Robert is a 55 - year - old truck driver with Type 2 Diabetes. His blood sugars are uncontrolled as evidenced by (AEB) A1C >10 and he complains of increasing n umbness in his feet and fingers, frequent urination during the day and overnight. Robert has a history of hypertension and hyperlipidemia.
Ht 6´3â (1.90m) Wt 242 lb (11 0 kg) BMI 30, BP: 155/90 mm Hg
Medications (daily) : Lantis 80 units at HS, Metformin 100 0mg BID, simvastatin 40 mg, enalapril 10 mg,
Lipid profile
⢠TC: 228 mg/dL , TG: 545 mg/dL , HDL - C: 39 mg/dL , LDL - C: 136 mg/dL
SMBG shows shows:
Aggregate mean: 218 mg/dL, Standard deviation: 48 (n = 68) over last 30 days
Frequency â 2 x/day
Fasting ( 6 AM): 173 mg/dL, Standard deviation: 35 (n = 21)
Prebreakfast (9 AM): 248 mg/dL, Standard deviation: 30 (n = 6)
Prelunch: (1 PM): 193 mg/dL, Standard deviation: 47 (n = 17)
Predinner (6 PM): 195 mg/dL, Standard deviation: 33 (n = 11)
Bedtime (n = 9): 260 mg/dL, Standard deviation 34 (n = 13)
Range: 69 mg/dL to 304 mg/dL
Food and nutrition history
Due to his job, Robert is often away from home for extended periods of time and he eats at truck stop diners, where he selects hamburgers, fried eggs with bacon and deep fried foods; he eats large quantities of chips and beef jerky as snacks. He drinks diet soda and almost no water. On weekends, when Robert is at home, he enjoys drink ing beer (8 to 10 - 12 - oz cans) and making barbecues.
1. What observations do you have about Robertâs diet? ( 1)
2. Calculate Robertâs EER using two methods for determining Robertâs calorie requirements (show your work) (2)
3. What lifestyle factors could have inc reased the risk for Robertâs diabetes diagnosis? (2)
4. What criteria are used to Diagnose Metabolic Syndrome? Can you diagnose Metabolic Syndrome for Robert? Why or why not? (4)
5. List diabetic symptoms that Robert is showing (3)
6. Explain the pathophysiology of these symptoms (3)
7. What labs would be elevated if you suspect Robert is dehydrated? (2)
8. What is considered to be good control for BS (blood sugar) for someone with diabetes and what is considered poor control? (4)
9. Explain how Robertâs medications help control his diabetes (3)
10. Robertâs physician wants to initiate mealtime insulin injections. What dietary guidelines will you give to Robert regarding his food choices? (2)
11. What are some common causes of hypoglycemia and what w ill you recommend to Robert if he experiences hypoglycemia? (4)
