Question

DF is a 53 year old male with diagnosed Type II diabetes, approximately 8 years ago. He admits he has never really cared about regulating the condition. He is currently taking Metformin and they are starting to notice that his blood sugar numbers are becoming more and more irregular, regardless of the medication trying to regulate it. DF is a very successful business man and travels, he frequently entertains his clients at restaurants and bars. DF is not an overweight individual and admits to having “too many cocktails” daily. He admits he doesn’t eat consistently or at frequent intervals.

Initial Assessment:

B/P: 135/80

Height: 5.9”

Weight: 175 lbs

BMI: 25

Fat%: 27

History:

DF has never struggled with his health. He has a family history of alcoholism, heart disease and diabetes. He has trouble sleeping, suffers from fatigue, memory issues, some acid reflux, low libido, severe headaches and some aggressive outbursts. He very seldom craves anything according to him. His doctor is also concerned about his fatty liver, and has told him to lay off the alcohol. DF does not believe he has a drinking problem but realizes he needs to cut back. DF tests his blood sugar daily with glucometer and he is really worried about his glucose numbers, they go as high as 400 and as low as 58. DF is concerned because he is starting to have vision issues (blurred) and some numbness and tingling in his extremities. He is also noticing poor wound healing on his body. He is fearful of needles and cannot foresee himself injecting insulin. He is up for a medical checkup in three months. And wants to know if there is something you can do to make his numbers go down?

He is very eager and even pushy to have the results happen quickly, but is willing to do anything for three months to the letter of the rule that you lay out as the clinical professional. Can you do this??

Medication and Supplements:

Metformin- 500 mg twice daily

Pepcid- 20 mg once daily

Multi vitamin (Centrum)- 1 daily

(Not currently taking statin – was prescribed but gets severe muscle aches when taking)

Laboratory Data:

AST: 84H (0-40 U/L)

ALT: 78H (0-55 U/L)

Cholesterol: 249 H (100-199 mg/dL)

Triglycerides: 588 H (0-149 mg/dL)

LDL: 143 H (<130 mg/dL)

Fasting glucose: 170H (0-105 mg/dL)

Hgb A1C: 7.1 H (< 5.7%)

Dietary Intake:

When DF eats during the day it will look like this, however it is not uncommon for him to eat just one meal per day and snack on bits and pieces)

DF likes diet sodas and drinks no water

Breakfast: Cheerios with low fat milk

Snack: Protein bar

Lunch: Philly cheese steak, pizza (one slice), hot dog, hamburger

Snack: Peanuts, cashews or some salty pretzel

Late afternoon: Scotch, Gin, Whiskey on the rocks “to take the edge off”

Dinner: Steak/fish some vegetables, depending on the restaurant. He likes having good dinners with a couple of glasses of wine

Questions-

1. Identify DF’s chief complaint?

2. Analyze lab data and identify what if any further tests are necessary.

3. Analyze DF’s diet and Comprise a 1 day food protocol treatment plan.

4. Identify any dietary supplement and lifestyle modifications that DF should make.

Answer 1

1.DF's chief complaints are

• Increased blood glucose level
• Tingling sensation of the extremities
• poor wound healing
• low libido
• blurred vision
• Insomnia
• Fatigue
• memory issues
• acid reflux
• severe headaches

2.Further Lab tests:

• Fasting Blood sugar and Post Pandrial Blood sugar( as follow up)
• cholestrol levels( as its on higher side)
• Glucose tolerance test
• BLood Urea and Nitrogen, creatinine levels( to check with the functioning of the kidney)
• Bilirubin and Biliverdin (to check the liver functioning) as he has Fatty liver

Other tests:

• Echo as to check with functioning of heart(family history of cardiovascular disease and uncontrolled DM)
• Ultra sonogram of Abdomen.

3.DF's 1 day food protocol:

Breakfast : I cup of Oats, and a glass of slim milk

Snack: one apple or cucumer salad or handfull of almonds

Lunch : Whole grain bread,beans,starchy vegetables, boiled chicken or tuna fish, a cup of whole grain pasta,cup of yogurt.

Snack: Almonds or bananas

Lafe afternoon: Sprouted grains salad or fruit salad

Dinner: fish/ some vegetables, 2 slices of whole wheat bread,butter milk.

4.Dietary supplementary that DF should make is

• avoid carbonated, sugar drinks
• should take high fibre and low processed carbohydrates
• should add on more green leafy vegetables
• low fat diary products
• lean protein dit
• using of canola or olive oil

Life style modifications that DF should do

• Regular excerises or everyday 30 mins of brisk walking
• Regular monitoring of blood sugar levels
• Restrict drinking
• Avoid fatty foods and junk food
• Avoid skipping medications
• Follow diadetic diet