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Case Study Presentation

Case Study Presentation. Angela Stancil Dietetic Intern 10/18/13. Pre-diabetes.

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Case Study Presentation

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  1. Case Study Presentation Angela Stancil Dietetic Intern 10/18/13

  2. Pre-diabetes Behan KJ. New ADA guidelines for diagnosis, screening of diabetes. Laboratory.2011;20 (1):2. http://laboratory-manager.advanceweb.com/Archives/Article-Archives/New-ADA-Guidelines-for-Diagnosis-Screening-of-Diabetes.aspx. Accessed October 16, 2013. Impaired Fasting Glucose (IFG) or Impaired Glucose Tolerance (IGT) Occurs when hyperglycemia is present but diabetes has not been diagnosed

  3. Table 2. Percentages of U.S. Adults Who Have Ever Been Told They Have Prediabetes, by State, 2010 Table 2. Percentages of U.S. Adults Who Have Ever Been Told They Have Prediabetes, by State, 2010 States with Highest Percentages of U.S. Adults Who Have Ever Been Told They Have Pre-diabetes, 2010

  4. States with Lowest Percentages of U.S. Adults Who Have Ever Been Told They Have Pre-diabetes, 2010

  5. Tennessee - Percentage of Adults (aged 18 years or older) Reporting Pre-diabetes, 2008 - 2010

  6. Under Normal Conditions Liver makes basal level of glucose Body is able to sense changes in basal BG level and is adjusted When you eat: Insulin increases Blood glucose decreases Etiology

  7. Etiology Pre-diabetes/Diabetes • Take in more CHOs than insulin is able to clear • Extra calories stored as visceral fat • Visceral fat releases chemicals • Insulin increases • Gluconeogenesis increases • Kidney is unable to clear excess glucose • 3 P’s • Excess glucose stored as visceral fat • FFA released

  8. Risk Factors

  9. Symptoms Acanthosis nigricans

  10. Complications of Disease

  11. Treatment

  12. Mr. H

  13. Overview of Patient 51 y/o, AA, M Past Medical History: GERD, Colonic polys, Chronic arthritis, smoking, ETOH, marijuana use Medical Diagnosis: Pre-diabetes Referred to Nutrition Copper clinic due to A1C of 6.2 and the 3 P’s

  14. Nutrition Assessment • Anthropometrics: Ht: 68 in. Wt:144.3 lbs DBW: 138 – 169 lbs % DBW: 94% Recent Weight Changes: -2 lbs since last visit with PCP BMI 21.9 (normal)

  15. Nutrition Assessment Pertinent Labs: A1C of 6.2 % , all other labs WNL Pertinent Medications: Omeprazole Physical Activity : None Diet History:

  16. Nutrition Diagnosis Imbalance of nutrients related to meal inconsistency and frequent intake of calorically dense snacks as evidenced by A1C of 6.2% at last PCP visit.

  17. During the Session the Following was Discussed: Concern about improving blood glucose to prevent diabetes Desire to eat healthier foods Concern about vision Sleep Patient mentioned fasting for religious reasons for up to 7 days at a time

  18. Nutrition Education Patient was educated on how hyperglycemia can negatively affect organs Patient was introduced to the importance of maintaining blood glucose through meal consistency Handouts provided: Nutrition Goals

  19. Nutrition Intervention NUTRITION PRESCRIPTION: Decrease blood glucose to A1C ≤ 5.7 % NUTRITION INTERVENTION: Meal consistency a. aim for three meals/snacks daily 2. Choose foods that you like for these meals 3. Reduce juice to ≤ 4-8oz. servings/day

  20.  NUTRITION MONITORING and EVALUATION:  Lab values WNL - A1C at goal of ≤ 5.7 % Comply with appropriate diet - meal or snack three times daily

  21. Summary • Disease Prognosis “Without lifestyle changes to improve their health, 15% to 30% of people with pre-diabetes will develop type 2 diabetes within five years.” • Center for Disease Control and Prevention • Nutrition Prognosis • Comprehension : Good • Expected Compliance : Fair – the patient seemed to understand the importance of changing his diet but not ready to make big changes

  22. Q & A

  23. References American Diabetes Association. Prediabetes. Diabetes Basics webpage. Available at http://www.diabetes.org/diabetes-basics/prevention/pre-diabetes/. Accessed October 14, 2013. Center for Disease Control and Prevention. Diabetes Report Card 2012:National and State Profile of Diabetes and its Complications. Diabetes webpage. Available at http://www.cdc.gov/diabetes/pubs/reportcard/prediabetes.htm. August 12, 2012. Accessed October 14, 2013. Center for Disease Control and Prevention. Prediabetes. Diabetes webpage. Available at http://www.cdc.gov/diabetes/consumer/prediabetes.htm. August 13, 2012. Accessed October 14, 2013. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. Prediabetes: What You Need to Know. Available at http://diabetes.niddk.nih.gov/dm/pubs/prediabetes_ES/. July 24, 2013. Accessed October 14, 2013. Center for Disease Control and Prevention. Diabetes Data and Trends. Diabetes webpage. Available at http://apps.nccd.cdc.gov/DDTSTRS/Index.aspx?stateId=47&state=Tennessee&cat=riskfactorsfordiabetes&Data=data&view=TO&trend=Prediabetes&id=27. Accessed October 16, 2013. Center for Disease Control and Prevention. 2011 National Diabetes Fact Sheet. Diabetes webpage. Available at http://www.cdc.gov/diabetes/pubs/general11.htm. May 20, 2011. Accessed October 16, 2013.

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