Mitch, a 53-year-old man with uncontrolled type 2 diabetes, was admitted to the ER with hyperglycemic hyperosmolar syndrome (HHS). His blood glucose was 1524 mg/dL and osmolality was 360 mmol/kg/water. He was started on insulin therapy with Lispro and glargine to control his blood sugar. As his diabetes was poorly controlled for an extended period, he is at high risk for chronic complications and will likely need to continue insulin. The nutrition consult will focus on diabetes self-management education and transitioning Mitch to a consistent carbohydrate diet.
Food PoisoningNutritional Problems In Pakistan: Their Control And PreventionDrSindhuAlmas
According to WHO, foodborne diseases are mounting up at an alarming rate, causing significant impediment to socio-economic development of a country. Food based outbreak causes mortality of 2.2 million that contributes 4% of all deaths each year worldwide.
This document discusses diabetes, including its origins, types, symptoms, diagnosis, and treatment. It defines diabetes as a disease that affects the body's ability to produce or use insulin. There are three main types of diabetes: type 1, type 2, and gestational diabetes. Type 1 occurs when the pancreas does not produce insulin, type 2 occurs when the body does not produce enough insulin or the cells do not use insulin properly, and gestational diabetes affects some women during pregnancy. Common symptoms include extreme thirst, frequent urination, blurry vision, hunger, and tiredness. Diagnosis involves random blood sugar tests, fasting blood sugar tests, and oral glucose tolerance tests. Treatment aims to control blood sugar levels and involves insulin
1) Diarrhea can cause secondary lactase deficiency and lactose intolerance by damaging the intestinal mucosa. This reduces absorption of lactose from cow's milk and regular formula.
2) Studies show low lactose formula improves early weight gain and recovery in infants with acute diarrhea compared to regular formula. Low lactose formula also improves recovery of lactose tolerance after diarrhea resolves.
3) For infants and children with diarrhea, guidelines recommend continued breastfeeding and early refeeding with low lactose foods and formula instead of complete milk avoidance to support adequate nutrition and faster recovery.
This document summarizes medical nutrition therapy for various pulmonary diseases. It discusses the anatomy and physiology of the respiratory system and mechanics of breathing. It then covers several chronic pulmonary diseases including asthma, bronchopulmonary dysplasia, chronic obstructive pulmonary disease, and cystic fibrosis. For each condition, it describes nutritional implications, recommended nutritional assessments, and medical nutrition therapy goals and strategies.
This document discusses nutritional management of chronic renal disease. It covers several key topics:
- Protein restriction is important to reduce workload on kidneys and lower blood pressure. High-quality proteins like egg are recommended.
- Phosphorus intake should be restricted to reduce calcium-phosphorus crystallization in kidneys. The calcium to phosphorus ratio should be over 1.
- Sodium intake must be restricted to control hypertension, with a goal of 15-50 mg/kg daily for dogs and 0.24% salt for cats. Several renal-friendly diet formulations are provided for dogs and cats.
BR, a 22-year old female, was referred to the gastroenterology clinic for diarrhea, abdominal distention, rash, joint pain, and unexplained weight loss. Blood tests showed positive for celiac disease antibodies. A gluten-free diet, nutrition consult, and small intestinal biopsy were recommended to diagnose celiac disease. Celiac disease is an autoimmune response to gluten that damages villi in the small intestine and causes malabsorption.
Food PoisoningNutritional Problems In Pakistan: Their Control And PreventionDrSindhuAlmas
According to WHO, foodborne diseases are mounting up at an alarming rate, causing significant impediment to socio-economic development of a country. Food based outbreak causes mortality of 2.2 million that contributes 4% of all deaths each year worldwide.
This document discusses diabetes, including its origins, types, symptoms, diagnosis, and treatment. It defines diabetes as a disease that affects the body's ability to produce or use insulin. There are three main types of diabetes: type 1, type 2, and gestational diabetes. Type 1 occurs when the pancreas does not produce insulin, type 2 occurs when the body does not produce enough insulin or the cells do not use insulin properly, and gestational diabetes affects some women during pregnancy. Common symptoms include extreme thirst, frequent urination, blurry vision, hunger, and tiredness. Diagnosis involves random blood sugar tests, fasting blood sugar tests, and oral glucose tolerance tests. Treatment aims to control blood sugar levels and involves insulin
1) Diarrhea can cause secondary lactase deficiency and lactose intolerance by damaging the intestinal mucosa. This reduces absorption of lactose from cow's milk and regular formula.
2) Studies show low lactose formula improves early weight gain and recovery in infants with acute diarrhea compared to regular formula. Low lactose formula also improves recovery of lactose tolerance after diarrhea resolves.
3) For infants and children with diarrhea, guidelines recommend continued breastfeeding and early refeeding with low lactose foods and formula instead of complete milk avoidance to support adequate nutrition and faster recovery.
This document summarizes medical nutrition therapy for various pulmonary diseases. It discusses the anatomy and physiology of the respiratory system and mechanics of breathing. It then covers several chronic pulmonary diseases including asthma, bronchopulmonary dysplasia, chronic obstructive pulmonary disease, and cystic fibrosis. For each condition, it describes nutritional implications, recommended nutritional assessments, and medical nutrition therapy goals and strategies.
This document discusses nutritional management of chronic renal disease. It covers several key topics:
- Protein restriction is important to reduce workload on kidneys and lower blood pressure. High-quality proteins like egg are recommended.
- Phosphorus intake should be restricted to reduce calcium-phosphorus crystallization in kidneys. The calcium to phosphorus ratio should be over 1.
- Sodium intake must be restricted to control hypertension, with a goal of 15-50 mg/kg daily for dogs and 0.24% salt for cats. Several renal-friendly diet formulations are provided for dogs and cats.
BR, a 22-year old female, was referred to the gastroenterology clinic for diarrhea, abdominal distention, rash, joint pain, and unexplained weight loss. Blood tests showed positive for celiac disease antibodies. A gluten-free diet, nutrition consult, and small intestinal biopsy were recommended to diagnose celiac disease. Celiac disease is an autoimmune response to gluten that damages villi in the small intestine and causes malabsorption.
The document discusses the components and approaches for developing a nutrition care plan. It outlines that a nutrition care plan includes nutritional assessment, determining nutritional requirements, deciding on oral or tube feeding access, selecting appropriate nutrient formulations, developing a delivery method, and establishing monitoring strategies. The key components are assessing the patient's nutritional needs, calculating macro and micronutrient requirements based on age and medical condition, and choosing an access route, formula, and delivery approach along with monitoring to ensure the plan meets the patient's nutritional goals.
The document discusses dietary recommendations for patients with kidney disease. The kidneys play an important role in filtering waste and regulating electrolytes, so a kidney-friendly diet is important. The diet focuses on maintaining nutrition while limiting sodium, protein, phosphorus, potassium, and fluids based on a person's stage of kidney disease. It provides guidance on appropriate portion sizes and recommends limiting high-sugar and high-phosphorus foods. The goal is to slow disease progression and manage related conditions like diabetes or high blood pressure.
