MEER IFRAH

Incharge – Mrs. Anuradha Shekhar

 DIABETES MELLITUS

It is a chronic metabolic disorderThe body prevents to utilize glucose completely or partially In a healthy person, the blood glucose level is regulated by several 

hormones, primarily insulin In diabetes, glucose in the blood cannot move efficiently into cells, so 

blood glucose levels remain highAll the cells starves that need the glucose for fuel

MAJOR RISK FACTORS OF TYPE 2 DIABETES

SYMPTOMS OF TYPE 2 DIABETES

Unexplained weight lossExcessive eating (polyphagia)Excessive urination (polyuria)Excessive thirst (polydipsia)Fatigue, constantly tiredHyperglycemiaFluid and electrolyte imbalanceBlurry visionPoor wound healing

COMPLICATIONS OF TYPE 2 DIABETES

DIABETIC FOOT

It is one of long term complication of type 2 Diabetes

Foot problems commonly develop: With damage to the nervous system, a person with diabetes

may not be able to feel his or her feet properly Foot injuries cause ulcers and infections. Difficult to heal these wounds One of the treatment is amputation

PATIENT HISTORY

Name: XYZAge: 75yrs oldSex: MaleOccupation: Retired Ethnicity: HinduFood habit: VegetarianActivity: SedentaryBlood group:       A+veAdmitted:           31/10/12Discharged                6/11/12

DIAGNOSIS

Personal history: No HypertensionNo TuberculosisNo Ischemic heart diseases2nd and 3rd right toes amputation on September   

             2004No addiction and allergy.

Primary diagnosis:  Diabetic mellitus and  right diabetic footPresent complain:  Non-healing ulcer of right foot since 7yrs Course of hospitalization:  Patient admitted with non-healing ulcer, right 

foot, right below knee amputation (BKA).Family history: Nil

ANTHROPOMETRIC DATA

 Height: 155cmWeight: 53kgBMI: 22IBW: 55kg

PARAMETERS ON ADMISSION

Temperature: 98 FPulse rate:                  60/minBlood pressure: 120/80 mmHgHeart rate: 116/minRespiration Rate:220/min

BLOOD SUGAR LEVEL

Date Fasting Blood Sugar Prelunch Predinner

Normal Value 60-110mg/dl 60-140mg/dl 60-140mg/dl

31/10/12 ……………….. ………………….. 189

2/11/12 148 108 180

3/11/12 90 289 270

4/11/12 133 133 290

5/11/12 132 236 246

6/11/12 117 ………. ………..

COMPLETE HEMOGRAMLevel Unit Nomal values

Hb 7.70 (L) g/dl 13-18

RBC count 2.79 *10^6/ul 3.8-6.2

PCV 23.50 % 36-52

MCV 84.20 Fl 80-96

MCH 27.60 Pg 27-33

MCHC 32.80 g/dl 32-36

RDW 12.90 % 11-16

WBC count 13.27(H) *10^3/ul 4-11

Differential count

Neutrophils 80.6 % 50-70

Lymphocytes 14.8 % 20-45

Eosinophils 0.2 % 1-6

Monocytes 4.2 % 0-1

Basophils 0.2 % 0-1

Platelets counts 387 *10^3/ul 150-400

PLASMA GLUCOSE RANDOM

Level Unit Normal level

Plasma glucose

random

241.33 mg/dl 60-140

Serum

Creatinine

1.46 mg/dl 0.5-1.5

CASE STUDY INTERPRETATION Case of Type 2 Diabetes  The all other biological parameters are all normal.  Hyperglycemic index. 

The persons BMI is also normal.

HOME RECALL

HOME RECALL7:30 Breakfast Tea -75ml milk+1tsp sugar

1k upma: 30gms rawa + 1/4 onion + ¼ tomato + 1 tsp oil1:00 Lunch: 2phulka: 30 Gms wheat flour

1k rice: 30gms riceVegetable: 1/2 spinach + ¼ onion + ¼ tomatoes + ½ potato + 1tsp oil 1k curd: 75 ml curd

4:30 Snacks: Tea – 75 milk + 1 tsp sugar Chivda: 30 Gms puffed rice + 15 gms ground nuts Fruits: banana

9:00 Dinner:1k rice: 30 Gms wheat flour1k amti: 30gms dal + ¼ onion +1/4 tomato + 1 tsp jaggery + 1 tsp oil2 phulka: 30gms wheat flour Vegetable: ½ Spinach + ¼ onion + ¼ tomatoes + ½ potato +1tsp oil1k curd: 75 ml curdFruits: papaya

