1. What are the standard diagnostic criteria for T2DM? Identify those found in Mr. Fagan’s medical record.

The standard diagnostic criteria for T2DM are symptoms of DM and causal blood glucose of greater
than or equal to 200 mg/dL. A fasting plasma glucose of greater than or equal to 126 mg/dL with no
caloric intake for at least eight hours. A two hour plasma glucose of greater than or equal to 200 mg/dL
during a 75 gram oral glucose tolerance test. Lastly, a patient having a HgbA1C of greater than or equal
to 6.5 %. In Mr. Fagan’s medical record, it indicates he has a history of T2DM, his blood glucose is
greater than 200 mg/dL which was 855 mg/dL, and his HbA1C was 11.5%.

Resource: Diabetes PowerPoint in ilearn

2. Mr. Fagan was previously diagnosed with T2DM. He admits that he often does not take his medications.
What types of medications are metformin and glyburide? Describe their mechanisms as well as their
potential side effects/drug–nutrient interactions.

Metformin belongs to the biguanide class of medicines. Metformin aids in the regulation of blood
glucose (sugar). It reduces the quantity of glucose absorbed from food as well as the amount of glucose
produced by the liver. Metformin also improves the body's reaction to insulin, a naturally occurring
chemical that regulates the quantity of glucose in the blood. It works by decreasing hepatic glucose
synthesis, decreasing intestinal glucose absorption, and improving insulin sensitivity. Food reduces the
amount and somewhat slows absorption. Management is usually administering the medication with a
meal.

Glyburide is part of a group of medication known as sulfonylureas. It increases insulin sensitivity at

peripheral target locations by stimulating insulin release from pancreatic beta cells and decreasing
glucose production from the liver. Ethanol has been linked to rare disulfiram responses. Management is
to monitor the patients.

Resources:
https://online.lexi.com/lco/action/doc/retrieve/docid/patch_f/7260?cesid=6pgDYylVkpr&searchUrl=
%2Flco%2Faction%2Fsearch%3Fq%3DmetFORMIN%26t%3Dname%26acs%3Dtrue%26acq
%3Dmetformin
https://medlineplus.gov/druginfo/meds/a696005.html
https://www.mayoclinic.org/drugs-supplements/glyburide-oral-route/description/drg-20072094
https://online.lexi.com/lco/action/doc/retrieve/docid/patch_f/6988?cesid=3S4yFiXdjxj&searchUrl=
%2Flco%2Faction%2Fsearch%3Fq%3DGlyburide%26t%3Dname%26acs%3Dfalse%26acq
%3DGlyburide#foi

3. What other medications does Mr. Fagan take? List their mechanisms and potential side effects/drug–
nutrient interactions.

Mr. Fagan also takes 25 mg hydrochlorothiazide, 37.5 mg triamterene, and atorvastatin 20 mg daily.
Hydrochlorothiazide inhibits sodium reabsorption in the distal tubules, resulting in increased sodium and
water excretion as well as potassium and hydrogen ions. Some side effects include dermatologic
toxicity, electrolyte disturbances, gout, hypersensitivity reactions, and ocular effects. Triamterene
reduces sodium reabsorption from the lumen by blocking epithelial sodium channels in the late distal
convoluted tubule (DCT) and collecting duct. This efficiently lowers intracellular sodium, reducing the
action of Na+/K+ ATPase and resulting in potassium retention and reduced calcium, magnesium, and
This study source was downloaded by 100000870014564 from CourseHero.com on 08-27-2023 10:47:51 GMT -05:00

https://www.coursehero.com/file/206180639/Case-Study-16docx/
 hydrogen excretion. Because the DCT/collecting duct has a low capacity for salt absorption, the
natriuretic, diuretic, and antihypertensive effects are typically regarded as modest. Some potential side
effects are dizziness, hyperkalemia, nausea, vomiting, and more. Atorvastatin is an inhibitor of 3-
hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, the rate-limiting enzyme in cholesterol
synthesis (reduces mevalonic acid generation from HMG-CoA); this causes a compensatory increase in
LDL receptor expression on hepatocyte membranes and promotion of LDL catabolism. HMG-CoA
reductase inhibitors not only have the ability to lower levels of high-sensitivity C-reactive protein
(hsCRP), but they also have pleiotropic properties such as improved endothelial function, reduced
inflammation at the site of the coronary plaque, inhibition of platelet aggregation, and anticoagulant
effects. Grapefruit juice may raise serum concentrations of atorvastatin. Avoid drinking large amounts of
grapefruit juice at the same time.