Ulcerative colitis is an inflammatory bowel disease that causes inflammation and tiny ulcers on the lining of the colon. It typically begins in the rectum and spreads upward. Most patients are diagnosed between ages 15-25 or in their 60s. Stress can exacerbate ulcerative colitis over time. Dietary risk factors include high intake of red meat, processed meat, alcohol, sulphur, and certain fats and vitamins. Treatment may include dietary modifications in addition to medication. A case study describes a patient presenting with appetite loss, weight loss, and abdominal pain who was diagnosed with ulcerative colitis and anemia and prescribed a low-fiber, moderate-fat, moderate-carbohydrate diet high in protein
The document discusses nutrition care for patients with chronic kidney disease (CKD) and those undergoing hemodialysis (HD). It outlines the stages of CKD based on glomerular filtration rate. The nutrition care process involves assessment, diagnosis, intervention, and monitoring. Key dietary recommendations for CKD and HD patients include restricting protein, sodium, and phosphorus while maintaining adequate energy, carbohydrates, and fat intake. Regular nutrition counseling and monitoring of nutritional status indicators are important for managing the disease and preventing complications.
malnutrition classification and severe malnutrition managementMuhammad Jawad
The document discusses malnutrition, defining it as a cellular imbalance between nutrient supply and demand. It describes different types of malnutrition including protein-energy malnutrition (PEM) and specific forms like marasmus and kwashiorkor. PEM is the primary nutritional problem in developing countries, affecting growth and survival in children under 5 years old. Management of severe malnutrition involves treating infections, regulating electrolytes, micronutrients and gradual feeding to support recovery without overwhelming the body's slowed systems.
Diarrhea is loose, watery stools. Having
diarrhea means passing loose stools three or more times a day. Acute diarrhea
is a common problem that usually lasts 1 or 2 days and goes away on its own.
Diarrhea lasting more than 2 days may be a
sign of a more serious problem. Chronic diarrhea—diarrhea that lasts at least 4
weeks—may be a symptom of a chronic disease. Chronic diarrhea symptoms may be
continual or they may come and go.
Diarrhea of any duration may cause
dehydration, which means the body lacks enough fluid and electrolytes—chemicals
in salts, including sodium, potassium, and chloride—to function properly. Loose
stools contain more fluid and electrolytes and weigh more than solid stools.
People of all ages can get diarrhea. In the
United States, adults average one bout of acute diarrhea each year, and young
children have an average of two episodes of acute diarrhea each year.
Nutritional management of renal diseasesWajid Rather
The document discusses the major roles of the kidney in metabolic regulation including water-electrolyte homeostasis, calcium-phosphate balance, waste product removal, acid-base balance, erythropoietin production, and blood pressure regulation. It then summarizes the goals of nutritional therapy in renal failure and discusses nutritional problems patients with renal failure often experience like anorexia and metabolic abnormalities. Guidelines for protein intake, energy intake, fluid intake, sodium intake, and potassium intake are provided for non-dialysis patients, patients undergoing hemodialysis, and patients undergoing peritoneal dialysis.
Gastroenteritis is inflammation of the stomach and intestines that causes diarrhea, vomiting and abdominal cramps. It is usually caused by viruses like rotavirus or bacteria like Campylobacter. Common symptoms include diarrhea, vomiting, fever and dehydration. Treatment focuses on rehydration through oral rehydration therapy. Antiemetics may help reduce vomiting, and antibiotics are sometimes used for bacterial causes. Prevention involves handwashing, sanitation and food safety.
This file contains the epidemiology, diagnostic tecnhiques, prevention methods and control strategies of dengue fever in context of developing countries like Nepal.
(Welcome to collaborate to write book, book chapter or review papers)
Clinical assessment of nutritional statusDR RML DELHI
This document discusses the clinical assessment of nutritional status through physical examination. It provides guidance on identifying and classifying common physical signs of malnutrition, such as hair changes, skin and eye conditions, and muscle wasting. The summary is:
1) Physical examination can help detect nutritional deficiencies by identifying signs like delayed growth, skin pallor, and hair/body changes. However, signs are not specific and environmental factors can also cause similar signs.
2) Health workers can be trained to recognize major signs of malnutrition and refer patients for detailed examination. The WHO proposed a classification system to standardize identification and interpretation of signs.
3) Physical signs must be interpreted cautiously and confirmed with dietary and biochemical data, as signs can
How is COPD and Nutrition Overlapped and Affecting Each Other
How to Solve the Problem as a Part of Pulmonary Rehabilitation
The Presentation is Discussing these items in the form of Problem Solving
Malabsorption disorders cause insufficient nutrient absorption due to maldigestion or malabsorption. Causes include exocrine pancreas defects, liver diseases, intestinal diseases, and specific defects. Celiac disease is a genetic autoimmune disorder triggered by gluten that causes intestinal damage. Symptoms include diarrhea, failure to thrive, and malnutrition. Diagnosis involves serology and biopsy showing intestinal damage. Treatment is lifelong gluten-free diet. Cow milk protein allergy symptoms develop in infants and include diarrhea, vomiting, and failure to thrive. Lactose intolerance is caused by lactase deficiency leading to diarrhea from intestinal sugar accumulation after milk ingestion. Treatment involves milk elimination or use of lactase supplements.
diabetic ketoacidosis life-threatening problem that affects people with diabetes. It occurs when the body starts breaking down fat at a rate that is much too fast. The liver processes the fat into a fuel called ketones, which causes the blood to become acidic.
This document discusses various methods used to collect food intake data, including both prospective and retrospective methods. Prospective methods include food diaries using household measures or weights, as well as chemical analysis of duplicate meals. Retrospective methods include 24-hour dietary recalls, food frequency questionnaires, and diet histories. The advantages and limitations of each method are described. National dietary surveys provide a means to investigate food intake trends over time using consistent methodology. The purpose of dietary surveys is to inform public health efforts around nutrition.
This case study describes a patient diagnosed with celiac disease based on positive antibody tests and small intestinal biopsy findings. The patient has a low BMI and lab tests indicate iron deficiency anemia. A review of the patient's diet found gluten was present at each meal. Nutrition diagnoses identified suboptimal iron intake, impaired nutrient utilization due to celiac symptoms, and need for education on a gluten-free diet. Interventions include encouraging an iron-rich gluten-free diet and education on avoiding gluten and addressing nutrient deficiencies.
Chapter 19 Nutrition and Liver Diseases KellyGCDET
The document discusses various liver diseases and their relationship to nutrition. It covers fatty liver disease, hepatitis, cirrhosis, and liver transplantation. Key points include:
1) Fatty liver disease is caused by an accumulation of fat in the liver from excess alcohol, drugs, or metabolic issues like insulin resistance. It can progress to inflammation and more serious conditions if not addressed.
2) Hepatitis is liver inflammation that can result from viral infections or other causes like excess alcohol. Symptoms include fatigue and jaundice. Treatment focuses on supportive care and antiviral drugs.
3) Cirrhosis is scarring of the liver that impairs its function. Major causes in the US are alcohol and hepatitis C
Johnny, an 8-year-old boy, is experiencing weight loss, abdominal discomfort, and loose stool. He has a history of type 1 diabetes and possible thyroid issues. Given his symptoms and medical history, celiac disease is a top consideration. Tests would include a small intestine biopsy to check for villi damage and serologic tests for antibodies associated with celiac disease. Celiac disease is an autoimmune response triggered by gluten that causes chronic inflammation and damages the small intestine. It is treated by maintaining a strict gluten-free diet.
Executive summary 2021 Global Nutrition ReportCIkumparan
1) Progress is being made on some global nutrition targets but not others, and accelerated efforts are needed. Most countries are not on track to meet targets for stunting, wasting, anaemia, obesity, and diet-related diseases. Covid-19 has exacerbated the problem.
