocks insulin’s ability to adequately suppress liver glucose production.

  5. results in impaired removal of excess glucose from blood.

6. a

Question 5.17

7. The elevated blood glucose level that is needed for a diagnosis of diabetes following an oral glucose tolerance test is:

  1. 100 mg/100 ml blood.

  2. 125 mg/100 ml blood.

  3. 150 mg/100 ml blood.

  4. 175 mg/100 ml blood.

  5. 200 mg/110 ml blood.

7. d

Question 5.18

8. All of the following are true with regard to complications from diabetes, EXCEPT that they:

  1. can be minimized or avoided with proper blood glucose management.

  2. are much more prevalent in type 1 than in type 2 diabetes.

  3. can result in the primary cause of adult blindness.

  4. increased risk of heart attack and stroke due to the effect on blood vessels.

  5. can cause weight loss and increased burning of fat for energy.

8. b

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Question 5.19

9. Expectant mothers with gestational diabetes:

  1. usually give birth to a full-term baby that is significantly smaller than normal birth weight.

  2. have increased risk of complications during pregnancy.

  3. are at the same risk for developing the condition whether they are underweight, normal, or overweight.

  4. are almost always still diabetic following delivery.

  5. represent only about 2% of mothers.

9. b

Question 5.20

10. All of the following are dietary factors associated with increased risk of developing type 2 diabetes, EXCEPT:

  1. sugar-sweetened beverage consumption.

  2. high intake of refined carbohydrates.

  3. excess calorie intake.

  4. unsaturated fat intake.

  5. low intake of whole grains.

10. d

Question 5.21

11. Diets that emphasize foods with a low glycemic index (GI):

  1. may be low in dietary fiber.

  2. increase the risk of hyperglycemia.

  3. may help in blood glucose control.

  4. are generally high in sugar.

  5. increase risk of obesity.

11. c

Question 5.22

12. The type of hypoglycemia that may occur in a few individuals following a meal is termed:

  1. reactive hypoglycemia.

  2. insulin resistant hypoglycemia.

  3. autoimmune hypoglycemia.

  4. fasting hypoglycemia.

  5. metabolic syndrome.

12. a

Take It Further

Describe the roles of insulin and glucagon in maintaining a desirable blood glucose level.

Dietary Analysis Using SuperTracker

Dietary Analysis Using SuperTracker

Analyzing specific dietary carbohydrates

Complete this diet analysis to identify specific dietary carbohydrates that are associated with metabolic disorders.

Question 5.23

1. Log onto the United States Department of Agriculture (USDA) website at www.supertracker.usda.gov. If you have not done so already, you will need to create a profile to get a personalized diet plan. This profile will allow you to save your information and diet intake for future reference. Do not use the general plan.

Question 5.24

2. Click the Track Food and Activity option.

Question 5.25

3. For one day, record food and beverage intake that most reflects your typical eating patterns. Enter each food and beverage you consume into the food tracker. Note that there may not always be an exact match to the food or beverage that you consume, so select the best match available.

Question 5.26

4. Once you have entered all of your food and beverage choices into the food tracker, on the right side of the page under the bar graph, you will see Related Links: View by Meal and Nutrient Intake Report. Print these reports and use them to answer the following questions:

  1. How many grams of carbohydrate did you consume? Did you reach your target level?

  2. Was your carbohydrate intake within the 45% to 65% of calories that is recommended?

  3. How many grams of added sugars did you consume? How would this amount need to be modified for a person with diabetes?

  4. Identify two dietary changes a person with diabetes would be advised to make to help keep their blood sugar under control.

  5. Next, analyze your lactose intake. How many foods did you consume that contain lactose? How would this need to be modified for a person with lactose intolerance?