Question

medical therapy
Case study

Teresa is a 45-year-old woman who is diagnosed of diabetes type 2 for 3 years and therefore now referred to nutrition counseling. She works in private food canteen. There is history of CVD in her family. She does not smoke and her current weight is 178 lb and her height is 63 inches. She has been at this weight for more than 6 months. She states that nutrition counseling will not help to solve her problem because the only advice she gets is to reduce sugar and sweets and lose weight, neither of which she has been able to do.

Medication: She takes some drugs to lose weight but she thinks it doesn’t work and costs too much.

Lab tests: HbA1C 8.6%, Total Cholesterol 234 mg/dl, HDL 53, TG 285 mg/dl, FBG: 120 mg/dl ,

Measurements: BP: 120/78 mm/Hg. Waist circumference = 38”.

Patient 24-hour diet recall. It has been analyzed and it provides approximately:

•          120 gm protein

•          220 gm carbohydrate

•          90 gm fat

•          Total calories: 2200 kcal

Recommended macronutrients percentage for T2DM.

Protein 15-20%

Fat 20-35%

Carbohydrate 45-65% (based on individual need)

Answer the following questions:

1. Calculate the percentage of kcals provided by each macronutrient in her diet.

2. What is your opinion about her diet?

3. Write two PES statement.

Answer 1

Ans 1

Protein-

1 gram protein provide 4 kcal so 120gm will give

120 * 4 = 480 kcal

Therefore 480*100/2200 = 21.18% protein

Carbohydrate-

1 gram carbohydrate give 4 kcal so 220gm will give

220*4=880 kcal

Therefore 880*100/2200=40% carbohydrate

Fat-

1 gram fat gives 9 kcal so 90 gm wil give

90 *9 =810 kcal

Therefore 810*100/2200=36.81% fat

Ans 2-

Fat content of in daily nutrition intake is little high. So she should decrease fat content in her diet as cholesterol and triglycerides are raised and so cardiovascular diesease can be precipitated.

Ans 3-

PES STATEMENT 1

Problem-Excessive blood glucose levels related to excessive energy and carbohydrate intake as evidenced by analysis of usual dietary intake.

Etiology- Boderline diabetes type 2 as evidenced by fbg level

Symptoms- hba1c =8.6% which show boderline diabetes and dietary control required

PES STATEMENT 2-

PROBLEM-Overweight/obesity related to inability to sustain diet/lifestyle change, as evidenced by many previous attempts at weight loss with weight regain .

Etiology- obesity as result of lack of physical exercise and stationary life style

Symptoms- increased total cholesterol and triglycerides due to high fat intake and no physical activity.