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Laura Hahn
FN 4360 Case Study
Diabetes Mellitus
17 February 2016

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Table of Contents:
Introduction.3
Hypothesis6
Methods......6
Results..7
Calculations.11
Discussion........12
Hypothesis Resolution..13
References14

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Introduction
Diabetes mellitus, commonly known as type 2 diabetes, is a growing epidemic in the
world. Approximately 2 million people are diagnosed with diabetes in the United States
each year (1). Type 2 diabetes is most common in middle aged and older adults, specifically
in persons over the age of 45 years old (2).
An individual has type 2 diabetes when the cells become resistant to the pancreatic
hormone, insulin. Insulin is responsible for pushing glucose from the bloodstream into the
cells to provide the body with energy. In an individual with type 2 diabetes, the body still
produces insulin, however, the insulin is not properly removing glucose from the blood and
putting it into each cell (2). This causes a buildup of glucose in the body, and can eventually
reach toxic levels. The fasting blood glucose levels of a person with type 2 diabetes is 126
mg/dL or higher, while the fasting blood glucose levels of a healthy person would be
between 70 and 100 mg/dL (2).
To counteract the buildup of glucose in the body, the pancreas may create and
release more insulin to push the glucose into the cells. Over time, if the diabetes is not well
controlled, the pancreas becomes too damaged to produce more insulin, and stops
production (3).
There are several reasons why cells in the body become resistant to insulin, causing
type 2 diabetes. Being pre-diabetic puts an individual at a large risk for developing diabetes
mellitus. Pre-diabetes is having blood glucose levels higher than normal, but not high
enough to be diagnosed as a type 2 diabetic. Some of the causes for type 2 diabetes people
can have no control over. Genetics play a large role in the bodys ability to regulate glucose.

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People with a genetic predisposition to type 2 diabetes are more likely to become diabetic
than people without a genetic predisposition. Additionally, if a women develops gestational
diabetes during a pregnancy, she is more at risk for developing type 2 diabetes in later life.
Age and gender are also factors that influence how likely a person will become type 2
diabetic. Middle and older adults are more at risk than younger people. Statistically women
are more likely to become diabetic than men. Fortunately, there are type 2 diabetes risk
factors that people can control. Diet is also a large part in why a person may become
diabetic. Certain foods are handled differently by the body. For example, eating large
amounts of simple carbohydrates without fiber, fat, and protein causes extreme spikes in
blood glucose and insulin levels. After time, the drastic spikes of glucose and insulin in the
blood can cause insulin resistance. Lack of physical activity can also be a reason why an
individual may become a type 2 diabetic. Exercise can help force glucose molecules into the
cells from the bloodstream, aiding in blood sugar regulation and insulin efficiency (2).
It is very common or middle aged and older adults to get bloodwork during routine
physicals to test blood glucose levels. The bloodwork can help detect diabetes mellitus
early on. Symptoms of type 2 diabetes include frequent urination, excessive thirst,
unintentional weight loss, increased hunger, and extreme fatigue. Diabetes can cause
frequent urination because the kidneys filter out the abundant glucose in the blood and put
it into the urine, also causing excessive thirst to maintain fluids for urine output. Weight
loss and hunger occur because the cells inside the body are not getting glucose to function.
The body can feel exhausted when a person is diabetic because there is not proper fuel for
the cells (4).

