Sort 2 DM - Case Study

Presentation Transcript

2/18/00 Type 2 DM - Case Study Jean Kerver, MS, RD, CDE kerverje@pilot.msu.edu

DR is a 45 y.o. male; Ht : 5'9"; Wt : 215 lbs Present protestation : polydipsia, polyuria, exhaustion. 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 sort 2 DM at age 60 yrs Social hx : modeler; lives alone; nonsmoker; no customary physical movement. Consume less calories hx : no known sustenance sensitivities; no supplements (vit/min or other); no uncommon eating regimen; drinks 2 brews qd after work; brkfst at home; lunch out—fast food or store sort; dinner at home — cooks or requests take-out nourishment; seldom snacks.

Breakfast (24-hr review) 2 mugs raisin grain 1 lg banana 1 glass entire drain 8 oz squeezed orange Lunch 4 oz corned hamburger 1 oz swiss cheddar 2 cuts rye bread ½ container cole slaw 2 tbsp russian dressing 1 little sack potato chips 12 oz juice mixed drink 4 starch, 1 fruit 380 kcals 2 fruit 120 kcals 1 high fat milk 150 kcals 2 fruit 120 kcals 4 med-fat meat 300 kcals 1 high-fat meat 100 kcals 2 starch 160 kcals 1 vege, 1 fat 70 kcals 2 fat 90 kcals 1 starch, 1 fat 125 kcals 150 kcals

Dinner (24-hr review, cont'd) 1 glass fricasseed rice 4 oz Hunan chicken (seared) 4 oz shrimp and cashews 2 bottles lager 1 lg orange Total kcals : 3411 Protein : 14% Fat : 40% Carb : 46% 3 starch, 3 fat 375 kcals 4 high fat meat 400 kcals 4 high fat meat 400 kcals 2 beer 300 kcals 2 fruit 120 kcals Total Kcals : 3360

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 half 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

Negotiate, Then Convert Into Exchanges First, decide what number of servings of drain, natural product, and vegetables the patient will eat every day. Next, include the CHO from the drain, natural product, and vegetable gatherings and subtract that measure of CHO from the aggregate sum of CHO required. At that point isolate the rest of the measure of CHO into starch trades. Do likewise for PRO and FAT.

Negotiate, then Convert CHO (250 g)

Convert PRO (100 g)

Convert FAT (67 g)

Diet Pattern 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 fringe glucose take-up Increased Insulin Sensitivity

Multiple Dose Regimen When Therapy Changes NPH + Humalog BID Add Bedtime NPH to Orals Combinations of Oral Agents: Metformin + Sulfonylureas, and so forth. Monotherapy Oral Agents: Sulfonylureas, Metformin, Troglitazones, and so on. Dinner Planning and Physical Activity

Diabetes Education Tell quiet what's in store Individualize-dependably give decisions Be deliberate organize Discuss adapting systems Special circumstances

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 - expenses to - keeps appts. Weight/BMI wellbeing arrangement - Rx refills Blood weight Complications Better work Q of Life study participation