Case Study Presentation

Angela StancilDietetic Intern10/18/13

Pre-diabetes

Impaired Fasting Glucose (IFG) or Impaired Glucose Tolerance (IGT) Occurs when hyperglycemia is present but diabetes has not been

diagnosed

Behan KJ. New ADA guidelines for diagnosis, screening of diabetes. Laboratory.2011;20 (1):2. http://laboratory-manager.advanceweb.com/Archives/Article-Archives/New-ADA-Guidelines-for-Diagnosis-Screening-of-Diabetes.aspx. Accessed October 16, 2013.

States with Highest Percentages of U.S. Adults Who Have Ever Been Told They Have Pre-diabetes, 2010

State PercentageTennessee 10.2

California 8.0

Hawaii 7.5

Idaho 7.3

Kentucky 7.2

Alabama , Alaska 7.0

New Hampshire 6.8

Mississippi 6.7

Minnesota 6.6

States with Lowest Percentages of U.S. Adults Who Have Ever Been Told They Have Pre-diabetes, 2010

State PercentageVermont 4.4

Wyoming, Massachusetts 4.8

Montana 4.7

Utah 5.1

South Dakota 5.2

Ohio, Connecticut 5.3

Iowa, Nebraska 5.4

New York, Illinois, D.C. 5.5

Tennessee - Percentage of Adults (aged 18 years or older) Reporting Pre-diabetes, 2008 - 2010

EtiologyUnder Normal Conditions Liver makes basal level of glucose Body is able to sense changes in basal BG level

and is adjusted When you eat:

Insulin increases Blood glucose decreases

EtiologyPre-diabetes/Diabetes Take in more CHOs than insulin is able to clear Extra calories stored as visceral fat Visceral fat releases chemicals

Insulin increases Gluconeogenesis increases

Kidney is unable to clear excess glucose 3 P’s Excess glucose stored as visceral fat FFA released

Risk Factors

SymptomsAcanthosis nigricans

Complications of Disease

Treatment

Mr. H

Overview of Patient

51 y/o, AA, M Past Medical History:

GERD, Colonic polys, Chronic arthritis, smoking, ETOH, marijuana use

Medical Diagnosis: Pre-diabetes Referred to Nutrition Copper

clinic due to A1C of 6.2 and the 3 P’s

Nutrition Assessment

Anthropometrics:Ht: 68 in.Wt:144.3 lbsDBW: 138 – 169 lbs % DBW: 94%Recent Weight Changes: -2 lbs since last visit with PCP BMI 21.9 (normal)

Nutrition Assessment

Pertinent Labs: A1C of 6.2 % , all other labs WNLPertinent Medications: Omeprazole Physical Activity : NoneDiet History:

Breakfast Lunch Dinner Snacks Beverages

Nothing Nothing "country meal“Proteins: baked chickenVegetables: mashed potatoes, lima beansGrains: roll, cornbread

Snack cakes (oatmeal cream pies)

candy bars (Paydays, Kit-Kats)

pork rinds (after dinner)

Water Cranberry juice

( 4-5 8 oz servings daily)

≤ 1 soda per day

Nutrition Diagnosis

Imbalance of nutrients related to meal inconsistency and frequent intake of calorically dense snacks as evidenced by A1C of 6.2% at last PCP visit.

During the Session the Following was Discussed:

Concern about improving blood glucose to prevent diabetes

Desire to eat healthier foods Concern about vision Sleep Patient mentioned fasting for religious reasons for

up to 7 days at a time

Nutrition Education

Patient was educated on how hyperglycemia can negatively affect organs

Patient was introduced to the importance of maintaining blood glucose through meal consistency

Handouts provided: Nutrition Goals

Nutrition Intervention

NUTRITION PRESCRIPTION:

Decrease blood glucose to A1C ≤ 5.7 %

NUTRITION INTERVENTION:

1. Meal consistency

a. aim for three meals/snacks daily

2. Choose foods that you like for these meals

3. Reduce juice to ≤ 4-8oz. servings/day

 NUTRITION MONITORING and EVALUATION:

 Lab values WNL - A1C at goal of ≤ 5.7 % Comply with appropriate diet - meal or snack three times

daily

Summary Disease Prognosis

“Without lifestyle changes to improve their health, 15% to 30% of people with pre-diabetes will develop type 2 diabetes within five years.”

- Center for Disease Control and Prevention

Nutrition Prognosis Comprehension : Good Expected Compliance : Fair – the patient seemed to

understand the importance of changing his diet but not ready to make big changes

Q & A

References

American Diabetes Association. Prediabetes. Diabetes Basics webpage. Available at http://www.diabetes.org/diabetes-basics/prevention/pre-diabetes/. Accessed October 14, 2013.

Center for Disease Control and Prevention. Diabetes Report Card 2012:National and State Profile of Diabetes and its Complications. Diabetes webpage. Available at http://www.cdc.gov/diabetes/pubs/reportcard/prediabetes.htm. August 12, 2012. Accessed October 14, 2013.

Center for Disease Control and Prevention. Prediabetes. Diabetes webpage. Available at http://www.cdc.gov/diabetes/consumer/prediabetes.htm. August 13, 2012. Accessed October 14, 2013.

National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. Prediabetes: What You Need to Know. Available at http://diabetes.niddk.nih.gov/dm/pubs/prediabetes_ES/. July 24, 2013. Accessed October 14, 2013.

Center for Disease Control and Prevention. Diabetes Data and Trends. Diabetes webpage. Available at http://apps.nccd.cdc.gov/DDTSTRS/Index.aspx?stateId=47&state=Tennessee&cat=riskfactorsfordiabetes&Data=data&view=TO&trend=Prediabetes&id=27. Accessed October 16, 2013.

Center for Disease Control and Prevention. 2011 National Diabetes Fact Sheet. Diabetes webpage. Available at http://www.cdc.gov/diabetes/pubs/general11.htm. May 20, 2011. Accessed October 16, 2013.