2) Unhealthy and unsustainable diets are harming health and the environment. No region meets recommendations for healthy diets, while diet-related deaths and environmental impacts are rising.
3) Financing needs to meet nutrition targets are growing but resources are falling, though the economic costs of inaction are far greater. Traditional and innovative financing must be expanded to close the gap.
Type 2 diabetes is a condition where the body cannot effectively control blood sugar levels. It develops over many years as the body becomes resistant to the effects of insulin. Prediabetes occurs when blood sugar levels are higher than normal but not high enough to be diagnosed as diabetes. The best way to prevent type 2 diabetes is through lifestyle changes like regular physical activity and modest weight loss. Maintaining a healthy lifestyle can significantly reduce risk of developing diabetes and its serious health complications.
Mitch, a 53-year-old man with type 2 diabetes, was admitted to the emergency room with hyperglycemic hyperosmolar syndrome (HHS). He had an A1C of 11.5%, plasma glucose of 855 mg/dL, and was dehydrated. He was started on IV fluids and an insulin drip to rehydrate and lower his blood glucose. Due to his non-compliance with medications and diet, it is likely he will need to continue insulin therapy. The nutrition therapy will focus on diabetes education, achieving 5-10% weight loss, determining an appropriate macronutrient distribution and physical activity goals to help control his diabetes and comorbid conditions of hypertension and high cholesterol.
Determination of Blood Glucose Using Glusose Oxidase-Peroxidase MethodZoldylck
This document discusses blood glucose determination using the oxidase-peroxidase method. It begins by introducing diabetes and its prevalence worldwide. It then describes the materials and methodology used, which involves collecting a blood sample, separating the plasma, and adding an O-toluidine reagent before measuring absorbance. The results showed the patient's glucose level was within the normal range. It further discusses hyperglycemia and hypoglycemia, the different types of diabetes, diagnostic criteria, and gestational diabetes.
The document discusses the components and approaches for developing a nutrition care plan. It outlines that a nutrition care plan includes nutritional assessment, determining nutritional requirements, deciding on oral or tube feeding access, selecting appropriate nutrient formulations, developing a delivery method, and establishing monitoring strategies. The key components are assessing the patient's nutritional needs, calculating macro and micronutrient requirements based on age and medical condition, and choosing an access route, formula, and delivery approach along with monitoring to ensure the plan meets the patient's nutritional goals.
The document discusses dietary recommendations for patients with kidney disease. The kidneys play an important role in filtering waste and regulating electrolytes, so a kidney-friendly diet is important. The diet focuses on maintaining nutrition while limiting sodium, protein, phosphorus, potassium, and fluids based on a person's stage of kidney disease. It provides guidance on appropriate portion sizes and recommends limiting high-sugar and high-phosphorus foods. The goal is to slow disease progression and manage related conditions like diabetes or high blood pressure.
Ulcerative colitis is an inflammatory bowel disease that causes inflammation and tiny ulcers on the lining of the colon. It typically begins in the rectum and spreads upward. Most patients are diagnosed between ages 15-25 or in their 60s. Stress can exacerbate ulcerative colitis over time. Dietary risk factors include high intake of red meat, processed meat, alcohol, sulphur, and certain fats and vitamins. Treatment may include dietary modifications in addition to medication. A case study describes a patient presenting with appetite loss, weight loss, and abdominal pain who was diagnosed with ulcerative colitis and anemia and prescribed a low-fiber, moderate-fat, moderate-carbohydrate diet high in protein
The document discusses nutrition care for patients with chronic kidney disease (CKD) and those undergoing hemodialysis (HD). It outlines the stages of CKD based on glomerular filtration rate. The nutrition care process involves assessment, diagnosis, intervention, and monitoring. Key dietary recommendations for CKD and HD patients include restricting protein, sodium, and phosphorus while maintaining adequate energy, carbohydrates, and fat intake. Regular nutrition counseling and monitoring of nutritional status indicators are important for managing the disease and preventing complications.
malnutrition classification and severe malnutrition managementMuhammad Jawad
The document discusses malnutrition, defining it as a cellular imbalance between nutrient supply and demand. It describes different types of malnutrition including protein-energy malnutrition (PEM) and specific forms like marasmus and kwashiorkor. PEM is the primary nutritional problem in developing countries, affecting growth and survival in children under 5 years old. Management of severe malnutrition involves treating infections, regulating electrolytes, micronutrients and gradual feeding to support recovery without overwhelming the body's slowed systems.
Diarrhea is loose, watery stools. Having
diarrhea means passing loose stools three or more times a day. Acute diarrhea
is a common problem that usually lasts 1 or 2 days and goes away on its own.
Diarrhea lasting more than 2 days may be a
sign of a more serious problem. Chronic diarrhea—diarrhea that lasts at least 4
weeks—may be a symptom of a chronic disease. Chronic diarrhea symptoms may be
continual or they may come and go.
Diarrhea of any duration may cause
dehydration, which means the body lacks enough fluid and electrolytes—chemicals
in salts, including sodium, potassium, and chloride—to function properly. Loose
stools contain more fluid and electrolytes and weigh more than solid stools.
People of all ages can get diarrhea. In the
United States, adults average one bout of acute diarrhea each year, and young
children have an average of two episodes of acute diarrhea each year.
Nutritional management of renal diseasesWajid Rather
The document discusses the major roles of the kidney in metabolic regulation including water-electrolyte homeostasis, calcium-phosphate balance, waste product removal, acid-base balance, erythropoietin production, and blood pressure regulation. It then summarizes the goals of nutritional therapy in renal failure and discusses nutritional problems patients with renal failure often experience like anorexia and metabolic abnormalities. Guidelines for protein intake, energy intake, fluid intake, sodium intake, and potassium intake are provided for non-dialysis patients, patients undergoing hemodialysis, and patients undergoing peritoneal dialysis.
Gastroenteritis is inflammation of the stomach and intestines that causes diarrhea, vomiting and abdominal cramps. It is usually caused by viruses like rotavirus or bacteria like Campylobacter. Common symptoms include diarrhea, vomiting, fever and dehydration. Treatment focuses on rehydration through oral rehydration therapy. Antiemetics may help reduce vomiting, and antibiotics are sometimes used for bacterial causes. Prevention involves handwashing, sanitation and food safety.
This file contains the epidemiology, diagnostic tecnhiques, prevention methods and control strategies of dengue fever in context of developing countries like Nepal.
(Welcome to collaborate to write book, book chapter or review papers)
Clinical assessment of nutritional statusDR RML DELHI
This document discusses the clinical assessment of nutritional status through physical examination. It provides guidance on identifying and classifying common physical signs of malnutrition, such as hair changes, skin and eye conditions, and muscle wasting. The summary is:
1) Physical examination can help detect nutritional deficiencies by identifying signs like delayed growth, skin pallor, and hair/body changes. However, signs are not specific and environmental factors can also cause similar signs.
2) Health workers can be trained to recognize major signs of malnutrition and refer patients for detailed examination. The WHO proposed a classification system to standardize identification and interpretation of signs.
