CHO Rx: * 1500-1750 keal/day diet with + 30% CHO (190-220 g) or * 13-15 CHO choices in a 24-hour period * 6 meals a day (3 meals/3 snacks) One Day Meal Plan Meals CHO carb count Breakfast % cup brown rice crisp cereal | 3 CHO (unsweetened) with 1 cup | low-fat milk : 4 cup vanilla yogurt eve! apa ae 1 cup coffee black with 1 tsp amma) 3 Snack T cup grapes 2CHO cup raw unsalted almonds Lunch 2 slices whole grain bread | 3 CHO | 2 slices of turkey (deli) -lettuce, tomato -1 tbsp. mayo 1 small apple Snack Tstalks celery with 4 tbsp. | 1 CHO peanut butter Dinner T cup brown rice 3CHO 3 oz. baked skinless chicken breast 2 cup shredded lettuce -3 tbsp. ranch light dressing Snack 3 cups light popcorn (no 2CHO butter) 1 frozen sugar-free popsicle 8. Write a nutrition diagnosis for this patient using a PES statement. Excessive CHO intake related to lack of food and nutrition knowledge as evidenced by blood glucose levels of 855 mg/dL. compared to normal range of 70-99 mg/dL. ow) mann CHO Cherws y he Cormenrne, VS ok Smeg ©) Do9. Write a nutrition assessment for this patient using the ADIME format. Nutrition Assessment 55-year-old diabetic female w/ family history of HTN, CAD, Type 2 DM. Admitted through ER with severe hyperglycemia and dehydration. He: S'7” (170em) CBW: 197 Ibs. (89.5 kg) Lake IBW: 135 Ibs. (61.4 kg) [BW 146% (range >120%: nutritional risk obesity) Medo BMI: 89.5kg/ (1.70m’ = 30.9 (obe Physical Activity: N/A ‘Social Hx: Tobacco ppd x 25 yrs ~ now quit. Alcohol 3-4 drinks/week. Married for 30.yrs.— (a Diet Related Behaviors: Patient often eats out at restaurants with husband. Does not add salt — tries to avoid high-cholesterol foods and stays away from high sugar desserts. Does not take . diabetes medications regularly. Has not seen anyone for diabetes teaching. corel te Diet and nutrition hx reveal lack of knowledge on following an appropriate diabetic diet. Estimated nutrient needs: 1500-1750 keal/day with intentional weight loss of % - 1 Ib. per week. Estimated CHO nutrient needs: 190-220g (750 — 875 keal). : 30.0 - 39.9) Dak Nutrition Diagnosis Excessive CHO intake related to lack of food and nutrition knowledge as evidenced by blood glucose levels of 855 mg/dL over normal range of 70-99 mg/dL. Nutrition Intervention Do «Verbal and written nutrition education on CHO Counting for diabetic diet. [C1@ / Sq Ne Refer to CDE for T2DM management. Dewonstrake CHO cei Sam Decrease daily keal intake to 1500-1750 keal/day mas PeNaes hx Limit intake of CHO to 50% of keals. (190-220 g) or 13-15 CHO choices per'day. Tnerease physical activity with 30 min of brisk walking 3-5X a week. (with medical clearance from patient’s physician) + Recommend to MD educate patient to use SMBG for better glycemic control. Nutrition Monitoring and Evaluation + Patient will Jeam to appropriately count CHO to maintain T2DM. + Patient will leam to eat CHO filled meals and snacks on schedule to control blood glucose levels. Mewes ee acdDone- tk + Patient will lose weight over time'dveraging '4 - 1 Ib per week with deficit of 250- S00kcals in diet and/or exercise. Mewite wt «Patient will be educated on doing SMBG to maintain blood glucose levels at 70-99mg/dL, Ly Moniker ofa conker ake wrekuenReferences: Braun, M., Rameheya, R., Bengtsson, M., Zhang, Q., Karanauskaite, J., Partridge, ... C..Rorsman, P. (2008, June). Diabetes. Retrieved April, 2016, from http://diabetes.diabetesjournals.org/content/57/6/1618.full Insulin Glargine (DNA origin) Injection: MedlinePlus Drug Information, (n.d.). Retrieved from https://www.nlm.nih.gov/medlineplus/druginfo/meds/a600027.html Molecular mechanisms of action of glyburide on the beta cell. (n.d.). Retrieved April, 2016, from http://www nebi.nlm.nih.gov/pubmed/2117388 Nahikian-Nelms, M., & Sucher, K. (n.4.). Nutrition Therapy and Pathophysiology (3rd ed.). Boston, MA: Cengage Learning. Pronksy, Z. M., Elbe, D., & Ayoob, K. (n.d.). Food Medication Interactions (18th ed.). Birchrunville, PA: FOOD-MEDICATION INTERACTIONS. Viollet, B., Guigas, B., Garcia, N. S., Leclerc, J., Foretz, M., & Andreelli, F. (n.d.). Cellular and molecular mechanisms of metformin: An overview. Retrieved April, 2016, from http:/www.nebi.nlm.nih.gov/pme/articles/PMC3398862/