Patient with DM type 2

Valentina Dwi Hartati Tambunan

Philippine Women’s University
3rd year BS Nutrition and Diatetics
 Personal Data
• Denny Setyawan
• indonesian
• 28 Years old
• Male
• 173 cm
• 76 kg
• Burgendy Tower Makati
• Call center agent
• W. before: 95 kg
• W. During: 60 kg
• Family history: -
• Check up every 3 mos
 ETIOLOGY
• Lack of exercise
• Excessive food intake
• Inactive lifestyle
 NUTRIENT DIAGNOSE
• Before
High glucose blood related to the excessive
food intake as evidence by 24 hr food recall
• Now
Normal Glucose blood level related to intake
of medicine and injection of insulin medicine
as evidenced by blood test of 4.7 %
BEFORE AFTER
Medical data
Medical Data
Medical Data
Medical Data
 Clinical Test
Date Test TEST RESULT INTERVENTION Reference
range

May 11 CREATININE 66.34 normal 53.00-

2017 115.00
umol/L
May 11 ALT 7.28 normal  
2017
October 4, ALT 11.39 Normal  
2017

Oct 4 2017 Blood glucose 5.0 Normal 4.0-6.0

January Blood glucose 4.7 Normal 4.0-6.0
23 2018
 Physical Examination
Intervention

Face -

Skin Wound mark

Eyes Eyeglasses

Nails -

Hairs -

Teeth -
 Medication
Medicine Amount Time

Insuline Toujeo 12 units 1 12 noon

Metformin 500 mg 2 After dinner

 Insuline Toujeo
• Insuline Toujeo is a long-acting human
insulin analog indicated to improve
glycemic control in adults.
• Once a day into the abdominal area, thigh,
or deltoid
• Anti-diabetic drugs may need to be
adjusted, to minimize the risk of
hypoglycemia
 Side Effects
• Pain, redness, itching, or swelling at the
injection site
• Skin thickening or thinning at the injection
site
• Weight gain
• cough
 METFORMIN
• Is an oral diabetes medicine helps to
control blood sugar levels.
• For treating DM type 2
 Side Effect
• Abdominal or stomach discomfort
• Cough or hoarseness
• Decreased appetite
• Diarrhea
• Fast or shallow breathing
• Fever
• Muscle pain
• sleepines
ASSESSMENT
 24hr FOOD RECALL (Sunday)
FOOD ITEM EX CHO PRO FAT ENERG
g g g Y
kcal
3t Diabetasol Milk 0.75 29.25 7.5 5.25 194.25
3T Quaker Oats ( instan) 1.28 25.98 5.5 40.96 494.56
½ Rice 1 23 2 - 100
1 pc fried chicken 1 - 8 6 86
½ c sautee kangkong 0.5 1.5 0.5 2.5 30.5
½ Rice 1 23 2 - 100
1 pc fried chicken 1 - 8 6 86
½ c sautee kangkong 0.5 1.5 0.5 2.5 30.5
½ Rice 1 23 2 - 100
1 pc fried chicken 1 - 8 6 86
½ c sautee kangkong 0.5 1.5 0.5 2.5 30.5
1 c mung beans 2.30 14.26 7.36 0.46 90.62
1t sugar 1 5 - - 20
1 pc apple 1 10 - - 40
TOTAL 157.99 51.86 72.17 1,488.93
 %ADEQUACY of Sunday
NUTRIENT %ADEQUACY

CHO 72%

PRO 69%

FAT 160%

ENERGY 93%
 24hr FOOD RECALL (Monday)
FOOD ITEM EX CHO PRO FAT ENERGY
g g g kcal
3t Diabetasol Milk 0.75 29.25 7.5 5.25 194.25
3T Quaker Oats ( instan) 1.28 25.98 5.5 40.96 494.56
½ Rice 1 23 2 - 100
1 pc fried chicken 1 - 8 6 86
1 c chap suey 1 3 1 5 61
½ Rice 1 23 2 - 100
1 pc fried chicken 1 - 8 6 86
1c chap suey 1 3 1 5 61
½ Rice 1 23 2 - 100
1 pc fried chicken 1 - 8 6 86
½ c chap suey 0.5 1.5 0.5 2.5 30.5
1 c mung beans 2.30 14.26 7.36 0.46 90.62
1t sugar 1 5 - - 20
1 pc apple 1 10 - - 40
TOTAL 160.99 52.86 77.17 1,545.97
 %ADEQUACY of Monday
NUTRIENT %ADEQUACY