3) Physical signs must be interpreted cautiously and confirmed with dietary and biochemical data, as signs can
How is COPD and Nutrition Overlapped and Affecting Each Other
How to Solve the Problem as a Part of Pulmonary Rehabilitation
The Presentation is Discussing these items in the form of Problem Solving
Malabsorption disorders cause insufficient nutrient absorption due to maldigestion or malabsorption. Causes include exocrine pancreas defects, liver diseases, intestinal diseases, and specific defects. Celiac disease is a genetic autoimmune disorder triggered by gluten that causes intestinal damage. Symptoms include diarrhea, failure to thrive, and malnutrition. Diagnosis involves serology and biopsy showing intestinal damage. Treatment is lifelong gluten-free diet. Cow milk protein allergy symptoms develop in infants and include diarrhea, vomiting, and failure to thrive. Lactose intolerance is caused by lactase deficiency leading to diarrhea from intestinal sugar accumulation after milk ingestion. Treatment involves milk elimination or use of lactase supplements.
diabetic ketoacidosis life-threatening problem that affects people with diabetes. It occurs when the body starts breaking down fat at a rate that is much too fast. The liver processes the fat into a fuel called ketones, which causes the blood to become acidic.
This document discusses various methods used to collect food intake data, including both prospective and retrospective methods. Prospective methods include food diaries using household measures or weights, as well as chemical analysis of duplicate meals. Retrospective methods include 24-hour dietary recalls, food frequency questionnaires, and diet histories. The advantages and limitations of each method are described. National dietary surveys provide a means to investigate food intake trends over time using consistent methodology. The purpose of dietary surveys is to inform public health efforts around nutrition.
This case study describes a patient diagnosed with celiac disease based on positive antibody tests and small intestinal biopsy findings. The patient has a low BMI and lab tests indicate iron deficiency anemia. A review of the patient's diet found gluten was present at each meal. Nutrition diagnoses identified suboptimal iron intake, impaired nutrient utilization due to celiac symptoms, and need for education on a gluten-free diet. Interventions include encouraging an iron-rich gluten-free diet and education on avoiding gluten and addressing nutrient deficiencies.
Chapter 19 Nutrition and Liver Diseases KellyGCDET
The document discusses various liver diseases and their relationship to nutrition. It covers fatty liver disease, hepatitis, cirrhosis, and liver transplantation. Key points include:
1) Fatty liver disease is caused by an accumulation of fat in the liver from excess alcohol, drugs, or metabolic issues like insulin resistance. It can progress to inflammation and more serious conditions if not addressed.
2) Hepatitis is liver inflammation that can result from viral infections or other causes like excess alcohol. Symptoms include fatigue and jaundice. Treatment focuses on supportive care and antiviral drugs.
3) Cirrhosis is scarring of the liver that impairs its function. Major causes in the US are alcohol and hepatitis C
Johnny, an 8-year-old boy, is experiencing weight loss, abdominal discomfort, and loose stool. He has a history of type 1 diabetes and possible thyroid issues. Given his symptoms and medical history, celiac disease is a top consideration. Tests would include a small intestine biopsy to check for villi damage and serologic tests for antibodies associated with celiac disease. Celiac disease is an autoimmune response triggered by gluten that causes chronic inflammation and damages the small intestine. It is treated by maintaining a strict gluten-free diet.
Executive summary 2021 Global Nutrition ReportCIkumparan
1) Progress is being made on some global nutrition targets but not others, and accelerated efforts are needed. Most countries are not on track to meet targets for stunting, wasting, anaemia, obesity, and diet-related diseases. Covid-19 has exacerbated the problem.
2) Unhealthy and unsustainable diets are harming health and the environment. No region meets recommendations for healthy diets, while diet-related deaths and environmental impacts are rising.
3) Financing needs to meet nutrition targets are growing but resources are falling, though the economic costs of inaction are far greater. Traditional and innovative financing must be expanded to close the gap.
Type 2 diabetes is a condition where the body cannot effectively control blood sugar levels. It develops over many years as the body becomes resistant to the effects of insulin. Prediabetes occurs when blood sugar levels are higher than normal but not high enough to be diagnosed as diabetes. The best way to prevent type 2 diabetes is through lifestyle changes like regular physical activity and modest weight loss. Maintaining a healthy lifestyle can significantly reduce risk of developing diabetes and its serious health complications.
Mitch, a 53-year-old man with type 2 diabetes, was admitted to the emergency room with hyperglycemic hyperosmolar syndrome (HHS). He had an A1C of 11.5%, plasma glucose of 855 mg/dL, and was dehydrated. He was started on IV fluids and an insulin drip to rehydrate and lower his blood glucose. Due to his non-compliance with medications and diet, it is likely he will need to continue insulin therapy. The nutrition therapy will focus on diabetes education, achieving 5-10% weight loss, determining an appropriate macronutrient distribution and physical activity goals to help control his diabetes and comorbid conditions of hypertension and high cholesterol.
Determination of Blood Glucose Using Glusose Oxidase-Peroxidase MethodZoldylck
This document discusses blood glucose determination using the oxidase-peroxidase method. It begins by introducing diabetes and its prevalence worldwide. It then describes the materials and methodology used, which involves collecting a blood sample, separating the plasma, and adding an O-toluidine reagent before measuring absorbance. The results showed the patient's glucose level was within the normal range. It further discusses hyperglycemia and hypoglycemia, the different types of diabetes, diagnostic criteria, and gestational diabetes.
This document discusses diabetes mellitus (DM), a metabolic disorder caused by factors that result in chronic hyperglycemia. It begins with background on DM and how it is an increasing health problem. DM is classified into type 1, caused by autoimmune destruction of insulin-producing beta cells, and type 2, caused by insulin resistance. Signs and symptoms of DM include frequent urination, excessive thirst, hunger, and weight loss. DM is diagnosed through blood tests measuring glucose levels when fasting and after consuming glucose. Treatment depends on the type, with type 1 requiring insulin injection and type 2 often controlled through diet, exercise and oral medication.
Dental Management Of Diabetic Patients By Dr Wid Al Kindi872ceo_dentalsurgery
The document discusses dental management considerations for patients with diabetes. It notes that periodontal disease is more common in patients with poorly controlled diabetes. Other oral complications that may be associated with diabetes include xerostomia (dry mouth), fungal infections, oral burning sensations, and delayed wound healing. The dental provider should assess the severity and control of the patient's diabetes and educate them on oral health risks from their condition.
Makalah bahasa inggris diabetes melitusWarnet Raha
1. The document discusses diabetes mellitus, including its definition, pathophysiology, classification, signs and symptoms, and diagnosis. It is a metabolic disorder caused by many factors that results in chronic hyperglycemia and impaired processing of carbohydrates, fats, and proteins.
2. There are two main types of diabetes - type 1 is characterized by an inability to produce insulin, while type 2 involves decreased sensitivity to insulin. Diagnosis involves measuring fasting blood glucose levels and levels after consuming glucose.
3. Common symptoms include frequent urination, excessive thirst, unexplained weight loss, and tingling or numbness in the extremities. Diagnosis is based on blood tests measuring glucose levels according to WHO criteria.
This document provides an introduction to diabetes mellitus, including:
1. A definition of diabetes mellitus and discussion of its pathophysiology and classification into types 1 and 2.
2. Details on the signs and symptoms, diagnosis, and factors that can contribute to diabetes.
3. An overview of treatment approaches including physical exercise, medications like sulfonylureas, and management of blood sugar levels.