Resources:
https://online.lexi.com/lco/action/doc/retrieve/docid/patch_f/7036?cesid=145aR6pKWE0&searchUrl=
%2Flco%2Faction%2Fsearch%3Fq%3DHydrochlorothiazide%26t%3Dname%26acs%3Dfalse%26acq
%3DHydrochlorothiazide#arsc
https://online.lexi.com/lco/action/doc/retrieve/docid/patch_f/7811?cesid=6HU3S7mS3ZF&searchUrl=
%2Flco%2Faction%2Fsearch%3Fq%3Dtriamterene%26t%3Dname%26acs%3Dfalse%26acq
%3Dtriamterene#
https://online.lexi.com/lco/action/doc/retrieve/docid/patch_f/6396?cesid=18YjjtEAxJQ&searchUrl=
%2Flco%2Faction%2Fsearch%3Fq%3Datorvastatin%26t%3Dname%26acs%3Dfalse%26acq
%3Datorvastatin#foi

4. Describe the metabolic events that led to Mr. Fagan’s symptoms and subsequent admission to the ED
with the diagnosis of uncontrolled T2DM with hyperglycemic hyperosmolar syndrome (HHS). Be sure
to include the information in Mr. Fagan’s chart that supports this diagnosis. Compare and contrast HHS
with the other common clinical emergency condition of diabetes—diabetic ketoacidosis (DKA).

The metabolic event that prompted his symptoms and ER admission for T2DM and HHS was caused by
Mr. Fagan’s uncontrolled diabetes. Therefore, there was extra glucose in his blood which caused the
kidneys to try to excrete the glucose through the urine. But with the lack of fluid consumed, the kidneys
cannot work in the correct way to remove the glucose. This can cause the glucose levels to rise even
more causing hyperglycemic hyperosmolar syndrome (HHS). This can cause dehydration, drowsiness,
confusion, and more which were some of the symptoms Mr. Fagan had before being admitted into the
ED.

The two most severe metabolic complications of diabetes mellitus are diabetic ketoacidosis (DKA) and
hyperosmolar hyperglycemic state (HHS). These complications can arise in both type 1 and type 2
diabetes. DKA is identified by hyperglycemia, the development of ketone bodies, and metabolic
acidosis. In most cases, the initial reasons are infection or lack of insulin. HHS is characterized by a
significant increase in blood glucose, hyperosmolality, and little or no ketosis. Infection, untreated
diabetes, and drug misuse are all risk factors for HHS. The reduction in effective insulin action paired
with increased counterregulatory hormones are the basic shared pathophysiological processes in both
diseases, which differ mainly in the extent of dehydration and degree of ketoacidosis. While in DKA, a
lack of insulin mixed with elevated catecholamines leads to rapid lipolysis and hence excess fatty acid
synthesis, leading to beta-oxidation and ketogenesis, residual beta-cell activity in HHS is sufficient to
prevent lipolysis but not hyperglycemia. Both disorders have a significantly poorer prognosis in
individuals over the age of 65, as well as in the presence of coma and hypotension. Intravenous insulin
This study source was downloaded by 100000870014564 from CourseHero.com on 08-27-2023 10:47:51 GMT -05:00

https://www.coursehero.com/file/206180639/Case-Study-16docx/
 and fluid replacement, as well as concurrent treatment of the triggering causes, are the mainstays of
therapy.

Resources:
https://my.clevelandclinic.org/health/diseases/21147-hyperosmolar-hyperglycemic-syndrome
https://pubmed.ncbi.nlm.nih.gov/16802531/

5. HHS is often associated with dehydration. After reading Mr. Fagan’s chart, list the data that are
consistent with dehydration. What factors in Mr. Fagan’s history may have contributed to his
dehydration?

