1. Case Study
Type 1 Diabetes Case
Fall 2016
Assignment 4
Due date: Oct 7, 2016
Yeyan Jin
CSUID:829840439
FSHN 450
I pledge on my honor that I have not given or received any unauthorized assistance on this
assignment

2. FSHN 450
Type 1 Diabetes Case
Due Date: October 7, 2016
Mrs. DM is a 35-year-old woman with type 1 diabetes. She presents for her annual visit with
poorly controlled hypertension and moderate albuminuria. She has been under a physician’s care
for diabetes for the past 20 years. She has no history of retinopathy, or neuropathy. She has
never had a cardiovascular event and reports no cardiac symptoms. She monitors her fasting
glucose levels three times a day using a personal glucometer, and her morning fasting glucose
levels have ranged between 120 and 140 mg/dl and post meal 160 - 180. Her hypertension is
treated with hydrochlorothiazide (25 mg daily) and lisinopril (20 mg daily). She takes aspirin (81
mg daily), 30 Units NPH ( 20 U in the am and 10 U at bedtime) and uses 30 U Lispro at
meals( 10 U at breakfast lunch and dinner) . She notes that she consistently takes her
medications. She has a family history of cardiovascular disease. Her Weight is 145# (65.9 Kg)
and Ht is 5’5”. Body-mass index is 24.2 Kg/M2.
Her blood pressure is 148/95 mm Hg. Her
general assessment, including cardiorespiratory, abdominal, and neurologic examinations, is
normal. Her HA1c level is 8.1%, and her creatinine 0.9 mg per deciliter, BUN 27, Hgb 12.1, Hct
37%. Liver function tests are normal. Her urine albumin is 4+ (> 300 mg/dl). An additional
antihypertensive medication was prescribed and an outpatient nutrition consult was ordered.
Her 24 hour dietary recall revealed a typical day:
AM 1/2 cup orange juice, 2 boiled eggs and 1 slice of toast with butter and unsweetened
strawberry jam (about 1TSP), coffee with sugar substitute and ¼ cup 1% milk.
NOON1 personal pizza with pepperoni and cheese (or MacDonald’s Big Mac, with medium
fries) and a large diet Coke.
2PM 1 diet coke and 1 chocolate chip cake (about 3” in diameter)
5:30 PM 1 chicken breast, 1/2 cup broccoli, 1 cup mashed potatoes with 4TBSP gravy, ½ cup
vanilla ice cream
7:30 PM 1 cup popcorn with salt and butter
HS 1 cup 1% milk and 4 Oreo cookies
Assess the patients laboratory data and provide an interpretation in table format.
Patients Value Normal Range Explanation
Assess drug:nutrient interactions. When reporting these interactions, report only those
interactions which pertain to this patient
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 for three goals (one in each domain- clinical, intake, behavioral).
Explain the rationale for each goal. P Include follow-up plans. Provide a reference for your
intervention from the recent literature and include the abstract. 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?

3. 1.Assess drug:nutrient interactions. When reporting these interactions, report only those
interactions which pertain to this patient
hydrochlorothiazide (25 mg daily) and lisinopril (20 mg daily). She takes aspirin (81 mg daily),
30 Units NPH ( 20 U in the am and 10 U at bedtime) and uses 30 U Lispro at meals( 10 U at
breakfast lunch and dinner)
Hydrochlorothiazide: That drug side effects may cause high blood sugar.
Magnesium, Potassium and Zinc. These diuretics promote urination. Minerals are often lost in
the process.
Lisinopril :
Negative
Potassium: Consuming potassium while taking lisinopril may increase the risk of hyperkalemia.
Arginine: Supplementation with arginine while taking lisinopril may alter potassium levels.
Positive
Zinc: Consuming zinc while on lisinopril may help combat drug-induced depletion of this
mineral.
Iron: Iron supplementation concurrent with lisinopril use may help alleviate the undesired side
effect of a dry cough. (Iron should be taken with caution, as it may also decrease drug
absorption.)
Aspirin:
Aspirin increases urinary excretion of vitamin C. Decreased vitamin status with respect to
vitamin C as well as folate have been noted.
Taking vitamin E together with aspirin has been associated with bleeding problems.
The use of over three grams of aspirin has been associated with zinc depletion.
There is no specific nutrient interaction with NPH and Lispro. CHO intake may decrease the
effects of NPH and Loispro.
2.Provide a reference for your intervention from the recent literature and include the
abstract.
Add one cup of orange for breakfast and lunch to increase fruit intake. According to that article,
proper fruit can help control high blood pressure.
Domingos TB, Pereira AF, Yokoo EM, Salles-Costa R. Low fruit consumption and omission of
daily meals as risk factors for increased blood pressure in adults. British Journal of Nutrition Br
J Nutr, 116(04), 683-691. doi:10.1017/s0007114516002397
Abstract
A population-based cross-sectional survey with cluster sampling design and with inverse
sampling was conducted in 2010, in a sample of 1590 adults (19-60 years old) exposed to a high
prevalence of food insecurity, in the municipality of Duque de Caxias, metropolitan region of

