Question

Case Study Diabetes Mellitus Type I

5. You may work with a partner or group and hand in one case study for the group. Make sure all names are on the case study. Do not “divide and conquer” – work together.
5. All answers require a reference you ½ point will be deducted per question.
5. The Lewis text book is a good resource.  But also utilize your Maternal Child as well as your nutrition text. These may be helpful.

• Scenario

You work in the diabetes mellitus (DM) center at a large teaching hospital.  The first patient you meet is K.W., a 25-year-old Hispanic woman, who was just released from the hospital 2 days ago after being diagnosed with type I DM.

            Nine days ago K.W. went to see the physician after a 1-month history of frequent urination, thirst, severe fatigue, blurred vision and some burning and tingling in her feet. She attributed those symptoms to working long hours at the computer. Her random glucose level was 410 mg/dL. The next day her laboratory values were as follows: fasting glucose 335 mg/dL, hemoglobin A_1c(HBA_1c) 8.8%, cholesterol 310 mg/dL, triglycerides 300 mg/dL, high-density lipoprotein (HDL) 25 mg/dL, low-density (LDL) 160 mg/dL and creatinine 0.9 mg/dL. Her body mass index is 37.6. Her blood pressure is 160/96. She was admitted to the hospital for control of her glucose levels and the initiation of insulin therapy with carbohydrate (CHO) counting. After discharge, K.W. has been referred to you for comprehensive education. You are to cover four basic areas: pharmacotherapy, glucose monitoring, medication nutrition therapy and exercise.

1. K.W. states her diet is mostly fast foods, and the foods cooked at home are high starch and fat. She says because of her work schedule, mealtimes often very form day to day. What is carbohydrate (CHO) counting and shy would this method work well for K.W.?

2. Identify important pints to be covered in a basic nutrition plan with CHO counting.

3. K.W. states that she currently does not exercise at all. What benefits will K.W. receive from participation in an exercise program?

4. What do you need to teach K.W. regarding safe exercise?

5. K.W. states she and her husband were planning to have another child in a year or two. She want to know if DM will affect the pregnancy. Pregnancy in a persons with DM is complex issue. What basic information can you share with K.W. today without overwhelming her?

6. What evaluative parameter could you use to determine whether your teaching with K.S. was effective?

Answer 1

1)Comprehensive education to the patient:

Patients with type 1 DM requires lifelong insulin therapy. By considering the blood glucose levels you may sometimes require one or more injections daily as prescribed by the physician. The doses are adjusted on the basis of self monitoring of blood glucose levels.

You can use instrument for self monitoring of blood glucose. So you can better able to adjust insulin doses and monitor for hypoglycaemia. You can otherwise choose CGMs which is sensor inserted under skin which will measure the level of glucose every minute.

A healthy balanced diet and regular excersice is recommended for this patient. Eat regularly and eat variety of foods in right amount. Try to avoid alcohol consumption. Regular physical activity is better for physical and mental health. Find out the best activity that works with you.

2) carbohydrate counting is a meal planning for people with diabetes. It keep track of amount of carbohydrates in the food you take. As this patient usually takes fast food it is better to use carbohydrates counting. It will help to delay or prevent diabetes problems.

3) Nutrition plan with CHO counting: make a meal plan and figure out carbohydrates, protein, and fats from it. By the use of this counting you can maintain your blood sugar level steady. A diabetes patient may require 45 to 60 grams of carbohydrates in the diet. You can take starch, fruits or milk of about 15 grams. Carbohydrates counting focuses on number of them you eat at each meal but not the types of foof you eat. Healthy carbohydrates like fruits, vegetables and whole grain gives you minerals, vitamin and fiber.

4) Benefits of excersice: Excersice can lower your blood glucose levels. It can boost your body’s sensitivity to insulin. Exercise can counter the insulin resistance. Studies show that exercise lowers HbA1C values.