Chaya

 Wilhelm         FNDH  631  

Case  Study  2-­‐  Type  I  Diabetes  
 
Home Office
03/09/ 2017 10:15 am

A: Patient is a 37 year old female with type I diabetes with DKA. HLP, HTN, psoriasis, hysterectomy. Records
show that patient is disabled and has a limited metal capacity.
Patient is single, raising 2 children with the help of family. She is on Medicare for disability, has limited
finances, and does not work outside the home. She prepares some meals at home, but uses a lot of microwave
unhealthy items. She reports smoking 1 ppd but denies the use of ETOH. She has demonstrated a history of
non-compliance with medications
Patient became ill with flu like symptoms and was brought to the ER by family. She came unresponsive and BG
of 487 mg/dL and 3+ Ketones.  Pt  developed  acute  renal  failure,  acute  metabolic  encephalopathy,  and  
became  ventilator  dependent.  Pt  had  hypokalemia,  severe  sepsis,  streptococcal  septicemia  and  
hypernatremia.  A  swallow  study  revealed  pt  had  dysphagia.  Pt  weaned  off  of  NG  feeding  tube  after  1  
week  and  will  start  oral  intake.  Pt  transferred  to  Swing  Bed  Status  to  begin  therapies  and  receive  
education  for  management  of  diabetes.    
Ht: 65” Wt: 163 # BMI: 27.2 (Overweight) DBW: 130# %DBW: 125%
BP: 128/84 HR: 72 Temp: 98.2 O2 Stat: 96%
Diet Order: Dietary consult ordered for weight management
EER: 1712 kcal/day (Mifflin (1427) x 1.2 AF) Protein Needs: 59.3  grams  (0.8/g/kg  body  weight)    
Labs: CO2 32 (High), HgA1c 11.3 (High)
Medication: Lantus, Novolog, Lisinopril, Omeprazole
Family hx: Mother  and  sister,  type  2  dm.  Grandfather  (paternal)  heart  attack  age  72

D: PES  #1:  Food  and  nutrition  related  knowledge  deficit  (NB  1.1)  RT  diabetes  management  AEB  patient’s  
history  of  non-­‐compliance  with  medications  and  diet.  
         PES  #2:  Altered  nutrition  related  lab  values  (NC-­‐2.2)  for  glucose  levels  RT  insufficient  insulin  and  high  
microwaved  meals  consumption  AEB  blood  glucose  value  of  497  mg/dL  upon  admittance  to  the  hospital  
and  a  HgA1c  value  of  11.3  upon  admittance  to  Swing  Bed  therapy.    

I: Intervention  #1:  Purpose  of  nutrition  education  (E-­‐1.1)  by  guiding  the  patient  with  individualized  
nutrition  and  meal  planning  as  well  as  self  management  education  for  insulin  administration.  Education  
will  start  with  using  her  actual  hospital  meals  as  a  demonstration  tool  to  help  her  understand  the  
importance  of  diet  for  managing  her  blood  glucose.  
       Intervention  #2:  Carbohydrate  modified  diet  (ND-­‐1.2.4)  by  decreasing  his  consumption  of  microwaved  
meals  and  increasing  consumption  of  healthy  carbohydrate  meal  options.    

M/E:
• Total  Carbohydrate  intake  (FH-­‐1.5.5.1)  
• Areas  and  level  of  knowledge  and  skill  (FH-­‐4.1.1)  
• Self  management  as  agreed  upon  (FH-­‐5.1.5)  (for  glucose  levels  and  carbohydrate  intake)  
• HgA1C  (BD-­‐  1.5.3)  
• Readiness  to  change  nutrition  related  behaviors  (FH-­‐  4.2.7)  

Chaya Wilhelm
Future RDN, LD