Type II Diabetes ADIME Note

Name: Lanie Sumlin

Admitting Dx: Uncontrolled T2DM, morbid obesity

Patient Initials: N/A

Age: 27

Gender: Male

NUTRITION ASSESSMENT Complete as applicable:

Past Med/Surgical
poorly controlled T2DM, hypertension, and morbid obesity
History:
Current Diet Order:

Controlled carb (2200 kcal/d)

Nutrition Support:

N/A

Anthropometric Data
Height
Admit weight
BMI
BMI Assessment
IBW

62
392 lbs. (178 kg)
50.3 kg/m2
Class 3 obesity (ad. wt.)
190 lbs. (86.4 kg)

% IBW
%206
% IBW reference
N/A
Food/Nutrition Related History:
Current Food & Fluid Intake:

UBW
N/A
% UBW
N/A
%UBW reference
N/A
Adjusted IBW
109.6 kg
Wt change: provide time Intentional wt. lose of 208 in 3
reference
years
Evaluation of wt. change Not significant wt. change

ESTIMATE ENERGY, PROTEIN, FLUID NEEDS-make sure

to provide measurements in kg, g, mL. Provide reference-E.g.
current/ admit wt., UBW, IBW, Adjusted IBW, etc. AND your
method.

Consumed 100% of carb

controlled meals (2200 kcal)
Breakfast: 9 CHO
Mid-morning snack: 4 CHO
Calories/day: 2180-2725 kcal/d (20-25 kcal/d Adj. IBW)
Lunch: 12 CHO
Afternoon snack: 0 CHO
Grams Protein/day: 95-112 g/d (1.1-1.3 g/kg IBW)
Dinner: 6 CHO
HS snack: 6 CHO
Milliliters of fluid/day: 3200-4400 (30-40 mL/kg Adj. IBW)
Total: 37 CHO
Food and Fluid Intake
History:
Daily kcal intake: 3810
Daily protein intake: 180 g
Nutrition Focused Physical Findings:
Relevant Medical Tests and Procedures:
-

morbid obesity,
N/A
with warm/dry skin,
edema of scrotum and penis,
bowel sounds active x4 with no tender abdomen or
distension
Nutrition-Related Labs:
Blood sugar: 255
A1c: 11.7 (H)

Type II Diabetes ADIME Note

Glucose: 248 (H)

Nutrition-Related Meds:
Home:
Metformin, Lisinopril,
Hospital:
Taken off Metaformin for Humalog
Summary of Nutrition Assessment:
adequately
nourished

obese

at risk for
malnutrition

moderate
malnutrition

severe
malnutrition

NUTRITION DIAGNOSIS: (Problem, Etiology, Signs/Symptoms Statement)

Excessive energy intake R/T food and nutrition knowledge deficit AEB: consuming 155% of his
recommended kcal intake and a total of 37 CHO choices/d.
NUTRITION INTERVENTION: Recommendations/Plan (Diet and/or nutrition support,
collaboration/referrals of care):
Meals and snacks- controlled carbohydrate diet
Nutrition-related medications management- prescription medicine insulin use
GOALS:
1. Include 3-5 CHO choices/meal, 1-2 choices/snack
2. Weight loss of 1-2 lbs./wk.
3. Consume no more than 19 CHO choices/d
MONITORING/EVALUATION:
1.
2.
3.
4.

Total energy intake

Weight
Total carbohydrates intake
Insulin to carbohydrate ration