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Name _______Grace Boamah_____________________

Diabetes Case Study Nutrition Care Plan (total 10pts)

Case Presentation

W.G. is a 41-year-old white man with a new diagnosis of type two diabetes. He is now beginning diabetes education and
medical nutrition therapy (MNT) upon referral from his primary care physician. His hemoglobin A1c is 8.0%. He denies
smoking, alcohol, and drug use; and knows of no health problems other than diabetes. His history revealed a blood
glucose level 245 mg/dl at the time of diagnosis. He complains of frequent urination, hunger, and thirst. He is very
concerned and feels agitated and anxious.

Physical assessment reveals a height of 74 inches, weight of 274 lb. He reports a 35-lb weight gain over the past 5 years

W.G. reports he eats a moderate breakfast and lunch and a bigger dinner before his exercise in the evening. He reports
that he is not currently able to maintain his usual 0.5 hours per day of lifting weights and playing basketball because of
fatigue and lack of energy.

Nutrition Assessment
41 yo Caucasian male dxd with type 2 DM. No other notable PMH. Pt c/o polyuria, polyphagia and polydipsia.

Anthropometric measurements: Ht: 74 (188 cm) Wt: 274 lb.


C/o 35 lb. wt gain over past 5 years

Labs: HgbA1C 8.0% & FBG: 245 mg/dL

Diet Hx: Actual intake: 3800 kcal/d, no fruits, few vegetables


Exercise: Usual but currently unable to maintain 0.5 hrs weight lifting and basketball

1. Estimated Requirements (1pt)


Use Mifflin St. Jeor (take a screen grab and submit with case study)

3300Kcal 500 = 2800Kcal

2. Diet recommendations: (complete form below and summarize here) (1pt)

3. Nutrition Diagnosis (list 2) (1pt)


a) Class 2 obese (BMI 35) related to excessive energy intake as evidence by weight gain
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b) Excessive calorie intake related to uncontrolled type two diabetes as evidence by increased blood
glucose and HgbA1C

4. Nutrition Interventions (list 3) (1pt)


a) The goal is to consume 2600 Kcal a day which will help with 10 % (1-2 Ibs per week) weight lost each
day.
b) Food, glucose and physical activity monitoring. The goal is to improve Mr. W. Gs health and also help
reduce any risk of developing hypertension
c) To complete nutrition assessment such as diet history. This will help the patient in morning his diabetes.