EXCHANGE LIST

FOOD EXCHANGENo. Of

exchangeAmount

(gm)Energy (Kcal) CHO (gm) Protein (gm) Fat (gm)

Cereal 6 180 600 132 15 3

Pulses 1 30 100 17 7 0.5

Nuts & oilseeds 0.5 15 50 1.5 1.5 4

Milk & milk products 2 300 200 14 10 12

Potato 1 100 100 24 1.8 0

Vegetable 3 300 105 21 6 0

Fruits 2   100 25 0 0

Sugar 3 15 60 15 0 0

Fats & oils 4 20 180 0 0 20

             

      1510 249.5 41.3 39.5

 Percentage %       66.09 10.94 23.54

DISTRIBUTIONS OF EXCHANGES

Food

GroupTotal Breakfast

Mid

morningLunch Evening

Mid

eveningDinner Bed time

Cereals 6 1 2 1 2

Pulses 1 1

Nuts and

oilseeds½ ½

Milk and

milk

products

2.5 ½ 2/3 ½ 2/3

Potato 1 1/2 1/2

vegetable 3 ½ 1 1 ½

FRUITS 2 1 1

Sugar 3 1 1 1

Fats and

oil4 1 1` 2

HOSPITAL RECALL

EXCHANGE LIST

FOOD EXCHANGE

No. Of exchange

Amount (gm)

Energy (Kcal) CHO (gm)

Protein (gm) Fat (gm)

Cereal 4 120 400 88 10 2

Bread 1   100 21 3 0.5Marie Biscuits (4) 1.5   150 27 3 3

Pulses 2 60 200 34 14 1Milk & milk products 4 600 400 28 20 24

Vegetable 3 300 105 21 6 0

Fruits 1   50 12.5 0 0

Fats & oils 4 5 180 0 0 20

             

    1600 231.5 56 50.5Percentage %       57.88 14.00 28.41

DAY 1: SOFT DIET (1700 DD Kcals)INTERPRETATION: The patient intake was moderate. 

DISTRIBUTIONS OF EXCHANGES Food Group

Total Early Morning

Breakfast

Mid Morning

Lunch Mid Lunch

Snacks

Mid Evening

Dinner Bed Time

Cereals 6.5 1 1.5 1.5 1.5

Pulses 2 1 1

Milk And Milk Product

4 1 1/3 2/3 1/3 2/3 1

Vegetable 3 1 0.5 1.5

Fruits 1 1

Fats And Oil 4 1 1 1 1

EXCHANGE LIST:

FOOD EXCHANGE

No. Of exchange

Amount (gm)

Energy (Kcal) CHO (gm)

Protein (gm) Fat (gm)

Cereal 6.5 195 650 143 16.25 3.25

Pulses 2.5 75 250 42.5 17.5 1.25

Milk & milk products 4 600 400 28 20 24

Vegetable 3 300 105 21 6 0

Fruits 1   50 12.5 0 0

Fats & oils 4 20 180 0 0 20

             

      1650 247 59.75 48.5

 Percentage %       59.88 14.48 26.45

INTERPRETATION: The patient intake was moderate.

Day 2:Full diabetic diet(1700 kcal)

DISTRIBUTIONS OF EXCHANGES

FOOD GROUP

TOTAL EARLY MORNING

BREAKFAST

MID MORNING

LUNCH MID LUNCH

SNACK

MID EVENING

DINNER

BED TIME

Cereals 6.5 1 2 1.5 2

Pulses 2.5 1 1.5

Milk and milk product

4 1 1/3 2/3 1/3 2/3 1

Vegetables

3 1 0.5 1.5

FRUITS 1 1

Fats and oil

4 1 1 1 1

EXCHANGE LIST

FOOD EXCHANGE

No. Of exchange

Amount (gm)

Energy (Kcal) CHO (gm)

Protein (gm) Fat (gm)

Cereal 7 210 700 154 17.5 3.5

Pulses 2.5 75 250 42.5 17.5 1.25Milk & milk products 4 600 400 28 20 24

Vegetable 3 300 105 21 6 0

Fruits 1   50 12.5 0 0

Sugar 0 5 0 0 0 0

Fats & oils 4 20 180 0 0 20

             

      1700 258 61 48.75 Percentage %       60.71 14.35 25.81

INTERPRETATION: The patient intake was Adequate.