4. Rio de Janeiro, Brazil. The objective of the study was to evaluate the association of socio-
demographic factors, the consumption of fruits and vegetables and the number of meals with
increased blood pressure (BP). A hierarchical model that considered variables related to the
basic, intermediate and immediate determinants of increased BP was adopted. By using Poisson's
regression, univariate models were tested to obtain the prevalence ratio (PR) and its respective
95% CI. After fitting the model, age (age group 50-59 years) (PR 1.62; 95% CI 1.09, 2.41), low
consumption of fruits in a week (PR 1.37; 95% CI 1.07, 1.74), fewer meals per day (PR 1.72;
95% CI 1.21, 2.43) and overweight (PR 1.78; 95% CI 1.31, 2.20) remained significantly
associated with increased BP. Therefore, the results found here reinforce the importance of
encouraging and developing strategies that ensure access to healthy foods to minimise increased
BP in similar populations.
3.Describe the diabetes education which you would provide to this patient to help her
achieve her dietary goals.
I would like to show her a chart about normal range of blood sugar level. And educate her how to
control her blood sugar level and why she needs to do it. I will educate her to know how to
estimate how many CHO she takes for each meal. Controlling CHO intake is to help her control
her blood sugar level. I will also educate her to know the relationship between dietary intake to
diabetes.
4.What self-care activities would you suggest for this patient?
1. Healthy eating
She need to know the nutrient (especially carbohydrate) content of foods, how to read labels,
how to cook foods to maintain nutrient content and avoid adding extra saturated fat and sodium
and learn how to choose appropriately in restaurants.
2. Being active
She needs engage in aerobic activity, strength building and flexibility training most days of the
week.
3. Monitoring
She needs to check her blood glucose and allow her health care provider to see how her blood
sugars are responding to the medications and lifestyle.
4. Taking Medician
It is important to understand how the medication works, how to properly take the medication and
what side effects it may have. Knowing these things will make it easier for her to determine if
her medication is working properly.
5. Problem Solving
She needs to know how to respond to high and low blood sugars with appropriate changes in
activity, food and medicine.
6. Risk Reduction
Blood pressure checks, regular eye, foot, dental exams, lab tests for microalbumin, cholesterol
and lipid labs –knowing what these tests measure, what the therapeutic goals are, how frequently
she should get them checked will help her plan her care more responsibly.

5. ADIME
Assessment
Patients Value Normal Range Explanation
Fasting glucose
120 to 140 mg/dl
70 to 100 mg/dl Higher than normal. Diabetes
Post meal glucose
160 to 180 mg/dl
Less than 140 mg/dl Higher than normal. Diabetes
BUN 27 mg/dl 7 to 20 mg/dl Higher than normal. Excessive
protein levels
HA1c 8.1% Less than 5.7% Higher than normal. Diabetes
Creatinine 0.9 mg/dl 0.6 to 1.1 mg/dL Normal
Urine albumin 4+
>300mg/dl
<300 mg/dl Higher than normal. Diabetes,
albuminuria.
Hgb 12.1 g/dl 13.5 to 17.5 g/dl Normal
Hct 37 % 38.8 to 50 % Lower than normal. Too little
iron, folate, vitamin B12, and
vitamin B6 in the diet
BMI 24.2 Kg/ M2
BMI is in normal range.
Blood pressure 148/95 mmHg. Normal range is 120/80 mmHg. Higher than normal because of
her hypertension.
BMR=1354 Calories/day
Protein needs per day= 65.9*1.4=92.26 gm/day
Medical: She has hypertension and albuminuria. And she has type 1 diabetes for many years.
She has no retinopathy or neuropathy. No symptoms of any heart disease. Glucose test, HA1c
test, and Urine albumin test showed she is in diabetes condition. BUN test and Urine albumin
test showed she has albuminuria.
Social: She likes to eat fast food for lunch. Looks like she doesn’t have much time to eat a
“healthy lunch”. Or she just likes to eat junk food. That is not good for her long term hleath.
Diet: Her Hct test is lower than normal, so she may lack of iron, folate, vitamin B12, and
vitamin B6 intake. Look through her 24 hour dietary recall. I found out that she still take many
foods that is not good for her diabetes condition. Such as juice, chocolate chip cake, and ice
cream. These foods may increase her blood glucose level. And she is taking fast food as lunch.
Fast food has high calories but low nutrients that may relate to her low Hct. The another reason
for that is she doesn’t eat enough vegetable.

6. Diagnosis
Behavioral
Likes to eat sweeten foods r/t lack of knowledge of diabetes AEB high blood glucose
Clinical
May have microvascular disease in the future r/t she has diabetes for a long time AEB high blood
pressure
Intake
Low intake of vegetables r/t too much junk foods intake AEB hypertension and low Hct
Intervention
Drink ½ cup of tea instead of juice in the morning. (Juice has high content of sugar will increase
her blood sugar level)
Add one cup of orange for breakfast and lunch to increase fruit intake. (It is good for her high
blood pressure control (reference see previous page) )
Take ½ cup sugar free vanilla ice cream instead of the regular one during dinner.(High sugar
content food will increase her blood sugar level)
Mornitoring/Evaluation
Have a 3 day’s food intake recall, I want to see if she changes her food intake.
The expected outcome is she start eating more vegetables and reduce sugar intake.

7. Diagnosis
Behavioral
Likes to eat sweeten foods r/t lack of knowledge of diabetes AEB high blood glucose
Clinical
May have microvascular disease in the future r/t she has diabetes for a long time AEB high blood
pressure
Intake
Low intake of vegetables r/t too much junk foods intake AEB hypertension and low Hct
Intervention
Drink ½ cup of tea instead of juice in the morning. (Juice has high content of sugar will increase
her blood sugar level)
Add one cup of orange for breakfast and lunch to increase fruit intake. (It is good for her high
blood pressure control (reference see previous page) )
Take ½ cup sugar free vanilla ice cream instead of the regular one during dinner.(High sugar
content food will increase her blood sugar level)
Mornitoring/Evaluation
Have a 3 day’s food intake recall, I want to see if she changes her food intake.
The expected outcome is she start eating more vegetables and reduce sugar intake.