Type 2 DM - Case Study Jean Kerver, MS, RD, CDE 2/18/00

DR is a 45 y.o. male; Ht: 5’9”; Wt: 215 lbs Present complaint: polydipsia, polyuria, fatigue. Past med hx: Type 2 DM x 5 yrs. Meds: None; NKDA. Labs: No SBGM; serum glucose=285 mg/dL 1 hr ppd; urinary glucose=2+; temp=98.8 F.

Family med hx: Grandma type 2 DM at age 60 yrs Social hx: architect; lives alone; nonsmoker; no regular physical activity. Diet hx: no known food allergies; no supplements (vit/min or other); no special diet; drinks 2 beers qd after work; brkfst at home; lunch out—fast food or deli type; dinner at home —cooks or orders take-out food; seldom snacks.

Breakfast 2 cups raisin bran 1 lg banana 1 cup whole milk 8 oz orange juice Lunch 4 oz corned beef 1 oz swiss cheese 2 slices rye bread ½ cup cole slaw 2 tbsp russian dressing 1 small bag potato chips

Dinner 1 cup fried rice 4 oz Hunan chicken (fried) 4 oz shrimp and cashews 2 bottles beer 1 lg orange Total kcals: 3411 Protein:14% Fat:40% Carb:46%

How Many kcals Should He Have? Ht: 5’9”; Wt: 215 lbs IBW: 106 lbs + (9” x 6 lbs) = 160 lbs % IBW = 215 lbs /160 lbs = 134% AdjBW = 0.25 ( ) = 174 lbs (79 kg) 25 kcals/kg = 25 x 79 = 1975 kcals/d 24-hr = 3411 kcals – 500 kcals= 2900 kcals

Calculation of Dietary Pattern Total kcals = % CHO = 0.50 x kcal = 0.50 x 2000 = 250 g CHO 4 kcal/g CHO 4 20% PRO = 0.20 x kcal = 0.20 x 2000 = 100 g PRO 4 kcal/g PRO 4 30% FAT = 0.30 x kcal = 0.30 x 2000 = 67 g FAT 9 kcal/g FAT 9

ADA Exchanges Food GpCHO (g)PRO (g)FAT (g)Kcals Starch Meat Vege52-25 Fruit Milk Fat--545

Negotiate, then Convert CHO No. of Exchanges CHO (g)PRO (g)FAT (g) Milk Vege Fruit Starch

Convert PRO No. of Exchanges CHO (g)PRO (g)FAT (g) Milk Vege Starch Meat

Convert FAT No. of Exchanges CHO (g)PRO (g)FAT (g) Milk Meat Fat

Diet Pattern Food Group No. of Exchanges CHO (g)PRO (g)FAT (g) Starch Meat Vege Fruit Milk Fat Totals:

Diabetes Education Tell patient what to expect Individualize-always give choices Be systematic-prioritize Discuss coping strategies Special situations