The University of Maryland Dietetic Internship

Mini Case Study

Samantha Koterwas
September 2015

Nutrition Assessment: Medical Dx Hyperglycemia, New onset of Type 2 Diabetes Mellitus

Age: 40
Labs:
Gender: Male
Labs
9/17
9/18
Weight: 174# (81.3kg)
Glucose
696
203
138% IBW
FSBG
290-360
201-218
ABW: 65kg
HgbA1C
11.4
TG
838
Height: 64 in (162.56cm)
HDL
37
BMI: 30.67 ~ 31 (Obese)
Total C
222
Non HDL C
185
PMHx
HTN
Symptoms
Pt c/o polyuria x5 days PTA, weakness
Diet History
100% PO intake since admission.
Per pt, eats jasmine rice everyday, does not
pay attention to portion size. Previously
uninterested in nursing education per
GEMBA. In denial regarding Dx does
not plan on taking insulin at this time.

Medications:
Heparin sodium (anticoagulant)
Pepcid (histamine-2 blocker- decreases the
amount of acid the stomach produces)
Zofran (antiemetic)
Insulin aspart (NovoLOG, HumanLOG)
-100 Units, Q4
Current Diet
CCD low 1200-1500 kcal

Nutrition Diagnosis utilize PES Statements

1. Food and nutrition related knowledge deficit (NB-1.1) related to need for carbohydrate controlled
diet as evidence by new onset of Type 2 Diabetes Mellitus.
2. Impaired nutrient utilization (NC-2.1) related to uncontrolled/undiagnosed diabetes as evidence
by elevated blood sugars and HgbA1C of 11.4.
Nutrition Intervention Nutrition prescription, Interventions with goals
Nutrition Prescription
Intervention with goals
(Using ABW r/t Obesity)
1. RC-1.4: Collaboration with other providers:
22-26 kcal/kg 1430 1690 kcal per day
recommend adding Cardiac diet along w/ current
CCD low diet.
0.8-1.0 gm/kg 52-65 grams per day
Goal diet ordered
2. Diabetes E-1.3: Nutrition education- CHO
After reviewing pts lipid profile, plan on
consistent MNT
adding Cardiac restrictions to current diet
- Discussed the important of carbohydrate
order. Also noted that Patient does not plan
counting in blood glucose control.
to use insulin at this time. Although a CCD
- Indicated foods that contain carbohydrates
low diet barely meets patients estimated
- Reviewed 1 serving of food with carbohydrate
needs, most appropriate without
has about 15 grams of carbohydrate. This concept
medications. Pt is also Obese moderate
is the major concept when meal planning and label
weight loss would be beneficial.
reading.
- Recommended healthy food options that fit well
1500 calorie, CCD low, Cardiac diet
in a diabetic diet, and ones that dont.
- Demonstrated MyPlate method with patient and
provided a sample menu.
Goal Client understands the importance of
carbohydrate-controlled diet.

Nutrition Monitoring and Evaluation

Indicator
1. FH-5.1.3: Ability to recall nutrition
goals

Criteria
1. Patient can verbalize the basics of carbohydrate
counting and describe the basic concepts of the
MyPlate Method.

2. FH-1.2.2.3: Meal/snack pattern

2. Ability to describe a healthy diet pattern with

correct carbohydrate servings at each meal/snack.

3. BD-1.5: Nutrition-related labs

3. Monitor glucose levels, HgbA1C

After reviewing the sources below, the most overarching concept is that there is no ideal percentage of
carbohydrates, protein, or fat for all people with diabetes; macronutrient distribution should be
individualized.
Source
Kcal requirements
Protein requirements
Fluid requirements
Facility standards
1430 1690 kcal per day 52-65 grams per day
1,950
(using 22-26 kcal/kg)
(using 0.8-1.0 g/day)
(Using 30 ml/kg)

EAL

25-30 kcal/kg is general

formula to keep stable
weight however Pt is
obese and shows no other
comorbidies that would
require increased energy
intake.
Reduction of energy
intake and weight loss
independently improve
insulin sensitivity in
individuals with type 2
diabetes in the shortterm.

Other Source
(American Diabetes
Association)

Your calorie needs are

individualized on many
factors: age, weight,
activity level,
comorbidies

Online nutrition care

manual

For overweight or obese

adults with type 2
diabetes, reducing energy
intake while maintaining
a healthy eating pattern is
recommended.

References:

Pt shows no other
comorbidies that would
require increased
protein.

Pt does not show a need

for fluid restriction. Pt
is recovering from
dehydration r/t polyuria
x5 days.

In persons with type 2

diabetes, with normal
renal function, the RD
should advise that usual
protein intake of
approximately 15-20%
of daily energy intake
and does not need to be
changed.
While amount of protein
is generally stays the
same, protein foodsources should be also
considered for type and
amount of fat content.
Goals for protein should
be individualized.

N/A*

N/A*

N/A*

1. Academy of Nutrition Dietetics Evidence Analysis Library. 2008 Diabetes Mellitus Type (DM)
1 and 2 Evidence-Based Nutrition Practice Guideline. Published 2008.
2. Academy of Nutrition and Dietetics. International Dietetics and Nutrition Terminology (IDNT)
Reference Manual. Chicago, IL: American Dietetic Association; 2013.
3. Academy of Nutrition and Dietetics. Nutrition Care Manual.
http://www.nutritioncaremanual.org. Accessed September 2015.
4. "Protein Foods." American Diabetes Association. N.p., 26 Aug. 2014. Web. 28 Sept. 2015.
a. http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-foodchoices/meat-and-plant-based-protein.html
5. "How Many Calories Do I Need?" American Diabetes Association. N.p., 15 May 2015. Web.
28 Sept. 2015.
a. http://www.diabetes.org/food-and-fitness/weight-loss/food-choices/how-many-caloriesdo-i-need.html

Social
Unemployed, not-married, lives
with parents.
Provided education to pt as well
as significant other to promote
diet change adherence and
support.
Provided handouts - suggested
displaying sample menu on the
fridge for all household
members to be aware of
information.

More tightly controlled diet is

more appropriate.
3 meals per day(3 carbohydrate
servings at each), 1 HS snack (1-2
carbohydrate servings)
Promote weight loss through
physical activity and healthy diet.
Pt does not wish to be on insulin
at this time

Patient
Specific
Diabetic
Educatio
n

Medication

Reportedly "in denial"

Questions r/t specific food
options

Patient Feedback

Used Basic methods to explain,

such as MyPlate and reading
the food label.
Emphasized that moderation is
key. Rice is still okay to
consume, however, limit to one
time per day and pay close
attention to serving size. Try
switching to brown rice.

New dx
Pt enjoys Jasmine Rice

Encouraged patient participation,

such as food preferences -i.e.
"What are some of your favorite
vegetables?"
Following the pace of the patient
during education - interested in
reading food labels.

Diet History