Question

Mr. Jimenez is a 61-year-old Spanish-speaking man who presented to the emergency room with his wife. His wife also speaks Spanish but does understand some English. Mr. Jimenez complains of nausea and vomiting for the last two days and symptoms of confusion. His blood glucose is 796 mg\deciliter. He has a past medical history of coronary artery disease (CAD) and hypertension (HTN). He has smoked one pack per day of cigarettes for the last 35 years as well as drinking two beers per day. Intravenous regular insulin (Novolin R) is prescribed and he is admitted for further evaluation. He will require teaching regarding his newly diagnosed diabetes.

Mr. Jimenez is a newly diagnosed diabetic.

His hemoglobin A1C is 10.3%. He is slightly overweight and is 5’10” tall and weighs 174 pounds (79kg). He reports no form of regular exercise. He does not follow a special diet at home. He states, “I eat whatever my wife places in front of me.” For the past few months, his wife is noticed that Mr. Jimenez has been very thirsty and has been up and down to the bathroom many times per day. Neither Mr. Jimenez nor his wife can recall when the symptoms all began but know it’s been going on for quite a while.

Discuss what lifestyle modifications may improve Mr. Jimenez’s health outcomes.

Answer 1

Life style modifications includes:

1) Diet : Low carb diet. carbohydrates are the most important factor determining blood glucose levels. Meal planning is needed to limit the amount of carbohydrate intake. Using measuring cups or a scale will ensure accurate carbohydrate count.

2) Balanced diet : Every meal must contain good mix of starch, fruits, greeny vegetables,proteins and fats. Food low in carbohydrates and rich in fibre help to lower the blood glucose values.

3) Keep an eye on medication management: Hypoglycemia is a common danger if diet intake is not adjusted with insulin therapy.

4) Avoid sweetened beverages as it is rich in sugar/ fructose.

5) Keep an exercise schedule

6) Drink more water to prevent dehydration secondary polydipsia a common symptom of diabetes

7) Restrict the intake of alcohol as it may aggravate complications such as diabetic retinopathy and neuropathy.

8) Periodical blood glucose monitoring will helps patient to keep their blood glucose values in track.

9) Adhere to relaxation techniques like breathing exercises, guided imagery to reduce stress level, as stress is a predisposing factor for diabetes.