This document provides information about hyperglycemic hyperosmolar syndrome (HHS), including other names for the condition, definitions, pathophysiology, diagnostic tests, treatment, complications, nursing diagnoses, and more. HHS is a life-threatening emergency caused by severe hyperglycemia and lack of insulin. It is characterized by extremely high blood glucose levels over 400 mg/dL, hyperosmolality due to water loss from cells, and lack of ketosis. Diagnostic tests show electrolyte imbalances. Treatment focuses on rapid fluid replacement and slow insulin administration to lower blood glucose levels over 24-48 hours. Complications can include organ failure, infection, and death if not properly treated.
diabetes mellitus by Tushar 202345.pptxTushar Mankar
This document provides information on diabetes mellitus and considerations for anesthesia. It begins with an introduction to diabetes and classifications of type 1 and type 2 diabetes. It then discusses anesthetic considerations including preoperative evaluation of diabetes control and complications, intraoperative glucose management goals, and techniques for perioperative insulin administration. The goals are to avoid hypoglycemia while maintaining blood glucose under 180 mg/dL. Tight control below 150 mg/dL is not recommended. Frequent glucose monitoring is important. The document outlines various insulin regimens that can be used during surgery including Alberti-Thomas and tight control protocols.
Diabetes mellitus is a group of metabolic diseases characterized by high blood glucose level caused by either absolute or relative deficiency of insulin. Classifications,sings and symptoms,complications,and prevalence of the disease particularly in Egypt are presented. Management of diabetic patients undergoing oral surgical procedures is discussed.
This document provides an overview of diabetes mellitus, including its classification, pathophysiology, clinical features, investigations, diagnostic criteria, and management. It discusses the different types of diabetes, risk factors, characteristics, and laboratory findings. Type 1 diabetes results from beta cell destruction leading to insulin deficiency, while type 2 involves insulin resistance with relative insulin deficiency. Gestational diabetes occurs during pregnancy.
This document provides an overview of diabetes mellitus, including its classification, pathophysiology, clinical features, investigations, diagnostic criteria, and management. It discusses the different types of diabetes, focusing on type 1 and type 2. Key points include that diabetes results from defects in insulin secretion or action leading to hyperglycemia, its classification is now based on etiology rather than treatment, and management involves lifestyle modifications, oral medications, and possibly insulin therapy.
The document provides information about hypoglycemia including:
1. It defines hypoglycemia as a reduction in plasma glucose concentration that can induce symptoms like confusion or loss of consciousness.
2. The most common cause is medications used to treat diabetes like insulin and sulfonylureas.
3. Symptoms range from neurogenic symptoms like sweating to neuroglycopenic symptoms like weakness, and gestational hypoglycemia has certain features.
This document outlines the key points about diabetes mellitus and its acute complications. It begins with definitions of diabetes mellitus and an overview of the different types. The acute complications discussed are diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar nonketotic syndrome (HHNS), and hypoglycemia. For DKA, it covers causes, pathophysiology, signs/symptoms, diagnostic tests, medical management including fluid resuscitation and insulin therapy, and nursing care. HHNS is defined as a hyperglycemic condition without acidosis seen in older patients. Risk factors, signs, and treatment are also summarized.
This document provides an overview of the pathophysiology of diabetes mellitus. It defines diabetes as a group of metabolic disorders resulting in hyperglycemia and dyslipidemia due to defects in insulin secretion or action. The document discusses the classification, symptoms, diagnosis and complications of both type 1 and type 2 diabetes. It also covers the physiology of insulin synthesis, secretion and action, as well as the risk factors and pathophysiology underlying different types of diabetes.
Diabetes mellitus (DM) is a disease of inadequate control of blood levels of glucose. It has many subclassifications, including type 1, type 2, maturity-onset diabetes of the young (MODY), gestational diabetes, neonatal diabetes, and steroid-induced diabetes. Type 1 and 2 DM are the main subtypes, each with different pathophysiology, presentation, and management, but both have a potential for hyperglycemia. This activity outlines the pathophysiology, evaluation, and management of DM and highlights the role of the interprofessional team in managing patients with this condition.
Objectives:
Describe the pathophysiology of diabetes mellitus.
Outline the epidemiology and risk factors of diabetes mellitus.
Review the treatment considerations and common complications of diabetes mellitus.
Identify the importance of improving collaboration and care coordination amongst the interprofessional team to enhance the delivery of care for patients affected by diabetes mellitus.
Access free multiple choice questions on this topic.
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Introduction
Diabetes mellitus is taken from the Greek word diabetes, meaning siphon - to pass through and the Latin word mellitus meaning sweet. A review of the history shows that the term "diabetes" was first used by Apollonius of Memphis around 250 to 300 BC. Ancient Greek, Indian, and Egyptian civilizations discovered the sweet nature of urine in this condition, and hence the propagation of the word Diabetes Mellitus came into being. Mering and Minkowski, in 1889, discovered the role of the pancreas in the pathogenesis of diabetes. In 1922 Banting, Best, and Collip purified the hormone insulin from the pancreas of cows at the University of Toronto, leading to the availability of an effective treatment for diabetes in 1922. Over the years, exceptional work has taken place, and multiple discoveries, as well as management strategies, have been created to tackle this growing problem. Unfortunately, even today, diabetes is one of the most common chronic diseases in the country and worldwide. In the US, it remains as the seventh leading cause of death.
Diabetes mellitus (DM) is a metabolic disease, involving inappropriately elevated blood glucose levels. DM has several categories, including type 1, type 2, maturity-onset diabetes of the young (MODY), gestational diabetes, neonatal diabetes, and secondary causes due to endocrinopathies, steroid use, etc. The main subtypes of DM are Type 1 diabetes mellitus (T1DM) and Type 2 diabetes mellitus (T2DM), which classically result from defective insulin secretion (T1DM) and/or action (T2DM). T1DM presents in children or adolescents, while T2DM is thought to affect middle-aged and older adults who have prolonged hyperglycemia due to poor lifestyle and dietary choices. The pathogenesis for T1DM and T2DM is drastically different, and therefore each type has various etiologies, presentations, and treatments.
Diabetes mellitus is a metabolic disorder characterized by relative or absolute insulin deficiency that affects 6% of the US population. There are two main types of diabetes: type 1 is characterized by autoimmune destruction of insulin-producing cells and requires insulin treatment; type 2 is more common and results from impaired insulin function and insulin resistance. Without proper glucose control, diabetes can lead to serious long-term complications affecting many organ systems like the eyes, kidneys, heart, and nerves. Dental professionals need to consider a patient's medical history and glycemic control to minimize risks during treatment and manage emergencies like hypoglycemia or hyperglycemia.
This document provides information on diabetes mellitus (DM), including definitions, types, pathophysiology, clinical manifestations, diagnosis, and management. It begins by defining the objectives of the session and introducing the pancreas and pancreatic hormones like insulin, glucagon, and somatostatin. It then defines DM, describes the two main types (type 1 and type 2), and other less common types. Risk factors, clinical features, diagnostic criteria involving blood tests, and potential complications of both short-term and long-term hyperglycemia are outlined. Management of DM focuses on diet, exercise, and medication like insulin or oral hypoglycemic agents.
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The document describes a study that induced type 1 diabetes in rats using streptozotocin injections to study the progression of diabetic nephropathy. Rats were divided into normal, diabetic, and diabetic fed a high-fat diet groups. Over 8 weeks, the diabetic and diabetic high-fat diet rats displayed increased blood glucose, water intake, urine output and glomerular mesangial expansion compared to normal rats, indicating the onset and progression of diabetic nephropathy. Streptozotocin successfully induced diabetes in rats and the addition of a high-fat diet exacerbated nephropathy severity.