The data in Mr. Fagan’s chart that is consistent with dehydration was his low blood pressure of 90/70,
frequent vomiting, a faster than normal heart rate of 105, a urine appearance of amber/cloudy, an
abnormal urinalysis, and a decrease in sodium levels. Factors in Mr. Fagan’s history that may have
contributed to his dehydration is his smoking, not taking his diabetic medications, and his alcohol use.

Resource:
https://www.mayoclinic.org/diseases-conditions/dehydration/diagnosis-treatment/drc-
20354092#:~:text=Urinalysis.,signs%20of%20a%20bladder%20infection

6. Assess Mr. Fagan’s intake/output record for the first 24 hours of his admission. What does this tell you?
Assuming that Mr. Fagan tells you that his usual weight is 228 lbs., can you estimate the volume of his
dehydration?

The fluid balance of a patient is indicated by intake and output (I&O). The aim is for input and output to
be equal. Excessive input might result in fluid overload. Dehydration can result from excessive
production. According to Mr. Fagan’s usual body weight of 228lbs., he requires between 3000-3500mL
of fluids daily. This was calculated by multiplying his weight in kg, which was 103, by 30 mL/kg to get
3090mL. Using his usual body weight of 228 lbs., subtracting it by his current body weight, dividing it
by his usual body, and multiplying it by 100 gives us 6% dehydration.

Resources:
https://cna.plus/faq/basic-cna-aide-care/intake-output-purpose/#:~:text=Intake%20and%20output%20(I
%26O)%20indicate,much%20output%20can%20cause%20dehydration
Pocket Guide to Nutrition Assessment 3rd Edition Pg. 231
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3460795/

7. Mr. Fagan was started on normal saline with potassium as well as an insulin drip. Why are these fluids a
component of his rehydration and a correction of the HHS?

The insulin will aid in the normalization of his blood glucose levels. The potassium-containing saline
solution will hydrate him while replacing his electrolytes. Potassium is supplied because insulin
stimulates an intracellular potassium shift. Additionally, potassium is needed to replace the loss of
essential ions during diarrhea and vomiting.

Resources:

This study source was downloaded by 100000870014564 from CourseHero.com on 08-27-2023 10:47:51 GMT -05:00

https://www.coursehero.com/file/206180639/Case-Study-16docx/
 https://www.ghsupplychain.org/sites/default/files/2019-02/MNCH%20Commodities-
OralRehydration.pdf
https://www.ncbi.nlm.nih.gov/books/NBK545210/

8. Describe the insulin therapy that was started for Mr. Fagan. What is Lispro? What is glargine? How
likely is it that Mr. Fagan will need to continue insulin therapy?

The insulin therapy that was started for Mr. Fagan was one rapid acting insulin with one long acting
insulin. Lispro is used to assist in treatment type 2 diabetics who require insulin to control their diabetes.
Lispro may be used with another kind of insulin or oral diabetic medication(s) in people with type 2
diabetes. Lispro is a synthetic, short-acting variant of human insulin. It works by replacing the insulin
that the body typically produces and by assisting in the movement of sugar from the blood into other
bodily tissues where it is needed for energy. They also prevent the liver from generating more sugar.
Glargine is a synthetic, long-acting version of human insulin. Insulin glargine also works by replacing
insulin that the body typically produces and by assisting in the movement of sugar from the blood into
other bodily tissues where it is utilized for energy. It also prevents the liver from creating additional
sugar. Mr. Fagan will more than likely need to keep his insulin therapy because he has not been able to
regulate his blood glucose and is diabetes.

Resources: https://medlineplus.gov/druginfo/meds/a697021.html
https://medlineplus.gov/druginfo/meds/a600027.html

9. Mr. Fagan was NPO when admitted to the hospital. What does this mean? What are the signs that will
alert the RDN and physician that Mr. Fagan may be ready to eat?

NPO means nothing by mouth for the patient. He will be able to eat orally after his hydration and
glucose levels return to normal. He must also be able to tolerate eating, therefore little amounts of food
will be necessary at the beginning.

