1 / 17

Type 2 DM - Case Study

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 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;

doane
Télécharger la présentation

Type 2 DM - Case Study

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. 2/18/00 Type 2 DM - Case Study Jean Kerver, MS, RD, CDE kerverje@pilot.msu.edu

  2. 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.

  3. 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.

  4. Breakfast (24-hr recall) 2 cups raisin bran 1 lg banana 1 cup whole milk 8 oz orange juice Lunch 4 oz corned beef 1 oz swiss cheese 2 slices rye bread ½ cup cole slaw 2 tbsp russian dressing 1 small bag potato chips 12 oz juice cocktail 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

  5. Dinner (24-hr recall, cont’d) 1 cup fried rice 4 oz Hunan chicken (fried) 4 oz shrimp and cashews 2 bottles beer 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

  6. 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

  7. 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

  8. ADA Exchanges

  9. 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.

  10. Negotiate, then Convert CHO (250 g)

  11. Convert PRO(100 g)

  12. Convert FAT (67 g)

  13. Diet Pattern Totals: 249 101 65 Rx Totals:250 100 67

  14. Metabolic Effects of Exercise in Type 2 DM Lipolysis Decreased Plasma Insulin Lower Blood Glucose Increased peripheral glucose uptake Increased Insulin Sensitivity

  15. Multiple Dose Regimen When Therapy Changes 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

  16. Diabetes Education • Tell patient what to expect • Individualize-always give choices • Be systematic-prioritize • Discuss coping strategies • Special situations

  17. Evaluating Outcomes in DM Treatment Outcomes Can Be: ClinicalEconomicQuality 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

More Related