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MNT 1.

Diabetes Case Study (total 15pts)


Haley Pollock

due 11/29 in class

Case Presentation
W.G. is a 41-year-old white man with a new diagnosis of type two diabetes. He is
now beginning diabetes education and medical nutrition therapy (MNT) upon
referral from his primary care physician. His hemoglobin A1C is 8.5%. He denies
smoking, alcohol, and drug use; and knows of no health problems other than
diabetes. His history revealed a fasting blood glucose level 245 mg/dl at the time of
diagnosis. He complains of frequent urination, hunger, and thirst. He is very
concerned and feels agitated and anxious. His mother had T2DM and died of a heart
Physical assessment reveals a height of 71 inches, weight of 274 lb. He reports a
35-lb weight gain over the past year. He has abdominal obesity with a WC of 44.
W.G. reports he eats a small breakfast a small or moderate lunch and a big dinner
because he feels starving at the end of the day. You (the RDN) diet hx reveals actual
intake: 3000 kcal/d, few fruits and vegetables, 40% fat, 15% protein, 45% carb.
He reports that he is not currently able to maintain his usual 0.5 hours per day of
playing basketball because of fatigue and lack of energy.

What nutrition assessment data parameters can you identify for this patient
(5 categories)?
a. Food/Nutrition- Related History

Eating a lot later in the day; slow metabolism, storing more calories
because eating before bedtime/rest, not burning these calories off
during the day

Not eating enough throughout the day

Not enough fruits, vegetables

High fat consumption; even more of a risk factor as cardiovascular

disease runs in the family

Low protein consumption; could be lacking B12 (feeling fatigued)

Excessive energy intake: should be ~2162 calories BMR but

consuming about 1000 calories over the recommended BMR

b. Anthropometric Measurements , include IBW, % of IBW, % of UBW, BMI

and BMI category

50 kg + 2.3*11 = 75.3 kg * 2.2 = 165 pound IBW

274 lb. 165 lb. / 165 lb. = 66% above IBW

274 lb. 35 lb. weight gain = 239 lb. usual


274 lb. / 239 lb. = 114.6 UBW

114.6 - 100 = 14.6% Weight change

274 lb. * 703 / 71*71 inches = 38.2 BMI, Obese

c. Biochemical Data, Medical Tests, and Procedures

High A1C

High blood glucose levels

d. Nutrition-Focused Physical Findings

Increased urination, hunger, and thirst all signs of type two
Waist circumference over 40 inches
Little physical activity
Feeling tired/fatigued
e. Client History

Mother had type two diabetes and heart complications

What are his estimated Requirements (1pt), Use Mifflin St. Jeor, remember
to add an activity factor (take a screen grab and submit with case study).
Adjust calories to allow for wt loss.

2162 500 calories/day = 1662 calories/day to lose 1 pound a week

Nutrition Diagnosis (list 2)

a. Excessive energy intake & Disordered eating pattern

Nutrition Interventions (list 2) Remember your interventions target your

nutrition dx etiology
a. Nutrition counseling to address excessive energy intake, weight gain,
disordered eating, importance of consistent carbohydrate intake, set
goals, and monitor progress in weight loss and controlling blood
b. Coordination of care to monitor and treat type two diabetes/blood
glucose levels and monitor cardiovascular health as this is an added
risk factor due to diet and family history.
Nutrition Monitoring and Evaluation (list 2) remember your M/E targets your
nutrition dx signs and symptoms
a. Monitor blood glucose daily as well as check AIC quarterly.
b. Keep a food journal for one month and evaluate BMI and % weight loss
at each counseling session with patient.

Calculate W.G.s daily meal plan using the 12 step DM meal planning
worksheet posted on HuskyCT. Use the calorie level you determined in
question 2. You can hand write this page.

Create a one daily meal plan using actual foods for W.G. using the DM meal
plan worksheet posted on HuskyCT. You can hand write this page.