10. Outline the basic principles for Mr. Fagan’s nutrition therapy to assist in control of his DM.

The basic principles for Mr. Fagan’s nutrition therapy to assist in control of his DM is attaining HbA1C
of less than seven, blood pressure less than 140/80, and improved lipid levels (LDL of less than 100,
triglycerides les than 150, and HDL and cholesterol greater than 40). Achieve and maintain a healthy
body weight and delay or prevent complications from diabetes. Additionally, addressing his individual
nutritional needs based on his lifestyle.

Resource: Nutrition Therapy and Pathophysiology 3rd Edition Pg. 496

11. Assess Mr. Fagan’s weight and BMI. What would be a healthy weight range for him?

Mr. Fagan’s current weight is 214 lbs. which is 97 kg.

BMI=kg/m2
97kg/ 1.752 = 31.7
This indicates that Mr. Fagan is in the obese category due to his BMI being over 30.
Lower End of weight range: 18.5 x 1.752= 57 kg Upper End of weight range: 24.9 x 1.752= 76 kg
A healthy weight range for Mr. Fagan would be between 57 kg and 76 kg.

This study source was downloaded by 100000870014564 from CourseHero.com on 08-27-2023 10:47:51 GMT -05:00

https://www.coursehero.com/file/206180639/Case-Study-16docx/
 Resources: Pocket Guide to Nutrition Assessment 3rd Edition Pg. 56
Pocket Guide to Nutrition Assessment 3rd Edition Pg. 59

12. Identify and discuss any abnormal laboratory values measured upon Mr. Fagan’s admission. How did
they change after hydration and initial treatment of his HHS?

The abnormal labs that Mr. Fagan had in his chart were sodium 132 mEq/L, BUN 31 mg/dL, creatinine
serum 1.9 mg/dL, Est GFR 39 mL/min/1.73 m2, Glucose 855 mg/dL, Phosphate, inorganic 1.8 mg/dL,
Anion gap 6.0 mmol/L, Osmolality 322.6 mmol/kg/H2O, Cholesterol 205 mg/dL, VLDL 37 mg/dL,
LDL 123 mg/dL, Triglycerides 185 mg/dL, HbA1C 11.5%, WBC 13.5 x10 3/mm3, Hct 57%, specific
gravity 1.045, protein of 10, glucose of +3, and ketones of +1. After hydration and initial treatment of
his HHS some of his labs moved towards normal range but still remain abnormal. His sodium level
increased a to 135 but it is still below normal, his BUN (20), creatinine serum(1.3), Est. GFR (62) all are
in normal range, his glucose decreased to 475, but still above normal range, his phosphate did increase
to 2.1 but still below normal range, and his osmolality decreased to 303.5 but still above normal levels.

Resource: Medical Nutrition Therapy: A Case Study Approach Pg. 188-190

13. Determine Mr. Fagan’s energy and protein requirements for weight maintenance. What energy and
protein intakes would you recommend to assist with weight loss?

Mifflin-St Jeor Equation for Men:

RMR= (9.99(Weight in kilograms) + (6.25(Height in centimeters)) – (4.92(Age in years)) +5
(9.99(97)) + (6.25(175.26)) – (4.92(57)) + 5 = 1789
1789 x 1.1 = 1968

I chose the activity factor of 1.1 because Mr. Fagan has a sedentary lifestyle according to history in his
medical chart.

Protein Requirements: Obesity Class I or II 1.9 g/kg IBW (with hypocaloric feeding)
1.9 g/kg x 97 kg = 184 g

Resource: Pocket Guide to Nutrition Assessment 3rd Edition Pg. 216 and 224

14. Select two nutrition problems and complete the PES statement for each.

1. Inadequate fluid intake related to excess vomiting as evidenced by HHS, as evidenced

by drowsiness, vomiting, warm skin with poor turgor, rapid respiration, and fast pulse, cloudy urine
and pale skin, and elevated BUN and creatinine levels of 31mg/dl and 1.9 mg/dL, respectively, and
low sodium and phosphate levels of 132mEq/L and 1.8 mg/dL.