DAY 3 FULL DIABETIC DIET (1700 kcals)

DISTRIBUTIONS OF EXCHANGES

Food Group

TotalEarly Morni

ng

Breakfast

Mid Morni

ngLunch

Mid Lunch

Snacks

Mid Eveni

ng

Dinner

Bed Time

Cereals

7 1.5 2 1.5 2

Pulses 2.5 1 1.5

Milk And Milk

Product

4 1 1/3 2/3 1/3 2/3 1

Vegetables

3 1 0.5 1.5

Fruits 1 1

Fats And Oil

4 1 1 1 1

AVERAGE NUTRITIONAL PROFILE OF HOSPITAL RECALL

EnergyKcal

Proteingms

CHOgms

Fatsgms

Day 1 1600 56 231.5 50.5

Day 2 1650 59.75 247 48.5

Day 3 1700 61 258 48.75

Average 1650 57.9 245.5 49.25

MEDICAL NUTRITIONAL THERAPY

CARBOHYDRATE:60-65% of total caloriePROTEIN:12-16% of kcals FAT:20-25% of total calorie

VITAMIN AND MINERAL: adequate amounts.

NUTRITIONAL ASSESSMENT

Height:         155cmWeight:          53kgBMI:               22IBW:               55kg

Assessed Calorie:   55x30 =1650 kcalsAssessed protein:  55x1=55g

DISCHARGED DIET

Total Calorie: 1650-1700kcals

Protein: 55g

EXCHANGE LIST

FOOD EXCHANGE

No. Of exchange

Amount (gm)

Energy (Kcal) CHO (gm)

Protein (gm) Fat (gm)

Cereal 7 210 700 154 17.5 3.5

Pulses 2 60 200 34 14 1Milk & milk products 4 600 400 28 20 24

Vegetable 3 300 105 21 6 0

Fruits 2   100 25 0 0

Fats & oils 4 20 180 0 0 20

             

      1700 262 57.5 48.5 Percentage %       61.65 13.53 25.68

DISCHARGE DIET MENU7:00 am Early morning 1 Cup Milk (150ml) without

sugar

8:30- 9:00am Breakfast Tea:1/3 cup milk (without sugar)

1 bowl Upma/

poha/khakra(3)/uttapa(2)

/thalipit/idli

11:00am Mid morning Fruit

1:00 pm Lunch ½ bowl rice

3 Phulka

1 bowl Dal

1 bowl vegetable and salad

1k Curd:100 ml

3:00pm Mid lunch 1 bowl soup/salad

5:00pm Snacks Tea:1/3 cup milk (without sugar)

Khakra/dhokla/bhel/chivda/rawa

porridge

7:00 Mid evening Fruits

9:00 Dinner ½ bowl rice

3 Phulka

1 bowl Dal

1 bowl vegetable and salad

1k curd:100ml

11:00 Bed time 1 cup milk without sugar

DISTRIBUTIONS OF EXCHANGES

Food

GroupTotal

Early

Morni

ng

Breakfa

st

Mid

Morni

ng

LunchMid

Lunch

Snack

s

Mid

Evenin

g

DinnerBed

Time

Cereals 7 1.5 2 1.5 2

Pulses 2 1 1

Milk

And

Milk

Product

4 1 1/3 2/3 1/3 2/3 1

Vegeta

bles3 0.5 1 0.5 1

Fruits 2 1 1

Fats

And Oil4 1 1 1 1

GENERAL DIETARY INSTRUCTIONS

Foods To Be Avoided

Foods To Be Restricted

Foods Allowed

•Sugar, honey, jaggery, sweet items •Fried foods•Thickening agents like corn flour and Maida in soups•Soft drinks , fruit juices and alcohol.•Reused oils and hydrogenated fats (dalda, vanaspati)

•Refined and processed food items, maida preparations•Oily and thick gravies prepared of coconut, cashew nut, ground nuts etc., and oily pickles•High Calorie Vegetables like Potato, Sweet potato

•Green leafy vegetable•Salads•Soup•Fruits •Buttermilk•Lime water without sugar

DIETARY TIPSAvoid fasting & skipping mealsSpace out the meals like proper breakfast, mid morning, lunch, 

evening snack, dinner and a bed time snack.Drink plenty of water (8-10 glasses per day)Whole cereals, Whole Pulses, Milk & Milk products, and Fresh Fruits 

as advised.Prefer  almonds and walnut among nuts  (3-4 pieces) in a dayOil consumption should be restricted to ½ kg/ month/ person i.e., 3-

4 teaspoon per day. Avoid trans fatty acid (reused oils, Dalda,Vanspati)