Alice is a 45-year-old woman who has had the diagnosis of ...



Danielle Selden

2-13-2012

TR5320 Case Study #2 Type 2 diabetes

Follow all the instructions to be eligible to receive full credit.

□ Use this format to submit your work.

□ Use the formats indicated by the Annotated Sample SOAP using PES statements

A 45-year-old woman who has had the diagnosis of type 2 diabetes for 3 years is referred for diabetes nutrition counseling. She works as the manager of a school cafeteria and is around food all day long. Her mother and father both have been diagnosed with CVD. She does not smoke and she has stable family life and a low stress lifestyle. Her current weight is 178 lb and her height is 63 inches. She has been at this weight for more than 6 months. She states that she doesn’t think nutrition counseling can help her because the only advice she gets is to lose weight and to stay away from sweets, neither of which is she has been able to do.

Rx: Glucophage 500mg twice a day. Occasionally takes the OTC drug Alli to try to lose weight but she thinks it doesn’t work and costs too much.

Lab tests: A1C 8.6%, TC 234 mg/dl, HDL 53, TG 285 mg/dl, FBG: 120 mg/dl ,

Measurements: BP: 120/78 mm/Hg. Waist circumference = 38” and frame size = medium.

Look at her 24-hour diet recall. It has been analyzed and it provides approximately:

• 120 gm protein

• 220 gm carbohydrate

• 90 gm fat

• 2200 kcal

Calculate the percentage of kcals in her diet provided by:

(1 pt) Protein (120 x 4(480/2200 x 100(21.8% (22%)

(1 pt) CHO (220 x 4(880/2200 x 100( 40.0% (40%)

(1 pt) Fat (90 x 9(810/2200 x 100(36.8% (37%)

(3 pts) Compared to the AMDR and dietary goals for individuals with T2DM discuss the significance of her dietary percentages for each macronutrient—protein, carbohydrate, fats.

The AMDR’s for people with T2DM have no specific differences from the normal individuals. Pt’s calculated AMDR’s:

Protein: 10-35% kcal from protein ( pt AMDR 22%, within desirable range. Pt has elevated FBG, 120mg/dl and could benefit from increasing pt’s protein intake, as referenced to protein in diabetes management (Diabetes 2, slide 15 Kazaks), “In individuals with T2DM, ingested protein can increase insulin response without increasing plasma glucose concentrations.”

CHO: 45-65% kcal from CHO ( pt AMDR 40%, below desirable range, pt needs adequate amount of CHO’s in the diet. Pt should increase CHO intake slightly but pt’s main focus must be on CHO balance and timing within the diet. In addition; goals of Medical Nutrition Therapy for Diabetes also states (Diabetes 2, slide 3 Kazaks), “Attain and maintain optimal metabolic outcomes, by keeping blood glucose normal or near normal range or as close to normal as possible.”

Fat: 20-35% kcal from fat ( pt AMDR 37%, above desirable range. Pt needs to decrease fat intake as indicated by fat in diabetes management (Diabetes 2, slide 3 Kazaks), “Limit saturated fat intake to 99% serum protein bound, but drug is minimally absorbed from intestine. Do not take with chronic malabsorption. Blood/ Serum: lower vitamin D levels, slightly lower cholesterol, lowered LDL, high HDL, high TG, lower fasting insulin, lower Vitamin A, K, E, and lower beta-carotene levels. Monitor: vitamin D levels.

Calculate the following:

(1 point) IBW:

IBW(100lbs for the first 60 inches + 5lbs/ each inch over 60 inches

100 + 5lbs(3in) (115lbs

+/-11 range( (104-126)

(2 points) BMI and category:

Kg/M2 = BMI 63 inches x 2.54cm= 160cm/ 100m= 2.6m2

178lbs/ 2.2= 52.27kg

81 Kg/2.6m2= 31.6 BMI ( Obese

(4 points) Calculate the following (show calculations and factors used)

a. Estimated calorie needs—Use the Mifflin-St Jeor Equation this time:

Mifflin-St. Jeor

(10 x wt-kg) + (6.25 x ht-cm) – (5 x age) -161 ( REE (female)

(10 x 80.9kg) + (6.25 x 160.0cm) – (5 x 45yrs) – 161 (REE

809 + 1000 – 225 – 161 (REE (1423 kcal/day

1423 kcal (1.2 activity factor) (1707.6 (1700 kcal/day

1423 kcal (1.3 activity factor) (1849.9( 1800 kcal/day

b. Identify what percentage of estimated kcal needs your client’s current diet is providing:

Percentage of estimated kcal from current diet(

Current calorie intake/ estimated calorie needs

2200 kcal/ 1700kcal x 100( 129.41( 129%

2220 kcal/ 1800kcal x 100( 122.22( 122%

(3 pts) Which of her lab tests could be directly related to her carbohydrate consumption and why?

HbAiC: Pt’s HbA1C lab results are directly related to pt’s carbohydrate consumption. A1C test results reflect average blood sugar levels over the past 2-3months by measuring what percentage of hemoglobin is glycated. When this occurs, diabetes is uncontrolled and results with too much glucose within the blood stream, binding to hemoglobin. Thus, this could indicate usual intake of carbohydrates.

FBG: Pt’s FBG lab results are elevated at 120mg/dL. The normal range for a fasting state is at 70-99mg/dL. Her diet is full of heavy processed CHO’s and simple surgers, which is evident by her FBG results. The main concern is her CHO timing that can be contributing to the problem of blood glucose regulation.

TG: Pt’s TG lab results are elevated at 234 mg/dL. The normal TG levels should be ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download