2. Inadequate beta glucan intake related to high blood sugar levels and cholesterol as evidence by
patient reporting not taking diabetes mediation, blood glucose levels of 855mg/dL, and cholesterol
of 205 mg/dL.

Resources: https://www.ncpro.org/pubs/2020-encpt-en/codeNI-3-1
https://www.ncpro.org/pubs/2020-encpt-en/codeNI-4-1
This study source was downloaded by 100000870014564 from CourseHero.com on 08-27-2023 10:47:51 GMT -05:00

https://www.coursehero.com/file/206180639/Case-Study-16docx/
 15. Determine Mr. Fagan’s initial CHO prescription using his diet history as well as your assessment of his
energy requirements.

Mr. Fagan has T2DM, thus he must spread his carbohydrate consumption throughout the day. He should
consume 50 to 60% of his daily calories from carbs. Mr. Fagan has to consume 2500-3000 kcal per day
to sustain life. As a result, his CHO consumption should range between 1250 and 1500 kcal per day.
After using the diabetes exchange list, I was able to find the amount of carbohydrates in his diet. I added
all of the carbohydrates together to get 260 g and then multiplied it by 4 kcal/g to ger 1040 kcal. From
this, his CHO consumption is 69% of his total daily kcal. He gets the most of his CHO in the afternoon.
He can have a third of his CHO kcal in the morning, another third around midday, and a third around
dinnertime.

Resources: https://resources.jimmyjohns.com/downloadable-files/NutritionGuide.pdf
https://dtc.ucsf.edu/pdfs/FoodLists.pdf

16. Identify two initial nutrition goals to assist with weight loss.

1. Ideal Goal: Add 45 minutes of physical activity three times a week for the next three months.
Intervention: Provide different exercise the patient can do at first and gradually increase level of
difficulty, explain the importance of exercise and its benefits, and continue with RD nutrition
counseling for behavior modifications, motivation, and dietary education.

2. Ideal Goal: Increase fruit consumption to two cups, vegetable consumption to three cups, and whole
grain consumption to six ounces daily for the next three months.
Intervention: Provide patient with a list of different fruits and vegetables they can try, give patient
examples of what whole grains are and which ones are best for him, and nutrition counseling to
educate the patient on the diabetic diet and its benefits.

17. Mr. Fagan also has hypertension and high cholesterol levels. Describe how your nutrition interventions
for diabetes can include nutrition therapy for his other conditions.

My nutrition interventions for Mr. Fagan’s diabetes can include nutrition therapy for his hypertension
and high cholesterol by helping guide these condition back into normal range. Fruits and vegetables
include potassium, a mineral that is necessary for the body to function and helps to decrease blood
pressure. Consuming fruits and vegetables immediately counteracts the effect of salt, which includes
sodium which elevates blood pressure. A diet high in fruits and vegetables can improve one’s intake of
essential cholesterol-lowering chemicals. These molecules, known as plant stanols or sterols, function
similarly to soluble fiber. Eating more whole-grain items has various health benefits, including weight
management because whole-grain foods make individuals feel fuller for longer, raising potassium levels,
which are associated with lower blood pressure, reducing the risk of insulin resistance, and minimizing
blood vessel damage. Regular physical exercise strengthens the heart. A stronger heart is capable of
pumping more blood with less effort. As a result, the force on the arteries lowers, resulting in a drop in
blood pressure. Regular exercise additionally aids in maintaining a healthy weight, which is another
essential factor in blood pressure regulation. If someone is overweight, even reducing 5 pounds will help

This study source was downloaded by 100000870014564 from CourseHero.com on 08-27-2023 10:47:51 GMT -05:00

https://www.coursehero.com/file/206180639/Case-Study-16docx/
 decrease blood pressure. Lastly, exercise reduces the harmful, fatty LDL cholesterol by increasing
the HDL cholesterol which helps improve ones cholesterol.

