PRACTICAL ACTIVITY–1

During your visit to the hospital take the diet history of a newly admitted diabetic patient using
the diet history sheet, also prescribe the carbohydrate exchanges and allowances per meal.

Hospital:.....................................................................................................................
Name of the Patient:...................................................................................................
Address: .....................................................................................................................
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Hospital No: ............................................. Clinic/Deptt.:......................................
Height ........................... Weight……………. Standard Weight.....................
Age:.......................................................... Sex: ....................................................
Investigation & Diagnosis: ........................................................................................
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Complications: ...........................................................................................................
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Diet History of last two days before admission
Meals D1 Weight (g) Meals D2 Weight (g)
Breakfast Breakfast
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Mid-morning Snacks Mid-morning Snacks
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Lunch Lunch
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Afternoon Snacks Afternoon Snacks
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Dinner Dinner
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Bed Time Bed Time
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Average Nutrient intake per day.

Energy Fat Intake (g)
Protein Intake (g) Carbohydrate Intake _ (g)
Conclusion derived from the Diet History.................................................................
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Diet Prescription

Now Recommend Total Carbohydrate Allowance Per Meal

Meal Time CHO Exchanges

1. Break-fast ......................................
2. Snacks ......................................
3. Lunch Time ......................................
4. Snacks ......................................
5. Dinner ......................................
6. Bedtime ......................................

Further Advice
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Tutor’s Comments
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Mark Obtained: ........................................ Tutor’s Signature: ..............................