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1. Name(s):MarisaGutierrez,Laurie Hill,JessicaLeslie,AshleyMarsh
Date: 3/27/2014
Class period: TR 1:30-2:45
NTR 341
Due: On the date stated in your syllabus by 10:00 pm via Blackboard
Case Study #17 – Adult Type 2 Diabetes Mellitus: Transition to Insulin
Understanding the Disease and Pathophysiology
1. (3 points) What are the standard diagnostic criteria for T2DM? Which are found in
Mitch’s medical record?
The standard diagnostic criteria for T2DM are symptoms of diabetes which include
polyuria, polydipsia, polyphagia, and weight loss, weakness and fatigue. Neuropathyor
retinopathy may be present as complications in a patient with undiagnosed T2DM. Most
patients do not have symptoms indicating T2DM (1). Clinically the diagnostic will be one
of the following:
plasma glucose concentration ≥200 mg/dL
fasting plasma glucose ≥126 mg/dL
2-hour post-prandial glucose ≥200 mg/dL during an oral glucose test
(2 pg. 485).
Mitch’s serum glucose in the ER was 1524 mg/dL. The next day his glucose level was at
475. This is still elevated since normal limits are between 70-110 mg/dL and his HbA1c
was 15.2%, normal is between 3.9-5.2, indicating that his blood glucose has not been in
control the past few months (3 pg. 198-199). His osmolality was 360 the first day he was
in the hospital and then the 2nd day it was 304 which is improved but not within the
normal limits of 285-295 (3 pg. 198). His urinalysis showed protein, glucose, and ketones.
2. (3 points) What types of medications are metformin and glyburide? Describe their
mechanisms as well as their potential side effects/drug-nutrient interactions.
Metformin is in a category of drugs called biguanides and is used to treat Type 2
diabetes. It works to control the glucose in the blood by lowering the amount of glucose
that manufactured by the liver as well as that glucose the body would absorb from food
consumption. Metformin will help the body respond to insulin that is naturally produced
in the body. Some people may have side effects that include the following: diarrhea,
bloating, stomach pain, gas, indigestion, constipation, unpleasant metallic taste in
mouth, heartburn, headache, flushing of the skin, nail changes, muscle pain. More
serious complications such as chest pain or a rash may appear and need immediate
emergency treatment. Lactic acidosis may also occur. There may be other side effects
such a polyps in the uterus but have not been proven in humans (4). Metformin is known
2. to lower B12 absorption which if there is adequate intake of B12 in the diet, taking
metformin will not necessarily cause a problem. However, in some cases it can cause a
nutrient deficiency and the following are more at risk: older age, vegetarian diet, if the
drug is used in high doses or taken for more than 3 years. Correction of the deficiency
would be to supplement with 1000-2000 mcg on a daily basis (5).
Glyburide is in the sulfonylureas classification of drugs. This medication is used to
decrease blood sugar by stimulating the pancreas to produce insulin and assist in
productivelyutilizing the insulin. Some of the complications from this medication may
include nausea, upper abdominal fullness, heartburn, rash. More serious side effects
may include yellowing of the skin or eyes, light colored stools, dark urine, pain in the
upper right part of the stomach, unusual bruising or bleeding, diarrhea, fever, sore
throat, and swelling of the eyes, face, lips, tongue, or throat. Other symptoms may
appear as well (6).
3. (4 points ) Describe the metabolic events that led to Mitch’s symptoms and subsequent
admission to the ER with the diagnosis of uncontrolled T2DM with HHS. Make sure to define
HHS and relate this to the patients’ symptoms.
The metabolic events that led to Mitch’s symptoms and admission to the ER with T2DM
and HHS were caused by the body’s inability to use the insulin and his body breaking
down muscle and producing ketone bodies. This led to drowsiness and confusion which
was observed upon the arrival of the co-worker.
HHS is Hyperglycemic Hyperosmolar Syndrome which can occur in patients who have
T2DM with a blood glucose greater than 600 mg/dL. Mitch presented at the ER with a
glucose level of 1524 mg/dL. HHS also occurs when a patient’s serum osmolality is
greater than 320 mOsm/kg of water, Mitch had an osmolality level of 360 mmol/kg/water.
Patients with HHS will also not have a presence of ketoacidosis. HHS can be initiated by
both dehydration and infections (2 pg. 499). Mitch had been vomiting and due to his
physical state of being drowsy and confused upon his co-worker’s arrival, he was
hyperglycemic and dehydrated. He also had ketones present in his urine.
4. (4 points) HHS and DKA are the common metabolic complications associated with
diabetes. Discuss each of these clinical emergencies. Describe the information in Mitch’s chart
that supports the diagnosis of HHS.
HHS is Hyperglycemic Hyperosmolar Syndrome and many people with type 2 diabetes
can have this complication. HHS is initiated by an infection or severe illness which can
cause dehydration if vomiting or diarrhea are involved. There are three main factors that
contribute to HHS: 1. excessivelyhigh levels of blood glucose, >600 mg/dL 2.
dehydration from lack of fluid intake or excessive loss of fluid 3. decreased
consciousness. These symptoms do not occur all at once and are a result of lifestyle and
are not usually recognized until there is a problem (2 pg. 499). Other symptoms include
3. undiagnosed diabetes, polyuria, polydipsia, fever (due to infection), weight loss that is
unexplained. Laboratory tests include a plasma glucose >600 mg/dL, arterial pH >7.3,
serum bicarbonate >15 mEq/L, urine and plasma ketones will both be small, and serum
osmolality >320 mOsm/kg. These symptoms result in the need of hospital treatment for
re-hydration to occur at a slow rate, treat any underlying conditions such as an infection,
balance electrolytes, and possible use of insulin to bring the blood glucose back in
control (2 pg.503).
DKA is diabetic ketoacidosis and occurs in patients with type 1 diabetes and those who
have undiagnosed type 2 diabetes, are obese & do secrete insulin and use it efficiently.
There are many issues that can cause DKA such as infections, psychological stress, lack
of self-monitoring blood glucose, not using insulin or the need for more insulin due to
growth, pump malfunction, drug abuse, or severe illnesses which include CVA, MI,
pancreatitis, pulmonary embolism, alcohol or drug abuse. Symptoms of DKA include
polyuria, polydipsia, weight loss (unexplained), vomiting, abdominal pain, dehydration
indicated by loss of skin turgor and dry mucous membranes, tachycardia, hypotension,
patients may also have acetone breath which is a fruity breath, and kussmaul
respirations which is a deep labored breathing. Laboratory tests include a plasma
glucose >250 mg/dL, arterial pH <7.0 to 7.3, serum bicarbonate < 10 to 18 mEq/L, ketones
in both blood and urine will be positive and serum osmolality will be variable. Hospital
treatment is necessary for IV fluids to hydrate the patient as well as insulin, and
assessment of blood electrolytes (2 pg. 503).
Mitch’s arrival at the hospital he had dry mucous membranes in the throat, he was
drowsy and mildly confused, his skin was warm, dry and had poor turgor. His lab values
show a blood glucose of 1524 mg/dL, and osmolality of 360 mmol/kg/water. His urinalysis
had positive values for both glucose and ketones. These symptoms and lab values fit the
criteria for HHS.