5. Nutrition Monitoring and Evaluation (list 3) (1pt)


a. Check weight status (1 2Ibs a week). Every 2-3 weeks visit or once a month visit can be scheduled
b. Increase physical activity. 15-minute walking for at least 3 times a week
c. Check lab values for glucose and HgbA1C on each visit.
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1 2 3 4 5
Directions Exchange # of CHO Protein Fat kcal
Group Exchanges 4 kcal/g 4 kcal/g 9 kcal/g
STEP 1: Calories
a. Fill in the desired calorie level in column 5 50% = 20% = 30% = 2800
b. Use the percentages in columns 2, 3 and 4 to calculate the number of calories for 1400 560 840
each nutrient (NOTE: These are typical but may be adjusted to fit individual needs.) kcal kcal kcal
STEP 2: Grams Kcal 4 Kcal 4 Kcal 9
a. Convert calories to grams, dividing by 4 for CHO & protein, by 9 for Fat. List the = 350 = 140 = 93
desired number of grams in each column grams grams grams
STEP 3: MILK
a. Estimate the number of milk exchanges (column 1); typically aim for 2 MILK
b. Determine whether the patient drinks skim, low fat (1%, 2%) or whole milk. If you 12 g CHO, 2 12*2 = 8*2 =16 3*2 = 6 100*2 =
are not sure, start with 1% low fat. 8g pro, 24 200
c. Calculate the appropriate grams of CHO, pro & fat for the number of milk exchanges 0/3/5/8g fat
listed. 90/100/120/16
d. Multiply appropriate number of calories for type of milk by the number of exchanges 0 kcal
(column 5).
STEP 4: FRUIT
a. Estimate the number of fruit exchanges; typically start with 3. FRUIT 3 15*3 = 60*3 = 180
b. Calculate the gram of CHO for that number of exchanges. 15g CHO, 60 45
c. Multiply appropriate number of kcal for fruit by the number of exchanges. kcal
STEP 5: VEGETABLES VEGETABL
a. Estimate the number of vegetables exchanges; typically start with 2. ES 5 5*5 = 25 2*5 = 10 25*5 = 125
b. Calculate the number of grams of CHO and protein for that number of exchanges. 5 g CHO
c. Multiply appropriate number of calories for vegetables by the number of exchanges. 2 g pro
25 kcal
STEP 6: CARBOHYDRATE SUBTOTAL Subtotal
a. Subtotal the number of CHO grams in column 2 from milk, fruit & vegetables CHO 94
b. Subtract the subtotal CHO grams from the total desired CHO grams to the remaining SUBTOTAL Subtotal
CHO gram 256
STEP 7: STARCH STARCH
a. Divide remaining CHO grams by 15 to get a number of starch exchanges 15 g CHO 17 17*15 = 3*17 = 17*80 =
b. Calculate the gram of CHO and Pro for that number of exchanges 3 g Pro 255 51 1360
c. Multiply appropriate number of calories for starch by the number of exchanges 80 kcal
STEP 8: Protein Subtotal Subtotal
a. Subtotal the number of protein grams in column 3 from milk, vegetables & starches. PROTEIN 77
b. Subtract subtotal protein grams from total desired protein grams to get remaining SUBTOTAL Subtotal
protein grams. 63
STEP 9: MEAT & MEAT SUBSTITUTES MEAT & 01/3/5/8
a. Divide remaining protein grams by 7 to get the number of meat exchanges. MEAT g fat;
b. Calculate the grams of protein & fat for the number of exchanges (columns 3 & 4) SUBSTITUT 9 28-37 9*7 = 63 9*3 = 27 55*9 = 495
c. Multiply appropriate number of calories for meat by the number of exchanges ES /55/73/
7 grams 100 kcal
protein
STEP 10: FAT SUBTOTAL Subtotal
a. Subtotal the number of fat grams in column 4 from milk & meat FAT 33
b. Subtract subtotal fat grams from total desired fat grams to get remaining fat grams SUBTOTAL Subtotal
60
STEP 11: FAT FAT 12*5 = 45*12 =
a. Divide remaining fat gram by 5 to get total number of fat exchanges 5 g fat 12 60 540
b. Calculate grams of fat and calories for that number of exchanges 45 kcal
STEP 12: CHECKING YOUR WORK
a. Record your total grams of CHO, pro & fat in columns 2, 3 & 4 TOTALS
b. Multiply the grams totals by appropriate calories/gram to determine calories for each 349 140 93 2793
nutrient; add the 3 calorie numbers together & compare this total to the calories total in
column 5.
c. Divide calories for each nutrient into total calories for row (not column) to derive
your final percent distribution of calories; compare with original goals.
e. Calculate W.G.s daily meal plan you can hand write this page (2pts)
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f. Create a one daily meal plan using actual foods for W.G. you can hand write this page (3pts)

Exchang #
e Exchan Breakfast Snack Lunch Snack Dinner Snack CHO g Pro g Fat g Kcal
Group ges AM PM
1 1 24 16 4 200
Milk 1 cup 1%
2 1 cup Skim milk
milk
1 1 1 45 _ _ 180
Fruit
3 cup fresh 1 cup 1 apple
pineapple raspberries

2 2 1 25 10 _ 125
Veg. raw
5 tomatoes 1 cup carrot 1 cup
raw onion broccoli
3 1 5 1 5 2 255 34 0 1360
Starch 3 gram 1 cup cooked 6/8 oz pretzel
17 2 Slice of 8 animal 3 oz baked crackers brown rice
wheat bread crackers potato 1 cup corn
1 Corn bread 1 cup cooked
peas

1 3 5 _ 63 18 405
Meat cup egg 3 oz baked fish 5 oz chicken
9 substitute

2 1 4 1 4 _ _ 60 540
Fat 1 Tbsp 2 tsp olive oil 1 tsp 1 tsp olive oil
12 butter 1 tsp peanut 2 Tbsp reduce peanut 3 Tbsp
1 tsp olive oil fat butter butter butter
123*4 82*9 = 2626
Totals: 349*4 = = 492 738
1396
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