Case Study 2: Bill (please answer question 2 and 5only)
Bill is 52 and has been previously diagnosed with Type 2Diabetes Mellitus. He admits that he often does not take hismedications which are metformin and glyburide.
1. What types of medications are metformin and glyburide?Briefly describe their general mechanisms as well as theirpotential side effects/drug-nutrient interactions
Bill has come into hospital because he has been diagnosed withHHS. Hyperosmolar hyperglycemic state/ syndrome (HHS) is when adiabetes patient has an abnormally high plasma glucose level(greater than 30 mmol/L) due to inadequate amounts of insulin tomaintain normoglycemia. HHS is very common amongst T2DM olderadults, and symptoms tend to include dehydration due to reducedthirst recognition—this causes older adults to be slightlyconfused. This happens when T2DM is uncontrolled for a long time.Symptoms may include poluyuria and polydipsia. Patients must behospitalized.
The treatment of HHS consists of correction of the dehydrationwith intravenous fluids, reduction of the blood sugar levels withinsulin, and management of any other underlying conditions thatmight have precipitated the condition
In hospital insulin therapy is started for Bill.
2. Outline the basic principles for Bill’s nutrition therapy toassist in control of his DM.
Bill’s measurements and typical daily diet is recorded asfollows:
Weight: 97.3 kg; Height: 175
Daily Diet:
BF: 2 crumpets, 1 tbspn each of honey and cream cheese, dietcola
MT: 1 coffee scroll, 1 coffee with milk, no sugar
Lunch: Fast-food roll from subway (full size), 9 Chips
Dinner: 1 breast grilled chicken/beef, 1 cup salad, 1potato/rice
Supper: 4 biscuits and a hot chocolate made with full creammilk
3. Assess Bill’s weight and BMI. What would be a healthy weightrange for Bill?
4. Determine Bill’s energy and protein requirements for weightmaintenance. What energy and protein intakes would you recommend toassist with weight loss?
5. Prioritize two nutrition problems and discuss how you wouldimplement solutions to these. What foods would you change? Writeout some daily food choices