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After an individual becomes a type 2 diabetic, there are many measures that can be
taken to ensure that the disease does not progress or cause damage to the body. Health
clinicians monitor the individuals hemoglobin A1C score to see how well the diabetes is
managed. Hemoglobin, red blood cells, are in the blood stream along with glucose
molecules. While in the blood stream, glucose can bump into and stick to the hemoglobin
cells. A hemoglobin A1C score tests how many glucose molecules are stuck to each red
blood cell. This score gives an average of the individuals blood glucose levels over a span of
three months. The hemoglobin A1C score gives a very accurate representation of each
individuals management of diabetes because it shows the average blood glucose levels
over time as a fasting blood glucose test only shows the glucose levels in that moment. The
values of the A1C score represent the percentage of the hemoglobin cell that is covered
with glucose. Evidence shows that having a hemoglobin A1C score of below 6.5-7 is good
control of type 2 diabetes (5).
Medication alone may not be enough to prevent the progression of this disease.
Clinicians may refer people with hemoglobin A1C scores above a 6.5-7 to a registered
dietitian to learn how to better manage diabetes mellitus. Registered dietitians can educate
people on how to count carbohydrates with each meal and snack, and how to couple
carbohydrates with other macronutrients to avoid high blood sugar. Twelve to seventeen
grams of carbohydrates is considered one serving. A person with diabetes can have two to
three servings of carbohydrates with each meal. It is important to eat complex
carbohydrates that are dense in fiber to slow the absorption rate of glucose in the
bloodstream and avoid glucose and insulin spikes. It is also important to eat protein with
each meal to maintain satiety and promote healing. Dietitians can also educate people on

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the importance of physical activity, as exercise can help push glucose molecules into the
cells from the blood stream.
Poorly managed diabetes mellitus can have serious consequences over time. High
levels of glucose in the blood can severely damage blood vessels and nerves. Nerve damage
can begin to happen in the extremities, causing a constant tingling and numbness in the
toes and feet. It is extremely important for diabetes to regularly check their feet for sores
and cuts to ensure that no infections occur. Blood vessel damage begins in tiny vessels in
the body, for example the kidneys and eyes. Poorly managed diabetes can cause blindness
and kidney failure because of damaged blood vessels (6). Extremely unmanaged diabetes
mellitus can even be fatal (7).
Hypothesis
The patient in this study is a 57 year old female, Mary. Mary was diagnosed with
diabetes mellitus when she was 40 years old. She is 5 feet 5 inches tall and weighs 170
pounds with a BMI of 28 (overweight). Mary routinely sees an endocrinologist for her
diabetes mellitus. She was also referred to a registered dietitian when she was diagnosed
seventeen years ago. It was hypothesized that Mary has very good control over her
diabetes and eats food to sustain her health because she regularly sees a specialized
physician for her type 2 diabetes.
Methods
On February 14, 2016 Mary was interviewed about her diabetes mellitus. The
interview was done in her home and on a one-on-one setting. Mary was asked about her
typical diet, what measures she takes to control her diabetes, and how diabetes impacts her

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daily life. The interview included a 3-day food record of the food that she consumed. Mary
was informed to record all the food that she ate for two weekdays and one weekend in
advance.
After the 3-day food record was collected, the information given was inputted into
SuperTracker, an application to analyze the nutrients consumed from each food that was
eaten.
Results
Mary explained during her interview that she was first diagnosed with diabetes
mellitus when she was 40 years old. Her mother had diabetes that was very poorly
managed and out of fear, she asked her doctor to test her, indicating that she also was a
diabetic. Mary also said that it was not a surprise to her that she was diagnosed because
she had gestational diabetes with one of her pregnancies.
Mary sees an endocrinologist every three months to monitor her diabetes. Her most
recent hemoglobin A1C score was a 6.1 and has never been higher than a 6.3.
When Mary was first diagnosed with type 2 diabetes seventeen years ago, her
doctor referred her to a registered dietitian and an endocrinologist. She has never been
back to a dietitian, but follows dietitians who are Certified Diabetes Educators on blog
channels. She also takes walks every evening after dinner.
The only issue Mary has ever had with her diabetes mellitus is that she has
experienced very low blood sugar two years ago. She felt dizzy and fainted. After this
episode, her doctor lessened her dosage of diabetes medication because her numbers were

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so well controlled that she did not need as much. Over time, Marys dosage of medicine
continues to be cut back, and she does not need to take insulin.
Table 1. The food that Mary stated she ate in her 3-day food record.
Day 1 Intake (Feb. 9)

Day 2 Intake (Feb. 10)

Day 3 Intake (Feb. 13)

