Is Maria’s vegetable and fruit intake adequate? What are Maria’s pre/post meal g
ID: 82528 • Letter: I
Question
Is Maria’s vegetable and fruit intake adequate?
What are Maria’s pre/post meal glucose targets?
What are appropriate interventions for Maria?
What will you assess in a follow-up visit?
What would you recommend if Maria develops an acute illness? How would her treatment change?
CLINICAL CASE STUDY Dinner: Maria P is a 65 ar old, non-smoker Hispanic female who is coming to see Her blood glucose levels are 2 CU 16 O anagement by an diabetes. she of urination during in her feet and and her fingers, and frequent uncontrolled as evidenced occasionally in the day interviewing her and review After no HS sna Food aller Previous ing her health record, you learn the following about Did not high school through middle school Vitamins occupation: Not employed outside the home, babysits infant grandchild on vitam a daily basis Household Members: Lives with her husband and with one of her four Tx Plans adult children Ethnic Background: Latin American, born in Mexico, emigrated to US in 1980 1. Referr with a Religious Affiliation: Catholic Language. Native Spanish, speaks English has difficulty reading English 2. Phys Patient History: Weighed more than 9 lb at birth a. rap Maria was diagnosed with T2DM. 10 or 15 years ago and her diabetes Pre meal management history is as follows breakfa Type of Treatment: Nutrition therapy plus oral diabetes medication and lunch 15 long-acting insulin at bedtime (HS) 2 dinner Medications: Meds: glargine 80 units at Hs, metformin XR 1000 mg BID Correct i enalapril 10 mg daily, simvastatin 40 mg daily, levothyroxine 75 mog daily evel 50 Family history: Mother had type 2 diabetes, 12 year old grandson recently diagnosed with prediabetes Medical History type 2 diabetes, hypertension, hyperlipidemia, hypothy roidism, episodic migraines (last occurrence 2012) Nutrit Physical exam shows the following: Weight: 201 lbs 1) Why Height: 5'2" inches med Temp: 98.6 F 2) Whi BP: 143/88 mm Hg Heart rate; 80 bpm Labs: A1C9.8%, TSH 8r FT4 0.3; Total cholesterol 144 mg/dL, LDL 116 mg/ 4) Wh dL, HDL 54 mg/dL, Triglycerides 545 mg/dL, BUN 14 phy Self monitoring of blood glucose record shows: 5) Ide Aggregate mean: 218 mg/dL, Standard deviation: 48 (n 68) over last 30 days 6) Wh Frequency 2 x/day Fasting (6 AM): 173 mg/dL, Standard deviation: 35 (n 21 Pre breakfast (9 AM): 248 mg/dL, Standard deviation: 30 (n Prelunch: (1 PM): 193 mg/dL, Standard deviation: 47 (n Nutri Predinner (6 PM): 195 mg/dL, Standard deviation: 33 (n 7) De 9): 260 mg/dL, Standard deviation 34 (n Bedtime (n 13 Range: 69 mg/dL to 304 mg/dL Nutrition History Genera: Good appetite, with wide consumption of foods and beverages native to the region in Mexico where she was born. She plans and prepares meals for the household Performed a 24-hour diet recall Breakfast: coffee with milk and sugar (several spoons Sweet bread 3 to 4 pieces Lunch: chicken and vegetable soup corn tortillas (4-6), home-prepared fruit juice (1-2 x 16 ounce glass)Explanation / Answer
Ans 1) Yes, her consumption of fruits and vegetable is inadequate because in none of her meal she consumes a whole fruit. She includes fruit juices but does not get the benefit of whole fruit intake. Apart from beans, none of her meal includes vegetable which makes it inadequate in terms of consumption.
Ans 2) Maria’s pre/post mean glucose target range from 69mg/dL to 304 mg/dL. And, if pre-meal blood glucose level is less than 150 mg/dL, then to drop 50mg/dL she consumes 1 unit of insulin.
Ans 3) The appropriate interventions for Maria will be to keep a check on her glucose level and design a meal plan that keeps her diabetes under check. She has been on nutrition therapy and oral diabetes medication along with bedtime triggered long acting insulin. She would be checked for type 2 diabetes, hypertension, hyperlipidemia and migranes.
Ans 4) In the following visit, her nutritional and meal intake will be checked along with variation in glucose level.
Related Questions
drjack9650@gmail.com
Navigate
Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.