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Type 2 DM - Case Study

2/18/00. Type 2 DM - Case Study. Jean Kerver, MS, RD, CDE kerverje@pilot.msu.edu. DR is a 45 y.o. male; Ht : 5’9”; Wt : 215 lbs Present complaint : polydipsia, polyuria, fatigue. Past med hx : Type 2 DM x 5 yrs. Meds : None; NKDA. Labs : No SBGM; serum glucose=285 mg/dL 1 hr ppd;

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Type 2 DM - Case Study

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  1. 2/18/00 Type 2 DM - Case Study Jean Kerver, MS, RD, CDE kerverje@pilot.msu.edu

  2. DR is a 45 y.o. male; Ht: 5’9”; Wt: 215 lbs • Present complaint: polydipsia, polyuria, fatigue. • Past med hx: Type 2 DM x 5 yrs. • Meds: None; NKDA. • Labs: No SBGM; serum glucose=285 mg/dL 1 hr ppd; urinary glucose=2+; temp=98.8 F.

  3. Family med hx: Grandma type 2 DM at age 60 yrs • Social hx: architect; lives alone; nonsmoker; no regular physical activity. • Diet hx: no known food allergies; no supplements (vit/min or other); no special diet; drinks 2 beers qd after work; brkfst at home; lunch out—fast food or deli type; dinner at home —cooks or orders take-out food; seldom snacks.

  4. Breakfast 2 cups raisin bran 1 lg banana 1 cup whole milk 8 oz orange juice Lunch 4 oz corned beef 1 oz swiss cheese 2 slices rye bread ½ cup cole slaw 2 tbsp russian dressing 1 small bag potato chips

  5. Dinner 1 cup fried rice 4 oz Hunan chicken (fried) 4 oz shrimp and cashews 2 bottles beer 1 lg orange Total kcals: 3411 Protein: 14% Fat: 40% Carb: 46%

  6. How Many kcals Should He Have? • Ht: 5’9”; Wt: 215 lbs • IBW: 106 lbs + (9” x 6 lbs) = 160 lbs • % IBW = 215 lbs /160 lbs = 134% • AdjBW = 0.25 (215-160) + 160 = 174 lbs (79 kg) • 25 kcals/kg = 25 x 79 = 1975 kcals/d • 24-hr = 3411 kcals – 500 kcals= 2900 kcals

  7. Calculation of Dietary Pattern • Total kcals = 2000 • 50% CHO = 0.50 x kcal = 0.50 x 2000 = 250 g CHO 4 kcal/g CHO 4 • 20% PRO = 0.20 x kcal = 0.20 x 2000 = 100 g PRO 4 kcal/g PRO 4 • 30% FAT = 0.30 x kcal = 0.30 x 2000 = 67 g FAT 9 kcal/g FAT 9

  8. ADA Exchanges

  9. Negotiate, then Convert CHO

  10. Convert PRO

  11. Convert FAT

  12. Diet Pattern Totals:

  13. Diabetes Education • Tell patient what to expect • Individualize-always give choices • Be systematic-prioritize • Discuss coping strategies • Special situations

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