Medium Banana

Half a grapefruit

2 strips bacon

cup vanilla Greek yogurt

2 scrambled eggs

2 scrambled eggs

Hardboiled egg

1 cup Pretzels

1 piece buttered wheat toast

Cheese stick

cup cubed cheese

cup vanilla Greek yogurt

Small apple

1 cup vegetable soup

cup fresh berries

Peanut butter sandwich - wheat

2 cups corn tortilla chips

cup mashed potatoes

1 glass 1% milk

1 cup Pico de Gallo

3 oz. baked chicken breast

cup crackers

1 glass 1% milk

1 cup steamed green beans

1 cup brown steamed rice

3 oz. baked salmon fillet

2 Tbs. chicken gravy

1 cup steamed broccoli

cup sauted red potatoes

1 glass red wine

3 oz. baked chicken breast

1 cup steamed carrots

3 oz. filet mignon

1 glass red wine

cup vanilla ice cream

1 cup steamed asparagus

1 medium banana

1 small dinner roll with butter

2 Tbs. peanut butter

cup vanilla wafer cookies

1 glass 1% milk

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Table 2. SuperTracker macronutrient report for day 1 in food record.

Nutrients Target Average Eaten

Total Calories

Status

2000 Calories 1928

OK

Calories
Protein (g)***

46 g

106 g

OK

Protein (%

10 - 35%

22%

OK

Calories

Calories

Calories)***

Carbohydrate (g)*** 130 g

236 g

OK

Carbohydrate (%

45 - 65%

49%

OK

Calories

Calories

Dietary Fiber

25 g

23 g

Under

Total Sugars

No Daily

96 g

No Daily

Calories)***

Target or

Target or

Limit

Limit

Added Sugars

< 50 g

16 g

OK

Total Fat

20 - 35%

25%

OK

Calories

Calories

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Table 3. SuperTracker macronutrient report for day 2 in food record.

Nutrients Target Average Eaten

Status

Total Calories

2000 Calories

1342
Calories

Under

Protein (g)***

46 g

71 g

OK

Protein (% Calories)*** 10 - 35% Calories 21%


Calories

OK

Carbohydrate (g)***

OK

Carbohydrate (%
Calories)***

130 g

181 g

45 - 65% Calories 54%


Calories

OK

Dietary Fiber

25 g

24 g

Under

Total Sugars

No Daily Target
or Limit

69 g

No Daily Target
or Limit

Added Sugars

< 50 g

12 g

OK

Total Fat

20 - 35% Calories 27%


Calories

OK

Table 4. SuperTracker macronutrients report for day 3 in food record.

Nutrients Target

Average Eaten

Status

Total Calories

2000 Calories

1226
Calories

Under

Protein (g)***

46 g

96 g

OK

Protein (% Calories)***

10 - 35% Calories

31%
Calories

OK

Carbohydrate (g)***

130 g

128 g

Under

45 - 65% Calories

42%
Calories

Under

Dietary Fiber

25 g

19 g

Under

Total Sugars

No Daily Target or
Limit

49 g

No Daily Target or
Limit

Added Sugars

< 50 g

26 g

OK

Total Fat

20 - 35% Calories

19%
Calories

Under

Carbohydrate (%
Calories)***

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Calculations
170 lbs. / 2.2 kg = 77.3 kg
65 in. x 2.54 cm = 165 cm
BMI = kg/m^2 = 77.3/1.65^2 = 28.4
A BMI of 28.4 classifies Mary as overweight.
Ideal Body Weight = 100 lbs. + 5 lbs. (5 in.) = 125 lbs. +/- 10%
170 lbs. / 125 lbs. = 136% Ideal Body Weight
Calorie - Mifflin St. Jeor (women) = -161 + 10(weight) + 6.25(height) 5(age)
-161 + 10(77.3 kg) + 6.25(165 cm) 5(57 years) = 1616.5 kcal
1616.5 kcal x 1.3 (activity) x 1.0 (injury) = 2101.5 kcal
Three-day food recall shows daily Caloric intake average is 1499 kcal.
(1928 + 1342 + 1226) / 3 = 1499 kcal
1499/2101.5 x 100% = 71.3% daily Calorie needs
Protein 1.0 g / kg
1.0 g x 77.3 kg = 77.3 g protein
Three-day food recall shows daily protein intake average is 91 grams.
(96 + 71 + 106) / 3 = 91 grams
91/77.3 x 100% = 117% daily protein needs
Fluid 30 cc / kg