Resources:
https://www.bloodpressureuk.org/your-blood-pressure/how-to-lower-your-blood-pressure/healthy-
eating/fruit-and-vegetables-and-your-blood-pressure/
https://medlineplus.gov/howtolowercholesterolwithdiet.html
https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/whole-grain-
foods/faq-20058417
https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-
20045206
https://health.clevelandclinic.org/does-exercise-lower-cholesterol/

18. Write an ADIME note for your initial nutrition assessment.

Assessment:

Food and Nutrition History: Lack of fluid, Lack of fruits and vegetables, eats out often, 4 cups of coffee
per day, and alcohol-3-4 drinks per week

Anthropometrics: Ht 5’9”, Wt. 214 lbs., BMI of 31.7 kg/m2, Healthy weight range: 126-168 lbs., IBW of
160lbs using the Hamwi Formula, %IBW of 134%

Biochemical/Tests/Procedures: Temperature 100.5 degree F (high), BP 90/70 (low), Pulse 105 BPM
(high), Resp rate: 26 (high), Sodium-132 mEq/L (low), BUN-31mg/dL (high), Creatinine serum
1.9mg/dL (high), Glucose 855 mg/dL (high), Phosphate-1.8 mg/dL (low), Osmolality 322.6
mmol/kg/H2O (high), Cholesterol 205mg/dL (high), Triglycerides 185 mg/dL (high), HbA1c- 11.5%
(high), WBC 13.5 (x10^3/mm^3) (high), Hematocrit 57% (high), Specific Gravity-1.045 (high), Protein
10 (high), Ketones-present (high), Prot chk-present(high).

Nutrition Focused Physical Find: Obese, tense abdomen, cloudy/amber urine, pale skin, diaphoretic,
drowsy and confused, poor skin turgor, rapid respiration, and vomiting

Client History: Type 2 DM for 1 year-metformin and glyburide, Hypertension, Hyperlipidemia, Gout,
ORIF R ulna, hernia repair

Medication History: Glyburide 20 mg daily; 500 mg metformin twice daily; 25 mg hydrochlorothiazide

and 37.5 mg triamterene; Atorvastatin 20 mg daily

Family History: Father HTN and CAD Mother: type2DM

Diagnosis:

1. Inadequate fluid intake related to excess vomiting as evidenced by HHS, as evidenced

by drowsiness, vomiting, warm skin with poor turgor, rapid respiration, and fast pulse, cloudy urine
and pale skin, and elevated BUN and creatinine levels of 31mg/dl and 1.9 mg/dL, respectively, and
low sodium and phosphate levels of 132mEq/L and 1.8 mg/dL.
This study source was downloaded by 100000870014564 from CourseHero.com on 08-27-2023 10:47:51 GMT -05:00

https://www.coursehero.com/file/206180639/Case-Study-16docx/
 2. Inadequate beta glucan intake related to high blood sugar levels and cholesterol as evidence by
patient reporting not taking diabetes mediation, blood glucose levels of 855mg/dL, and cholesterol
of 205 mg/dL.

Intervention:

1. Ideal Goal: Add 45 minutes of physical activity three times a week for the next three months.
Intervention: Provide different exercise the patient can do at first and gradually increase level of
difficulty, explain the importance of exercise and its benefits, and continue with RD nutrition
counseling for behavior modifications, motivation, and dietary education.

2. Ideal Goal: Increase fruit consumption to two cups, vegetable consumption to three cups, and whole
grain consumption to six ounces daily for the next three months.
Intervention: Provide patient with a list of different fruits and vegetables they can try, give patient
examples of what whole grains are and which ones are best for him, and nutrition counseling to
educate the patient on the diabetic diet and its benefits.

Monitoring/Evaluating:

Have patient create a 24 hour recall once normal limits have been achieved. Ask how the patient is
feeling when taking his diabetic medications to assess any stomach pain or discomfort. Additionally ask
how often he is taking his medication and if he is taking them as prescribed. Lastly, I would check his
blood glucose levels and A1C levels at the next visit to assess any changes due to the addition of
physical activity and dietary changes.

This study source was downloaded by 100000870014564 from CourseHero.com on 08-27-2023 10:47:51 GMT -05:00

https://www.coursehero.com/file/206180639/Case-Study-16docx/
Powered by TCPDF (www.tcpdf.org)