Transcript Table 2. Percentages of US Adults Who Have Ever Been Told They

Case Study
Presentation
Angela Stancil
Dietetic Intern
10/18/13
Pre-diabetes
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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/ArticleArchives/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
Percentage
Tennessee
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
Percentage
Vermont
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
Etiology
Under 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
Etiology
Pre-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
Symptoms
Acanthosis nigricans
Complications of Disease
Treatment
Mr. H
Overview of Patient
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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 lbs
DBW: 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 WNL
Pertinent Medications: Omeprazole
Physical Activity : None
Diet History:
Breakfast
Nothing
Lunch
Nothing
Dinner
"country meal“
Proteins: baked chicken
Vegetables: mashed
potatoes, lima beans
Grains: roll, cornbread
Snacks
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Snack cakes
(oatmeal cream
pies)
candy bars
(Paydays, KitKats)
pork rinds (after
dinner)
Beverages

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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:
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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
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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:
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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
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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=riskfactorsfordiab
etes&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.