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    Type 2 DM - Case Study: Jean Kerver, MS, RD, CDE Kerverje@pilot - Msu.edu

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    Joey Policar
    This case study describes a 45-year-old male with type 2 diabetes who is non-compliant with his diet and medication. He consumes over 3000 calories per day and has an HbA1c level of 9.2%, indicating poor blood sugar control. The document outlines recommendations to help control his blood sugar levels through a 2000 calorie diet plan divided into carbohydrate, protein and fat exchanges. It also discusses the benefits of exercise and diabetes education to improve insulin sensitivity and self-management.

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    Type 2 DM - Case Study: Jean Kerver, MS, RD, CDE Kerverje@pilot - Msu.edu

    Uploaded by

    Joey Policar
    59 views17 pages
    This case study describes a 45-year-old male with type 2 diabetes who is non-compliant with his diet and medication. He consumes over 3000 calories per day and has an HbA1c level of 9.2%, indicating poor blood sugar control. The document outlines recommendations to help control his blood sugar levels through a 2000 calorie diet plan divided into carbohydrate, protein and fat exchanges. It also discusses the benefits of exercise and diabetes education to improve insulin sensitivity and self-management.

    Original Description:

    Case study 2019

    Original Title

    Diabetes 4

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    This case study describes a 45-year-old male with type 2 diabetes who is non-compliant with his diet and medication. He consumes over 3000 calories per day and has an HbA1c level of 9.2%, indicating poor blood sugar control. The document outlines recommendations to help control his blood sugar levels through a 2000 calorie diet plan divided into carbohydrate, protein and fat exchanges. It also discusses the benefits of exercise and diabetes education to improve insulin sensitivity and self-management.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    59 views17 pages

    Type 2 DM - Case Study: Jean Kerver, MS, RD, CDE Kerverje@pilot - Msu.edu

    Uploaded by

    Joey Policar
    This case study describes a 45-year-old male with type 2 diabetes who is non-compliant with his diet and medication. He consumes over 3000 calories per day and has an HbA1c level of 9.2%, indicating poor blood sugar control. The document outlines recommendations to help control his blood sugar levels through a 2000 calorie diet plan divided into carbohydrate, protein and fat exchanges. It also discusses the benefits of exercise and diabetes education to improve insulin sensitivity and self-management.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 17

    2/18/00

    Type 2 DM - Case Study


    Jean Kerver, MS, RD, CDE
    [email protected]
    DR is a 45 y.o. male; Ht: 5’9”; Wt: 215 lbs
    Present complaint: polydipsia, polyuria,
    fatigue.
    Past med hx: Type 2 DM x 5 yrs.
    Meds: None; NKDA.
    Labs: No SBGM;
    serum glucose=285 mg/dL 1 hr ppd;
    HbA1C=9.2%
    urinary glucose=2+;
    temp=98.8 F.
    Family med hx: Grandma type 2 DM at age
    60 yrs
    Social hx: architect; lives alone; nonsmoker;
    no regular physical activity.
    Diet hx: no known food allergies;
    no supplements (vit/min or other);
    no special diet;
    drinks 2 beers qd after work;
    brkfst at home;
    lunch out—fast food or deli type;
    dinner at home —cooks or orders take-out
    food;
    seldom snacks.
    Breakfast (24-hr recall)
    2 cups raisin bran 4 starch, 1 fruit 380 kcals
    1 lg banana 2 fruit 120 kcals
    1 cup whole milk 1 high fat milk 150 kcals
    8 oz orange juice 2 fruit 120 kcals
    Lunch
    4 oz corned beef 4 med-fat meat 300 kcals
    1 oz swiss cheese 1 high-fat meat 100 kcals
    2 slices rye bread 2 starch 160 kcals
    ½ cup cole slaw 1 vege, 1 fat 70 kcals
    2 tbsp russian dressing 2 fat 90 kcals
    1 small bag potato chips 1 starch, 1 fat 125 kcals
    12 oz juice cocktail 150 kcals
    Dinner (24-hr recall, cont’d)
    1 cup fried rice 3 starch, 3 fat 375 kcals
    4 oz Hunan chicken (fried) 4 high fat meat 400 kcals
    4 oz shrimp and cashews 4 high fat meat 400 kcals
    2 bottles beer 2 beer 300 kcals
    1 lg orange 2 fruit 120 kcals