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30 cc x 77.3 kg = 2319 cc fluid


Discussion
Mary had three risk factors that contributed to her diagnosis. Mary is female, her
mother had type 2 diabetes, and she developed gestational diabetes in one of her
pregnancies. When Mary was diagnosed with diabetes, she realized that it did not mean
that she could eat what she wanted and not exercise because she already was a diabetic;
she took her diagnosis very seriously. Marys commitment to managing her diabetes is
proven through her bloodwork and lab results, she has maintained optimal hemoglobin
A1C scores throughout the seventeen years of having type 2 diabetes. Also, her regulation
through diet and exercise has allowed her to cut back on her medications.
Before Mary was diagnosed with diabetes mellitus, she experienced many of the
symptoms without realizing what was causing it. When her mother was diagnosed with
diabetes, she became more aware of what her symptoms were representing. Mary said that
she had a thirst that would cause her to drink glass after glass of water and her thirst could
not be quenched. She also urinated frequently, but initially mistook this for growing older
as she had just turned 40 years old.
It is very clear through the 3-day food record that Mary knows how to count and
pair her carbohydrates with every meal and snack. She never eats a carbohydrate alone,
and she monitors the grams of carbohydrates she consumes to ensure that she does not
overeat. Mary explained that carbohydrate counting becomes second nature after being
diabetic. The results of her food record shows that she eats, on average, less than what is
recommended, 71% Calorie needs. However, since Marys BMI classifies her as overweight

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[28], and she is 136% her ideal body weight, her restricted Calories may be due to an
attempted weight loss. Also, Mary consistently eats more protein than needed, 117%
protein needs. Marys increased intake of protein may be due to fear of consuming too
many carbohydrates. Consuming too many carbohydrates may affect her diabetes.
Since Mary has her diabetes mellitus well managed, she luckily has not experienced
any of the symptoms that occur with poorly regulated blood glucose levels. Mary has never
felt tingling or numbness in her extremities, her vision has not been changed due to the
disease, and her kidneys are functioning properly.
The hypothesis that Mary would have very well managed diabetes was proven
correct. Marys hemoglobin A1C score, her 3-day food record, and her cut back of
medication because of her diet and exercise show that she has a handle on her type 2
diabetes. Mary has very well managed diabetes.

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References
1. National diabetes statistics report: estimates of diabetes and its burden in the
United States. US Dept of Health and Hum Serv. 2014; 1(14): 1-12.
2. Purnell, Jonathon. The effect of excess weight gain with intensive diabetes mellitus.
Epidem and Prev. 2013; 127: 180-187.
3. Ryden, Lars. Guidelines on diabetes, pre-diabetes, and cardiovascular disease:
executive summary. Euro Heart Journ. 2007; 28(1): 88-136.
4. Type 2 diabetes [Internet]. Mayo Clin Dis and Condit; 2015 [updated Jan. 2016; cited
Feb. 2016]. Available from: http://www.mayoclinic.org/diseases-conditions/type2-diabetes/symptoms-causes/dxc-20169861
5. The hemoglobin A1C test for diabetes [Internet]. WebMD Diab Health Cent; 2014
[updated Jan. 2015; cited Feb. 2016]. Available from:
http://www.webmd.com/diabetes/guide/glycated-hemoglobin-test-hba1c
6. Donath, Marc. Type 2 diabetes as an inflammatory disease. Immun. 2011; 4(11): 98107.
7. Murray, Christopher. Improving the comparability of diabetes mortality rates in the
United States and Mexico. Diab Care. 2008; 12(31): 451-458.