5. (3 points) Describe the insulin therapy that was started for Mitch. What is Lispro? What
is glargine? How likely is it that Mitch will need to continue insulin therapy?
Mitch will begin Lispro, 0.5 units every2 hours until blood glucose levels reach 150-200
mg/dL. Mitch will also be given glargine, 19 units. Lispro is a short acting form of insulin
used to control the amount of glucose in the blood. Glargine is a long acting form of
insulin that will lower blood glucose levels at a constant rate over time. It is verylikely
that Mitch will continue insulin therapy after discharge from hospital. His poorly
controlled diabetes and poor diet cause him to be at an increased risk for recurring
episodes of HHS and possibly DKA.
4. 6. (5 points) What are the chronic complications associated with diabetes mellitus?
Describe the pathophysiology associated with these complications, specifically addressing the
role of chronic hyperglycemia.
Chronic complications of DM include neuropathy, renal complications, blindness,
amputations of the lower extremities, MI and CVA. The complications are related to the
changes in the blood vessels caused by DM. Chronic hyperglycemia caused by poorly
controlled DM causes inflammation within the vessels. The resulting inflammation by this
excess glucose in the bloodstream is cause for cardiovascular and cerebrovascular
complications. Risks include but are not limited to MI or CVA. The microvascular
changes due to inflammation also cause damage to nerves in the extremities (7). This
damage causes pain and numbness and in severe cases, complete loss of function and
ultimately amputation. Renal complications as they relate to chronic hyperglycemia and
vasculature include hardening of the microvessels, or glomeruli of the kidneys (7). This
progressive DM complication is referred to as glomerular sclerosis (8). Ophthalmic
complications are also included in the list of complications due to vascular and
microvascular changes associated with DM. Chronic hyperglycemia, or excessive
glucose circulating in the blood, will cause more rapid and extensive damage to the
vessels. Damage to these vessels will, in turn cause complications throughout the body
systems.
*Requirement - Please cite at least one review article from a peer reviewed medical/nutrition
journal that is no more than 10 years old. Your reference(s) must be properly cited, and a pdf
copy of the full article you used must uploaded separately when you submit your case study
online. *
Nutrition Assessment
7. (6 points) Identify any abnormal laboratory values measured upon his admission. Which
lab values changed after hydration and initial treatment of his HHS?
5. Biochemic
al Value
Patient’s
Value
(Indicate
high or
low)
Reason for
Abnormality
Nutrition
Implication
(nutrition
related
concern with
abnormality)
Did values
change?
Sodium
(mEq/L)
132, low Vomiting
Retaining
nutritional
and fluid
intake
no
significant
change
BUN
(mg/dL)
31, high
Altered kidney
function due
to Diabetes
Must alter
protein intake
moderate
decrease
in BUN
Creatinine
serum
(mg/dL)
1.9,
high
Dehydration,
kidney
problems
Must
increase fluid
intake
small
change
Glucose
(mg/dL)
1524!,
high
Mal-
absorption of
insulin as a
complication
of DM
Sugar and
CHO levels in
diet
Significant
change in
BS levels
after tx
Phosphate
, inorganic
(mg/dL)
1.8, low
increased
loss of
bicarbonate in
urine, caused
by altered
kidney
function in
relation to
poorly
controlled DM.
Poor nutrition,
vitamin D
deficiency
slight
increase
osmolality
(mmol/kg/
H2O)
360,
high
diet lower in
LDL, and
higher in HDL
slight
decrease
after tx
Cholesterol
205,
high
atherosclerosi
s as related to
DM
diet lower in
LDL, and
higher in HD
would not
change
after initial
tx
Triglycerides
(mg/dL)
185,
high
high blood
glucose levels
alter intake of
saturated fat
would not
change
6. creating fatty
acids
after initial
treatment
HbA1c (%)
15.2,
high
excess blood
sugar over 3
months due to
DM
uncontrolled
Dietary
control of
blood sugar
levels
no
immediate
change in
percentag
e after
initial
treatment
WBC’s
13.5,
high
inflammation
caused by DM
included
inflammation
reducing
foods
especially
those with
Omega-3’s
no
immediate
change
Hematocrit 57, high Dehydration
Rehydrate
patient
will
change
over time
8. (2 points) Determine Mitch’s energy and protein requirements.
Kcal Needs:
Pt weighs 214 lbs 214/2.2 = 97.3 kg
kcal: 25 - 30 kcal/kg/day
Range for pt: 25 x 97.3 = 2432 kcal/day up to 30 x 97.3= 2919 kcal/day
Protein Needs:
Normal = 0.8(97.27)kg = 77.82 g Protein
Minor illness = 1.2(97.27kg) = 116.72 g Protein
Protein needs for pt: 77.82 g/day - 116.72 g/day
Nutrition Monitoring and Evaluation
(20 points) Write your nutrition care from the standpoint of your initial nutrition consult. Please
also add education goals that you plan on addressing prior to this patient’s discharge from the
hospital.
7. Sun Devil Nutrition Care Form (Total = 20 Points)
Please record N/Aif data is unavailable
Please show all calculations used to determine kcal, protein and fluid needs
DATA & ASSESSMENT: 2 Points: (all or nothing here)
Subjective Data:
Mitchell is a single, 53 year old caucasian white male who lives alone. He is retired
military, currently working as a consultant to a military equipment company. Mr. Fagan
has smoked 1ppd for 20 years but has now quit, he also admits to 3 to 4 drinks per week.
Family history of HTN and type 2 DM. Does not take his medication for diabetes regularly
as he does not like how the side effects make him feel. Does take all other medications
as prescribed.
Patient is not currently following a strict diet but does avoid added salt, high cholesterol
foods, and high sugar desserts. Has not had any formal education for diabetes aside
from what his physician has provided.
Usual Intake:
AM: Coffee with half and half
Midmorning: Bagel with cream cheese, 2-3 c of coffee
Lunch: Out at restaurant - usually Jimmy John’s or fast-food sandwich,
chips, and diet soda
Dinner: Cooks sometimes at home - this would be grilled chicken or beef,
salad, and potatoes or rice. Often will meet friends for dinner -
likes all foods and especially likes to try different ethnic foods
such as Chinese, Mexican, Indian, or Thai
Age: 53 y.o Gender: Male Height: 5’9” (175.26cm) Weight: 214lbs (97.27kg)Weight History:
n/a
Medical Diagnosis: Type 2 DM uncontrolled with HHS
Reason for Consult:
Consult dietitian for advancement, total carbohydrate Rx, and distribution
Diabetes education for self-management training
Medications:
Glyburide 20 mg daily
Metformin 500 mg twice daily
Dyazide once daily (25 mg hydrochlorothiazide and 37.5 mg triamterene)
Lipitor 20 mg daily
Current Diet Order:
NPO except for ice chips and medications, after 12 hours clear liquids if stable.
