Question

John is a 55 year-old Caucasian man with diabetes and asthma. He teaches math at a local high school in New York City. He was diagnosed with type 2 diabetes on blood tests performed when he applied for life insurance at age 51. At the time, he was obese, weighing 220 pounds at 5 feet, 10 inches height (BMI = 31.6). He stopped smoking at age 46 and he does not consume alcohol.

Discuss two (2) care management recommendations for J.W.

Answer 1

Care management recommendations for client with diabetes mellitus

The risk factors include

• Being overweight
• Physical inactivity
• Family history of diabetes mellitus
• Age above 45 years
• PCOD for women

In this case, John is overweight, hence the care management will focus mainly on diet and exercise.

Nutritional therapy

• Reduce calorie intake if weight loss is needed.

1. Protein-15% to 20% of total daily calories. Those with nephropathy should limit protein intake to 10%.
2. Fat-less than 10% of daily calories from saturated fat.
3. Cholesterol intake should be less than 300 mg/day.
4. Carbohydrate-should constitute the remaining percentage of calories after determining protein and fat needs.

• Carbohydrates should include whole grains, fresh vegetables, and fresh fruits. Choose foods lower in fat and calories and higher in fiber.
• Overall intake of simple sugar should be limited as much as possible, its consumption is acceptable in moderate amounts when counted as part of total carbohydrate intake.
• Sodium-intake should be less than 2400 mg/day.
• Fiber-approximately 25 to 30 g/day from a variety of food sources.
• Alcohol is high in calories, has no nutritive value. So it should be avoided.
• Self monitoring of blood glucose is advised since it provides a better adjustment of diet and exercise based on the glucose level.

Exercise

• Regular exercise has been shown to improve blood glucose control, reduce cardiovascular risk factors, and contribute to weight loss.
• Exercise does not have to be vigorous to be effective. The blood glucose-reducing effects of exercise can be attained with exercise such as brisk walking.
• Aim for a minimum of 30 to 60 minutes of moderate physical activity — or 15 to 30 minutes of vigorous aerobic activity — on most days.
• Take a brisk daily walk. If you can't fit in a long workout, spread your activity throughout the day.
• The exercises selected should be enjoyable to foster regularity.
• Exercise is best done after meals, when the blood glucose level is rising.
• It is important to self-monitor blood glucose levels before, during and after exercise to determine the effect exercise has on blood glucose level at particular times of the day.
• Be alert to the possibility of delayed exercise-induced hypoglycemia, which may occur several hours after the completion of exercise.
• Taking a glucose-lowering medication does not mean that planned or spontaneous exercise cannot occur.
• it is important to compensate for extensive planned and Spontaneous activity by monitoring blood glucose level to make adjustments in the insulin dosage (if taken) and food Intake
• Prolonged sitting should be interrupted every 30 min for reducing blood glucose. Decrease the amount of time spent in daily sedentary behavior.  
• Flexibility training and balance training are recommended 2–3 times/week for older adults with diabetes. Yoga and tai chi may be included based on individual preferences to increase flexibility, muscular strength, and balance.