Question

Case Study 2: Bill (please answer question 2 and 5 only)

Bill is 52 and has been previously diagnosed with Type 2 Diabetes Mellitus. He admits that he often does not take his medications which are metformin and glyburide.

1. What types of medications are metformin and glyburide? Briefly describe their general mechanisms as well as their potential side effects/drug-nutrient interactions

Bill has come into hospital because he has been diagnosed with HHS. Hyperosmolar hyperglycemic state/ syndrome (HHS) is when a diabetes patient has an abnormally high plasma glucose level (greater than 30 mmol/L) due to inadequate amounts of insulin to maintain normoglycemia. HHS is very common amongst T2DM older adults, and symptoms tend to include dehydration due to reduced thirst recognition—this causes older adults to be slightly confused. This happens when T2DM is uncontrolled for a long time. Symptoms may include poluyuria and polydipsia. Patients must be hospitalized.

The treatment of HHS consists of correction of the dehydration with intravenous fluids, reduction of the blood sugar levels with insulin, and management of any other underlying conditions that might have precipitated the condition

In hospital insulin therapy is started for Bill.

2. Outline the basic principles for Bill’s nutrition therapy to assist in control of his DM.

Bill’s measurements and typical daily diet is recorded as follows:

Weight: 97.3 kg; Height: 175

Daily Diet:

BF: 2 crumpets, 1 tbspn each of honey and cream cheese, diet cola

MT: 1 coffee scroll, 1 coffee with milk, no sugar

Lunch: Fast-food roll from subway (full size), 9 Chips

Dinner: 1 breast grilled chicken/beef, 1 cup salad, 1 potato/rice

Supper: 4 biscuits and a hot chocolate made with full cream milk

3. Assess Bill’s weight and BMI. What would be a healthy weight range for Bill?

4. Determine Bill’s energy and protein requirements for weight maintenance. What energy and protein intakes would you recommend to assist with weight loss?

5. Prioritize two nutrition problems and discuss how you would implement solutions to these. What foods would you change? Write out some daily food choices

Answer 1

2) Bill is suffering from type 2 Diabetes mellitus with HHS. Thus inorder to control this situation Bill needs a nutrition therapy.

Nutrition education helps in improving the metabolic outcomrs.Thus the patients suffering from diabetis should follow some principles to control the DM.

The basic principles which Bill should know are as follows:-

• Know your diabete.Learn about the disease in and out.
• Take care about the levels of Glucose, cholesterol, Blood pressure.Regularly monitor them and maintain the optimal values to avoid complications.
• Get regular help from physician.Ask about the tests to be done to keep a check on the lipid and lipoprotein profile,obesity,etc
• Know about proper healthy eating habits which will help control your diabetes.
• Know what exercise need to be done to be fit and to reduce the risk of cardiovascular disease.
• You should know What are the required limits of nutrients according to the status of your disease. Take that fixed amount of food only.

5)The nutrition therapy involves keeping a check on the healthy food intake of the patient which include the required nutrients .

i) Increased Carbohydrates problem

Increase in carbohydrate intake lead to increase in postprandial levels of plasma glucose, insulin and triglycerides.

Considering the glycemic effects of carbohydrates, the total amount of carbohydrates included in the diet are important.

The patients who need to take daily doses of insulin should be consistent in daily carbohydrate intake.

Hence the subway fast food and full cream milk can be replaced by including whole grains, fruits, vegetables, and low-fat cow's milk.

ii) Nutrient problem of Fats

Persons with diabetes are more sensitive to dietary cholesterol than normal persons

The fat intakes can lead to weight gain and obesity leading to risk of cardiovascular diseases.

Thus eating grilled chicken with high fat contents can be changed.

The fat intake should be reduced.This can be done by reducing the amount of high fats containing food in the diet. Low fat rich foods or fat replacement can be done by including whole fruits,cereals, green peas and legumes .