    Total kcals: 3411


    Total Kcals: 3360
    Protein: 14%
    Fat: 40%
    Carb: 46%
    How Many kcals Should He Have?
    Ht: 5’9”; Wt: 215 lbs
    IBW: 106 lbs + (9” x 6 lbs) = 160 lbs
    % IBW = 215 lbs /160 lbs = 134%
    AdjBW = 0.25 (215-160) + 160 = 174 lbs (79
    kg)

    25 kcals/kg = 25 x 79 = 1975 kcals/d


    24-hr = 3411 kcals – 500 kcals= 2900 kcals
    Calculation of Initial Dietary Pattern

    Total kcals = 2000

    50% CHO = 0.50 x kcal = 0.50 x 2000 = 250 g CHO


    4 kcal/g CHO 4

    20% PRO = 0.20 x kcal = 0.20 x 2000 = 100 g PRO


    4 kcal/g PRO 4

    30% FAT = 0.30 x kcal = 0.30 x 2000 = 67 g FAT


    9 kcal/g FAT 9
    ADA Exchanges
    Food Gp CHO (g) PRO (g) FAT (g) Kcals
    Starch 15 3 - 80
    Meat - 7 3-8 55-100
    Vege 5 2 - 25
    Fruit 15 - - 60
    Milk 12 8 0-8 90-150
    Fat - - 5 45
    Negotiate, Then Convert Into Exchanges
    First, determine how many servings of milk,
    fruit, and vegetables the patient is willing to
    eat each day.
    Next, add up the CHO from the milk, fruit,
    and vegetable groups and subtract that
    amount of CHO from the total amount of CHO
    needed.
    Then divide the remaining amount of CHO
    into starch exchanges.
    Do the same for PRO and FAT.
    Negotiate, then Convert CHO (250 g)
    No. of CHO (g) PRO (g) FAT (g)
    Exchanges
    Milk (12) (8) (5 - 2%)

    2 24 16 10
    Vege (5) (2) -

    3 15 6
    Fruit (15) - -

    4 60

    Starch (15) (3) -

    10 150 30
    Convert PRO (100 g)
    No. of CHO (g) PRO (g) FAT (g)
    Exchanges
    Milk (12) (8) (5 - 2%)

    2 24 16 10
    Vege (5) (2) -

    3 15 6
    Starch (15) (3) -

    10 150 30

    Meat - (7) (5)

    7 49 35
    Convert FAT (67 g)
    No. of CHO (g) PRO (g) FAT (g)
    Exchange
    s
    Milk (12) (8) (5 - 2%)

    2 24 16 10
    Meat - (7) (5)

    7 49 35

    Fat - - (5)

    4 20
    Diet Pattern
    Food No. of CHO (g) PRO (g) FAT (g)
    Group Exchanges
    Starch (15) (3) -

    10 150 30
    Meat - (7) (5)

    7 49 35
    Vege (5) (2) -

    3 15 6
    Fruit (15) - -

    4 60
    Milk (12) (8) (5 - 2%)

    2 24 16 10
    Fat - - (5)

    4 20
    Totals: 249 101 65
    Rx Totals: 250 100 67
    Metabolic Effects of Exercise in Type 2 DM

    Lipolysis

    Decreased Plasma
    Insulin

    Lower Blood Glucose

    Increased peripheral glucose uptake

    Increased Insulin Sensitivity


    Multiple
    When Therapy Changes Dose
    Regimen
    NPH + Humalog
    BID

    Add Bedtime NPH


    to Orals

    Combinations of Oral Agents:


    Metformin + Sulfonylureas, etc.

    Monotherapy Oral Agents: Sulfonylureas,


    Metformin, Troglitazones, etc.

    Meal Planning and Physical Activity


    Diabetes Education
    Tell patient what to expect
    Individualize-always give choices
    Be systematic-prioritize
    Discuss coping strategies
    Special situations
    Evaluating Outcomes in DM Treatment

    Outcomes Can Be:

    Clinical Economic Quality of


    Life

    Glycemic Control length/stay Participation in


    care
    HbA1c -ER visits - SMBG
    Blood lipids -costs to - keeps appts.
    Weight/BMI health plan - Rx refills
    Blood pressure
    Complications Better work Q of Life survey
    attendance

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