Test
Question 1
Body weight
Family history
Inactivity
Race
The AIC test should be done using a method that is certified by National Glycohemoglobin Standardization Program.
Question 2
The standard diagnostic criteria for T2DM are the following:
AIC≥6.5
FPG≥126mg/dL (7.0mmol/L)
Two hour PG≥200mg/dL(11.1mmol/L)
Presence of classic symptoms of hyperglycemia of hyperglycemic crisis (a random plasma glucose ≥200mg/dL or 11.1 mmol/L)
Adane’s medical record contains AIC=6.9 and random plasma glucose: 171mg/dL.
Question 3
The mechanism of insulin resistance includes the defects of primary target cells, genetic defects of primary target cells, accelerated insulin degradation, autoantibodies to insulin, a decrease in insulin receptors and failure of post-receptor to activate tyrosine kinase (Medscape, 2015, para. 6). Obesity is one of the factors causing insulin resistance. Obesity is associated with insulin resistance in that it leads to decreased number of insulin receptors. Since Adane is obese, she is likely to be exhibiting insulin resistance.
Question 4
Diabetes is associated with uncontrolled blood glucose. Uncontrolled blood glucose causes damage to the blood vessels making them more predisposed to damage through hypertension and atherosclerosis. Besides, people with diabetes often exhibit an abnormal level of blood lipid level. Adane’s lipid profile is not desirable. Her cholesterol and triglyceride levels are higher than the recommended level. Therefore, she is at a high risk of developing cardiovascular disease.
Question 5
Statins are indicated for children aged 8 years or more whose LDL cholesterol is more than 190mg/d. Besides, this drug is also recommended for children with a family history of heart disease, cholesterol level more than 160mg/dL, and have at least two other risk factors).
Question 6
The presence of protein in urine may be an indicator of diabetes-associated kidney damage.
Question 7
Adane and her family should be taught about self-monitoring of blood glucose to help them achieve the target blood glucose level. The standard recommendation for daily frequency testing in patients with diabetes type 2 is not known (American Diabetes Association, 2003, Recommendations, para. 1). However, it is recommended that SMBG be performed as frequently as possible.
Question 8
Nutrition therapy for Adane is intended to achieve the following goals:
Maintain optimal blood glucose level to lower the risk of complications
Maintain optimal protein profile to reduce the risk of macrovascular disease
Question 9
Adane’s desirable weight is 74 lb
Question 10
One of the abnormal laboratory values for Adane is glycated hemoglobin (AIC) of 6.9%. This level is above the target level of 6.5%.Glycated hemoglobin is a measure of the average level of blood glucose in a period of weeks or months. .
Question 11
Adane’s energy requirement is estimated to be 1200 Calories per day based on the recommended daily allowance. Weight loss is not a component of the estimation because the estimation is based on the recommended dietary allowance.
Question 12
The two nutrition problems are the following:
High lipid profile
PES:
High intake of cholesterol related to lack of knowledge about the desirable level of intake of cholesterol as evidenced by blood cholesterol of 210mg/dL.
Poor blood glucose control
PES:
Poor glycemic control related to lack of knowledge about the appropriate intake of glucose as evidenced by AIC higher than the normal level.
Question 13
The following initial steps would be applied in teaching Adane and her family about nutrition and diabetes:
Step 1: I would think about what aspect of nutrition to teach them
Step 2: I will identify the activities to undertake during the teaching exercise
Step 3: I would identify how the teaching would be conducted
Step 4: I would decide when to conduct the teaching
References
American Diabetes Association. (2003, January). Tests of Glycaemia in Diabetes. American Diabetes Association, vol. 26, 106-s108. doi: 10.2337/diacare.26.2007.S106
Medscape. (Jan 30, 2015). Insulin Resistance. Retrieved from http://emedicine.medscape.com/article/122501-overview#a3
