Question

A 69-year-old retiree was diagnosed 5 years ago with type 2 diabetes. The patient is 5.7’ tall, weighs 178lb and has a waist measuring 40inches. He gets up multiple times during the night to use the restroom, especially after large pasta meals. He may feel unusually thirsty from time to time. Lately he has also been feeling unusually tired and fatigued. He has been unsuccessfully trying to lose weight for the past 6 months. He is not monitoring his sugar as recommended by his physician. The patient also has a family history of diabetes; as both his parents were diabetic. The patient has limited knowledge of self-management and states that he does not eat sweets and has never been sick in his life. He lives with his wife of 48 years. She scours the internet for information regarding diabetes and brings home supplements and herbal medications to help his condition.

He has never visited a dietician. He is referred to you by his physician. His dietary habits reveal excessive carbohydrate consumption mostly in the form of pasta, pizza and white bread. He prefers chicken and fish but these are usually combined with pasta in tomato or white sauce. He may sometimes eat fruits for snacks. He used to smoke, but has not done so for the past ten years.

Lab report

Parameter	Patient	Normal
Blood glucose	178mg/dl	65-109mg/dl
Lipid panel Total Cholesterol HDL Cholesterol LDL Cholesterol Triglycerides Cholesterol to HDL ratio	162mg/dl 43mg/dl 84mg/dl 177mg/dl 3.8	<200mg/dl >40mg/dl <100mg/dl <150mg/dl <5
A1C	8.1%	4-6%

Use the following links to help design a diet plan for ONE day to help this patient manage his diabetes.

Diabetes resources are available at by clicking on the following link (Diabetes)

Use the USDA link to calculate the calories and nutrient requirements for this client.

Write a two paragraph analysis on how you would approach this patient and make recommendations to help him achieve his goal of losing about 20lb in a sustainable manner.

On the diet plan find ways to balance the following nutrients

carbohydrates (45-65% of the daily calories),

lipids (20-35% with < 10% saturated), and

protein (10-25% of the daily calories.

Diet plan should not exceed recommended levels of cholesterol or sodium. The plan should also be showing okay under each food group (the top line) and be within 200 kcal of the recommended kcalories per day and not go over the recommended “extra calories.” The amount of added sugar should be kept below 20 grams. Most of the vitamins and minerals should be as close to 100% (specially water soluble vitamins).

Answer 1

Patient’s Profile

Age: 69

Weight – 178lb (80.7 kg)

Height – 5.7 (173.7 cm)

BMI = Weight in kg/ Height in m2 = 80.7/2.99 = 26.99 = 27 kg/ m2

According to patient’s current BMI, he is coming under Grade 1 obesity

His calorie requirement as per USDA is 2000Kcal. But according to his weight 0.5kg/ week weight reduction is the possible way which can be sustainable. So 5ooKcal reduction from calories needed.

Therefore the calorie requirement of the patient is 1500 Kcal/d

Carbohydrate requirement is (60%) = 1500* 60%/ 4 = 170gm

Fat requirement is (25%) = 1500* 25%/ 9 = 42 gm

Protein requirement is (15%) = 1500* 15% /4= 56 gm

Dietary Guidelines

• · The patient has to include one cereal serving, one pulse or legume serving, milk or meat, vegetables and fat in his main meals
• · Frequent meals are advised rather than heavy meals at a time which may shoot up the blood sugar.
• · Split the carbohydrate containing food is better tolerated
• · Healthy fats are recommended

Avoid- fried foods, red meats, processed food like high fat containing foods

Include small fishes like salmon, tuna, herring, rainbow trout, mackerel and saradine

• · Include fresh vegetables
• · One Whole fruit with low glycemic index is recommended than fruit juices
• · If he consumes any sweet that should be compensated by reduce the carbohydrate food in the next meal.
• Handful of nuts are also preferable
• Cooking methods - broilong, roasting, baking, stewing, steaming, grilling and pressure cooking rather than fat as a medium of cooking
• He should include dietary fibre containing foods like whole grains, whole pulses, raw vegetables etc.

Time	Menu	Amount	Ingredients	Calorie
Early Morning	Black Tea/Black Coffee	1 glass
Breakfast	Cooked oats meal Almonds Chia seed Baked Potato	1 cup 1 bowl 1 teaspoon 1 bowl	Oats – 50g Almonds- 30g Chia seed – 5g Potato – 20g	189.5 113.7 24.3 14.0
Midmorning	Any low glycemic index fruit – Orange/Apple/ Sapota (only one fruit)	1	40g	25.53
Lunch	Tomato soup Macroni Whole wheat bread with cheese Boiled Vegetables Grilled Chicken	1 bowl 1 bowl 2 slices 1 cup 1	Tomato – 50g Macroni- 100g Whole wheat- 40g Cheese – 5 gm Any vegetables- 10gm/each Chicken- 40gm	9.8 357 128.11 18.02 30 43.6
Evening	Tea/Coffee/Skimmed milk Vegetable salad	1 glass 1 bowl	Milk – 100 ml Any Vegetable- 10gm/ each	72.9 40
Dinner	Quinoa Wheat Wrap Boiled Egg white Sprouted Beans Steamed broccoli	1 bowl 1 1 1 bowl 1 bowl	Quinoa- 30gm Whole Wheat -50g Egg white- 40gm Beans- 20gm Broccoli- 30gm	98.5 160.13 21 20 10
Bed time	Skimmed milk	1 glass	Skimmed milk- 100ml	34
TOTAL CALORIES	1410.09 Kcal