Then, advance to consistent-carbohydrate diet
8. Past Medical/Surgical History:
Medical Hx:
Type 2 DM x 1 year
Hypertension
Hyperlipidemia
Gout
Surgical Hx:
ORIF R ulna
Hernia repair
1 Point:
Lab Values and Assessment:
Chemistry Ref. Range 4/12 @ 1780 4/13 @ 1522
Sodium(mEq/L) 136-145 132 ↓ 134 ↓
BUN (mg/dL) 8-18 31 ↑ 20 ↑
Creatine serum
(mg/dL)
0.6-1.2 1.9 ↑ 1.3 ↑
Glucose (mg/dL) 70-110 1524 ↑ 475 ↑
Phosphate,inorganic
(mg/dL)
2.3-4.7 1.8 ↓ 2.1 ↓
Calcium(mg/dL) 9-11 10 9.8
Osmolality
(mmol/kg/H2O)
285-295 360↑ 304↑
Cholesterol (mg/dL) 120-199 205↑
HbA1c (%) 3.9-5.2 15.2↑
C-peptide (ng/mL) 0.51-2.72 1.10
Urinalysis showed positive for protein, glucose, and ketones.
Upon admission patient showed an elevated serumglucose of 1524 mg/dL, after insulin
infusion levels dropped to 475 mg/dL which is still elevated but heading back into a
normal range. Patient’s HbA1c level was at 15.2% upon admission which displays that
his blood glucose levels have not been controlled overthe past 3 to 6 months.
9. 1 Point:
Weight Assessment (BMI and/or Hamwi Range - not just IBW):
BMI = weight (kg) / height (m2
) = 97.27kg/ (1.753m)2
= 31.6
Hamwi = 106 + (6 x 9)= 160 lbs
Hamwi range = 144 lbs - 176 lbs
Mr. Fagan’s ideal body weight would be 160 lbs. Based on patient’s BMI of 31.6 he is in
the obese category and according to the Hamwi equation he is 21% overweight (214
lbs/176 lbs).
1 Point:
Energy Needs:
25kcal (97.27kg) = 2,431.75 kcal
30kcal (97.27kg) = 2,918.10 kcal
To maintain his current weight he needs to consume 2,432-2,918 kcal according to the
kcal/kg method . It is recommended that Mr. Fagan consume between 1,932- 2,418 kcal to
promote weight loss.
1 Point:
Protein Needs: Protein requirements would range from 77.82g - 116.72g
Normal = 0.8(97.27)kg = 77.82 g Protein
Minor illness = 1.2(97.27kg) = 116.72 g Protein
1 Point:
Fluid Needs:
2000-2500 mL after rehydration
4 Points:
NUTRITION ASSESSMENT NARRATIVE - Be specific so your audience (MD, RN, staff RD,
etc) understands your assessment.
Patient has experienced an episode of diabetic ketoacidosis due to not eating for 12-24
hours. Patient suffers from Type 2 Diabetes but admits to not using his medication.
Patient also suffers from hypertension, hyperlipidemia and gout. Patient reports recently
quitting smoking 1 ppd. Patient also drinks alcohol 3-4 times per week. Based on
patients usual intake, his diet consists of a majority of fast food items and coffee. This
means that his diet is high in sugar (which cannot make it into his cells due to lack of
medication/insulin) saturated fat, caffeine, and sodium. It is also low in vitamins,
minerals, and water (drinks coffee instead).
10. 3 Points:
NUTRITION DIAGNOSIS:
Problem (Terminology):
Impaired nutrient utilization (NC- 2.1)
Related To
Food- and nutrition-related knowledge deficit (NB-1.1)
As Evidenced by
24 hour recall
2 Points:
NUTRITION INTERVENTIONNARRATIVE - Be specific so your audience (MD, RN, staff RD,
etc) understands your desired intervention, what it provides and why this needs to take place.
First and foremost, the patient needs to meet with a diabetes educator to understand his
condition and how to properlytake his medication regularly. He should learn how to
determine administration of insulin based on his carbohydrate intake. He should
understand that carbohydrates are necessary in his diet, but insulin is required with it.
The side effects of the medication should also be addressed in order to ensure
compliance. A journal on patient’s daily diet and administration of insulin would be
preferable to ensure patient understands keyconcepts.
As for his diet, the daily caloric intake should be reduced by 500 kcal/day and further
reduced as needed to promote weight loss. He should be educated on the DASH diet to
prevent future CAD or CVD. He should be instructed on how to properly substitute the
foods high in empty calories in his diet for nutrient dense foods (e.g. drink water or juice
instead of coffee).
For non-dietary goals, the patient should continue cessation of smoking and should
begin regular exercise.
1 Point:
Nutrition Intervention (Terminology):
Goals:
General/healthful diet (ND-1.1)
Nutrition Education- survival information (E-1.3)
Nutrition Counseling- Health Belief Model (C-1.2)
Goal Setting (C-2.2)
Relapse prevention (C-2.9)
Referral to RD with different expertise- CDE (RC-1.4)
11. 2 Points:
NUTRITION MONITORING NARRATIVE - Be specific so your audience (MD, RN, staff RD, etc)
understands your desired monitoring plans and why this needs to take place.
In one week, call patient to ensure compliance. Ask specific questions on the patients
diet and administration of insulin. If compliance low or patient cannot recall his
education, have him come in for re-education. If compliance is high, schedule for
appointment in one month. When he comes in, track weight loss, Hemoglobin A1C levels
and blood glucose levels. Continue checks ups as seen fit.
1 Point:
Nutrition Monitoring (Terminology):
Goals:
Modified diet (FH-1.1.1.2)
Meal/snack pattern (FH-1.3.2.3)
Total Carbohydrate Intake (FH-1.6.3.1)
Food and nutrition Knowledge (FH-3.1)
Motivation (FH-3.2.4)
Ability to recall nutrition goals (FH-4.1.3)
Self-management as agreed upon (FH-4.1.5)
Physical Activity (FH-6.3)
Weight (AD-1.1.2)
Glucose, fasting (BD-1.5.1)
Glucose, regular (BD-1.5.2)
HgbA1c (BD-1.5.3)
RD Signature:Marisa Gutierrez, Laurie Hill, Jessica Leslie, Ashley Marsh (students)Date: 3/27/2014
12. References
1. Virtual Health Care Team. (2013). Diabetes mellitus type 2. Retrieved from
http://shp.missouri.edu/vhct/case2600/symptoms.htm
2. Nelms M., Sucher K.P., Lacey K., Roth SL (2011). Nutrition Therapy & Pathophysiology
2nd edition. Belmont, CA:Cengage Learning.
3. Nelms, M.N., & Roth, S.L. (2014). Medical Nutrition Therapy: A Case Study Approach
4th edition. Stamford, CT: Cengage Learning
4. Medline Plus. (2014). Metformin. Retrieved from:
http://www.nlm.nih.gov/medlineplus/druginfo/meds/a696005.html
5. Therapeutic Research Faculty. (2014). Drug-induced nutrient depletion. Retrieved from
http://naturaldatabase.therapeuticresearch.com/ce/ceCourse.aspx?s=ND&cs=&pm=5&p
c=11-108&AspxAutoDetectCookieSupport=1
6. Medline Plus. (2014). Glyburide. Retrieved from
http://www.nlm.nih.gov/medlineplus/druginfo/meds/a684058.htm
7. Lau C.W. David, MD, PhD, FRCPC. (2014). Cardiovascular Complications of Diabetes.
Canadian Journal of Diabetes, 37 (5). Retrieved from
http://www.sciencedirect.com.ezproxy1.lib.asu.edu/science/article/pii/S14992671130120
94?via=ihub#
8. Min T.Z., Stephens M.W., Kumar P., Chudleigh R.A. (2012 September 7). Renal
Complications of Diabetes. British Medical Bulletin., 104 (1). Retrieved from
http://bmb.oxfordjournals.org.ezproxy1.lib.asu.edu/content/104/1/113