List factors that are important for working with the diabetic ...

[Garrulous]

List factors that are important for working with the diabetic patient when determining their needs, tailoring a management plan, patient education and counseling, and monitoring progress over time.

Question 2

Medical History: A.R. is a healthy 51-year old premenopausal Caucasian woman with pallor who is employed full-time in an office job. She had a pancreatic cyst removed six years ago. She was asymptomatic until one year ago when she developed acute pancreatitis flare-ups after consuming fatty foods. The condition was attributed to scarring at the pancreatic duct, which secretes pancreatic lipase, and was accompanied by severe abdominal pain radiating to her back, vomiting, and steatorrhea. She was placed on oral pancreatic lipase enzyme tablets (Pancrease) that digest fat, and was also prescribed to follow a low-fat diet. The medication and diet help to reduce her symptoms, and she notes that flare-ups generally only occur when she eats too much fat.
  Anthropometric: Ht: 5'2 . Wt: 156 lbs. Wt 1 yr ago: 199 lbs. Frame size: Medium.
  Clinical/Labs: A.R.'s serum vitamin D was low (20 ng/mL; normal is 25-80 ng/mL), but all other labs were within normal limits when she last visited her internal medicine physician several months ago. She was placed on a 5,000-IU vitamin D supplement, to be reduced to a 2,000-IU vitamin D supplement thereafter; she takes no other vitamins or minerals. Other medications include Synthroid and Aygestin.
  Current Chief Complaints: A.R.'s current problems include constipation and dry skin.
  Diet: My usual grocery list consists of boneless chicken breasts, turkey, pork chops (infrequently), strip steak (infrequently), 90/10 ground beef, pasta (half whole-wheat, half regular), tomatoes and sauce to make pasta sauce, 90 percent fat-free lunch meat ham or turkey, brown rice, steamable microwave vegetables, red and green lettuce, tomatoes, onions, cereal, blueberries if on sale, apples, tangerines, red licorice, bread, crackers, and canned soup. I am concerned about not having enough protein or iron because I am afraid to eat very much red meat. The foods I miss the most include iced tea, which I skip because of caffeineI am getting bored with water. I like to bake and miss baked goods, and I also miss cheeseI am afraid it is too high in fat. I have a hard time figuring out what to pack for lunch. The restaurants I go to if I do go out are Chick-Fil-A, Panera, Viva, a local diner, and an Italian restaurant. I like Italian and Mexican food. Usually if I do eat out it is for lunch but it is sometimes hard to figure out something safe to eat... Dairy foods: Twice a day, drinks 2 8-oz glasses of 1 milk. Fruits: 1 cup per day.
  A.R.'s diet prescription is 35 of kcalories from fat. A.R. looks at menus online before going out to eat, and appropriately selects:
 
 a. Manhattan clam chowder in a bread bowl (670 kcal, 29 g of fat).
  b. barbeque chicken chopped salad with vinaigrette dressing (500 kcal, 25 g of fat).
  c. Mediterranean veggie sandwich on basil-tomato bread (590 kcal, 13 g of fat).
  d. Black Forest ham on a pretzel roll (325 kcal, 13 g of fat).

[Ksh22]

Answer to Question 1

In diabetes, the following are important for determining the individual's needs, tailoring a diabetes management plan and patient education and counseling, and monitoring progress over time:
 Weight status
 Current eating pattern; types and amounts of food typically eaten throughout the day, especially types and amounts of carbohydrate
 Knowledge about diabetes and how food intake and physical activity relate to blood glucose changes
 Usual physical activity and opportunities and interests for increasing physical activity
 Laboratory values for glycemic control, self-monitored blood glucose records, and hypoglycemia or hyperglycemia events
 Medical history relevant to management of diabetes and comorbidities, CVD risk factors and disease, lipid profile, and blood pressure
 Medications for glycemic management and others, and supplement use
 Social, financial, and environmental factors impacting diabetes self-management
 Past education and experience with meal planning, carbohydrate counting, or exchange lists; and attitudes about diabetes and expectations for medical management and outcomes

Answer to Question 2

c

[Garrulous]

Thanks

[Ksh22]

Welcome