1. Anna King
FSHN 450; Fall Semester 2014
Case Study IV: Type I Diabetes
October 19, 2014
I have not given, received, or used any unauthorized assistance on this assignment.
Anna King, 10/10/2014

2. Assess the patient’s laboratory data and provide an interpretation in table format.
Value Patient’s Value Normal Range Reason for Deviation
Fasting Glucose 120-140 mg/dl 70-99 mg/dl Diagnosis of Diabetes
mellitus (>126 mg/dl are
diagnostic at the causal
level); stress
Postprandial Glucose 160-180 mg/dl <140 mg/dl Diagnosis of Diabetes
mellitus; physiological
stress
Blood Pressure 148/95 mm Hg <130/80 mm Hg Hypertension
HA1c level 8.1% Nondiabetic=4-5.9%
Good diabetic
control= 4-7%
Fair diabetic control=
6-8%
Poor diabetic
control= >8%
Keeping control of blood
glucose levels over long
term (long term glucose
control is getting out of
hand)
Creatinine 0.9 mg/dl 1.9-3.8 nmol/dl Decreased levels with
diabetes mellitus
BUN 27 5-20 mg/dl Excessive protein
catabolism
Hgb 12.1 g/dl 12-16 g/dl No deviation
Hct 37% 35-47% No deviation
LFT Normal -------------------------- No deviation
Urine Albumin 4+ (>300 mg/dl) 3.5-5 g/dl No deviation
Assess drug/nutrient interactions. When reporting these interactions, report only those
interactions which pertain to this patient.
The patient is taking hydrochlorothiazide (25 mg daily) and lisinopril (25 mg daily) for
hypertension. Hydrochlorothiazide is a thiazide diuretic; it increases urinary excretion of
sodium, potassium, and magnesium. Lisinopril is an ACE inhibitor; it may increase
serum potassium levels.

3. She is taking aspirin (81 mg/day), which is a platelet inhibitor; it may decrease uptake of
vitamin C by leukocytes (which will be excreted in the urine), decrease systemic levels of
iron, folic acid, sodium, and potassium (especially if used long-term).
She is taking 30 units of NPH (20 U in the AM and 10 U at bedtime) and 30 U of lispro
at meals (10 U at breakfast, lunch, and dinner); these are used to control blood glucose
levels, and therefore interact with glucose as it is being digested and absorbed (patient
has to time the intake of these medications to her eating patterns or she could become
hypoglycemic or hyperglycemic).
Assess the patient’s nutritional intake and nutritional status. Use the ADIME format to
communicate the patient’s nutritional needs and provide an appropriate nutrition diagnosis and
PES statement and intervention three goals and follow-up for each goal. Explain the rationale for
each goal. Provide a reference for your intervention from recent literature.
Assessment:
35 y/o female Dx: Type I Diabetes mellitus
Height: 5’ 5” Weight: 145 lbs (65.9 Kg) BMI: 24.2 Kg/m2
Family hx: cardiovascular disease
Nutritional needs:
Energy- 1403.81 Kcal.day (BEE equation)
Protein- 65.9 g/day (1.0 g/Kcal/day)
Fluid- 1043 ml/day (1 ml/Kcal/day)
Nutritionally-relevant labs:
General assessment (cardiorespiratory, abdominal, neurological examinations)- normal
Fasting blood glucose- 120-140 mg/dl
Post-prandial blood glucose- 160-180 mg/dl
Blood pressure- 148/95 mm Hg
HA1c- 8.1%
Creatinine 0.9 mg/dl
BUN- 27
Hgb- 12.1
Hct- 37%

4. LFT-normal levels
Urine albumin- 4+ (>300 mg/dl)
Medication and supplement usage: hydrochlorothiazide (25 mg daily), lisinopril (20 mg daily),
aspirin (81 mg daily), 30 units NPH (20 U in the AM and 10 U at bedtime), 30 U Lispro (10 U at
breakfast, lunch, and dinner). No herbal supplements reported.
Food Intake History: diet high in simple carbohydrates and fat (excess amounts), overall high in
calories and low in micronutrients (vitamins and minerals).
Diagnosis:
Low adherence to nutrition-related recommendations [NB-1.6] in relation to Type I Diabetes
mellitus as evidence by inappropriate eating habits (a diet high in simple carbohydrates and fat)
in combination with the patient’s known condition (she has been seeing a doctor for her
condition for 20 years); high fasting and post-prandial blood glucose levels, high blood pressure,
high HA1c levels, and decreased creatinine levels.
Intervention:
1. Emphasize the importance of adhering to a diabetes-friendly diet, because if she keeps
eating the foods in her dietary recall, her lab result levels will continue to spin out of
control (with fatal consequences). A study by Diabetic Medicine showed that “a positive
trend in change in HbA1c after introduction of advanced carbohydrate counting” was
demonstrated in patients with Type I Diabetes (1).
2. Increase the patient’s knowledge/understanding of how to count carbohydrates, because
then she will learn that if she is smart about what she consumes, she can still eat most of
the foods she loves. She will learn that her condition doesn’t control her, she controls it-
she’ll feel empowered and will then be more likely to stick to a diabetes-appropriate diet.
3. Suggest meal components that the patient can “splurge” on when counting carbohydrates
to reemphasize the fact that she doesn’t have to feel restricted by her diabetes. Lack of
knowledge about the condition she has isn’t necessarily the problem (because she’s had it
for 20 years, it is no longer a surprise or shock), she merely needs to find a way to deal
with it to keep her health in tact.

5. Monitoring/Evaluation:
Keep tabs on the patient’s dietary intake, monitor glucose levels, blood pressure, BUN,
creatinine, and HA1c levels to track progress.
Describe the diabetes education which you would provide to this patient to help her achieve her
dietary goals. What self-care activities would you suggest for this patient?
I would provide information and applicable scenarios (to test her actual knowledge) on
counting carbohydrates. This would ensure that she keeps a conscious record and
monitoring system of the nutrients she is consuming and would help control some of the
internal conditions she is experiencing (hypertension, etc).
I would also make sure to include ways that she can have treats she enjoys eating and
how to monitor her eating out at restaurants as self-care activities, so she doesn’t feel
constrained by her diabetes and so she doesn’t feel the need to cheat herself out of eating
the foods she should be eating (reverting to binging, which could cause hyperglycemia).

6. Work Cited
1. Schmidt S, Schelde B, Noergaard K. Effects of advanced carbohydrate counting
in patients with Type 1 diabetes: a systematic review. Diabetic Medicine. Aug
2014.
<http://search.proquest.com.ezproxy2.library.colostate.edu:2048/health/docview/1
549754651/4330AFB4B094412FPQ/3?accountid=10223>. Accessed October 9,
2014.