CHO 73%

PRO 66%

FAT 171%

ENERGY 97%
 24hr FOOD RECALL (Tuesday)
FOOD ITEM EX CHO PRO FAT ENERGY
g g g kcal
3t Diabetasol Milk 0.75 29.25 7.5 5.25 194.25
3T Quaker Oats ( instan) 1.28 25.98 5.5 40.96 494.56
½ Rice 1 23 2 - 100
1 pc fried Tilapya 0.5 - 4 5.5 65.5
1 c sautee string beans 1 3 1 5 61
½ Rice 1 23 2 - 100
1 pc fried Tilapya 0.5 - 4 5.5 65.5
1c sautee string beans 1 3 1 5 61
½ Rice 1 23 2 - 100
1 pc fried Tilapya 0.5 - 4 5.5 65.5
½ c string beans 0.5 1.5 0.5 2.5 30.5
1 c mung beans 2.30 14.26 7.36 0.46 90.62
1t sugar 1 5 - - 20
1 pc apple 1 10 - - 40
TOTAL 160.99 33.86 75.67 1,460.43
 %ADEQUACY of Tuesday
NUTRIENT %ADEQUACY

CHO 73

PRO 42

FAT 168

ENERGY 91%
 DIET PLAN
• TER: 69.63 x 30(sedentary)= 2100 kcal
TER: 2100 kcal – 500 kcal = 1600 kcal
• 55% - 20% - 25%
• CHO: 1600 Kcal x 55%= 220g
• PRO: 1600 kcal x 20% = 80g
• FAT: 1600 kcal x 25% = 45g
• DIET RX 1600 kcal; C220g; P80g; F45g
Limit source of simple sugar, limit intake of sodium,
limit intake of sat fat, diet devide in to 3 meals and
3 snacks
 DISTRIBUTION
FOOD GROUP EX CHO PRO FAT ENERGY
220g 80g 60g kcal
Vegetable A 2 6 2 - 32

Vegetable B 3 9 3 - 48

Fruit 3 30 - - 120

Sugar - - - - -

Milk 1 12 8 10 170

Rice 7 161 14 - 700

Meat (low fat) 4 - 32 4 164

Meat (medium fat) 2 - 16 12 172

Fat 4 - - 20 180

TOTAL 218g 75g 46g 1,586

 cont.
FOOD GROUP BF AM L PM D BT

Vegetable A I I

Vegetable B I I I

Fruit I I I

Sugar

Milk I

Rice I I II I I I

Meat (low fat) I III

Meat (medium fat) II

Fat I I I I
 RECOMENDATION
• Lose weight
• Keep drink medicine
• Eat variety food
• Regular check up every 3 mos
• Achieve Normal BMI
• Limit intake of Sodium it can lead to hypertension
• No or limit simple sugar due to sugar content
that can increase the glucose level
• Limit the saturated fat will lead to CVD
 1 Day Sample Menu
BREAKFAST AM SNACK LUNCH
Chicken sandwich
- 2 slices whole wheat 1 pcs Pan de Bonete 1 c chapsuey
bread 1 c fresh mango juice 1 slice water melon
-2 t mayonnaise 1c rice
-1/8 boiled chicken 3 pcs chicken satay
-boiled carrot
1 cup milk
PM SNACK DINNER BEDTIME

1 pc apple 1 c sayur Pecel 1 pcs Pande leche

1/8 c baked sweet potato 1 c rice
2 pcs ayam gulay ( wing
part)
 Thank You

Presented by:
Vantina D.H Tambunan